不同年龄冠心病患者冠状动脉介入治疗临床特征分析

目的:比较不同年龄组接受冠状动脉介入治疗(PCI)的冠心病住院患者的临床特点,为加强冠心病的一级预防和二级预防提供依据。方法:收集2005年6月至2008年6月在安贞医院心脏内科接受PCI治疗的1428例冠心病患者住院期间的临床资料,对不同年龄组血压、血脂、血糖及吸烟等传统危险因素的合并及控制情况进行比较,并对住院期间的药物治疗情况进行分析和比较。结果:1.60岁以下的青、中年患者占47.7%;在接受PCI治疗的患者中女性在青、中年年龄组中的比例显著低于老年前期及老年组。2.各年龄组患者入院时有血脂异常和糖尿病的比例均较低,而合并高血压的比例较高。3.青年(45岁以下)、中年(45～59岁)、老年前期(60～74岁)和老年(75～89岁)各年龄组患者入院时有高血压、糖尿病的比例随着年龄的增加而增加,而吸烟、饮酒等不良生活习惯的患者比例随着年龄的增加而减少。4.各年龄组患者入院时血压、血糖及血清胆固醇的控制状况均较差。结论:目前住院接受PCI治疗的患者中,青、中年患者占了近50%,并且大部分患者血压、血糖和血清胆固醇均在正常范围,因此,在冠心病的一级预防和二级预防中除了控制传统的危险因素外,还应研究和预防其它心血管病发病的危险因素。     

冠心病患者血压和血脂及血糖达标率分析

目的分析经冠状动脉造影诊断为冠心病患者的血压、血脂和血糖达标率情况,评价其3个危险因素达标率对冠心病的影响。方法选择冠心病患者2916例,根据指南规定的达标标准,分析入院时的血压、血脂和血糖水平及出院时的血压水平。结果 291 6例冠心病患者血压以<130/80 mm Hg(1 mm Hg=0.13 kPa)为达标,入院时达标率28.4%,出院时87.5%;以<140/90 mm Hg为达标,入院时达标率65.8%,出院时90.0%。HDL-C和TG入院时达标率分别为23.0%和58.0%;978例高危患者LDL-C和TC入院时达标率分别为54.3%和49.5%,1 938例极高危患者LDL-C和TC入院时达标率分别为17.4%和5.8%。糖尿病患者538例,占冠心病的18.5%,入院时达标率仅为1.9%;糖尿病和空腹血糖受损者共1138例,占冠心病的39.0%。结论冠心病患者入院时血压、血脂和血糖的达标率相对较低,尤其以空腹血糖理想达标率及极高危患者LDL-C和TC达标率低为特点,提高冠心病患者的血糖、血脂和血压达标率,对于冠心病的二级预防极为重要。     

冠心病合并高脂血症患者血脂治疗达标分析

目的 了解冠心病合并高脂血症患者临床干预的达标情况.方法 利用电子病例管理系统回顾性检索2010年4月、5月首次住院的冠心病合并高脂血症患者115例,比较首次住院期间和随访期间血清总胆固醇、甘油三酯、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、谷丙转氨酶、谷草转氨酶等指标水平的变化,同时观察随访期间不良事件.结果 高危患者首次住院期间血清总胆固醇、低密度脂蛋白胆固醇、非高密度脂蛋白胆固醇达标率分别为22.1％、50％、35.3％;随访期间血清总胆固醇、低密度脂蛋白胆固醇、非高密度脂蛋白胆固醇达标率分别为57.4％、70.6％、70.6％.随访期间高密度脂蛋白胆固醇和非高密度脂蛋白胆固醇达标率均较住院期间有升高(P=0.024,P＜0.001).极高危患者首次住院期间血清总胆固醇、低密度脂蛋白胆固醇、非高密度脂蛋白胆固醇达标率分别为2.1％、19.1％、8.5％.随访期间血清总胆固醇、低密度脂蛋白胆固醇、非高密度脂蛋白胆固醇达标率分别为10.6％、46.8％、44.7％.高危患者的血清总胆固醇及低密度脂蛋白胆固醇达标率均高于极高危患者(均P＜0.001).肌痛发生率低,未见明显肝肾功能损害和横纹肌溶解,不良事件发生率低.结论 冠心病患者血脂干预与达标仍有距离,临床要重视高危和极高危患者的强化血脂治疗和达标.     

110例冠心病患者二级预防现况调查及随访分析

目的:对冠心病患者危险因素及二级预防的情况进行调查,了解冠心病二级预防的现状,探讨推广冠心病二级预防规范化治疗的效果。方法:对明确诊断为冠心病,并曾住院治疗的110例患者进行住院前及后续2年随访对危险因素的知晓及二级预防用药的情况。结果:110例冠心病患者与住院前比较,随访时对冠心病危险因素及二级预防,在知晓率、控制情况方面均有明显提高(P<0.05);住院时患者二级预防药物的使用是规范的(P<0.05),但除阿司匹林的服药率在随访2年时仍保持较高比例,与院内比率相近(P>0.05)外,冠心病患者未能长期坚持服用他汀类调脂药、β-受体阻滞剂、血管紧张素转化酶抑制剂或血管紧张素受体拮抗剂(P<0.05)3种药物。结论:冠心病二级预防规范化管理是提高冠心病患者二级预防依从性的重要手段之一。     

80岁以上冠心病患者二级预防及危险因素控制现状

目的:研究调查广州市80岁以上冠心病患者二级预防及危险因素控制现状。方法:对2016-03-05在我院体检的80岁以上冠心病患者进行横断面调查,共收集有效调查表752份(752例)。调查表内容包括基本情况、合并症、体重、血压、血脂、血糖水平及二级预防用药物使用情况等。结果:(1)用药情况:752例患者抗血小板聚集药物、β受体阻滞剂、他汀类药物、血管紧张素转换酶抑制剂(ACEI)/血管紧张素Ⅱ受体拮抗剂(ARB)类药物的服药率分别为55.72%(419例)、30.98%(233例)、25.13%(189例)、42.69%(321例);没有使用二级预防药物的患者占21.94%(165例);仅4.92%(37例)联合使用以上四种药物;(2)血压、空腹血糖、餐后2小时血糖、体重指数达标率分别为81.17%(470/579)、77.61%(253/326)、55.21%(180/326)、54.73%(266/486),以低密度脂蛋白胆固醇1.8 mmol/L为达标标准,达标率为14.06%(63/448)。结论:该调查人群中,指南推荐的四类药物使用率均较低,与指南要求差距较大,且危险因素达标情况不理想,如何提高二级预防合理用药,使指南与临床实践紧密结合,并且进一步控制危险因素降低冠心病复发率已成为广大医务工作者的重要任务。     

冠心病患者介入治疗后吸烟控制情况分析

目的了解冠心病患者接受经皮冠状动脉介入治疗术后吸烟的控制情况，分析其与循证医学指南的差距。方法选择在北京华信医院急诊科接受介入治疗并且出院后随访时间在180d的所有冠心病患者，分析其入院时与随访期吸烟情况的变化。结果在总共337例患者中，299例接受了6个月的随访（随访率为88．7％）。入院时与随访时的吸烟比率分别为47．5％（142／299）和23．1％（69／299，P=0．003）；入院时吸烟的患者在随访时仍吸烟者为35．9％（51／142），入院时无吸烟的患者随访时吸烟率为11．5％（18／157）；在随访期间将患者按年龄分组分析，结果显示：非老年组（≤65岁）患者的再吸烟率为52．8％（47／89），老年组（〉65岁）患者为41．5％（22／53），非老年组患者高于老年组（P=0．023）；老年组在随访期内戒烟率为49．1％（26／53），高于非老年组患者32．6％（29／89，P=0．012）；老年组随访期新发吸烟率为5．4％（5／93），低于非老年组20．3％（13／64，P=0．001）。结论冠心病患者在介入治疗后的吸烟控制情况不理想。应加强对冠心病患者的戒烟宣传教育，努力缩小临床实践与循证指南的差距。     

150例冠心病患者二级预防的效果

目的:调查分析本院冠心病人二级预防的效果。方法:对明确诊断为冠心病,并曾住院治疗的150例患者,进行门诊随访,以问卷的方式,对其冠心病二级预防的情况进行调查。所有患者均进行病史询问,汇总分析了解戒烟、控制血压、血糖,调脂治疗等的效果。结果:150例患者与住院前比较,住院后门诊随访的戒烟率(38%:58%),血压达标率(26.7%:68.7%)、血脂达标率(20.7%:54.0%)、血糖达标率(51.3%:72.7%)、运动达标率(7.3%:22.7%),以及使用阿司匹林、氯吡格雷、他汀类药物、β受体阻滞剂、血管紧张素转换酶抑制剂类有显著增加(P均0.05),说明二级预防的效果及依从性均有显著提高。结论:冠心病二级预防的效果甚好,应推广,普及。     

单中心冠心病患者对危险因素认知程度及控制现状的调查

目的分析我院门诊及住院的冠心病患者危险因素认知程度及控制现状。方法设计冠心病危险因素认知调查表,由经培训的调查员使用统一的调查表对患者进行面对面的问卷调查,分析2012—2014年我院门诊及住院诊治的经冠状动脉造影检查确诊的冠心病患者1 127例,所有患者均详细询问病史,检测血脂、血糖、糖化血红蛋白水平,行口服葡萄糖耐量试验,测量身高和体质量。结果 926例(82.2%)的患者认为应规律服用冠心病二级预防药物。患者对高血压是冠心病的危险因素知晓率最高,为65.22%(735/1127);对常见的4种危险因素全部知晓率为9.58%(108/1 127);经过住院宣教,出院后危险因素检出和控制情况:住院时吸烟的患者375例(33.27%),随访时下降至93例(8.25%)(P=0.002);住院时908例高血压患者中398例(43.83%)血压控制,随访时上升至662例(72.91%)(P=0.021);住院时共有757例(67.17%)血脂异常者,随访时下降至256例(22.72%)(P=0.002);住院时检出糖代谢异常者466例(41.35%),随访时检出672例(59.63%)(P=0.026)。结论本中心冠心病患者对疾病认知程度不甚理想,冠心病危险因素整体控制不佳,医务人员应进一步加强对患者冠心病二级预防的宣传教育。     

规范化二级预防对冠心病患者预后结局的影响

目的:探讨规范二级预防对冠心病患者预后结局的影响。方法:128例冠心病患者被随机分为二级预防组和常规治疗组,各64例。常规治疗组住院期间给予常规冠心病治疗,并作常规出院指导,半年随访1次。二级预防组住院过程中由专门医师负责,给予二级预防干预,出院后每月随访1次;对冠心病患者进行问卷调查,了解其对冠心病危险因素的掌握情况、出院后二级预防药物服用依从情况,评估各组危险因素控制、冠心病复发率等。结果:随访1年后,与常规治疗组比较,二级预防组危险因素知晓率(34.38%比78.18%)、危险因素(血压、血脂、吸烟、饮食、运动等)控制、出院后二级预防药物服用率(18.75%比87.50%)明显提高,临床事件[心力衰竭(18.75%比4.69%)、心绞痛(28.13%比6.25%)、再入院(21.89%比3.13%)、再发心肌梗死(15.63%比4.69%)]明显降低(P0.05或0.01)。结论:对冠心病患者实施规范化二级预防行之有效,值得在临床上推广。     

1864例老年冠心病患者诊疗状况及其预后的前瞻性研究

目的 探讨老年冠心病患者住院治疗和二级预防存在问题与防治策略. 方法 对北京市和天津市三级甲等中医或中西医结合医院老年冠心病患者进行前瞻性研究,利用冠心病个体化诊疗信息采集平台,采用纵向临床流行病学调查方法,实时采集冠心病住院患者临床资料及出院后1年的终点指标和事件发生情况,以相关指南为评价依据.评价老年冠心病患者诊疗状况,对影响终点指标和事件的相关因素进行单因素和多因素分析. 结果 1864例老年冠心病患者符合入选标准,男性1113例,女性751例.年龄60～98岁,平均(72.2±6.8)岁,主要并存疾病是高血压、糖尿病、脑血管病、高脂血症.入院时并存高脂血症患者血脂水平达标率分别为总胆固醇(TC)74.1%(1381例)、三酰甘油(TG)32.9%(613例)、低密度脂蛋白胆固醇(LDL-C)19.4%(362例)、高密度脂蛋白胆固醇87.8%(1637例);高血压患者收缩压达标率64.6%(857/1327),舒张压达标率84.7%(1124/1327).住院期间药物使用率:β受体阻滞剂69.6%(1297例),血管紧张素转化酶抑制剂或血管紧张素受体拮抗剂(ACEI或ARB)68.4%(1275例),他汀类调脂药63.6%(1186例),血运重建29.1%(391例).1682例患者完成随访观察,112例(6.0%)失访,随访期间心原性死亡72例(4.3%),其他原因死亡5例(0.3%),急性心肌梗死(AMI)9例(0.5%),血运重建15例(0.8%).多因素Logistic回归分析,可导致终点事件发生的因素有急性心肌梗死、心功能不全.可防止终点事件发生的因素有他汀调脂药物、无并存周围血管疾病、血运重建、中西医结合治疗、年龄<75岁. 结论 北京市和天津市中医及中西医结合医院老年冠心病患者在血脂达标(TG、LDL-C)方面不足,血运重建有待加强,ACEI或ARB、β受体阻滞剂和他汀类调脂药和相关指南的要求尚有差距,冠心病二级预防有待加强,规范地遵循指南从事医疗实践,多种危险因素共同控制、综合干预是预防老年冠心病患者心血管事件的主要策略.     

Changes in smoking behavior and adherence to preventive guidelines among smokers after a heart attack

Objective Risk factor modification is key to preventing subsequent cardiac events after a heart attack. This study was designed to investigate the disparity between preventive guidelines and clinical practice among smoking patients. Methods The study was carried out in smokers admitted with myocardial infarction (MI). A total of 275 patients who had been regularly followed for over one year after MI were randomly selected and enrolled in this study. We investigated changes in smoking behavior and the adherence rate to ACC/AHA Guidelines for secondary prevention in patients with coronary artery disease at the time of, and one year after, the index event. Results The study population consisted of 275 patients (97.1% males) with a mean age of 57.0 ± 11.2 years. Achievement of target goals at one year was as follows: smoking cessation, 52.3%; blood pressure, 83.9%; HbA1c, 32.7%; lipid profile, 65.5%; and body mass index (BMI), 50.6%. Over one year, 80% of the patients attempted to quit smoking; 27% of them re-started smoking within one month after discharge while 65% succeeded in cessation of smoking. At one year, only 52% of the patients overall had stopped smoking. From the multivariate logistic analysis including smoking patterns and clinical characteristics, the severity of coronary artery disease was the only independent predictor for smoking cessation (Relative risk (RR): 1.230; P = 0.022). Conclusions Only a small percentage of MI patients adhere to guidelines for secondary prevention and a sizable proportion fail to stop smoking. These findings underscore the need for an effective patient education system.     

Registration and management of smoking behaviour in patients with coronary heart disease. The EUROASPIRE survey.

AIMS: To establish to what extent smoking status and its management is recorded in coronary patients' medical records, and to investigate their motivation to change smoking behaviour. METHODS: In EUROASPIRE, a survey on secondary prevention in 21 hospitals in the Czech Republic, Finland, France, Germany, Hungary, Italy, the Netherlands, Slovenia and Spain, data were collected from records of 4863 consecutive patients =<70 years of age, with previous (>6 months) admission for coronary bypass operation, angioplasty, myocardial infarction or ischaemia. Of these, 3569 patients were interviewed 1.6 years following their index hospitalization. RESULTS: Of the 82% of patients whose pre-hospitalization smoking behaviour was known, 34% were smokers. Documentation was significantly better in younger patients, in males and patients requiring angioplasty or bypass operation. In only 35% of 1364 smokers was the smoking habit recorded again after discharge from hospital At the time of the interview, 554 of the interviewed patients were still smoking. In over 90% of the smokers, advice to quit smoking was reported at interview. A positive relationship was found between receiving advice and seeking help to stop smoking, between receiving advice to stop smoking and attempting to stop, as well as between seeking help and attempting to stop. CONCLUSION: In almost 20% of coronary patients, smoking habits are not documented in medical records, and in only 35% of the smoking patients is smoking status documented at the follow-up. After a cardiac event requiring hospitalization as many as 50% of patients continue their smoking habit and so there is further potential to reduce the risk of recurrent coronary disease. Advice to stop smoking motivates patients to seek help and to attempt to stop smoking. Physicians repeated advice to stop smoking is important and smoking status should always be documented at follow-up.     

Knowledge and perception of guidelines and secondary prevention of coronary heart disease among general practitioners and internists. Results from a physician survey in Germany.

AIMS: This study investigated knowledge and perception of guidelines in secondary prevention of coronary heart disease and the impact of guideline knowledge on treatment practices in coronary patients among primary care physicians. DESIGN AND METHODS: A representative questionnaire survey was performed in 2002-2003 among all 1023 general practitioners and office-based internists in the Region of Münster, Germany. The survey instrument contained questions on knowledge and attitudes toward guidelines, risk factors and treatment practices in secondary prevention of coronary heart disease. RESULTS: In total, 681 (66.6%) physicians participated. Seventy percent of physicians reported knowledge of at least one guideline. Participants expressed mainly positive attitudes toward guidelines but also reported important barriers to their implementation such as lack of reimbursement. Only 63 and 32%, respectively, reported to start antihypertensive and lipid-lowering treatment according to guidelines. Physicians reporting guideline knowledge were more likely to initiate lipid-lowering treatment of elevated low-density lipoprotein (LDL)-cholesterol [odds ratio (OR) 2.3; 95% confidence interval (CI) 1.5-3.5], to intensively advise overweight patients (OR 1.5; 95% CI 1.0-2.5), to make use of nicotine replacement therapy or cessation courses in smoking patients (OR 1.7; 95% CI 1.2-2.4), and to comply with an overall measure of guideline adherence (OR 1.8; 95% CI 1.1-2.8). CONCLUSIONS: In this study, guideline knowledge led to improved cardiovascular risk factor treatment among GPs and internists. Many physicians, however, do not treat coronary patients according to evidence-based guidelines. Further dissemination of guidelines and educational efforts are essential to improve secondary prevention of coronary heart disease.     

Antiplatelet therapy for postdischarge medical management of acute coronary syndrome

Postdischarge management of patients with acute coronary syndrome is often suboptimal, despite their high risk of a subsequent event. Updated American College of Cardiology/American Heart Association guidelines emphasize the need for aggressive modification of risk factors and treatment with antiplatelet, antihypertensive, and lipid-lowering agents commenced in-hospital and continued long-term. Antiplatelet therapy involving aspirin and clopidogrel is the mainstay of secondary risk reduction. Increased adherence to medication and risk factor modification at discharge has been demonstrated with acute care quality improvement initiatives. Extension of these initiatives to postdischarge care will provide data on medication adherence post acute coronary syndrome and functional outcomes in the community setting. Successful secondary prevention of cardiovascular events requires implementation of evidence-based guidelines by physicians, and adherence to pharmacotherapy and lifestyle modifications by patients. Primary care physicians are well placed to influence adherence through their ongoing relationships with patients and can save lives by implementing secondary risk reduction measures after discharge.     

襄阳市急性冠脉综合征患者出院后服药情况和相关因素分析

目的 观察和分析襄阳市急性冠脉综合征患者服药情况和相关因素。方法 收集我院已诊断急性心肌梗死或不稳定型心绞痛患者,使用标准的问卷来研究患者坚持服药以及未坚持服药的原因,采用logistic回归分析出院后6个月与12个月的服药情况。结果 在出院的时候药物治疗比例很高（98%服用阿司匹林,85%服用β-受体拮抗剂,97.8%服用他汀类药物）,但是在随后的随访中服药比例是减少的。只有72%的出院患者同时服用4种药物（阿司匹林,倍他乐克,血管紧张素转换酶抑制剂或血管紧张素受体拮抗剂和他汀类药物）。而在出院后1年服药比例减少至52.9%,使用logistic回归分析提示在出院以及随访中,医疗保险、血脂异常、高血压病和介入治疗为重要的服药的相关因素,而医生对很大比例的患者服药情况未予宣教,部分药物费用过高也是影响坚持联合用药的原因。结论 襄樊市已诊断急性冠脉综合征患者出院1年时按规范服药率为52.9%,影响服药依从性的因素是是否患有并发症、宣传不到位和费用高。     

Depressive symptoms and smoking cessation after hospitalization for cardiovascular disease

BACKGROUND: Although smoking cessation is essential for prevention of secondary cardiovascular disease (CVD), many smokers do not stop smoking after hospitalization. Mild depressive symptoms are common during hospitalization for CVD. We hypothesized that depressive symptoms measured during hospitalization for acute CVD would predict return to smoking after discharge from the hospital. METHODS: This was a planned secondary analysis of data from a placebo-controlled, double-blind, randomized trial of bupropion hydrochloride therapy in 245 smokers hospitalized for acute CVD. All subjects received smoking counseling in the hospital and for 12 weeks after discharge. Depressive symptoms were measured during hospitalization with the Beck Depression Inventory (BDI), and smoking cessation was biochemically validated at 2-week, 12-week, and 1-year follow-up. The effect of depressive symptoms on smoking cessation was assessed using multiple logistic regression and survival analyses. RESULTS: Twenty-two percent of smokers had moderate to severe depressive symptoms (BDI >or= 16) during hospitalization. These smokers were more likely to resume smoking by 4 weeks after discharge (P= .007; incidence rate ratio, 2.40; 95% confidence interval, 1.48-3.78) than were smokers with lower BDI scores. Smokers with low BDI scores were more likely to remain abstinent than were those with high BDI scores at 3-month follow-up (37% vs 15%; adjusted odds ratio, 3.02; 95% confidence interval, 1.28-7.09) and 1-year follow-up (27% vs 10%; adjusted odds ratio, 3.77; 95% confidence interval, 1.31-10.82). We estimate that 27% of the effect of the BDI score on smoking cessation was mediated by nicotine withdrawal symptoms. CONCLUSIONS: Moderate to severe depressive symptoms during hospitalization for acute CVD are independently associated with rapid relapse to smoking after discharge and lower rates of smoking cessation at long-term follow-up. The relationship was mediated in part by the stronger nicotine withdrawal symptoms experienced by smokers with higher depressive symptoms.     

Secondary prevention strategies for coronary heart disease

Patients with established coronary heart disease (CHD) have a high risk of subsequent cardiovascular events, including myocardial infarction (MI), stroke, and death from cardiovascular disease. Adherence to evidence-based secondary prevention therapies for CHD has improved in recent years but still remains suboptimal. Mortality from CHD in the United States (US) has decreased substantially in recent decades. The decline in US deaths from CHD from 1980 through 2000 has been attributed to reductions in major risk factors and utilization of evidence-based medical therapies. It has been estimated that optimization of secondary prevention strategies could save as many as 80,000 more lives per year in the US. The American College of Cardiology (ACC) and American Heart Association (AHA) updated its guidelines for secondary prevention for patients with atherosclerotic vascular disease in 2006. The guidelines emphasize evidence-based developments in the field of CHD secondary prevention and also reinforce the need to implement these recommendations in actual clinical practice through programs such as the ACC’s Guidelines Applied to Practice and the AHA’s Get With The Guidelines. This review will discuss the epidemiology and risk assessment of CHD, current pharmacologic and nonpharmacologic strategies available for the secondary prevention of CHD, and summarize the guidelines and evidence that support these treatment options. There will be an emphasis on antiplatelet therapy given the important role of thrombosis in clinical cardiovascular events.     

One-year outcome of patients after acute coronary syndromes (from the Canadian Acute Coronary Syndromes Registry)

The objective of this study was to determine the management and outcome of fewer selected patients with an acute coronary syndrome during hospitalization and up to 1 year after discharge. The Canadian Acute Coronary Syndromes Registry was a prospective observational study of patients admitted with suspected acute coronary syndromes. Data on demographic and clinical characteristics, in-hospital treatment, and outcomes were recorded. At 1 year, vital status, medication use, recurrent cardiac events, and procedures were determined by telephone contact. Of the 5,312 patients enrolled, 4,627 had a final diagnosis of acute coronary syndrome, with Q-wave myocardial infarction in 27.7%, non-Q-wave myocardial infarction in 33.2%, and unstable angina pectoris in 39.1%. During hospitalization, coronary angiography and revascularization were performed in 39.6% and 20.3% of patients, respectively. The in-hospital mortality rate was 2.4% overall. At discharge, 87.8%, 76.4%, 56.0%, and 54.8% of patients were prescribed aspirin, β blockers, angiotensin-converting enzyme inhibitors, and lipid-lowering agents, respectively. Unadjusted 1-year mortality rates for hospital survivors were 6.5%, 10%, and 5.4% for those with Q-wave myocardial infarction, non-Q-wave myocardial infarction, and unstable angina pectoris groups, respectively (p <0.0001). This difference in mortality rate remained significant after adjusting for other prognosticators, whereas the use of coronary angiography and revascularization after discharge was similar across patients. At 1 year, fewer patients were maintained on aspirin and β blockers, whereas the use of lipid-lowering therapy increased (all p <0.0001). Despite similar rates of coronary angiography and revascularization after discharge, patients with non-Q-wave myocardial infarction had worse outcomes at 1 year. Moreover, there was a significant opportunity to enhance the discharge and long-term use of evidence-based secondary prevention therapies.     

The Reliability of Smoking History Amongst Survivors of Myocardial Infarction

One hundred and seventeen survivors of a first attack of acute coronary heart disease had blood carboxy-haemoglobin levels checked and smoking histories recorded. All were participants in a longterm follow-up and secondary prevention programme. At last follow-up, four to eighteen years after the initial attack, 35 stated that they were still smoking, 57 claimed to be ex-smokers, 6 were non-smokers and 19 were pipe or cigar smokers. Thirty-one of the 35 current smokers had a COHb concentration which exceeded 1.6 %. Five of the ex-smokers had concentrations between 1.6 and 2.3%. There was a low and possibly zero deception rate amongst the ex-smokers. This may reflect a high degree of rapport achieved between patients and medical staff during an exceptionally long and regular follow-up period.