Cardiac outcomes after myocardial infarction in elderly patients with diabetes mellitus.

OBJECTIVES: To examine the association between (1) comorbid conditions related to diabetes mellitus, clinical findings on arrival at the hospital, and characteristics of the myocardial infarction and (2) risk of heart failure, recurrent myocardial infarction, and mortality in the year after myocardial infarction in elderly 30-day survivors of myocardial infarction who had non-insulin- or insulin-treated diabetes. METHODS: Medical records for June 1, 1992, through February 28, 1993, of Medicare beneficiaries (n = 1698), 65 years or older, hospitalizedfor acute myocardial infarction in Connecticut were reviewed by trained abstractors. RESULTS: One year after myocardial infarction, elderly patients with non-insulin- and insulin-treated diabetes mellitus had significantly greater risk for readmission for heart failure and recurrent myocardial infarction than did patients without diabetes mellitus, and risk was greater in patients treated with insulin than in patients not treated with insulin. Diabetes mellitus, comorbid conditions related to diabetes mellitus, clinical findings on arrival, and characteristics of the myocardial infarction, specifically measures of ventricular function, were important predictors of these outcomes. Mortality was greater in patients not treated with insulin than in patients treated with insulin; the increased risk was mostly due to comorbid conditions related to diabetes mellitus and poorer ventricular function. CONCLUSIONS: Risk of heart failure, recurrent myocardial infarction, and mortality is elevated in elderly patients who have non-insulin- or insulin-treated diabetes mellitus. Comorbid conditions related to diabetes mellitus and ventricular function at the time of the index myocardial infarction are important contributors to poorer outcomes in patients with diabetes mellitus.     

In-hospital mortality after acute myocardial infarction in patients with diabetes mellitus.

OBJECTIVES: To examine in-hospital mortality after acute myocardial infarction in patients with diabetes mellitus. METHODS: All patients in an 800-bed teaching hospital who had a discharge diagnosis of myocardial infarction, verified by creatine kinase levels at admission, between 1991 and 1993 made up the study population. All 118 such patients who died during this period made up the case group. Two control subjects (n = 236), survivors of the hospitalization, matched by sex, age, and length of hospitalization, were selected randomly for each case. Information on the presence of diabetes mellitus, medical history, and data related to myocardial infarction were obtained through retrospective chart review. RESULTS: The mean age of all subjects in the study was 76 years. Thirty-three percent of the patients in the case group and 31% of the control subjects had a history of diabetes mellitus (odds ratio = 1.04; 95% CI, 0.64-1.70), indicating that diabetes mellitus was not associated with an increased risk of in-hospital death. The adjusted odds ratio was 1.10 (95% CI, 0.48-2.51) in patients with non-insulin-treated diabetes mellitus and 0.80 (95% CI, 0.34-1.86) in insulin-treated patients. Multivariate analysis, with conditional logistic regression, confirmed that known prognostic factors for myocardial infarction, rather than diabetic status, are predictive of in-hospital mortality. CONCLUSIONS: Once the effects of age are accounted for, the risk of in-hospital mortality is not greater in patients with diabetes mellitus than in patients without diabetes; however, diabetes mellitus may be an important factor for long-term survival.     

Age-related differences in case-fatality rates among diabetic patients with myocardial infarction. Findings from National Hospital Discharge Survey, 1979-1987.

OBJECTIVE: To determine age-related differences in case-fatality rates among diabetic patients with myocardial infarction (MI). Published studies have demonstrated 60% higher case-fatality rates during acute MI among diabetic patients compared with those without diabetes. However, many previous reports have been of insufficient size to examine the effect of age on mortality and have not been drawn from a representative sample of hospitals. The National Hospital Discharge Survey provides data on discharge diagnosis and vital status from a random sample of approximately 500 short-stay American hospitals. RESEARCH DESIGN AND METHODS: In this analysis, people with acute MI listed as the first diagnosis on the discharge sheet were studied. Any mention of diabetes mellitus on the discharge sheet was used to stratify the patients into those with and without diabetes. RESULTS: Age-adjusted case-fatality rates were identical in patients with and without diabetes for both sexes: 16.1 vs. 16.3 in men and 18 vs. 18.2 in women, respectively. Mortality rates were, however, higher among the younger patients with diabetes. Ratios of the case-fatality percentage by 10-yr age-groups (age 35-75 yr) and greater than or equal to 75 yr old for diabetes versus no diabetes were 1.7, 1.8, 1.2, 0.9, and 0.9 for men and 2.4, 1.2, 1.1, 1, and 0.9 for women. CONCLUSIONS: Diabetes thus appears to increase the in-hospital mortality risk with acute MI disproportionately in the younger age-groups, particularly among men, and does not appear to be a marker of increased risk among the elderly.     

1827例急性心肌梗死患者梗死部位的相关分析

目的　调查不同部位急性心肌梗死患者梗死的发病特点。方法　通过回顾病史 ,将符合诊断标准的住院患者按照不同发病部位分组 ,分别记录发病特点 ,了解不同发病部位的构成比 ,不同发病部位的男女构成比以及发病部位与病死率的关系。结果　符合条件的病例共 182 7例 ,前壁急性心肌梗死 (前壁、前间壁和广泛前壁 )占总发病的 4 5 8% ,其次是下壁急性心肌梗死组占 2 6 7%。在所有部位急性心肌梗死病例中 ,男性发病比例 (6 4 0 %～ 88 3% )与女性 (11 7%～ 36 0 % )相比均有很大差别 (P <0 0 5 )。各部位急性心肌梗死的病死率为 8 7%～ 2 0 6 %。除急性前壁合并下壁组心肌梗死病例病死率差异有显著性外 (P <0 0 5 ) ,其他部位急性心肌梗死患者的病死率与急性心肌梗死平均住院病死率相比差异未见显著性(P >0 0 5 )。结论　急性心肌梗死以前壁或下壁为主 ,男性仍是发生急性心肌梗死的主要人群 ,急性前壁和合并下壁心肌梗死的病死率显著高于急性心肌梗死平均病死率。     

Diabetes increases mortality after myocardial infarction by oxidizing CaMKII

Diabetes increases oxidant stress and doubles the risk of dying after myocardial infarction, but the mechanisms underlying increased mortality are unknown. Mice with streptozotocin-induced diabetes developed profound heart rate slowing and doubled mortality compared with controls after myocardial infarction. Oxidized Ca²⁺/calmodulin-dependent protein kinase II (ox-CaMKII) was significantly increased in pacemaker tissues from diabetic patients compared with that in nondiabetic patients after myocardial infarction. Streptozotocin-treated mice had increased pacemaker cell ox-CaMKII and apoptosis, which were further enhanced by myocardial infarction. We developed a knockin mouse model of oxidation-resistant CaMKIIδ (MM-VV), the isoform associated with cardiovascular disease. Streptozotocin-treated MM-VV mice and WT mice infused with MitoTEMPO, a mitochondrial targeted antioxidant, expressed significantly less ox-CaMKII, exhibited increased pacemaker cell survival, maintained normal heart rates, and were resistant to diabetes-attributable mortality after myocardial infarction. Our findings suggest that activation of a mitochondrial/ox-CaMKII pathway contributes to increased sudden death in diabetic patients after myocardial infarction.     

Stroke in patients with acute myocardial infarction

The analysis has been performed of 40 cases of acute myocardial infarction with concomitant stroke versus 26 cases of acute myocardial infarction alone. Being a complication of acute myocardial infarction in 0.94% of the cases, the stroke was ischemic in 95% and hemorrhagic in 5% of the patients. Association of the two events accounted for lethal outcomes in 80% of the cases. The principal factors of the stroke risk in myocardial infarction are suggested. They involve: an advanced age, cardiac arrhythmias, cardiogenic shock, diabetes mellitus, recurrent or transmural myocardial infarction, previous acute episodes of disturbed cerebral circulation, essential hypertension and hyperglycemia.     

急性心肌梗死患者应激性血糖升高的临床研究

目的研究急性心肌梗死时应激性高血糖对患者心功能、心律失常及院内死亡率的影响。方法200例急性心肌梗死患者被分成非糖尿病组及糖尿病组,前者又被分为应激性血糖增高组及血糖正常组,并详细记录三组患者的临床资料。结果非糖尿病血糖增高组心力衰竭、心律失常及院内死亡率均高于血糖正常组,而血糖>10.0 mmol/L组,则上述指标与糖尿病患者相似。结论急性心肌梗死时伴有应激性高血糖可增加患者心力衰竭、心律失常及院内死亡率。     

Prevalence and mortality of acute myocardial infarction in patients with diabetes

The purpose of this study was to investigate if insulin-dependent diabetes mellitus (IDDM) and non-insulin-dependent diabetes mellitus (NIDDM) predispose to the development of acute myocardial infarction (AMI) and modify the prognosis. The study includes 832 AMI patients consecutively hospitalized over a 3-yr period. The prevalence of diabetes mellitus among the AMI patients was 9.7% and is significantly higher than in an age-matched population, where it is 6.1% (P less than 0.001). The prevalence of diabetes was higher for women than for men (14.9% versus 7.6%). The risk of AMI was found to be twice as high among IDDM than among nondiabetic patients (P less than 0.001). Men with NIDDM were not found to have a significantly higher risk of AMI (P greater than 0.1), but the risk of AMI in women with NIDDM was approximately doubled (P less than 0.01). During the first month following AMI the mortality rate for nondiabetic patients was 20.2% compared with 42.0% for diabetic patients (P less than 0.001). Insulin treatment in NIDDM was associated with a reduced mortality rate compared with treatment with oral agents (P less than 0.05). The mortality rate was significantly higher in patients with poor metabolic control compared with patients in good control, whether before AMI or at the time of hospitalization. Diabetic patients had a higher risk of developing cardiogenic shock and conduction disorders than nondiabetic patients. We conclude that diabetes mellitus disposes to AMI and that the mortality rate of AMI is significantly increased among diabetic patients. Poor metabolic regulation of the diabetes may aggravate the prognosis for AMI.     

Soluble urokinase receptor as a predictor of non-cardiac mortality in patients with percutaneous coronary intervention treated ST-segment elevation myocardial infarction

BackgroundIdentification of patients at high risk of non-cardiac mortality following ST-segment elevation myocardial infarction (STEMI) could guide clinicians to identify patients who require attention due to serious non-cardiac conditions after the acute phase of STEMI. The purpose of this study was to evaluate if the non-specific and prognostic biomarker of inflammation and comorbidity, soluble urokinase receptor (suPAR), could predict non-cardiac mortality in a cohort of STEMI patients.MethodsSuPAR was measured in 1,190 STEMI patients who underwent primary percutaneous coronary intervention (pPCI). The primary endpoint was non-cardiac mortality, secondary endpoints were cardiac mortality, all-cause mortality, reinfarction and periprocedural acute kidney injury. Backwards elimination of potential confounders significantly associated with the respective outcome was used to adjust associations.ResultsPatients were followed for a median of 3.0 years (interquartile range 2.5– 3.6 years). Multivariate cox regression revealed that a plasma suPAR level above 3.70 ng mL⁻¹ was associated with non-cardiac and cardiac mortality at hazard ratios 3.33 (95% confidence interval 1.67–6.63, p = 0.001, adjusted for age) and 0.99 (0.18–5.30, p = 0.98, adjusted for previous myocardial infarction and left ventricular ejection fraction), respectively.ConclusionIn patients with pPCI treated STEMI, suPAR was an independent prognostic biomarker of non-cardiac but not cardiac mortality and may identify patients with high risk of non-cardiac mortality.     

Short- and long-term mortality after myocardial infarction in patients with and without diabetes: changes from 1985 to 2008

OBJECTIVE To study temporal trends in short- and long-term outcome after myocardial infarction (MI) according to diabetes status. RESEARCH DESIGN AND METHODS We included all 14,434 consecutive patients admitted for ST-segment elevation MI or non-ST-segment elevation MI at our center between 1985 and 2008. The study patients were compared according to prevalent diabetes. Temporal trend analyses were performed by comparing decades of admission (1985-1989 vs. 1990-1999 vs. 2000-2008). RESULTS A total of 2,015 (14%) of the patients had prevalent diabetes. The risk of presenting with diabetes increased from 8 to 17% from 1985 to 2008. Diabetic patients presented with a higher prevalence of cardiovascular risk factors. With time, the use of evidence-based therapies increased in both patients with and without diabetes. Diabetes is associated with a 1.5-fold increased risk of mortality at the 20-year follow-up. Ten-year mortality decreased over time in patients with diabetes, from 53% in 1985-1989 to 39% in 2000-2008 (adjusted hazard ratio 0.56 [95% CI 0.43-0.73]), and in those without diabetes, from 38% in 1985-1989 to 29% in 2000-2008 (0.66 [0.60-0.73]; P interaction = 0.83). Patients with diabetes benefitted from a higher 30-day and 10-year absolute survival increase. CONCLUSIONS Temporal mortality reductions after MI between 1985 and 2008 were at least as high in patients with diabetes compared with those without diabetes. However, long-term mortality remained higher in diabetic patients. Awareness of the high-risk profile of diabetic patients is warranted and might stimulate optimal medical care and outcome.     

Predictors of acute myocardial infarction mortality in hypertensive patients treated in primary care: a population-based follow-up study in the Skaraborg Project

OBJECTIVE: To explore risk factors for acute myocardial infarction (AMI) mortality in hypertensive patients treated in primary care. DESIGN: Community-based cohort study. SETTING: Hypertension outpatient clinic in primary health care. SUBJECTS: Patients who consecutively underwent an annual follow-up during 1992-1993 (n =894; 377 men and 517 women). METHODS: All events of fatal AMI were ascertained by record linkage to the National Mortality Register to December 31, 2002. Gender-specific predictors for AMI mortality were analysed by Cox regression. MAIN OUTCOME MEASURE: AMI mortality. RESULTS: During a mean follow-up of 8.7 years 32 cases (8.5%) of fatal AMI were observed in men and 31 cases (6.0%) were observed in women. Most important predictors for AMI mortality in men were microalbuminuria (HR 3.8, CI 1.8-8.0) and left ventricular hypertrophy (HR 4.0, CI 1.7-9.4), whilst in women type 2 diabetes (HR 4.8, CI 2.4-9.8) was an important predictor. In hypertensive patients without diabetes male gender was associated with high AMI mortality (HR 2.7, CI 1.4-5.3), but in patients with both hypertension and type 2 diabetes the higher risk in men disappeared (HR 0.8, CI 0.4-1.7). CONCLUSION: Cardiovascular disease risk factors remain strong predictors of AMI mortality in hypertensive patients but with a different pattern in the two genders. Markers of organ damage are more important predictors in men, whereas markers of impaired glucose metabolism are more important predictors in women.     

老年急性心肌梗死患者住院死亡危险因素分析

目的探讨入院时影响老年急性心肌梗死(AMI)患者住院病死率的危险因素。方法选取因AMI收住的356例老年患者为研究对象。分析病死组(45例)与存活组(311例)患者的临床特征、实验室化验指标、心血管并发症(心源性休克、心力衰竭、室速/室颤),以Logistic多因素逐步回归分析影响老年AMI患者住院病死率的相关因素。结果单因素分析显示:年龄、糖尿病史、陈旧性MI病史、脑卒中病史、肾功能不全、贫血、首发症状呼吸困难、并发心源性休克、心力衰竭、室速/室颤,入院时血清肌酐升高、肾小球滤过率(eGFR)及血红蛋白减低、肌酸激酶及其同工酶峰值水平与老年AMI患者住院病死率相关(均P0.05)。多因素分析显示:年龄、糖尿病史、陈旧性MI病史,并发心源性休克、心力衰竭、室速/室颤,入院时eGFR水平是影响老年AMI患者住院病死率的独立危险因素(均P0.05)。结论年龄、糖尿病及陈旧性MI病史、发生心血管并发症、入院时eGFR水平是影响老年AMI患者住院病死率的独立危险因素。     

Prognostic significance of admission cardiac troponin T in patients treated successfully with direct percutaneous interventions for acute ST-segment elevation myocardial infarction

BACKGROUND: Cardiac troponin T (cTnT) elevations at admission indicate a high-risk subgroup of patients with acute ST-segment elevation myocardial infarction, possibly due to a higher failure rate of reperfusion therapies. OBJECTIVE: We sought to determine the predictive role of admission cTnT in patients with ST-segment elevation myocardial infarction undergoing successful direct percutaneous coronary intervention. METHODS: A total of 218 consecutive patients with ST-segment elevation myocardial infarction were enrolled. Patients were stratified according to admission cTnT and infarct location. They were followed prospectively for short-term and long-term outcomes.RESULTS A positive cTnT (47.7%) was associated with higher mortality rates at 30 days (14.4% vs. 3.5%, p = .003) and 12 months (17.3% vs. 4.4%, p =.007). cTnT allowed discrimination of patients at high and low risk for cardiac death at 30 days and 12 months among anterior (19.2% vs. 7.9%, p = .19, and 25% vs. 13.2%, p = .22, respectively) and, more impressively, among nonanterior acute myocardial infarction (9.6% vs. 1.3%, p = .04, and 11.5% vs. 1.3%, p = .017, respectively). In multivariate analysis, older age, anterior infarct location, and depressed left ventricular function were the most potent independent predictors of future risk. Among clinical variables available at admission, cTnT indicated independently a higher risk of cardiac death (odds ratio, 3.1 [1.07-9.01], p =.038). This increased risk associated with a positive cTnT was almost independent of time delays from onset of symptoms to admission (3.8 vs. 2.3 hrs in cTnT-positive vs. cTnT-negative patients, p <.001). CONCLUSIONS: Admission cTnT is a strong predictor of future cardiac risk in patients with ST-segment elevation myocardial infarction, despite successful restoration of Thrombolysis in Myocardial Infarction grade 3 coronary flow by direct percutaneous coronary intervention.     

Prevalence of right ventricular myocardial infarction in patients with acute inferior wall myocardial infarction

The objective was to evaluate the prevalence of right ventricular myocardial infarction (RVMI) in patients with acute inferior wall myocardial infarction (IWMI) admitted to the National Institute of Cardiovascular Diseases, Karachi, Pakistan. Between August 2000 and May 2001, a total of 100 patients with acute IWMI were enrolled. History of all patients was taken, and thorough clinical examination was performed to asses the presence of signs of right ventricular infarction. Standard 12-lead electrocardiogram was recorded immediately on arrival of patients along with right precordial leads. All patients were considered for thrombolytic therapy in the absence of any contraindication and were managed with standard treatment strategies. Complications arising during the course of admission were recorded and compared between the two groups. There were 86 (86%) males and 14 (14%) females. Mean age was 56.3 +/- 13.13 years (range 33-83 years). The prevalence of RVMI in IWMI was 34%. Smoking and diabetes were more prevalent in RVMI group, while hypertension and family history of ischemic heart disease were more common in isolated IWMI. Ninety per cent of patients received thrombolytic therapy. In-hospital mortality (23.5%) was higher in RVMI group than isolated IWMI (18.1%). Other major complications were also higher in RVMI group than isolated IWMI. Right ventricular infarction was found in approximately one-third of IWMI. Right ventricular infarction was associated with considerable morbidity and mortality, and its presence defines a higher risk subgroup of patients with inferior wall left ventricular infarction.     

Does diabetes mellitus explain the higher hospital mortality of women with acute myocardial infarction? Results from the Berlin Myocardial Infarction Registry.

BACKGROUND: Women with acute myocardial infarction (AMI) exhibit greater hospital mortality than do men. In general, diabetes mellitus is one of the major factors influencing the outcome of patients with AMI. The aim of this study was to analyze the interaction between diabetes and gender, specifically with regard to the higher hospital mortality of female AMI patients aged < or = 75 years. METHODS: We prospectively collected data from 3,715 patients aged < or = 75 (2,794 men, 921 women) with acute myocardial infarction who were treated in 25 hospitals in Berlin, Germany, from 1999 to 2002. In a multivariate analysis, we specifically studied the interaction between the factors diabetes mellitus and gender in their effects on hospital mortality. RESULTS: After adjustment in multivariate analysis, the interaction between gender and diabetes was statistically significant, and the estimated odds ratios were as follows: female diabetic patients compared with male diabetic patients, odds ratio (OR) = 2.28 (95% confidence interval [CI] 1.42-3.68); female diabetic patients compared with male nondiabetic patients, OR = 2.90 (95% CI 1.90-4.42); and female diabetic patients compared with female nondiabetic patients, OR = 2.92 (95% CI 1.75-4.87). There was no statistically significant difference between the risk of dying for female nondiabetic patients or for male diabetic patients when compared with male nondiabetic patients. CONCLUSIONS: In AMI patients aged < or = 75 years, female gender alone is not an independent predictor of hospital mortality. Detailed, multivariate analysis reveals that specifically diabetic women demonstrate higher hospital mortality than do men. Special attention should be provided to these female diabetic patients.     

Use of antibiotics is not associated with decreased risk of myocardial infarction among patients with diabetes

OBJECTIVE: To study the relationship between exposure to antibiotic treatment and risk of subsequent myocardial infarction (MI) in patients with diabetes. RESEARCH DESIGN AND METHODS: A case-control design was used to assess the effect of previous antibiotic exposure in diabetes patients with acute, nonfatal or fatal MI (case subjects) and individually matched control subjects (four control subjects to one case subject, matched on sex, age, and index date). Subjects were sampled from the Northern California Kaiser Permanente Diabetes Registry, a well-characterized, ethnically diverse diabetic population from Kaiser Permanente Medical Care Program, Northern California Region. MI events were ascertained during a 2-year observation period (1998-1999). Separate conditional logistic regression models were specified to assess antibiotic exposure history (cephalosporins only, penicillins only, macrolides only, quinolones only, sulfonamides only, tetracyclines only, as well as more than one, any, or no antibiotic) for three nested windows before the index date (0-6 months, 0-12 months, 0-24 months), facilitating assessment of whether the potential effect was dependent on the timing of the exposure. RESULTS: A total of 1,401 MI case subjects were observed. Odds ratios were calculated in models adjusted for age, sex, race, education attainment, time since diabetes diagnosis, diabetes type and treatment, use of diet and exercise, total cholesterol, HDL cholesterol, triglyceride levels, hypertension, elevated urinary albumin excretion, serum creatinine, BMI, and smoking. We found no evidence of a protective effect of any of these therapeutic classes of antibiotics during any of the three time frames. CONCLUSIONS: Our study does not support the hypothesis that use of antibiotics has a protective effect for prevention of coronary heart disease in diabetic patients.     

急性心肌梗死相关因素的临床分析

目的 :探讨不同部位、不同性别急性心肌梗死患者梗死的发病特点。方法 :通过对急性心肌梗死患者不同的梗死部位进行分组 ,分别记录发病特点 ,分析梗死部位与病死率及性别的关系。结果 :符合诊断标准的病例共 4 0 0例 ,前壁急性心肌梗死发生率最高 (2 9.2 5 % ) ,其次是下壁急性心肌梗死 (2 5 .5 0 % )。男性发病比例与女性相比均有很大差别(P<0 .0 5 )。本组急性心肌梗死的病死率为 7.14 %～ 2 9.71% ,其中前壁合并下壁的病死率最高 (2 9.17% ) ,与平均病死率相比差异具有显著性 (P<0 .0 5 )。结论 :急性心肌梗死以前壁或下壁为主 ,男性仍是发生急性心肌梗死的主要人群 ,急性前壁和合并下壁心肌梗死的病死率显著高于急性心肌梗死平均病死率     

Use of allicor to lower the risk of myocardial infarction

The aim of the study was to investigate the effects of allicor (a long-action garlic-based preparation) on the risk of acute myocardial infarction (MI) and sudden death (SD) in patients with coronary artery disease (CAD). Fifty one CAD patients were included in this double-blind placebo-controlled study. The prognostic risk of MI and SD during ten following years was counted using Cox proportional hazards model based on the results of Munster study. Allicor administered for 12 months was demonstrated to reduce absolute ten-year risk of acute MI and SD 1.5 times in men and 1.3 times in women. The reduction in calculated risk parameters was associated with changes in blood plasma lipid profile, the most significant of which was reduction in the level of low density lipoprotein cholesterol (p < 0.05) by 32.9 mg/dl in men and 27.3 mg/dl in women. The results of this study demonstrate that allicor is effective for the reduction of multifactor MI and SD risk as a means of secondary CAD prophylaxis.     

Arrhythmia and its risk factors post myocardial infarction:A prospective study

Objectives:To determine the occurrence of arrhythmia and its associated risk factors in the first week after acute myocardial infarction(MI).Methods:A total of 100 patients with acute MI were recruited,who were followed up for one week to determine the occurrence of arrhythmia and its association with electrolyte disturbances,left ventricular ejection fraction(LVEF),and demographic factors.Univariate and multivariate logistic regression was used to identify significant risk factors of arrhythmia.Results:Among 100 cases,arrhythmia was seen in 27 patients.Sinus tachycardia was the commonest,followed by ventricular premature beats and sinus bradycardia.Ejection fraction,serum calcium and magnesium were significantly different between non-arrhythmia and arrhythmia patients(P<0.05).Multivariate logistic regression analysis showed that ejection fraction was an independent significant risk factor of arrhythmia.Patients with ejection fraction>40%had a significantly lower risk of arrhythmia with an adjusted odds ratio of 0.22(95%CI:0.08 to 0.64).Conclusions:Arrhythmia is common in the first week after myocardial infarction.The type of arrhythmia and the type of block may depend on the heart muscles involved during myocardial infarction.Ejection fraction is a risk factor that may affect the occurrence of arrhythmia.     

Thrombolysis in acute myocardial infarction: analysis of studies comparing accelerated t-PA and streptokinase.

OBJECTIVES: To compare outcomes from accelerated alteplase (recombinant tissue plasminogen activator, t-PA) and streptokinase use in acute myocardial infarction. METHODS: Review of available studies identified by Medline and other literature searches that met the criteria of being a prospective, randomised clinical trial enrolling over 1000 patients with acute myocardial infarction. The studies had to contain an intervention arm comprising accelerated infusion t-PA, or an intervention arm comprising streptokinase provided accelerated t-PA that was compared in the same trial. Interventions compared were streptokinase 1.5 million units given over one hour compared with accelerated t-PA infusion, with concomitant use of aspirin and heparin, and main outcome measure of 30 day mortality. RESULTS: Four studies met prespecified criteria, these being the GUSTO I, GUSTO IIb Angioplasty Substudy, GUSTO III, and COBALT trials. There was a total study population of 64,387 patients of whom 20,251 received streptokinase, 19,474 received t-PA, with others receiving different treatment. Pooled data show that accelerated t-PA produces a marginal 30 day mortality advantage compared with streptokinase (6.6% v 7.3%, p = 0.02, Bonferroni adjusted p = 0.12, that is borderline significance, relative risk 0.918, 95% confidence interval 0.854 to 0.986). Any benefit is attributable entirely to patients recruited in the United States in the GUSTO I study. There is an increased incidence of stroke with t-PA. CONCLUSIONS: The data do not consistently show a 30 day mortality benefit from using t-PA compared with streptokinase in acute myocardial infarction, but do show increased risk of stroke. Streptokinase can be considered the thrombolytic agent of choice.