Prodromal angina is associated with myocardial salvage in acute ST-segment elevation myocardial infarction

Pier Giorgio Masci, Daniele Andreini, Marco Francone, Erika Bertella, Laura De Luca, Michele Coceani, Saima Mushtaq, Massimiliano Mariani, Iacopo Carbone, Gianluca Pontone, Luciano Agati, Jan Bogaert, Massimo Lombardi

Research output: Contribution to journalArticle

Abstract

AimsPrevious studies have shown that prodromal angina (PA) occurs frequently in acute myocardial infarction (MI) patients. However, the potential benefits of PA on ischaemic myocardial damage remain unknown.Methods and resultsOne-hundred and fifty-four patients with acute ST-segment elevation MI successfully treated with primary percutaneous coronary intervention (PPCI) were prospectively evaluated for new-onset PA in the week preceding infarction and other factors known to influence myocardial salvage. Cardiovascular magnetic resonance was performed 8 ± 3 days after MI for the assessment of area-at-risk (AAR), MI size, myocardial haemorrhage (MH), microvascular obstruction (MO), and myocardial salvage index (MSI).Patients with PA (n = 60) compared with those without PA (n = 94) showed similar AAR but significantly smaller MI size leading to larger MSI (0.53 ± 0.27 vs. 0.32 ± 0.26, P <0.001). Additionally, patients with PA had lower incidence of MH (18 vs. 33%) and MO (22 vs. 46%) than non-PA patients (both P <0.05). At univariate analysis, higher MSI was associated with new-onset PA, lower myocardial oxygen consumption before PPCI, shorter time-to-PPCI, and higher post-procedural TIMI flow-grade. Neither collateral circulation nor medications administered before PPCI were associated to MSI. After correction for other covariates by multivariate analysis, new-onset PA remained significantly associated with MSI (β-value: 0.352, P <0.001).ConclusionIn acute MI patients, new-onset PA is associated with higher MSI independent of others factors known to influence jeopardized myocardium, as well as with less microvascular damage.

Original languageEnglish
Pages (from-to)1041-1048
Number of pages8
JournalEuropean Heart Journal Cardiovascular Imaging
Volume14
Issue number11
DOIs
Publication statusPublished - Nov 2013

Keywords

  • Cardioprotection
  • Myocardial infarction
  • Prodromal angina

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging

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    Masci, P. G., Andreini, D., Francone, M., Bertella, E., De Luca, L., Coceani, M., Mushtaq, S., Mariani, M., Carbone, I., Pontone, G., Agati, L., Bogaert, J., & Lombardi, M. (2013). Prodromal angina is associated with myocardial salvage in acute ST-segment elevation myocardial infarction. European Heart Journal Cardiovascular Imaging, 14(11), 1041-1048. https://doi.org/10.1093/ehjci/jet063