RESUMO
BACKGROUND: Pre-infarction angina (PIA) has been shown to reduce the microvascular obstruction (MVO) rate in patients with ST-segment elevation myocardial infarction (STEMI). We sought to evaluate the potential modulator role of cardiovascular risk factors (CRFs) on this protective effect. METHODS AND RESULTS: Two hundred patients with STEMI were enrolled. PIA was defined as typical chest pain within the 48 h preceding STEMI onset. Angiographic MVO was defined as TIMI flow grade <2 or TIMI flow 3 with myocardial blush grade <2; electrocardiographic (ECG) MVO was defined as ST-segment elevation resolution <70%. Common CRFs were collected. In the absence of hypertension, both angiographic and ECG MVO rates were lower in patients with PIA as compared with those without, whereas, in the presence of hypertension, they were similar in both study groups (P for interaction=0.01 and P=0.014, respectively). Among nonsmokers, angiographic and ECG MVO rates were lower in patients with PIA as compared with those without, whereas within smokers, they were similar in both study groups (P for interaction=0.037 and P=0.037, respectively). In the absence of dyslipidemia, the angiographic and ECG MVO rates were lower in patients with PIA as compared with those without, whereas within dyslipidemic patients, they were similar in both study groups (P for interaction=0.012 and P=0.04, respectively). CONCLUSIONS: The protective effect of PIA on MVO is blunted by CRFs.
Assuntos
Angiografia Coronária , Eletrocardiografia , Angina Microvascular , Infarto do Miocárdio , Intervenção Coronária Percutânea , Idoso , Feminino , Humanos , Masculino , Angina Microvascular/diagnóstico por imagem , Angina Microvascular/fisiopatologia , Angina Microvascular/cirurgia , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico por imagem , Infarto do Miocárdio/fisiopatologia , Infarto do Miocárdio/cirurgia , Fatores de RiscoRESUMO
Enhanced external counterpulsation (EECP) was used to treat 30 patients with refractory angina due to cardiac Syndrome X, with an initial improvement in CCS angina class (3.57 to 1.43; p<0.001) and regional ischemia in all treated patients. At a mean of 11.9 months follow-up, 87% of patients had sustained improvement in angina and were without MACE. EECP, by improving endothelial function, may be an effective and durable treatment for this often difficult to treat problem.
