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MYOCARDIAL INFARCTION

Preinfarction angina protects against out-of-hospital ventricular fibrillation in patients with acute occlusion of the left coronary artery

Peter J. Gheeraert, MD^*,*, José P. S. Henriques, MD, Marc L. De Buyzere, MSc^*, Michel De Pauw, MD^*, Yves Taeymans, MD, PhD^* and Felix Zijlstra, MD, PhD

^* Department of Cardiology, University Hospital, Gent, Belgium
Department of Cardiology, De Weezenlanden Hospital, Zwolle, The Netherlands

Manuscript received February 16, 2001; revised manuscript received June 14, 2001, accepted July 19, 2001.

^* Reprint requests and correspondence: Dr. Peter Gheeraert, Department of Cardiology, University Hospital, De Pintelaan 185, B-9000 Gent, Belgium
peter.gheeraert{at}rug.ac.be

OBJECTIVES

The goal of this study was to evaluate the effect of preconditioning on out-of-hospital ventricular fibrillation (VF) in patients with acute myocardial infarction (AMI).

BACKGROUND

More than half of the deaths associated with AMI occur out of the hospital and within 1 h of symptom onset. In humans, preinfarction angina (PA), which can serve as a surrogate marker for preconditioning, reduces infarct size, but the protective effect against out-of-hospital VF has not been investigated.

METHODS

Preinfarction angina status and acute coronary angiographic findings of 72 consecutive patients with AMI complicated by out-of-hospital VF were compared with 144 matched controls without this complication.

RESULTS

Preinfarction angina is associated with a lower risk for VF (odds ratio [OR]: 0.40, 95% confidence interval [CI]: 0.18 to 0.88). In patients with acute occlusion of the left coronary artery (LCA) (n = 136), the risk reduction is pronounced (OR: 0.25, 95% CI: 0.10 to 0.66), whereas, in patients with acute occlusion of the right coronary artery (RCA) (n = 67), the protective effect of PA on VF was not observed (OR: 2.25, 95% CI: 0.45 to 11.22). Subgroup and multivariate analyses show that the protective effect is independent of cardiovascular risk factors, preinfarction treatment with beta-adrenergic blocking agents or aspirin, the presence of collaterals or residual antegrade flow or the extent of coronary artery disease.

CONCLUSIONS

Preinfarction angina protects against out-of-hospital VF in patients with acute occlusion of the LCA. This protection is independent of risk factors or coronary anatomy. A larger study is needed to examine the apparently different effect in patients with acute occlusion of the RCA.

Abbreviations and Acronyms   AMI = acute myocardial infarction   CAD = coronary artery disease   CI = confidence interval   IRA = infarct-related coronary artery   LCA = left coronary artery   MI = myocardial infarction   OR = odds ratio   PA = preinfarction angina   RCA = right coronary artery   VF = ventricular fibrillation

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