Smoking and myocardial infarction: secondary prevention

This prospective study examines the question ''Is it too late to stop smoking cigarettes once you have had a myocardial infarction?'' One hundred and nineteen cigarette smokers (90 men, 29 women) who survived their first myocardial infarction for one month were followed for five years or until their death if earlier. The age corrected mortality rate of men who continued to smoke cigarettes was 2.2 times the age corrected mortality rate of those who stopped smoking after their infarct. The women who continued to smoke had 2.4 times the age corrected mortality of those who stopped smoking. The age and sex corrected mortality rates for the combined group of men and women show that those who stopped smoking after their infarction have 55% of the mortality of those who continued to smoke (P less than 0.05). These results suggest that smoking is not merely a ''risk factor'' for myocardial infarction but is also a causal factor whose effects can be avoided by both men and women after an initial myocardial infarction.     

Plasma lipids can be reliably assessed within 24 hours after acute myocardial infarction

Total serum cholesterol and triglycerides were measured in 159 Indian patients (134 males) with acute myocardial infarction during their stay in hospital (days 1 and 2) and 3 months later in order to assess whether lipid levels measured soon after acute myocardial infarction represent basal values. Early and 3 month lipid levels were also compared according to the sex and glucose tolerance of the patients. The mean total cholesterol levels on admission (day 1) were comparable to the 3 month values in both men (6.09 +/- 0.10 vs 6.18 +/- 0.09 mmol/l) and women (6.75 +/- 0.30 vs 6.44 +/- 0.22 mmol/l) irrespective of glucose tolerance. In the entire group cholesterol levels on day 2 were significantly lower than the admission and 3 month values. Nevertheless there was a significant correlation between day 2 and 3 month values (P less than 0.0005). Serum triglyceride levels on day 2 were influenced by glucose tolerance and were significantly lower than the 3 month values in patients with normal glucose tolerance but not in patients with abnormal glucose tolerance. However there with a significant correlation between day 2 triglyceride values in patients with both normal and abnormal glucose tolerance. These results suggest that serum cholesterol measured on admission after acute myocardial infarction may be reliably used to represent basal values in both men and women irrespective of glucose tolerance. Although cholesterol and triglycerides measured on day 2 vary with either the gender or glucose tolerance of the patients, these values are still a useful guide to the patients' basal lipid state.     

应变率成像对急性心肌梗死经皮冠状动脉介入治疗术后局部心肌功能的评价

目的应用应变率成像技术评价早期、延期的经皮冠状动脉介入治疗(PCI)对急性心肌梗死患者局部心肌功能的影响。方法将30例ST段抬高型急性心肌梗死患者分为早期PCI组、延期PCI组,在PCI术前及术后1周、1个月、3个月分别测定收缩期、舒张早期、舒张晚期的应变率峰值(SR)。结果早期PCI组:PCI术后1个月及3个月的收缩期应变率峰值(SRS)、舒张早期应变率峰值(SRE)和舒张晚期应变率峰值(SRA)与术前间差异均有统计学意义(P<0.01);延期PCI组:术后3个月的SRE与术前间差异有统计学意义(P<0.05)。结论应变率成像可定量评价急性心肌梗死患者早期、延期PCI后局部心肌功能的变化。     

心肌梗死量对性行为影响的临床研究

目的 探讨心肌梗死后性行为引起心肌缺血、损伤的危险因素。方法 急性心肌梗死(AMI)42例入院后动态测定血清肌酸激酶-MB蛋白(CK-MBmass)计算其心肌梗死量,根据心肌梗死范围大小患者分为A、B组;患者出院后性行为时佩戴动态心电图检测ST-T变化。结果 根据血清CK-MBmass动态变化计算其心肌梗死量,其中A组患者平均为32.2 CK-MBmass-g,B组患者平均为21-7CK-MBmass-g,两组对比差异有统计学意义(P<0.01)。出院后患者性行为时计算心电图∑T波、∑ST段改变的面积,其中A组患者平均为5.6mm2、2.3mm2;B组患者平均为3.7mm2、1.2mm2,两组对比差异有统计学意义(P<001)。结论 心肌梗死后性行为能否诱发心肌缺血、损伤,取决于心肌梗死量的大小。     

原发性高血压患者急性心肌梗死前后血压变化的临床研究

目的研究HT患者在AMI前后血压的变化,探讨其发生的原因。方法以45例有HT病史但无AMI患者作为对照组,对比分析41例有HT病史发生AMI前后的临床资料。结果HT患者在AMI后LVEF较AMI前降低(P<0.05),HT患者在AMI后E/A比值较AMI前降低(P<0.05),HT患者在AMI后SBP较AMI前显著降低(P<0.01),HT患者在AMI后DBP较AMI前降低(P<0.05)。对照组以上临床指标未见明显变化(P>0.05)。结论HT患者AMI后血压(SBP和DBP)较AMI前有所降低。     

Trial of early nifedipine in acute myocardial infarction: the Trent study

Over 30 months 9292 consecutive patients admitted to nine coronary care units with suspected myocardial infarction were considered for admission to a randomised double blind study comparing the effect on mortality of nifedipine 10 mg four times a day with that of placebo. Among the 4801 patients excluded from the study the overall one month fatality rate was 18.2% and the one month fatality rate in those with definite myocardial infarction 26.8%. A total of 4491 patients fulfilled the entry criteria and were randomly allocated to nifedipine or placebo immediately after assessment in the coronary care unit. Roughly 64% of patients in both treatment groups sustained an acute myocardial infarction. The overall one month fatality rates were 6.3% in the placebo treated group and 6.7% in the nifedipine treated group. Most of the deaths occurred in patients with an in hospital diagnosis of myocardial infarction, and their one month fatality rates were 9.3% for the placebo group and 10.2% for the nifedipine group. These differences were not statistically significant. Subgroup analysis also did not suggest any particular group of patients with suspected acute myocardial infarction who might benefit from early nifedipine treatment in the dose studied.     

溶栓治疗对急性心肌梗死患者NT-proBNP变化及心室重塑的影响

目的探讨溶栓治疗对急性心肌梗死患者NT-proBNP变化及心室重塑的影响。方法选取2010年9月~2012年4月于本院进行溶栓治疗的30例急性心肌梗死患者作为观察组,同期不符合溶栓治疗指征的30例患者作为对照组,将两组患者发病后即刻及治疗后不同时间的血清NT-ProBNP、心肌蛋白谱及心室重塑指标进行检测及比较。结果观察组治疗后3、7、15 d及1个月的血清NT-ProBNP分别为（2 633.18±102.17）、（1 802.42±82.38）、（1 169.48±74.62）及（545.20±50.34）ng/L,均低于对照组3、7、15 d及1个月的血清NT-proBNP[（3 784.36±110.29）、（3 346.78±106.85）、（1 942.06±88.17）、（1 401.20±72.28）ng/L],同时心肌蛋白谱水平均低于对照组,而心室重塑各个指标改善幅度均大于对照组,差异均有统计学意义（P〈0.05）。结论溶栓治疗对急性心肌梗死患者NT-proBNP变化及心室重塑的影响非常明显,对于改善疾病状态有积极的临床作用。     

Sexual activity after myocardial infarction.

Questionnaires on sexual activity were completed by 161 patients attending an exercise-centred rehabilitation program an average of some 3 years after a myocardial infarction. In almost half the group, sexual activity was unchanged or increased compared with the period before the infarction. In the remainder it was reduced; this group included 29 men who had adopted a more passive sexual role and 26 who were now having angina or ventricular premature beats during intercourse. Although the patients with diminished activity could not be distinguished by means of formal personality test, questionnaires completed by their wives suggested that they were less willing to assume responsibility, had increased difficulty in adjusting to life at home and at work and were more neurotic and depressed than those with normal or increased activity. Furthermore, those with decreased sexual activity had a poorer response to training in terms of attendance, final average jogging distance and gains in physiologic status. Since the frequency of angina and ventricular premature beats was less during intercourse than during standard laboratory exercise, it was concluded that normal sexual relations carry no special risk for the average postcoronary patient; indeed, by enhancing self-esteem and encouraging effective participation in an exercise programm, acceptance of normal sexual activity may improve the prognosis.     

RT-3DE定量评价心梗患者PCI术前后左室功能的变化

为探讨实时三维超声心动图(RT-3DE)定量评估心梗患者经皮冠状动脉介入治疗(PCI)术前后左室收缩功能及同步性参数的变化,选取100例接受PCI治疗的心肌梗死患者和100例正常对照组,应用RT-3DE技术对正常对照组和心梗患者PCI术前及术后1个月测量左心室收缩功能及同步性参数并进行比较。心梗患者PCI术前组左心室各功能参数值均劣于正常对照组,而术后1个月左心室各参数值均较术前明显改善。PCI术前、术后应用RT-3DE能够准确定位、定量反映左心室收缩功能及运动同步性,对心肌梗死的临床诊断及疗效评估具有重要价值。     

冠状动脉粥样硬化性心脏病患者及其家属在手术前后心理状态的对比研究

目的 本研究旨在调查住院冠状动脉粥样硬化性心脏病（以下简称冠心病）患者及其家属在经皮冠状动脉支架置入（percutaneous coronary intervention,PCI）术前、后的焦虑和/或抑郁状态的发生情况及变化特点。方法 选取拟行PCI术的住院冠心病患者和与陪同就诊的家属共50对。在术前1 d、出院当天及术后1个月分别进行抑郁自评量表（Self-rating Depression Scale,SDS）和焦虑自评量表（Self-rating Anxiety Scale,SAS）评估。并增设开放性问题补充了解患者及其家属的关注点。结果 在术前、出院当天及术后1月共3个时间点,有、无心理困扰的家庭,患者及家属的SDS和SAS评分呈现出4种不同的变化特点,无心理困扰的家庭比例逐渐升高,分别占42%、52%及54%;存在心理困扰的家庭比例在出院当天略降低（占8%）,术前（占12%）和术后（占14%）相似;存在心理困扰的家属比例逐渐降低,分别占30%、26%及18%;存在心理困扰的患者比例未见明显变化,分别占16%、14%及14%,但上述变化的差异无统计学意义（P值为0.437~0.948）。随着时间的变化,家属SDS和SAS平均值逐渐减低,而患者SDS和SAS平均值在术前和出院1个月时均较高,但患者和家属上述变化的差异均无统计学意义（P值为0.113~0.610）。存在心理困扰的研究对象共同的主要症状为睡眠障碍。术前患者及其家属最关系的焦点均是手术相关问题;在术后1个月时,患者最为担心的方面涉及病情、药物及工作和/或生活,家属最关心患者的手术效果。结论 术前存在焦虑或抑郁状态的冠心病患者和家庭,其心理状态在PCI术后未见明显改善趋势。     

心肌梗死455例PCI后临床疗效观察

目的:观察评价不同时期心肌梗死(MI)患者经皮冠状动脉介入治疗(PCI)后即刻疗效及远期疗效. 方法:对1988-04/2001-12住西京医院的455例经PTCA(经皮冠状动脉腔内成形术)或(和)支架术并在术前已明确诊断的MI患者进行1 mo～8 a的随访. 其中69例为急性MI(AMI)后直接PCI或溶栓后补救性PCI;263例为AMI后2 mo内择期PCI和123例陈旧性MI(OMI,MI时间大于2 mo)后的PCI. 结果:在66例单纯球囊扩张术及389例结合支架术或直接支架术中,手术成功率98.5%,2例术中死亡,3例行冠状动脉旁路移植术. 382例随访1 mo,无症状存活率87.7%,死亡12例. 129例随访2～8 a,无症状存活52.7%,死亡10例. 71例有症状复查冠脉造影中,30例发生再狭窄. 结论:MI患者PCI即刻疗效好,远期无事件存活率52.7%,AMI伴多支病变或心源性休克是术后早期死亡的主要原因. 大于2 mo以上的MI患者也能在PCI中获益.     

Changes in volume and density of platelets in myocardial infarction

The distributions of platelet volume and density were measured in 15 men suffering myocardial infarction and in 22 healthy controls. The method used separated 93% of the total platelet population from whole blood. Mean platelet volume of the study group compared with that of controls was increased by a mean of 0.98 fl (p less than 0.001) in the first 12 hours after myocardial infarction, and by 1.24 fl six weeks later (p less than 0.001). Distribution of platelet volume remained log normal after myocardial infarction. Modal platelet density was increased by a mean of 25 g/l (p less than 0.05) after myocardial infarction. Platelet volume is probably chronically large in men suffering myocardial infarction and may be related to changes in megakaryocytes. It is suggested that the increase in platelet volume occurs before infarction.     

HIV risk behaviour among injecting drug users in Perth: the Australian National AIDS and Injecting Drug Use Study.

OBJECTIVE: This study was carried out in 1989 to examine behaviour involving risk of human immunodeficiency virus (HIV) infection and to measure the prevalence of HIV antibodies in a sample of injecting drug users (IDUs) in Perth. DESIGN: The study was a cross-sectional survey with a sample of convenience of 196 IDUs drawn from drug treatment (54%) and non-treatment (46%) populations. RESULTS: Sixty-five per cent of the sample were men and 35% women. Subjects were predominantly heterosexual, were in their late twenties, had not completed secondary school, and were on sickness, unemployment or pension benefits. The majority were poly-drug users, but heroin and amphetamines were the only drugs that had been injected by more than 20% of the sample more than once a month. Respondents reported injecting an average of 43.6 (SD 83.6) times a month and using 33.7 (SD 55.4) new needles a month. The majority (70%) had injected within weeks of the interview. Sixty-seven per cent had shared needles within months. Respondents claimed to pass on used needles more frequently than to accept them, and were most likely to share with close friends or lovers when clean needles were unavailable and/or when they were withdrawing. While most respondents cleaned used needles, few used bleach all or most of the time. Most (78%) respondents had been tested for HIV seropositivity at least once. Most had multiple sexual partners and 92.3% had engaged in at least one unsafe sexual practice during the previous six months. Sixty-four per cent had changed some aspect of drug using, and 38% some aspect of sexual behaviour since hearing about the acquired immunodeficiency syndrome (AIDS). HIV seroprevalence for the 179 respondents who were tested was 2.2%, but this figure should not be taken as an estimate of seroprevalence for the Perth IDU population. CONCLUSION: Respondents' behaviour placed them at a high level of risk for HIV infection. Based on reported behaviour, it is recommended that education for IDUs in Perth should emphasise, among other things: not passing on used needles; cleaning used needles and syringes with bleach; planning ahead so that sterile equipment is available; and further risk reduction, particularly the adoption of safer sexual practices.     

山西省某市外来流动人口的社会人口学特征与安全套使用

目的了解中部地区外来流动人口的社会人口学特征、安全套使用情况及其影响因素。方法采用配额抽样,一对一、面对面匿名调查形式,对外来流动人口较为集中的6类工作场所里的1280名外来人员进行流行病学调查。结果饭店宾馆和娱乐场所里的流动人员比较年轻,大多数未婚;市场里的流动人员大多数和配偶一起住,其流动性较小;工厂和建筑工地的工人文化程度最低。各场所最近1个月有性行为的流动人员中曾使用过安全套者所占的比例分别为娱乐场所87％、市场32％、饭店宾馆59％、工厂和建筑工地25％。年龄较轻者、具有较高文化程度者以及具有安全套预防HIV感染知识者的安全套使用率较高。结论除娱乐场所外还应在市场、饭店宾馆、建筑工地和工厂这些外来人口聚集的场所推广使用安全套。同时应特别加强有关“安全套可以预防艾滋病”知识的宣传并提倡“在和配偶等固定性伴性交时使用安全套”。     

Recombinant tissue-plasminogen activator (rt-PA) in acute myocardial infarction in the Chinese in Hong Kong.

Eighty-nine consecutive Chinese patients (69 males, 20 females) with acute myocardial infarction treated by 100 mg recombinant tissue-plasminogen activator (rt-PA) (7 intracoronarily, 82 intravenously) at 3.7 +/- 1.0 hours after onset, and intravenous heparin or dipyridamole therapy started at 3 hours, were studied prospectively. Their mean age was 59.6 +/- 10.6 years. Forty-six patients (51.7%) had anterior and 39 patients (43.8%) had inferior infarcts. Clinical evidence of reperfusion was seen in 63 patients (72.8%), while new complications included hypotension (5.6%), heart failure (6.7%), cardiac arrhythmias (76.4%), hematoma around vascular access sites (23.6%), melena (2.2%) and cerebral infarction (2.2%). Maximal changes in coagulation profiles were seen at 3 hours, including a decrease in fibrinogen (by 64.2%), an increase in FDP by 11.7 times and D-dimers by 4.4 times. Nine patients (10.1%) had recurrence of angina and 6 patients (6.9%) died due to pump failure (5) and reinfarction (1). Angiogram at 14 days confirmed TIMI (2 or 3) patency of infarct related arteries in 62/81 (76.5%) patients, with a mean global ejection fraction of 52.5 +/- 12.4%. Nearly all survivors could maintain class I-II functional status after discharge. The safety and promises of rt-PA for acute myocardial infarction in the Chinese were confirmed.

     

眉山市城区2005年暗娼行为学监测分析

目的了解商业性性服务者(CSW)艾滋病危险行为现状、特点和变化趋势,制定有效的干预措施,为政府调整和完善艾滋病防治策略提供依据。方法采用问卷调查方式对城区内高危场所CSW进行调查。结果360名CSW最近7天平均接客人数11个;最近一次与客人性交时,按高、中、低档场所,安全套使用率分别为95.17%、95.80%、70.24%;最近一次与客人性交时没有使用安全套的原因主要是客人反对,占70.27%;最近一个月商业性行为时安全套坚持使用率为39.45%,低档场所明显低于中、高档场所。结论以中、低档场所为重点,以促进安全套使用为核心的艾滋病防治综合干预工作应尽快在本市展开。政府各有关部门应加强配合,切实履行自身在艾滋病防治工作中的职责,以控制艾滋病在我市经性途径的传播与蔓延。     

Prognosis after first myocardial infarction. Comparison of Q-wave and non-Q-wave myocardial infarction in the Framingham Heart Study.

OBJECTIVE--To compare the short- and long-term prognosis following a first Q-wave or non-Q-wave myocardial infarction. DESIGN--Cohort study with a mean follow-up period of 5.1 +/- 4.9 years. SETTING--Population-based. PARTICIPANTS--Framingham (Mass) Heart Study subjects with an initial recognized myocardial infarction during a 17-year period were studied, including 227 men and 136 women with a mean age of 67.2 years. Seventy-seven percent of first infarctions were Q-wave infarctions and 23% were non-Q-wave infarctions. MAIN OUTCOME MEASURES--Reinfarction and death from coronary heart disease. RESULTS--During the follow-up period, subjects with non-Q-wave infarctions had a significantly higher rate of reinfarction than subjects in the Q-wave group (P = .02 for the entire follow-up). The 10-year reinfarction rates were 44.8% vs 27.4%. When analyzed separately by age and sex, differences in reinfarction rates were only noted in men and in those under the age of 65 years. There were no differences in coronary heart disease death rates based on Q-wave status, even when examined separately by age and sex. Multivariate analysis revealed a 1.8-fold higher risk of reinfarction in the non-Q-wave group (95% confidence interval, 1.1 to 3.1), and also demonstrated that baseline hypertension was an independent risk factor for predicting reinfarction (relative risk, 1.8; 95% confidence interval, 1.1 to 3.2). There were no differences in the rates of sudden death or all-cause mortality following the two types of myocardial infarction. Additionally, subjects with a first Q-wave infarction had a higher rate of subsequent congestive heart failure, while those with non-Q-wave infarctions had a significantly higher rate of coronary insufficiency (unstable angina with transient ST-T wave abnormalities). CONCLUSIONS--These results confirm and extend findings from prior studies that have identified patients with first non-Q-wave myocardial infarctions as potentially unstable, with greater subsequent morbidity and similar mortality to their counterparts with Q-wave infarctions.     

高同型半胱氨酸对急性心肌梗死合并高血压患者行急诊PCI术后6个月心功能及死亡的影响

  目的   回顾性分析高同型半胱氨酸（homocysteine，Hcy）对急性ST段抬高型心肌梗死(ST-segment elevation myocardial infarction，STEMI)合并高血压患者急诊行经皮冠状动脉介入治疗（percutaneous coronary intervention，PCI）后6个月左心功能及死亡的影响。   方法   纳入2015年6月至2016年12月期间因STEMI合并高血压在联勤保障部队第九二O医院心内科行急诊PCI的患者78例，依据Hcy水平是否≥15.0 μmol/L分为STEMI合并H型高血压组、STEMI合并单纯高血压组各39例。比较两组患者一般资料如人口学特征、合并症、术前用药情况、相关检验结果等，PCI术中及住院期间相关数据如冠脉病变情况、术中手术情况、辅助治疗以及术后用药等，术后6个月左室射血分数及累计死亡的情况。   结果   性别、血肌酐、Hcy、病变血管支数对比组间有差异，具有统计学意义（P < 0.05）。住院左心室射血分数（left ventricular ejection fractions，LVEF）、6月LVEF、两次LVEF差值以及6月累计死亡，差异均无统计学意义（P > 0.05）。   结论   高Hcy对STEMI合并高血压患者行急诊PCI术后6月心功能及累计死亡无影响。     

High mean platelet volume after myocardial infarction: is it due to consumption of small platelets?

Seventy nine men surviving after sustaining a myocardial infarction in 1982, and who had at that time had raised mean platelet volumes compared with controls, were followed up after 18 months. The shape of each man's platelet distribution curve was calculated from the mean platelet volume, platelet count, and platelet distribution width. The calculated curves were in close agreement with the curves plotted by the Coulter counter from the raw data. These curves did not differ significantly from those of a current control group, but the curves plotted from the variables measured at the time of myocardial infarction in 1982 showed a deficit of platelets in the volume range 5-12 fl amounting at maximum to 30% (p less than 0.0001); there were no significant differences above 12 fl. The deficit of small platelets became more appreciable during initial admission, was less at one month's follow up, and had disappeared at one year. The deficit of small platelets is probably an effect rather than a cause of infarction.     

大鼠左冠状动脉不同结扎时间对心肌梗死面积及心功能的影响

目的:探索大鼠左冠状动脉前降支不同结扎处理后,对心肌形态学及心功能的影响,以建立适合移植干细胞再生修复心肌梗死研究的稳定、可靠和更合乎发病机理的动物模型。方法:雄性W istar大鼠70只,随机分为六组即:假手术组、结扎(15 m in、30 m in、45 m in、60 m in)再灌、结扎非再灌。于处理后1 d、1周、2周或4周动态观察心肌梗死变化,并于处理一月后测量动脉收缩压(ASP)、动脉舒张压(ADP)、左室收缩压(LVSP)、左室舒张末压(LV-EDP)及左室压力上升及下降最大速度(±dp/dtm ax)。结果:引起明显的心肌梗死至少需要结扎30 m in。结扎(45m in、60 m in)再灌、结扎非再灌的心肌梗死明显,并观察到梗死区域心肌已绝大部分纤维化,且梗死面积变化较恒定。同时测定不同结扎时间心功能的变化发现,结扎(45 m in、60 m in)再灌或结扎非再灌各组ASP、ADP、LVSP、±dp/dtm ax显著下降,LVEDP明显升高。并且不同结扎时间处理后,大鼠心功能的变化与心肌梗死后的梗死面积变化密切相关。结论:建立了在实验大鼠左冠状动脉前降支中上1/3处结扎45 m in以上的大鼠心肌梗死模型,不仅合乎临床心肌梗死的发病机理,而且梗死部位、梗死区域面积稳定,适合于移植细胞再生修复心肌梗死的研究。