Syed Mohsin Ali Shah, Muhammad Arif Nadeem, Tariq Waseem, Abdul Hafeez Khan.
A comparison of early Echocardiographic findings in patients having first acute Myocardial Infarction with or without pre-infarct angina.
Esculapio J Services Inst Med Sci Jan ;3(2):7-12.

Background: Acute myocardial infarction (AMI) is the most common cause of morbidity and mortality. In order to reduce myocardial infarct size, a new technique i.e. ischemic pre-conditioning has evolved. The brief periods of ischemia followed by reperfusion appear to pre-condition the heart and make it more resistant to a subsequent longer period of ischemia. Pre-conditioning is defined as “a rapid, adaptive response to a brief ischemic insult, which slows the rate of cell death during a subsequent, prolonged period of ischemia.” Material & Methods: A comparative study was conducted to identify the patients of AMI with or without pre-infarction angina, to find out the differences in their in-hospital course and to assess the prognostic value of pre-infarction angina in first episode of AMI during hospital stay. Results: Twenty-five patients with (Group A) and 25 patients without (Group B) pre-infarction angina were compared for their in-hospital course. Mean age ± SD in Group A was 55 ± 7 years and in Group B 54 ± 8 years. There were 18 (72%) males and 7 (28%) females in Group A, and 17 (68%) males and 8 (32%) females in Group B. As far as the baseline risk factors in two groups were concerned, 5 vs 7 patients had diabetes mellitus, 7 vs 8 had hypertension, 16 (64%) vs 13 (52%) were smoker, 3 vs 4 had obesity, 4 vs 5 had family history of IHD and 5 vs 6 had hyperlipidemia in Group A and Group B respectively. Regarding the intake of anti-anginal medication like calcium channel blockers, beta-blockers and nitrates in the two groups, there were more patients in Group A as compared to B who were taking them (p<0.05). Similarly there were also 10 (40%) vs 2 patients in Group A and B respectively who were taking aspirin (p<0.05). In-hospital complications like cardiogenic shock, CCF, LVF, RVF, recurrent ischemic pain, infarct extension and rhythm abnormalities were more in Group B as compared to Group A (p<0.05). When echocardiography was performed, the data showed that the ejection fraction percentage (mean ± SD) in Group A was 55% ± 7.8 versus 44% ± 7.9 in Group B (p<0.001). There were 3 in Group A vs 13 patients in Group B who had developed aneurysm (p<0.05), 2 in Group A vs 1 in Group B who had papillary muscle rupture, 1 in Group A vs 5 in Group B who developed VSD and 4 in Group A vs 10 in Group B who had clot in left ventricle. While in-hospital mortality between two groups was observed, there was only 1 in-hospital death in Group A vs 6 (24%) in Group B (p<0.05). Conclusion: The presence of pre-infarction angina had a favorable effect on in-hospital course after AMI i.e. a lower incidence of in-hospital mortality, a lower incidence of in-hospital complications, development of significantly smaller infarct size with a higher ejection fraction and a lower incidence of aneurysmal formation.

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