Criteria for stable angina verification in cases of difficult diagnosis

The purpose of the study was to develop specific angiographic criteria of stable exertional angina (SEA) in patients with possible old myocardial infarction (MI). The subjects were 23 patients with uncertain signs of old MI. In 16 patients SEA was excluded after performing maximal loading test (LD). In 7 patients SEA was verified by LD (angina-like discomfort and ST segment depression by at least 0.2 mV). All the patients underwent selective coronarography. The specificity of conventional angiographic criteria of CHD (stenosing of any magistral coronary artery with the reduction of its lumen by at least 50-75%) in diagnostics of SEA in patients with possible old MI is not higher than 56.3 +/- 12.8%. The authors developed angiographic criteria system, which allows detection of SEA with a diagnostic precision of 95.7 +/- 4.3% in patients with uncertain signs of old MI. These criteria significantly increase accuracy of differential diagnosis between SEA and isolated painless myocardial ischemia in patients with hemodynamically significant lesions of the vascular system.     

Diagnostic and prognostic aspects of angina pectoris preceding myocardial infarction in long-term follow-up

AIM: To trace relations of premyocardial infarction (preMI) angina, myocardial reserves and clinical peculiarities within a year of outpatient follow-up. MATERIAL AND METHODS: Coronary and myocardial reserves were studied in 320 MI survivors using veloergometry, transesophageal pacing (TEP), 24-h ECG monitoring, echocardiography. Cardiac output reaction to TEP was assessed. RESULTS: Patients with preMI attacks of stable angina had coronary reserve 47.9% less than they had before MI while cardiac failure by NYHA criteria aggravated by 33.3%. Myocardial ischemia at bicycle exercise in these patients developed much later and its threshold rose by 34.2%. The degree of cardiac ejection fall in TEP in patients without angina before MI was 2.4 times greater than in patients without history of IHD. There were specific features of diastolic relaxation of the myocardium and variability of cardiac rhythm in the compared groups though the groups did not differ significantly by arrhythmia events and morphological characteristics of the scar zone. Survival showed a tendency to lowering of lethal outcome risk in the compared groups followed up since the observation month 6 without significant differences depending on the presence of preMI angina. CONCLUSION: PreMI angina contributes to formation of coronary and myocardial reserves which are better to assess at TEP and with analysis of hemodynamic reaction to induced rise in heart rate.     

Immediate and long-term outcomes after "Ephesos" coronary stent implantation in patients with stable or unstable angina

AIM: An open non-randomized trial was initiated to assess clinical and angiographic results of using the coronary stent "Ephesos" in 457 patients with stable or unstable angina pectoris and native coronary affections. MATERIAL AND METHODS: 268 stents have been implanted in 231 patients with stable angina (SA) and 271 stents--in 226 patients with unstable angina (UA). 46% lesions were complicated. The length of stenosis was 12.9 +/- 6.7 mm in the group SA and 14.1 +/- 7.4 mm in the group UA, 30% stenoses were long. RESULTS: Successful stenting was stated in 99% without cases of acute thrombosis. Non-fatal myocardial infarction took place in hospital in 1.3% of SA patients and in 2.6% of UA patients. Incidence of cardiac complications (death, recurrent angina pectoris, myocardial infarction, restenosis, repeated revascularization) for 6-month follow-up was 15.6% in SA group and 18.1% in UA group. At angiographic control, the index of vascular diameter loss made up 0.22 +/- 0.2 in SA group and 0.3 +/- 0.27 in UA group. Incidence of restenosis was 12 and 14%, respectively. 18-month follow-up found no differences in frequency of complications: 21.6 and 22.6% in groups SA and UA, respectively. CONCLUSION: Implantation of the stent "Ephesos" is effective in prevention of thrombosis and restenosis in patients with stable or unstable angina pectoris at high risk of intervention.     

The ratio of plasma to whole-blood serotonin may be a novel marker of atherosclerotic cardiovascular disease

Because atherosclerotic vascular lesions stimulate platelets, the platelets release serotonin (5-hydroxytryptamine, aka 5-HT). We therefore measured 5-HT concentrations not only in platelet-poor plasma but also in whole blood as a means of assessing vascular lesions. The plasma concentration of 5-HT tended to increase with age, whereas that in whole blood decreases. Therefore the ratio of the plasma to the whole-blood concentration of 5-HT (P/WB) increases with age. This may be a result of the activation of platelets in older subjects with atherosclerotic vascular damage. Patients who underwent coronary angiography (CAG) were classified into 4 groups according to diagnosis: effort-induced angina pectoris (eAP), old myocardial infarction (OMI), vasospastic angina pectoris (VSAP), and unstable angina (uAP). The mean plasma 5-HT concentration was significantly (P <.01) greater in patients with eAP, uAP, OMI, and VSAP than in healthy controls, whereas the concentration in whole blood was lower in patients with eAP than in healthy controls. When the P/WB ratios were calculated, the mean levels in all disease groups were significantly higher than that in the healthy controls. These findings suggested that 5-HT is released into the plasma from the platelets and that the concentration in the platelets decreases in patients with atherosclerosis.     

Early postoperative complications and prevention of them in ischemic heart disease patients after direct myocardial revascularization

AIM: To specify risk factors affecting development and frequency of complications early after the bypass operation in direct myocardial revascularization. MATERIAL AND METHODS: 455 patients with ischemic heart disease (IHD) of whom 392 (86.2%) had stable angina pectoris class III-IV, 25 (5.5%) had unstable angina pectoris (UAP) and 38 (8.5%) had survived myocardial infarction (MI) underwent autovenous coronary artery bypass operation. IHD combined with arterial hypertension in 103 (22.6%), diabetes mellitus type II in 67 (14.7%), cardiac failure (CF) stage IIa in 97 (21.3%) patients. The ejection fraction (EF) was 37.8 +/- 3.3% in 113 (24.8) patients, in the others it was 46.7 +/- 2.7%. RESULTS: Early postoperative complications arose more frequently in patients with UAP, MI, CF and low EF. Postoperative acute cardiovascular failure was registered in 132 (29.5%) patients, arrhythmia--in 60 (13.4%), perioperative MI--in 13 (2.9%) patients. CONCLUSION: The most significant risk factors of postoperative complications in the above patients are the following: UAP, MI, CF, low EF. These risk factors should be allowed for in preparation of patients for coronary bypass surgery.     

Pharmacologic stress echocardiography predicts total mortality early after acute myocardial infarction.

OBJECTIVE: The aim of this multicenter, prospective, observational study was to assess the value of inducible ischemia in a large population of survivors of a first uncomplicated myocardial infarction (MI). METHODS AND RESULTS: Pharmacologic stress echocardiography either with high-dose dipyridamole (0.84 mg/kg over 10 minutes) or high-dose dobutamine (up to 40 microg/kg over 3 minutes) (DET) was performed 9 +/- 10 days after a first acute uncomplicated MI in 1681 patients (1499 males; 57 +/- 10 years) with technically satisfactory rest echocardiographic study. Patients were followed up for a mean of 16 +/- 18 months (range: 1-122). DET was positive for myocardial ischemia in 884 (52.5%) and negative in 797 (47.5%) patients. During the follow-up there were 49 deaths for all-cause mortality (2.9% of the total population), 22 of which were cardiac; 62 (3.6%) nonfatal MIs; and 164 (9.7%) hospital readmissions for unstable angina. In all, 376 patients (22%) underwent coronary revascularization (bypass operation or angioplasty). RESULTS: Hard events occurred in 71 of the 884 patients with positive and in 40 of the 797 patients with negative DET (8% vs 5%, P =.014). Using the Cox proportional hazards model, age (relative risk [RR] 1.07, 95% confidence interval [CI] 1.03-1.1), history of angina (RR 3.8, 95% CI 1.6-8.6), peak wall-motion score index (RR 2.2, 95% CI 1.1-4.4), and pharmacologic dose at ischemia (RR 1.5, 95% CI 1.04-2.3) were independent predictors of all-cause death. CONCLUSIONS: In survivors of a first acute uncomplicated MI DET allows effective risk stratification on the basis of the presence, severity, and extent the induced ischemia.     

小心肌梗死的MRI诊断

目的：探讨小心肌梗死的MRI诊断价值;材料和方法：对12例心绞痛患者进行MRSE和MR电影成像,分析MRI表现与心肌核素显像（单光子发射计算机断层,SPECT）、冠状动脉狭窄和临床表现的关系;结果：12例心绞痛中MRI（T2WI和Gd－DTPAT1WI）发现5例有高信号的小心肌梗死灶（≤2cm）,与无高信号病冽（7例）相比,其心绞痛持续时间长、硝酸甘油效果差,冠状动脉狭窄严重,SPECT有明显局限性灌注缺损或稀疏区,心酶谱阳性率高,心电图有缺血表现（P＜0.05）;结论：MRI是检测小心肌梗死敏感而有效的方法。     

Assessing the clinical and economic burden of coronary artery disease: 1986-1998

BACKGROUND: The acute phase of coronary artery disease (CAD) is dramatic and receives much attention because of its high mortality and associated treatment cost. However, the acute phase typically resolves within 30 days whereas CAD is a chronic disease, which most patients will live with for more than a decade. We compared the clinical and economic burden of CAD during the acute phase (first 30 days) with that in the postacute phase (31st day through 10 years). METHODS: We included acute coronary syndrome (ACS) patients with significant CAD receiving an initial cardiac catheterization at Duke University Medical Center between 1986 and 1997 with follow-up continuing through 1998. Inpatient medical costs were estimated from ACS clinical trial and economic study data. Costs were adjusted to 1997 values and discounted at 3% per annum. RESULTS: Our study included 9,876 ACS patients (5,557 with an acute myocardial infarction [MI] and 4,319 with unstable angina [UA]). Acute MI patients had higher 30-day mortality than UA patients (5.6% vs. 2.3%, P <0.001). In addition, acute MI and UA patients had significant 10-year unadjusted and adjusted survival differences (both P <0.001). For patients who survived to 30 days, there was no difference in 10-year survival between acute MI and UA patients before adjustment (P = 0.472). After adjustment, however, unstable angina patients who survived to 30 days had greater survival than myocardial infarction patients (P = 0.011). Mean 10-year discounted ACS inpatient medical costs were $45,253 ($23,510 acute phase and $21,819 postacute phase, P = 0.002). Ten year costs for unstable angina patients were $46,423 ($21,824 acute phase and $24,599 postacute phase, P = 0.003); ten year costs for myocardial infarction patients were $44,663 ($24,823 acute phase and $19,840 postacute phase, P <0.001). CONCLUSIONS: We found that the clinical and economic burden of CAD continues long after a patient's acute event has resolved and that postacute CAD cardiac event rates and inpatient medical costs may be higher than previously estimated. With much of all medical costs occurring in the postacute phase, the potential for effective secondary prevention therapies is substantial.     

Morning cortisol production in coronary heart disease patients

BACKGROUND: The circadian cycle of the endogenous anti-inflammatory system (EAIS) is characterized by a morning increase in cortisol production. Circulating interleukin-6 (IL-6) activates the EAIS. A circadian variation in the onset of myocardial infarction, sudden death, stable angina (SA) and unstable angina (UA) has been reported. The aim of this study was to determine morning cortisol production in coronary heart disease (CHD) patients. MATERIALS AND METHODS: Serum cortisol and IL-6 were measured in 129 patients with either SA (n = 65) or UA (n = 64) and 40 healthy volunteers. Blood samples were taken between 9 : 00 h and 12 : 00 h. The upper normal range of cortisol (25 microg dL-1) was used as a reference to classify patients. RESULTS: Forty-eight patients had elevated cortisol levels (ECL) (32.5 +/- 5.4 microg dL-1), while 81 patients had normal cortisol levels (NCL) (15.7 +/- 5.9 microg dL-1). In NCL patients, IL-6 levels (26.6 pg mL-1, ranged from 0.2 to 183.7) were significantly higher (P < 0.004) than in ECL patients (9.70 pg mL-1, range 0.07-56.5). Forty-eight patients with UA belonged to the NCL group of patients, while only 16 UA patients belonged to the ECL group (chi(2) = 0.000). Thirty-two patients with SA belonged to the ECL group, and 33 to the NCL group (chi(2) = 0.08). CONCLUSIONS: Patients with 'inappropriately' normal morning cortisol production had high IL-6 levels. 'Inappropriately' normal cortisol, detected in 75% of UA and 50% of SA patients, may be insufficient for limiting inflammation. These findings have novel clinical implications and suggest new therapeutic approaches in the treatment of these patients.     

Monitoring myocardial infarct (diagnostic combination,prodromal period,behavioral characteristics) using the WHO program "Registry of Acute Myocardial Infarct", Monica

AIM: A 22-year study of diagnostic categories of myocardial infarction (MI), a prodromal period, behavioral characteristics of the patients. MATERIAL AND METHODS: WHO programs Acute Myocardial Infarction Register and MONICA were performed in Novosibirsk population aged 25-64 years. From January 1, 1977, to December 31, 1998, monitoring registered 5180 cases of MI (1774 lethal outcomes). RESULTS: The diagnostic category "Possible" MI occurred more frequently than "definite" MI, this difference being more noticeable in women than in men. In both diagnostic categories the disease presented with a typical clinical picture. In the category "definite" MI there were many cases of atypical disease. Most cases of MI developed at home though it occurred outdoors more frequently in men and at home in women. Half of the patients had arterial hypertension (AH) and effort angina (EA), one third of the patients had survived MI before. 91% of MI men were heavy smokers. Alcohol intake at MI onset was insignificant. Pain syndrome 2 weeks before MI was the same in survivors and the deceased. Those who died suddenly felt extremely tied before MI, those whose death was not sudden experienced exacerbation of EA and dyspnea, those who survived experienced exacerbation of EA. CONCLUSION: Long-term monitoring showed that MI clinical presentation did not differ for 2 decades. A significant number of MI patients with a history of hypertension, effort angina, previous MI, heavy smoking evidenced for the lack of prophylactic education among population.     

Diagnosis of perioperative myocardial infarction by considering relationship of postoperative electrocardiogram changes and enzyme increases after coronary bypass operation

We report the results of enzyme determinations in sera from 88 patients, 65 of whom showed inconspicuous reconvalescence, 14 who had myocardial infarction within 24 h (MI 1) after bypass surgery, and nine with myocardial infarction between 24 and 48 h postoperatively (MI 2). We wanted to determine whether the consequent measurement of activities of total creatine kinase (CK), CK isoenzyme MB (CK-MB), lactate dehydrogenase, alpha-hydroxybutyrate dehydrogenase, and aspartate aminotransferase, conducted as a part of routine laboratory diagnostics, provided meaningful information for diagnosing infarcts besides that obtained from the electrocardiogram. The postoperative mean values of the enzyme activities in blood were significantly different among the three groups; however, only a combined evaluation of CK and CK-MB by means of a discriminant analysis allowed the prediction of MI (sensitivity: MI 1 = 98.5%, MI 2 = 95.4%; specificity: MI 1 = 71.4%, MI 2 = 81.8%). CK greater than 600 U/L or CK-MB greater than 45 U/L supports the diagnosis of acute MI.     

Cardiac hypertrophy in athletes

The diagnostic and prognostic value of symptom limited exercise tests (ET) performed before discharge and after one month were compared in men admitted to hospital after an episode of unstable angina or a non-Q-wave myocardial infarction (MI). A ‘Positive ET’ was defined as either a maximal work load below 100 W or ST-depression ≥0.1 mV in 1–2 leads below 130 W or ST-depression ≥0.1 mV in more than 2 leads at any load at the ET. During follow-up, severe angina was the only indication for coronary angiography and revascularization. There were no significant differences in diagnostic findings between the tests — Positive ET in 47% and Negative ET in 25% at both ETs. The occurrence of MI or death and the need of revascularization were related to signs of ischemia at both ETs. There were no differences in prognostic value between the early and late tests regarding MI or death or future severe angina during the 11 months' follow-up after the one month ET. However, half (10%) of the overall event rate (20%) during the one year follow-up occurred during the first months. The risk of these events could be identified by the predischarge but, for obvious reasons, not by the one month ET. Therefore, the present study suggests that a symptom limited ET should be performed before discharge in men stabilized after an episode of unstable angina or non-Q-wave MI.     

Can changes in systolic longitudinal deformation quantify regional myocardial function after an acute infarction? An ultrasonic strain rate and strain study.

OBJECTIVES: The aim of this study was to evaluate the additional value of ultrasonic strain rate and strain to myocardial velocity in the identification and quantification of regional asynergy after an acute myocardial infarction (MI). METHODS: Forty patients (59 +/- 13 years) were investigated 3 +/- 2 days after a first infarction and compared with 14 age-matched controls with normally contracting segments (group A, n = 146). Longitudinal myocardial velocities, strain rate (SR) and strain (epsilon) were postprocessed from basal, mid, and apical segments interrogated using apical views. In a subset of patients with coronary angiograms (n = 24), myocardial segments were divided into 3 groups: normally contracting segments supplied by a normal coronary artery (group B1), normally contracting segments supplied by a diseased coronary artery (group B2), and segments with abnormal motion (group B3). Velocities were decreased in patients with myocardial infarction (MI) (P <.05 vs controls) but failed to accurately differentiate normally from abnormally contracting segments. At the opposite end, systolic SR and epsilon decreased significantly with segmental asynergy severity and could identify infarct-involved segments (group B3) with a sensitivity/specificity of 85% (systolic SR and epsilon cutoff values of -0.8 s(-1) and -13%, respectively). CONCLUSION: Strain rate and strain can better assess segmental dysfunction severity than myocardial velocities alone after an acute MI.     

Multicenter Study of Creatine Kinase-MB Use: Effect on Chest Pain Clinical Decision Making

Objective: To determine whether creatine kinase-MB isomer (CK-MB) levels affect initial physician decisions regarding patients with potential cardiac chest pain.
Methods: A prospective, multicenter, observational cohort study was performed at seven university teaching hospital EDs. Hemodynamically stable chest pain patients >25 years old and without ST-segment elevation on their ECGs were observed with one to two sets of CK-MB level determinations obtained three hours apart prior to disposition. The physicians committed to a dichotomous (yes/no) absolute decision regarding the diagnosis of myocardial infarction (MI), need for hospital admission, and need for coronary care unit (CCU) admission both before and after enzyme results were obtained. The physicians ranked the perceived importance of initial history and physical, serial clinical observation, initial ECG, and CK-MB level to their decision making (rank score: 1 = most important, 4 = least important).
Results: Of the 1,042 patients enrolled, 777 (74.6%) were admitted to the hospital. For the 67 MI patients (8.6% of the admissions), changes in absolute decisions about the diagnosis of MI and planned CCU admission were associated with increased CK-MB importance (p = 0.04 and p = 0.02, respectively). Of the 146 patients who had new-onset angina or unstable angina, changes in absolute decisions were not associated with CK-MB importance. No patient who had MI or unstable angina was released from the ED. There were three of 67 (4%) MI patients and one of 146 (1%) unstable/new-onset angina patients initially slated for release home who were admitted to the hospital.
Conclusions: For a minority of the patients who had subsequently proven MI, the CK-MB result helped guide disposition decisions. The CK-MB availability did not adversely impact the disposition of the patients who had unstable or new-onset angina.     

Dobutamine stress echocardiography early after myocardial infarction treated with thrombolysis

The aim of the study was to assess the ability of dobutamine stress echocardiography to detect myocardial viability and ischemia in patients with acute myocardial infarction treated with thrombolysis and to correlate the acute response to dobutamine with late spontaneous functional recovery at follow-up. Forty-two consecutive patients with myocardial infarction treated with thrombolysis underwent low- (5 and 10 mcg/kg/min) and high-dose (20 to 40 mcg/kg/min) dobutamine stress echocardiography at a mean of 7 ± 3 days of the acute phase. A follow-up 2D-echocardiogram was performed in all patients to evaluate the spontaneous recovery of function in the infarct area. On the basis of the response to the test, 3 groups of patients were identified: group 1 included 7 patients showing an improvement in left ventricular asynergy score index at low doses (from 1.5±0.3 to 1.3±0.2, p<0.05) with no deterioration at high doses, indicative of myocardial viability without ischemia; group 2 (23 patients) showed a significant improvement in the asynergy index at low doses (from 1.58±0.3 to 1.32±0.32, p<0.05) followed by a deterioration at high doses (1.68±0.4, p<0.05 vs low-dose), suggestive of residual myocardial ischemia in the infarct zone; group 3 included 12 patients who showed no significant changes in the baseline asynergy score index (1.67±0.2) either at low or at high doses. The acute response to dobutamine stress echocardiography accurately predicted the spontaneous recovery of function in the infarct area at follow-up: both group 1 and group 2 patients showed a significant reduction in the asynergy score index (group 1: 1.16±0.3 vs 1.5±0.2, p<0.001; group 2: 1.43±0.3 vs 1.58±0.3, p<0.05), while group 3 had no recovery in the asynergy index (1.67±0.2 vs 1.67±0.2). Thus, in patients with acute myocardial infarction treated with thrombolysis dobutamine stress echocardiography can detect myocardial viability in 71% and ischemia in the infarct zone in 55% of patients; moreover, the response to the test during the acute phase is correlated with the degree of the late spontaneous recovery of function in the infarct area.     

Characteristics of the pathogenesis, manifestations and clinical course of psychogenically induced myocardial infarctions

With the purpose of investigating peculiarities of psychogenically induced myocardial infarction (PIMI) 82 patients with primary myocardial infarction (MI) were chosen as the subjects of the given controlled study and divided into two groups. The main group consisted of 33 patients, the rest 49 formed the control group. The study showed that coronary atherosclerosis was more pronounced in the patients of the main group, among whom cases of exertional angina in past history were more frequent, and who had more pronounced coronary calcinosis compared to the patients of the control group. At the same time, the clinical course of MI in such patients is relatively benign, but it is more often complicated by early postinfarction angina. All this suggests that the pathogenesis of PIMI differs from that of "classic" MI. In particular, PIMI may be associated with the involvement of more distant parts of coronary vessels. Patients with PIMI seem to need to be regarded as having high risk of repeated coronary disasters.     

Myocardial perfusion and wall motion in infarction border zone: assessment by myocardial contrast echocardiography.

Several mechanisms have been proposed to explain the decreased wall motion (WM) at the borders of myocardial infarction (MI). We used myocardial contrast echocardiography (MCE) to investigate the relation of perfusion to WM in infarcted border zones (BZs) 6 weeks after MI in 5 sheep. After quantifying the extent of WM abnormality and the perfusion defect, normal (NL), infarcted, and BZs were defined. Peak intensity after contrast was measured in acoustic units (AU). Radiolabeled microspheres were injected to measure regional blood flow. The heart was stained with 2,3, 5-triphenyltetrazolium chloride (TTC). The perfusion defect on MCE was 33% +/- 7% of the total myocardial area and correlated well with TTC (r = 0.92, P <.03). The BZ was 8% +/- 5% of the total myocardial area. Peak intensity after contrast was decreased in MI compared with BZ and NL (MI: 2.5 +/- 1.9 AU, BZ: 8.0 +/- 3.8 AU, P <.005; NL: 10.2 +/- 6.9 AU, P <.02) and comparable in NL and BZ. The blood flow measured by microspheres was not different in NL and BZ but was decreased in MI (NL: 1.6 mL/g/min, BZ: 1.5 +/- 0.5 mL/g/min, MI: 0.7 +/- 0.5 mL/g/min; P <.0001). In this model of chronic ovine MI, the BZ was small and its perfusion was preserved. These findings support the hypothesis that tethering of normal myocardial segments explains the abnormal wall motion noted at the borders of MI.     

Myocardial infarction in patients with non-insulin-dependent diabetes mellitus and dependence of the quality of life on the individual psychological type

AIM: To examine clinical features, complications, short- and long-term outcomes of myocardial infarction (MI) as well as quality of life (QL) in patients with non-insulin-dependent diabetes mellitus (NIDDM), to analyze relations between the above parameters and psychologic personal traits of the patients. MATERIAL AND METHODS: The study entered 240 NIDDM patients with MI (the test group) and 260 control nondiabetic MI patients. The examination was made using standard techniques and AMPI. RESULTS: An anginal variant of initial MI in NIDDM patients was registered significantly less frequently than in the controls (76.7 vs 88.2%). The asthmatic variant occurred in 16.3 and 4.6% of the cases, respectively. In MI, NIDDM patients developed preinfarction and postinfarction angina pectoris less often than control patients (20 and 12.1% vs 71.9 and 25.7%, respectively). Mean psychological profile was high by AMPI scales 1, 2 and 6 in NIDDM patients, by scales 1, 3 and 8 in control patients. CONCLUSION: Pain syndrome in anginal initial MI in NIDDM patients is less pronounced and becomes weaker with growing duration of diabetes. Concomitant diabetes mellitus has an insignificant influence on deterioration of quality of life in the postinfarction period.     

无心绞痛病史心肌梗塞患者的临床特征及预后

目的：探讨无心绞痛病史的心肌梗塞患者的临床特征及预后。方法：对１１８例无心绞痛病史的心肌梗塞患者（Ａ组）与同期２９３例心肌梗塞前反复出现心绞痛患者（Ｂ组）的临床及随诊资料作对比分析。结果：Ａ组５５．９３％患者诱因明显，多数患者发病年龄较轻，老年患者占１６．１０％，梗塞范围较大；Ｂ组有明显诱因患者仅占２９．３５％，老年患者占３７．２０％，两组比较均有非常显著性差异（Ｐ均＜０．０１）。此外在急性心肌梗塞和随诊期间Ａ组并发症多，病死率高，为９．３２％；Ｂ组病死率为４．１０％，两组比较有显著性差异（Ｐ＜０．０５）。在随诊的３８４例中，Ａ组病死率，尤其是１年内的病死率较Ｂ组为高，且室壁瘤、心力衰竭、各种心律失常的发生率也均明显高于Ｂ组。结论：无心绞痛病史心肌梗塞患者心肌梗塞期间和远期预后不良，但若能在加强常规药物治疗的同时，尽早溶栓治疗并及时进行冠状动脉造影选择冠状动脉内球囊扩张术或冠状动脉旁路手术，可使相当部分患者预后得到改善。     

APACHE II score and mortality in respiratory failure due to cardiogenic pulmonary edema

We reviewed retrospectively 88 patients to assess whether the APACHE II severity of disease classification system can predict mortality in patients with respiratory failure due to cardiac pulmonary edema. Mean score for survivors was higher than for nonsurvivors (24.5 +/- 6.7 vs. 20.7 +/- 5.7, p less than .01), and increasing APACHE II scores were not associated with increasing mortality. Mortality was 54% for APACHE II scores less than or equal to 18, 43% for scores greater than 18 and less than or equal to 24, 22% for scores greater than 24 and less than or equal to 31, and 25% for scores between 32 and 40. The relationship of APACHE II scores to mortality did not improve when the 25 patients with ICU stays less than 48 h were analyzed; the mean score of survivors in this group was 24.3 +/- 5.2 vs. 18.8 +/- 4.6 for nonsurvivors, p less than .001. The presence of myocardial infarction (MI) was associated with a high mortality. Mortality in the 51 MI patients was 52.9% vs. 13.5% in the 37 patients without MI (p less than .001), but APACHE II scores were similar (22.6 +/- 6.6 and 23.7 +/- 6.4, respectively). The relationship between APACHE II scores and mortality did not improve if patients with and without MI are analyzed separately. For patients with MI, mortality was 78.6% for scores between 12 and 17, 56.2% for scores between 18 and 23, 33.3% for scores between 24 and 29, and 33.3% for scores greater than 29.(ABSTRACT TRUNCATED AT 250 WORDS)