Maternal Resilience: A Case Report of Cesarean Section One Week after Acute Myocardial Infarction

Coronary artery disease (CAD) such as acute myocardial infarction (MI) share several common risk factors with cancers, and each disease may influence the prognosis of the other. Recently, acute MI was demonstrated to accelerate the outgrowth of preexisting breast cancer cells but the risk of breast cancer after MI remains unclear. This study aimed to investigate the association between acute MI and a subsequent diagnosis of breast cancer. Female patients with and without a history of acute MI were identified from nationwide databases in Taiwan. Patients with a diagnosis of cancer, MI or CAD prior to the study period were excluded. After reducing confounding through inverse probability of treatment weighting, we compared the incidence of newly diagnosed breast cancer between patients with a history of acute MI and those without. As a result, a total of 66,445 female patients were obtained, including 15,263 patients with a history of acute MI and 51,182 patients without. The incidences of breast cancer during follow-up were 1.93 (95% confidence interval [CI] 1.78–2.09) and 1.80 (95% CI 1.67–1.93) per 1,000 person-years for patients with and without a history of acute MI, respectively. The hazard ratio (HR) was 1.05 (95% CI 0.78–1.41, P = 0.756). In subgroup analysis, breast cancer risk was significantly associated with acute MI in patients using antidiabetic drugs (HR 1.27; 95% CI 1.02–1.58) and in low to moderate urbanization levels (HR 1.28; 95% CI 1.06–1.53). In conclusion, the risk of newly diagnosed breast cancer was not increased in patients with acute MI when compared to general population without MI or CAD.

Frequency of Family History of Acute Myocardial Infarction in Patients With Acute Myocardial Infarction

Background & objectives: Acute myocardial infarction is the single most common cause of death in large parts of the world. Although the mortality rate after admission for myocardial infarction has declined significantly over the last two decades but it still remains high. Therefore, the aim of this study was to determine hospital mortality and its related factor in patients with acute myocardial infarction hospitalized in Dr. Heshmat hospital. Material & Methods: In this cross-sectional study, we assessed medical records of 227 patients with acute Myocardial Infarction that hospitalized in CCU. Demographic and clinical factors were collected from the medical records. Data analysis was performed using SPSSv.16 software at P>0.05. Results: In-hospital mortality rate of acute myocardial infarction patients was 8.4%. In univariate analysis, condition of patients with acute myocardial infarction after hospitalization was related with number of hospitalization days (P<0.002), left ventricular ejection fraction (P<0.002) and previous history of acute myocardial infarction (P<0.014). In regression analysis, only left ventricular ejection fraction was related with Hospital mortality rate (P<0.019, OR=0.885). Conclusion: Despite applying of preventive programs and therapeutic improvements, hospital mortality rate also is high (8.4%).In present study, hospital mortality was related with number of hospitalization days, left ventricular ejection fraction and previous history of acute myocardial infarction.

Preliminary studies have suggested that microalbuminuria--a slightly increased urinary excretion of albumin--is a risk factor for atherosclerosis. The aim of this study was to examine whether an association exists between urinary excretion of albumin and a history of acute myocardial infarction, in a major population sample. The study was performed as a part of the 3rd Copenhagen City Heart Study, Denmark, 1992-1994, and included 2,613 participants aged 30-70 years, and without diabetes mellitus, renal or urinary tract disease or haematuria. The study programme included measurement of urinary albumin excretion rate, acquisition of information regarding previous acute myocardial infarction (verified by the Danish Hospital Register) and tobacco and alcohol consumption, 12-lead resting electrocardiogram, and measurement of blood pressure, body mass index, waist:hip ratio, plasma concentrations of total cholesterol, HDL cholesterol and fibrinogen, serum albumin concentration and glomerular filtration rate. Among the participants, 3.6% presented with a history of acute myocardial infarction. There was a positive association between urinary albumin excretion rate (logarithmically transformed) and acute myocardial infarction (odds ratio 1.35, 95% confidence interval 1.08 to 1.70, n = 2, 613; P = 0.01), which was independent of age, sex conventional atherosclerotic risk factors, and glomerular filtration rate. The odds ratio for acute myocardial infarction associated with microalbuminuria (urinary albumin excretion rate exceeding the upper decile in the entire study population) was 2.06 (95% confidence interval 1.20 to 3.55, n = 2,613; P = 0.009). There exists a positive and independent association between urinary excretion of albumin and a history of acute myocardial infarction. Follow-up analyses should determine the time sequence of this association.

Usefulness of Breast Arterial Calcium Detected on Mammography for Predicting Coronary Artery Disease or Cardiovascular Events in Women With Angina Pectoris and/or Positive Stress Tests

Acute Myocardial Infarction While Using the Nicotine Patch

An association between periodontitis and cardiovascular diseases has been suggested. To study whether a combination of clinical variables in a functional risk diagram enhanced the ability to differentiate between subjects with or without an immediate history of acute myocardial infarction (AMI). A functional periodontal pentagon risk diagram (PPRD) with five periodontal risk vectors was created. The surface of individual PPRDs was calculated using data from 88 subjects with recent AMI and 80 matched control subjects with no history of AMI. Age, gender, number of remaining teeth (mean value: 21.1 versus 21.6 teeth), smoking status, and pocket probing depth (PPD) distribution did not differ by group. Gingival recession was greater in control subjects (mean difference: 5.7, SD: +/- 1.9, p<0.01, 95% CI: 1.8-9.6). Bone loss > or = 4.0 mm was at all levels studied was significantly greater in subjects with AMI and bone loss > or = 50% (> or = 4 mm) was the best individual predictor of AMI (beta = 2.99, p < 0.000, 95% CI: 7.5-53.4). Only PPRD scores were associated with AMI status when factors not included in the PPRD were studied (beta = 22.1, SE: 5.9, p < 0.0001, 95% CI: 10.3-33.7). The best association between AMI status and study variables was the combination of > or = 4 mm of bone loss > or = 50%, proportion of bleeding on probing (%BOP), %PPDs > or = 6 mm, and tooth loss (Nagelkirke r2 = 0.46). The combination of five periodontal parameters in a PPRD added predictive value, suggesting that comprehensive data should be used in studies of associations between periodontitis and heart diseases. Radiographic evidence of bone loss was the best individual parameter.

Background:Fine particulate matter (PM2.5) is a known risk factor for cardiovascular disease (CVD). Neighborhood walkability and greenness may also be associated with CVD, but there is limited evidence on their joint or interacting effects with PM2.5.Methods:Cox proportional hazard models were used to estimate the risk of CVD mortality among adults with a history of acute myocardial infarction and/or stroke living in Northern California. We assessed the independent and joint effects of walkability, greenness (Normalized Differentiated Vegetation Index [NDVI]), and PM2.5 at residential addresses, controlling for age, sex, race/ethnicity, comorbidities, BMI, smoking, revascularization, medications, and socioeconomic status.Results:Greenness had a nonlinear association with CVD mortality (P = 0.038), with notably protective effects (HR = 0.87 [95% confidence interval {CI} = 0.78, 0.97]) at higher greenness levels (NDVI ≥ 0.3) and moderate attenuation after adjusting for PM2.5 (HR = 0.92 [95% CI = 0.82, 1.03]) per 0.1 increase in NDVI. Walkability had no independent effect on CVD mortality. PM2.5 had a strong independent effect in models adjusted for greenness and walkability (HR = 1.20 [95% CI = 1.08, 1.33)) per 10 μg/m3 increase in PM2.5. There was an interaction between walkability and PM2.5 (P = 0.037), where PM2.5 had slightly stronger associations in more walkable than less walkable neighborhoods (HR = 1.23 [95% CI = 1.06, 1.42] vs. 1.17 [95% CI = 1.04, 1.32]) per 10 μg/m3 increase in PM2.5. Greenness had no interaction with PM2.5 (P = 0.768) nor walkability (P = 0.385).Conclusions:High greenness may be protective of CVD mortality among adults with CVD history. PM2.5 associated CVD mortality risk varies slightly by level of neighborhood walkability, though these small differences may not be clinically meaningful.

Ten-year mortality rate in relation to observations at a bicycle exercise test in patients with a suspected or confirmed ischemic event but no or only minor myocardial damage: Influence of subsequent revascularization

Association of cardiovascular disease with health-related quality of life among older women with early-stage breast cancer undergoing adjuvant endocrine therapy

Funding Acknowledgements Type of funding sources: None. Introduction Patients with a history of Acute Myocardial Infarction (AMI) continue to be underrepresented in large studies on Acute Coronary Syndromes (ACS). Purpose To characterize patients with ACS and previous AMI and to evaluate their impact on the therapeutic approach, complications and in-hospital mortality. Methods We studied 722 patients admitted to a Cardiac Intensive Care Unit with a diagnosis of ACS. We considered 2 groups: patients with previous AMI and patients without previous AMI. Age, gender, personal history, clinical and electrocardiographic presentation of the ACS, treatment at admission, left ventricular ejection fraction (EF), coronary angiography and angioplasty were recorded. The following in-hospital complications were defined: heart failure, cardiogenic shock, re-infarction, mechanical complications, stroke and major hemorrhage. In-hospital mortality was compared between both groups. Results Patients with previous AMI constituted 26.8% (194 patients) of the population studied. These had a higher prevalence of arterial hypertension (92.8% vs 71.2%; p&amp;lt;0.001), diabetes (47.9% vs 30.4%, p&amp;lt;0.001), dyslipidemia (73.6% vs 49 .2%, p&amp;lt;0.001), previous angioplasty (62.1% vs 0.0%; p&amp;lt;0.001), heart failure (14.0% vs 4.7%, p&amp;lt;0.001), arterial disease (13.5% vs 3.6%, p&amp;lt;0.001), chronic renal failure (18.7% vs 9.6%, p=0.009) and previous bleeding (5.3% vs 1.3 %, p=0.002). The D with previous AMI presented more frequently with AMI without ST elevation (62.4% vs 40.7%; p&amp;lt;0.001) and Unstable Angina (10.3% vs 5.3%, p=0.02 ) and less with ST-elevation AMI (22.2% vs 47.3%, p&amp;lt;0.001). At admission, patients with previous AMI received less therapy with unfractionated heparin (20.6% vs 30.7%; p=0.007) and more therapy with angiotensin-2 antagonists (6.2% vs 2.3% , p=0.009), nitrates (62.9% vs 49.2%, p=0.001), ivabradine (5.2% vs 1.7%, p=0.01) and diuretics (34.5% vs 22 .3%, p=0.009). The coronary angiography rate was similar between the groups, however patients with previous AMI underwent more coronary angiography via the femoral route (36.9% vs 15.7%, p&amp;lt;0.0001) and fewer angioplasties (58.5% vs 69 .5%, p=0.006). EF was slightly lower in patients with previous AMI (45.7 ± 9.3% vs 48.3 ± 10.4%, p=0.04). However, there were no differences in the presence of any of the complications considered, as well as in in-hospital mortality. Conclusion Patients with previous AMI have a higher prevalence of co-morbidities and a higher prevalence of AMI without ST elevation and Unstable Angina. The presence of previous AMI was not per se a predictor of in-hospital complications or mortality.

Secondary prevention of myocardial infarction: Role of β-adrenergic blockers and angiotensin-converting enzyme inhibitors

The use of β-adrenergic blocking drugs in patients with myocardial infarction

BACKGROUND AND OBJECTIVESUnderstanding the nature and pattern of young coronary artery disease (CAD) is important due to the tremendous impact on these patients’ socio-economic and physical aspect. Data on young CAD in the southeast Asian region is rather patchy and limited. Hence we utilized our National Cardiovascular Disease Database (NCVD)—Percutaneous Coronary Intervention (PCI) Registry to analyze young patients who underwent PCI in the year 2007 to 2009.DESIGN AND SETTINGSThis is a retrospective study of all patients who had undergone coronary angioplasty from 2007 to 2009 in 11 hospitals across Malaysia.METHODSData were obtained from the NCVD—PCI Registry, 2007 to 2009. Patients were categorized into 2 groups—young and old, where young was defined as less than 45 years for men and less than 55 years for women and old was defined as more than or equals to 45 years for men and more than or equals to 55 years for women. Patients’ baseline characteristics, risk factor profile, extent of coronary disease and outcome on discharge, and 30-day and 1-year follow-up were compared between the 2 groups.RESULTSWe analyzed 10 268 patients, and the prevalence of young CAD was 16% (1595 patients). There was a significantly low prevalence of Chinese patients compared to other major ethnic groups. Active smoking (30.2% vs 17.7%) and obesity (20.9% vs 17.3%) were the 2 risk factors more associated with young CAD. There is a preponderance toward single vessel disease in the young CAD group, and they had a favorable clinical outcome in terms of all-cause mortality at discharge (RR 0.49 [CI 0.26–0.94]) and 1-year follow-up (RR 0.47 [CI 0.19–1.15]).CONCLUSIONWe observed distinctive features of young CAD that would serve as a framework in the primary and secondary prevention of the early onset CAD.

Alimentary lipemia enhances procoagulatory effects of inflammation in patients with a history of acute myocardial infarction complicated by ventricular fibrillation