The effect of ischemia and alterations of heart rate on myocardial potassium balance in man.
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Biomedical subjects
Publications and source records attributed to R B Case.
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These data indicate that the observed PCO2 change following an abrupt change in myocardial O2 consumption, occurs too slowly to participate in the initial adjustment in metabolic coronary flow change, which is essentially complete within 30 sec. Also, the magnitude of PCO2 response is insufficient to conclude that CO2 can provide the major cause of flow regulation. However, CO2 could act as a back-up regulator. These conclusions may be modified if further information becomes available.
OBJECTIVE: To determine if the presence of a disrupted marriage or living alone would be an independent prognostic risk factor for a subsequent major cardiac event following an initial myocardial infarction. DESIGN: Prospective evaluation in the placebo wing of a randomized, double-blind drug trial in patients with an enzyme-documented acute myocardial infarction who were admitted to a coronary care facility. Data for living alone and/or a marital disruption were entered into a Cox proportional hazards model constructed from important physiologic and nonphysiologic factors in the same database. SETTING: Multicenter trial in a mixture of community and academic hospitals in the United States and Canada. PATIENTS: All consenting patients who were 25 to 75 years of age and without other serious diseases were enrolled (placebo, N = 1234) within 3 to 15 days of the index infarction and followed for a period of 1 to 4 years (mean, 2.1 years). Nine hundred sixty-seven patients were followed for 1.1 years and 530 for 2.2 years. PRIMARY OUTCOME MEASURE: Recurrent major cardiac event (either recurrent nonfatal infarction or cardiac death). RESULTS: Living alone was an independent risk factor, with a hazard ratio of 1.54 (95% confidence interval, 1.04 to 2.29; P less than .03). Using the Kaplan-Meier statistical method for calculation, the recurrent cardiac event rate at 6 months was 15.8% in the group living alone vs 8.8% in the group not living alone. Risk remained significant throughout the follow-up period (P = .001). A disrupted marriage was not an independent risk factor. CONCLUSION: Living alone but not a disrupted marriage is an independent risk factor for prognosis after myocardial infarction when compared with all other known risk factors.