Kloner R A, Shook T, Antman E M, Cannon C P, Przyklenk K, Yoo K, McCabe C H, Braunwald E
Good Samaritan Hospital, Los Angeles, University of Southern California, 90017, USA.
Circulation. 1998 Mar 24;97(11):1042-5. doi: 10.1161/01.cir.97.11.1042.
The timing of onset of angina before myocardial infarction in relation to outcome is unknown.
We prospectively determined the importance of the time of onset of preinfarction angina in relation to 30-day outcomes in the TIMI-9B study from standardized forms. Of the 3002 patients entered into the study, 425 reported angina before their myocardial infarction. Patients with angina onset within 24 hours of infarction had a lower 30-day cardiac event rate (mortality, recurrent myocardial infarction, heart failure, or shock) at 4% than those with onset of angina >24 hours (17%; P=.030). A history of any angina alone was not associated with reduced event rate. Peak creatine kinase levels tended to be lower in the group with angina within 24 hours. These benefits were not due to higher rates of use of antianginal medicines or aspirin and were not a consequence of differences in baseline characteristics or disease states (hypertension, hypercholesterolemia) among subgroups.
These temporal observations are consistent with the concept of preconditioning by preinfarction angina but do not rule out other mechanisms.
心肌梗死前心绞痛发作时间与预后的关系尚不清楚。
在TIMI-9B研究中，我们根据标准化表格前瞻性地确定梗死前心绞痛发作时间与30天预后的关系。在纳入研究的3002例患者中，425例报告在心肌梗死前出现心绞痛。梗死24小时内出现心绞痛的患者30天心脏事件发生率（死亡率、再发心肌梗死、心力衰竭或休克）为4%，低于梗死24小时后出现心绞痛的患者（17%；P = 0.030）。仅有心绞痛病史与事件发生率降低无关。梗死24小时内出现心绞痛的组肌酸激酶峰值水平往往较低。这些益处并非由于抗心绞痛药物或阿司匹林的使用频率较高，也不是亚组间基线特征或疾病状态（高血压、高胆固醇血症）差异的结果。
这些时间观察结果与梗死前心绞痛预处理的概念一致，但不排除其他机制。
