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Sample records for risk zone infarcted

  1. Electro-mechanical characteristics of myocardial infarction border zones and ventricular arrhythmic risk: novel insights from grid-tagged cardiac magnetic resonance imaging

    International Nuclear Information System (INIS)

    Wong, Dennis T.L.; Weightman, Michael J.; Baumert, Mathias; Tayeb, Hussam; Richardson, James D.; Puri, Rishi; Bertaso, Angela G.; Roberts-Thomson, Kurt C.; Sanders, Prashanthan; Worthley, Matthew I.; Worthley, Stephen G.

    2012-01-01

    To investigate whether grid-tag myocardial strain evaluation can characterise 'border-zone' peri-infarct region and identify patients at risk of ventricular arrhythmia as the peri-infarct myocardial zone may represent an important contributor to ventricular arrhythmia following ST-segment elevation myocardial infarction (STEMI). Forty-five patients with STEMI underwent cardiac magnetic resonance (CMR) imaging on days 3 and 90 following primary percutaneous coronary intervention (PCI). Circumferential peak circumferential systolic strain (CS) and strain rate (CSR) were calculated from grid-tagged images. Myocardial segments were classified into 'infarct', 'border-zone', 'adjacent' and 'remote' regions by late-gadolinium enhancement distribution. The relationship between CS and CSR and these distinct myocardial regions was assessed. Ambulatory Holter monitoring was performed 14 days post myocardial infarction (MI) to estimate ventricular arrhythmia risk via evaluation of heart-rate variability (HRV). We analysed 1,222 myocardial segments. Remote and adjacent regions had near-normal parameters of CS and CSR. Border-zone regions had intermediate CS (-9.0 ± 4.6 vs -5.9 ± 7.4, P < 0.001) and CSR (-86.4 ± 33.3 vs -73.5 ± 51.4, P < 0.001) severity compared with infarct regions. Patients with 'border-zone' peri-infarct regions had reduced very-low-frequency power on HRV analysis, which is a surrogate for ventricular arrhythmia risk (P = 0.03). Grid-tagged CMR-derived myocardial strain accurately characterises the mechanical characteristics of 'border-zone' peri-infarct region. Presence of 'border-zone' peri-infarct region correlated with a surrogate marker of heightened arrhythmia risk following STEMI. (orig.)

  2. Overestimation of myocardial infarct size on two-dimensional echocardiograms due to remodelling of the infarct zone.

    Science.gov (United States)

    Johnston, B J; Blinston, G E; Jugdutt, B I

    1994-01-01

    To assess the effect of early regional diastolic shape distortion or bulging of infarct zones due to infarct expansion on estimates of regional left ventricular dysfunction and infarct size by two-dimensional echocardiographic imaging. Quantitative two-dimensional echocardiograms from patients with a first Q wave myocardial infarction and creatine kinase infarct size data, and normal subjects, were subjected to detailed analysis of regional left ventricular dysfunction and shape distortion in short-axis images by established methods. Regional left ventricular asynergy (akinesis and dyskinesis) and shape distortion indices (eg, peak [Pk]/radius [ri]) were measured on endocardial diastolic outlines of short-axis images in 43 postinfarction patients (28 anterior and 15 inferior, 5.9 h after onset) and 11 normal subjects (controls). In the infarction group, endocardial surface area of asynergy was calculated by three-dimensional reconstruction of the images and infarct size from serial creatine kinase blood levels. Diastolic bulging of asynergic zones was found in all infarction patients. The regional shape distortion indices characterizing the area between the 'actual' bulging asynergic segment and the derived 'ideal' circular segment (excluding the bulge) on indexed sections were greater in infarct than control groups (Pk/ri 0.31 versus 0, P 0.001). Importantly, the degree of distortion correlated with overestimation of asynergy (r = 0.89, P < 0.001), and the relation between infarct size and total 'ideal' asynergy showed a leftward shift from that with 'actual' asynergy. Early regional diastolic bulging of the infarct zone results in overestimation of regional ventricular dysfunction, especially in patients with anterior infarction. This effect should be considered when assessing effects of therapy on infarct size, remodelling and dysfunction using tomographical imaging.

  3. Remote Zone Extracellular Volume and Left Ventricular Remodeling in Survivors of ST-Elevation Myocardial Infarction

    Science.gov (United States)

    Carberry, Jaclyn; Carrick, David; Haig, Caroline; Rauhalammi, Samuli M.; Ahmed, Nadeem; Mordi, Ify; McEntegart, Margaret; Petrie, Mark C.; Eteiba, Hany; Hood, Stuart; Watkins, Stuart; Lindsay, Mitchell; Davie, Andrew; Mahrous, Ahmed; Ford, Ian; Sattar, Naveed; Welsh, Paul; Radjenovic, Aleksandra; Oldroyd, Keith G.

    2016-01-01

    The natural history and pathophysiological significance of tissue remodeling in the myocardial remote zone after acute ST-elevation myocardial infarction (STEMI) is incompletely understood. Extracellular volume (ECV) in myocardial regions of interest can now be measured with cardiac magnetic resonance imaging. Patients who sustained an acute STEMI were enrolled in a cohort study (BHF MR-MI [British Heart Foundation Magnetic Resonance Imaging in Acute ST-Segment Elevation Myocardial Infarction study]). Cardiac magnetic resonance was performed at 1.5 Tesla at 2 days and 6 months post STEMI. T1 modified Look-Locker inversion recovery mapping was performed before and 15 minutes after contrast (0.15 mmol/kg gadoterate meglumine) in 140 patients at 2 days post STEMI (mean age: 59 years, 76% male) and in 131 patients at 6 months post STEMI. Remote zone ECV was lower than infarct zone ECV (25.6±2.8% versus 51.4±8.9%; Premote zone ECV (Premote zone ECV (P=0.010). No ST-segment resolution (P=0.034) and extent of ischemic area at risk (Premote zone ECV at 6 months (ΔECV). ΔECV was a multivariable associate of the change in left ventricular end-diastolic volume at 6 months (regression coefficient [95% confidence interval]: 1.43 (0.10–2.76); P=0.036). ΔECV is implicated in the pathophysiology of left ventricular remodeling post STEMI, but because the effect size is small, ΔECV has limited use as a clinical biomarker of remodeling. Clinical Trial Registration— URL: https://www.clinicaltrials.gov. Unique identifier: NCT02072850. PMID:27354423

  4. Significance of collateral circulation on peri-infarct zone: assessment with stress thallium-201 scintigraphy

    International Nuclear Information System (INIS)

    Imamura, T.; Araki, H.; Fukuyama, T.; Maruoka, Y.; Ootsubo, H.; Nakamura, M.; Koiwaya, Y.; Tanaka, K.

    1986-01-01

    To evaluate the significance of collateral circulation on peri-infarct zone, stress myocardial scintigraphy and contrast left ventriculography (LVG) were performed in 38 patients with recent myocardial infarction (MI). All patients had at least one completely occluded coronary artery corresponding to the infarct area. In patients with good collaterals, stress induced transient enlargement of the perfusion defect, however, in those with poor or no collaterals the enlargement did not occur (p less than 0.05). Wall motion abnormality on LVG was significantly milder in the former patients than in the latter (p less than 0.001). Transient enlargement of the perfusion defect after stress and milder left ventricular asynergy were more frequently observed in patients with anterior MI and good collaterals. These observations indicate that good collaterals may keep some myocardium in the peri-infarct zone viable

  5. Alcohol and the risk of myocardial infarction.

    Science.gov (United States)

    Flesch, M; Rosenkranz, S; Erdmann, E; Böhm, M

    2001-04-01

    Epidemiological studies have repeatedly demonstrated a beneficial effect of moderate alcohol consumption on the incidence of coronary heart disease, myocardial infarction and overall mortality. The latter increases with excessive alcohol consumption. Although most epidemiological studies demonstrate a beneficial effect of alcohol consumption independent from the specific kind of alcoholic beverage, there is increasing evidence that wine and in particular red wine might contain pharmacological substances, which prevent atherosclerosis and myocardial infarction independent from the wine ethanol. Pathophysiological mechanisms mediating these beneficial effects include effects of wine phenols and tannins on LDL-cholesterol oxidation status, thrombocyte aggregation, endothelial function and smooth muscle cell proliferation. Identification and characterization of the pharmacologically active substances might provide the stage for the development of new substances to be used in the prevention of coronary artery disease and myocardial infarction.

  6. Risk profile in young patients with acute myocardial infarction

    International Nuclear Information System (INIS)

    Safdar, M.H.K.; Fazal, I.; Ejaz, A.; Awan, Z.I.

    2010-01-01

    The objective of this study was to determine the frequency of risk factors in young patients with acute myocardial infarction and thus with ischemic heart disease (IHD), aged 20 to 40 years, in our population. All patients who fulfilled the inclusion criteria who presented to emergency reception of the hospital with a diagnosis of Acute MI were included. The patients were admitted to coronary care unit (CCU) and were managed for Acute myocardial infarction (MI). Their detailed history was then taken including symptoms at presentation and their risk factors were assessed with the help of history and laboratory investigations. A total of 137 patients were included during the study period. Mean age was 36 years (SD=3.67). Majority of patients were males. Smoking was the major risk factor (64.2%) followed by family history of IHD (30.7%). Most frequent risk factor for Acute myocardial infarction (MI) at young age is smoking followed by family history. (author)

  7. Quantitative estimation of viable myocardium in the infarcted zone by infarct-redistribution map from images of exercise thallium-201 emission computed tomography

    International Nuclear Information System (INIS)

    Sekiai, Yasuhiro

    1988-01-01

    To evaluate, quantitatively, the viable myocardium in the infarcted zone, we invented the infarct-redistribution map which is produced from images of exercise thallium-201 emission computed tomography performed on 10 healthy subjects and 20 patients with myocardial infarction. The map displayed a left ventricle in which the infarcted area both with and without redistribution, the redistribution area without infarction, and normal perfusion area were shown separated in same screen. In these circumstances, the nonredistribution infarct lesion was found as being surrounded by the redistribution area. Indices of infarct and redistribution extent (defect score, % defect, redistribution ratio (RR) and redistribution index (RI)), were induced from the map and were used for quantitative analysis of the redistribution area and as the basis for comparative discussion regarding regional wall motion of the left ventricle. The quantitative indices of defect score, % defect, RR and RI were consistent with the visual assessment of planar images in detecting the extent of redistribution. Furthermore, defect score and % defect had an inverted linear relationship with % shortening (r = -0.573; p < 0.05, r = -0.536; p < 0.05, respectively), and RI had a good linear relationship with % shortening (r = 0.669; p < 0.01). We conclude that the infarct-redistribution map accurately reflects the myocardial viability and therefore may be useful for quantitative estimation of viable myocardium in the infarcted zone. (author)

  8. Smoking and risk of myocardial infarction in women and men

    DEFF Research Database (Denmark)

    Prescott, E; Hippe, M; Schnohr, P

    1998-01-01

    cholesterol concentrations, triglyceride concentrations, diabetes, body mass index, height, alcohol intake, physical activity, and level of education. CONCLUSION: Women may be more sensitive than men to some of the harmful effects of smoking. Interactions between components of smoke and hormonal factors......OBJECTIVE: To compare risk of myocardial infarction associated with smoking in men and women, taking into consideration differences in smoking behaviour and a number of potential confounding variables. DESIGN: Prospective cohort study with follow up of myocardial infarction. SETTING: Pooled data...... from three population studies conducted in Copenhagen. SUBJECTS: 11,472 women and 13,191 men followed for a mean of 12.3 years. MAIN OUTCOME MEASURES: First admission to hospital or death caused by myocardial infarction. RESULTS: 1251 men and 512 women had a myocardial infarction during follow up...

  9. Myocardial infarction in the conscious dog: three dimensional mapping of infarct, collateral flow and region at risk

    International Nuclear Information System (INIS)

    Jugdutt, B.I.; Hutchins, G.M.; Bulkley, B.H.; Becker, L.C.

    1979-01-01

    Myocardial infarcts were examined in dogs to determine the spatial distribution of infarction in the region at risk and the relation between infarction and collateral blood flow. Permanent occlusion of the left circumflex (LC) coronary artery at a constant site was made in 27 conscious dogs that were sacrificed 2 days later. The anatomic region at risk was defined by postmortem coronary arteriography as the volume of the occluded LC coronary bed. The masses of the left ventricle (LV), infarct (I) and risk region (R) were calculated from planimetered areas of weighted bread-loaf sections of LV. Infarct size was directly related to the mass of the risk region (I = 0.53 R - 9.87; r = 0.97; p < 0.001). There was no infarction when R was less than about 20 g or 20% of the LV. The infarcts were mainly subendocardial and tapered from base to apex of the LV; 34% of the risk region became infarcted at the base compared with 22% at the apex. In all dogs, a significant rim of noninfarcted myocardium was identified at lateral aspects of the risk region, even at the endocardial surface. Using 9-μ radioactive microspheres, initial postocclusion flow at the margin of the infarct, but well within the risk region, was higher than at the center, and outer flows were higher than inner flows. Postocclusion flow was even higher in the noninfarcted rim within the risk region, but was still significantly less than flow to normal, nonrisk areas. Collateral flows throughout the risk region increased during the first hour after occlusion, and were even higher at 2 days.Epicardially and laterally within the anatomic risk region there is a substantial amount of tissue that does not infarct despite initally reduced blood flow

  10. Plasma HDL cholesterol and risk of myocardial infarction

    DEFF Research Database (Denmark)

    Voight, Benjamin F; Peloso, Gina M; Orho-Melander, Marju

    2012-01-01

    High plasma HDL cholesterol is associated with reduced risk of myocardial infarction, but whether this association is causal is unclear. Exploiting the fact that genotypes are randomly assigned at meiosis, are independent of non-genetic confounding, and are unmodified by disease processes...

  11. Prognostic Importance of Cardiovascular Risk Factors in Myocardial Infarction Patients

    Czech Academy of Sciences Publication Activity Database

    Monhart, Z.; Grünfeldová, H.; Zvárová, Jana; Janský, P.

    2010-01-01

    Roč. 122, č. 2 (2010), e253 ISSN 0009-7322. [World Congress of Cardiology . 16.06.2010-19.06.2010, Beijing] Institutional research plan: CEZ:AV0Z10300504 Keywords : cardiology * risk factors * myocardioal infarction Subject RIV: FA - Cardiovascular Diseases incl. Cardiotharic Surgery

  12. Class of Antiretroviral Drugs and the Risk of Myocardial Infarction

    DEFF Research Database (Denmark)

    Friis-Møller, Nina; Reiss, P; Sabin, CA

    2007-01-01

    BACKGROUND: We have previously demonstrated an association between combination antiretroviral therapy and the risk of myocardial infarction. It is not clear whether this association differs according to the class of antiretroviral drugs. We conducted a study to investigate the association of cumu...

  13. A detailed family history of myocardial infarction and risk of myocardial infarction

    DEFF Research Database (Denmark)

    Ranthe, Mattis Flyvholm; Petersen, Jonathan Aavang; Bundgård, Henning

    2015-01-01

    of cardiovascular medications. CONCLUSION: A detailed family history, particularly number of affected first- and second-degree relatives, contributes meaningfully to risk assessment, especially in middle-aged persons. Future studies should test for potential improvement of risk algorithm prediction using detailed......BACKGROUND: Family history of myocardial infarction (MI) is an independent risk factor for MI. Several genetic variants are associated with increased risk of MI and family history of MI in a first-degree relative doubles MI risk. However, although family history of MI is not a simple dichotomous...... risk factor, the impact of specific, detailed family histories has not received much attention, despite its high clinical relevance. We examined risk of MI by MIs in first- and second-degree relatives and by number and age of affected relatives. METHODS AND FINDINGS: Using Danish national registers, we...

  14. Dysfunctional nitric oxide signalling increases risk of myocardial infarction.

    Science.gov (United States)

    Erdmann, Jeanette; Stark, Klaus; Esslinger, Ulrike B; Rumpf, Philipp Moritz; Koesling, Doris; de Wit, Cor; Kaiser, Frank J; Braunholz, Diana; Medack, Anja; Fischer, Marcus; Zimmermann, Martina E; Tennstedt, Stephanie; Graf, Elisabeth; Eck, Sebastian; Aherrahrou, Zouhair; Nahrstaedt, Janja; Willenborg, Christina; Bruse, Petra; Brænne, Ingrid; Nöthen, Markus M; Hofmann, Per; Braund, Peter S; Mergia, Evanthia; Reinhard, Wibke; Burgdorf, Christof; Schreiber, Stefan; Balmforth, Anthony J; Hall, Alistair S; Bertram, Lars; Steinhagen-Thiessen, Elisabeth; Li, Shu-Chen; März, Winfried; Reilly, Muredach; Kathiresan, Sekar; McPherson, Ruth; Walter, Ulrich; Ott, Jurg; Samani, Nilesh J; Strom, Tim M; Meitinger, Thomas; Hengstenberg, Christian; Schunkert, Heribert

    2013-12-19

    Myocardial infarction, a leading cause of death in the Western world, usually occurs when the fibrous cap overlying an atherosclerotic plaque in a coronary artery ruptures. The resulting exposure of blood to the atherosclerotic material then triggers thrombus formation, which occludes the artery. The importance of genetic predisposition to coronary artery disease and myocardial infarction is best documented by the predictive value of a positive family history. Next-generation sequencing in families with several affected individuals has revolutionized mutation identification. Here we report the segregation of two private, heterozygous mutations in two functionally related genes, GUCY1A3 (p.Leu163Phefs*24) and CCT7 (p.Ser525Leu), in an extended myocardial infarction family. GUCY1A3 encodes the α1 subunit of soluble guanylyl cyclase (α1-sGC), and CCT7 encodes CCTη, a member of the tailless complex polypeptide 1 ring complex, which, among other functions, stabilizes soluble guanylyl cyclase. After stimulation with nitric oxide, soluble guanylyl cyclase generates cGMP, which induces vasodilation and inhibits platelet activation. We demonstrate in vitro that mutations in both GUCY1A3 and CCT7 severely reduce α1-sGC as well as β1-sGC protein content, and impair soluble guanylyl cyclase activity. Moreover, platelets from digenic mutation carriers contained less soluble guanylyl cyclase protein and consequently displayed reduced nitric-oxide-induced cGMP formation. Mice deficient in α1-sGC protein displayed accelerated thrombus formation in the microcirculation after local trauma. Starting with a severely affected family, we have identified a link between impaired soluble-guanylyl-cyclase-dependent nitric oxide signalling and myocardial infarction risk, possibly through accelerated thrombus formation. Reversing this defect may provide a new therapeutic target for reducing the risk of myocardial infarction.

  15. Cancer risk of patients discharged with acute myocardial infarct

    DEFF Research Database (Denmark)

    Dreyer, L; Olsen, J H

    1998-01-01

    We studied whether common shared environmental or behavioral risk factors, other than tobacco smoking, underlie both atherosclerotic diseases and cancer. We identified a group of 96,891 one-year survivors of acute myocardial infarct through the Danish Hospital Discharge Register between 1977...... and 1989. We calculated the incidence of cancer in this group by linking it to the Danish Cancer Registry for the period 1978-1993. There was no consistent excess over the expected figures for any of the categories of cancer not related to tobacco smoking. Specifically, the rates of colorectal cancer...... in acute myocardial infarct patients were similar to those of the general population, as were the rates for hormone-related cancers, including endometrial and postmenopausal breast cancers. We found a moderate increase in the risk for tobacco-related cancers, which was strongest for patients with early...

  16. Does retirement reduce the risk of myocardial infarction?

    DEFF Research Database (Denmark)

    Olesen, Kasper; Rugulies, Reiner; Rod, Naja Hulvej

    2014-01-01

    BACKGROUND: Recent studies have suggested that retirement may have beneficial effects on health outcomes. In this study we examined whether the risk of myocardial infarction (MI) was reduced following retirement in a Danish population sample. METHODS: Participants were 617 511 Danish workers, born...... of 1.11 (95% confidence interval: 1.06, 1.16) when comparing retirees with active workers of the same age. CONCLUSIONS: This study does not support the hypothesis that retirement reduces risk of MI. On the contrary, we find that retirement is associated with a modestly increased risk of MI....

  17. Risk factors for myocardial infarction in women and men

    DEFF Research Database (Denmark)

    Pedersen, Lene Rørholm; Frestada, Daria; Michelsen, Marie Mide

    2016-01-01

    physically active than women while women have healthier dietary habits. Genetic factors also affect cardiovascular risk but no sex differences have been seen. Increased cardiovascular risk attributed to psychosocial distress is similar in men and women, but since women are more prone to psychosocial distress......Background: Cardiovascular disease has been the leading cause of death in both sexes in developed countries for decades. In general, men and women share the same cardiovascular risk factors. However, in recent trials including both men and women sexspecific analyses have raised awareness of sex...... differences in cardiovascular risk factors due to both biological and cultural differences. Results: Women experience their first myocardial infarction (MI) 6-10 years later than men and a protective effect of their natural estrogen status prior to menopause has been suggested. Female sex hormones have been...

  18. Strain Echocardiography Improves Risk Prediction of Ventricular Arrhythmias After Myocardial Infarction

    DEFF Research Database (Denmark)

    Haugaa, Kristina H; Grenne, Bjørnar L; Eek, Christian H

    2013-01-01

    The aim of this study was to test the hypothesis that strain echocardiography might improve arrhythmic risk stratification in patients after myocardial infarction (MI).......The aim of this study was to test the hypothesis that strain echocardiography might improve arrhythmic risk stratification in patients after myocardial infarction (MI)....

  19. Income as mediator of the effect of occupation on the risk of myocardial infarction

    DEFF Research Database (Denmark)

    Andersen, Ingelise; Gamborg, Michael; Osler, Merete

    2005-01-01

    To investigate whether the effect of occupational grade on the risk of myocardial infarction (MI) is mediated by income with different aspects of income taken into account.......To investigate whether the effect of occupational grade on the risk of myocardial infarction (MI) is mediated by income with different aspects of income taken into account....

  20. Evaluation by contrast-enhanced MR imaging of the lateral border zone in reperfused myocardial infarction in a cat model

    International Nuclear Information System (INIS)

    Jeong, Ae Kyung; Choi, Sang Il; Kim, Dong Hun; Park, Sung Bin; Lee, Seoung Soo; Choi, Seong Hoon; Lim, Tae Hwan

    2000-01-01

    To identify and evaluate the lateral border zone by comparing the size and distribution of the abnormal signal area demonstrated by MR imaging with the infarct area revealed by pathological examination in a reperfused myocardial infarction cat model. In eight cats, the left anterior descending coronary artery was occluded for 90 minutes, and this was followed by 90 minutes of reperfusion. ECG-triggered breath-hold turbo spin-echo T2-weighted MR images were initially obtained along the short axis of the heart before the administration of contrast media. After the injection of Gadomer-17 and Gadophrin-2, contrastenhanced T1-weighted MR images were obtained for three hours. The size of the abnormal signal area seen on each image was compared with that of the infarct area after TTC staining. To assess ultrastructural changes in the myocardium at the infarct area, lateral border zone and normal myocardium, electron microscopic examination was performed. The high signal area seen on T2-weighted images and the enhanced area seen on Gadomer-17-enhanced T1WI were larger than the enhanced area on Gadophrin-2-enhanced T1WI and the infarct area revealed by TTC staining; the difference was expressed as a percentage of the size of the total left ventricle mass (T2= 39.2 %; Gadomer-17 =37.25 % vs Gadophrin-2 = 29.6 %; TTC staining = 28.2 %; p < 0.05). The ultrastructural changes seen at the lateral border zone were compatible with reversible myocardial damage. In a reperfused myocardial infarction cat model, the presence and size of the lateral border zone can be determined by means of Gadomer-17- and Gadophrin-2-enhanced MR imaging

  1. Difference in MRI findings and risk factors between multiple infarction without dementia and multi-infarct dementia

    International Nuclear Information System (INIS)

    Yanagisawa, Masashi; Kaieda, Makoto; Nagatsumi, Atsushi; Terashi, Akiro

    1995-01-01

    MRI findings and risk factors for vascular dementia were evaluated with multi-variate analysis in 96 multi-infarct patients without dementia and 40 multi-infarct patients with dementia (MID). Only subjects with small infarcts in the territory of the perforator artery or deep white matter were studied. The diagnosis of MID was diagnosed according to DMS-III criteria and Hachinski's ischemia score. Location and area of patchy high-intensity areas including small infarcts, the degree of periventricular high intensity (PVH), and the degree of brain atrophy were examined with MR images. Independent variables were: history of hypertension, diabetes mellitus, other complications; systolic and diastolic blood pressure, atherosclerotic index, hematocrit, history of smoking, level of education, and activities of daily life (ADL). Hayashi's quantification method II was used to analyze the data. The most significant correlation was found between history of hypertension and dementia (partial correlation coefficient: 0.39). Significant correlations were also found between ADL and dementia (0.32), between thalamic infarction and dementia (0.31), and between PVH and dementia (0.27). Age, brain atrophy index, and history of diabetes mellitus contributed little to dementia. The contribution to dementia did not differ significantly between right and left patchy high-intensity areas on MR images. Location of infarcts, except for bilateral thalamic infarcts and large PVH, contributed little to dementia. Thus it would be difficult to base a prediction of the prevalence of vascular dementia on MRI findings. However, both hypertention and ADL contribute to vascular dementia and both are treatable, which may be significant for the prevention of dementia. (author)

  2. Peri-infarct zone pacing to prevent adverse left ventricular remodelling in patients with large myocardial infarction

    DEFF Research Database (Denmark)

    Stone, Gregg W; Chung, Eugene S; Stancak, Branislav

    2016-01-01

    AIMS: We sought to determine whether peri-infarct pacing prevents left ventricular (LV) remodelling and improves functional and clinical outcomes in patients with large first myocardial infarction (MI). METHODS AND RESULTS: A total of 126 patients at 27 international sites within 10 days of onset.......92). There were also no significant between-group differences in the change in LV end-systolic volume or ejection fraction over time. Quality of life, as assessed by the Minnesota Living with Heart Failure (HF) and European Quality of Life-5 Dimension questionnaires and New York Heart Association class, was also...

  3. Risk factors in young patients of acute myocardial infarction

    International Nuclear Information System (INIS)

    Faisal, A.W.; Khan, R.A.A.T.; Ayub, M.; Husnain, S.S.

    2011-01-01

    Background: Ischemic heart disease is a leading cause of death throughout the world. CAD has been recognized among younger age group more frequently in recent years. Very limited data is available regarding the prevalence of various risk factors in our younger patients that is why this study was planed. Objectives of the study were to look for the risk factors most prevalent in our young patient of first Acute Myocardial Infarction. And to also look for the number of Risk Factors present in each patient. Methods: We studied 100 consecutive patients from 16-45 years of age presenting with first acute MI. Twelve risk factors were studied namely, gender, family history of premature CAD, smoking hypertension, diabetes, dyslipidemia, obesity, mental stress (type A personality), alcohol, oral contraceptive pills (OCPs), physical activity, and diet. We divided the patients into two groups. Group A with patients 35 years of age or less and group B with patients 36-45 years of age. All risk factors were compared in both the groups. Results: Smoking, diabetes mellitus, dyslipidemia and hypertension were statistically different between the two groups. Frequency wise risk factors were lined up as male sex (91%) Diet (66%), Dyslipidemia (62%), smoking (46%), Type A personality(46%), family history (32%), diabetes mellitus (28%), sedentary lifestyle (26%), hypertension (22%), obesity (17%), alcohol (3%), and OCPs (0%) Most of the patients that is 94% had 3 or more risk factors. Conclusion: Smoking, hypertension, diabetes and dyslipidemia are the major modifiable risk factors in our young adults. If a young male who is smoker or a young female who is diabetic, presents in emergency room with chest pain, always suspect coronary artery disease. Other conventional risk factors are also prevalent but alcohol and OCPs are not a major health problem for us. (author)

  4. Risk factors in young patients of acute myocardial infarction

    Energy Technology Data Exchange (ETDEWEB)

    Faisal, A W; Khan, R A.A.T. [General Physician Minir Hospital, Sargodha (Pakistan); Ayub, M [Munir Hospital, Sargodha (Pakistan); Husnain, S S [Allama Iqbal Medical College, Lahore (Pakistan)

    2011-07-15

    Background: Ischemic heart disease is a leading cause of death throughout the world. CAD has been recognized among younger age group more frequently in recent years. Very limited data is available regarding the prevalence of various risk factors in our younger patients that is why this study was planed. Objectives of the study were to look for the risk factors most prevalent in our young patient of first Acute Myocardial Infarction. And to also look for the number of Risk Factors present in each patient. Methods: We studied 100 consecutive patients from 16-45 years of age presenting with first acute MI. Twelve risk factors were studied namely, gender, family history of premature CAD, smoking hypertension, diabetes, dyslipidemia, obesity, mental stress (type A personality), alcohol, oral contraceptive pills (OCPs), physical activity, and diet. We divided the patients into two groups. Group A with patients 35 years of age or less and group B with patients 36-45 years of age. All risk factors were compared in both the groups. Results: Smoking, diabetes mellitus, dyslipidemia and hypertension were statistically different between the two groups. Frequency wise risk factors were lined up as male sex (91%) Diet (66%), Dyslipidemia (62%), smoking (46%), Type A personality(46%), family history (32%), diabetes mellitus (28%), sedentary lifestyle (26%), hypertension (22%), obesity (17%), alcohol (3%), and OCPs (0%) Most of the patients that is 94% had 3 or more risk factors. Conclusion: Smoking, hypertension, diabetes and dyslipidemia are the major modifiable risk factors in our young adults. If a young male who is smoker or a young female who is diabetic, presents in emergency room with chest pain, always suspect coronary artery disease. Other conventional risk factors are also prevalent but alcohol and OCPs are not a major health problem for us. (author)

  5. Higher relative, but lower absolute risks of myocardial infarction in women than in men

    DEFF Research Database (Denmark)

    Reuterwall, C; Hallqvist, J; Ahlbom, A

    1999-01-01

    Middle-aged men have often been the subjects of multifactorial studies of myocardial infarction (MI) risk factors. One major objective of the SHEEP study was to compare the effects of different MI risk factors in women and men.......Middle-aged men have often been the subjects of multifactorial studies of myocardial infarction (MI) risk factors. One major objective of the SHEEP study was to compare the effects of different MI risk factors in women and men....

  6. IS OPIUM ADDICTION A RISK FACTOR FOR ACUTE MYOCARDIAL INFARCTION?

    Directory of Open Access Journals (Sweden)

    "S. M. Sadr Bafghi

    2005-06-01

    Full Text Available There is a misconception among our people that opioids may prevent or have ameliorating effects in the occurrence of cardiovascular diseases. In this study we evaluated 556 consecutive male patients hospitalized due to acute myocardial infarction (MI in city of Yazd, from May 2000 to October 2001 and compared the characteristics of opium addicts to non opium users. Prevalence of opium addiction in MI patients was 19% in comparison with 2-2.8% in general population. There were not any differences in prevalence of traditional risk factors between opium users and non-users. Overall, in-hospital mortality was 18.6 percent among opium users and 6.2 percent among non-opium users (unadjusted odd ratio, 1.3; 95% confidence interval, 0.7 to 2.7, P = 0.2. After adjustment for the differences in the baseline features (age and other risk factors, odds ratio increased to 2.2 (95 percent confidence interval, 0.9 to 5.1. It seems that opium addiction may work as a risk factor in cardiovascular disease.

  7. Association between divorce and risks for acute myocardial infarction.

    Science.gov (United States)

    Dupre, Matthew E; George, Linda K; Liu, Guangya; Peterson, Eric D

    2015-05-01

    Divorce is a major life stressor that can have economic, emotional, and physical health consequences. However, the cumulative association between divorce and risks for acute myocardial infarction (AMI) is unknown. This study investigated the association between lifetime exposure to divorce and the incidence of AMI in US adults. We used nationally representative data from a prospective cohort of ever-married adults aged 45 to 80 years (n=15,827) who were followed biennially from 1992 to 2010. Approximately 14% of men and 19% of women were divorced at baseline and more than one third of the cohort had ≥1 divorce in their lifetime. In 200,524 person-years of follow-up, 8% (n=1211) of the cohort had an AMI and age-specific rates of AMI were consistently higher in those who were divorced compared with those who were continuously married (Pdivorce (hazard ratio, 1.24; 95% confidence interval, 1.01-1.55), ≥2 divorces (hazard ratio, 1.77; 95% confidence interval, 1.30-2.41), and among the remarried (hazard ratio, 1.35; 95% confidence interval, 1.07-1.70) compared with continuously married women after adjusting for multiple risk factors. Multivariable-adjusted risks were elevated only in men with a history of ≥2 divorces (hazard ratio, 1.30; 95% confidence interval, 1.02-1.66) compared with continuously married men. Men who remarried had no significant risk for AMI. Interaction terms for sex were not statistically significant. Divorce is a significant risk factor for AMI. The risks associated with multiple divorces are especially high in women and are not reduced with remarriage. © 2015 American Heart Association, Inc.

  8. The Association Between Divorce and Risks for Acute Myocardial Infarction

    Science.gov (United States)

    Dupre, Matthew E.; George, Linda K.; Liu, Guangya; Peterson, Eric D.

    2015-01-01

    Background Divorce is a major life stressor that can have economic, emotional, and physical health consequences. However, the cumulative association between divorce and risks for acute myocardial infarction (AMI) is unknown. This study investigated the association between lifetime exposure to divorce and the incidence of AMI in U.S. adults. Methods and Results We used nationally representative data from a prospective cohort of ever-married adults aged 45 to 80 (n=15,827) who were followed biennially from 1992 to 2010. Approximately 14% of men and 19% of women were divorced at baseline and more than one-third of the cohort had at least one divorce in their lifetime. In 200,524 person-years of follow-up, 8% (n=1,211) of the cohort had an AMI and age-specific rates of AMI were consistently higher in those who were divorced relative to those who were continuously married (Pdivorce (HR, 1.24; 95% CI, 1.01-1.55), 2 or more divorces (HR, 1.77; 95% CI, 1.30-2.41), and among the remarried (HR, 1.35; 95% CI, 1.07-1.70) compared with continuously married women after adjusting for multiple risk factors. Multivariable-adjusted risks were elevated only in men with a history of 2 or more divorces (HR, 1.30; 95%CI, 1.02-1.66) relative to continuously married men. Men who remarried had no significant risk for AMI. Interaction terms for sex were not statistically significant. Conclusions Divorce is a significant risk factor for AMI. The risks associated with multiple divorces are especially high in women and are not reduced with remarriage. PMID:25872508

  9. Risk factors for myocardial infarction during vacation travel.

    Science.gov (United States)

    Kop, Willem J; Vingerhoets, Ad; Kruithof, Gert-Jan; Gottdiener, John S

    2003-01-01

    Medical emergencies occur increasingly outside the usual health care area as a result of increased leisure and professional travel. Acute coronary syndromes are the leading cause of mortality during vacation. Vacation activities include physical and emotional triggers for myocardial infarction (MI). This study examines characteristics of vacation travel as risk factors for MI. Patients diagnosed with MI during vacation abroad (N = 92; age, 59.5 +/- 10.2; 79 men) were recruited through an emergency health insurance organization. Risk indicators for Vacation MI were examined and included: cardiovascular risk factors, psychosocial measures, and specific demands and activities related to vacation (eg, lodging accommodations, unfamiliar destination, mode of transportation, short-term planning). Vacation MI patients were compared with two reference groups: age-matched Vacation Controls with noncardiovascular medical emergencies (N = 67) and Hospital MI Controls, admitted in their usual health care area (N = 30). Vacation MI occurred disproportionately (21.1%) during the first 2 days of vacation. Cardiovascular risk factors were more prevalent among Vacation MI patients than Vacation Controls (p values traveling by car versus other modes of transportation (OR = 2.5, CI = 1.0-6.1) and among patients staying in a tent or mobile home versus hotel (OR = 9.7, CI = 2.0-47.9). Incidence of MI during vacation is highest during the first 2 days of vacation. Vacation activities such as adverse driving conditions and less luxurious accommodations may increase risk for MI. Individuals with known vulnerability for MI may therefore benefit from minimizing physical and emotional challenges specifically related to vacation travel.

  10. In-hospital outcome of acute myocardial infarction in correlation with 'thrombolysis in myocardial infarction' risk score

    International Nuclear Information System (INIS)

    Masood, A.; Naqvi, M.A.; Jafar, S.S.

    2009-01-01

    Effective risk stratification is integral to management of acute coronary syndromes (ACS). The Thrombolysis in Myocardial Infarction (TIMI) risk score for ST-segment elevation myocardial infarction (STEMI) is a simple integer score based on 8 high-risk parameters that can be used at the bedside for risk stratification of patients at presentation with STEMI. To evaluate the prognostic significance of TIMI risk score in a local population group of acute STEMI. The study included 160 cases of STEMI eligible for thrombolysis. TIMI risk score was calculated for each case at the time of presentation and were then followed during their hospital stay for the occurrence of electrical and mechanical complications as well as mortality. The patients were divided into three risk groups, namely 'low risk', 'moderate-risk' and 'high-risk' based on their TIMI scores (0-4 low-risk, 5-8 moderate-risk, 9-14 high risk). The frequencies of complications and deaths were compared among the three risk groups. Post MI arrhythmias were noted in 2.2%, 16% and 50%; cardiogenic shock in 6.7%, 16% and 60%; pulmonary edema in 6.7%, 20% and 80%; mechanical complications of MI in 0%, 8% and 30%; death in 4.4%, 8%, and 60% of patients belonging to low-risk, moderate-risk and high-risk groups respectively. Frequency of complications and death correlated well with TIMI risk score (p=0.001). TIMI risk score correlates well with the frequency of electrical or mechanical complications and death after STEMI. (author)

  11. Risk-based zoning for urbanizing floodplains.

    Science.gov (United States)

    Porse, Erik

    2014-01-01

    Urban floodplain development brings economic benefits and enhanced flood risks. Rapidly growing cities must often balance the economic benefits and increased risks of floodplain settlement. Planning can provide multiple flood mitigation and environmental benefits by combining traditional structural measures such as levees, increasingly popular landscape and design features (green infrastructure), and non-structural measures such as zoning. Flexibility in both structural and non-structural options, including zoning procedures, can reduce flood risks. This paper presents a linear programming formulation to assess cost-effective urban floodplain development decisions that consider benefits and costs of development along with expected flood damages. It uses a probabilistic approach to identify combinations of land-use allocations (residential and commercial development, flood channels, distributed runoff management) and zoning regulations (development zones in channel) to maximize benefits. The model is applied to a floodplain planning analysis for an urbanizing region in the Baja Sur peninsula of Mexico. The analysis demonstrates how (1) economic benefits drive floodplain development, (2) flexible zoning can improve economic returns, and (3) cities can use landscapes, enhanced by technology and design, to manage floods. The framework can incorporate additional green infrastructure benefits, and bridges typical disciplinary gaps for planning and engineering.

  12. Is albuminuria a myocardial infarction risk equivalent for atherothrombotic events?

    Science.gov (United States)

    Rein, Philipp; Saely, Christoph H; Vonbank, Alexander; Fraunberger, Peter; Drexel, Heinz

    2015-05-01

    People with chronic kidney disease frequently experience cardiovascular events. This study sought to investigate whether the presence of albuminuria displays a vascular risk equivalent to that in patients with prior myocardial infarction. Albuminuria was defined as a urinary albumin to creatinine ratio of 30 μg/mg or greater in 852 consecutive patients undergoing coronary angiography. Prospectively, we recorded vascular events over 3.2±1.2 years. From our patients, 513 (60.2%) had neither albuminuria nor a history of MI, 126 (14.8%) had albuminuria without prior MI, 137 (16.1%) did not have albuminuria but had a history of MI, and 76 (8.9%) had both, albuminuria and prior MI. Compared with the incidence of the composite endpoint among normoalbuminuric patients with no prior MI (11.9%), event rates nearly doubled both in patients with albuminuria without prior MI (24.6%; p=0.003) and in normoalbuminuric patients with a history of prior MI (21.2%; p=0.004) and were highest in patients with both, albuminuria and prior MI (36.8%; p<0.001). Importantly, event rates were not significantly different between patients with albuminuria and no prior history of MI and those with normoalbuminuria but prior MI (p=0.972). Moreover, the event rate in patients with both, albuminuria and history of MI, was significantly higher (p<0.05) than in the two groups exhibiting only one of the two conditions. This is the first study demonstrating that albuminuria is a CAD risk equivalent. Thus, cardiovascular risk factors in albuminuric patients should be treated as aggressively as in patients with prior MI. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  13. Acute Myocardial Infarction: The First Manifestation of Ischemic Heart Disease and Relation to Risk Factors

    Directory of Open Access Journals (Sweden)

    Manfroi Waldomiro Carlos

    2002-01-01

    Full Text Available OBJECTIVE: To assess the association between cardiovascular risk factors and acute myocardial infarction as the first manifestation of ischemic heart disease, correlating them with coronary angiographic findings. METHODS: We carried out a cross-sectional study of 104 patients with previous acute myocardial infarction, who were divided into 2 groups according to the presence or absence of angina prior to acute myocardial infarction. We assessed the presence of angina preceding acute myocardial infarction and risk factors, such as age >55 years, male sex, smoking, systemic arterial hypertension, lipid profile, diabetes mellitus, obesity, sedentary lifestyle, and familial history of ischemic heart disease. On coronary angiography, the severity of coronary heart disease and presence of left ventricular hypertrophy were assessed. RESULTS: Of the 104 patients studied, 72.1% were males, 90.4% were white, 73.1% were older than 55 years, and 53.8% were hypertensive. Acute myocardial infarction was the first manifestation of ischemic heart disease in 49% of the patients. The associated risk factors were systemic arterial hypertension (RR=0.19; 95% CI=0.06-0.59; P=0.04 and left ventricular hypertrophy (RR=0.27; 95% CI=0,.8-0.88; P=0.03. The remaining risk factors were not statistically significant. CONCLUSION: Prevalence of acute myocardial infarction as the first manifestation of ischemic heart disease is high, approximately 50%. Hypertensive individuals more frequently have symptoms preceding acute myocardial infarction, probably due to ventricular hypertrophy associated with high blood pressure levels.

  14. Risk determination after an acute myocardial infarction: review of 3 clinical risk prediction tools.

    Science.gov (United States)

    Scruth, Elizabeth Ann; Page, Karen; Cheng, Eugene; Campbell, Michelle; Worrall-Carter, Linda

    2012-01-01

    The objective of the study was to provide comprehensive information for the clinical nurse specialist (CNS) on commonly used clinical prediction (risk assessment) tools used to estimate risk of a secondary cardiac or noncardiac event and mortality in patients undergoing primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI). The evolution and widespread adoption of primary PCI represent major advances in the treatment of acute myocardial infarction, specifically STEMI. The American College of Cardiology and the American Heart Association have recommended early risk stratification for patients presenting with acute coronary syndromes using several clinical risk scores to identify patients' mortality and secondary event risk after PCI. Clinical nurse specialists are integral to any performance improvement strategy. Their knowledge and understandings of clinical prediction tools will be essential in carrying out important assessment, identifying and managing risk in patients who have sustained a STEMI, and enhancing discharge education including counseling on medications and lifestyle changes. Over the past 2 decades, risk scores have been developed from clinical trials to facilitate risk assessment. There are several risk scores that can be used to determine in-hospital and short-term survival. This article critiques the most common tools: the Thrombolytic in Myocardial Infarction risk score, the Global Registry of Acute Coronary Events risk score, and the Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications risk score. The importance of incorporating risk screening assessment tools (that are important for clinical prediction models) to guide therapeutic management of patients cannot be underestimated. The ability to forecast secondary risk after a STEMI will assist in determining which patients would require the most aggressive level of treatment and monitoring postintervention including

  15. Abacavir use and risk of recurrent myocardial infarction

    NARCIS (Netherlands)

    Sabin, Caroline A.; Ryom, Lene; D'Arminio Monforte, Antonella; Hatleberg, Camilla I.; Pradier, Christian; El-Sadr, Wafaa; Kirk, Ole; Weber, Rainer; Phillips, Andrew N.; Mocroft, Amanda; Bonnet, Fabrice; Law, Matthew; de Wit, Stephane; Reiss, Peter; Lundgren, Jens D.

    2018-01-01

    To investigate the association between abacavir (ABC) use and recurrent myocardial infarction (MI) among HIV-positive people with a prior MI. International multicohort collaboration with follow-up from 1999 to 2016. The rate of recurrent MI was described among D:A:D participants who experienced an

  16. Class of Antiretroviral Drugs and the Risk of Myocardial Infarction

    DEFF Research Database (Denmark)

    Friis-Møller, Nina; Reiss, P.; Sabin, C.A.

    2007-01-01

    of myocardial infarction, which is partly explained by dyslipidemia. We found no evidence of such an association for nonnucleoside reverse-transcriptase inhibitors; however, the number of person-years of observation for exposure to this class of drug was less than that for exposure to protease inhibitors...

  17. Valproate attenuates the risk of myocardial infarction in patients with epilepsy: a nationwide cohort study

    DEFF Research Database (Denmark)

    Olesen, J. B.; Hansen, P. R.; Abildstrom, S. Z.

    2011-01-01

    Purpose Patients with epilepsy have increased risk of myocardial infarction (MI). Valproate can exert anti-atherosclerotic effects. We therefore examined the risk of MI in patients with epilepsy receiving valproate. Methods Two cohorts of patients with valproate-treated epilepsy and sex- and age-...

  18. Socioeconomic differences in risk of myocardial infarction 1971-1994 in Sweden

    DEFF Research Database (Denmark)

    Hallqvist, J; Lundberg, Mats; Diderichsen, Finn

    1998-01-01

    The general trend in incidence of myocardial infarction (MI) in the Stockholm area changed from increasing to decreasing around 1980. The objective of this study is to examine time trends in incidence in major socioeconomic strata, relative risk between socioeconomic groups and population risk...... attributable to socioeconomic differences during this period....

  19. Discontinuation of beta-blockers and the risk of myocardial infarction in the elderly.

    NARCIS (Netherlands)

    Teichert, M.; Smet, P.A.G.M. de; Hofman, A.; Witteman, J.C.; Stricker, B.H.C.

    2007-01-01

    BACKGROUND: It has been shown that the abrupt cessation of treatment with beta-adrenoceptor antagonists (beta-blockers) increases the risk of myocardial infarction in patients with hypertension. As beta-blockers differ in their pharmacokinetic and pharmacodynamic properties, this risk of

  20. Combined oral contraceptives : the risk of myocardial infarction and ischemic stroke

    NARCIS (Netherlands)

    Roach, Rachel E J; Helmerhorst, Frans M.; Lijfering, Willem M.; Stijnen, Theo; Algra, Ale; Dekkers, Olaf M.

    2015-01-01

    BACKGROUND: Combined oral contraceptives (COCs) have been associated with an increased risk of arterial thrombosis, i.e. myocardial infarction or ischemic stroke. However, as these diseases are rare in young women and as many types of combined oral contraception exist, the magnitude of the risk and

  1. Discontinuation of β-blockers and the risk of myocardial infarction in the elderly

    NARCIS (Netherlands)

    M. Teichert (Martina); P.A. de Smet (Peter); A. Hofman (Albert); J.C.M. Witteman (Jacqueline); B.H.Ch. Stricker (Bruno)

    2007-01-01

    textabstractBackground: It has been shown that the abrupt cessation of treatment with β-adrenoceptor antagonists (β-blockers) increases the risk of myocardial infarction in patients with hypertension. As β-blockers differ in their pharmacokinetic and pharmacodynamic properties, this risk of

  2. Myocardial infarction (heart attack) and its risk factors: a statistical study

    International Nuclear Information System (INIS)

    Salahuddin; Alamgir

    2005-01-01

    A Statistical technique of odds ratio analysis was performed to look at the association of Myocardial Infarction with sex, smoking, hypertension, cholesterol, diabetes, family history, number of dependents, household income and residence. For this purpose a total of 506 patients were examined and their personal and medical data were collected. For each patient, the phenomenon of myocardial infarction was studied in relation to different risk factors. The analysis suggests that smoking, hypertension, cholesterol level, diabetes, family history are important risk factors for the occurrence of MI. (author)

  3. Myocardial infarction risk and psychosocial work environment: an analysis of the male Swedish working force.

    Science.gov (United States)

    Alfredsson, L; Karasek, R; Theorell, T

    1982-01-01

    The project was designed to test the assumption that certain psychosocial characteristics of occupational groups are associated with elevated myocardial infarction risk. All cases of myocardial infarction below the age of 65 in men living in the region of greater Stockholm during the years 1974-1976 were identified (deaths as well as survivals) in the official registries of hospitalizations and deaths. For each case two controls without infarction (in younger ages four) matched for age, area of residence and sex were selected randomly from the parish registries. For each case and control (n = 334 and 882, respectively) information was available regarding occupation. The psychosocial characteristics of each one of the 118 occupations were recorded by means of a nation wide interview survey (3876 working men) in 1977. Relative age-adjusted risks of developing a myocardial infarction were calculated for occupations in which many vs occupations in which few subjects reported a given characteristic (50% with most vs 50% with least). Shift work and monotony were associated with significant excess risk. Hectic work was not associated with excess risk by itself but in combination with variables associated with low decision latitude and/or few possibilities for growth it was associated with significant excess risk.

  4. Plasma HDL cholesterol and risk of myocardial infarction : A mendelian randomisation study

    NARCIS (Netherlands)

    Voight, Benjamin F.; Peloso, Gina M.; Orho-Melander, Marju; Frikke-Schmidt, Ruth; Barbalic, Maja; Jensen, Majken K.; Hindy, George; Holm, Hilma; Ding, Eric L.; Johnson, Toby; Schunkert, Heribert; Samani, Nilesh J.; Clarke, Robert; Hopewell, Jemma C.; Thompson, John F.; Li, Mingyao; Thorleifsson, Gudmar; Newton-Cheh, Christopher; Musunuru, Kiran; Pirruccello, James P.; Saleheen, Danish; Chen, Li; Stewart, Alexandre F. R.; Schillert, Arne; Thorsteinsdottir, Unnur; Thorgeirsson, Gudmundur; Anand, Sonia; Engert, James C.; Morgan, Thomas; Spertus, John; Stoll, Monika; Berger, Klaus; Martinelli, Nicola; Girelli, Domenico; McKeown, Pascal P.; Patterson, Christopher C.; Epstein, Stephen E.; Devaney, Joseph; Burnett, Mary-Susan; Mooser, Vincent; Ripatti, Samuli; Surakka, Ida; Nieminen, Markku S.; Sinisalo, Juha; Lokki, Marja-Liisa; Perola, Markus; Havulinna, Aki; de Faire, Ulf; Gigante, Bruna; Ingelsson, Erik; Zeller, Tanja; Wild, Philipp; de Bakker, Paul I. W.; Klungel, Olaf H.; Maitland-van der Zee, Anke-Hilse; Peters, Bas J. M.; de Boer, Anthonius; Grobbee, Diederick E.; Kamphuisen, Pieter W.; Deneer, Vera H. M.; Elbers, Clara C.; Onland-Moret, N. Charlotte; Hofker, Marten H.; Wijmenga, Cisca; Verschuren, W. M. Monique; Boer, Jolanda M. A.; van der Schouw, Yvonne T.; Rasheed, Asif; Frossard, Philippe; Demissie, Serkalem; Willer, Cristen; Do, Ron; Ordovas, Jose M.; Abecasis, Goncalo R.; Boehnke, Michael; Mohlke, Karen L.; Daly, Mark J.; Guiducci, Candace; Burtt, Noel P.; Surti, Aarti; Gonzalez, Elena; Purcell, Shaun; Gabriel, Stacey; Marrugat, Jaume; Peden, John; Erdmann, Jeanette; Diemert, Patrick; Willenborg, Christina; Koenig, Inke R.; Fischer, Marcus; Hengstenberg, Christian; Ziegler, Andreas; Buysschaert, Ian; Lambrechts, Diether; Van de Werf, Frans; Fox, Keith A.; El Mokhtari, Nour Eddine; Rubin, Diana; Schrezenmeir, Juergen; Schreiber, Stefan; Schaefer, Arne; Danesh, John; Blankenberg, Stefan; Roberts, Robert; McPherson, Ruth; Watkins, Hugh; Hall, Alistair S.; Overvad, Kim; Rimm, Eric; Boerwinkle, Eric; Tybjaerg-Hansen, Anne; Cupples, L. Adrienne; Reilly, Muredach P.; Melander, Olle; Mannucci, Pier M.; Ardissino, Diego; Siscovick, David; Elosua, Roberto; Stefansson, Kari; O'Donnell, Christopher J.; Salomaa, Veikko; Rader, Daniel J.; Peltonen, Leena; Schwartz, Stephen M.; Altshuler, David; Kathiresan, Sekar

    2012-01-01

    Background High plasma HDL cholesterol is associated with reduced risk of myocardial infarction, but whether this association is causal is unclear. Exploiting the fact that genotypes are randomly assigned at meiosis, are independent of non-genetic confounding, and are unmodified by disease

  5. Use of nucleoside reverse transcriptase inhibitors and risk of myocardial infarction in HIV-infected patients

    DEFF Research Database (Denmark)

    Lundgren, Jens

    2008-01-01

    BACKGROUND: Two nucleos(t)ide reverse transcriptase inhibitors (NRTIs)--abacavir and didanosine--may each be associated with excess risk of myocardial infarction. The reproducibility of this finding in an independent dataset was explored and plausible biological mechanisms were sought. METHODS...

  6. Risk of Myocardial Infarction Attributable to Elevated Levels of Total Cholesterol Among Hypertensives

    NARCIS (Netherlands)

    Glazer, Nicole L.; Smith, Nicholas L.; Heckbert, Susan R.; Doggen, Catharina Jacoba Maria; Lemaitre, Rozenn N.; Psaty, Bruce M.

    2005-01-01

    Background Although cholesterol is an important risk factor for coronary heart disease (CHD) among hypertensives, the burden of CHD among hypertensives that may be due to elevated cholesterol has not been well documented. This study aimed to estimate the proportion of incident myocardial infarction

  7. Intake of whole grains is associated with lower risk of myocardial infarction

    DEFF Research Database (Denmark)

    Helnæs, Anne; Kyrø, Cecilie; Andersen, Ingelise

    2016-01-01

    of whole-grain products was available from a self-administered food-frequency questionnaire, and intakes of total whole grain and whole-grain species (wheat, rye, and oats) were estimated. The association between intake of whole grains and risk of myocardial infarction was examined with the use of a Cox...

  8. Hormone therapy and risk of myocardial infarction: a national register study

    DEFF Research Database (Denmark)

    Nielsen, Lars Hougaard; Løkkegaard, Ellen Christine Leth; Andreasen, Anne Helms

    2008-01-01

    AIM: To assess the risk of myocardial infarction (MI) as a result of hormone therapy (HT), with focus on the influence of age, duration of HT, various regimens and routes, progestagen type, and oestrogen dose. METHODS AND RESULTS: All healthy Danish women (n = 698,098, aged 51-69) were followed d...

  9. Exome sequencing identifies rare LDLR and APOA5 alleles conferring risk for myocardial infarction

    NARCIS (Netherlands)

    Do, Ron; Stitziel, Nathan O.; Won, Hong-Hee; Jørgensen, Anders Berg; Duga, Stefano; Angelica Merlini, Pier; Kiezun, Adam; Farrall, Martin; Goel, Anuj; Zuk, Or; Guella, Illaria; Asselta, Rosanna; Lange, Leslie A.; Peloso, Gina M.; Auer, Paul L.; Girelli, Domenico; Martinelli, Nicola; Farlow, Deborah N.; DePristo, Mark A.; Roberts, Robert; Stewart, Alexander F. R.; Saleheen, Danish; Danesh, John; Epstein, Stephen E.; Sivapalaratnam, Suthesh; Hovingh, G. Kees; Kastelein, John J.; Samani, Nilesh J.; Schunkert, Heribert; Erdmann, Jeanette; Shah, Svati H.; Kraus, William E.; Davies, Robert; Nikpay, Majid; Johansen, Christopher T.; Wang, Jian; Hegele, Robert A.; Hechter, Eliana; Marz, Winfried; Kleber, Marcus E.; Huang, Jie; Johnson, Andrew D.; Li, Mingyao; Burke, Greg L.; Gross, Myron; Liu, Yongmei; Assimes, Themistocles L.; Heiss, Gerardo; Lange, Ethan M.; Folsom, Aaron R.; Taylor, Herman A.; Olivieri, Oliviero; Hamsten, Anders; Clarke, Robert; Reilly, Dermot F.; Yin, Wu; Rivas, Manuel A.; Donnelly, Peter; Rossouw, Jacques E.; Psaty, Bruce M.; Herrington, David M.; Wilson, James G.; Rich, Stephen S.; Bamshad, Michael J.; Tracy, Russell P.; Cupples, L. Adrienne; Rader, Daniel J.; Reilly, Muredach P.; Spertus, John A.; Cresci, Sharon; Hartiala, Jaana; Tang, W. H. Wilson; Hazen, Stanley L.; Allayee, Hooman; Reiner, Alex P.; Carlson, Christopher S.; Kooperberg, Charles; Jackson, Rebecca D.; Boerwinkle, Eric; Lander, Eric S.; Schwartz, Stephen M.; Siscovick, David S.; McPherson, Ruth; Tybjaerg-Hansen, Anne; Abecasis, Goncalo R.; Watkins, Hugh; Nickerson, Deborah A.; Ardissino, Diego; Sunyaev, Shamil R.; O'Donnell, Christopher J.; Altshuler, David; Gabriel, Stacey; Kathiresan, Sekar; Gabriel, Stacey B.; Altshuler, David M.; Abecasis, Gonçalo R.; Daly, Mark J.; de Bakker, Paul I. W.; Fennell, Tim; Garimella, Kiran; Hu, Youna; Jordan, Daniel M.; Jun, Goo; Kang, Hyun Min; Lettre, Guillaume; Li, Bingshan; Newton-Cheh, Christopher H.; Padmanabhan, Sandosh; Peloso, Gina; Pulit, Sara; Reich, David; Schwartz, Steve; Scott, Laura; Stoletzki, Nina; Voight, Benjamin F.; Willer, Cristen J.; Akylbekova, Ermeg; Atwood, Larry D.; Ballantyne, Christie M.; Barbalic, Maja; Barr, R. Graham; Benjamin, Emelia J.; Bis, Joshua; Bowden, Donald W.; Brody, Jennifer; Budoff, Matthew; Burke, Greg; Buxbaum, Sarah; Carr, Jeff; Chen, Donna T.; Chen, Ida Y.; Chen, Wei-Min; Concannon, Pat; Crosby, Jacy; D'Agostino, Ralph; DeStefano, Anita L.; Dreisbach, Albert; Dupuis, Josée; Durda, J. Peter; Ellis, Jaclyn; Fornage, Myriam; Fox, Caroline S.; Fox, Ervin; Funari, Vincent; Ganesh, Santhi K.; Gardin, Julius; Goff, David; Gordon, Ora; Grody, Wayne; Guo, Xiuqing; Hall, Ira M.; Heard-Costa, Nancy L.; Heckbert, Susan R.; Heintz, Nicholas; Hickson, DeMarc; Hwang, Shih-Jen; Jacobs, David R.; Jenny, Nancy S.; Johnson, Craig W.; Kawut, Steven; Kronmal, Richard; Kurz, Raluca; Larson, Martin G.; Lawson, Mark; Lewis, Cora E.; Levy, Daniel; Li, Dalin; Lin, Honghuang; Liu, Chunyu; Liu, Jiankang; Liu, Kiang; Liu, Xiaoming; Longstreth, William T.; Loria, Cay; Lumley, Thomas; Lunetta, Kathryn; Mackey, Aaron J.; Mackey, Rachel; Manichaikul, Ani; Maxwell, Taylor; McKnight, Barbara; Meigs, James B.; Morrison, Alanna C.; Musani, Solomon K.; Mychaleckyj, Josyf C.; Nettleton, Jennifer A.; North, Kari; O'Leary, Daniel; Ong, Frank S.; Palmas, Walter; Pankow, James S.; Pankratz, Nathan D.; Paul, Shom; Perez, Marco; Person, Sharina D.; Polak, Joseph; Post, Wendy S.; Quinlan, Aaron R.; Raffel, Leslie J.; Ramachandran, Vasan S.; Reiner, Alexander P.; Rice, Kenneth; Rotter, Jerome I.; Sanders, Jill P.; Schreiner, Pamela; Seshadri, Sudha; Shea, Steve; Sidney, Stephen; Silverstein, Kevin; Smith, Nicholas L.; Sotoodehnia, Nona; Srinivasan, Asoke; Taylor, Kent; Thomas, Fridtjof; Tsai, Michael Y.; Volcik, Kelly A.; Wassel, Chrstina L.; Watson, Karol; Wei, Gina; White, Wendy; Wiggins, Kerri L.; Wilk, Jemma B.; Williams, O. Dale; Wilson, Gregory; Wolf, Phillip; Zakai, Neil A.; Hardy, John; Meschia, James F.; Nalls, Michael; Singleton, Andrew; Worrall, Brad; Barnes, Kathleen C.; Abdulhamid, Ibrahim; Accurso, Frank; Anbar, Ran; Beaty, Terri; Bigham, Abigail; Black, Phillip; Bleecker, Eugene; Buckingham, Kati; Cairns, Anne Marie; Caplan, Daniel; Chatfield, Barbara; Chidekel, Aaron; Cho, Michael; Christiani, David C.; Crapo, James D.; Crouch, Julia; Daley, Denise; Dang, Anthony; Dang, Hong; de Paula, Alicia; DeCelie-Germana, Joan; Dozor, Allen; Drumm, Mitch; Dyson, Maynard; Emerson, Julia; Emond, Mary J.; Ferkol, Thomas; Fink, Robert; Foster, Cassandra; Froh, Deborah; Gao, Li; Gershan, William; Gibson, Ronald L.; Godwin, Elizabeth; Gondor, Magdalen; Gutierrez, Hector; Hansel, Nadia N.; Hassoun, Paul M.; Hiatt, Peter; Hokanson, John E.; Howenstine, Michelle; Hummer, Laura K.; Jamal, Seema M.; Kanga, Jamshed; Kim, Yoonhee; Knowles, Michael R.; Konstan, Michael; Lahiri, Thomas; Laird, Nan; Lange, Christoph; Lin, Lin; Lin, Xihong; Louie, Tin L.; Lynch, David; Make, Barry; Martin, Thomas R.; Mathai, Steve C.; Mathias, Rasika A.; McNamara, John; McNamara, Sharon; Meyers, Deborah; Millard, Susan; Mogayzel, Peter; Moss, Richard; Murray, Tanda; Nielson, Dennis; Noyes, Blakeslee; O'Neal, Wanda; Orenstein, David; O'Sullivan, Brian; Pace, Rhonda; Pare, Peter; Parker, H. Worth; Passero, Mary Ann; Perkett, Elizabeth; Prestridge, Adrienne; Rafaels, Nicholas M.; Ramsey, Bonnie; Regan, Elizabeth; Ren, Clement; Retsch-Bogart, George; Rock, Michael; Rosen, Antony; Rosenfeld, Margaret; Ruczinski, Ingo; Sanford, Andrew; Schaeffer, David; Sell, Cindy; Sheehan, Daniel; Silverman, Edwin K.; Sin, Don; Spencer, Terry; Stonebraker, Jackie; Tabor, Holly K.; Varlotta, Laurie; Vergara, Candelaria I.; Weiss, Robert; Wigley, Fred; Wise, Robert A.; Wright, Fred A.; Wurfel, Mark M.; Zanni, Robert; Zou, Fei; Rieder, Mark J.; Green, Phil; Shendure, Jay; Akey, Joshua M.; Bustamante, Carlos D.; Crosslin, David R.; Eichler, Evan E.; Fox, P. Keolu; Fu, Wenqing; Gordon, Adam; Gravel, Simon; Jarvik, Gail P.; Johnsen, Jill M.; Kan, Mengyuan; Kenny, Eimear E.; Kidd, Jeffrey M.; Lara-Garduno, Fremiet; Leal, Suzanne M.; Liu, Dajiang J.; McGee, Sean; O'Connor, Timothy D.; Paeper, Bryan; Robertson, Peggy D.; Smith, Joshua D.; Staples, Jeffrey C.; Tennessen, Jacob A.; Turner, Emily H.; Wang, Gao; Yi, Qian; Jackson, Rebecca; Peters, Ulrike; Anderson, Garnet; Anton-Culver, Hoda; Beresford, Shirley; Bizon, Chris; Black, Henry; Brunner, Robert; Brzyski, Robert; Burwen, Dale; Caan, Bette; Carty, Cara L.; Chlebowski, Rowan; Cummings, Steven; Curb, J. David; Eaton, Charles B.; Ford, Leslie; Franceschini, Nora; Fullerton, Stephanie M.; Gass, Margery; Geller, Nancy; Howard, Barbara V.; Hsu, Li; Hutter, Carolyn M.; Ioannidis, John; Jiao, Shuo; Johnson, Karen C.; Kuller, Lewis; LaCroix, Andrea; Lakshminarayan, Kamakshi; Lane, Dorothy; Lasser, Norman; LeBlanc, Erin; Li, Kuo-Ping; Limacher, Marian; Lin, Dan-Yu; Logsdon, Benjamin A.; Hutchinson, Fred; Ludlam, Shari; Manson, JoAnn E.; Margolis, Karen; Martin, Lisa; McGowan, Joan; Monda, Keri L.; Kotchen, Jane Morley; Nathan, Lauren; Ockene, Judith; O'Sullivan, Mary Jo; Phillips, Lawrence S.; Prentice, Ross L.; Robbins, John; Robinson, Jennifer G.; Sangi-Haghpeykar, Haleh; Sarto, Gloria E.; Shumaker, Sally; Simon, Michael S.; Stefanick, Marcia L.; Stein, Evan; Tang, Hua; Taylor, Kira C.; Thomson, Cynthia A.; Thornton, Timothy A.; van Horn, Linda; Vitolins, Mara; Wactawski-Wende, Jean; Wallace, Robert; Wassertheil-Smoller, Sylvia; Zeng, Donglin; Applebaum-Bowden, Deborah; Feolo, Michael; Gan, Weiniu; Paltoo, Dina N.; Sholinsky, Phyliss; Sturcke, Anne

    2015-01-01

    Myocardial infarction (MI), a leading cause of death around the world, displays a complex pattern of inheritance(1,2). When MI occurs early in life, genetic inheritance is a major component to risk(1). Previously, rare mutations in low-density lipoprotein (LDL) genes have been shown to contribute to

  10. Risk Stratification and Effects of Pharmacotherapy in Patients with Acute Myocardial Infarction (AMI) based on data from Pilot AMI Registry

    Czech Academy of Sciences Publication Activity Database

    Peleška, Jan; Grünfeldová, H.; Monhart, Z.; Faltus, Václav; Tomečková, Marie; Ryšavá, D.; Velimský, T.; Ballek, L.; Hubač, J.; Charalampidi, K.; Jánský, P.

    2007-01-01

    Roč. 30 (2007), s. 367-367 ISSN 1420-4096. [Central European Meeting on Hypertension and Cardiovascular Disease Prevention. 11.10.2007-13.10.2007, Kraków] R&D Projects: GA MŠk(CZ) 1M06014 Institutional research plan: CEZ:AV0Z10300504 Keywords : pilot registry of acute myocardial infarction * risk stratification in acute myocardial infarction * effects of pharmacotherapy in acute myocardial infarction Subject RIV: FA - Cardiovascular Disease s incl. Cardiotharic Surgery

  11. Plasma methionine and risk of acute myocardial infarction: Effect modification by established risk factors.

    Science.gov (United States)

    Dhar, Indu; Lysne, Vegard; Seifert, Reinhard; Svingen, Gard F T; Ueland, Per M; Nygård, Ottar K

    2018-05-01

    Methionine (Met) is an essential amino acid involved in methylation reactions and lipid metabolism. A Met-deficient diet may cause hepatic lipid accumulation, which is considered an independent risk factor for atherosclerosis. However, the prospective relationship between circulating Met and incident acute myocardial infarction (AMI) is unknown. We studied the associations of plasma Met and incident AMI in 4156 patients (77% men; median age 62 years) with stable angina pectoris, among whom the majority received lipid lowering therapy with statins. Risk associations were estimated using Cox-regression analyses. Plasma Met was negatively related to age, serum levels of total cholesterol, low-density lipoprotein cholesterol (LDL-C) and apolipoprotein (apo) B at baseline (all p≤0.05). During a median follow-up of 7.5 years, 534 (12.8%) patients experienced an AMI. There was no overall association between plasma Met and incident AMI; however, plasma Met was inversely associated with risk among patients with high as compared to low levels of serum LDL-C or apo B 100 (multivariate adjusted HRs per SD [95% CI] 0.84 [0.73-0.96] and 0.83[0.73-0.95], respectively; p-interaction ≤0.02). Trends towards an inverse risk relationship were also observed among those younger than 62 years and patients without diabetes or hypertension. Low plasma Met was associated with increased risk of AMI in patients with high circulating levels of atherogenic lipids, but also in subgroups with presumably lower cardiovascular risk. The determinants of Met status and their relation with residual cardiovascular risk in patients with coronary heart disease should be further investigated. Copyright © 2018 Elsevier B.V. All rights reserved.

  12. Sociodemographic differences in myocardial infarction risk perceptions among people with coronary heart disease

    DEFF Research Database (Denmark)

    Aalto, Anna-Mari; Weinman, John; French, David P

    2007-01-01

    This study examines sociodemographic differences in myocardial infarction (MI) risk perceptions among people with coronary heart disease (CHD) (N = 3130). Two variables for comparative risk perceptions were computed: (1) own risk compared to that of an average person; and (2) own risk compared...... to that of an average person with CHD. Comparative optimism in MI risk perceptions was common, particularly among men and those with higher education. CHD severity and psychosocial resources mediated these sociodemographic differences. These results suggest challenges for secondary prevention in CHD, particularly...

  13. Symptoms of anxiety and depression and risk of acute myocardial infarction: the HUNT 2 study

    OpenAIRE

    Gustad, Lise Tuset; Laugsand, Lars Erik; Janszky, Imre; Dalen, Håvard; Bjerkeset, Ottar

    2013-01-01

    Aims The nature of the association of depression and anxiety with risk for acute myocardial infarction (AMI) remains unclear. We aimed to study the prospective association of single and recurrent self-reported symptoms of anxiety and depression with a risk of AMI in a large Norwegian population based cohort. Methods and results In the second wave of the Nord-Trøndelag Health Study (HUNT2, 1995–97) baseline data on anxiety and depression symptoms, sociodemographic variables, health status...

  14. The predictive value of CHADS₂ risk score in post myocardial infarction arrhythmias - a Cardiac Arrhythmias and RIsk Stratification after Myocardial infArction (CARISMA) substudy

    DEFF Research Database (Denmark)

    Ruwald, Anne-Christine Huth; Gang, Uffe; Thomsen, Poul Erik Bloch

    2014-01-01

    BACKGROUND: Previous studies have shown substantially increased risk of cardiac arrhythmias and sudden cardiac death in post-myocardial infarction (MI) patients. However it remains difficult to identify the patients who are at highest risk of arrhythmias in the post-MI setting. The purpose...... of this study was to investigate if CHADS₂ score (congestive heart failure, hypertension, age ≥75 years, diabetes and previous stroke/TCI [doubled]) can be used as a risk tool for predicting cardiac arrhythmias after MI. METHODS: The study included 297 post-MI patients from the CARISMA study with left....... Patients were stratified according to CHADS₂ score at enrollment. Congestive heart failure was defined as LVEF ≤40% and NYHA class II, III or IV. RESULTS: We found significantly increased risk of an arrhythmic event with increasing CHADS₂ score (CHADS₂ score=1-2: HR=2.1 [1.1-3.9], p=0.021, CHADS₂ score ≥ 3...

  15. Value of planar 201Tl imaging in risk stratification of patients recovering from acute myocardial infarction

    International Nuclear Information System (INIS)

    Gibson, R.S.; Watson, D.D.

    1991-01-01

    Although exercise ECG testing has been shown to have important prognostic value after acute myocardial infarction, exercise 201Tl scintigraphy offers several potential advantages, including: (1) increased sensitivity for detecting residual myocardial ischemia; (2) the ability to localize ischemia to a specific area or areas subtended by a specific coronary artery; (3) the ability to identify exercise-induced left ventricular dysfunction, which is manifested by increased lung uptake or transient left ventricular dilation; and (4) more reliable risk stratification of individual patients. The more optimal prognostic efficiency of 201Tl scintigraphy partially results from the fact that the error rate in falsely classifying patients as low risk is significantly smaller with 201Tl scintigraphy than with stress ECG. Because of these substantial advantages, there seems to be adequate rationale for recommending exercise perfusion imaging rather than exercise ECG alone as the preferred method for evaluating mortality and morbidity risks after acute myocardial infarction

  16. Menopause and myocardial infarction risk among employed women in relation to work and family psychosocial factors in Lithuania.

    Science.gov (United States)

    Malinauskiene, Vilija; Tamosiunas, Abdonas

    2010-05-01

    To assess the relationship between menopause and age at menopause and the risk of the first non-fatal myocardial infarction taking into account the possible influence of psychosocial job characteristics, marital stress, level of social support, educational level, occupation, age and traditional ischemic heart disease risk factors. Population-based case-control study among 35-61 years old employed women in Kaunas, Lithuania. Totally 122 myocardial infarction cases and 371 controls were interviewed in 2001-2004. The logistic regression analysis was performed. Younger age at menopause (women was 1.15; 95% CI 0.48-2.75. The association between low job control and myocardial infarction showed step increase, women in the lowest quartile of job control had the highest myocardial infarction risk (OR=4.51; 95% CI 1.90-10.75), while those in the second and third quartiles showed modest risk. Marital stress was an independent myocardial infarction risk factor for employed women (adjusted OR=2.36; 95% CI 1.07-5.19). Menopausal status and younger age at menopause showed only a tendency for increase in myocardial infarction risk among the employed women in Kaunas, Lithuania. Adverse psychosocial job characteristics as low job control, as well as marital stress play more important role in the development of the first myocardial infarction. Copyright 2010 Elsevier Ireland Ltd. All rights reserved.

  17. The post-infarction nurse practitioner project A prospective study comparing nurse intervention with conventional care in a non-high-risk myocardial infarction population

    NARCIS (Netherlands)

    Broers, C. J. M.; Sinclair, N.; van der Ploeg, T. J.; Jaarsma, T.; van Veldhuisen, D. J.; Umans, V. A. W. M.

    Objectives. To confirm the feasibility of nurse practitioner intervention in non-high-risk patients with recent myocardial infarction (MI). Design. Observational study. Setting. Acute coronary care unit in a teaching hospital. Methods. We performed an open-label feasibility study to identify

  18. Frequency of risk factors of cerebral infarction in stroke patients. a study of 100 cases in naseer teaching hospital, peshawar

    International Nuclear Information System (INIS)

    Safeer, M.; Tariq, M.; Rehman, U.U.

    2008-01-01

    To study the risk factors of cerebral infarction in stroke patients. It is a descriptive hospital based study conducted at the Department of Medicine, Naseer Teaching Hospital, Peshawar from January 2005 to December 2005. One hundred patients of stroke with cerebral infarction confirmed on C.T. scan brain and more than twenty years of age were included. Risk factors for cerebral infarction were defined in terms of hypertension, diabetes mellitus, ischemic heart disease, smoking, dyslipidaemia, TIAs (transient ischemic attacks), carotid artery stenosis and family history of stroke. Data of 100 cases with cerebral infarction was recorded. Most of the patients had more than one risk factors for cerebral infarction. hypertension was commonest risk factor (55%), smoking (30%), ischemic heart disease (34%), diabetes mellitus) (26%), hyperlipedaemia (30%), atrial fibrillation (25%), carotid artery stenosis (27%), obesity (15%) and family history of stroke (12%). 39% of patients had physical inactivity. Males were slightly predominant than females (51% vs 49%) and mean age was 50 years. females were rather older with mean age of 53 years. Cerebral infarction accounts for 80% to 85% of cases of stroke, which is a common neurological disorder. It increases a burden of disability and misery for patients and their families. Most of the risk factors of cerebral infarction are modifiable, its prevention should be the main cause of concern for the community. (author)

  19. Genetic variation of the androgen receptor and risk of myocardial infarction and ischemic stroke in women.

    Science.gov (United States)

    Rexrode, Kathryn M; Ridker, Paul M; Hegener, Hillary H; Buring, Julie E; Manson, JoAnn E; Zee, Robert Y L

    2008-05-01

    Androgen receptors (AR) are expressed in endothelial cells and vascular smooth-muscle cells. Some studies suggest an association between AR gene variation and risk of cardiovascular disease (CVD) in men; however, the relationship has not been examined in women. Six haplotype block-tagging single nucleotide polymorphisms (rs962458, rs6152, rs1204038, rs2361634, rs1337080, rs1337082), as well as the cysteine, adenine, guanine (CAG) microsatellite in exon 1, of the AR gene were evaluated among 300 white postmenopausal women who developed CVD (158 myocardial infarctions and 142 ischemic strokes) and an equal number of matched controls within the Women's Health Study. Genotype distributions were similar between cases and controls, and genotypes were not significantly related to risk of CVD, myocardial infarctions or ischemic stroke in conditional logistic regression models. Seven common haplotypes were observed, but distributions did not differ between cases and controls nor were significant associations observed in logistic regression analysis. The median CAG repeat length was 21. In conditional logistic regression, there was no association between the number of alleles with CAG repeat length >or=21 (or >or=22) and risk of CVD, myocardial infarctions or ischemic stroke. No association between AR genetic variation, as measured by haplotype-tagging single nucleotide polymorphisms and CAG repeat number, and risk of CVD was observed in women.

  20. Incidence of Brain Infarcts, Cognitive Change, and Risk of Dementia in the General Population: The AGES-Reykjavik Study (Age Gene/Environment Susceptibility-Reykjavik Study).

    Science.gov (United States)

    Sigurdsson, Sigurdur; Aspelund, Thor; Kjartansson, Olafur; Gudmundsson, Elias F; Jonsdottir, Maria K; Eiriksdottir, Gudny; Jonsson, Palmi V; van Buchem, Mark A; Gudnason, Vilmundur; Launer, Lenore J

    2017-09-01

    The differentiation of brain infarcts by region is important because their cause and clinical implications may differ. Information on the incidence of these lesions and association with cognition and dementia from longitudinal population studies is scarce. We investigated the incidence of infarcts in cortical, subcortical, cerebellar, and overall brain regions and how prevalent and incident infarcts associate with cognitive change and incident dementia. Participants (n=2612, 41% men, mean age 74.6±4.8) underwent brain magnetic resonance imaging for the assessment of infarcts and cognitive testing at baseline and on average 5.2 years later. Incident dementia was assessed according to the international guidelines. Twenty-one percent of the study participants developed new infarcts. The risk of incident infarcts in men was higher than the risk in women (1.8; 95% confidence interval, 1.5-2.3). Persons with both incident and prevalent infarcts showed steeper cognitive decline and had almost double relative risk of incident dementia (1.7; 95% confidence interval, 1.3-2.2) compared with those without infarcts. Persons with new subcortical infarcts had the highest risk of incident dementia compared with those without infarcts (2.6; 95% confidence interval, 1.9-3.4). Men are at greater risk of developing incident brain infarcts than women. Persons with incident brain infarcts decline faster in cognition and have an increased risk of dementia compared with those free of infarcts. Incident subcortical infarcts contribute more than cortical and cerebellar infarcts to incident dementia which may indicate that infarcts of small vessel disease origin contribute more to the development of dementia than infarcts of embolic origin in larger vessels. © 2017 American Heart Association, Inc.

  1. Risk and benefit of dual antiplatelet treatment among nonrevascularized myocardial infarction patients in different age groups

    DEFF Research Database (Denmark)

    Juul, Nikolai; Gislason, Gunnar; Olesen, Jonas Bjerring

    2017-01-01

    revascularization. METHODS: Patients admitted with first-time myocardial infarction in 2002-2010, not undergoing revascularization, were identified from nationwide Danish registers. Dual anti-platelet treatment use was assessed by claimed prescriptions. Stratified into age groups, risk of bleeding, all.......63; 95% CI 1.17-2.26), 60-69 years (HR=1.22; 95% CI 0.97-1.59, NS), 70-79 years (HR=1.42; 95% CI 1.17-1.72) and >79 years (HR=1.46; 95% CI 1.22-1.74). Similar tendencies in all four age groups were found in the propensity-matched population. CONCLUSION: Dual anti-platelet treatment use was less likely...... among elderly patients although similar effects regarding both risk and benefit were found in all age groups. Increased focus on initiating dual anti-platelet treatment in elderly, non-invasively treated myocardial infarction patients is warranted....

  2. Myocardial Infarction Risk Due to Aircraft, Road, and Rail Traffic Noise.

    Science.gov (United States)

    Seidler, Andreas; Wagner, Mandy; Schubert, Melanie; Dröge, Patrik; Pons-Kühnemann, Jörn; Swart, Enno; Zeeb, Hajo; Hegewald, Janice

    2016-06-17

    Traffic noise can induce stress reactions that have effects on the cardiovascular system. The exposure-risk relationship between aircraft, road, and rail traffic noise and myocardial infarction is currently unknown. 19 632 patients from the Rhine-Main region of Germany who were diagnosed with myocardial infarction in the years 2006-2010 were compared with 834 734 control subjects. The assignment of persons to groups was performed on the basis of billing and prescription data from three statutory health insurance carriers. The exposure of all insurees to aircraft, road, and rail traffic noise in 2005 was determined from their residence addresses. As estimators of risk, odds ratios (OR) were calculated by logistic regression analysis, with adjustment for age, sex, regional social status variables, and individual social status (if available). The evaluation was performed on the basis of the continuous 24-hour noise level and the categorized noise level (in 5 decibel classes). The linear model revealed a statistically significant risk increase due to road noise (2.8% per 10 dB rise, 95% confidence interval [1.2; 4.5]) and railroad noise (2.3% per 10 dB rise [0.5; 4.2]), but not airplane noise. Airplane noise levels of 60 dB and above were associated with a higher risk of myocardial infarction (OR 1.42 [0.62; 3.25]). This higher risk is statistically significant if the analysis is restricted to patients who had died of myocardial infarction by 2014/2015 (OR 2.70 [1.08; 6.74]. In this subgroup, the risk estimators for all three types of traffic noise were of comparable magnitude (3.2% to 3.9% per 10 dB rise in noise level). In this study, a substantial proportion of the population was exposed to traffic noise levels that were associated with an albeit small increase in the risk of myocardial infarction. These findings underscore the importance of effective traffic noise prevention.

  3. Extreme lipoprotein(a) levels and risk of myocardial infarction in the general population

    DEFF Research Database (Denmark)

    Kamstrup, Pia R; Benn, Marianne; Tybjaerg-Hansen, Anne

    2008-01-01

    Elevated lipoprotein(a) levels are associated with myocardial infarction (MI) in some but not all studies. Limitations of previous studies include lack of risk estimates for extreme lipoprotein(a) levels, measurements in long-term frozen samples, no correction for regression dilution bias, and lack...... of absolute risk estimates in the general population. We tested the hypothesis that extreme lipoprotein(a) levels predict MI in the general population, measuring levels shortly after sampling, correcting for regression dilution bias, and calculating hazard ratios and absolute risk estimates....

  4. Effect of resveratrol and aerobic exercise on some cardiovascular risk factors in rats with acute myocardial infarction

    Directory of Open Access Journals (Sweden)

    Bahram Jamali Qarakhanlou

    2017-09-01

    Conclusion: Regular exercise and resveratrol supplementation is likely to be effective on cardiovascular risk factors and the combination of the two variables in the prevention of inflammation and will have a significant role in heart damage caused by myocardial infarction

  5. The inter-relationship of diabetes and left ventricular systolic function on outcome after high-risk myocardial infarction

    DEFF Research Database (Denmark)

    Shah, Amil M; Uno, Hajime; Køber, Lars

    2010-01-01

    Diabetes is a potent risk factor for death and heart failure (HF) hospitalization following myocardial infarction (MI). Whether diabetes modifies the relationship between left ventricular ejection fraction (LVEF) and outcomes in the post-MI population is unknown....

  6. Coffee consumption after myocardial infarction and risk of cardiovascular mortality

    NARCIS (Netherlands)

    Dongen, Van Laura H.; Molenberg, Famke; Soedamah-Muthu, Sabita S.; Kromhout, Daan; Geleijnse, Johanna M.

    2017-01-01

    Background: Consumption of coffee, one of the most popular beverages around the world, has been associated with a lower risk of cardiovascular and all-cause mortality in population-based studies. However, little is known about these associations in patient populations. Objective: This prospective

  7. The inter-relationship of diabetes and left ventricular systolic function on outcome after high-risk myocardial infarction

    DEFF Research Database (Denmark)

    Shah, Amil M; Uno, Hajime; Køber, Lars

    2010-01-01

    Diabetes is a potent risk factor for death and heart failure (HF) hospitalization following myocardial infarction (MI). Whether diabetes modifies the relationship between left ventricular ejection fraction (LVEF) and outcomes in the post-MI population is unknown.......Diabetes is a potent risk factor for death and heart failure (HF) hospitalization following myocardial infarction (MI). Whether diabetes modifies the relationship between left ventricular ejection fraction (LVEF) and outcomes in the post-MI population is unknown....

  8. Risk of myocardial infarction in parents of HIV-infected Individuals: a population-based Cohort Study

    DEFF Research Database (Denmark)

    Rasmussen, Line D; Omland, Lars H; Pedersen, Court

    2010-01-01

    with the HIV disease and HAART or whether life-style related or genetic factors also increase the risk in this population. To establish whether the increased risk of myocardial infarction in HIV patients partly reflects an increased risk of MI in their families, we estimated the relative risk of MI in parents...

  9. Prognostic Value of the Thrombolysis in Myocardial Infarction Risk Score in ST-Elevation Myocardial Infarction Patients With Left Ventricular Dysfunction (from the EPHESUS Trial).

    Science.gov (United States)

    Popovic, Batric; Girerd, Nicolas; Rossignol, Patrick; Agrinier, Nelly; Camenzind, Edoardo; Fay, Renaud; Pitt, Bertram; Zannad, Faiez

    2016-11-15

    The Thrombolysis in Myocardial Infarction (TIMI) risk score remains a robust prediction tool for short-term and midterm outcome in the patients with ST-elevation myocardial infarction (STEMI). However, the validity of this risk score in patients with STEMI with reduced left ventricular ejection fraction (LVEF) remains unclear. A total of 2,854 patients with STEMI with early coronary revascularization participating in the randomized EPHESUS (Epleronone Post-Acute Myocardial Infarction Heart Failure Efficacy and Survival Study) trial were analyzed. TIMI risk score was calculated at baseline, and its predictive value was evaluated using C-indexes from Cox models. The increase in reclassification of other variables in addition to TIMI score was assessed using the net reclassification index. TIMI risk score had a poor predictive accuracy for all-cause mortality (C-index values at 30 days and 1 year ≤0.67) and recurrent myocardial infarction (MI; C-index values ≤0.60). Among TIMI score items, diabetes/hypertension/angina, heart rate >100 beats/min, and systolic blood pressure model, lower LVEF, lower estimated glomerular filtration rate (eGFR), and previous MI were significantly associated with all-cause mortality. The predictive accuracy of this model, which included LVEF and eGFR, was fair for both 30-day and 1-year all-cause mortality (C-index values ranging from 0.71 to 0.75). In conclusion, TIMI risk score demonstrates poor discrimination in predicting mortality or recurrent MI in patients with STEMI with reduced LVEF. LVEF and eGFR are major factors that should not be ignored by predictive risk scores in this population. Copyright © 2016 Elsevier Inc. All rights reserved.

  10. Hypercoagulability and the risk of myocardial infarction and ischemic stroke in young women.

    Science.gov (United States)

    Siegerink, B; Maino, A; Algra, A; Rosendaal, F R

    2015-09-01

    Myocardial infarction (MI) and ischemic stroke (IS) are acute forms of arterial thrombosis and share some, but not all, risk factors, indicating different pathophysiological mechanisms. This study aims to determine if hypercoagulability has a differential effect on the risk of MI and IS. We reviewed the results from the Risk of Arterial Thrombosis in Relation to Oral Contraceptives study, a population-based case-control study involving young women ( 1; for 12 (41%), it was > 2; and for 5 (17%), it was > 2.75. The five risk factors with the largest differences in associations were high levels of activated factor XI (FXI) and FXII, kallikrein, the presence of lupus anticoagulans, and a genetic variation in the FXIII gene. In young women, prothrombotic factors are associated more with the risk of IS than with MI risk, suggesting a different role of hypercoagulability in the mechanism leading to these two diseases. © 2015 International Society on Thrombosis and Haemostasis.

  11. The stability of myocardial area at risk estimated electrocardiographically in patients with ST elevation myocardial infarction

    DEFF Research Database (Denmark)

    Carlsen, Esben A; Hassell, Mariëlla E C J; van Hellemond, Irene E G

    2014-01-01

    In patients with ST-elevation myocardial infarction (STEMI) the amount of myocardial area at risk (MaR) indicates the maximal potential loss of myocardium if the coronary artery remains occluded. During the time course of infarct evolution ischemic MaR is replaced by necrosis, which results...... in a decrease in ST segment elevation and QRS complex distortion. Recently it has been shown that combining the electrocardiographic (ECG) Aldrich ST and Selvester QRS scores result in a more accurate estimate of MaR than using either method alone. Therefore, we hypothesized that the combined Aldrich...... reperfusion (ECG2). The combined Aldrich and Selvester score was considered stable if the difference between ECG1 and ECG2 was ST elevation in 4...

  12. Risk factors for acute myocardial infarction in coastal region of india: A case-control study

    Directory of Open Access Journals (Sweden)

    Vinay Rao

    2014-01-01

    Full Text Available Background: Various studies have shown that people of Indian origin have an increased risk of ischemic heart disease (IHD compared with most other ethnic groups. This increased risk has been attributed to multiple risk factors related to lifestyle. Patients and Methods: A total of 100 cases and 100 age and sex-matched controls were taken into this prospective case-control study from Intensive Coronary Care Unit. Prevalence of the following risk factors for myocardial infarction: Age, sex, diet, smoking, alcohol consumption, history of hypertension, history of diabetes mellitus, and lipid profile were studied. Patient data were extracted from the medical records department and by interview. Results: The most important predictor of acute myocardial infarction (AMI was high low-density lipoprotein (adjusted odds ratio [OR]: 4.124, confidence interval [CI]: 1.44-11.73, P = 0.008 history of hypertension and of overt diabetes mellitus were also independent risk factors (OR: 2, CI: 1.4-3 and OR: 2.29, CI: 1.5-3.5, respectively. Low high-density lipoprotein was found to have no significant association with AMI. Heavy drinkers were found to have a high-risk (OR: 68, while moderate drinkers were found to have protection (OR: 1. Conclusion: Smoking and heavy drinking cessation, treatment of hypertension and reduction in blood glucose, correction of abnormal lipid profile either through use of statins or by dietary modification may be important in preventing IHD in Asian Indians.

  13. Vertebral Artery Hypoplasia and Posterior Circulation Infarction in Patients with Isolated Vertigo with Stroke Risk Factors.

    Science.gov (United States)

    Zhang, Dao Pei; Lu, Gui Feng; Zhang, Jie Wen; Zhang, Shu Ling; Ma, Qian Kun; Yin, Suo

    2017-02-01

    We aimed in this study to investigate the prevalence of vertebral artery hypoplasia (VAH) in a population with isolated vertigo in association with stroke risk factors, to determine whether VAH is an independent risk factor for posterior circulation infarction (PCI). We sequentially enrolled 245 patients with isolated vertigo with at least 1 vascular risk factor, who were divided into PCI and non-PCI groups, according to present signs of acute infarction on diffusion-weighted magnetic resonance imaging. All patients underwent magnetic resonance angiography and cervical contrast-enhanced magnetic resonance angiography to screen for VAH. Univariate and multivariate logistic regression analyses were performed to identify the significant risk factors for PCI. VAH was found in 64 of 245 patients (26%). VAH (odds ratio [OR] = 2.70, 95%confidence interval [CI] 1.17-6.23, P = .020), median stenosis of the posterior circulation (OR = 7.09, 95%CI = 2.54-19.79, P vertigo with PCI complicated by VAH was mainly small-artery occlusion. Our findings suggest that VAH is an independent risk factor for PCI in patients with isolated vertigo with confirmed risk from stroke. Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  14. Low Adiponectin Levels and Increased Risk of Type 2 Diabetes in Patients With Myocardial Infarction

    DEFF Research Database (Denmark)

    Lindberg, Søren; Jensen, Jan S; Pedersen, Sune H

    2014-01-01

    OBJECTIVE: Patients with acute myocardial infarction (MI) have increased risk of developing type 2 diabetes mellitus (T2DM). Adiponectin is an insulin-sensitizing hormone produced in adipose tissue, directly suppressing hepatic gluconeogenesis, stimulating fatty acid oxidation and glucose uptake...... 5.3-6.1]) 6% (n = 38) developed T2DM. Risk of T2DM was analyzed using a competing risk analysis. RESULTS: Low adiponectin levels were associated with increased risk of T2DM (P age, sex, hypertension, hypercholesterolemia, current smoking.......001). Importantly, plasma adiponectin added to the predictive value of blood glucose, with the combination of high blood glucose and low plasma adiponectin, vastly increasing the risk of developing T2DM (HR 9.6 [3.7-25.3]; P

  15. Elevated triglycerides and risk of myocardial infarction in HIV-positive persons

    DEFF Research Database (Denmark)

    Worm, Signe W; Kamara, David Alim; Reiss, Peter

    2011-01-01

    Objectives: To explore the relationship between elevated triglyceride levels and the risk of myocardial infarction (MI) in HIV-positive persons after adjustment for total cholesterol (TC), high-density lipoprotein–cholesterol (HDL-C) and nonlipid risk factors. Background: Although elevated...... triglyceride levels are commonly noted in HIV-positive individuals, it is unclear whether they represent an independent risk factor for MI. Methods: The incidence of MI during follow-up was stratified according to the latest triglyceride level. Multivariable Poisson regression models were used to describe...... the independent association between the latest triglyceride level and MI risk after adjusting for TC and HDL-C, nonlipids cardiovascular disease (CVD) risk factors, HIV and treatment-related factors. Results: The 33 308 persons included in the study from 1999 to 2008 experienced 580 MIs over 178 835 person...

  16. Renal Complications in Patients with Renal Infarction: Prevalence and Risk Factors

    Directory of Open Access Journals (Sweden)

    Jae Hyun Kwon

    2016-11-01

    Full Text Available Background/Aims: This study aimed to investigate the incidence and risk factors for acute kidney injury (AKI and chronic kidney disease (CKD in patients with renal infarction. Methods: A single-center retrospective study was conducted from January 2005 to December 2013. Baseline and clinical characteristics of the enrolled patients with renal infarction were evaluated and analyzed according to the presence of AKI and CKD. In particular, predictors for AKI and CKD were determined using logistic regression analysis. Results: Of the 105 patients included in present study, 41 (39.0% patients had AKI. A total of 80 patients were followed up for 2 years after hospital discharge. Among these patients, 27 (33.8% patients had CKD. In the multivariate analysis, the predictors were mean blood pressure (odds ratio [OR] 1.062, 95% confidence interval [CI] 1.015-1.112, p = 0.009 and bilateral involvement (OR 4.396, 95% CI 1.096-17.632, p = 0.037 for AKI, and AKI (OR 14.799, 95% CI 4.173-52.490, p Conclusions: Physicians should pay attention to the development of AKI and CKD after renal infarction and follow patients over a long term.

  17. RISK FACTORS AND ETIOLOGY OF TRANSIENT ISCHEMIC ATTACKS IN PATIENTS WITH BRAIN INFARCTION

    Directory of Open Access Journals (Sweden)

    Kavian Ghandehari

    2010-12-01

    Full Text Available   Abstract INTRODUCTION: Transient ischemic attacks (TIA are warnings of future stroke. There is no difference in risk factors, pathophysiology and prevention between TIA and brain infarction. methods: Consecutive patients with brain infarction admitted to Ghaem Hospital, Mashhad, Northeastern Iran, were enrolled in a prospective study during 2006. Diagnosis of ischemic stroke was established by a neurologist who also obtained history of TIA and vascular risk factors. All of the stroke patients underwent a standard battery of diagnostic investigations and etiology of ischemic stroke was determined by the Practical Iranian Criteria classification. Fisher’s exact test was used for statistical analysis. results: 348 stroke patients (186 women, 162 men were studied. History of TIA was present in 42 patients (29 women, 13 men, i.e. 12% of the stroke patients. TIA was more common in women (df=1, P=0.02. The frequency of hypertension, diabetes and ipsilateral carotid stenosis was not significantly different between patients with history of TIA and other stroke patients (P=0.87, P=0.64 and P=0.61, respectively. Hyper-cholesterolemia and smoking were significantly more frequent in stroke patients with history of TIA (P=0.011 and P=0.014, respectively. The frequency of TIA was not significantly different among patients with lacunar, versus large vessel territory infarcts (df=1, P=0.84. There was no significant difference in the frequency of various stroke etiologies in patients with and without history of TIA (df=4, P=0.61. CONCLUSIONS: Stroke patients with history of TIA have vascular risk factors similar to other stroke patients. A positive history of TIA does not affirm any specific etiology of ischemic stroke.     Keywords: Risk factors, etiology, transient ischemic attacks.

  18. Analysis on risk factors of short-term poor outcome among different subtypes of acute cerebral infarction

    International Nuclear Information System (INIS)

    Zhang Xiaolong; Ju Zhong; Xu Tan; Zhang Yonghong; Zhang Jintao; Peng Ying

    2012-01-01

    Objective: to investigate the risk factors of short-term poor outcome among patients suffering from acute cerebral infarction who had different subtypes of cerebral infarction. Methods: A total of 3231 acute cerebral infarction patients were included in the present study. Data on demographic characteristics, life style, risk factors, history of cardiovascular disease, admission blood pressure, and clinical outcome at discharge were collected for all participants. Poor outcome was defined as NIHSS ≥10 at discharge or death occurring during hospitalization. The association between poor outcome of cerebral infarction and risk factors was analyzed by using multiple logistic models. Results: Incidence rate of poor outcome is the highest in the patients with cerebral embolism, next in patients with cerebral thrombosis and the lowest in patients with lacunar infarction. Cerebral thrombosis was positively associated with smoking (OR: 1.228; 95% CI: 1.013∼1.637), dyslipidemia (OR: 1.264; 95% CI: 1.081∼1.478), and a history of diabetes mellitus (OR: 1.371; 95% CI: 1.075∼1.747); cerebral embolism was positively associated with a history of atrial fibrillation (OR: 3.131; 95% CI: 1.206∼8.128) and a history of rheumatic heart disease (OR: 5.601; 95% CI: 1.561∼20.091); lacunar infarction is positively associated with alcohol consumption, (OR: 1.428; 95% CI: 1.063∼1.919). Conclusion: The incidence rate of poor outcome is the highest in the patients with cerebral embolism among three subtypes of cerebral infarction, there are different risk factors of poor outcome for three subtypes of cerebral infarction. (authors)

  19. Analysis on risk factors of short-term poor outcome among different subtypes of acute cerebral infarction

    Energy Technology Data Exchange (ETDEWEB)

    Xiaolong, Zhang; Zhong, Ju; Tan, Xu; Yonghong, Zhang [Dept of Epidemiology, School of Public Health, Medical College, Soochow University, Suzhou (China); Jintao, Zhang [Dept of Neurology, the 88th Hospital of PLA, Shandong (China); Ying, Peng [Dept of Epidemiology, School of Public Health, Medical College, Soochow University, Suzhou (China); Antituberculosis Station, Center for Disease Prevention and Control of Zhejiang (China)

    2012-01-15

    Objective: to investigate the risk factors of short-term poor outcome among patients suffering from acute cerebral infarction who had different subtypes of cerebral infarction. Methods: A total of 3231 acute cerebral infarction patients were included in the present study. Data on demographic characteristics, life style, risk factors, history of cardiovascular disease, admission blood pressure, and clinical outcome at discharge were collected for all participants. Poor outcome was defined as NIHSS ≥10 at discharge or death occurring during hospitalization. The association between poor outcome of cerebral infarction and risk factors was analyzed by using multiple logistic models. Results: Incidence rate of poor outcome is the highest in the patients with cerebral embolism, next in patients with cerebral thrombosis and the lowest in patients with lacunar infarction. Cerebral thrombosis was positively associated with smoking (OR: 1.228; 95% CI: 1.013∼1.637), dyslipidemia (OR: 1.264; 95% CI: 1.081∼1.478), and a history of diabetes mellitus (OR: 1.371; 95% CI: 1.075∼1.747); cerebral embolism was positively associated with a history of atrial fibrillation (OR: 3.131; 95% CI: 1.206∼8.128) and a history of rheumatic heart disease (OR: 5.601; 95% CI: 1.561∼20.091); lacunar infarction is positively associated with alcohol consumption, (OR: 1.428; 95% CI: 1.063∼1.919). Conclusion: The incidence rate of poor outcome is the highest in the patients with cerebral embolism among three subtypes of cerebral infarction, there are different risk factors of poor outcome for three subtypes of cerebral infarction. (authors)

  20. Scores for post-myocardial infarction risk stratification in the community.

    Science.gov (United States)

    Singh, Mandeep; Reeder, Guy S; Jacobsen, Steven J; Weston, Susan; Killian, Jill; Roger, Véronique L

    2002-10-29

    Several scores, most of which were derived from clinical trials, have been proposed for stratifying risk after myocardial infarctions (MIs). Little is known about their generalizability to the community, their respective advantages, and whether the ejection fraction (EF) adds prognostic information to the scores. The purpose of this study is to evaluate the Thrombolysis in Myocardial Infarction (TIMI) and Predicting Risk of Death in Cardiac Disease Tool (PREDICT) scores in a geographically defined MI cohort and determine the incremental value of EF for risk stratification. MIs occurring in Olmsted County were validated with the use of standardized criteria and stratified with the ECG into ST-segment elevation (STEMI) and non-ST-segment elevation (NSTEMI) MI. Logistic regression examined the discriminant accuracy of the TIMI and PREDICT scores to predict death and recurrent MI and assessed the incremental value of the EF. After 6.3+/-4.7 years, survival was similar for the 562 STEMIs and 717 NSTEMIs. The discriminant accuracy of the TIMI score was good in STEMI but only fair in NSTEMI. Across time and end points, irrespective of reperfusion therapy, the discriminant accuracy of the PREDICT score was consistently superior to that of the TIMI scores, largely because PREDICT includes comorbidity; EF provided incremental information over that provided by the scores and comorbidity. In the community, comorbidity and EF convey important prognostic information and should be included in approaches for stratifying risk after MI.

  1. [Splenic infarction].

    Science.gov (United States)

    Cuquerella, J; Ferrer, L; Rivera, P; Tuset, J A; Medina, E; Pamós, S; Ariete, V; Tomé, A; García, V

    1996-06-01

    A 53-year-old male suffered splenic infarction etiologically related to atrial fibrillation and non-obstructive hypertrophic cardiomyopathy. The main clinical manifestations were a one-month history of epigastric and left upper quadrant pain, with tenderness to palpation in the later zone. Laboratory tests revealed a slight leucocytosis (14.700) with left shift and a marked increase in LDH concentration (945 IU). Abdominal CAT and arteriography established the diagnosis, Echography proved normal. Patient evolution was satisfactory with conservative medical treatment. We conclude that splenic infarction should be considered in all cases of acute or chronic pain in the left hypochondrium. The diagnosis is established by CAT, arteriography and hepatosplenic gammagraphy. Medical management is initially advocated, surgery being reserved for those cases involving complications or in which diagnosis is not clear. Emphasis is placed on the main etiological, clinical, diagnostic and management characteristics of splenic infarction.

  2. Impact of depression on risk of myocardial infarction, stroke and cardiovascular death in patients with psoriasis

    DEFF Research Database (Denmark)

    Egeberg, Alexander; Khalid, Usman; Gislason, Gunnar Hilmar

    2016-01-01

    Psoriasis is associated with depression, myocardial infarction (MI) and stroke. Patients with depression have increased cardiovascular risk. However, the link between psoriasis, depression and cardiovascular disease is unclear. This link was investigated in a nationwide Danish cohort of patients.......43–2.66), and cardiovascular death (IRR 2.24, 95% CI 1.53–3.26) were increased significantly during acute depression, and risk of stroke (IRR 1.51, 95% CI 1.19–1.90) was increased significantly in chronic depression. During remission from depression, only the risk of stroke was increased. In conclusion, in patients...... with psoriasis, depression is associated with increased risk of MI, stroke and cardiovascular death, especially during acute depression....

  3. Coronary angiographic findings in diagnostically manifested myocardial infarctions: Their relationship to psychlosocial and somatic risk factors

    International Nuclear Information System (INIS)

    Waschk, O.

    1981-01-01

    The investigation was meant as an attempt to illustrate coronary arteriosclerosis as the cause of myocardial infarction and the mechanisms of its development as well as the conditions influencing it. The paper consists of two parts: 1) Literature part: In this part, risk factors of coronary arteriosclerosis and the mechanism of its effects (as far as known) are introduced. The results obtained by other authors are also summarized. 2) Empiric part: The following empiric part covers the author's own results which are discussed and compared to the results obtained by other authors. (orig./MG) [de

  4. Do factors in the psychosocial work environment mediate the effect of socioeconomic position on the risk of myocardial infarction? Study from the Copenhagen Centre for Prospective Population Studies

    DEFF Research Database (Denmark)

    Andersen, I; Burr, H; Kristensen, T S

    2004-01-01

    To investigate whether the effect of socioeconomic position on risk of myocardial infarction (MI) is mediated by differential exposure or differential susceptibility to psychosocial work environment....

  5. Comparison of carotid artery intima - media thickness and risk factors of atherosclerosis in lacunar versus non-lacunar cerebral infarcts

    Directory of Open Access Journals (Sweden)

    Seyed Ali Mousavi

    2007-07-01

    Full Text Available

    BACKGROUND: Increases in the thickness of the intima-media of the carotid artery have been associated with an increased risk of myocardial infarction and stroke in subjects without a history of cardiovascular disease. Lacunar infarcts, one of the most common subtypes of ischemic stroke, show unique pathological and clinicoradiological characteristics. The present study examined the relationship between the vascular risk factors, including carotid artery intimamedia thickness (IMT, and lacunar versus non-lacunar infarcts.
    METHODS: We collected data from patients admitted to hospital with acute ischemic stroke. 195 Patients and 96 control subjects underwent B-mode ultrasonographic measurements of IMT of the common carotid artery. We examined the association of lacunar and non-lacunar infarcts with age, sex, and potential vascular risk factors.
    RESULTS: Of 195 adult patients with acute ischemic stroke, 87 were considered lacunar and 108 were considered nonlacunar strokes. Between these two groups of patients, we did not find a significantly different percentage of diabetes,
    smoking, hypertension, dyslipidemia, myocardial infarction, or previous history of ischemic stroke, alcohol, obesity,
    atherogen diet, exercise, and IMT. However, patients with lacunar infarct, diabetes mellitus (P = 0.02, and hypertension
    (P = 0.02 had a significantly higher percentage of history of prior CVA (P = 0.03 and a significantly higher percentage
    of non-lacunar infarct.
    CONCLUSIONS: The present results indicated that diabetes mellitus and hypertension are more common in patients with lacunar infarcts, and history of CVA is more common in patients with non–lacunar infarcts. We further concluded that IMT cannot differentiate subtypes of ischemic stroke. Because risk factors and clinical presentation of ischemic stroke differ among races, more national studies

  6. Awareness of modifiable acute myocardial infarction risk factors has little impact on risk perception for heart attack among vulnerable patients.

    Science.gov (United States)

    Abed, Mona A; Khalil, Amani A; Moser, Debra K

    2015-01-01

    Poor awareness of modifiable risks for acute myocardial infarction (AMI) may explain the reported weak relationship between patients' actual and perceived risk for AMI. To assess the level of awareness of modifiable risks and perceived vulnerability for AMI among Jordanian patients, and to determine their independent association. This was a cross-sectional correlational study (N = 231). Perceived risk, awareness of risk factors and risk profile were collected by self-reports and medical chart review. Patients were mostly males (80%) and had a mean of 55.3 ± 12.6 years for age. Perceived and actual AMI risks were not highly congruent even though patients had, on average, two modifiable risks and were knowledgeable of them. Awareness of risk factors independently explained 3.5% of the variance in perceived risk. The risk for developing AMI is underestimated among cardiac patients and it is only weakly linked with their awareness of AMI risk factors. Copyright © 2015 Elsevier Inc. All rights reserved.

  7. The joint impact of family history of myocardial infarction and other risk factors on 12-year coronary heart disease mortality

    NARCIS (Netherlands)

    Boer, J M; Feskens, E.J.; Verschuren, W M Monique; Seidell, J C; Kromhout, D.

    1999-01-01

    We investigated the impact of family history of myocardial infarction on 12-year coronary heart disease mortality. Men and women with a family history had an increased risk for coronary heart disease death, irrespective of other risk factors (RR = 1.58; 95% CI = 1.17-2.13 and RR = 2.12; 95% CI =

  8. A Statistical Study of Socio-economic and Physical Risk Factors of Myocardial Infarction

    Directory of Open Access Journals (Sweden)

    M. Alamgir

    2005-07-01

    Full Text Available A sample of 506 patients from various hospitals in Peshawar was examined to determine significant socio-economic and physical risk factors of Myocardial Infarction (heart attack. The factors examined were smoking (S, hypertension (H, cholesterol (C, diabetes (D, family history (F, residence (R, own a house (OH, number of dependents (ND, household income (I, obesity and lack of exercise (E. The response variable MI was binary. Therefore, logistic regression was applied (using GLIM and SPSS packages to analyze the data and to select a parsimonious model. Logistic regression models have been obtained indicating significant risk factors for both sexes, for males and for females separately. The best-selected model for both sexes is of factors S, F, D, H and C. The best-selected model for males is of factors CIFH, S, H, D, C and F, while the best-selected model for females is of factors D, H, C and F.

  9. Risk and benefit of dual antiplatelet treatment among non-revascularized myocardial infarction patients in different age groups.

    Science.gov (United States)

    Juul, Nikolai; Gislason, Gunnar; Olesen, Jonas Bjerring; Lamberts, Morten; Hansen, Morten Lock; Karasoy, Deniz; Christiansen, Christine Benn; Torp-Pedersen, Christian; Sorensen, Rikke

    2017-09-01

    Dual anti-platelet treatment with clopidogrel and aspirin is indicated for most patients after myocardial infarction. We examined the risk/benefit relationship of dual anti-platelet treatment according to age in a nationwide cohort of 30,532 myocardial infarction patients without revascularization. Patients admitted with first-time myocardial infarction in 2002-2010, not undergoing revascularization, were identified from nationwide Danish registers. Dual anti-platelet treatment use was assessed by claimed prescriptions. Stratified into age groups, risk of bleeding, all-cause mortality and a combined endpoint of cardiovascular death, recurrent myocardial infarction and ischaemic stroke was analysed by Cox proportional-hazard models and tested in a propensity-score matched population. A total of 21,302 users and 9230 non-users of dual anti-platelet treatment were included (mean age 67.02 (±13.8) years and 64.7% males). Use of dual anti-platelet treatment decreased with age: 80% (79 years). We found a reduced risk of cardiovascular death, recurrent myocardial infarction and ischaemic stroke in users 79 years (HR=0.92; 95% CI 0.84-1.01, NS). Risk of bleeding increased with dual anti-platelet treatment use in patients aged 79 years (HR=1.46; 95% CI 1.22-1.74). Similar tendencies in all four age groups were found in the propensity-matched population. Dual anti-platelet treatment use was less likely among elderly patients although similar effects regarding both risk and benefit were found in all age groups. Increased focus on initiating dual anti-platelet treatment in elderly, non-invasively treated myocardial infarction patients is warranted.

  10. High risk for obstructive sleep apnea in patients with acute myocardial infarction

    Directory of Open Access Journals (Sweden)

    Carla Renata Silva Andrechuk

    2015-10-01

    Full Text Available Objectives: to stratify the risk for obstructive sleep apnea in patients with acute myocardial infarction, treated at a public, tertiary, teaching hospital of the state of São Paulo, Brazil, and to identify related sociodemographic and clinical factors.Method: cross-sectional analytical study with 113 patients (mean age 59.57 years, 70.8% male. A specific questionnaire was used for the sociodemographic and clinical characterization and the Berlin Questionnaire for the stratification of the risk of obstructive sleep apnea syndrome.Results: the prevalence of high risk was 60.2% and the outcome of clinical worsening during hospitalization was more frequent among these patients. The factors related to high risk were body mass index over 30 kg/m2, arterial hypertension and waist circumference indicative of cardiovascular risk, while older age (60 years and over constituted a protective factor.Conclusion: considering the high prevalence of obstructive sleep apnea and its relation to clinical worsening, it is suggested that nurses should monitor, in their clinical practice, people at high risk for this syndrome, guiding control measures of modifiable factors and aiming to prevent the associated complications, including worsening of cardiovascular diseases.

  11. Is the effect of job strain on myocardial infarction risk due to interaction between high psychological demands and low decision latitude?

    DEFF Research Database (Denmark)

    Hallqvist, J; Diderichsen, Finn; Theorell, T

    1998-01-01

    The objectives are to examine if the excess risk of myocardial infarction from exposure to job strain is due to interaction between high demands and low control and to analyse what role such an interaction has regarding socioeconomic differences in risk of myocardial infarction. The material...

  12. Acute Myocardial Infarction Readmission Risk Prediction Models: A Systematic Review of Model Performance.

    Science.gov (United States)

    Smith, Lauren N; Makam, Anil N; Darden, Douglas; Mayo, Helen; Das, Sandeep R; Halm, Ethan A; Nguyen, Oanh Kieu

    2018-01-01

    Hospitals are subject to federal financial penalties for excessive 30-day hospital readmissions for acute myocardial infarction (AMI). Prospectively identifying patients hospitalized with AMI at high risk for readmission could help prevent 30-day readmissions by enabling targeted interventions. However, the performance of AMI-specific readmission risk prediction models is unknown. We systematically searched the published literature through March 2017 for studies of risk prediction models for 30-day hospital readmission among adults with AMI. We identified 11 studies of 18 unique risk prediction models across diverse settings primarily in the United States, of which 16 models were specific to AMI. The median overall observed all-cause 30-day readmission rate across studies was 16.3% (range, 10.6%-21.0%). Six models were based on administrative data; 4 on electronic health record data; 3 on clinical hospital data; and 5 on cardiac registry data. Models included 7 to 37 predictors, of which demographics, comorbidities, and utilization metrics were the most frequently included domains. Most models, including the Centers for Medicare and Medicaid Services AMI administrative model, had modest discrimination (median C statistic, 0.65; range, 0.53-0.79). Of the 16 reported AMI-specific models, only 8 models were assessed in a validation cohort, limiting generalizability. Observed risk-stratified readmission rates ranged from 3.0% among the lowest-risk individuals to 43.0% among the highest-risk individuals, suggesting good risk stratification across all models. Current AMI-specific readmission risk prediction models have modest predictive ability and uncertain generalizability given methodological limitations. No existing models provide actionable information in real time to enable early identification and risk-stratification of patients with AMI before hospital discharge, a functionality needed to optimize the potential effectiveness of readmission reduction interventions

  13. Posttraumatic stress and myocardial infarction risk perceptions in hospitalized acute coronary syndrome patients

    Directory of Open Access Journals (Sweden)

    Donald eEdmondson

    2012-05-01

    Full Text Available Posttraumatic stress disorder (PTSD is related to acute coronary syndrome (ACS; i.e., myocardial infarction or unstable angina recurrence and poor post-ACS adherence to medical advice. Since risk perceptions are a primary motivator of adherence behaviors, we assessed the relationship of probable PTSD to ACS risk perceptions in hospitalized ACS patients (n= 420. Participants completed a brief PTSD screen 3-7 days post-ACS, and rated their 1-year ACS recurrence risk relative to other men or women their age. Most participants exhibited optimistic bias (mean recurrence risk estimate between average and below average. Further, participants who screened positive for current PTSD (n=15 showed significantly greater optimistic bias than those who screened negative (p< .05, after adjustment for demographics, ACS severity, medical comorbidities, depression, and self-confidence in their ability to control their heart disease. Clinicians should be aware that psychosocial factors, and PTSD in particular, may be associated with poor adherence to medical advice due to exaggerated optimistic bias in recurrence risk perceptions.

  14. CAN TIMI RISK SCORE PREDICT ANGIOGRAPHIC INVOLVEMENT IN PATIENTS WITH ST-ELEVATION MYOCARDIAL INFARCTION?

    Directory of Open Access Journals (Sweden)

    Allahyar Golabchi

    2010-11-01

    Full Text Available BACKGROUND: In most studies, the agreeable risk scores for ST-elevation myocardial infarction (STEMI consist of thrombolytic in myocardial infarction (TIMI risk score and modified Gensini risk score. Researchers showed significant relations between TIMI with angiography scores in patients with UA/NSTEMI. We studied this relation in patients with STEMI.    METHODS: We studied CCU patients with STEMI hospitalized in several hospitals of Isfahan, Iran from September 2007 to June 2008. Sampling method of 240 patients was random and simple. Exclusion criteria were incomplete history, nonspecific electrocardiogram changes, left bundle branch block and not accomplished angiography or accomplished angiography after 2 months of STEMI. Questionnaire indices collected on the basis of TIMI (0-14 points. Echocardiography and angiography were done and then, we used Gensini (0-400 points to review films of angiography. Spearman`s rank test and Pearson correlation coefficient were used to study the relation between these scores.    RESULTS: One hundred and sixty one patients were male and their average age was 60.02 years. Averages of TIMI and Gensini scores were 6.30 ± 2.5 and 120.77 ± 50.4, respectively. Study showed significant relation between TIMI, age and LVEF (P <0.001, r=-0.46. Also, between Gensini and age, gender and LVEF significant relation was found (P <0.001. But, a meaningful correlation didn’t exist between TIMI and the gender (P =0.08. Our study proved direct relation between TIMI risk scores and modified Gensini scores (P <0.001, r=0.55.     CONCLUSION: We may decide quickly and correctly in emergency room to distinguish which patients with STEMI could derive a benefit from invasive strategies using TIMI score. Also, TIMI risk score can be a good predictor to determine the extension of coronary artery disease in patients with STEMI. As a result, we suggest determination of TIMI score for any patient entered emergency room. Also

  15. Predischarge maximal exercise test identifies risk for cardiac death in patients with acute myocardial infarction

    DEFF Research Database (Denmark)

    Nielsen, J R; Mickley, H; Damsgaard, E M

    1990-01-01

    A maximal exercise test was performed in 54 patients with acute myocardial infarction (AMI) before discharge and in 49 age-matched control subjects. The long-term prognosis was assessed after an average follow-up of 7.6 years in AMI patients and 5.8 years in control subjects. The maximal work...... capacity and systolic blood pressure increase in AMI patients was 59% that of control subjects (p less than 0.001). Seventeen AMI patients had significant ST-segment shifts, 13 with ST depression and 4 with ST elevation. In AMI patients experiencing a cardiac death during follow-up the maximal work...... were of no significant value. In this study maximal work capacity turned out to be the best single exercise variable for identifying groups of AMI patients with very low and relative high risk of cardiac death. When all 3 exercise variables were combined, the predischarge maximal exercise test...

  16. Admission blood glucose level as risk indicator of death after myocardial infarction in patients with and without diabetes mellitus

    NARCIS (Netherlands)

    Stranders, Ischa; Diamant, Michaela; van Gelder, Rogier E.; Spruijt, Hugo J.; Twisk, Jos W. R.; Heine, Robert J.; Visser, Frans C.

    2004-01-01

    High admission blood glucose levels after acute myocardial infarction (AMI) are common and associated with an increased risk of death in subjects with and without known diabetes. Recent data indicate a high prevalence of abnormal glucose metabolism in patients with unknown diabetes at the time of

  17. Clinical Characteristics and Risk Factors of Left Ventricular Thrombus after Acute Myocardial Infarction: A Matched Case-control Study

    Directory of Open Access Journals (Sweden)

    Yue-Xin Jiang

    2015-01-01

    Conclusions: This study indicated that lower LVEF, extensive anterior myocardial infarction, severe RWMA, and left ventricular aneurysm were independent risk factors of LVT after AMI. It also suggested that further efforts are needed for the LVT diagnosis after AMI in clinical practice.

  18. Baldness and myocardial infarction in men: the atherosclerosis risk in communities study.

    Science.gov (United States)

    Shahar, Eyal; Heiss, Gerardo; Rosamond, Wayne D; Szklo, Moyses

    2008-03-15

    Because hair loss may be a surrogate measure of androgenic activity-possibly a determinant of coronary atherosclerosis-several studies have explored the presence and magnitude of an association between male pattern baldness and myocardial infarction (MI). In particular, vertex baldness, but not frontal baldness alone, was strongly associated with incident MI in a large, hospital-based, case-control study. The authors examined these associations in a cross-sectional sample of 5,056 men aged 52-75 years, of whom 767 had a history of MI. The sample was derived from the Atherosclerosis Risk in Communities (ARIC) Study (1987-1998). As compared with a baldness-free reference group, the estimated odds ratios for prevalent MI from a multivariable model were 1.28 (frontal baldness), 1.02 (mild vertex baldness), 1.40 (moderate vertex baldness), and 1.18 (severe vertex baldness). Other regression models have yielded similar results, including the absence of a monotonic "dose-response relation" between the extent of vertex baldness and prevalent MI. The authors also examined the relation of baldness pattern to carotid intimal-medial thickness, a measure of atherosclerosis, among those who were free of clinical cardiovascular disease. The estimated mean differences in carotid intimal-medial thickness between groups of men with various types of baldness and their baldness-free counterparts were all close to zero. The results of this study suggest that male pattern baldness is not a surrogate measure of an important risk factor for myocardial infarction or asymptomatic atherosclerosis.

  19. Transmural Colonic Infarction after Routine Colonoscopy in a Young Patient without Risk Factors

    Directory of Open Access Journals (Sweden)

    Maurizio Zizzo

    2016-09-01

    Full Text Available Colonoscopy is one of the most widely used procedures in medical practice for the diagnosis and treatment of many benign and malignant diseases of the colorectal tract. Colonscopy has become the reference procedure for screening and surveillance of colorectal cancer. The overall rate of adverse events is estimated to be about 2.8 per 1,000 procedures, while complications requiring hospitalization are about 1.9 per 1,000 colonoscopies. Mortality from all causes and colonoscopy-specific mortality are estimated to be 0.07 and 0.007%, respectively. An exceptional fearsome postcolonoscopy complication is colon ischemia (CI; only few cases have been reported worldwide. We present the case of a 43-year-old woman who presented to the emergency department complaining of abdominal pain; fever and rectal bleeding appeared 12 h after a voluntary ‘screening’ colonoscopy. She had no risk factors for CI. Her laboratory tests showed alterations in inflammatory markers and a computed tomography scan showed a circumferential thickening in the left colon and free fluid in the abdomen. After 12 h of observation and conservative therapy, the clinical state of the patient worsened with the rising of signs of peritonitis. Laparoscopy showed that colon infarction extended from the distal third of the transverse colon to the proximal rectum. Laparotomy, resection of the pathological colon and terminal colostomy were performed. The specimen examined confirmed an extended ischemic colitis and transmural infarction on the antimesocolic side, in the absence of a vasculitis. The patient underwent recanalization after 8 months. CI after colonoscopy is a rare and alarming complication that must be known and taken into account in the differential diagnosis of symptomatic cases after colonoscopy, particularly in patients with known risk factors. The diagnosis is mainly based on clinical data, imaging and especially endoscopy. Treatment is almost always conservative but, in

  20. Acute Myocardial Infarction: A Comparison of the Risk between Physicians and the General Population

    Science.gov (United States)

    Chen, Yen-ting; Huang, Chien-Cheng; Weng, Shih-Feng; Hsu, Chien-Chin; Wang, Jhi-Joung; Lin, Hung-Jung; Su, Shih-Bin; Guo, How-Ran; Juan, Chi-Wen

    2015-01-01

    Physicians in Taiwan have a heavy workload and a stressful workplace, both of which may contribute to cardiovascular disease. However, the risk of acute myocardial infarction (AMI) in physicians is not clear. This population-based cohort study used Taiwan's National Health Insurance Research Database. We identified 28,062 physicians as the case group and randomly selected 84,186 nonmedical staff patients as the control group. We used a conditional logistic regression to compare the AMI risk between physicians and controls. Subgroup analyses of physician specialty, age, gender, comorbidities, area, and hospital level were also done. Physicians have a higher prevalence of HTN (23.59% versus 19.06%, P Taiwan's physicians had higher prevalences of HTN and hyperlipidemia, but a lower risk of AMI than did the general population. Medical center physicians had a lower risk than did local clinic physicians. Physicians are not necessary healthier than the general public, but physicians, especially in medical centers, have a greater awareness of disease and greater access to medical care, which permits timely treatment and may prevent critical conditions such as AMI induced by delayed treatment. PMID:25802869

  1. Noninvasive risk stratification of lethal ventricular arrhythmias and sudden cardiac death after myocardial infarction

    Directory of Open Access Journals (Sweden)

    Kenji Yodogawa, MD

    2014-08-01

    Full Text Available Prediction of lethal ventricular arrhythmias leading to sudden cardiac death is one of the most important and challenging problems after myocardial infarction (MI. Identification of MI patients who are prone to ventricular tachyarrhythmias allows for an indication of implantable cardioverter-defibrillator placement. To date, noninvasive techniques such as microvolt T-wave alternans (MTWA, signal-averaged electrocardiography (SAECG, heart rate variability (HRV, and heart rate turbulence (HRT have been developed for this purpose. MTWA is an indicator of repolarization abnormality and is currently the most promising risk-stratification tool for predicting malignant ventricular arrhythmias. Similarly, late potentials detected by SAECG are indices of depolarization abnormality and are useful in risk stratification. However, the role of SAECG is limited because of its low predictive accuracy. Abnormal HRV and HRT patterns reflect autonomic disturbances, which may increase the risk of lethal ventricular arrhythmias, but the existing evidence is insufficient. Further studies of noninvasive assessment may provide a new insight into risk stratification in post-MI patients.

  2. Post-traumatic stress disorder following myocardial infarction: prevalence and risk factors.

    Science.gov (United States)

    Roberge, Marie-Anne; Dupuis, Gilles; Marchand, André

    2010-05-01

    Post-traumatic stress disorder (PTSD) is associated with negative impacts on physical health. Victims of a myocardial infarction (MI) who develop PTSD may be particularly affected by these impacts due to their cardiovascular vulnerability. Post-traumatic reactions in this population are not well known. To examine the prevalence of PTSD after MI and its risk factors, and to validate a prediction model for PTSD symptoms. Patients hospitalized for MI (n=477) were recruited in three hospitals. The Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, and questionnaires concerning PTSD symptoms and general measures were administered to patients during hospitalization and at one-month follow-up. Four per cent of the patients had PTSD and 12% had partial PTSD. The perception of a threat to life, the intensity of acute stress disorder and depression symptoms several days after the MI, a history of referral to a psychologist or psychiatrist, and female sex were risk factors for the intensity of PTSD symptoms in a sequential multiple regression analysis (R=0.634). The prediction model was validated by applying the regression equation to 48 participants who were not included in the initial regression (R=0.633). The risk factors for development of PTSD symptoms identified in the present study could be used to facilitate the detection of patients at risk for developing PTSD symptoms so they can later be offered psychological interventions as needed.

  3. Risk of ischemic stroke after an acute myocardial infarction in patients with diabetes mellitus.

    Science.gov (United States)

    Jakobsson, Stina; Bergström, Lisa; Björklund, Fredrik; Jernberg, Tomas; Söderström, Lars; Mooe, Thomas

    2014-01-01

    Incidence, any trend over time, and predictors of ischemic stroke after an acute myocardial infarction (AMI) in diabetic patients are unknown. Data for 173,233 unselected patients with an AMI, including 33,503 patients with diabetes mellitus, were taken from the Swedish Register of Information and Knowledge about Swedish Heart Intensive Care Admissions (RIKS-HIA) during 1998 to 2008. Ischemic stroke events were recorded during 1 year of follow-up. Patients with diabetes mellitus more often had a history of cardiovascular disease, received less reperfusion therapy, and were treated with acetylsalicylic acid, P2Y12 inhibitors, and statins to a lesser extent compared with patients without diabetes mellitus. However, the use of evidence-based therapies increased markedly in both groups during the study period. The incidence of ischemic stroke during the first year after AMI decreased from 7.1% to 4.7% in patients with diabetes mellitus and from 4.2% to 3.7% in patients without diabetes mellitus. Risk reduction was significantly larger in the diabetic subgroup. Reperfusion therapy, acetylsalicylic acid, P2Y12 inhibitors, and statins were independently associated with the reduced stroke risk. Ischemic stroke is a fairly common complication after an AMI in patients with diabetes mellitus, but the risk of stroke has decreased during recent years. The increased use of evidence-based therapies contributes importantly to this risk reduction, but there is still room for improvement.

  4. Acute Myocardial Infarction: A Comparison of the Risk between Physicians and the General Population

    Directory of Open Access Journals (Sweden)

    Yen-ting Chen

    2015-01-01

    Full Text Available Physicians in Taiwan have a heavy workload and a stressful workplace, both of which may contribute to cardiovascular disease. However, the risk of acute myocardial infarction (AMI in physicians is not clear. This population-based cohort study used Taiwan’s National Health Insurance Research Database. We identified 28,062 physicians as the case group and randomly selected 84,186 nonmedical staff patients as the control group. We used a conditional logistic regression to compare the AMI risk between physicians and controls. Subgroup analyses of physician specialty, age, gender, comorbidities, area, and hospital level were also done. Physicians have a higher prevalence of HTN (23.59% versus 19.06%, P<0.0001 and hyperlipidemia (21.36% versus 12.93%, P<0.0001 but a lower risk of AMI than did the controls (adjusted odds ratio (AOR: 0.57; 95% confidence interval (CI: 0.46–0.72 after adjusting for DM, HTN, hyperlipidemia, and area. Between medical specialty, age, and area subgroups, differences in the risk for having an AMI were nonsignificant. Medical center physicians had a lower risk (AOR: 0.42; 95% CI: 0.20–0.85 than did local clinic physicians. Taiwan’s physicians had higher prevalences of HTN and hyperlipidemia, but a lower risk of AMI than did the general population. Medical center physicians had a lower risk than did local clinic physicians. Physicians are not necessary healthier than the general public, but physicians, especially in medical centers, have a greater awareness of disease and greater access to medical care, which permits timely treatment and may prevent critical conditions such as AMI induced by delayed treatment.

  5. Risk stratification of periprocedural myocardial infarction after percutaneous coronary intervention: Analysis based on the SCAI definition.

    Science.gov (United States)

    Zhang, Dong; Li, Yiping; Yin, Dong; He, Yuan; Chen, Changzhe; Song, Chenxi; Yan, Ruohua; Zhu, Chen'gang; Xu, Bo; Dou, Kefei

    2017-03-01

    To investigate the predictors of and generate a risk prediction method for periprocedural myocardial infarction (PMI) after percutaneous coronary intervention (PCI) using the new PMI definition proposed by the Society for Cardiovascular Angiography and Interventions (SCAI). The SCAI-defined PMI was found to be associated with worse prognosis than the PMI diagnosed by other definitions. However, few large-sample studies have attempted to predict the risk of SCAI-defined PMI. A total of 3,371 patients (3,516 selective PCIs) were included in this single-center retrospective analysis. The diagnostic criteria for PMI were set according to the SCAI definition. All clinical characteristics, coronary angiography findings and PCI procedural factors were collected. Multivariate logistic regression analysis was performed to identify independent predictors of PMI. To evaluate the risk of PMI, a multivariable risk score (PMI score) was constructed with incremental weights attributed to each component variable according to their estimated coefficients. PMI occurred in 108 (3.1%) of all patients. Age, multivessel treatment, at least one bifurcation treatment and total treated lesion length were independent predictors of SCAI-defined PMI. PMI scores ranged from 0 to 20. The C-statistic of PMI score was 0.71 (95% confidence interval: 0.66-0.76). PMI rates increased significantly from 1.96% in the non-high-risk group (PMI score < 10) to 6.26% in the high-risk group (PMI score ≥ 10) (P < 0.001). Age, multivessel treatment, at least one bifurcation treatment, and total treated lesion length are predictive of PMI. The PMI score could help identify patients at high risk of PMI after PCI. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

  6. Crash Prediction and Risk Evaluation Based on Traffic Analysis Zones

    Directory of Open Access Journals (Sweden)

    Cuiping Zhang

    2014-01-01

    Full Text Available Traffic safety evaluation for traffic analysis zones (TAZs plays an important role in transportation safety planning and long-range transportation plan development. This paper aims to present a comprehensive analysis of zonal safety evaluation. First, several criteria are proposed to measure the crash risk at zonal level. Then these criteria are integrated into one measure-average hazard index (AHI, which is used to identify unsafe zones. In addition, the study develops a negative binomial regression model to statistically estimate significant factors for the unsafe zones. The model results indicate that the zonal crash frequency can be associated with several social-economic, demographic, and transportation system factors. The impact of these significant factors on zonal crash is also discussed. The finding of this study suggests that safety evaluation and estimation might benefit engineers and decision makers in identifying high crash locations for potential safety improvements.

  7. Effects of epilepsy and selected antiepileptic drugs on risk of myocardial infarction, stroke, and death in patients with or without previous stroke: a nationwide cohort study

    DEFF Research Database (Denmark)

    Olesen, Jonas Bjerring; Abildstrøm, Steen Zabell; Erdal, Jesper

    2011-01-01

    Patients with epilepsy have increased morbidity and mortality. We evaluated the risk of myocardial infarction (MI), stroke, and death associated with epilepsy and examined if this risk was modified by treatment with antiepileptic drugs (AEDs).......Patients with epilepsy have increased morbidity and mortality. We evaluated the risk of myocardial infarction (MI), stroke, and death associated with epilepsy and examined if this risk was modified by treatment with antiepileptic drugs (AEDs)....

  8. Can prostatic arterial embolisation (PAE) reduce the volume of the peripheral zone? MRI evaluation of zonal anatomy and infarction after PAE

    Energy Technology Data Exchange (ETDEWEB)

    Lin, Yen-Ting [Assistance Publique Hopitaux de Paris. Hopital Europeen Georges-Pompidou, Vascular and Oncological Interventional Radiology, Paris (France); Department of Radiology, Taichung Veterans General Hospital, Taichung City (China); Amouyal, Gregory; Pereira, Helena; Del Giudice, Costantino; Dean, Carole [Assistance Publique Hopitaux de Paris. Hopital Europeen Georges-Pompidou, Vascular and Oncological Interventional Radiology, Paris (France); Correas, Jean-Michel [Assistance Publique Hopitaux de Paris. Hopital Europeen Georges-Pompidou, Vascular and Oncological Interventional Radiology, Paris (France); Hopital Necker, Radiology Department, Paris (France); Pellerin, Olivier; Sapoval, Marc [Assistance Publique Hopitaux de Paris. Hopital Europeen Georges-Pompidou, Vascular and Oncological Interventional Radiology, Paris (France); Inserm (Institut national de la sante et de la recherche medicale) U970, Paris (France); Universite Paris Descartes, Paris (France); Thiounn, Nicolas [Assistance Publique Hopitaux de Paris, Hopital Europeen Georges-Pompidou, Urology, Paris (France)

    2016-10-15

    To assess the impact of prostatic arterial embolisation (PAE) on various prostate gland anatomical zones. We retrospectively reviewed paired MRI scans obtained before and after PAE for 25 patients and evaluated changes in volumes of the median lobe (ML), central gland (CG), peripheral zone (PZ) and whole prostate gland (WPV) following PAE. We used manual segmentation to calculate volume on axial view T2-weighted images for ML, CG and WPV. We calculated PZ volume by subtracting CG volume from WPV. Enhanced phase on dynamic contrasted-enhanced MRI was used to evaluate the infarction areas after PAE. Clinical results of International Prostate Symptom Score and International Index of Erectile Function questionnaires and the urodynamic study were evaluated before and after PAE. Significant reductions in volume were observed after PAE for ML (26.2 % decrease), CG (18.8 %), PZ (16.4 %) and WPV (19.1 %; p < 0.001 for all these volumes). Patients with clinical failure had smaller volume reductions for WPV, ML and CG (all p < 0.05). Patients with significant CG infarction after PAE displayed larger WPV, ML and CG volume reductions (all p < 0.01). PAE can significantly decrease WPV, ML, CG and PZ volumes, and poor clinical outcomes are associated with smaller volume reductions. (orig.)

  9. Ecotoxicology for risk assessment in arid zones: some key issues.

    Science.gov (United States)

    Everts, J W

    1997-01-01

    In the hot arid zones of the world, ecotoxicological research is in statu nascendi. In these zones, the major sources of contamination by toxicants are: (1) plant protection and vector control in wet zones; (2) large-scale crop protection campaigns in dry and ephemeral wet zones; (3) refuse and obsolete pesticides in dry zones; and (4) mining. Economic development in many of these zones requires an adequate knowledge of certain basic principles, i.e., where extrapolating existing knowledge does not apply. The vulnerability of ecosystems to contaminants is closely related to water flow. In dry areas, species are susceptible to factors that interfere with the ecophysiological properties regulating water loss. Most hot arid areas are found at low latitudes where temperatures show striking extremes both in time and space. Living organisms are physiologically resistant and/or show adaptive behavior to these temperature extremes. Very little is known about the effects of toxicants on these key resistant and adaptive functions, although by extrapolation a few assumptions can be made. The effects of hyperthermia, for instance, can be aggravated by GSH depleting substances, and the temporary disabling effects characteristic of many pesticides may prove fatal under these circumstances. Most wet areas show a spatial concentration of both human activity and wildlife. In mesic zones, the contamination of water represents a health risk to both humans and other living organisms. The vast majority of aquatic communities are those inhabiting temporary pools and streams. Their populations are characterized by short reproductive cycles and/or long dormant stages. Toxicants affecting growth in these areas have been shown to have a deleterious effect. In a synthesis of existing knowledge the most prominent gaps are identified and priorities for further research are made.

  10. Early Risk stratification for Arrhythmic death in Patients with ST-Elevation Myocardial Infarction

    Directory of Open Access Journals (Sweden)

    Mohammad Ali Sadr-Ameli

    2007-01-01

    Full Text Available Background: Sudden cardiac death is a leading cause of death in patients with ST-elevation myocardial infarction (MI. According to high cost of modern therapeutic modalities it is of paramount importance to define protocols for risk stratification of post-MI patients before considering expensive devices such as implantable cardioverter-defibrillator.Methods: One hundred and thirty seven patients with acute ST-elevation MI were selected and underwent echocardiographic study, holter monitoring and signal-averaged electrocardiography (SAECG. Then, the patients were followed for 12 ±3 months.Results: During follow-up, 13 deaths (9.5% occurred; nine cases happened as sudden cardiac death (6.6%. The effect of ejection fraction (EF less than 40% on occurrence of arrhythmic events was significant (P<0.001. Sensitivity and positive predictive value of EF<40% was 100% and 76.95% respectively. Although with lesser sensitivity and predictive power than EF<40%, abnormal heart rate variability (HRV and SAECG had also significant effects on occurrence of sudden death (P=0.02 and P=0.003 respectively. Nonsustained ventricular tachycardia was not significantly related to risk of sudden death in this study (P=0.20.Conclusions: This study indicated that EF less than 40% is the most powerful predictor of sudden cardiac death in post MI patients. Abnormal HRV and SAECG are also important predictors and can be added to EF for better risk stratification.

  11. Occupational and leisure time physical activity and the risk of nonfatal acute myocardial infarction in Italy.

    Science.gov (United States)

    Altieri, Andrea; Tavani, Alessandra; Gallus, Silvano; La Vecchia, Carlo

    2004-08-01

    Physical activity has long been related to a reduced risk of coronary heart disease (CHD), including acute myocardial infarction (AMI). However, the quantitative estimates of the possible protective role of physical activity appear to vary across studies and populations. A case-control study conducted in Italy between 1995 and 1999, including 507 incident cases below 79 years (378 men, 129 women) with a first episode of AMI, and 478 controls (297 men, 181 women) admitted to hospitals for acute conditions. Compared with the lowest level of occupational physical activity, the multivariate odds ratios (OR) of AMI for the highest level were 0.61 (95% confidence interval [CI], 0.38-0.97) at age 15 to 19 years, 0.57 (95% CI, 0.34-0.95) at age 30 to 39 years, and 0.51 (95% CI, 0.29-0.90) at age 50 to 59 years. The corresponding values for leisure time activity were 0.54 (95% CI, 0.38-0.77), 0.86 (95% CI, 0.57-1.30), and 1.00 (95% CI, 0.57-1.74), respectively. The association was consistent across strata of age, sex, education, smoking, and other selected covariates. The attributable risk for low occupational exercise at age 30 to 39 years was over 10%, indicating the scope for further intervention on this modifiable risk factor in this Italian population, particularly in consideration of the public health importance of CHD.

  12. Risk of anxiety and depressive disorders in patients with myocardial infarction

    Science.gov (United States)

    Feng, Hsin-Pei; Chien, Wu-Chien; Cheng, Wei-Tung; Chung, Chi-Hsiang; Cheng, Shu-Meng; Tzeng, Wen-Chii

    2016-01-01

    Abstract Anxiety and depressive symptoms are associated with adverse cardiovascular events after an acute myocardial infarction (MI). However, most studies focusing on anxiety or depression have used rating scales or self-report methods rather than clinical diagnosis. This study aimed to investigate the association between psychiatrist-diagnosed psychiatric disorders and cardiovascular prognosis. We sampled data from the National Health Insurance Research Database; 1396 patients with MI were recruited as the study cohort and 13,960 patients without MI were recruited as the comparison cohort. Cox proportional hazard regression models were used to examine the effect of MI on the risk of anxiety and depressive disorders. During the first 2 years of follow-up, patients with MI exhibited a significantly higher risk of anxiety disorders (adjusted hazard ratio [HR] = 5.06, 95% confidence interval [CI]: 4.61–5.54) and depressive disorders (adjusted HR = 7.23, 95% CI: 4.88–10.88) than those without MI did. Greater risk for anxiety and depressive disorders was observed among women and patients aged 45 to 64 years following an acute MI. Patients with post-MI anxiety had a 9.37-fold (95% CI: 4.45–19.70) higher risk of recurrent MI than those without MI did after adjustment for age, sex, socioeconomic status, and comorbidities. This nationwide population-based cohort study provides evidence that MI increases the risk of anxiety and depressive disorders during the first 2 years post-MI, and post-MI anxiety disorders are associated with a higher risk of recurrent MI. PMID:27559951

  13. High-risk carotid plaques identified by CT-angiogram can predict acute myocardial infarction.

    Science.gov (United States)

    Mosleh, Wassim; Adib, Keenan; Natdanai, Punnanithinont; Carmona-Rubio, Andres; Karki, Roshan; Paily, Jacienta; Ahmed, Mohamed Abdel-Aal; Vakkalanka, Sujit; Madam, Narasa; Gudleski, Gregory D; Chung, Charles; Sharma, Umesh C

    2017-04-01

    Prior studies identified the incremental value of non-invasive imaging by CT-angiogram (CTA) to detect high-risk coronary atherosclerotic plaques. Due to their superficial locations, larger calibers and motion-free imaging, the carotid arteries provide the best anatomic access for the non-invasive characterization of atherosclerotic plaques. We aim to assess the ability of predicting obstructive coronary artery disease (CAD) or acute myocardial infarction (MI) based on high-risk carotid plaque features identified by CTA. We retrospectively examined carotid CTAs of 492 patients that presented with acute stroke to characterize the atherosclerotic plaques of the carotid arteries and examined development of acute MI and obstructive CAD within 12-months. Carotid lesions were defined in terms of calcifications (large or speckled), presence of low-attenuation plaques, positive remodeling, and presence of napkin ring sign. Adjusted relative risks were calculated for each plaque features. Patients with speckled (<3 mm) calcifications and/or larger calcifications on CTA had a higher risk of developing an MI and/or obstructive CAD within 1 year compared to patients without (adjusted RR of 7.51, 95%CI 1.26-73.42, P = 0.001). Patients with low-attenuation plaques on CTA had a higher risk of developing an MI and/or obstructive CAD within 1 year than patients without (adjusted RR of 2.73, 95%CI 1.19-8.50, P = 0.021). Presence of carotid calcifications and low-attenuation plaques also portended higher sensitivity (100 and 79.17%, respectively) for the development of acute MI. Presence of carotid calcifications and low-attenuation plaques can predict the risk of developing acute MI and/or obstructive CAD within 12-months. Given their high sensitivity, their absence can reliably exclude 12-month events.

  14. Proton Pump Inhibitor Usage and the Risk of Myocardial Infarction in the General Population.

    Directory of Open Access Journals (Sweden)

    Nigam H Shah

    Full Text Available Proton pump inhibitors (PPIs have been associated with adverse clinical outcomes amongst clopidogrel users after an acute coronary syndrome. Recent pre-clinical results suggest that this risk might extend to subjects without any prior history of cardiovascular disease. We explore this potential risk in the general population via data-mining approaches.Using a novel approach for mining clinical data for pharmacovigilance, we queried over 16 million clinical documents on 2.9 million individuals to examine whether PPI usage was associated with cardiovascular risk in the general population.In multiple data sources, we found gastroesophageal reflux disease (GERD patients exposed to PPIs to have a 1.16 fold increased association (95% CI 1.09-1.24 with myocardial infarction (MI. Survival analysis in a prospective cohort found a two-fold (HR = 2.00; 95% CI 1.07-3.78; P = 0.031 increase in association with cardiovascular mortality. We found that this association exists regardless of clopidogrel use. We also found that H2 blockers, an alternate treatment for GERD, were not associated with increased cardiovascular risk; had they been in place, such pharmacovigilance algorithms could have flagged this risk as early as the year 2000.Consistent with our pre-clinical findings that PPIs may adversely impact vascular function, our data-mining study supports the association of PPI exposure with risk for MI in the general population. These data provide an example of how a combination of experimental studies and data-mining approaches can be applied to prioritize drug safety signals for further investigation.

  15. Chocolate consumption and risk of myocardial infarction: a prospective study and meta-analysis.

    Science.gov (United States)

    Larsson, Susanna C; Åkesson, Agneta; Gigante, Bruna; Wolk, Alicja

    2016-07-01

    To examine whether chocolate consumption is associated with a reduced risk of ischaemic heart disease, we used data from a prospective study of Swedish adults and we performed a meta-analysis of available prospective data. The Swedish prospective study included 67 640 women and men from the Cohort of Swedish Men and the Swedish Mammography Cohort who had completed a food-frequency questionnaire and were free of cardiovascular disease at baseline. Myocardial infarction (MI) cases were ascertained through linkage with the Swedish National Patient and Cause of Death Registers. PubMed and EMBASE databases were searched from inception until 4 February 2016 to identify prospective studies on chocolate consumption and risk of ischaemic heart disease. The results from eligible studies were combined using a random-effects model. During follow-up (1998-2010), 4417 MI cases were ascertained in the Swedish study. Chocolate consumption was inversely associated with MI risk. Compared with non-consumers, the multivariable relative risk for those who consumed ≥3-4 servings/week of chocolate was 0.87 (95% CI 0.77 to 0.98; p for trend =0.04). Five prospective studies on chocolate consumption and ischaemic heart disease were identified. Together with the Swedish study, the meta-analysis included six studies with a total of 6851 ischaemic heart disease cases. The overall relative risk for the highest versus lowest category of chocolate consumption was 0.90 (95% CI 0.82 to 0.97), with little heterogeneity among studies (I(2)=24.3%). Chocolate consumption is associated with lower risk of MI and ischaemic heart disease. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  16. Using decision trees to manage hospital readmission risk for acute myocardial infarction, heart failure, and pneumonia.

    Science.gov (United States)

    Hilbert, John P; Zasadil, Scott; Keyser, Donna J; Peele, Pamela B

    2014-12-01

    To improve healthcare quality and reduce costs, the Affordable Care Act places hospitals at financial risk for excessive readmissions associated with acute myocardial infarction (AMI), heart failure (HF), and pneumonia (PN). Although predictive analytics is increasingly looked to as a means for measuring, comparing, and managing this risk, many modeling tools require data inputs that are not readily available and/or additional resources to yield actionable information. This article demonstrates how hospitals and clinicians can use their own structured discharge data to create decision trees that produce highly transparent, clinically relevant decision rules for better managing readmission risk associated with AMI, HF, and PN. For illustrative purposes, basic decision trees are trained and tested using publically available data from the California State Inpatient Databases and an open-source statistical package. As expected, these simple models perform less well than other more sophisticated tools, with areas under the receiver operating characteristic (ROC) curve (or AUC) of 0.612, 0.583, and 0.650, respectively, but achieve a lift of at least 1.5 or greater for higher-risk patients with any of the three conditions. More importantly, they are shown to offer substantial advantages in terms of transparency and interpretability, comprehensiveness, and adaptability. By enabling hospitals and clinicians to identify important factors associated with readmissions, target subgroups of patients at both high and low risk, and design and implement interventions that are appropriate to the risk levels observed, decision trees serve as an ideal application for addressing the challenge of reducing hospital readmissions.

  17. A comprehensive risk analysis of coastal zones in China

    Science.gov (United States)

    Wang, Guanghui; Liu, Yijun; Wang, Hongbing; Wang, Xueying

    2014-03-01

    Although coastal zones occupy an important position in the world development, they face high risks and vulnerability to natural disasters because of their special locations and their high population density. In order to estimate their capability for crisis-response, various models have been established. However, those studies mainly focused on natural factors or conditions, which could not reflect the social vulnerability and regional disparities of coastal zones. Drawing lessons from the experiences of the United Nations Environment Programme (UNEP), this paper presents a comprehensive assessment strategy based on the mechanism of Risk Matrix Approach (RMA), which includes two aspects that are further composed of five second-class indicators. The first aspect, the probability phase, consists of indicators of economic conditions, social development, and living standards, while the second one, the severity phase, is comprised of geographic exposure and natural disasters. After weighing all of the above indicators by applying the Analytic Hierarchy Process (AHP) and Delphi Method, the paper uses the comprehensive assessment strategy to analyze the risk indices of 50 coastal cities in China. The analytical results are presented in ESRI ArcGis10.1, which generates six different risk maps covering the aspects of economy, society, life, environment, disasters, and an overall assessment of the five areas. Furthermore, the study also investigates the spatial pattern of these risk maps, with detailed discussion and analysis of different risks in coastal cities.

  18. Multiple zone power forwards. A value at risk framework

    International Nuclear Information System (INIS)

    Demers, Jean-Guy

    2009-01-01

    Over the 1990s, deregulated power markets in New-England provided zones with fluctuating spot prices. Such prices have a notoriously high volatility, owing to the difficulty of storing electrical energy and the delays needed to adjust generation levels. In this context, forward contracts have become increasingly popular and understanding their dynamic is a problem facing many market players. This paper proposes a parsimonious parametric model, based on the price series of all n-month forward contracts (n = 1,2,3..), encompassing multiple zones. The model is then used for value at risk forecasts, which are backtested and compared with the ones in use by the risk management unit of an important electricity producer. Extensions to include natural gas and power-relevant oil-based future markets are discussed. (author)

  19. Serial assessment of the area at risk in myocardial infarction with Gd-DTPA-enhanced MR imaging in humans

    International Nuclear Information System (INIS)

    de Roos, A.; Doornbos, J.; Matheijssen, N.; van Dijkman, P.; van der Wall, E.; van Voorthuisen, A.E.

    1989-01-01

    Experimental studies have shown that the region of increased myocardial signal intensity with Gd-DTPA correlates with the area at risk but overestimates the infarct size. The authors have assessed the evolution of the area at risk in acute myocardial infarction in seven patients, using Gd-DTPA enhanced MR imaging at 1 and 2 weeks after the acute event. Multisection MR imaging of the total left ventricle was performed at 0.5 T after injection of 0.2 mmol/kg of Gd-DTPA. The area with a signal intensity greater than that of normal myocardium (± 2SDs) was designated as the area at risk in each section. The summation of these areas was measured by two observers at 1 and 2 weeks after infarction; intra- and interobserver variability was 3%. The area at risk ranged from 3% to 18%; at 2 weeks the size of the area at risk showed only slight changes (P = not significant). The authors discuss how Gd- DTPA enhances the area at risk and may be useful in assessing the evolution of the size of this area

  20. Wine, beer and spirits and the risk of myocardial infarction: a systematic review.

    Science.gov (United States)

    Cleophas, T J

    1999-10-01

    Alcohol has beneficial and harmful effects on health at the same time. Wine may be more beneficial for the heart than other types of alcoholic beverages. 1. To assess the current status of knowledge regarding the relationship between death and alcohol consumption. 2. To assess the relationship between myocardial infarction (MI) and consumption of different types of alcoholic beverages, both low doses (1-4 drinks a day), and high doses (> 4 drinks a day). Meta-analysis of major cohort and case-control studies. For the assessment of death and alcohol consumption eight cohort studies were used; for the assessment of MI and different types of alcoholic beverages, 12 cohort and two case-control studies were used. 1. Small doses of alcohol (1-4 drinks a day) are associated with a slightly reduced risk of mortality and coronary heart disease (CHD). 2. Small doses (1-4 drinks a day) of wine, beer, and spirits are equally beneficial. 3. Apart from a direct beneficial effect of low doses of alcohol on mortality and CHD, some psychological factors may contribute to its beneficial effect. 4. High doses of alcohol (> or = 5 drinks a day) are not associated with a reduced risk of death and CHD. 5. Apart from a direct effect of alcohol, confounding factors, particularly those of a psychological nature, may very well again contribute to the loss of benefits.

  1. Childhood Misfortune, Personality, and Heart Attack: Does Personality Mediate Risk of Myocardial Infarction?

    Science.gov (United States)

    Morton, Patricia M; Turiano, Nicholas A; Mroczek, Daniel K; Ferraro, Kenneth F

    2016-03-12

    Previous research has revealed a link between childhood experiences and adult health, but the mechanisms underlying this relationship are less clear. To elucidate this relationship, we investigated the pathway from childhood misfortune to nonfatal myocardial infarction (MI) via individual differences in personality. Longitudinal data were drawn from the National Survey of Midlife Development in the United States, which sampled 3,032 men and women aged 25-74 years at baseline. Big 5 personality traits and multiple measures of childhood misfortune were used to assess whether personality mediated the effect of childhood misfortune on MI risk. A series of proportional hazards models revealed that neuroticism mediated the effect of additive childhood misfortune on adult MI risk. Childhood misfortune may be formative in the development of personality, which, subsequently, can be consequential to health. These findings highlight the salient roles of early-life experiences and personality to shape health and aging. © The Author 2016. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  2. Risk of Cerebral Infarction in Japanese Hemodialysis Patients: Miyazaki Dialysis Cohort Study (MID study

    Directory of Open Access Journals (Sweden)

    Tatsunori Toida

    2016-07-01

    Full Text Available Background/Aims: Predictors including the preventive effects of antiplatelet and anticoagulant drugs on cerebral infarction (CI events have not yet been clarified in dialysis patients. The aim of the present study was to examine the risk of CI and preventive effects of these drugs in Japanese hemodialysis patients. Methods: Patients receiving maintenance hemodialysis (n=1,551, median age (interquartile range, 69.0 (59.0-78.0 years; 41.5% female were enrolled in the Miyazaki Dialysis Cohort Study and prospectively followed-up for 3 years. Kaplan-Meier and Cox's regression analyses were used to clarify the risk of CI. Results: Eighty-four patients developed CI at an incidence of 21.5/1000 patients per year. The presence of a previous history of CI, atrial fibrillation (AF, and diabetes mellitus in addition to age were also identified as predictive factors for new CI, whereas no relationship was observed between antiplatelet and/or anticoagulant usage and CI. Furthermore, no significant difference was noted in the frequency of CI events between patients with AF who received warfarin and those who did not. Conclusions: The incidence of CI was higher in dialysis patients with a previous history of CI and AF; however, the preventive effects of antiplatelet/anticoagulant drugs on the development of CI were not evident.

  3. The role of infarct transmural extent in infarct extension: A computational study.

    Science.gov (United States)

    Leong, Chin-Neng; Lim, Einly; Andriyana, Andri; Al Abed, Amr; Lovell, Nigel Hamilton; Hayward, Christopher; Hamilton-Craig, Christian; Dokos, Socrates

    2017-02-01

    Infarct extension, a process involving progressive extension of the infarct zone (IZ) into the normally perfused border zone (BZ), leads to continuous degradation of the myocardial function and adverse remodelling. Despite carrying a high risk of mortality, detailed understanding of the mechanisms leading to BZ hypoxia and infarct extension remains unexplored. In the present study, we developed a 3D truncated ellipsoidal left ventricular model incorporating realistic electromechanical properties and fibre orientation to examine the mechanical interaction among the remote, infarct and BZs in the presence of varying infarct transmural extent (TME). Localized highly abnormal systolic fibre stress was observed at the BZ, owing to the simultaneous presence of moderately increased stiffness and fibre strain at this region, caused by the mechanical tethering effect imposed by the overstretched IZ. Our simulations also demonstrated the greatest tethering effect and stress in BZ regions with fibre direction tangential to the BZ-remote zone boundary. This can be explained by the lower stiffness in the cross-fibre direction, which gave rise to a greater stretching of the IZ in this direction. The average fibre strain of the IZ, as well as the maximum stress in the sub-endocardial layer, increased steeply from 10% to 50% infarct TME, and slower thereafter. Based on our stress-strain loop analysis, we found impairment in the myocardial energy efficiency and elevated energy expenditure with increasing infarct TME, which we believe to place the BZ at further risk of hypoxia. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

  4. The long-term risk of recognized and unrecognized myocardial infarction for depression in older men.

    Science.gov (United States)

    Jovanova, O; Luik, A I; Leening, M J G; Noordam, R; Aarts, N; Hofman, A; Franco, O H; Dehghan, A; Tiemeier, H

    2016-07-01

    The association between myocardial infarction (MI) and depression is well described. Yet, the underlying mechanisms are unclear and the contribution of psychological factors is uncertain. We aimed to determine the risk of recognized (RMI) and unrecognized (UMI) myocardial infections on depression, as both have a similar impact on cardiovascular health but differ in psychological epiphenomena. Participants of the Rotterdam Study, 1823 men aged ⩾55 years, were followed for the occurrence of depression. RMI and UMI were ascertained using electrocardiography and medical history at baseline. We determined the strength of the association of RMI and UMI with mortality, and we studied the relationship of RMI and UMI with depressive symptoms and the occurrence of major depression. The risk of mortality was similar in men with RMI [adjusted hazard ratio (aHR) 1.71, 95% confidence interval (CI) 1.45-2.03] and UMI (aHR 1.58, 95% CI 1.27-1.97). Men with RMI had on average [unstandardized regression coefficient (B) 1.14, 95% CI 0.07-2.21] higher scores for depressive symptoms. By contrast, we found no clear association between UMI and depressive symptoms (B 0.55, 95% CI -0.51 to 1.62) in men. Analysis including occurrence of major depression as the outcome were consistent with the pattern of association. The discrepant association of RMI and UMI with mortality compared to depression suggests that the psychological burden of having experienced an MI contributes to the long-term risk of depression.

  5. The Analysis of the Risk Factors of Adverse Prognosis of Myocardial Infarction in the Acute Period

    Directory of Open Access Journals (Sweden)

    A. E. Zakharova

    2016-01-01

    Full Text Available The aim was to identify the risk factors contributed to adverse outcome of myocardial infarction (MI in the acute period of the disease at a prehospital stage.Materials and methods. The study included the call cards of specialized resuscitation and anesthesia units of the budgetary institution A. S. Puchkov «Station of emergency medical care», to patients with complicated MI. The study included two groups of patients. The first group comprized of patients with complicated MI which resulted in circulatory arrest (n=184, the second group (the group of comparison included patients with com plicated MI without the outcome in circulatory arrest (n=271. Statistical processing of the material: significance of differences between two binomial observations was evaluated by the Barnard's Exact Test.The results of the research. The presence of risk of MI complication as a stopping of blood circulation was confirmed in patients of the age group of 40—60 years (P=0.01. Patients with MI complicated by a circulatory arrest was characterized by a significantly greater intensity of pain syndrome (the pain intensity of 9—10 points was typ ical for 11,2% and 3% of patients of the group with circulatory arrest and the group of comparison, respectively; P< 0.001. The combination of clinical manifestations of alveolar pulmonary edema and arrhythmia occurred in 50% of patients with circulatory arrest, resulted in poor prognosis (the frequency of same parameters in a control group was 28,7%, P=0.018. Tachysystolic arrhythmia was the most common form of alteration at a circulatory arrest.Conclusions. The risk factors for MI adverse outcome in acute period included age from 40 to 60 years, pain of high intensity, presence of cardiogenic shock in combination with alveolar pulmonary edema and tachyarrhythmia.

  6. Glyburide increases risk in patients with diabetes mellitus after emergent percutaneous intervention for myocardial infarction - A nationwide study

    DEFF Research Database (Denmark)

    Jørgensen, C H; Gislason, G H; Bretler, D

    2011-01-01

    Danish patients receiving glucose-lowering drugs admitted with myocardial infarction between 1997 and 2006 who underwent emergent percutaneous coronary intervention were identified from national registers. Multivariable Cox proportional hazards models were used to analyze the risk of cardiovascular.......9%) received metformin. Cox proportional hazard regression analyses adjusted for age, sex, calendar year, comorbidity and concomitant pharmacotherapy showed an increased risk of cardiovascular mortality (hazard ratio [HR] 2.91, 95% confidence interval [CI] 1.26-6.72 ; p=0.012), cardiovascular mortality...... and nonfatal myocardial infarction (HR 2.69 , 95% CI 1.21-6.00; p=0.016), and all-cause mortality (HR 2.46, 95% CI 1.11-5.47; p=0.027), respectively, with glyburide compared to metformin. CONCLUSIONS: Glyburide is associated with increased cardiovascular mortality and morbidity in patients with diabetes...

  7. Comparison of the effects of streptokinase and tissue plasminogen activator on regional wall motion after first myocardial infarction: analysis by the centerline method with correction for area at risk.

    Science.gov (United States)

    Cross, D B; Ashton, N G; Norris, R M; White, H D

    1991-04-01

    In a trial of streptokinase versus recombinant tissue-type plasminogen activator (rt-PA) for a first myocardial infarction, 270 patients were randomized. Regional left ventricular function was assessed in 214 patients at 3 weeks. The infarct-related artery was the left anterior descending artery in 78 patients, the right coronary artery in 122 and a dominant left circumflex artery in 14. Analysis was by the centerline method with a novel correction for the area of myocardium at risk, whereby the search region was determined by the anatomic distribution of the infarct-related artery. Infarct-artery patency at 3 weeks was 73% in the streptokinase group and 71% in the rt-PA group. Global left ventricular function did not differ between the two groups. Mean chord motion (+/- SD) in the most hypokinetic half of the defined search region was similar in the streptokinase and rt-PA groups (-2.4 +/- 1.5 versus -2.3 +/- 1.3, p = 0.63). There were no differences in hyperkinesia of the noninfarct zone. Compared with conventional centerline analysis, regional wall motion in the defined area at risk was significantly more abnormal. The two methods correlated strongly, however (r = 0.99, p less than 0.0001), and both methods produced similar overall results. Patients with a patent infarct-related artery and those with an occluded artery at the time of catheterization had similar levels of global function (ejection fraction 58 +/- 12% versus 57 +/- 12%, p = 0.58).(ABSTRACT TRUNCATED AT 250 WORDS)

  8. Can the inflammatory response be evaluated using 18F-FDG within zones of microvascular obstruction after myocardial infarction?

    Science.gov (United States)

    Prato, Frank S; Butler, John; Sykes, Jane; Keenliside, Lynn; Blackwood, Kimberley J; Thompson, R Terry; White, James A; Mikami, Yoko; Thiessen, Jonathan D; Wisenberg, Gerald

    2015-02-01

    Inflammation that occurs after acute myocardial infarction plays a pivotal role in healing by facilitating the creation of a supportive scar. (18)F-FDG, which is taken up avidly by macrophages, has been proposed as a marker of cell-based inflammation. However, its reliability as an accurate indicator of inflammation has not been established, particularly in the early postinfarction period when regional myocardial perfusion is often severely compromised. Nine adult dogs underwent left anterior descending coronary occlusion with or without reperfusion. Animals were imaged between 7 and 21 d after infarction with PET/MR imaging after bolus injection of gadolinium-diethylenetriaminepentaacetic acid (DTPA), bolus injection of (18)F-FDG, bolus injection of (99)Tc-DTPA to simulate the distribution of gadolinium-DTPA (which represents its partition coefficient in well-perfused tissue), and injection of (111)In-labeled white blood cells 24 h earlier. After sacrifice, myocardial tissue concentrations of (18)F, (111)In, and (99)Tc were determined in a well counter. Linear regression analysis evaluated the relationships between the concentrations of (111)In and (18)F and the dependence of the ratio of (111)In/(18)F to the apparent distribution volume of (99m)Tc-DTPA. In 7 of 9 animals, (111)In increased as (18)F increased with the other 2 animals, showing weak negative slopes. With respect to the dependence of (111)In/(18)F with partition coefficient, 4 animals showed no dependence and 4 showed a weak positive slope, with 1 animal showing a negative slope. Further, in regions of extensive microvascular obstruction, (18)F significantly underestimated the extent of the presence of (111)In. In the early post-myocardial infarction period, (18)F-FDG PET imaging after a single bolus administration may underestimate the extent and degree of inflammation within regions of microvascular obstruction. © 2015 by the Society of Nuclear Medicine and Molecular Imaging, Inc.

  9. Levothyroxine Substitution in Patients with Subclinical Hypothyroidism and the Risk of Myocardial Infarction and Mortality

    Science.gov (United States)

    Andersen, Mette Nygaard; Olsen, Anne-Marie Schjerning; Madsen, Jesper Clausager; Faber, Jens; Torp-Pedersen, Christian; Gislason, Gunnar Hilmar; Selmer, Christian

    2015-01-01

    Background Subclinical hypothyroidism is associated with a number of cardiovascular risk factors, yet only limited data exist on long-term outcome of levothyroxine treatment of this condition with respect to hard end-points. The aim of this retrospective cohort study was to determine effects of levothyroxine treatment on myocardial infarction (MI), cardiovascular death and all-cause mortality, in patients with subclinical hypothyroidism. Methods and Results Primary care patients aged 18 years and older that underwent thyroid function tests between 2000 and 2009 were enrolled. Participants were identified by individual-level linkage of nationwide registers. Patients with subclinical hypothyroidism at baseline were included in the study. Exclusion criteria included a history of thyroid disease, related medication or medication affecting thyroid function. The total cohort comprised 628,953 patients of which 12,212 (1.9%) had subclinical hypothyroidism (mean age 55.2 [SD ± 18.8] years; 79.8% female). Within the first six months 2,483 (20.3%) patients claimed a prescription for levothyroxine. During a median follow-up of 5.0 (IQR: 5.2) years, 358 MI’s and 1,566 (12.8%) deaths were observed. Out of these, 766 of the deaths were cardiovascular related. No beneficial effects were found in levothyroxine treated patients on MI (IRR 1.08 [95% CI: 0.81 to 1.44]), cardiovascular death (IRR 1.02 [95% CI: 0.83 to 1.25]) or all-cause mortality (IRR 1.03 [95% CI: 0.90 to 1.19]), except in patients under the age of 65 years (IRR 0.63 [95% CI: 0.40 to 0.99]). Conclusion Levothyroxine substitution in subclinical hypothyroid patients does not indicate an association with lower mortality or decreased risk of MI. PMID:26069971

  10. Levothyroxine Substitution in Patients with Subclinical Hypothyroidism and the Risk of Myocardial Infarction and Mortality.

    Directory of Open Access Journals (Sweden)

    Mette Nygaard Andersen

    Full Text Available Subclinical hypothyroidism is associated with a number of cardiovascular risk factors, yet only limited data exist on long-term outcome of levothyroxine treatment of this condition with respect to hard end-points. The aim of this retrospective cohort study was to determine effects of levothyroxine treatment on myocardial infarction (MI, cardiovascular death and all-cause mortality, in patients with subclinical hypothyroidism.Primary care patients aged 18 years and older that underwent thyroid function tests between 2000 and 2009 were enrolled. Participants were identified by individual-level linkage of nationwide registers. Patients with subclinical hypothyroidism at baseline were included in the study. Exclusion criteria included a history of thyroid disease, related medication or medication affecting thyroid function. The total cohort comprised 628,953 patients of which 12,212 (1.9% had subclinical hypothyroidism (mean age 55.2 [SD ± 18.8] years; 79.8% female. Within the first six months 2,483 (20.3% patients claimed a prescription for levothyroxine. During a median follow-up of 5.0 (IQR: 5.2 years, 358 MI's and 1,566 (12.8% deaths were observed. Out of these, 766 of the deaths were cardiovascular related. No beneficial effects were found in levothyroxine treated patients on MI (IRR 1.08 [95% CI: 0.81 to 1.44], cardiovascular death (IRR 1.02 [95% CI: 0.83 to 1.25] or all-cause mortality (IRR 1.03 [95% CI: 0.90 to 1.19], except in patients under the age of 65 years (IRR 0.63 [95% CI: 0.40 to 0.99].Levothyroxine substitution in subclinical hypothyroid patients does not indicate an association with lower mortality or decreased risk of MI.

  11. Levothyroxine Substitution in Patients with Subclinical Hypothyroidism and the Risk of Myocardial Infarction and Mortality.

    Science.gov (United States)

    Andersen, Mette Nygaard; Olsen, Anne-Marie Schjerning; Madsen, Jesper Clausager; Faber, Jens; Torp-Pedersen, Christian; Gislason, Gunnar Hilmar; Selmer, Christian

    2015-01-01

    Subclinical hypothyroidism is associated with a number of cardiovascular risk factors, yet only limited data exist on long-term outcome of levothyroxine treatment of this condition with respect to hard end-points. The aim of this retrospective cohort study was to determine effects of levothyroxine treatment on myocardial infarction (MI), cardiovascular death and all-cause mortality, in patients with subclinical hypothyroidism. Primary care patients aged 18 years and older that underwent thyroid function tests between 2000 and 2009 were enrolled. Participants were identified by individual-level linkage of nationwide registers. Patients with subclinical hypothyroidism at baseline were included in the study. Exclusion criteria included a history of thyroid disease, related medication or medication affecting thyroid function. The total cohort comprised 628,953 patients of which 12,212 (1.9%) had subclinical hypothyroidism (mean age 55.2 [SD ± 18.8] years; 79.8% female). Within the first six months 2,483 (20.3%) patients claimed a prescription for levothyroxine. During a median follow-up of 5.0 (IQR: 5.2) years, 358 MI's and 1,566 (12.8%) deaths were observed. Out of these, 766 of the deaths were cardiovascular related. No beneficial effects were found in levothyroxine treated patients on MI (IRR 1.08 [95% CI: 0.81 to 1.44]), cardiovascular death (IRR 1.02 [95% CI: 0.83 to 1.25]) or all-cause mortality (IRR 1.03 [95% CI: 0.90 to 1.19]), except in patients under the age of 65 years (IRR 0.63 [95% CI: 0.40 to 0.99]). Levothyroxine substitution in subclinical hypothyroid patients does not indicate an association with lower mortality or decreased risk of MI.

  12. Genetic variants associated with myocardial infarction and the risk factors in Chinese population.

    Directory of Open Access Journals (Sweden)

    Yongqin Wang

    Full Text Available BACKGROUND: Recent genome-wide association (GWA studies in Caucasians identified multiple single nucleotide polymorphisms (SNPs associated with coronary artery disease (CAD. The associations of those SNPs with myocardial infarction (MI have not been replicated in Asian populations. Among those previously identified SNPs, we selected nine (rs10953541, rs1122608, rs12190287, rs12413409, rs1412444, rs1746048, rs3798220, rs4977574, rs579459, in or near genes 7q22, LDLR, TCF21, CYP17A1, LIPA, CXCL12, LPA, CDKN2A, ABO, respectively because of the relatively high minor allele frequencies in Chinese individuals and tested the associations of the SNPs with MI and MI related risk factors in Chinese population. METHODS AND RESULTS: We conducted a case-control association study on a cohort of 2365 MI patients and 2678 unrelated controls from the Chinese population. Genotyping of 9 SNPs were performed by the TaqMan Real Time PCR method. After age, sex, and BMI adjustment, we observed the SNPs rs12190287, rs12413409, rs1412444, rs1746048 and rs4977574, were significantly associated with MI in additive models and rs12190287, rs12413409, rs4977574 were significantly associated with phenotypes of MI at the same time. We also found three SNPs rs1122608, rs3798220 and rs579459 were significantly associated with risk factors of MI, although they had no association with MI in Chinese population. CONCLUSION: Results of this study indicate that 5 SNPs were associated with MI and 3 SNPs were associated with associated with lipoprotein levels but not with MI in a Chinese population. The present study supports some CAD-related genes in Caucasian as important genes for MI in a Chinese population.

  13. Risk reduction of brain infarction during carotid endarterectomy or stenting using sonolysis - Prospective randomized study pilot data

    Science.gov (United States)

    Kuliha, Martin; Školoudík, David; Martin Roubec, Martin; Herzig, Roman; Procházka, Václav; Jonszta, Tomáš; Krajča, Jan; Czerný, Dan; Hrbáč, Tomáš; Otáhal, David; Langová, Kateřina

    2012-11-01

    Sonolysis is a new therapeutic option for the acceleration of arterial recanalization. The aim of this study was to confirm risk reduction of brain infarction during endarterectomy (CEA) and stenting (CAS) of the internal carotid artery (ICA) using sonolysis with continuous transcranial Doppler (TCD) monitoring by diagnostic 2 MHz probe, additional interest was to assess impact of new brain ischemic lesions on cognitive functions. Methods: All consecutive patients 1/ with ICA stenosis >70%, 2/ indicated to CEA or CAS, 3/ with signed informed consent, were enrolled to the prospective study during 17 months. Patients were randomized into 2 groups: Group 1 with sonolysis during intervention and Group 2 without sonolysis. Neurological examination, assessment of cognitive functions and brain magnetic resonance imaging (MRI) were performed before and 24 hours after intervention in all patients. Occurrence of new brain infarctions (including infarctions >0.5 cm3), and the results of Mini-Mental State Examination, Clock Drawing and Verbal Fluency tests were statistically evaluated using T-test. Results: 97 patients were included into the study. Out of the 47 patients randomized to sonolysis group (Group 1) 25 underwent CEA (Group 1a) and 22 CAS (Group 1b). Out of the 50 patients randomized to control group (Group 2), 22 underwent CEA (Group 2a) and 28 CAS (Group 2b). New ischemic brain infarctions on follow up MRI were found in 14 (29.8%) patients in Group 1-4 (16.0%) in Group 1a and 10 (45.5%) in Group 1b. In Group 2, new ischemic brain infarctions were found in 18 (36.0%) patients-6 (27.3%) in Group 2a and 12 (42.9%) in Group 2b (p>0.05 in all cases). New ischemic brain infarctions >0.5 cm3 were found in 4 (8.5 %) patients in Group 1 and in 11 (22.0 %) patients in Group 2 (p= 0.017). No significant differences were found in cognitive tests results between subgroups (p>0.05 in all tests). Conclusion: Sonolysis seems to be effective in the prevention of large ischemic

  14. Locations of cerebral infarctions in tuberculous meningitis

    International Nuclear Information System (INIS)

    Hsieh, F.Y.; Chia, L.G.; Shen, W.C.

    1992-01-01

    The locations of cerebral infarctions were studied in 14 patients with tuberculous meningitis (TBM) and 173 patients with noninflammatory ischemic stroke (IS). In patients with TBM, 75% of infarctions occurred in the 'TB zone' supplied by medial striate and thalamoperforating arteries; only 11% occurred in the 'IS zone' supplied by lateral striate, anterior choroidal and thalamogeniculate arteries. In patients with IS, 29% of infarctions occurred in the IS zone, 29% in the subcortical white matter, and 24% in (or involving) the cerebral cortex. Only 11% occurred in the TB zone. Bilaterally symmetrical infarctions of the TB zone were common with TBM (71%) but rare with IS (5%). (orig.)

  15. Impact of acute hyperglycemia on myocardial infarct size, area at risk and salvage in patients with ST elevation myocardial infarction and the association with exenatide treatment - results from a randomized study

    DEFF Research Database (Denmark)

    Lønborg, Jacob Thomsen; Vejlstrup, Niels Grove; Kelbæk, Henning Skov

    2014-01-01

    Hyperglycemia upon hospital admission in patients with ST-segment elevation myocardial infarction (STEMI) occurs frequently and is associated with adverse outcomes. It is, however, unsettled as to whether an elevated blood glucose level is the cause or consequence of increased myocardial damage....... In addition, whether the cardioprotective effect of exenatide, a glucose-lowering drug, is dependent on hyperglycemia remains unknown. The objectives of this substudy were to evaluate the association between hyperglycemia and infarct size, myocardial salvage, and area at risk, and to assess the interaction...... between exenatide and hyperglycemia. A total of 210 STEMI patients were randomized to receive intravenous exenatide or placebo before percutaneous coronary intervention. Hyperglycemia was associated with larger area at risk and infarct size compared with patients with normoglycemia, but the salvage index...

  16. The Arctic zone: possibilities and risks of development

    Science.gov (United States)

    Sentsov, A.; Bolsunovskaya, Y.; Melnikovich, E.

    2016-09-01

    The authors analyze the Arctic region innovative possibilities from the perspective of political ideology and strategy. The Arctic region with its natural resources and high economic potential attracts many companies and it has become an important area of transnational development. At present, the Arctic region development is of great importance in terms of natural resource management and political system development. However, the most important development issue in the Arctic is a great risk of different countries’ competing interests in economic, political, and legal context. These are challenges for international partnership creating in the Arctic zone, Russian future model developing for the Arctic, and recognition of the Arctic as an important resource for the Russians. The Russian economic, military, and political expansion in the Arctic region has the potential to strengthen the national positions. The authors present interesting options for minimizing and eliminating political risks during the Arctic territories development and define an effective future planning model for the Russian Arctic.

  17. HIGH RISK ZONES ON FLOODS AND LANDSLIDES DISASTERS IN RWANDA

    Directory of Open Access Journals (Sweden)

    Nsengiyumva J.ean Baptiste

    2014-01-01

    Full Text Available Disaster risk management as an issue at stake worldwide shifts its emphases from post disaster to pre-disaster phases. Management activities required in pre-disaster phases, such as risk assessment, hazard identification, preparedness or preventive and mitigation measures needs detailed information about hazard characteristics, social, economic, structural vulnerability and capacity. That information is not usually available in many different countries, as it is the case in Rwanda. Based on the international experiences and practices, knowledge of disaster prone areas can be assumed as an alternative for detailed information acquisition, thus contributing to effective disaster risk management. Identification of disaster higher risk zones on floods and landslides, can lead to better understanding of disaster risk and putting in place measures for risk reduction. Consequently, as Rwanda is prone to natural hazards with lack of adequate information that is essential for effective disaster risk management, due to limited scientific researches; this study aims to address that gap. The results revealed that some areas of the North-Western parts of Rwanda are highly prone to floods and landslides, namely Burera, Musanze, Rulindo, Nyabihu, Ngororero and Rubavu Districts. This is aggravated by some triggering factors such as steep slopes, soil types, heavy rains, landuse Practices and others. Intensity and frequency of disaster events vary from district to district and this geographical dispersal confirms the non-spatial clustering (as confirmed by Moran’s I analysis of risks due to uneven level of Disaster vulnerabilities, coping capacities and available hazards whereby lack of normal distribution of hazards all over all Districts.

  18. Age-distribution, risk factors and mortality in smokers and non-smokers with acute myocardial infarction: a review. TRACE study group. Danish Trandolapril Cardiac Evaluation

    DEFF Research Database (Denmark)

    Ottesen, M M; Jørgensen, S; Kjøller, E

    1999-01-01

    Smoking is a risk factor for acute myocardial infarction; paradoxically, many studies have shown a lower post-infarct mortality among smokers. There are some important differences between smokers and non-smokers, which might explain the observed difference in mortality: smokers have less...... multivessel disease and atherosclerosis but are more thrombogenic; thrombolytic therapy seems to be more effective among smokers; smoking might result in an increased out-of-hospital mortality rate, by being more arrhythmogenic; and smokers are on average a decade younger than non-smokers at the time...... of infarction, and have less concomitant disease. Adjusting for these differences in regression analyses shows that smoking is not an independent risk factor for mortality after acute myocardial infarction. The difference in age and risk factors are responsible for the lower mortality among smokers....

  19. Distinction of salvaged and infarcted myocardium within the ischaemic area-at-risk with T2 mapping

    DEFF Research Database (Denmark)

    Hammer-Hansen, Sophia; Ugander, Martin; Hsu, Li-Yueh

    2014-01-01

    values from T2 maps and signal intensities on T2-weighted images were measured in the corresponding areas. RESULTS: At both imaging time points, the T2 of the salvaged myocardium was longer than of remote (66.0 ± 6.9 vs. 51.4 ± 3.5 ms, P ...AIM: Area-at-risk (AAR) measurements often rely on T2-weighted images, but subtle differences in T2 may be overlooked with this method. To determine the differences in oedema between salvaged and infarcted myocardium, we performed quantitative T2 mapping of the AAR. We also aimed to determine...... (14.7 ± 5.6 vs. 8.7 ± 5.1 ms, P = 0.02). CONCLUSIONS: T2 relaxation parameters are different in the infarcted and salvaged myocardium, and both are significantly longer than remote. Furthermore, the magnitude of increase in T2 was less in the salvaged myocardium after longer reperfusion, indicating...

  20. Socioeconomic context in area of living and risk of myocardial infarction: results from Stockholm Heart Epidemiology Program (SHEEP)

    DEFF Research Database (Denmark)

    Kölegård Stjärne, M; Diderichsen, F; Reuterwall, C

    2002-01-01

    STUDY OBJECTIVE: To analyse if socioeconomic characteristics in area of living affect the risk of myocardial infarction in a Swedish urban population, and to evaluate to what extent the contextual effect is confounded by the individual exposures. DESIGN: A population based case-referent study......; class structure, social exclusion and poverty. Among men, there were increased relative risks of similar magnitudes (1.28 to 1.33) in the more deprived areas according to all three dimensions of the socioeconomic context. However, when adjusting for individual exposures, the poverty factor had...

  1. The Impact of Fasting on the Interpretation of Triglyceride Levels for Predicting Myocardial Infarction Risk in HIV-Positive Individuals

    DEFF Research Database (Denmark)

    Lundgren, Jens

    2011-01-01

    We assessed whether fasting modifies the prognostic value of these measurements for the risk of myocardial infarction (MI). Analyses used mixed effect models and Poisson regression. After confounders were controlled for, fasting triglyceride levels were, on average, 0.122 mmol/L lower than...... nonfasting levels. Each 2-fold increase in the latest triglyceride level was associated with a 38% increase in MI risk (relative rate, 1.38; 95% confidence interval, 1.26-1.51); fasting status did not modify this association. Our results suggest that it may not be necessary to restrict analyses to fasting...

  2. [The role of diabetes mellitus as a risk factor of acute myocardial infarction].

    Science.gov (United States)

    Peng, Xiao-ren; Zhao, Yan-fang; Zou, Da-jin; Gu, Ping

    2011-06-01

    To determine the impact of elevated in-hospital glucose level on outcome of patients with acute myocardial infarction (AMI), and evaluate the role of diabetes mellitus as a risk factor of AMI. The study included a retrospective analysis of AMI patients who were admitted to No. 81 Hospital of PLA from January 2000 to May 2010. In patients without a history of diabetes, and those with fasting blood glucose (FBG)≥7.0 mmol/L at admission but returned to normal range soon after admission were defined as stress hyperglycemia of non-diabetic AMI patients. Both diabetic patients and non-diabetic patients were stratified into four mutually exclusive groups according to FBG levels: independent risk factor of death with relative odds ratio (OR) 1.03, with 95% confidence interval (95%CI) 1.01-1.16, P=0.012, and OR 1.56, 95%CI 1.09-2.23, P=0.015 in diabetic group and non-diabetic group, respectively. The incidence of congestive heart failure in diabetic group was significantly higher than that in non-diabetic group (40.0% vs. 22.4%, P=0.027). In non-diabetic group, the incidence of lung infection, congestive heart failure, serious arrhythmias and acute cerebrovascular events (51.1%, 34.0%, 27.7%, 14.9%, respectively) was increased significantly in patients with FBG≥7.0 mmol/L than that in patients with FBG<7.0 mmol/L (18.3%, 13.3%, 10.0%, 0, respectively, P<0.05 or P<0.01). This association was not seen in diabetic group. 80.0% of patients (36 cases) in diabetic group received anti-hyperglycemia treatments in which insulin therapy accounted for 63.9% (23 cases), while there was not even 1 patient who needed insulin therapy in non-diabetic patients with stress hyperglycemia. In-hospital mortality and complications were significantly increased in diabetic AMI patients and in non-diabetic AMI patients with stress hyperglycemia. Both a history of diabetes mellitus and stress hyperglycemia have strong influence on AMI prognosis. It seems to be more plausible to collaborate blood

  3. Proton pump inhibitor use and risk of adverse cardiovascular events in aspirin treated patients with first time myocardial infarction: nationwide propensity score matched study

    DEFF Research Database (Denmark)

    Charlot, Mette; Grove, Erik; Hansen, Peter Riis

    2011-01-01

    : All aspirin treated patients surviving 30 days after a first myocardial infarction from 1997 to 2006, with follow-up for one year. Patients treated with clopidogrel were excluded. MAIN OUTCOME MEASURES: The risk of the combined end point of cardiovascular death, myocardial infarction, or stroke...... associated with use of proton pump inhibitors was analysed using Kaplan-Meier analysis, Cox proportional hazard models, and propensity score matched Cox proportional hazard models. Results 3366 of 19 925 (16.9%) aspirin treated patients experienced recurrent myocardial infarction, stroke, or cardiovascular...

  4. Increased risk of sudden and non-sudden cardiovascular death in patients with atrial fibrillation/flutter following acute myocardial infarction

    DEFF Research Database (Denmark)

    Pedersen, Ole Dyg; Abildstrøm, Steen Z; Ottesen, Michael M

    2005-01-01

    AIMS: Atrial fibrillation (AF) is a common complication in patients with acute myocardial infarction and is associated with an increase in the risk of death. The excess mortality associated with AF complicating acute myocardial infarction has not been studied in detail. Observations indicate...... that AF facilitates induction of ventricular arrhythmias, which may increase the risk of sudden cardiovascular death (SCD). A close examination of the mode of death could potentially provide useful knowledge to guide further investigations and treatments. METHODS AND RESULTS: We analysed the relation...... between AF/atrial flutter (AFL) and modes of death in 5983 consecutive patients discharged alive after an acute myocardial infarction screened in the TRAndolapril Cardiac Evaluation registry. This cohort of patients with an enzyme-verified acute myocardial infarction was admitted to 27 centres in 1990...

  5. Duration of clopidogrel treatment and risk of mortality and recurrent myocardial infarction among 11 680 patients with myocardial infarction treated with percutaneous coronary intervention: a cohort study

    Directory of Open Access Journals (Sweden)

    Køber Lars

    2010-01-01

    Full Text Available Abstract Background The optimal duration of clopidogrel treatment after percutaneous coronary intervention (PCI is unclear. We studied the risk of death or recurrent myocardial infarction (MI in relation to 6- and 12-months clopidogrel treatment among MI patients treated with PCI. Methods Using nationwide registers of hospitalizations and drug dispensing from pharmacies we identified 11 680 patients admitted with MI, treated with PCI and clopidogrel. Clopidogrel treatment was categorized in a 6-months and a 12-months regimen. Rates of death, recurrent MI or a combination of both were analyzed by the Kaplan Meier method and Cox proportional hazards models. Bleedings were compared between treatment regimens. Results The Kaplan Meier analysis indicated no benefit of the 12-months regimen compared with the 6-months in all endpoints. The Cox proportional hazards analysis confirmed these findings with hazard ratios for the 12-months regimen (the 6-months regimen used as reference for the composite endpoint of 1.01 (confidence intervals 0.81-1.26 and 1.24 (confidence intervals 0.95-1.62 for Day 0-179 and Day 180-540 after discharge. Bleedings occurred in 3.5% and 4.1% of the patients in the 6-months and 12-months regimen (p = 0.06. Conclusions We found comparable rates of death and recurrent MI in patients treated with 6- and 12-months' clopidogrel. The potential benefit of prolonged clopidogrel treatment in a real-life setting remains uncertain.

  6. Clot lysis time and the risk of myocardial infarction and ischaemic stroke in young women; results from the RATIO case-control study

    NARCIS (Netherlands)

    Siegerink, Bob; Meltzer, Mirjam E.; de Groot, Philip G.; Algra, Ale; Lisman, Ton; Rosendaal, Frits R.

    Reduced overall fibrinolytic capacity increases the risk of myocardial infarction (MI), as demonstrated in studies with predominantly male participants. We determined the influence of altered fibrinolysis on the risk of MI and ischaemic stroke (IS) in young women. The RATIO (Risk of Arterial

  7. Anhedonic depression, history of depression, and anxiety as gender-specific risk factors of myocardial infarction in healthy men and women: The HUNT study

    Directory of Open Access Journals (Sweden)

    Eva Langvik

    2014-11-01

    Full Text Available This prospective study examines gender-specific psychological risk factors of myocardial infarction. Out of 41,248 participants free of coronary heart disease at baseline, 822 cases of myocardial infarction were identified in the Nord-Trøndelag Health Study or the mortality register. The participants completed the Hospital Anxiety and Depression Scale. Cholesterol, blood pressure, and waist–hip ratio were measured by medical staff. Smoking, diabetes, non-fatal myocardial infarction, and history of depressive episode were self-reported. Anhedonic depression (Hospital Anxiety and Depression Scale-D ≥8 was a significant predictor of myocardial infarction in women but not in men. Gender difference in risk estimate based on Hospital Anxiety and Depression Scale-D was significant ( p  < .01. History of depressive episode was a significant predictor of myocardial infarction in men. Symptoms of anxiety (Hospital Anxiety and Depression Scale-A ≥8 reduced the risk of having a myocardial infarction.

  8. Risk factors of late cardiogenic shock and mortality in ST-segment elevation myocardial infarction patients

    DEFF Research Database (Denmark)

    Obling, Laust; Frydland, Martin; Hansen, Rikke

    2018-01-01

    BACKGROUND: The incidence of cardiogenic shock (CS) in patients with ST-segment elevation myocardial infarction (STEMI) is as high as 10%. The majority of patients are thought to develop CS after admission (late CS), but the incidence in a contemporary STEMI cohort admitted for primary percutaneo...

  9. Collateral blood supply to the myocardium at risk in human myocardial infarction: a quantitative postmortem assessment

    NARCIS (Netherlands)

    Piek, J. J.; Becker, A. E.

    1988-01-01

    The relation between the type and size of myocardial infarcts and collateral development was studied in postmortem human hearts with a new approach that allows quantification of vascular beds. The coronary arteries were perfused with radioactive microspheres and were visualized by injecting a

  10. Risk of myocardial infarction in parents of HIV-infected individuals: a population-based cohort study

    DEFF Research Database (Denmark)

    Rasmussen, Line D; Omland, Lars H; Pedersen, Court

    2010-01-01

    associated with the HIV disease and HAART or whether life-style related or genetic factors also increase the risk in this population. To establish whether the increased risk of myocardial infarction in HIV patients partly reflects an increased risk of MI in their families, we estimated the relative risk...... of MI in parents of HIV-infected individuals METHODS: From the Danish HIV Cohort Study and the Danish Civil Registration System we identified the parents of all HIV-infected patients born in Denmark after 1952 in whom a Danish born mother was identifiable. For each HIV patient, 4 matched population...... controls and their parents were identified. Cumulative incidence functions were constructed to illustrate time to first MI of the parents as registered in the Danish National Hospital Registry. Incidence rate ratios (IRR) were estimated by Cox's regression analyses. Due to the confidential type...

  11. The impact of passive and active smoking on inflammation, lipid profile and the risk of myocardial infarction.

    Science.gov (United States)

    Attard, Ritienne; Dingli, Philip; Doggen, Carine J M; Cassar, Karen; Farrugia, Rosienne; Wettinger, Stephanie Bezzina

    2017-01-01

    To investigate the effect of passive smoking, active smoking and smoking cessation on inflammation, lipid profile and the risk of myocardial infarction (MI). A total of 423 cases with a first MI and 465 population controls from the Maltese Acute Myocardial Infarction (MAMI) Study were analysed. Data were collected through an interviewer-led questionnaire, and morning fasting blood samples were obtained. ORs adjusted for the conventional risk factors of MI (aORs) were calculated as an estimate of the relative risk of MI. The influence of smoking on biochemical parameters was determined among controls. Current smokers had a 2.7-fold (95% CI 1.7 to 4.2) and ex-smokers a 1.6-fold (95% CI 1.0 to 2.4) increased risk of MI. Risk increased with increasing pack-years and was accompanied by an increase in high-sensitivity C reactive protein levels and an abnormal lipid profile. Smoking cessation was associated with lower triglyceride levels. Exposure to passive smoking increased the risk of MI (aOR 3.2 (95% CI 1.7 to 6.3)), with the OR being higher for individuals exposed to passive smoking in a home rather than in a public setting (aOR 2.0 (95% CI 0.7 to 5.6) vs aOR 1.2 (95% CI 0.7 to 2.0)). Passive smoke exposure was associated with higher levels of total cholesterol, triglycerides and total cholesterol:high-density lipoprotein cholesterol ratio compared with individuals not exposed to passive smoking. Both active and passive smoking are strong risk factors for MI. This risk increased with increasing pack-years and decreased with smoking cessation. Such effects may be partly mediated through the influence of smoking on inflammation and lipid metabolism.

  12. Income as mediator of the effect of occupation on the risk of myocardial infarction: does the income measurement matter?

    DEFF Research Database (Denmark)

    Andersen, Ingelise; Gamborg, Michael; Osler, Merete

    2005-01-01

    women (in total 47% fatal). The hazards by household and individual income showed a graded effect with a hazard ratio (HR) of 1.43 (95% CI 1.12 to 1.83) for the lowest household income group compared with the highest, whereas equivalent income showed an inverse "J shape" effect with a HR of 1.55 (95% CI......AIM: To investigate whether the effect of occupational grade on the risk of myocardial infarction (MI) is mediated by income with different aspects of income taken into account. METHODS: Data were used from three prospective population studies conducted in Copenhagen. A total of 16 665 employees...

  13. Relationship of Psychosocial Risk Factors, Certain Personality Traits and Myocardial Infarction in Indians: A Case-control Study.

    Science.gov (United States)

    Gupta, Rajni; Kishore, Jugal; Bansal, Yogesh; Daga, Mk; Jiloha, Rc; Singal, Rajeev; Ingle, Gk

    2011-07-01

    To investigate the relationship of psychosocial factors (lack of social support, stress and subjective well-being) and personality traits with myocardial infarction (MI). A case-control study involving 100 cases and 100 matched controls was conducted in Lok Nayak Hospital, New Delhi. Stress over 1 year was significantly higher in cases (P introvert (P < 0.001) personalities. Certain personality traits and recent stress may be important risk factors of MI, especially in Indians. The finding may have implications on the preventive strategies planned for MI patients.

  14. Relationship of Psychosocial Risk Factors, Certain Personality Traits and Myocardial Infarction in Indians: A Case–control Study

    Science.gov (United States)

    Gupta, Rajni; Kishore, Jugal; Bansal, Yogesh; Daga, MK; Jiloha, RC; Singal, Rajeev; Ingle, GK

    2011-01-01

    Objective: To investigate the relationship of psychosocial factors (lack of social support, stress and subjective well-being) and personality traits with myocardial infarction (MI). Materials and Methods: A case–control study involving 100 cases and 100 matched controls was conducted in Lok Nayak Hospital, New Delhi. Results: Stress over 1 year was significantly higher in cases (P introvert (P < 0.001) personalities. Conclusion: Certain personality traits and recent stress may be important risk factors of MI, especially in Indians. The finding may have implications on the preventive strategies planned for MI patients. PMID:22090670

  15. Swiss Re Global Flood Hazard Zones: Know your flood risk

    Science.gov (United States)

    Vinukollu, R. K.; Castaldi, A.; Mehlhorn, J.

    2012-12-01

    Floods, among all natural disasters, have a great damage potential. On a global basis, there is strong evidence of increase in the number of people affected and economic losses due to floods. For example, global insured flood losses have increased by 12% every year since 1970 and this is expected to further increase with growing exposure in the high risk areas close to rivers and coastlines. Recently, the insurance industry has been surprised by the large extent of losses, because most countries lack reliable hazard information. One example has been the 2011 Thailand floods where millions of people were affected and the total economic losses were 30 billion USD. In order to assess the flood risk across different regions and countries, the flood team at Swiss Re based on a Geomorphologic Regression approach, developed in house and patented, produced global maps of flood zones. Input data for the study was obtained from NASA's Shuttle Radar Topographic Mission (SRTM) elevation data, Advanced Spaceborne Thermal Emission and Reflection Radiometer (ASTER) Global Digital Elevation Model (GDEM) and HydroSHEDS. The underlying assumptions of the approach are that naturally flowing rivers shape their channel and flood plain according to basin inherent forces and characteristics and that the flood water extent strongly depends on the shape of the flood plain. On the basis of the catchment characteristics, the model finally calculates the probability of a location to be flooded or not for a defined return period, which in the current study was set to 100 years. The data is produced at a 90-m resolution for latitudes 60S to 60N. This global product is now used in the insurance industry to inspect, inform and/or insure the flood risk across the world.

  16. Is there continued evidence for an association between abacavir usage and myocardial infarction risk in individuals with HIV?

    DEFF Research Database (Denmark)

    Sabin, Caroline A; Reiss, Peter; Ryom, Lene

    2016-01-01

    BACKGROUND: In March 2008, the D:A:D study published results demonstrating an increased risk of myocardial infarction (MI) for patients on abacavir (ABC). We describe changes to the use of ABC since this date, and investigate changes to the association between ABC and MI with subsequent follow......-up. METHODS: A total of 49,717 D:A:D participants were followed from study entry until the first of an MI, death, 1 February 2013 or 6 months after last visit. Associations between a person's 10-year cardiovascular disease (CVD) risk and the likelihood of initiating or discontinuing ABC were assessed using...... multivariable logistic/Poisson regression. Poisson regression was used to assess the association between current ABC use and MI risk, adjusting for potential confounders, and a test of interaction was performed to assess whether the association had changed in the post-March 2008 period. RESULTS: Use of ABC...

  17. High-risk subgroup of inferior myocardial infarction. Importance of anterior wall motion and right ventricular function

    Energy Technology Data Exchange (ETDEWEB)

    Nishimura, Tsunehiko; Yasuda, Tsunehiro; Gold, H K; Leinbach, R C; Boucher, C A; McKusick, K A; Strauss, H W

    1986-12-01

    To identify high-risk subgroups of inferior myocardial infarction, 75 patients presenting with their first inferior infarction were investigated by sequential gated blood pool scans. The patients were divided into four groups based on the right ventricular function (RVF) and anterior wall motion (AWM) of the left ventricle by scan at the time of admission. A second blood pool scan was performed at ten days to evaluate RV and LV function. Thirty-eight patients had cardiac catheterization before discharge and all patients were followed up for one year to determine their clinical outcome. Depressed RVF and reduced AWM were observed in 26 (35%) (Group A); depressed RVF and normal AWM were found in 20 (27%) (Group B); reduced AWM and normal RVE in 10 (13%) (Group C); and normal RVF and AWM in 19 (25%) (Group D). The mean values of biventricular function (LVEF, RVEF) in groups A, B, C, and D were (44.9 +- 8.4%, 32.5 +- 9.9%), (59.9 +- 8.6%, 34.5 +- 8.0%), (44.9 +- 15.7%, 48.2 +- 3.3%), and (60.4 +- 9.1%, 51.6 +- 10.6%), respectively, at admission. In serial measurements, LVEF did not change significantly in any group, however, RVEF improved nearly 10 points in groups A and B at 10 days. Group A also had the highest incidence (82 %) of left anterior descending coronary artery involvement, and the highest mean creatine phosphokinase levels (762 +- 318 U/1): Furthermore, group A had a high incidence of major complications during their hospital course and high mortality during the one-year follow-up. These data clearly identified group A as a high-risk subgroup of patients with inferior infarction.

  18. Determinants of Excess Genetic Risk of Acute Myocardial Infarction - A Matched Case-Control Study

    Czech Academy of Sciences Publication Activity Database

    Valenta, Zdeněk; Mazura, Ivan; Kolář, M.; Feglarová, Petra; Peleška, Jan; Tomečková, Marie; Kalina, Jan; Slovák, Dalibor; Zvárová, Jana

    2012-01-01

    Roč. 8, č. 1 (2012), s. 34-43 ISSN 1801-5603 R&D Projects: GA MŠk(CZ) 1M06014 Institutional support: RVO:67985807 Keywords : genome-wide association study * gene expression * myocardial infarction * genetic predisposition * predictive modeling Subject RIV: BB - Applied Statistics, Operational Research http://www.ejbi.org/img/ejbi/2012/1/Valenta_en.pdf

  19. Implementing the number needed to harm in clinical practice: risk of myocardial infarction in HIV-1-infected patients treated with abacavir

    DEFF Research Database (Denmark)

    Kowalska, J D; Kirk, O; Mocroft, A

    2010-01-01

    OBJECTIVES: The D:A:D study group reported a 1.9-fold increased relative risk (RR) of myocardial infarction (MI) associated with current or recent use of abacavir. The number needed to harm (NNH) incorporates information about the underlying risk of MI and the increased RR of MI in patients taking...

  20. Long-term cardiovascular risk of nonsteroidal anti-inflammatory drug use according to time passed after first-time myocardial infarction

    DEFF Research Database (Denmark)

    Olsen, Anne-Marie Schjerning; Fosbøl, Emil L; Lindhardsen, Jesper

    2012-01-01

    The cardiovascular risk after the first myocardial infarction (MI) declines rapidly during the first year. We analyzed whether the cardiovascular risk associated with using nonsteroidal anti-inflammatory drugs (NSAIDs) was associated with the time elapsed following first-time MI....

  1. Risk of myocardial infarction in men and women with type 2 diabetes in the UK: a cohort study using the General Practice Research Database

    NARCIS (Netherlands)

    Mulnier, H.E.; Seaman, H.E.; Raleigh, V.S.; Soedamah-Muthu, S.S.; Colhoun, H.M.; Lawrenson, R.A.; Vries, de C.S.

    2008-01-01

    Aims/hypothesis Our primary aim was to establish reliable and generalisable estimates of the risk of myocardial infarction (MI) for men and women with type 2 diabetes in the UK compared with people without diabetes. Our secondary aim was to investigate how the MI risk associated with diabetes

  2. Zonal frequency analysis of the gyral and sulcal extent of cerebral infarcts. Part III: Middle cerebral artery and watershed infarcts

    International Nuclear Information System (INIS)

    Naidich, T.P.; Firestone, M.I.; Blum, J.T.; Abrams, K.J.

    2003-01-01

    We tested the hypothesis that frequency analysis of the anatomic zones affected by single anterior (A), posterior (P), and middle (M) cerebral artery (CA), multivessel, and watershed infarcts will disclose specific sites (peak zones) most frequently involved by each type, sites most frequently injured by multiple different types (vulnerable zones), and overlapping sites of equal relative frequency for two or more different types of infarct (equal frequency zones). We adopted precise definitions of each vascular territory. CT and MRI studies of 50 MCA, 20 ACA-MCA, three PCA-MCA, and 30 parasagittal watershed infarcts were mapped onto a standard template. Relative infarct frequencies in each zone were analyzed within and across infarct types to identify the centers and peripheries of each, vulnerable zones, and equal frequency zones. These data were then correlated with the prior analysis of 47 ACA, PCA, dual ACA-PCA, and ACA-PCA-MCA infarcts. Zonal frequency data for MCA and watershed infarcts, the sites of peak infarct frequency, the sites of vulnerability to diverse infarcts, and the overlapping sites of equal infarct frequency are tabulated and displayed in standardized format for direct comparison of different infarcts. This method successfully displays the nature, sites, and extent of individual infarct types, illustrates the shifts in zonal frequency and lesion center that attend dual and triple infarcts, and clarifies the relationships among the diverse types of infarct. (orig.)

  3. Quantification of both the area-at-risk and acute myocardial infarct size in ST-segment elevation myocardial infarction using T1-mapping.

    Science.gov (United States)

    Bulluck, Heerajnarain; Hammond-Haley, Matthew; Fontana, Marianna; Knight, Daniel S; Sirker, Alex; Herrey, Anna S; Manisty, Charlotte; Kellman, Peter; Moon, James C; Hausenloy, Derek J

    2017-08-01

    A comprehensive cardiovascular magnetic resonance (CMR) in reperfused ST-segment myocardial infarction (STEMI) patients can be challenging to perform and can be time-consuming. We aimed to investigate whether native T1-mapping can accurately delineate the edema-based area-at-risk (AAR) and post-contrast T1-mapping and synthetic late gadolinium (LGE) images can quantify MI size at 1.5 T. Conventional LGE imaging and T2-mapping could then be omitted, thereby shortening the scan duration. Twenty-eight STEMI patients underwent a CMR scan at 1.5 T, 3 ± 1 days following primary percutaneous coronary intervention. The AAR was quantified using both native T1 and T2-mapping. MI size was quantified using conventional LGE, post-contrast T1-mapping and synthetic magnitude-reconstructed inversion recovery (MagIR) LGE and synthetic phase-sensitive inversion recovery (PSIR) LGE, derived from the post-contrast T1 maps. Native T1-mapping performed as well as T2-mapping in delineating the AAR (41.6 ± 11.9% of the left ventricle [% LV] versus 41.7 ± 12.2% LV, P = 0.72; R 2 0.97; ICC 0.986 (0.969-0.993); bias -0.1 ± 4.2% LV). There were excellent correlation and inter-method agreement with no bias, between MI size by conventional LGE, synthetic MagIR LGE (bias 0.2 ± 2.2%LV, P = 0.35), synthetic PSIR LGE (bias 0.4 ± 2.2% LV, P = 0.060) and post-contrast T1-mapping (bias 0.3 ± 1.8% LV, P = 0.10). The mean scan duration was 58 ± 4 min. Not performing T2 mapping (6 ± 1 min) and conventional LGE (10 ± 1 min) would shorten the CMR study by 15-20 min. T1-mapping can accurately quantify both the edema-based AAR (using native T1 maps) and acute MI size (using post-contrast T1 maps) in STEMI patients without major cardiovascular risk factors. This approach would shorten the duration of a comprehensive CMR study without significantly compromising on data acquisition and would obviate the need to perform T2 maps and LGE imaging.

  4. Risk of Stroke/Transient Ischemic Attack or Myocardial Infarction with Herpes Zoster: A Systematic Review and Meta-Analysis.

    Science.gov (United States)

    Zhang, Yanting; Luo, Ganfeng; Huang, Yuanwei; Yu, Qiuyan; Wang, Li; Li, Ke

    2017-08-01

    Accumulating evidence indicates that herpes zoster (HZ) may increase the risk of stroke/transient ischemic attack (TIA) or myocardial infarction (MI), but the results are inconsistent. We aim to explore the relationship between HZ and risk of stroke/TIA or MI and between herpes zoster ophthalmicus (HZO) and stroke. We estimated the relative risk (RR) and 95% confidence intervals (CIs) with the meta-analysis. Cochran's Q test and Higgins I 2 statistic were used to check for heterogeneity. HZ infection was significantly associated with increased risk of stroke/TIA (RR = 1.30, 95% CI: 1.17-1.46) or MI (RR = 1.18, 95% CI: 1.07-1.30). The risk of stroke after HZO was 1.91 (95% CI 1.32-2.76), higher than that after HZ. Subgroup analyses revealed increased risk of ischemic stroke after HZ infection but not hemorrhagic stroke. The risk of stroke was increased more at 1 month after HZ infection than at 1-3 months, with a gradual reduced risk with time. The risk of stroke after HZ infection was greater with age less than 40 years than 40-59 years and more than 60 years. Risk of stroke with HZ infection was greater without treatment than with treatment and was greater in Asia than Europe and America but did not differ by sex. Our study indicated that HZ infection was associated with increased risk of stroke/TIA or MI, and HZO infection was the most marked risk factor for stroke. Further studies are needed to explore whether zoster vaccination could reduce the risk of stoke/TIA or MI. Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  5. Effect of antecedent hypertension and follow-up blood pressure on outcomes after high-risk myocardial infarction

    DEFF Research Database (Denmark)

    Thune, J.J.; Signorovitch, J.; Velazquez, E.J.

    2007-01-01

    myocardial infarction in the Valsartan in Myocardial Infarction Trial. We assessed the relationship between antecedent hypertension and outcomes and the association between elevated (systolic: >140 mm Hg) or low blood pressure (systolic:

  6. Trends and Predictors of Participation in Cardiac Rehabilitation Following Acute Myocardial Infarction: Data From the Behavioral Risk Factor Surveillance System.

    Science.gov (United States)

    Peters, Anthony E; Keeley, Ellen C

    2017-12-29

    Participation in cardiac rehabilitation (CR) after acute myocardial infarction has been proven to significantly reduce morbidity and mortality. Historically, participation rates have been low, and although recent efforts have increased referral rates, current data on CR participation are limited. Utilizing data from the Behavioral Risk Factor Surveillance System conducted by Centers for Disease Control and Prevention, we performed a population-based, cross-sectional analysis of CR post-acute myocardial infarction. Unadjusted participation from 2005 to 2015 was evaluated by univariable logistic regression. Multivariable logistic regression was performed with patient characteristic variables to determine adjusted trends and associations with participation in CR in more recent years from 2011 to 2015. Among the 32 792 survey respondents between 2005 and 2015, participation ranged from 35% in 2005 to 39% in 2009 ( P =0.005) and from 38% in 2011 to 32% in 2015 ( P =0.066). Between 2011 and 2015, participants were less likely to be female (odds ratio [OR] 0.763, 95% confidence interval [CI] 0.646-0.903), black (OR 0.700, 95% CI 0.526-0.931), uninsured (OR 0.528, 95% CI 0.372-0.751), less educated (OR 0.471, 95% CI 0.367-0.605), current smokers (OR 0.758, 95% CI 0.576-0.999), and were more likely to be retired or self-employed (OR 1.393, 95% CI 1.124-1.726). Only one third of patients participate in CR following acute myocardial infarction despite the known health benefits. Participants are less likely to be female, black, and uneducated. Future studies should focus on methods to maximize the proportion of CR referrals converted into CR participation. © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

  7. Occipital lobe infarctions are different

    OpenAIRE

    Naess, Halvor; Waje-Andreassen, Ulrikke; Thomassen, Lars

    2007-01-01

    Halvor Naess, Ulrikke Waje-Andreassen, Lars ThomassenDepartment of Neurology, Haukeland University Hospital, University of Bergen, N-5021 Bergen, NorwayObjectives: We hypothesized that occipital lobe infarctions differ from infarctions in other locations as to etiology, risk factors and prognosis among young adults.Methods: Location, etiology, risk factors and long-term outcome were evaluated among all young adults 15–49 years suffering from cerebral infarction in Hordaland County, Norw...

  8. Proton pump inhibitor use and risk of adverse cardiovascular events in aspirin treated patients with first time myocardial infarction: nationwide propensity score matched study

    DEFF Research Database (Denmark)

    Charlot, Mette; Grove, Erik; Hansen, Peter Riis

    2011-01-01

    OBJECTIVE: To examine the effect of proton pump inhibitors on adverse cardiovascular events in aspirin treated patients with first time myocardial infarction. DESIGN: Retrospective nationwide propensity score matched study based on administrative data. Setting All hospitals in Denmark. PARTICIPANTS...... analysis showed no increase in risk related to use of H(2) receptor blockers (1.04, 0.79 to 1.38; P=0.78). Conclusion In aspirin treated patients with first time myocardial infarction, treatment with proton pump inhibitors was associated with an increased risk of adverse cardiovascular events....

  9. Nonfasting cholesterol and triglycerides and association with risk of myocardial infarction and total mortality: the Copenhagen City Heart Study with 31 years of follow-up

    DEFF Research Database (Denmark)

    Langsted, A; Freiberg, J J; Tybjaerg-Hansen, A

    2011-01-01

    Abstract. Langsted A, Freiberg JJ, Tybjaerg-Hansen A, Schnohr P, Jensen GB, Nordestgaard BG (Herlev Hospital, Herlev; University of Copenhagen; Bispebjerg Hospital; and Rigshospitalet, Copenhagen Ø, Denmark) Nonfasting cholesterol and triglycerides and association with risk of myocardial infarction...... and total mortality: the Copenhagen City Heart Study with 31 years of follow-up. J Intern Med 2010; doi: 10.1111/j.1365-2796.2010.02333.x. Objectives. We compared the ability of very high levels of nonfasting cholesterol and triglycerides to predict risk of myocardial infarction and total mortality. Design...

  10. Association of NSAID use with risk of bleeding and cardiovascular events in patients receiving antithrombotic therapy after myocardial infarction

    DEFF Research Database (Denmark)

    Schjerning Olsen, Anne-Marie; Gislason, Gunnar H; McGettigan, Patricia

    2015-01-01

    IMPORTANCE: Antithrombotic treatment is indicated for use in patients after myocardial infarction (MI); however, concomitant use of nonsteroidal anti-inflammatory drugs (NSAIDs) could pose safety concerns. OBJECTIVE: To examine the risk of bleeding and cardiovascular events among patients...... with prior MI taking antithrombotic drugs and for whom NSAID therapy was then prescribed. DESIGN, SETTING, AND PARTICIPANTS: Using nationwide administrative registries in Denmark (2002-2011), we studied patients 30 years or older admitted with first-time MI and alive 30 days after discharge. Subsequent...... treatment with aspirin, clopidogrel, or oral anticoagulants and their combinations, as well as ongoing concomitant NSAID use, was determined. EXPOSURES: Use of NSAIDs with ongoing antithrombotic treatment after first-time MI. MAIN OUTCOMES AND MEASURES: Risk of bleeding (requiring hospitalization...

  11. [Risk of death 4 years after a 1st cerebral infarction: prospective study in Barquisimeto, Estado Lara, Venezuela].

    Science.gov (United States)

    Poni, E; Granero, R; Escobar, B

    1995-12-01

    Stroke, the 5th. cause of death in Venezuela, has been associated to cerebral infarction. However, there is little information concerning lethality factors. 33 atherothrombotic subtype stroke patients, 31 (96%) Latino and 2(4%) white, were admitted into a prospective study to analyze the role of 11 mortality risk factors for those patients. A mortality relative risk (RR) > 1.5 or Mortality RR for patients age 65 and over (RR = 2.95) and 4 year mortality RR for male patients (RR = 2.04) were clinically and statistically significant. History of high blood pressure was protective (RR = 0.62) probably due to good medical control. Cumulative mortality was higher than that of comparable studies, even from the first week of follow-up, reaching 67% at the 4th year.

  12. Trajectories of Risk for Specific Readmission Diagnoses after Hospitalization for Heart Failure, Acute Myocardial Infarction, or Pneumonia.

    Science.gov (United States)

    Krumholz, Harlan M; Hsieh, Angela; Dreyer, Rachel P; Welsh, John; Desai, Nihar R; Dharmarajan, Kumar

    2016-01-01

    The risk of rehospitalization is elevated in the immediate post-discharge period and declines over time. It is not known if the extent and timing of risk vary across readmission diagnoses, suggesting that recovery and vulnerability after discharge differ by physiologic system. We compared risk trajectories for major readmission diagnoses in the year after discharge among all Medicare fee-for-service beneficiaries hospitalized with heart failure (HF), acute myocardial infarction (AMI), or pneumonia from 2008-2010. We estimated the daily risk of rehospitalization for 12 major readmission diagnostic categories after accounting for the competing risk of death after discharge. For each diagnostic category, we identified (1) the time required for readmission risk to peak and then decline 50% from maximum values after discharge; (2) the time required for readmission risk to approach plateau periods of minimal day-to-day change; and (3) the extent to which hospitalization risks are higher among patients recently discharged from the hospital compared with the general elderly population. Among >3,000,000 hospitalizations, the yearly rate of rehospitalization was 67.0%, 49.5%, and 55.3% after hospitalization for HF, AMI, and pneumonia, respectively. The extent and timing of risk varied by readmission diagnosis and initial admitting condition. Risk of readmission for gastrointestinal bleeding/anemia peaked particularly late after hospital discharge, occurring 10, 6, and 7 days after hospitalization for HF, AMI, and pneumonia, respectively. Risk of readmission for trauma/injury declined particularly slowly, requiring 38, 20, and 38 days to decline by 50% after hospitalization for HF, AMI, and pneumonia, respectively. Patterns of vulnerability to different conditions that cause rehospitalization vary by time after hospital discharge. This finding suggests that recovery of various physiologic systems occurs at different rates and that post-discharge interventions to minimize

  13. Trajectories of Risk for Specific Readmission Diagnoses after Hospitalization for Heart Failure, Acute Myocardial Infarction, or Pneumonia.

    Directory of Open Access Journals (Sweden)

    Harlan M Krumholz

    Full Text Available The risk of rehospitalization is elevated in the immediate post-discharge period and declines over time. It is not known if the extent and timing of risk vary across readmission diagnoses, suggesting that recovery and vulnerability after discharge differ by physiologic system.We compared risk trajectories for major readmission diagnoses in the year after discharge among all Medicare fee-for-service beneficiaries hospitalized with heart failure (HF, acute myocardial infarction (AMI, or pneumonia from 2008-2010.We estimated the daily risk of rehospitalization for 12 major readmission diagnostic categories after accounting for the competing risk of death after discharge. For each diagnostic category, we identified (1 the time required for readmission risk to peak and then decline 50% from maximum values after discharge; (2 the time required for readmission risk to approach plateau periods of minimal day-to-day change; and (3 the extent to which hospitalization risks are higher among patients recently discharged from the hospital compared with the general elderly population.Among >3,000,000 hospitalizations, the yearly rate of rehospitalization was 67.0%, 49.5%, and 55.3% after hospitalization for HF, AMI, and pneumonia, respectively. The extent and timing of risk varied by readmission diagnosis and initial admitting condition. Risk of readmission for gastrointestinal bleeding/anemia peaked particularly late after hospital discharge, occurring 10, 6, and 7 days after hospitalization for HF, AMI, and pneumonia, respectively. Risk of readmission for trauma/injury declined particularly slowly, requiring 38, 20, and 38 days to decline by 50% after hospitalization for HF, AMI, and pneumonia, respectively.Patterns of vulnerability to different conditions that cause rehospitalization vary by time after hospital discharge. This finding suggests that recovery of various physiologic systems occurs at different rates and that post-discharge interventions to

  14. Probabilistic estimation of dune erosion and coastal zone risk

    NARCIS (Netherlands)

    Li, F.

    2014-01-01

    Coastal erosion has gained global attention and has been studied for many decades. As a soft sea defence structure, coastal sandy dunes protect coastal zones all over the world, which usually are densely populated areas with tremendous economic value. The coastal zone of the Netherlands, one of the

  15. Single-living is associated with increased risk of long-term mortality among employed patients with acute myocardial infarction

    Directory of Open Access Journals (Sweden)

    Finn Erl

    2010-05-01

    Full Text Available Finn Erland Nielsen, Shan MardDepartment of Cardiology S, Herlev University Hospital, DenmarkObjective: There is conflicting evidence about the impact of social support on adverse outcome after acute myocardial infarction (MI. We examined the relation between single-living and long-term all-cause mortality after MI.Design: A prospective cohort study of 242 employed patients with MI followed up to 16 years after MI.Results: A total of 106 (43.8% patients died during the follow-up. Single-living nearly doubled the risk of death; after adjusting for potential confounding factors, single-living was an independent predictor of death, with a hazard ratio of 2.55 (95% confidence interval: 1.52–4.30. Other predictors of death were diabetes mellitus, atrial fibrillation, age, and ejection fraction less than 35%.Conclusion: Single-living is a prognostic determinant of long-term all-cause mortality after MI.Keywords: acute myocardial infarction, social support, single-living, prognosis.

  16. The Incidence and the Risk Factors of Silent Embolic Cerebral Infarction After Coronary Angiography and Percutaneous Coronary Interventions.

    Science.gov (United States)

    Deveci, Onur Sinan; Celik, Aziz Inan; Ikikardes, Firat; Ozmen, Caglar; Caglıyan, Caglar Emre; Deniz, Ali; Bicakci, Kenan; Bicakci, Sebnem; Evlice, Ahmet; Demir, Turgay; Kanadasi, Mehmet; Demir, Mesut; Demirtas, Mustafa

    2016-05-01

    Silent embolic cerebral infarction (SECI) is a major complication of coronary angiography (CAG) and percutaneous coronary intervention (PCI). Patients with stable coronary artery disease (CAD) who underwent CAG with or without PCI were recruited. Cerebral diffusion-weighted magnetic resonance imaging was performed for SECI within 24 hours. Clinical and angiographic characteristics were compared between patients with and without SECI. Silent embolic cerebral infarction occurred in 12 (12%) of the 101 patients. Age, total cholesterol, SYNTAX score (SS), and coronary artery bypass history were greater in the SECI(+) group (65 ± 10 vs 58 ± 11 years,P= .037; 223 ± 85 vs 173 ± 80 mg/dL,P= .048; 30.1 ± 2 vs 15 ± 3,PSECI was more common in the PCI group (8/24 vs 4/77,P= .01). On subanalysis, the SS was significantly higher in the SECI(+) patients in both the CAG and the PCI groups (29.3 ± 1.9 vs 15 ± 3,PSECI after CAG and PCI increases with the complexity of CAD (represented by the SS). The SS is a predictor of the risk of SECI, a complication that should be considered more often after CAG. © The Author(s) 2015.

  17. Psycho-emotional disorders as incoming risk factors for myocardial infarction with non-obstructive coronary arteries.

    Science.gov (United States)

    Pais, Javier López; Izquierdo Coronel, Bárbara; Galán Gil, David; Espinosa Pascual, María Jesús; Martinez Peredo, Carlos Gustavo; Awamleh García, Paula; Górriz Magaña, Juan; Mata Caballero, Rebeca; Fraile Sanz, Alfonso; Muñiz, Javier; Martín, Joaquín J Alonso

    2018-01-01

    There is an emerging field underlying the myocardial infarction (MI) with non-obstruc-tive coronary arteries (MINOCA). The aim of this study was to evaluate the impact of psycho-emotional disorders and social habits in MINOCA patients. The study included 95 consecutive patients diagnosed of MINOCA and 178 patients with MI and obstructive lesions. MINOCA patients were included when they fulfilled the three main criteria: accomplishment of the Third Universal Definition of Myocardial Infarction, absence of obstructive coronary arteries and no clinically overt specific cause for the acute presentation. MINOCA patients had a higher frequency of previous psychiatric illnesses than the obstructive coronary arteries group (29.7% vs. 12.9%, p = 0.001). MINOCA patients recognized emotional stress in 75.7% of the cases, while only 32.1% of the obstructive related group did (p Psycho-emotional disorders are related to MINOCA and they could act as risk fac-tor. This relationship is maintained after excluding takotsubo from the analysis. (Cardiol J 2018; 25, 1: 24-31).

  18. Diabetes patients requiring glucose-lowering therapy and nondiabetics with a prior myocardial infarction carry the same cardiovascular risk: a population study of 3.3 million people

    DEFF Research Database (Denmark)

    Schramm, Tina Ken; Gislason, Gunnar H; Køber, Lars

    2008-01-01

    BACKGROUND: Previous studies reveal major differences in the estimated cardiovascular risk in diabetes mellitus, including uncertainty about the risk in young patients. Therefore, large studies of well-defined populations are needed. METHODS AND RESULTS: All residents in Denmark > or = 30 years...... of age were followed up for 5 years (1997 to 2002) by individual-level linkage of nationwide registers. Diabetes patients receiving glucose-lowering medications and nondiabetics with and without a prior myocardial infarction were compared. At baseline, 71 801 (2.2%) had diabetes mellitus and 79 575 (2.......4%) had a prior myocardial infarction. Regardless of age, age-adjusted Cox proportional-hazard ratios for cardiovascular death were 2.42 (95% confidence interval [CI], 2.35 to 2.49) in men with diabetes mellitus without a prior myocardial infarction and 2.44 (95% CI, 2.39 to 2.49) in nondiabetic men...

  19. The effect of leisure-time physical activity on the risk of acute myocardial infarction depending on Body Mass Index: a population-based case-control study

    Directory of Open Access Journals (Sweden)

    Reuterwall Christina

    2006-12-01

    Full Text Available Abstract Background High body mass index (BMI and lack of physical activity have been recognized as important risk factors for coronary heart disease. The aim of the present study was to evaluate whether leisure-time physical activity compensates for the increased risk of acute myocardial infarction associated with overweight and obesity. Methods Data from the SHEEP (Stockholm Heart Epidemiology Program study were used. The SHEEP study is a large Swedish population-based case-control study, comprising 1204 male and 550 female cases, and 1538 male and 777 female controls, conducted in Stockholm County, Sweden, during the period 1992–1994. Odds ratios (OR, together with 95 % confidence intervals (95% CI, were calculated using unconditional logistic regression, as estimates of the relative risks. Results Regular leisure-time physical activity was associated with a decreased risk of myocardial infarction among lean, normal-weight and overweight subjects, but not among obese subjects. Obese (BMI ≥ 30 and physically active persons had an almost twofold risk of myocardial infarction, compared with normal-weight and sedentary persons (OR 1.85, 95% CI 1.07–3.18. The results were similar for men and women. Conclusion While regular leisure-time physical activity seems to provide protection against myocardial infarction among lean, normal-weight and overweight subjects, this does not appear to be the case in obese subjects.

  20. Plasma cystathionine and risk of acute myocardial infarction among patients with coronary heart disease: Results from two independent cohorts.

    Science.gov (United States)

    Dhar, Indu; Svingen, Gard F T; Pedersen, Eva R; DeRatt, Barbara; Ulvik, Arve; Strand, Elin; Ueland, Per M; Bønaa, Kaare H; Gregory, Jesse F; Nygård, Ottar K

    2018-04-21

    Cystathionine is a thio-ether and a metabolite formed from homocysteine during transsulfuration. Elevated plasma cystathionine levels are reported in patients with cardiovascular disease; however prospective relationships with acute myocardial infarction (AMI) are unknown. We investigated associations between plasma cystathionine and AMI among patients with suspected and/or verified coronary heart disease (CHD). Subjects from two independent cohort studies, the Western Norway Coronary Angiography Cohort (WECAC) (3033 patients with stable angina pectoris; 263 events within 4.8 years of median follow-up) and the Norwegian Vitamin Trial (NORVIT) (3670 patients with AMI; 683 events within 3.2 years of median follow-up) were included. In both cohorts, plasma cystathionine was associated with several traditional CHD risk factors (P coronary heart disease, and is possibly related to altered redox homeostasis. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

  1. Relationship of psychosocial risk factors, certain personality traits and myocardial infarction in Indians: A case-control study

    Directory of Open Access Journals (Sweden)

    Rajni Gupta

    2011-01-01

    Full Text Available Objective: To investigate the relationship of psychosocial factors (lack of social support, stress and subjective well-being and personality traits with myocardial infarction (MI. Materials and Methods: A case-control study involving 100 cases and 100 matched controls was conducted in Lok Nayak Hospital, New Delhi. Results: Stress over 1 year was significantly higher in cases (P < 0.001. However, difference was not significant when scores of social support (P = 0.2, Presumptive Stressful Life Event (PSLE over lifetime (P = 0.058 and subjective well-being (P = 0.987 were compared. MI was significantly associated with hyperactive (P < 0.001, dominant (P = 0.03, egoistic (P < 0.001 and introvert (P < 0.001 personalities. Conclusion: Certain personality traits and recent stress may be important risk factors of MI, especially in Indians. The finding may have implications on the preventive strategies planned for MI patients.

  2. Genetically elevated non-fasting triglycerides and calculated remnant cholesterol as causal risk factors for myocardial infarction

    DEFF Research Database (Denmark)

    Jørgensen, Anders Berg; Frikke-Schmidt, Ruth; West, Anders Sode

    2012-01-01

    AimsElevated non-fasting triglycerides mark elevated levels of remnant cholesterol. Using a Mendelian randomization approach, we tested whether genetically increased remnant cholesterol in hypertriglyceridaemia due to genetic variation in the apolipoprotein A5 gene (APOA5) associates with an incr......AimsElevated non-fasting triglycerides mark elevated levels of remnant cholesterol. Using a Mendelian randomization approach, we tested whether genetically increased remnant cholesterol in hypertriglyceridaemia due to genetic variation in the apolipoprotein A5 gene (APOA5) associates...... with an increased risk of myocardial infarction (MI).Methods and resultsWe resequenced the core promoter and coding regions of APOA5 in individuals with the lowest 1% (n = 95) and highest 2% (n = 190) triglyceride levels in the Copenhagen City Heart Study (CCHS, n = 10 391). Genetic variants which differed...... in frequency between the two extreme triglyceride groups (c.-1131T > C, S19W, and c.*31C > T; P-value: 0.06 to...

  3. Does moving from war zone change emotions and risk perceptions? A field study of Israeli students

    Directory of Open Access Journals (Sweden)

    Shosh Shahrabani

    2012-09-01

    Full Text Available The current field study uses data collected after the 2009 war between Israel and the Hamas militias in the Gaza Strip ended. The study compares recalled emotions and perceived risks among two groups of students, all of whom were exposed to rocket attacks. Individuals in the ``left the war zone'' group left the region under attack as a precautionary action, while the ``stayed in the war zone'' group remained in the region during war. The results indicate no significant differences in the levels of recalled fear and anger between the two groups, while the perceived self-risk from terror was higher among the ``stayed in the war zone'' group. Yet, a higher level of recalled fear was found among those who left the war zone and whose parents resided in the war zone, compared to those who left the war zone and whose parents resided outside the war zone. In addition, fearful people became more pessimistic about their level of personal risk from terror, but not about the routine risks. We conclude that civilians need attention even if they leave the war zone since leaving the attacked region as a precautionary action may mitigate perceived self-risk from terror but does not seem to eliminate the high level of negative emotions evoked by the terror attacks.

  4. Levels and trends in cardiovascular risk factors and drug treatment in 4837 elderly Dutch myocardial infarction patients between 2002 and 2006

    NARCIS (Netherlands)

    Soedamah-Muthu, S. S.; Geleijnse, J. M.; Giltay, E. J.; de Goede, J.; Oude Griep, L. M.; Waterham, E.; Teitsma-Jansen, A. M.; Mulder, B. J. M.; de Boer, M.-J.; Deckers, J. W.; Zock, P. L.; Kromhout, D.

    2012-01-01

    It is important to gain insight into opportunities for secondary prevention of cardiovascular disease. Our aim was to investigate levels and trends in cardiovascular risk factors and drug treatment in Dutch post-myocardial infarction (MI) patients between 2002 and 2006 and to make comparisons with

  5. Previously known and newly diagnosed atrial fibrillation: a major risk indicator after a myocardial infarction complicated by heart failure or left ventricular dysfunction

    DEFF Research Database (Denmark)

    Køber, Lars; Swedberg, Karl; McMurray, John J V

    2006-01-01

    AIMS: To characterize the relationship between known and newly diagnosed atrial fibrillation (AF) and the risk of death and major cardiovascular (CV) events in patients with acute myocardial infarction (MI) complicated by heart failure (HF) and/or left ventricular systolic dysfunction (LVSD). MET...

  6. Return to work and risk of subsequent detachment from employment after myocardial infarction

    DEFF Research Database (Denmark)

    Smedegaard, Laerke; Numé, Anna Karin; Charlot, Mette

    2017-01-01

    Background--Limited data are available on return to work and subsequent detachment from employment after admission for myocardial infarction (MI). Methods and Results--Using individual-level linkage of data from nationwide registries, we identified patients of working age (30-65 years) discharged...... after first-time MI in the period 1997 to 2012, who were employed before admission. To assess the cumulative incidence of return to work and detachment from employment, the Aalen Johansen estimator was used. Incidences were compared with population controls matched on age and sex. Logistic regression...... was applied to estimate odds ratios for associations between detachment from employment and age, sex, comorbidities, income, and education level. Of 39 296 patients of working age discharged after first-time MI, 22 394 (56.9%) were employed before admission. Within 1 year 91.1% (95% confidence interval [CI...

  7. Improved cognition after control of risk factors for multi-infarct dementia

    International Nuclear Information System (INIS)

    Meyer, J.S.; Judd, B.W.; Tawaklna, T.; Rogers, R.L.; Mortel, K.F.

    1986-01-01

    A cohort of 52 patients (30 men and 22 women) with multi-infarct dementia (MID) has been followed up prospectively for a mean interval of 22.2 months. Clinical course has been documented by serial history taking and interviews and neurological, medical, and psychological examinations, and correlated with measurements of cerebral blood flow. The clinical course and cognitive performance have been compared with those of age-matched normal volunteers and patients with Alzheimer's disease. Patients with MID were subdivided into hypertensive and normotensive groups, and also into those displaying stabilized or improved cognition and those whose condition deteriorated. Among hypertensive patients with MID, improved cognition and clinical course correlated with control of systolic blood pressure within upper limits of normalf (135 to 150 mm Hg), but if systolic blood pressure was reduced below this level, patients with MID deteriorated. Among normotensive patients with MID, improved cognition was associated with cessation of smoking cigarettes

  8. The value of radionuclide angiography for risk assessment of patients following acute myocardial infarction

    International Nuclear Information System (INIS)

    Morris, K.G.

    1985-01-01

    Radionuclide angiography (RNA) is an accurate noninvasive method for the evaluation of left ventricular function at rest and exercise. Both the change in ejection fraction from rest to exercise and the exercise ejection fraction correlate with the severity of coronary artery disease and are more sensitive than ST-segment changes for detecting abnormalities due to exercise-induced myocardial ischemia. The amount of left ventricular dysfunction produced acutely by myocardial ischemia appears to vary linearly with the severity of ischemia produced. Thus rest and exercise RNA provide information noninvasively regarding both the severity of left ventricular dysfunction and the amount of potentially ischemic myocardium, two of the three major pathophysiologic mechanisms related to prognosis. It is reasonable to hypothesize that rest and exercise RNA may provide useful prognostic information concerning subsequent mortality and morbidity in survivors of acute myocardial infarction

  9. Underutilization of aspirin in people living with human immunodeficiency virus at increased risk for acute myocardial infarction: Systematic review and meta-analysis

    Directory of Open Access Journals (Sweden)

    Stella Pak

    2017-01-01

    Full Text Available Context: With the increased availability of potent combination antiretroviral therapies, the life expectancy of people living with human immunodeficiency virus (PLHIV has greatly increased. This rapid improvement in lifespan has served as a catalyst for a paradigm shift in human immunodeficiency virus (HIV care. The focus of HIV care models has transitioned from the sole treatment of acute opportunistic infections to comprehensive management of chronic diseases, such as cardiovascular disease (CVD. Multiple studies have demonstrated that PLHIV are 50% more likely to develop acute myocardial infarction (AMI, compared to the general population. Cardiovascular risk prevention is becoming an essential component of the overarching HIV treatment plan. Aims: This meta-analysis aims to compare the rate of aspirin use for AMI prevention in indicated patients between PLHIV and general population. Methods: PubMed, EMBASE, Web of Science, Cochrane Library, CINAHL, and MEDLINE databases were used to identify observational cohort trials. Studies were assessed by two reviewers for inclusion criteria. Two separate random-effects meta-analyses' models were performed using the DerSimonian and Laird method. Heterogeneity was assessed using the I2 value. Meta-regression with study level variables was used to explore potential sources of heterogeneity. The funnel-plot-based trim-and-fill method was applied to detect and adjust for potential publication bias. Statistical tests were two-sided and P< 0.05 was considered statistically significant. Results: A total of 13 studies were included for analysis. In these trials, 30.4% of PLHIV with increased risk for coronary heart disease (CHD used aspirin for AMI prevention, compared to 36.9% of patients at risk of CHD in the general population. Conclusions: The results of this meta-analysis provide evidence that aspirin is underutilized in both PLHIV and the general population across broad geographical zones. Aspirin use

  10. A probabilistic quantitative risk assessment model for the long-term work zone crashes.

    Science.gov (United States)

    Meng, Qiang; Weng, Jinxian; Qu, Xiaobo

    2010-11-01

    Work zones especially long-term work zones increase traffic conflicts and cause safety problems. Proper casualty risk assessment for a work zone is of importance for both traffic safety engineers and travelers. This paper develops a novel probabilistic quantitative risk assessment (QRA) model to evaluate the casualty risk combining frequency and consequence of all accident scenarios triggered by long-term work zone crashes. The casualty risk is measured by the individual risk and societal risk. The individual risk can be interpreted as the frequency of a driver/passenger being killed or injured, and the societal risk describes the relation between frequency and the number of casualties. The proposed probabilistic QRA model consists of the estimation of work zone crash frequency, an event tree and consequence estimation models. There are seven intermediate events--age (A), crash unit (CU), vehicle type (VT), alcohol (AL), light condition (LC), crash type (CT) and severity (S)--in the event tree. Since the estimated value of probability for some intermediate event may have large uncertainty, the uncertainty can thus be characterized by a random variable. The consequence estimation model takes into account the combination effects of speed and emergency medical service response time (ERT) on the consequence of work zone crash. Finally, a numerical example based on the Southeast Michigan work zone crash data is carried out. The numerical results show that there will be a 62% decrease of individual fatality risk and 44% reduction of individual injury risk if the mean travel speed is slowed down by 20%. In addition, there will be a 5% reduction of individual fatality risk and 0.05% reduction of individual injury risk if ERT is reduced by 20%. In other words, slowing down speed is more effective than reducing ERT in the casualty risk mitigation. 2010 Elsevier Ltd. All rights reserved.

  11. Targeting Pioglitazone Hydrochloride Therapy After Stroke or Transient Ischemic Attack According to Pretreatment Risk for Stroke or Myocardial Infarction.

    Science.gov (United States)

    Kernan, Walter N; Viscoli, Catherine M; Dearborn, Jennifer L; Kent, David M; Conwit, Robin; Fayad, Pierre; Furie, Karen L; Gorman, Mark; Guarino, Peter D; Inzucchi, Silvio E; Stuart, Amber; Young, Lawrence H

    2017-11-01

    There is growing recognition that patients may respond differently to therapy and that the average treatment effect from a clinical trial may not apply equally to all candidates for a therapy. To determine whether, among patients with an ischemic stroke or transient ischemic attack and insulin resistance, those at higher risk for future stroke or myocardial infarction (MI) derive more benefit from the insulin-sensitizing drug pioglitazone hydrochloride compared with patients at lower risk. A secondary analysis was conducted of the Insulin Resistance Intervention After Stroke trial, a double-blind, placebo-controlled trial of pioglitazone for secondary prevention. Patients were enrolled from 179 research sites in 7 countries from February 7, 2005, to January 15, 2013, and were followed up for a mean of 4.1 years through the study's end on July 28, 2015. Eligible participants had a qualifying ischemic stroke or transient ischemic attack within 180 days of entry and insulin resistance without type 1 or type 2 diabetes. Pioglitazone or matching placebo. A Cox proportional hazards regression model was created using baseline features to stratify patients above or below the median risk for stroke or MI within 5 years. Within each stratum, the efficacy of pioglitazone for preventing stroke or MI was calculated. Safety outcomes were death, heart failure, weight gain, and bone fracture. Among 3876 participants (1338 women and 2538 men; mean [SD] age, 63 [11] years), the 5-year risk for stroke or MI was 6.0% in the pioglitazone group among patients at lower baseline risk compared with 7.9% in the placebo group (absolute risk difference, -1.9% [95% CI, -4.4% to 0.6%]). Among patients at higher risk, the risk was 14.7% in the pioglitazone group vs 19.6% for placebo (absolute risk difference, -4.9% [95% CI, -8.6% to 1.2%]). Hazard ratios were similar for patients below or above the median risk (0.77 vs 0.75; P = .92). Pioglitazone increased weight less among patients at

  12. Myocardial area at risk after ST-elevation myocardial infarction measured with the late gadolinium enhancement after scar remodeling and T2-weighted cardiac magnetic resonance imaging

    DEFF Research Database (Denmark)

    Lønborg, Jacob; Engstrøm, Thomas; Mathiasen, Anders B

    2011-01-01

    To evaluate the myocardial area at risk (AAR) measured by the endocardial surface area (ESA) method on late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) when applied after scar remodeling (3 months after index infarction) compared to T2-weighted CMR imaging. One hundred...... and sixty nine patients with ST-elevation myocardial infarction, treated with primary percutaneous coronary intervention, underwent one CMR within 1 week after index treatment to determine the AAR with T2-weighted imaging and a second scan 3 months after to measure AAR with the ESA method...

  13. Myocardial area at risk after ST-elevation myocardial infarction measured with the late gadolinium enhancement after scar remodeling and T2-weighted cardiac magnetic resonance imaging

    DEFF Research Database (Denmark)

    Lønborg, Jacob; Engstrøm, Thomas; Mathiasen, Anders B

    2012-01-01

    To evaluate the myocardial area at risk (AAR) measured by the endocardial surface area (ESA) method on late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) when applied after scar remodeling (3 months after index infarction) compared to T2-weighted CMR imaging. One hundred...... and sixty nine patients with ST-elevation myocardial infarction, treated with primary percutaneous coronary intervention, underwent one CMR within 1 week after index treatment to determine the AAR with T2-weighted imaging and a second scan 3 months after to measure AAR with the ESA method...

  14. Study on Ecological Risk Assessment of Guangxi Coastal Zone Based on 3s Technology

    Science.gov (United States)

    Zhong, Z.; Luo, H.; Ling, Z. Y.; Huang, Y.; Ning, W. Y.; Tang, Y. B.; Shao, G. Z.

    2018-05-01

    This paper takes Guangxi coastal zone as the study area, following the standards of land use type, divides the coastal zone of ecological landscape into seven kinds of natural wetland landscape types such as woodland, farmland, grassland, water, urban land and wetlands. Using TM data of 2000-2015 such 15 years, with the CART decision tree algorithm, for analysis the characteristic of types of landscape's remote sensing image and build decision tree rules of landscape classification to extract information classification. Analyzing of the evolution process of the landscape pattern in Guangxi coastal zone in nearly 15 years, we may understand the distribution characteristics and change rules. Combined with the natural disaster data, we use of landscape index and the related risk interference degree and construct ecological risk evaluation model in Guangxi coastal zone for ecological risk assessment results of Guangxi coastal zone.

  15. STUDY ON ECOLOGICAL RISK ASSESSMENT OF GUANGXI COASTAL ZONE BASED ON 3S TECHNOLOGY

    Directory of Open Access Journals (Sweden)

    Z. Zhong

    2018-05-01

    Full Text Available This paper takes Guangxi coastal zone as the study area, following the standards of land use type, divides the coastal zone of ecological landscape into seven kinds of natural wetland landscape types such as woodland, farmland, grassland, water, urban land and wetlands. Using TM data of 2000–2015 such 15 years, with the CART decision tree algorithm, for analysis the characteristic of types of landscape’s remote sensing image and build decision tree rules of landscape classification to extract information classification. Analyzing of the evolution process of the landscape pattern in Guangxi coastal zone in nearly 15 years, we may understand the distribution characteristics and change rules. Combined with the natural disaster data, we use of landscape index and the related risk interference degree and construct ecological risk evaluation model in Guangxi coastal zone for ecological risk assessment results of Guangxi coastal zone.

  16. Physical activity levels, ownership of goods promoting sedentary behaviour and risk of myocardial infarction: results of the INTERHEART study.

    Science.gov (United States)

    Held, Claes; Iqbal, Romaina; Lear, Scott A; Rosengren, Annika; Islam, Shofiqul; Mathew, James; Yusuf, Salim

    2012-02-01

    To evaluate the association between occupational and leisure-time physical activity (PA), ownership of goods promoting sedentary behaviour, and the risk of myocardial infarction (MI) in different socio-economic populations of the world. Studies in developed countries have found low PA as a risk factor for cardiovascular disease; however, the protective effect of occupational PA is less certain. Moreover, ownership of goods promoting sedentary behaviour may be associated with an increased risk. In INTERHEART, a case-control study of 10 043 cases of first MI and 14 217 controls who did not report previous angina or physical disability completed a questionnaire on work and leisure-time PA. Subjects whose occupation involved either light [multivariable-adjusted odds ratio (OR) 0.78, confidence interval (CI) 0.71-0.86] or moderate (OR 0.89, CI 0.80-0.99) PA were at a lower risk of MI, whereas those who did heavy physical labour were not (OR 1.02, CI 0.88-1.19), compared with sedentary subjects. Mild exercise (OR 0.87, CI 0.81-0.93) as well as moderate or strenuous exercise (OR 0.76, CI 0.69-0.82) was protective. The effect of PA was observed across countries with low, middle, and high income. Subjects who owned both a car and a television (TV) (multivariable-adjusted OR 1.27, CI 1.05-1.54) were at higher risk of MI compared with those who owned neither. Leisure-time PA and mild-to-moderate occupational PA, but not heavy physical labour, were associated with a reduced risk, while ownership of a car and TV was associated with an increased risk of MI across all economic regions.

  17. Cause-specific cardiovascular risk associated with nonsteroidal anti-inflammatory drugs among myocardial infarction patients--a nationwide study.

    Directory of Open Access Journals (Sweden)

    Anne-Marie Schjerning Olsen

    Full Text Available BACKGROUND: Non steroidal anti-inflammatory drugs (NSAIDs increase mortality and morbidity after myocardial infarction (MI. We examined cause-specific mortality and morbidity associated with NSAIDs in a nationwide cohort of MI patients. METHODS AND RESULTS: By individual-level linkage of nationwide registries of hospitalization and drug dispensing from pharmacies in Denmark, patients aged >30 years admitted with first-time MI during 1997-2009 and their subsequent NSAID use were identified. The risk of three cardiovascular specific endpoints: cardiovascular death, the composite of coronary death and nonfatal MI, and the composite of fatal and nonfatal stroke, associated with NSAID use was analyzed by Cox proportional hazard analyses. Of 97,698 patients included 44.0% received NSAIDs during follow-up. Overall use of NSAIDs was associated with an increased risk of cardiovascular death (hazard ratio [HR] 1.42, 95% confidence interval [CI] 1.36-1.49. In particular use of the nonselective NSAID diclofenac and the selective cyclooxygenase-2 inhibitor rofecoxib was associated with increased risk of cardiovascular death (HR 1.96 [1.79-2.15] and HR1.66 [1.44-1.91], respectively with a dose dependent increase in risk. Use of ibuprofen was associated with increased risk of cardiovascular death (HR 1.34[1.26-1.44], whereas naproxen was associated with the lowest risk of (e.g., HR 1.27[1.01-1.59]. CONCLUSION: Use of individual NSAIDs is associated with different cause-specific cardiovascular risk and in particular rofecoxib and diclofenac were associated with increased cardiovascular morbidity and mortality. These results support caution with use of all NSAIDs in patients with prior MI.

  18. Demographic And Technical Risk Factors Of 30-Day Stroke, Myocardial Infarction, And/Or Death In Standard And High Risk Patients Who Underwent Carotid Angioplasty And Stenting

    Directory of Open Access Journals (Sweden)

    Samaneh Yousefi

    2017-02-01

    Full Text Available Background: Carotid angioplasty and stenting (CAS is an accepted treatment to prevent stroke in patients with carotid artery stenosis. The purpose of this study is to identify risk factors for major complications after carotid angioplasty and stenting. Methods and Material: This is a prospective study conducted at Shiraz University of Medical Sciences in southern Iran from March 2011 to June 2014. Consecutive patients undergoing carotid angioplasty and stenting were enrolled. Both standard risk and high risk patients for endarterectomy were enrolled. Demographic data, atherosclerotic risk factors, site of stenosis, degree of stenosis, and data regarding technical factors were recorded. 30-day stroke, myocardial infarction, and/or death were considered as the composite primary outcome of the study. Results:  two hundred and fifty one patients were recruited (mean age: 71.1+ 9.6 years, male: 65.3%.  One hundred and seventy eight (70.9% patients were symptomatic; 73 (29.1%, 129 (51.4%, 165 (65.7% and 62 (24.7% patients were diabetic, hyperlipidemic, hypertensive and smoker respectively. CAS performed for left ICA in 113 (45.4% patients. 14 (5.6% patients had Sequential bilateral stenting. Mean stenosis of operated ICA was 80.2 +13.8 %. Embolic protection device was used in 203 (96.2% patients. Predilation and post-dilation were performed in 39 (18.5% and 182 (86.3% patients respectively. Composite outcome was observed in 3.6% (3.2% stroke, 0% myocardial infarction and 1.2% death. Left sided lesions and presence of DM was significantly associated with poor short term outcome. (P value: 0.025 and 0.020, respectively Conclusion: There was a higher risk of short term major complications in diabetic patients and left carotid artery intervention.

  19. Influence of risk area size and location on native collateral resistance and ischemic zone perfusion

    International Nuclear Information System (INIS)

    Gumm, D.C.; Cooper, S.M.; Thompson, S.B.; Marcus, M.L.; Harrison, D.C.

    1988-01-01

    To examine the effect of risk area size on collateral resistance and ichemic region perfusion, the authors produced different sized risk areas by occluding either the left anterior descending (LAD) or the circumflex (Cx) coronary artery at different sites. The most proximal occlusion of the LAD and Cx produced risk areas of 43 ± 5 and 36 ± 2% of left ventricular (LV) mass, respectively, whereas distal LAD and Cx occlusions produced risk areas of 13 ± 2 and 17 ± 2% of LV weight, respectively. Although total collateral flow was highest to the largest risk areas, collateral flow per 100 g of ischemic myocardium was 80% higher to the small LAD risk area compared with the large LAD risk area and 43% higher to the small Cx risk area compared with the large Cx risk area. Collateral resistance, calculated from the transcollateral pressure and perfusion per 100 g of myocardium was significantly lower in the small risk areas than in the large ones. They examined the effect of risk area location on collateral perfusion and resistance. These experiments show that collateral resistance is influenced both by ischemic region size and location. Small risk areas receive more collateral flow per mass of tissue than large risk areas, and apical risk areas receive greater quantities of collateral flow than those located at the base. These data may explain why small risk areas often do not develop infarction after coronary occlusion

  20. Adherence to a healthy Nordic food index and risk of myocardial infarction in middle-aged Danes

    DEFF Research Database (Denmark)

    Gunge, V B; Andersen, I; Kyrø, C

    2017-01-01

    BACKGROUND/OBJECTIVES: For decades, the Mediterranean diet has been in focus regarding healthy eating as it has been associated with reduced risk of non-communicable diseases. Less interest has been given to health benefits of other regional diets. The aim of the present study was to assess whether...... adherence to a healthy Nordic food index was associated with lower risk of myocardial infarction (MI) among middle-aged Danes. SUBJECTS/METHODS: Data were obtained from the Danish Diet, Cancer and Health cohort study of 57 053 men and women aged 50 − 64 years recruited between 1993 and 1997. The healthy.......55, 95% CI = 0.37, 0.82) relative to those scoring 0 points in the index (lowest score). A significantly lower MI risk was found per 1-point increment in the index in both men (HR = 0.95, 95% CI = 0.92, 0.99) and women (HR = 0.93, 95% CI = 0.88, 0.98). CONCLUSIONS: A healthy Nordic diet is associated...

  1. C-reactive protein gene polymorphisms and myocardial infarction risk: a meta-analysis and meta-regression.

    Science.gov (United States)

    Zhu, Yanbin; Liu, Tongku; He, Haitao; Sun, Yuqing; Zhuo, Fengling

    2013-12-01

    C-reactive protein (CRP), the classic acute-phase protein, plays an important role in the etiology of myocardial infarction (MI). Emerging evidence has shown that the common polymorphisms in the CRP gene may influence an individual's susceptibility to MI; but individually published studies showed inconclusive results. This meta-analysis aimed to derive a more precise estimation of the associations between CRP gene polymorphisms and MI risk. A literature search of PubMed, Embase, Web of Science, and China BioMedicine (CBM) databases was conducted on articles published before June 1st, 2013. Crude odds ratio (OR) with 95% confidence interval (CI) were calculated. Nine case-control studies were included with a total of 2992 MI patients and 4711 healthy controls. The meta-analysis results indicated that CRP rs3093059 (T>C) polymorphism was associated with decreased risk of MI, especially among Asian populations. However, similar associations were not observed in CRP rs1800947 (G>C) and rs2794521 (G>A) polymorphisms (all p>0.05) among both Asian and Caucasian populations. Univariate and multivariate meta-regression analyses showed that ethnicity may be a major source of heterogeneity. No publication bias was detected in this meta-analysis. In conclusion, the current meta-analysis indicates that CRP rs3093059 (T>C) polymorphism may be associated with decreased risk of MI, especially among Asian populations.

  2. Risk of acute myocardial infarction in patients with gastroesophageal reflux disease: A nationwide population-based study.

    Directory of Open Access Journals (Sweden)

    Wei-Yi Lei

    Full Text Available Gastroesophageal reflux disease (GERD is a common disease which can cause troublesome symptoms and affect quality of life. In addition to esophageal complications, GERD may also be a risk factor for extra-esophageal complications. Both GERD and coronary artery disease (CAD can cause chest pain and frequently co-exist. However, the association between GERD and acute myocardial infarction (AMI remain unclear. The purpose of the study was to compare the incidence of acute myocardial infarction in GERD patients with an age-, gender-, and comorbidity matched population free of GERD. We also examine the association of the risk of AMI and the use of acid suppressing agents in GERD patients.We identified patients with GERD from the Taiwan National Health Insurance Research Database. The study cohort comprised 54,422 newly diagnosed GERD patients; 269,572 randomly selected age-, gender-, comorbidity-matched subjects comprised the comparison cohort. Patients with any prior CAD, AMI or peripheral arterial disease were excluded. Incidence of new AMI was studied in both groups.A total 1,236 (0.5% of the patients from the control group and 371 (0.7% patients from the GERD group experienced AMI during a mean follow-up period of 3.3 years. Based on Cox proportional-hazard model analysis, GERD was independently associated with increased risk of developing AMI (hazard ratio (HR = 1.48; 95% confidence interval (CI: 1.31-1.66, P < 0.001. Within the GERD group, patients who were prescribed proton pump inhibitors (PPIs for more than one year had slightly decreased the risk of developing AMI, compared with those without taking PPIs (HR = 0.57; 95% CI: 0.31-1.04, P = 0.066.This large population-based study demonstrates an association between GERD and future development of AMI, however, PPIs use only achieved marginal significance in reducing the occurrence of AMI in GERD patients. Further prospective studies are needed to evaluate whether anti-reflux medication may

  3. Risk of anxiety and depressive disorders in patients with myocardial infarction: A nationwide population-based cohort study.

    Science.gov (United States)

    Feng, Hsin-Pei; Chien, Wu-Chien; Cheng, Wei-Tung; Chung, Chi-Hsiang; Cheng, Shu-Meng; Tzeng, Wen-Chii

    2016-08-01

    Anxiety and depressive symptoms are associated with adverse cardiovascular events after an acute myocardial infarction (MI). However, most studies focusing on anxiety or depression have used rating scales or self-report methods rather than clinical diagnosis. This study aimed to investigate the association between psychiatrist-diagnosed psychiatric disorders and cardiovascular prognosis.We sampled data from the National Health Insurance Research Database; 1396 patients with MI were recruited as the study cohort and 13,960 patients without MI were recruited as the comparison cohort. Cox proportional hazard regression models were used to examine the effect of MI on the risk of anxiety and depressive disorders.During the first 2 years of follow-up, patients with MI exhibited a significantly higher risk of anxiety disorders (adjusted hazard ratio [HR] = 5.06, 95% confidence interval [CI]: 4.61-5.54) and depressive disorders (adjusted HR = 7.23, 95% CI: 4.88-10.88) than those without MI did. Greater risk for anxiety and depressive disorders was observed among women and patients aged 45 to 64 years following an acute MI. Patients with post-MI anxiety had a 9.37-fold (95% CI: 4.45-19.70) higher risk of recurrent MI than those without MI did after adjustment for age, sex, socioeconomic status, and comorbidities.This nationwide population-based cohort study provides evidence that MI increases the risk of anxiety and depressive disorders during the first 2 years post-MI, and post-MI anxiety disorders are associated with a higher risk of recurrent MI.

  4. Validation of the RRE-90 Scale to Predict Stroke Risk after Transient Symptoms with Infarction: A Prospective Cohort Study.

    Directory of Open Access Journals (Sweden)

    Bo Song

    Full Text Available The risk of stroke after a transient ischemic attack (TIA for patients with a positive diffusion-weighted image (DWI, i.e., transient symptoms with infarction (TSI, is much higher than for those with a negative DWI. The aim of this study was to validate the predictive value of a web-based recurrence risk estimator (RRE; http://www.nmr.mgh.harvard.edu/RRE/ of TSI.Data from the prospective hospital-based TIA database of the First Affiliated Hospital of Zhengzhou University were analyzed. The RRE and ABCD2 scores were calculated within 7 days of symptom onset. The predictive outcome was ischemic stroke occurrence at 90 days. The receiver-operating characteristics curves were plotted, and the predictive value of the two models was assessed by computing the C statistics.A total of 221 eligible patients were prospectively enrolled, of whom 46 (20.81% experienced a stroke within 90 days. The 90-day stroke risk in high-risk TSI patients (RRE ≥4 was 3.406-fold greater than in those at low risk (P <0.001. The C statistic of RRE (0.681; 95% confidence interval [CI], 0.592-0.771 was statistically higher than that of ABCD2 score (0.546; 95% CI, 0.454-0.638; Z = 2.115; P = 0.0344 at 90 days.The RRE score had a higher predictive value than the ABCD2 score for assessing the 90-day risk of stroke after TSI.

  5. Chronic and acute anemia and extracranial internal carotid stenosis are risk factors for silent cerebral infarcts in sickle cell anemia.

    Science.gov (United States)

    Bernaudin, Françoise; Verlhac, Suzanne; Arnaud, Cécile; Kamdem, Annie; Vasile, Manuela; Kasbi, Florence; Hau, Isabelle; Madhi, Fouad; Fourmaux, Christine; Biscardi, Sandra; Epaud, Ralph; Pondarré, Corinne

    2015-03-05

    Early transcranial Doppler (TCD) screening of the Créteil sickle cell anemia (SCA)-newborn cohort, and rapid initiation of transfusion programs, resulted in successful prevention of overt strokes, but a high cumulative risk of silent cerebral infarcts (SCI) remained, suggesting that TCD screening does not identify all patients with SCA at risk for SCI. We hypothesized that episodes of hypoperfusion/hypoxia, as observed during acute chest syndromes or acute anemic events (AAE), and extracranial internal carotid artery (eICA) stenoses, detectable via submandibular Doppler sonography and cervical magnetic resonance angiography (MRA), could also be risk factors for SCI. This study includes 189 stroke-free patients with SCA from the Créteil newborn cohort (1992-2010) followed longitudinally by magnetic resonance imaging/MRA, including cervical MRA at the last assessment. All patients with abnormal TCD and/or intracranial stenoses were placed on a transfusion program. Mean follow-up was 9.9 years (range, 2.2-19.9 years; 1844 patient-years). Annual rates of clinical events were calculated. The cumulative risk for SCI was 39.1% (95% confidence interval [CI], 23.5%-54.7%) by age 18 years, with no plateau. We confirm that baseline hemoglobin level lower than 7 g/dL before age 3 years is a highly significant predictive risk factor for SCI (hazard ratio, 2.97; 95% CI, 1.43-6.17; P = .004). Furthermore, we show that AAE rate (odds ratio, 2.64 per unit increase; 95% CI, 1.09-6.38; P = .031) and isolated eICA stenosis (odds ratio, 3.19; 95% CI, 1.18-8.70; P = .023) are significant and independent risk factors for SCI. © 2015 by The American Society of Hematology.

  6. Related factors and incidence risk of acute myocardial infarction among the people with disability: A national population-based study.

    Science.gov (United States)

    Huang, Ying-Ying; Kung, Pei-Tseng; Chiu, Li-Ting; Tsai, Wen-Chen

    2014-11-06

    Cardiovascular disease has always been a leading cause of death worldwide. Because the mobility of people with disability is relatively decreased, their risk of cardiovascular disease is increased. This study investigated the risks and relevant factors of acute myocardial infarction (AMI) among people with disability. This is a retrospective cohort study based on secondary data analysis. This study focused on 798,328 people with disability who were aged 35 and above during 2002-2008 and were registered in the National Disability Registration Database; the relevant medical data from 2000 to 2011 were acquired from the National Health Insurance Research Database. A Cox proportional hazards model was adopted for analyzing the relative AMI risks among different disability types and finding latent risk factors. The results indicated that the AMI incidence rate (per 1000 patient-years) among people with disability was 2.48. Men had an AMI incidence rate of 2.68 per 1000 patient-years, which was significantly higher than that of women (2.21; pdisability aged 65 and above had an AMI risk that was 5.01-6.03 times the risk for people with disability aged below 45. Disabled indigenous people had a relatively higher AMI risk (HR=1.35, 95% CI=1.19-1.52). The AMI risk for people with disability with a Charlson comorbidity index (CCI) of 4 and above was 5.89 times (95% CI=5.56-6.25) the risk for those with a CCI of 0. Compared with people with physical disabilities, people with visual impairment and people with dysfunctional primary organs had significantly higher AMI risks (HR=1.15; HR=1.66). This study found that people with disability who were male, aged 65 and above, married, indigenous, with physical disabilities, with high comorbidity, or with high disability levels had relatively higher AMI risks than other people with disability. The research outcomes can be used as references by public health authorities to improve the engagement of people with disability in AMI

  7. Depression and the Risk of Myocardial Infarction and Coronary Death: A Meta-Analysis of Prospective Cohort Studies.

    Science.gov (United States)

    Wu, Qing; Kling, Juliana M

    2016-02-01

    Findings regarding the association between depression and risk of coronary heart disease are inconsistent. We aimed to assess the association between depression and risk of myocardial infarction (MI) and coronary death through a meta-analysis.We performed an electronic literature search of MEDLINE, EMBASE, PsycINFO, ISI Web of Science, and Scopus databases through August 1, 2015, and manual search of the references of the eligible papers and related review articles. Two investigators independently conducted study selection and data abstraction. Disagreement was resolved by consensus. Confounder-adjusted hazard ratios (HRs) were pooled using a random-effects model. Heterogeneity was evaluated using the Cochran Q statistic and Higgins index. Publication bias was assessed by funnel plot and Egger test. Study quality was appraised with the Newcastle-Ottawa Scale.Among 19 eligible cohort studies including 323,709 participants, 8447 cases of MI and coronary death were reported during follow-up ranging from 4 to 37 years. The pooled adjusted HRs for patients with depression (vs those without) were 1.22 (95% CI, 1.13-1.32) for combined MI and coronary death, 1.31 (95% CI, 1.09-1.57) for MI alone (9 studies), and 1.36 (95% CI, 1.14-1.63) for coronary death alone (8 studies). The increased risk of MI and coronary death associated with depression was consistent using modified inclusion criteria, across most subgroups, and after adjusting for possible publication bias.Depression is associated with a significantly increased risk of MI and coronary death. Effective prevention and treatment of depression may decrease such risk.

  8. Cerebral Microbleeds and the Risk of Incident Ischemic Stroke in CADASIL (Cerebral Autosomal Dominant Arteriopathy With Subcortical Infarcts and Leukoencephalopathy).

    Science.gov (United States)

    Puy, Laurent; De Guio, François; Godin, Ophélia; Duering, Marco; Dichgans, Martin; Chabriat, Hugues; Jouvent, Eric

    2017-10-01

    Cerebral microbleeds are associated with an increased risk of intracerebral hemorrhage. Recent data suggest that microbleeds may also predict the risk of incident ischemic stroke. However, these results were observed in elderly individuals undertaking various medications and for whom causes of microbleeds and ischemic stroke may differ. We aimed to test the relationship between the presence of microbleeds and incident stroke in CADASIL (Cerebral Autosomal Dominant Arteriopathy With Subcortical Infarcts and Leukoencephalopathy)-a severe monogenic small vessel disease known to be responsible for both highly prevalent microbleeds and a high incidence of ischemic stroke in young patients. We assessed microbleeds on baseline MRI in all 378 patients from the Paris-Munich cohort study. Incident ischemic strokes were recorded during 54 months. Survival analyses were used to test the relationship between microbleeds and incident ischemic stroke. Three hundred sixty-nine patients (mean age, 51.4±11.4 years) were followed-up during a median time of 39 months (interquartile range, 19 months). The risk of incident ischemic stroke was higher in patients with microbleeds than in patients without (35.8% versus 19.6%, hazard ratio, 1.87; 95% confidence interval, 1.16-3.01; P =0.009). These results persisted after adjustment for history of ischemic stroke, age, sex, vascular risk factors, and antiplatelet agents use (hazard ratio, 1.89; 95% confidence interval, 1.10-3.26; P =0.02). The presence of microbleeds is an independent risk marker of incident ischemic stroke in CADASIL, emphasizing the need to carefully interpret MRI data. © 2017 American Heart Association, Inc.

  9. Does menopausal hormone therapy reduce myocardial infarction risk if initiated early after menopause? A population-based case-control study.

    Science.gov (United States)

    Carrasquilla, Germán D; Berglund, Anita; Gigante, Bruna; Landgren, Britt-Marie; de Faire, Ulf; Hallqvist, Johan; Leander, Karin

    2015-06-01

    This study aims to assess whether the timing of menopausal hormone therapy initiation in relation to onset of menopause and hormone therapy duration is associated with myocardial infarction risk. This study was based on the Stockholm Heart Epidemiology Program, a population-based case-control study including 347 postmenopausal women who had experienced a nonfatal myocardial infarction and 499 female control individuals matched for age and residential area. Odds ratios (with 95% CIs) for myocardial infarction were calculated using logistic regression. Early initiation of hormone therapy (within 10 y of onset of menopause or before age 60 y), compared with never use, was associated with an odds ratio of 0.87 (95% CI, 0.58-1.30) after adjustments for lifestyle factors, body mass index, and socioeconomic status. For late initiation of hormone therapy, the corresponding odds ratio was 0.97 (95% CI, 0.53-1.76). For hormone therapy duration of 5 years or more, compared with never use, the adjusted odds ratio was 0.64 (95% CI, 0.35-1.18). For hormone therapy duration of less than 5 years, the odds ratio was 0.97 (95% CI, 0.63-1.48). Neither the timing of hormone therapy initiation nor the duration of therapy is significantly associated with myocardial infarction risk.

  10. Risk stratification of cardiovascular events in hypertensive patients with asymptomatic or symptomatic lacunar infarcts by 24-hour ambulatory blood pressure monitoring

    International Nuclear Information System (INIS)

    Shiraishi, Makoto; Watanabe, Hirofumi; Sakurai, Kenzo; Kato, Bunta; Hasegawa, Yasuhiro

    2012-01-01

    Our goal was to investigate the utility of 24-hour ambulatory blood pressure monitoring (ABPM) for the risk stratification of cardiovascular events in hypertensive patients with asymptomatic or symptomatic lacunar infarcts. A total of 175 hypertensive patients with MRI evidence of asymptomatic or symptomatic lacunar infarcts (92 men, mean age of 69±11 years old) were studied. Patients with symptomatic infarctions were included whose events occurred more than 6 months after the onset. ABPM was performed in all patients in the outpatient clinic. Parameters obtained from ABPM were related to the composite outcome which consisted of all death and fatal or non-fatal cardiovascular events by using the Cox proportional hazard model. Mean follow-up period was 4.8 years and the composite outcome was recorded in 38 patients. 34 of them (89%) had recurrence of lacunar infarcts. Significant association between sleep-time lowest systolic blood pressure and composite outcome was demonstrated by multivariate Cox hazard analyses (heart rate (HR) 1.025, 95% confidence interval (CI) 1.011-1.039, p<0.001). The risk for composite outcome in patients with the highest tertile of sleep-time lowest systolic blood pressure (≥133 mmHg) was significantly elevated when compared to the lowest tertile (<132 mmHg, HR 3.93, 95% CI 1.57-9.86, p=0.004). Sleep-time lowest systolic blood pressure in ABPM may be a useful parameter for the risk stratification of future cardiovascular events in hypertensive patients with asymptomatic or symptomatic lacunar infarcts, especially for the recurrence of these events. (author)

  11. Genetic Variants from Lipid-Related Pathways and Risk for Incident Myocardial Infarction

    Science.gov (United States)

    Song, Ci; Pedersen, Nancy L.; Reynolds, Chandra A.; Sabater-Lleal, Maria; Kanoni, Stavroula; Willenborg, Christina; Syvänen, Ann-Christine; Watkins, Hugh; Hamsten, Anders; Prince, Jonathan A.; Ingelsson, Erik

    2013-01-01

    Background Circulating lipids levels, as well as several familial lipid metabolism disorders, are strongly associated with initiation and progression of atherosclerosis and incidence of myocardial infarction (MI). Objectives We hypothesized that genetic variants associated with circulating lipid levels would also be associated with MI incidence, and have tested this in three independent samples. Setting and Subjects Using age- and sex-adjusted additive genetic models, we analyzed 554 single nucleotide polymorphisms (SNPs) in 41 candidate gene regions proposed to be involved in lipid-related pathways potentially predisposing to incidence of MI in 2,602 participants of the Swedish Twin Register (STR; 57% women). All associations with nominal P<0.01 were further investigated in the Uppsala Longitudinal Study of Adult Men (ULSAM; N = 1,142). Results In the present study, we report associations of lipid-related SNPs with incident MI in two community-based longitudinal studies with in silico replication in a meta-analysis of genome-wide association studies. Overall, there were 9 SNPs in STR with nominal P-value <0.01 that were successfully genotyped in ULSAM. rs4149313 located in ABCA1 was associated with MI incidence in both longitudinal study samples with nominal significance (hazard ratio, 1.36 and 1.40; P-value, 0.004 and 0.015 in STR and ULSAM, respectively). In silico replication supported the association of rs4149313 with coronary artery disease in an independent meta-analysis including 173,975 individuals of European descent from the CARDIoGRAMplusC4D consortium (odds ratio, 1.03; P-value, 0.048). Conclusions rs4149313 is one of the few amino acid changing variants in ABCA1 known to associate with reduced cholesterol efflux. Our results are suggestive of a weak association between this variant and the development of atherosclerosis and MI. PMID:23555974

  12. Olson method for locating and calculating the extent of transmural ischemic areas at risk of infarction.

    Science.gov (United States)

    Olson, Charles W; Wagner, Galen S; Terkelsen, Christian Juhl; Stickney, Ronald; Lim, Tobin; Pahlm, Olle; Estes, E Harvey

    2014-01-01

    The purpose of this study is to present a new and improved method for translating the electrocardiographic changes of acute myocardial ischemia into a display which reflects the location and extent of the ischemic area and the associated culprit coronary artery. This method could be automated to present a graphic image of the ischemic area in a manner understandable by all levels of caregivers; from emergency transport personnel to the consulting cardiologist. Current methods for the ECG diagnosis of ST elevated myocardial infarction (STEMI) are criteria driven, and complex, and beyond the interpretive capability of many caregivers. New methods are needed to accurately diagnose the presence of acute transmural myocardial ischemia in order to accelerate a patient's clinical "door to balloon time." The proposed new method could potentially provide the information needed to accomplish this objective. The new method improves the precision of diagnosis and quantification of ischemia by normalizing the ST segment inputs from the standard 12 lead ECG, transforming these into a three dimensional vector representation of the ischemia at the electrical center of the heart. The myocardial areas likely to be involved in this ischemia are separately analyzed to assess the probability that they contributed to this event. The source of the ischemia is revealed as a specific region of the heart, and the likely location of the associated culprit coronary artery. Seventy 12 lead ECGs from subjects with known single artery occlusion in one of the three main coronary arteries were selected to test this new method. Graphic plots of the distribution of ischemia as indicated by the method are consistent with the known occlusion. The analysis of the distribution of ischemic areas in the myocardium reveals that the relationships between leads with either ST elevation or ST depression, provide critical information improving the current method. Copyright © 2014 Elsevier Inc. All rights

  13. Evaluation of risk factors in acute myocardial infarction patients admitted to the coronary care unit, Tripoli Medical Centre, Libya.

    Science.gov (United States)

    Abduelkarem, A R; El-Shareif, H J; Sharif, S I

    2012-04-01

    The aim of this study was to provide an overview of the risk factors for acute myocardial infarction in patients attending Tripoli Medical Centre, Libya. Records were reviewed for 622 patients with a mean age of 58.3 (SD 12.9) years. Diabetes mellitus (48.2%), hypertension (35.7%) and smoking (50.6%) were among the risk factors reported. There were 110 patients (17.7%) who died during hospitalization, mainly suffering cardiogenic shock (48.0%). The rate of use of thrombolytic therapy was low in patients who were female (40.4% versus 58.4% for males), older age (31.6% for those > 85 years versus 63.3% for patients < 55 years), diabetics (45.3% versus 62.0% for non-diabetic patients) and hypertensives (47.3% versus 57.8% for non-hypertensive patients). Prevention strategies should be implemented in order to improve the long-term prognosis and decrease overall morbidity and mortality from coronary artery disease in Libyan patients.

  14. An alarming trend: Change in the risk profile of patients with ST elevation myocardial infarction over the last two decades.

    Science.gov (United States)

    Mentias, Amgad; Hill, Elizabeth; Barakat, Amr F; Raza, Mohammad Q; Youssef, Dalia; Banerjee, Kinjal; Sawant, Abhishek C; Ellis, Stephen; Murat Tuzcu, E; Kapadia, Samir R

    2017-12-01

    Coronary artery disease (CAD) is the leading cause of mortality around the world. We sought to study changes in the risk profile of patients presenting with ST elevation myocardial infarction (STEMI). We retrospectively studied all patients presenting with STEMI to our center between 1995 and 2014. Patients were divided into four quartiles, 5years each. Baseline risk factors and comorbidities were recorded. Sub-analysis was done for patients with established CAD and their household incomes. A total of 3913 patients (67.9% males) were included; 42.5% presented with anterior STEMI and 57.5% inferior STEMI. Ages were 64±12, 62±13, 61±13 and 60±13 in the four quartiles respectively. Obesity prevalence was 31, 37, 38 and 40% and diabetes mellitus prevalence was 24, 25, 24 and 31%, while hypertension was 55, 67, 70 and 77%, respectively, prisk factors and more focus on preventive cardiology, patients presenting with STEMI over the past 20years are getting younger and more obese, with more prevalence of smoking, hypertension, and diabetes mellitus. This trend is greater in the lower income population. Copyright © 2017 Elsevier B.V. All rights reserved.

  15. Cephalometric risk factors associated with myocardial infarction in patients suffering from obstructive sleep apnea: A pilot case-control study.

    Science.gov (United States)

    Davoudmanesh, Zeinab; Bayat, Mohamad; Abbasi, Mohsen; Rakhshan, Vahid; Shariati, Mahsa

    2017-01-01

    Obstructive sleep apnea (OSA) and its craniofacial anatomic risk factors might play a role in several cardiovascular diseases, including myocardial infarction (MI). However, there are no data about cephalometric findings among OSA patients with MI. In this pilot case-control study, about 2000 individuals referred to the sleep center were evaluated according to apnea - hypopnea index (AHI) and other inclusion criteria. Included were 62 OSA male patients (AHI > 10), of whom 6 had an MI history. In both control (n = 56) and MI groups (n = 6), 18 cephalometric parameters were traced. Data were analyzed using independent samples t-test. Compared with control OSA patients, OSA patients with MI showed a significantly larger tongue length (p = 0.015). The other cephalometric variables were not significantly different between the two groups. An elongated tongue might be considered a risk factor for MI in OSA patients. The role of other variables remains inconclusive and open to investigation with larger samples (determined based on pilot studies such as this report) collected in longitudinal fashion.

  16. Diagnosis of myocardial infarction using the new universal definition: is it enough for risk stratification and guiding decision for revascularization?

    Science.gov (United States)

    Calé, Rita; Ferreira, Jorge; Aguiar, Carlos; Santos, Nuno; Carmo, Pedro; Figueira, João; Raposo, Luis; Gonçalves, Pedro; Silva, José Aniceto

    2010-12-01

    Abstract Objectives: Evaluate the new ESC/ACCF/AHA/WHF universal definition of myocardial infarction (MI) in relation to its prognostic implications and the role for guiding decision for revascularization. It was also compared with the multivariable based GRACE Risk Score (GRS). Single centre registry of 389 consecutive patients admitted with non-ST-segment elevation (NSTE) ACS. We calculated the adjusted HR & 95%CI for death/MI at 30-days and one-year follow-up, between the presence or absence of MI using: (1) universal definition: > 99th URL for cTnI (> 0.06 ng/ml) or MBm (> 3.2 ng/ml); (2) MBm > 2 × URL (> 12.2 ng/ml); 3) old WHO: MBact > 2 × URL (> 32U/l). Logistic analysis was performed to test the interaction between tertiles of biomarkers or GRS and the effect of revascularization on the outcome. The universal definition increased the incidence of MI in 3.5-fold for cTnI, but was not an independent predictor of outcome. The GRS was the only independent predictor of prognosis at 30-days and one-year. The interaction with the prognostic impact of revascularization was only present for the GRS categorized by tertiles. In a contemporary unselected population with NSTE-ACS, the universal definition of MI alone was not adequate for risk assessment and revascularization decision making. These purposes were fully addressed with the GRS.

  17. A new risk scoring model for prediction of poor coronary collateral circulation in acute non-ST-elevation myocardial infarction.

    Science.gov (United States)

    İleri, Mehmet; Güray, Ümit; Yetkin, Ertan; Gürsoy, Havva Tuğba; Bayır, Pınar Türker; Şahin, Deniz; Elalmış, Özgül Uçar; Büyükaşık, Yahya

    2016-01-01

    We aimed to investigate the clinical features associated with development of coronary collateral circulation (CCC) in patients with acute non-ST-elevation myocardial infarction (NSTEMI) and to develop a scoring model for predicting poor collateralization at hospital admission. The study enrolled 224 consecutive patients with NSTEMI admitted to our coronary care unit. Patients were divided into poor (grade 0 and 1) and good (grade 2 and 3) CCC groups. In logistic regression analysis, presence of diabetes mellitus, total white blood cell (WBC) and neutrophil counts and neutrophil to lymphocyte ratio (NLR) were found as independent positive predictors of poor CCC, whereas older age (≥ 70 years) emerged as a negative indicator. The final scoring model was based on 5 variables which were significant at p risk score ≤ 1, 29 had good CCC (with a 97% negative predictive value). On the other hand, 139 patients had risk score ≥ 4; out of whom, 130 (with a 93.5% positive predictive value) had poor collateralization. Sensitivity and specificity of the model in predicting poor collateralization in patients with scores ≤ 1 and ≥ 4 were 99.2% (130/131) and +76.3 (29/38), respectively. This study represents the first prediction model for degree of coronary collateralization in patients with acute NSTEMI.

  18. Upper Gastrointestinal Complications and Cardiovascular/Gastrointestinal Risk Calculator in Patients with Myocardial Infarction Treated with Aspirin.

    Science.gov (United States)

    Wen, Lei

    2017-08-20

    Aspirin is widely used for the prevention of cardiovascular and cerebrovascular diseases for the past few years. However, much attention has been paid to the adverse effects associated with aspirin such as gastrointestinal bleeding. How to weigh the benefits and hazards? The current study aimed to assess the feasibility of a cardiovascular/gastrointestinal risk calculator, AsaRiskCalculator, in predicting gastrointestinal events in Chinese patients with myocardial infarction (MI), determining unique risk factor(s) for gastrointestinal events to be considered in the calculator. The MI patients who visited Shapingba District People's Hospital between January 2012 and January 2016 were retrospectively reviewed. Based on gastroscopic data, the patients were divided into two groups: gastrointestinal and nongastrointestinal groups. Demographic and clinical data of the patients were then retrieved for statistical analysis. Univariate and multiple logistic regression analyses were used to identify independent risk factors for gastrointestinal events. The receiver operating characteristic (ROC) curves were used to assess the predictive value of AsaRiskCalculator for gastrointestinal events. A total of 400 MI patients meeting the eligibility criteria were analyzed, including 94 and 306 in the gastrointestinal and nongastrointestinal groups, respectively. The data showed that age, male gender, predicted gastrointestinal events, and Helicobacter pylori (HP) infection were positively correlated with gastrointestinal events. In multiple logistic regression analysis, predicted gastrointestinal events and HP infection were identified as risk factors for actual gastrointestinal events. HP infection was highly predictive in Chinese patients; the ROC curve indicated an area under the curve of 0.822 (95% confidence interval: 0.774-0.870). The best diagnostic cutoff point of predicted gastrointestinal events was 68.0‰, yielding sensitivity and specificity of 60.6% and 93

  19. Serum metabolites and risk of myocardial infarction and ischemic stroke: a targeted metabolomic approach in two German prospective cohorts.

    Science.gov (United States)

    Floegel, Anna; Kühn, Tilman; Sookthai, Disorn; Johnson, Theron; Prehn, Cornelia; Rolle-Kampczyk, Ulrike; Otto, Wolfgang; Weikert, Cornelia; Illig, Thomas; von Bergen, Martin; Adamski, Jerzy; Boeing, Heiner; Kaaks, Rudolf; Pischon, Tobias

    2018-01-01

    Metabolomic approaches in prospective cohorts may offer a unique snapshot into early metabolic perturbations that are associated with a higher risk of cardiovascular diseases (CVD) in healthy people. We investigated the association of 105 serum metabolites, including acylcarnitines, amino acids, phospholipids and hexose, with risk of myocardial infarction (MI) and ischemic stroke in the European Prospective Investigation into Cancer and Nutrition (EPIC)-Potsdam (27,548 adults) and Heidelberg (25,540 adults) cohorts. Using case-cohort designs, we measured metabolites among individuals who were free of CVD and diabetes at blood draw but developed MI (n = 204 and n = 228) or stroke (n = 147 and n = 121) during follow-up (mean, 7.8 and 7.3 years) and among randomly drawn subcohorts (n = 2214 and n = 770). We used Cox regression analysis and combined results using meta-analysis. Independent of classical CVD risk factors, ten metabolites were associated with risk of MI in both cohorts, including sphingomyelins, diacyl-phosphatidylcholines and acyl-alkyl-phosphatidylcholines with pooled relative risks in the range of 1.21-1.40 per one standard deviation increase in metabolite concentrations. The metabolites showed positive correlations with total- and LDL-cholesterol (r ranged from 0.13 to 0.57). When additionally adjusting for total-, LDL- and HDL-cholesterol, triglycerides and C-reactive protein, acyl-alkyl-phosphatidylcholine C36:3 and diacyl-phosphatidylcholines C38:3 and C40:4 remained associated with risk of MI. When added to classical CVD risk models these metabolites further improved CVD prediction (c-statistics increased from 0.8365 to 0.8384 in EPIC-Potsdam and from 0.8344 to 0.8378 in EPIC-Heidelberg). None of the metabolites was consistently associated with stroke risk. Alterations in sphingomyelin and phosphatidylcholine metabolism, and particularly metabolites of the arachidonic acid pathway are independently associated with risk of MI in

  20. Care zoning in a psychiatric intensive care unit: strengthening ongoing clinical risk assessment.

    Science.gov (United States)

    Mullen, Antony; Drinkwater, Vincent; Lewin, Terry J

    2014-03-01

    To implement and evaluate the care zoning model in an eight-bed psychiatric intensive care unit and, specifically, to examine the model's ability to improve the documentation and communication of clinical risk assessment and management. Care zoning guides nurses in assessing clinical risk and planning care within a mental health context. Concerns about the varying quality of clinical risk assessment prompted a trial of the care zoning model in a psychiatric intensive care unit within a regional mental health facility. The care zoning model assigns patients to one of 3 'zones' according to their clinical risk, encouraging nurses to document and implement targeted interventions required to manage those risks. An implementation trial framework was used for this research to refine, implement and evaluate the impact of the model on nurses' clinical practice within the psychiatric intensive care unit, predominantly as a quality improvement initiative. The model was trialled for three months using a pre- and postimplementation staff survey, a pretrial file audit and a weekly file audit. Informal staff feedback was also sought via surveys and regular staff meetings. This trial demonstrated improvement in the quality of mental state documentation, and clinical risk information was identified more accurately. There was limited improvement in the quality of care planning and the documentation of clinical interventions. Nurses' initial concerns over the introduction of the model shifted into overall acceptance and recognition of the benefits. The results of this trial demonstrate that the care zoning model was able to improve the consistency and quality of risk assessment information documented. Care planning and evaluation of associated outcomes showed less improvement. Care zoning remains a highly applicable model for the psychiatric intensive care unit environment and is a useful tool in guiding nurses to carry out routine patient risk assessments. © 2013 John Wiley & Sons

  1. Risk zoning around nuclear power plants in comparison to other major hazardous industrial installations

    International Nuclear Information System (INIS)

    Kirchsteiger, Christian

    2006-01-01

    The background and current status of the information basis leading to the definition of risk and emergency zones around Nuclear Power Plants (NPPs) in different countries in Europe and beyond are analysed. Although dependable plant-specific Probabilistic Safety Assessment (PSA) of Level 2 and/or Level 3 could in principle provide sufficiently detailed input to define the geographical dimension of a NPP's risk and emergency zones, the analysis of the status in some European and other countries shows that other, 'deterministic' approaches using a Reference Accident are actually used in practice. Regarding use of Level 2 PSA for emergency planning, the approach so far has been to use the Level 2 PSA information retrospectively to provide the justification for the choice of Reference Accident(s) used to define the emergency plans and Emergency Planning Zones (EPZs). There are significant differences in the EPZs that are defined in different countries, ranging from about 1 km to 30 km. Further, there is a striking contrast in the extent of using probabilistic information to define emergency zones between the nuclear and other high risk industry sectors, such as the chemical process industry, and the reasons for these differences are not entirely clear, but seem to be more related to risk perception than actual risk potential. Finally, based on consensus discussions at a recent JRC/OECD International Seminar on Risk and Emergency Zoning around NPPs, recommendations are given in the areas of more comprehensive use of available risk information for risk zoning purposes, risk communication and comparative risk assessment. (author)

  2. Is digoxin an independent risk factor for long-term mortality after acute myocardial infarction?

    DEFF Research Database (Denmark)

    Køber, L; Torp-Pedersen, C; Gadsbøll, N

    1994-01-01

    age, LVEF, diabetes mellitus, heart failure, atrial fibrillation or flutter, ventricular fibrillation, gender, dose of furosemide at discharge and calcium antagonists and digoxin treatment as covariates, digoxin was independently associated with an increased risk of death (relative risk 1.8 (95...

  3. Pain-to-hospital times, cardiovascular risk factors, and early intrahospital mortality in patients with acute myocardial infarction

    Directory of Open Access Journals (Sweden)

    Brković E

    2015-02-01

    Full Text Available Eliana Brković,1 Katarina Novak,2,3 Livia Puljak3 1Department of Psychiatry, 2Department of Internal Medicine, Division of Cardiology, 3Laboratory for Pain Research, University of Split School of Medicine, Split, Croatia Background: The aim of the study was to analyze the most recent trends in myocardial infarction (MI care, the number of patients treated for MI and their outcomes, cardiovascular disease risk factors, and pain-to-hospital times in MI patients. Subjects and methods: For 778 patients treated for acute MI at the Coronary Care Unit (CCU of University Hospital Split, Croatia the following data were acquired: outcome during hospitalization (survived, deceased, cardiovascular risk factors (hypertension, diabetes, dyslipidemia, previous MI, smoking, and pain-to-CCU time. Results: Among 778 patients treated for acute MI, there were 291 (37% women and 487 (63% men. Forty-five patients (6% died during hospitalization, mostly due to cardiogenic shock. An association was found between early intrahospital mortality and the following risk factors: age >70 years, female sex, previous MI, and smoking. Median pain-to-call time was 2 hours, and median time from the onset of pain to arrival into the CCU was 4 hours. There were 59 (7.6% patients admitted to the CCU within recommended 90 minutes. Diabetic comorbidity was not associated with early death or with longer time from pain to emergency calls. Conclusion: Some of the risk factors associated with adverse outcomes in MI are modifiable. Prehospital delay of 4 hours observed in patients who suffered an MI is too long, and more effort should be devoted to investments in health care and education of the general public regarding chest pain symptoms. Keywords: prehospital delay, ischemic heart disease

  4. A population-based case-cohort study of the risk of myocardial infarction following radiation therapy for breast cancer

    International Nuclear Information System (INIS)

    Paszat, Lawrence F.; Vallis, Katherine A.; Benk, Veronique M.A.; Groome, Patti A.; Mackillop, William J.; Wielgosz, Andreas

    2007-01-01

    Objective: To describe the risk of acute myocardial infarction (AMI) after radiation therapy (RT) for breast cancer (BrCa) in an exposed population. Methods: We identified and validated cases of AMI (vAMI), by electrocardiographic or enzyme criteria, among all 6680 women who received post-operative RT following lumpectomy or mastectomy, within 12 months following diagnosis of BrCa between 1982 and 1988 in Ontario, Canada. We identified women without vAMI whose death certification was ascribed to AMI (dAMI). We abstracted risk factors and treatment exposures for a random sample of women from the 6680, and for all with vAMI or dAMI. The hazards of vAMI and of dAMI were estimated using multivariate Cox proportional hazards models, corrected for study design. Results: We validated 121 cases of vAMI and identified 92 cases of dAMI. The risk of vAMI associated with RT to the left breast HR = 1.96 (1.09, 3.54) among women at age ≥ 60 at time of RT, adjusted for history of smoking and prior MI. The adjusted HR dAMI = 1.90 (1.08, 3.35) for exposure to anterior internal mammary node (IMC) RT. Among women who received anterior left breast boost RT, increasing area of the boost is associated with adjusted HR vAMI = 1.02 (1.00, 1.03)/cm 2 , and adjusted HR dAMI = 1.02 (1.01, 1.03)/cm 2 . Conclusion: The risks of vAMI and dAMI following RT for BrCa are related to anatomic sites of RT (left breast, area of anterior left breast boost field, and anterior IMC field)

  5. Risk reduction by use of a buffer zone

    NARCIS (Netherlands)

    Wijnant-Timmerman, S.L.; Wiersma, T.

    2008-01-01

    In situations where chemical industries and residential areas are situated close to each other, the population runs a safety risk associated with the accidental release of toxic gases. TNO has investigated the possibilities to reduce this risk by integrating safety measures in the area between the

  6. Risk-Informed Selection of Steel Connections for Seismic Zones

    Directory of Open Access Journals (Sweden)

    De León-Escobedo D.

    2011-04-01

    Full Text Available The findings about the fragile behavior of steel welded connections after the Northridge 1994 earthquake, specially for frames designed to withstand lateral force, has brought an amount of new attention to the design and safety issues of the welded connections for structures located on seismic zones. In México, practitioners and designers are wondering about the seismic effectiveness of the several kinds of connections as used in steel structures. A decision must be made to balance the safety required with the costs incurred after exceeding the serviceability limit state. Structural reliability techniques provide the proper framework to include the inherent uncertainties into the design process. Registered motions after the 1985 Mexico City earthquake are properly scaled according to the seismic hazard curve for soft soil in Mexico City. Earthquake occurrence is modeled as a Poisson process and the expected life-cycle cost is taken as the decision criteria. Parametric analyses allow the identification of dominant variables and ranges where one option is more recommendable than the other one. The proposed formulation may support designers and builders for the decision making process about the selection of the convenient connection type for the seismic zones with soft soil in Mexico City.

  7. Migrainous infarction

    DEFF Research Database (Denmark)

    Laurell, K; Artto, V; Bendtsen, L

    2011-01-01

    Migrainous infarction (MI), i.e. an ischemic stroke developing during an attack of migraine with aura is rare and the knowledge of its clinical characteristics is limited. Previous case series using the International Classification of Headache Disorders (ICHD) included......Migrainous infarction (MI), i.e. an ischemic stroke developing during an attack of migraine with aura is rare and the knowledge of its clinical characteristics is limited. Previous case series using the International Classification of Headache Disorders (ICHD) included...

  8. Risk Assessment of Maize Drought Disaster in Agro-Pastoral Transitional Zone in North China

    Science.gov (United States)

    Jia, H.; Pan, D.

    2017-12-01

    Agricultural drought is one of the focuses of global concern and one of the natural disasters that affect the agriculture production mostly in China. Farming-pastoral zones in China are located in the monsoon fringe area, precipitation of which is extremely unstable, and drought occurs frequently. The agro-pastoral transitional zone in North China is one of the main producing areas of northern spring maize in northern China, and maize is the second largest grain crop in the region. An assessment of the risk of drought disaster in this region is therefore important in ensuring a reduction in such disasters and an increase in food security. A risk assessment model, EPIC (Environmental Policy Integrated Climate) model, for maize drought disasters based on the Erosion Productivity Impact Calculator crop model is proposed for areas with the topographic characteristics of agro-pastoral transitional zone in North China. The results showed that the hazard risk level for the maize zone of agro-pastoral transitional zone in North China is generally high. Most hazard index values were between 0.4 and 0.5, accounting for 48.77% of total study area. The high-risk areas were mainly distributed in Ordos Plateau (South of Inner Mongolia Autonomous region), South of Ningxia Hui Autonomous Region and Center of Gansu Province. These results provide a scientific basis and support for the reduction of agricultural drought disasters and an increase in food security in the agro-pastoral transitional zone in North China.

  9. Microbial Translocation in HIV Infection is Associated with Dyslipidemia, Insulin Resistance, and Risk of Myocardial Infarction

    DEFF Research Database (Denmark)

    Pedersen, Karin Kaereby; Pedersen, Maria; Trøseid, Marius

    2013-01-01

    Microbial translocation has been suggested to be a driver of immune activation and inflammation. We hypothesized that microbial translocation may be related to dyslipidemia, insulin resistance, and the risk of coronary heart disease in HIV-infected individuals.......Microbial translocation has been suggested to be a driver of immune activation and inflammation. We hypothesized that microbial translocation may be related to dyslipidemia, insulin resistance, and the risk of coronary heart disease in HIV-infected individuals....

  10. A Mediterranean diet and risk of myocardial infarction, heart failure and stroke: A population-based cohort study.

    Science.gov (United States)

    Tektonidis, Thanasis G; Åkesson, Agneta; Gigante, Bruna; Wolk, Alicja; Larsson, Susanna C

    2015-11-01

    The Mediterranean diet, which is palatable and easily achievable, has been associated with lower all-cause and cardiovascular disease (CVD) incidence and mortality. Data on heart failure (HF) and stroke types are lacking. The aim was to examine a Mediterranean diet in relation to incidence of myocardial infarction (MI), HF and stroke types in a Swedish prospective cohort. In a population-based cohort of 32,921 women, diet was assessed through a self-administered questionnaire. The modified Mediterranean diet (mMED) score was created based on high consumption of vegetables, fruits, legumes, nuts, whole grains, fermented dairy products, fish and monounsaturated fat, moderate intakes of alcohol and low consumption of red meat, on a 0-8 scale. Relative risks (RR) with 95% confidence intervals (CI), adjusted for potential confounders, were estimated by Cox proportional hazards regression models. During 10 y of follow-up (1998-2008), 1109 MIs, 1648 HFs, 1270 ischemic strokes and 262 total hemorrhagic strokes were ascertained. A high adherence to the mMED score (6-8), compared to low, was associated with a lower risk of MI (RR: 0.74, 95% CI: 0.61-0.90, p = 0.003), HF (RR: 0.79, 95% CI: 0.68-0.93, p = 0.004) and ischemic stroke (RR: 0.78, 95% CI: 0.65-0.93, p = 0.007), but not hemorrhagic stroke (RR: 0.88, 95% CI: 0.61-1.29, p = 0.53). Better adherence to a Mediterranean diet was associated with lower risk of MI, HF and ischemic stroke. The Mediterranean diet is most likely to be beneficial in primary prevention of all major types of atherosclerosis-related CVD. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  11. The metabolic syndrome and risk of myocardial infarction in familial hypertension (hypertension heredity in Malmö evaluation study).

    Science.gov (United States)

    Fedorowski, Artur; Burri, Philippe; Hulthén, Lennart; Melander, Olle

    2009-01-01

    The aim of this study was to examine whether three main definitions of the metabolic syndrome (MetS)--WHO, National Cholesterol Education Program--Adult Treatment Panel III and International Diabetes Federation--identify the same individuals and are able to predict incident myocardial infarction (MI) in families with essential hypertension. The tested definitions were prospectively related to data on MI in a cohort of approximately 1700 individuals with overt essential hypertension and their normotensive first-degree relatives. At baseline, 616 participants had MetS, yet only 209 of them (33.9%) were identified by all definitions, and compatibility rate for each pair of definitions was approximately 50%. During follow-up (Tmean approximately 6.6 years) 53 participants developed MI and they were generally older and more dysmetabolic than the rest of the cohort. There were also more men, smokers and diabetic individuals in this group. After adjustment for all conventional cardiovascular risk factors, including hypertension and diabetes, only the National Cholesterol Education Program definition could predict the increased risk of MI [odds ratio (OR) = 2.2, confidence interval (CI) = 1.2-4.0, P = 0.01]. Among individual MetS components, incident MI was independently associated with three of them: low high-density lipoprotein-cholesterol (OR = 2.03, CI = 1.09-3.78, P = 0.025) insulin resistance (OR = 2.02, CI = 1.08-3.78, P = 0.028) and increased albumin excretion rate (OR = 1.24, CI = 0.99-1.55, P = 0.060). The presence of MetS in hypertensive and genetically hypertension prone individuals may signal the increased risk of future MI. However, only the National Cholesterol Education Program criteria appear to have a sufficient predictive accuracy.

  12. Shift work and 20-year incidence of acute myocardial infarction: results from the Kuopio Ischemic Heart Disease Risk Factor Study.

    Science.gov (United States)

    Wang, Aolin; Arah, Onyebuchi A; Kauhanen, Jussi; Krause, Niklas

    2016-09-01

    It remains unclear whether different types of shift work impose similar risks for cardiovascular events in middle-aged workers, especially those with pre-existing ischaemic heart disease (IHD). This study investigated the relations between different shift types and incident acute myocardial infarction (AMI) among men with and without pre-existing IHD, respectively. We analysed data on 1891 men, aged 42-60 years at baseline, in the prospective Kuopio Ischemic Heart Disease Risk Factor Study cohort, using Cox proportional hazard models with adjustment for demographic, biological, behavioural and psychosocial job factors. We evaluated the associations of baseline shift work with 20-year incidence of AMI, and their modification by pre-existing IHD, using both stratified analysis and models with product terms between shift work and IHD. Travelling work (at least 3 nights per week away from home) was strongly positively associated with AMI among men with IHD (HR=2.45, 95% CI 1. 08 to 5.59) but not among men without (HR=0.93, 95% CI 0.43 to 2.00). No clear associations were found between other types of shift work and AMI for both men with and without IHD. On both additive and multiplicative scales, baseline IHD status positively modified the association of travelling work with AMI (relative excess risk for interaction=3.23, 95% CI -0.50 to 6.97, p for multiplicative interaction=0.044). We found mixed results for the associations between different types of shift work and AMI among those with and without pre-existing IHD. Future research should investigate these associations and effect modification for a broad spectrum of work schedules. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  13. Relative Risk of Acute Myocardial Infarction in People with Schizophrenia and Bipolar Disorder: A Population-Based Cohort Study.

    Directory of Open Access Journals (Sweden)

    Shu-I Wu

    Full Text Available Despite high mortality associated with serious mental illness, risk of acute myocardial infarction (AMI remains unclear, especially for patients with bipolar disorder. The main objective was to investigate the relative risk of AMI associated with schizophrenia and bipolar disorders in a national sample.Using nationwide administrative data, an 11-year historic cohort study was assembled, comprised of cases aged 18 and above who had received a diagnosis of schizophrenia or bipolar disorder, compared to a random sample of all other adults excluding those with diagnoses of serious mental illness. Incident AMI as a primary diagnosis was ascertained. Hazard ratios stratified by age and gender were calculated and Cox regression models were used to adjust for other covariates.A total of 70,225 people with schizophrenia or bipolar disorder and 207,592 people without serious mental illness were compared. Hazard ratios in men adjusted for age, income and urbanization were 1.15 (95% CI 1.01~1.32 for schizophrenia and 1.37 (1.08~1.73for bipolar disorder, and in women, 1.85 (1.58~2.18 and 1.88(1.47~2.41 respectively. Further adjustment for treated hypertension, diabetes and hyperlipidaemia attenuated the hazard ratio for men with schizophrenia but not the other comparison groups. Hazard ratios were significantly stronger in women than men and were stronger in younger compared to older age groups for both disorders; however, gender modification was only significant in people with schizophrenia, and age modification only significant in people with bipolar disorder.In this large national sample, schizophrenia and bipolar disorder were associated with raised risk of AMI in women and in the younger age groups although showed differences in potential confounding and modifying factors.

  14. Relative Risk of Acute Myocardial Infarction in People with Schizophrenia and Bipolar Disorder: A Population-Based Cohort Study.

    Science.gov (United States)

    Wu, Shu-I; Chen, Su-Chiu; Liu, Shen-Ing; Sun, Fang-Ju; Juang, Jimmy J M; Lee, Hsin-Chien; Kao, Kai-Liang; Dewey, Michael E; Prince, Martin; Stewart, Robert

    2015-01-01

    Despite high mortality associated with serious mental illness, risk of acute myocardial infarction (AMI) remains unclear, especially for patients with bipolar disorder. The main objective was to investigate the relative risk of AMI associated with schizophrenia and bipolar disorders in a national sample. Using nationwide administrative data, an 11-year historic cohort study was assembled, comprised of cases aged 18 and above who had received a diagnosis of schizophrenia or bipolar disorder, compared to a random sample of all other adults excluding those with diagnoses of serious mental illness. Incident AMI as a primary diagnosis was ascertained. Hazard ratios stratified by age and gender were calculated and Cox regression models were used to adjust for other covariates. A total of 70,225 people with schizophrenia or bipolar disorder and 207,592 people without serious mental illness were compared. Hazard ratios in men adjusted for age, income and urbanization were 1.15 (95% CI 1.01~1.32) for schizophrenia and 1.37 (1.08~1.73)for bipolar disorder, and in women, 1.85 (1.58~2.18) and 1.88(1.47~2.41) respectively. Further adjustment for treated hypertension, diabetes and hyperlipidaemia attenuated the hazard ratio for men with schizophrenia but not the other comparison groups. Hazard ratios were significantly stronger in women than men and were stronger in younger compared to older age groups for both disorders; however, gender modification was only significant in people with schizophrenia, and age modification only significant in people with bipolar disorder. In this large national sample, schizophrenia and bipolar disorder were associated with raised risk of AMI in women and in the younger age groups although showed differences in potential confounding and modifying factors.

  15. Changes over time in risk factors for cardiovascular disease and use of lipid-lowering drugs in HIV-infected individuals and impact on myocardial infarction

    DEFF Research Database (Denmark)

    Sabin, C A; d'Arminio Monforte, A; Friis-Moller, N

    2008-01-01

    for CVD and the use of lipid-lowering therapy in HIV-infected individuals and assessed the impact of any changes on the incidence of myocardial infarction. METHODS: The Data Collection on Adverse Events of Anti-HIV Drugs Study is a collaboration of 11 cohorts of HIV-infected patients that included follow...... was more common for those with abnormal lipid values and those with traditional risk factors for CVD (male sex, older age, higher body mass index [calculated as the weight in kilograms divided by the square of the height in meters], family and personal history of CVD, and diabetes mellitus). After...... controlling for these, use of lipid-lowering drugs became relatively less common over time. The incidence of myocardial infarction (0.32 cases per 100 person-years [PY]; 95% confidence interval [CI], 0.29-0.35 cases per 100 PY) appeared to remain stable. However, after controlling for changes in risk factors...

  16. Area at risk and collateral circulation in a first acute myocardial infarction with occluded culprit artery. STEMI vs non-STEMI patients.

    Science.gov (United States)

    Figueras, Jaume; Otaegui, Imanol; Marti, Gerard; Domingo, Enric; Bañeras, Jordi; Barrabés, José A; Del Blanco, Bruno Garcia; Garcia-Dorado, David

    2018-05-15

    It is unclear why among patients with first acute myocardial infarction and an occluded culprit artery only some present ST segment elevation. In fact, there is no study that compares the angiographic area at risk and the collateral circulation in first NSTEMI vs STEMI patients. 205 patients admitted for myocardial infarction with occluded culprit artery were included, 132 STEMI and 73 NSTEMI. Demographic data, the area at risk determined by the BARI score and collateral supply by the Rentrop score from the 2 groups were compared. NSTEMI patients showed lower peak Tn I than STEMI in the overall group but also in the 3 subsets with different culprit arteries (p collaterals (Rentrop score ≥ 2, 1.82 vs 0.41, p collateral blood supply than STEMI patients in each of the 3 main culprit arteries. Copyright © 2018 Elsevier B.V. All rights reserved.

  17. Low protein Z plasma level is a risk factor for acute myocardial infarction in coronary atherosclerosis disease patients

    Science.gov (United States)

    Liu, Baoxin; Li, Yong; Luo, Jiachen; Dai, Liming; Zhao, Jinlong; Li, Hongqiang; Jie, Qiqiang; Wang, Dongzhi; Huang, Xin; Wei, Yidong

    2016-01-01

    Objectives To examine plasma protein Z (PZ) levels in acute myocardial infarction (AMI) and chronic coronary atherosclerosis disease (CCAD) patients without history of AMI and explore its potential clinical significance. Methods Plasma PZ concentrations were measured in 90 AMI patients (Group A), 87 CCAD patients without AMI history who remained free of major clinical events at least one year (Group B), and 88 clinically healthy controls (Group C). Results PZ was found to be significantly lower (PC (2001.7 ± 733.0 ng/mL) groups and in A+B compared with C Group (A+B 1663.1±570.0, PC groups (P=0.081). PZ level was significantly correlated with concentration of creatine kinase MB, high sensitive-cardiac troponin T, high sensitive C reactive protein, D-dimer and coagulation factor II and may be a useful predictor for AMI (OR: 1.38, 95% CI: 1.13-1.77, P=0.03). Subgroup analysis showed PZ concentration below the lowest tertile (< 1398 ng/mL) had a significantly increased risk for AMI and CCAD (OR: 3.39; 95% CI: 1.12-10.31; P=0.03 and OR: 7.39; 95% CI: 2.62-20.79; P<0.001 respectively). Conclusions PZ deficiency is found in AMI patients and could potentially reflect the myocardium injury, local coagulation activation and inflammation response during the acute phase of coronary atherosclerosis disease. PMID:27770663

  18. A serum biomarker reflecting collagen type I degradation (C1M) is an independent risk factor for acute myocardial infarction in postmenopausal women: results from the PERF study

    DEFF Research Database (Denmark)

    Bertelsen, D.M.; Nielsen, Signe Holm; Neergaard, J.S.

    2017-01-01

    Cardiovascular disease (CVD) is the leading cause of death in postmenopausal women, and symptoms of ischemic heart disease (IHD) and acute myocardial infarction (AMI) are often overlooked. With the loss of estrogen production collagen stability is affected with potential of an increased risk of u...... of unstable plaques in coronary vessels. Collagen type I, a major component of the cardiac extracellular matrix (ECM), is cleaved by matrix metalloproteinases (MMPs) and known to be active remodeled in CVD....

  19. The interaction between coagulation factor 2 receptor and interleukin 6 haplotypes increases the risk of myocardial infarction in men.

    Directory of Open Access Journals (Sweden)

    Bruna Gigante

    Full Text Available The aim of the study was to investigate if the interaction between the coagulation factor 2 receptor (F2R and the interleukin 6 (IL6 haplotypes modulates the risk of myocardial infarction (MI in the Stockholm Heart Epidemiology Program (SHEEP. Seven SNPs at the F2R locus and three SNPs at the IL6 locus were genotyped. Haplotypes and haplotype pairs (IL6*F2R were generated. A logistic regression analysis was performed to analyze the association of the haplotypes and haplotype pairs with the MI risk. Presence of an interaction between the two haplotypes in each haplotype pair was calculated using two different methods: the statistical, on a multiplicative scale, which includes the cross product of the two factors into the logistic regression model; the biological, on an additive scale, which evaluates the relative risk associated with the joint presence of both factors. The ratio between the observed and the predicted effect of the joint exposure, the synergy index (S, indicates the presence of a synergy (S>1 or of an antagonism (S<1. None of the haplotypes within the two loci was associated with the risk of MI. Out of 22 different haplotype pairs, the haplotype pair 17 GGG*ADGTCCT was associated with an increased risk of MI with an OR (95%CI of 1.58 (1.05-2.41 (p = 0.02 in the crude and an OR of 1.72 (1.11-2.67 (p = 0.01 in the adjusted analysis. We observed the presence of an interaction on a multiplicative scale with an OR (95%CI of 2.24 (1.27-3.95 (p = 0.005 and a slight interactive effect between the two haplotypes on an additive scale with an OR (95%CI of 1.56 (1.02-2.37 (p = 0.03 and S of 1.66 (0.89-31. In conclusion, our results support the hypothesis that the interaction between these two functionally related genes may influence the risk of MI and suggest new mechanisms involved in the genetic susceptibility to MI.

  20. Risk of myocardial infarction and death associated with the use of nonsteroidal anti-inflammatory drugs (NSAIDs) among healthy individuals: a nationwide cohort study

    DEFF Research Database (Denmark)

    Fosbøl, E L; Gislason, G H; Jacobsen, S

    2008-01-01

    Use of some nonsteroidal anti-inflammatory drugs (NSAIDs) is associated with increased cardiovascular risk in several patient groups, but whether this excess risk exists in apparently healthy individuals has not been clarified. Using a historical cohort design, we estimated the risk of death...... and myocardial infarction associated with the use of NSAIDs. Participants in the study were selected from the Danish population and were defined as healthy according to a history of no hospital admissions and no concomitant selected pharmacotherapy. The source population consisted of 4,614,807 individuals...

  1. Levothyroxine substitution in patients with subclinical hypothyroidism and the risk of myocardial infarction and mortality

    DEFF Research Database (Denmark)

    Andersen, Mette Nygaard; Olsen, Anne-Marie Schjerning; Madsen, Jesper Clausager

    2015-01-01

    BACKGROUND: Subclinical hypothyroidism is associated with a number of cardiovascular risk factors, yet only limited data exist on long-term outcome of levothyroxine treatment of this condition with respect to hard end-points. The aim of this retrospective cohort study was to determine effects of ...

  2. Feelings of being disabled as a risk factor for mortality up to 8 years after acute myocardial infarction

    DEFF Research Database (Denmark)

    van der Vlugt, Maureen J; van Domburg, Ron T; Pedersen, Susanne S.

    2005-01-01

    We examined the independent prognostic value of the four subscales of the Heart Patients Psychological Questionnaire (HPPQ) on mortality in acute myocardial infarction (AMI) survivors up to 8 years after the event.......We examined the independent prognostic value of the four subscales of the Heart Patients Psychological Questionnaire (HPPQ) on mortality in acute myocardial infarction (AMI) survivors up to 8 years after the event....

  3. Time-perspective in cardiovascular risk of NSAID use after first-time myocardial infarction

    DEFF Research Database (Denmark)

    Olsen, Anne-Marie Schjerning; Gislason, Gunnar H; Fosbøl, Emil L

    2013-01-01

    PURPOSE OF REVIEW: Despite the fact that NSAIDs are not recommended among patients with established cardiovascular disease, many patients receive NSAID treatment for a short period of time. However, up until recently, data on the relationship between treatment duration and associated cardiovascular...... furthermore demonstrated that NSAID use among patients with first-time MI was associated with persistently increased risk of all-cause mortality and of a composite of coronary death or nonfatal recurrent MI for at least 5 years thereafter. SUMMARY: The present review indicates that there is no apparent well......-tolerated therapeutic window for associated cardiovascular risk and NSAID use in patients with prior MI. Further randomized studies are warranted to evaluate the cardiovascular safety of NSAIDs, but, at this point, the overall evidence suggests advising caution in using NSAIDs at all times after MI. Legislation bodies...

  4. Analytical Hierarchy Process modeling for malaria risk zones in Vadodara district, Gujarat

    Science.gov (United States)

    Bhatt, B.; Joshi, J. P.

    2014-11-01

    Malaria epidemic is one of the complex spatial problems around the world. According to WHO, an estimated 6, 27, 000 deaths occurred due to malaria in 2012. In many developing nations with diverse ecological regions, it is still a large cause of human mortality. Owing to the incompleteness of epidemiological data and their spatial origin, the quantification of disease incidence burdening basic public health planning is a major constrain especially in developing countries. The present study focuses on the integrated Geospatial and Multi-Criteria Evaluation (AHP) technique to determine malaria risk zones. The study is conducted in Vadodara district, including 12 Taluka among which 4 Taluka are predominantly tribal. The influence of climatic and physical environmental factors viz., rainfall, hydro geomorphology; drainage, elevation, and land cover are used to score their share in the evaluation of malariogenic condition. This was synthesized on the basis of preference over each factor and the total weights of each data and data layer were computed and visualized. The district was divided into three viz., high, moderate and low risk zones .It was observed that a geographical area of 1885.2sq.km comprising 30.3% fall in high risk zone. The risk zones identified on the basis of these parameters and assigned weights shows a close resemblance with ground condition. As the API distribution for 2011overlaid corresponds to the risk zones identified. The study demonstrates the significance and prospect of integrating Geospatial tools and Analytical Hierarchy Process for malaria risk zones and dynamics of malaria transmission.

  5. Evaluation of risk scores for risk stratification of acute coronary syndromes in the Myocardial Infarction National Audit Project (MINAP) database.

    Science.gov (United States)

    Gale, C P; Manda, S O M; Weston, C F; Birkhead, J S; Batin, P D; Hall, A S

    2009-03-01

    To compare the discriminative performance of the PURSUIT, GUSTO-1, GRACE, SRI and EMMACE risk models, assess their performance among risk supergroups and evaluate the EMMACE risk model over the wider spectrum of acute coronary syndrome (ACS). Observational study of a national registry. All acute hospitals in England and Wales. 100 686 cases of ACS between 2003 and 2005. Model performance (C-index) in predicting the likelihood of death over the time period for which they were designed. The C-index, or area under the receiver-operating curve, range 0-1, is a measure of the discriminative performance of a model. The C-indexes were: PURSUIT C-index 0.79 (95% confidence interval 0.78 to 0.80); GUSTO-1 0.80 (0.79 to 0.81); GRACE in-hospital 0.80 (0.80 to 0.81); GRACE 6-month 0.80 (0.79 to 0.80); SRI 0.79 (0.78 to 0.80); and EMMACE 0.78 (0.77 to 0.78). EMMACE maintained its ability to discriminate 30-day mortality throughout different ACS diagnoses. Recalibration of the model offered no notable improvement in performance over the original risk equation. For all models the discriminative performance was reduced in patients with diabetes, chronic renal failure or angina. The five ACS risk models maintained their discriminative performance in a large unselected English and Welsh ACS population, but performed less well in higher-risk supergroups. Simpler risk models had comparable performance to more complex risk models. The EMMACE risk score performed well across the wider spectrum of ACS diagnoses.

  6. Use of nucleoside reverse transcriptase inhibitors and risk of myocardial infarction in HIV-infected patients enrolled in the D:A:D study: a multi-cohort collaboration

    DEFF Research Database (Denmark)

    Sabin, Caroline A; Worm, Signe W; Weber, Rainer

    2008-01-01

    cohort of HIV-infected patients. METHODS: We used Poisson regression models to quantify the relation between cumulative, recent (currently or within the preceding 6 months), and past use of zidovudine, didanosine, stavudine, lamivudine, and abacavir and development of myocardial infarction in 33 347......BACKGROUND: Whether nucleoside reverse transcriptase inhibitors increase the risk of myocardial infarction in HIV-infected individuals is unclear. Our aim was to explore whether exposure to such drugs was associated with an excess risk of myocardial infarction in a large, prospective observational...... patients enrolled in the D:A:D study. We adjusted for cardiovascular risk factors that are unlikely to be affected by antiretroviral therapy, cohort, calendar year, and use of other antiretrovirals. FINDINGS: Over 157,912 person-years, 517 patients had a myocardial infarction. We found no associations...

  7. The adjusted Global AntiphosPholipid Syndrome Score (aGAPSS) for risk stratification in young APS patients with acute myocardial infarction.

    Science.gov (United States)

    Radin, M; Schreiber, K; Costanzo, P; Cecchi, I; Roccatello, D; Baldovino, S; Bazzan, M; Cuadrado, M J; Sciascia, S

    2017-08-01

    Young adults with acute myocardial infarction are a critical group to examine for the purpose of risk factor stratification and modification. In this study we aimed to assess the clinical utility of the adjusted Global AntiphosPholipid Syndrome Score (aGAPSS) for the risk stratification of acute myocardial infarction in a cohort of young patients with antiphospholipid syndrome (APS). The analysis included 83 consecutive APS patients (≤50years old) who presented with arterial or venous thromboembolic events. Data on cardiovascular risk factors and antiphospholipid antibodies (aPL) positivity were retrospectively collected. The aGAPSS was calculated by adding the points corresponding to the risk factors, based on a linear transformation derived from the ß-regression coefficient as follows: 3 for hyperlipidaemia, 1 for arterial hypertension, 5 for aCL IgG/IgM, 4 for anti-b2 glycoprotein I IgG/IgM and 4 for LA. Higher aGAPSS values were observed in patients with acute myocardial infarction when compared to the others [mean aGAPSS 11.9 (S.D. 4.15, range 4-18) Vs. mean aGAPSS 9.2 (S.D. 5.1, range 1-17); T test: psyndrome compared to patients with a history of peripheral or cerebrovascular arterial thrombotic events [mean aGAPSS 11.9 (S.D. 4.15, range 4-18) Vs. mean aGAPSS 6.7 (S.D. 5.7, range 1-17); T test: P<0.005]. The aGAPSS is based upon a quantitative score and could aid risk stratifying APS patients younger than 50years for the likelihood of developing coronary thrombotic events and may guide pharmacological treatment for high-risk patients. Copyright © 2017 Elsevier B.V. All rights reserved.

  8. Predictive value of routine point-of-care cardiac troponin T measurement for prehospital diagnosis and risk-stratification in patients with suspected acute myocardial infarction

    DEFF Research Database (Denmark)

    Rasmussen, Martin B; Stengaard, Carsten; Sørensen, Jacob T

    2017-01-01

    -of-care cardiac troponin T measurements (11.0%) had a value ≥50 ng/l, including 966 with acute myocardial infarction (sensitivity: 44.2%, specificity: 92.8%). Patients presenting with a prehospital point-of-care cardiac troponin T value ≥50 ng/l had a one-year mortality of 24% compared with 4.8% in those...... with values analysis: point-of-care cardiac troponin T≥50 ng/l (hazard ratio 2.10, 95% confidence interval: 1.90-2.33), congestive heart failure (hazard ratio 1.93, 95% confidence interval: 1......OBJECTIVE: The purpose of this study was to determine the predictive value of routine prehospital point-of-care cardiac troponin T measurement for diagnosis and risk stratification of patients with suspected acute myocardial infarction. METHODS AND RESULTS: All prehospital emergency medical service...

  9. Short-term mortality risk of serum potassium levels in acute heart failure following myocardial infarction

    DEFF Research Database (Denmark)

    Krogager, Maria Lukács; Eggers-Kaas, Lotti; Aasbjerg, Kristian

    2015-01-01

    /L, normal potassium 4.3-4.5 mmol/L, high normal potassium 4.6-5.0 mmol/L, mild hyperkalaemia 5.1-5.5 mmol/L, and severe hyperkalaemia: >5.5 mmol/L. Follow-up was 90 days and using normal potassium 3.9-4.2 mmol/L as a reference, we estimated the risk of death with a multivariable-adjusted Cox proportional.......14-3.19], and mild and severe hyperkalaemia (HR: 2, CI: 1.25-3.18 and HR: 5.6, CI: 3.38-9.29, respectively). Low and high normal potassium were also associated with increased mortality (HR: 1.84, CI: 1.23-2.76 and HR: 1.55, CI: 1.09-2.22, respectively). CONCLUSION: Potassium levels outside the interval 3.9-4.5 mmol...

  10. Absolute cardiovascular risk in a Fiji medical zone.

    Science.gov (United States)

    Gyaneshwar, Rajat; Naidu, Swaran; Raban, Magdalena Z; Naidu, Sheetal; Linhart, Christine; Morrell, Stephen; Tukana, Isimeli; Taylor, Richard

    2016-02-09

    The population of Fiji has experienced emergence of non-communicable disease (NCD) and a plateau in life expectancy over the past 20 years. A mini-STEPS survey (n = 2765) was conducted in Viseisei in Western Fiji to assess NCD risk factors (RFs) in i-Taukei (Melanesians) and those of Indian descent aged 25-64 years (response 73 %). Hypertension (HT) was defined as systolic blood pressure (BP) ≥140 mmHg or diastolic BP ≥90 mmHg or on medication for HT; type 2 diabetes mellitus (T2DM) as fasting plasma glucose ≥7.0 mmol/L or on medication for T2DM; and obesity as a body mass index (kilograms/height(metres)(2)) ≥30. Data were age-adjusted to 2007 Fiji Census. Associations between RFs and ethnicity/education were investigated. Comparisons with Fiji STEPS surveys were undertaken, and the absolute risk of a cardiovascular disease (CVD) event/death in 10 years was estimated from multiple RF charts. NCD/RFs increased with age except excessive alcohol intake and daily smoking (women) which declined. Daily smoking was higher in men 33 % (95 % confidence interval: 31-36) than women 14 % (12-116); women were more obese 40 % (37-43) than men 23 % (20-26); HT was similar in men 37 % (34-40) and women 34 % (31-36), as was T2DM in men 15 % (13-17) and women 17 % (15-19). i-Taukei men had an odds ratio (OR) of 0.41 (0.28-0.58) for T2DM compared to Indians (1.00); and i-Taukei (both sexes) had a higher OR for obesity and low fruit/vegetable intake, daily smoking, excessive alcohol intake and HT in females. Increasing education correlated with lesser smoking, but with higher obesity and lower fruit/vegetable intake. Compared to the 2011 Fiji STEPS survey, no significant differences were evident in obesity, HT or T2DM prevalences. The proportion (40-64 years) classified at high or very high risk (≥20 %) of a CVD event/death (over 10 years) based on multiple RFs was 8.3 % for men (8.1 % i-Taukei, 8.5 % Indian), and 6.7 % for women (7.9 % i-Taukei, 6.0 % Indian). The results

  11. Permafrost Degradation Risk Zone Assessment using Simulation Models

    DEFF Research Database (Denmark)

    Daanen, R.P.; Ingeman-Nielsen, Thomas; Marchenko, S.

    2011-01-01

    In this proof-of-concept study we focus on linking large scale climate and permafrost simulations to small scale engineering projects by bridging the gap between climate and permafrost sciences on the one hand and on the other technical recommendation for adaptation of planned infrastructures...... to climate change in a region generally underlain by permafrost. We present the current and future state of permafrost in Greenland as modelled numerically with the GIPL model driven by HIRHAM climate projections up to 2080. We develop a concept called Permafrost Thaw Potential (PTP), defined...... as the potential active layer increase due to climate warming and surface alterations. PTP is then used in a simple risk assessment procedure useful for engineering applications. The modelling shows that climate warming will result in continuing wide-spread permafrost warming and degradation in Greenland...

  12. Reduction in acute myocardial infarction mortality in the United States: risk-standardized mortality rates from 1995-2006.

    Science.gov (United States)

    Krumholz, Harlan M; Wang, Yun; Chen, Jersey; Drye, Elizabeth E; Spertus, John A; Ross, Joseph S; Curtis, Jeptha P; Nallamothu, Brahmajee K; Lichtman, Judith H; Havranek, Edward P; Masoudi, Frederick A; Radford, Martha J; Han, Lein F; Rapp, Michael T; Straube, Barry M; Normand, Sharon-Lise T

    2009-08-19

    During the last 2 decades, health care professional, consumer, and payer organizations have sought to improve outcomes for patients hospitalized with acute myocardial infarction (AMI). However, little has been reported about improvements in hospital short-term mortality rates or reductions in between-hospital variation in short-term mortality rates. To estimate hospital-level 30-day risk-standardized mortality rates (RSMRs) for patients discharged with AMI. Observational study using administrative data and a validated risk model to evaluate 3,195,672 discharges in 2,755,370 patients discharged from nonfederal acute care hospitals in the United States between January 1, 1995, and December 31, 2006. Patients were 65 years or older (mean, 78 years) and had at least a 12-month history of fee-for-service enrollment prior to the index hospitalization. Patients discharged alive within 1 day of an admission not against medical advice were excluded, because it is unlikely that these patients had sustained an AMI. Hospital-specific 30-day all-cause RSMR. At the patient level, the odds of dying within 30 days of admission if treated at a hospital 1 SD above the national average relative to that if treated at a hospital 1 SD below the national average were 1.63 (95% CI, 1.60-1.65) in 1995 and 1.56 (95% CI, 1.53-1.60) in 2006. In terms of hospital-specific RSMRs, a decrease from 18.8% in 1995 to 15.8% in 2006 was observed (odds ratio, 0.76; 95% CI, 0.75-0.77). A reduction in between-hospital heterogeneity in the RSMRs was also observed: the coefficient of variation decreased from 11.2% in 1995 to 10.8%, the interquartile range from 2.8% to 2.1%, and the between-hospital variance from 4.4% to 2.9%. Between 1995 and 2006, the risk-standardized hospital mortality rate for Medicare patients discharged with AMI showed a significant decrease, as did between-hospital variation.

  13. Clinical study on magnetic resonance imaging of lacunar infarcts and cerebrovascular high-risk group

    Energy Technology Data Exchange (ETDEWEB)

    Hironaka, Masatoshi (Hiroshima Univ. (Japan). School of Medicine)

    1990-04-01

    Magnetic resonance imaging (MRI) study was performed in 32 patients with recent lacunar stroke. T2-weighted images showed ischemic lesions more clearly than T1-weighted images. Sixty-six percent of 32 patients had periventricular lesions. Eighty-four percent had subcortical white matter lesions. Sixty-nine percent had lesions in basal ganglia. Twenty-eight percent had lesions in brainstem. Periventricular lesions were revealed symmetrically. On the other hand, lesions in other areas were not detected symmetrically. Severe periventricular lesions on MRI were similar to those of Binswanger's disease. Patients with severe periventricular lesions had often hypertension. Moreover, two of them had dementia. Twenty-three patients with transient ischemic attack had less remarkable lesions than patients with lacunar stroke. Thirty-seven patients with a history of cerebrovascular risk factors (hypertension, diabetes mellitus) had severer lesions compared with normal controls. Sixty-one percent of controls, who had no cerebrovascular symptoms and signs, had MRI lesions. These results suggest that MRI is useful for detection of cerebral ischemic lesions with no associated clinical symptoms or signs. (author).

  14. Effect of goal attainment theory based education program on cardiovascular risks, behavioral modification, and quality of life among patients with first episode of acute myocardial infarction: Randomized study.

    Science.gov (United States)

    Park, Moonkyoung; Song, Rhayun; Jeong, Jin-Ok

    2017-06-01

    Effect of goal-attainment-theory-based education program on cardiovascular risks, behavioral modification, and quality of life among patients with first episode of acute myocardial infarction: randomized study BACKGROUND: The behavioral modification strategies should be explored at the time of admission to lead the maximum effect of cardiovascular risk management. This randomized study aimed to elucidate the effects of a nurse-led theory-based education program in individuals with a first episode of acute myocardial infarction on cardiovascular risks, health behaviors, and quality of life over 6 months. The study involved a convenience sample of 64 patients with acute myocardial infarction who were randomly assigned to either the education group or the control group. The goal-attainment-based education program was designed to set the mutually agreed goals of risk management and the behavioral modification strategies for achieving those goals. Those in the control group received routine management only. The participants in both groups were contacted at 6-8 weeks and at 6 months after discharge to measure outcome variables. Repeated measure ANOVA was conducted using SPSSWIN (version 20.0) to determine the significance of differences in outcome variables over 6 months between the groups. Both groups showed significant positive changes in cardiovascular risks, health behaviors, and quality of life over 6 months. The 2-year risk of cardiovascular disease was significantly reduced in both study groups, but with no significant interaction effect (F=2.01, p=0.142). The performance and maintenance of health behaviors (F=3.75, p=0.029) and the mental component of quality of life (F=4.03, p=0.020) were significantly better in the education group than the control group. Applying a goal-oriented education program at an early stage of hospital management improved and maintained blood glucose, health behaviors, and mental component of the quality of life up to six months in

  15. Myocardial infarction

    International Nuclear Information System (INIS)

    Ando, Jyoji; Yasuda, Hisakazu; Miyamoto, Atsushi; Kobayashi, Tsuyoshi

    1980-01-01

    sup(99m)Tc-pyrophosphate (PYP) scintigraphy and 201 Tl myocardial scintigraphy were utilized for the diagnoses of the presence, the region, and the extent of myocardial infarction. Exercise 201 Tl myocardial scintigrams and exercise radionuclide ventriculography were utilized for diagnosis of coronary artery lesions in angina pectoris. Radionuclide ventriculography was used to investigate effects of coronary artery lesions on cardiac function and hemodynamics. In order to select adequate treatments for myocardial infarction and estimate the prognosis, it was necessary to detect the presence, the region, and the extent of acute myocardial infarction and to investigate effects of partial infarction on hemodynamics by using radionuclide imaging. Exercise myocardial scintigraphy could be carried out noninvasively and repeatedly for diagnosis of coronal artery disease. Therefore, this method could be applied widely. It was possible to use this method as a screening test of coronary artery diseases for the diagnoses of asymptomatic patients who showed ST changes in ECG, the patients with cardiac neurosis and the patency after a reconstructive surgery of coronary artery. (Tsunoda, M.)

  16. Flood Risk Zoning by Using 2D Hydrodynamic Modeling: A Case Study in Jinan City

    Directory of Open Access Journals (Sweden)

    Tao Cheng

    2017-01-01

    Full Text Available Climate change and rapid urbanization have aggravated the rainstorm flood in Jinan City during the past decades. Jinan City is higher in the south and lower in the north with a steep slope inclined from the south to the north. This results in high-velocity overland flow and deep waterlogging, which poses a tremendous threat to pedestrians and vehicles. Therefore, it is vital to investigate the rainstorm flood and further perform flood risk zoning. This study is carried out in the “Sponge City Construction” pilot area of Jinan City, where the InfoWorks ICM 2D hydrodynamic model is utilized for simulating historical and designed rainfall events. The model is validated with observations, and the causes for errors are analyzed. The simulated water depth and flow velocity are recorded for flood risk zoning. The result shows that the InfoWorks ICM 2D model performed well. The flood risk zoning result shows that rainfalls with larger recurrence intervals generate larger areas of moderate to extreme risk. Meanwhile, the zoning results for the two historical rainfalls show that flood with a higher maximum hourly rainfall intensity is more serious. This study will provide scientific support for the flood control and disaster reduction in Jinan City.

  17. Vaccine Hesitancy: In Search of the Risk Communication Comfort Zone.

    Science.gov (United States)

    Greenberg, Joshua; Dubé, Eve; Driedger, Michelle

    2017-03-03

    This paper reports the findings of a national online survey to parents of children aged 5 and younger. The objectives of the study were to assess parental understanding of childhood immunizations, identify sources of information that they trust for vaccine-related content, assess where parents with young children stand on the key issues in the public debate about vaccination, and identify which risk communication messages are most effective for influencing the behaviours of vaccine hesitant parents. A total of 1,000 surveys (closed and open-ended questions) were administered in November 2015 using the Angus Reid Forum Panel, a key consumer panel consisting of approximately 150,000 Canadian adults aged 18 and older, spread across all geographic regions of Canada. Approximately 92% of the Canadian parents surveyed consider vaccines safe and effective, and trust doctors and public health officials to provide timely and credible vaccine-related information. However, a concerning number of them either believe or are uncertain whether there is a link between vaccines and autism (28%), worry that vaccines might seriously harm their children (27%), or believe the pharmaceutical industry is behind the push for mandatory immunization (33%). Moreover, despite the common assumption that social media are becoming the go-to source of health news and information, most parents still rely on traditional media and official government websites for timely and credible information about vaccines and vaccine preventable diseases, particularly during community-based disease outbreaks. Finally, parents reported high levels of support for pro-vaccine messaging that has been demonstrated in previous research to have little to no positive impact on behaviour change, and may even be counterproductive. The study's results are highly relevant in a context where public health officials are expending significant resources to increase rates of childhood immunization and combat vaccine

  18. Coffee consumption after myocardial infarction and risk of cardiovascular mortality: a prospective analysis in the Alpha Omega Cohort.

    Science.gov (United States)

    van Dongen, Laura H; Mölenberg, Famke Jm; Soedamah-Muthu, Sabita S; Kromhout, Daan; Geleijnse, Johanna M

    2017-10-01

    Background: Consumption of coffee, one of the most popular beverages around the world, has been associated with a lower risk of cardiovascular and all-cause mortality in population-based studies. However, little is known about these associations in patient populations. Objective: This prospective study aimed to examine the consumption of caffeinated and decaffeinated coffee in relation to cardiovascular disease (CVD) mortality, ischemic heart disease (IHD) mortality, and all-cause mortality in patients with a prior myocardial infarction (MI). Design: We included 4365 Dutch patients from the Alpha Omega Cohort who were aged 60-80 y (21% female) and had experienced an MI coffee consumption over the past month was collected with a 203-item validated food-frequency questionnaire. Causes of death were monitored until 1 January 2013. HRs for mortality in categories of coffee consumption were obtained from multivariable Cox proportional hazard models, adjusting for lifestyle and dietary factors. Results: Most patients (96%) drank coffee, and the median total coffee intake was 375 mL/d (∼3 cups/d). During a median follow-up of 7.1 y, a total of 945 deaths occurred, including 396 CVD-related and 266 IHD-related deaths. Coffee consumption was inversely associated with CVD mortality, with HRs of 0.69 (95% CI: 0.54, 0.89) for >2-4 cups/d and 0.72 (0.55, 0.95) for >4 cups/d, compared with 0-2 cups/d. Corresponding HRs were 0.77 (95% CI: 0.57, 1.05) and 0.68 (95% CI: 0.48, 0.95) for IHD mortality and 0.84 (95% CI: 0.71, 1.00) and 0.82 (95% CI: 0.68, 0.98) for all-cause mortality, respectively. Similar associations were found for decaffeinated coffee and for coffee with additives. Conclusion: Drinking coffee, either caffeinated or decaffeinated, may lower the risk of CVD and IHD mortality in patients with a prior MI. This study was registered at clinicaltrials.gov as NCT03192410. © 2017 American Society for Nutrition.

  19. Edad avanzada y factores de riesgo para infarto agudo de miocardio Risk factors for acute myocardial infarction in the elderly

    Directory of Open Access Journals (Sweden)

    M. A. Ciruzzi

    2002-12-01

    Full Text Available Este estudio caso-control analizó en los sujetos añosos el rol de los factores de riesgo coronario en el desarrollo del infarto agudo de miocardio (IAM, estableció la naturaleza de esta asociación y el grado de riesgo. Los datos fueron obtenidos en una investigación que incluyó 1060 casos y 1071 controles, realizada en 35 unidades coronarias de centros médicos de Argentina entre noviembre de 1991 y agosto de 1994. Nuestro análisis se basó en la información de los sujetos mayores de 65 años. Los casos fueron 427 pacientes con un primer IAM. Los controles fueron 396 sujetos sin evidencias clinicas de enfermedad cardiovascular, seleccionados en los mismos centros que los casos. Los Odds Ratios (OR y su intervalo de confianza del 95% (IC 95% se obtuvieron mediante un análisis de regresión logística, incluyendo variables como la edad, educación, clase social, tabaquismo, antecedente de diabetes o hipertensión arterial, índice de masa corporal e historia familiar de enfermedad coronaria. Los factores de riesgo relacionados independientemente con IAM fueron los siguientes: hipercolesterolemia (colesterol sérico > 240 mg/dl: OR=1.76 (IC 95%: 1.25-2.49, tabaquismo: OR=1.6 (IC 95%: 1.06-2.4, hipertensión arterial: OR=2.05 (IC 95%: 1.51-2.73, diabetes OR=1.71 (IC 95%: 1.12-2.70, historia de un familiar con enfermedad coronaria: OR=1.36 (IC 95%: 0.93-1.97 y de dos o más familiares: OR=2.63 (IC 95%: 1.21-5.71. Este estudio, confirma en los sujetos de edad avanzada la importancia de la hipercolesterolemia, del tabaquismo, la hipertesión arterial, la diabetes y la historia familiar de enfermedad coronaria como factores de riesgo de IAMThis case-control study, analized the role of coronary risk factors in acute myocardial infarction (AMI in the elderly, and established the nature of this association and the degree of risk. Data were derived from an investigation (1060 cases and 1071 controls conducted in 35 coronary care units from clinical

  20. The effect of tobacco control measures during a period of rising cardiovascular disease risk in India: a mathematical model of myocardial infarction and stroke.

    Directory of Open Access Journals (Sweden)

    Sanjay Basu

    Full Text Available We simulated tobacco control and pharmacological strategies for preventing cardiovascular deaths in India, the country that is expected to experience more cardiovascular deaths than any other over the next decade.A microsimulation model was developed to quantify the differential effects of various tobacco control measures and pharmacological therapies on myocardial infarction and stroke deaths stratified by age, gender, and urban/rural status for 2013 to 2022. The model incorporated population-representative data from India on multiple risk factors that affect myocardial infarction and stroke mortality, including hypertension, hyperlipidemia, diabetes, coronary heart disease, and cerebrovascular disease. We also included data from India on cigarette smoking, bidi smoking, chewing tobacco, and secondhand smoke. According to the model's results, smoke-free legislation and tobacco taxation would likely be the most effective strategy among a menu of tobacco control strategies (including, as well, brief cessation advice by health care providers, mass media campaigns, and an advertising ban for reducing myocardial infarction and stroke deaths over the next decade, while cessation advice would be expected to be the least effective strategy at the population level. In combination, these tobacco control interventions could avert 25% of myocardial infarctions and strokes (95% CI: 17%-34% if the effects of the interventions are additive. These effects are substantially larger than would be achieved through aspirin, antihypertensive, and statin therapy under most scenarios, because of limited treatment access and adherence; nevertheless, the impacts of tobacco control policies and pharmacological interventions appear to be markedly synergistic, averting up to one-third of deaths from myocardial infarction and stroke among 20- to 79-y-olds over the next 10 y. Pharmacological therapies could also be considerably more potent with further health system

  1. The effect of tobacco control measures during a period of rising cardiovascular disease risk in India: a mathematical model of myocardial infarction and stroke.

    Science.gov (United States)

    Basu, Sanjay; Glantz, Stanton; Bitton, Asaf; Millett, Christopher

    2013-01-01

    We simulated tobacco control and pharmacological strategies for preventing cardiovascular deaths in India, the country that is expected to experience more cardiovascular deaths than any other over the next decade. A microsimulation model was developed to quantify the differential effects of various tobacco control measures and pharmacological therapies on myocardial infarction and stroke deaths stratified by age, gender, and urban/rural status for 2013 to 2022. The model incorporated population-representative data from India on multiple risk factors that affect myocardial infarction and stroke mortality, including hypertension, hyperlipidemia, diabetes, coronary heart disease, and cerebrovascular disease. We also included data from India on cigarette smoking, bidi smoking, chewing tobacco, and secondhand smoke. According to the model's results, smoke-free legislation and tobacco taxation would likely be the most effective strategy among a menu of tobacco control strategies (including, as well, brief cessation advice by health care providers, mass media campaigns, and an advertising ban) for reducing myocardial infarction and stroke deaths over the next decade, while cessation advice would be expected to be the least effective strategy at the population level. In combination, these tobacco control interventions could avert 25% of myocardial infarctions and strokes (95% CI: 17%-34%) if the effects of the interventions are additive. These effects are substantially larger than would be achieved through aspirin, antihypertensive, and statin therapy under most scenarios, because of limited treatment access and adherence; nevertheless, the impacts of tobacco control policies and pharmacological interventions appear to be markedly synergistic, averting up to one-third of deaths from myocardial infarction and stroke among 20- to 79-y-olds over the next 10 y. Pharmacological therapies could also be considerably more potent with further health system improvements. Smoke

  2. Comparison of renal function and cardiovascular risk following acute myocardial infarction in patients with and without diabetes mellitus

    DEFF Research Database (Denmark)

    Anavekar, Nagesh S; Solomon, Scott D; McMurray, John J V

    2008-01-01

    . The valiant trial identified 14,527 patients with acute myocardial infarction complicated by either clinical or radiologic signs of heart failure and/or left ventricular dysfunction for whom baseline creatinine was measured. Patients were randomly assigned to receive captopril, valsartan, or both. Glomerular...

  3. Depression treatment after myocardial infarction and long-term risk of subsequent cardiovascular events and mortality: A randomized controlled trial

    NARCIS (Netherlands)

    Zuidersma, M.; Conradi, H.J.; van Melle, J.P.; Ormel, J.; de Jonge, P.

    2013-01-01

    Objective: Evaluating the effects of implementing an antidepressant treatment strategy in depressed myocardial infarction (MI)-patients on long-term cardiovascular outcomes and all-cause mortality. Methods: MI-patients were evaluated for the presence of a diagnosis of post-MI depression at 3, 6, 9

  4. Depression treatment after myocardial infarction and long-term risk of subsequent cardiovascular events and mortality : A randomized controlled trial

    NARCIS (Netherlands)

    Zuidersma, Marij; Conradi, Henk Jan; van Melle, Joost P.; Ormel, Johan; de Jonge, Peter

    Objective: Evaluating the effects of implementing an antidepressant treatment strategy in depressed myocardial infarction (MI)-patients on long-term cardiovascular outcomes and all-cause mortality. Methods: MI-patients were evaluated for the presence of a diagnosis of post-MI depression at 3, 6, 9

  5. Feelings of being disabled as a risk factor for mortality up to 8 years after acute myocardial infarction.

    NARCIS (Netherlands)

    Vlugt, M.J. van der; Domburg, R.T. van; Pedersen, S.S.; Veerhoek, R.J.; Leenders, I.M.; Pop, G.A.M.; Keurs, D. ter; Deckers, J.W.; Simoons, M.L.; Erdman, R.

    2005-01-01

    OBJECTIVE: We examined the independent prognostic value of the four subscales of the Heart Patients Psychological Questionnaire (HPPQ) on mortality in acute myocardial infarction (AMI) survivors up to 8 years after the event. METHODS: The HPPQ, which measures well-being, feelings of being disabled,

  6. Construction Project Administration and Management for Mitigating Work Zone Accidents and Fatalities: An Integrated Risk Management Model

    Science.gov (United States)

    2009-10-01

    The goal of this research is to mitigate the risk of highway accidents (crashes) and fatalities in work zones. The approach of this research has been to address the mitigation of work zone crashes through the creation of a formal risk management mode...

  7. Acute myocardial infarction in very young adults: A clinical presentation, risk factors, hospital outcome index, and their angiographic characteristics in North India-AMIYA Study.

    Science.gov (United States)

    Sinha, Santosh Kumar; Krishna, Vinay; Thakur, Ramesh; Kumar, Ashutosh; Mishra, Vikas; Jha, Mukesh Jitendra; Singh, Karandeep; Sachan, Mohit; Sinha, Rupesh; Asif, Mohammad; Afdaali, Nasar; Mohan Varma, Chandra

    2017-03-01

    India is currently in the fourth stage of epidemiological transitions where cardiovascular disease is the leading cause of mortality and morbidity. Purpose of the present study was to assess the risk factors, clinical presentation, angiographic profile including severity, and in-hospital outcome of very young adults (aged ≤ 30 years) with first acute myocardial infarction (AMI). Total of 1,116 consecutive patients with ST-segment elevation acute myocardial infarction (STEMI) were studied between March 2013 and February 2015 at LPS Institute of Cardiology, Kanpur, Uttar Pradesh, India. Mean age of the patients was 26.3 years. Risk factors were smoking (78.5%), family history of premature coronary artery disease (CAD) (46.8%), obesity (39.1%), physical inactivity (38.7%) and stressful life events (29.6%). The most common symptom and presentation was chest pain and anterior wall myocardial infarction (AWMI) in 94.8% and 58.8%, respectively. About 80.6% of patients had obstructive CAD with single vessel disease (57.6%), double-vessel disease (12.9%) and left main involvement (3.2%). Left anterior descending (LAD) was commonest culprit artery (58.1%) followed by right coronary artery in 28.2%. In-hospital mortality was 2.8%. Percutaneous coronary intervention was performed in 71.6% of patients. Median number and length of stent were 1.18 and 28 ± 16 mm, respectively. AMI in very young adult occurred most commonly in male. Smoking was the most common risk factor. AWMI owing to LAD artery involvement was the most common presentation. Mean time of presentation after symptom onset was 16.9 hours. In contrast to western population, it is characterised by earlier onset, delayed presentation, more severity, diffuse disease, and more morbidity but with favourable in-hospital mortality.

  8. Race and Sex Differences in Post-Myocardial Infarction Angina Frequency and Risk of 1-Year Unplanned Rehospitalization.

    Science.gov (United States)

    Hess, Connie N; Kaltenbach, Lisa A; Doll, Jacob A; Cohen, David J; Peterson, Eric D; Wang, Tracy Y

    2017-02-07

    Race and sex disparities in in-hospital treatment and outcomes of patients with acute myocardial infarction (MI) have been described, but little is known about race and sex differences in post-MI angina and long-term risk of unplanned rehospitalization. We examined race and sex differences in post-MI angina frequency and 1-year unplanned rehospitalization to identify factors associated with unplanned rehospitalization, testing for whether race and sex modify these relationships. Using TRANSLATE-ACS (Treatment With Adenosine Diphosphate Receptor Inhibitors: Longitudinal Assessment of Treatment Patterns and Events after Acute Coronary Syndrome) data, we examined 6-week and 1-year angina frequency and 1-year unplanned rehospitalization stratified by race and sex among MI patients treated with percutaneous coronary intervention. We used multivariable logistic regression to assess factors associated with unplanned rehospitalization and tested for interactions among angina frequency, race, and sex. A total of 11 595 MI patients survived to 1 year postdischarge; there were 66.6% white male patients, 24.3% white female patients, 5.3% black male patients, and 3.8% black female patients. Overall, 29.7% had angina at 6 weeks, and 20.6% had angina at 1 year postdischarge. Relative to white patients, black patients were more likely to have angina at 6 weeks (female: 44.2% versus 31.8%; male: 33.5% versus 27.1%; both Prace or sex (adjusted 3-way P interaction =0.41). One-fifth of MI patients treated with percutaneous coronary intervention report 1-year postdischarge angina, with black and female patients more likely to have angina and to be rehospitalized. Better treatment of post-MI angina may improve patient quality of life and quality of care and help to lower rates of rehospitalization overall and particularly among black and female patients, given their high prevalence of post-MI angina. URL: http://www.clinicaltrials.gov. Unique identifier: NCT01088503. © 2017 American

  9. Homocysteine enhances the predictive value of the GRACE risk score in patients with ST-elevation myocardial infarction.

    Science.gov (United States)

    Fan, Yan; Wang, Jianjun; Zhang, Sumei; Wan, Zhaofei; Zhou, Dong; Ding, Yanhong; He, Qinli; Xie, Ping

    2017-09-01

    The present study aims to investigate whether the addition of homocysteine level to the Global Registry of Acute Coronary Events (GRACE) risk score enhances its predictive value for clinical outcomes in ST-elevation myocardial infarction (STEMI). A total of 1143 consecutive patients with STEMI were included in this prospective cohort study. Homocysteine was detected, and the GRACE score was calculated. The predictive power of the GRACE score alone or combined with homocysteine was assessed by the receiver operating characteristic (ROC) analysis, methods of net reclassification improvement (NRI) and integrated discrimination improvement (IDI). During a median follow-up period of 36.7 months, 271 (23.7%) patients reached the clinical endpoints. It showed that the GRACE score and homocysteine could independently predict all-cause death [GRACE: HR=1.031 (1.024-1.039), p<0.001; homocysteine: HR=1.023 (1.018-1.028), p<0.001] and MACE [GRACE: HR=1.008 (1.005-1.011), p<0.001; homocysteine: HR=1.022 (1.018-1.025), p<0.001]. When they were used in combination to assess the clinical outcomes, the area under the ROC curve significantly increased from 0.786 to 0.884 (95% CI=0.067-0.128, Z=6.307, p<0.001) for all-cause death and from 0.678 to 0.759 (95% CI=0.055-0.108, Z=5.943, p<0.001) for MACE. The addition of homocysteine to the GRACE model improved NRI (all-cause death: 0.575, p<0.001; MACE: 0.621, p=0.008) and IDI (all-cause death: 0.083, p<0.001; MACE: 0.130, p=0.016), indicating effective discrimination and reclassification. Both the GRACE score and homocysteine are significant and independent predictors for clinical outcomes in patients with STEMI. A combination of them can develop a more predominant prediction for clinical outcomes in these patients.

  10. Atrial fibrillation and cognitive decline-the role of subclinical cerebral infarcts: the atherosclerosis risk in communities study.

    Science.gov (United States)

    Chen, Lin Y; Lopez, Faye L; Gottesman, Rebecca F; Huxley, Rachel R; Agarwal, Sunil K; Loehr, Laura; Mosley, Thomas; Alonso, Alvaro

    2014-09-01

    The mechanism underlying the association of atrial fibrillation (AF) with cognitive decline in stroke-free individuals is unclear. We examined the association of incident AF with cognitive decline in stroke-free individuals, stratified by subclinical cerebral infarcts (SCIs) on brain MRI scans. We analyzed data from 935 stroke-free participants (mean age±SD, 61.5±4.3 years; 62% women; and 51% black) from 1993 to 1995 through 2004 to 2006 in the Atherosclerosis Risk in Communities Study, a biracial community-based prospective cohort study. Cognitive testing (including the digit symbol substitution and the word fluency tests) was performed in 1993 to 1995, 1996 to 1998, and 2004 to 2006 and brain MRI scans in 1993 to 1995 and 2004 to 2006. During follow-up, there were 48 incident AF events. Incident AF was associated with greater annual average rate of decline in digit symbol substitution (-0.77; 95% confidence interval, -1.55 to 0.01; P=0.054) and word fluency (-0.80; 95% confidence interval, -1.60 to -0.01; P=0.048). Among participants without SCIs on brain MRI scans, incident AF was not associated with cognitive decline. In contrast, incident AF was associated with greater annual average rate of decline in word fluency (-2.65; 95% confidence interval, -4.26 to -1.03; P=0.002) among participants with prevalent SCIs in 1993 to 1995. Among participants who developed SCIs during follow-up, incident AF was associated with a greater annual average rate of decline in digit symbol substitution (-1.51; 95% confidence interval, -3.02 to -0.01; P=0.049). The association of incident AF with cognitive decline in stroke-free individuals can be explained by the presence or development of SCIs, raising the possibility of anticoagulation as a strategy to prevent cognitive decline in AF. © 2014 American Heart Association, Inc.

  11. Long-term outcomes of left bundle branch block in high-risk survivors of acute myocardial infarction: the VALIANT experience

    DEFF Research Database (Denmark)

    Stephenson, Kent; Skali, Hicham; McMurray, John J V

    2006-01-01

    was to determine if new LBBB is an independent predictor of long-term fatal and nonfatal outcomes in high-risk survivors of MI by reviewing data from the VALsartan In Acute myocardial iNfarcTion (VALIANT) trial. METHODS: In VALIANT, 14,703 patients with LV systolic dysfunction and/or HF were randomized...... to valsartan, captopril, or both a mean of 5 days after MI. Baseline ECG data were available from 14,259 patients. We assessed the predictive value of new LBBB for death and major cardiovascular outcomes after 3 years, adjusting for multiple baseline covariates including LV ejection fraction. RESULTS...

  12. Evaluation of the impact of genetic polymorphisms in glutathione-related genes on the association between methylmercury or n-3 polyunsaturated long chain fatty acids and risk of myocardial infarction: a case-control study

    Directory of Open Access Journals (Sweden)

    Norberg Margareta

    2011-04-01

    Full Text Available Abstract Background The n-3 polyunsaturated fatty acids eicosapentaenoic acid and docosahexaenoic acid, which are present in fish, are protective against myocardial infarction. However, fish also contains methylmercury, which influences the risk of myocardial infarction, possibly by generating oxidative stress. Methylmercury is metabolized by conjugation to glutathione, which facilitates elimination. Glutathione is also an antioxidant. Individuals with certain polymorphisms in glutathione-related genes may tolerate higher exposures to methylmercury, due to faster metabolism and elimination and/or better glutathione-associated antioxidative capacity. They would thus benefit more from the protective agents in fish, such as eicosapentaenoic+docosahexaenoic acid and selenium. The objective for this study was to elucidate whether genetic polymorphisms in glutathione-related genes modify the association between eicosapentaenoic+docosahexaenoic acid or methylmercury and risk of first ever myocardial infarction. Methods Polymorphisms in glutathione-synthesizing (glutamyl-cysteine ligase catalytic subunit, GCLC and glutamyl-cysteine ligase modifier subunit, GCLM or glutathione-conjugating (glutathione S-transferase P, GSTP1 genes were genotyped in 1027 individuals from northern Sweden (458 cases of first-ever myocardial infarction and 569 matched controls. The impact of these polymorphisms on the association between erythrocyte-mercury (proxy for methylmercury and risk of myocardial infarction, as well as between plasma eicosapentaenoic+docosahexaenoic acid and risk of myocardial infarction, was evaluated by conditional logistic regression. The effect of erythrocyte-selenium on risk of myocardial infarction was also taken into consideration. Results There were no strong genetic modifying effects on the association between plasma eicosapentaenoic+docosahexaenoic acid or erythrocyte-mercury and risk of myocardial infarction risk. When eicosapentaenoic

  13. Comparing patients with spinal cord infarction and cerebral infarction: clinical characteristics, and short-term outcome

    Directory of Open Access Journals (Sweden)

    Naess H

    2011-08-01

    Full Text Available Halvor Naess, Fredrik RomiDepartment of Neurology, Haukeland University Hospital, N-5021 Bergen, NorwayBackground: To compare the clinical characteristics, and short-term outcome of spinal cord infarction and cerebral infarction.Methods: Risk factors, concomitant diseases, neurological deficits on admission, and short-term outcome were registered among 28 patients with spinal cord infarction and 1075 patients with cerebral infarction admitted to the Department of Neurology, Haukeland University Hospital, Bergen, Norway. Multivariate analyses were performed with location of stroke (cord or brain, neurological deficits on admission, and short-term outcome (both Barthel Index [BI] 1 week after symptom onset and discharge home or to other institution as dependent variables.Results: Multivariate analysis showed that patients with spinal cord infarction were younger, more often female, and less afflicted by hypertension and cardiac disease than patients with cerebral infarction. Functional score (BI was lower among patients with spinal cord infarctions 1 week after onset of symptoms (P < 0.001. Odds ratio for being discharged home was 5.5 for patients with spinal cord infarction compared to cerebral infarction after adjusting for BI scored 1 week after onset (P = 0.019.Conclusion: Patients with spinal cord infarction have a risk factor profile that differs significantly from that of patients with cerebral infarction, although there are some parallels to cerebral infarction caused by atherosclerosis. Patients with spinal cord infarction were more likely to be discharged home when adjusting for early functional level on multivariate analysis.Keywords: spinal cord infarction, cerebral infarction, risk factors, short-term outcome

  14. Longitude Position in a Time Zone and Cancer Risk in the United States.

    Science.gov (United States)

    Gu, Fangyi; Xu, Shangda; Devesa, Susan S; Zhang, Fanni; Klerman, Elizabeth B; Graubard, Barry I; Caporaso, Neil E

    2017-08-01

    Background: Circadian disruption is a probable human carcinogen. From the eastern to western border of a time zone, social time is equal, whereas solar time is progressively delayed, producing increased discrepancies between individuals' social and biological circadian time. Accordingly, western time zone residents experience greater circadian disruption and may be at an increased risk of cancer. Methods: We examined associations between the position in a time zone and age-standardized county-level incidence rates for total cancers combined and 23 specific cancers by gender using the data of the Surveillance, Epidemiology, and End Results Program (2000-2012), including four million cancer diagnoses in white residents of 607 counties in 11 U.S. states. Log-linear regression was conducted, adjusting for latitude, poverty, cigarette smoking, and state. Bonferroni-corrected P values were used as the significance criteria. Results: Risk increased from east to west within a time zone for total and for many specific cancers, including chronic lymphocytic leukemia (both genders) and cancers of the stomach, liver, prostate, and non-Hodgkin lymphoma in men and cancers of the esophagus, colorectum, lung, breast, and corpus uteri in women. Conclusions: Risk increased from the east to the west in a time zone for total and many specific cancers, in accord with the circadian disruption hypothesis. Replications in analytic epidemiologic studies are warranted. Impact: Our findings suggest that circadian disruption may not be a rare phenomenon affecting only shift workers, but is widespread in the general population with broader implications for public health than generally appreciated. Cancer Epidemiol Biomarkers Prev; 26(8); 1306-11. ©2017 AACR . ©2017 American Association for Cancer Research.

  15. The effects of centre-based rehabilitation after acute myocardial infarction on exercise capacity and risk factors for coronary heart disease

    Directory of Open Access Journals (Sweden)

    Polona Mlakar

    2014-11-01

    Full Text Available Background Rehabilitation following acute myocardial infarction (AMI is a crucial part of secondary prevention for coronary heart disease. The aim of our study was to determine the efficiency of our national in-patient rehabilitation program in improving exercise capacity and lowering risk factors for coronary heart disease.Methods 25 patients 3-9 weeks after AMI, undergoing 2 week in-patient cardiac rehabilitation, were included in our study. We performed exercise stress testing and measurement of classic risk factors before and after the rehabilitation. Classic risk factors were compared with 25 age matched adults without known risk factors for coronary heart disease.Results Patients after AMI had lower exercise capacity than healthy adults (p≤0.002 for double product, maximal load, systolic blood pressure, heart rate and time of load. Patients recieved appropriate drug therapy after myocardial infarction, which presented as lower diastolic and a trend to lower systolic blood pressure (p=0.002 and 0.080, lower total and LDL cholesterol values (both p<0.001 than healthy adults, but higher values of metabolic syndrome parameters (higher waist cifcumference p=0.045, higher hip-waist ratio, lower HDL cholesterol, both p<0.001, and a trend to higher body mass index. Although we observed significant increases in exercise capacity (higher, maximal load, systolic blood pressure,double product and time of load, all p≤0.003, no changes in classic risk factors during rehabilitaiton were demonstrated.Conclusions In-patient program of cardiac rehabilitation efficiently elevates exercise capacity in patients after AMI, but fails to influence classic risk factors for coronary heart disease, which might be due to lack of controlled cardioprotective diet during rehabilitation.

  16. Derivation and validation of a risk standardization model for benchmarking hospital performance for health-related quality of life outcomes after acute myocardial infarction.

    Science.gov (United States)

    Arnold, Suzanne V; Masoudi, Frederick A; Rumsfeld, John S; Li, Yan; Jones, Philip G; Spertus, John A

    2014-01-21

    Before outcomes-based measures of quality can be used to compare and improve care, they must be risk-standardized to account for variations in patient characteristics. Despite the importance of health-related quality of life (HRQL) outcomes among patients with acute myocardial infarction (AMI), no risk-standardized models have been developed. We assessed disease-specific HRQL using the Seattle Angina Questionnaire at baseline and 1 year later in 2693 unselected AMI patients from 24 hospitals enrolled in the Translational Research Investigating Underlying disparities in acute Myocardial infarction Patients' Health status (TRIUMPH) registry. Using 57 candidate sociodemographic, economic, and clinical variables present on admission, we developed a parsimonious, hierarchical linear regression model to predict HRQL. Eleven variables were independently associated with poor HRQL after AMI, including younger age, previous coronary artery bypass graft surgery, depressive symptoms, and financial difficulties (R(2)=20%). The model demonstrated excellent internal calibration and reasonable calibration in an independent sample of 1890 AMI patients in a separate registry, although the model slightly overpredicted HRQL scores in the higher deciles. Among the 24 TRIUMPH hospitals, 1-year unadjusted HRQL scores ranged from 67-89. After risk-standardization, HRQL score variability narrowed substantially (range=79-83), and the group of hospital performance (bottom 20%/middle 60%/top 20%) changed in 14 of the 24 hospitals (58% reclassification with risk-standardization). In this predictive model for HRQL after AMI, we identified risk factors, including economic and psychological characteristics, associated with HRQL outcomes. Adjusting for these factors substantially altered the rankings of hospitals as compared with unadjusted comparisons. Using this model to compare risk-standardized HRQL outcomes across hospitals may identify processes of care that maximize this important patient

  17. Existing and potential infection risk zones of yellow fever worldwide: a modelling analysis

    OpenAIRE

    Shearer, Freya M; Longbottom, Joshua; Browne, Annie J; Pigott, David M; Brady, Oliver J; Kraemer, Moritz U G; Marinho, Fatima; Yactayo, Sergio; de Araújo, Valdelaine E M; da Nóbrega, Aglaêr A; Fullman, Nancy; Ray, Sarah E; Mosser, Jonathan F; Stanaway, Jeffrey D; Lim, Stephen S

    2018-01-01

    Summary: Background: Yellow fever cases are under-reported and the exact distribution of the disease is unknown. An effective vaccine is available but more information is needed about which populations within risk zones should be targeted to implement interventions. Substantial outbreaks of yellow fever in Angola, Democratic Republic of the Congo, and Brazil, coupled with the global expansion of the range of its main urban vector, Aedes aegypti, suggest that yellow fever has the propensity t...

  18. Understanding factors that influence the use of risk scoring instruments in the management of patients with unstable angina or non-ST-elevation myocardial infarction in the Netherlands: a qualitative study of health care practitioners’ perceptions.

    NARCIS (Netherlands)

    Engel, J.; Heeren, M.J.; Wulp, I. van der; Bruijne, M.C. de; Wagner, C.

    2014-01-01

    Background Cardiac risk scores estimate a patient’s risk of future cardiac events or death. They are developed to inform treatment decisions of patients diagnosed with unstable angina or non-ST-elevation myocardial infarction. Despite recommending their use in guidelines and

  19. Influence of interleukin-1 beta gene polymorphisms on the risk of myocardial infarction and ischemic stroke at young age in vivo and in vitro.

    Science.gov (United States)

    Yang, Bo; Zhao, Hua; X, Bin; Wang, Ya-Bin; Zhang, Jian; Cao, Yu-Kang; Wu, Qing; Cao, Feng

    2015-01-01

    In this study, by using vivo and vitro model, we assessed whether interleukin (IL)-1beta gene polymorphisms influence on the risk of myocardial infarction and ischemic stroke at young age. 147 patients (age stroke were deeded as control group and greed to give blood samples for DNA analysis and biochemical measurements by written informed consent. IL-1β-511 wild type (WT, CC) and SNP (TT) were established and transfected into Rat myocardial H9c2 cell and Mouse brain endothelial bEND.3 cells. In Young Age MI or stroke patients, the IL-1β levels of patients with 511CC are higher than that of patients with 511TT. In our study, NF-κB miRNA, iNOS activity, NF-κB, iNOS and Bax protein expressions of MI-induced H9c2 cell or stroke-induced bEND.3 cells in IL-1β-511TT group were lower than those of IL-1β-511CC. Additionally, the protein expression of MMP-2 of MI-induced H9c2 cell or stroke-induced bEND.3 cells in IL-1β-511TT group were higher than that of IL-1β 511CC group. In conclusion, our data indicate that IL-1β-511TT/CC influence on the risk of myocardial infarction and ischemic stroke at young age through NF-κB, iNOS, MMP-2 and Bax.

  20. Relation of the aortic stiffness with the GRACE risk score in patients with the non ST-segment elevation myocardial infarction.

    Science.gov (United States)

    Omer, Gedikli; Gokhan, Aksan; Adem, Uzun; Sabri, Demircan; Korhan, Soylu

    2014-01-01

    Current guidelines recommend clinical risk scoring systems for the patients diagnosed and determinated treatment strategy with in Non-ST-elevation elevation myocardial infarction (NSTEMI). Previous studies demonstrated association between aortic elasticity properties, stiffness and severity CAD. However, the associations between Aortic stiffness, elasticity properties and clinical risk scores have not been investigated. In the present study we have evaluated the relation between the Global Registry of Acute Coronary Events (GRACE) risk score and aortic stiffness in patients with NSTEMI. We prospectively analyzed 87 consecutive patients with NSTEMI. Aortic elastic parameter and stiffness parameter were calculated from the echocardiographically derived thoracic aortic diameters (mm/m(2)), and the measurement of pulse pressure obtained by cuff sphygmomanometry. We have categorized the patients in to two groups as low ((n = 45) (GRACE risk score ≤ 140)) and high ((n = 42) (GRACE risk score > 140)) risk group according to GRACE risk score and compare the both groups. Table 1 shows baseline characteristics of patients. Our study showed that Aortic strain was significantly low (3.5 ± 1.4, 7.9 ± 2.3 respectively, p < 0.001) and aortic stiffness index was significantly high (3.9 ± 0.38; 3 ± 0.35, respectively, p < 0.001) in the high risk group values compared to those with low risk group. The aortic stiffness index was the only independent predictor of GRACE risk score (OR: 119.390; 95% CI: 2.925-4872.8; p = 0.011) in multivariate analysis. We found a significant correlation between aortic stiffness, impaired elasticity and GRACE risk score. Aortic stiffness index was the only independent variable of the high GRACE risk score. The inclusion of aortic stiffness into the GRACE risk score could allow improved risk classification of patients with ACS at admission and this may be important in the diagnosis, follow up and treatment of the patients.

  1. Estimation of the area at risk in myocardial infarction of rats by means of I-123 β-methyliodophenyl pentadecanoic acid imaging

    International Nuclear Information System (INIS)

    Hasegawa, Shinji; Hori, Masatsugu; Nishimura, Tsunehiko; Kusuoka, Hideo; Fukuchi, Kazuki

    2000-01-01

    Clinical investigations have suggested that the defects in SPECT images of a free fatty acid analog, I-123 β-methyliodophenyl pentadecanoic acid (BMIPP) may indicate the ischemic risk area. To elucidate whether I-123 BMIPP can indicate the area at risk of ischemia, ex-vivo autoradiography was performed in rats whose left coronary artery was occluded for 60 min and then reperfused. I-123 BMIPP was injected at the acute stage (n=10), or the subacute stage (7 days after reperfusion; n=9). Infarction and the area at risk were identified by triphenyl tetrazolium chloride staining and injection of methylene blue during religation just before sacrifice, respectively. The BMIPP uptake in the risk area was significantly lower than that in the remote area at the acute (risk, 53.7±23.3% of the uptake at right ventricle, mean ±SD; remote, 109.3±11.8%; p<0.01) and subacute (risk, 52.5±11.5%; remote, 97.9±14.3%; p<0.01) stages. In addition, the area with reduced uptake of I-123 BMIPP showed a significant correlation with the area at risk both at the acute (r=0.98, P<0.01) and subacute (r=0.92, p<0.01) stages. In conclusion, the area at risk can be evaluated by I-123 BMIPP both at the acute and subacute stages. (author)

  2. Early versus late percutaneous revascularization in patients hospitalized with non ST-segment elevation myocardial infarction: The atherosclerosis risk in communities surveillance study.

    Science.gov (United States)

    Arora, Sameer; Matsushita, Kunihiro; Qamar, Arman; Stacey, R Brandon; Caughey, Melissa C

    2018-02-01

    Current guidelines recommend early invasive intervention (<24 hr) for high risk patients with non-ST-segment elevation myocardial infarction (NSTEMI). A delayed invasive strategy (24-72 hr) is considered reasonable for low risk patients. The real-world effectiveness of this strategy is unknown. The ARIC Study has conducted hospital surveillance of acute myocardial infarction (MI) since 1987. NSTEMI was classified using a validated algorithm. We limited our study to patients undergoing early (<24 hr of the event onset), or late (≥24 hr) percutaneous coronary intervention (PCI). Patients were stratified into low (TIMI score 2-4), and high risk (TIMI score 5-7, or presence of cardiogenic shock, ventricular fibrillation, or cardiac arrest). Associations between early versus late PCI and mortality were analyzed using multivariable logistic regression adjusted for demographics, hospitalization year, TIMI score, and comorbidities. From 1987 to 2012, 6,746 patients were hospitalized with NSTEMI and underwent PCI. Most were white (79%), male (68%), with mean age 61 years. The 28-day and 1-year mortality were 2% and 5%, respectively. Most revascularizations (65%) were late. After accounting for potential confounders, early PCI was associated with a 58% reduced 28-day mortality (OR = 0.42; 95% CI: 0.21-0.84) for the entire population, and 57% reduced mortality (OR = 0.43; 95% CI: 0.21-0.88) for high risk patients. By 1-year of follow up, there was no significant difference in mortality with respect to early vs. late PCI. In hospitalized NSTEMI patients with high risk of clinical events, early PCI is associated with improved 28-day survival. © 2017 Wiley Periodicals, Inc.

  3. Reducing risk where tectonic plates collide—U.S. Geological Survey subduction zone science plan

    Science.gov (United States)

    Gomberg, Joan S.; Ludwig, Kristin A.; Bekins, Barbara; Brocher, Thomas M.; Brock, John C.; Brothers, Daniel; Chaytor, Jason D.; Frankel, Arthur; Geist, Eric L.; Haney, Matt; Hickman, Stephen H.; Leith, William S.; Roeloffs, Evelyn A.; Schulz, William H.; Sisson, Thomas W.; Wallace, Kristi; Watt, Janet; Wein, Anne M.

    2017-06-19

    The U.S. Geological Survey (USGS) serves the Nation by providing reliable scientific information and tools to build resilience in communities exposed to subduction zone earthquakes, tsunamis, landslides, and volcanic eruptions. Improving the application of USGS science to successfully reduce risk from these events relies on whole community efforts, with continuing partnerships among scientists and stakeholders, including researchers from universities, other government labs and private industry, land-use planners, engineers, policy-makers, emergency managers and responders, business owners, insurance providers, the media, and the general public.Motivated by recent technological advances and increased awareness of our growing vulnerability to subduction-zone hazards, the USGS is uniquely positioned to take a major step forward in the science it conducts and products it provides, building on its tradition of using long-term monitoring and research to develop effective products for hazard mitigation. This science plan provides a blueprint both for prioritizing USGS science activities and for delineating USGS interests and potential participation in subduction zone science supported by its partners.The activities in this plan address many USGS stakeholder needs:High-fidelity tools and user-tailored information that facilitate increasingly more targeted, neighborhood-scale decisions to mitigate risks more cost-effectively and ensure post-event operability. Such tools may include maps, tables, and simulated earthquake ground-motion records conveying shaking intensity and frequency. These facilitate the prioritization of retrofitting of vulnerable infrastructure;Information to guide local land-use and response planning to minimize development in likely hazardous zones (for example, databases, maps, and scenario documents to guide evacuation route planning in communities near volcanoes, along coastlines vulnerable to tsunamis, and built on landslide-prone terrain);New tools

  4. Zoning the territory of the Republic of Kazakhstan as to the risk of rabies among various categories of animals.

    Science.gov (United States)

    Abdrakhmanov, Sarsenbay K; Sultanov, Akhmetzhan A; Beisembayev, Kanatzhan K; Korennoy, Fedor I; Кushubaev, Dosym B; Каdyrov, Ablaikhan S

    2016-05-31

    This paper presents the zoning of the territory of the Republic of Kazakhstan with respect to the risk of rabies outbreaks in domestic and wild animals considering environmental and climatic conditions. The national database of rabies outbreaks in Kazakhstan in the period 2003-2014 has been accessed in order to find which zones are consistently most exposed to the risk of rabies in animals. The database contains information on the cases in demes of farm livestock, domestic animals and wild animals. To identify the areas with the highest risk of outbreaks, we applied the maximum entropy modelling method. Designated outbreaks were used as input presence data, while the bioclim set of ecological and climatic variables, together with some geographic factors, were used as explanatory variables. The model demonstrated a high predictive ability. The area under the curve for farm livestock was 0.782, for domestic animals -0.859 and for wild animals - 0.809. Based on the model, the map of integral risk was designed by following four categories: negligible risk (disease-free or favourable zone), low risk (surveillance zone), medium risk (vaccination zone), and high risk (unfavourable zone). The map was produced to allow developing a set of preventive measures and is expected to contribute to a better distribution of supervisory efforts from the veterinary service of the country.

  5. [A scale for early assessment of risk of death and myocardial infarction during initial hospitalization of patients with acute coronary syndromes (based on data from the RECORD registry)].

    Science.gov (United States)

    Érlikh, A D

    2010-01-01

    Independent predictors of death and death or myocardial infarction (MI) during initial hospitalization of patients with acute coronary syndromes (ACS) were determined using database of Russian independent ACS registry RECORD. These predictors (admission Killip class II, ST-segment elevation 1 mm, systolic blood pressure 100 mm Hg, hemoglobin <110 g/L, age 65 years, history of diabetes) were attributed equal weight (1 point) and combined in a prognostic scale for assessment of risk of inhospital death and death or MI. The scale did not include markers of necrosis, and the most time consuming component was measurement of hemoglobin. Sensitivity and specificity of risk scores for prediction of death were 78.5%. The use of GRACE score in this group of patients gave similar results. These preliminary data require confirmation on larger populations of patients with ACS.

  6. Clopidogrel bioactivation and risk of bleeding in patients cotreated with angiotensin-converting enzyme inhibitors after myocardial infarction

    DEFF Research Database (Denmark)

    Kristensen, K E; Zhu, H-J; Wang, X

    2014-01-01

    in vitro and linked the results with a pharmacoepidemiological study. In vitro, ACEIs inhibited CES1-mediated hydrolysis of a model substrate, and trandolapril and enalapril increased formation of clopidogrel active metabolite. In 70,934 patients with myocardial infarction, hazard ratios for clinically...... significant bleeding in ACEI-treated patients cotreated with or without clopidogrel were 1.10 (95% confidence interval (CI): 0.97-1.25, P = 0.124) and 0.90 (95% CI: 0.81-0.99, P = 0.025), respectively, as compared with patients who did not receive ACEIs. This difference was statistically significant (P = 0...

  7. RISK-FACTORS, PATHOGENESIS, AND PHARMACEUTICAL APPROACHES FOR TREATMENT OF STEROID-INDUCED BONE INFARCTION OF FEMORAL HEAD.

    Science.gov (United States)

    Wang, Fei; Wang, Yang; Hu, Ningning; Miao, Xuman

    2016-01-01

    During first year of steroid usage, osteocyte necrosis and blood vessel blockage may occur, which subsequently may produce steroid-induced bone infarction (SIBI) resulting in painful movement of patient. For treatment of SIBI, pharmaceutical strategy is the basic approach. It involves the use of various pharmacologically active compounds including bisphosphonates, hyperbaric oxygen (HBO), coenzyme Q10, erythropoietin, antihyperlipidemics, anticoagulants, antioxidants, and tissue repair protein. Out of these, there is no pharmaceutical agent that may completely treat this disease because many factors are found to be responsible for SIBI development; therefore, there are multiple biomarkers of this disease. This situation argues for need of new therapeutic agents for SIEB1.

  8. Landslide Risk: Economic Valuation in The North-Eastern Zone of Medellin City

    Science.gov (United States)

    Vega, Johnny Alexander; Hidalgo, César Augusto; Johana Marín, Nini

    2017-10-01

    Natural disasters of a geodynamic nature can cause enormous economic and human losses. The economic costs of a landslide disaster include relocation of communities and physical repair of urban infrastructure. However, when performing a quantitative risk analysis, generally, the indirect economic consequences of such an event are not taken into account. A probabilistic approach methodology that considers several scenarios of hazard and vulnerability to measure the magnitude of the landslide and to quantify the economic costs is proposed. With this approach, it is possible to carry out a quantitative evaluation of the risk by landslides, allowing the calculation of the economic losses before a potential disaster in an objective, standardized and reproducible way, taking into account the uncertainty of the building costs in the study zone. The possibility of comparing different scenarios facilitates the urban planning process, the optimization of interventions to reduce risk to acceptable levels and an assessment of economic losses according to the magnitude of the damage. For the development and explanation of the proposed methodology, a simple case study is presented, located in north-eastern zone of the city of Medellín. This area has particular geomorphological characteristics, and it is also characterized by the presence of several buildings in bad structural conditions. The proposed methodology permits to obtain an estimative of the probable economic losses by earthquake-induced landslides, taking into account the uncertainty of the building costs in the study zone. The obtained estimative shows that the structural intervention of the buildings produces a reduction the order of 21 % in the total landslide risk.

  9. Existing and potential infection risk zones of yellow fever worldwide: a modelling analysis.

    Science.gov (United States)

    Shearer, Freya M; Longbottom, Joshua; Browne, Annie J; Pigott, David M; Brady, Oliver J; Kraemer, Moritz U G; Marinho, Fatima; Yactayo, Sergio; de Araújo, Valdelaine E M; da Nóbrega, Aglaêr A; Fullman, Nancy; Ray, Sarah E; Mosser, Jonathan F; Stanaway, Jeffrey D; Lim, Stephen S; Reiner, Robert C; Moyes, Catherine L; Hay, Simon I; Golding, Nick

    2018-03-01

    Yellow fever cases are under-reported and the exact distribution of the disease is unknown. An effective vaccine is available but more information is needed about which populations within risk zones should be targeted to implement interventions. Substantial outbreaks of yellow fever in Angola, Democratic Republic of the Congo, and Brazil, coupled with the global expansion of the range of its main urban vector, Aedes aegypti, suggest that yellow fever has the propensity to spread further internationally. The aim of this study was to estimate the disease's contemporary distribution and potential for spread into new areas to help inform optimal control and prevention strategies. We assembled 1155 geographical records of yellow fever virus infection in people from 1970 to 2016. We used a Poisson point process boosted regression tree model that explicitly incorporated environmental and biological explanatory covariates, vaccination coverage, and spatial variability in disease reporting rates to predict the relative risk of apparent yellow fever virus infection at a 5 × 5 km resolution across all risk zones (47 countries across the Americas and Africa). We also used the fitted model to predict the receptivity of areas outside at-risk zones to the introduction or reintroduction of yellow fever transmission. By use of previously published estimates of annual national case numbers, we used the model to map subnational variation in incidence of yellow fever across at-risk countries and to estimate the number of cases averted by vaccination worldwide. Substantial international and subnational spatial variation exists in relative risk and incidence of yellow fever as well as varied success of vaccination in reducing incidence in several high-risk regions, including Brazil, Cameroon, and Togo. Areas with the highest predicted average annual case numbers include large parts of Nigeria, the Democratic Republic of the Congo, and South Sudan, where vaccination coverage in 2016

  10. Existing and potential infection risk zones of yellow fever worldwide: a modelling analysis

    Directory of Open Access Journals (Sweden)

    Freya M Shearer, BSc

    2018-03-01

    Full Text Available Summary: Background: Yellow fever cases are under-reported and the exact distribution of the disease is unknown. An effective vaccine is available but more information is needed about which populations within risk zones should be targeted to implement interventions. Substantial outbreaks of yellow fever in Angola, Democratic Republic of the Congo, and Brazil, coupled with the global expansion of the range of its main urban vector, Aedes aegypti, suggest that yellow fever has the propensity to spread further internationally. The aim of this study was to estimate the disease's contemporary distribution and potential for spread into new areas to help inform optimal control and prevention strategies. Methods: We assembled 1155 geographical records of yellow fever virus infection in people from 1970 to 2016. We used a Poisson point process boosted regression tree model that explicitly incorporated environmental and biological explanatory covariates, vaccination coverage, and spatial variability in disease reporting rates to predict the relative risk of apparent yellow fever virus infection at a 5 × 5 km resolution across all risk zones (47 countries across the Americas and Africa. We also used the fitted model to predict the receptivity of areas outside at-risk zones to the introduction or reintroduction of yellow fever transmission. By use of previously published estimates of annual national case numbers, we used the model to map subnational variation in incidence of yellow fever across at-risk countries and to estimate the number of cases averted by vaccination worldwide. Findings: Substantial international and subnational spatial variation exists in relative risk and incidence of yellow fever as well as varied success of vaccination in reducing incidence in several high-risk regions, including Brazil, Cameroon, and Togo. Areas with the highest predicted average annual case numbers include large parts of Nigeria, the Democratic Republic of the

  11. Fatores de risco para infarto do miocárdio no Brasil: estudo FRICAS Risk factors for acute myocardial infarction in Brazil (FRICAS study

    Directory of Open Access Journals (Sweden)

    Marco Aurélio Dias da Silva

    1998-11-01

    Full Text Available OBJETIVO: Determinar os fatores de risco para a ocorrência de infarto agudo do miocárdio (IAM no Brasil. MÉTODOS: Estudo conduzido entre janeiro/94 e março/95, em 20 centros médicos no Brasil, constituído de casos, 299 pacientes com IAM e, controles, 292 indivíduos, identificados no mesmo centro que os casos, e admitidos com largo espectro de doenças agudas, não relacionadas a fatores de risco conhecidos ou suspeitos para IAM. Os dados foram colhidos por meio de um questionário estruturado, preenchido pelo próprio paciente. Os efeitos das variáveis pesquisadas sobre a ocorrência de IAM foram estudadas em abordagens univariadas, considerando-se significativo pPURPOSE: To determine risk factors related to acute myocardial infarction (AMI in Brazil. METHODS: Five hundred ninety one patients were selected in 20 medical centers in Brazil, between January/94 and March/95. Two-hundred-ninety-nine patients were cases, and 292 controls with a variety of acute diseases not related to the suspected or known risk factors for acute myocardial infarction. All data were collected through a structured questionnaire filled by the patients. The evaluation of the variables was done through univariate analysis with a significance level of 5%. RESULTS: The factors related to acute myocardial infarction were respectively to cases and controls: Hypercholesterolemia - 210.93±46.74mg/dl and 185.71±45.45mg/dl, (p=0.000; smoking - 41.69% and 27.20% (p=0.000; hypertension - 52.35% and 20.88% (p=0.000; diabetes - 19.70% and 9.93% (p=0.001; family history - related to the patient's father in 42.14% and 33.22% (p=0.025 and to the mother in 42.14% and 30.82% (p=0.007; socioeconomic level - 88.99% and 60.20% owned house (p=0.002; 44.45% and 33.21% owned car (p=0.010; physical activity - 56.83% and 48.28% had the habit of walking in the year prior to study entry (p=0.029; diet - 38.79% and 28.42% consumed canned food (p=0.013. The mean weight was 72.50±26.89kg

  12. Optimism During Hospitalization for First Acute Myocardial Infarction and Long-Term Mortality Risk: A Prospective Cohort Study.

    Science.gov (United States)

    Weiss-Faratci, Netanela; Lurie, Ido; Benyamini, Yael; Cohen, Gali; Goldbourt, Uri; Gerber, Yariv

    2017-01-01

    To assess the association between dispositional optimism, defined as generalized positive expectations about the future, and long-term mortality in young survivors of myocardial infarction (MI). A subcohort of 664 patients 65 years and younger, drawn from the longitudinal Israel Study of First Acute Myocardial Infarction, completed an adapted Life Orientation Test (LOT) questionnaire during their index hospitalization between February 15, 1992, and February 15, 1993. Additional sociodemographic, clinical, and psychosocial variables were assessed at baseline; mortality follow-up lasted through December 31, 2015. Cox proportional hazards regression models were fit to assess the hazard ratios for mortality associated with LOT-derived optimism. The mean age of the participants was 52.4±8.6 years; 98 (15%) were women. The median follow-up period was 22.4 years (25th-75th percentiles, 16.1-22.8 years), during which 284 patients (43%) had died. The mean LOT score was 16.5±4.1. Incidence density rates for mortality in increasing optimism tertiles were 25.4, 25.8, and 16.0 per 1000 person-years, respectively (Poptimism during hospitalization for MI were associated with reduced mortality over a 2-decade follow-up period. Optimism training and positive psychology should be examined as part of psychosocial interventions and rehabilitation after MI. Copyright © 2016 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

  13. Sex differences in the risk profile and male predominance in silent brain infarction in community-dwelling elderly subjects. The Sefuri brain MRI study

    International Nuclear Information System (INIS)

    Takashima, Yuki; Mori, Takahiro; Hashimoto, Manabu; Yuzuriha, Takefumi; Yao, Hiroshi; Miwa, Yoshikazu; Sasaguri, Toshiyuki; Uchino, Akira

    2010-01-01

    Although brain infarction is more common in men, the male predominance of silent brain infarction (SBI) was inconsistent in the earlier studies. This study was to examine the relationship between sex differences in the risk profile and SBI. We conducted a population-based, cross-sectional analysis of cardiovascular risk factors and SBI on MRI. We asked all the female participants about the age at natural menopause and parity. SBI was detected in 77 (11.3%) of 680 participants (266 men and 414 women) with a mean age of 64.5 (range 40-93) years. In the logistic analysis, age (odds ratio (OR)=2.760/10 years, 95% confidence interval (CI)=2.037-3.738), hypertension (OR=3.465, 95% CI=1.991-6.031), alcohol intake (OR=2.494, 95% CI=1.392-4.466) and smoking (OR=2.302, 95% CI=1.161-4.565) were significant factors concerning SBI. Although SBI was more prevalent among men, this sex difference disappeared on the multivariate model after adjustment for other confounders. In 215 women aged 60 years or older, age at natural menopause, early menopause, duration of menopause, number of children and age at the last parity were not significantly associated with SBI after adjustment for age. Hypertension and age were considered to be the major risk factors for SBI in community-dwelling people. Male predominance in SBI was largely due to higher prevalence of alcohol habit and smoking in men than in women in our population. (author)

  14. Contribution of contractile state of the non-infarcted area to global ventricular performance after acute myocardial infarction

    International Nuclear Information System (INIS)

    Nishimura, Tsunehiko; Yasuda, Tsunehiro; Gold, H.K.; Leinbach, R.C.; Boucher, C.A.; McKusick, K.A.; Strauss, H.W.

    1986-01-01

    To evaluate the regional contractile state of the non-infarcted zone and to determine the contribution of this area to left ventricular (LV) performance, 112 patients (42 anterior and 70 inferior infarction) with their first acute myocardial infarction were investigated by radionuclide ventriculography at admission and 10 days after admission. Wall motion at the non-infarcted area was defined as hyperkinetic, normal, or hypokinetic, if radial chord shortening had above normal, normal, or below normal values, respectively, by quantitative wall motion analysis. Hyperkinetic, normal, and hypokinetic wall motion of the non-infarcted area were observed in three (7 %), 12 (29 %), and 27 (64 %) patients in anterior infarction and 14 (20 %), 28 (40 %), and 28 (40 %) in inferior infarction, respectively. In the patients with hypokinetic wall motion at the non-infarcted area, the infarct involved more than 30 % of the left ventricle manifesting akinetic contractile segment (ACS), radial chord shortening in the infarcted area was severely depressed, and the incidence of multi-vessel involvement was higher compared with those with hyperkinetic or normal wall motion. In serial measurements, radial chord shortening in the infarcted and non-infarcted area, percent ACS, left ventricular ejection fraction, and left ventricular end-diastolic volume index did not change significantly from acute to follow-up study in any group. In conclusion, our data indicated that the non-infarcted area following acute infarction had various contractile states and these conditions were determined primarily by the severity and extent of infarct and underlying coronary artery disease. Furthermore, the contractile state of the non-infarcted area has a supplemental role in determination of LV function following acute infarction. (author)

  15. Ecological risk caused by land use change in the coastal zone: a case study in the Yellow River Delta High-Efficiency Ecological Economic Zone

    International Nuclear Information System (INIS)

    Di, X H; Wang, Y D; Hou, X Y

    2014-01-01

    China's coastal zone plays an important role in ecological services production and social-economic development; however, extensive and intensive land resource utilization and land use change have lead to high ecological risk in this area during last decade. Regional ecological risk assessment can provide fundamental knowledge and scientific basis for better understanding of the relationship between regional landscape ecosystem and human activities or climate changes, facilitating the optimization strategy of land use structure and improving the ecological risk prevention capability. In this paper, the Yellow River Delta High-Efficiency Ecological Economic Zone is selected as the study site, which is undergoing a new round of coastal zone exploitation and has endured substantial land use change in the past decade. Land use maps of 2000, 2005 and 2010 were generated based on Landsat images by visual interpretation method, and the ecological risk index was then calculated. The index was 0.3314, 0.3461 and 0.3176 in 2000, 2005 and 2010 respectively, which showed a positive transition of regional ecological risk in 2005

  16. Cerebrovascular risk factors for patients with cerebral watershed infarction: A case-control study based on computed tomography angiography in a population from Southwest China.

    Science.gov (United States)

    Dong, Mei-Xue; Hu, Ling; Huang, Yuan-Jun; Xu, Xiao-Min; Liu, Yang; Wei, You-Dong

    2017-07-01

    To determine cerebrovascular risk factors for patients with cerebral watershed infarction (CWI) from Southwest China.Patients suffering from acute ischemic stroke were categorized into internal CWI (I-CWI), external CWI (E-CWI), or non-CWI (patients without CWI) groups. Clinical data were collected and degrees of steno-occlusion of all cerebral arteries were scored. Arteries associated with the circle of Willis were also assessed. Data were compared using Pearson chi-squared tests for categorical data and 1-way analysis of variance with Bonferroni post hoc tests for continuous data, as appropriate. Multivariate binary logistic regression analysis was performed to determine independent cerebrovascular risk factors for CWI.Compared with non-CWI, I-CWI had higher degrees of steno-occlusion of the ipsilateral middle cerebral artery, ipsilateral carotid artery, and contralateral middle cerebral artery. E-CWI showed no significant differences. All the 3 arteries were independent cerebrovascular risk factors for I-CWI confirmed by multivariate binary logistic regression analysis. I-CWI had higher degrees of steno-occlusion of the ipsilateral middle cerebral artery compared with E-CWI. No significant differences were found among arteries associated with the circle of Willis.The ipsilateral middle cerebral artery, carotid artery, and contralateral middle cerebral artery were independent cerebrovascular risk factors for I-CWI. No cerebrovascular risk factor was identified for E-CWI.

  17. Determination of risk zones, due to radon : prospecting and analysis of spring water in Wallonia

    International Nuclear Information System (INIS)

    1990-01-01

    The emanation of radon from geologic formations can be detected by analyzing the ground water at the emergence of springs. Two measuring methods are described and compared : the Lucas method and the liquid scintillation method. Although more sampling has to be done, a first conclusion can be drawn from the results. The link between the radium concentration in some geologic formations and the determination of risk zones for radon contamination can be proved through radon measurements in water. 9 figs., 6 tabs., 2 charts (H.E.)

  18. Smoking, alcohol consumption, physical activity, and family history and the risks of acute myocardial infarction and unstable angina pectoris: a prospective cohort study

    Directory of Open Access Journals (Sweden)

    Gorgels Anton PM

    2011-03-01

    Full Text Available Abstract Background Few studies investigated the association between smoking, alcohol consumption, or physical activity and the risk of unstable angina pectoris (UAP, while the strength of these associations may differ compared to other coronary diseases such as acute myocardial infarction (AMI. Therefore, we investigated whether the associations of these lifestyle factors with UAP differed from those with AMI. Additionally, we investigated whether these effects differed between subjects with and without a family history of myocardial infarction (MI. Methods The CAREMA study consists of 21,148 persons, aged 20-59 years at baseline and randomly sampled from the Maastricht region in 1987-1997. At baseline, all participants completed a self-administered questionnaire. After follow-up of maximally 16.9 years, 420 AMI and 274 UAP incident cases were registered. Incidence rate ratios (RRs were estimated using Cox proportional hazards models. Results For both diseases, smoking increased the risk while alcohol consumption was associated with a protective effect. Associations with both risk factors were stronger for AMI than UAP, although this difference was only statistically significant for smoking. In men, an inverse association was found with physical activity during leisure time which seemed to be stronger for the risk of UAP than of AMI. On the contrary, physical activity during leisure time was associated with an increased risk of both AMI and UAP in women which seemed to be weaker for UAP than for AMI. Except for occupational physical activity in women, no significant interactions on a multiplicative scale were found between the lifestyle factors and family history of MI. Nevertheless, the highest risks were found in subjects with both a positive family history and the most unfavorable level of the lifestyle factors. Conclusions The strength of the associations with the lifestyle factors did not differ between AMI and UAP, except for smoking

  19. A Simplified Methodology For Risk Assessment of The Oolitic Limestone Aquifer, West of Alexandria Coastal Zone

    International Nuclear Information System (INIS)

    Sadek, M.A.; Hussein, R.A.

    2013-01-01

    Groundwater risk analysis helps to assess the effects of contaminants reach to specific position in groundwater system after introduction at some location above the uppermost aquifer. This provides a basis for initiating protective and mitigation measures for important groundwater resources. An attempt has been made in the present study to assess the risk of diffuse groundwater pollution at the north western coast of Alexandria against landfill waste disposal as well as agricultural pollutants leachates which are the main land use in the studied area. A simplified weighing/ rating approach have been functioned for this purpose, Slovene methodology, which is relevant for fissured carbonate aquifers that characterize the studied area. This method is based on an origin-pathway-target model, which applies for both resource and source protection. Conservative values for the intrinsic geological, hydrogeological, geo morphological and climatological parameters have been reviewed and determined for assessment of the source and resource vulnerability, hazards and risk (lithology, texture and structure of soil zone, lithology and thickness of the unsaturated zone and aquifer conditions, morphological features, slope and vegetation cover, average annual stormy days, travel time and karst network , the fertilizers and pesticide used for agriculture, the volume of unlined waste disposal site). The methodology applied in the present study emphasizes how the physical properties of the hydrological system can be integrated in an index that reflects the level of risk of a diffuse pollution to groundwater. This aligns with the prospective of site safety evaluation around risky installations such as a nuclear power plants or waste disposal facilities where assurance should be done that the risk to the public and environment is acceptably low. According to the functioned methodology, the fissured limestone under study is low vulnerable and highly protectable against surface diffuse

  20. Assessment of risk factors in radionuclides pollution of coastal zone and river basins by numerical modelling

    International Nuclear Information System (INIS)

    Tsitskishvili, M.; Tsitskishvili, L.; Kordzakhia, G.; Diasamidze, R.; Shaptoshvili, A.; Valiaev, A.

    2006-01-01

    Full text: All types of industrial activities require the norms of protection, assessment of corresponding risks to preserve the pollution and degradation of corresponding areas. To make available the sustainable development of the country the risk assessment of possible accidents on the big enterprises is foreseen that provides preparedness of the country and possibility of the prevention measures and mitigation of the accidents. While big anthropogenic accidents in mountainous countries - the main paths for transportation of the pollution are the rivers and sea basins. Due to overpopulation of these areas assessment of the pollution risks are very important. For this aim the special deterministic models on the basis of passive admixture's turbulence diffusion equation is used. For numerical calculations Mc Kormack's predictor-corrector two steps scheme is used. The scheme is disintegrated, second order in space and time. Such scheme is established because the turbulent velocities very differ in horizontal and vertical directions and model allows implementing singular independent steps in different directions. Grid step for the model is 26.88 km in horizontal direction and 20 m m in vertical until 200 m. Time step is equal to 4 hours and computational time period - 4 months. Number of grid points is equal to 4983 for all calculation areas. Computations are carried out separately for big rivers basins as well as for Black and Caspian Seas water areas. The model calculations are made for cases with various locations of pollutant sources including accidental throws. For different realistic scenarios are calculated the concentrations of admixtures. The directions of their propagation are also determined. The risks are calculated in comparison with the Maximum Permissible Concentrations (MPC) of the pollutants according to achieved results. That gives possibility to define the most vulnerable areas in coastal zones. Realized methodology is verified by means of various

  1. Hepatic infarction in HELLP syndrome; a case report

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Mi Jeong; Kim, Hong [Keimyung Univ. School of Medicine, Taegu (Korea, Republic of)

    2000-11-01

    Hepatic infarction is a rare but potentially life-threatening complication of pregnancy-associated preeclampsia or HELLP (hemolysis, elevated liver function tests, low platelets) syndrome. We present a case of hepatic infarction subsequent to HELLP syndrome and occurring during the immediate postpartum, and the associated radiologic findings. Sonography revealed poorly defined hypoechoic zones of infarction. Computed tomography(CT) demonstrated the characteristic features of nonenhancing, low attenuation, relatively well-defined, wedge shaped or geographic hepatic lesions, without mass effect.

  2. Hepatic infarction in HELLP syndrome; a case report

    International Nuclear Information System (INIS)

    Kim, Mi Jeong; Kim, Hong

    2000-01-01

    Hepatic infarction is a rare but potentially life-threatening complication of pregnancy-associated preeclampsia or HELLP (hemolysis, elevated liver function tests, low platelets) syndrome. We present a case of hepatic infarction subsequent to HELLP syndrome and occurring during the immediate postpartum, and the associated radiologic findings. Sonography revealed poorly defined hypoechoic zones of infarction. Computed tomography(CT) demonstrated the characteristic features of nonenhancing, low attenuation, relatively well-defined, wedge shaped or geographic hepatic lesions, without mass effect

  3. Mortality and cardiovascular risk associated with different insulin secretagogues compared with metformin in type 2 diabetes, with or without a previous myocardial infarction: a nationwide study

    DEFF Research Database (Denmark)

    Schramm, Tina Ken; Gislason, Gunnar Hilmar; Vaag, Allan

    2011-01-01

    Aims The impact of insulin secretagogues (ISs) on long-term major clinical outcomes in type 2 diabetes remains unclear. We examined mortality and cardiovascular risk associated with all available ISs compared with metformin in a nationwide study. Methods and results All Danish residents >20 years......, initiating single-agent ISs or metformin between 1997 and 2006 were followed for up to 9 years (median 3.3 years) by individual-level linkage of nationwide registers. All-cause mortality, cardiovascular mortality, and the composite of myocardial infarction (MI), stroke, and cardiovascular mortality...... associated with individual ISs were investigated in patients with or without previous MI by multivariable Cox proportional-hazard analyses including propensity analyses. A total of 107 806 subjects were included, of whom 9607 had previous MI. Compared with metformin, glimepiride (hazard ratios and 95...

  4. Transulnar sheathless percutaneous coronary intervention during bivalirudin infusion in high-risk elderly female with non-ST segment elevation myocardial infarction

    Directory of Open Access Journals (Sweden)

    Marina Mustilli

    2012-06-01

    Full Text Available Due to the ageing population and raised life expectancy, elderly patients are increasingly referred for percutaneous coronary intervention (PCI during acute coronary syndromes (ACS. Bleeding complications are not infrequent during ACS, occurring in 2-5% of patients with prognostic and economic consequences. In particular, periprocedural bleeding and vascular complications are associated with worse clinical outcome, prolonged hospital stay and increased short- and long-term mortality, especially in elderly patients with acute coronary syndromes. We report the case of an 83-year old female referred to our hospital because of non-ST segment elevation myocardial infarction with high bleeding risk and unsuitable radial artery undergoing transulnar sheathless PCI during bivalirudin infusion. The clinical, technical, pharmacological and prognostic implications are discussed.

  5. Ultra-Sensitive C-Reactive Protein (US-CRP) in Patients With Periodontal Disease and Risk of Acute Myocardial Infarction.

    Science.gov (United States)

    Uriza, Catalina Latorre; Arregoces, Francina Escobar; Porras, Juliana Velosa; Camargo, Maria Beatriz Ferro; Morales, Alvaro Ruiz

    2011-02-01

    The purpose of this study was to determine if the US-CRP values associated with periodontal disease are risk markers for Acute Myocardial Infarction (AMI) and to determine if the US-CRP levels associated with recent AMI are higher in patients with Periodontal disease. In order to meet the goal of the study, a case control study design was conducted. The analysis sample consisted of 401 adults (30 - 75 years old), living in Bogota D.C., Colombia, from the Hospital Universitario San Ignacio, the Faculty of Dentistry at the Pontificia Universidad Javeriana, and the Fundacion Cardio Infantil. Patients with current infections, antibiotic use in the last 3 months, periodontal treatment at least six months before the baseline of this study, mouth ulcerations caused by any type of prosthesis, candidiasis, stomatitis, or less than 7 teeth in mouth were excluded. Periodontal examination for the case group and the control group was conducted by three previously calibrated examiners. Periodontal disease was diagnosed by the presence of bleeding on probing and attachment loss. The Chronic Periodontitis diagnosis was confirmed with these clinical signs, according to the 1999 Armitage classification. The assessment of the US-CRP was performed using the IMMULITE method containing one monoclonal and one polyclonal anti-CRP antibody. This method provides a measurement range of 0.1 - 500 mg/L. Statistical analysis of variables was performed with OR and confidence intervals. A multivariate analysis was performed to determine the association between the US-CRP increase, periodontal disease and acute myocardial infarction, adjusting for smoking and other confounding factors identified in the analysis. The study population was constituted by 401 patients, 56.1% (225) males, with a mean age of 52.6. When groups were compared it was observed that, in those patients with AMI and chronic severe or moderate periodontitis, 24.2% had HDL-C values lower than 40 mg/dl, 78.8% had LDL-C values

  6. Non-Steroidal Anti-Inflammatory Drug Use and the Risk of Acute Myocardial Infarction in the General German Population: A Nested Case-Control Study.

    Science.gov (United States)

    Thöne, Kathrin; Kollhorst, Bianca; Schink, Tania

    2017-09-01

    Use of non-steroidal anti-inflammatory drugs (NSAIDs) has been associated with an increased relative risk of acute myocardial infarction (AMI), but the label warnings refer particularly to patients with cardiovascular risk factors. The magnitude of relative AMI risk for patients with and without cardiovascular risk factors varies between studies depending on the drugs and doses studied. The aim of our study was to estimate population-based relative AMI risks for individual and widely used NSAIDs, for a cumulative amount of NSAID use, and for patients with and without a prior history of cardiovascular risk factors. Based on data from the German Pharmacoepidemiological Research Database (GePaRD) of about 17 million insurance members from four statutory health insurance providers, for the years 2004-2009, a nested case-control study was conducted within a cohort of 3,476,931 new NSAID users classified into current, recent, or past users. Up to 100 controls were matched to each case by age, sex, and length of follow-up using risk set sampling. Multivariable conditional logistic regression was applied to estimate odds ratios (ORs) and 95% confidence intervals (CIs). Duration of NSAID use was calculated by the cumulative amount of dispensed defined daily doses (DDDs), and stratified analyses were conducted for potential effect modifiers. Overall, 17,236 AMI cases were matched to 1,714,006 controls. Elevated relative AMI risks were seen for current users of fixed combinations of diclofenac with misoprostol (OR 1.76, 95% CI 1.26-2.45), indometacin (1.69, 1.22-2.35), ibuprofen (1.54, 1.43-1.65), etoricoxib (1.52, 1.24-1.87), and diclofenac (1.43, 1.34-1.52) compared with past use. A low cumulative NSAID amount was associated with a higher relative AMI risk for ibuprofen, diclofenac, and indometacin. The relative risk associated with current use of diclofenac, fixed combinations of diclofenac with misoprostol, etoricoxib, and ibuprofen was highest in the younger age group

  7. The Climate Change Vulnerability and Risk Management Matrix for the Coastal Zone of The Gambia

    Directory of Open Access Journals (Sweden)

    Joshua Amuzu

    2018-02-01

    Full Text Available Global Climate Change is one of the dire challenges facing the international community today. Coastal zones are vulnerable to its impacts. An effective approach with long-term prospects in addressing climate change impacts is it’s mainstreaming into development agenda of sectoral policies. A comprehensive risk and vulnerability assessment is a pre-requisite to ensure that the right adaptive response is taken for effective integration into developmental plans. The objective of this study is to evaluate and prioritize risks, vulnerability and adaptation issues of current and anticipated impacts of climate change on the coastal zone of The Gambia. The study will also give a methodological contribution for assessing risks, vulnerability and adaptation from the sub-national to local levels. The relevance of this study will be to create a link between the sub-national and local levels in order to facilitate the integration and mainstreaming of climate change into sectoral and local policies for more climate-resilient communities. This will aid in the promotion of strategic investment of constrained developmental resources to actualize successfully dynamic coping strategies, elude ‘maladaptation’ and less compelling responsive measures. A purposive expert sampling technique was used in selecting respondents for the study. The findings of the study reveal that by the end of the 21st century, the climatic variables likely to have the highest impact on the coastal zone of The Gambia are ‘increased flood severity’ and ‘increased temperature’. The coastal zone of The Gambia showed a high vulnerability to these climate change variables. The suggested adaptive response in addressing the impacts of increased flood intensity in the study area includes; improving regulations for restricting agriculture and livestock grazing activities to improve land cover; strengthening of early-warning systems, among others. The suggested adaptive response in

  8. Changes in physical activity in leisure time and the risk of myocardial infarction, ischemic heart disease, and all-cause mortality

    DEFF Research Database (Denmark)

    Petersen, Christina Bjørk; Grønbæk, Morten; Helge, Jørn Wulff

    2012-01-01

    and the risk of myocardial infarction (MI), ischemic heart disease (IHD), and all-cause mortality as well as changes in blood pressure in 4,487 men and 5,956 women in the Copenhagen City Heart Study. Physical activity was measured in 1976-1978 and 1981-1983 and participants were followed in nation......-wide registers until 2009. Men who decreased physical activity by at least two levels and women who decreased by one level had a higher risk of MI relatively to an unchanged physical activity level (hazard ratio [HR] = 1.74, 95% confidence interval [95% CI]: 1.17-2.60 and HR = 1.30, 95% CI: 1.03-1.65). Similar...... associations were found for IHD although only significant in women. In all-cause mortality, men who increased physical activity had a lower risk and both men and women who reduced physical activity had a higher risk compared to an unchanged physical activity level. No association between changes in physical...

  9. Real time forest fire warning and forest fire risk zoning: a Vietnamese case study

    Science.gov (United States)

    Chu, T.; Pham, D.; Phung, T.; Ha, A.; Paschke, M.

    2016-12-01

    Forest fire occurs seriously in Vietnam and has been considered as one of the major causes of forest lost and degradation. Several studies of forest fire risk warning were conducted using Modified Nesterov Index (MNI) but remaining shortcomings and inaccurate predictions that needs to be urgently improved. In our study, several important topographic and social factors such as aspect, slope, elevation, distance to residential areas and road system were considered as "permanent" factors while meteorological data were updated hourly using near-real-time (NRT) remotely sensed data (i.e. MODIS Terra/Aqua and TRMM) for the prediction and warning of fire. Due to the limited number of weather stations in Vietnam, data from all active stations (i.e. 178) were used with the satellite data to calibrate and upscale meteorological variables. These data with finer resolution were then used to generate MNI. The only significant "permanent" factors were selected as input variables based on the correlation coefficients that computed from multi-variable regression among true fire-burning (collected from 1/2007) and its spatial characteristics. These coefficients also used to suggest appropriate weight for computing forest fire risk (FR) model. Forest fire risk model was calculated from the MNI and the selected factors using fuzzy regression models (FRMs) and GIS based multi-criteria analysis. By this approach, the FR was slightly modified from MNI by the integrated use of various factors in our fire warning and prediction model. Multifactor-based maps of forest fire risk zone were generated from classifying FR into three potential danger levels. Fire risk maps were displayed using webgis technology that is easy for managing data and extracting reports. Reported fire-burnings thereafter have been used as true values for validating the forest fire risk. Fire probability has strong relationship with potential danger levels (varied from 5.3% to 53.8%) indicating that the higher

  10. Ecological Risk Assessment of Land Use Change in the Poyang Lake Eco-economic Zone, China

    Science.gov (United States)

    Xie, Hualin; Wang, Peng; Huang, Hongsheng

    2013-01-01

    Land use/land cover change has been attracting increasing attention in the field of global environmental change research because of its role in the social and ecological environment. To explore the ecological risk characteristics of land use change in the Poyang Lake Eco-economic Zone of China, an eco-risk index was established in this study by the combination of a landscape disturbance index with a landscape fragmentation index. Spatial distribution and gradient difference of land use eco-risk are analyzed by using the methods of spatial autocorrelation and semivariance. Results show that ecological risk in the study area has a positive correlation, and there is a decreasing trend with the increase of grain size both in 1995 and 2005. Because the area of high eco-risk value increased from 1995 to 2005, eco-environment quality declined slightly in the study area. There are distinct spatial changes in the concentrated areas with high land use eco-risk values from 1995 to 2005. The step length of spatial separation of land use eco-risk is comparatively long—58 km in 1995 and 11 km in 2005—respectively. There are still nonstructural factors affecting the quality of the regional ecological environment at some small-scales. Our research results can provide some useful information for land eco-management, eco-environmental harnessing and restoration. In the future, some measures should be put forward in the regions with high eco-risk value, which include strengthening land use management, avoiding unreasonable types of land use and reducing the degree of fragmentation and separation. PMID:23343986

  11. Growth factor-induced mobilization of cardiac progenitor cells reduces the risk of arrhythmias, in a rat model of chronic myocardial infarction.

    Directory of Open Access Journals (Sweden)

    Leonardo Bocchi

    Full Text Available Heart repair by stem cell treatment may involve life-threatening arrhythmias. Cardiac progenitor cells (CPCs appear best suited for reconstituting lost myocardium without posing arrhythmic risks, being commissioned towards cardiac phenotype. In this study we tested the hypothesis that mobilization of CPCs through locally delivered Hepatocyte Growth Factor and Insulin-Like Growth Factor-1 to heal chronic myocardial infarction (MI, lowers the proneness to arrhythmias. We used 133 adult male Wistar rats either with one-month old MI and treated with growth factors (GFs, n = 60 or vehicle (V, n = 55, or sham operated (n = 18. In selected groups of animals, prior to and two weeks after GF/V delivery, we evaluated stress-induced ventricular arrhythmias by telemetry-ECG, cardiac mechanics by echocardiography, and ventricular excitability, conduction velocity and refractoriness by epicardial multiple-lead recording. Invasive hemodynamic measurements were performed before sacrifice and eventually the hearts were subjected to anatomical, morphometric, immunohistochemical, and molecular biology analyses. When compared with untreated MI, GFs decreased stress-induced arrhythmias and concurrently prolonged the effective refractory period (ERP without affecting neither the duration of ventricular repolarization, as suggested by measurements of QTc interval and mRNA levels for K-channel α-subunits Kv4.2 and Kv4.3, nor the dispersion of refractoriness. Further, markers of cardiomyocyte reactive hypertrophy, including mRNA levels for K-channel α-subunit Kv1.4 and β-subunit KChIP2, interstitial fibrosis and negative structural remodeling were significantly reduced in peri-infarcted/remote ventricular myocardium. Finally, analyses of BrdU incorporation and distribution of connexin43 and N-cadherin indicated that cytokines generated new vessels and electromechanically-connected myocytes and abolished the correlation of infarct size with deterioration

  12. Prognostic Significance of Remote Myocardium Alterations Assessed by Quantitative Noncontrast T1 Mapping in ST-Segment Elevation Myocardial Infarction.

    Science.gov (United States)

    Reinstadler, Sebastian J; Stiermaier, Thomas; Liebetrau, Johanna; Fuernau, Georg; Eitel, Charlotte; de Waha, Suzanne; Desch, Steffen; Reil, Jan-Christian; Pöss, Janine; Metzler, Bernhard; Lücke, Christian; Gutberlet, Matthias; Schuler, Gerhard; Thiele, Holger; Eitel, Ingo

    2018-03-01

    This study assessed the prognostic significance of remote zone native T1 alterations for the prediction of clinical events in a population with ST-segment elevation myocardial infarction (STEMI) who were treated by primary percutaneous coronary intervention (PPCI) and compared it with conventional markers of infarct severity. The exact role and incremental prognostic relevance of remote myocardium native T1 mapping alterations assessed by cardiac magnetic resonance (CMR) after STEMI remains unclear. We included 255 consecutive patients with STEMI who were reperfused within 12 h after symptom onset. CMR core laboratory analysis was performed to assess left ventricular (LV) function, standard infarct characteristics, and native T1 values of the remote, noninfarcted myocardium. The primary endpoint was a composite of death, reinfarction, and new congestive heart failure within 6 months (major adverse cardiac events [MACE]). Patients with increased remote zone native T1 values (>1,129 ms) had significantly larger infarcts (p = 0.012), less myocardial salvage (p = 0.002), and more pronounced LV dysfunction (p = 0.011). In multivariable analysis, remote zone native T1 was independently associated with MACE after adjusting for clinical risk factors (p = 0.001) or other CMR variables (p = 0.007). In C-statistics, native T1 of remote myocardium provided incremental prognostic information beyond clinical risk factors, LV ejection fraction, and other markers of infarct severity (all p remote zone native T1 to a model of prognostic CMR parameters (ejection fraction, infarct size, and myocardial salvage index) led to net reclassification improvement of 0.82 (95% confidence interval: 0.46 to 1.17; p remote zone alterations by quantitative noncontrast T1 mapping provided independent and incremental prognostic information in addition to clinical risk factors and traditional CMR outcome markers. Remote zone alterations may thus represent a novel therapeutic target and a

  13. The association of lifetime education with the prevalence of myocardial infarction: an analysis of the 2006 Behavioral Risk Factor Surveillance System.

    Science.gov (United States)

    Kelly, Michael J; Weitzen, Sherry

    2010-02-01

    Socioeconomic status is likely an independent risk factor for coronary heart disease but little research has been done in the United States to study this association in a nationally representative sample. We sought to determine the association between lifetime education and the prevalence of myocardial infarction (MI) among adults over the age of 39 in the US. A cross sectional study was conducted using the 2006 Behavioral Risk Factor Surveillance System (BRFSS). A multivariable logistic regression was performed. The analysis was conducted in 2008. Among respondents aged 40 years and older to the 2006 BRFSS survey those with less than a high school education had 3.09 (95% CI: 2.79-3.43) times the odds of having had an MI compared to college graduates. After adjusting for confounders, respondents with less than a high school education had 1.61 (95% CI: 1.41-1.83) times the odds of having had an MI compared to college graduates. Both those with a high school education and those who completed some college or technical school had 1.22 times the odds of having had an MI compared to college graduates after adjusting for confounders. This study suggests that education is a risk factor for MI. More national prospective studies are needed in the US to better understand the link between socioeconomic status and coronary heart disease.

  14. Impact of obesity as a mortality predictor in high-risk patients with myocardial infarction or chronic heart failure: a pooled analysis of five registries

    DEFF Research Database (Denmark)

    Abdulla, Jawdat; Køber, Lars; Abildstrøm, Steen Z

    2008-01-01

    AIMS: To explore the influence of obesity on prognosis in high-risk patients with myocardial infarction (MI) or heart failure (HF). METHODS AND RESULTS: Individual data of 21 570 consecutively hospitalized patients from five Danish registries were pooled together. After a follow-up of 10.4 years......, all-cause mortality using multivariate model and adjusted hazard ratios (HR) with 95% confidence intervals were calculated. Compared with normal weight [body mass index (BMI) 18.5-24.9 kg/m2], obesity class II (BMI >or= 35 kg/m2) was associated with increased risk of death in patients with MI...... but not HF [HR = 1.23 (1.06-1.44), P = 0.006 and HR = 1.13 (0.95-1.36), P = 0.95] (P-value for interaction = 0.004). Obesity class I (BMI 30-34.9 kg/m2) was not associated with increased risk of death in MI or HF [HR = 0.99 (0.92-1.08) and 1.00 (0.90-1.11), P > 0.1]. Pre-obesity (BMI 25-29.9 kg/m2...

  15. Long-term use of non-steroidal anti-inflammatory drugs and the risk of myocardial infarction in the general population

    Directory of Open Access Journals (Sweden)

    González-Pérez Antonio

    2005-11-01

    Full Text Available Abstract Background Recent data indicate that chronic use of coxibs leads to an increased occurrence of thrombotic cardiovascular events. This raises the question as to whether traditional non-steroidal anti-inflammatory drugs (tNSAIDs might also produce similar hazards. Our aim has been to evaluate the association between the chronic use of tNSAIDs and the risk of myocardial infarction (MI in patients. Methods We performed a nested case-control analysis with 4,975 cases of acute MI and 20,000 controls, frequency matched to cases by age, sex, and calendar year. Results Overall, current use of tNSAID was not associated with an increased risk of MI (RR:1.07;95%CI: 0.95–1.21. However, we found that the relative risk (RR of MI for durations of tNSAID treatment of >1 year was 1.21 (95% CI, 1.00–1.48. The corresponding RR was 1.34 (95% CI, 1.06–1.70 for non-fatal MI. The effect was independent from dose. The small risk associated with long-term use of tNSAIDs was observed among patients not taking low-dose aspirin (RR: 1.29; 95% CI, 1.01–1.65. The effect of long-term use for individual tNSAIDs ranged from a RR of 0.87 (95% CI, 0.47–1.62 with naproxen to 1.38 (95% CI, 1.00–1.90 with diclofenac. Conclusion This study adds support to the hypothesis that chronic treatment with some tNSAIDs is associated with a small increased risk of non-fatal MI. Our data are consistent with a substantial variability in cardiovascular risks between individual tNSAIDs.

  16. Derivation and Validation of a Risk Standardization Model for Benchmarking Hospital Performance for Health-Related Quality of Life Outcomes after Acute Myocardial Infarction

    Science.gov (United States)

    Arnold, Suzanne V.; Masoudi, Frederick A.; Rumsfeld, John S.; Li, Yan; Jones, Philip G.; Spertus, John A.

    2014-01-01

    Background Before outcomes-based measures of quality can be used to compare and improve care, they must be risk-standardized to account for variations in patient characteristics. Despite the importance of health-related quality of life (HRQL) outcomes among patients with acute myocardial infarction (AMI), no risk-standardized models have been developed. Methods and Results We assessed disease-specific HRQL using the Seattle Angina Questionnaire at baseline and 1 year later in 2693 unselected AMI patients from 24 hospitals enrolled in the TRIUMPH registry. Using 57 candidate sociodemographic, economic, and clinical variables present on admission, we developed a parsimonious, hierarchical linear regression model to predict HRQL. Eleven variables were independently associated with poor HRQL after AMI, including younger age, prior CABG, depressive symptoms, and financial difficulties (R2=20%). The model demonstrated excellent internal calibration and reasonable calibration in an independent sample of 1890 AMI patients in a separate registry, although the model slightly over-predicted HRQL scores in the higher deciles. Among the 24 TRIUMPH hospitals, 1-year unadjusted HRQL scores ranged from 67–89. After risk-standardization, HRQL scores variability narrowed substantially (range=79–83), and the group of hospital performance (bottom 20%/middle 60%/top 20%) changed in 14 of the 24 hospitals (58% reclassification with risk-standardization). Conclusions In this predictive model for HRQL after AMI, we identified risk factors, including economic and psychological characteristics, associated with HRQL outcomes. Adjusting for these factors substantially altered the rankings of hospitals as compared with unadjusted comparisons. Using this model to compare risk-standardized HRQL outcomes across hospitals may identify processes of care that maximize this important patient-centered outcome. PMID:24163068

  17. Risk factors and prognostic role of an electrical storm in patients after myocardial infarction with an implanted ICD for secondary prevention.

    Science.gov (United States)

    Kwaśniewski, Wojciech; Filipecki, Artur; Orszulak, Michał; Orszulak, Witold; Urbańczyk, Dagmara; Roczniok, Robert; Trusz-Gluza, Maria; Mizia-Stec, Katarzyna

    2018-04-01

    The aim of our study was to determine the risk factors for electrical storm (ES) and to assess the impact of ES on the long-term prognosis in patients after myocardial infarction (MI) with an implantable cardioverter-defibrillator (ICD) for secondary prevention of sudden cardiac death (SCD). We retrospectively analyzed 416 patients with coronary artery disease after MI who had an implanted ICD for secondary prevention of SCD. Fifty (12%) patients had one or more incidents of an electrical storm - the ES (+) group. We matched the reference group of 47 patients from 366 ES (-) patients. We analyzed 3,408 episodes of ventricular arrhythmias: 3,148 ventricular tachyarrhythmic episodes in the ES (+) group (including 187 episodes of ES) and 260 in the ES (-) group. Multivariate logistic regression showed that inferior wall MI (RR = 3.98, 95% CI: 1.52-10.41) and the absence of coronary revascularization (RR = 2.92, 95% CI: 1.18-7.21) were independent predictors of ES ( p = 0.0014). During 6-year observation of 97 patients, there were 39 (40%) deaths: 25 (50%) subjects in the ES (+) group and 14 (30%) in the ES (-) group ( p = 0.036). Independent predictors of death were: the occurrence of ES (HR = 1.93), older age (HR = 1.06), and lower left ventricular ejection fraction (HR = 0.95) (for all p storm in patients after MI with ICD for secondary prevention is a relatively common phenomenon and has a negative prognostic significance. Myocardial infarction of the inferior wall and the absence of coronary revascularization are predisposing factors for the occurrence of an ES.

  18. A genetic risk score of 45 coronary artery disease risk variants associates with increased risk of myocardial infarction in 6041 Danish individuals

    DEFF Research Database (Denmark)

    Krarup, N T; Borglykke, A; Allin, K H

    2015-01-01

    with age as time scale was adjusted for sex, BMI, type 2 diabetes mellitus and smoking status. Analyses were also stratified either by sex or median age (below or above 45 years of age). We estimated GRS contribution to MI prediction by assessing net reclassification index (NRI) and integrated...... discrimination improvement (IDI) added to the European SCORE for 10-year MI risk prediction. RESULTS: The GRS associated significantly with risk of incident MI (allele-dependent hazard ratio (95%CI): 1.06 (1.02-1.11), p = 0.01) but not with CAD (p = 0.39). Stratification revealed association of GRS with MI...... in men (1.06 (1.01-1.12), p = 0.02) and in individuals above the median of 45.11 years of age (1.06 (1.00-1.12), p = 0.03). There was no interaction between GRS and gender (p = 0.90) or age (p = 0.83). The GRS improved neither NRI nor IDI. CONCLUSION: The GRS of 45 GWAS identified risk variants increase...

  19. Fasting Hyperglycemia Increases In-Hospital Mortality Risk in Nondiabetic Female Patients with Acute Myocardial Infarction: A Retrospective Study

    Directory of Open Access Journals (Sweden)

    Guojing Luo

    2014-01-01

    Full Text Available Previous studies had shown that elevated admission plasma glucose (APG could increase mortality rate and serious complications of acute myocardial infarction (AMI, but whether fasting plasma glucose (FPG had the same role remains controversial. In this retrospective study, 253 cases of AMI patients were divided into diabetic (n=87 and nondiabetic group (n=166. Our results showed that: compared with the nondiabetic patients, diabetic patients had higher APG, FPG, higher plasma triglyceride, higher rates of painless AMI (P0.05. While nondiabetic patients were subgrouped in terms of APG and FPG (cut points were 11.1 mmol/L and 7.0 mmol/L, resp., the mortality rate had significant difference (P<0.01, whereas glucose level lost significance in diabetic group. Multivariate logistic regression analysis showed that FPG (OR: 2.014; 95% confidence interval: 1.296–3.131; p<0.01 but not APG was independent predictor of in-hospital mortality for nondiabetic patients. These results indicate that FPG can be an independent predictor for mortality in nondiabetic female patients with AMI.

  20. Upper Gastrointestinal Complications and Cardiovascular/Gastrointestinal Risk Calculator in Patients with Myocardial Infarction Treated with Aspirin

    Directory of Open Access Journals (Sweden)

    Lei Wen

    2017-01-01

    Conclusions: AsaRiskCalculator had a predictive value for gastrointestinal events in Chinese patients with MI. HP infection seemed to be an independent risk factor for gastrointestinal events caused by long-term aspirin treatment in Chinese patients with MI, and it should be included in the risk calculator adapted for Chinese patients.

  1. Depression following myocardial infarction

    DEFF Research Database (Denmark)

    Larsen, Karen Kjær

    2013-01-01

    whether the mental burden of MI is so heavy that it increases the risk of suicide. Although post-MI depression is common and burdensome, the condition remains under-recognised and under-treated. The development of new strategies to improve the quality of care for people with post-MI depression requires...... between post-MI depression and new cardiovascular events or death, taking potential mediators into account (Paper III); 4. To examine the association between MI and suicide (Paper IV). Two different study designs were employed: a population-based cohort study using data obtained from registers......Myocardial infarction (MI) is a severe life event that is accompanied by an increased risk of depression. Mounting evidence suggests that post-MI depression is associated with adverse outcomes, but the underlying mechanisms of this association remain unclear, and no previous studies have examined...

  2. Adherence to a healthy Nordic food index and risk of myocardial infarction in middle-aged Danes: the diet, cancer and health cohort study.

    Science.gov (United States)

    Gunge, V B; Andersen, I; Kyrø, C; Hansen, C P; Dahm, C C; Christensen, J; Tjønneland, A; Olsen, A

    2017-05-01

    For decades, the Mediterranean diet has been in focus regarding healthy eating as it has been associated with reduced risk of non-communicable diseases. Less interest has been given to health benefits of other regional diets. The aim of the present study was to assess whether adherence to a healthy Nordic food index was associated with lower risk of myocardial infarction (MI) among middle-aged Danes. Data were obtained from the Danish Diet, Cancer and Health cohort study of 57 053 men and women aged 50-64 years recruited between 1993 and 1997. The healthy Nordic food index comprised healthy Nordic food items selected a priori (fish, cabbage, rye bread, oatmeal, apple and pears and root vegetables). Information on incident MI was ascertained through linkage with national registries. Hazard ratios (HR) with 95% confidence intervals (CI) were estimated from sex-specific Cox proportional hazard models. In total, 1669 men and 653 women developed MI during follow-up (13.6 median years). In adjusted models, those with an index score of 5-6 points (highest scores) had significantly lower MI risk (men: HR=0.77, 95% CI=0.62, 0.97; women: HR=0.55, 95% CI=0.37, 0.82) relative to those scoring 0 points in the index (lowest score). A significantly lower MI risk was found per 1-point increment in the index in both men (HR=0.95, 95% CI=0.92, 0.99) and women (HR=0.93, 95% CI=0.88, 0.98). A healthy Nordic diet is associated with lower MI risk among middle-aged Danes, suggesting that Nordic diets should be considered in recommendations for dietary changes in the promotion of coronary health.

  3. Long-term cardiovascular risk of nonsteroidal anti-inflammatory drug use according to time passed after first-time myocardial infarction: a nationwide cohort study.

    Science.gov (United States)

    Olsen, Anne-Marie Schjerning; Fosbøl, Emil L; Lindhardsen, Jesper; Folke, Fredrik; Charlot, Mette; Selmer, Christian; Bjerring Olesen, Jonas; Lamberts, Morten; Ruwald, Martin H; Køber, Lars; Hansen, Peter R; Torp-Pedersen, Christian; Gislason, Gunnar H

    2012-10-16

    The cardiovascular risk after the first myocardial infarction (MI) declines rapidly during the first year. We analyzed whether the cardiovascular risk associated with using nonsteroidal anti-inflammatory drugs (NSAIDs) was associated with the time elapsed following first-time MI. We identified patients aged 30 years or older admitted with first-time MI in 1997 to 2009 and subsequent NSAID use by individual-level linkage of nationwide registries of hospitalization and drug dispensing from pharmacies in Denmark. We calculated the incidence rates of death and a composite end point of coronary death or nonfatal recurrent MIs associated with NSAID use in 1-year time intervals up to 5 years after inclusion and analyzed risk by using multivariable adjusted time-dependent Cox proportional hazards models. Of the 99 187 patients included, 43 608 (44%) were prescribed NSAIDs after the index MI. There were 36 747 deaths and 28 693 coronary deaths or nonfatal recurrent MIs during the 5 years of follow-up. Relative to noncurrent treatment with NSAIDs, the use of any NSAID in the years following MI was persistently associated with an increased risk of death (hazard ratio 1.59 [95% confidence interval, 1.49-1.69]) after 1 year and hazard ratio 1.63 [95% confidence interval, 1.52-1.74] after 5 years) and coronary death or nonfatal recurrent MI (hazard ratio, 1.30 [95% confidence interval,l 1.22-1.39] and hazard ratio, 1.41 [95% confidence interval, 1.28-1.55]). The use of NSAIDs is associated with persistently increased coronary risk regardless of time elapsed after first-time MI. We advise long-term caution in the use of NSAIDs for patients after MI.

  4. Usefulness of Desirable Lifestyle Factors to Attenuate the Risk of Heart Failure Among Offspring whose Parents had Myocardial Infarction before Age 55 Years

    Science.gov (United States)

    Khawaja, Owais; Kotler, Gregory; Gaziano, John Michael; Djoussé, Luc

    2012-01-01

    Heart failure (HF) is one of the leading causes of hospitalization and death in United States and throughout Europe. While a higher risk of HF with antecedent myocardial infarction (MI) has been reported in offspring whose parents had MI before age 55, it is unclear whether adherence to healthful behaviors could mitigate that risk. The aim of the current study was therefore to prospectively examine if adherence to healthy weight, regular exercise, moderate alcohol consumption, and abstinence from smoking can attenuate such increased HF risk. The information on parental history of MI and lifestyle factors was collected using questionnaires. Subjects adhering to at least three healthy lifestyle factors were classified as having good vs. poor lifestyle score. Incident HF was assessed via yearly follow-up questionnaires and validated in a subsample. During an average follow up of 21.7 (6.5) years, 1,323 new HF cases (6.6%) of which 190 (14.4%) were preceded by MI occurred. Compared to subjects with good lifestyle score and no parental history of premature MI, multivariable adjusted hazard ratios (95% CI) for incident HF with antecedent MI was 3.21 (1.74–5.91) for people with good lifestyle score and parental history of premature MI; 1.52 (1.12–2.07) for individuals with poor lifestyle score and no parental history of premature MI; and 4.60 (2.55–8.30) for people with poor lifestyle score and parental history of premature MI. In conclusion, our data suggest that even in people at higher risk of HF due to genetic predisposition, adherence to healthful lifestyle factors may attenuate such an elevated HF risk. PMID:22516528

  5. Influence of Androgen Deprivation Therapy on All-Cause Mortality in Men With High-Risk Prostate Cancer and a History of Congestive Heart Failure or Myocardial Infarction

    International Nuclear Information System (INIS)

    Nguyen, Paul L.; Chen, Ming-Hui; Beckman, Joshua A.; Beard, Clair J.; Martin, Neil E.; Choueiri, Toni K.; Hu, Jim C.; Hoffman, Karen E.; Dosoretz, Daniel E.; Moran, Brian J.; Salenius, Sharon A.; Braccioforte, Michelle H.; Kantoff, Philip W.; D’Amico, Anthony V.; Ennis, Ronald D.

    2012-01-01

    Purpose: It is unknown whether the excess risk of all-cause mortality (ACM) observed when androgen deprivation therapy (ADT) is added to radiation for men with prostate cancer and a history of congestive heart failure (CHF) or myocardial infarction (MI) also applies to those with high-risk disease. Methods and Materials: Of 14,594 men with cT1c–T3aN0M0 prostate cancer treated with brachytherapy-based radiation from 1991 through 2006, 1,378 (9.4%) with a history of CHF or MI comprised the study cohort. Of these, 22.6% received supplemental external beam radiation, and 42.9% received a median of 4 months of neoadjuvant ADT. Median age was 71.8 years. Median follow-up was 4.3 years. Cox multivariable analysis tested for an association between ADT use and ACM within risk groups, after adjusting for treatment factors, prognostic factors, and propensity score for ADT. Results: ADT was associated with significantly increased ACM (adjusted hazard ratio [AHR] = 1.76; 95% confidence interval [CI], 1.32–2.34; p = 0.0001), with 5-year estimates of 22.71% with ADT and 11.62% without ADT. The impact of ADT on ACM by risk group was as follows: high-risk AHR = 2.57; 95% CI, 1.17–5.67; p = 0.019; intermediate-risk AHR = 1.75; 95% CI, 1.13–2.73; p = 0.012; low-risk AHR = 1.52; 95% CI, 0.96–2.43; p = 0.075). Conclusions: Among patients with a history of CHF or MI treated with brachytherapy-based radiation, ADT was associated with increased all-cause mortality, even for patients with high-risk disease. Although ADT has been shown in Phase III studies to improve overall survival in high-risk disease, the small subgroup of high-risk patients with a history of CHF or MI, who represented about 9% of the patients, may be harmed by ADT.

  6. Influence of Androgen Deprivation Therapy on All-Cause Mortality in Men With High-Risk Prostate Cancer and a History of Congestive Heart Failure or Myocardial Infarction

    Energy Technology Data Exchange (ETDEWEB)

    Nguyen, Paul L., E-mail: pnguyen@LROC.harvard.edu [Department of Radiation Oncology, Dana Farber Cancer Institute and Brigham and Women' s Hospital, Harvard Medical School, Boston, MA (United States); Chen, Ming-Hui [Department of Statistics, University of Connecticut, Storrs, CT (United States); Beckman, Joshua A. [Department of Cardiology, Brigham and Women' s Hospital, Harvard Medical School, Boston, MA (United States); Beard, Clair J.; Martin, Neil E. [Department of Radiation Oncology, Dana Farber Cancer Institute and Brigham and Women' s Hospital, Harvard Medical School, Boston, MA (United States); Choueiri, Toni K. [Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA (United States); Hu, Jim C. [Division of Urologic Surgery, Brigham and Women' s/Faulkner Hospital, Harvard Medical School, Boston, MA (United States); Hoffman, Karen E. [Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States); Dosoretz, Daniel E. [21st Century Oncology, Fort Myers, FL (United States); Moran, Brian J. [Chicago Prostate Center, Westmont, IL (United States); Salenius, Sharon A. [21st Century Oncology, Fort Myers, FL (United States); Braccioforte, Michelle H. [Chicago Prostate Center, Westmont, IL (United States); Kantoff, Philip W. [Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA (United States); D' Amico, Anthony V. [Department of Radiation Oncology, Dana Farber Cancer Institute and Brigham and Women' s Hospital, Harvard Medical School, Boston, MA (United States); Ennis, Ronald D. [Department of Radiation Oncology, St. Luke' s-Roosevelt and Beth Israel Hospitals, Continuum Cancer Centers of New York, Albert Einstein College of Medicine, New York, NY (Israel)

    2012-03-15

    Purpose: It is unknown whether the excess risk of all-cause mortality (ACM) observed when androgen deprivation therapy (ADT) is added to radiation for men with prostate cancer and a history of congestive heart failure (CHF) or myocardial infarction (MI) also applies to those with high-risk disease. Methods and Materials: Of 14,594 men with cT1c-T3aN0M0 prostate cancer treated with brachytherapy-based radiation from 1991 through 2006, 1,378 (9.4%) with a history of CHF or MI comprised the study cohort. Of these, 22.6% received supplemental external beam radiation, and 42.9% received a median of 4 months of neoadjuvant ADT. Median age was 71.8 years. Median follow-up was 4.3 years. Cox multivariable analysis tested for an association between ADT use and ACM within risk groups, after adjusting for treatment factors, prognostic factors, and propensity score for ADT. Results: ADT was associated with significantly increased ACM (adjusted hazard ratio [AHR] = 1.76; 95% confidence interval [CI], 1.32-2.34; p = 0.0001), with 5-year estimates of 22.71% with ADT and 11.62% without ADT. The impact of ADT on ACM by risk group was as follows: high-risk AHR = 2.57; 95% CI, 1.17-5.67; p = 0.019; intermediate-risk AHR = 1.75; 95% CI, 1.13-2.73; p = 0.012; low-risk AHR = 1.52; 95% CI, 0.96-2.43; p = 0.075). Conclusions: Among patients with a history of CHF or MI treated with brachytherapy-based radiation, ADT was associated with increased all-cause mortality, even for patients with high-risk disease. Although ADT has been shown in Phase III studies to improve overall survival in high-risk disease, the small subgroup of high-risk patients with a history of CHF or MI, who represented about 9% of the patients, may be harmed by ADT.

  7. Limitation of Infarct Size and No-Reflow by Intracoronary Adenosine Depends Critically on Dose and Duration.

    Science.gov (United States)

    Yetgin, Tuncay; Uitterdijk, André; Te Lintel Hekkert, Maaike; Merkus, Daphne; Krabbendam-Peters, Ilona; van Beusekom, Heleen M M; Falotico, Robert; Serruys, Patrick W; Manintveld, Olivier C; van Geuns, Robert-Jan M; Zijlstra, Felix; Duncker, Dirk J

    2015-12-28

    In the absence of effective clinical pharmacotherapy for prevention of reperfusion-mediated injury, this study re-evaluated the effects of intracoronary adenosine on infarct size and no-reflow in a porcine model of acute myocardial infarction using clinical bolus and experimental high-dose infusion regimens. Despite the clear cardioprotective effects of adenosine, when administered prior to ischemia, studies on cardioprotection by adenosine when administered at reperfusion have yielded contradictory results in both pre-clinical and clinical settings. Swine (54 ± 1 kg) were subjected to a 45-min mid-left anterior descending artery occlusion followed by 2 h of reperfusion. In protocol A, an intracoronary bolus of 3 mg adenosine injected over 1 min (n = 5) or saline (n = 10) was administered at reperfusion. In protocol B, an intracoronary infusion of 50 μg/kg/min adenosine (n = 15) or saline (n = 21) was administered starting 5 min prior to reperfusion and continued throughout the 2-h reperfusion period. In protocol A, area-at-risk, infarct size, and no-reflow were similar between groups. In protocol B, risk zones were similar, but administration of adenosine resulted in significant reductions in infarct size from 59 ± 3% of the area-at-risk in control swine to 46 ± 4% (p = 0.02), and no-reflow from 49 ± 6% of the infarct area to 26 ± 6% (p = 0.03). During reperfusion, intracoronary adenosine can limit infarct size and no-reflow in a porcine model of acute myocardial infarction. However, protection was only observed when adenosine was administered via prolonged high-dose infusion, and not via short-acting bolus injection. These findings warrant reconsideration of adenosine as an adjuvant therapy during early reperfusion. Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  8. Vulnerability and hydrogeologic risk of SAG in the outcroupping zone of Rivera Uruguay

    International Nuclear Information System (INIS)

    Collazo, P.; Montano, J.; Auge, M.; jmont@fcien.edu.uy mpauge@ciudad.com.ar

    2007-01-01

    The studied area belongs to the outcroupping zone of the Guarani Aquifer in the Department of Rivera, Uruguay. It comprises an approximate area of 2900 Km2. The outcropping Guarani Aquifer (AGa) is formed by two sections, an upper one corresponding to the Rivera Unit (UR) and a lower one corresponding to the Tacuarembo Unit (UT), both with vertical hydraulic continuity. The Rivera Unit is entirely represented by the homonymous formation and it consists of medium to fine sandstones with a mean effective porosity of 14% and mean Transmissivity of 88 m2/dia. The Tacuarembo Unit is constituted by fine to very fine sandstone levels interbedded with pelitic sandstone and shales. This unit behaves like unconfined aquifer in the upper section, where it contains the phreatic layer and it passes to semi-confined as the depth increases. The effective porosity is approximatelly of 9% and mean T 24 m2/dia. Chemically, both units are classified as calcicbicarbonated and magnesic-bicarbonated. To determine the vulnerability, it was applied the GOD method yielding high vulnerability for levels lower than 10m and moderate for levels of water larger than 10m. From the study of risk the conclusions are: high risk of groundwater contamination due to the lack of sewage systems and to the rubbish dump leakage. The industrial activity, cemeteries and mining activity represents moderated risks in most of the cases

  9. Classification of myocardial infarction

    DEFF Research Database (Denmark)

    Saaby, Lotte; Poulsen, Tina Svenstrup; Hosbond, Susanne Elisabeth

    2013-01-01

    The classification of myocardial infarction into 5 types was introduced in 2007 as an important component of the universal definition. In contrast to the plaque rupture-related type 1 myocardial infarction, type 2 myocardial infarction is considered to be caused by an imbalance between demand...

  10. Prognosis and high-risk complication identification in unselected patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention

    DEFF Research Database (Denmark)

    Andersson, Hedvig; Ripa, Maria Sejersten; Clemmensen, Peter

    2010-01-01

    The aim of this study was to evaluate treatment with primary percutaneous coronary intervention (PCI) in unselected patients with ST-segment elevation myocardial infarction (STEMI).......The aim of this study was to evaluate treatment with primary percutaneous coronary intervention (PCI) in unselected patients with ST-segment elevation myocardial infarction (STEMI)....

  11. ɛ3ɛ4 Genotype as Risk Factor of Myocardial Infarction in Middle-Aged People in Spain

    Directory of Open Access Journals (Sweden)

    Carmen Garcés

    2005-01-01

    Full Text Available Apolipoprotein E (apoE plays an important role in lipid metabolism. Its ɛ4 allele has been consistently associated with lipoprotein disorders but its connection to myocardial infarction (MI is controversial. Because ɛ4 frequency decreases with age we thought that the contradictory results in different studies could be due to the wide age range of the subjects included. To test our hypothesis, ApoE genotyping was performed in 474 MI cases and an analysis was performed by percentiles of age. The frequencies of ɛ3ɛ4 genotype and ɛ4 allele in the MI group as a whole (subjects aged 31 to 92 were not significantly different from those in our area general population. However, significant differences were observed when comparing by group of age. The frequencies decreased as age increased. The ɛ3ɛ4 and ɛ4 frequencies were significantly higher in MI subjects aged 31 to 56 than in subjects over 74. The ɛ3ɛ4 genotype prevalence in an age and sex matched control group of subjects aged 31 to 56 was significantly lower than in the 31–56 year-old MI group. In conclusion, our data shows different ɛ3ɛ4 and ɛ4 frequencies depending on the age range of the subjects with MI, being significantly higher in the middle-aged group. This finding may help explain the discrepancies between studies analyzing association between apoE genotype and MI, and emphasizes the idea of considering apoE genotype for prevention at early age.

  12. Race and Sex Differences in the Incidence and Prognostic Significance of Silent Myocardial Infarction in the Atherosclerosis Risk in Communities (ARIC) Study.

    Science.gov (United States)

    Zhang, Zhu-Ming; Rautaharju, Pentti M; Prineas, Ronald J; Rodriguez, Carlos J; Loehr, Laura; Rosamond, Wayne D; Kitzman, Dalane; Couper, David; Soliman, Elsayed Z

    2016-05-31

    Race and sex differences in silent myocardial infarction (SMI) are not well established. The analysis included 9498 participants from the Atherosclerosis Risk in Communities (ARIC) study who were free of cardiovascular disease at baseline (visit 1, 1987-1989). Incident SMI was defined as ECG evidence of MI without clinically documented MI (CMI) after the baseline until ARIC visit 4 (1996-1998). Coronary heart disease and all-cause deaths were ascertained starting from ARIC visit 4 until 2010. During a median follow-up of 8.9 years, 317 participants (3.3%) developed SMI and 386 (4.1%) developed CMI. The incidence rates of both SMI and CMI were higher in men (5.08 and 7.96 per 1000-person years, respectively) than in women (2.93 and 2.25 per 1000-person years, respectively; Prace were detected. SMI represents >45% of incident MIs and is associated with poor prognosis. Race and sex differences in the incidence and prognostic significance of SMI exist that may warrant considering SMI in personalized assessments of coronary heart disease risk. © 2016 American Heart Association, Inc.

  13. Depressive Symptoms and Risk of New Cardiovascular Events or Death in Patients with Myocardial Infarction: A Population-Based Longitudinal Study Examining Health Behaviors and Health Care Interventions

    DEFF Research Database (Denmark)

    Larsen, Karen Kjær; Christensen, Bo; Søndergaard, Jens

    2013-01-01

    Mange mennesker rammes af depression efter en blodprop i hjertet (AMI), og denne kombination er forbundet med en dårligere prognose. Dette studie er det første, der viser, at depression udgør en selv-stændig risikofaktor for tidlig død hos patienter med blodprop i hjertet. Undersøgelsen tyder dog...... bruges til at skærpe opmærksomheden over for denne patientgruppe hos de praktiserende læger, hvor op mod 90 % af alle patienter med depression bliver diagnosticeret og behandlet. Background: Depressive symptoms is associated with adverse cardiovascular outcomes in patients with myocardial infarction (MI......), but the underlying mechanisms are unclear and it remains unknown whether subgroups of patients are at a particularly high relative risk of adverse outcomes. We examined the risk of new cardiovascular events and/or death in patients with depressive symptoms following first-time MI taking into account other secondary...

  14. Prognostic impact of physical activity prior to myocardial infarction

    DEFF Research Database (Denmark)

    Ejlersen, Hanne; Andersen, Zorana Jovanovic; von Euler-Chelpin, My Catarina

    2017-01-01

    the course of myocardial infarction by reducing case fatality and the subsequent risk of heart failure and mortality. Methods: A total of 14,223 participants in the Copenhagen City Heart Study were assessed at baseline in 1976-1978; 1,664 later developed myocardial infarction (mean age at myocardial...... estimated by logistic and Cox proportional hazards regression models, adjusted for age at myocardial infarction and other potential confounders. Results: A total of 425 (25.5%) myocardial infarctions were fatal. Higher levels of LTPA prior to myocardial infarction were associated with lower case fatality...

  15. Use of haloperidol versus atypical antipsychotics and risk of in-hospital death in patients with acute myocardial infarction: cohort study.

    Science.gov (United States)

    Park, Yoonyoung; Bateman, Brian T; Kim, Dae Hyun; Hernandez-Diaz, Sonia; Patorno, Elisabetta; Glynn, Robert J; Mogun, Helen; Huybrechts, Krista F

    2018-03-28

    To compare the risk of in-hospital mortality associated with haloperidol compared with atypical antipsychotics in patients admitted to hospital with acute myocardial infarction. Cohort study using a healthcare database. Nationwide sample of patient data from more than 700 hospitals across the United States. 6578 medical patients aged more than 18 years who initiated oral haloperidol or oral atypical antipsychotics (olanzapine, quetiapine, risperidone) during a hospital admission with a primary diagnosis of acute myocardial infarction between 2003 and 2014. In-hospital mortality during seven days of follow-up from treatment initiation. Among 6578 patients (mean age 75.2 years) treated with an oral antipsychotic drug, 1668 (25.4%) initiated haloperidol and 4910 (74.6%) initiated atypical antipsychotics. The mean time from admission to start of treatment (5.3 v 5.6 days) and length of stay (12.5 v 13.6 days) were similar, but the mean treatment duration was shorter in patients using haloperidol compared with those using atypical antipsychotics (2.4 v 3.9 days). 1:1 propensity score matching was used to adjust for confounding. In intention to treat analyses with the matched cohort, the absolute rate of death per 100 person days was 1.7 for haloperidol (129 deaths) and 1.1 for atypical antipsychotics (92 deaths) during seven days of follow-up from treatment initiation. The survival probability was 0.93 in patients using haloperidol and 0.94 in those using atypical antipsychotics at day 7, accounting for the loss of follow-up due to hospital discharge. The unadjusted and adjusted hazard ratios of death were 1.51 (95% confidence interval 1.22 to 1.85) and 1.50 (1.14 to 1.96), respectively. The association was strongest during the first four days of follow-up and decreased over time. By day 5, the increased risk was no longer evident (1.12, 0.79 to 1.59). In the as-treated analyses, the unadjusted and adjusted hazard ratios were 1.90 (1.43 to 2.53) and 1.93 (1.34 to 2

  16. “To Assess the Clinical Profile and Risk Factors Associated with Myocardial Infarction In Young Adults”

    Directory of Open Access Journals (Sweden)

    Chandrashekhar Yadav

    2016-01-01

    Conclusion: In young MI cases conventional risk factors like diabetes mellitus, hypertension play less important role as compared to old individuals. Smoking and novel emerging risk factors like hyperhomocysteinemia, protein C & S deficiency play much prominent role in young patients with MI.

  17. Patient awareness of stent type, risk of cardiac events, and symptoms of myocardial infarction among PCI patients: a missed educational opportunity?

    Science.gov (United States)

    D'Elia, Alexis A; Hafiz, Abdul Moiz; Naidu, Srihari S; Marzo, Kevin P

    2011-04-01

     Timely and successful treatment of myocardial infarction (MI) requires accurate recognition by the patient of the signs and symptoms. As patients who have undergone percutaneous coronary intervention (PCI) remain at risk for cardiac events, it is important that they have a basic understanding of their cardiac status.  We surveyed 80 consecutive patients following elective PCI using a simple multiple-choice questionnaire. Type of stent (bare metal or drug-eluting), how they perceive the procedure would affect their cardiovascular health, their perceived risk of a future MI, and whether they recalled specific education on how to recognize symptoms of an MI were queried.  45% (n = 36) of patients were unaware of stent type. 10% stated PCI was performed to relieve symptoms of angina, 30% (n = 24) stated it would prevent MI, 56.3% (n = 45) stated that it would both prevent MI and reduce symptoms of angina, while 3.8% stated it would do neither. 86.3% (n = 69) stated they remained at risk for MI despite the procedure. However, 42.5% (n = 34) of patients did not perceive to have received specific education on the signs and symptoms of MI during their hospital stay.  Patient understanding of stent type, expected cardiovascular outcomes, and recognition of MI post-PCI appears low in the real-world setting. A systematic approach to post-PCI education should be incorporated into routine care, in order to capitalize on the educational opportunity afforded by this high risk population. ©2010, Wiley Periodicals, Inc.

  18. Incidence of myocardial infarction among Swedish and immigrant smoking women: can physical activity modify the risk? An epidemiological study on the Malmo Diet and Cancer Study.

    Science.gov (United States)

    Nayak, Raj Kumar; Zdravkovic, Slobodan; Janzon, Ellis

    2013-11-01

    Sweden has shown a decreasing tendency in the incidence of myocardial infarction (MI), except among middle-aged women. The incidence among middle-aged immigrant women is less explored. To determine if foreign-born women have a higher risk of MI as compared to women born in Sweden. Furthermore, to examine if physical activity (PA) modifies the risk of MI regardless of immigration status and smoking habits. The Malmö Diet and Cancer Study was used for analyses. A total of 16,776 women aged 45-73 years participated. The mean follow-up time was 13.8±4 years. Mean age was 57.4±7.9 years. No difference was found in incidence of MI between Swedish and immigrant women (p=0.72). For current smokers among Swedish women, the relative risk (RR) with no/low PA was 2.93 (95% CI 2.07-4.14) and with moderate/high PA, the RR was 2.21 (95% CI 1.61-3.03) with no/low PA-never smoker as the reference group. Among immigrant smoking women, the RR with no/low PA was 4.56 (95% CI 1.62-12.8) and with moderate/high PA, the RR was 3.27 (95% CI 1.21-8.84) with no/low PA-never smoker as the reference group. PA reduces the risk of MI in non-smokers as well as in smokers, regardless of immigration status. Furthermore, PA was even more beneficial for women born outside Sweden. Against this background, immigrant women ought to get special consideration and attention from both caregivers and public health workers.

  19. A comparison of cardiovascular risk factors among Indo-Asian and caucasian patients admitted with acute myocardial infarction in Kuala Lumpur, Malaysia and Birmingham, England.

    Science.gov (United States)

    Dhanjal, T S; Lal, M; Haynes, R; Lip, G

    2001-12-01

    Indo-Asians in the UK are at an increased risk of coronary artery disease (CAD); this may be a reflection of their cardiovascular risk factor profile as well as of a more sedentary lifestyle. We hypothesised that Indo-Asians in Malaysia and the UK may exhibit a similar cardiovascular risk factor and physical activity profile, which would be more adverse compared with caucasians. We studied 70 consecutive Indo-Asian patients admitted to hospitals in Kuala Lumpur, Malaysia (n=42; 35 males; mean age 60.6 years, SD 11.8); and Birmingham, England (n=28; 20 males; mean age 60.8 years, SD 12.9). Both groups of Indo-Asian patients were compared with 20 caucasian patients (13 males; mean age 62.7 years, SD 9.4) admitted with myocardial infarction from Birmingham. There was a higher prevalence of diabetes among Indo-Asians in both countries than among caucasians (p=0.0225). By contrast, caucasians had a higher prevalence of hypercholesterolaemia (p=0.0113), peripheral vascular disease (p=0.0008), regular alcohol consumption (pleisure activity score (p=0.001) and total physical activity score (p=0.003) among Indo-Asians in both countries than among caucasians. This survey has demonstrated differences in cardiovascular risk factors among Indo-Asian and caucasian patients. The high prevalence of diabetes, as well as the lower physical activity and sedentary lifestyles among Indo-Asians, in both Malaysia and the UK, may in part contribute to the high incidence of CAD in this ethnic group.

  20. Comparison of Risk Factors of Stroke and Myocardial Infarction in Patients 15 to 45 Years in Affiliated Hospitals of Babol University of Medical Sciences

    Directory of Open Access Journals (Sweden)

    Alijan Ahmadi Ahangar

    2016-12-01

    Full Text Available Background Myocardial infarction (MI and stroke are the second and third leading causes of death in the world. By identifying the risk factors we can take the necessary measures to prevent the occurrence of these diseases. Methods In this retrospective study, 90 MI patients and 90 stroke patients 15 - 45 year admitted to hospitals of Babol University of Medical Sciences that randomly arranged by the time of hospitalization conducted. Demographics, laboratory test and risk factors were collected using check list. The data analyzed with McNemar and Npar tests by using SPSS 21 version software. Results The most common risk factor in young patient was a history of cerebrovascular disease that in stroke was 31 cases (34% And in MI was 33 cases (37%. History of cerebrovascular disease with MI was significant 33 (37%, 57(63%, P = 0.047. A history of cardiovascular disease with stroke was significant (20 (22%, 70 (68, P = 0.001. A history of addiction with MI was significant (23 (26%, 67 (74%, P < 0.001. In stroke patients 52 cases (% 57 low-density lipoprotein (LDL was high and in 66 cases (73.1% high-density lipoprotein (HDL was low. In patients with MI in 46 patients (51% LDL was high and the 66 patients (73% HDL was low. Conclusions Young peoples with a history of cerebrovascular, cardiovascular disease and addictions should be considering as target society. Primary health care system must identify high-risk individuals, and policy barriers that prevent implementation of programs to lower death rate.

  1. Etiology, Localization and Prognosis in Cerebellar Infarctions

    Directory of Open Access Journals (Sweden)

    Yavuz Yücel

    2006-01-01

    Full Text Available Cerebrovasculer disease are the most frequent disease of the brain. Cerebellar infarct remains % 1.5-4.2 of these diseases. Etiological factors, lesion localization, symptoms and findings and relationship with prognosis of our patients with cerebellar infarct were investigated in our study. For this purpose, 32 patients were evaluated who were admitted to the Dicle University Medical School Department of Neurology in 1995-2001 hospitalized with the diagnosis of clinically and radiological confirmed cerebellar infarction.All of patients in the study group, 21 (%65.6 were male and 11 (%34.3 female. Age of overall patients ranged between 40 and 75 years with a mean of 57.8±10.2 years. Atherothrombotic infarct was the most frequent reason at the etiologic clinical classification. The most frequently found localization was the posterior inferior cerebellar artery infarct (%50. The leading two risk factors were hypertension (%78.1 and cigarette smoking (%50. The most common sign and symptoms were vertigo (%93.7, vomiting (%75, headache (%68.7 and cerebellar dysfunction findings (%50. The mean duration of hospitalization was 16.3±7.6 days. Overall mortality rate was found to be % 6.2. Finally, the most remarkable risk factors at cerebellar infarct patients are hypertension and atherosclerosis at etiology. We are considering that, controlling of these factors will reduce the appearance frequency of cerebellar infarcts.

  2. Seroprevalence and risk factors for brucellosis in cattle in selected districts of Jimma zone, Ethiopia.

    Science.gov (United States)

    Dirar, Bashahun Gebremichael; Nasinyama, George William; Gelalcha, Benti Deresa

    2015-12-01

    A cross-sectional study was carried out in Jimma town and Chora Botor district of Jimma zone from February 2014 to May 2014 to determine seroprevalence and risk factors of brucellosis in cattle. A total of 348 blood samples (174 each from zebu and crossbreed) were collected. The sera were separated and screened by Rose Bengal plate test (RBPT), and positive sera were retested by complement fixation test (CFT) for confirmation. The overall seroprevalence of bovine brucellosis was 1.4 and 0.3 % as tested by RBPT and CFT, respectively. The seroprevalence of bovine brucellosis in indigenous and crossbreed cattle was 1.1 and 0.6 % and 1.7 and 0 % using RBPT and CFT, respectively. Retained fetal membrane was the only risk factor found to be significantly associated with seropositivity of brucellosis in this study (p = 0.019). The overall seroprevalence of brucellosis was very low. However, due to the zoonotic and economic importance of the disease, prevention and control measures are required to stop further spread of the disease. To effectively implement this, the One Health (OH) is the most constructive approach we recommend.

  3. Clinical significance of late high-degree atrioventricular block in patients with left ventricular dysfunction after an acute myocardial infarction--a Cardiac Arrhythmias and Risk Stratification After Acute Myocardial Infarction (CARISMA) substudy

    DEFF Research Database (Denmark)

    Gang, Uffe Jakob Ortved; Jøns, Christian; Jørgensen, Rikke Mørch

    2011-01-01

    High-degree atrioventricular block (HAVB) is a frequent complication in the acute stages of a myocardial infarction associated with an increased rate of mortality. However, the incidence and clinical significance of HAVB in late convalescent phases of an AMI is largely unknown. The aim of this st...... of this study was to assess the incidence and prognostic value of late HAVB documented by continuous electrocardiogram (ECG) monitoring in post-AMI patients with reduced left ventricular function....

  4. [Risk of fatal/non-fatal events in patients with previous coronary heart disease/acute myocardial infarction and treatment with non-steroidal anti-inflammatory drugs].

    Science.gov (United States)

    Muñoz Olmo, L; Juan Armas, J; Gomariz García, J J

    2017-09-04

    Primary Care is the fundamental axis of our health system and obliges us to be consistent with our prescriptions. The non-steroidal anti-inflammatory drugs (NSAIDs) have been associated with increased cardiovascular risk and increased risk of all causes of death, as well as acute myocardial infarction (AMI) in patients with a previous myocardial infarction. Pain and cardiac patient management are 2 basic pillars in our daily activity, and we must know the limitations of NSAIDs in patients with established cardiovascular risk. We present a review of the scientific literature with primary interest in the role of NSAIDs and cardiovascular risk. The objective is to determine the relationship between the consumption of different NSAIDs and the fatal and non-fatal events among patients with known coronary disease. This is a review of the scientific literature with primary interest in the role of NSAIDs and cardiovascular risk. The literature review was conducted in PubMed search engines like Tripdatabase and with certain keywords. Of the 15 original papers found, 9 did not correspond completely to the central focus, so the approach was decided from 6 original articles from the past 5 years, which address the central focus of increased cardiovascular risk found (fatal and non-fatal events) in patients with prior cardiovascular disease or AMI being prescribed NSAIDs for any reason. The risk of fatal/non-fatal events in each of the studies is expressed by the odds ratio (OR)/hazard ratio (HR), defined as the probability of an event occurring. A moderate risk was observed for ibuprofen. It increases the risk of acute coronary syndrome after 5 years of cardiovascular event, especially in the 2nd year (OR 1.63; 95% CI 1.42-1.87). It also increases the risk of stroke (HR 1.23; 95% IC 1.10-1.38). Cyclo-oxygenase-2 inhibitors were the third risk group, after nabumetone and diclofenac. Celecoxib increases risk from the 14th day of treatment (HR 2.3; 95% CI 1.79-3.02), having an OR

  5. Cardiovascular Disease Burden: Evolving Knowledge of Risk Factors in Myocardial Infarction and Stroke through Population-Based Research and Perspectives in Global Prevention

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    GUSTAVO B.F. OLIVEIRA

    2015-08-01

    Full Text Available Current knowledge and research perspectives on the top ranking causes of mortality worldwide, i.e., ischemic heart disease and cerebrovascular diseases have developed rapidly. In fact, until recently, it was considered that only half of the myocardial infarctions were due to traditional risk factors such as hypertension, hypercholesterolemia, smoking and diabetes. In addition, most of the available evidence of incidence, risk factors, and clinical outcomes, if not all of it, was derived from studies conducted in developed countries, which included lower proportion of female individuals and with low ethnic diversity. Recent reports by the WHO have provided striking public health information, i.e., the global burden of cardiovascular mortality for the next decades is expected to predominantly occur among developing countries. Therefore, multi-ethnic population-based research including prospective cohorts and, when appropriate, case-control studies, is warranted. These studies should be specifically designed to ascertain key public health measures such as geographic variations in noncommunicable diseases, diagnosis of traditional and potential newly discovered risk factors, causes of death and disability, and gaps for improvement in healthcare prevention (both primary and secondary and specific treatments. As an example, a multinational, multiethnic population-based cohort study is the Prospective Urban and Rural Epidemiology (PURE study, which is the largest global initiative of 150,000 adults aged 35-70 yrs, looking at environmental, societal and biological influences on obesity and chronic health conditions such as ischemic heart disease, stroke and cancer among urban and rural communities in low-, middle-, and high-income countries, with national, community, household and individual-level data. Implementation of population-based strategies is crucial to optimizing limited health system resources while improving care and cardiovascular morbidity

  6. The association of eight potentially functional polymorphisms in five adrenergic receptor-encoding genes with myocardial infarction risk in Han Chinese.

    Science.gov (United States)

    Xia, Kun; Ding, Rongjing; Zhang, Zhiyong; Li, Weiming; Shang, Xiaoming; Yang, Xinchun; Wang, Lefeng; Zhang, Qi

    2017-08-15

    Adrenergic receptors play a key role in activating the sympathetic nervous system, which often accompanies with the development of myocardial infarction (MI). Here, we aimed to test the association of eight potentially functional polymorphisms in five adrenergic receptor-encoding genes with MI risk. Genotypes were available for 717 MI patients and 612 controls. There were no detectable deviations from the Hardy-Weinberg equilibrium for all study polymorphisms. Allele frequencies differed remarkably for ADRA2B D/I (P<0.001), ADRB1 Ser49Gly (P=0.002), ADRB2 Gln27Glu (P=0.005), and ADRB3 Trp64Arg (P<0.001) polymorphisms, even after the Bonferroni correction. Systolic blood pressure was significantly lower in ADRA2B II genotype carriers than in the DD genotype carriers (P=0.006), while plasma high-density lipoprotein cholesterol was significantly higher in patients carrying ADRA2B I allele and ADRB1 49Ser allele than in patients with the DD genotype and 49Gly/49Gly genotype, respectively (P=0.018 and 0.033). Overall best interaction model consisted of ADRA2B D/I, ADRB1 Ser49Gly, dyslipidemia and hypertension, with the highest testing accuracy of 0.627 and the maximal 10-fold cross-validation consistency (P=0.017). Finally, a nomogram was depicted based on four significant polymorphisms and metabolic risk factors, and it had a better predictive utility and was internally validated with a discrimination C-index of 0.723 (P<0.001). Altogether, we identified two polymorphisms, ADRA2B D/I and ADRB1 Ser49Arg, which not only altered genetic susceptibility to MI, but also impacted on blood pressure and plasma lipid changes, and their combination with metabolic risk factors constituted the overall best interaction model. Copyright © 2017. Published by Elsevier B.V.

  7. Polymorphisms related to the serum 25-hydroxyvitamin D level and risk of myocardial infarction, diabetes, cancer and mortality. The Tromso Study.

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    Rolf Jorde

    Full Text Available OBJECTIVE: Low serum 25(OHD levels are associated with cardiovascular risk factors, and also predict future myocardial infarction (MI, type 2 diabetes (T2DM, cancer and all-cause mortality. Recently several single nucleotide polymorphisms (SNPs associated with serum 25-hydroxyvitamin D (25(OHD level have been identified. If these relations are causal one would expect a similar association between these SNPs and health. METHODS: DNA was prepared from subjects who participated in the fourth survey of the Tromsø Study in 1994-1995 and who were registered with the endpoints MI, T2DM, cancer or death as well as a randomly selected control group. The endpoint registers were complete up to 2007-2010. Genotyping was performed for 17 SNPs related to the serum 25(OHD level. RESULTS: A total of 9528 subjects were selected for genetic analyses which were successfully performed for at least one SNP in 9471 subjects. Among these, 2025 were registered with MI, 1092 with T2DM, 2924 with cancer and 3828 had died. The mean differences in serum 25(OHD levels between SNP genotypes with the lowest and highest serum 25(OHD levels varied from 0.1 to 7.8 nmol/L. A genotype score based on weighted risk alleles regarding low serum 25(OHD levels was established. There was no consistent association between the genotype score or individuals SNPs and MI, T2DM, cancer, mortality or risk factors for disease. However, for rs6013897 genotypes (located at the 24-hydroxylase gene (CYP24A1 there was a significant association with breast cancer (P<0.05. CONCLUSION: Our results do not support nor exclude a causal relationship between serum 25(OHD levels and MI, T2DM, cancer or mortality, and our observation on breast cancer needs confirmation. Further genetic studies are warranted, particularly in populations with vitamin D deficiency. TRIAL REGISTRATION: ClinicalTrials.gov NCT01395303.

  8. At-admission risk stratification for in-hospital life-threatening ventricular arrhythmias and death in non-ST elevation myocardial infarction patients.

    Science.gov (United States)

    Zorzi, Alessandro; Turri, Riccardo; Zilio, Filippo; Spadotto, Veronica; Baritussio, Anna; Peruzza, Francesco; Gasparetto, Nicola; Marra, Martina Perazzolo; Cacciavillani, Luisa; Marzari, Armando; Tarantini, Giuseppe; Iliceto, Sabino; Corrado, Domenico

    2014-12-01

    Identification of patients with non-ST elevation acute myocardial infarction (NSTEMI) at higher risk of in-hospital life-threatening ventricular arrhythmias (LT-VA) and death is crucial for determining appropriate levels of care/monitoring during hospitalisation. We assessed predictors of in-hospital LT-VA and all-cause mortality in a consecutive series of NSTEMI patients. We prospectively studied 1325 consecutive patients (69.7% males, median age 70 (61-79) years) presenting with NSTEMI and undergoing continuous electrocardiographic monitoring. The primary study end-point was the occurrence of spontaneous (unrelated to coronary interventions) in-hospital LT-VA, including sustained ventricular tachycardia and ventricular fibrillation; the secondary end-point was in-hospital mortality from all causes. Of 1325 patients, 21 (1.5%) experienced LT-VA and 62 (4.7%) died from either arrhythmias (n=1) or other causes (n=61). Seven of the 20 patients who survived LT-VA subsequently died of heart failure. Independent predictors of in-hospital LT-VA were the Global Registry of Acute Coronary Events (GRACE) score >140 (odds ratio (OR)=7.5; 95% confidence interval (CI) 1.7-33.3; p=0.008) and left ventricular ejection fraction (LV-EF)140 (OR=14.6; 95% CI 3.4-62) and LV-EF 140 and LV-EF<35%, while it was respectively 0.2% and 0% among the 627 (47.3%) with GRACE score ≤140 and LV-EF ≥35%. Simple risk stratification at admission based on GRACE score and echocardiographic LV-EF allows early identification of NSTEMI patients at higher risk of both in-hospital LT-VA and all-cause mortality. © The European Society of Cardiology 2014.

  9. Acute Myocardial Infarction Risk in Patients with Coronary Artery Disease Doubled after Upper Gastrointestinal Tract Bleeding: A Nationwide Nested Case-Control Study.

    Directory of Open Access Journals (Sweden)

    Chia-Jung Wu

    Full Text Available Prior studies of upper gastrointestinal bleeding (UGIB and acute myocardial infarction (AMI are small, and long-term effects of UGIB on AMI have not been delineated. We investigated whether UGIB in patients diagnosed with coronary artery disease (CAD increased their risk of subsequent AMI. This was a population-based, nested case-control study using Taiwan's National Health Insurance Research Database. After propensity-score matching for age, gender, comorbidities, CAD date, and follow-up duration, we identified 1,677 new-onset CAD patients with AMI (AMI[+] between 2001 and 2006 as the case group and 10,062 new-onset CAD patients without (AMI[-] as the control group. Conditional logistic regression was used to examine the association between UGIB and AMI. Compared with UGIB[-] patients, UGIB[+] patients had twice the risk for subsequent AMI (adjusted odds ratio [AOR] = 2.08; 95% confidence interval [CI], 1.72-2.50. In the subgroup analysis for gender and age, UGIB[+] women (AOR = 2.70; 95% CI, 2.03-3.57 and patients < 65 years old (AOR = 2.23; 95% CI, 1.56-3.18 had higher odds of an AMI. UGIB[+] AMI[+] patients used nonsignificantly less aspirin than did UGIB[-] AMI[+] patients (27.69% vs. 35.61%, respectively. UGIB increased the risk of subsequent AMI in CAD patients, especially in women and patients < 65. This suggests that physicians need to use earlier and more aggressive intervention to detect UGIB and prevent AMI in CAD patients.

  10. Area at risk can be assessed by iodine-123-meta-iodobenzylguanidine single-photon emission computed tomography after myocardial infarction: a prospective study.

    Science.gov (United States)

    Hedon, Christophe; Huet, Fabien; Ben Bouallegue, Fayçal; Vernhet, Hélène; Macia, Jean-Christophe; Cung, Thien-Tri; Leclercq, Florence; Cade, Stéphane; Cransac, Frédéric; Lattuca, Benoit; Vandenberghe, D'Arcy; Bourdon, Aurélie; Benkiran, Meriem; Vauchot, Fabien; Gervasoni, Richard; D'estanque, Emmanuel; Mariano-Goulart, Denis; Roubille, François

    2018-02-01

    Myocardial salvage is an important surrogate endpoint to estimate the impact of treatments in patients with ST-segment elevation myocardial infarction (STEMI). The aim of this study was to evaluate the correlation between cardiac sympathetic denervation area assessed by single-photon emission computed tomography (SPECT) using iodine-123-meta-iodobenzylguanidine (I-MIBG) and myocardial area at risk (AAR) assessed by cardiac magnetic resonance (CMR) (gold standard). A total of 35 postprimary reperfusion STEMI patients were enrolled prospectively to undergo SPECT using I-MIBG (evaluates cardiac sympathetic denervation) and thallium-201 (evaluates myocardial necrosis), and to undergo CMR imaging using T2-weighted spin-echo turbo inversion recovery for AAR and postgadolinium T1-weighted phase sensitive inversion recovery for scar assessment. I-MIBG imaging showed a wider denervated area (51.1±16.0% of left ventricular area) in comparison with the necrosis area on thallium-201 imaging (16.1±14.4% of left ventricular area, Parea (P=0.23) and was adequately correlated (R=0.56, P=0.0002). Myocardial salvage evaluated by SPECT imaging (mismatch denervated but viable myocardium) was significantly higher than by CMR (P=0.02). In patients with STEMI, I-MIBG SPECT, assessing cardiac sympathetic denervation may precisely evaluate the AAR, providing an alternative to CMR for AAR assessment.

  11. Multi-vendor, multicentre comparison of contrast-enhanced SSFP and T2-STIR CMR for determining myocardium at risk in ST-elevation myocardial infarction

    Science.gov (United States)

    Nordlund, David; Klug, Gert; Heiberg, Einar; Koul, Sasha; Larsen, Terje H.; Hoffmann, Pavel; Metzler, Bernhard; Erlinge, David; Atar, Dan; Aletras, Anthony H.; Carlsson, Marcus; Engblom, Henrik; Arheden, Håkan

    2016-01-01

    Aims Myocardial salvage, determined by cardiac magnetic resonance imaging (CMR), is used as end point in cardioprotection trials. To calculate myocardial salvage, infarct size is related to myocardium at risk (MaR), which can be assessed by T2-short tau inversion recovery (T2-STIR) and contrast-enhanced steady-state free precession magnetic resonance imaging (CE-SSFP). We aimed to determine how T2-STIR and CE-SSFP perform in determining MaR when applied in multicentre, multi-vendor settings. Methods and results A total of 215 patients from 17 centres were included after percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction. CMR was performed within 1–8 days. These patients participated in the MITOCARE or CHILL-MI cardioprotection trials. Additionally, 8 patients from a previous study, imaged 1 day post-CMR, were included. Late gadolinium enhancement, T2-STIR, and CE-SSFP images were acquired on 1.5T MR scanners (Philips, Siemens, or GE). In 65% of the patients, T2-STIR was of diagnostic quality compared with 97% for CE-SSFP. In diagnostic quality images, there was no difference in MaR by T2-STIR and CE-SSFP (bias: 0.02 ± 6%, P = 0.96, r2 = 0.71, P < 0.001), or between treatment and control arms. No change in size or quality of MaR nor ability to identify culprit artery was seen over the first week after the acute event (P = 0.44). Conclusion In diagnostic quality images, T2-STIR and CE-SSFP provide similar estimates of MaR, were constant over the first week, and were not affected by treatment. CE-SSFP had a higher degree of diagnostic quality images compared with T2 imaging for sequences from two out of three vendors. Therefore, CE-SSFP is currently more suitable for implementation in multicentre, multi-vendor clinical trials. PMID:27002140

  12. Laser microdissection and capture of pure cardiomyocytes and fibroblasts from infarcted heart regions: perceived hyperoxia induces p21 in peri-infarct myocytes.

    Science.gov (United States)

    Kuhn, Donald E; Roy, Sashwati; Radtke, Jared; Khanna, Savita; Sen, Chandan K

    2007-03-01

    Myocardial infarction caused by ischemia-reperfusion in the coronary vasculature is a focal event characterized by an infarct-core, bordering peri-infarct zone and remote noninfarct zone. Recently, we have reported the first technique, based on laser microdissection pressure catapulting (LMPC), enabling the dissection of infarction-induced biological responses in multicellular regions of the heart. Molecular mechanisms in play at the peri-infarct zone are central to myocardial healing. At the infarct site, myocytes are more sensitive to insult than robust fibroblasts. Understanding of cell-specific responses in the said zones is therefore critical. In this work, we describe the first technique to collect the myocardial tissue with a single-cell resolution. The infarcted myocardium was identified by using a truncated hematoxylin-eosin stain. Cell elements from the infarct, peri-infarct, and noninfarct zones were collected in a chaotropic RNA lysis solution with micron-level surgical precision. Isolated RNA was analyzed for quality by employing microfluidics technology and reverse transcribed to generate cDNA. Purity of the collected specimen was established by real-time PCR analyses of cell-specific genes. Previously, we have reported that the oxygen-sensitive induction of p21/Cip1/Waf1/Sdi1 in cardiac fibroblasts in the peri-infarct zone plays a vital role in myocardial remodeling. Using the novel LMPC technique developed herein, we confirmed that finding and report for the first time that the induction of p21 in the peri-infarct zone is not limited to fibroblasts but is also evident in myocytes. This work presents the first account of an analytical technique that applies the LMPC technology to study myocardial remodeling with a cell-type specific resolution.

  13. Coffee consumption after myocardial infarction and risk of cardiovascular mortality : A prospective analysis in the Alpha Omega Cohort

    NARCIS (Netherlands)

    van Dongen, Laura H.; Molenberg, Famke J. M.; Soedamah-Muthu, Sabita S.; Kromhout, Daan; Geleijnse, Johanna M.

    2017-01-01

    Background: Consumption of coffee, one of the most popular beverages around the world, has been associated with a lower risk of cardiovascular and all-cause mortality in population-based studies. However, little is known about these associations in patient populations.  Objective: This prospective

  14. Coffee consumption after myocardial infarction and risk of cardiovascular mortality: a prospective analysis in the Alpha Omega Cohort

    NARCIS (Netherlands)

    Van Dongen, Laura H; Mölenberg, Famke Jm; Soedamah-Muthu, S.S.; Kromhout, Daan; Geleijnse, Johanna M

    2017-01-01

    Background: Consumption of coffee, one of the most popular beverages around the world, has been associated with a lower risk of cardiovascular and all-cause mortality in population-based studies. However, little is known about these associations in patient populations. Objective: This prospective

  15. Interaction between the Gly460Trp alpha-adducin gene variant and diuretics on the risk of myocardial infarction

    NARCIS (Netherlands)

    van Wieren-de Wijer, Diane B M A; Maitland-van der Zee, Anke-Hilse; de Boer, Anthonius; Kroon, Abraham A; de Leeuw, Peter W; Schiffers, Paul; Janssen, Rob G J H; Psaty, Bruce M; van Duijn, Cornelia M; Stricker, Bruno H Ch; Klungel, Olaf H

    INTRODUCTION: The Gly460Trp variant of the alpha-adducin gene has been associated with the salt-sensitive and diuretic responsive form of hypertension. OBJECTIVE: The aim of the study was to determine whether the alpha-adducin 460Trp variant allele modifies the risk-lowering effect of diuretics on

  16. Cerebellar cortical infarct cavities and vertebral artery disease

    Energy Technology Data Exchange (ETDEWEB)

    Cocker, Laurens J.L. de [University Medical Center Utrecht, Department of Radiology, Utrecht (Netherlands); Kliniek Sint-Jan Radiologie, Brussels (Belgium); Compter, A.; Kappelle, L.J.; Worp, H.B. van der [University Medical Center Utrecht, Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, Utrecht (Netherlands); Luijten, P.R.; Hendrikse, J. [University Medical Center Utrecht, Department of Radiology, Utrecht (Netherlands)

    2016-09-15

    Cerebellar cortical infarct cavities are a newly recognised entity associated with atherothromboembolic cerebrovascular disease and worse physical functioning. We aimed to investigate the relationship of cerebellar cortical infarct cavities with symptomatic vertebrobasilar ischaemia and with vascular risk factors. We evaluated the MR images of 46 patients with a recent vertebrobasilar TIA or stroke and a symptomatic vertebral artery stenosis ≥50 % from the Vertebral Artery Stenting Trial (VAST) for the presence of cerebellar cortical infarct cavities ≤1.5 cm. At inclusion in VAST, data were obtained on age, sex, history of vertebrobasilar TIA or stroke, and vascular risk factors. Adjusted risk ratios were calculated with Poisson regression analyses for the relation between cerebellar cortical infarct cavities and vascular risk factors. Sixteen out of 46 (35 %) patients showed cerebellar cortical infarct cavities on the initial MRI, and only one of these 16 patients was known with a previous vertebrobasilar TIA or stroke. In patients with symptomatic vertebrobasilar ischaemia, risk factor profiles of patients with cerebellar cortical infarct cavities were not different from patients without these cavities. Cerebellar cortical infarct cavities are seen on MRI in as much as one third of patients with recently symptomatic vertebral artery stenosis. Since patients usually have no prior history of vertebrobasilar TIA or stroke, cerebellar cortical infarct cavities should be added to the spectrum of common incidental brain infarcts visible on routine MRI. (orig.)

  17. Evaluation of the NICE mini-GRACE risk scores for acute myocardial infarction using the Myocardial Ischaemia National Audit Project (MINAP) 2003-2009: National Institute for Cardiovascular Outcomes Research (NICOR).

    Science.gov (United States)

    Simms, Alexander D; Reynolds, Stephanie; Pieper, Karen; Baxter, Paul D; Cattle, Brian A; Batin, Phillip D; Wilson, John I; Deanfield, John E; West, Robert M; Fox, Keith A A; Hall, Alistair S; Gale, Christopher P

    2013-01-01

    To evaluate the performance of the National Institute for Health and Clinical Excellence (NICE) mini-Global Registry of Acute Coronary Events (GRACE) (MG) and adjusted mini-GRACE (AMG) risk scores. Retrospective observational study. 215 acute hospitals in England and Wales. 137 084 patients discharged from hospital with a diagnosis of acute myocardial infarction (AMI) between 2003 and 2009, as recorded in the Myocardial Ischaemia National Audit Project (MINAP). Model performance indices of calibration accuracy, discriminative and explanatory performance, including net reclassification index (NRI) and integrated discrimination improvement. Of 495 263 index patients hospitalised with AMI, there were 53 196 ST elevation myocardial infarction and 83 888 non-ST elevation myocardial infarction (NSTEMI) (27.7%) cases with complete data for all AMG variables. For AMI, AMG calibration was better than MG calibration (Hosmer-Lemeshow goodness of fit test: p=0.33 vs pModel performance was reduced in patients with NSTEMI, chronic heart failure, chronic renal failure and in patients aged ≥85 years. The AMG and MG risk scores, utilised by NICE, demonstrated good performance across a range of indices using MINAP data, but performed less well in higher risk subgroups. Although indices were better for AMG, its application may be constrained by missing predictors.

  18. Thrombotic stroke and myocardial infarction with hormonal contraception

    DEFF Research Database (Denmark)

    Lidegaard, Øjvind; Løkkegaard, Ellen; Jensen, Aksel Karl Georg

    2012-01-01

    Although several studies have assessed the risk of venous thromboembolism with newer hormonal contraception, few have examined thrombotic stroke and myocardial infarction, and results have been conflicting.......Although several studies have assessed the risk of venous thromboembolism with newer hormonal contraception, few have examined thrombotic stroke and myocardial infarction, and results have been conflicting....

  19. Myocardial infarction in Swedish subway drivers.

    Science.gov (United States)

    Bigert, Carolina; Klerdal, Kristina; Hammar, Niklas; Gustavsson, Per

    2007-08-01

    Particulate matter in urban air is associated with the risk of myocardial infarction in the general population. Very high levels of airborne particles have been detected in the subway system of Stockholm, as well as in several other large cities. This situation has caused concern for negative health effects among subway staff. The aim of this study was to investigate whether there is an increased incidence of myocardial infarction among subway drivers. Data from a population-based case-control study of men aged 40-69 in Stockholm County in 1976-1996 were used. The study included all first events of myocardial infarction in registers of hospital discharges and deaths. The controls were selected randomly from the general population. National censuses were used for information on occupation. Altogether, 22 311 cases and 131 496 controls were included. Among these, 54 cases and 250 controls had worked as subway drivers. The relative risk of myocardial infarction among subway drivers was not increased. It was 0.92 [95% confidence interval (95% CI) 0.68-1.25] when the subway drivers were compared with other manual workers and 1.06 (95% CI 0.78-1.43) when the subway drivers were compared with all other gainfully employed men. Subgroup analyses indicated no influence on the risk of myocardial infarction from the duration of employment, latency time, or time since employment stopped. Subway drivers in Stockholm do not have a higher incidence of myocardial infarction than other employed persons.

  20. Lacunar infarcts in childhood

    International Nuclear Information System (INIS)

    Nakano, Chizuko; Eda, Isematsu; Takashima, Sachio; Takeshita, Kenzo; Kanetoh, Yasuko.

    1984-01-01

    Nine cases, ranging in age from 6 months to 9 years, were diagnosed as lacunar infarcts on computed tomography (CT). Hemiplegia developed rapidly or gradually in 8 cases. Three of 8 cases had transient ischemic attacks of hemiplegia. Other neurological deficits were dysarthria, aphasia, confusion and coarse tremor. One case was asymptomatic. Each of 8 cases had single lacuna and one case two lacunae on CT. These lacunae were localized in the internal capsule, the putamen or the caudate nucleus. Lacunae involving the internal capsule were associated with contralateral hemiplegia, whereas asymptomatic lacunae did not iovolve it. Severity of hemiplegia in the acute stage did not correlate with localization or size of lacunae. Moderate neurological sequelae were noticed in 3 cases, mild sequelae in two and none in three. The sequelae were related to the lacunae which involved the lateral lenticulostriate branch zone of the middle cerebral artery or larger areas. Prognosis did not correlate with the mode of onset or the severity of neurological signs in the acute stage. There were 2 cases with the occlusion of the left internal carotid artery or congenital heart disease, but the etiology of lacunae was unknown in the other cases. (author)

  1. A common polymorphism in the promoter region of the TNFSF4 gene is associated with lower allele-specific expression and risk of myocardial infarction.

    Directory of Open Access Journals (Sweden)

    Massimiliano Ria

    Full Text Available BACKGROUND: The TNFSF4/TNFRSF4 system, along with several other receptor-ligand pairs, is involved in the recruitment and activation of T-cells and is therefore tentatively implicated in atherosclerosis and acute coronary syndromes. We have previously shown that genetic variants in TNFSF4 are associated with myocardial infarction (MI in women. This prompted functional studies of TNFSF4 expression. METHODS AND RESULTS: Based on a screening of the TNFSF4 genomic region, a promoter polymorphism (rs45454293 and a haplotype were identified, conceivably involved in gene regulation. The rs45454293T-allele, in agreement with the linked rs3850641G-allele, proved to be associated with increased risk of MI in women. Haplotype-specific chromatin immunoprecipitation of activated polymerase II, as a measure of transcriptional activity in vivo, suggested that the haplotype including the rs45454293 and rs3850641 polymorphisms is functionally important, the rs45454293T- and rs3850641G-alleles being associated with lower transcriptional activity in cells heterozygous for both polymorphisms. The functional role of rs45454293 on transcriptional levels of TNFSF4 was clarified by luciferase reporter assays, where the rs45454293T-allele decreased gene expression when compared with the rs45454293C-allele, while the rs3850641 SNP did not have any effect on TNFSF4 promoter activity. Electromobility shift assay showed that the rs45454293 polymorphism, but not rs3850641, affects the binding of nuclear factors, thus suggesting that the lower transcriptional activity is attributed to binding of one or more transcriptional repressor(s to the T-allele. CONCLUSIONS: Our data indicate that the TNFSF4 rs45454293T-allele is associated with lower TNFSF4 expression and increased risk of MI.

  2. Atopic dermatitis and risk of hypertension, type 2 diabetes, myocardial infarction and stroke in a cross-sectional analysis from the Canadian Partnership for Tomorrow Project.

    Science.gov (United States)

    Drucker, A M; Qureshi, A A; Dummer, T J B; Parker, L; Li, W-Q

    2017-10-01

    Atopic dermatitis (AD) has been associated with cardiovascular risk factors and diseases, but epidemiological studies to date have found conflicting results. To determine the associations of AD with hypertension, type 2 diabetes (T2D), myocardial infarction (MI) and stroke. We conducted a cross-sectional analysis of baseline data from the Canadian Partnership for Tomorrow Project, which includes Canadian residents aged 30-74 years living in British Columbia, Alberta, Ontario, Quebec and the Atlantic Provinces. We excluded participants with incomplete data on AD, hypertension, T2D, MI or stroke, who had type 1 or gestational diabetes or who developed any of the outcomes at an age prior to a diagnosis of AD. This left 259 119 participants in our analysis. We used logistic regression to calculate age- and sex-, and multivariable-adjusted odds ratios (ORs) and 95% confidence intervals (CIs) between AD and subsequent hypertension, T2D, MI and stroke. AD was reported by 21 379 (8·4%) participants. In total, 52 787 cases of hypertension, 12 739 cases of T2D, 4390 cases of MI and 2235 cases of stroke were reported by participants at enrolment. In the multivariable-adjusted model, AD was associated with decreased odds of hypertension (OR 0·87, 95% CI 0·83-0·90), T2D (OR 0·78, 95% CI 0·71-0·84), MI (OR 0·87, 95% CI 0·75-1·00) and stroke (OR 0·79, 95% CI 0·66-0·95). We did not find evidence of a positive association between AD and subsequent hypertension, T2D, MI or stroke; AD was inversely associated with these outcomes in our study. Given our findings and the conflicting literature, AD is likely not a major risk factor for cardiovascular disease. © 2017 British Association of Dermatologists.

  3. Blunted cyclic variation of heart rate predicts mortality risk in post-myocardial infarction, end-stage renal disease, and chronic heart failure patients

    Science.gov (United States)

    Hayano, Junichiro; Yasuma, Fumihiko; Watanabe, Eiichi; Carney, Robert M.; Stein, Phyllis K.; Blumenthal, James A.; Arsenos, Petros; Gatzoulis, Konstantinos A.; Takahashi, Hiroshi; Ishii, Hideki; Kiyono, Ken; Yamamoto, Yoshiharu; Yoshida, Yutaka; Yuda, Emi; Kodama, Itsuo

    2017-01-01

    Abstract Aims Cyclic variation of heart rate (CVHR) associated with sleep-disordered breathing is thought to reflect cardiac autonomic responses to apnoeic/hypoxic stress. We examined whether blunted CVHR observed in ambulatory ECG could predict the mortality risk. Methods and results CVHR in night-time Holter ECG was detected by an automated algorithm, and the prognostic relationships of the frequency (FCV) and amplitude (ACV) of CVHR were examined in 717 patients after myocardial infarction (post-MI 1, 6% mortality, median follow-up 25 months). The predictive power was prospectively validated in three independent cohorts: a second group of 220 post-MI patients (post-MI 2, 25.5% mortality, follow-up 45 months); 299 patients with end-stage renal disease on chronic haemodialysis (ESRD, 28.1% mortality, follow-up 85 months); and 100 patients with chronic heart failure (CHF, 35% mortality, follow-up 38 months). Although CVHR was observed in ≥96% of the patients in all cohorts, FCV did not predict mortality in any cohort. In contrast, decreased ACV was a powerful predictor of mortality in the post-MI 1 cohort (hazard ratio [95% CI] per 1 ln [ms] decrement, 2.9 [2.2–3.7], P < 0.001). This prognostic relationship was validated in the post-MI 2 (1.8 [1.4–2.2], P < 0.001), ESRD (1.5 [1.3–1.8], P < 0.001), and CHF (1.4 [1.1–1.8], P = 0.02) cohorts. The prognostic value of ACV was independent of age, gender, diabetes, β-blocker therapy, left ventricular ejection fraction, sleep-time mean R-R interval, and FCV. Conclusion Blunted CVHR detected by decreased ACV in a night-time Holter ECG predicts increased mortality risk in post-MI, ESRD, and CHF patients. PMID:27789562

  4. Blunted cyclic variation of heart rate predicts mortality risk in post-myocardial infarction, end-stage renal disease, and chronic heart failure patients.

    Science.gov (United States)

    Hayano, Junichiro; Yasuma, Fumihiko; Watanabe, Eiichi; Carney, Robert M; Stein, Phyllis K; Blumenthal, James A; Arsenos, Petros; Gatzoulis, Konstantinos A; Takahashi, Hiroshi; Ishii, Hideki; Kiyono, Ken; Yamamoto, Yoshiharu; Yoshida, Yutaka; Yuda, Emi; Kodama, Itsuo

    2017-08-01

    Cyclic variation of heart rate (CVHR) associated with sleep-disordered breathing is thought to reflect cardiac autonomic responses to apnoeic/hypoxic stress. We examined whether blunted CVHR observed in ambulatory ECG could predict the mortality risk. CVHR in night-time Holter ECG was detected by an automated algorithm, and the prognostic relationships of the frequency (FCV) and amplitude (ACV) of CVHR were examined in 717 patients after myocardial infarction (post-MI 1, 6% mortality, median follow-up 25 months). The predictive power was prospectively validated in three independent cohorts: a second group of 220 post-MI patients (post-MI 2, 25.5% mortality, follow-up 45 months); 299 patients with end-stage renal disease on chronic haemodialysis (ESRD, 28.1% mortality, follow-up 85 months); and 100 patients with chronic heart failure (CHF, 35% mortality, follow-up 38 months). Although CVHR was observed in ≥96% of the patients in all cohorts, FCV did not predict mortality in any cohort. In contrast, decreased ACV was a powerful predictor of mortality in the post-MI 1 cohort (hazard ratio [95% CI] per 1 ln [ms] decrement, 2.9 [2.2-3.7], P < 0.001). This prognostic relationship was validated in the post-MI 2 (1.8 [1.4-2.2], P < 0.001), ESRD (1.5 [1.3-1.8], P < 0.001), and CHF (1.4 [1.1-1.8], P = 0.02) cohorts. The prognostic value of ACV was independent of age, gender, diabetes, β-blocker therapy, left ventricular ejection fraction, sleep-time mean R-R interval, and FCV. Blunted CVHR detected by decreased ACV in a night-time Holter ECG predicts increased mortality risk in post-MI, ESRD, and CHF patients. © The Author 2016. Published by Oxford University Press on behalf of the European Society of Cardiology.

  5. Homocyst(e)ine and risk of cerebral infarction in a biracial population : the stroke prevention in young women study.

    Science.gov (United States)

    Kittner, S J; Giles, W H; Macko, R F; Hebel, J R; Wozniak, M A; Wityk, R J; Stolley, P D; Stern, B J; Sloan, M A; Sherwin, R; Price, T R; McCarter, R J; Johnson, C J; Earley, C J; Buchholz, D W; Malinow, M R

    1999-08-01

    Genetic enzyme variation and vitamin intake are important determinants of blood homocyst(e)ine levels. The prevalence of common genetic polymorphisms influencing homocyst(e)ine levels varies by race, and vitamin intake varies by socioeconomic status. Therefore, we examined the effect of vitamin intake, race, and socioeconomic status on the association of homocyst(e)ine with stroke risk. All 59 hospitals in the greater Baltimore-Washington area participated in a population-based case-control study of stroke in young women. One hundred sixty-seven cases of first ischemic stroke among women aged 15 to 44 years were compared with 328 controls identified by random-digit dialing from the same region. Risk factor data were collected by standardized interview and nonfasting phlebotomy. Plasma homocyst(e)ine was measured by high-performance liquid chromatography and electrochemical detection. Blacks and whites did not differ in median homocyst(e)ine levels, nor did race modify the association between homocyst(e)ine and stroke. After adjustment for cigarettes per day, poverty status, and regular vitamin use, a plasma homocyst(e)ine level of >/=7.3 micromol/L was associated with an odds ratio for stroke of 1.6 (95% CI, 1.1 to 2.5). The association between elevated homocyst(e)ine and stroke was independent not only of traditional vascular risk factors but also of vitamin use and poverty status. The degree of homocyst(e)ine elevation associated with an increased stroke risk in young women is lower than that previously reported for middle-aged men and the elderly and was highly prevalent, being present in one third of the control group.

  6. Edaravone, a free radical scavenger, attenuates cerebral infarction and hemorrhagic infarction in rats with hyperglycemia.

    Science.gov (United States)

    Okamura, Koichi; Tsubokawa, Tamiji; Johshita, Hiroo; Miyazaki, Hiroshi; Shiokawa, Yoshiaki

    2014-01-01

    Thrombolysis due to acute ischemic stroke is associated with the risk of hemorrhagic infarction, especially after reperfusion. Recent experimental studies suggest that the main mechanism contributing to hemorrhagic infarction is oxidative stress caused by disruption of the blood-brain barrier. Edaravone, a free radical scavenger, decreases oxidative stress, thereby preventing hemorrhagic infarction during ischemia and reperfusion. In this study, we investigated the effects of edaravone on hemorrhagic infarction in a rat model of hemorrhagic transformation. We used a previously established hemorrhagic transformation model of rats with hyperglycemia. Hyperglycemia was induced by intraperitoneal injection of glucose to all rats (n  =  20). The rats with hyperglycemia showed a high incidence of hemorrhagic infarction. Middle cerebral artery occlusion (MCAO) for 1.5 hours followed by reperfusion for 24 hours was performed in edaravone-treated rats (n  =  10) and control rats (n  =  10). Upon completion of reperfusion, both groups were evaluated for infarct size and hemorrhage volume and the results obtained were compared. Edaravone significantly decreased infarct volume, with the average infarct volume in the edaravone-treated rats (227.6 mm(3)) being significantly lower than that in the control rats (264.0 mm(3)). Edaravone treatment also decreased the postischemic hemorrhage volumes (53.4 mm(3) in edaravone-treated rats vs 176.4 mm(3) in controls). In addition, the ratio of hemorrhage volume to infarct volume was lower in the edaravone-treated rats (23.5%) than in the untreated rats (63.2%). Edaravone attenuates cerebral infarction and hemorrhagic infarction in rats with hyperglycemia.

  7. An index-based method to assess risks of climate-related hazards in coastal zones: The case of Tetouan

    Science.gov (United States)

    Satta, Alessio; Snoussi, Maria; Puddu, Manuela; Flayou, Latifa; Hout, Radouane

    2016-06-01

    The regional risk assessment carried out within the ClimVar & ICZM Project identified the coastal zone of Tetouan as a hotspot of the Mediterranean Moroccan coast and so it was chosen for the application of the Multi-Scale Coastal Risk Index for Local Scale (CRI-LS). The local scale approach provides a useful tool for local coastal planning and management by exploring the effects and the extensions of the hazards and combining hazard, vulnerability and exposure variables in order to identify areas where the risk is relatively high. The coast of Tetouan is one of the coastal areas that have been most rapidly and densely urbanized in Morocco and it is characterized by an erosive shoreline. Local authorities are facing the complex task of balancing development and managing coastal risks, especially coastal erosion and flooding, and then be prepared to the unavoidable impacts of climate change. The first phase of the application of the CRI-LS methodology to Tetouan consisted of defining the coastal hazard zone, which results from the overlaying of the erosion hazard zone and the flooding hazard zone. Nineteen variables were chosen to describe the Hazards, Vulnerability and Exposure factors. The scores corresponding to each variable were calculated and the weights assigned through an expert judgement elicitation. The resulting values are hosted in a geographic information system (GIS) platform that enables the individual variables and aggregated risk scores to be color-coded and mapped across the coastal hazard zone. The results indicated that 10% and 27% of investigated littoral fall under respectively very high and high vulnerability because of combination of high erosion rates with high capital land use. The risk map showed that some areas, especially the flood plains of Restinga, Smir and Martil-Alila, with distances over 5 km from the coast, are characterized by high levels of risk due to the low topography of the flood plains and to the high values of exposure

  8. Prepregnancy Obesity and Associations With Stroke and Myocardial Infarction in Women in the Years After Childbirth

    DEFF Research Database (Denmark)

    Schmiegelow, Michelle Dalgas; Andersson, Charlotte; Køber, Lars

    2014-01-01

    BACKGROUND: Cardiovascular events (stroke or myocardial infarction) are often associated with poorer prognosis in younger, compared with older individuals. We examined the associations between prepregnancy obesity and the risks of myocardial infarction and stroke in young, healthy women. METHODS ...

  9. [Study of cerebellar infarction with isolated vertigo].

    Science.gov (United States)

    Utsumi, Ai; Enomoto, Hiroyuki; Yamamoto, Kaoru; Kimura, Yu; Koizuka, Izumi; Tsukuda, Mamoru

    2010-07-01

    Isolated vertigo is generally attributed to labyrinthine disease, but may also signal otherwise asymptomatic cerebellar infarction. Of 309 subjects admitted between April 2004 and March 2009 for the single symptom of acute vertigo initially thought to be labyrinthine, four were found to have cerebellar infarction of the posterior inferior cerebellar artery area (PICA). All were over 60 years old and had risk factors including hypertension, diabetes mellitus, arrhythmia, and/or hyperlipidemia. Two had trunk ataxia, with magnetic resonance imaging (MRI) showing infarction within a few days. The other two could walk without apparent trunk ataxia, however, it took 4 to 7 days to find the infarction, mainly through neurological, neurootological, and MRI findings. Neurologically, astasia, dysbasia or trunk ataxia were important signs. Neurootologically, nystagmus and electronystagmographic testing involving eye tracking, saccade, and optokinetic patttens were useful.

  10. Perfusion scintigraphy in acute myocardial infarction

    International Nuclear Information System (INIS)

    Schricke, U.; Schwaiger, M.; Kastrati, A.; Schoemig, A.

    1999-01-01

    The Tc-99m sestamibi perfusion SPECT scintigraphy in acute myocardial infarction is a feasible method to assess the size of area at risk and the residual blood flow to this area as the most important determinants of final infarct size without any delay in treatment. In combination with a follow-up study final infarct size as well as myocardial salvage can be quantified. Clinical indications for the use of Tc-99m sestamibi scintigraphy are the noninvasive identification of arterial occlusion in patients suspected to acute myocardial infarction without electrocardiographic ST-elevation and the assessment of reperfusion success. In clinical trials Tc-99m sestamibi scintigraphy has proven to be a useful method to assess the impact of varying reperfusion therapies. The present review article discusses the indication, the study protocol, the interpretation of results and the clinical and scientifically importance of this method. (orig.) [de

  11. Prevalence, Risk Factors, and Outcome of Myocardial Infarction with Angiographically Normal and Near-Normal Coronary Arteries: A Systematic Review and Meta-Analysis

    Directory of Open Access Journals (Sweden)

    Samad Ghaffari

    2016-12-01

    Full Text Available Context: Coronary artery diseases are mostly detected using angiographic methods demonstrating arteries status. Nevertheless, Myocardial Infarction (MI may occur in the presence of angiographically normal coronary arteries. Therefore, this study aimed to investigate the prevalence of MI with normal angiography and its possible etiologies in a systematic review. Evidence Acquisition: In this meta-analysis, the required data were collected from PubMed, Science Direct, Google Scholar, Scopus, Magiran, Scientific Information Database, and Medlib databases using the following keywords: “coronary angiograph”, “normal coronary arteries”, “near-normal coronary arteries”, “heart diseases”, “coronary artery disease”, “coronary disease”, “cardiac troponin I”, “Myocardial infarction”, “risk factor”, “prevalence”, “outcome”, and their Persian equivalents. Then, Comprehensive Meta-Analysis software, version 2 using randomized model was employed to determine the prevalence of each complication and perform the meta-analysis. P values less than 0.05 were considered to be statistically significant. Results: Totally, 20 studies including 139957 patients were entered into the analysis. The patients’ mean age was 47.62 ± 6.63 years and 64.4% of the patients were male. The prevalence of MI with normal or near-normal coronary arteries was 3.5% (CI = 95%, min = 2.2%, and max = 5.7%. Additionally, smoking and family history of cardiovascular diseases were the most important risk factors. The results showed no significant difference between MIs with normal angiography and 1- or 2-vessel involvement regarding the frequency of major adverse cardiac events (5.4% vs. 7.3%, P = 0.32. However, a significant difference was found between the patients with normal angiography and those with 3-vessel involvement in this regard (5.4% vs. 20.2%, P < 0.001. Conclusions: Although angiographic studies are required to assess the underlying

  12. Assessment of risk factors in pollution of coastal zone and river basins by numerical modelling

    International Nuclear Information System (INIS)

    Tsitskishvili, M.; Kordzakhia, G.; Shaptoshvili, A.; Tsitskishvili, L.; Diasamidze, R.; Soloduchin, V.

    2005-01-01

    pollution. For this aim the special deterministic models on the basis of passive admixture's turbulence diffusion equation is used. For numerical calculations Mc Kormack's predictor-corrector two steps scheme is used. The scheme is disintegrated, second order in space and time. Such scheme is established because the turbulent velocities very differ in horizontal and vertical directions and model allows implementing singular independent steps in different directions. Grid step for the model is 26.88 km in horizontal direction and 20 m m in vertical until 200 m. Time step is equal to 4 hours and computational time period - 4 months. Number of grid points is equal to 4983 for all calculation areas. Computations are carried out separately for big rivers basins as well as for Black and Caspian Seas water areas. The model calculations are made for cases with various locations of pollutant sources including accidental throws. For different realistic scenarios are calculated the concentrations of admixtures. The directions of their propagation are also determined. The risks are calculated in comparison with the Maximum Permissible Concentrations (MPC) of the pollutants according to achieved results. That gives possibility to define the most vulnerable areas in coastal zones. Realized methodology is verified by means of various scenarios for mentioned rivers and sea basins. The maps with indication of risk zones in river basins as well as of Black and Caspian Seas water areas are created

  13. The Crop Risk Zones Monitoring System for resilience to drought in the Sahel

    Science.gov (United States)

    Vignaroli, Patrizio; Rocchi, Leandro; De Filippis, Tiziana; Tarchiani, Vieri; Bacci, Maurizio; Toscano, Piero; Pasqui, Massimiliano; Rapisardi, Elena

    2016-04-01

    -making. Since the '90s, analysis tools and models based on meteorological satellites data have been developed within different regional and national initiatives to allow near-real-time monitoring of the cropping season. The software was in general stand-alone applications, transferred to MWGs without continuous user support and updates. Currently MWGs in the Sahel do not have any working operational tool for drought risk identification and forecast, because such tools are by now obsolete from the IT perspective. The challenge and the objective of this work is to provide to MWGs and local end-users an open access/source Crop Risk Zones Monitoring System (CRZ-MS) supporting decision making for drought risk reduction and resilience improvement. A first prototype has been developed for Niger and Mali NMSs, based on a coherent Open Source web-based infrastructure to treat all input and output data in a interoperable, platform-independent and uniform way. The System architecture and functions are based on a agro-meteorological model, running in two different modes: 1) diagnostic mode for the drought monitoring during the agro-pastoral campaign allowing MWGs to identify agricultural drought risk areas in order to support decision making at local and national level in agricultural drought management. This early warning information also represents an input for estimating the nutritional food insecurity, for the identification of potentially vulnerable populations and assessing food crises risks by National EWSs put in place by CILSS with EU, FAO and WFP. 2) predictive mode for "advisory-support" activities to the farmers by the Agricultural Extension Services, in order to implement the most appropriate strategies for minimizing drought risk on crops (i.e. identification of the optimal period of sowing, choice of varieties based on the expected length of the growing season, adoption of suitable cultural practices for soil water management) and to build farmers resilience. To increase the

  14. Reduced risk of recurrent myocardial infarction in homozygous carriers of the chromosome 9p21 rs1333049 C risk allele in the contemporary percutaneous coronary intervention era: a prospective observational study

    Science.gov (United States)

    Hara, Masahiko; Sakata, Yasuhiko; Nakatani, Daisaku; Suna, Shinichiro; Usami, Masaya; Matsumoto, Sen; Ozaki, Kouichi; Nishino, Masami; Sato, Hiroshi; Kitamura, Tetsuhisa; Nanto, Shinsuke; Hamasaki, Toshimitsu; Tanaka, Toshihiro; Hori, Masatsugu; Komuro, Issei

    2014-01-01

    Objectives Chromosome 9p21 single nucleotide polymorphism (SNP) is a susceptibility variant for acute myocardial infarction (AMI) in the primary prevention setting. However, it is controversial whether this SNP is also associated with recurrent myocardial infarction (ReMI) in the secondary prevention setting. The purpose of this study is to evaluate the impact of chromosome 9p21 SNP on ReMI in patients receiving secondary prevention programmes after AMI. Design A prospective observational study. Setting Osaka Acute Coronary Insufficiency Study (OACIS) in Japan. Participants 2022 patients from the OACIS database. Interventions Genotyping of the 9p21 rs1333049 variant. Primary outcome measures ReMI event after survival discharge for 1 year. Results A total of 43 ReMI occurred during the 1 year follow-up period. Although the rs1333049 C allele had an increased susceptibility to their first AMI in an additive model when compared with 1373 healthy controls (OR 1.20, 95% CI 1.09 to 1.33, p=2.3*10−4), patients with the CC genotype had a lower incidence of ReMI at 1 year after discharge of AMI (log-rank p=0.005). The adjusted HR of the CC genotype as compared with the CG/GG genotypes was 0.20 (0.06 to 0.65, p=0.007). Subgroup analysis demonstrated that the association between the rs1333049 CC genotype and a lower incidence of 1 year ReMI was common to all subgroups. Conclusions Homozygous carriers of the rs1333049 C allele on chromosome 9p21 showed a reduced risk of 1 year ReMI in the contemporary percutaneous coronary intervention era, although the C allele had conferred susceptibility to their first AMI. PMID:25232560

  15. American College of Cardiology/American Heart Association/European Society of Cardiology/World Heart Federation universal definition of myocardial infarction classification system and the risk of cardiovascular death: observations from the TRITON-TIMI 38 trial (Trial to Assess Improvement in Therapeutic Outcomes by Optimizing Platelet Inhibition With Prasugrel-Thrombolysis in Myocardial Infarction 38).

    Science.gov (United States)

    Bonaca, Marc P; Wiviott, Stephen D; Braunwald, Eugene; Murphy, Sabina A; Ruff, Christian T; Antman, Elliott M; Morrow, David A

    2012-01-31

    The availability of more sensitive biomarkers of myonecrosis and a new classification system from the universal definition of myocardial infarction (MI) have led to evolution of the classification of MI. The prognostic implications of MI defined in the current era have not been well described. We investigated the association between new or recurrent MI by subtype according to the European Society of Cardiology/American College of Cardiology/American Heart Association/World Health Federation Task Force for the Redefinition of MI Classification System and the risk of cardiovascular death among 13 608 patients with acute coronary syndrome in the Trial to Assess Improvement in Therapeutic Outcomes by Optimizing Platelet Inhibition with Prasugrel-Thrombolysis in Myocardial Infarction 38 (TRITON-TIMI 38). The adjusted risk of cardiovascular death was evaluated by landmark analysis starting at the time of the MI through 180 days after the event. Patients who experienced an MI during follow-up had a higher risk of cardiovascular death at 6 months than patients without an MI (6.5% versus 1.3%, P<0.001). This higher risk was present across all subtypes of MI, including type 4a (peri-percutaneous coronary intervention, 3.2%; P<0.001) and type 4b (stent thrombosis, 15.4%; P<0.001). After adjustment for important clinical covariates, the occurrence of any MI was associated with a 5-fold higher risk of death at 6 months (95% confidence interval 3.8-7.1), with similarly increased risk across subtypes. MI is associated with a significantly increased risk of cardiovascular death, with a consistent relationship across all types as defined by the universal classification system. These findings underscore the clinical relevance of these events and the importance of therapies aimed at preventing MI.

  16. In-depth analysis of drivers' merging behavior and rear-end crash risks in work zone merging areas.

    Science.gov (United States)

    Weng, Jinxian; Xue, Shan; Yang, Ying; Yan, Xuedong; Qu, Xiaobo

    2015-04-01

    This study investigates the drivers' merging behavior and the rear-end crash risk in work zone merging areas during the entire merging implementation period from the time of starting a merging maneuver to that of completing the maneuver. With the merging traffic data from a work zone site in Singapore, a mixed probit model is developed to describe the merging behavior, and two surrogate safety measures including the time to collision (TTC) and deceleration rate to avoid the crash (DRAC) are adopted to compute the rear-end crash risk between the merging vehicle and its neighboring vehicles. Results show that the merging vehicle has a bigger probability of completing a merging maneuver quickly under one of the following situations: (i) the merging vehicle moves relatively fast; (ii) the merging lead vehicle is a heavy vehicle; and (iii) there is a sizable gap in the adjacent through lane. Results indicate that the rear-end crash risk does not monotonically increase as the merging vehicle speed increases. The merging vehicle's rear-end crash risk is also affected by the vehicle type. There is a biggest increment of rear-end crash risk if the merging lead vehicle belongs to a heavy vehicle. Although the reduced remaining distance to work zone could urge the merging vehicle to complete a merging maneuver quickly, it might lead to an increased rear-end crash risk. Interestingly, it is found that the rear-end crash risk could be generally increased over the elapsed time after the merging maneuver being triggered. Copyright © 2015 Elsevier Ltd. All rights reserved.

  17. Polymorphisms of the P-selectin gene and risk of myocardial infarction in men and women in the ECTIM extension study. Etude cas-temoin de l'infarctus myocarde.

    Science.gov (United States)

    Kee, F; Morrison, C; Evans, A E; McCrum, E; McMaster, D; Dallongeville, J; Nicaud, V; Poirier, O; Cambien, F

    2000-11-01

    Studies in animal models and humans implicate cell adhesion molecules in atherogenesis but their role in mediating the risk of myocardial infarction is unclear. The ECTIM (étude cas-temoin de l'infarctus myocarde) extension study was established to determine whether a previously implicated polymorphism of the P-selectin gene was associated with myocardial infarction risk in men and women in Belfast and Glasgow. PATIENTS AND STUDY SETTING: 696 cases with a recent myocardial infarction and 561 age matched controls (both male and female) were recruited into a case-control study in MONICA project areas of Belfast and Glasgow. Demographic and lifestyle information was collected by interview administered questionnaire, and each subject was examined and provided a blood sample for DNA extraction. The polymerase chain reaction (PCR) was used to amplify regions encompassing the P-selectin Thr-->Pro (A/C) polymorphism at position 715. Genotype odds ratios for myocardial infarction were estimated by logistic regression adjusted for population, age, and sex. There was no significant association between conventional risk factors (such as hypercholesterolaemia, increased body mass index, or raised blood pressure) and either the rare or the common Pro(715) allele of the P-selectin gene in controls. Overall, comparing Pro(715)/Pro(715) and Pro(715)/Thr(715) with Thr(715)/Thr(715), with adjustment for centre, age, and sex, the odds ratio was 0.78 (95% confidence interval 0.60 to 1.00) (p = 0.054), indicating a "protective" effect of the less common Pro(715) allele. There was no significant heterogeneity in odds ratios between men and women either in this sample or when combined with the original ECTIM subjects. In a large population based study in two regions of the UK, we have been able to corroborate the earlier ECTIM findings of a lower frequency of the Thr/Pro(715) polymorphism in subjects with myocardial infarction. An apparently "protective effect" of similar magnitude also

  18. HBV or HCV coinfections and risk of myocardial infarction in HIV-infected individuals: the D:A:D Cohort Study

    DEFF Research Database (Denmark)

    Weber, Rainer; Sabin, Caroline; Reiss, Peter

    2010-01-01

    Data on a link between HCV or HBV infection and the development of cardiovascular disease among HIV-negative and HIV-positive individuals are conflicting. We sought to investigate the association between HBV or HCV infection and myocardial infarction in HIV-infected individuals.......Data on a link between HCV or HBV infection and the development of cardiovascular disease among HIV-negative and HIV-positive individuals are conflicting. We sought to investigate the association between HBV or HCV infection and myocardial infarction in HIV-infected individuals....

  19. Natural and traditional defense mechanisms to reduce climate risks in coastal zones of Bangladesh

    OpenAIRE

    Mohammed Ataur Rahman; Sowmen Rahman

    2015-01-01

    Substantially resourceful and densely populated coastal zones of Bangladesh experience numerous extreme events linked to hydro-meteorological processes viz. cyclones, tidal surges, floods, salinity intrusion and erosion etc. These hazards give rise to extensive damage to property and loss of lives every year. Further, anthropogenic activities in the coastal zones are accentuating environmental degradation causing widespread suffering. Cyclones and tornadoes in particular damage infrastructure...

  20. Incidence and risk factors of ventricular fibrillation before primary angioplasty in patients with first ST-elevation myocardial infarction: a nationwide study in Denmark.

    Science.gov (United States)

    Jabbari, Reza; Engstrøm, Thomas; Glinge, Charlotte; Risgaard, Bjarke; Jabbari, Javad; Winkel, Bo Gregers; Terkelsen, Christian Juhl; Tilsted, Hans-Henrik; Jensen, Lisette Okkels; Hougaard, Mikkel; Chiuve, Stephanie E; Pedersen, Frants; Svendsen, Jesper Hastrup; Haunsø, Stig; Albert, Christine M; Tfelt-Hansen, Jacob

    2015-01-05

    We aimed to investigate the incidence and risk factors for ventricular fibrillation (VF) before primary percutaneous coronary intervention (PPCI) among patients with ST-segment elevation myocardial infarction (STEMI) in a prospective nationwide setting. In this case-control study, patients presenting within the first 12 hours of first STEMI who survived to undergo angiography and subsequent PPCI were enrolled. Over 2 years, 219 cases presenting with VF before PPCI and 441 controls without preceding VF were enrolled. Of the 219 case patients, 182 (83%) had STEMI with out-of-hospital cardiac arrest due to VF, and 37 (17%) had cardiac arrest upon arrival to the emergency room. Medical history was collected by standardized interviews and by linkage to national electronic health records. The incidence of VF before PPCI among STEMI patients was 11.6%. Multivariable logistic regression analysis identified novel associations between atrial fibrillation and alcohol consumption with VF. Patients with a history of atrial fibrillation had a 2.80-fold odds of experiencing VF before PPCI (95% CI 1.10 to 7.30). Compared with nondrinkers, patients who consumed 1 to 7 units, 8 to 14 units, or >15 units of alcohol per week had an odds ratio (OR) of 1.30 (95% CI, 0.80 to 2.20), 2.30 (95% CI, 1.20 to 4.20), or 3.30 (95% CI, 1.80 to 5.90), respectively, for VF. Previously reported associations for preinfarction angina (OR 0.46; 95% CI 0.32 to 0.67), age of history of sudden death (OR 1.60; 95% CI 1.10 to 2.40) were all associated with VF. Several easily assessed risk factors were associated with VF occurring out-of-hospital or on arrival at the emergency room before PPCI in STEMI patients, thus providing potential avenues for investigation regarding improved identification and prevention of life-threatening ventricular arrhythmias. © 2015 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

  1. Clinical presentation, Quality of care, Risk factors and Outcomes in Women with Acute ST-Elevation Myocardial Infarction (STEMI): An Observational Report from Six Middle Eastern Countries.

    Science.gov (United States)

    Shehab, Abdulla; AlHabib, Khalid F; Bhagavathula, Akshaya Srikanth; Hersi, Ahmad; Alfaleh, Hussam; Alshamiri, Mostafa Q; Ullah, Anhar; Sulaiman, Khadim; Almahmeed, Wael; Al Suwaidi, Jassim; Alsheikh-Ali, Alwai A; Amin, Haitham; Al Jarallah, Mohammed; Salam, Amar M

    2018-03-14

    Most of the available literature on ST-Elevated myocardial infarction (STEMI) in women was conducted in the developed world and data from Middle-East countries was limited. To examine the clinical presentation, patient management, quality of care, risk factors and in-hospital outcomes of women with acute STEMI compared with men using data from a large STEMI registry from the Middle East. Data were derived from the third Gulf Registry of Acute Coronary Events (Gulf RACE-3Ps), a prospective, multinational study of adults with acute STEMI from 36 hospitals in 6 Middle-Eastern countries. The study included 2928 patients; 296 women (10.1%) and 2632 men (89.9%). Clinical presentations, management and in-hospital outcomes were compared between the 2 groups. Women were 10 years older and more likely to have diabetes mellitus, hypertension, and hyperlipidemia compared with men who were more likely to be smokers (all p<0.001). Women had longer median symptom-onset to emergency department (ED) arrival times (230 vs. 170 min, p<0.001) and ED to diagnostic ECG (8 vs. 6 min., p<0.001). When primary percutaneous coronary intervention (PPCI) was performed, women had longer door-to-balloon time (DBT) (86 vs. 73 min., p=0.009). When thrombolytic therapy was not administered, women were less likely to receive PPCI (69.7 vs. 76.7%, p=0.036). The mean duration of hospital stay was longer in women (6.03 ± 22.51 vs. 3.41 ± 19.45 days, p=0.032) and the crude in-hospital mortality rate was higher in women (10.4 vs. 5.2%, p<0.001). However, after adjustments, multivariate analysis revealed a statistically non-significant trend of higher in-hospital mortality among women than men (6.4 vs. 4.6%), (p=0.145). Our study demonstrates that women in our region have almost double the mortality from STEMI compared with men. Although this can partially be explained by older age and higher risk profiles in women, however, correction of identified gaps in quality of care should be attempted to reduce

  2. Fleeing to Fault Zones: Incorporating Syrian Refugees into Earthquake Risk Analysis along the East Anatolian and Dead Sea Rift Fault Zones

    Science.gov (United States)

    Wilson, B.; Paradise, T. R.

    2016-12-01

    The influx of millions of Syrian refugees into Turkey has rapidly changed the population distribution along the Dead Sea Rift and East Anatolian Fault zones. In contrast to other countries in the Middle East where refugees are accommodated in camp environments, the majority of displaced individuals in Turkey are integrated into cities, towns, and villages—placing stress on urban settings and increasing potential exposure to strong shaking. Yet, displaced populations are not traditionally captured in data sources used in earthquake risk analysis or loss estimations. Accordingly, we present a district-level analysis assessing the spatial overlap of earthquake hazards and refugee locations in southeastern Turkey to determine how migration patterns are altering seismic risk in the region. Using migration estimates from the U.S. Humanitarian Information Unit, we create three district-level population scenarios that combine official population statistics, refugee camp populations, and low, median, and high bounds for integrated refugee populations. We perform probabilistic seismic hazard analysis alongside these population scenarios to map spatial variations in seismic risk between 2011 and late 2015. Our results show a significant relative southward increase of seismic risk for this period due to refugee migration. Additionally, we calculate earthquake fatalities for simulated earthquakes using a semi-empirical loss estimation technique to determine degree of under-estimation resulting from forgoing migration data in loss modeling. We find that including refugee populations increased casualties by 11-12% using median population estimates, and upwards of 20% using high population estimates. These results communicate the ongoing importance of placing environmental hazards in their appropriate regional and temporal context which unites physical, political, cultural, and socio-economic landscapes. Keywords: Earthquakes, Hazards, Loss-Estimation, Syrian Crisis, Migration

  3. Assessing the joint impact of DNAPL source-zone behavior and degradation products on the probabilistic characterization of human health risk

    Science.gov (United States)

    Henri, Christopher V.; Fernàndez-Garcia, Daniel; de Barros, Felipe P. J.

    2016-02-01

    The release of industrial contaminants into the subsurface has led to a rapid degradation of groundwater resources. Contamination caused by Dense Non-Aqueous Phase Liquids (DNAPLs) is particularly severe owing to their limited solubility, slow dissolution and in many cases high toxicity. A greater insight into how the DNAPL source zone behavior and the contaminant release towards the aquifer impact human health risk is crucial for an appropriate risk management. Risk analysis is further complicated by the uncertainty in aquifer properties and contaminant conditions. This study focuses on the impact of the DNAPL release mode on the human health risk propagation along the aquifer under uncertain conditions. Contaminant concentrations released from the source zone are described using a screening approach with a set of parameters representing several scenarios of DNAPL architecture. The uncertainty in the hydraulic properties is systematically accounted for by high-resolution Monte Carlo simulations. We simulate the release and the transport of the chlorinated solvent perchloroethylene and its carcinogenic degradation products in randomly heterogeneous porous media. The human health risk posed by the chemical mixture of these contaminants is characterized by the low-order statistics and the probability density function of common risk metrics. We show that the zone of high risk (hot spot) is independent of the DNAPL mass release mode, and that the risk amplitude is mostly controlled by heterogeneities and by the source zone architecture. The risk is lower and less uncertain when the source zone is formed mostly by ganglia than by pools. We also illustrate how the source zone efficiency (intensity of the water flux crossing the source zone) affects the risk posed by an exposure to the chemical mixture. Results display that high source zone efficiencies are counter-intuitively beneficial, decreasing the risk because of a reduction in the time available for the production

  4. Environmental Risk of Metal Mining Contaminated River Bank Sediment at Redox-Transitional Zones

    Directory of Open Access Journals (Sweden)

    Sarah F. L. Lynch

    2014-01-01

    Full Text Available Diffuse metal pollution from mining impacted sediment is widely recognised as a potential source of contamination to river systems and may significantly hinder the achievement of European Union Water Framework Directive objectives. Redox-transitional zones that form along metal contaminated river banks as a result of flood and drought cycles could cause biogeochemical changes that alter the behaviour of polyvalent metals iron and manganese and anions such as sulphur. Trace metals are often partitioned with iron, manganese and sulphur minerals in mining-contaminated sediment, therefore the dissolution and precipitation of these minerals may influence the mobility of potentially toxic trace metals. Research indicates that freshly precipitated metal oxides and sulphides may be more “reactive” (more adsorbent and prone to dissolution when conditions change than older crystalline forms. Fluctuations at the oxic-anoxic interface brought about through changes in the frequency and duration of flood and drought episodes may therefore influence the reactivity of secondary minerals that form in the sediment and the flux of dissolved trace metal release. UK climate change models predict longer dry periods for some regions, interspersed with higher magnitude flood events. If we are to fully comprehend the future environmental risk these climate change events pose to mining impacted river systems it is recommended that research efforts focus on identifying the primary controls on trace metal release at the oxic-anoxic interface for flood and drought cycles of different duration and frequency. This paper critically reviews the literature regarding biogeochemical processes that occur at different temporal scales during oxic, reducing and dry periods and focuses on how iron and sulphur based minerals may alter in form and reactivity and influence the mobility of trace metal contaminants. It is clear that changes in redox potential can alter the composition

  5. Platelet HPA-1 a/HPA-1 b polymorphism and the risk of periprocedural myocardial infarction in patients undergoing elective PCI

    NARCIS (Netherlands)

    Verdoia, M.; Secco, G.G.; Barbieri, L.; Cassetti, E.; Schaffer, A.; Sinigaglia, F.; Marino, P.; Suryapranata, H.; Luca, G. De

    2014-01-01

    Periprocedural myocardial infarction (PMI) represents a relatively common complication of percutaneous coronary intervention (PCI) and large interests have been focused on platelets in order to prevent such a complication. The single nucleotide polymorphism Leu33Pro of platelet glycoprotein IIIa has

  6. Risk of myocardial infarction in patients with HIV infection exposed to specific individual antiretroviral drugs from the 3 major drug classes: the data collection on adverse events of anti-HIV drugs (D:A:D) study

    DEFF Research Database (Denmark)

    Worm, Signe Westring; Sabin, Caroline; Weber, Rainer

    2010-01-01

    BACKGROUND. The risk of myocardial infarction (MI) in patients with human immunodeficiency virus (HIV) infection has been assessed in 13 anti-HIV drugs in the Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) study. METHODS. Poisson regression models were adjusted for cardiovascular risk...... factors, cohort, calendar year, and use of other antiretroviral drugs and assessed the association between MI risk and cumulative (per year) or recent (current or in the past 6 months) use of antiretroviral drugs, with >30,000 person-years of exposure. RESULTS. Over 178,835 person-years, 580 patients......% CI, 1.01-1.17], respectively) after adjustment for lipids but were not altered further after adjustment for other metabolic parameters. CONCLUSIONS. Of the drugs considered, only indinavir, lopinavir-ritonavir, didanosine, and abacavir were associated with a significantly increased risk of MI...

  7. Advances in computational modelling for personalised medicine after myocardial infarction.

    Science.gov (United States)

    Mangion, Kenneth; Gao, Hao; Husmeier, Dirk; Luo, Xiaoyu; Berry, Colin

    2018-04-01

    Myocardial infarction (MI) is a leading cause of premature morbidity and mortality worldwide. Determining which patients will experience heart failure and sudden cardiac death after an acute MI is notoriously difficult for clinicians. The extent of heart damage after an acute MI is informed by cardiac imaging, typically using echocardiography or sometimes, cardiac magnetic resonance (CMR). These scans provide complex data sets that are only partially exploited by clinicians in daily practice, implying potential for improved risk assessment. Computational modelling of left ventricular (LV) function can bridge the gap towards personalised medicine using cardiac imaging in patients with post-MI. Several novel biomechanical parameters have theoretical prognostic value and may be useful to reflect the biomechanical effects of novel preventive therapy for adverse remodelling post-MI. These parameters include myocardial contractility (regional and global), stiffness and stress. Further, the parameters can be delineated spatially to correspond with infarct pathology and the remote zone. While these parameters hold promise, there are challenges for translating MI modelling into clinical practice, including model uncertainty, validation and verification, as well as time-efficient processing. More research is needed to (1) simplify imaging with CMR in patients with post-MI, while preserving diagnostic accuracy and patient tolerance (2) to assess and validate novel biomechanical parameters against established prognostic biomarkers, such as LV ejection fraction and infarct size. Accessible software packages with minimal user interaction are also needed. Translating benefits to patients will be achieved through a multidisciplinary approach including clinicians, mathematicians, statisticians and industry partners. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless

  8. Pathway-Specific Aggregate Biomarker Risk Score Is Associated With Burden of Coronary Artery Disease and Predicts Near-Term Risk of Myocardial Infarction and Death

    DEFF Research Database (Denmark)

    Ghasemzedah, Nima; Hayek, Salim; Ko, Yi-An

    2017-01-01

    BACKGROUND: Inflammation, coagulation, and cell stress contribute to atherosclerosis and its adverse events. A biomarker risk score (BRS) based on the circulating levels of biomarkers C-reactive protein, fibrin degradation products, and heat shock protein-70 representing these 3 pathways was a st...

  9. Omental Infarction Mimicking Cholecystitis

    Directory of Open Access Journals (Sweden)

    David Smolilo

    2015-01-01

    Full Text Available Omental infarction can be difficult to diagnose preoperatively as imaging may be inconclusive and patients often present in a way that suggests a more common surgical pathology such as appendicitis. Here, a 40-year-old Caucasian man presented to casualty with shortness of breath and progressive right upper abdominal pain, accompanied with right shoulder and neck pain. Exploratory laparoscopy was eventually utilised to diagnose an atypical form of omental infarction that mimics cholecystitis. The vascular supply along the long axis of the segment was occluded initiating necrosis. In this case, the necrotic segment was adherent with the abdominal wall, a pathology not commonly reported in cases of omental infarction.

  10. Proton chemical shift imaging after myocardial infarction

    International Nuclear Information System (INIS)

    Bouchard, A.; Doyle, M.; Pohost, G.M.

    1989-01-01

    The present study was undertaken to test whether chemical shift imaging could detect spatially the lipids known to accumulate in myocardium after an ischemic insult. Seven dogs underwent a 24-hour coronary artery occlusion. Hearts were removed and imaged ex vivo by the Dixon method (1.5 T), and myocardial samples were obtained for high-resolution H-1 spectroscopy. Lipid images revealed regions of increased signal intensity in the periphery f the myocardial infarction. The zones of high lipid signal corresponded to zones with elevated mobile lipids as detected by H-1 spectroscopy

  11. Acute Myocardial Infarction Patients

    Directory of Open Access Journals (Sweden)

    Bruce Ovbiagele

    2011-01-01

    Full Text Available Background. Diabetes mellitus (DM confers high vascular risk and is a growing national epidemic. We assessed clinical characteristics and prevalence of diagnosed DM among patients hospitalized with acute myocardial infarction (AMI in the US over the last decade. Methods. Data were obtained from all states within the US that contributed to the Nationwide Inpatient Sample. All patients admitted to hospitals between 1997 and 2006 with a primary discharge diagnosis of AMI were included. Time trends in the proportion of these patients with DM diagnosis were computed. Results. The portion of patients with comorbid diabetes among AMI hospitalizations increased substantially from 18% in 1997 to 30% in 2006 (<.0001. Absolute numbers of AMI hospitalizations in the US decreased 8% (from 729, 412 to 672, 243, while absolute numbers of AMI hospitalizations with coexisting DM rose 51% ((131, 189 to 198, 044, both (<.0001. Women with AMI were significantly more likely to have DM than similarly aged men, but these differences diminished with increasing age. Conclusion. Although overall hospitalizations for AMI in the US diminished over the last decade, prevalence of diabetes rose substantially. This may have important consequences for the future societal vascular disease burden.

  12. Prevalence and anatomic characteristics of infarct-like lesions on MR images of middle-aged adults: the atherosclerosis risk in communities study.

    Science.gov (United States)

    Bryan, R N; Cai, J; Burke, G; Hutchinson, R G; Liao, D; Toole, J F; Dagher, A P; Cooper, L

    1999-08-01

    MR imaging has revealed putative evidence of subclinical cerebrovascular disease (CVD) as reflected by white matter signal changes and infarct-like lesions (ILLs). Nonetheless, the prevalence of this condition in the general population has been defined only to a limited extent. We herein report the prevalence and anatomic characteristics of ILLs seen on cranial MR images obtained as part of a population-based study of cardiovascular disease in middle-aged adults. These results are contrasted to those of previous similar studies, particularly those of an elderly population in the Cardiovascular Health Study (CHS). This Atherosclerosis Risk in Communities (ARIC) cohort consists of a probability sample of community-living persons who were 55 to 72 years old at the time of MR examination. MR imaging of 1890 participants was performed at two ARIC field centers, based on a common protocol. MR studies were evaluated by trained readers at the MR Reading Center using original digital data displayed on a high-resolution workstation. The measures of lesion size, anatomic location, and signal intensity were collected. The definition for an ILL was a non-mass, hyperintense region with an arterial vascular distribution on spin-density and T2-weighted images. Two hundred ninety participants had ILLs, for an overall prevalence of 15.3%. Eighty-two percent of participants with ILLs had lesions that were 3 mm or larger in maximal dimension, although 87% of these lesions were 20 mm or smaller in maximal dimension. The prevalence of ILLs increased with age, from 7.9% in the 55- to 59-year-old age group to 22.9% in the 65- to 72-year-old age group (P male and female participants. The basal ganglia and thalamic region was the most commonly affected anatomic site, accounting for 78.9% of the lesions. Considering that the prevalence of self-reported stroke or transient ischemic attack in ARIC participants is 1.5%, these results suggest that there is significantly more subclinical than

  13. Combining criteria for delineating lahar- and flash-flood-prone hazard and risk zones for the city of Arequipa, Peru

    Directory of Open Access Journals (Sweden)

    J.-C. Thouret

    2013-02-01

    Full Text Available Arequipa, the second largest city in Peru, is exposed to many natural hazards, most notably earthquakes, volcanic eruptions, landslides, lahars (volcanic debris flows, and flash floods. Of these, lahars and flash floods, triggered by occasional torrential rainfall, pose the most frequently occurring hazards that can affect the city and its environs, in particular the areas containing low-income neighbourhoods. This paper presents and discusses criteria for delineating areas prone to flash flood and lahar hazards, which are localized along the usually dry (except for the rainy season ravines and channels of the Río Chili and its tributaries that dissect the city. Our risk-evaluation study is based mostly on field surveys and mapping, but we also took into account quality and structural integrity of buildings, available socio-economic data, and information gained from interviews with risk-managers officials.

    In our evaluation of the vulnerability of various parts of the city, in addition to geological and physical parameters, we also took into account selected socio-economic parameters, such as the educational and poverty level of the population, unemployment figures, and population density. In addition, we utilized a criterion of the "isolation factor", based on distances to access emergency resources (hospitals, shelters or safety areas, and water in each city block. By combining the hazard, vulnerability and exposure criteria, we produced detailed risk-zone maps at the city-block scale, covering the whole city of Arequipa and adjacent suburbs. Not surprisingly, these maps show that the areas at high risk coincide with blocks or districts with populations at low socio-economic levels. Inhabitants at greatest risk are the poor recent immigrants from rural areas who live in unauthorized settlements in the outskirts of the city in the upper parts of the valleys. Such settlements are highly exposed to natural hazards and have little access

  14. Combining criteria for delineating lahar- and flash-flood-prone hazard and risk zones for the city of Arequipa, Peru

    Science.gov (United States)

    Thouret, J.-C.; Enjolras, G.; Martelli, K.; Santoni, O.; Luque, J. A.; Nagata, M.; Arguedas, A.; Macedo, L.

    2013-02-01

    Arequipa, the second largest city in Peru, is exposed to many natural hazards, most notably earthquakes, volcanic eruptions, landslides, lahars (volcanic debris flows), and flash floods. Of these, lahars and flash floods, triggered by occasional torrential rainfall, pose the most frequently occurring hazards that can affect the city and its environs, in particular the areas containing low-income neighbourhoods. This paper presents and discusses criteria for delineating areas prone to flash flood and lahar hazards, which are localized along the usually dry (except for the rainy season) ravines and channels of the Río Chili and its tributaries that dissect the city. Our risk-evaluation study is based mostly on field surveys and mapping, but we also took into account quality and structural integrity of buildings, available socio-economic data, and information gained from interviews with risk-managers officials. In our evaluation of the vulnerability of various parts of the city, in addition to geological and physical parameters, we also took into account selected socio-economic parameters, such as the educational and poverty level of the population, unemployment figures, and population density. In addition, we utilized a criterion of the "isolation factor", based on distances to access emergency resources (hospitals, shelters or safety areas, and water) in each city block. By combining the hazard, vulnerability and exposure criteria, we produced detailed risk-zone maps at the city-block scale, covering the whole city of Arequipa and adjacent suburbs. Not surprisingly, these maps show that the areas at high risk coincide with blocks or districts with populations at low socio-economic levels. Inhabitants at greatest risk are the poor recent immigrants from rural areas who live in unauthorized settlements in the outskirts of the city in the upper parts of the valleys. Such settlements are highly exposed to natural hazards and have little access to vital resources. Our

  15. Rift Valley fever in a zone potentially occupied by Aedes vexans in Senegal: dynamics and risk mapping

    Directory of Open Access Journals (Sweden)

    Cécile Vignolles

    2009-05-01

    Full Text Available This paper presents an analysis of the interaction between the various variables associated with Rift Valley fever (RVF such as the mosquito vector, available hosts and rainfall distribution. To that end, the varying zones potentially occupied by mosquitoes (ZPOM, rainfall events and pond dynamics, and the associated exposure of hosts to the RVF virus by Aedes vexans, were analyzed in the Barkedji area of the Ferlo, Senegal, during the 2003 rainy season. Ponds were identified by remote sensing using a high-resolution SPOT-5 satellite image. Additional data on ponds and rainfall events from the Tropical Rainfall Measuring Mission were combined with in-situ entomological and limnimetric measurements, and the localization of vulnerable ruminant hosts (data derived from QuickBird satellite. Since “Ae. vexans productive events” are dependent on the timing of rainfall for their embryogenesis (six days without rain are necessary to trigger hatching, the dynamic spatio-temporal distribution of Ae. vexans density was based on the total rainfall amount and pond dynamics. Detailed ZPOM mapping was obtained on a daily basis and combined with aggressiveness temporal profiles. Risks zones, i.e. zones where hazards and vulnerability are combined, are expressed by the percentages of parks where animals are potentially exposed to mosquito bites. This new approach, simply relying upon rainfall distribution evaluated from space, is meant to contribute to the implementation of a new, operational early warning system for RVF based on environmental risks linked to climatic and environmental conditions.

  16. Delineating risk zones and evaluation of shelter centres for flood disaster management along the Pahang River Basin, Malaysia

    Directory of Open Access Journals (Sweden)

    Anizan Isahak

    2018-04-01

    Full Text Available Shelter centres are important locations to safeguard people from helpless situations and are an integral part of disaster risk reduction (DRR, particularly for flood DRR. The establishment of shelter centres, and their design based on scientific assessment, is crucial. Yet, they are very much related to the geographic location, socio-economic conditions and the livelihoods of the affected communities. However, many parts of the developing world are still lagging behind in ensuring such scientific design. Considering the flood disaster in 2014 that affected the residents living along the Pahang River Basin, in this study we delineate the communities at risk and evaluate the existing shelter centres to determine how they reduce people’s vulnerability to the risks associated with rural and urban landscapes. We used spatial analysis tools to delineate risk zones and to evaluate existing evacuation systems. A flood disaster risk map was produced to determine which communities are living with risks. Subsequently, the distribution of shelter centres examined whether they are able to support people living at the flood risk zones. These centres were also evaluated using a set of international guidelines for effective disaster shelters. This reveals that the number of shelter centres is not adequate. The designation and designing of shelter centres are not being done scientifically. The maps produced here have a lot of potential to support disaster management decisions, in particular site selection and the prioritisation of centres. The study concludes with a set of guidelines and recommendations for structural and non-structural measures, such as alternative livelihoods and the potential of ecotourism, which may improve the resilience among flood-affected communities; and the decision-making process for the overall flood DRR initiatives.

  17. Quantification of myocardium at risk in ST- elevation myocardial infarction: a comparison of contrast-enhanced steady-state free precession cine cardiovascular magnetic resonance with coronary angiographic jeopardy scores.

    Science.gov (United States)

    De Palma, Rodney; Sörensson, Peder; Verouhis, Dinos; Pernow, John; Saleh, Nawzad

    2017-07-27

    Clinical outcome following acute myocardial infarction is predicted by final infarct size evaluated in relation to left ventricular myocardium at risk (MaR). Contrast-enhanced steady-state free precession (CE-SSFP) cardiovascular magnetic resonance imaging (CMR) is not widely used for assessing MaR. Evidence of its utility compared to traditional assessment methods and as a surrogate for clinical outcome is needed. Retrospective analysis within a study evaluating post-conditioning during ST elevation myocardial infarction (STEMI) treated with coronary intervention (n = 78). CE-SSFP post-infarction was compared with angiographic jeopardy methods. Differences and variability between CMR and angiographic methods using Bland-Altman analyses were evaluated. Clinical outcomes were compared to MaR and extent of infarction. MaR showed correlation between CE-SSFP, and both BARI and APPROACH scores of 0.83 (p < 0.0001) and 0.84 (p < 0.0001) respectively. Bias between CE-SSFP and BARI was 1.1% (agreement limits -11.4 to +9.1). Bias between CE-SSFP and APPROACH was 1.2% (agreement limits -13 to +10.5). Inter-observer variability for the BARI score was 0.56 ± 2.9; 0.42 ± 2.1 for the APPROACH score; -1.4 ± 3.1% for CE-SSFP. Intra-observer variability was 0.15 ± 1.85 for the BARI score; for the APPROACH score 0.19 ± 1.6; and for CE-SSFP -0.58 ± 2.9%. Quantification of MaR with CE-SSFP imaging following STEMI shows high correlation and low bias compared with angiographic scoring and supports its use as a reliable and practical method to determine myocardial salvage in this patient population. Clinical trial registration information for the parent clinical trial: Karolinska Clinical Trial Registration (2008) Unique identifier: CT20080014. Registered 04 th January 2008.

  18. Natural and traditional defense mechanisms to reduce climate risks in coastal zones of Bangladesh

    Directory of Open Access Journals (Sweden)

    Mohammed Ataur Rahman

    2015-03-01

    Full Text Available Substantially resourceful and densely populated coastal zones of Bangladesh experience numerous extreme events linked to hydro-meteorological processes viz. cyclones, tidal surges, floods, salinity intrusion and erosion etc. These hazards give rise to extensive damage to property and loss of lives every year. Further, anthropogenic activities in the coastal zones are accentuating environmental degradation causing widespread suffering. Cyclones and tornadoes in particular damage infrastructures and crops every year affecting the economy of the country negatively. Some naturally adapted plants as well as landscapes usually reduce the speed of cyclones and tornadoes and thus, protect the coastal zones. However, human activities have destroyed many of the forests and landscapes. Sundarbans and Chokoria Sundarbans mangrove forests of Bangladesh are under a great threat of extinction due to illicit logging and agricultural expansion. At least 34 plant species of tropical forest are on the verge of extinction. Many animals e.g., cats, bears, porcupines, wild boars, pythons and anteaters are in the process of being wiped out from the coastal areas. Among the marine and coastal species, Red crabs, jelly-fish, sharks, and dolphins are also rare but these were the major species prior to 1980s. This study revealed that during the recent decades there has been massive plantations and construction of embankment and polderization but these and other measures have been found to be impractical and ineffective in reducing disasters in coastal areas. There is a need for integration of traditional coping practices and wisdoms with modern approaches. Available knowledge on some of these traditional practices has been documented for establishing a sustainable policy for management of coastal zones of Bangladesh. By combining traditional and scientific management of coastal ecosystem with mangroves and other plants following triple-tier mechanism and habitat, it is

  19. Statins and perioperative myocardial infarction. | Levin | Southern ...

    African Journals Online (AJOL)

    The growing prevalence of atherosclerosis means that perioperative myocardial infarction (PMI) is of significant concern to anesthesiologists. Perioperative revascularization (if indicated medically), beta blockade (in high risk patients) and statin therapy are therapeutic modalities that are currently employed to reduce PMI.

  20. [Transportation and risk assessment of heavy metal pollution in water-soil from the Riparian Zone of Daye Lake, China].

    Science.gov (United States)

    Zhang, Jia-quan; Li, Xiu; Zhang, Quan-fa; Li, Qiong; Xiao, Wen-sheng; Wang, Yong-kui; Zhang, Jian-chun; Gai, Xi-guang

    2015-01-01

    Each 20 water samples and soil samples (0-10 cm, 10-20 cm) were collected from the riparian zone of Daye Lake in dry season during March 2013. Heavy metals (Cu, Ph, Cd, Zn) have been detected by flame atomic absorption spectrometric (FAAS). The results showed that the average concentrations of Cu, Pb, Cd, Zn in the water were 7.14, 25.94, 15.72 and 37.58 microg x L(-1), respectively. The concentration of Cu was higher than the five degree of the surface water environment quality standard. The average concentrations of Cu, Pb, Cd, Zn in soil(0-10 cm) were 108.38, 53.92, 3.55, 139.26 mg x kg(-1) in soil (10-20 cm) were 93.00, 51.72, 2.08, 171.00 mg x kg(-1), respectively. The Cd concentrations were higher than the three grade value of the national soil environment quality standard. The transportation of Pb from soil to water was relatively stable, and Zn was greatly influenced by soil property and the surrounding environment from soil to water. The transformation of heavy metal in west riparian zone was higher than that of east riparian zone. The potential environmental risk was relatively high. Cu, Pb, Cd, Zn were dominated by residue fraction of the modified BCR sequential extraction method. The overall migration order of heavy metal element was: Pb > Cu > Cd > Zn. There were stronger transformation and higher environmental pollution risk of Cu, Pb. The index of assessment and potential ecological risk coefficient indicated that heavy metal pollution in soil (0-10 cm) was higher than the soil (10-20 cm), Cd was particularly serious.

  1. Risk zones of human Leishmaniases in the Western Mediterranean basin: correlations between vector sand flies, bioclimatology and phytosociology.

    Science.gov (United States)

    Rispail, Philippe; Dereure, Jacques; Jarry, Daniel

    2002-06-01

    Correspondence analysis was applied to sand fly sampling in 865 stations from the Western Mediterranean basin. The position of each of 24 species was determined with respect to the bioclimatic belts. Thus, the multidimensional analyses manifest clear correlations between bioclimatic belts and their expression in the area, the phytosociological groupings, and vector species of visceral and cutaneous leishmaniases. The transfer of these data to usual maps allows to delimit the geographical distribution of these diseases in the Western Mediterranean basin and contributes to the determination, in a rational manner, of the high risk zones.

  2. Risk Zones of Human Leishmaniases in the Western Mediterranean Basin: Correlations between Vector Sand Flies, Bioclimatology and Phytosociology

    Directory of Open Access Journals (Sweden)

    Philippe Rispail

    2002-06-01

    Full Text Available Correspondence analysis was applied to sand fly sampling in 865 stations from the Western Mediterranean basin. The position of each of 24 species was determined with respect to the bioclimatic belts. Thus, the multidimensional analyses manifest clear correlations between bioclimatic belts and their expression in the area, the phytosociological groupings, and vector species of visceral and cutaneous leishmaniases. The transfer of these data to usual maps allows to delimit the geographical distribution of these diseases in the Western Mediterranean basin and contributes to the determination, in a rational manner, of the high risk zones.

  3. Impact of newly diagnosed abnormal glucose regulation on long-term prognosis in low risk patients with ST-elevation myocardial infarction: A follow-up study

    Directory of Open Access Journals (Sweden)

    Abdelnoor Michael

    2011-07-01

    Full Text Available Abstract Background Patients with acute myocardial infarction and newly detected abnormal glucose regulation have been shown to have a less favourable prognosis compared to patients with normal glucose regulation. The importance and timing of oral glucose tolerance testing (OGTT in patients with acute myocardial infarction without known diabetes is uncertain. The aim of the present study was to evaluate the impact of abnormal glucose regulation classified by an OGTT in-hospital and at three-month follow-up on clinical outcome in patients with acute ST elevation myocardial infarction (STEMI without known diabetes. Methods Patients (n = 224, age 58 years with a primary percutanous coronary intervention (PCI treated STEMI were followed for clinical events (all-cause mortality, non-fatal myocardial re-infarction, recurrent ischemia causing hospital admission, and stroke. The patients were classified by a standardised 75 g OGTT at two time points, first, at a median time of 16.5 hours after hospital admission, then at three-month follow-up. Based on the OGTT results, the patients were categorised according to the WHO criteria and the term abnormal glucose regulation was defined as the sum of impaired fasting glucose, impaired glucose tolerance and type 2-diabetes. Results The number of patients diagnosed with abnormal glucose regulation in-hospital and at three-month was 105 (47% and 50 (25%, respectively. During the follow up time of (median 33 (27, 39 months, 58 (25.9% patients experienced a new clinical event. There were six deaths, 15 non-fatal re-infarction, 33 recurrent ischemia, and four strokes. Kaplan-Meier analysis of survival free of composite end-points showed similar results in patients with abnormal and normal glucose regulation, both when classified in-hospital (p = 0.4 and re-classified three months later (p = 0.3. Conclusions Patients with a primary PCI treated STEMI, without previously known diabetes, appear to have an excellent

  4. Effective mine risk education in war-zone areas--a shared responsibility.

    Science.gov (United States)

    Durham, Joanne; Gillieatt, Sue; Sisavath, Bounpheng

    2005-09-01

    The focus of this paper is effective health education and promotion in the field of mine awareness, or what has more recently been re-titled 'mine risk education'. According to the United Nations, mine risk education comprises educational activities that aim to reduce the risk of injury from landmine/unexploded ordnance (UXO) through raising awareness and promoting behavioural change and includes public information dissemination, education and training, and community mine action liaison. Specifically, this paper is an empirical study of mine risk education practices using data collected during the implementation of a mine risk education programme that commenced in Lao PDR in 1996 and is ongoing. In particular, it considers lessons learned from the programme's monitoring and evaluation process. The authors argue that in a country such as Lao PDR, where communities have lived with UXO infestation for over 25 years, more mine risk education is not necessarily needed. This paper concludes that common programmes of mine risk education using top-down educational methods, based on the assumption that ignorance of landmine/UXO risk is the key factor in mine accidents, are inadequate. Evidence from the literature on health promotion and the experience of the programme indicate that there is a need to supplement or replace existing common mine risk education practices with techniques that incorporate an understanding of the economic, social and political circumstances faced by communities at risk.

  5. Acute myocardial infarction in a young patient

    International Nuclear Information System (INIS)

    Hameed, A.; Ata-ur-Rehman Quraishi

    2004-01-01

    Myocardial infarction (MI) is considered to be the disease of the fifth and sixth decade as seen in the West but an earlier age incidence is not infrequently encountered in the South Asian population. However, occurrence of MI in the teen-age still remains a rare happening. We are reporting a case of a teenager, who suffered a myocardial infarction with cardiogenic shock and pulmonary edema on two separate occasions with ECG and biochemical evidence of myocardial infarction. An exercise stress test done in between the two episodes was negative at a workload of 13.5 METs. A coronary angiogram done after the second event revealed normal coronary arteries and a preserved left ventricular systolic and segmental function. Except for low HDL (high density lipoprotein) and mildly raised homocysteine levels, the patient did not have other conventional or novel risk factors for coronary artery disease. (author)

  6. Risk factors of methane hydrate resource development in the concentrated zones distributed in the eastern Nankai Trough

    Science.gov (United States)

    Yamamoto, K.; Nagakubo, S.

    2009-04-01

    Some environmental and safety concerns on the offshore methane hydrate development have been raised, but the ground of such allegations are sometime not fully reasonable. The risks of methane hydrate resource development to environment and safety should be discussed upon methane hydrate occurrences condition, the production methods, and the designs of production system, under comprehensively scientific manners. In the Phase 1 of the Methane Hydrate Exploitation Program in Japan (FY2001-2008), the Research Consortium for Methane Hydrate Resources in Japan (MH21 Research Consortium) found methane hydrate concentrated zones in the eastern Nankai Trough that are potential prospects for resource development. The concentrated zones are consisted of turbidite-derived sandy sediments and hydrate crystals in pore spaces of sand grains (pore-filling type structure). The MH21 Research Consortium proposed the depressurization method as prime technique due to its efficiency of gas production in such concentrated zones, and has tried to develop conceptual designs of production systems based on the information of existing devices and facilities. Under the condition and circumstances described above, the authors tried to extract and evaluate some risk factors concerning methane hydrate development using depressurization in the area. Leakage of methane gas, that is less harmful substance to ecosystem than heavier hydrocarbons, from production system can be one possible risk. However, in the case of gas production through wellbore, even if catastrophic damages happen in the subsea production system during gas production, the leakages do not continue because the borehole could be filled by seawater and depressurization is stopped immediately. Another possible risk is a leakage of produced gas through seafloor. If methane hydrate production makes high pressure or temperature zones in sediments, the risk should be considered. However, depressurization method makes opposite condition

  7. Radiation protection zoning

    International Nuclear Information System (INIS)

    2015-01-01

    Radiation being not visible, the zoning of an area containing radioactive sources is important in terms of safety. Concerning radiation protection, 2 work zones are defined by regulations: the monitored zone and the controlled zone. The ministerial order of 15 may 2006 settles the frontier between the 2 zones in terms of radiation dose rates, the rules for access and the safety standards in both zones. Radioprotection rules and the name of the person responsible for radiation protection must be displayed. The frontier between the 2 zones must be materialized and marked with adequate equipment (specific danger signs and tapes). Both zones are submitted to selective entrance, the access for the controlled zone is limited because of the radiation risk and of the necessity of confining radioactive contamination while the limitation of the access to the monitored zone is due to radiation risk only. (A.C.)

  8. Understanding factors that influence the use of risk scoring instruments in the management of patients with unstable angina or non-ST-elevation myocardial infarction in the Netherlands: a qualitative study of health care practitioners' perceptions.

    Science.gov (United States)

    Engel, Josien; Heeren, Marie-Julie; van der Wulp, Ineke; de Bruijne, Martine C; Wagner, Cordula

    2014-09-22

    Cardiac risk scores estimate a patient's risk of future cardiac events or death. They are developed to inform treatment decisions of patients diagnosed with unstable angina or non-ST-elevation myocardial infarction. Despite recommending their use in guidelines and evidence of their prognostic value, they seem underused in practice. The purpose of the study was to gain insight in the motivation for implementing cardiac risk scores, and perceptions of health care practitioners towards the use of these instruments in clinical practice. This qualitative study involved semi-structured interviews with 31 health care practitioners at 11 hospitals throughout the Netherlands. Participants were approached through purposive sampling to represent a broad range of participant- and hospital characteristics, and included cardiologists, medical residents, medical interns, nurse practitioners and an emergency physician. The Pettigrew and Whipp Framework for strategic change was used as a theoretical basis. Data were initially analysed through open coding to avoid forcing data into categories predetermined by the framework. Cardiac risk score use was dependent on several factors, including IT support, clinical relevance for daily practice, rotation of staff and workload. Both intrinsic and extrinsic drivers for implementation were identified. Reminders, feedback and IT solutions were strategies used to improve and sustain the use of these instruments. The scores were seen as valuable support systems in improving uniformity in treatment practices, educating interns, conducting research and quantifying a practitioner's own risk assessment. However, health care practitioners varied in their perceptions regarding the influence of cardiac risk scores on treatment decisions. Health care practitioners disagree on the value of cardiac risk scores for clinical practice. Practitioners driven by intrinsic motivations predominantly experienced benefits in policy-making, education and research

  9. POLAND IN AND OUTSIDE THE EURO ZONERISKS AND BENEFITS IN THE LIGHT OF NEW POLITICAL AND ECONOMIC DETERMINANTS

    Directory of Open Access Journals (Sweden)

    Krzysztof Dobrowolski

    2017-09-01

    Full Text Available This article analyzes the benefits and risks of Poland adopting the euro in the light of current political and economic conditions. For this purpose, the following research methods were used: literature research, intuitive method and descriptive statistics. Poland has fulfilled the criteria for nominal convergence for two years, apart from participating in the ERM II mechanism, but the political situation in the country precludes the adoption of measures leading to the euro zone. The future shape of this zone is yet unknown, as its closer integration is planned. Theoretical analysis indicates that the process of globalization makes it difficult for medium-sized, open-economy countries to pursue autonomous monetary and exchange rate policy, so the loss of these instruments after the adoption of the euro should not jeopardize long-term economic growth, even in the case of asymmetric shocks. The market mechanisms of restoring the balance and fiscal policy may then be used. The economy will also benefit from the elimination of transaction costs and exchange rate risks in the euro zone. The analysis shows that it is possible to use the opportunity for faster GDP growth associated with the adoption of the common currency if the right economic policy is pursued. Adopting the euro may also incur costs. For banks it can be the loss of foreign exchange earnings and commissions on FX hedge transactions. For the economy it can be the possibility of speculative bubbles, as a result of excessive consumption growth, caused by possibly too low interest rates. Expected benefits should, however, outweigh any losses.

  10. Prevalence of smear positive pulmonary tuberculosis and associated risk factors among prisoners in Hadiya Zone prison, Southern Ethiopia.

    Science.gov (United States)

    Fuge, Terefe G; Ayanto, Samuel Y

    2016-04-02

    People concentrated in congregated systems such as prisons, are important but often neglected reservoirs for tuberculosis transmission, and threaten those in the outside community. The condition is more serious in Africa particularly in Sub-Saharan Africa (SSA) due to its poor living conditions and ineffective health services. This study was conducted to determine the prevalence of smear positive pulmonary tuberculosis and associated risk factors among prisoners in Hadiya Zone prison. A cross-sectional survey was carried out from May to June 2013 in Hadiya Zone prison. Prison inmates who had history of cough for at least a week were included in the study. Three morning sputum samples were collected from suspected inmates and examined through compound light microscopy. The data obtained was analyzed using statistical software like Epidata and STATA. A total of 164 prisoners were included in the survey using active screening strategy and the point prevalence of smear positive pulmonary tuberculosis (PTB) in the prison was 349.2 per 100,000 populations; about three times higher than its prevalence in the general population. Even though lack of visit from family was the only variable identified as a risk factor for PTB (P = 0.029), almost all of the PTB positive cases were rural residents, farmers, male youngsters and those who shared cell with TB patients and chronically coughing persons as well as those who stayed in a cell that contains >100 inmates. There is high prevalence of TB in Hadiya Zone prison with possible active transmission of TB within the prison. The study also documented a number of factors which may facilitate exposures to TB though most of them are not significantly associated. Therefore, strong cooperation between prison authorities and the national tuberculosis control programmes is urgently required to develop locally appropriate interventions to reduce transmission.

  11. Benchmarking of the saturated-zone module associated with three risk assessment models: RESRAD, MMSOILS, and MEPAS

    International Nuclear Information System (INIS)

    Whelan, Gene; Mcdonald, J P.; Gnanapragasam, Emmanuel K.; Laniak, Gerard F.; Lew, Christine S.; Mills, William B.; Yu, C

    1998-01-01

    A comprehensive benchmarking is being performed between three multimedia risk assessment models: RESRAD, MMSOILS, and MEPAS. Each multimedia model is comprised of a suite of modules (e.g., groundwater, air, surface water, exposure, and risk/hazard), all of which can impact the estimation of human-health risk. As a component of the comprehensive benchmarking exercise, the saturated-zone modules of each model were applied to an environmental release scenario, where uranium-234 was released from the waste site to a saturated zone. Uranium-234 time-varying emission rates exiting from the source and concentrations at three downgradient locations (0 m, 150 m, and 1500 m) are compared for each multimedia model. Time-Varying concentrations for uranium-234 decay products (i.e., thorium-230, radium-226, and lead-210) at the 1500-m location are also presented. Different results are reported for RESRAD, MMSOILS, and MEPAS, which are solely due to the assumptions and mathematical constructs inherently built into each model, thereby impacting the potential risks predicted by each model. Although many differences were identified between the models, differences that impacted these benchmarking results the most are as follows: (1) RESRAD transports its contaminants by pure translation, and MMSOILS and MEPAS solve the one-dimensional advective, three-dimensional dispersive equation. (2) Due to the manner in which the retardation factor is defined, RESRAD contaminant velocities will always be faster than MMSOILS or MEPAS. (3) RESRAD uses a dilution factor to account for a withdrawal well; MMSOILS and MEPAS were designed to calculate in-situ concentrations at a receptor location. (4) RESRAD allows for decay products to travel at different velocities, while MEPAS assumes the decay products travel at the same speed as their parents. MMSOILS does not account for decay products and assumes degradation/decay only in the aqueous phase

  12. Risk of bleeding in patients with acute myocardial infarction treated with different combinations of aspirin, clopidogrel, and vitamin K antagonists in Denmark: a retrospective analysis of nationwide registry data

    DEFF Research Database (Denmark)

    Sørensen, Rikke; Hansen, Morten L; Abildstrøm, Steen

    2009-01-01

    BACKGROUND: Combinations of aspirin, clopidogrel, and vitamin K antagonists are widely used in patients after myocardial infarction. However, data for the safety of combinations are sparse. We examined the risk of hospital admission for bleeding associated with different antithrombotic regimens...... according to the following groups: monotherapy with aspirin, clopidogrel, or vitamin K antagonist; dual therapy with aspirin plus clopidogrel, aspirin plus vitamin K antagonist, or clopidogrel plus vitamin K antagonist; or triple therapy including all three drugs. Risk of hospital admission for bleeding...... was 2.6% for the aspirin group, 4.6% for clopidogrel, 4.3% for vitamin K antagonist, 3.7% for aspirin plus clopidogrel, 5.1% for aspirin plus vitamin K antagonist, 12.3% for clopidogrel plus vitamin K antagonist, and 12.0% for triple therapy. With aspirin as reference, adjusted hazard ratios...

  13. Role of myocardial perfusion imaging in evaluating thrombolytic therapy for acute myocardial infarction

    International Nuclear Information System (INIS)

    Beller, G.A.

    1987-01-01

    Myocardial thallium-201 scintigraphy is being increasingly employed as a method for assessing the efficacy of coronary reperfusion in acute myocardial infarction. New thallium uptake after intracoronary tracer administration after successful recanalization indicates that nutrient blood flow has been successfully restored. One may also presume that some myocardial salvage occurred if thallium administered in this manner is transported intracellularly by myocytes with intact sarcolemmal membranes. However, if one injects thallium by way of the intracoronary route immediately after reperfusion, the initial uptake of thallium in reperfused myocardium may predominantly represent hyperemic flow and regional thallium counts measured may not be proportional to the mass of viable myocytes. When thallium is injected intravenously during the occlusion phase the degree of redistribution after thrombolysis is proportional to the degree of flow restoration and myocardial viability. When thallium is injected for the first time intravenously immediately after reperfusion, an overestimation of myocardial salvage may occur because of excess thallium uptake in the infarct zone consequent to significant hyperemia. Another approach to myocardial thallium scintigraphy in patients undergoing thrombolytic therapy is to administer two separate intravenous injections before and 24 hours or later after treatment. Finally, patients with acute myocardial infarction who receive intravenous thrombolytic therapy are candidates for predischarge exercise thallium-201 scintigraphy for risk stratification and detection of residual ischemia

  14. Additive prognostic value of left ventricular ejection fraction to the TIMI risk score for in-hospital and long-term mortality in patients with ST segment elevation myocardial infarction.

    Science.gov (United States)

    Wei, Xue-Biao; Liu, Yuan-Hui; He, Peng-Cheng; Jiang, Lei; Zhou, Ying-Ling; Chen, Ji-Yan; Tan, Ning; Yu, Dan-Qing

    2017-01-01

    To investigate whether the addition of left ventricular ejection fraction (LVEF) to the TIMI risk score enhances the prediction of in-hospital and long-term death in ST segment elevation myocardial infarction (STEMI) patients. 673 patients with STEMI were divided into three groups based on TIMI risk score for STEMI: low-risk group (TIMI ≤3, n = 213), moderate-risk group (TIMI 4-6, n = 285), and high-risk group (TIMI ≥7, n = 175). The predictive value was evaluated using the receiver operating characteristic. Multivariate logistic regression was used to determine risk predictors. The rates of in-hospital death (0.5 vs 3.2 vs 10.3 %, p risk group. Multivariate analysis showed that TIMI risk score (OR 1.24, 95 % CI 1.04-1.48, P = 0.015) and LVEF (OR 3.85, 95 % CI 1.58-10.43, P = 0.004) were independent predictors of in-hospital death. LVEF had good predictive value for in-hospital death (AUC: 0.838 vs 0.803, p = 0.571) or 1-year death (AUC: 0.743 vs 0.728, p = 0.775), which was similar to TIMI risk score. When compared with the TIMI risk score alone, the addition of LVEF was associated with significant improvements in predicting in-hospital (AUC: 0.854 vs 0.803, p = 0.033) or 1-year death (AUC: 0.763 vs 0.728, p = 0.016). The addition of LVEF to TIMI risk score enhanced net reclassification improvement (0.864 for in-hospital death, p value to TIMI risk score.

  15. Computerized detection of lacunar infarcts in brain MR images

    International Nuclear Information System (INIS)

    Uchiyama, Yoshikazu; Matsui, Atsushi; Yokoyama, Ryujiro

    2007-01-01

    Asymptomatic lacunar infarcts are often found in the Brain Dock. The presence of asymptomatic lacunar infarcts increases the risk of serious cerebral infarction. Thus, it is an important task for radiologists and/or neurosurgeons to detect asymptomatic lacunar infarctions in MRI images. However, it is difficult for radiologists and/or neurosurgeons to identify lacunar infarcts correctly in MRI images, because it is hard to distinguish between lacunar infarcts and enlarged Virchow-Robin space. Therefore, the purpose of our study was to develop a computer-aided diagnosis scheme for detection of lacunar infarctions in order to assist radiologists and/or neurosurgeons' interpretation as a ''second opinion.'' Our database consisted of 1143 T2-weighted MR images and 1143 T1-weighted MR images, which were selected from 132 patients. First, we segmented the cerebral parenchyma region by use of a region growing technique. The white-tophat transformation was then applied for enhancement of lacunar infarcts. The multiple-phase binarization was used for identifying initial candidates of lacunar infarcts. For removal of false positives (FPs), 12 features were determined in each of the initial candidates in T2 and T1-weighted MR images. The rule-based schemes and an artificial neural network with these features were used for distinguishing between lacunar infarcts and FPs. The sensitivity of detection of lacunar infarcts was 96.8% (90/93) with 0.69 (737/1063) FP per image. This computerized method may be useful for radiologists and/or neurosurgeons in detecting lacunar infracts in MRI images. (author)

  16. Acute myocardial infarction after mediastinal radiotherapy

    International Nuclear Information System (INIS)

    Gagliardi, Juan; Tezanos Pinto, Miguel; Avalos, Adolfo; Sarubbi, Augusto; Padilla, Lucio; Espinosa, Daniel

    2004-01-01

    Mediastinal radiotherapy can affect the heart and great vessels to different degrees. It may turn up as coronary heart disease and less frequently as acute myocardial infarction. We report the case of a patient without coronary risk factors and an antecedent of mediastinal radiotherapy for Hodgkin's lymphoma. Considerations about mediastinal radiation as a risk factor for early development of coronary heart diseases are exposed. (author) [es

  17. Danger zone: Men, masculinity and occupational health and safety in high risk occupations

    OpenAIRE

    Stergiou-Kita, Mary; Mansfield, Elizabeth; Bezo, Randy; Colantonio, Angela; Garritano, Enzo; Lafrance, Marc; Lewko, John; Mantis, Steve; Moody, Joel; Power, Nicole; Theberge, Nancy; Westwood, Eleanor; Travers, Krista

    2015-01-01

    The workplace is a key setting where gender issues and organizational structures may influence occupational health and safety practices. The enactment of dominant norms of masculinity in high risk occupations can be particularly problematic, as it exposes men to significant risks for injuries and fatalities. To encourage multi-disciplinary collaborations and advance knowledge in the intersecting areas of gender studies, men’s health, work and workplace health and safety, a national network of...

  18. Polycyclic aromatic hydrocarbons and black carbon in intertidal sediments of China coastal zones: Concentration, ecological risk, source and their relationship

    Energy Technology Data Exchange (ETDEWEB)

    Li, Xiaofei [School of Geographical Sciences, East China Normal University, 3663 North Zhongshan Road, Shanghai 200062 (China); Hou, Lijun [State Key Laboratory of Estuarine and Coastal Research, East China Normal University, 3663 North Zhongshan Road, Shanghai 200062 (China); Li, Ye [School of Geographical Sciences, East China Normal University, 3663 North Zhongshan Road, Shanghai 200062 (China); Liu, Min, E-mail: mliu@geo.ecnu.edu.cn [School of Geographical Sciences, East China Normal University, 3663 North Zhongshan Road, Shanghai 200062 (China); Key Laboratory of Geographic Information Science, Ministry of Education, East China Normal University, 3663 North Zhongshan Road, Shanghai 200062 (China); Lin, Xianbiao; Cheng, Lv [School of Geographical Sciences, East China Normal University, 3663 North Zhongshan Road, Shanghai 200062 (China)

    2016-10-01

    Polycyclic aromatic hydrocarbons (PAHs) and black carbon (BC) have attracted many attentions, especially in the coastal environments. In this study, spatiotemporal distributions of PAHs and BC, and the correlations between BC and PAHs were investigated in the intertidal sediments of China coastal zones. BC in sediments was measured through dichromate oxidation (BC{sub Cr}) and thermal oxidation (BC{sub CTO}). The concentrations of BC{sub Cr} in the intertidal sediments ranged between 0.61 and 6.32 mg g{sup −1}, while BC{sub CTO} ranged between 0.57 and 4.76 mg g{sup −1}. Spatial variations of δ{sup 13}C signatures in TOC and BC were observed, varying from − 21.13‰ to − 24.87‰ and from − 23.53‰ to − 16.78‰, respectively. PAH contents of sediments ranged from 195.9 to 4610.2 ng g{sup −1} in winter and 98.2 to 2796.5 ng g{sup −1} in summer, and significantly seasonal variations were observed at most sampling sites. However, the results of potential toxicity assessment indicated low ecological risk in the intertidal sediments of China coastal zones. Greater concentrations of PAHs measured in the sediments of estuarine environments indicated that rivers runoff may have been responsible for the higher PAH pollution levels in the intertidal sediments of China coastal zones. Pearson's correlation analysis suggested that pyrogenic compounds of PAH were significantly related to BC, due to that both BC and these compounds derived mainly from the combustion process of fossil fuels and biomass. Overall, increasing energy consumptions caused by anthropogenic activities can contribute more emissions of BC as well as PAHs and thus improve the importance of BC in indicating pyrogenic compounds of PAHs in the intertidal sediments of China coastal zones. - Highlights: • River runoffs were responsible for the high PAH pollution levels in the study area. • BC and PAHs derived mainly from the combustion process of fossil fuels. • BC was associated

  19. Investigation of the Relationship between Myocardial Infarction, Angina Pectoris, and Venous Thrombosis and Some Risk Factors in the Women Suffering from Cardiovascular Diseases with a History of Contraceptive Pills Consumption

    Directory of Open Access Journals (Sweden)

    Marzieh Akbarzade

    2016-06-01

    Full Text Available Background: Cardiovascular diseases have various etiologies. Previous studies have come to contradictory results regarding the effects of Oral Contraceptive Pills (OCPs on the risk of myocardial infarction, angina pectoris, and venous thrombosis. Thus, further investigation is required in this area. Objectives: This study aimed to determine the relationship between cardiovascular diseases and some risk factors in the women with a history of contraceptive pills consumption. Patients and Methods: The present case-control study was conducted on 317 women with cardiovascular diseases (myocardial infarction, angina pectoris, and deep venous thrombosis selected through simple purposive sampling from CCU, ICU, post-ICU, and neurology departments of Nemazee, Faghihi, and Al-Zahra heart hospitals. Also, 371 controls were selected among 20 – 60 year-old women without cardiac diseases. The data were collected through questionnaires, interviewing the patients and their first-degree relatives, and the patients’ medical records. The main variables studied in both groups included the history of OCPs consumption, weight gain, blood sugar level, and hypertension. Then, the data were analyzed using chi-square test, correlation coefficient, and odds ratio. Besides, P < 0.05 was considered to be statistically significant. Results: The mean age of the study population was 49.2 ± 13.4 years. Besides, 10.6%, 4%, and 2.7% of the women had used OCPs for 6 - 10, 11 - 15, and more than 16 years, respectively. There were no significant differences between the two groups in terms of history of using OCPs (47.3% vs. 51.5%, P = 0.8. In addition, no significant relationship was observed between consumption of OCPs and incidence of myocardial infarction (P = 0.202, angina pectoris (P = 0.260, and thrombosis (P = 0.389. However, a significant difference was found between the two groups regarding the frequency of hyperlipidemia, hyperglycemia, and hypertension (P < 0

  20. The contribution of nuclear medicine in the six months following a myocardium infarction

    International Nuclear Information System (INIS)

    Franken, Ph.R.

    2002-01-01

    The techniques of nuclear medicine allow to estimate the myocardial infarction size, to measure the ejection fraction and the ventricles volumes and to identify the presence of high-risk and viable myocardium. This information is essential to evaluate the important complications risks after an acute myocardial infarction, that is to say the infarction recurrence and the cardiac death coming from rhythm troubles or a left ventricle failure. (N.C.)

  1. Cardiac Arrest following a Myocardial Infarction in a Child Treated with Methylphenidate

    DEFF Research Database (Denmark)

    Munk, Kim; Gormsen, Lise Kirstine; Kim, Won Yong

    2015-01-01

    -years, did not report any cases of myocardial infarction in current users of methylphenidate, and the risk of serious adverse cardiac events was not found to be increased. We present a case with an 11-year-old child, treated with methylphenidate, who suffered cardiac arrest and was diagnosed with a remote...... myocardial infarction. This demonstrates that myocardial infarction can happen due to methylphenidate exposure in a cardiac healthy child, without cardiovascular risk factors....

  2. An innovative approach to determine economically optimal coastal setback lines for risk informed coastal zone management

    NARCIS (Netherlands)

    Ranasinghe, R.; Jongejan, R.B.; Callaghan, D.; Vrijling, J.K.

    2012-01-01

    Current methods used to determine Coastal setback lines have several limitations. Furthermore, the historical practice of defining setback lines based on a single deterministic estimate is also proving inadequate with the emergence of risk management style coastal planning frameworks which require

  3. CT features of renal infarction

    International Nuclear Information System (INIS)

    Suzer, Okan; Shirkhoda, Ali; Jafri, S. Zafar; Madrazo, Beatrice L.; Bis, Kostaki G.; Mastromatteo, James F.

    2002-01-01

    Purpose: To demonstrate the different patterns of renal infarction to avoid pitfalls. To present 'flip-flop enhancement' pattern in renal infarction. Materials and methods: Retrospective review of a total of 41 renal infarction in 37 patients were done. These patients underwent initial CT and the diagnosis of renal infarction was confirmed with either follow up CT or at surgery. Results: Twenty-three patients had wedge-shaped focal infarcts, nine patients had global and five patients had multifocal infarcts of the kidneys. Cortical rim sign was seen predominantly with global infarcts. In five patients, a 'flip-flop enhancement' pattern was observed. In two patients, planned renal biopsies due to tumefactive renal lesions were cancelled because of 'flip-flop enhancement' pattern on follow up CTs. Conclusion: Although most of our cases were straightforward for the diagnosis of renal infarction, cases with tumefactive lesions and global infarctions without the well-known cortical rim sign were particularly challenging. We describe a new sign, flip-flop enhancement pattern, which we believe solidified the diagnosis of renal infarction in five of our cases. The authors recommend further investigations for association of flip-flop enhancement and renal infarction

  4. Cd pollution and ecological risk assessment for mining activity zone in Karst Area

    Science.gov (United States)

    Yang, B.; He, J. L.; Wen, X. M.; Tan, H.

    2017-08-01

    The monitored soil samples were collected from farmland in the area with mining activity in Karst area in Liupanshui. In this article, moss bag technology and TSP were used simultaneously for Cd transportation and deposition in the study area. Geostatistics and GIS were then used for the spatial distribution of Cd in the soil. Afterwards, Cd pollution to the soil environment and human health was studied by using the geo-accumulation index and potential ecological risk index methods. The results indicated that atmospheric deposition is the major route of Cd pollution. A moderate to strong pollution of Cd in the area and the degree of potential ecological risk was in a high level in the study area. Furthermore, Cd pollution in Liupanshui may originate from mining activity and atmospheric deposition.

  5. Risk assessment and early warning systems for industrial facilities in seismic zones

    International Nuclear Information System (INIS)

    Salzano, Ernesto; Garcia Agreda, Anita; Di Carluccio, Antonio; Fabbrocino, Giovanni

    2009-01-01

    Industrial equipments and systems can suffer structural damage when hit by earthquakes, so that accidental scenarios as fire, explosion and dispersion of toxic substances can take place. As a result, overall damage to people, environment and properties increases. The present paper deals with seismic risk analysis of industrial facilities where atmospheric storage tanks (anchored or unanchored to ground), horizontal pressurised tanks, reactors and pumps are installed. Simplified procedures and methodologies based on historical database and literature data on natural-technological (Na-Tech) accidents for seismic risk assessment are discussed. Equipment-specific fragility curves have been thus derived depending on a single earthquake measure, peak ground acceleration (PGA). Fragility parameters have been then transformed to linear probit coefficients in order to obtain reliable threshold values for earthquake intensity measure, both for structural damage and loss of containment. These threshold values are of great interest when development of active and passive mitigation actions and systems, safety management, and the implementation of early warning system are concerned. The approach is general and can be implemented in any available code or procedure for risk assessment. Some results of seismic analysis of atmospheric storage tanks are also presented for validation.

  6. Danger zone: Men, masculinity and occupational health and safety in high risk occupations.

    Science.gov (United States)

    Stergiou-Kita, Mary; Mansfield, Elizabeth; Bezo, Randy; Colantonio, Angela; Garritano, Enzo; Lafrance, Marc; Lewko, John; Mantis, Steve; Moody, Joel; Power, Nicole; Theberge, Nancy; Westwood, Eleanor; Travers, Krista

    2015-12-01

    The workplace is a key setting where gender issues and organizational structures may influence occupational health and safety practices. The enactment of dominant norms of masculinity in high risk occupations can be particularly problematic, as it exposes men to significant risks for injuries and fatalities. To encourage multi-disciplinary collaborations and advance knowledge in the intersecting areas of gender studies, men's health, work and workplace health and safety, a national network of thirteen researchers and health and safety stakeholders completed a critical literature review examining the intersection between masculinities and men's workplace health and safety in order to: (i) account for research previously undertaken in this area; (ii) identify themes that may inform our understanding of masculinity and workplace health and safety and; (iii) identify research and practice gaps in relation to men's workplace health and safety. In this paper we present key themes from this review. Recommendations are made regarding: (i) how to define gender; (ii) how to attend to and identify how masculinities may influence workers' identities, perceptions of occupational risks and how institutionalized practices can reinforce norms of masculinity; (iii) the importance of considering how masculinities may intersect with other variables (e.g. historical context, age, class, race, geographical location) and; (iv) the added significance of present-day labour market forces on men's occupational health and safety.

  7. New insight into the levels, distribution and health risk diagnosis of indoor and outdoor dust-bound FRs in colder, rural and industrial zones of Pakistan.

    Science.gov (United States)

    Khan, Muhammad Usman; Li, Jun; Zhang, Gan; Malik, Riffat Naseem

    2016-09-01

    This is the first robust study designed to probe selected flame retardants (FRs) in the indoor and outdoor dust of industrial, rural and background zones of Pakistan with special emphasis upon their occurrence, distribution and associated health risk. For this purpose, we analyzed FRs such as polybrominated diphenylethers (PBDEs), dechlorane plus (DP), novel brominated flame retardants (NBFRs) and organophosphate flame retardants (OPFRs) in the total of 82 dust samples (indoor and outdoor) collected three from each zone: industrial, rural and background. We found higher concentrations of FRs (PBDEs, DP, NBFRs and OPFRs) in industrial zones as compared to the rural and background zones. Our results reveal that the concentrations of studied FRs are relatively higher in the indoor dust samples being compared with the outdoor dust and they are ranked as: ∑OPFRs > ∑NBFRs > ∑PBDEs > ∑DP. A significant correlation in the FRs levels between the indoor and outdoor dust suggest the potential intermixing of these compounds between them. The principal component analysis/multiple linear regression predicts the percent contribution of FRs from different consumer products in the indoor and outdoor dust of industrial, rural and background zones to trace their source origin. The FRs detected in the background zones reveal the dust-bound FRs suspended in the air might be shifted from different warmer zones or consumers products available/used in the same zones. Hazard quotient (HQ) for FRs via indoor and outdoor dust intake at mean and high dust scenarios to the exposed populations (adults and toddlers) are found free of risk (HQ < 1) in the target zones. Furthermore, our nascent results will provide a baseline record of FRs (PBDEs, DP, NBFRs and OPFRs) concentrations in the indoor and outdoor dust of Pakistan. Copyright © 2016 Elsevier Ltd. All rights reserved.

  8. Age-dependent interaction of apolipoprotein E gene with eastern birthplace in Finland affects severity of coronary atherosclerosis and risk of fatal myocardial infarction--Helsinki Sudden Death Study.

    Science.gov (United States)

    Tyynelä, Petri; Goebeler, Sirkka; Ilveskoski, Erkki; Mikkelsson, Jussi; Perola, Markus; Lehtimäki, Terho; Karhunen, Pekka J

    2013-05-01

    Mortality from coronary heart disease (CHD) has been constantly higher in eastern late settlement regions compared to western early settlements in Finland, unrelated to classical risk factors. In line with this, eastern birthplace was an age-dependent predictor of severe coronary atherosclerosis and pre-hospital sudden coronary death among male residents of Helsinki. We investigated a possible interaction of apolipoprotein E (APOE) gene with birthplace on the risk of myocardial infarction (MI) and coronary atherosclerosis. APOE genotypes were analyzed in the Helsinki Sudden Death Study series comprising out-of-hospital deaths among males aged 33-70 years (n = 577), who were born in high (east, n = 273) or low (west, n = 304) CHD mortality area. Eastern-born men ≤ 55 years carried 30% more often (P = 0.017) and older men 40% less often (P = 0.022) the APOE ϵ4 allele compared to western-born men (P = 0.003 for birthplace-by-age interaction). In multivariate analysis, the ϵ4 allele associated with the risk of out-of-hospital MI (odds ratio 2.58; 95% CI 1.20-5.55; P = 0.016) only in eastern-born men and with advanced atherosclerosis in both regions of origin, respectively. Birthplace-bound risk of CHD was age-dependently modified by APOE ϵ4 allele, suggesting genetic differences in CHD susceptibility between early and late settlement regions in Finland and providing one explanation for the eastern high mortality.

  9. [Analysis of 58 neonatal cases with cerebral infarction].

    Science.gov (United States)

    Li, Zhi-hua; Chen, Chao

    2013-01-01

    Cerebral infarction (CI) is one of severe diseases of central nervous system in neonates, and some infants with CI could have poor prognosis in the long term. This study aimed to analyze the clinical data and prognosis of all neonatal cases with cerebral infarction in recent years and to help future clinical work. Totally 58 neonatal cases with CI admitted to NICU of the hospital from January 1999 to December 2010 were included in this study. We analyzed all clinical data and prognosis by retrospective analysis. Fifty-two term babies and six preterm babies were included. There were altogether 51 cases with asphyxia and 7 with hemorrhagic cerebral infarction. Perinatal hypoxia-ischemia was the most common high-risk factor and it accounted for 46.6%. Seizure was the most frequent initial symptom and the most common clinical manifestation (accounted for 77.6%), and it was followed by intermittent cyanosis, apnea and lethargy. Cerebral CT scan and magnetic resonance imaging were major methods to help to make the diagnosis and they also had close relation with prognosis. Diffusion weighted imaging was very helpful to diagnose infarction in early stage. Left middle cerebral artery was the most common artery to be involved. Supportive therapy and symptomatic treatment were the main methods in the acute stage of neonatal cerebral infarction. Those babies with poor prognosis mostly had large infarction involving cerebral hemisphere, thalamus and basal ganglia. Neonatal cerebral infarction was a severe brain injury affecting long tern nervous system prognosis. Perinatal hypoxia was the most common high-risk factor and seizure was the most frequent initial symptom. Diffusion weighted imaging was valuable to diagnose infarction in early stage. Most of infants with poor prognosis had large infarction involving hemisphere, thalamus and basal ganglia. Early diagnosis with brain imaging would be helpful for rehabilitation therapy and improving prognosis.

  10. Ischemic spinal cord infarction in children without vertebral fracture

    OpenAIRE

    Nance, Jessica R.; Golomb, Meredith R.

    2007-01-01

    Spinal cord infarction in children is a rare condition which is becoming more widely recognized. There are few reports in the pediatric literature characterizing etiology, diagnosis, treament and prognosis. The risk factors for pediatric ischemic spinal cord infarction include obstruction of blood flow associated with cardiovascular compromise or malformation, iatrogenic or traumatic vascular inujury, cerebellar herniation, thrombotic or embolic disease, infection, and vasculitis. In many chi...

  11. Electrocardiographic infarct size assessment after thrombolysis: insights from the Acute Myocardial Infarction STudy ADenosine (AMISTAD) trial.

    Science.gov (United States)

    Barbagelata, Alejandro; Di Carli, Marcelo F; Califf, Robert M; Garg, Jyotsna; Birnbaum, Yochai; Grinfeld, Liliana; Gibbons, Raymond J; Granger, Christopher B; Goodman, Shaun G; Wagner, Galen S; Mahaffey, Kenneth W

    2005-10-01

    Noninvasive methods are needed to evaluate reperfusion success in patients with acute myocardial infarction (MI). The AMISTAD trial was analyzed to compare MI size and myocardial salvage determined by electrocardiogram (ECG) with technetium Tc 99m sestamibi single-photon emission computerized tomography (SPECT) imaging. Of 236 patients enrolled in AMISTAD, 166 (70 %) with no ECG confounding factors and no prior MI were included in this analysis. Of these, group 1 (126 patients, 53%) had final infarct size (FIS) available by both ECG and SPECT. Group 2 (56 patients, 24%) had myocardium at risk, FIS, and salvage index (SI) assessed by both SPECT and ECG techniques. Aldrich/Clemmensen scores for myocardium at risk and the Selvester QRS score for final MI size were used. Salvage index was calculated as follows: SI = (myocardium at risk-FIS)/(myocardium at risk). In group 1, FIS was 15% (6, 24) as measured by ECG and 11% (2, 27) as measured by SPECT. In the adenosine group, FIS was 12% (6, 21) and 11% (2, 22). In the placebo group, FIS was 16.5% (7.5, 24) and 11.5% (3.0, 38.5) by ECG and SPECT, respectively. The overall correlation between SPECT and ECG for FIS was 0.58 (P = .0001): 0.60 in the placebo group (P = .0001) and 0.54 (P = .0001) in the adenosine group. In group 2, myocardium at risk was 23% (17, 30) and 26% (10, 50) with ECG and SPECT, respectively (P = .0066). Final infarct size was 17% (6, 21) and 12% (1, 24) (P < .0001). The SI was 29% (-7, 57) and 46% (15, 79) with ECG and SPECT, respectively (P = .0510). The ECG measurement of infarct size has a moderate relationship with SPECT infarct size measurements in the population with available assessments. This ECG algorithm must further be validated on clinical outcomes.

  12. ST-segment elevation myocardial infarction treated with thrombolytic therapy in a patient with thrombotic thrombocytopenic purpura.

    Science.gov (United States)

    Doll, Jacob A; Kelly, Jacob P

    2014-07-01

    Acute myocardial infarction is a common complication of thrombotic thrombocytopenic purpura (TTP), but rarely the presenting manifestation. Anti-thrombotic therapy for myocardial infarction is rarely utilized in the setting of TTP because of elevated bleeding risk. We report a case of TTP presenting with ST-segment elevation myocardial infarction and treated with thrombolytic therapy. The resultant cardiac and neurological complications highlight the challenges of using evidence-based therapy for myocardial infarction in the setting of TTP.

  13. A proposal for terrain zoning for risk management focusing on land use definition

    International Nuclear Information System (INIS)

    Aristizabal, Edier; Hermelin, Michel

    2011-01-01

    Land use planning is an essential tool for adequate risk management, which reduce its current scenarios and avoids the construction of future ones exposed to hazards; it should be approached from a knowledge of the risk as an element associated with communities development and in particular how they occupy and how they manage territory and their resources. The disaster-development relationship is critical, and its solution requires considering planning schemes of sectorial, environmental and territories development, Although in the past 10 years considerable progress has been made in this direction, there are still difficulties for a proper incorporation of hazard and/or susceptibility maps as structural elements of land use planning and of land use suitability for development of human settlements. It is fundamental to identify measures to reduce, mitigate or eliminate hazards in urbanized, rural and expansion areas, as well as to guide the uses and appropriate treatments which can be given according to their characteristics of susceptibility to natural phenomena. This paper proposes to divide the territory in urbanized areas which are themselves divided into stable areas for building, potentially unstable areas for intervention and unstable areas for recovery; undeveloped areas which could be urbanized, are divided into areas with minimal restrictions and areas with significant restrictions; and finally undeveloped areas not to be used for urbanization, which are divided into stable areas for rural consolidation, potentially instable areas for intervention, and instable areas for recovery and conservation.

  14. Acute myocardial infarction

    International Nuclear Information System (INIS)

    RISCHPLER, Christoph

    2016-01-01

    Inflammatory processes after myocardial infarction have gained major interest in recent cardiovascular research. It is believed that not only the degree of cell recruitment to the heart plays a pivotal role in the quality of wound healing after myocardial infarction, but also the balance between different types or even subtypes of cells. It is also this balance which is thought to control key processes in tissue repair, such as apoptosis and neoangiogenesis. In this paper, we aim to review imaging strategies (with a special focus on nuclear molecular imaging strategies) that target cells and processes involved in postischemic inflammation and that have a high potential to be translated into clinic or that are already being used and evaluated in humans.

  15. Mapping Of Leptospirosis Environmental Risk Factors and Determining the Level of Leptospirosis Vulnerable Zone In Demak District Using Remote Sensing Image

    Science.gov (United States)

    Rahayu, Siti; Sakundarno Adi, Mateus; Saraswati, Lintang Dian

    2018-02-01

    Leptospirosis, a zoonotic disease, transmitted to human trough contact with contaminated animal urine and contaminated environment. Demak District is an endemic area where cases increased in the past 2 years. The aim of the study was to map environmental risk factor of Leptospirosis and to determine Leptospirosis vulnerable zone using cross-sectional study design. There were 42 cases mapped by GPS and overlaid using remote sensing (Quickbird image) by using ArcView program then interpreted by Spatial Feature and Spatial Analyses. Leptospirosis cases were spread out and grouped in Demak Sub District area. More cases were males (61.9%), 21-50 years old age group (59.3%) and farmers (40.4%). Spatial analyses showed that all the leptospirosis cases took place in the area with low plain profile (28.6%), tidal inundation's profile (7.1%), vegetation (59.5%). Leptospirosis high-risk zone was in 37,801.8 ha (41.32%), moderate risk zone was 43,570.23 ha (48.55%), and low-risk zone was 9,090.96 ha (10.13%). Densely populated housing, bad environment condition, and the presence of rat and puddles that were contaminated by rat's urine were risk factors of Leptospirosis cases in Demak District.

  16. Risk of new acute myocardial infarction hospitalization associated with use of oral and parenteral non-steroidal anti-inflammation drugs (NSAIDs: a case-crossover study of Taiwan's National Health Insurance claims database and review of current evidence

    Directory of Open Access Journals (Sweden)

    Shau Wen-Yi

    2012-02-01

    Full Text Available Abstract Background Previous studies have documented the increased cardiovascular risk associated with the use of some nonsteroidal anti-inflammatory drugs (NSAIDs. Despite this, many old NSAIDs are still prescribed worldwide. Most of the studies to date have been focused on specific oral drugs or limited by the number of cases examined. We studied the risk of new acute myocardial infarction (AMI hospitalization with current use of a variety of oral and parenteral NSAIDs in a nationwide population, and compared our results with existing evidence. Methods We conducted a case-crossover study using the Taiwan's National Health Insurance claim database, identifying patients with new AMI hospitalized in 2006. The 1-30 days and 91-120 days prior to the admission were defined as case and matched control period for each patient, respectively. Uses of NSAIDs during the respective periods were compared using conditional logistic regression and adjusted for use of co-medications. Results 8354 new AMI hospitalization patients fulfilled the study criteria. 14 oral and 3 parenteral NSAIDs were selected based on drug utilization profile among 13.7 million NSAID users. The adjusted odds ratio, aOR (95% confidence interval, for risk of AMI and use of oral and parenteral non-selective NSAIDs were 1.42 (1.29, 1.56 and 3.35 (2.50, 4.47, respectively, and significantly greater for parenteral than oral drugs (p for interaction Conclusions The collective evidence revealed the tendency of increased AMI risk with current use of some NSAIDs. A higher AMI risk associated with use of parenteral NSAIDs was observed in the present study. Ketorolac had the highest associated risk in both oral and parenteral NSAIDs studied. Though further investigation to confirm the association is warranted, prescribing physicians and the general public should be cautious about the potential risk of AMI when using NSAIDs.

  17. Failing States as Epidemiologic Risk Zones: Implications for Global Health Security.

    Science.gov (United States)

    Hirschfeld, Katherine

    Failed states commonly experience health and mortality crises that include outbreaks of infectious disease, violent conflict, reductions in life expectancy, and increased infant and maternal mortality. This article draws from recent research in political science, security studies, and international relations to explore how the process of state failure generates health declines and outbreaks of infectious disease. The key innovation of this model is a revised definition of "the state" as a geographically dynamic rather than static political space. This makes it easier to understand how phases of territorial contraction, collapse, and regeneration interrupt public health programs, destabilize the natural environment, reduce human security, and increase risks of epidemic infectious disease and other humanitarian crises. Better understanding of these dynamics will help international health agencies predict and prepare for future health and mortality crises created by failing states.

  18. Assessment of Myocardial Infarction by Cardiac Magnetic Resonance Imaging and Long-Term Mortality

    Energy Technology Data Exchange (ETDEWEB)

    Petriz, João Luiz Fernandes, E-mail: jlpetriz@cardiol.br [Universidade Federal do Rio de Janeiro (UFRJ) / Instituto do Coração Edson Saad - Programa de Pós Graduação em Medicina (Cardiologia), Rio de Janeiro, RJ (Brazil); Hospital Barra D’Or, Rio de Janeiro, RJ (Brazil); Instituto D’Or de Pesquisa e Ensino, Rio de Janeiro, RJ (Brazil); Gomes, Bruno Ferraz de Oliveira; Rua, Braulio Santos [Hospital Barra D’Or, Rio de Janeiro, RJ (Brazil); Azevedo, Clério Francisco [Instituto D’Or de Pesquisa e Ensino, Rio de Janeiro, RJ (Brazil); Hadlich, Marcelo Souza [Universidade Federal do Rio de Janeiro (UFRJ) / Instituto do Coração Edson Saad - Programa de Pós Graduação em Medicina (Cardiologia), Rio de Janeiro, RJ (Brazil); Instituto D’Or de Pesquisa e Ensino, Rio de Janeiro, RJ (Brazil); Mussi, Henrique Thadeu Periard [Universidade Federal do Rio de Janeiro (UFRJ) / Instituto do Coração Edson Saad - Programa de Pós Graduação em Medicina (Cardiologia), Rio de Janeiro, RJ (Brazil); Hospital Barra D’Or, Rio de Janeiro, RJ (Brazil); Taets, Gunnar de Cunto [Instituto D’Or de Pesquisa e Ensino, Rio de Janeiro, RJ (Brazil); Nascimento, Emília Matos do; Pereira, Basílio de Bragança; Silva, Nelson Albuquerque de Souza e [Universidade Federal do Rio de Janeiro (UFRJ) / Instituto do Coração Edson Saad - Programa de Pós Graduação em Medicina (Cardiologia), Rio de Janeiro, RJ (Brazil)

    2015-02-15

    Cardiac magnetic resonance imaging provides detailed anatomical information on infarction. However, few studies have investigated the association of these data with mortality after acute myocardial infarction. To study the association between data regarding infarct size and anatomy, as obtained from cardiac magnetic resonance imaging after acute myocardial infarction, and long-term mortality. A total of 1959 reports of “infarct size” were identified in 7119 cardiac magnetic resonance imaging studies, of which 420 had clinical and laboratory confirmation of previous myocardial infarction. The variables studied were the classic risk factors – left ventricular ejection fraction, categorized ventricular function, and location of acute myocardial infarction. Infarct size and acute myocardial infarction extent and transmurality were analyzed alone and together, using the variable named “MET-AMI”. The statistical analysis was carried out using the elastic net regularization, with the Cox model and survival trees. The mean age was 62.3 ± 12 years, and 77.3% were males. During the mean follow-up of 6.4 ± 2.9 years, there were 76 deaths (18.1%). Serum creatinine, diabetes mellitus and previous myocardial infarction were independently associated with mortality. Age was the main explanatory factor. The cardiac magnetic resonance imaging variables independently associated with mortality were transmurality of acute myocardial infarction (p = 0.047), ventricular dysfunction (p = 0.0005) and infarcted size (p = 0.0005); the latter was the main explanatory variable for ischemic heart disease death. The MET-AMI variable was the most strongly associated with risk of ischemic heart disease death (HR: 16.04; 95%CI: 2.64-97.5; p = 0.003). The anatomical data of infarction, obtained from cardiac magnetic resonance imaging after acute myocardial infarction, were independently associated with long-term mortality, especially for ischemic heart disease death.

  19. Acute myocardial infarcts

    International Nuclear Information System (INIS)

    Just, H.

    1988-01-01

    Acute myocardial infarction is a major complication of stenosing coronary artery disease and constitutes the most frequent single cause of death. It is caused by thrombotic occlusion of one of the major epicardial coronary arterial branches in most cases. Sudden death due to ventricular fibrillation is responsible for the majority of early fatalities. In 60% of all fatal infarcts, death occurs within 1 h of the onset of pain. The final extension of myocardial necrosis is reached within 2-4 h. An integrated programme has therefore been developed for the supervision and treatment of patients suffering acute coronary attack; it has been shown that it can markedly lower infarct mortality. It includes mobile prehospital care, intensive care treatment in the hospital, and rehabilitative procedures for application during reconvalescence. Early antiarrhythmic treatment and myocardial reperfusion via fibrinolysis are the main therapeutic procedures in the earliest stage. In hospital an operating room and an operating team must be available round the clock for the performance of coronary angiography followed by percutaneous transluminal coronary angioplasty or bypass surgery, which can be safely carried out in the acute stage provided the indications are strictly observed. Mortality and morbidity can be significantly lowered and both life expectancy and quality of life can be remarkably improved. (orig.) [de

  20. Influence of pre-infarction angina, collateral flow, and pre-procedural TIMI flow on myocardial salvage index by cardiac magnetic resonance in patients with ST-segment elevation myocardial infarction.

    Science.gov (United States)

    Lønborg, Jacob; Kelbæk, Henning; Vejlstrup, Niels; Bøtker, Hans Erik; Kim, Won Yong; Holmvang, Lene; Jørgensen, Erik; Helqvist, Steffen; Saunamäki, Kari; Thuesen, Leif; Krusell, Lars Romer; Clemmensen, Peter; Engstrøm, Thomas

    2012-05-01

    In patients with ST-segment elevation myocardial infarction (STEMI) pre-infarction angina, pre-procedural TIMI flow and collateral flow to the myocardium supplied by the infarct related artery are suggested to be cardioprotective. We evaluated the effect of these factors on myocardial salvage index (MSI) and infarct size adjusting for area at risk in patients with STEMI treated with primary percutaneous coronary intervention. Cardiac magnetic resonance (CMR) was used to measure myocardial area at risk within 1-7 days and final infarct size 90 ± 21 days after the STEMI in 200 patients. MSI was calculated as (area-at-risk infarct size) / area-at-risk. Patients with pre-infarction angina had a median MSI of 0.80 (IQR 0.67 to 0.86) versus 0.72 (0.61 to 0.80) in those without pre-infarction angina, P = 0.004). In a regression analysis of the infarct size plotted against the area-at-risk there was a strong trend that the line for the pre-infarction angina group was below the one for the non-angina group (P = 0.05). Patients with pre-procedural TIMI flow 0/1, 2 and 3 had a median MSI of (0.69 (IQR 0.59 to 0.76), 0.78 (0.68 to 0.86) and 0.85 (0.77 to 0.91), respectively (PCollateral flow did not change MSI (P = 0.45) nor area-at-risk (P = 0.40) and no significant difference in infarct size adjusted for area at risk (P = 0.25) was observed. Pre-infarction angina increases MSI in patients with STEMI supporting the theory that pre-infarction angina leads to ischemic preconditioning. As opposed to the presence of angiographically visible collateral flow to the infarct area pre-procedural TIMI flow is strongly associated with MSI.

  1. Comparison of coronary angiography and early oral dipyridamole thallium-201 scintigraphy in patients receiving thrombolytic therapy for acute myocardial infarction

    International Nuclear Information System (INIS)

    Jain, A.; Hicks, R.R.; Myers, G.H.; McCarthy, J.J.; Perry, J.R.; Adams, K.F.

    1990-01-01

    We evaluated 50 consecutive patients who received thrombolytic therapy for acute myocardial infarction using thallium-201 single photon emission computed tomography in combination with oral dipyridamole to assess the frequency of residual myocardial ischemia. Thallium studies were performed early after myocardial infarction at a mean of 4.6 days. The time from the onset of chest pain to the administration of thrombolytic therapy was 2.6 hours (range 0.5 to 5.5). Q wave myocardial infarction was evident in 46 patients; four patients had a non-Q wave infarction (anterior infarction in 31 patients and inferior infarction in 19 patients). The serum mean peak creatinine kinase was 1503 IU/L (range 127 to 6500). Coronary angiography was performed in all patients at a mean of 3.1 days (range 2 to 10) and revealed the infarct-related vessel to be patent in 36 patients (72%). The ejection fraction was 48% (range 26% to 67%). After dipyridamole administration, 13 patients (26%) developed angina that was easily reversed with the administration of intravenous aminophylline. Systolic blood pressure decreased from 122 to 115 mm Hg (p less than 0.05) and the heart rate increased from 76 to 85 beats/min (p less than 0.05). None of the patients had significant hypotension, arrhythmias, or evidence of infarct extension. Perfusion abnormalities were present on the initial thallium images in 48 patients. Redistribution suggestive of ischemia was present in 36 patients (72%). Ischemia confined to the vascular distribution of the infarct vessel was evident in 22 patients. Seven patients had ischemia in the infarct zone as well as in a remote myocardial segment. Thus 29 patients (58%) had ischemia in the distribution of the infarct vessel. Ischemia in the infarct zone was evident in 19 of 36 patients with open infarct vessels and in 10 of 14 patients with occluded infarct vessels

  2. [Interventional therapy of acute myocardial infarction].

    Science.gov (United States)

    Zahn, R; Zeymer, U

    2008-09-01

    Currently an acute myocardial infarction has to be differentiated into ST-elevation myocardial infarction (STEMI) or non ST-elevation myocardial infarction (NSTEMI). However, there exists another definition of acute coronary syndromes (ACS), which is more important in clinical practice, for all recommendations from the guidelines of the cardiac societies concerning the invasive strategies rely on this one. Here one has to differentiate an ACS with ST-elevation (STE-ACS = STEMI) from an ACS without ST-elevation (NSTE-ACS). The last one is further divided into an NSTE-ACS with or without high risk. In patients with an NSTE-ACS with high risk an early invasive strategy is recommended within 72 h after the diagnosis. In patients with an NSTE-ACS without high risk a more conservative approach can be pursued. In STE-ACS patients primary angioplasty is the reperfusion therapy of choice, if it can be performed in a timely fashion within 2 h after diagnosis at an interventional centre with experienced interventionalists and short "door-to-balloon" times. In Germany this goal is achievable almost everywhere. Therefore it is currently the most important task to establish local networks to reach this goal.

  3. Socially disadvantaged city districts show a higher incidence of acute ST-elevation myocardial infarctions with elevated cardiovascular risk factors and worse prognosis.

    Science.gov (United States)

    Schmucker, J; Seide, S; Wienbergen, H; Fiehn, E; Stehmeier, J; Günther, K; Ahrens, W; Hambrecht, R; Pohlabeln, H; Fach, A

    2017-09-22

    The importance of socioeconomic status (SES) for coronary heart disease (CHD)-morbidity is subject of ongoing scientific investigations. This study was to explore the association between SES in different city-districts of Bremen/Germany and incidence, severity, treatment modalities and prognosis for patients with ST-elevation myocardial infarctions (STEMI). Since 2006 all STEMI-patients from the metropolitan area of Bremen are documented in the Bremen STEMI-registry. Utilizing postal codes of their home address they were assigned to four groups in accordance to the Bremen social deprivation-index (G1: high, G2: intermediate high, G3: intermediate low, G4: low socioeconomic status). Three thousand four hundred sixty-two consecutive patients with STEMI admitted between 2006 and 2015 entered analysis. City areas with low SES showed higher adjusted STEMI-incidence-rates (IR-ratio 1.56, G4 vs. G1). This elevation could be observed in both sexes (women IRR 1.63, men IRR 1.54) and was most prominent in inhabitants  3000 U/l, OR 1.95, 95% CI 1.4-2.8) and severe impairment of LV-function post-STEMI (OR 2.0, 95% CI 1.2-3.4). Long term follow-up revealed that lower SES was associated with higher major adverse cardiac or cerebrovascular event (MACCE)-rates after 5 years: G1 30.8%, G2 35.7%, G3 36.0%, G4 41.1%, p (for trend) = 0.02. This worse prognosis could especially be shown for young STEMI-patients (<50 yrs. of age) 5-yr. mortality-rates(G4 vs. G1) 18.4 vs. 3.1%, p = 0.03 and 5-year-MACCE-rates (G4 vs. G1) 32 vs. 6.3%, p = 0.02. This registry-data confirms the negative association of low socioeconomic status and STEMI-incidence, with higher rates of smoking and obesity, more extensive infarctions and worse prognosis for the socio-economically deprived.

  4. Quantitation of the critically ischemic zone at risk during acute coronary occlusion using PET

    International Nuclear Information System (INIS)

    Merhige, M.; Garza, D.; Sease, D.; Rowe, R.W.; Tewson, T.; Emran, A.; Bolomey, L.; Gould, K.L.

    1991-01-01

    Critical myocardial ischemia has been defined experimentally during acute coronary occlusion as flow reduction of 50% or more since cellular ATP depletion begins to occur beyond this flow reduction threshold, placing tissue at risk of cellular injury. To test the hypothesis that critically ischemic fractional left ventricular mass can be measured noninvasively with PET, nine dogs were imaged in a multi-slice positron camera using the perfusion tracer 13N-ammonia, while radiolabeled microspheres were injected into the left atrium during acute coronary occlusion. Images were processed using a 50% threshold and the size of the resulting perfusion defect was expressed as a fraction of total left ventricular image volume. The critically ischemic left ventricular fraction determined in vitro from the microsphere perfusion data, ranged from 5% to 30% of the total left ventricular weight and correlated closely with that determined noninvasively by PET with r = 0.94 (y = 1.05X - 2.0%). The authors conclude that the fraction of left ventricular myocardium rendered critically ischemic during acute coronary occlusion can be measured accurately and noninvasively in vivo using perfusion imaging with positron emission tomography

  5. [Myocardial infarction and stress at work place and in the family: 10-year risk of development in an open population of 2564 year old men (epidemiological study in a framework of the WHO program MONICA-PSYCHOSOCIAL)].

    Science.gov (United States)

    Gafarov, V V; Gromova, E A; Gafarova, A V; Gagulin, I V

    2011-01-01

    With the aim of assessment of 10 year risk of myocardial infarction (MI) development in men in dependence on stress at work place and in the family in a framework of the WHO program "MONICA-PSYCHOSOCIAL" we examined random representative sample of men (n=657) aged 25-64 years inhabitants of one of districts in Novosibirsk. During 10 years (1994-2004) we registered all cases of MI. For assessment of relative risk of MI development we used COX proportional regression model. Among men with first MI 47.4% had high level of stress in the family and 57.9% were subjected to stress at work place. Five and 10 year risk of MI in men with high test levels of stress at home and work place was 2-5 times greater than in those without. Among men subjected to stress in the family MI risk was the highest at age 55-64 years, while permanent stressful situations at work place were more common in age group 45-54 years. Among men with high levels of stress in the family and at work place higher rate of MI development was observed in widowers, divorced men with incomplete high or elementary education, heavy or moderate manual labor workers, and pensioners. The results indicate that critical life events as well as chronic stressful influences increase risk of MI among men aged 25-64 years. The group of greatest risk - middle and old age persons who are less protected against social, political and economical disbalance in the society.

  6. Pharmacoeconomic impact evaluation of statin adherence in high-risk unselected post myocardial infarction population: an administrative database-guided analysis.

    Science.gov (United States)

    Summaria, Francesco; Ciaralli, Fabrizio; Mustilli, Marina; Sette, Antonella; Lanzillo, Chiara; Vasselli, Loredana

    2013-01-01

    The compliance to statins in secondary prevention is very low, increasing health-care costs principally for rehospitalization. To evaluate the cost of lack of persistence to statin therapy together with identification and cost-estimation of poor compliance. Retrospective observational study starting from administrative database analysis of statin prescription after myocardial infarction. Among 463 patients enrolled, 25.1% were never treated, 70.8% received statins regularly; 14.9% received only 1-2 prescriptions (spot prescription), and 12% were occasional users. Among the 288 nonoccasional users, we found a compliance rate of 80% only in the 59.7%. The cost analysis shows that 59.787,72 euros (23.4%) have been spent for patients with compliance of less than 80% (ineffective adherence). As the lower compliance affects the health-care costs, the identification of occasional users and spot prescriptions of the nonoccasional users, has a potential role in reducing medical expense with limited increase in costs.

  7. Use of selective cyclooxygenase-2 inhibitors and nonselective nonsteroidal antiinflammatory drugs in high doses increases mortality and risk of reinfarction in patients with prior myocardial infarction

    DEFF Research Database (Denmark)

    Sørensen, Rikke; Abildstrøm, Steen Zabell; Torp-Pedersen, C.

    2008-01-01

    The selective cyclooxygenase-2 (COX-2) inhibitors and other nonselective nonsteroidal antiinflammatory drugs (NSAIDs) have been associated with increased cardiovascular risk, but the risk in patients with established cardiovascular disease is unknown. In the present study, we analyzed the risk of...

  8. Final infarct size measured by cardiovascular magnetic resonance in patients with ST elevation myocardial infarction predicts long-term clinical outcome

    DEFF Research Database (Denmark)

    Lønborg, Jacob Thomsen; Vejlstrup, Niels Grove; Kelbæk, Henning Skov

    2013-01-01

    AIMS: Tailored heart failure treatment and risk assessment in patients following ST-segment elevation myocardial infarction (STEMI) is mainly based on the assessment of the left ventricular (LV) ejection fraction (EF). Assessment of the final infarct size in addition to the LVEF may improve...

  9. Optimal high b-value for diffusion weighted MRI in diagnosing high risk prostate cancers in the peripheral zone.

    Science.gov (United States)

    Agarwal, Harsh K; Mertan, Francesca V; Sankineni, Sandeep; Bernardo, Marcelino; Senegas, Julien; Keupp, Jochen; Daar, Dagane; Merino, Maria; Wood, Bradford J; Pinto, Peter A; Choyke, Peter L; Turkbey, Baris

    2017-01-01

    To retrospectively determine the optimal b-value(s) of diffusion-weighted imaging (DWI) associated with intermediate-high risk cancer in the peripheral zone (PZ) of the prostate. Forty-two consecutive patients underwent multi b-value (16 evenly spaced b-values between 0 and 2000 s/mm 2 ) DWI along with multi-parametric MRI (MP-MRI) of the prostate at 3 Tesla followed by trans-rectal ultrasound/MRI fusion guided targeted biopsy of suspicious lesions detected at MP-MRI. Computed DWI images up to a simulated b-value of 4000 s/mm 2 were also obtained using a pair of b-values (b = 133 and 400 or 667 or 933 s/mm 2 ) from the multi b-value DWI. The contrast ratio of average intensity of the targeted lesions and the background PZ was determined. Receiver operator characteristic curves and the area under the curve (AUCs) were obtained for separating patients eligible for active surveillance with low risk prostate cancers from intermediate-high risk prostate cancers as per the cancer of the prostate risk assessment (CAPRA) scoring system. The AUC first increased then decreased with the increase in b-values reaching maximum at b = 1600 s/mm 2 (0.74) with no statistically significant different AUC of DWI with b-values 1067-2000 s/mm 2 . The AUC of computed DWI increased then decreased with the increase in b-values reaching a maximum of 0.75 around b = 2000 s/mm 2 . There was no statistically significant difference between the AUC of optimal acquired DWI and either of optimal computed DWI. The optimal b-value for acquired DWI in differentiating intermediate-high from low risk prostate cancers in the PZ is b = 1600 s/mm 2 . The computed DWI has similar performance as that of acquired DWI with the optimal performance around b = 2000 s/mm 2 . 4 J. Magn. Reson. Imaging 2017;45:125-131. © 2016 International Society for Magnetic Resonance in Medicine.

  10. Clinical Manifestation of Acute Myocardial Infarction in the Elderly

    Directory of Open Access Journals (Sweden)

    Miftah Suryadipradja

    2003-12-01

    Full Text Available A retrospective study were performed in patients with acute myocardial infarction (AMI that hospitalized in ICCU Cipto Mangunkusumo hospital, Jakarta during the period of January 1994 until Decmber 1999. There were 513 patients hospitalized with MCI, 227 patients (44.2% were classified as elderly, and 35.2% of them were female. Most of the elderly AMI patients reported typical chest pain just like their younger counterparts. Elderly AMI patients tend to come later to the hospital, and more Q-wave myocardial infarction were identified compared to non- Q-wave myocardial infarction. Risk factors of diabetes mellitus and hypertension were more common among the elderly. The prevalence of atrial fibrillation and the mortality rate were higher among elderly AMI patients. (Med J Indones 2003; 12: 229-35 Keywords: clinical manifestation, acute myocardial infarction, elderly

  11. Watershed Cerebral Infarction in a Patient with Acute Renal Failure

    Directory of Open Access Journals (Sweden)

    Ruya Ozelsancak

    2016-02-01

    Full Text Available Acute renal failure can cause neurologic manifestations such as mood swings, impaired concentration, tremor, stupor, coma, asterixis, dysarthria. Those findings can also be a sign of cerebral infarct. Here, we report a case of watershed cerebral infarction in a 70-year-old female patient with acute renal failure secondary to contrast administration and use of angiotensin converting enzyme inhibitor. Patient was evaluated with magnetic resonance imaging because of dysarthria. Magnetic resonance imaging revealed milimmetric acute ischemic lesion in the frontal and parietal deep white matter region of both cerebral hemisphere which clearly demonstrated watershed cerebral infarction affecting internal border zone. Her renal function returned to normal levels on fifth day of admission (BUN 32 mg/dl, creatinine 1.36 mg/dl and she was discharged. Dysarthria continued for 20 days.

  12. Interaction effects of long-term air pollution exposure and variants in the GSTP1, GSTT1 and GSTCD genes on risk of acute myocardial infarction and hypertension: a case-control study.

    Science.gov (United States)

    Levinsson, Anna; Olin, Anna-Carin; Modig, Lars; Dahgam, Santosh; Björck, Lena; Rosengren, Annika; Nyberg, Fredrik

    2014-01-01

    Experimental and epidemiological studies have reported associations between air pollution exposure, in particular related to vehicle exhaust, and cardiovascular disease. A potential pathophysiological pathway is pollution-induced pulmonary oxidative stress, with secondary systemic inflammation. Genetic polymorphisms in genes implicated in oxidative stress, such as GSTP1, GSTT1 and GSTCD, may contribute to determining individual susceptibility to air pollution as a promoter of coronary vulnerability. We aimed to investigate effects of long-term traffic-related air pollution exposure, as well as variants in GSTP1, GSTT1 and GSTCD, on risk of acute myocardial infarction (AMI) and hypertension. In addition, we studied whether air pollution effects were modified by the investigated genetic variants. Genotype data at 7 single nucleotide polymorphisms (SNPs) in the GSTP1 gene, and one in each of the GSTT1 and GSTCD genes, as well as air pollution exposure estimates, were available for 119 AMI cases and 1310 randomly selected population controls. Population control individuals with systolic blood pressure ≥140 mmHg, diastolic blood pressure ≥90 mmHg or on daily antihypertensive medication were defined as hypertensive (n = 468). Individual air pollution exposure levels were modeled as annual means of NO₂ (marker of vehicle exhaust pollutants) using central monitoring data and dispersion models, linking to participants' home addresses. Air pollution was significantly associated with risk of AMI: OR 1.78 (95%CI 1.04-3.03) per 10 µg/m³ of long-term NO₂ exposure. Three GSTP1 SNPs were significantly associated with hypertension. The effect of air pollution on risk of AMI varied by genotype strata, although the suggested interaction was not significant. We saw no obvious interaction between genetic variants in the GST genes and air pollution exposure for hypertension. Air pollution exposure entails an increased risk of AMI, and this risk differed over genotype strata

  13. Risk of nonfatal acute myocardial infarction associated with non-steroidal antiinflammatory drugs, non-narcotic analgesics and other drugs used in osteoarthritis: a nested case-control study.

    Science.gov (United States)

    de Abajo, Francisco J; Gil, Miguel J; García Poza, Patricia; Bryant, Verónica; Oliva, Belén; Timoner, Julia; García-Rodríguez, Luis A

    2014-11-01

    The purpose of this study is to estimate the risk of nonfatal acute myocardial infarction (AMI) associated with traditional NSAIDs (tNSAIDs), non-narcotic analgesics (paracetamol and metamizole), and symptomatic slow-acting drugs in osteoarthritis (SYSADOAs) overall and in different subgroups of patients. We performed a nested case-control study using a Primary Care Database (Base de datos para la Investigación Farmacoepidemiológica en Atención Primaria), over the study period, 2001-2007. We included patients aged 40-90 years, with nonfatal AMI and randomly selected controls matched for age, sex and calendar year. Exposure to drugs was assessed within a 30-day window before the index date. We did not find an association with nonfatal AMI in patients at low-intermediate background cardiovascular risk (odds ratio = 0.92; 95% confidence interval: 0.76-1.12), whereas there was a moderate significant association among those at high risk (1.28; 1.06-1.54) or when tNSAIDs were used for longer than 365 days (1.43; 1.12-1.82). The greatest risk occurred when these two conditions were combined (1.80; 1.26-2.58). The risk varied across individual tNSAIDs, with ibuprofen (0.95; 0.78-1.16) in the lower and aceclofenac (1.59; 1.15-2.19) in the upper part of the range. Low-dose aspirin did not modify the risk profile showed by any of the individual tNSAIDs examined. Paracetamol (0.84; 0.74-0.95), metamizole (1.06; 0.87-1.29) and SYSADOAs (0.68; 0.47-0.99) were not associated with an increased risk overall or in any subgroup of patients. The risk of nonfatal AMI varied with individual tNSAIDs, duration of treatment and background cardiovascular risk. Paracetamol, metamizole and SYSADOAs did not increase the risk in any of the conditions examined. Copyright © 2014 John Wiley & Sons, Ltd.

  14. Application value of different transformation zone types and its genetic relationship with high-risk HPV type in diagnosis and therapy of cervical disease.

    Science.gov (United States)

    Chen, Yan; Zhou, Jia-De

    2015-01-01

    This study aims to discuss the influence of different types of transformation zone (TZ) on positive surgical margin of loop electrosurgical excision procedure (LEEP) and the significance of infection of different genetic high-risk HPV for cervical intraepithelial neoplasm. The clinical data of patients who had CIN2+ and received LEEP during January to December 2013 was investigated. The conditions of positive surgical margin of patients of different transformation zone (type I, II, III) were analyzed. The clinical high-risk types of HPV were divided into three groups, including A5/6, A7 and A9, compared with the pathological conditions of pre-operation and post-operation of the patients in respective group. The results indicated that type III transformation zone is more likely to cause positive cutting margin. For CIN2+ patients, sensitivity and specificity are 0.89% and 79.56% in group A5/6, and negative and positive predicted value (NPV, PPV) are 40% and 5%. The sensitivity, specificity, NPV, PPV in group A7 is 12.5%, 44.08%, 29.49% and 21.21%, respectively. The sensitivity, specificity, NPV, PPV in group A9 is 88.99%, 87.09%, 85.26%, 81.51%, respectively. Transformation zone type was correlated positively with positive cutting margin percentage (r = 0.8732, P zone is more likely to cause pathological upgrades. In conclusion, different types of transformation zone and high-risk HPV have clinical significance in causing positive cutting margin of surgery and disease extent.

  15. Common genetic variation in six lipid-related and statin-related genes, statin use and risk of incident nonfatal myocardial infarction and stroke.

    Science.gov (United States)

    Hindorff, Lucia A; Lemaitre, Rozenn N; Smith, Nicholas L; Bis, Joshua C; Marciante, Kristin D; Rice, Kenneth M; Lumley, Thomas; Enquobahrie, Daniel A; Li, Guo; Heckbert, Susan R; Psaty, Bruce M

    2008-08-01

    Genetic polymorphisms are associated with lipid-lowering response to statins, but generalizeability to disease endpoints is unclear. The association between 82 common single nucleotide polymorphisms (SNPs) in six lipid-related or statin-related genes (ABCB1, CETP, HMGCR, LDLR, LIPC, NOS3) and incident nonfatal myocardial infarction (MI) and ischemic stroke was analyzed according to current statin use and overall in a population-based case-control study (856 MI, 368 stroke, 2686 controls). Common SNPs were chosen from resequencing data using pairwise linkage disequilibrium. Gene-level analyses (testing global association within a gene) and SNP-level analyses (comparing the number of observed vs. expected associations across all genes) were performed using logistic regression, setting nominal statistical significance at P value of less than 0.05. No gene-level interactions with statin use on MI or stroke were identified. Across all genes, two SNP-statin interactions on MI were observed (one ABCB1, one LIPC) and five interactions on stroke (one CETP, four LIPC). The strongest SNP-statin interaction was for synonymous CETP SNP rs5883 on stroke (P=0.008). Gene-level associations were present for LIPC and MI (P=0.026), but not other genes or outcomes. SNP-level associations included three SNPs with MI (one LDLR, two LIPC) and two SNPs with stroke (one CETP, one LDLR). The number of observed SNP associations was no greater than expected by chance. Several potential novel associations or interactions of SNPs in ABCB1, CETP, LDLR, and LIPC with MI and stroke were identified; however, our results should be regarded as hypothesis generating until corroborated by other studies.

  16. Effects of epilepsy and selected antiepileptic drugs on risk of myocardial infarction, stroke, and death in patients with or without previous stroke: a nationwide cohort study

    DEFF Research Database (Denmark)

    Olesen, J. B.; Abildstrom, S. Z.; Erdal, Jesper

    2011-01-01

    .64; 95%CI, 1.57-1.72), and all-cause death (HR, 1.92; 95%CI, 1.86-1.97). Compared with carbamazepine monotherapy, valproate was associated with a decreased risk of MI (HR, 0.72; 95%CI, 0.59-0.87) and stroke (HR, 0.86; 95%CI, 0.76-0.96), oxcarbazepine and phenobarbital with increased risk...... Patients with epilepsy exhibit increased risk of MI, stroke, cardiovascular death, and all-cause death. Compared with carbamazepine monotherapy, valproate may decrease, and oxcarbazepine and phenobarbital may increase, the risk of adverse cardiovascular events in these patients. Copyright (C) 2011 John...

  17. [Prediction value of deceleration capacity of rate and GRACE risk score on major adverse cardiac events in patients with acute myocardial infarction].

    Science.gov (United States)

    Gao, L; Chen, Y D; Shi, Y J; Xue, H; Wang, J L

    2016-07-24

    To investigate the prediction value of deceleration capacity of rate (DC) and GRACE risk score for cardiovascular events in AMI patients. Consecutive AMI patients with sinus rhythm hospitalized in our department during August 2012 to August 2013 were included in this prospective study. 24-hour ECG Holter monitoring was performed within 1 week, and the DC value was analyzed, GRACE risk score was acquired with the application of GRACE risk score calculator. Patients were followed up for more than 1 year and major adverse cardiac events (MACE) were obtained. Analysised the Kaplan Meier survival according to DC and GRACE score risk stratification respectively. A total of 157 patients were enrolled in the study (average age: (58.9±12.7)years old). The average follow-up was (20.54±2.85) months. Mortality during follow-up was significantly higher in patients with DC>2.5 compared to patients with DC≤2.5 (Prisk stratification was 0.898 (95%CI 0.840-0.940, Prisk stratification was 0.786 (95%CI 0.714-0.847, Prisk stratification was 0.708 (95%CI 0.652-0.769, Prisk patients than those with intermediate and low risk patients according to DC risk stratification in intermediate and low risk patients by GRACE risk stratification (Prisk stratification is superior to GRACE risk score on outcome assessment in this AMI patient cohort.

  18. Clinical predictors of lacunar syndrome not due to lacunar infarction

    Directory of Open Access Journals (Sweden)

    Comes Emili

    2010-05-01

    Full Text Available Background Lacunar syndrome not due to lacunar infarct is poorly characterised. This single centre, retrospective study was conducted to describe the clinical characteristics of patients with lacunar syndrome not due to lacunar infarct and to identify clinical predictors of this variant of lacunar stroke. Methods A total of 146 patients with lacunar syndrome not due to lacunar infarction were included in the "Sagrat Cor Hospital of Barcelona Stroke Registry" during a period of 19 years (1986-2004. Data from stroke patients are entered in the stroke registry following a standardized protocol with 161 items regarding demographics, risk factors, clinical features, laboratory and neuroimaging data, complications and outcome. The characteristics of these 146 patients with lacunar syndrome not due to lacunar infarct were compared with those of the 733 patients with lacunar infarction. Results Lacunar syndrome not due to lacunar infarct accounted for 16.6% (146/879 of all cases of lacunar stroke. Subtypes of lacunar syndromes included pure motor stroke in 63 patients, sensorimotor stroke in 51, pure sensory stroke in 14, atypical lacunar syndrome in 9, ataxic hemiparesis in 5 and dysarthria-clumsy hand in 4. Valvular heart disease, atrial fibrillation, sudden onset, limb weakness and sensory symptoms were significantly more frequent among patients with lacunar syndrome not due to lacunar infarct than in those with lacunar infarction, whereas diabetes was less frequent. In the multivariate analysis, atrial fibrillation (OR = 4.62, sensorimotor stroke (OR = 4.05, limb weakness (OR = 2.09, sudden onset (OR = 2.06 and age (OR = 0.96 were independent predictors of lacunar syndrome not due to lacunar infarct. Conclusions Although lacunar syndromes are highly suggestive of small deep cerebral infarctions, lacunar syndromes not due to lacunar infarcts are found in 16.6% of cases. The presence of sensorimotor stroke, limb weakness and sudden onset in a patient

  19. Vascular Function and Structure in Veteran Athletes after Myocardial Infarction.

    NARCIS (Netherlands)

    Maessen, M.F.H.; Eijsvogels, T.M.H.; Hijmans-Kersten, B.T.P.; Grotens, A.; Schreuder, T.H.A.; Hopman, M.T.E.; Thijssen, D.H.J.

    2017-01-01

    PURPOSE: Although athletes demonstrate lower cardiovascular risk and superior vascular function compared with sedentary peers, they are not exempted from cardiac events (i.e., myocardial infarction [MI]). The presence of an MI is associated with increased cardiovascular risk and impaired vascular

  20. Multimodality imaging of pulmonary infarction

    International Nuclear Information System (INIS)

    Bray, T.J.P.; Mortensen, K.H.; Gopalan, D.

    2014-01-01

    Highlights: • A plethora of pulmonary and systemic disorders, often associated with grave outcomes, may cause pulmonary infarction. • A stereotypical infarct is a peri