Download PDF
Thromb Haemost 1999; 82(S 01): 68-72
DOI: 10.1055/s-0037-1615557
Commentaries
Schattauer GmbH

Preinfarction Angina and Improved Reperfusion of the Infarct-related Artery

Felicita Andreotti
1   From the Institute of Cardiology, Catholic University, Rome, Italy
,
Alessandro Sciahbasi
1   From the Institute of Cardiology, Catholic University, Rome, Italy
,
Eugenia De Marco
1   From the Institute of Cardiology, Catholic University, Rome, Italy
,
Attilio Maseri
1   From the Institute of Cardiology, Catholic University, Rome, Italy
› Author Affiliations
Further Information

Publication History

Publication Date:
14 December 2017 (online)

    Permissions and Reprints

Summary

Preinfarction angina and early reperfusion of the infarct-related artery are major determinants of reduced infarct-size in patients with acute myocardial infarction. The beneficial effects of preinfarction angina on infarct size have been attributed to the development of collateral vessels and/or to post-ischemic myocardial protection. However, recently, a relation has been found between prodromal angina, faster coronary recanalization, and smaller infarcts in patients treated with rt-PA: those with preinfarction angina showed earlier reperfusion (p = 0.006) and a 50% reduction of CKMB-estimated infarct-size (p = 0.009) compared to patients without preinfarction angina. This intriguing observation is consistent with a subsequent observation of higher coronary recanalization rates following thrombolysis in patients with prodromal preinfarction angina compared to patients without antecedent angina. Recent findings in dogs show an enhanced spontaneous lysis of plateletrich coronary thrombi with ischemic preconditioning, which is prevented by adenosine blockade, suggesting an antithrom-botic effect of ischemic metabolites. Understanding the mechanisms responsible for earlier and enhanced coronary recanalization in patients with preinfarction angina may open the way to new reperfusion strategies.

A vast number of studies, globally involving ≈17,000 patients with acute myocardial infarction, have unequivocally shown that an infarction preceded by angina evolves into a smaller area of necrosis compared to an infarct not preceded by angina (Table 1) (1). So far, preinfarction angina has been thought to have cardioprotective effects mainly through two mechanisms: collateral perfusion of the infarctzone (2-4), and ischemic preconditioning of the myocardium (5-7). Here we discuss a further mechanism of protection represented by improved reperfusion of the infarct-related artery.

Key words

Prodromal angina - myocardial infarction - reperfusion - thrombolysis
 

  • References

  • 1 Andreotti F, DeMarco E, Maseri A, Sciahbasi A. Angina preinfartuale e ricanalizzazione post-trombolisi. Cardiologia 1998; 43: 893-9.
    PubMedGoogle Scholar
  • 2 Cortina A, Ambrose JA, Prieto-Granada J, Moris C, Simarro E, Holt J, Fuster V. Left ventricular function after myocardial infarction: clinical and angiographic correlations. J Am Coll Cardiol 1985; 5: 619-24.
    CrossrefPubMedGoogle Scholar
  • 3 Hirai T, Fujita M, Yamanishi K, Ohno A, Miwa K, Sasayama S. Significance of preinfarction angina for preservation of left ventricular function in acute myocardial infarction. Am Heart J 1992; 1124: 19-24.
    PubMedGoogle Scholar
  • 4 Midwall J, Ambrose J, Pichard A, Abedin Z, Herman M. Angina pectoris before and after myocardial infarction. Chest 1982; 81: 681-6.
    CrossrefPubMedGoogle Scholar
  • 5 Kloner AR, Shook T, Przyklenk K, Davis VG, Junio L, Matthews RV, Burstein S, Gibson M, Poole K, Cannon CP, McCabe C, Braunwald E. Previous angina alters in-hospital outcome in TIMI 4. A clinical correlate to preconditioning. Circulation 1995; 91: 37-47.
    CrossrefPubMedGoogle Scholar
  • 6 Ottani F, Galvani M, Ferrini D, Sorbello F, Limonetti P, Pantoli D, Rusticali F. Prodromal angina limits infarct size. Circulation 1995; 91: 291-7.
    CrossrefPubMedGoogle Scholar
  • 7 Nakagawa Y, Ito H, Kitakaze M, Kusuoka H, Hori M, Kuzuya T, Higashino Y, Fujii K, Minamino T. Effect of angina pectoris on myocardial protection in patients with reperfused anterior wall myocardial infarction: retrospective clinical evidence of “preconditioning”. J Am Coll Cardiol 1995; 25: 1076-83.
    CrossrefPubMedGoogle Scholar
  • 8 Brush JE, Brand DA, Acampora D, Goldman L, Cabin HS. Relation of peak creatine kinase levels during acute myocardial infarction to presence or absence of previous manifestations of myocardial ischemia (angina pectoris or healed myocardial infarction). Am J Cardiol 1988; 62: 534-7.
    CrossrefPubMedGoogle Scholar
  • 9 Behar S, Reicher-Reiss Abinader E, Agmon J, Friedman Y, Barzilai H, Kaplinsky E, Kauli N, Kishon Y, Palant A, Peled B, Rabinovich B, Reisin L, Schlesinger Z, Zahavi I, Zion M, Goldbourt U. The prognostic significance of angina pectoris preceding the occurrence of a first acute myo-cardial infarction in 4166 consecutive hospitalized patients. Am Heart J 1992; 123: 1481-6.
    CrossrefPubMedGoogle Scholar
  • 10 Barbash GI, White HD, Modan M, van de Werf F. for the Investigators of the International Tissue Plasminogen Activator/Streptokinase Trial Antecedent angina pectoris predicts worse outcome after myocardial infarction in patients receiving thrombolytic therapy: experience gleaned from the international tissue plasminogen activator/Streptokinase mortality trial. J Am Coll Cardiol 1992; 20: 36-41.
    CrossrefPubMedGoogle Scholar
  • 11 Pierard LA, Dubois C, Smeets JP, Boland J, Carlier J, Kulbertus HE. Prognostic significance of angina pectoris before first acute myocardial infarction. Am J Cardiol 1988; 61: 984-7.
    CrossrefPubMedGoogle Scholar
  • 12 Muller DWM, Topol EJ, Califf RM, Sigmon KN, Gorman L, George BS, Kereiakes DJ, Lee KL, Ellis SG. and the TAMI Study Group. Relationship between antecedent angina pectoris and short-term prognosis after thrombolytic therapy for acute myocardial infarction. Am Heart J 1990; 119: 224-31.
    CrossrefPubMedGoogle Scholar
  • 13 Yoshikawa T, Inoue S, Abe S, Akaishi M, Mitamura H, Ogawa S, Handa S. Acute myocardial infarction without warning: clinical characteristics and significance of preinfarction angina. Cardiology 1993; 82: 42-7.
    CrossrefPubMedGoogle Scholar
  • 14 Harper RW, Kennedy G, DeSanctis RW, Hutter AM. The incidence and pattern of angina prior to acute myocardial infarction: A study of 577 cases. Am Heart J 1979; 97: 178-83.
    CrossrefPubMedGoogle Scholar
  • 15 Cohen M, Rentrop PK. Limitation of myocardial ischemia by collateral circulation during sudden controlled coronary artery occlusion in human subjects: a prospective study. Circulation 1986; 74: 469-76.
    CrossrefPubMedGoogle Scholar
  • 16 Cohen M, Sherman W, Rentrop PK, Gorlin R. Determinants of collateral filling observed during sudden controlled coronary artery occlusion in human subjects. J Am Coll Cardiol 1989; 13: 297-303.
    CrossrefPubMedGoogle Scholar
  • 17 Billinger M, Fleisch M, Eberli FR, Garachemani A, Meier B, Seiler C. Is the development of myocardial tolerance to repeated ischemia in humans due to preconditioning or to collateral recruitment?. J Am Coll Cardiol 1999; 33: 1027-35.
    CrossrefPubMedGoogle Scholar
  • 18 Schwartz H, Leiboff RH, Ren GB, Wasserman AG, Katz RJ, Varghese PJ, Sokil AB, Ross AM. Temporal evolution of the human coronary collateral circulation after myocardial infarction. J Am Coll Cardiol 1984; 4: 1088-93.
    CrossrefPubMedGoogle Scholar
  • 19 Nitzberg WD, Nath HP, Rogers WJ, Hood Jr. WP, Whitlow PL, Reeves R, Baxley WA. Collateral flow in patients with acute myocardial infarction. Am J Cardiol 1985; 56: 729-36.
    CrossrefPubMedGoogle Scholar
  • 20 Little WC, Constantinescu M, Applegate RJ, Kutcher MA, Burrows MT, Kahl FR, Santamore WP. Can coronary angiography predict the site of a subsequent myocardial infarction in patients with mild to moderate coronary artery disease?. Circulation 1988; 78: 1157-66.
    CrossrefPubMedGoogle Scholar
  • 21 Hackett D, Verwilghen J, Davies G, Maseri A. Coronary stenoses before and after acute myocardial infarction. Am J Cardiol 1989; Jun 15 63 (20) 1517-8.
    CrossrefPubMedGoogle Scholar
  • 22 Fujita M, Sasayama S, Ohno A, Nakajima H, Asanoi H. Importance of angina for development of collateral circulation. Br Heart J 1987; 57: 139-43.
    CrossrefPubMedGoogle Scholar
  • 23 Murry CE, Jennings RB, Reimer KA. Preconditioning with ischemia: a delay of lethal cell injury in ischemic myocardium. Circulation 1986; 74: 1124-36.
    CrossrefPubMedGoogle Scholar
  • 24 Kuzuya T, Hoshida S, Yamashita N, Fuji H, Oe H, Hori M, Kamada T, Tada M. Delayed effects of sublethal ischemia on the acquisition of tolerance to ischemia. Circ Res 1993; 72: 1293-9.
    CrossrefPubMedGoogle Scholar
  • 25 Baxter GF, Goma FM, Yellon DM. Characterisation of the infarct-limiting effect of delayed preconditioning: time-course and dose-dependency studies in rabbit myocardium. Basic Res Cardiol 1997; 92: 159-67.
    CrossrefPubMedGoogle Scholar
  • 26 Kloner RA, Bolli R, Marban E, Reinlib L, Braunwald E, and Participants. Medical and cellular implications of stunning, hibernation and preconditioning. An NHLBI workshop. Circulation 1998; 97: 1848-67.
    CrossrefPubMedGoogle Scholar
  • 27 Liu GS, Thornton J, Van Winkle DM, Stanley AWH, Olsson RA, Downey JM. Protection against infarction afforded by preconditioning is mediated by A1 adenosine receptors in rabbit heart. Circulation 1991; 84: 350-6.
    CrossrefPubMedGoogle Scholar
  • 28 Zhu P, Zaugg CE, Simper D, Hornstein P, Allegrini PR, Buser PT. Brady-kinin improves postischemic recovery in the rat heart: role of high energy phosphates nitric oxide and prostacyclin. Cardiovasc Res 1995; 29: 658-63.
    CrossrefPubMedGoogle Scholar
  • 29 Arad M, Oxman T, Leor R, Rabinowitz B. Prostaglandins and the anti-arrhythmic effect of preconditioning in the isolated rat heart. Mol Cell Biochem 1996; 160: 249-55.
    PubMedGoogle Scholar
  • 30 Mei DA, Elliott GT, Gross GJ. K-ATP channels mediate late preconditioning against infarction produced by monophosphoryl lipid A. Am J Physiol 1996; 271: H2723-9.
    PubMedGoogle Scholar
  • 31 Baxter GF, Marber MS, Patel VC, Yellon DM. Adenosine receptor involvement in a delayed phase of myocardial protection 24 hours after ischemic preconditioning. Circulation 1994; 90: 2993-3000.
    CrossrefPubMedGoogle Scholar
  • 32 Kim SJ, Ghaleh B, Kudej RK, Huang CH, Hintze TH, Vatner SF. Delayed enhanced nitric oxide-mediated coronary vasodilation following brief ischemia and prolonged reperfusion in conscious dogs. Circ Res 1997; 81: 53-9.
    CrossrefPubMedGoogle Scholar
  • 33 Szekeres L, Tosaki A. Release of 6-keto-PGF1alpha and thromboxane B2 in late appearing cardioprotection induced by the stable PGI analogue: 7-oxo-PGI. Mol Cell Biochem 1993; 119: 129-32.
    CrossrefPubMedGoogle Scholar
  • 34 Born GVR, Haslam RJ, Goldman M, Lowe RD. Comparative effectiveness of adenosine analogues as inhibitors of blood platelet aggregation and vasodilators in man. Nature 1965; 205: 678-80.
    CrossrefPubMedGoogle Scholar
  • 35 McIntyre TM, Zimmerman GA, Satoh K, Prescott SM. Cultured endothelial cells synthesize both platelet-activating factor and prostacyclin in response to histamine, bradykinin and adenosine triphosphate. J Clin Invest 1985; 76: 271-90.
    CrossrefPubMedGoogle Scholar
  • 36 Brown NJ, Nadeau JH, Vaughan DE. Selective stimulation of tissue-type plasminogen activator (t-PA) in vivo by infusion of bradykinin. Thromb Haemost 1997; 77: 522-5.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 37 Wenmalm A. Endothelial nitric oxide and cardiovascular disease. J Intern Med 1994; 235: 317-27.
    CrossrefPubMedGoogle Scholar
  • 38 Vane JR, Anggard EE, Botting RM. Regulatory functions of the vascular endothelium. N Engl J Med 1990; 323: 27-31.
    CrossrefPubMedGoogle Scholar
  • 39 Andreotti F, Pasceri V. Ischaemic preconditioning. Lancet. 1996 348. 204 (Letter).
    PubMedGoogle Scholar
  • 40 Hirsh PD, Hillis DL, Campbell WB, Firth BG, Willerson JT. Release of prostaglandins and thromboxane into the coronary circulation in patients with ischemic heart disease. N Engl J Med 1981; 304: 685-91.
    CrossrefPubMedGoogle Scholar
  • 41 Fitzgerald DJ, Roy L, Catella F, Fitzgerald GA. Platelet activation in unstable coronary artery disease. N Engl J Med 1986; 315: 983-9.
    CrossrefPubMedGoogle Scholar
  • 42 Marzilli M, Orsini E, Marraccini P, Testa R. Beneficial effects of adenosine adjunct to primary angioplasty in acute myocardial infarction. J Am Coll Cardiol 1999; 33: 376A (Abs.).
    CrossrefPubMedGoogle Scholar
  • 43 Nakayama H, Nanto S, Tomoki Ohara, Morozumi T, Nagata S, Hoki N, Minamino T, Hori M. Intracoronary administration of ATP combined with direct PTCA reduces the size of myocardial infarction?: Cooperative Osaka Adenosine Trial for acute myocardial infarction (COAT). J Am Coll Cardiol 1999; 33: 376A (Abs.).
    CrossrefPubMedGoogle Scholar
  • 44 Di Carli MF, Barbagelata A, Mahaffey KW, Casas CA, Puma JA, Granger CB. Does preinfarction angina reduce infarct size? An ancillary study from the controlled, randomized AMISTAD trial. Circulation 1998; 98: I-630 (Abs).
    PubMedGoogle Scholar
  • 45 Topol EJ, Ellis SG, Califf RM, George BS, Stump DC, Bates ER, Nabel EG, Walton JA, Candela RJ, Lee KL, et al. Combined tissue-type plasminogen activator and prostacyclin therapy for acute myocardial infarction. Thrombolysis and angioplasty in myocardial infarction (TAMI) 4 study group.
    PubMedGoogle Scholar
  • 46 Nicolini FA, Mehta JL, Nichols WW, Saldeen TG, Grant M. Prostacyclin analogue iloprost decreases thrombolytic potential of tissue-type plas-minogen activator in canine coronary thrombosis. Circulation 1990; 81: 1115-22.
    CrossrefPubMedGoogle Scholar
  • 47 Kerins DM, Shuh M, Kunitada S, Fitzgerald GA, Fitzgerald DJ. A prostacyclin analog impairs the response to tissue type plasminogen activator during coronary thrombolysis: evidence for a pharmacokinetic interaction. J Pharmacol Exp Ther 1991; 257: 487-92.
    PubMedGoogle Scholar
  • 48 Cohen G, Shirai T, Weisel R, Rao V, Merante F, Tumiati LC, Mohabeer MK, Borger MA, Li RK, Mickle DAG. Optimal myocardial preconditioning in a human model of ischemia and reperfusion. Circulation 1998; 98: 184-96.
    CrossrefPubMedGoogle Scholar
  • 49 Solomon HA, Edwards AL, Killip T. Prodromata in acute myocardial infarction. Circulation 1969; 40: 463-71.
    CrossrefPubMedGoogle Scholar
  • 50 Anzai T, Yoshikawa T, Asakura Y, Abe S, Akaishi M, Mitamura H, Handa S, Ogawa S. Preinfarction angina as a major predictor of left ventricular function and long term prognosis after a first Q wave myocardial infarction. J Am Coll Cardiol 1995; 26: 319-27.
    CrossrefPubMedGoogle Scholar
  • 51 Shiraki H, Yoshikawa T, Anzai T, Negishi K, Takahashi T, Asakura Y, Akaishi M, Mitamura H, Ogawa S. Association between preinfarction angina and a lower risk of right ventricular infarction. N Engl J Med 1998; 338: 941-7.
    CrossrefPubMedGoogle Scholar
  • 52 Cupples LA, Gagnon DR, Wong ND, Ostfeld AM, Kannel WB. Preexisting cardiovascular conditions and long term prognosis after initial myocardial infarction. Am J Cardiol 1995; 75: 224-7.
    CrossrefPubMedGoogle Scholar
  • 53 Matsuda Y, Ogawa H, Moritani K, Matsuda M, Naito H, Matsuzaki M, Ikee Y, Kusukawa R. Effects of the presence or absence of preceding angina pectoris on left ventricular function after acute myocardial infarction. Am Heart J 1984; 108: 955-8.
    CrossrefPubMedGoogle Scholar
  • 54 Pasceri V, Cianflone D, Finocchiaro ML, Crea F, Maseri A. Relation between myocardial infarction site and pain location in Q-wave acute myocardial infarction. Am J Cardiol 1995; 75: 224-7.
    CrossrefPubMedGoogle Scholar
  • 55 Andreotti F, Pasceri V, Hackett DR, Davies GJ, Haider AW, Maseri A. Preinfarction angina as a predictor of more rapid coronary thrombolysis in patients with acute myocardial infarction. N Engl J Med 1996; 334: 7-12.
    CrossrefPubMedGoogle Scholar
  • 56 Ishihara M, Hikaru S, Hironobu T, Kawagoe T, Shimatani Y, Kurisu S, Sakai K, Kentarou U. Implications of prodromal angina pectoris in anterior wall acute myocardial infarction: acute angiographic findings and long-term prognosis. J Am Coll Cardiol 1997; 30: 970-5.
    CrossrefPubMedGoogle Scholar
  • 57 Kloner RA, Gibson M, Cannon C, Braunwald E. Preinfarction angina. N Engl J Med 1996; 335: 59-60 (Letter).
    CrossrefPubMedGoogle Scholar
  • 58 Napoli C, Liguori A, Chiariello M, Di Ieso N, Condorelli M, Ambrosio G. New-onset angina preceding acute myocardial infarction is associated with improved contractile recovery after thrombolysis. Eur Heart J 1998; 19: 411-9.
    CrossrefPubMedGoogle Scholar
  • 59 Hata K, Whittaker P, Kloner RA, Przyklenk K. Brief antecedent ischemia attenuates platelet-mediated thrombosis in damaged and stenotic canine coronary arteries. Role of adenosine. Circulation 1998; 97: 692-702.
    CrossrefPubMedGoogle Scholar