Key result
New-onset prodromal angina before myocardial infarction significantly limited infarct size compared to no prodromal symptoms (additional 33% reduction; 95% CI 7.1% to 58.9%; P=0.01).
Why the study?
Does new-onset prodromal angina reduce infarct size in patients with a first anterior myocardial infarction?
Population
25 patients with their first anterior myocardial infarction treated with thrombolysis. Key inclusion…
Comparison
New-onset prodromal angina vs Complete absence of symptoms before onset of…
Design
Cohort
Follow-up
24 +/- 5 days
Authors
Discussion
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Implication
May represent clinical ischemic preconditioning; hypothesis-generating and requires prospective validation before practice change.
Study Design
Type
Cohort (n=25)
Structured PICO
Does new-onset prodromal angina reduce infarct size in patients with a first anterior myocardial infarction?
P
Population
25 patients with their first anterior myocardial infarction treated with thrombolysis (recombinant tissue plasminogen activator [r-TPA], 100 mg/3 hours). Key inclusion criteria: < 120 minutes from onset of symptoms to reperfusion therapy, < 90 minutes from the beginning of thrombolytic therapy to reperfusion, infarct-related coronary artery with TIMI 3 flow, and complete absence of collateral circulation to the infarct related artery.
I
Intervention
New-onset prodromal angina (typical chest pain episodes occurring at rest within 24 hours before onset of infarction)
C
Comparator
Complete absence of symptoms before onset of infarction (no prodromal angina)
O
Outcome
Infarct size (assessed by peak CKMB release and number of hypokinetic segments)surrogate
Main Result
Effect estimate: Absolute difference 33% (95% CI 7.1% to 58.9%)
Absolute Event Rate: 69% vs 36%
p-value: p=0.01
Prodromal angina occurring within 24 hours before a first anterior myocardial infarction is associated with a significantly smaller infarct size, suggesting it acts as a clinical correlate of ischemic preconditioning.
Cite This Study
Ottani et al. (1995) conducted a cohort in First anterior myocardial infarction (n=25). Prodromal angina vs. No prodromal angina was evaluated on Limitation of infarct size (%) (Absolute difference 33%, 95% CI 7.1% to 58.9%, p=0.01). New-onset prodromal angina before myocardial infarction significantly limited infarct size compared to no prodromal symptoms (additional 33% reduction; 95% CI 7.1% to 58.9%; P=0.01).