Determinants Of Myocardial Infarction Onset Study Research Articles

Marijuana use and long-term mortality among survivors of acute myocardial infarction

Smoking marijuana has been reported to increase risk of myocardial infarction (MI) immediately after use, but less is known about the long-term impact of marijuana use among patients with established coronary disease. The Determinants of MI Onset Study is a multicenter inception cohort study of myocardial infarction (MI) patients enrolled in 1989 to 1996 and followed up for mortality using the National Death Index. In an initial analysis of 1,935 MI survivors followed up for a median of 3.8 years, we found an increased mortality rate among marijuana users. The current article includes 3,886 Determinants of MI Onset Study patients followed up for up to 18 years. We used Cox proportional hazards models to calculate the hazard ratio and 95% CI for the association between marijuana use and mortality and a propensity score matched analysis to further control confounding. Over up to 18 years of follow-up, 519 patients died, including 22 of the 109 reporting marijuana use in the year before their MI. There was no statistically significant association between marijuana use and mortality. Compared with nonusers, the mortality rate was 29% higher (95% CI 0.81-2.05, P = .28) among those reporting any marijuana use. Habitual marijuana use among patients presenting with acute MI was associated with an apparent increased mortality rate over the following 18 years that did not reach nominal statistical significance. Larger studies with repeated measures of marijuana use are needed to definitively establish whether there are adverse cardiovascular consequences of smoking marijuana among patients with established coronary heart disease.

DISTANCE TO ROADWAY AND LONG-TERM SURVIVAL FROM ACUTE MYOCARDIAL INFARCTION

Background and Aims: The relationship between exposure to traffic-related air pollution and long-term survival from myocardial infarction (MI) has not been thoroughly investigated. We investigated the association between distance between residence and major roadway and 10-year all-cause mortality after MI in the Determinants of MI Onset Study (Onset Study), hypothesizing that living closer to a major roadway at the time of MI would be associated with increased risk of mortality. Methods: The Onset Study enrolled 3886 individuals hospitalized for MI in 64 centers across the United States from 1989-1996. Institutionalized patients, those providing only Post Office Boxes, and those whose addresses could not be geocoded were excluded, leaving 3263 patients eligible for analysis. Addresses were geocoded and the distance to the nearest A1/A2 roadway was assigned and dichotomized to > 100m or ≤100m, based on previous studies. All patients were followed for mortality through 2007. We used Cox regression to calculate hazard ratios (HRs) after 10 years of follow-up, adjusting for personal characteristics (age, sex, race, educational attainment, marital status, smoking, body mass index, comorbidities, medications), neighborhood-level characteristics derived from US Census block group data (median income, education, urbanicity), and clinical characteristics at the time of MI (thrombolysis, peak CK, development of CHF and/or ventricular tachycardia). Results: There were 941 deaths at 10 years of follow-up. In crude analyses, living within 100m of a major roadway was associated with an HR of 1.35 (95% confidence interval [CI] 1.07, 1.70). In fully adjusted analyses the HR was 1.26 (95% CI 0.99, 1.60). Conclusions: In this group of survivors of acute MI from across the United States, living close to a major roadway at the time of MI was associated with increased risk of all-cause 10-year mortality; this relationship persisted but lost statistical significance even after adjusting for individual and neighborhood-level covariates.

Stress ECG utilization in the evaluation of patients with chest pain: The real practice in Hungary with 10 million inhabitants

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