Effect of angina pectoris on myocardial protection in patients with reperfused anterior wall myocardial infarction: retrospective clinical evidence of "preconditioning"

Division of Cardiology, Sakurabashi Watanabe Hospital, Osaka, Japan.

OBJECTIVES. We examined whether angina pectoris occurring shortly before the onset of acute myocardial infarction can actually preserve postischemic left ventricular function in humans. BACKGROUND. Experimental studies indicate that brief, transient episodes of ischemia render the heart very resistant to infarction from a subsequent sustained ischemic insult, an effect termed ischemic preconditioning. However, no clinical data are available concerning the implications of angina pectoris shortly before the onset of infarction in humans. METHODS. We studied 84 patients with an acute anterior myocardial infarction. All patients had total occlusion of the proximal or medial portion of the left anterior descending coronary artery and achieved reflow within 6 h of onset. Patients were classified into three groups on the basis of duration of antecedent angina pectoris: group 1 = no angina (37 patients); group 2 = new angina pectoris occurring < or = 7 days of onset of infarction (22 patients); group 3 = angina pectoris beginning > 7 days before onset of infarction (25 patients). All patients underwent left ventriculography on the day of, and 28 days after, onset of infarction to determine ejection fraction and regional wall motion in the territory of the left anterior descending coronary artery by the centerline method. RESULTS. Angiographic collateral flow grade was higher in group 3 than in groups 1 and 2 ([mean +/- SD] group 1 = 0.08 +/- 0.7, group 2 = 0.7 +/- 0.7, group 3 = 1.5 +/- 0.8). Although there were no differences in baseline ejection fraction and regional wall motion among the three groups, the degree of improvement was significantly greater in groups 2 and 3 than in group 1 (late minus baseline ejection fraction: group 1 = 0 +/- 8%, group 2 = 7 +/- 10% group 3 = 6 +/- 10% [p < 0.05 group 1 vs. groups 2 and 3]; late minus baseline regional wall motion: group 1 = 0.2 +/- 0.4, group 2 = 0.6 +/- 0.5, group 3 = 0.5 +/- 0.6 SD/chord [p < 0.05, group 1 vs. group 2]). When the study was limited to those patients with no or poor collateral flow (31 in group 1, 19 in group 2, 10 in group 3), only group 2 patients had a significant improvement in wall motion. Angina pectoris within 24 h before onset of infarction was more frequent in group 2 (82%) than group 3 (28%, p < 0.05). CONCLUSIONS. Episodes of angina pectoris occurring shortly before the onset of infarction may preserve myocardial contractile function in reperfused myocardial infarction despite less support from collateral flow channels, although these are suggestive results in a limited number of patients.

This article has been cited by other articles:

				H. Ishii, T. Amano, T. Matsubara, and T. Murohara Pharmacological Intervention for Prevention of Left Ventricular Remodeling and Improving Prognosis in Myocardial Infarction Circulation, December 16, 2008; 118(25): 2710 - 2718. [Full Text] [PDF]

				T Takahashi, Y Hiasa, Y Ohara, S Miyazaki, K Mahara, R Ogura, H Miyajima, K Yuba, N Suzuki, S Hosokawa, et al. Acute hyperglycaemia prevents the protective effect of pre-infarction angina on microvascular function after primary angioplasty for acute myocardial infarction Heart, November 1, 2008; 94(11): 1402 - 1406. [Abstract] [Full Text] [PDF]

				S. Namiuchi, Y. Kagaya, J. Ohta, N. Shiba, M. Sugi, M. Oikawa, H. Kunii, H. Yamao, N. Komatsu, M. Yui, et al. High Serum Erythropoietin Level Is Associated With Smaller Infarct Size in Patients With Acute Myocardial Infarction Who Undergo Successful Primary Percutaneous Coronary Intervention J. Am. Coll. Cardiol., May 3, 2005; 45(9): 1406 - 1412. [Abstract] [Full Text] [PDF]

				D. A. Liem, M. te Lintel Hekkert, O. C. Manintveld, F. Boomsma, P. D. Verdouw, and D. J. Duncker Myocardium tolerant to an adenosine-dependent ischemic preconditioning stimulus can still be protected by stimuli that employ alternative signaling pathways Am J Physiol Heart Circ Physiol, March 1, 2005; 288(3): H1165 - H1172. [Abstract] [Full Text] [PDF]

				T. Kurotobi, H. Sato, K. Kinjo, D. Nakatani, H. Mizuno, M. Shimizu, K. Imai, A. Hirayama, K. Kodama, M. Hori, et al. Reduced collateral circulation to the infarct-related artery in elderly patients with acute myocardial infarction J. Am. Coll. Cardiol., July 7, 2004; 44(1): 28 - 34. [Abstract] [Full Text] [PDF]

				E. A. Amsterdam and S. Schaefer Ischemic preconditioning in coronary heart disease: a therapeutic golden fleece? J. Am. Coll. Cardiol., May 5, 2004; 43(9): 1515 - 1516. [Full Text] [PDF]

				H. J. Penttila, M. V.K. Lepojarvi, P. K. Kaukoranta, K. T. Kiviluoma, K. V. Ylitalo, and K. J. Peuhkurinen Ischemic preconditioning does not improve myocardial preservation during off-pump multivessel coronary operation Ann. Thorac. Surg., April 1, 2003; 75(4): 1246 - 1252. [Abstract] [Full Text] [PDF]

				L. G. Kevin, A. K. S. Camara, M. L. Riess, E. Novalija, and D. F. Stowe Ischemic preconditioning alters real-time measure of O2 radicals in intact hearts with ischemia and reperfusion Am J Physiol Heart Circ Physiol, February 1, 2003; 284(2): H566 - H574. [Abstract] [Full Text] [PDF]

				K. Iwakura, H. Ito, M. Ikushima, S. Kawano, A. Okamura, K. Asano, T. Kuroda, K. Tanaka, T. Masuyama, M. Hori, et al. Association between hyperglycemia and the no-reflow phenomenon inpatients with acute myocardial infarction J. Am. Coll. Cardiol., January 1, 2003; 41(1): 1 - 7. [Abstract] [Full Text] [PDF]

				E. G. Lakatta and S. J. Sollott The "Heartbreak" of Older Age Mol. Interv., November 1, 2002; 2(7): 431 - 446. [Abstract] [Full Text] [PDF]

				R. A Kloner, M. T Speakman, and K. Przyklenk Ischemic preconditioning: a plea for rationally targeted clinical trials Cardiovasc Res, August 15, 2002; 55(3): 526 - 533. [Full Text] [PDF]

				M. Ishihara, I. Inoue, T. Kawagoe, Y. Shimatani, S. Kurisu, K. Nishioka, Y. Kouno, T. Umemura, S. Nakamura, and H. Sato Diabetes mellitus prevents ischemic preconditioning in patients with a first acute anterior wall myocardial infarction J. Am. Coll. Cardiol., October 1, 2001; 38(4): 1007 - 1011. [Abstract] [Full Text] [PDF]

				K. Iwakura, H. Ito, S. Kawano, Y. Shintani, K. Yamamoto, A. Kato, M. Ikushima, K. Tanaka, M. Kitakaze, M. Hori, et al. Predictive factors for development of the no-reflow phenomenon in patients with reperfused anterior wall acute myocardial infarction J. Am. Coll. Cardiol., August 1, 2001; 38(2): 472 - 477. [Abstract] [Full Text] [PDF]

				G. Heusch Nitroglycerin and Delayed Preconditioning in Humans : Yet Another New Mechanism for an Old Drug? Circulation, June 19, 2001; 103(24): 2876 - 2878. [Full Text] [PDF]

				I. Iglesias-Garriz, F.e. Corral, M. A. Rodriguez, C. Garrote, M. Montes, and E. Sevillano Pre-infarction angina elicits greater myocardial viability on reperfusion after myocardial infarction: a dobutamine stress echocardiographic study J. Am. Coll. Cardiol., June 1, 2001; 37(7): 1846 - 1850. [Abstract] [Full Text] [PDF]

				T. Matsubara, S. Minatoguchi, H. Matsuo, K. Hayakawa, T. Segawa, Y. Matsuno, S. Watanabe, M. Arai, Y. Uno, M. Kawasaki, et al. Three minute, but not one minute, ischemia and nicorandil have a preconditioning effect in patients with coronary artery disease J. Am. Coll. Cardiol., February 1, 2000; 35(2): 345 - 351. [Abstract] [Full Text] [PDF]

				D Karila-Cohen, D Czitrom, E Brochet, M Faraggi, P Seknadji, D Himbert, J.-M Juliard, P Assayag, and P.G Steg Decreased no-reflow in patients with anterior myocardial infarction and pre-infarction angina Eur. Heart J., December 1, 1999; 20(23): 1724 - 1730. [Abstract] [PDF]

				T. Noda, S. Minatoguchi, K. Fujii, M. Hori, T. Ito, K. Kanmatsuse, M. Matsuzaki, T. Miura, H. Nonogi, M. Tada, et al. Evidence for the delayed effect in human ischemic preconditioning: Prospective multicenter study for preconditioning in acute myocardial infarction J. Am. Coll. Cardiol., December 1, 1999; 34(7): 1966 - 1974. [Abstract] [Full Text] [PDF]

				H. Shiraki, T. Yoshikawa, T. Anzai, K. Negishi, T. Takahashi, Y. Asakura, M. Akaishi, H. Mitamura, and S. Ogawa Association between Preinfarction Angina and a Lower Risk of Right Ventricular Infarction N. Engl. J. Med., April 2, 1998; 338(14): 941 - 947. [Abstract] [Full Text] [PDF]

				E. R. Schwarz, J. Fleischhauer, H. Montino, R. Chakupurakal, M. Foresti, T. Schuetz, S. Sack, M. Mohri, M. Arras, W. Schaper, et al. Infarct Size Reduction by Ischemic Preconditioning is a Monophasic, Short-Lived Phenomenon in Anesthetized Pigs Journal of Cardiovascular Pharmacology and Therapeutics, January 1, 1998; 3(1): 63 - 70. [Abstract] [PDF]

				G. Rioufol, M. Ovize, J. Loufoua, C. Pop, X. Andre-Fouet, and Y. Minaire Ventricular fibrillation in preconditioned pig hearts: role of K+ATP channels Am J Physiol Heart Circ Physiol, December 1, 1997; 273(6): H2804 - H2810. [Abstract] [Full Text] [PDF]

				R. L. Engler and D. M. Yellon Sulfonylurea KATP Blockade in Type II Diabetes and Preconditioning in Cardiovascular Disease: Time for Reconsideration Circulation, November 1, 1996; 94(9): 2297 - 2301. [Full Text]