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Ischaemic preconditioning effect of prodromal angina pectoris is lost in patients with prior myocardial infarction
  1. M Ishihara,
  2. I Inoue,
  3. T Kawagoe,
  4. Y Shimatani,
  5. S Kurisu,
  6. T Hata,
  7. Y Nakama,
  8. Y Kijima,
  9. E Kagawa
  1. Department of Cardiology, Hiroshima City Hospital, Hiroshima, Japan
  1. Correspondence to:
    Dr M Ishihara
    Department of Cardiology, Hiroshima City Hospital, 7-33, Moto-machi, Naka-ku, Hiroshima 730-8518, Japan; ishifami{at}fb3.so-net.ne.jp

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Prodromal angina occurring shortly before the onset of acute myocardial infarction (MI) has a cardioprotective effect in patients with acute MI by the mechanism of ischaemic preconditioning.1,2 However, it has been reported that several conditions, including aging and diabetes mellitus, may abolish the beneficial effect of prodromal angina.3,4 Recent experimental studies have reported that the cardioprotective mechanism of preconditioning is impaired by post-MI left ventricular (LV) remodelling.5 Patients with prior MI have an increased risk of developing acute MI. Once acute MI has occurred, the prognosis is worse than that for patients without prior MI. This study was undertaken to investigate the influence of prior MI on the effect of prodromal angina in patients with acute MI.

METHODS

This study enrolled 1076 patients with acute MI who underwent coronary angiography within 24 hours after the onset of chest pain. Acute MI was diagnosed by chest pain persisting longer than 30 minutes and concomitant ECG changes. Serum creatine kinase was measured every three hours. Peak creatine kinase concentration had to be more than twice the normal upper limit. Immediately after coronary angiography, reperfusion therapy was performed, if appropriate. Most (84%) of the patients underwent primary coronary angioplasty with (n  =  584) or without coronary stents (n  =  315). Contrast left ventriculography was performed before reperfusion therapy (n  =  635) and at predischarge catheterisation (n  =  656).

Prodromal …

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