The effect of prodromal angina pectoris on short-term prognosis of acute ST elevation myocardial infarction

According to the report of World Health Organization coronary artery disease every year has been considered as the leading death cause of more than 3.8 million men and 3.4 million women all over the world. Prodromal angina that occurs a short time before acute myocardial infarction onset has efficient protective effect in cardiovascular system with ischemic preconditioning but in conditions such as old age and diabetes mellitus these efficient effects may decrease. This study was conducted to investigate the effects of prodromal angina pectoris on short term acute ST elevation in myocardial infarction. This analytical and prospective study conducted on 148 hospitalized patients with STEMI (ST elevation myocardial infarction), that divided into two groups, one with prodromal angina pectoris and the other without preinfarction angina. Angina pectoris is defined as transient myocardial ischemia existence during 24 hours before acute myocardial infarction onset. Fifty-nine patients were in the group with preinfarction angina and 89 patients in the group without preinfarction angina. In-hospital and out-hospital mortality in one month and left ventricular ejection fraction (LVEF) with echocardiography, serum creatine Kinase-MB (CKMB), intensity and rate of response to thrombolytic therapy according to ST echocardiography changes, and also inhospital arrhythmias were investigated as variables of short term prognosis. There were significant differences between the results of patients with preinfarction angina with patients without preinfarction angina for heart failure intensity (p value< 0.001; relative risk =5.859) and infarction extent (mean CKMB=148.2 VS 3589; p value < 0.01). There were no significant differences between mortality and in-hospital arrhythmias and intensity and rate of response to thrombolytic therapy. Prodromal angina pectoris has desired effect on short term prognosis of STEMI patients that it seems this effect is due to reduction of infarction extent and limitation of involved part. Prodromal angina pectoris despite the efficient effect on infarction extent was not accompanied with lower in-hospital short term mortality in patients that had chest pain 24 hours ago. However, due to insufficient volume of the samples enough assurance did not obtained from the recent results accuracy. Thus, the authors suggest more sophisticated studies to elucidate the exact effects of prodromal angina pectoris on short term prognosis of acute ST elevation myocardial infarction.