| Objective: To evaluate the protection effects of preinfarction angina(PA) on patients with first acute myocardial infarction(AMI) underwent primary percutaneous coronary intervention(PCI) by analyzing the angiographic characteristics, markers of damage myocardium, incidence of arrhythmias and the heart function.Methods: From 2009-6 to 2010-9, a total of 104 AMI patients underwent emergency PCI within 12 hours after the onset enrolled in the study(74 male and 30 female). All patients is in accordance with the criterion of WHO on coronary heart disease AMI diagnose. Patients were excluded for any of the following reasons:①previous myocardial infarction, previous precutaneous coronary intervention or coronary artery bypass graft treatment.②tumor, severe immunity disease, liver and kidney dysfunction, severe infectious disease, potential bleeding, anemias;③the congenital valvular heart disease, cardiomyopathy, myocarditis, pericarditis, primary pulmonary hypertension;④more then 12h from onset to PCI;⑤underwent thrombolysis therapy.Each patient was assigned to without angina group(A group 38 cases), PA group(B group, 31 cases) according to occurrences of typical angina within 24h before AMI and a group with angina but without PA(C group 35 cases). All patients underwent coronary angiography, recorded the charac- teritics of lesion, infarct related artery(IRA), TIMI, spontaneous recanalization, collateral circulation, etc. Before PCI,all patients took aspirin(300mg)and clopidogrel(300mg),after tirofiban was given intravenously, 0.0115ug/ kg/min) for 24 hours after a bous of 10ug/kg.After operation, criteria antiplatelet and antithrombotic therepies was given, other medication such as angiotensin- converting anzyme inhibitor(ACEI), statins, nitrates, if necessary,β-blockers was also given if there is no contraindication. Basic clinical information of each patient were Collected, including age, sex, body mass index, smoking, drinking, hypertention, diabetes and family history, and the use of antiplatelet agents, stains, nitrates, hyperlipidemia, electrocardiogram, myocardial enzymes, cardiac troponin I, BNP, liver and kidney function, ect. All patients took echocardiography 1 week and 3 month after AMI. All date are applied SPSS 13.0 for statistical analysis, normal measurement data express in mean±standard deviation, use t test; count data express in rate, use X~2 test; rank data use rank sum test.Results:1 There were no significantly difference between baseline clinical document on age, sex, body mass index, smoking, drinking, hypertension, diabetes, family history and the time of revasculatization of IRA in each group(P>0.05).2 The peak value of CK-MB was higher in group A and group C than that in group B and there is a significant statistical difference(266.12±197.49 VS 177.29±73.85 VS 232.31±90.93,P=0.001)。3 There was no statistically significant in the characteristic of lesion, the number of lesion vascular and lesion vascular, the score of leaman to evaluate coronary artery angusty and coronary collateral circulation in group A and group B was no significiant difference. The blood flow of the IRA before the stent implanation was lower in group A and group C than that in group B. The incidence of SR was lower in group A than that in group B and group C. There was no significantly difference about the phenomenon of no-flow in the three groups. The incidence coronary collateral circulation in group B and group C was higher than that in group A.4 There was no significantly difference in the incidence of ventricular arrhythmia in the three groups, the score of ventricular arrhythmia in group B was lower than that in group A and C, and had significantly difference(42 VS 29 VS 38,P=0.035).5 There was significantly difference in the value of BNP in the three groups(413.99±207.69 VS 302.49±146.73 VS 396.57±189.81, P=0.035). The value of BNP in group B was lower than that in group A and group C.The outcome of UCG displayed: there was no significantly difference of the value of EF, LVEDVI and LVESVI in the three groups on the first week(47.54±4.13 VS 49.10±3.57 VS 48.21±3.55,P=0.194). there was significantly difference of the value of EF, LVEDVI and LVESVI in the three groups on the third month.there was significantly difference of the value of EF in the three groups on the third month(52.09±3.41 VS 57.25±3.38 VS 53.38±3.96,P<0.05). there was significantly difference between group A and group B(52.09±3.41 VS 57.25±3.38,P<0.05), between group B and group C(57.25±3.38 VS 53.38±3.96,P<0.05), there was no significantly difference between group A and group C(52.09±3.4 VS 53.38±3.96,P>0.05). We can say that the value of EF in group B was higher than that in group A and group C on the third month. there was significantly difference of the value of LVEDVI in the three groups on the third month (51.59±4.12 VS 45.98±4.44 VS 51.16±4.85,P<0.05), there was significantly difference between group A and group B(51.59±4.12 VS 45.98±4.44, P<0.05), between group B and group C(45.98±4.44 VS 51.16±4.85,P<0.05), there was no significantly difference between group A and group C(51.59±4.12 VS 51.16±4.85, P>0.05). We can say that the value of LVEDVI in group B was lower than that in group A and group C on the third month. there was significantly difference of the value of LVESVI in the three groups on the third month (24.42±3.09VS 20.54±3.25 VS 23.35±4.30,P < 0.05), there was significantly difference between group A and group B(24.42±3.09 VS 20.54±3.25, P<0.05), between group B and group C(20.54±3.25 VS 23.35±4.30, P<0.05), there was no significantly difference between group A and group C(24.42±3.09 VS 23.35±4.30, P>0.05). We can say that the value of LVESVI in group B was lower than that in group A and group C on the third month. Compared within group: The value of EF was higher, LVEDVI and LVESVI was lowerer on the third month than that on the first week in group A(P=0.000,P=0.001,P=0.000); The value of EF was higher, LVEDVI and LVESVI was lower on the third month than that on the first week in group B, all had significantly difference (P=0.000, P=0.009, P=0.000). The value of EF was higher, LVEDVI and LVESVI was lower on the third month than that on the first week in group C and all had significantly difference (P=0.006, P=0.000, P=0.000).Concusion:1 Preinfarction angina can reduce the injure extent of myocardium in patients with first AMI after emergency PCI.2 Preinfarction angina have beneficial effect on the blood flow of IRA before PCI, and increase the possibility of SR in patients with first AMI after emergency PCI.3 Preinfarction angina decrease the possibility of malignant ventricular arrhythmias in the patients with first AMI after emergency PCI.4 Preinfarction angina have beneficial effect for heart function and inhibit ventricular remodel. |
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