Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Infarction”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 955 records · Page 53Linked to original sources
PubMed1998

Impact of diabetes on mortality after the first myocardial infarction. The FINMONICA Myocardial Infarction Register Study Group.

OBJECTIVE: To study diabetic and nondiabetic patients with their first myocardial infarction to determine overall 1-year mortality, out-of-hospital mortality, 28-day mortality of hospitalized patients, and 1-year mortality of 28-day survivors. RESEARCH DESIGN AND METHODS: This study--based on the FINMONICA Myocardial Infarction Register, a part of the Finnish contribution to the WHO MONICA Project (World Health Organization Multinational Monitoring of Trends and Determinants of Cardiovascular Disease)--covered coronary heart disease (CHD) deaths and acute CHD events occurring during hospitalization among residents of Finland aged 25-64 years in three geographically defined areas. The study population comprised 620 diabetic and 3,445 nondiabetic patients who had their first myocardial infarction during the years 1988-1992. RESULTS: The age- and area-adjusted mortality rates and hazard ratios (HRs) for diabetic versus nondiabetic patients (95% CI) were as follows: The 1-year mortality rate was 44.2% in diabetic men and 32.6% in nondiabetic men (HR, 1.38; 1.18-1.61) and 36.9% in diabetic women and 20.2% in nondiabetic women (HR, 1.86; 1.40-2.46); the out-of-hospital mortality rate was 28.3% in diabetic men and 22.4% in nondiabetic men (HR, 1.25; 1.03-1.52) and 10.4% in diabetic women and 11.0% in nondiabetic women (HR, 0.95; 0.58-1.54); the 28-day mortality rate of hospitalized patients was 14.4% in diabetic men and 8.8% in nondiabetic men (HR, 1.58; 1.15-2.18) and 21.7% in diabetic women and 7.8% in nondiabetic women (HR, 2.60; 1.71-3.95); and the 1-year mortality rate of 28-day survivors was 9.6% in diabetic men and 5.0% in nondiabetic men (HR, 1.97; 1.25-3.12) and 10.7% in diabetic women and 2.5% in nondiabetic women (HR, 4.17; 2.05-8.51). CONCLUSIONS: The high mortality rate of diabetic patients after their first myocardial infarction and the high proportion of out-of-hospital deaths in this group imply that vigorous primary and secondary preventive measures should become an integral part of their medical care.

Adult↗
PubMed1990

Use of biochemical tests for myocardial infarction in the county of Västernorrland, a clinical chemistry routine for the diagnosis of myocardial infarction.

A study of 116 patients admitted on the suspicion of myocardial infarction is presented. Twenty three of the patients were found to have infarction. For the diagnosis of infarct the most reliable biochemical analyses at present appear to be serum creatine kinase (S-CK, E.C.2.7.3.2.) with its isoenzyme S-CKMB and serum lactate dehydrogenase (S-LD, E.C.1.1.1.27.) with its isoenzyme S-LD-1. If an organization with blood samples at fixed intervals after the appearance of symptoms could be arranged, this would be most recommendable. In many hospitals this is, however, difficult and the blood samples have to be drawn at specified hours. In the four hospitals in the county of Västernorrland, Sweden, this latter procedure has been introduced. Blood is drawn at the arrival of the patient, at 8 am and 8 pm the first day, and at 8 am the next two days of the stay in hospital. In the first two samples S-CK and S-LD are determined, in the third S-CK, in the fourth S-CK and S-LD and in the fifth S-CK. If the values are elevated, S-CKMB and S-LD-1 are determined. S-Myoglobin has been found valuable in the early exclusion of the diagnosis of infarction.

Aged↗
PubMed1981

beta-Blockade in acute myocardial infarction. Inability of relatively late administration to influence infarct size and arrhythmias.

The effects of orally administered timolol maleate (10 mg twice a day) were assessed in 88 patients entered into a double-blind study within 10.74 +/- 5.07 hours of onset of myocardial infarction. Timolol maleate produced no significant change in crude mortality rate, infarct size, incidence of arrhythmias or significant left ventricular failure. Withdrawals from study because of recurrent angina or hypertension were confined to the placebo group. The results of this study suggested that, when given relatively late after infarction, timolol maleate does not reduce either infarct size or incidence of arrhythmias, despite production of a safe and effective beta-blockade.

Arrhythmias, Cardiac↗
PubMed1988

Myocardial infarct extension: occurrence, outcome, and risk factors in the Multicenter Investigation of Limitation of Infarct Size.

The occurrence, outcome, and predictors of myocardial infarct extension were determined in 848 patients with acute myocardial infarction. An increase in the level of plasma MB creatine kinase activity was used to detect extension, which occurred in 71 of 848 patients (8.4%). For these patients, hospital mortality was more than four times higher than for those without extension (30% versus 7%, P less than 0.01). However, for patients surviving the initial hospitalization, there was no significant difference in mortality during the following year (12% compared with 9%). Multivariable analyses indicated that extension was more likely to occur in patients with recurrent ischemic pain during the second hospital day, a history of previous myocardial infarction, and ST segment depression on the admission electrocardiogram. The occurrence of extension in patients with two of these risk factors was more than twice that of patients without any of the risk factors (15.1% compared with 5.8%). Patients with these risk factors should be considered for early coronary angiography and possible intervention to prevent infarct extension and its sequellae.

Analysis of Variance↗
PubMed1998

Bundle-branch block and in-hospital mortality in acute myocardial infarction. National Registry of Myocardial Infarction 2 Investigators.

BACKGROUND: Left bundle-branch block (BBB) is considered an important predictor of poor outcome in patients with acute myocardial infarction, but the consequences of right BBB are not well understood. OBJECTIVES: To 1) estimate the prevalence of left and right BBB in patients with myocardial infarction; 2) compare the clinical characteristics of and treatments received by patients with left, right, or no BBB; and 3) determine the independent association of left BBB and right BBB with in-hospital death. DESIGN: Retrospective cohort study. SETTING: Multicenter registry of 1571 U.S. hospitals. PATIENTS: 297,832 patients with acute myocardial infarction who had left, right, or no BBB on initial electrocardiography. MEASUREMENTS: Presence and type of BBB, clinical characteristics of patients, therapies given, and in-hospital death. RESULTS: Patients with left BBB (n = 19,967; 6.7%) or right BBB (n = 18,354; 6.2%) were older and had more comorbid illness and congestive heart failure than patients with no BBB. Among patients for whom thrombolytic therapy was clearly indicated, fewer patients with left or right BBB (16.6% and 32.0%, respectively) than patients with no BBB (66.5%) received this therapy (P < 0.001). Fewer patients with left or right BBB (60.6% and 67.3%, respectively) than patients with no BBB (75.6%) received aspirin within the first 24 hours (P < 0.001), and fewer patients with left or right BBB (23.9% and 31.8%, respectively) than patients with no BBB (40.4%) received beta-blockers within the first 24 hours (P < 0.001). Unadjusted in-hospital mortality rates were almost twice as high for patients with left or right BBB (22.6% and 23.0%, respectively) as for patients with no BBB (13.1%) (P < 0.001). Compared with no BBB and no ST-segment elevation, left BBB was associated with a 34% increase (odds ratio, 1.34 [95% CI, 1.28 to 1.39]) and right BBB was associated with a 64% increase (odds ratio, 1.64 [CI, 1.57 to 1.71]) in the risk for in-hospital death, after adjustment for potential confounders. CONCLUSIONS: In patients with acute myocardial infarction, prevalences of right and left BBB are similar. Patients with BBB have more comorbid conditions, are less likely to receive therapy, and have an increased risk for in-hospital death compared with patients with no BBB. Compared with left BBB, right BBB seems to be a stronger independent predictor of in-hospital death.

Bundle-Branch Block↗
PubMedDate not supplied

[A case of Foix-Chavany-Marie syndrome and crossed aphasia after right corona radiata infarction with history of left hemispheric infarction].

Foix-Chavany-Marie syndrome (FCMS) is a syndrome that presents facio-pharyngo-glosso-masticatory diplegia with automatic voluntary dissociation. Its most common etiology is stroke in the regions of bilateral opercula. We described a 75-year-old woman with FCMS and crossed aphasia. She had cerebral infarction of left middle cerebral artery territory 23 years before. At that time she had transient right hemiparesis, but no aphasia. This time, she suddenly became mute and was brought to our hospital. Neurological examination revealed severe weakness in her bilateral lower face, pharynx, tongue, and sternocleidomastoideus. She had no weakness of limbs. Her listening comprehension was moderately disturbed and handwriting was paragraphic. Her emotional facial movement was maintained despite of disturbed volitional facial movement. CT scan disclosed fresh infarction at the right corona radiata and old infarction at the left middle cerebral artery territory. In this patient, lesions at the left operculum and right corona radiata with the preserved right operculum gave rise to FCMS. This implies following possibilities: 1) the corticobulbar tract and corticospinal tract run separately at the corona radiata, 2) volitional and emotional tracts of facial movement run separately at the corona radiata. It was demonstrated that FCMS is not always caused by bilateral operculum lesions. Our patient did not show aphasia after the first stroke including left language area, but became severely aphasic after the right corona radiata infarction. Simultaneous occurrence of FCMS and aphasia after corona radiata lesion suggested that the corticobulbar tract and a tract that conducts linguistic information are running adjacently in the corona radiata. Our case suggested that restricted corona radiata lesion may cause severe subcortical aphasia and in case of additional contralateral corticobulbar tract lesion, severe dysarthria may occur.

Aged↗
PubMed1999

[A case who needed additional Daggett's procedure for residual shunt after infarction exclusion technique for post-infarction ventricular septal perforation].

A 71-year-old woman had the surgical repair of post-infarction ventricular septal perforation with infarction exclusion technique. Three days after operation, residual shunt was observed by echocardiogram and she developed cardiac failure. Pulmonary to systemic flow ratio was 2.1, and pulmonary artery pressure was 42/23 (33) mmHg. Additional surgery for residual shunt was performed 22 days after the first operation. The part of Xenomedica patch was found loosely floating in the LV cavity. The infarcted myocardium was firm enough to closed directly, so a double Hemashield cardiovascular fabric was sutured on the left side of the perforated septum around VSP (Daggett's Procedure). The ventriculotomy was closed including the fabric with two felt strips. The postoperative course was uneventful. Though infarction exclusion technique has the advantage in many cases, much attention must be paid to prevent residual shunt.

Aged↗
PubMed2000

Early administration of verapamil after thrombolysis in acute anterior myocardial infarction. Effect on left ventricular remodeling and clinical outcome. VAMI Study Group. Verapamil Acute Myocardial Infarction.

BACKGROUND: The administration of verapamil during the reperfusion phase of acute myocardial infarction can reduce the extent and severity of microvessel damage and limit myocardial dysfunction. We aimed at investigating the effect of early verapamil administration on left ventricular remodeling and the clinical evolution after myocardial infarction. METHODS: Eighty-eight patients with first acute anterior myocardial infarction thrombolysed < 4 hours from symptom onset were enrolled in a multicenter, randomized, double-blind, controlled study of verapamil administration (5 mg i.v. + 2 microg/kg/min over 24 hours). Echocardiographic end-diastolic (EDV) and end-systolic (ESV) left ventricular volumes were assessed by biplane Simpson's rule. RESULTS: At 90 days, EDV in the verapamil and placebo groups was respectively 88.9 +/- 27.8 and 95.8 +/- 30.7 ml (p = 0.11), ESV was 52.6 +/- 22.7 and 57.7 +/- 25.4 ml (p = 0.18). There was no change over time in the verapamil group (day 3 vs day 90: EDV 85.0 +/- 17.7 vs 88.9 +/- 27.8 ml, p = NS; ESV 48.7 +/- 14.1 vs 52.6 +/- 22.7 ml, p = NS) while left ventricular volume increased in the placebo group (day 3 vs day 90: EDV 87.6 +/- 21.1 vs 95.8 +/- 30.7 ml, p = 0.03; ESV 52.0 +/- 16.9 vs 57.7 +/- 25.4 ml, p = 0.08). NYHA functional classes were differently distributed at 30 and 90 days (chi2 = 0.009 and 0.07), with a lower prevalence of classes II and III in the verapamil group (p = 0.03). CONCLUSIONS: The early intravenous administration of verapamil in thrombolysed patients can reduce left ventricular remodeling and NYHA functional class after acute anterior myocardial infarction.

Calcium Channel Blockers↗
PubMed2001

[Assessment of myocardial function at infarct zone after PTCA infarct-related artery--a study with tissue Doppler echocardiography].

UNLABELLED: Angioplasty of an infarct-related artery (IRA) performed several weeks or months after myocardial infarction (MI) may improve myocardial function. It is still unclear though, how soon wall function is restored following the procedure. This study was designed to assess quantitatively changes of regional left ventricular function after PTCA of IRA by means of tissue Doppler echocardiography (TDE). Thirty nine patients (30 male, mean age 53.4 +/- 8.4 yrs) who had MI 13 +/- 6 weeks earlier were qualified for IRA angioplasty on the basis of dobutamine stress echocardiography (DSE) if a viable myocardium was demonstrated. Regional wall function at infarct zone was assessed by TDE one day before PTCA (exam 1), 1-3 days (exam 2) and 28-30 days (exam 3) after successful angioplasty. Myocardial velocities and time--derived TDE intervals were calculated both in systole (systolic peak velocity--S, pre-ejection period--PEP, contraction time--CT), and diastole (E and A velocity waves, E/A ratio, isovolumic relaxation time--IVRT, rapid filling time--RFT, atrial filling time--AFT). All parameters were measured in longitudinal direction (annulus, basal and medial segments) of posterior (20 pts), anterior (17 pts) and lateral (2 pts) walls. S wave velocity increased between exam 1 and 2 (4.9 +/- 1.2 cm/s vs 5.6 +/- 1.3 cm/s, p < 0.02), whereas E wave decreased between examinations. Pre-PTCA E/A ratio was significantly lower than in exam 2 and 3. PEP decreased between exam 1 and 2 (96 +/- 23 ms vs 84 +/- 16 ms, p < 0.01). Significant correlation was found in IVRT and RFT prior and immediately after PTCA (103 +/- 21 ms vs 87 +/- 20 ms, p < 0.001, 151 +/- 39 ms, vs 170 +/- 30 ms p < 0.01 respectively). CONCLUSIONS: Patients after infarction with persisted viable myocardium may benefit from late angioplasty of IRA. In regional wall function assessment TDE seems to be more sensitive technique than visual wall motion analysis alone. TDE parameters demonstrated a rapid initial improvement. Changes of myocardial velocities (S, E) and time--derived TDE intervals (IVRT, PEP, RFT) are sensitive markers of restored myocardial function.

Adrenergic beta-Agonists↗
PubMed2002

Single-point cardiac troponin T at coronary care unit discharge after myocardial infarction correlates with infarct size and ejection fraction.

BACKGROUND: One of the major concerns in replacing creatine kinase MB (CK-MB) with cardiac troponins is the lack of evidence of the ability of troponins to estimate the size of acute myocardial infarction (AMI). We investigated the ability of a single measurement of cardiac troponin T (cTnT) at coronary care unit (CCU) discharge to estimate infarct size and assess left ventricular (LV) function in AMI patients. METHODS: We studied 65 AMI patients in whom infarct size was estimated by CK-MB peak concentrations and gated single-photon emission computed tomography (SPECT) myocardial perfusion using technetium-99m sestamibi and LV function by SPECT imaging. Measurements of cTnT and SPECT were performed 72 h (median) after admission (range, 40-160 h). SPECT was also repeated 3 months later. RESULTS: We found a significant correlation between cTnT and both the peak CK-MB concentrations (r = 0.76; P <0.001) and the perfusion defect size at SPECT (r = 0.62; P <0.001). cTnT was inversely related to LV ejection fraction (LVEF) assessed both early (r = -0.56; P <0.001) and 3 months after AMI (r = -0.70; P <0.001). cTnT >2.98 micro g/L predicted a LVEF <40% at 3 months with a sensitivity of 86.7%, specificity of 81.4%, and a likelihood ratio for a positive test of 4.7 (95% confidence interval, 4.0-5.4). CONCLUSIONS: A single cTnT measurement at CCU discharge after AMI is useful as a noninvasive estimate of infarct size and for the assessment of LV function in routine clinical setting.

Adult↗
PubMed2000

Serial troponin I measurements detect recurrent myocardial infarction after initial acute myocardial infarction.

UNLABELLED: Serial serum troponin I and CK-MB measurements were obtained for 36 patients presenting to the emergency department with a confirmed diagnosis of acute myocardial infarction (AMI). For each patient, the normalized percentage of maximum troponin I concentration (%max TropI) was plotted vs. the time from the maximum value to obtain a kinetic decay plot. The linear correlation plots of the--Log (%max TropI) vs. time were compared. Patients with uncomplicated AMI (n = 31) showed linear correlation coefficients (CC) above 0.97 (mean CC = 0.991). Patients with AMI complicated by recurrent myocardial infarction (n = 5) documented by corroborate clinical findings, electrocardiographic abnormalities and/or abnormal CK-MB results showed linear correlation coefficients (CC) less than 0.97 (mean CC = 0.763). Using a cutoff value of CC = 0.97, both patient groups were completely separated and re-infarction or extension of infarction was predicted with 100% accuracy, sensitivity and specificity. CONCLUSION: Kinetic modeling of troponin I decay in patients with AMI correctly differentiates patients with complicated vs. non-complicated courses.

Creatine Kinase↗
PubMed1978

[The radiological findings of caisson-induced bone infarcts. The relationship between acute arthralgia and bone infarcts (author's transl)].

The radiological features, such as calcification in long bones due to infarcts, resulting from Caisson disease are described by the author on the basis of an extensive experience. The similar localisation of acute "arthralgia" and bone infarcts make it appear probable that the infarcts play a primary role in the production of "osteo-articular" pain. The author stresses the advisability of examining the adjacent portions of the tibia and femur at the initial pre-employment examination, since bone infarcts can be caused by a variety of conditions other than work in Caissons.

Bone and Bones↗
PubMedDate not supplied

Plasma profiles of circulating granulocyte-macrophage colony-stimulating factor and soluble cellular adhesion molecules in acute myocardial infarction. Contribution to post-infarction left ventricular dysfunction.

No in vivo data exist about the relationship of circulating granulocyte-macrophage colony stimulating factor (GM-CSF) and soluble adhesion molecules ICAM-1 and VCAM-1 (sICAM-1 and sVCAM-1) to the severity of acute myocardial infarction (AMI) and the pathophysiological events of post-infarction left ventricular dysfunction. We investigated the kinetics of these inflammatory mediators in the plasma of patients with AMI, and correlated the findings with the clinical severity of the disease during the first week of hospitalization as well as the degree of left ventricular dysfunction one month after the AMI. Plasma levels of inflammatory markers were determined in 41 AMI patients (all received thrombolytic treatment) by ELISA assays, serially during the first week of hospitalization and one month after hospital admission. Patients (n = 20) with uncomplicated AMI (Killip class I) were classified as group A, patients (n = 21) with AMI complicated by heart failure manifestations (Killip classes II and III) were classified as group B, while 20 age- and sex-matched volunteers were used as healthy controls. A sustained increase in GM-CSF, sICAM-1 and sVCAM-1 plasma concentrations was observed only in group B during the first week of the study. Patients from group B exhibited significantly higher levels of GM-CSF (P < 0.01), sICAM-1 (P < 0.05) and sVCAM-1 (P < 0.01) than patients from group A and the healthy controls (P < 0.001). In group B patients, significant correlations were observed between the peak of GM-CSF levels and the peak of serum creatine kinase-MB (r = 0.42; P < 0.05), white blood cell counts (r = 0.67; P < 0.001) and LVEF (r =- 0.51; P < 0.01). At one month follow-up, patients (n = 17) with severe post-infarction left ventricular dysfunction (LVEF 35%). Significant correlations were observed between GM-CSF levels and left ventricular end-diastolic volume index (r = 0.55; P < 0.001) or left ventricular end-systolic volume index (r = 0.49; P = 0.001). We have found a significant elevation of plasma GM-CSF and soluble adhesion molecules during the course of AMI, with the highest values in patients with AMI complicated by heart failure manifestations and severe left ventricular dysfunction. These monocyte-related inflammatory mediators may actively contribute to the pathophysiology of the disease and post-infarction cardiac dysfunction.

Aged↗
PubMed1992

Gender differences in the treatment and outcome of acute myocardial infarction. Results from the Myocardial Infarction Triage and Intervention Registry.

BACKGROUND: The objective of this study was to compare treatment and outcome of acute myocardial infarction in women and men. METHODS: In this survey, patient hospital records were reviewed, and information about patient characteristics, treatments, and hospital events was entered in the Myocardial Infarction Triage and Intervention Registry. Between January 1988 and June 1990, a total of 4891 consecutive patients, including 1659 women, were hospitalized for acute myocardial infarction in 19 hospitals in the Seattle (Wash) metropolitan area. In-hospital thrombolytic therapy, coronary angiography, angioplasty, and bypass surgery were examined, as were in-hospital complications and death. RESULTS: Women were older and more often had histories previous hypertension and previous congestive heart failure. Thrombolytic therapy was used less often in women, although information about eligibility for treatment was not available to determine if this difference was due to treatment bias or differences in eligibility. Both coronary angiography and coronary angioplasty were used less frequently in women. However, of patients who had coronary angiography, equal proportions of women and men received angioplasty and/or coronary bypass surgery. Hospital mortality was 16% for women and 11% for men, although this difference was diminished by age adjustment. Mortality was higher in women undergoing bypass surgery, but this difference, too, was less apparent after age adjustment. CONCLUSIONS: Despite high levels of risk factors and mortality, coronary angiography and angioplasty were used less often in women, although among those who underwent coronary angiography, there were no gender differences in the use of angioplasty or bypass surgery. Clearly, more needs to be known about decision making for coronary angiography, as this process seems to differ for women and men with acute myocardial infarction.

Aged↗
PubMed2006

Peri-infarct reorganization in a patient with corona radiata infarct: a combined study of functional MRI and diffusion tensor image tractography.

PURPOSE: We investigated the motor recovery mechanism of a stroke patient using functional MRI (fMRI) and diffusion tensor image tractography (DTT). METHODS: A 60 year-old woman with right corona radiata infarct presented with complete paralysis of the left upper extremity. The motor function of the affected upper extremity recovered slowly for 6 months to a point of nearly normal function. The motor function of the patient was evaluated by fMRI and DTT at 6 months from the onset. FMRI was performed at 1.5 T with timed hand grasp-release movements. DTT was performed using 1.5 T with a synergy-L Sensitivity Encoding head coil. Three dimensional reconstructions of the fiber tracts were obtained with FA < 0.3, angle > 45 degrees as termination criteria. RESULTS: The contralateral primary sensorimotor cortex (SM1) was activated during both affected (left) and unaffected hand movements. DTT showed that the tracts originated from either SM1; the tracts then descended along the known pathway of the corticospinal tract, with the exception that the tract of the affected (right) hemisphere descended along the posterior portion of the infarcted corona radiata. CONCLUSIONS: It seems that the motor function of the affected upper extremity was reorganized to the posterior portion of the infarcted corona radiata. This finding may reflect functional reorganization of the motor pathway following corticospinal tract damage. This appears to be one motor recovery mechanism of subcortical infarct.

Animals↗
PubMedDate not supplied

Acute-phase proteins in stroke: influences of its cause (cerebral hemorrhage or infarction), of the cerebral site of infarction, and of the sex of patients.

In most of the 129 patients with a recent stroke by cerebral hemorrhage or infarction a note-worthy acute-phase response was found, as demonstrated by important quantitative alterations of blood levels of several acute-phase proteins (APP). These alterations were different in patients with cerebral hemorrhage as compared to those with cerebral infarction. The alterations due to cerebral infarction were not different according to the site of the infarction in brain, i.e. in the brain territories irrigated by the carotid artery system or by the basilar artery system. The APP alterations do not depend on the sex of patients or on the time elapsed from stroke-onset to blood collection.

Acute-Phase Proteins↗
PubMed1991

Effect of verapamil on ischemia and ventricular arrhythmias after an acute myocardial infarction: prognostic implications. The Danish Verapamil Infarction Trial II Study Group.

This article is a review of presented subsets of the Danish Verapamil Infarction Trial II (DAVIT II) regarding the effect of verapamil on postinfarction ischemia, ventricular arrhythmias, and heart rate (HR), and the prognostic implications of these findings. Patients underwent Holter monitoring for 24-48 h at 1 week, i.e., before randomization to long-term treatment with placebo or verapamil, and after 1 month and about 1 year of study treatment. Ischemia: 18% of the patients had transient ST-segment deviation before randomization; 24% of the placebo- and 8% of the verapamil-treated patients (p = 0.04) showed ischemia after 1 month; and after 1 year, the figures were 26 and 4%, respectively (p = 0.02). The 18-month major event rate, i.e., first reinfarction or death, in patients with ischemia before randomization were 40 and 23.8% in patients without ischemia (p = 0.06). Arrhythmias: In the placebo group the prevalence and incidence of many ventricular ectopic beats (VEBs), i.e., more than 10 VEBs/h, increased significantly during the first years after infarction; this was not the case in the verapamil patients group. The mean HR was significantly reduced by verapamil treatment after 1 month and after 16 months of treatment. Multivariate analysis demonstrated the presence of more than 10 VEBs/h only early (i.e., 1 week) but not late (i.e., 1 month) after infarction, to be an independent predictor of major events during 18 months' follow-up observation. A HR above 80 beats/min independently predicted major events when appearing both early and late after infarction.(ABSTRACT TRUNCATED AT 250 WORDS)

Analysis of Variance↗
PubMed1991

Affective disorders and survival after acute myocardial infarction. Results from the post-infarction late potential study.

Psychological data from 560 male survivors of acute myocardial infarction (AMI) were documented in the third week after onset of AMI. The psychodiagnostic assessment was designed to detect different forms of depression as well as hyperactive behaviour. A complete follow-up of these patients, which covers a period of 6 months, is available. Our findings indicate that affective disorders play an important role in the post-acute phase after AMI although the extent of myocardial infarction (as defined by an ECG score) and behaviour responses are not significantly related to one another. Different subforms of depression are not influenced by a history of angina pectoris, the degree and location of myocardial infarction, the occurrence of late potentials and age, whereas dyspnoea (P less than 0.001) and the recurrence of myocardial infarction (P less than 0.001) favour depressive mood states. Twelve cardiac deaths and 17 arrhythmic events occurred during the study period; they were significantly predicted by severe forms of post-AMI depression as revealed by univariate analysis. The evidence was stronger for predicting cardiac death (P less than 0.001) than for arrhythmic events (P = less than 0.035). The effect remains of borderline significance for cardiac death if all risk factors with a significant univariate influence are included in a multiple logistic regression model. The effect of depression is illustrated by Kaplan-Meier survival curves separated for patient groups with high as compared to low degrees of depression. Hyperactivity showed no impact on patient survival.

Adult↗