Abstract 11190: Association Between Preinfarction Angina and a Lower Risk of Severe Microvascular Dysfunction Assessed by Cardiovascular Magnetic Resonance After Primary Angioplasty in Patients with Acute Myocardial Infarction
Background: Several studies suggest that patients with preinfarction angina have smaller infarcts and better prognosis than those without angina in patients with acute ST-segment elevation myocardial infarction (STEMI). Non-invasive assessment of microvascular obstruction (MVO) and interstitial myocardial hemorrhage by cardiovascular magnetic resonance (CMR) provides a specific biomarker of severe microvascular dysfunction. However, the relationship between preinfarction angina and severe microvascular dysfunction has not been fully evaluated. The aim of this study was to determine whether preinfarction angina was related to the presence of severe microvascular dysfunction determined by CMR in patients with acute STEMI.
Methods: The study population consisted of 79 consecutive patients with a first STEMI successfully treated with primary percutaneous coronary intervention (PCI). CMR performed within 3 days after primary PCI was used to identify the presence of reperfusion hemorrhage and contrast enhancement was used to measure MVO. We assessed the association between preinfarction angina and microvascular dysfunction determined by CMR. The association between the timing of angina during the week before infarction and microvascular dysfunction was also assessed.
Results: Thirty-five/79 (44%) patients had MVO and 27 of these showed myocardial hemorrhage. Angina occurred 24 to 72 hours before infarction was the most strongly associated with reductions in the rates of MVO (adjusted odds ratio, 0.17; 95% confidence interval, 0.039 to 0.76; p=0.020) and myocardial hemorrhage (adjusted odds ratio, 0.07; 95% confidence interval, 0.01 to 0.67; p=0.021). Patients with MVO (52% vs 18%, p=0.013) and hemorrhagic myocardial infarction (42% vs 6%, p<0.01) were more frequently observed in patients without angina occurred 24 to 72 hours before infarction compared to those with the preinfarction angina.
Conclusion: Preinfarction angina was an independent predictor of the absence of severe microvascular dysfunction in patients with STEMI.
- © 2011 by American Heart Association, Inc.