Mortality Survival Research Articles

Asset Liability Management of Longevity and Interest Rate Risks: Using Survival–Mortality Bonds

In this article, we propose to attach a mortality index to a conventional bond, called a survival–mortality (SM) bond. Its cash flow pattern is like a conventional bond but it can be separated into a survival (S) part and a mortality (M) part; the cash flow pattern in the former is like an annuity or a longevity bond and that in the latter is like a mortality–catastrophe bond. We further propose to split it into S, M, and SM zero-coupon STRIPS (Separate Trading Registered Interest and Principal Securities). We apply these S, M, and SM issues to hedging longevity risk and interest rate risk of 1-year and multiple-year annuity exposures for the asset liability management of an annuity provider by adopting mortality, interest, mortality–interest duration, and convexity matching strategies. Numerical illustrations show that using SM STRIPS rather than S STRIPS can be sufficient to hedge the risks embedded in 1-year annuity exposures, whereas for multiple-year annuity exposures using S issues is more effective to reduce longevity risk and interest rate risk than using SM issues. We can infer that mortality-linked bonds play an essential role in asset liability management; the proposed survival–mortality bonds will be a feasible way to develop an efficient market for longevity risk.

Prevalence and impact of fracture on postmenopausal women with aortic stenosis who underwent transcatheter aortic valve replacement.

Information regarding fracture in patients with transcatheter aortic valve replacement (TAVR) is limited. We investigated the prevalence and impact of fracture in patients with severe aortic stenosis who had undergone TAVR. Of 913 consecutive patients with symptomatic, severe aortic stenosis who underwent TAVR at the Sakakibara Heart Institute between October 2013 and April 2020, 633 women were enrolled. The primary endpoint was all-cause mortality following TAVR. Patients with a history of fracture displayed smaller body mass indices, increased frailty, a higher prevalence of osteoporosis, and stroke history. Notably, 61.7% of patients with a history of fracture reported to have not taken any osteoporosis medications. Estimated all-cause mortality survival rates post-TAVR were significantly lower in patients with fractures than those without fractures. In the multivariate analysis, history of fracture was independently associated with all-cause mortality following TAVR. Furthermore, fracture prevalence was significantly greater in those who had a higher clinical frailty scale score were slower in the 5-m walk test, had more severe dementia as per the revised Hasegawa dementia scale, and performed poorly in the hand grip strength test. History of fracture was an independent predictor for all-cause mortality in patients undergoing TAVR. In addition, our study demonstrated that osteoporotic fracture may be under-treated in this population. History of fracture may be one of the phenotypes of frailty given its significant relationship with frailty markers in this population.

Transient Global Ischemia-Induced Brain Inflammatory Cascades Attenuated by Targeted Temperature Management.

Sudden cardiac arrest leads to a significantly increased risk of severe neurological impairment and higher mortality rates in survivors due to global brain tissue injury caused by prolonged whole-body ischemia and reperfusion. The brain undergoes various deleterious cascading events. Among these damaging mechanisms, neuroinflammation plays an especially crucial role in the exacerbation of brain damage. Clinical guidelines indicate that 33 °C and 36 °C are both beneficial for targeted temperature management (TTM) after cardiac arrest. To clarify the mechanistic relationship between TTM and inflammation in transient global ischemia (TGI) and determine whether 36 °C produces a neuroprotective effect comparable to 33 °C, we performed an experiment using a rat model. We found that TTM at 36 °C and at 33 °C attenuated neuronal cell death and apoptosis, with significant improvements in behavioral function that lasted for up to 72 h. TTM at 33 °C and 36 °C suppressed the propagation of inflammation including the release of high mobility group box 1 from damaged cells, the activation and polarization of the microglia, and the excessive release of activated microglia-induced inflammatory cytokines. There were equal neuroprotective effects for TTM at 36 °C and 33 °C. In addition, hypothermic complications and should be considered safe and effective after cardiac arrest.

Analysis of the curative effect and prognosis factors of surgical treatment for hilar cholangiocarcinoma

Objective To exlore and analyze the curative effect and pognostic factors of surgical treatment for hilar cholangiocarcinoma. Methods The clinical data and prognosis of 92 patients with hilar cholangiocarcinoma admitted to Anhui Provincial Hospital Affiliated to Anhui Medical University from January 2010 to January 2018 were retrospectively analyzed. There were 58 males and 34 females, with an age range of 35-81 years and average age of 61.3 years. Among them, 50 patients underwent radical resection of tumors (radical operation group), and 42 patients were discussed to undergo radical operation before operation, but only palliative resection of tumors or simple biliary drainage (palliative operation group) were performed because of the high location of tumors or distant metastasis during operation. Of the 50 patients who received radical surgery, 27 underwent simple perihepatic portectomy (perihepatic hilar resection group), and 23 underwent combined hepatic lobectomy (extended hepatectomy group). The incidence of perioperative complications, perioperative mortality and long-term survival rate of all patients were collected. The data of clinical cases included in the study were analyzed by univariate and multivariate analysis, and the relationship between perioperative mortality and prognosis survival time was discussed. The measurement data that accord with normal distribution were expressed by (Mean±SD). The comparison between the two groups was performed by t-test, the comparison between multiple groups was performed by one-way ANOVA; Measurement data with non-normal distribution were described as M(P25, P75), and comparison between groups was done using Mann-Whitney U test. The comparison between counting data groups was performed by chi-square test. Results Ninety-two patients included in this study successfully completed the operation. One patient died during the perioperative period, with a mortality rate of 1.09%. The incidence of complications was 35.87%. Biliary tract infection and bile leakage were the most common complications. The incidence of complications was 14.13%(13/92) and 9.78%(9/92) respectively. The survival time of patients in the radical operation group 34.23(13.00, 52.25) months was significantly different from that in the palliative operation group 4.75(2.88, 7.25) months (Z=-6.708, P=0.000). There was no significant difference in the survival time between the extended hepatectomy group 33.87(13.00, 56.00) months and the simple perihepatectomy group 34.54(13.00, 51.00) months (Z=-0.156, P=0.876). Univariate analysis showed that the factors related to the prognosis of hilar cholangiocarcinoma were preoperative history of calculi, tumor size, preoperative highest serum total bilirubin level, preoperative CA19-9 level, surgical modality and tumor differentiation(HR=0.200, 2.692, 2.942, 4.350, 3.740, 0.198; 95%CI: 0.043-0.938, 0.995-7.283, 1.022-8.469, 1.174-16.114, 1.229-11.382, 0.049~0.806, P<0.05). Multivariate analysis showed that tumor size, tumor differentiation and surgical modality were related to hilar cholangiocarcinoma. Surgical prognosis of patients with cholangiocarcinoma was significantly correlated(OR=1.034, 6.444, 12.527; 95%CI: 1.007-1.062, 1.012-41.037, 3.187-49.243, P<0.05). Conclusions Radical resection is an effective way to improve the survival of patients with hilar cholangiocarcinoma. The effective grasp of surgical indications can improve the overall treatment prognosis. Key words: Bile duct neoplasms; Surgical procedures, operative; Prognosis; Treatment outcome; Complications

In-Hospital Coronary Revascularization Rates and Post-Discharge Mortality Risk in Non–ST-Segment Elevation Acute Coronary Syndrome

BackgroundThe relationship between in-hospital coronary revascularization rate (CRR) and post-discharge mortality rates in survivors of non–ST-segment elevation acute coronary syndrome (NSTE-ACS) at a system level is unclear. ObjectivesThe purpose of this study was to evaluate CRR and 2-year post-discharge mortality rate (2YMR) in NSTE-ACS. MethodsCRR and 2YMR were analyzed by hospital rate of CRR (in deciles), by country, and by world region in 11,931 patients with NSTE-ACS who survived to discharge and were enrolled in the EPICOR (long-tErm follow uP of antithrombotic management patterns In acute CORonary syndrome patients) and EPICOR Asia: twin multinational, observational, prospective cohort studies. ResultsSignificant differences in patient baseline characteristics, medical therapies, CRR, and 2YMR were found. Mean CRR ranged from 0.0% to 96.8% in the first and tenth decile, respectively (p < 0.001); from 12.3% in Romania to 92.4% in Slovenia (p < 0.001); and from 53.9% in South East Asia (SEAsia) to 90.4% in South Korea–Singapore–Hong Kong. 2YMR varied significantly between hospital deciles of CRR (3.6% in tenth decile vs. 9.2% in first decile; p < 0.001), countries (lowest 1.5% in Slovenia, highest 19.4% in Malaysia; p < 0.001), and regions (lowest 3.8% in South Korea–Singapore–Hong Kong, highest 11.7% in SEAsia; p < 0.001). Poisson regression models, adjusted for 15 mortality predictors, showed a significant inverse association between CRR and 2YMR for hospitals (r = −0.90; p < 0.001), countries (r = −0.65; p < 0.001), and regions (r = −0.87; p = 0.005). ConclusionsHigher CRRs at the hospital, country, and world region levels are strongly associated with higher post-discharge survival, suggesting CRR as a marker of higher system quality.

Relationship between clinical outcomes and Dutch frailty score among elderly patients who underwent surgery for hip fracture.

BackgroundFrailty is a geriatric condition that is associated with an increased risk of mortality and functional decline. To date, mainly the Groningen Frailty Indicator (GFI) and Hospital Safety Management (VeiligheidsManagementSysteem [VMS]) frailty score are used to determine frailty in several hospitals in the Netherlands. However, it is yet unknown, which method has the best predictive value on clinical outcomes.ObjectiveThe aim of this study was to investigate the predictive value of GFI and VMS on clinical outcomes among patients who underwent hip fracture surgery.DesignThis is a prospective observational cohort study.MethodsWe selected all patients aged 70 years or higher, who underwent hip fracture surgery in our general hospital, between November 2014 and November 2015. Among all patients, VMS, GFI and Barthel-20 index (BI) were assessed. McNemar’s paired test and Cohen’s κ were used to examine the difference and the level of agreement between the two scoring methods. Kaplan–Meier and multivariable regression analyses were performed to determine overall survival and mortality, respectively, 3 years and 30 days after surgery.ResultsA total of 280 patients were included in the study. The median follow-up was 25 months. No systematic difference was found between the two methods (P=0.237), while a fair level of agreement could be measured (κ=0.363 [95% CI =0.23–50]). VMS showed a statistically significant difference in overall survival as compared to nonfrail patients (57 vs 80%, respectively [Plogrank <0.001] with an HR of 3.5 [95% CI =2.1–5.7; P<0.001]). Classification according to GFI yielded a lower but still significant HR 2.3 (95% CI =1.2–4.1; P=0.008).ConclusionVMS can be used in classifying frailty, whereby VMS frailty score is associated with clinical outcomes as overall survival mortality in older patients with hip fracture and who underwent surgery.

One-year mortality among hospital survivors of cholinesterase inhibitor poisoning based on Taiwan National Health Insurance Research Database from 2003 to 2012

BackgroundAcute cholinesterase inhibitor (CI) poisoning, including organophosphate and carbamate poisoning, is a crucial problem in developing countries. Acute intoxication results in a cholinergic crisis, neurological symptoms, or respiratory failure. However, the short-term and long-term outcomes of CI poisoning are seldom reported.MethodsData from the National Health Insurance Research Database were used to investigate the outcomes after organophosphate and carbamate poisoning. Patients who were hospitalized for a first episode of acute CI poisoning between 2003 and 2012 were enrolled in this study. Outcomes of acute CI poisoning with or without mechanical ventilation were analyzed.ResultsAmong 6832 patients with CI poisoning, 2010 developed respiratory failure requiring mechanical ventilation, and the other 4822 patients did not require mechanical ventilation. The hospital mortality rate was higher in patients requiring mechanical ventilation than in those not requiring mechanical ventilation (33.3% versus 4.7%, p < 0.0001). In patients with respiratory failure with mechanical ventilation, the patients without pneumonia had higher mortality rate than those with pneumonia. (36.0% versus 19.9%, p < 0.0001). The 1-year mortality rate the survivors of CI poisoning was 6.7%. Among 5932 survivors after cholinesterase inhibitor poisoning, the one-year mortality rate in patients with mechanical ventilation during hospitalization was higher than those without mechanical ventilation during hospitalization (11.4% versus 5.4% respectively, p < 0.0001).ConclusionsThe one-year mortality rate of survivors after CI poisoning was 6.7%. Meanwhile, age, pneumonia, and mechanical ventilation may be predictive factors for the one-year mortality among the survivors after CI poisoning. Diabetes mellitus was not a risk factor for hospital mortality in patients with CI poisoning.

Toxicity of Cadmium and their effect on some Heamatological parameters of common carp (Cyprinus Carpio) exposed to crude leaf extract of Abutilon Indicum

The present work aimed to estimate the toxicity of cadmium and their common carp Cyprinus carpio fish, as well as the effect of different concentrations of Cadmium and some haematological parameters. such as, the red blood cells (RBC), white blood cells (WBC) and haemoglobin (Hb) Survival mortality was observed in the blood of Common carp Cyprinus carpio treated with Abutilon indicum extract and the result showed that the RBC counts, WBC counts, Hb, Survival mortality were much increased when compared to the control. 8, 16, 24 and 32 of RBC, WBC, and haemoglobin, Survival mortality levels were P significantly elevated in the experimental fish over the control and the WBC level was decreased significantly P in experimental fish.

Surgical treatment of 56 patients with hilar cholangiocarcinoma in a single center

Objective To study the safety and efficacy of surgical treatment for hilar cholangiocarcinoma (HC). Methods We retrospectively analyzed the clinical data of 56 patients with HC who underwent resection at the Beijing YouAn Hospital, Capital Medical University, from January 2010 to July 2015. The patients were divided into two groups according to the types of operations: the minor hepatectomy group (n=12) and the major hepatectomy group (n=44). The postoperative complications, mortality and long-term survival rates were compared and the clinical data were analyzed using uni- and multivariate analyses to examine the significant factors of survival. Results (1) The morbidity rates of the two groups were 33.3% and 63.6%, respectively, with the latter group being significantly higher than the former group; (2) The 1-and 3-year overall survival rates were 60% and 15% in the minor liver resection group and 64% and 15% in the major resection group, and there was no significant difference between the two groups (P>0.05). The median survival was 16 months; (3) The median survival of R0 resection was significantly longer than the R1/R2 resection group (22 months vs 10 months, P<0.05); (4) Age, preoperative CA19-9 level, vascular invasion, surgical margin, tumor differentiation and nodular metastasis were significantly correlated with prognosis on univariate analysis. Multivariate analysis showed surgical margin and tumor differentiation to be significant prognostic factors. Conclusions R0 resection obviously prolonged survival of HC patients, and histopathology negative surgical margin should be emphasized. With R0 resection, minor liver resection significantly reduced postoperative complications and mortality in selected patients. Key words: Hilar cholangiocarcinoma; Minor hepatectomy; Postoperative complications; Resection; Survival rate

Diet and cardiovascular disease: Dietary patterns, foods and nutrients

Diet and cardiovascular disease: Dietary patterns, foods and nutrients

A meta-analysis of clinical outcomes after laparoscopic operation for rectal cancer

To evaluate the clinical outcomes after laparoscopic surgery for rectal cancer. A systematic literature search (Medline, Embase, Cochrane Library) as of March 2010 was performed to identify all eligible studies. Two reviewers independently screened and extracted the data. Differences in short-term and long-term clinical outcomes after laparoscopic resection (LR) and open resection (OR) were analyzed using RevMan 5. A total of 1042 abstracts were retrieved and 16 clinical controlled studies finally included. The total number of patients was 2850. There were 1145 patients received LR and 1705 received OR. The analyses showed that LR had longer operative time (WMD=42.50, 95%CI: 29.27 to 55.74, P<0.05), less harvested lymph nodes (WMD=-0.94, 95%CI: -1.47 to -0.41, P<0.05), and less blood loss (WMD=-158.46, 95%CI: -221.08 to -95.84, P<0.05) as compared to OR. LR was superior to OR in terms of surgical mortality (OR=0.40, 95%CI: 0.18 to 0.92, P=0.03), postoperative complications (OR=0.73, 95%CI: 0.61 to 0.87, P<0.05), and 5-year overall survival rate (OR=1.56, 95%CI: 1.21 to 2.02, P<0.05). There was no significant difference in positive rate of circumferential resection margin between the two groups (OR=1.00, 95%CI: 0.45 to 2.20, P=1.00). Compared to open surgery, short-term and long-term clinical outcomes after laparoscopic surgery are favorable.

Long-Term Outcomes of Acute Kidney Injury

Acute kidney injury (AKI) is common in the intensive care unit and is associated with significant morbidity and mortality. Based on the RIFLE criteria, AKI occurs in up to 67% of patients in the intensive care unit (ICU), with approximately 4% of critically ill patients requiring renal replacement therapy (RRT). It is well known that this subset of AKI patients who require RRT have an in-hospital mortality rate exceeding 50%. However, long-term outcomes of survivors of AKI requiring RRT remain poorly described. Long-term mortality is greater in those patients who survived AKI when compared with critically ill patients without AKI. Long-term morbidity, renal and extrarenal, is a frequent and underappreciated complication of AKI. Among survivors of AKI at long-term follow-up (1-10 years), approximately 12.5% are dialysis dependent (wide range of 1%-64%, depending on the patient population) and 19% to 31% have chronic kidney disease. According to the United States Renal Data System, "acute tubular necrosis without recovery" as a cause of end-stage kidney disease increased from 1.2% in 1994 to 1998 to 1.7% in 1999 to 2003. The incidence will likely continue to rise with the aging population, increase in comorbidities, and expansion of intensive care unit capabilities. AKI is an underrecognized cause of chronic kidney disease (CKD) and patients who survive should be followed closely for new CKD and/or progression of underlying CKD.

Reduced Ejection Fraction After Myocardial Infarction: Is it Sufficient to Justify Implantation of a Defibrillator?

Improved survival after prophylactic implantation of a defibrillator in patients with reduced left ventricular ejection fraction (EF) after myocardial infarction (MI) has been demonstrated in patients with remote MI experienced in the 1990's. The absolute survival benefit conferred by this recommended strategy must be related to the current risk of arrhythmic death which is evolving. This study evaluates the mortality rate in survivors of MI with impaired left ventricular function and its relation to pre-discharge baseline characteristics. Clinical records of patients who had sustained acute MI from 1999 to 2000 and were discharged with an EF ≤ 0.40 were included. Baseline characteristics, drug prescriptions and invasive procedures were recorded. Bivariate and multivariate analyses were performed using a primary endpoint of total mortality. 165 patients were included. During a median follow-up of 30 months (interquartile range 22-36) 18 patients died. One and two-year mortality rates were 6.7% and 8.6%, respectively. Variables reflecting coronary artery disease and its management (prior MI, acute reperfusion, complete revascularization) had a greater impact on mortality than variables reflecting mechanical dysfunction (EF, Killip class). Mortality in survivors of MI with reduced EF is substantially lower than reported in the 1990's. This decreased absolute mortality implies a proportional increase in the number of patients needed to treat with a prophylactic defibrillator. The risk of event may even be sufficiently low to limit the detectable benefit of defibrillators in patients with the prognostic features identified in our study. This argues for additional risk stratification prior to the prophylactic implantation of a defibrillator.

Reduced Ejection Fraction After Myocardial Infarction: Is It Sufficient To Justify Implantation of a Defibrillator?

Improved survival after prophylactic implantation of a defibrillator in patients with reduced left ventricular ejection fraction (EF) after myocardial infarction (MI) has been demonstrated in patients who experienced remote MIs in the 1990s. The absolute survival benefit conferred by this recommended strategy must be related to the current risk of arrhythmic death, which is evolving. This study evaluates the mortality rate in survivors of MI with impaired left ventricular function and its relation to pre-hospital discharge baseline characteristics.The clinical records of patients who had sustained an acute MI between 1999 and 2000 and had been discharged from the hospital with an EF of < or = 40% were included. Baseline characteristics, drug prescriptions, and invasive procedures were recorded. Bivariate and multivariate analyses were performed using a primary end point of total mortality.One hundred sixty-five patients were included. During a median follow-up period of 30 months (interquartile range, 22 to 36 months) 18 patients died. The 1-year and 2-year mortality rates were 6.7% and 8.6%, respectively. Variables reflecting coronary artery disease and its management (ie, prior MI, acute reperfusion, and complete revascularization) had a greater impact on mortality than variables reflecting mechanical dysfunction (ie, EF and Killip class).The mortality rate among survivors of MIs with reduced EF was substantially lower than that reported in the 1990s. The strong decrease in the arrhythmic risk implies a proportional increase in the number of patients needed to treat with a prophylactic defibrillator to prevent one adverse event. The risk of an event may even be sufficiently low to limit the detectable benefit of defibrillators in patients with the prognostic features identified in our study. This argues for additional risk stratification prior to the prophylactic implantation of a defibrillator.

Low Frequency of Site Fidelity by Golden-Fronted Woodpeckers

Interest in site fidelity is rooted in its influence on population structure, including dispersal and recruitment (Shields, 1984). Familiarity with the local habitat is increased through fidelity, which in turn may enhance defendability and access to the best nesting, staging, and wintering sites. Factors proposed that might influence the degree of site tenacity include age, sex, local habitat and nest-site stability, and prior breeding experience (Shields, 1984). Ideally, statistical analysis of site fidelity should include data on mortality-survival rates and dispersal distance. For the golden-fronted woodpecker (Melanerpes aurifrons) these data are unavailable (Husak and Maxwell, 1998) so we discuss site faithfulness in this species relative to that documented for congeners. Fidelity has been documented among migratory and non-migratory birds (e.g., Freer, 1979; Greenwood, 1980; Shields, 1984; Blancher and Robertson, 1985; Rimmer and Darmstadt, 1996; Flint et al., 2000; Weggler, 2000), but few studies have focused on woodpeckers. In North America, nest-site fidelity has been documented in red-cockaded (Picoides borealis; Jackson, 1994), red-headed (Melanerpes erythrocephalus), and red-bellied (M. carolinus) woodpeckers (Ingold, 1991), and migratory northern flickers (Colaptes auratus), and yellow-bellied sapsuckers (Sphyrapicus varius; Lawrence, 1967). The only site fidelity data for golden-fronted woodpeckers prior to our research involved anecdotal observations of re-use of nest sites over

Carotid Endarterectomy in Women: Challenging the results from NASCET and ACAS.

P203 Purpose: The randomized trials have clearly demonstrated the benefits of carotid endarterectomy in specific symptomatic and asymptomatic patients. However, the short and long-term benefits in women appear to be less clear, and the role of CEA among women remains uncertain. The purpose of our study was to evaluate and compare the outcomes in women and men after CEA. Methods: Over a recent 21 year period 1204 CEAs were performed, of which 465 (39%) were in women and 739 (61%)in men. Complete follow-up was available in 80% of patients. Results: Women were more likely to be hypertensive, and had a greater incidence of diabetes. The mean age at CEA was 68.5 ± 9.5 years for women and 68.0 ± 8.5 years for men. Operative mortality rates were nearly identical for symptomatic (women, 0.3% vs men, 0.8%) and asymmptomatic (women, 0.0% vs 0.8%)patients. Perioperative stroke rates were similar for symptomatic (women, 2.9% vs 4.5%) (p=0.27) and asymptomatic (women, 0.6% vs. men, 1.2%) (p=0.66) patients. Life-table stroke-free rates at 1, 5, and 8 years were similar for symptomatic women and men, 96% vs. 93%, 89% vs. 89%, and 83% vs. 85% (p>0.10), and asymptomatic women and men, 98% vs. 97%, 97% vs. 92%, and 97% vs. 86% (p>0.11). Long-term survival rates at 1, 5, and 8 years were higher for symptomatic women compared to men, 96% vs. 92%, 88% vs. 76%, and 67% vs. 58% (p=0.06), and for asymptomatic women as compared to men, 97% vs. 96%, 92% vs. 75%, 79% vs. 58% (p=0.01 > 5 years). As a result, stroke-free survival rates at these follow-up intervals were increased for symptomatic women compared to men, 93% vs. 89%, 76% vs. 73%, and 64% vs. 58% (p>0.11), and asymptomatic women as compared to men, 95% vs. 93%, 89% vs. 76%, and 77% vs. 64% (p>0.07). Conclusion: The results from our study challenge the conclusions from the NASCET and ACAS regarding the lack of benefit of CEA in women. Female gender did not adversely affect early or late survival, stroke-free, or stroke-free mortality rates following CEA. We conclude that CEA can be performed safely in women with symptomatic and asymptomatic carotid artery disease, and physicians should expect comparable benefits in women and men undergoing CEA.

Prevalence and prognosis of chronic obstructive pulmonary disease among 5,839 consecutive patients with acute myocardial infarction

purpose: The purpose of this study was to report the prevalence and the clinical significance of clinically recognized chronic obstructive pulmonary disease (COPD) during acute myocardial infarction. patients and methods: During 1981 to 1983, a secondary prevention study with nifedipine (SPRINT) was conducted in Israel among 2,276 survivors of acute myocardial infarction. During the study, demographic, historical, and medical data were collected on special forms for all patients with diagnosed acute myocardial infarction in 13 hospitals (the SPRINT Registry, n = 5,839). Mortality follow-up was completed for 99% of hospital survivors for a mean follow-up of 5.5 years (range: 4.5 to 7 years). results: The prevalence of COPD was 7% (406 of 5,839). The latter rate increased significantly in men (7.6%), smokers (9.7%), and older patients (70 years or older, 10.0%). Patients with COPD exhibited a complicated hospital course with an in-hospital mortality rate of 23.9%. Subsequent mortality rates in survivors at 1 and 5 years were 12.3% and 35.9%, respectively. Rates at the same time periods in patients without COPD were 17.2%, 9.2%, and 26.9% (p <0.005 for in-hospital and 5 years). In a multivariate analysis that included age, gender, and history of myocardial infarction and congestive heart failure, COPD was not independently associated with either in-hospital or postdischarge excess fatality rates. conclusion: In this large cohort of consecutive patients with myocardial infarction, the prevalence of COPD was 7% and higher among smokers, men, and elderly patients. Although in-hospital and postdischarge mortality rates were higher among patients with COPD, this condition did not independently increase either the risk of early death or the risk of long-term mortality among survivors of acute myocardial infarction.

Cerebrovascular accident complicating acute myocardial infarction: Incidence, clinical significance, and short-long-term mortality rates

purpose: The purpose of this study was to report the incidence, the antecedents, and the clinical significance of clinically recognized cerebrovascular accidents or transient ischemic attacks (CVA-TIA) complicating acute myocardial infarction. patients and methods: During 1981 to 1983, a secondary prevention study with nifedipine (SPRINT) was conducted in 14 hospitals in Israel among 2,276 survivors of acute myocardial infarction. During the study, demographic, historical, and medical data were collected on special forms for all patients with diagnosed acute myocardial infarction in 13 of these 14 hospitals (the SPRINT registry, n = 5,839). Mortality followup was completed for 99% of hospital survivors for a mean follow-up of 5.5 years (range: 4.5 to 7 years). results: The incidence of CVA-TIA was 0.9% (54 of 5,839). The latter rate increased significantly only with age, from 0.4% among patients up to 59 years old to 1.6% among those aged greater than or equal to 70 years. Multivariate analysis identified age, congestive heart failure, and history of stroke as predictors of CVA-TIA during the acute phase of myocardial infarction. Patients with CVA-TIA exhibited a complicated hospital course, with a 15-day mortality rate of 41%. Subsequent mortality rates in survivors at 1 and 5 years were 34% and 59%, respectively. Rates at the same time points in patients without CVA-TIA were 16%,11%, and 29% (p <0.01). In a multivariate analysis that included age, gender, congestive heart failure, history of previous myocardial infarction, and hypertension, CVATIA was independently associated with increased 15-day mortality (covariate-adjusted odds ratio [OR]= 2.62; 90% confidence interval [CI], 1.59 to 4.32), as well as subsequent 1-year (OR = 3.29; 90% CI, 1.70 to 6.36) and long-term (mean follow-up = 5.5 years) mortality (OR = 2.46; 90% CI, 1.30 to 4.69). conclusion: In this large cohort of consecutive patients with myocardial infarction, CVATIA was a relatively infrequent complication of acute myocardial infarction. Factors independently favoring the occurrence of CVA-TIA were old age, previous CVA, and congestive heart failure. CVA-TIA occurring during acute myocardial infarction independently increased the risk of early death threefold as well as the risk of long-term mortality in early-phase survivors (2.5-fold).

Late potentials on signal-averaged electrocardiograms and patency of the infarct-related artery in survivors of acute myocardial infarction

This study evaluated the relation between patency of the infarct-related artery and the presence of late potentials on the signal-averaged electrocardiogram (ECG) in 124 consecutive patients (98 men, 26 women; mean age 59 years) with acute myocardial infarction receiving thrombolytic therapy, acute percutaneous transluminal coronary angioplasty or standard care. All patients were studied by coronary angiography, measurement of ejection fraction and signal-averaged ECG. The infarct-related artery was closed in 51 patients and open in 73. Among patients with no prior myocardial infarction undergoing early attempted reperfusion therapy, a patent artery was associated with a decreased incidence of late potentials (20% versus 71%; no significant difference in ejection fraction). In the 48 patients receiving thrombolytic agents within 4 h of symptom onset, the incidence of late potentials was 24% and 83% among patients with an open or closed artery, respectively (p less than 0.04). The most powerful predictors of late potentials were the presence of a closed infarct-related artery, followed by prior infarction and patient age. Among patients receiving thrombolytic agents within 4 h of symptom onset, the only variable that was predictive of the presence of late potentials was a closed infarct-related artery. These data imply that reperfusion of an infarct-related artery has a beneficial effect on the electrophysiologic substrate for serious ventricular arrhythmias that is independent of change in left ventricular ejection fraction as an index of infarct size. These findings might explain, in part, the low late mortality rate in survivors of myocardial infarction with documented reperfusion of the infarct-related artery.