One-year prognosis in patients hospitalized with a history of unstable angina pectoris

The prognosis during 1 year of follow-up in 715 patients admitted to one single hospital due to suspected acute myocardial infarction (AMI) with a history of unstable angina pectoris immediately preceding hospitalization is described. AMI developed in 192 patients (27%) during the first three days and in 255 patients (38%) during the first year. The mortality during hospitalization was 7% (50 patients) and during 1 year 19% (130 patients). Of the nonsurvivors, 54% died of AMI, 28% of congestive heart failure, and 20% of cardiogenic shock. Based on simple clinical parameters on admission to the emergency room, risk indicators for death during the following year could be identified as follows, in the order of significance: high age (p < 0.001), ST-segment depression on admission (p < 0.001), and a history of diabetes mellitus (p < 0.05). At admission to the emergency room, risk indicators for development of AMI during the following year were as follows: initial degree of suspicion of AMI (p < 0.001), electrocardiographic signs of acute ischemia on admission (p < 0.001), ST-segment elevation on admission (p < 0.01), age (p < 0.05), and lack of a previous history of chronic stable angina pectoris (p < 0.05). We conclude that, among patients admitted to hospital due to suspected AMI with a history of unstable angina pectoris immediately preceding hospitalization, 38% developed a confirmed infarction and 19% died during the following year.     

Prognosis in suspected acute myocardial infarction in relation to delay time between onset of symptoms and arrival in hospital

During a 21-month period, the prognosis in all patients admitted to a hospital ward from the emergency room with suspected acute myocardial infarction (AMI) was prospectively recorded and related to the time between onset of symptoms and arrival in hospital. They were classified as early arrivers (less than or equal to 2 h), intermediate arrivers (2-8 h) and late arrivers (greater than 8 h). Among patients developing a confirmed AMI (n = 909) the 1-year mortality rate was 26.0% in early arrivers, 28.1% in intermediate arrivers and 32.6% in late arrivers. The corresponding figures for patients in whom AMI was ruled out (n = 2,035) were 15.2, 15.1 and 17.6%, respectively. In AMI patients, various morbidity aspects during hospitalization and 1 year of follow-up appeared mainly independent of delay time, whereas among those in whom AMI was ruled out congestive heart failure during hospitalization was most common in early arrivers. We conclude that patients with suspected AMI who do not arrive early in hospital have a high 1-year mortality rate regardless of whether they develop AMI or not. Whether their prognosis can be improved by shortening of delay time remains to be clarified.     

Five-year mortality after acute myocardial infarction in relation to previous history, level of initial care, complications in hospital, and medication at discharge

Summary The purpose of this study was to describe the prognosis during 5 years of follow-up in a consecutive population of patients discharged from hospital after acute myocardial infarction (AMI) in relation to clinical history, level of initial care, complications during hospitalization, and medication at discharge. All patients admitted to a single hospital from February 15, 1986 to November 9, 1987 due to AMI, regardless of age and whether or not they were treated in the coronary care unit, and who were discharged alive from hospital were included in the study. There were 862 patients with AMI, 740 of whom were discharged alive. Information on medication at discharge was available in 713 patients (96%). In a multivariate analysis taking into account age, sex, history of cardiovascular diseases, whether patients were admitted to coronary care unit or not, complications during hospitalization, and medication at discharge, the following factors appeared to be independent predictors of mortality: age (p<0.001), history of AMI (p<0.001), congestive heart failure in hospital (p<0.001), whether beta-blockers had been prescribed at discharge (p<0.01), and a history of diabetes (p<0.01). This study indicates that in consecutive patients surviving the hospital phase of AMI, the development of complications while in hospital and the manner in which medication was prescribed at discharge independently influenced their longterm prognosis, but age was the most important factor in long-term prognosis.     

Relationship between Serum CK-MB-Estimated Acute Myocardial Infarct Size and Clinical Complications

ABSTRACT The relationship between acute myocardial infarct (AMI) size and morbidity and mortality was estimated in 317 patients followed for one year or until death. Infarct size was estimated from serum creatine kinase (CK)-MB levels measured thrice daily. The incidence of ventricular arrhythmias, congestive heart failure, cardiogenic shock, and the cardiac performance during exercise were studied during hospitalization. Hospital mortality and one-year mortality were registered. A positive correlation was found between serum CK-MB-estimated infarct size and the incidence of ventricular arrhythmias (p<0.05). Patients with congestive heart failure and patients with cardiogenic shock had significantly larger infarct size than patients without (p<0.05–0.01), although there was a substantial overlap. During exercise test the rise in systolic blood pressure correlated negatively and the rise in heart rate correlated positively to estimated infarct size (p<0.01). Both hospital mortality and one-year mortality were significantly related to estimated infarct size (p<0.01). Thus the infarct size, as estimated from serum CK-MB, seems to be of importance for development of the most common and serious complications after AMI.     

Prognosis in acute myocardial infarction in relation to development of Q waves.

In a totally nonselected group of patients with acute myocardial infarction (AMI) (n = 921) admitted from the emergency department to the coronary care unit or other hospital ward, the occurrence of non-Q-wave AMI and the prognosis in these patients was determined and compared with those in whom Q waves were developed. Fifty-two percent had AMI without new Q waves. Patients with a non-Q-wave AMI differed from patients with Q-wave AMI, more frequently having a previous history of AMI (p less than 0.001), angina pectoris (p less than 0.01), diabetes mellitus (p less than 0.05), congestive heart failure (p less than 0.001), and a higher mean age (p less than 0.001), whereas smoking was more common in Q-wave AMI. Patients with non-Q-wave AMI had a 1-year mortality of 31% compared with 26% in Q-wave AMI (p greater than 0.2) and a reinfarction rate of 20% compared with 12% for Q-wave AMI (p less than 0.01). Among patients aged less than 75 years without a previous history of AMI, congestive heart failure, and diabetes mellitus, the 1-year mortality rate was 16% for patients with Q waves versus 15% for those without Q waves (NS). Appearance of Q waves was not independently associated with death. We conclude that in a nonselected group of patients with AMI the occurrence of a non-Q-wave AMI is much higher than previously reported. The prognosis in AMI during one year of follow-up is not associated with development of Q waves.     

Five-year mortality in patients with acute chest pain in relation to smoking habits

BACKGROUND: Smoking is one of the major risk indicators for development of coronary artery disease, and smokers develop acute myocardial infarction (AMI) approximately a decade earlier than nonsmokers. In smokers with established coronary artery disease, quitting smoking has been associated with a more favorable prognosis. However, most of these studies comprised younger patients, the majority of whom were males. HYPOTHESIS: The purpose of the study was to determine mortality, mode of death, and risk indicators of death in relation to smoking habits among consecutive patients admitted to the emergency department with acute chest pain. METHODS: In all, 4,553 patients admitted with acute chest pain to the emergency department at Sahlgrenska University Hospital during a period of 21 months were included in the analyses and were prospectively followed for 5 years. RESULTS: Of these patients, 36% admitted current smoking. They were younger and had a lower prevalence of previous cardiovascular diseases than did nonsmokers. The 5-year mortality was 19.4% among smokers and 24.9% among non-smokers (p < 0.0001). However, when adjusting for difference in age, smoking was associated with an increased risk [relative risk (RR) 1.51; 95% confidence interval (CI) 1.32-1.74; p < 0.0001]. Among patients presenting originally with chest pain, the increased mortality for smokers was more pronounced in patients with non-acute than acute myocardial infarction (AMI). Among patients who died, death in smokers was less frequently associated with new-onset myocardial infarction (MI) and congestive heart failure. Among those who smoked at onset of symptoms and were alive 1 year later, 25% had stopped smoking. Patients with a confirmed AMI who continued smoking 1 year after onset of symptoms had a higher mortality (28.4%) during the subsequent 4 years than patients who stopped smoking (15.2%; p = 0.049). CONCLUSION: In consecutive patients admitted to the emergency department with acute chest pain, current smoking was significantly associated with an increased risk of death during 5 years of follow-up. Among patients who died, death in smokers was less frequently associated with new-onset MI and congestive heart failure than was death in nonsmokers.     

Prognosis and risk indicators of death during a period of 10 years for women admitted to the emergency department with a suspected acute coronary syndrome

AIM: To describe the 10-year prognosis and risk indicators of death in women admitted to the emergency department with acute chest pain or other symptoms raising a suspicion of acute myocardial infarction (AMI). Particular interest was paid to women of 相似文献   

Relationship between plasma homocysteine levels and congestive heart failure in patients with acute myocardial infarction. Homocysteine and congestive heart failure

Heart failure after acute myocardial infarction (AMI) is an important factor in determining clinical outcome. We examined whether the plasma homocysteine level was a predictor of heart failure in patients with AMI. A series of 96 patients without renal failure who were admitted to our hospital because of AMI between January 2003 and December 2005 were assigned to two groups; a group with a high homocysteine level (group H: n = 48) and a group with a low homocysteine level (group L: n = 48) based on a median homocysteine level. Congestive heart failure was defined as Killip Class II or higher at the time of admission or the development of congestive heart failure after hospitalization. The mean brain natriuretic peptide (BNP) level at the time of admission in group H was higher than that of group L (175.3 pg/mL versus 89.9 pg/mL; P = 0.068). The incidence of heart failure in group H was significantly higher than that in group L (43.7% versus 12.5%; P < 0.001, log-rank test; hazard ratio: 2.92). Multivariate Cox regression analysis indicated that a high plasma homocysteine level of 10.8 μmol/L or higher was a risk factor for the development of heart failure (HR: 7.175, P < 0.01). The plasma homocysteine level in patients with AMI may be related to the development of heart failure.     

Prognostic importance of digitalis after acute myocardial infarction

Because previous reports have suggested that digitalis administration may lead to increased mortality after hospital discharge for acute myocardial infarction, the independent importance of digitalis therapy in long-term prognosis after acute myocardial infarction was investigated by analyzing 1,599 patients after definite myocardial infarction. After hospital discharge, mortality rate for the entire group at 4 months was 7.7% and after 1 year 14.2%. At discharge, 36.6% of the patients were taking digitalis. Compared with those not taking digitalis, those taking digitalis had more historical risk factors and a higher incidence of important clinical prognostic variables during the hospitalization. Their cardiac mortality rate after 4 months and 1 year (12.5 and 22.4%, respectively) was significantly higher than that of patients not taking digitalis (5.0 and 9.6%, respectively). Mortality was higher for patients taking digitalis whether or not they had congestive heart failure during hospitalization. However, in a multivariate Cox analysis for 1 year outcome, neither digitalis nor any other medication variable displaced the important clinical variables of age, congestive heart failure during the hospitalization, previous myocardial infarction, maximal heart rate during the hospitalization and previous angina. Quinidine and digitalis at discharge were selected sixth and seventh (not significant) by the analysis. It is concluded that digitalis therapy at discharge after myocardial infarction was not an independent predictor of late mortality in these patients.     

近十一年来急性心肌梗死住院患者特点的回顾

目的　了解不同时期、不同性别及年龄的急性心肌梗死 (AMI)患者的特点。方法　根据本院近 11年来收集的 30 16例AMI患者的资料 ,按不同时期、不同性别及年龄分组 ,用 χ2 检验和u检验进行多侧面分析比较。结果　(1)近 11年来收治的AMI病例数大体呈逐年升高的趋势 ,AMI患者的总体住院天数及住院病死率有显著下降 ,但老年AMI患者人数构成比增加 ,特别患AMI再住院的老年患者人数构成比显著增加 ,同时住院费用也急剧增加。 (2 )性别比较发现 ,90年代后期患AMI第一次住院的青年男性患者及老年女性患者有明显增多趋势。 (3)住院病死率分析发现 ,90年代后期AMI住院病死率的下降主要体现在老年男性患者住院病死率的下降 ,而中青年男性患者及女性住院病死率无明显下降。 (4)死因分析 ,男女总死因的前三位均为心力衰竭 ,心源性休克以及心力衰竭并休克。男性≤ 6 0岁组心源性休克明显占较高比例。 (5 )比较男女部分特点发现 ,未经年龄校正前女性的住院病死率明显高于男性 ,经年龄校正后差异变得不显著。女性比男性更少接受冠脉造影和 或PTCA术 ,再住院率较高。结论　AMI患者近 11年来呈逐年升高的趋势 ,住院病死率明显下降 ,男性发病年轻化     

Hospital and long-term survival of patients with acute pulmonary edema associated with coronary artery disease

Cardiogenic acute pulmonary edema (APE) associated with coronary artery disease was diagnosed in 44 patients admitted over a 1-year period to a general university hospital. The patients' clinical characteristics at presentation were variable. Acute myocardial infarction (AMI) was present in 26 patients (59%). The hospital mortality rate was 46% (12 of 26 patients) in the presence of AMI and 6% (1 of 18) in its absence (p = 0.006). Long-term follow-up of all hospital survivors revealed that 8 of 30 (27%) had died at 1 year and that 21 of 30 patients (70%) had died at 6 years. However, there was no significant difference in subsequent survival between the AMI and non-AMI groups. A history of congestive heart failure was selected as the most important predictor of increased mortality risk by univariate analysis of the clinical characteristics of the hospital survivors (p = 0.02). The mortality rate at 6 years of follow-up was 85% (17 of 20 patients) in the presence of a history of congestive heart failure and 40% (6 of 10) in its absence.     

Influence of gender on survival,mode of death,reinfarction, use of medication,and aspects of well being during a period of five years after onset of acute myocardial infarction

Background and hypothesis: This study was undertaken to describe prognosis during a period of 5 years after an acute myocardial infarction (AMI) in relation to gender. Methods: All patients studied were hospitalized in a single hospital during a period of 21 months due to AMI, regardless of age and whether they were admitted to the coronary care unit or another ward. A total of 862 AMI patients [581 (67%) men and 281 (33%) women] were prospectively evaluated. Males were younger and less frequently had a history of congestive heart failure and hypertension. Results: The overall 5-year mortality rate was 48% among men compared with 61 % among women (p < 0.001). However, in a multivariate analysis considering age, gender, and a previous history of cardiovascular diseases, female gender was not independently associated with death. Revascularization in terms of coronary artery bypass grafting and percutaneous transluminal angioplasty did not differ significantly between men and women. The rate of reinfarction was 34% among men and 38% among women (p > 0.2). Conclusion: During 5 years of follow-up in a consecutive series of 862 AMI patients, women had a worse prognosis than men, with a mortality of 61 % compared with 48% (p < 0.001). However, after controlling for a number of potentially confounding prognostic factors, female gender was not independently associated with mortality.     

Long-term prognosis of patients with acute myocardial infarction: is mortality and morbidity as low as the incidence of ischemic heart disease in Japan

Long-term prognosis of hospital survivors with myocardial infarction (MI) was investigated to assess the validity of previous reports on the low incidence of ischemic heart disease in Japan. Among 686 patients with acute MI, 115 (16.8%) died during hospitalization and eight were lost to follow-up. The cumulative mortality rate of the 563 hospital survivors was 6.2% in the first year, 12.0% in the third year, and 19.1% in the fifth year, with cardiac death accounting for 63% of the deaths. Cumulative rates for recurrent MI were 4.4% in the first year, 11.0% in the third year, and 13.2% in the fifth year. Parameters influencing long-term mortality rates obtained by stepwise discriminant analysis were arteriosclerosis-related factors, presence of congestive heart failure at admission, age, and presence of previous MI, while parameters influencing the recurrence of MI were congestive heart failure, arteriosclerosis-related factors, and ischemic findings at discharge. Our findings indicate that the prognosis for patients with MI is far better in Japan than in Western countries and support the previous reports on the low incidence of ischemic heart disease in Japan, while factors influencing the prognosis are similar to those previously reported.     

Impact and Outcomes of Patients with Congestive Heart Failure Complicating Non-ST-Segment Elevation Myocardial Infarction,Results from a Nationally-Representative United States Cohort

IntroductionCongestive heart failure (CHF) is seen in up to 13–25% of patients with NSTEMI. Recent data describing the impact of congestive heart failure (CHF) on in-hospital outcomes in patients with non-ST-segment elevation myocardial infarction (NSTEMI) in the United States is limited. We sought to examine the in-hospital outcomes, and management of CHF in patients admitted to the hospital with NSTEMI.MethodsNational Inpatient Sample (NIS) database (2010–2014) was analyzed to identify patients with NSTEMI using ICD-9-CM codes. The primary outcome was in-hospital mortality. Propensity score-matching analysis compared mortality in CHF patients to matched controls without CHF.ResultsOf 247,624 patients with NSTEMI, 84,115 (34%) had CHF. Patients with CHF were less likely to receive percutaneous coronary intervention (PCI) [20.48% vs. 40.9%, P < 0.001] or coronary artery bypass grafting (CABG) [8.2% vs 9.6%, P < 0.001] during hospitalization. Also, they had longer lengths of stay and higher risk for in-hospital adverse outcomes. CHF was the strongest predictor of in-hospital death. The increased mortality risk was persistent after propensity matching (RR 1.27; 95% CI 1.22 to 1.33).ConclusionCHF among patients with NSTEMI is associated with increased risk for in-hospital mortality and adverse outcomes.     

Prognosis in hypertensives with acute myocardial infarction.

OBJECTIVES: A previous history of hypertension is overrepresented among patients with ischaemic heart disease. The present study aims at describing the influence of a previous history of hypertension upon the prognosis among patients hospitalized due to acute myocardial infarction. DESIGN: Patients were followed for 1 year. Mortality and morbidity are described during hospitalization and after discharge from hospital. SETTING: Sahlgrenska Hospital, serving half of the area of Gothenburg in Sweden. PATIENTS: All patients admitted to Sahlgrenska Hospital during 21 months due to acute myocardial infarction regardless of age and whether they were admitted to the coronary care unit. RESULTS: Among all patients with confirmed acute myocardial infarction (n = 917) a previous history of hypertension was reported in 324 patients. Hypertensives more frequently had a previous history of acute myocardial infarction, angina pectoris, congestive heart failure and diabetes mellitus. Their mortality during hospitalization was similar to that in normotensives. However, the total mortality during 1 year of follow-up was 35% in hypertensives and 25% for normotensives (P < 0.01), and a previous history of hypertension was an independent risk indicator for death after discharge from hospital. Place and mode of death appeared similar in normotensives and hypertensives. Reinfarction was twice as common in hypertensives as in normotensives, and a previous history of hypertension was an independent risk indicator for reinfarction. CONCLUSIONS: Among patients with acute myocardial infarction a previous history of hypertension indicates a poor prognosis, one-third of patients dying and one-quarter developing reinfarction during the first year after onset of acute myocardial infarction.     

Trends in hospitalization and mortality for heart failure in Spain, 1980-1993

AIMS: To describe, for the first time, trends in hospitalization andmortality rates for congestive heart failure in Spain duringthe period 1980–1993. METHODS AND RESULTS: Data on primary diagnosis of congestive heart failure were takenfrom the National Hospital Morbidity Survey and the NationalVital Statistics. The number of hospital admissions for congestiveheart failure rose by 71% (from 42 965 in 1980 to 73 448 in1993) and hospitalization rates for congestive heart failureincreased by 47% (from 348 per 100 000 in 1980 to 511 per 100000 in 1993). The rise in hospitalizations was limited to personsaged 65 years, and proved greater among women. Congestive heartfailure was the leading cause of hospitalization in personsaged 65 years, accounting for 5% of all hospital admissionsin this age group. Age-adjusted congestive heart failure mortalitydeclined by 23%. The decline affected all age groups, with thesole exception of the 80-year group in which mortality rose.Nevertheless, congestive heart failure remained the third leadingcause of cardiovascular death. CONCLUSION: Congestive heart failure represents a significant hospital anddemographic burden for the Spanish population. The hospitalburden increased substantially in the period 1980–1993,and will continue to do so in future with the growth of theelderly population.     

Effect of metoprolol in postinfarction patients with increased heart size

Mortality was analysed in relation to clinical and radiologicalsigns of left ventricular failure in a doubleblind randomizedcomparison of 154 post-myocardial infarction patients assignedto metoprolol (100 mg b.i.d.) and 147 patients assigned to placebotreatment. The maximal respiratory rate in the coronary careunit and the relative heart size measured by chest X-ray examinationprior to discharge from hospital were used for evaluation ofmyocardial function. In the placebo group mortality was higherin those with elevated maximal respiratory rate (11% vs. 27%,P<0.05) and in those with larger hearts (8% vs. 33%, P<0.001).No increase in mortality in patients with findings of left ventriculardysfunction was found in the metoprolol treated group. Thiswas not due to an excess mortality in patients with preservedleft ventricular function, but rather due to a reduction inmortality among patients with impaired left ventricular function.In patients with relative heart sizes > 460 ml m^–2( = median), mortality was higher in the placebo treated patientsas compared to metoprolol treated patients (33% vs 16%, P<0.05). During the three year follow-up, repeat chest X-ray examinationsshowed similar heart sizes in the two treatment groups. Furthermore,treatment with digitalis and diuretics were similar in the twotreatment groups although more patients in the metoprolol groupwere withdrawn due to uncontrolled left ventricular heart failure(7 vs 1, P<0.05). We conclude that elevated maximal respiratory rate in the coronarycare unit and heart enlargement on a pre-discharge chest X-ray,indicate a worsened prognosis. This excess mortality is reducedby metoprolol treatment during a three year follow-up.