Impact of risk factors for non-fatal acute myocardial infarction

The impact of risk factors for acute myocardial infarction (AMI) strongly differs across populations and most studies do not consider age as an effect modifier. This study aims to estimate the population attributable fractions (PAFs) of established risk factors for non-fatal AMI, considering age stratification, within a population-based case–control study of Portuguese men. Cases were male patients consecutively admitted with an incident AMI, during 1999–2003 (n = 638) and controls were a representative sample of the non-institutionalized Porto, Portugal in-habitants (n = 851). PAFs were derived by the equation: PAF = 1 − Σ (ρ/R), in which ρ is the proportion of cases in each exposure stratum and R is the adjusted odds ratio. PAFs were obtained for the individual effect of each factor and for combinations of them, after allowance for confounding. High waist-to-hip ratio (>0.90), smoking and lower education levels (0–4 years) had the highest PAFs among men aged ≤45 years: 81.2% (95% CI: 71.2–88.2), 63.5% (95% CI: 42.0–80.6) and 53.8% (95% CI: 40.9–66.2), respectively. For the oldest men, high waist-to-hip ratio (PAF = 88.7%, 95% CI: 77.6–94.7) and lack of leisure-time physical activity (PAF = 44.8%, 95% CI: 32.0–58.2) were the risk factors with the highest impact. Lifestyles explained 77.2% (95% CI: 53.4–90.9) of young myocardial infarction cases and 77.6% (95% CI: 65.3–86.4) of the cases aged >45 years. Preventive targeted interventions to decrease the prevalence of such modifiable risk factors would likely reduce morbidity and mortality of cardiovascular events and related conditions.     

Risk factors for myocardial infarction in young women

The interim results of a case-control study of myocardial infarction in women below age 55 years conducted in northern Italy since January 1983 are presented, based on 168 cases of acute myocardial infarction and 251 hospital controls. Cigarette smoking was strongly related to myocardial infarction, with risk estimates elevated more than 10-fold for heavy (more than 25 cigarettes per day) smokers. Smoking-related relative risks were of similar magnitude in younger (less than 45 years) and in perimenopausal (45-54 years) women and were largely unaffected by allowance for several potential distorting factors. Other factors independently and strongly related to the risk of myocardial infarction were diabetes, hypertension, and history of coronary heart disease in more than one first-degree relative. Relative risks were also elevated in women who gave birth to their first child earlier (below age 20 years) and in oral contraceptive users. However, these estimates were not significant. The apparent positive associations with clinical history of hyperlipidemia, hypertension in pregnancy, and heavy coffee consumption could be explained largely in terms of confounding, but the protection conveyed by moderate alcohol consumption remained after multivariate analysis. Thus, the interim results of this investigation in a low incidence population confirm the importance of several risk factors previously described in data collected in Northern Europe and the United States. Furthermore, possibly because of the low baseline risk, the proportion of cases attributable to smoking in middle-aged women in this population may be even larger than that previously reported from higher incidence areas.     

Risk factors for myocardial infarction in young women.

Seventy-seven women discharged from hospital with a diagnosis of myocardial infarction and 207 control patients were investigated. All were under 45 years of age at the time of admission. Heavy cigarette smoking, reported treatment for pre-eclamptic toxaemia, and type II hyperlipoproteinaemia were found to be independent risk factors for myocardial infarction. Reported treatment for hypertension and diabetes are probably also independently associated with subsequent development of the condition, but the associations between myocardial infarction and reported treatment for obesity and psychiatric illness appear to be secondary. Previous publications have suggested that use of oral contraceptives is an independent risk factor. Examination of the effect of several factors combined, suggests that they act synergistically, the presence of three or more factors increasing the risk 128-fold.     

急性心肌梗死患者医院感染危险因素分析与预防

目的分析急性心肌梗死患者发生医院感染的部位、病原菌分布和危险因素,提出预防措施,减少医院感染。方法回顾性分析医院2012年6月-2014年12月收治的816例急性心肌梗死并发医院感染的患者临床资料,调查其医院感染率、感染部位、病原菌分布,并对其危险因素进行单因素分析。结果 816例患者发生医院感染93例,医院感染率为11.4%,感染部位依次为:下呼吸道38例、泌尿道22例、消化道17例、上呼吸道9例及皮肤及黏膜7例,分别占40.9%、23.6%、18.3%、9.7%及7.5%;感染病原菌以革兰阴性菌为主,占73.5%,其次为革兰阳性菌占23.5%和真菌占3.0%;急性心肌梗死患者医院感染与患者的年龄、住院时间、合并糖尿病、心功能Ⅲ和Ⅳ分级、介入手术、气管插管和呼吸机使用等因素相关(P<0.05)。结论急性心肌梗死患者医院感染率较高,医院感染以呼吸道感染为主,大多数感染由革兰阴性菌引起,感染相关因素较多,临床应加强感染监测,并制定合理干预措施,减少医院感染发生。     

急性心肌梗死患者医院感染的危险因素分析

目的 探讨急性心肌梗死患者医院感染的原因及分析危险因素,并总结预防对策,以减少急性心肌梗死医院感染的发生率.方法 对2010年1月-2011年12月在医院治疗的120例急性心肌梗死患者进行医院感染调查,分析其危险因素,并总结预防对策.结果 120例急性心肌梗死患者发生医院感染14例,感染率为11.67％;主要感染部位为呼吸道、泌尿系统、消化道,分别占42.86％、21.43％、21.43％;医院感染的危险因素为年龄、就诊时间、心脏左室功能不全、合并高血压、糖尿病及慢性支气管炎、住院时间、侵入性操作等.结论 抗菌药物的预防使用并不能减少医院感染的发生率,缩短住院时间、避免侵入性操作等可有效预防急性心肌梗死患者医院感染的发生.     

急性心肌梗死患者医院感染危险因素分析及对策

目的研究急性心肌梗死患者医院感染的流行病学特征,分析其危险因素及预防策略,以期为急性心肌梗死患者医院感染的预防提供参考依据。方法采用横断面研究法,调查2013年12月-2015年9月317例急性心肌梗死住院患者临床资料、医院感染率以及医院感染流行病学特征;根据感染的特点,对多项可能的急性心肌梗死患者医院感染危险因素进行单因素和多因素分析。结果 317例急性心肌梗死患者共发生感染37例、41例次,医院感染率为11.67%;感染部位以呼吸道为主,共发生25例次,占60.98%;单因素分析结果显示,年龄、住院天数、糖尿病、慢性阻塞性肺疾病、心功能等级、预防性应用抗菌药物等是影响患者医院感染的危险因素,经非条件logistic回归分析结果显示,年龄≥60岁、住院天数≥7d、合并糖尿病、合并慢性阻塞性肺疾病、心功能等级Ⅲ~Ⅵ等为急性心肌梗死患者发生医院感染的独立危险因素。结论急性心肌梗死患者医院感染的高危险因素有高龄、合并基础疾病、心功能差等,针对这些人群应提前采取预防措施以降低医院感染的发生率。     

急性心肌梗死患者医院感染的危险因素及护理对策

目的了解急性心肌梗死(AMI)住院患者医院感染发生情况,分析相关危险因素,探讨预防对策。方法采用回顾性调查方法,对2007年1月-2010年6月入住心血管内科的420例AMI患者的临床资料进行统计分析,内容包括年龄、性别、住院时间、合并其他疾病、心功能情况、有否入住冠心病重症监护病房(CCU)、介入手术、心肌梗死部位、抗菌药物应用等。结果共发生医院感染62例,总发生率14.8%;医院感染部位以呼吸道最为常见,占59.7%,其次是泌尿道12.9%,胃肠道11.3%,口腔9.7%,穿刺部位6.4%;单部位感染46例,2个部位感染12例,≥3个部位感染4例;病原学送检查,标本阳性率为68.6%,检出病原菌以革兰阴性杆菌为主占74.3%,革兰阳性球菌占20.0%,真菌占5.7%;医院感染危险因素包括高龄,住院时间较长,合并高血压、糖尿病、肺部疾病、脑血管病变、肾功能不全,入住CCU,心功能情况、多壁心肌梗死。结论 AMI患者医院感染发生率高,应引起高度重视,制定和完善医院感染防止规范、加强基础护理、保护易感染人群、合理使用抗菌药物等是降低AMI患者医院感染发生率的有效措施。     

急性心肌梗死住院患者发生医院感染的相关危险因素分析

目的 探讨急性心肌梗死住院患者发生医院感染的相关危险因素,为临床控制医院感染提供依据.方法 回顾性分析331例急性心肌梗死住院患者临床资料,对相关危险因素进行分析.结果 发生医院感染72例,感染率21.75％;感染部位主要为下呼吸道、泌尿系、胃肠道、上呼吸道及其他部位,分别占55.56％、16.67％、13.89％、6.94％及6.94％;患者年龄、合并高血压、合并糖尿病、合并肺部疾病、意识障碍、心力衰竭、心律失常、留置导尿、鼻饲、气管插管、使用呼吸机、预防用抗菌药物、使用H2阻滞剂及住院时间≥20 d等因素是引起急性心肌梗死患者发生医院感染的相关因素(P＜0.01);多因素logistic回归分析显示,心力衰竭、留置导尿、预防用抗菌药物、气管插管、使用呼吸机、住院时间长是引起急性心肌梗死住院患者发生医院感染的独立危险因素.结论 急性心肌梗死住院患者医院感染发生率高,医院感染是多因素综合作用所致,应针对危险因素进行干预以预防及控制医院感染的发生.     

中老年急性心肌梗死发病的危险因素

目的探讨中老年急性心肌梗死(AMI)的主要危险因素,为三级预防AMI提供临床流行病学依据。方法采用1∶1配比病例对照研究法,135例AMI患者作为病例组和135例非心血管疾病患者作为对照组,分别进行问卷调查研究。结果肥胖(OR=2.081)、吸烟(OR=2.316)、饮酒(OR=2.609)、咸菜(OR=1.923)、冠心病家族史(OR=4.787)、高血压史(OR=2.136)、缺乏锻炼(OR=1.687)是发生AMI的危险因素。结论急性AMI的主要危险因素包含遗传因素、不良生活习惯、高血压、肥胖等,应针对这些因素进行早期三级有效预防。     

Decomposing differences in acute myocardial infarction fatality in Italian regions

The paper develops a general method for evaluating geographical differences in the outcome of acute myocardial infarction patients, by looking at the process of disease occurrence from infarction to hospitalization and possible death or recovery. The method is applied to regional data in Italy, where the long history of geographical diversities in economical, social and cultural fields is reflected in health care. Specific features of AMI, such as high fatality and fast course of the disease, make it a suitable tracer condition to investigate into the differences of regional health systems during the acute phase of hospitalization. The paper combines administrative and official statistics by region and offers a tool providing suggestions to policy-makers where further eventual investigations are needed around the care pathway and also what possible actions might be undertaken to improve the outcomes.     

Alcohol,smoking, coffee and risk of non-fatal acute myocardial infarction in Italy

Objectives: To assess the relation between cigarette smoking, alcohol, coffee, decaffeinated coffee and tea consumption, and the risk of non-fatal acute myocardial infarction (AMI). Design and setting: Hospital-based case–control study conducted in 1995–1999 in Milan, Italy. Patients: 507 cases with a first episode of non-fatal AMI, and 478 controls admitted to hospital for acute diseases. Methods: Information was collected by interviewer-administered questionnaires. Odds ratios (OR) and 95% confidence intervals (CI) were calculated by multiple logistic regression. Results: Compared to alcohol non-drinkers the OR was 0.6 (95% CI: 0.4–0.9) in drinkers, and 0.5 in drinkers of >3 drinks/day. The OR for >1 drink/day of wine was 0.5, and those for beer, amari, grappa and spirits ranged between 0.4 and 0.6. Compared to never smokers, the OR was 2.2 (95% CI: 1.5–3.1) among current smokers, and 4.6 among current smokers of 25 cigarettes/day. The risk was similar to that of never smokers 5 years after cessation (OR: 1.1 after 5–9 years, 0.7 after 10 years). The OR was 2.3 for low tar cigarettes and 2.0 for high tar ones. The OR for coffee intake (expresso and mocha) was around unity up to 3 cups/day, but rose to 1.9 (95% CI: 1.1–3.3) for 6 cups/day. Moderate decaffeinated coffee and tea intake was not associated with AMI risk. Compared to non-smokers drinking 3 cups of coffee/day, the OR was 1.6 among non-smokers drinking >3 cups of coffee/day and 3.3 (95% CI: 2.1–5.0) among current smokers drinking >3 cups of coffee/day. Compared to alcohol drinkers with a coffee intake of 3 cups/day, alcohol non-drinkers with higher coffee intake had an OR of 2.2, and compared to non-smokers alcohol drinkers, the OR was 3.3 in current smokers alcohol non-drinkers. Conclusions: In this Italian population alcohol intake was inversely associated to AMI risk, while smoking and heavy (but not moderate) coffee drinking increased the risk.     

老年冠心病患者并发急性心肌梗死危险因素分析

目的 探讨老年冠心病患者并发急性心肌梗死（AMI）的危险因素,为采取相应的预防控制措施提供参考。方法 于2013年10月-2016年10月在齐齐哈尔医学院附属第三医院随机抽取心内科就诊的老年冠心病并发AMI患者73例作为AMI组,另抽取该科室同期就诊的老年单纯冠心病患者132例作为非AMI组,采用多因素logistic回归模型分析老年冠心病患者并发AMI危险因素。结果 AMI组老年冠心病患者血清高敏C反应蛋白（hs-CRP）和血肌酐（SCr）水平分别为（7.02±1.83） mmol/L和（94.23±19.23） mmol/L,均高于非AMI组老年冠心病患者的（4.56±0.89） mmol/L和（88.27±16.06） mmol/L,差异均有统计学意义（均P<0.05）;多因素logistic回归分析结果显示,吸烟、高血压、糖尿病、有心血管病家族史和hs-CRP水平较高是老年冠心病患者并发AMI的独立危险因素。结论 吸烟、高血压、糖尿病、有心血管病家族史和hs-CRP水平较高均会增加老年冠心病患者发生AMI的风险。     

急性心肌梗死患者感染的危险因素及预后分析

目的探讨急性心肌梗死(AMI)患者感染的主要危险因素及预后分析,为感染的防治提供指导。方法选择2008年1月-2012年12月的202例急性AMI感染患者作为观察组,并随机从同期AMI患者中选择非感染患者202例作为对照组,分析比较两组患者相关的临床资料,采用SPSS 17.0软件对研究中的统计数据进行统计分析。结果观察组AMI患者感染类型为呼吸道感染153例占75.74%、泌尿道感染23例占11.39%、胃肠道感染21例占10.40%、皮肤感染5例占2.48%;两组患者在年龄、合并高血压或糖尿病、住院时间、心力衰竭、应用抗菌药物等差异均有统计学意义(P<0.05),在性别、吸烟、意识模糊等方面的差异无统计学意义。结论年龄较大、合并高血压或糖尿病、住院时间较长、出现心力衰竭、应用抗菌药物等是急性AMI感染的主要危险因素,在合并感染时一定做好预后的护理工作,提高患者免疫力,促进患者身体康复。     

Time urgency and risk of non-fatal myocardial infarction

BACKGROUND: Inconsistencies in the literature linking Type A behaviour pattern (TAB) to coronary heart disease (CHD) may be due to differences in the effects of various components of TAB, namely aggressiveness, hostility, ambitiousness, competitive drive, and a chronic sense of time urgency. METHODS: We investigated the association between sense of time urgency/impatience and non-fatal myocardial infarction (MI) in a study of 340 cases and an equal number of age-, sex-, and community-matched controls. RESULTS: A dose-response relation was apparent among subjects who rated themselves higher on the four-item time urgency/impatience scale (P-value for trend <0.001), with a matched odds ratio (OR) for non-fatal MI of 4.45 (95% CI : 2.20-8.99) comparing those with the highest rating to those with the lowest. After further adjustment for family history of premature MI, physical activity, body mass index, occupation, cigarette smoking, total caloric intake, per cent calories from saturated fat, alcohol intake, lipid levels, treated hypertension and diabetes, the dose-response relation remained (P-value for trend = 0.015) and the adjusted OR for MI was 3.99 (95% CI : 1.32-12.0) comparing those with the highest rating to those with the lowest. CONCLUSION: In these data, a sense of time urgency/impatience was associated with a dose-response increase in risk of non-fatal MI, independent of other risk factors. Prospective cohort studies of time urgency/impatience and incident CHD events are needed to confirm or refute these observations from a case-control study.     

Vasectomy and non-fatal acute myocardial infarction: a hospital-based case-control study in Seoul, Korea

One hundred and sixty-three Korean men aged 35-64 who were admitted to a university-affiliated hospital diagnosed for the first time with acute myocardial infarction (AMI) were compared with 326 matched non-AMI patients hospitalized with a diagnosis considered unrelated to vasectomy. When other potentially confounding variables were controlled for, vasectomized men were found to be 2.6 times (adjusted odds ratio) more likely to have had an AMI as compared to the non-vasectomized men (95% CL: 1.1, 6.1). The adjusted odds ratio of AMI for subjects having had a vasectomy less than or equal to 9 years ago was the same as those who had a vasectomy greater than or equal to 15 years (OR = 2.5), although those who had had a vasectomy 10-14 years ago were associated with a higher odds ratio of 4.2. Among those subjects with vasectomies who were also cigarette-smokers and/or hypertensive, the risk of development of AMI increased multiplicatively compared with those with none of these conditions. We suspect that our finding of this positive association may be spurious due to possible bias introduced during selection of controls and during the process of data collection. Cancer patients may have been less likely to undergo an elective surgical procedure such as vasectomy prior to the admission. When multivariate analysis included only controls who were non-cancer patients (N = 241 controls), the adjusted odds ratio between vasectomy and hospitalization for AMI was reduced to 2.1, (95% CL: 0.8, 5.7), which is no longer statistically significant. When the analysis was further limited to only those control subjects admitted with a diagnosis of digestive system problems, the adjusted odds ratio was reduced to close to unity (1.1). Recognizing the importance of the study topic and the fact that all previous epidemiological studies showed no association between vasectomy and cardiovascular diseases, we urge further studies. A historical cohort study in the Korean setting is considered feasible and is recommended.     

Overtime work,insufficient sleep,and risk of non-fatal acute myocardial infarction in Japanese men

Objectives: To examine the relation between working hours and hours of sleep and the risk of acute myocardial infarction (AMI), with special reference to the joint effect of these two factors.

Method: Case-control study in Japan. Cases were 260 men aged 40–79 admitted to hospitals with AMI during 1996–8. Controls were 445 men free from AMI matched for age and residence who were recruited from the resident registers. Odds ratios of AMI relative to mean weekly working hours and daily hours of sleep in the past year or in the recent past were calculated.

Results: Weekly working hours were related to progressively increased odds ratios of AMI in the past year as well as in the past month, with a twofold increased risk for overtime work (weekly working hours ≥61) compared with working hours ≤40. Short time sleep (daily hours of sleep ≤5) and frequent lack of sleep (2 or more days/week with <5 hours of sleep) were also associated with a two to threefold increased risk. Frequent lack of sleep and few days off in the recent past showed greater odds ratios than those in the past year.

Conclusions: Overtime work and insufficient sleep may be related to increased risk of AMI.

     

老年急性心肌梗死预后因素的分析

目的探讨影响老年急性心肌梗死(AMI)预后因素的特点.方法将1984～1997年因AMI住院的老年人(年龄≥60岁)279例、中青年(年龄＜60岁)154例的临床表现进行对比分析.结果老年组及中青年组病死率分别为15.77%及5.19%(P＜0.01);老年组因广泛前壁加两处以上梗死死亡率(12.9%)明显高于中青年组(4.5%)(P＜0.01);严重心律失常在老年组及中青年组死亡率分别为61.38%、8.75%,存活者为20.85%、28.08%(P＜0.001),Ⅳ°以上泵衰竭死亡者占52.27%、62.50%,存活者为8.04%、3.24%(P＜0.001),伴存两种以上疾病死亡者为50.00%、12.50%,存活者为2.98%、0%(P＜0.001),老年组高于中青年组;血脂增高在两组无明显差异(P＞0.05).结论影响老年人AMI预后的主要因素除梗塞部位与面积大小、严重心律失常、泵衰竭外,更应注意年龄及伴存疾病这两个因素.     

初发急性心肌梗死与再梗死危险因素分析

目的 研究初发心肌梗死(心梗)和再梗死危险因素,以提高对危险因素的认识,并积极干预,降低发病率及病死率.方法 对146例诊断明确的急性心梗患者分为初发心梗组与再梗死组,比较两组发病危险因素.结果 高血糖、高血脂、吸烟,肥胖及精神紧张是急性心肌再梗死的重要危险因素,发病率显著高于初发组(P＜0.05),高血压、饮酒、高血黏、年龄及性别均是初发与再发心梗的危险因素.结论 对初发急性心梗患者,在干预高血压,积极治疗高血脂、高血黏、控制理想血糖水平,同时戒烟酒,控制体重,避免紧张才能进一步降低心肌再梗死发病率和病死率.