Apolipoprotein A and prognosis after myocardial infarction in non-diabetic men.

The implications of apolipoproteins A-I and A-II for the prognosis of 178 non-diabetic men after acute myocardial infarction were studied. During a mean follow-up period of 4 years, one or more "coronary events" (nonfatal myocardial infarction, fatal coronary heart disease, coronary artery bypass graft surgery, deterioration of exercise ECG) were recorded in 37 patients. Serum levels of apolipoproteins A-I and A-II did not discriminate between patients with and without coronary events. This applied to the entire sample as much as to subgroups defined by presence or absence of interventions (coronary artery bypass graft surgery, long-term therapy with beta-blockers or lipid-lowering drugs). We conclude that coronary events in the first years after myocardial infarction cannot be predicted by apolipoprotein A-I or A-II levels.

Long-term prognosis of patients with silent ischemia, symptomatic ischemia and without ischemia after acute myocardial infarction.

The prognosis of 55 patients with silent ischemia (group I: asymptomatic ST segment depression of greater than or equal to 0.1 mV on symptom-limited ergometer exercise) was compared with that of 25 patients with angina and ST depression (group II), 22 patients with angina but without ST depression (group III) and 94 patients without angina and without ST depression (group IV) on ergometer testing in the first post-infarction month. Patients for whom PTCA or coronary artery bypass graft surgery was planned for the next months following discharge were excluded. Groups were well matched in terms of age, sex, diabetes, non-Q-wave infarctions and global left ventricular function, but groups I and II had more inferior wall infarctions (76% and 68% respectively) than groups III and IV (18% and 34%, p less than 0.0001). After a mean follow-up time of between 26 and 33 months 11% in group I, 16% in group II, 14% in group III, but only 6% in group IV had died from cardiac disease or reinfarcted (p = 0.06). Using Cox's model, the Killip index, presence of non-Q-wave infarction, maximal ST depression on ergometer exercise and global left ventricular ejection fraction were found to be important prognostic variables affecting reinfarction-free survival, whilst angina was not. Results suggest that the presence or absence of angina as an isolated symptom is not of prognostic important after acute myocardial infarction, in comparison with objectively determinable parameters.

[Acute myocardial infarct in patients over 70. Results of a 2-year survey]. / Der akute Myokardinfarkt bei über 70jährigen. Ergebnisse bis zu zwei Jahren.

581 consecutive patients admitted to hospital for acute myocardial infarction between January 1983 and June 1985 were divided into two groups. Group A (286) patients were aged 70 years or over (76 +/- 4 years); those in group B (246) were 65 or younger (56 +/- 8 years). Group A patients had a significantly higher incidence of anterior-wall infarction (30% vs. 18% in group B); heart failure (55% vs. 32%); pulmonary oedema (18% vs. 6%); cardiogenic shock (17% vs. 6.5%); or rupture (6% vs. 2%). Patients of the older age group also significantly less often underwent systemic fibrinolysis (0.3% vs. 21%); coronary angiography (2% vs. 61%); percutaneous transluminal coronary angioplasty (PTCA) or aorto-coronary bypass operation (0% vs. 22%) (P = 0.00001). Among the older patient group the cumulative mortality rate during hospitalization was 26.9% vs. 11.8% in group B, after six months it was 39% vs. 15%, after 12 months 46% vs. 17%, and after 24 months 61% vs. 21% (P = 0.00001). Causes of death were comparable in the two age groups, cardiac ones predominating. Angina in NYHA classes III-IV after discharge was present in 10% of the younger but 38% among the older patients (P = 0.00001). The death rate in patients of group A was very high under conservative treatment and surviving patients had a poor quality of life. Yet both coronary artery surgery and PTCA gave demonstrably better long-term results, both as to function and survival. Therefore, patients of even this higher age should more than is the case at present be more aggressively treated with invasive diagnostic and therapeutic procedures.

[Importance of risk factors in myocardial infarction (author's transl)]. / Die Bedeutung der Risikofaktoren für den Verlauf des Myokardinfarktes.

Importance of risk factors as hypertension, hyperlipidaemia, diabetes mellitus and cigarette smoking because of hemodynamic and complication during acute myocardial infarction and influence of live quality during the first year after myocardial infarct was pointed out in this study. No risk factor was found in 12.1% out of 248 patients. 25.8% had one, 33.5% two, 12.9% three and 3.2% four risk factors. If only one risk factor for coronary heart disease was documented, 35.9% showed cigarette smoking. If there were two risk factors, most of the people had diabetes mellitus and hypertension, and the combination diabetes mellitus, hyperlipidaemia and cigarette smoking was favourite if there were three risk factors present. The mean age of all patients was 65.9 +/- 10.8 years. Patients who smoked or had hyperlipidaemia were statistically significantly younger (p < 0.001). There was no correlation between number of risk factors or kind of it and pulse frequence, cardiac index, pulmonary artery pressure and third heart sound during phase of acute myocardial infarction. Also no correlation was found between the risk factors hypertension, diabetes mellitus and cigarette smoking and rhythm disturbance of reinfarction. Patients with normal lipids had significant more bradycard or tachycard rhythm disturbances as patients with hyperlipidaemia (p < 0.05). Patients without diabetes mellitus or hypertension had better bicycle tests than patients with this risk factors (p < 0.01). 92% of hypertensive patients had regular drug medication; 14.1% of smoking patients continued smoking cigarettes after acute myocardial infarction. Only 62.1% of diabetic patients, 54.1% of hyperlipidaemic patients and 40% of overweight patients kept diet. Because of this bad quality of patient compliance there was no exact information possible in predicting value of secondary preventive measurements after acute myocardial infarction.