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Abstract Ischemic preconditioning refers to the ability of short periods of ischemia to render the myocardium more resistant to a subsequent ischemic insult. The presence of PA was associated with better clinical course after AMI and reduction in infarct size, as assessed indirectly by measurement of myocardial necrosis markers. Other authors have found a decrease in ventricular remodeling as well as in the incidence of ventricular arrhythmias, congestive heart failure, cardiogenic shock, and death. Reperfusion of the infarct related artery was also found to be faster after thrombolytic therapy when AMI was preceded by PA. Clinical studies of intravenous thrombolysis have repeatedly demonstrated that angina attacks shortly before an acute ST-segment elevation myocardial infarction (STEMI) limited infarct size and were associated with favorable clinical outcomes. Since primary percutaneous coronary intervention (PCI) with adjunctive antithrombotic medications is now the first therapeutic option, when considering improvement in myocardial reperfusion and prognosis for patients with STEMI, it is rational to reevaluate the clinical significance of angina prior to acute STEMI on outcome after primary PCI. This study was designed to evaluate the impact of angina prior to acute ST-elevation myocardial infarction on short term outcomes after primary percutaneous coronary intervention in patients presenting to Alexandria University Main Hospital, Alexandria Police Hospital and Nasr City Insurance Hospital, Cardiology Departments. The study was conducted on 60 patients diagnosed as STEMI. They divided into 2 groups (PA group and non PA group). All patients were subjected to: • History taking (Questions about onset, course and duration of chest pain, presence of angina attacks during the 24 hours preceding the onset of chest pain, risk factors or any other disease if present. • Physical examination (vital signs and complete cardiac examination). • Laboratory tests (complete blood count, blood glucose and serum electrolytes, cardiac biomarkers including: (CK-MB) and cardiac troponin by qualitative assessment. • Standard 12-lead ECGs recorded on admission and after primary PCI, and the degree of ST-segment elevation and ST resolution (STR) measured 90 minute after PCI. • Coronary angiography and primary PCI were performed. • Conventional transthoracic echocardiographies during first presentation and after 30 days of clinical follow up. In this study there was no significant relation between the presence of preinfarction angina with age, gender distribution, prevalence of hypertension, diabetes, current smoking, previous history of MI and location of MI. The patients with PA presented earlier than non PA patients with mean of 3.19 ± 1.6 hours comparable with mean of 5.95 ± 5.60 hours in non PA group. More patients in non PA group presented with advanced heart failure symptoms (36.7% of patients had KILLIP class II). Total occlusion of the IRA (TIMI flow grade 0) was less frequent in the PA group (66.7%) while 83.3 % in non PA which may be due to the presence of ischemic preconditioning and intermittent occlusion of the culprit vessels. After PCI, more patients in the PA group (76.7%) had TIMI flow grade 3 in the IRA while (66.7%) in patients without. SO, patients with PA show better TIMI flow in the culprit vessels at initial angiography and after the PCI procedure. More patients in the PA group associated with statistically significant complete ST resolution at 90 minutes after the procedure (90%) while (76.6%) of patients without PA show successful ST resolution. According to this PA associated with better reperfusion. At 30 day clinical follow up, left ventricular function were significantly improved in patients with PA there median value was 47% and became 50% in comparable with non PA group which showed median value of 44 % at presentation and became 42% at follow up. According to MACE events including cardiac death, re-MI, and TVR the Non PA group had more MACE events than the PA group including two deaths, one re-MI and one TVR due to definite in stent thrombosis without statistical significance. |