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Preinfarction angina associated with significant myocardial protection for stenting
A retrospective analysis and the largest cohort to date found that preinfarction angina is associated with significant myocardial protection for primary PCI with stenting during STEMI.
“Preinfarction angina is very common (20%-40% of patients), but is never taken into account in clinical trials that are examining ways to reduce infarct size or reperfusion injury. These patients should be accounted for in clinical trials because they may have a significant impact on the data,” study investigator Jay H. Traverse, MD, with Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, told Cardiology Today’s Intervention.
Traverse and colleagues reviewed records of 1,031 patients admitted with a first STEMI with ischemic times between 1 and 6 hours who received primary PCI. In this group, 245 patients had occluded arteries upon presentation, of whom 79 patients had documented chest pain within 24 hours of infarction and a 50% reduction in infarct size (measured as a surrogate as the peak creatine kinase level) compared with the 166 patients without preinfarction angina.
Patients with preinfarction angina had peak creatine kinase of 1,094 ± 75 IU/L compared with 2,270 ± 102 IU/L for those without (P<.0001). Patients with preinfarction angina had creatine kinase area under curve of 18,420 ± 18,941 IU/h per liter compared with 36,810 ± 21,741 IU/h per liter for those without (P<.0001) despite having similar ischemic times (185 ± 8 minutes vs. 181 ± 5 minutes; P=.67) and angiographic area at risk (24.1 ± 1.2% vs. 25.3 ± 0.9%; P=.43).
Patients with preinfarction angina had an absolute 4% improvement in left ventricular ejection fraction before discharge (P<.02).
Jay H. Traverse
“Whereas infarct size was smaller in patients with preinfarction angina regardless of ischemic time, the differences were most pronounced in prolonged ischemic time, suggesting that the protective effect of preinfarction angina may last for at least 6 hours,” Traverse and colleagues wrote. “This also implies that the benefit of late PCI may be greater in patients with preinfarction angina because more myocardium can be salvaged.”
Disclosure: The researchers report no relevant financial disclosures.