Rates Of Fatal Myocardial Infarction Research Articles

The acute coronary syndromes: advances in medical and interventional management

Unstable angina is one of the commonest reasons for hospital admission. It is not a benign diagnosis: within 2 weeks of admission acute myocardial infarction develops in about 12%. Subsequently, the rate of fatal myocardial infarction is 4% within 1 year. Medical therapy has undergone enormous change in the last few years and is highly effective with around 90% of patients being stabilized by combinations of agents including aspririn, beta-blockers, low molecular weight heparin, statins and more recently glycoprotein IIb-IIIa receptor inhibitors. There have also been monumental advances in identification of patients who are at highest risk of further cardiac events by utilization of risk stratification that is dependent upon both clinical condition and also, more recently, on serum concentrations of the cardiac specific proteins, troponins T & I. Finally, percutaneous coronary angioplasty with stent insertion has revolutionised the revascularization of patients with on-going ischaemia and also those now k...

The acute coronary syndromes: advances in medical and interventional management

Unstable angina is one of the commonest reasons for hospital admission. It is not a benign diagnosis: within 2 weeks of admission acute myocardial infarction develops in about 12%. Subsequently, the rate of fatal myocardial infarction is 4% within 1 year. Medical therapy has undergone enormous change in the last few years and is highly effective with around 90% of patients being stabilized by combinations of agents including aspririn, beta-blockers, low molecular weight heparin, statins and more recently glycoprotein IIb-IIIa receptor inhibitors. There have also been monumental advances in identification of patients who are at highest risk of further cardiac events by utilization of risk stratification that is dependent upon both clinical condition and also, more recently, on serum concentrations of the cardiac specific proteins, troponins T & I. Finally, percutaneous coronary angioplasty with stent insertion has revolutionised the revascularization of patients with on-going ischaemia and also those now known to be at high risk of further cardiac events. PTCA has recently been shown to improve prognosis in this group as well as remove their symptoms in a highly effective manner.

Wirkung von Östrogenen auf das kardiovaskuläre System

There is an ongoing discussion on the risk-benefit-ratio of hormonal replacement therapy (HRT). Potential risks of oestrogen replacement include the progression of malignant tumours. However postmenopausal morbidity can be significantly reduced by HRT. There is increasing evidence that oestrogens exercise protective effects on the cardiovascular system. HRT can reduce the development of atherosclerotic lesions and the rate of fatal myocardial infarction due to atherosclerosis. Oestrogens have direct and indirect effects on vascular physiology. Indirect effects derive from modulation of lipid metabolism. In addition, oestrogens may exert direct effects on vascular cells e.g. endothelial and smooth muscle cells by receptor-mediated mechanisms (so called genomic effects) and receptor-independent actions (=non-genomic effects). Especially these non-genomic oestrogen effects have been attracting much attention during recent years.

Family history in patients with transient ischemic attacks.

To determine the influence of family history on vascular disease, we surveyed hospital patients discharged with a diagnosis of transient ischemic attack. Of 117 respondents, 81 knew their family history for myocardial infarction and 81 knew their family history for stroke. Of 83 responding 43 reported a personal history of myocardial infarction, and of 85 responding 66 reported a personal history of stroke. As expected, there was an association between positive family and personal histories of myocardial infarction in younger (aged less than 70 years) patients (Fisher's two-tailed exact test, p = 0.014). This association was reversed for stroke (Fisher's two-tailed exact test, p = 0.017). Older (aged greater than or equal to 70 years) patients had a stronger association between positive family and personal histories of stroke; 14 (74%) of 19 older patients with a positive personal history of stroke had a positive family history of stroke. The reason for this reversal in the relation between family and personal histories of stroke compared with myocardial infarction may relate to the older age at onset of most strokes, differing stroke subtypes in older age groups, or lower rates of fatal myocardial infarction. This study suggests that familial factors may be important in some subtypes of cerebrovascular disease. Familial effects may be different in vascular diseases of the heart and brain.

The Primary Preventive Study in Uppsala

A health survey of middle-aged men was carried out in 1970-73 in the municipality of Uppsala. Subjects with hypertension, hyperlipidaemia, reduced glucose tolerance, and smokers were invited to join various therapy groups. By 1980 this multifactorial intervention programme had thus been running for 10 years. This report describes the results of a follow-up undertaken to evaluate the efficacy of the programme. The annual rate of fatal myocardial infarction (MI) was lower among the participants (n = 2322) in the health examination as well as among participants and non-participants (n = 446) combined than among the male Swedish population of the same age (162 and 187 compared with 296 per 100 000 men, respectively). The annual rate of non-fatal MI among participants and non-participants combined was 295 per 100 000 men, which is lower than in other Swedish cities. In the hypertensive group (n = 126), six men had fatal and seven non-fatal MI. These 13 men had higher blood pressures (BPs) from the start than the other hypertensives. In addition, their BP reduction was smaller than in a control group randomly selected among the hypertensive subjects. In the hyperlipidaemic treatment group (n = 363) there were eight fatal and 10 non-fatal MIs. Nine of these events occurred in individuals who had dropped out from therapy. It is suggested that the low total mortality and the low rates of fatal and non-fatal MI in this middle-aged male population may be related to the multifactorial intervention programme, as the incidences were also low among the treated high-risk groups.

Life expectancy after coronary artery surgery

In the face of an increasing incidence of multivessel disease and worse preoperative left ventricular performance, operative risk has decreased. The decrease in morbidity and mortality is attributed to improved myocardial protection. The 5 and 10 year survival rates for patients with chronic stable angina are 92.3 and 77.3 percent respectively. Reports indicate that ejection fraction is the best indicator of late survival. Controlled studies such as the Seattle Heart Watch and the European Cooperative Study show significantly higher 5 year survival rates with surgical treatment. Results in patients with left main stenosis and poor left ventricular function show improvement in operative risk and medium-term survival. Evidence exists that coronary artery surgery favorably influences the annual rate of fatal myocardial infarction and sudden death. The number of candidates for reoperation has gradually increased with time; the 5 year survival rate for reoperation is 89.2 percent.