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Clinical Investigations: CARDIOLOGY |

Preinfarction Angina Limits Myocardial Infarction Size in Nondiabetic Patients Treated With Primary Coronary Angioplasty*

Ignacio Iglesias-Garriz, MD; Felipe Fernández-Vazquez, MD; Armando Perez, MD; Julio Jimenez-Bonilla, MD; Carmen Garrote, MD; Pedro Uriarte, MD; Carmen DelaFuente, MD
Author and Funding Information

*From the Division of Cardiology (Drs. Iglesias-Garriz, Fernández-Vazquez, Perez, and Garrote) and Nuclear Medicine (Drs. Jimenez-Bonilla, Uriarte, and DelaFuente), Hospital de León, León, Spain.

Correspondence to: Ignacio Iglesias-Garriz, MD, Division of Cardiology, Hospital de León, 24071 León, Spain; e-mail: med016340@saludalia.com



Chest. 2005;127(4):1116-1121. doi:10.1378/chest.127.4.1116
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Objective: To evaluate myocardial necrosis extent after myocardial infarction (MI) and reperfusion with primary coronary angioplasty in nondiabetic patients and the relationship with unstable preinfarction angina (PA).

Design: Prospective cohort study.

Setting: Studies suggest PA limits infarct size. This effect is questioned in patients treated with primary coronary angioplasty.

Patients: Seventy-eight, nondiabetic, consecutive MI patients.

Interventions: Primary coronary angioplasty and scintigraphic study to assess the myocardial infarct size.

Main outcome measures: Scintigraphic myocardial infarct size.

Results: There were 32 patients with PA (PA +) and 46 without PA (PA −) in the 24-h period prior to MI onset. There were no significant differences in the baseline characteristics between the two groups. The scintigraphy indicated myocardial infarct size significantly smaller in PA + patients: mean, 18.0% (SD, 14.7) vs 27.0% (SD, 20.1) [p = 0.033]. This occurs even though Thrombolysis in Myocardial Infarction grade 3 flow achieved in both groups was similar (84.8% vs 84.4%, p = 1.000). We found a higher percentage of ST-segment resolution (≥ 70%) in PA + patients (65.6% vs 45.7%, p = 0.082) together with a lower incidence of left ventricular systolic dysfunction (3.2% vs 18.6%, p = 0.071).

Conclusions: PA exerts a beneficial effect in nondiabetic patients with ST-segment elevation acute MI even when treated with primary PCI. The infarct size is limited, and left ventricular systolic function is preserved. The effects may be related to a better preservation of tissue reperfusion in patients with PA.


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