Recurrence of angina after ST-segment elevation myocardial infarction: the role of coronary microvascular obstruction

Rocco A Montone; Vincenzo Vetrugno; Giovanni Santacroce; Marco Giuseppe Del Buono; Maria Chiara Meucci; Massimiliano Camilli; Mattia Galli; Antonio M Leone; Domenico D'Amario; Antonio Buffon; Cristina Aurigemma; Francesco Burzotta; Carlo Trani; Giampaolo Niccoli; Filippo Crea

doi:10.1177/2048872619880661

Recurrence of angina after ST-segment elevation myocardial infarction: the role of coronary microvascular obstruction

Eur Heart J Acute Cardiovasc Care. 2021 Aug 24;10(6):624–632. doi: 10.1177/2048872619880661. Epub 2019 Oct 16.

Authors

Rocco A Montone¹, Vincenzo Vetrugno², Giovanni Santacroce², Marco Giuseppe Del Buono², Maria Chiara Meucci², Massimiliano Camilli², Mattia Galli², Antonio M Leone¹, Domenico D'Amario¹, Antonio Buffon^{1

2}, Cristina Aurigemma¹, Francesco Burzotta^{1

2}, Carlo Trani^{1

2}, Giampaolo Niccoli^{1

2}, Filippo Crea^{1

2}

Affiliations

¹ Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A Gemelli IRCCS, Italy.
² Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy.

PMID: 31617387
DOI: 10.1177/2048872619880661

Abstract

Background: The recurrence of angina after percutaneous coronary intervention affects 20-35% of patients with stable coronary artery disease; however, few data are available in the setting of ST-segment elevation myocardial infarction. We evaluated the relation between coronary microvascular obstruction and the recurrence of angina at follow-up.

Methods: We prospectively enrolled patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Microvascular obstruction was defined as thrombolysis in myocardial infarction flow less than 3 or 3 with myocardial blush grade less than 2. The primary endpoint was the recurrence of angina at follow-up. Moreover, angina status was evaluated by the Seattle angina questionnaire summary score (SAQSS). Therapy at follow-up and the occurrence of major adverse cardiovascular events were also collected.

Results: We enrolled 200 patients. Microvascular obstruction occurred in 52 (26%) of them. Follow-up (mean time 25.17±9.28 months) was performed in all patients. Recurrent angina occurred in 31 (15.5%) patients, with a higher prevalence in patients with microvascular obstruction compared with patients without microvascular obstruction (13 (25.0%) vs. 18 (12.2%), P=0.008). Accordingly, SAQSS was lower and the need for two or more anti-anginal drugs was higher in patients with microvascular obstruction compared with patients without microvascular obstruction. At multiple linear regression analysis a history of previous acute coronary syndrome and the occurrence of microvascular obstruction were the only independent predictors of a worse SAQSS. Finally, the occurrence of major adverse cardiovascular events was higher in patients with microvascular obstruction compared with patients without microvascular obstruction.

Conclusions: The recurrence of angina in ST-segment elevation myocardial infarction patients treated with primary percutaneous coronary intervention is an important clinical issue. The occurrence of microvascular obstruction portends a worse angina status and is associated with the use of more anti-anginal drugs.

Keywords: Angina; STEMI; microvascular obstruction; primary PCI.