Recurrent myocardial infarction. 1. Natural History of fatal and non-fatal events

1306 men below 68 years of age who survived a first myocardialinfarction (MI) during 1968–1977 were followed up between2 and 12 years after discharge from hospital. The mean follow-uptime was 6.5 years. The patients were unselected and paid regularvisits to a Post-MI Clinic where treatment was standardized. The diagnosis of a non-fatal reinfarction was based on conventionalclinical criteria, and the diagnosis of fatal reinfarction onautopsy findings of a recent myocardial injury and/or a freshcoronary thrombus. The autopsy rate was high and the follow-upof endpoints was complete. The total cumulative rate of endpoint free patients was 64%at 5 years and 50% at 10 years follow-up. The total mortalityrate was 19% at 5 years and 33% at 10 years follow-up. The totalcumulative rate of a first reinfarction was 28% at 5 years and37% at 10 years follow-up (80% non-fatal and 20% fatal). 63patients suffered more than one reinfarction. The mortalityrate was strongly associated with age. In contrast the rateof non-fatal reinfarctions was independent of age.     

冠心病与无症状性脑梗死相关性临床研究

目的探讨无症状性脑梗死(SBI)与冠心病的相关性.方法对52例冠心病病人作选择性冠状动脉造影和Gensini评分,以评定冠状动脉硬化的程度.并于冠状动脉造影后一周进行头颅的CT扫描及颈动脉超声显像检查,然后分析两病的相关性.结果(1)头颅CT查出SBI患者14例(26.9%);(2)14例SBI病人中11例(78.5%)伴有冠状动脉左前降支狭窄;(3)与无SBI者比较,14例SBI者的年龄(65.57±2.42岁)显著增大(P＜0.001);冠状动脉造影评分(1.928±0.286)、Gensini评分(35.86±5.13)均显著升高(P均＜0.005);(4)冠状动脉造影评分与SBI阳性率的相关系数为0.892,Gensini评分与SBI病灶数的相关系数为0.957.结论冠心病与无症状性脑梗死呈显著正相关关系,老年冠心病人尤其是冠状动脉左前降支狭窄者易并发无症状性脑梗死.     

Sex-specific effect of serum urate levels on coronary heart disease and myocardial infarction prevention: A Mendelian randomization study

Background and aimsObservational studies have examined serum urate levels in relation to coronary heart disease (CHD) and myocardial infarction (MI). Whether these associations are causal remains controversial, due to confounding factors and reverse causality. We aim to investigate the causality of these associations using Mendelian randomization method.Methods and resultsInstrumental variables were obtained from the largest genome-wide association studies of serum urate (457,690 individuals) to date. Summary statistics were from CARDIoGRAMplusC4D consortium (60,801 CHD cases; 43,676 MI cases), FinnGen (21,012 CHD cases; 12,801 MI cases), UK Biobank (10,157 CHD cases; 7018 MI cases), and Biobank Japan (29,319 CHD cases). Inverse-variance weighted method was applied as the main results. Other statistical methods and reverse MR analysis were conducted in the supplementary analyses. Elevated genetically determined serum urate levels were associated with increased risks of CHD and MI. The association pattern remained for the datasets in FinnGen, the combined results of three independent data sources (CHD: odds ratio (OR), 1.10; 95%CI, 1.06–1.15; p = 4.2 × 10^?6; MI: OR, 1.12; 95%CI, 1.07–1.18; p = 2.7 × 10^?6), and East Asian population. Interestingly, sex-specific subgroup analyses revealed that these associations kept in men only, but not among women in individuals of European ancestry. No consistent evidence was found for the causal effect of CHD or MI on serum urate levels.ConclusionWe provide consistent evidence for the causal effect of genetically predicted serum urate levels on CHD and MI, but not the reverse effect. Urate-lowering therapy may be of cardiovascular benefit in the prevention of CHD and MI, especially for men.     

Coronary heart disease: from a disease of middle-aged men in the late 1970s to a disease of elderly women in the 2000s.

AIMS: To analyse secular changes in the prevalence of coronary heart disease (CHD) and to assess changes in the burden of CHD at population level. METHODS AND RESULTS: Data were used from two large cross-sectional health examination surveys representing the entire Finnish adult population in 1980 and 2000. In the 1978-80 survey, the sample covered 5101 individuals aged > or =45, of whom 88% participated. The 2000-2001 survey comprised 5310 individuals in the same age range. Participation rate in the health examination was 87%. Prevalence of CHD decreased in men and women under the age of 65 and increased among those aged > or =75. Prevalence of large Q-waves indicating previous myocardial infarction decreased in all male age groups and in women aged 65-74. The total estimated number of persons with CHD increased by 18% (95% CI=6-30) during the past 20 years in Finland. In 1980, the most dominant CHD group was men aged 45-64, whereas in 2000, women aged > or =75 comprised the largest CHD group. CONCLUSION: Although the prevalence of CHD has decreased among middle-aged persons, the number of CHD cases has increased during the past 20 years in Finland.     

Myocardial infarction in diabetic and non-diabetic persons with and without prior myocardial infarction: the FINAMI Study

Aims/hypothesis We compared the risk of acute coronary events in diabetic and non-diabetic persons with and without prior myocardial infarction (MI), stratified by age and sex. Methods A Finnish MI-register study known as FINAMI recorded incident MIs and coronary deaths (n=6988) among people aged 45 to 74 years in four areas of Finland between 1993 and 2002. The population-based FINRISK surveys were used to estimate the numbers of persons with prior diabetes and prior MI in the population. Results Persons with diabetes but no prior MI and persons with prior MI but no diabetes had a markedly greater risk of a coronary event than persons without diabetes and without prior MI. The rate of recurrent MI among non-diabetic men with prior MI was higher than the incidence of first MI among diabetic men aged 45 to 54 years. The rate ratio was 2.14 (95% CI 1.40–3.27) among men aged 50. Among elderly men, diabetes conferred a higher risk than prior MI. Diabetic women had a similar risk of suffering a first MI as non-diabetic women with a prior MI had for suffering a recurrent MI. Conclusions/interpretation Both persons with diabetes but no prior MI, and persons with a prior MI but no diabetes are high-risk individuals. Among men, a prior MI conferred a higher risk of a coronary event than diabetes in the 45–54 year age group, but the situation was reversed in the elderly. Among diabetic women, the risk of suffering a first MI was similar to the risk that non-diabetic women with prior MI had of suffering a recurrent MI.     

反复急性冠状动脉栓塞致心肌梗死一例

<正>1病例资料患者女性,57岁。因"突发胸痛2 h"于2008年8月16日入院。患者胸痛发作时正在步行上坡,胸痛部位位于前胸偏右侧,呈持续性胀痛,伴气短、心悸。既往史:30年前开始无诱因出现阵发性心悸、气短,左前胸点状疼痛,含服硝酸异     

Serum lipoprotein(a) level in relation to severity of coronary artery disease and coronary artery patency in acute myocardial infarction

Lipoprotein(a) (Lp(a)) is a low-density lipoprotein (LDL)-like particle that may accelerate atherogenesis and promote thrombosis. In the present study, relationships between serum Lp(a) levels and the severity of coronary artery disease and infarct artery patency were studied in 14 patients with acute myocardial infarction. Lp(a) was measured by enzyme-linked immunosorbent assay and the timing of reperfusion was evaluated using the creatine kinase myosin-brain fraction and myoglobin release curves. Thrombolysis in Myocardial Infarction (TIMI) flow grade and severity of coronary artery disease were assessed using a scoring system based on coronary angiography performed during hospitalization and 6 months thereafter. The median Lp(a) level on admission was 127 (range 11–2 513) mg/l. The overall coronary score was higher in patients with Lp(a) levels greater than 127 mg/l than in those with Lp(a) less than 127 mg/l (P < 0.01). Lp(a) level correlated with the coronary score measured during hospitalization (r = 0.80, P < 0.01) and 6 months later (r = 0.79, P < 0.01). The timing of reperfusion and infarct artery patency were not dependent on the serum Lp(a) level. The results show that the serum Lp(a) level is associated with the angiographic severity of coronary artery disease postmyocardial infarction but does not determine the patency of the infarct-related artery. Received: May 14, 2001 / Accepted: September 22, 2001     

冠心病和急性心肌梗死与血清胆红素水平的关系研究

目的　探讨冠心病和急性心肌梗死 (AMI)患者与血清胆红素水平的关系。方法　 1 0 0例病人分为三组 ,其中冠心病组 35例、AMI组 34例和对照组 31例 ,用重氮法和一步酶法分别测定血清胆红素和低密度脂蛋白 (L DL )。结果　冠心病组和 AMI组的血清胆红素水平低于对照组 (P<0 .0 5) ,尤其是间接胆红素水平 ,而 LDL则高于对照组 (P<0 .0 5)。结论　血清胆红素和间接胆红素水平降低与冠心病密切相关     

应用冠状动脉造影分析γ谷氨酰转移酶与冠心病的相关性

目的探讨血浆γ谷氨酰转移酶(γ-GT)水平与冠心病的相关关系。方法选择行冠状动脉造影术的425例患者为研究对象,其中正常组196例、急性心肌梗死组65例、不稳定型心绞痛组84例和稳定型心绞痛组80例。所有患者测定血浆γ-GT水平;根据造影结果采用Gensini评分系统对冠心病组每支血管病变程度进行定量评定,行记录住院期间心血管事件(MACE)的发生。应用卡方检验、方差分析及t检验比较各项临床资料的差异,Pearson积距相关分析γ-GT与冠状动脉病变严重程度的相关性。并采用Logistic回归模型方法分析MACE的危险因素,应用受试者工作曲线(ROC)分析其最佳切入值。结果与对照组相比,冠心病组血浆γ-GT水平显著升高[(27.2±16.1)U/L比(19.5±12.1)U/L,P=0.003]。相关分析显示血浆γ-GT水平与冠状动脉病变严重程度呈正相关(r=0.343,P=0.01)。Logistic回归分析表明血浆γ-GT水平是心血管事件发生的危险因素(OR=1.202,P<0.001),切入值为33 U/L。结论血浆γ-GT与冠状动脉病变严重程度相关,是心血管事件发生的危险因素。     

达格列净联合二甲双胍对糖尿病合并冠心病患者氧化应激与糖脂代谢的影响

目的探讨达格列净联合二甲双胍对糖尿病合并冠心病患者氧化应激与糖脂代谢的影响。 方法选择2019年3月至2020年3月于广东省化州市人民医院心血管内科治疗的2型糖尿病合并冠心病患者共50例,随机分为处理组和对照组,每组25例,其中处理组采用达格列净联合二甲双胍干预血糖,对照组采用二甲双胍干预,比较两组患者干预前和干预6个月后的氧化应激指标包括血清丙二醛（MDA）、超氧化物歧化酶（SOD）、总抗氧化能力（TAC）,脂代谢指标包括低密度脂蛋白（LDL-C）、高密度脂蛋白（HDL-C）、甘油三酯（TG）和总胆固醇（TC）;糖代谢指标包括糖化血红蛋白（HbA1c）、空腹血糖（FPG）、餐后2 h血糖（2hPG）、空腹C肽。 结果两组干预前的TAC、SOD、以及MDA水平对比差异无统计学意义（P>0.05）,干预12周处理组的TAC和SOD水平均显著高于对照组,MDA水平显著低于对照组,差异具有统计学意义（P<0.05）。干预12周后处理组的TC、TG、LDL-C水平均显著低于对照组（P<0.05）,处理组的HDL-C水平显著高于对照组（P<0.05）,治疗12周后处理组FPG、2hPG和HbA1c水平显著低于对照组,而处理组的平均C肽水平显著高于对照组,差异具有统计学意义（P<0.05）。 结论达格列净联合二甲双胍对糖尿病合并冠心病患者能显著提高机体抗氧化应激能力,改善患者的糖脂代谢。     

血尿酸、黄嘌呤氧化酶与冠心病

冠状动脉粥样硬化性心脏病是指冠状动脉粥样硬化使血管腔狭窄或阻塞,或（和）因冠状动脉功能性改变（痉挛）导致心肌缺血缺氧或坏死而引起的心脏病,统称冠状动脉性心脏病（coronary heart disease,CHD）,简称冠心病。随着人们生活水平的提高,其发病率和死亡率呈现逐年上升趋势,因此,对CHD的病理生理机制以及治疗的探讨一直是国际医学界的研究热点。     

心理应激性心肌缺血与中青年女性冠心病的研究

中青年女性发生冠心病的预后不如男性好，这种现象不能用已经证实的传统的心血管疾病危险因素完全解释。心理应激作为新的危险因素，被广泛证实可诱发可逆的心肌缺血，称之为心理应激性心肌缺血。在缺血性心脏病患者中，心理应激性心肌缺血发生率高且可加重预后转归。与男性患者相比，中青年女性更容易发生心理应激性心肌缺血。最新的研究数据表明微循环障碍可能在中青年女性心理应激性心肌缺血的发生中扮演重要角色。这篇文章首次综述心理应激性心肌缺血与中青年女性冠心病的研究进展。     

糖尿病与冠心病急性心肌梗死

探讨糖尿病(DM)和冠心病心肌梗死的关系。本文主要综述DM并发急性心肌梗死(AMI)的病理生理机制、检测糖化血红蛋白(GHb)的意义、临床及冠状动脉造影特点、治疗方法和今后的研究方向。     

冠状动脉造影正常的年轻人心肌梗死(附7例报告)

目的观察冠状动脉造影正常年轻人心肌梗死的临床和血管造影特点.方法 1996年1月～2000年3月315例心肌梗死患者中26例血管造影显示冠状动脉完全正常,其中7例年龄<45岁.回顾性分析患者的临床和冠状动脉造影特点.结果 7例患者均为男性,平均年龄41岁.既往均无高血压、糖尿病、高血脂及冠心病家族史,前壁梗死5例,下壁梗死2例.7例患者均有发病前大量吸烟、劳累和紧张等明确诱发因素,其中4例于发病后12小时内入院行静脉溶栓治疗,预后良好,另外3例入院时间超过12小时而行一般药物治疗,出院时留有不同程度心功能不全.结论年轻人心肌梗死可发生在冠状动脉完全正常患者中,一般都有明确诱因,及时入院行溶栓治疗预后良好.     

Coffee consumption and risk of coronary heart disease: a meta-analysis

Background and aimsDuring the past three decades the relationship between habitual coffee drinking and coronary heart disease (CHD) has been assessed in numerous studies, with conflicting results. The aim of this study was to systematically examine the data published on the association between habitual coffee consumption and risk of CHD.Methods and resultsThirteen case–control and 10 cohort studies were included. Case–control studies incorporated 9487 cases of CHD and 27,747 controls, and cohort studies included a total of 403,631 participants that were followed for between 3 and 44 years. The summary of odds ratios (OR) for the case–control studies showed statistically significant associations between coffee consumption and CHD for the highest intake group (>4 cups/day), OR 1.83 (95% CI 1.49–2.24; P < 0.0001), and for the second highest category (3–4 cups/day), OR 1.33 (95% CI 1.04–1.71; P < 0.0001), while no significant association emerged for low daily coffee intake (≤2 cups/day), OR 1.03 (95% CI 0.87–1.21; P = 0.45). The analysis of long-term follow-up cohort studies did not show any association between the consumption of coffee and CHD, with a relative risk (RR) of 1.16 (95% CI 0.95–1.41; P = 0.14) for the highest category, and 1.05 (95% CI 0.90–1.22; P = 0.57) and 1.04 (95% CI 0.90–1.19; P = 0.60) for the second and third highest categories, respectively. These results did not differ substantially when controlling for region of origin, fatal and non-fatal events, year of publication, and number of years of follow-up.ConclusionsDespite a significant association between high consumption of coffee and CHD reported among case–control studies, no significant association between daily coffee consumption and CHD emerged from long-term follow-up prospective cohort studies.     

Genetics of coronary artery disease and myocardial infarction

Atherosclerotic coronary artery disease(CAD) comprises a broad spectrum of clinical entities that include asymptomatic subclinical atherosclerosis and its clinical complications, such as angina pectoris, myocardial infarction(MI) and sudden cardiac death. CAD continues to be the leading cause of death in industrialized society. The long-recognized familial clustering of CAD suggests that genetics plays a central role in its development, with the heritability of CAD and MI estimated at approximately 50% to 60%. Understanding the genetic architecture of CAD and MI has proven to be difficult and costly due to the heterogeneity of clinical CAD and the underlying multi-decade complex pathophysiological processes that involve both genetic and environmental interactions. This review describes the clinical heterogeneity of CAD and MI to clarify the disease spectrum in genetic studies, provides a brief overview of the historical understanding and estimation of the heritability of CAD and MI, recounts major gene discoveries of potential causal mutations in familial CAD and MI, summarizes CAD and MIassociated genetic variants identified using candidate gene approaches and genome-wide association studies(GWAS), and summarizes the current status of the construction and validations of genetic risk scores for lifetime risk prediction and guidance for preventive strategies. Potential protective genetic factors against the development of CAD and MI are also discussed. Finally, GWAS have identified multiple genetic factors associated with an increased risk of in-stent restenosis following stent placement for obstructive CAD. This review will also address genetic factors associated with in-stent restenosis, which may ultimately guide clinical decision-making regarding revascularization strategies for patients with CAD and MI.     

Perioperative myocardial infarction in a patient with metabolic syndrome

We report on the case of a 19-year-old Hispanic male with metabolic syndrome who developed a myocardial infarction after an uneventful appendectomy. To our knowledge, this is the first published report of a young adult with metabolic syndrome suffering a major cardiac event after a simple abdominal surgical procedure. It raises the question as to how to prevent such complications in the future.     

Work stress and coronary heart disease: what are the mechanisms?

AIMS: To determine the biological and behavioural factors linking work stress with coronary heart disease (CHD). METHODS AND RESULTS: A total of 10 308 London-based male and female civil servants aged 35-55 at phase 1 (1985-88) of the Whitehall II study were studied. Exposures included work stress (assessed at phases 1 and 2), and outcomes included behavioural risk factors (phase 3), the metabolic syndrome (phase 3), heart rate variability, morning rise in cortisol (phase 7), and incident CHD (phases 2-7) on the basis of CHD death, non-fatal myocardial infarction, or definite angina. Chronic work stress was associated with CHD and this association was stronger among participants aged under 50 (RR 1.68, 95% CI 1.17-2.42). There were similar associations between work stress and low physical activity, poor diet, the metabolic syndrome, its components, and lower heart rate variability. Cross-sectionally, work stress was associated with a higher morning rise in cortisol. Around 32% of the effect of work stress on CHD was attributable to its effect on health behaviours and the metabolic syndrome. CONCLUSION: Work stress may be an important determinant of CHD among working-age populations, which is mediated through indirect effects on health behaviours and direct effects on neuroendocrine stress pathways.     

早发冠心病心肌梗死型与非心肌梗死型危险因素差异分析

目的探讨早发冠心病中心肌梗死型与非心肌梗死型的危险因素差异。方法回顾性分析2004年1月至2009年12月在沈阳医学院附属奉天医院心血管内科住院并确诊的45岁及以下冠心病患者165例,分为急性心肌梗死(AMI)组和非AMI组。对两组患者的相关临床资料及危险因素进行统计分析。结果 AMI组吸烟史比例、男性比率、血浆纤维蛋白原及D-二聚体均高于非AMI组,差异有统计学意义(P<0.05),两组的血脂异常率、血小板计数(PLT)、血小板压积、凝血酶原时间(PT)、国际标准化比值(INR)和活化部分凝血活酶时间(APTT)的差异无统计学意义。结论吸烟、男性性别、血脂水平异常是早发冠心病重要危险因素;血浆纤维蛋白原水平增高对于预测早发冠心病心肌梗死可能具有一定的临床意义。     

The extent of coronary artery disease in diabetic patients with myocardial infarction: an ECG study

In 91 non-diabetics (age 63 +/- 12, mean +/- SD, years range 31-94 years) and 85 patients with known diabetes or clearly abnormal levels of HbA1c (age 66 +/- 10 years, range 36-87 years) electrocardiograms were analysed sequentially after acute myocardial infarction (AMI). There was no significant difference in infarct site between the two groups. Generalized ischaemic change without ST elevation was seen in 33% of diabetics and 22% of non-diabetics (p greater than 0.1). In patients with transmural AMI, cardiogenic shock (CGS) was significantly commoner in diabetics (relative risk 3.1, CL 1.2-8.1) but there was no difference in the frequency of reciprocal change between the two groups. In both diabetic and non-diabetic patients the development of cardiogenic shock was more frequently associated with the presence of reciprocal change, the difference reaching significance in the diabetic group (chi 2 = 4.4, p less than 0.05). Thus cardiogenic shock in both diabetic and non-diabetic patients with AMI may be associated with the presence of extensive coronary artery disease, but differences in the prevalence of extensive disease do not explain the predisposition of diabetic patients to CGS.