Overtime work,insufficient sleep,and risk of non-fatal acute myocardial infarction in Japanese men

Objectives: To examine the relation between working hours and hours of sleep and the risk of acute myocardial infarction (AMI), with special reference to the joint effect of these two factors.

Method: Case-control study in Japan. Cases were 260 men aged 40–79 admitted to hospitals with AMI during 1996–8. Controls were 445 men free from AMI matched for age and residence who were recruited from the resident registers. Odds ratios of AMI relative to mean weekly working hours and daily hours of sleep in the past year or in the recent past were calculated.

Results: Weekly working hours were related to progressively increased odds ratios of AMI in the past year as well as in the past month, with a twofold increased risk for overtime work (weekly working hours ≥61) compared with working hours ≤40. Short time sleep (daily hours of sleep ≤5) and frequent lack of sleep (2 or more days/week with <5 hours of sleep) were also associated with a two to threefold increased risk. Frequent lack of sleep and few days off in the recent past showed greater odds ratios than those in the past year.

Conclusions: Overtime work and insufficient sleep may be related to increased risk of AMI.

     

Calcium:magnesium ratio in local groundwater and incidence of acute myocardial infarction among males in rural Finland

Several epidemiologic studies have shown an association between calcium and magnesium and coronary heart disease mortality and morbidity. In this small-area study, we examined the relationship between acute myocardial infarction (AMI) risk and content of Ca, Mg, and chromium in local groundwater in Finnish rural areas using Bayesian modeling and geospatial data aggregated into 10 km times symbol 10 km grid cells. Data on 14,495 men 35-74 years of age with their first AMI in the years 1983, 1988, or 1993 were pooled. Geochemical data consisted of 4,300 measurements of each element in local groundwater. The median concentrations of Mg, Ca, and Cr and the Ca:Mg ratio in well water were 2.61 mg/L, 12.23 mg/L, 0.27 microg/L, and 5.39, respectively. Each 1 mg/L increment in Mg level decreased the AMI risk by 4.9%, whereas a one unit increment in the Ca:Mg ratio increased the risk by 3.1%. Ca and Cr did not show any statistically significant effect on the incidence and spatial variation of AMI. Results of this study with specific Bayesian statistical analysis support earlier findings of a protective role of Mg and low Ca:Mg ratio against coronary heart disease but do not support the earlier hypothesis of a protective role of Ca.     

糖原磷酸化酶同工酶脑型在急性心肌梗死早期诊断中的临床意义

目的 探讨糖原磷酸化酶同工酶脑型(GPBB)在急性心肌梗死(AMI)早期诊断中的价值.方法 选择115例发病6 h内的胸痛患者,其中AMI患者45例(AMI组),非AMI患者70例(非AMI组).非AMI组中不稳定型心绞痛(UAP)40例、稳定型心绞痛(SAP)13例、非心源性胸痛17例;选择55例健康体检者作为健康对照组.检测发病0～6 h的血浆GPBB水平,并与心肌肌钙蛋白Ⅰ(cTnI)、肌酸激酶同工酶-MB(CK-MB)和肌红蛋白(MYO)的检测结果进行比较,分析上述指标诊断发病0～3 h和0～6 hAMI的灵敏度、特异度和准确度.结果 在O～3 h和0～6 h时间段,GPBB诊断AMI的灵敏度(64.29%、88.89%)显著高于cTnI(28.57%、60.00%)和CK-MB(21.43%、64.44%),P均<0.05;与MYO(71.43%、77.78%)比较差异无统计学意义.上述指标特异度差异无统计学意义.在0～3 h和0～6h时间段GPBB诊断AMI的准确度(80.77%、89.57%)显著高于cTnI(61.54%、81.74%)、CK-MB(50.00%、75.65%)和MYO(73.08%、73.91%),P均<0.05.结论 GPBB对于诊断早期AMI具有较高的灵敏度和特异度,其诊断准确度优于cTnI、CK-MB和MYO.     

肌钙蛋白T在急性心肌梗死中的诊断价值

目的 探讨血清肌钙蛋白T(cTnT)的动态变化对急性心肌梗死(AMI)的诊断价值。方法采用快速检测cTnT全血试剂条对58例AMI患者进行动态血清cTnT观察，同时测定CK-MB。结果cTnTAMI在梗塞后2h内阳性率为63．3％，8h-5d阳性率为100％，7、14、21d分别为91．8％、53．1％、2．04％，而CK-MB在梗死后2h内的阳性率为14．3％，8h～2d阳性率为100％．而3、4、5、7d分别为79．2％、34．6％、14．8％、0。结论 cTnT定性检测对AMI诊断有早期、特异性高、时间窗长的特点。     

A systematic review of troponin T and I for diagnosing acute myocardial infarction

OBJECTIVE: Elevations of serum troponin T and I values are being used to diagnose acute myocardial infarction (AMI) and to rule out the condition in patients before their discharge from the emergency department (ED). However, the sensitivity and specificity of these tests vary considerably. Our goal was to systematically review the data on the accuracy of troponin T and I for the diagnosis of AMI in the ED. SEARCH STRATEGY: We searched the MEDLINE database using the following strategy: troponin (text word) and diagnosis (medical subject heading [MeSH]) or troponin/diagnostic use (MeSH). The references of articles meeting our inclusion criteria were searched for additional articles. SELECTION CRITERIA: We evaluated each study for quality. Only prospective blinded cohort studies with an adequate reference standard were included in the analysis. DATA COLLECTION/ANALYSIS: Data from each study were abstracted by 2 investigators. We graphed sensitivity and specificity for different points in time from arrival in the ED or from the onset of pain and calculated summary estimates when appropriate and possible. MAIN RESULTS: Sensitivity increases for both troponin T and I from 10% to 45% within 1 hour of the onset of pain (depending on the cutoff) to more than 90% at 8 or more hours. Specificity declines gradually from 87% to 80% from 1 to 12 hours after the onset of chest pain for troponin T and is approximately 95% for troponin I. The peak abnormal value in the first 24 hours after admission to the ED has an area under the receiver operating characteristic curve of 0.99 and is very useful at ruling out AMI if negative. CONCLUSIONS: Although troponin T and I values are useful tools for the diagnosis of AMI, they must be interpreted according to the number of hours from the onset of chest pain. The test is particularly useful at ruling out MI when the value is negative at 8 or more hours after the onset of chest pain.     

急性心肌梗死介入治疗前后血清cTnI、BNP、IMA浓度变化的意义

目的:探讨急性心肌梗死(AMI)患者在PCI治疗前后血清肌钙蛋白I(cTnI)、脑钠肽(BNP)、缺血修饰白蛋白(IMA)的浓度变化及意义。方法:选取经PCI治疗的AMI患者35例,治疗前及治疗后6 h检测血清cTnI、BNP、IMA浓度,进行比较、评价。结果:(1)病例组血清cTnI[(50.53±29.95)ng/ml]、BNP[(5.01±1.23)mg/ml]、IMA[(1449.47±213.49)nmol/L]浓度较健康对照组显著升高(t=10.94,P<0.001;t=28.46,P<0.001;t=42.33,P<0.001)。(2)AMI患者经PCI治疗后6 h血清cTnI浓度[(47.02±28.11)ng/ml]与治疗前[(49.59±33.17)ng/ml]差别无统计学意义(t=1.625,P>0.05),但BNP浓度[(6.64±4.37)mg/ml]、IMA浓度[(1908.85±780.30)nmol/L]较治疗前[(5.06±1.16)mg/ml]、IMA[(1463.32±239.13)nmol/L]明显升高(t=-2.387,P<0.05;t=-3.311,P<0.01)。结论:PCI治疗前后血清cTnI浓度无明显变化,而BNP、IMA浓度较治疗前升高,提示PCI对AMI患者造成一过性心肌损伤,这些指标对AMI患者PCI治疗后心肌损伤监测及治疗有重要意义。     

多项指标联合检测在急性心肌梗死诊治中的临床意义

目的研究比较急性心肌梗死、不稳定型心绞痛、稳定性心绞痛患者血中肌钙蛋白I（cTnI）、磷酸肌酸激酶同工酶（CK-MB）、心肌型脂肪酸结合蛋白（H-FABP）、超敏C反应蛋白（Hs-CRP）、D-二聚体（DD）和纤维蛋白原（Fg）差异和变化,探讨上述指标在急性心肌梗死诊治中的应用价值。方法 150例冠心病患者分为急性心肌梗死组（AMI）、稳定性心绞痛组（SAP）、不稳定型心绞痛组（UAP）,分别采用免疫透射比浊法、凝血酶比浊法和免疫层析法测定CK-MB、Hs-CRP、DD、Fg、cTnI和H-FABP,同时选取35例健康人作为正常对照组。结果①入院12 h时,AMI组各项指标中以cTnI（87.5%）、CK-MB（93.8%）和H-FABP（92.8%）阳性率最高,且与UAP组、SAP组和对照组差异有统计学意义（P〈0.01）。②CK-MB、cTnI和H-FABP联合检测诊断AMI的灵敏度和特异度分别为98.0%和100%,优于三者单独检测。③AMI组Hs-CRP、DD和Fg水平均显著高于UAP组、SAP组和对照组（P〈0.05）,而SAP组和对照组SA间差异无统计学意义（P〉0.05）。④AMI组患者溶栓治疗后48 h内Hs-CRP含量持续增加,与治疗前比较差异有统计学意义（P〈0.05）;DD水平在溶栓后12h内明显下降（P〈0.05）,Fg水平明显升高（P〈0.05）,至治疗后48h,两者有不同程度恢复。结论联合检测cTnI、CK-MB和H-FABP可减少误诊,提高急性心肌梗死诊断的正确性,而Hs-CRP、DD和Fg对于急性心肌梗死病情判断、疗效观察和指导用药有重要意义。     

cTn-Ⅰ、Mb、CK-MB对急性心肌梗死快速诊断的价值

目的：探讨cTn-Ⅰ、Mb和CK-MB检验在急性心肌梗死患者中的临床诊断意义.方法：对35例本院确诊为急性心梗患者做回顾性调查分析,依据入院时间比较其CTn-Ⅰ、Mb、CK-MB的阳性率及阴性率,以及在各时段用CTn-Ⅰ、Mb、CK-MB诊断AMI的敏感性及特异性进行比较.结果：在AMI早期诊断中,Mb的灵敏度最高,而CK-MB在8h以内的结果与正常组比较没有统计学意义.cTn-Ⅰ的早期诊断价值良好.单项检测时CK-MB的特异性在AMI早期诊断中的价值有限.当多项目联合检测时,真阳性率有较大提高,可得到较满意的结果,加上连续动态检测,可以基本排除AMI漏检的可能性.Mb＋ cTn-Ⅰ组合的真阳性率,在4 ～8h已达到100％的满意效果,与Mb＋ cTn-Ⅰ＋CK-MB组相同.结论：在AMI的急诊患者及时做CK-MB、Mb、CTn-Ⅰ的检查及动态观察能提高确诊率（确定是AMI或非AMI）,可以为患者接受及时正确的治疗保障时间.     

In-hospital mortality among rural Medicare patients with acute myocardial infarction: the influence of demographics, transfer, and health factors

Context/Purpose: Most rural hospitals can provide medical care to acute myocardial infarction (AMI) patients, but a need for advanced cardiac care requires timely transfer to a tertiary hospital. There is little information on AMI in‐hospital mortality predictors among rural transfer patients. Methods: Cross‐sectional retrospective analyses on 2003‐2005 Medicare hospital inpatient data from 5 states were conducted to compare predictors of in‐hospital AMI mortality between rural hospital transferred and nontransferred patients. A total of 9,690 rural hospital AMI patients were identified: 3,087 were transferred to receiving hospitals and 6,603 were not transferred. Separate logistic regressions were conducted for transferred and nontransferred patient cohorts and results were compared. Results: Transfer patients were younger, more likely male, had fewer comorbidities/complications, and were less likely to expire (5.3% vs 16.7%) in the hospital. Congestive heart failure and cardiac dysrhythmia were the most common comorbidities/complications among transfer and no‐transfer AMI patients, but shock (OR = 9.44) and acute renal failure (OR = 3.67) had the strongest associations with in‐hospital mortality for both cohorts. Undergoing a percutaneous coronary intervention (PCI) was associated with a 42% reduction in hospital mortality risk for transfer patients. Conclusions: Transfer was associated with a greater likelihood of in‐hospital AMI survival, largely but not fully explained by transfer patients being younger with fewer comorbidities/complications who are receiving advanced cardiac care. Additional studies are needed to clarify other factors that explain higher in‐hospital mortality among nontransfers, such as patients’ health care decision‐making.     

急性心肌梗塞QT离散度的动态变化及与室性心律失常的关系

[目的]　研究急性心肌梗塞(AMI)患者QT离散度(QTd)和QTc离散度(QTcd)的动态变化,并分析与室性心律失常的关系。[方法]　采用体表静息标准12导联心电图监测208例AMI患者住院期间的QTd和QTcd。[结果]　AMI发病24小时内QTd、QTcd显著高于梗塞后第4天(P<0.01),梗塞后第4天与第4周QTd、QTcd比较无明显差异(P<0.05),室性心律失常组QTd、QTcd显著高于非室性心律失常对照组(P>0.01)。[结论]　AMIQT离散度增高发生于梗塞后早期,并与室性心律失常的发生密切相关。     

探讨和肽素在急性心肌梗死临床诊断中的作用

目的研究和肽素(C-terminal po rtion o f pro-vasopressin,Copeptin)应用在急性心肌梗死(acute myocardial infarction,AMI)临床诊断中的作用。方法将我院2018年5月—2019年5月收治且持续胸痛4 h内确诊的100例AMI患者设置为试验组,将同期持续胸痛4 h但冠状动脉造影术(Coronary angiography,CAG)无异常的40例患者设置为对照组,通过检测肌钙蛋白I(cardiac troponin I,cTnI)与Copeptin,分析两者诊断有效性。结果(1)试验组各时段cTnI水平均高于对照组(P<0.05),且12 h、24 h时仍在升高;(2)试验组各时段Copeptin水平均高于对照组(P<0.05),且4 h内升高,于6 h后下降;(3)Copeptin检测的ROC曲线下面积(Area under the ROC curve,AUC)高于cTnI检测。结论采用Copeptin可早期诊断AMI。     

急性心肌梗死后合并心源性休克的相关危险因素分析

[目的]从急性心肌梗死(acute myocardial infarction,AMI)患者中筛选出心源性休克(cardiogenic shock,CS)的相关危险因素,为临床医生和预防医学工作者提供参考依据。[方法]以1994～2004年中山大学和昆明医学院两所附属医院的2173例ST段抬高型AMI患者为研究对象,以是否发生CS为应变量,以患者的病史、性别、年龄、家族史、生活习惯和入院时的体检指标、治疗情况等指标为自变量,建立logistic回归模型,从而筛选出与CS密切相关的有价值的临床指标。[结果]年龄、性别、体重指数、心功能分级、心梗部位、外周动脉疾病、既往心梗病史、心血管病家族史,以及不接受溶栓治疗是与CS相关的9项危险因素。有心血管病家族史者发生CS的风险比无心血管病家族史者升高约43倍。未接受溶栓以及溶栓不成功者发生CS的可能性比溶栓成功者高15倍。在溶栓成功者中,41%的人在症状发作后6h内接受溶栓治疗;而在溶栓不成功者中,56%的人在症状发作超过12h才开始溶栓。[结论]AMI症状发作后早期接受溶栓治疗能大大减少CS的发生,早期溶栓治疗可作为中国老年人群CS第三级预防的一个有效手段。     

cTnI、MB和CK-MB联合检测在急性心肌梗死诊断中的临床应用

目的探讨心肌肌钙蛋白I（cTnl）、肌红蛋白（MB）和肌酸激酶同工酶（CK-MB）对急性心肌梗死（AMI）诊断的临床价值。方法对136例AMI患者于胸痛发作后24 h内检测血清中cTnI、MB和CK-MB水平,比较这3项指标对AMI诊断的敏感性和特异性。结果急性AMI患者的cTnI、MB、CK-MB检测结果分别为（1.29±0.93）、（426±214）、（23.7±17.8）μg/L,较正常对照组均有显著性升高（P〈0.05）。cTnl、MB、CK-MB对AMI的敏感性分别为97.1%、98.5%和77.9%,特异性分别为97.7%、87.8%和95.0%。结论急性AMI患者的cTnI、MB、CK-MB的值均明显升高。3项指标在AMI诊断中具有较高的灵敏度和特异性,其中以cTnI最佳。3项指标联合检测效果更好,在AMI的诊断中起到重要作用。     

肌钙蛋白T对急性心肌梗死的诊断价值及早期预后的判断

[目的 ]　研究血清cTnT测定对急性心肌梗死 (AMI)的诊断价值及其近期心脏事件发生的预测作用。　 [方法 ]　 137例因胸痛且高度怀疑急性冠状动脉缺血 (AICS)就诊的患者 ,分别于就诊后第 0、8、16、2 4h抽血测血清cTnT和CK- MB ,同时随访心电图检查。　 [结果 ]　 137例患者中 ,75例诊断为AMI ,以cTnT≥ 0 .2ng/mL诊断AMI的灵敏度为94.7% ,特异度为 91.9% ,以CK- MB≥ 2 3U /L诊断AMI灵敏度为 90 .7% ,特异度为 85 .5 % ;并且随着测得的血清cTnT升高 ,患者住院期间心脏事件发生率亦明显增多。　 [结论 ]　急诊胸痛就诊患者 ,早期测定cTnT对诊断AMI价值优于CK- MB ,并且对近期心脏事件发生的机率有预测作用。     

孟德尔随机化探究2型糖尿病与急性心肌梗死的性别特异性因果关系

目的 观察性研究结果显示2型糖尿病（type 2 diabetes, T2D）是急性心肌梗死（acute myocardial infarction, AMI）发生的风险因素，且这种风险存在一定的性别差异。然而观察性研究常受到混杂因素的影响，明确两者的因果关系有助于AMI的防控。本研究旨在利用孟德尔随机化(Mendelian randomization, MR)模型揭示T2D与AMI之间的因果效应及性别特异性。方法 T2D和AMI的全基因组关联研究(genome - wide association study, GWAS)结果汇总数据来源于欧洲。T2D数据共包含890 002例样本，其中男性425 613例样本，女性464 389例样本。AMI数据一共355 246例样本。利用T2D显著相关且独立的单核苷酸多态性(single nucleotide polymorphism, SNPs)作为工具变量，在总体及不同性别中利用两样本MR方法评估T2D与AMI的因果关联。以逆方差加权法(inverse variance weighted, IVW)作为主要的分析方法，使用Cochran Q检验检测性别异质性。结果 分析结果显示，整体人群中T2D对AMI的因果效应呈正相关(OR = 1.06; 95%CI: 1.04 ~ 1.09)。男性人群与总体人群的结果相似(OR = 1.03; 95%CI: 1.02 ~ 1.04)，但是在女性人群中并没有观察到T2D与AMI的因果关系(OR = 1.01; 95%CI: 1.00 ~ 1.02)。异质性分析显示男性和女性之间的结果确实存在显著差异(P = 0.004)。结论 本研究结果表明T2D会增加AMI的患病风险，且这种效应在男性群体中更加明显，具有性别特异性。     

Vasectomy and non-fatal acute myocardial infarction: a hospital-based case-control study in Seoul, Korea

One hundred and sixty-three Korean men aged 35-64 who were admitted to a university-affiliated hospital diagnosed for the first time with acute myocardial infarction (AMI) were compared with 326 matched non-AMI patients hospitalized with a diagnosis considered unrelated to vasectomy. When other potentially confounding variables were controlled for, vasectomized men were found to be 2.6 times (adjusted odds ratio) more likely to have had an AMI as compared to the non-vasectomized men (95% CL: 1.1, 6.1). The adjusted odds ratio of AMI for subjects having had a vasectomy less than or equal to 9 years ago was the same as those who had a vasectomy greater than or equal to 15 years (OR = 2.5), although those who had had a vasectomy 10-14 years ago were associated with a higher odds ratio of 4.2. Among those subjects with vasectomies who were also cigarette-smokers and/or hypertensive, the risk of development of AMI increased multiplicatively compared with those with none of these conditions. We suspect that our finding of this positive association may be spurious due to possible bias introduced during selection of controls and during the process of data collection. Cancer patients may have been less likely to undergo an elective surgical procedure such as vasectomy prior to the admission. When multivariate analysis included only controls who were non-cancer patients (N = 241 controls), the adjusted odds ratio between vasectomy and hospitalization for AMI was reduced to 2.1, (95% CL: 0.8, 5.7), which is no longer statistically significant. When the analysis was further limited to only those control subjects admitted with a diagnosis of digestive system problems, the adjusted odds ratio was reduced to close to unity (1.1). Recognizing the importance of the study topic and the fact that all previous epidemiological studies showed no association between vasectomy and cardiovascular diseases, we urge further studies. A historical cohort study in the Korean setting is considered feasible and is recommended.     

急性心肌梗塞后微量元素代谢变化的临床意义

<正> 近年来,微量元素在心血管疾病的发生、发展中的作用日益受到重视。微量元素失词与冠心病的发生、发展已被动物实验和临床研究所证实。但急性心肌梗塞(AMI)后微量元素的变化及临床意义还不甚了解。据此,本文观察了急性心肌梗塞(AMI)患者血清铜、铁、锌、镁、锰、钴、镉、镍、铬九种微量元素的变化,报告如下。     

Trends in the sensitivity, positive predictive value, false-positive rate, and comparability ratio of hospital discharge diagnosis codes for acute myocardial infarction in four US communities, 1987-2000

Variations in the validity of hospital discharge diagnoses can complicate the assessment of trends in incidence of acute myocardial infarction (AMI). To clarify trends in the validity of discharge codes, the authors compared event classification based on published Atherosclerosis Risk in Communities (ARIC) Study criteria with the presence or absence of an International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) hospital discharge code for AMI (code 410). Between 1987 and 2000, 154,836 coronary heart disease events involving hospitalization in the four ARIC communities had ICD-9-CM codes screened for AMI. The sensitivity of ICD-9-CM code 410 for classifying AMI in men (sensitivity = 0.65, 95% confidence interval (CI): 0.63, 0.66) was statistically significantly greater than that found for women (sensitivity = 0.60, 95% CI: 0.58, 0.62) and was greater in Whites (sensitivity = 0.67, 95% CI: 0.65, 0.68) than in Blacks (sensitivity = 0.50, 95% CI: 0.47, 0.53). The ethnic difference was related to a greater frequency of hypertensive heart disease and congestive heart failure codes encompassing AMI among Blacks as compared with Whites. The authors found that although the validity of ICD-9-CM code 410 to identify AMI was generally stable from 1987 through 2000, differences between Blacks and Whites and across geographic locations support investment in validation efforts in ongoing surveillance studies.