Evrengul Harun, Celek Turgay, Tanriverdi Halil, Kaftan Asuman, Dursunoglu Dursun, Kilic Mustafa
Department of Cardiology, Pamukkale University School of Medicine, Denizli, Turkey.
Can J Cardiol. 2005 Sep;21(11):915-20.
Preinfarction angina (PA) and early reperfusion of infarct-related arteries have been shown to reduce infarct size in patients with acute myocardial infarction (AMI). The beneficial effects of PA on infarct size have been attributed to the development of ischemic preconditioning and faster coronary recanalization in patients treated with thrombolytic therapy (TT).
To evaluate the effect of PA on clinical coronary reperfusion time in patients with AMI receiving successful TT.
Seventy-five patients presenting with AMI (within 6 h after the initial onset of symptoms) were studied. All patients received TT and were evaluated with coronary angiography (CA) at predischarge. The patients were divided into two groups: group 1 (PA-positive) comprised those who experienced a new onset of prodromal angina within 72 h before the onset of AMI. Group 2 (PA-negative) comprised those who had a sudden onset of AMI without the preceding angina. The successful myocardial reperfusion criteria after TT were ST segment resolution of 50% or greater, the appearance of reperfusion arrhythmias and the resolution of chest pain. The time of reperfusion criteria was recorded after TT. CA was performed in all patients at predischarge. Patients with no patent infarct-related arteries on CA and clinical failure of reperfusion were excluded from the study.
Clinical characteristics, risk factors and angiographic findings did not differ significantly between the groups. The time interval from the start of continuous chest pain to TT was also similar between the groups. The left ventricular ejection fraction was higher and there were less frequent ventricular arrhythmias in patients with PA than in those without PA (47.9+/-7.4 versus 44.4+/-8.1, P=0.041, and 17.1% versus 37.5%, P=0.043, respectively). The clinical reperfusion time was significantly shorter in the patients with PA than in those without PA (68.2+/-24.5 min versus 81.4+/-19.3, P=0.012). The clinical reperfusion time was positively correlated with age and the time interval from the start of continuous chest pain to TT but inversely related to the presence of PA.
In patients with AMI preceded by PA, TT resulted in more rapid clinical reperfusion than in patients without PA. Thus, earlier myocardial reperfusion may account for smaller infarct size and better prognosis in patients with PA.
梗死前心绞痛（PA）和梗死相关动脉的早期再灌注已被证明可减小急性心肌梗死（AMI）患者的梗死面积。PA对梗死面积的有益作用归因于缺血预处理的发展以及接受溶栓治疗（TT）患者冠状动脉再通更快。
评估PA对接受成功TT治疗的AMI患者临床冠状动脉再灌注时间的影响。
研究了75例出现AMI（症状初始发作后6小时内）的患者。所有患者均接受TT治疗，并在出院前进行冠状动脉造影（CA）评估。患者分为两组：第1组（PA阳性）包括那些在AMI发作前72小时内出现前驱性心绞痛新发的患者。第2组（PA阴性）包括那些突然发作AMI且无前驱心绞痛的患者。TT治疗后成功心肌再灌注的标准为ST段回落≥50%、出现再灌注心律失常和胸痛缓解。记录TT治疗后达到再灌注标准的时间。所有患者在出院前进行CA检查。CA显示梗死相关动脉未开通且临床再灌注失败的患者被排除在研究之外。
两组患者的临床特征、危险因素和血管造影结果无显著差异。两组从持续胸痛开始至TT的时间间隔也相似。PA患者的左心室射血分数较高，室性心律失常发生率低于无PA患者（分别为47.9±7.4对44.4±8.1，P = 0.041；17.1%对37.5%，P = 0.043）。PA患者的临床再灌注时间显著短于无PA患者（68.2±24.5分钟对8 /1.4±19.3，P = 0.012）。临床再灌注时间与年龄以及从持续胸痛开始至TT的时间间隔呈正相关，但与PA的存在呈负相关。
在有PA前驱的AMI患者中，TT导致的临床再灌注比无PA患者更快。因此，更早的心肌再灌注可能是PA患者梗死面积较小和预后较好的原因。
