Prodromal angina is associated with myocardial salvage in acute ST-segment elevation myocardial infarction
Pier Giorgio Masci1, Daniele Andreini, Marco Francone
1Fondazione CNR/Regione Toscana 'G. Monasterio', Via Moruzzi 1, 56124 Pisa, Italy.
Insights
Prodromal angina (PA) in acute myocardial infarction (MI) patients is linked to better outcomes. This chest pain before MI indicates reduced heart damage and less microvascular obstruction after treatment.
Area of Science:
- Cardiology
- Cardiovascular Medicine
- Interventional Cardiology
Background:
- Prodromal angina (PA) is common in acute myocardial infarction (MI) patients.
- The impact of PA on myocardial damage and salvage is not well understood.
Purpose of the Study:
- To investigate the association between new-onset PA and myocardial salvage in acute ST-segment elevation MI patients.
- To determine if PA influences infarct size, myocardial hemorrhage, and microvascular obstruction.
Main Methods:
- Prospective evaluation of 154 acute MI patients treated with primary percutaneous coronary intervention (PPCI).
- Cardiovascular magnetic resonance (CMR) assessed area-at-risk (AAR), MI size, myocardial hemorrhage (MH), microvascular obstruction (MO), and myocardial salvage index (MSI).
- Patients were categorized based on the presence or absence of new-onset PA in the week preceding MI.
Main Results:
- Patients with PA (n=60) exhibited significantly smaller MI size and larger MSI (0.53 vs. 0.32, P<0.001) compared to those without PA (n=94), despite similar AAR.
- PA was associated with a lower incidence of MH (18% vs. 33%) and MO (22% vs. 46%).
- Multivariate analysis confirmed that new-onset PA was independently associated with higher MSI (β=0.352, P<0.001).
Conclusions:
- New-onset prodromal angina in acute MI patients is an independent predictor of improved myocardial salvage.
- PA is associated with reduced microvascular damage, including less myocardial hemorrhage and microvascular obstruction.
- These findings suggest PA may serve as a protective biomarker in acute MI management.
Aims:
Previous 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 Results:
One-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).
Conclusion:
In 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.
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