Myocardial Infarction Morbidity Research Articles

Thrombotic diseases in young women and the influence of oral contraceptives

OBJECTIVE: In the evaluation of the clinical impact of thrombotic diseases in young women, age-specific incidence rates must be calculated for both arterial and venous thrombotic diseases, but also the case-fatality rate and figures for the clinical consequences among those who survive thrombosis must be included. The aim of this analysis was to quantify the clinical impacts of both arterial and venous thrombotic diseases among young, nonpregnant women and thereafter to assess the influences of oral contraceptives on these measures.STUDY DESIGN: Nationwide register data on the morbidity and mortality of venous thromboembolism, myocardial infarction, and thrombotic stroke in Denmark, 1980-1993, and 3 ongoing case-control studies to assess the influence of oral contraceptives on the risk for development of these thrombotic diseases.RESULTS: In women 15-29 years old venous thromboembolism is about twice as common as arterial complications, whereas in women 30-44 years old the number of arterial complications exceeds that of venous diseases by about 50%. The mortality rate from arterial diseases is 3.5 times higher than that from venous diseases among women <30 years old and 8.5 times higher than that from venous diseases in women 30-44 years old. The proportion of women with a significant disability among women who had an arterial complication was about 30%; the proportion was about 5% among women with venous thromboembolism.CONCLUSION: Anticipating a differential influence on venous and arterial diseases from oral contraceptives with second- and third-generation progestogens, it was calculated that users of oral contraceptives with second-generation progestogens had 30% greater increased risk of thrombotic diseases, 260% greater increased risk of thrombotic deaths, and 220% greater increased risk of thrombotic disability than users of oral contraceptives with third-generation progestogens. (Am J Obstet Gynecol 1998;179:S62-7.)

Socioeconomic differences in risk of myocardial infarction 1971-1994 in Sweden: time trends, relative risks and population attributable risks.

The general trend in incidence of myocardial infarction (MI) in the Stockholm area changed from increasing to decreasing around 1980. The objective of this study is to examine time trends in incidence in major socioeconomic strata, relative risk between socioeconomic groups and population risk attributable to socioeconomic differences during this period. All cases of MI from 1971 to 1986 were identified from hospital discharge and cause-of-death registers. Person-years for each year of follow-up were calculated from the population register in the Stockholm region 1971-1986. Census registers were used for information on socioeconomic status. Register information was individually linked through the Swedish personal identification number. Supplementary information for 1992-1994 was taken from the case-control study SHEEP (Stockholm Heart Epidemiology Program). The decline in MI risk among male high- and middle-level employees started in 1976 and in male manual workers in 1981. For women incidence increased from 1971 to 1986 among manual workers and decreased among high- and middle-level employees. The increase over time of the relative risk from low socioeconomic position continued into the 1990s. Despite the reduction of the category of manual workers, the population attributable risk from socioeconomic differences also increased over time. The process of social change influencing the size of the socioeconomic groups contributes to the change in time trends of MI morbidity. The increase over time of relative and population attributable risks of MI from low socioeconomic status add to the public health importance of social inequity.

Video assisted coronary bypass surgery.

An alternative way to revascularize coronary vessels is described, using arterial conduits without extracorporeal circulation. The heart is exposed via a small thoracotomy over the fifth left intercostal space. A thoracoscope is introduced into the thorax, to assist in the harvesting of the left internal mammary artery (LIMA). In selected patients with two or three vessel disease, the same procedure can be achieved on the right side, harvesting the right internal mammary artery to revascularize the right coronary artery. The gastroepiploic artery can be easily reached and used to revascularize the posterior descending artery, through a mini-subxiphoid median laparotomy. This technique was used to revascularize 30 patients from April 1994 to June 1995. All received a LIMA graft to the left anterior descending artery, and two had a free radial artery graft from the LIMA, sequentially bypassing the diagonal and obtuse marginal branches. There was neither perioperative mortality nor morbidity myocardial infarction. Fifteen patients were restudied angiographically before discharge. Average hospital stay was 43 +/- 11 hours.

Trends of acute myocardial infarction morbidity and case fatality in East Germany since 1970.

Because of the high risk factor levels and the high morbidity and mortality of cardiovascular diseases, a Myocardial Infarction Control Programme was implemented in East Germany in the 1970s. To measure its effect, many myocardial infarction registers have operated in the country ever since, and despite some methodological problems the results of these registers now make trend estimations possible. In recent years, we observed no decline in the acute myocardial infarction attack rates in the population aged 25-64 years, and in men there was even a slight increase towards the late 1980s. These somewhat different sex-specific trends run parallel to the trends of the risk factor levels, as well as the cardiovascular mortality rates in men and women. There was no decline in the case fatality rate either during that period. We have to conclude, therefore, that the aims of the Myocardial Infarction Control Programme have not been reached, and both primary and secondary myocardial infarction prevention must be intensified. Cardiovascular morbidity and mortality, under the new conditions existing in East Germany after unification, must be reduced at least to the level observed in West Germany.

Angioscopic evaluation of periprocedural and postprocedural abrupt closure after percutaneous coronary angioplasty

Abrupt closure remains a significant complication of PTCA. On the basis of the presumption of underlying cause (thrombus, dissection, spasm), various empiric medical and mechanical interventions have been used to prevent and/or treat this event. Despite these measures, however, abrupt closure remains a highly unpredictable occurrence with a substantial incidence of myocardial infarction and angioplasty-related morbidity and mortality. Direct visualization of the site of abrupt closure may allow determination of responsible mechanisms and appropriate treatment strategies. Intracoronary visualization using a new angioscope was carried out in two cases of abrupt closure after percutaneous coronary angioplasty. The angioscope features a movable fiberoptic bundle that provides continuous and uninterrupted imaging of the coronary artery segment incorporating the site of abrupt closure. In one patient with intraprocedural closure angioscopy revealed obstruction of the lumen with extruded plaque material. In a second patient with postprocedural closure, however, imaging at the site of coronary artery occlusion revealed a mass consistent with a large platelet thrombus. Intracoronary evaluation with angioscopy may yield important characteristics that identify lesions at risk for abrupt closure. Further elucidation of the mechanisms underlying abrupt closure may allow more appropriate selection of therapeutic interventions.

Acute myocardial infarction in patients treated for hypertension in the Skaraborg Hypertension Project

The Skaraborg Hypertension Project was undertaken in 1977-1981, and 1428 male and 1812 female hypertensives aged 40-69 years were involved at hypertension out-patient clinics in primary health care. Their long-term risk of acute myocardial infarction during a follow-up of 8.3 years was compared to that of age- and sex-matched controls drawn from the census register at the beginning of surveillance and to normotensive untreated controls identified in a population survey in 1977. Relative risks (with a 95% confidence interval) for acute myocardial infarction morbidity compared to the population was 0.99 (0.78, 1.25) in men and 1.36 (0.95, 1.94) in women. Corresponding figures for acute myocardial infarction mortality were 0.97 (0.68, 1.38) and 1.15 (0.67, 1.99). With normotensive controls used as reference and adjusting for smoking habits and body mass index, the relative risks for acute myocardial infarction morbidity were 1.48 (1.12, 1.98) in men and 2.34 (1.43, 3.85) in women, and for acute myocardial infarction mortality 1.66 (1.07, 2.57) and 1.71 (0.84, 3.48), respectively. Treated hypertension is a weak risk factor for acute myocardial infarction in unselected hypertensive patients.

Morbidity and mortality of myocardial infarction in the MONICA study area Augsburg in 1985.

In the year 1985, 998 (734 men, 264 women) cases of acute coronary events were registered among the 25-74 year-old residents of the study area (151,489 men and 171,093 women) of whom 583 (403 men, 180 women) died within 28 days (case fatality). Both AMI as a clinical diagnosis and AMI as a cause of death are validated by defined MONICA diagnostic criteria (acute symptoms, enzyme level, ECG, autopsy diagnosis). The AMI-risk (MONICA diagnostic categories 1, 2, 3, 9) in the study area Augsburg is relatively low (incidence: men 302, women 113; attack rate: men 444, women 138; death rate: men 241, women 92; all per 100,000 for each group). The 28-day case fatality is comparatively high (men 54%, women 67%). A comparison of the Augsburg rates with those of three other centers shows that the Augsburg figures are in the lower range.

Recent morbidity trends in myocardial infarction in Japan: investigation of death certificates and the survival rates at coronary care units.

To elucidate recent trends in the mortality and morbidity of myocardial infarction (MI), we investigated death certificates and changes in the survival rate of MI patients at coronary care units (CCUs), which may affect the death rates. For all cases of MI, acute heart failure (AHF), heart failure (HF) as underlying cause, and hypertension as underlying cause with HF or AHF (categorized as hypertensive heart disease) on death certificates in two rural and two urban populations between 1981 and 1984, medical records were reviewed and case histories obtained from interviews with patients' families to validate the diagnosis. The number of MI deaths on the death certificates was not underestimated because some MI deaths were misdiagnosed as AHF, HF and hypertensive heart disease and some MI death certificates were misdiagnosed. Survival of MI patients at CCUs improved in several major cities, Tokyo, Osaka, Wakayama and Asahikawa between 1978 and 1984; a total of 4318 MI deaths were estimated to be averted by CCUs in 1984 compared with the number of deaths in 1978. Therefore, improvement of MI cases at CCUs may be one of the factors attenuating the rise in death rates in all of Japan.

Duration of hospital stay and post-myocardial infarction morbidity and mortality: a Kaiser-Permanente experience.

Among 209 evaluable consecutive patients (mean age 57 years) admitted in 1978 and 1979 for acute myocardial infarction, 186 survived. The mean hospital stay of the survivors was 9.7 days. Of these patients, 99 (53%) with complicated myocardial infarction had a mean hospital stay of 11.2 days; 87 (47%) with uncomplicated infarction had a mean stay of 7.9 days. All patients were followed for at least 6 months. During the 6-month post-hospitalization interval, the overall mortality was about 6%. Of the 12 patients who died, 11 had complicated, and 1 had uncomplicated myocardial infarction. The reinfarction rate in 6 months was 4% for complicated and 2% for uncomplicated infarction. Congestive heart failure was 3% for complicated and zero for uncomplicated infarction. Comparing these findings with reported series of patients with longer hospitalizations, we found no evidence that shortened hospitalization adversely affects mortality or morbidity.

Mortality and morbidity in patients with intermittent claudication as defined by venous occlusion plethysmography. A ten-year follow-up study

Mortality and morbidity in non-diabetic patients with plethysmographically verified arterial insufficiency of the legs have been investigated in a 10-yr follow-up study of 312 patients, men and women, who were first examined in 1967–1969 with calf plethysmography because of clinical symptoms of intermittent claudication. The follow-up rate was 99.7%. The study population was divided into two groups depending on the results of the plethysmography, group P with signs of arterial occlusion and group N with normal findings. The 10-yr mortality in the N-group did not differ from that in the general population. For closer analysis of mortality and morbidity the material was divided into two groups, 40–54 and 55–69 yr of age. In the P-group the total mortality was between 2.2 and 4.9 times greater depending on age, due mainly to myocardial infarction. The autopsy rate was 92%. The relative mortality risk was higher in the younger patients than in the older ones. The 10-yr morbidity in myocardial infarction as well as in stroke and in cancer related to smoking was increased in the P-group. Compared to the N-group the relative risk for myocardial infarction was 4.7 in the older patients, for stroke between 3.6 and 4.9 in all patients, for cancer related to smoking more than 6.1 in the younger patients. Ten patients in the P-group required amputation of the lower limb giving an annual amputation rate of 0.7%. Only one patient in the N-group was amputated.

In-hospital prognosis of patients with first nontransmural and transmural infarctions.

We studied the in-hospital mortality and morbidity of 745 patients who had suffered a first myocardial infarction. One hundred twenty-four patients (16.6%) had nontransmural infarction and 621 (83.4%) had transmural infarction. Both groups of patients were similar in the distribution of age, sex, and coronary risk factors. Patients with nontransmural infarction had a significantly lower mortality (3% vs 11%, p less than 0.01) and a lower prevalence of premature ventricular complexes (81% vs 88%, p less than 0.05). The patients with transmural infarction were distributed evenly among the three subgroups with peak SGOT levels less than 120 units, 120-240 units and more than 240 units (31%, 34% and 35%, respectively), while most patients with nontransmural infarction (60%) had peak SGOT levels less than 120 units (p less than 0.0001). When the in-hospital mortality and morbidity were compared between the parallel subgroups, the prognosis of patients with the two types of infarctions was similar. This study shows that the peak SGOT level is more important than the type of infarction in determining the acute mortality and morbidity of first myocardial infarction.

Familial hypobetalipoproteinemia. Absence of atherosclerosis in a postmortem study

FAMILIAL hypobetalipoproteinemia is characterized by sharply reduced levels of plasma cholesterol and lowdensity lipoprotein cholesterol (C-LDL). 1,2 High-density lipoprotein cholesterol (C-HDL) level is normal to slightly elevated. 2 Men and women from hypobetalipoproteinemic kindreds had reported life expectancies that were seven and six years longer, respectively, than for US white populations ( P 2 Combined myocardial infarction morbidity and mortality was 2.5% in hypobetalipoproteinemic kindreds, fivefold less than in normolipemic controls (11%; P 2 In hypobetalipoproteinemia, low C-LDL, the atherogenic lipoprotein, 2-4 or a low ratio of C-LDL to C-HDL, the antiatherogenic lipoprotein, 2,4 may facilitate longevity and decrease morbidity and mortality from myocardial infarction. 2 We report what to our knowledge is the first documented autopsy study of a patient with familial hypobetalipoproteinemia and in whom there were no arterial atherosclerotic lesions on either gross or microscopic examination. Report of a Case A 76-year-old woman was found to

The association between blood pressure and serum cholesterol in healthy men: the Oslo study.

The association between serum cholesterol and blood pressure (BP) has been studied in 16 525 men. The study reveals that these Oslo men in their forties present with a serum cholesterol value which is on average 0.71 mmol/l (27.4 mg/100 ml) higher at diastolic BP greater than 110 mmHg than at BP less than 70 mmHg. According to earlier studies in Oslo, this cholesterol difference alone imparts a 10-year myocardial infarction morbidity difference of 25--30%. These findings might be of practical importance for epidemiological studies and for preventive measures against the two factors. The influence of other variables on the association between blood pressure and cholesterol has been studied in a multivariate analysis. Of these variables, only body mass index and serum triglycerides significantly influence the relationship between blood pressure and cholesterol, whereas age, cigarette smoking, non-fasting blood sugar, season, socioeconomic status, and physical activity at work and leisure do not influence the correlation.

Hypertensive Eye Ground Changes

ABSTRACT. As part of a prospective population study of cardiovascular disease, ophthalmoscopic examination was performed in 855 randomly selected 50‐year‐old men in 1963. The examination was repeated four years later, in 1967. On both occasions haemorrhages, exudates and papillary aedema were rarely seen. Attenuating arterioles, focal narrowing, crossing phenomena and broadened light reflex were all related to BP but attenuating arterioles and/or focal narrowing discriminated BP best. Isolated broadened reflex and/or crossing phenomena were not related to BP. The change in BP over four and ten years was the same in those who had and those who did not have hypertensive eye ground changes at the initial examination, indicating that eye ground changes do not precede hypertension. Mortality data and the morbidity in myocardial infarction and stroke were followed up until 1975. The importance of the separate eye ground variables for these mortality and morbidity end‐points was analyzed, taking into account the importance of BP, serum cholesterol and smoking. Focal narrowings were of importance for mortality, regardless of its cause, for stroke and for death from malignancy. Crossing phenomena were of importance for mortality, regardless of cause, for fatal coronary heert disease, for stroke and for deaths other than cardiovascular and cancer deaths. The eye ground variables are thus of differing importance for different end‐points. Grouping them as in Keith and Wagener's or other classification systems, means a loss of information and should be avoided.

The effect of beta-adrenoreceptive antagonists on the morbidity and mortality in cardiovascular disease.

The effect is critically reviewed of chronic administration of beta-adrenoreceptor antagonists on morbidity and mortality in angina pectoris and myocardial infarction. There is inconclusive evidence that the abrupt cessation of therapy with these agents may increase morbidity and mortality in angina pectoris. The type of anginal patient in which this may occur is not yet defined and neither is the mechanism. There is no evidence that beta-antagonists prolong the life of anginal patients. In the acute phase of experimental myocardial infarction, these drugs reduce mortality but do not do so in man. There is increasing evidence that they prolong life if administered to patients surviving the acute phase of myocardial infarction. The need for further studies is discussed.

Prophylactic total coronary care

The purpose of the study was to determine the effectiveness of a prophylactic total coronary care regime. Treatment commenced at home, continued in hospital with or without cardiographic monitoring, and extended to posthospitalization rehabilitation. Results were assessed according to four week and one year mortality, the effectiveness of treating and preventing early and late complications, and the degree of rehabilitation. Such assessment is the first of its kind reported in the literature. A prospective study of 100 consecutive infarct patients of whom the first 46 were unmonitored and the remaining 54 monitored were found comparable to each other and to the reported series as assessed according to accepted prognostic factors. The series differed in that patients were seen at an earlier stage with more frequent cardiac slowing and with a lower incidence of cardiogenic shock and the monitored patients were older. The hospital mortality rate was 10 per cent and the one year mortality rate a further 9 per cent. The over-all mortality rate is the lowest so far reported. Response to treatment of arrhythmias was 85 per cent, of cardiac failure to furosemide 77 per cent, and a further 12 per cent responded to additional digoxin. Hypotension was reverted in 90 per cent when associated with bradyarrhythmias and cardiogenic shock was reverted in 50 per cent. Angina disappeared in 27 per cent of those with angina prior to infarction. Prevention of complications during hospitalization was effective. Only one patient developed cardiac arrest due to ventricular fibrillation. Of the monitored patients 20 per cent developed arrhythmias and these were rarely serious. Eleven per cent of the total developed cardiac failure and 4 per cent reinfarcted. Post-hospitalization complications within 12 months were cardiac failure in 11 per cent and developing angina in 13 per cent. Half the patients were fully rehabilitated and one quarter had been and remained retired. Eighty per cent returned to work. Under this prophylactic regimen, results did not significantly differ in the monitored and unmonitored series. It is concluded that a prophylactic treatment regimen commencing in the prehospital phase effectively reduces mortality and morbidity of myocardial infarction. The regimen is applicable when monitoring facilities are not available.

Early stage effect of ischemic preconditioning for patients undergoing on-pump coronary artery bypass grafts surgery: systematic review and meta-analysis.

Background: During the on-pump coronary artery bypass grafts surgery, ischemia/reperfusion injury would happen. Ischemia preconditioning could increase the tolerance against subsequent ischemia and reduce the ischemia/reperfusion injury. However the clinical outcomes of the available trials were different. Methods : We searched the Cochrane Central Register of Controlled Trials on The Cochrane Library (Issue 3, 2013), the Medline/PubMed and CNKI in March 2013. RevMan 5.1.6 and GRADEprofiler 3.6 were used for statistical analysis and evidence quality assessment. Heterogeneity was evaluated with significance set at P≤0.10. Results: Eighteen randomized controlled trials were included. There were no differences on in-hospital mortality, postoperative myocardial infarction morbidity between ischemia preconditioning and control groups. The heterogeneity of creatine kinase-MB level 24 hours after surgery was obvious. The differences of 72 hours area under the curve of cardiac troponin T (mean differences of -14.50, 95% confidence interval of -21.71 to -7.28) and troponin I (mean differences -181.79, 95% confidence interval of -270.07 to -93.52) after surgery were observed. Conclusion s : All the 18 trails, the positive and the negative results were equal. The meta-analysis results should be interpreted with caution due to limited effective data. Because of high cost-effectiveness, ischemia preconditioning could not be denied completely. Large-scale randomized studies are needed, with the operation procedures and included criteria being more specific.