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Effects of Preinfarction Angina on Myocardial Injury in Patients with Acute Myocardial Infarction: A Study with Resting ¹²³I-BMIPP and ²⁰¹Tl Myocardial SPECT

First Department of Internal Medicine and Division of Nuclear Medicine, Osaka City University Medical School, Osaka, Japan

Correspondence: For correspondence or reprints contact: Hiroyuki Yamagishi, MD, First Department of Internal Medicine, Osaka City University Medical School, 1-5-7 Asahi-Machi, Abeno-Ku, Osaka 545-8586, Japan.

ABSTRACT

Methods: Recent studies have suggested that patients with preinfarction angina have smaller infarcts and a better in-hospital outcome than those without angina. The mechanisms responsible for limitation of infarct size in the presence of preinfarction angina are unclear. We examined the effects of preinfarction angina on myocardial injury in patients with the first acute myocardial infarction with resting ¹²³l-15-(p-iodophenyl)-3-(R,S)-methylpentadecanoic acid (BMIPP) ²⁰¹Tl myocardial scanning performed within 1 mo of infarction. Results: Of 136 patients tested, 48 (35%) had preinfarction angina within 72 h before infarction, whereas 88 (65%) did not. BMIPP and ²⁰¹Tl defects were scored in 9 segments of the left ventricle (0 = normal, 1 = mild defect, 2 = moderate defect, 3 = severe defect, and 4 = no uptake). The total defect score was defined as the sum of the defect scores. There was no significant difference in percentage diameters of stenoses of infarct-related arteries, collateral circulation, total defect scores for BMIPP, or ²⁰¹Tl between the groups with and without preinfarction angina. However, the ratio of total defect score for ²⁰¹Tl to that for BMIPP was significantly smaller for patients with than for those without preinfarction angina (0.64 ± 0.21 versus 0.74 ± 0.25, respectively; P = 0.007). Conclusion: Preinfarction angina did not affect the areas at risk in acute myocardial infarction, as shown by BMIPP defect, but decreased necrotic myocardium in the areas at risk, as shown by ²⁰¹Tl defect, and increased metabolically damaged but viable myocardium, as shown by BMIPP and ²⁰¹Tl mismatch through unidentified mechanisms other than collateral circulation (e.g., ischemic preconditioning).

Key Words: preconditioning • BMIPP • ²⁰¹Tl

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