Absence of preinfarction angina is associated with a risk of no-reflow phenomenon after primary coronary angioplasty for a first anterior wall acute myocardial infarction

Background: No-reflow phenomenon after primary coronary angioplasty is asso ciated with poorer left ventricular (LV) function and prognosis after acute myocardial infarction (AMI). The purpose of this study was to determine th e clinical significance of preinfarction angina in the no-reflow phenomenon . Methods and results: A total of 40 patients with first anterior AMI were examined. All patients underwent primary balloon angioplasty or stenting wi thin 12 h of the onset of AMI. No-reflow, defined as TIMI grade 2 flow or l ess without residual stenosis after angioplasty, was observed in 15 patient s. Patients with no-reflow were older (67 +/- 9 vs. 58 +/- 10 years, P = 0. 006) and had a lower incidence of preinfarction angina (7% vs. 48%, P = 0.0 1) than those without no-reflow. Patients with no-reflow had poorer LV func tion at predischarge and a higher incidence of pump failure, LV aneurysm, m alignant ventricular arrhythmias or cardiac death during the hospital cours e in association with higher peak serum C-reactive protein levels (12.7 +/- 8.0 vs. 7.1 +/- 5.5 mg/dl, P = 0.02). Multivariate analysis showed that th e absence of preinfarction angina was a major independent determinant of no -reflow (RR = 17.1, P = 0.02). Conclusions: The absence of preinfarction an gina is more frequently observed in patients with no-reflow. The beneficial effect of preinfarction angina on LV function may be explained, at least i n part, by prevention of no-reflow after reperfusion. (C) 2000 Elsevier Sci ence ireland Ltd. All rights reserved.