Effect of angina pectoris on myocardial protection in patients with reperfused anterior wall myocardial infarction

Retrospective clinical evidence of "preconditioning"

Yusuke Nakagawa, Hiroshi Itoh, Masafumi Kitakaze, Hideo Kusuoka, Masatsugu Hori, Tsunehiko Kuzuya, Yorihiko Higashino, Kenshi Fujii, Takazo Minamino

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Abstract

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 ≤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 = 0.8 ± 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.

Original languageEnglish
Pages (from-to)1076-1083
Number of pages8
JournalJournal of the American College of Cardiology
Volume25
Issue number5
DOIs
Publication statusPublished - 1995
Externally publishedYes

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Anterior Wall Myocardial Infarction
Angina Pectoris
Infarction
Myocardial Infarction
Coronary Vessels
Ischemic Preconditioning
Left Ventricular Function
Ischemia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Nursing(all)

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Effect of angina pectoris on myocardial protection in patients with reperfused anterior wall myocardial infarction : Retrospective clinical evidence of "preconditioning". / Nakagawa, Yusuke; Itoh, Hiroshi; Kitakaze, Masafumi; Kusuoka, Hideo; Hori, Masatsugu; Kuzuya, Tsunehiko; Higashino, Yorihiko; Fujii, Kenshi; Minamino, Takazo.

In: Journal of the American College of Cardiology, Vol. 25, No. 5, 1995, p. 1076-1083.

Research output: Contribution to journalArticle

Nakagawa, Yusuke ; Itoh, Hiroshi ; Kitakaze, Masafumi ; Kusuoka, Hideo ; Hori, Masatsugu ; Kuzuya, Tsunehiko ; Higashino, Yorihiko ; Fujii, Kenshi ; Minamino, Takazo. / Effect of angina pectoris on myocardial protection in patients with reperfused anterior wall myocardial infarction : Retrospective clinical evidence of "preconditioning". In: Journal of the American College of Cardiology. 1995 ; Vol. 25, No. 5. pp. 1076-1083.
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abstract = "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 ≤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 = 0.8 ± 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.",
author = "Yusuke Nakagawa and Hiroshi Itoh and Masafumi Kitakaze and Hideo Kusuoka and Masatsugu Hori and Tsunehiko Kuzuya and Yorihiko Higashino and Kenshi Fujii and Takazo Minamino",
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T1 - Effect of angina pectoris on myocardial protection in patients with reperfused anterior wall myocardial infarction

T2 - Retrospective clinical evidence of "preconditioning"

AU - Nakagawa, Yusuke

AU - Itoh, Hiroshi

AU - Kitakaze, Masafumi

AU - Kusuoka, Hideo

AU - Hori, Masatsugu

AU - Kuzuya, Tsunehiko

AU - Higashino, Yorihiko

AU - Fujii, Kenshi

AU - Minamino, Takazo

PY - 1995

Y1 - 1995

N2 - 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 ≤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 = 0.8 ± 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.

AB - 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 ≤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 = 0.8 ± 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.

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