BACKGROUND: Preinfarction angina, a clinical equivalent of ischemic preconditioning, seems to protect against in-hospital death, cardiogenic shock, and the combined endpoints in adult but not in elderly patients with acute myocardial infarction. Experimental evidence indicates that caloric restriction may restore ischemic preconditioning in aged animals. OBJECTIVE: The objective was to verify whether body mass index (BMI) influences the cardioprotective effect of preinfarction angina in the elderly. DESIGN: We retrospectively studied 820 patients aged >/= 65 y with acute myocardial infarction by evaluating BMI and major (death and cardiogenic shock) and minor in-hospital outcomes. RESULTS: In-hospital death, cardiogenic shock, and the combined endpoints were not significantly different between elderly patients with and without preinfarction angina. Interestingly, in-hospital death, cardiogenic shock, and the combined endpoints were significantly fewer in elderly patients with than without preinfarction angina in the subset of patients with the lowest BMI (P < 0.01, < 0.01, and < 0.01, respectively). Regression analysis showed that preinfarction angina did not protect against in-hospital death when analyzed in all patients independently of BMI, whereas it was protective in the subset of patients with the lowest BMI (odds ratio: 0.06; 95% CI: 0.00, 0.54). CONCLUSIONS: Preinfarction angina does not protect against in-hospital death, cardiogenic shock, or the combined endpoints in elderly patients with acute myocardial infarction. With stratification by quartiles of BMI, the protective effect of preinfarction angina is preserved in elderly patients with the lowest BMI.
BACKGROUND:Preinfarction angina, a clinical equivalent of ischemic preconditioning, seems to protect against in-hospital death, cardiogenic shock, and the combined endpoints in adult but not in elderly patients with acute myocardial infarction. Experimental evidence indicates that caloric restriction may restore ischemic preconditioning in aged animals. OBJECTIVE: The objective was to verify whether body mass index (BMI) influences the cardioprotective effect of preinfarction angina in the elderly. DESIGN: We retrospectively studied 820 patients aged >/= 65 y with acute myocardial infarction by evaluating BMI and major (death and cardiogenic shock) and minor in-hospital outcomes. RESULTS: In-hospital death, cardiogenic shock, and the combined endpoints were not significantly different between elderly patients with and without preinfarction angina. Interestingly, in-hospital death, cardiogenic shock, and the combined endpoints were significantly fewer in elderly patients with than without preinfarction angina in the subset of patients with the lowest BMI (P < 0.01, < 0.01, and < 0.01, respectively). Regression analysis showed that preinfarction angina did not protect against in-hospital death when analyzed in all patients independently of BMI, whereas it was protective in the subset of patients with the lowest BMI (odds ratio: 0.06; 95% CI: 0.00, 0.54). CONCLUSIONS:Preinfarction angina does not protect against in-hospital death, cardiogenic shock, or the combined endpoints in elderly patients with acute myocardial infarction. With stratification by quartiles of BMI, the protective effect of preinfarction angina is preserved in elderly patients with the lowest BMI.
Authors: Claudio Napoli; Sharon Williams-Ignarro; Filomena de Nigris; Lilach O Lerman; Francesco P D'Armiento; Ettore Crimi; Russell E Byrns; Amelia Casamassimi; Alessandro Lanza; Fernando Gombos; Vincenzo Sica; Louis J Ignarro Journal: Proc Natl Acad Sci U S A Date: 2006-06-26 Impact factor: 11.205
Authors: Ellen N Sutter; Anna E Mattlage; Marghuretta D Bland; Kendra M Cherry-Allen; Elinor Harrison; Swati M Surkar; Jeffrey M Gidday; Ling Chen; Tamara Hershey; Jin-Moo Lee; Catherine E Lang Journal: Transl Stroke Res Date: 2018-08-07 Impact factor: 6.829