Copyright © 1998 by the European Society of Cardiology.
New-onset angina preceding acute myocardial infarction is associated with improved contractile recovery after thrombolysis
a Division of Cardiology, Department of Internal Medicine, Cardiology and Cardiovascular Surgery, Federico II School of Medicine, Naples, Italy
b Department of Clinical and Experimental Medicine, Federico II School of Medicine, Naples, Italy
c Division of Cardiology-CCU, ‘Pellegrini’ Hospital, Naples, Italy
d Division of Cardiology, Department of Clinical Medicine and Pharmacology, University of Perugia School of Medicine, Perugia, Italy
accepted August 5, 1997
Background
Ischaemic preconditioning reduces myocardial infarct size in animal models. Clinical data suggest that episodes of angina immediately before acute myocardial infarction may be associated with smaller infarct size in man. However, it is unclear whether ischaemic episodes preceding acute myocardial infarction also affect contractile recovery in patients.
Objective
In this study we investigated the recovery of regional myocardial function after thrombolysis in two groups of patients at their first Q-wave acute myocardial infarction; in one group (n=42) myocardial infarction occurred unheralded, whereas patients of the second group (n=48) had experienced new-onset angina in the 48h that preceded infarction. Echocardiographic analysis of myocardial regional function in the infarct area was done at 2, 24 and 72h after thrombolysis, and at 1 week, and 1 and 3 months follow-up.
Results
Peak level of MB-creatine kinase was significantly lower in patients with new-onset angina (96±47 as compared with 221±108IU.l–1, P<0·01), as was the area under the MB-creatine kinase curve (1321±876 as compared to 3879±1555U.l–1/36h, P<0·01). Hypokinetic segments were fewer in patients with pre-infarction angina. Similarly, wall motion score improved significantly earlier in patients who had new-onset angina before acute myocardial infarction. Thus, contractile recovery was more rapid in patients with previous angina than in those in whom infarction occurred unheralded. Complications during the in-hospital outcome and other variables considered during the 4-week follow-up were similar between groups.
Conclusions
Patients who experienced new-onset angina before acute myocardial infarction showed better recovery of regional function after thrombolysis. Our study supports the hypothesis that brief periods of ischaemia immediately before myocardial infarction may precondition the human heart, thus improving contractile recovery.
Key Words: Preconditioning • stunning • regional function • coronary heart disease
Dr C. Napoli would like to dedicate this study, for her continued inspiration, to Dr M. de Nigris on the occasion of her birthday.
f1 Correspondence: Claudio Napoli, MD, FACA, Via B. Falcomatá 5, 80128 Naples, Italy.
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