Muhammad Arif Nadeem, Tariq Waseem, Syed Mohsin Ali Shah, Abdul Hafeez Khan.
Comparison of in-hospital course of patients having first acute myocardial infarction with or without pre-infarct angina.
Esculapio J Services Inst Med Sci Jan ;3(3):20-5.

Background: Acute myocardial infarction (AMI) is the most common cause of morbidity and mortality and to reduce myocardial infarct size a new technique i.e. ischemic pre-conditioning has evolved. The brief periods of ischemia followed by re-perfusion 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 and 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 smokers, 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 Groups A as compared to B who were taking them (p<0.05). Similarly there were 10 (40%) vs 2 (8%) patients in Groups 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). 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.

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