Healthcare Resource Utilization Following Acute Myocardial Infarction Findings from RECORD-MI Registry
Khawaja M. TalhaKendall HammondsAyman AlhamdowMonica BennettJaccallene BomarJason A EttlingerMonica Martinez-TrabaElisabeth Sophia Hartgers-GubbelsElisa L. PriestCourtney ShaverAasim AfzalR. Jay WidmerRobert GottliebMichael J. MackJaved Butler
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Variations in the ratio of "definite" to "possible" myocardial infarction for non-fatal cases were examined in studies that used World Health Organization criteria. There were large variations in this ratio, variations which appeared to be due to differences in the ascertainment of non-fatal cases of "possible" myocardial infarction, which, in turn, contributed to reported differences in the incidence of myocardial infarction. A significant proportion of cases of "possible" myocardial infarction probably do not have ischemic heart disease at all, since, in our data, cases of "possible" myocardial infarction (non-fatal) with a hospital discharge diagnosis of chest pain (undiagnosed) had a risk of death that was no worse than that in the general population. Thus the most reproducible, and possibly most accurate estimates of the incidence of myocardial infarction may come from including only fatal cases of "possible" myocardial infarction with both fatal and non-fatal cases of "definite" myocardial infarction.
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<p>The aim of our work was to inquire after frequency and characteristics of repeated myocardial infarction. We questioned prospectively 123 patients, diagnosed with acute myocardial infarction, who were hospitalized in the Coronary unit<br />of Krusevac Health centre, during the period of 01. 02.- 31. 07. 2001. Repeated myocardial infarction was found in 16,26%<br />of questioned patients. Non Q acute myocardial infarction was found in 35,00% on patients with repeated myocardial infarction and 8,74% on patients with the first myocardial infarction (p&lt;0,01). In patients with repeated myocardial infarction<br />more often was found heart failure (55,00% vs 20,39%, p&lt;0,01). Repeated myocardial infarction have difficulty clinical<br />flow, but have not statistical significantly higher early mortality</p>
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Objective: To study the variation of plasma inflammatory cytokine IL-6 and antiinflammatory cy-tokine IL-10 in patients with acute and old myocardial infarction, patients with acute myocardial infarction before and after thrombolytic therapy. Methods: 24 patients with acute myocardial infarction (10 patients subjected to thrombolytic therapy) and 20 patients with old myocardial infarction were studied. Plasma levels of IL-6 ang IL-10 were detected by ELISA. Results: In this study, significantly increased level of IL-6 and IL-10 were observed in patients with acute and old myocardial infarction. Plasma levels of LL-6 and IL-10 were significantly higher in acute myocardial infarction group compared with old myocardial infarction group. IL-10 levels were obviously decreased and EL-6 level were slightly increased in patients with acute myocardial infarction after thrombolytic therapy. From the statistic analysis, we have demonstrated that there were significant positive correlation between IL-10 and crea-tine kinade(CK), IL-10 and creatine kinade-MB(CK-MB), respectively. Conclusion: Our studies demonstrated increased plasma levels of DL-1 and EL-10 in patients with acute myocardial infarction. They could probably regulate each other in myocardial ischemia and reperfusion.
Creatine kinase
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Objective To analyze the clinical characteristics of atypical acute myocardial infarction,improve the diagnosis of myocardial infarction. Methods To analyze the main clinical characteristics of the patients with atypical acute myocardial infarction in our hospital in the past 3 years ,which compared to the typical acute myocardial infarction. Results Atypical acute myocardial infarction includes atypical symptom and atypical ECG, atypical symptoms is more prevail. Compared with typical acute myocardial infarction, the women, elderly people and hypertension patients is more common, fewer anterior myocardial infarction and poorer prognosis ( P ＜ 0.05 ). Conclusion To improve the understanding of atypical acute myocardial infarction,was benefit of reducing the misdiagnosis and mistreatment of acute myocardial infarction.
Key words:
Myocardial infarction
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Background: Knowledge is limited concerning the type of symptoms and the time from onset of symptoms to first medical contact at first and second myocardial infarction in the same patient. Aim: This study aimed to describe the type of symptoms and the time from onset of symptoms to first medical contact in first and second myocardial infarctions in men and women affected by two myocardial infarctions. Furthermore, the aim was to identify factors associated with prehospital delays ≥2 h at second myocardial infarction. Methods: A retrospective cohort study with 820 patients aged 31–74 years with a first and a second myocardial infarction from 1986 through 2009 registered in the Northern Sweden MONICA registry. Results: The most common symptoms reported among patients affected by two myocardial infarctions are typical symptoms at both myocardial infarction events. Significantly more women reported atypical symptoms at the second myocardial infarction compared to the first. Ten per cent of the men did not report the same type of symptoms at the first and second myocardial infarctions; the corresponding figure for women was 16.2%. The time from onset of symptoms to first medical contact was shorter at the second myocardial infarction compared to the first myocardial infarction. Patients with prehospital delay ≥2 h at the first myocardial infarction were more likely to have a prehospital delay ≥2 h at the second myocardial infarction. Conclusions: Symptoms of second myocardial infarctions are not necessarily the same as those of first myocardial infarctions. A patient’s behaviour at the first myocardial infarction could predict how he or she would behave at a second myocardial infarction.
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Background Myocardial infarction is an important cause of morbidity and mortality in both men and women. Atypical or the absence of symptoms, more prevalent among women, may contribute to unrecognized myocardial infarctions and missed opportunities for preventive therapies. The aim of this research is to investigate sex‐based differences of undiagnosed myocardial infarction in the general population. Methods and Results In the Lifelines Cohort Study, all individuals ≥18 years with a normal baseline ECG were followed from baseline visit till first follow‐up visit (≈5 years, n=97 203). Individuals with infarct‐related changes between baseline and follow‐up ECGs were identified. The age‐ and sex‐specific incidence rates were calculated and sex‐specific cardiac symptoms and predictors of unrecognized myocardial infarction were determined. Follow‐up ECG was available after a median of 3.8 (25th and 75th percentile: 3.0–4.6) years. During follow‐up, 198 women experienced myocardial infarction (incidence rate 1.92 per 1000 persons‐years) compared with 365 men (incidence rate 3.30; P <0.001 versus women). In 59 (30%) women, myocardial infarction was unrecognized compared with 60 (16%) men ( P <0.001 versus women). Individuals with unrecognized myocardial infarction less often reported specific cardiac symptoms compared with individuals with recognized myocardial infarction. Predictors of unrecognized myocardial infarction were mainly hypertension, smoking, and higher blood glucose level. Conclusions A substantial proportion of myocardial infarctions are unrecognized, especially in women. Opportunities for secondary preventive therapies remain underutilized if myocardial infarction is unrecognized.
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Cardiovascular disease is the most important health issue facing mankind and continues to be major cause of morbidity and mortality.Women are disproportionately affected by coronary artery disease(CAD) compared with men.There are different clinical presentations of heart disease and acute myocardial infarction in women than in men.Also different studies shows that there is difference in the major cardiovascular risk factors amongst men and women at younger age.The present study was undertaken with a view to understand the clinical prole of acute myocardial infarction in women and observe the variations in acute myocardial infarction between men and women. Materials and methods-This observational and analytical study includes 118 female cases of acute myocardial infarction admitted to ICCU and randomly selected 118 male cases of acute myocardial infarction admitted to ICCU during the same tenure.Various necessary th investigations were carried out and risk factors of acute myocardial infarction were determined.All the cases were followed up on the 7 day of admission and one month after discharge from the hospital for various complications.Data thus collected was analysed at the end of study. Results-Maximum number of female cases were in age group 60-69 years(45.6%)while maximum number of male cases were in age group 50- 59 years(33.05%).Anterior wall myocardial infarction was the commonest type of acute myocardial infarction in both groups.ST elevation myocardial infarction was more common in males(94.9%)as compared to females(83.89%) whereas non ST elevation myocardial infarction was common in females(10%) as compared to males (5%).Atypical chest pain was more common in female cases(50.8%)whereas typical chest pain was more common with male cases(52.4%).Also dyspnoea as presenting symptom was signicantly more in female cases(51.6%)as compared to male cases(20.3%).Among the risk factors as Diabetes mellitus,signicant difference was observed in female(45.7%) vs male cases(30.5%).Other risk factors like lack of physical activity was signicantly more in female cases(84.7%) as compared to male cases(50%).Central obesity and family history of CAD were more common in female cases . 42(35.6%) female cases had arrthymias during hospital stay as compared to 50(42.4%) male cases.Post MI angina was present in 21 (20.38%) female cases and 12(11.11%) male cases during one month follow up.Mortality was more common in female cases(12.7%) compared with the male cases(8.47%)but it was not statistically signicant. Females suffer from coronary artery disease slightly at older age Conclusions- as compared to males.Atypical chest pain and dyspnoea are more common presenting symptoms in females compared to males.Diabetes mellitus,central obesity, lack of physical activity and family history of CAD are most common risk factors in female cases for acute myocardial infarction.ST elevation myocardial infarction is less common in females as compared to males.Complications like congestive cardiac failure ,arrthymias are more common in females as compared to males.The overall mortality with acute myocardial infarction are common in females than males.
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Objective To investigate the clinical feature of painless myocardial infarction. Methods To retrospectively study the clinical data of 33 patients who suffered from painless myocardial infarction, and compare with that of typical acute myocardial infarction patients. Results There wash' t significant difference in gender(χ2 =1.63, P >0.05) and past history (χ2 = 4.88, P > 0.05) ,the time from visit to diagnosis (t = 1.44, P > 0.05) between painless myocardial infarction patients and typical acute myocardial infarction patients. But there was significant differ-ence in the age (χ2= 5.72, P < 0.05), the visit time (t = 30.98, P < 0.05), and the prognosis (χ2 = 32.17, P <0.0 ). Conclusion Patients with painless myocardial infarction have diverse clinical manifestations. They are usu-ally aged and delayed in seeking treatment and at last have a bad prognosis.
Key words:
Myocardial Infarction; Clinical feature
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In 1,395 patients admitted to hospital between 1976 and 1981 due to suspected acute myocardial infarction, the 5-year mortality rate was related to whether they developed infarction or not during the first 3 days. In all, patients with definite myocardial infarction had a 5-year mortality rate of 33.4% as compared with 13.3% in patients not fulfilling the criteria for this diagnosis (p less than 0.001). When separately analyzing patients with no previous myocardial infarction before admission and discharged from hospital, the corresponding mortality rate was 24.1% for myocardial infarction patients versus 8.1% in nonmyocardial infarction patients (p less than 0.001). Among all patients with nonconfirmed myocardial infarction, those who partly fulfilled the criteria (possible myocardial infarction) had a 5-year mortality rate of 16.7% as compared with 12.0% in those in whom myocardial infarction was completely ruled out (p = 0.18). Independent risk factors for death among patients not developing early infarction were high age and a clinical history of previous myocardial infarction and smoking. We conclude that in this study the long-term prognosis among patients admitted to hospital due to suspected acute myocardial infarction was clearly related to whether they developed an infarction or not during the first 3 days in hospital.
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