Unstable angina pectoris prior to ST elevation myocardialinfarction in patients treated with primary percutaneouscoronary intervention has no influence on prognosis
2015
Background. Pre-infarction unstable angina pectoris (UAP) can
be considered ischemic preconditioning. The aim of this study
was to compare short and long term outcomes in patients with or
without pre-infarction UAP and ST elevation myocardial
infarction (STEMI) treated with primary percutaneous coronary
intervention (PCI). Methods. 593 patients with STEMI (388
without and 205 with UAP) were evaluated. Levels of biomarkers
(troponin I, BNP, NT-ProBNP, neopterin, endoglin and
pentraxin-3) at hospital admission and 24 h after STEMI onset
were assessed. Echocardiography was undertaken on the fourth
day after MI and after 12 months. The median follow-up was 37
months. Results. We found no significant differences in sex,
age or risk factors for atherosclerosis between the UAP and
non-UAP group. As the median time from the onset of chest pain
to admission was significantly longer in the UAP group (228 min
vs 258 min; P=0.009), we used a propensity score to obtain
comparable matched groups for use in further analyses. The
levels of NT-proBNP were significantly higher on admission and
after 24 hours in the UAP group. Left ventricular functions
according to invasive and echocardiographic parameters were
entirely comparable at hospitalization and after 12 months. No
differences were found in severity index of acute heart failure
during hospitalization. The incidence of major acute coronary
events during follow-up was comparable for the groups.
Conclusions. In patients with STEMI treated with primary PCI,
pre-infarction UAP has no beneficial clinical effect during
hospitalization or during long-term follow-up.
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