Author + information
- Walid Jomaa,
- Zouhair Jnifene,
- Ikram Chamtouri,
- Aymen El Hraiech,
- Khaldoun Ben Hamda and
- Faouzi Maatouk
Ischemic preconditioning (IP) is associated with lesser myocardial infarct size in animal studies. In humans, when occurring before ST-elevation myocardial infarction (STEMI), the prognostic significance of IP episodes is still controversial. In this study, we sought to determine prognostic features associated with IP in patients admitted for STEMI.
The present study was carried out on our single-center retrospective STEMI registry. The registry enrolled 1498 patients presenting with STEMI between January 1998 and September 2014. Exploitable data from only 1404 patients were analyzed. Patients were managed by prehospital thrombolysis, primary percutaneous coronary intervention or conservatively (i.e., with no reperfusion therapy). Patients experiencing recurrent ischemic symptoms before the index STEMI were part of the IP group. Those with no symptoms were part of the Inaugural group. Univariate and multivariate predictors of in-hospital mortality, including IP, were studied.
Out of the study population, 442 (31.5%) patients were part of the IP group. Compared with the patients in the Inaugural group, patients in the IP group had more frequent arterial hypertension (36.7% vs. 27%, p<0.001), diabetes mellitus (41% vs. 32.7%, p=0.003) and a history of coronary artery disease (21% vs. 6.2%, p<0.001). Prevalence of heart failure on presentation was not significantly higher in the IP group. In-hospital mortality rate was significantly lower in the IP group compared to the Inaugural group (5.9% vs. 10.6%, p=0.004). In univariate analysis, the absence of IP, advanced age, female gender, arterial hypertension, diabetes mellitus, heart failure on presentation, and cardiogenic shock were significantly associated with in-hospital death. In multivariate analysis, in addition to other predictors, the absence of IP was independently associated with in-hospital death (HR: 2.38, 95% CI: 1.47-3.84, p<0.001).
According to our study, although associated with cardiovascular risk factors, IP in patients presenting with STEMI is independently associated to better in-hospital outcomes.