Survivors Of First Myocardial Infarction Research Articles

Prognostic Significance and Long‐term Natural History of Heart Rate Variability in Survivors of First Myocardial Infarction

Background:Reduced heart rate variability (HRV) is an established predictor of mortality after acute myocardial infarction (Ml). HRV is reduced early after Ml and begins to recover within a few weeks, reaching a plateau 3 to 6 months later and remains stable in the first year after Ml. How HRV develops during serial recordings beyond 1‐year follow‐up has not been studied. Methods:Serial 24‐hour Holter monitoring (discharge, 6 months, 1, 2, and 3 years) was performed in 123 patients recovering from a first acute Ml. During 6 years of follow‐up, 73 patients were free from subsequent events (mortality, nonfatal reinfarction, or coronary revascularization). The prognostic importance of early HRV values for the total group was assessed, and potential long‐term changes in HRV measurements in the 73 event‐free patients were studied. Results:HRV values at discharge (SDNN and HRV triangular index) were reduced compared with the findings in healthy controls, and the measurements predicted future mortality. In event‐free patients, SDNN and HRV triangular index improved over the following months, but the values did not reach the level of healthy controls, even at late follow‐up. No changes in HRV measurements were found between 1 and 3 years. Conclusions: Measurement of HRV is a useful tool in the prediction of mortality after first acute Ml. During the first few months an improvement in HRV is observed. The results of late serial recordings, however, demonstrate no additional changes in HRV values. Even at 3 years, HRV measurements did not reach the qualitative level of healthy controls. A.N.E. 1999;4(4):391–396

Relationship between plasma cholesterol and coronary artery disease in Asians

Cholesterol, high density lipoprotein (HDL) cholesterol and triglyceride concentrations were measured in 150 male survivors of first myocardial infarction and in 115 age and ethnic matched healthy controls. The total cholesterol concentration was higher in whites than in respective Asian groups and higher in patients than in controls (P < 0.001). The ratio of cholesterol to HDL cholesterol was significantly higher in patients (P < 0.001)and in both ethnic groups was a powerful independent predictor of cases. In Asians, the extent of coronary atheroma assessed by arteriography 2–12 weeks after infarction correlated independently with the total cholesterol concentration (P = 0.03). Thus, in Asian men, the lower level of total cholesterol compared to whites may be misleading. In Asian men the extent of atheroma correlated with the total cholesterol concentration and the relative risk of infarction increased with the ratio of total to HDL cholesterol. At a given level of cholesterol different ethnic groups may be at differing levels of cardiac risk and the cholesterol ratio may be a more appropriate means of inter-ethnic comparison.

Analysis of risk factors in 532 survivors of first myocardial infarction hospitalized in Jerusalem

During the period January 1979-March 1983, we have conducted in Jerusalem a case control study of all patients under the age of 65 surviving their first diagnosed myocardial infarction, in order to evaluate the importance of the conventional risk factors and to detect additional factors through quantifying plasma apolipoprotein concentrations. As a control group, we have chosen a sample from a previously studied Jewish population (LRC study), representative of the adult Jerusalemite population, parents of children born during 1958–1961. To complete the younger age group missing in the LRC population, we added a population studied in the Kiryat Yovel district of Jerusalem. We report here the results obtained from interviews and analysis of 532 cases (448 males and 84 females), and 869 controls (457 males and 412 females). In order to overcome the effects of age and ethnic origin on the risk factors, we have divided our populations according to age and country of origin of their fathers. Age, sex, smoking, history of high blood pressure, diabetes, elevated plasma triglycerides and/or cholesterol, and decrease in plasma HDL cholesterol, emerged as the most powerful and significant risk factors in this study. Other putative risk factors such as socioeconomic status, dietary habits, physical activity and obesity index were not found to be significantly different between cases and controls. It is noteworthy that smoking was more important as a risk factor in the younger age groups, whereas hypertension and diabetes were more important in the older age groups, particularly in females. The differences in lipid levels were considerably more prominent in the young age groups in both sexes. Myocardial infarction was observed more frequently in patients of European or American extractions. Apolipoproteins A-I, A-II, E and B determined in this study were shown to be affected partly by age and country of origin. Apo E and apo B levels were significantly higher and Apo A-I significantly lower in patients with myocardial infarction when compared to controls.

The role of prehospital discharge two-dimensional echocardiography in determining the prognosis of survivors of first myocardial infarction

Two-dimensional echocardiography (2DE) was performed in 47 consecutive survivors (mean age 47 years) of a first myocardial infarction (MI), to assess its value in predicting major cardiac complications (MCC) during the posthospital phase. 2DE was undertaken 1 day before hospital discharge (mean 15 days). A wall motion score was derived by analyzing endocardial motion in 11 left ventricular segments. During a mean 17-month follow-up, 17 patients had MCC: eight (47%) had significant angina; two (12%) reinfarcted, and seven (41%) died. Wall motion scores of patients with MCC (9.2 ± 0.9) (± SEM) were significantly higher compared to those without MCC (3.7 ± 0.4 ( p < 0.005). A wall motion score ≥8 was present in 82% (14 of 17) of patients with MCC compared to 7% (2 of 30) who remained asymptomatic. Patients who died had significantly higher wall motion scores compared to those who survived (11.3 ± 0.9 vs 4.7 ± 0.5) ( p < 0.005). Stepwise logistic regression and discriminant analysis, by means of age, infarct site, maximal Killip class, cardiac enzymes, and wall motion score, identified wall motion score and Killip class as the most significant predictors of MCC. Thus predischarge 2DE is capable of identifying high-risk patients prone to developing MCC after a first MI.

Prognosis after myocardial infarction--prediction in ambulatory patients by use of the bedside Valsalva maneuver.

One hundred survivors of first myocardial infarction were studied prior to hospital discharge by 24 hour ambulatory electrocardiography as well as radionuclide ventriculography. The bedside Valsalva maneuver, with simple sphygmomanometric determination of arterial pressure response, was performed 6 weeks post infarction and patients were followed for a mean of 22 months. The arterial pressure response pattern provided a semiquantitative estimate of resting left ventricular systolic function when related to the radionuclide ejection fraction (SIN, 0.56 +/- 0.13; ABO, 0.43 +/- 0.18; SQW, 0.16 +/- 0.06) (P less than 0.02). Abnormal Valsalva responses (ABO and SQW) were found more commonly in patients with diminished left ventricular systolic function and high grade ventricular arrhythmias. The SQW response pattern was highly predictive of future sudden cardiac death. The bedside Valsalva maneuver, performed 2-4 weeks after hospital discharge, upon the ambulatory patient is a simple, safe, inexpensive and uniformly applicable method which may serve as the basis for a strategy with which to approach the post-infarction patient regarding risk stratification and further clinical management.

Coronary and left ventricular angiographic anatomy and prognosis of survivors of first acute myocardial infarction

To relate coronary anatomy and left ventricular function to prognosis, 197 of 269 consecutive survivors of a first myocardial infarction (MI) ≤ 60 years old underwent prospective cardiac catheterization a median of 2 weeks after admission and were followed up for a median of 24 months (range 12 to 61). Seventy-two patients were excluded from angiography because of early death (9), severe noncoronary disease (44), MI complications (6), or patient refusal (13). The prevalence of multivessel disease was low (30%) and unrelated to the site of MI or presence of Q waves but was increased in patients with previous angina pectoris (p = 0.05) or those in Killip class II or III (p = 0.02). There were only 8 deaths from heart disease. The survival rate at 12 months was 97 ± 1% and at 24 and 36 months, 95 ± 2%. Nineteen patients underwent coronary revascularization surgery. As the number of deaths was small, the differences in survival between patients with single or multivessel disease and normal or depressed ejection fractions failed to reach significance. Survivors of a first MI ≤ 60 years old have a low prevalence of multivessel disease and a good prognosis.