Preinfarction angina does not affect infarct size in STEMI patients undergoing primary angioplasty

Several clinical studies have demonstrated that anginal attacks shortly before the onset of STEMI limit infarct size and improve short- and long-term outcomes. However, the clinical significance of preinfarction angina in STEMI patients treated by primary PCI is still controversial. Therefore, the aim of the current study was to evaluate the impact of preinfarction angina on scintigraphic infarct size in STEMI patients undergoing primary PCI.

Our population is represented by 430 STEMI patients undergoing primary PCI. Infarct size was evaluated at 30 days by technetium-99m-sestamibi.

Preinfarction angina was associated with more advanced age, a larger prevalence of family history for CAD, smoking, and longer ischemia time. No difference was observed in other clinical or angiographic characteristics. Preinfarction angina did not affect either the rate of postprocedural TIMI 3 flow or infarct size (19 ± 15.5 vs 16 ± 13.9, p = 0.18). Similar results were observed in subanalyses according to infarct location (anterior STEMI: 22.7 ± 14.8 vs 19.2 ± 16.1, p = 0.36; non-anterior STEMI: 16.1 ± 15.7 vs 13.8 ± 11.6, p = 0.36), gender (female gender: 15.6 ± 14.5 vs 11.5 ± 13.2, p = 0.30; male gender 20.4 ± 16 vs 17.2 ± 13.8, p = 0.3) or ischemia time (≤ or > 4 h) (17.6 ± 15.6 vs 15.8 ± 14.1, p = 0.52; 21.6 ± 15.5 vs 16.7 ± 13.3, p = 0.18). The absence of any impact of preinfarction angina on infarct size was confirmed after correction for baseline characteristics, such as age, smoking, family history for CAD and ischemia time (OR [95% CI] = 1.26 [0.66-2.41], p = 0.48).

This study shows that among STEMI patients undergoing primary PCI preinfarction angina does not affect infarct size.