Prevention Of Recurrent Myocardial Infarction Research Articles

Effect of antiplatelet or antianginal drugs on the prevention of recurrent myocardial infarction

Effect of antiplatelet or antianginal drugs on the prevention of recurrent myocardial infarction

Factors associated with recurrent myocardial infarction within one year after acute myocardial infarction

In a large population of patients (n = 3666) who were discharged from the hospital after acute myocardial infarction and followed up for 1 year, factors associated with recurrent nonfatal (n = 171) or fatal (n = 74) infarction were identified. Also, the effects of combining various end points (recurrent nonfatal or fatal infarction and other cardiac death) in multivariate analyses, a practice common in many small studies that evaluate the predictive value of various treatments or special tests, was examined. In univariate analyses, patients with nonfatal recurrent infarction did not differ with respect to age or gender from infarct-free survivors, but they more often had a history of previous myocardial infarction, congestive heart failure, angina pectoris, and diabetes; more severe pulmonary congestion was present on chest x-ray during the admission, and a non-Q wave index infarction was more frequent. Patients with either a fatal or nonfatal recurrent infarction had more angina pectoris during follow-up (55% to 60%) compared with 27% in event-free survivors and 31% in patients who died of other cardiac causes in whom this factor could be assessed before death. In multivariate analyses, historical and clinical prognostic factors were ranked differently for fatal or nonfatal reinfarction and other cardiac causes of death; angina pectoris at follow-up was highly related to recurrent infarction (fatal or nonfatal), along with a history of diabetes, and a non-Q wave index infarction. These factors were not independently related to other causes of cardiac death. When angina pectoris at follow-up was used in the multivariate analysis of recurrent infarction (fatal plus nonfatal), it was the most important factor. This finding supports the general practice of referring patients with angina pectoris during follow-up (34% of the population) for coronary angiography in an effort to identify those with severe disease who might benefit from revascularization, which is aimed at the prevention of recurrent myocardial infarction.

Prevention of recurrent myocardial infarction and sudden death with aspirin therapy.

In October 1985, the Food and Drug Administration approved a new indication of aspirin for the secondary prevention of recurrent myocardial infarction (MI) and death in patients with MI or unstable angina. Clinical trials have demonstrated the efficacy of this drug, especially when treatment is begun soon after the initial event. The antiplatelet actions of aspirin seem to be the most plausible explanation for its efficacy in reducing mortality and the rate of reinfarction. A single daily 325-mg tablet is effective and produces side-effect incidences of only zero to two percent above those produced by placebo. This article assesses the current state of knowledge regarding the value of aspirin therapy in survivors of acute MI and the implications for clinical practice.

Clinical trials on the efficacy of pharmacologic intervention reducing mortality from cardiovascular diseases.

Results of recent clinical trials on secondary prevention of ischemic heart disease indicate that judicious, long-term administration of adrenergic beta blockers and platelet-active drugs such as aspirin and Persantine (dipyridamole) would seem to yield protection against mortality associated with acute myocardial infarction, including sudden death. These drugs are beneficial also in prevention of recurrent myocardial infarction, especially among patients with unstable angina. These drugs should be considered as soon as the diagnosis of myocardial infarction or unstable angina is confirmed clinically. In terms of primary prevention of ischemic heart disease and cerebrovascular disease (stroke), the results of the Hypertension Detection and Follow-Up Program provide an excellent set of data on the efficacy of rigorous treatment of hypertension, especially those with mild hypertension. To be effective, treatment must start before there is evidence of target end organ damage, such as left ventricular hypertrophy. Recent data from the Australian Therapeutic Trial in Mild Hypertension also confirms these findings.

Relation of exercise to the recurrence rate of myocardial infarction in men: Ontario exercise-heart collaborative study

The Ontario Exercise-Heart Collaborative Study was a multicenter randomized clinical trial of high Intensity exercise for the prevention of recurrent myocardial infarction in men. The 4-year recurrence rate among 379 patients on a program of high intensity exercise did not differ significantly from that among 354 control patients on a program of light exercise, despite the greater reduction in heart rate in the former group. The relative odds of recurrence in the high intensity group were 1.09, with 95% confidence limits of 0.61 and 1.96.

Predictors of dropout from cardiac exercise rehabilitation: Ontario exercise-heart collaborative study

The Ontario Exercise-Heart Collaborative Study was a multicenter randomized clinical trial of high intensity exercise for the prevention of recurrent myocardial infarction in 733 men. Of the 678 subjects who could have participated for at least 3 years, 315 (46.5%) dropped out. Stepwise multiple linear logistic regression analysis was carried out to examine the relation between subject characteristics and the probability of dropping out during the study. Analysis was performed on the entry group as a whole by considering those subjects who had reinfarction while complying with the program and also by excluding all subjects with reinfarctions. The consistent and statistically significant predictors of dropout in both analyses were smoking and a blue collar occupation. Angina was significantly associated with dropout only when reinfarctions were excluded. It may be important to consider these factors when investigating the potential for compliance-improving strategies in reducing dropout from exercise rehabilitation programs.

RISKS OF LONG-TERM ORAL ANTICOAGULANT THERAPY IN ELDERLY PATIENTS AFTER MYOCARDIAL INFARCTION: Second Report of the Sixty Plus Reinfarction Study Research Group

The 32 intracranial events and 116 extracranial bleeding complications observed during a double-blind trial to assess long-term oral anticoagulant therapy in 878 elderly patients after myocardial infarction were studied in detail. Of the intracranial events, 12 occurred in the anticoagulant (AC) group and 20 in the placebo group, the number of definite haemorrhages being 8 and 1, respectively (p = 0·04). The 2 AC patients with a subdural haematoma recovered. The accumulated periods of neurological disablement amounted to 120 days in the AC group and 1204 days in the placebo group (p<0·01). Of the 106 extracranial bleeding episodes observed in the AC group 28 were referred to as major; none of the patients with major bleeds died but 10 required treatment in hospital, on average for a week. In the 4 placebo patients with a major extracranial haemorrhage no treatment was needed specific for bleeding. Minor episodes were noted 78 times in 56 AC patients and 6 times in 5 placebo patients. About 75% of the bleedings occurred when the prothrombin time was prolonged 2·7-4·5 times in terms of the international calibrated and British corrected ratios. Bleeding incidence was not related to sex or age, or to the duration of therapy. It is concluded that the bleeding risk associated with long-term oral anticoagulation as applied in the Sixty Plus Reinfarction Study does not materially detract from its beneficial effects with respect to the prevention of recurrent myocardial infarction.