Omar et al, in the August issue of VDM, discuss original research they conducted on ST-elevation myocardial infarction. The results suggest that patients who experienced STEMI and also had PAD had fewer complications. Read more below, and access the article at “The Comorbidity of Peripheral Arterial Disease Attenuates Complications During Primary Percutaneous Coronary Intervention in ST-Elevation Myocardial Infarction.”
ABSTRACT: Background: In animal studies, chronic skeletal muscle ischemia induces myocardial remote ischemic preconditioning (RIPC). We hypothesized that a history of peripheral arterial disease (PAD) might attenuate complications during primary percutaneous coronary intervention (PCI) in patents with acute ST-elevation myocardial infarction (STEMI). Methods: Seventy-five STEMI patients (40 with PAD and 35 without PAD) were retrospectively studied. PAD was defined as ankle brachial index <0.9, or brachial ankle pulse wave velocity >1,800 cm/s. MI size and acute complications during PCI were compared. For patients without post-stenting coronary flow worsening, the difference between post-stenting and pre-stenting fluoroscopic frame count (∆FFC) was also compared. Results: Mean age was 68±12 years and 60 patients were males. Apart from greater age and more cases with hypertension in the PAD group, basic clinical and PCI data were similar. PAD patients had lower complications during PCI (20 vs 8, P=.001), lower peak CK-total (3,590±2,657 vs 2,035±1,353 IU/L, P=.003), and lower peak CK-MB (298±192 vs 185±129 IU/L, P=.021). For the 53 patients without coronary flow worsening, PAD patients had lower ∆FFC (-2.26±8.5, SE=1.94 vs -4.28±1.19, SE=2.20 frames, P=.035). Conclusion: Our observation study suggests that PAD attenuates complications during PCI and infarct size in patients with STEMI, probably by PAD-induced RIPC.
VASCULAR DISEASE MANAGEMENT 2013:10(8):E142-E151
Key words: myocardial infarction, peripheral vascular disease, percutaneous coronary intervention, reperfusion injury