Cause Of Cardiac Death Research Articles

Acute coronary artery obstruction in myocardial infarction: Overview of thrombolytic therapy

Pump failure, ranging from ventricular dysfunction to acute cardiogenic shock, is now the leading cause of cardiac death. Efforts at temporary mechanical or pharmacologic support of the heart have been largely unsuccessful so that attention is now directed toward prevention of ventricular failure and limitation of myocardial infarct size or even outright prevention of infarction itself. In particular, attention has been refocused on earlier reperfusion efforts with streptokinase. The effect of thrombolysis in acute myocardial infarction on enzymatic infarct size, left ventricular function and early mortality was studied in subsets of patients in a randomized trial (Netherlands Interuniversity Cardiology Institute). Early thrombolytic therapy with intracoronary streptokinase (152 patients) or with intracoronary streptokinase preceded by intravenous streptokinase (117 patients) was compared with conventional treatment (264 patients). All 533 patients were admitted to the coronary care unit within 4 hours after onset of symptoms indicative of acute myocardial infarction. Of the patients eligible for this detailed analysis, 245 were allocated to thrombolytic therapy and 243 to conventional treatment. Early angiography was preformed in 212 of the 245 patients allocated to thrombolytic therapy. Patency of the infarct-related artery was achieved in 181 patients (85%). Enzymatic infarct size, measured from cumulative alpha-hydroxybutyrate dehydrogenase release, was smaller in patients allocated to thrombolytic therapy (median 760 versus 1,179 U/liter in control subjects, p = 0.0001). Left ventricular ejection fraction measured by radionuclide angiography before discharge was higher after thrombolytic therapy (median 50% versus 43% in control subjects, p = 0.0001). Twelve month mortality was lower in patients allocated to thrombolytic therapy (8% versus 16% in the control group, p less than 0.01). In multivariate regression analysis infarct size limitation, improvement of left ventricular ejection fraction and 3 month mortality were predicted by sigma ST, time from onset of symptoms to admission and Killip class at admission. Thrombolysis was most useful in patients admitted within 2 hours after onset of symptoms and in patients with a sigma ST segment of 1.2 mV or more. On the other hand, no beneficial effects of streptokinase on enzymatic infarct size, left ventricular function or mortality were observed in the subset of patients with sigma ST less than 1.2 mV, admitted 2 to 4 hours after onset of symptoms.

Primary myocardial revascularization: Trends in surgical mortality

From 1970 to 1982, 24,672 patients underwent primary isolated myocardial revascularization: Group I, 4,517 patients operated upon from 1970 to 1973; Group II, 6,181 patients from 1974 to 1976; Group III, 6,869 patients from 1977 to 1979; and Group IV, 7,105 patients from 1980 to 1982. Operative mortality was 1.2% for the entire experience and 1.2%, 1.4%, 1.6%, and 0.8% for Groups I to IV, respectively. Mortality for Group IV was significantly lower (p less than 0.001). In decreasing order of significance, the risk factors were emergency operation, congestive heart failure, left main disease, female gender, history of congestive heart failure, advancing age, normothermic arrest, number of grafts, poor ventricular function, and incomplete revascularization. The same analysis of Groups I to IV demonstrated that advanced age, emergency operation, female gender, and congestive heart failure persisted as risk factors while incomplete revascularization and abnormal electrocardiogram emerged as new risk factors. Cardiac causes accounted for 203 (66.2%) patient deaths. This gradually decreased from 75.3% in Group II to 58.5% in Group IV. Neurological deficit was the second most frequent cause of death, 29 (9.6%), reaching a high in Group IV (18.9%). We conclude that (1) morbidity and mortality have decreased significantly despite increasing risk factors; (2) congestive heart failure has replaced emergency operation as the principal risk factor; (3) left main disease, number of grafts, and poor ventricular function have been neutralized as risk factors; and (4) cardiac causes of death are decreasing and being replaced by other system failure.

Life expectancy and causes of death in the Marfan syndrome.

Abstract The Marfan syndrome is a dominantly inherited disorder of connective tissue with multisystem involvement. The cardiac complications, particularly aortic dilatation, dissection and rupture and involvement of the aortic and mitral valves, lead to a greatly reduced life expectancy. This poor survival was demonstrated in a series of 257 patients with the Marfan syndrome. The average age at death for the 72 deceased patients was 32 years. Cardiac problems led to 52 of the 56 deaths of known cause, with aortic dilatation and its complications accounting for 80 per cent of these. Congestive heart failure, myocardial infarction and bacterial endocarditis were other cardiac causes of death. In patients with early aortic changes treatment with propranolol or reserpine is suggested. These agents decrease myocardial contractility and diminish the pulsatile flow stress on the weakened aorta.