Effect of Preinfarction Angina Pectoris on Myocardial Blush Grade After Reperfusion in First Anterior Wall Acute Myocardial Infarction

Abstract

he presence of preinfarction angina pectoris (PIA) has been shown to have beneficial effects on left ventricular (LV) function and prognosis after acute myocardial infarction (AMI). [1][2][3][4][5][6][7] Recently, myocardial blush grade (MBG) has been shown to be a simple and useful marker of myocardial tissue-level reperfusion in AMI. [8][9][10][11] Because the effect of PIA on MBG has not yet been investigated, we conducted the present study. Methods Study PatientsWe examined 142 consecutive patients (115 men, 27 women, mean age 61±11 years) with first anterior wall AMI who were admitted within 6 h after onset of symptoms and who met the following criteria: (1) typical chest pain lasting ≥20 min; (2) ST-segment elevation ≥0.2 mV in ≥2 adjacent precordial leads on the admission electrocardiogram; (3) an increase in the serum creatine kinase (CK) level more than twice the normal value; (4) no other heart or lung disease; (5) emergency coronary angiography and coronary angiography and left ventriculography performed at predischarge; and (6) adequate assessment of MBG after reperfusion. Informed consent for revascularization therapy and follow-up catheterization was given by all patients.PIA was defined as typical chest pain within 48 h before onset of AMI. Diabetes mellitus (DM) was considered present if this diagnosis and treatment, including diet, drugs, or insulin, had been given to the patient or if an abnormal oral glucose tolerance test or hemoglobinA1c ≥6.5% was found after admission. Cardiac CatheterizationEmergency coronary arteriography was performed using the Judkins or Amplatz technique. Multiple projections were recorded to ensure optimal visualization of the coronary vessels. The coronary flow in the infarct-related artery was graded according to the classification used in the Thrombolysis In Myocardial Infarction (TIMI) trial. 12 Proximal left anterior descending coronary artery (LAD) occlusion was defined as an occlusion of the artery proximal to its first septal branch. The grade of collateral filling in the LAD was determined according to the criteria of Rentrop et al. 13 A collateral circulation with a grade of 2 or 3 was defined as "good". After angiographic confirmation of total or subtotal occlusion of the LAD, primary coronary angioplasty was performed. If an optimal result (residual stenosis <50% without severe dissection) could not be obtained by balloon coronary angioplasty, coronary stenting was performed (n=59). Successful reperfusion was defined as the establishment of TIMI grade 3 flow in the infarct-related artery on the final coronary arteriogram. MBG was evaluated as follows 8 on the final left coronary angiogram in the lateral view after reperfusion: 0= no myocardial blush or contrast density; 1= minimal myocardial blush or contrast density; 2= moderate myocardial blush or contrast density, but less than that obtained during angiography of the con- Effect of Preinfarction Angina Pectoris on Myocardial Blush Grade After Reperfusion in First Anterior Wall Acute Myocardial Infarc...

Ischemic Preconditioning Effect of Prodromal Angina Is Attenuated in Acute Myocardial Infarction Patients With Hypertensive Left Ventricular Hypertrophy

“…20 Tamura et al demonstrated that the myocardial blush grade was significantly greater in patients with prodromal angina than in those without. 29 Our study results are consistent with their findings. However, the blush grade was significantly smaller in hypertensive patients, suggesting that microcirculatory dysfunction after reperfusion was more evident in patients with hypertension, even those with prodromal angina.…”

Preinfarction Angina as a Clinical Form of the Ischemic Preconditioning Phenomenon

“…Влияние ПС на результаты первичной ЧТБКА В настоящее время протективное влияние ПС на течение ИМ у больных, перенесших первичную ЧТБКА, является предметом дискуссий. Данные ряда клинических испытаний продемонстрировали, что при выполнении ЧТБКА наличие ПС было связано с более низкой частотой развития феномена невозобновленного кровотока "no-reflow" [37][38][39]. Положительное влияние ПС у больных, перенесших ЧТБКА, было отмечено не во всех исследованиях [40].…”

Acute hyperglycaemia prevents the protective effect of pre-infarction angina on microvascular function after primary angioplasty for acute myocardial infarction

“…Pre-infarction angina (PIA) occurring shortly before the onset of AMI has a cardioprotective effect in patients with AMI by the mechanism of ischaemic preconditioning 6 – 8. Moreover, PIA has been shown to preserve microvascular function after reperfusion 9 – 12. However, no clinical data exist regarding the influence of acute hyperglycaemia on the relation between PIA and microvascular function after AMI.…”