Clinical Outcome and ECG Change in Patients with Acute Myocardial Infarction and Prodromal Angina

BACKGROUND AND OBJECTIVES: Ischemic preconditioning reduces the size of myocardial infarct in animal models, however its role in humans remains unclear. Clinical data suggests that episodes of angina immediately before acute myocardial infarction may be associated with a protective effect on the human myocardium. We performed an analysis on the effect of prodromal angina on infarct size, in-hospital outcome and newly developed Q-wave in patients with acute myocardial infarction. SUBJECTS AND METHODS: 65 patients who had received thrombolytic therapy were enrolled in the study. Eleven patients (17%) had experienced previous angina within 24 hours prior to acute myocardial infarction (group I), and the remaining 54 patients (83%) did not have a history of previous angina (group II). Killip class, cardiac enzyme, ECG findings, echocardiographic data and in-hospital outcomes were compared between the two groups. RESULTS: Group I tended to have lower peak creatine kinase (CK) and CK-MB levels, although the difference between the two groups in regards to the level of cardiac enzyme was statistically insignificant. Despite similar patient characteristics, Group I showed a lower incidence of heart failure during hospitalization than group II. 6/11 patients (55%) in group I and 47/54 (87%) in group II had a Q-wave at discharge ECG. Group I showed better left ventricular systolic function during admission. None of the DM patients (14 patients) had prodromal angina and 13 of 14 patients (93%) demonstrated Q-wave infarction. CONCLUSION: Prodromal angina prior to acute myocardial infarction as a marker of ischemic preconditioning may also confer beneficial effects in terms of in-hospital outcomes. Further studies concerning the long term outcomes of such cases are needed.

Serum soluble IL-2 receptor levels following interferon and ribavirin combination therapy with chronic hepatitis C / 대한내과학회지

BACKGROUND: To evaluate the cellular immune response to interferon(IFN)-alpha and ribavirin combination therapy in patients with chronic hepatitis C, we monitored serum levels of soluble IL-2 receptor(sIL2R) before and after the therapy. METHODS: Serum sIL2R levels before and after the combination therapy were measured in 19 patients with chronic hepatitis C. IFN(3 MU/day, 3 times/week) and ribavirin 1000 mg/day were administered for 24 weeks to all patients. RESULTS: After the therapy, sIL2R levels were increased (before, 3.13 0.67 ng/m L, and after 4.08 2.13 ng/mL, p=0.059) but statistically insignificant(p>0.05). The patients were divided into two groups : the responder group who were negative for serum hepatitis C virus(HCV)-RNA after the therapy, and the non-responder group who were still positive for HCV-RNA after the therapy. Between these two groups, sIL2R levels before and after the therapy were not significantly different. The ratio of sIL2R levels before and after the therapy was calculated, although the ratio was higher in responder group, but there was no significant difference between the two groups(sIL2R after the therapy)/(sIL2R before the therapy) : 1.43 0.70 in the responder group and 1.04 0.28 in the nonresponder group, p=0.096). CONCLUSION: Although these results failed to demonstrate that sIL2R level was increased during the combination therapy in patients with hepatitis C, this study suggested that cytokines which mediate immune response may be involved in the pathogenesis of chronic heaptitis C virus infection.