The prognosis of the course and outcome of small-focus myocardial infarct depending on the T-index values on the ECG based on data from the Novosibirsk Myocardial Infarct Registry program]

Overall 342 patients with small-focal myocardial infarction were analyzed for hospital complications and for outcomes during one- and four-year observation periods in groups with different magnitudes of the T parameter. The latter one is the negative T wave on the ECG computed similarly to the Z. L. Dolabchian's index for Q and R waves on days 1-2 and 28 of myocardial infarction. The use of the T parameter allows predicting the most frequently occurring complications during the hospital observation period and recurrent myocardial infarction and cardial death during the period indicated. In the acute stage, the magnitudes of the T parameter from 1 to 24 conventional units are predictors of the complications: lung edema, cardiogenic shock, rhythm disorders, myocardial infarction relapses, particularly in able-bodied men. If the T parameter amounts from 78 to 648 conventional units in the acute stage and on day 28, this suggests a high risk of repeated myocardial infarction and cardial death for one- and 4-year observation periods in accordance with materials of the "Myocardial Infarction Register" program in Novosibirsk.     

Study of mortality due to myocardial infarction and alcoholism on the basis of the WHO MONICA and Acute Myocardial Infarction Registry programs

AIM: To study trends of mortality due to alcoholism (A) and cardiovascular diseases (CVD) in Novosibirsk in 1981 to 1998. MATERIALS AND METHODS: The WHO MONICA and Acute Myocardial Infarction Register programmes were used to survey the population of 3 Novosibirsk districts. There were notified 9016 cases of nonviolent death, by exclusing another pathology, with the exception of CVD and alcoholic intoxication. RESULTS: Mortality rates due to myocardial infarction (MI) were relatively stable throughout the observation period, except for 1988, 1994, and 1998 (a significant increase). Those due to A showed the following trend: stabilization in 1981-1982, a significant increase in 1983-1987, stabilization in 1988-1991, a significant increase in 1992-1994, and a decrease in 1995-1998. Mortality rate from MI were 2-3 times greater than that from A, with the exception of 1994-1995 when they were equal, i.e. the trends of mortality from MI and A did not coincide. Social stress is a factor that greatly influences MI death rates, mainly due to prehospital mortality. As social stress increases, younger age groups, both males and females, are afflicted, which is extremely hazardous for the population. By taking into account the mortality trends, it may be stated that A hardly affects death rates from MI. In the pattern of mortality from CVD, death rates from MI and A were 50-70% in males and 35-60% and females; those from MI were 35-55 and 30-45%, respectively. The increase in alcoholism mortality is associated with the population's addictive behavior in the period of social upheavals in the community. CONCLUSION: According to official statistics, the mortality trends do not reflect the actual state of things. This may be done only by stringently standardized programmes with their schemes of data collection and diagnosis verification. The WHO MONICA and Acute Myocardial Infarction programmes belong to such programmes.     

Long-term outcome in early survivors of cardiogenic shock at the acute stage of myocardial infarction: a landmark analysis from the French registry of Acute ST-elevation and non-ST-elevation Myocardial Infarction (FAST-MI) Registry

Introduction

There are little data about patients with cardiogenic shock (CS) who survive the early phase of acute myocardial infarction (AMI). The aim of this study was to assess long-term (5-year) mortality among early survivors of AMI, according to the presence of CS at the acute stage.

Methods

We analyzed 5-year follow-up data from the French registry of Acute ST-elevation and non-ST-elevation Myocardial Infarction (FAST-MI) 2005 registry, a nationwide French survey including consecutive patients admitted for ST or non-ST-elevation AMI at the end of 2005 in 223 institutions.

Results

Of 3670 patients enrolled, shock occurred in 224 (6.1%), and 3411 survived beyond 30 days or hospital discharge, including 99 (2.9%) with shock. Early survivors with CS had a more severe clinical profile, more frequent concomitant in-hospital complications, and were less often managed invasively than those without CS.Five-year survival was 59% in patients with, versus 76% in those without shock (adjusted hazard ratio (HR) = 1.72 [1.24-2.38], P = 0.001). The excess of death associated with CS, however, was observed only during the first year (one-year survival: 77% vs 93%, adjusted HR: 2.87 [1.85 to 4.46] P <0.001), while survival from one to 5 years was similar (76% vs 82%, adjusted HR: 1.06 [0.64 to 1.74]). Propensity score-matched analyses yielded similar results.

Conclusions

In patients surviving the early phase of AMI, CS at the initial stage carries an increased risk of death up to one year after the acute event. Beyond one year, however, mortality is similar to that of patients without shock.

Trial registration

ClinicalTrials.gov number, {"type":"clinical-trial","attrs":{"text":"NCT00673036","term_id":"NCT00673036"}}NCT00673036, Registered May 5, 2008.

Electronic supplementary material

The online version of this article (doi:10.1186/s13054-014-0516-y) contains supplementary material, which is available to authorized users.     

Effects of hostility on the risk of arterial hypertension, myocardial infarction, stroke in a sample of males aged 25-64 years (epidemiological trial on the base of WHO program MONICA)

AIM: To study effects of hostility on the risk of arterial hypertension (AH), myocardial infarction (MI) and stroke in males aged 25-64 years. MATERIALS AND METHODS: A screening study of the population was performed in 1994 according to WHO program MONICA-psychosocial. The response in a random representative sample of 25-64-year-old males (n = 657) living in Novosibirsk was 82.1%. New cases of MI, AH and stroke were registered in the control periods 1994-2000, 1994-2002. Computer program package SPSS-10 was used for statistic processing. Cox regression model of the relative risk (RR) was employed. RESULTS: Hostility was rather prevalent among the examinees (76.9%). MI risk for 8 years was 4.65 times higher in hostile men. Hostility was not associated with higher risk of AH and stroke. Hostility was seen more frequently in men with poor education, workers and retired persons. These groups are also at the highest risk of MI. CONCLUSION: Hostility raises MI risk in unstable society but had no effect on the risk of AH and stroke.     

Reperfusion rate and inhospital mortality of patients with ST segment elevation myocardial infarction diagnosed already in the prehospital phase: Results of the German Prehospital Myocardial Infarction Registry (PREMIR)

AimsWe sought to evaluate the in-hospital fate of patients with ST segment elevation myocardial infarction (STEMI) diagnosed already in the prehospital phase by physican equipped ambulances.MethodsA total of 2326 consecutive STEMI patients were included in PREMIR. For this analysis 218 patients with prehospital cardiopulmonary resuscitation were excluded.ResultsThe median time between symptom onset and 12-lead ECG was 85 min. The median time intervals between the diagnostic 12-lead ECG and prehospital fibrinolysis were 10 min, until inhospital fibrinolysis 52 min and until primar PCI 86 min, respectively. Reperfusion therapy with prehospital fibrinolysis (24%), inhospital fibrinolysis (13%) or primary PCI (45%) was performed in 82% of the patients. Inhospital mortality was 6.0% in patients with prehospital fibrinolysis (n = 504), 5.8% in patients with inhospital fibrinolysis (n = 278), 4.5% in patients with primary percutaneous coronary intervention (n = 962) and 16.2% in patients without early reperfusion therapy (n = 377), respectively. In the multivariate propensity score analysis comparing prehospital fibrinolysis and primary PCI we observed no significant difference in the odds for in-hospital mortality (odds ratio: 1.57, 95% CI: 0.94–2.63). The final discharge diagnosis was STEMI in 90% of the patients, in patients with prehospital fibrinolysis 95%.ConclusionsIn patients with STEMI already diagnosed in the prehospital phase the ischemic time is short, accuracy of the diagnosis is high and reperfusion therapy is performed in over 82%. Inhospital mortality was not different between prehospital fibrinolysis and primary PCI.     

2001～2011年中国ST段抬高型心肌梗死(回顾性急性心肌梗死研究China PEACE):一项基于医院数据的回顾性研究

<正>背景:尽管ST段抬高型心肌梗死十分危险,但是过去10年中国并没有国家级有代表性的研究来描述其临床特征、处理方案以及结局。方法:采用回顾性分析住院病历的方法,应用双层的随机取样方法对2001年、2006年及2011年3年中在中国医院就诊的ST     

Effect of abnormal fasting plasma glucose level on all-cause mortality in older patients with acute myocardial infarction: results from the Beijing Elderly Acute Myocardial Infarction Study (BEAMIS)

OBJECTIVE: To assess whether the relationship between abnormal fasting plasma glucose (FPG) levels and patient outcomes holds for both older men and older women with acute myocardial infarction (AMI).PATIENTS AND METHODS: From April 1, 2004, to October 31, 2006, a total of 2016 consecutive older patients (age ≥65 years) presenting with AMI were screened. Of these patients, 1854 were consecutively enrolled in the study. Patients were categorized into 4 groups: the hypoglycemic group (FPG, ≤90.0 mg/dL [to convert to mmol/L, multiply by 0.0555]; n=443, 23.9%), the euglycemic group (FPG, 90.1-126.0 mg/dL; n=812, 43.8%), the mildly hyperglycemic group (FPG, 126.1-162.0 mg/dL; n=308, 16.6%), and the severely hyperglycemic group (FPG, ≥162.1 mg/dL; n=291, 15.7%). The primary outcomes were rates of in-hospital and 3-year mortality.RESULTS: Female patients were older and had a higher incidence of diabetes mellitus but lower rates of smoking and use of invasive therapy. Men tended to have a higher frequency of hypoglycemia, whereas women tended to have a higher frequency of hyperglycemia. No significant difference was found in in-hospital (10.9% vs 9.1%; P=.36) or 3-year (24.5% vs 24.5%; P=.99) mortality between male and female patients, and FPG-associated mortality did not vary significantly by sex.CONCLUSION: An increased FPG level was associated with a relatively higher risk of in-hospital mortality in men but not in women. Nonetheless, increased and decreased FPG levels at admission could predict higher mortality rates regardless of sex. There was a striking U-shaped relationship between FPG levels and in-hospital and 3-year mortality. The effect of abnormal FPG level on outcomes among older patients with AMI did not vary significantly by sex.AMI = acute myocardial infarction; BEAMIS = the Beijing Elderly Acute Myocardial Infarction Study; CABG = coronary artery bypass grafting; CI = confidence interval; DM = diabetes mellitus; FPG = fasting plasma glucose; PCI = percutaneous coronary interventionMany primary and secondary prevention strategies for acute myocardial infarction (AMI) shown to be efficacious in randomized controlled trials have been implemented by physicians and health care systems, resulting in improved control of cardiovascular risk factors in several populations.^1-5 Although better management of risk factors is an important quality benchmark, reductions in the incidence of myocardial infarction and mortality are better measures of quality. Previous studies of mortality associated with AMI have often focused on selected subgroups in populations with limited diversity with respect to coexisting conditions, and most have not examined differences due to sex, although management and outcomes differ markedly.^6-9 Several studies have reported that acute hyperglycemia in patients with AMI is related to a higher incidence of mortality.^10-16 No studies have evaluated the relationship between abnormal fasting plasma glucose (FPG) levels and outcomes separately for men and women. The aim of this study, therefore, was to assess whether the relationship between FPG levels and all-cause mortality is different for men and women among older patients with AMI by analyzing data from BEAMIS (the Beijing Elderly Acute Myocardial Infarction Study).     

The combination of diffuse kidney lesions with different diseases of the other organs of the urinary system (the diagnosis, characteristics of the course and outcomes)

The author characterizes in detail 4340 patients with diffuse renal lesions (chronic glomerulonephritis, renal amyloidosis, lupoid nephritis, diabetic glomerulosclerosis and nephrosclerosis) coupled with different diseases of the urinary organs including urolithiasis, cancerous and tuberculous processes, purulent diseases of the kidneys and prostatic lesions. Stage III chronic renal failure (CRF) was revealed in 2073 (57.1%) out of the 4340 patients. All of them died because of uremia. The mean lifespan of the patients was 1.6 +/- 0.1 yr. since manifestation of the concomitant process. The shortest times of CRF onset, the highest frequency of stage III CRF and the least lifespan were noted in patients with double association, particularly in those suffering from associated chronic glomerulonephritis with renal amyloidosis and urinary bladder cancer in the stage of compression with tumor of the intramural parts of the ureters, namely they were 0.6 +/- 0.1, 100% and 1.0 +/- 0.1 yr., respectively. The author holds that the main reason for such an abrupt CRF onset in patients with concomitant renal lesions of any type lies in simultaneous combined influence on the kidneys of absolutely different diseases bearing in mind their etiology and pathogenesis. Besides, according to the author's data, considerable influences on the times of CRF onset and rates of its progress are produced by both the course and stage (phase) of the development of each of the coexistent diseases. Attention is drawn to the necessity of early participation of urologists in the solution of the problems concerned with the policy of managing nephrological patients with diseases of other organs of the urinary system as well as with permanent dynamic follow-up of all the patients with concomitant processes, especially with double ones.     

Impact of cell number and microvascular obstruction in patients with bone-marrow derived cell therapy: final results from the randomized, double-blind, placebo controlled intracoronary Stem Cell therapy in patients with Acute Myocardial Infarction (SCAMI) trial

Background

In patients with acute myocardial infarction (AMI), the number of transplanted autologous bone-marrow cells (BMC) has been linked to improvement in left ventricular ejection fraction (LVEF). Complete obstruction of myocardial microvasculature is indicated by microvascular obstruction (MO) in cardiac magnetic resonance imaging (CMR). We analyzed whether the number of transplanted cells and presence of MO were associated with improved LVEF in the double-blind, placebo-controlled, randomized intracoronary Stem Cell therapy in patients with Acute Myocardial Infarction (SCAMI) trial.

Methods and results

Patients (N = 42) received study therapy mean 7 days after AMI. Median number of transplanted BMC was 324 × 10⁶. CMR was performed prior to study therapy and annually up to 3 years and revealed no difference between BMC and placebo population. Patients treated with a cell number above the median experienced a significant improvement in LVEF compared with patients with cell number below the median 3.6 ± 3.4 versus ?0.5 ± 6.4 % (difference 4.1, 95 % CI 0.2 to 8.1 %, p = 0.04) at 6 months. The difference in LVEF change between the groups remained with 3.8 % (p = 0.12) at 12 months, 4.5 % (p = 0.07) at 24 months and 5.6 % (p = 0.03) at 36 months. BMC treated patients without MO experienced a better improvement in LVEF compared with patients with MO at 6, 12, 24 and 36 months with 3.5, 5.3, 6.4 and 3.2 %.

Conclusions

In the randomized, placebo-controlled double-blind SCAMI trial improvement in LVEF up to 3 years was higher in BMC patients treated with a high cell number or without MO.     

"Hemodynamic efficacy" of two endoscopic clip devices used in the treatment of bleeding vessels, tested in an experimental setting using the compact Erlangen Active Simulator for Interventional Endoscopy (compactEASIE) training model

BACKGROUND AND STUDY AIMS: Hemoclip therapy is a well-established procedure in the treatment of gastrointestinal bleeding. Although new products are provided periodically by the industry, comparative investigations are lacking. We compared two different hemoclip devices in an experimental setting, assessing them using objective hemostatic parameters. MATERIALS AND METHODS: We compared two disposable clip devices (Olympus HX-200L-135 (n = 40) vs. Wilson-Cook Tri-Clip (n = 40)) in an experimental setting using the compact Erlangen Active Simulator for Interventional Endoscopy (compactEASIE) training model equipped with an upper gastrointestinal-organ package for bleeding simulation. This was a randomized, prospective, controlled trial. Four investigators with different levels of endoscopic experience applied ten hemoclip devices of each type to the spurting vessels, the clips allocated using a randomized list for each investigator. The efficacy of hemostasis was determined by continuous measurement of the pressure within the afferent vessel before and after clip application and calculation of the relative reduction of vessel diameter by the clip device. The system pressure was recorded over the period from 1 minute before to 1 minute after clip application. A secondary end point was a subjective assessment of the whole clip application procedure by the endoscopist and the assisting nurse, using a visual analog scale (0 - 100, with 100 representing the best experience). RESULTS: A total of 39/40 clips of each type were applied successfully. Both clip devices led to a significant increase in system pressure, representing significant relative reduction of vessel diameter (Olympus 5.4 +/- 7.5 %, p < 0.001; Cook 4.9 +/- 8.0 %, p < 0.001). Overall, there was no significant difference between the two devices ( P = 0.756). However, the investigator with the least experience in endoscopy (< 100 procedures) produced significantly inferior results compared with the other three investigators, who had performed between 2000 and 6000 procedures each ( P < 0.05). We found no evidence of a learning curve from the intra-observer results. The devices received good, but not significantly different, overall ratings by the endoscopists (Olympus 69 +/- 24 vs. Wilson-Cook 65 +/- 16) and by the assisting nurses (Olympus 77 +/- 9 vs. Wilson-Cook 70 +/- 22). CONCLUSIONS: Using an established cadaveric training model, no significant difference was found between the two types of hemoclip devices with respect to their "hemostatic efficacy". However, the experience of the endoscopist appears to play a major role in successful clip application. The use of a feedback mechanism in emergency endoscopy training, using continuous intravessel pressure monitoring, may substantially enhance the efficacy of training, resulting in a similar improvement in clinical results.