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J Am Coll Cardiol, 2001; 38:1007-1011 © 2001 by the American College of Cardiology Foundation |
a Department of Cardiology, Hiroshima City Hospital, Hiroshima, Japan
Manuscript received February 26, 2001; revised manuscript received May 22, 2001, accepted June 14, 2001.
Reprint requests and correspondence: Dr. Masaharu Ishihara, Department of Cardiology, Hiroshima City Hospital, 7-33, Moto-machi, Naka-ku, Hiroshima, 730-8518 Japan
ishifami{at}fb3.so-net.ne.jp
OBJECTIVES
This study was undertaken to assess whether prodromal angina could have beneficial effects in diabetic patients with acute myocardial infarction (AMI).
BACKGROUND
Prodromal angina occurring shortly before the onset of AMI is associated with favorable outcomes by the mechanism of ischemic preconditioning. However, little is known about the impact of diabetes on ischemic preconditioning.
METHODS
We studied 611 patients with a first anterior wall AMI who underwent emergency catheterization within 12 h after the onset of chest pain: 490 patients without diabetes and 121 patients with non–insulin treated diabetes. Prodromal angina was defined as angina episode(s) occurring within 24 h before the onset of AMI. Serial contrast left ventriculograms were obtained in 424 patients at the time of acute and predischarge catheterization.
RESULTS
In non-diabetic patients, prodromal angina was associated with lower peak creatine kinase (CK) value (3,068 ± 2,647 IU/l vs. 3,601 ± 2,462 IU/l, p = 0.037), larger increase in left ventricular ejection fraction (LVEF) (10.1 ± 13.0% vs. 5.8 ± 13.4%, p = 0.004) and lower in-hospital mortality (3.4% vs. 9.3%, p = 0.015). On the contrary, in diabetic patients, there was no significant difference in peak CK value (3,382 ± 2,520 IU/l vs. 3,233 ± 2,412 IU/l, p = NS), the change in LVEF (6.7 ± 13.8% vs. 7.1 ± 12.4%, p = NS) and in-hospital mortality (8.8% vs. 11.0%, p = NS) between patients with and patients without prodromal angina.
CONCLUSIONS
Prodromal angina limited infarct size, enhanced recovery of LV function and improved survival in non-diabetic patients with AMI. However, such beneficial effects of prodromal angina were not observed in diabetic patients, suggesting that diabetes might prevent ischemic preconditioning.
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