Prevention Of Acute Myocardial Infarction Research Articles

Twenty-five-year trends in myocardial infarction attack and mortality rates, and case-fatality, in six European populations

ObjectiveDue to the burden of coronary heart disease (CHD), the monitoring of CHD trends is required. This study sought to examine the acute myocardial infarction (AMI) trends in attack and...

Cost-Effectiveness of Treatment and Secondary Prevention of Acute Myocardial Infarction in India: A Modeling Study

BackgroundCardiovascular diseases are the single largest cause of death in India, with acute myocardial infarction (AMI) accounting for one-third of all heart disease deaths. Although effective treatment is available for AMI, access to treatment is dictated by cost and ability to pay. With scarce treatment resources, healthcare decisions are guided by local cost-effectiveness, for which country-level data are lacking. ObjectivesWe calculate the cost-effectiveness of policies that expand the use of aspirin, injection streptokinase, beta-blockers, angiotensin-converting enzyme inhibitors, and statins for the treatment and secondary prevention of AMI in India. We also estimate the cost-effectiveness of a hypothetical polypill (combining aspirin, beta blockers, angiotensin-converting enzyme inhibitors, and statins) for secondary prevention. MethodsWe conduct cost-effectiveness analyses of AMI treatment and secondary prevention for patients with previous coronary heart disease events in India. We estimate coronary heart disease events using Framingham risk scores and disease prevalence using a cohort ordinary differential model. Other parameter estimates are from the literature. Polypill treatment is assumed to cost less than the additive cost of all 4 oral medications, but it is not assumed to increase adherence. We conduct a Latin hypercube sampling sensitivity analysis on the model parameters. ResultsIncreasing coverage of AMI treatment with aspirin and streptokinase would be cost-effective and could avert approximately 335,000 (191,000 to 503,000) disability-adjusted life years among 30- to 69-year-olds in India. Secondary prevention with aspirin and beta-blockers at 80% coverage (and at lower rates) would be highly cost-effective, and the addition of angiotensin-converting enzyme inhibitors would also be cost-effective. Introducing the polypill dominates a strategy of a 4-drug regimen with the aforementioned drugs and statins. The cost-effectiveness ratio of 80% coverage with the polypill would be $1,690 ($1,220 to $2,410) per disability-adjusted life years averted. ConclusionsPolicies expanding both treatment and preventive therapies are cost-effective, based on gross domestic product per capita comparison. Introducing the polypill would be more effective than providing its components separately, even without accounting for the likely increase in treatment adherence.

Abstract 18304: Clinical Impact of Initial Reduction of Low-density Lipoprotein Cholesterol Level on Long-term Outcome of Acute Myocardial Infarction in the Statin Era

Background: In terms of secondary prevention of acute myocardial infarction (AMI), optimal period for achievement of target percent reduction of LDL-C level has not yet been well established. Methods: The Assessment of Lipophilic vs. Hydrophilic Statin Therapy in AMI (ALPS-AMI) study enrolled a total of 508 patients (mean age, 66.0±11.6 years, 80.6% male) hospitalized for AMI. Of these patients, 248 patients achieved percent reduction of LDL-C ≧ 30% until 8 week after randomization, 204 patients achieved at 4 week (early reduction group), 44 patients achieved at 8week (late reduction group). The two groups were identified prospectively and analyzed with regard to the composite end point (MACE: all-cause death, myocardial infarction, stroke). We evaluated long term clinical outcomes of AMI patients after PCI in terms of the period for achievement of target percent reductions in LDL-C. Results: MACE were significantly higher in the late reduction group compared to early reduction group (20.5% vs. 3.9 %, P<0.0001). The incidence of cardiac death were[[Unable to Display Character:  ]]significantly higher in the late reduction group than early reduction group (6.8% vs. 0.5%, P=0.003). In multivariate Cox proportional hazards analysis, percent reduction level of LDL-C during initial 4 week (HR, 0.93; 95% CI: 0.89-0.96, P<0.0001) and baseline LDL-C level (HR, 0.98; 95% CI: 0.96-0.99, P=0.038) predicted adverse events after adjustment for age. Conclusions: The earlier reduction of LDL-C level is important for the patients with AMI in terms of reduction of ischemic events. We should reduce LDL-C level to target percent reductions for at least moderate-intensity statin therapy as early as 4 weeks after primary PCI in patients with AMI.

The adverse association of diabetes with risk of first acute myocardial infarction is modified by physical activity and body mass index: prospective data from the HUNT Study, Norway.

Diabetes increases the risk of acute myocardial infarction (AMI) and effective means for primary prevention are warranted. We prospectively examined the joint association of diabetes and leisure-time physical activity, as well as of diabetes and BMI, with the risk of AMI. A total of 55,534 men and women in the Norwegian HUNT Study were followed-up for first AMI by hospital admission registries and the Cause of Death Registry. Cox proportional adjusted HRs with 95% CIs were estimated. Overall, 1,887 incident AMIs occurred during 12.3years. Compared with inactive people without diabetes, inactive people with diabetes had an HR of 2.37 (95% CI 1.58, 3.57), whereas the HR among highly active persons with diabetes was 1.04 (95% CI 0.62, 1.74). Normal-weight (BMI 18.5-25kg/m(2)) persons with diabetes had an HR of 1.60 (95% CI 1.05, 2.44) and obese (BMI > 30kg/m(2)) persons with diabetes had an HR of 2.55 (95% CI 1.97, 3.29) compared with normal-weight persons without diabetes. The data suggest biological interaction between diabetes and physical activity, with a relative excess risk of inactivity and diabetes of 1.43 (95% CI 0.08, 2.78). For obesity and diabetes, the excess risk due to interaction was smaller (0.67; 95% CI -0.24, 1.58). Body weight and, in particular, physical activity modified the association between diabetes and risk of first AMI. This highlights the potential importance of physical activity and weight maintenance in primary prevention of AMI among people with diabetes.

Dietary non-enzymatic antioxidant capacity and the risk of myocardial infarction: A case-control study in Italy

Background and aimsOxidative processes have been related to atherosclerosis, but there is scanty information on the role of dietary antioxidants in the prevention of acute myocardial infarction (AMI). Methods and resultsThe relationship between non-enzymatic antioxidant capacity (NEAC) and the risk of nonfatal AMI was investigated in a case-control study conducted in Milan, Italy, between 1995 and 2003. Cases were 760 patients below 75 years with a first episode of AMI and controls were 682 patients admitted to hospitals for acute conditions, who completed an interviewer-administered food frequency questionnaire, tested for validity and reproducibility. NEAC (excluding coffee) was measured using Italian food composition tables in terms of ferric reducing-antioxidant power (FRAP), Trolox equivalent antioxidant capacity (TEAC) and total radical-trapping antioxidant parameter (TRAP). The odds ratios (OR) of AMI, and the corresponding 95% confidence intervals (CI), were obtained by multiple logistic regression models including terms for main risk factors of AMI and total energy intake. NEAC was inversely related with the risk of AMI. The ORs for the highest quintile compared with the lowest one were 0.41 (95% CI, 0.27–0.63) for FRAP, 0.42 (95% CI, 0.27–0.65) for TEAC and 0.41 (95% CI, 0.27–0.62) for TRAP, with significant trends in risk. The inverse relationship was apparently stronger in women and in subjects aged ≥60 years. ConclusionsOur results support a favorable role of dietary NEAC in the prevention of AMI, and encourage a high consumption of fruit and vegetables and a moderate consumption of wine and whole cereals.

Review: Influenza vaccination reduces cardiovascular events in adults

ACP Journal Club18 February 2014Review: Influenza vaccination reduces cardiovascular events in adultsBruno Granwehr, MDBruno Granwehr, MDUniversity of Texas MD Anderson Cancer Center, Houston, Texas, USA (B.G.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-160-4-201402180-02002 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Source CitationUdell JA, Zawi R, Bhatt DL, et al. Association between influenza vaccination and cardiovascular outcomes in high-risk patients: a meta-analysis. JAMA. 2013;310:1711-20. https://pubmed.ncbi.nlm.nih.gov/24150467Clinical Impact RatingsGIM/FP/GP: Cardiology: References1 Centers for Disease Control and Prevention (CDC). Prevention and control of seasonal influenza with vaccines. Recommendations of the Advisory Committee on Immunization Practices–United States, 2013-2014. MMWR Recomm Rep. 2013;62:1-43. [PMID: 24048214]. Google Scholar2 Hung IF, Leung AY, Chu DW, et al. Prevention of acute myocardial infarction and stroke among elderly persons by dual pneumococcal and influenza vaccination: a prospective cohort study. Clin Infect Dis. 2010;51:1007-16. [PMID: 20887208] Google Scholar Author, Article, and Disclosure InformationAffiliations: University of Texas MD Anderson Cancer Center, Houston, Texas, USA (B.G.)This article was published at Annals.org on 4 February 2014. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byAberrant coagulation causes a hyper-inflammatory response in severe influenza pneumonia 18 February 2014Volume 160, Issue 4Page: JC2KeywordsCoronary revascularizationMyocardial infarctionStable coronary artery diseaseStrokeSystematic reviewsUnstable anginaVaccines ePublished: 18 February 2014 Issue Published: 18 February 2014 Copyright & PermissionsCopyright © 2014 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...

Practical Challenges of Current Video Rate OCT Elastography: Accounting for Dynamic and Static Tissue Properties.

Optical coherence tomography (OCT) elastography (OCTE) has the potential to be an important diagnostic tool for pathologies including coronary artery disease, osteoarthritis, malignancies, and even dental caries. Many groups have performed OCTE, including our own, using a wide range of approaches. However, we will demonstrate current OCTE approaches are not scalable to real-time, in vivo imaging. As will be discussed, among the most important reasons is current designs focus on the system and not the target. Specifically, tissue dynamic responses are not accounted, with examples being the tissue strain response time, preload variability, and conditioning variability. Tissue dynamic responses, and to a lesser degree static tissue properties, prevent accurate video rate modulus assessments for current embodiments. Accounting for them is the focus of this paper. A top-down approach will be presented to overcome these challenges to real time in vivo tissue characterization. Discussed first is an example clinical scenario where OTCE would be of substantial relevance, the prevention of acute myocardial infarction or heart attacks. Then the principles behind OCTE are examined. Next, constrains on in vivo application of current OCTE are evaluated, focusing on dynamic tissue responses. An example is the tissue strain response, where it takes about 20 msec after a stress is applied to reach plateau. This response delay is not an issue at slow acquisition rates, as most current OCTE approaches are preformed, but it is for video rate OCTE. Since at video rate each frame is only 30 msec, for essentially all current approaches this means the strain for a given stress is changing constantly during the B-scan. Therefore the modulus can’t be accurately assessed. This serious issue is an even greater problem for pulsed techniques as it means the strain/modulus for a given stress (at a location) is unpredictably changing over a B-scan. The paper concludes by introducing a novel video rate approach to overcome these challenges.

Risk of Acute Myocardial Infarction

Endogenous estrogens prevent lipid peroxidation, which is pivotal in atherogenesis. Dyslipidemia may therefore be more dangerous for men than for women as a risk factor for acute myocardial infarction (AMI). A differential effect by sex has not been empirically established. In a prospective population-based cohort study of 23,525 women and 20,725 men younger than 60 years of age at baseline, we followed participants for 12 years for a first AMI. By calculating the proportion of AMI among men with dyslipidemia attributable to the synergism between male sex and dyslipidemia, we assessed the degree to which dyslipidemia is more detrimental for men than for women. Dyslipidemia and male sex enhanced the effect of one another in relation to AMI risk. The proportion of AMI cases among men with dyslipidemia attributable to this synergism alone was 0.46 (95% confidence interval = 0.35 to 0.57) for high total serum cholesterol, 0.23 (0.05 to 0.41) for low high-density lipoprotein (HDL) cholesterol, and 0.52 (0.42 to 0.62) for high non-HDL cholesterol. In contrast, obesity and hypertension were equally detrimental for men and women in relation to AMI risk, with a corresponding attributable proportion of 0.02 (-0.21 to 0.25) and -0.01 (-0.27 to 0.24), respectively. Current clinical guidelines of dyslipidemia management do not distinguish between men and women in relation to primary prevention of AMI. Our results suggest that in middle age, dyslipidemia is much more detrimental for men than for women, and that preventing dyslipidemia has a greater potential to reduce the occurrence of AMI among men.

Prevention of acute myocardial infarction following blunt chest trauma

Acute myocardial infarction (AMI) following blunt chest trauma (BCT) is a life-threatening complication of blunt chest trauma [1], the incidence of this disease will increase with the growth of the population mobility. How to prevent and decrease the occurrence of this special myocardial infarction appropriately are not clear due to its infrequent occurrence and lack of prospective randomized studies and relevant guideline. There may be different etiologies and pathogenesis and preventive in this special myocardial infarction compared to general myocardial infarction [2].

An agent-based simulation modelling approach to extended cost-effectiveness analysis of health interventions

BackgroundCost-effectiveness analysis (CEA) is widely used as a tool for prioritising health interventions, particularly in low-income and middle-income settings. However, among the major limitations of CEA are the omission of health-care seeking behaviour, heterogeneous mechanisms across populations or regions that determine the delivery and quality of health interventions, and the economic benefits of such interventions. Extended CEA complements basic CEA and provides a basis for a multicriteria decision-making approach that looks beyond health measures, but is far less complex than a benefit–cost analysis. MethodsWe developed a dynamic agent-based simulation model, the Disease Control Priorities Simulation (DCPSim) model, to estimate the health and economic benefits of health interventions and policies. Using data from the District Level Household Survey (2007–08) and National Sample Survey (2004) of India, we created an underlying population characterised by various demographic and socioeconomic attributes. Additional interdependencies related to the disease, the health intervention, treatment seeking, and fertility behaviour of model households, and the quality of health-care system, were included. As a case study, we examined two different policies that can scale up the availability of drugs for secondary prevention of acute myocardial infarction (AMI) in India: a universal public provision (UPP) that provides a drug for free at public health facilities, and a universal public finance (UPF) that provides a drug for free at public facilities and fully finances it at private facilities. FindingsIn addition to measuring the number of lives saved by scaling up the availability of drugs such as aspirin and combination therapies, we also estimated the economic benefits of the UPP and UPF policies. In particular, we found that for every 1 million Indians, these policies averted out-of-pocket private medical expenditure ranging from US$255 726 to $300 061 related to both the secondary and primary treatment of AMIs in India. We also found that these policies provided up to a $56 932 value of insurance against financial risk and increased access to capital by reducing debt burden. InterpretationWe build on the new method of extended CEA to examine the economic benefits of scaling up various drug combinations for the prevention of AMI in India. Our agent-based model attempts to capture various interdependencies between demographic change, health-care seeking, disease epidemiology, intervention efficacy, and the quality of service delivery. Resultant economic outcomes are measured from a health-systems accounting perspective. FundingDisease Control Priorities (DCP-3) Project funded by the Bill & Melinda Gates Foundation.

Bleeding risks associated with vitamin K antagonists

Vitamin K antagonists are widely used for the prevention of stroke due to atrial fibrillation, treatment and secondary prevention of venous thromboembolism, prevention of valvular thromboembolism in patients with prosthetic heart valves, and secondary prevention of acute myocardial infarction. The most common adverse event experienced by patients receiving anticoagulant therapy is major bleeding. The incidence of major bleeding in patients receiving long-term anticoagulation with a vitamin K antagonist in contemporary studies is 1–3% per year. To determine if the benefits of anticoagulant therapy outweigh the risk of bleeding in an individual patient, physicians must be aware of the risk factors associated with major bleeding. This narrative review will provide an overview of the incidence of major bleeding in patients receiving therapeutic anticoagulant therapy with vitamin K antagonists, discuss the risk factors for bleeding, and outline the most commonly used clinical prediction rules for bleeding.

Plasma Vitamin E and Coenzyme Q10 Are Not Associated with a Lower Risk of Acute Myocardial Infarction in Singapore Chinese Adults ,

AbstractVitamin E and coenzyme Q10 (CoQ10) have antioxidant effects that may benefit cardiovascular health. Meta-analyses of randomized controlled trials have not shown a protective effect of supplementation with the vitamin E isomer α-tocopherol on the risk of acute myocardial infarction (AMI), but data on other isomers and CoQ10 are limited. Our objective was to examine the association of the plasma concentrations of vitamin E isomers (β-, γ-, and γ-tocopherol and β-, γ-, and δ-tocotrienol) and CoQ10 (ubiquinol and ubiquinone) with the incidence of AMI. We conducted a nested case-control study with 233 cases of incident AMI and 466 matched controls selected from the Singapore Chinese Health Study, aged 45–74 y at the time of recruitment and free of cardiovascular disease at the time of blood collection. We used conditional logistic regression to examine the association between vitamin E and CoQ10 and the risk of AMI adjusted for other risk factors. In the basic model, higher d-tocopherol and ubiquinone concentrations were significantly associated with a higher risk of AMI, whereas there were no significant associations for the other vitamin E and CoQ10 isomers. After adjusting for lifestyle and other risk factors, only the association between δ-tocopherol and AMI risk remained significant [OR = 3.09 (95% CI: 1.53, 6.25) highest vs. lowest quintile;P-trend = 0.028]. We did not observe an inverse association between plasma concentrations of vitamin E isomers or CoQ10 and risk of AMI in Singapore Chinese. In contrast, plasma δ-tocopherol concentrations were associated with a higher risk of AMI. Our findings do not support a role of higher vitamin E or CoQ10 intakes in the prevention of AMI.

Mortality after admission for acute myocardial infarction in Aboriginal and non-Aboriginal people in New South Wales, Australia: a multilevel data linkage study

BackgroundHeart disease is a leading cause of the gap in burden of disease between Aboriginal and non-Aboriginal Australians. Our study investigated short- and long-term mortality after admission for Aboriginal and non-Aboriginal people admitted with acute myocardial infarction (AMI) to public hospitals in New South Wales, Australia, and examined the impact of the hospital of admission on outcomes.MethodsAdmission records were linked to mortality records for 60047 patients aged 25–84 years admitted with a diagnosis of AMI between July 2001 and December 2008. Multilevel logistic regression was used to estimate adjusted odds ratios (AOR) for 30- and 365-day all-cause mortality.ResultsAboriginal patients admitted with an AMI were younger than non-Aboriginal patients, and more likely to be admitted to lower volume, remote hospitals without on-site angiography. Adjusting for age, sex, year and hospital, Aboriginal patients had a similar 30-day mortality risk to non-Aboriginal patients (AOR: 1.07; 95% CI 0.83-1.37) but a higher risk of dying within 365 days (AOR: 1.34; 95% CI 1.10-1.63). The latter difference did not persist after adjustment for comorbid conditions (AOR: 1.12; 95% CI 0.91-1.38). Patients admitted to more remote hospitals, those with lower patient volume and those without on-site angiography had increased risk of short and long-term mortality regardless of Aboriginal status.ConclusionsImproving access to larger hospitals and those with specialist cardiac facilities could improve outcomes following AMI for all patients. However, major efforts to boost primary and secondary prevention of AMI are required to reduce the mortality gap between Aboriginal and non-Aboriginal people.

Abstract P338: Differences in Costs, Length of Stay and Mortality for Myocardial Infarction and Related Disorders in Non Federal Hospitals

BACKGROUND: Validated estimates of costs, length of stay, and mortality rates are necessary for the treatment and prevention of acute myocardial infarction in patient admitted to federal hospitals. Estimates based on data from few healthcare institutions may not be generalizable to all hospitals. HYPOTHESIS: To assess the hypothesis that there will be significant differences in costs, length of stay, and in-hospital mortality rates between inpatient with: (1) acute myocardial infarction only, (2) diabetic acute myocardial infarction and (3) diabetes only in non federal hospitals. METHODS: Data were extracted and analyzed from 4,400 hospital patients with both diabetes and myocardial infarction using International Classification of Diseases-9-Clinical Modification (ICD 9-CM) primary diagnosis codes from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample database. Data were retrospectively extracted from 1,056 hospitals in 42 States. Descriptive and multivariate statistical techniques were used to examine patient characteristics and outcome-related factors associated with the inpatient costs. RESULTS: Patients with acute myocardial infarction only incurred the highest average cost ($68,036, n = 24,791), followed by patients with diabetic myocardial infarction ($65,937, n = 4,400), and diabetes only ($33,680, n = 1,021,933) in 2008 hospital stay. The average LOS was at 6.3 days for myocardial infarction, 7.5 days for diabetic myocardial infarction, 4.95 days for diabetes. Inpatient with myocardial infarction only 2,056 (8.2%), diabetic myocardial infarction 350 (7.9%) and diabetes only 25,377 (2.5%) died during hospitalization. Regression analysis showed that patient comorbidities for both diabetic myocardial infarction were highly significant at p < .0001 ranking from fluid and electrolyte 306 (6.0%), renal failure 558 (12.6%), peripheral vascular disorders 363 (8.2%) and congestive heart failure 306 (6.0%). For each procedure, as days from admission to the first procedure increased, average costs consistently decreased ranging from less than one day ($11, 681.00) to 9 days ($100.00). Also, average costs were significantly high, p < .0001 with patient location, patient disposition, risk mortality and disease severity. Patient gender and ethnicity were also significant, p < .005 and p <.006 respectively. CONCLUSIONS: In conclusion, acute myocardial infarction remains the index for increased inpatient mortality, costs and length of stay in patients with both diabetes and myocardial infarction. Inpatients outcomes could be decreased enormously if patient could be screened and treated appropriately on admission to prevent complications like acute myocardial infarction. This study has revealed that appropriate estimation of costs in acute myocardial infarction disorders would help in accurate allocation of funds for preventive measures.

Determinants of the decline in mortality from acute myocardial infarction in England between 2002 and 2010: linked national database study

Objective To report trends in event and case fatality rates for acute myocardial infarction and examine the relative contributions of changes in these rates to changes in total mortality from...

Tea consumption, incidence and long-term prognosis of a first acute myocardial infarction – The SHEEP study

Results of previous studies on tea consumption and incidence or prognosis of acute myocardial infarction (AMI) are conflicting. The aim of the present study was to examine the potential role of tea consumption in the previous 12 months in primary and secondary prevention of AMI. We studied a total of 1340 individuals with a first non-fatal AMI and 2303 frequency matched control participants on age, gender and hospital catchment area including querying their tea consumption over the previous 12 months. The cohort of AMI cases was then followed for total and cardiac mortality and for non-fatal cardiovascular events with national registers over 8 years. Estimates of relative risks for a first AMI were based on odds ratios from unconditional logistic regression and Cox proportional hazards models were used to examine the prognostic importance of tea consumption in the cohort of cases. The prevalence of daily tea consumption was 20.5% among cases and 21.5% among controls. Tea consumption was associated with a lower risk for a first AMI with adjustment for matching criteria alone, with an odds ratio of 0.78 (95% confidence interval, 0.64-0.95) comparing those who consumed tea daily to those never consuming tea. However, in multivariable adjusted model there was no evidence for an association, the corresponding odds ratio was 1.08(0.86-1.36). There was also no association between tea consumption and cardiac mortality and non-fatal cardiovascular events, with a corresponding adjusted hazard ratio of 0.99(0.77-1.27). In this epidemiological study, greater tea consumption in the previous year was associated with a lower risk of AMI. However, a clear association between tea consumption and the incidence or prognosis of AMI was not demonstrated, probably because of tea drinkers having a healthier lifestyle.

Biomarkers in the early period of acute myocardial infarction in rat serum and protective effects of Shexiang Baoxin Pill using a metabolomic method

Ethnopharmacological relevanceTo identify the biomarkers in early period of acute myocardial infarction (AMI) in rat serum and reveal the effective mechanism of a Traditional Chinese Medicine (TCM) named Shexiang Baoxin Pill (SBP). Material and methodA metabolomic approach using reversed-phase liquid chromatography/quadrupole time-of-flight mass spectrometry (LC-Q-TOF-MS) was developed. ResultsFourteen biomarkers in the early period of acute myocardial infarction (AMI) in rat serum were identified. These biomarkers include 5-methylcytosine, cystathionine ketimine, 2-oxoadipic acid, thymidine, epinephrine, homocystine, uric acid, 12(S)-hydroperoxyeicosatetraenoic acid (12s-HPETE), 11-dehydrocorticosterone, 12(S)-hydroxyeicosatetraenoic acid (12s-HETE), deoxycorticosterone, corticosterone, aldosterone and cortisol. Through pathway analysis of these biomarkers, inflammation, hypertrophy and oxidative injury were considered the most relevant pathological changes in early period of AMI. ConclusionIdentification of AMI biomarkers not only supplied a systematic view of the progression of AMI in the early period but also provided the theoretical basis for the prevention or treatment of AMI. The results demonstrated that SBP pretreatment could offer protective effects for AMI through regulating the pathway of steroid hormone biosynthesis.

P2-218 Secondary prevention in acute myocardial infarction in Chile

BackgroundIn 2005 the Chilean government started a healthcare reform that guarantees medical treatment for patients with acute myocardial infarction (MI), including secondary prevention.AimTo evaluate the impact of this program in...

Aspirin

> Among the many useful discoveries which this age has made, there are very few which better deserve the attention of the public that what I am going to lay before your Lordship. > > —Reverend Edward Stone –Chipping-Norton, Oxfordshire –April 25, 1763 These prophetic words, written by Reverend Edward Stone in a 1763 letter to George Parker, the second Earl of Macclesfield, describe the results of the first clinical trial recorded in medical history.1 Stone's report on the rediscovery of the medicinal value of willow bark among subjects suffering from malarial symptoms is considered a significant milestone in the development of aspirin. Although society now takes many of its beneficial effects for granted, aspirin did not suddenly appear for medicinal use after Reverend Stone's discovery. Instead, its tumultuous journey was fueled by individual scientific curiosity, accidental discoveries, and intense business rivalry.1 No other drug is used by a greater number of people worldwide than aspirin, the benefits of which span centuries, beginning with the very first uses of willow bark by Egyptian physicians (Figure 1). Aspirin single-handedly transformed a coal-dye company into a pharmaceutical giant and has emerged as a cornerstone in the present-day therapies available for treating cardiovascular disease (CVD), pain, and inflammation. This article discusses the sentinel historical aspects of the discovery and clinical cardiovascular developments of aspirin, as well as its contemporary use in today's medical arena. Figure 1. Timeline of historical events in the development of aspirin. ### Historical Developments of Salicylates On January 20, 1862, Edwin Smith made one of the most historically important purchases of his life. Well-regarded among his peers for his keen scholarship and intricate knowledge of Egyptology, Smith purchased, for £12, 2 worn papyrus scrolls in a local Luxor street market1 that later turned out to be a formative medical textbook unlocking ancient Egyptian's practice of medicine. Although authorless, the Ebers Papyrus is 110 pages …

Recent Trends in the Incidence, Treatment, and Outcomes of Patients with STEMI and NSTEMI

Background Despite the widespread use of electrocardiographic changes to characterize patients presenting with acute myocardial infarction, little is known about recent trends in the incidence rates, treatment, and outcomes of patients admitted for acute myocardial infarction further classified according to the presence of ST-segment elevation. The objectives of this population-based study were to examine recent trends in the incidence and death rates associated with the 2 major types of acute myocardial infarction in residents of a large central Massachusetts metropolitan area. Methods We reviewed the medical records of 5383 residents of the Worcester (MA) metropolitan area hospitalized for either ST-segment elevation acute myocardial infarction (STEMI) or non-ST-segment acute myocardial infarction (NSTEMI) between 1997 and 2005 at 11 greater Worcester medical centers. Results The incidence rates (per 100,000) of STEMI decreased appreciably (121 to 77), whereas the incidence rates of NSTEMI increased slightly (126 to 132) between 1997 and 2005. Although in-hospital and 30-day case-fatality rates remained stable in both groups, 1-year postdischarge death rates decreased between 1997 and 2005 for patients with STEMI and NSTEMI. Conclusions The results of this study demonstrate recent decreases in the magnitude of STEMI, slight increases in the incidence rates of NSTEMI, and decreases in long-term mortality in patients with STEMI and NSTEMI. Our findings suggest that acute myocardial infarction prevention and treatment efforts have resulted in favorable decreases in the frequency of STEMI and death rates from the major types of acute myocardial infarction.