Preinfarction angina prevents left ventricular remodeling in patients treated with thrombolysis for myocardial infarction

Background: It has been shown that preinfarction angina may have beneficial effects on infarct size and mortality. However, there are no studies that have serially assessed the impact of preinfarction angina on left ventricul ar (LV) function in a large series of patients. Hypothesis: The study was undertaken to determine whether preinfarction ang ina (within 7 days before infarction) influences LV remodeling. Methods: In all, 119 consecutive patients with acute myocardial infarction were serially evaluated by 2-dimensional echocardiography ton Days 1, 2, 3, and 7; at 3 and 6 weeks: and at 3, 6, and 12 months following infarction). Left ventricular volumes were determined using Simpson's biplane formula a nd normalized for body surface area. Wall motion score index and sphericity index were calculated for each study. Coronary angiography was performed b efore discharge. Results: Preinfarction angina was detected in 39 of 119 patients. Initial e chocardiographic and clinical data as well as the incidence of patent infar ct-related artery and collaterals were similar for patients with and withou t preinfarction angina. In the subset of thrombolysed patients, patients wi th preinfarction angina showed decrease of LV end-diastolic and end-systoli c volumes during the follow-up period (p = 0.033 and p = 0.001, respectivel y), and improvement of wall motion score index (p < 0.001) and ejection fra ction occurred (p = 0.001), without changing of LV shape (p <greater than> 0.05); in addition, patients with preinfarction angina had smaller LV volum es and higher ejection fraction than did those without angina, from 3 weeks onward. These favorable effects were not detected in patients not treated with thrombolysis. Conclusions: These data indicate that preinfarction angina has an inhibitin g effect on long-term LV remodeling in patients who underwent thrombolysis for first acute myocardial infarction. It appears that preinfarction angina has no impact on infarct size and early postinfarction LV function.