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.     

Femoral and lateral femoral cutaneous nerve block for muscle biopsies in children

Retrospective chart review (1978–1993) of 179 children less than age 18 (10.0 ± 3.8 SD yrs) undergoing muscle biopsy for determination of susceptibility to malignant hyperthermia provided data. One hundred and forty-six patients received femoral and lateral femoral cutaneous nerve blocks as their primary anaesthetic. We examined age, weight, duration of surgery, time to discharge from hospital, choice and dosage of local anaesthetics, choice and dosage of sedation, postoperative pain medications, and complications. All children receiving this form of anaesthesia remained outpatients. Between 1978 and 1985 procaine (10 mg·kg^-1) with hyaluronidase or 2-chloroprocaine (12 mg·kg^-1) provided nerve blockade; after 1985, lignocaine (6.8 mg·kg^-1), or a combination of lignocaine or mepivacaine and 2-chloroprocaine, were the preferred agents. More recently the combination of 2-chloroprocaine and bupivacaine has been popular. Three patients required admission to the recovery room postoperatively, due to heavy sedation. Forty-three children (29%) received pain medication during recovery. Femoral and lateral femoral cutaneous block anaesthesia with light to moderate sedation is well tolerated in children undergoing anterior thigh procedures.     

The multifactor primary prevention trial in Goteborg, Sweden

The effect of a multifactorial intervention programme on coronaryheart disease (CHD), stroke incidence and total mortality wasdetermined in a random sample of men, 47–55 years oldat entry. The intervention group comprised 10004 men, and thetwo control groups were of similar size. The intervention consistedof antihypertensive treatment in subjects with screening bloodpressure above 175 mmHg systolic or 115 mmHg diastolic, dietaryadvice to men with serum cholesterol levels above 260 mg per100 ml ( = 6.8 mMol l^–1), advice to stop smoking to subjectswho smoked more than 15 cigarettes per day. The interventionwas applied for 10 years during which time CHD and stroke incidenceand mortality were followed by means of special registers. Participationrate at first screening examination was 75%.     

INFLUENCE OF SEVERAL FACTORS ON BLOOD ALCOHOL CONCENTRATIONS AFTER DRINKING ALCOHOL

The influence of several factors on the blood alcohol courseafter drinking diluted ethanol was studied in young, healthyvolunteers under strictly standardized conditions. These factorswere sex, dose and concentration of the alcohol, physical exerciseimmediately after drinking, meal consumption before drinkingand energy content and composition of the meal. In 18 bloodsamples, taken within 6 hr after alcohol ingestion, blood alcoholconcentration (BAC) was determined enzymatically. Concomitantlybreath analyses were performed. In general, both methods gavesimilar results. Peak concentration and area under the bloodalcohol curve increased with increasing dose. With the sameamount of ethanol, peak concentration and area under the curvetended to be greater in women than in men. Consumption of ameal had an attenuating effect. The area under the curve wassmaller after a high-energy meal than after a low-energy meal.Peak concentration depended on meal composition, increasingin the order high protein < high sucrose = high complex carbohydrate< high fat. A similar trend was observed for the area underthe blood alcohol curve.     

Glucose tolerance, plasma insulin and α-lipoproteins in young male myocardial infarction survivors compared with controls matched on serum cholesterol concentration

Abstract. In order to identify metabolic risk factors other than hypercholesterolaemia, all cases of acute myocardial infarction, diagnosed in males aged under 40 years, were studied over a period of 6 years in Göteborg, Sweden. Twenty out of twenty-four patients who were alive at the time of the study were compared with forty controls matched for serum cholesterol concentration. A previous report has noted lower apolipoprotein A (apoA) and a higher α-lipoprotein triglyceride concentration in these young myocardial infarction patients compared with the matched controls. Basal blood glucose, oral glucose tolerance and plasma insulin levels did not differ between the patients and controls, i.e. decreased glucose tolerance and elevated plasma insulin levels were not found to be additional risk factors for myocardial infarction in young males if serum cholesterol concentration was taken into consideration. This finding could be explained by the fact that patients and controls were all high cholesterol individuals and a difference between the patients and the general population is still possible. Low apoA was a risk factor independent of serum cholesterol as well as glucose intolerance and elevated plasma insulin levels.     

Tolerability to Treatment with Metoprolol in Acute Myocardial Infarction in Relation to Age

ABSTRACT A double-blind trial with the β₁-selective blocker metoprolol in suspected acute myocardial infarction and during 3 months' follow-up included 1 395 patients, aged 40–74 years, 698 on metoprolol and 697 on placebo. In order to further evaluate the tolerability to β-blockade in the elderly, the total series was divided into 2 groups according to median age (61 years) and into quartiles, the lowest quartile (40–57 years) being compared with the highest (67–74 years). The decrease in heart rate and systolic blood pressure after intravenous metoprolol in the acute phase was similar in the elderly and the younger patients. Hypotension was observed more often in the metoprolol-treated than in the placebo-treated younger patients, while no difference was observed in the elderly. Bradycardia was observed more often in the motoprolol group in both age groups, while there was no difference regarding the incidence of congestive heart failure in either the younger or in the elderly patients. The effect on mortality, serious ventricular arrhythmias and chest pain seemed to be similar in different age groups. From the present series we conclude that hemodynamic reactions and tolerability to β-blockade can be expected to be similar in elderly and younger patients.     

The effect of a mobile coronary care unit on mortality in patients with acute myocardial infarction or cardiac arrest outside hospital

Patients requesting an ambulance for symptoms suggestive ofacute myocardial infarction (AMI) were randomized by the ambulancecontrollers to the hospital-based mobile coronary care unit(MCCU) or to a standard ambulance (STA) in the proportions 60%and 40%, respectively. The MCCU was operated by two ambulancedrivers and two CCU nurses. Eight hundred and twenty-one patientsunder 75 years of age were included in the study, of whom 56patients were found to have cardiac arrest. Two of the 36 inthe MCCU group were successfully resuscitated and dischargedfrom hospital. No patient in the STA group of 20 survived. Among765 patients who were alive when the ambulance arrived, 163had a definite hospital diagnosis of AMI, 99 in the MCCU and64 in the STA group. Median delay time from the start of thesymptoms to the call for an ambulance was 2 h. During transport,two patients in the MCCU developed ventricular fibrillationand were successfully resuscitated. Two patients in the STAdied suddenly and could not be resuscitated. No significantdifference in mortality in the prehospital and hospital phasewas found for any of the randomized patients. For AMI patients,alive when the ambulance arrived, mortality was 17% for MCCUpatients and 33% for STA patients (P=0.036). The differencein mortality remained for up to five years. It is concluded that a MCCU caused a moderate reduction in mortalityin patients with cardiac arrest outside hospital and a significantreduction of mortality in AMI patients alive at the arrivalof the ambulance.