Pj. Gheeraert et al., Preinfarction angina protects against out-of-hospital ventricular fibrillation in patients with acute occlusion of the left coronary artery, J AM COL C, 38(5), 2001, pp. 1369-1374
Citations number
36
Categorie Soggetti
Cardiovascular & Respiratory Systems","Cardiovascular & Hematology Research
Objectives The goal of this study was to evaluate the effect of preconditio
ning on out-of-hospital ventricular fibrillation (VF) in patients with acut
e myocardial infarction (AMI).
Background More than half of the deaths associated with AMI occur out of th
e hospital and within 1 h of symptom onset. In humans, preinfarction angina
(PA), which can serve as a surrogate marker for preconditioning, reduces i
nfarct size, but the protective effect against out-of-hospital VF has not b
een investigated.
Methods Preinfarction angina status and acute coronary angiographic finding
s of 72 consecutive patients with AMI complicated by out-of-hospital VF wer
e compared with 144 matched controls without this complication.
Results Preinfarction angina is associated with a lower risk for VF (odds r
atio [OR]: 0.40, 95% confidence interval [CI]: 0.18 to 0.88). In patients w
ith acute occlusion of the left coronary artery (LCA) (n=136), the risk red
uction is pronounced (OR: 0.25, 95% CI: 0.10 to 0.66), whereas, in patients
with acute occlusion of the right coronary artery (RCA) (n=67), the protec
tive efFect of PA on VF was not observed (OR: 2.25, 95% CI: 0.45 to 11.22).
Subgroup and multivariate analyses show that the protective effect is inde
pendent of cardiovascular risk factors, preinfarction treatment with beta-a
drenergic blocking agents or aspirin, the presence of collaterals or residu
al antegrade flow or the extent of coronary artery disease.
Conclusions Preinfarction angina protects against out-of-hospital VF in pat
ients with acute occlusion of the LCA. This protection is independent of ri
sk factors or coronary anatomy. A larger study is needed to examine the app
arently different effect in patients with acute occlusion of the RCA. (J Am
Coll Cardiol 2001.;38:1369-74) (C) 2001 by the American College of Cardiol
ogy.