A circadian pattern with a morning peak and the triggering role of emotional stress have been suggested for ventricular arrhythmias. After controlling for participant baseline characteristics and ...medication used, the authors studied the association of emotional upset, physical activity, and meteorologic parameters with occurrence of ventricular tachycardia (VT) in 457 Croatian participants aged 11–88 years consecutively assigned to undergo continuous 24-hour Holter monitoring. In 2001, multivariate analysis of possible VT precipitators was performed separately for men, women, those aged <65 years, and those aged >64 years. A U-shaped pattern of wind speed (either very weak or very strong), rising relative air moisture, falling atmospheric pressure, and emotional upset were independent predictors of VT episodes in all participant subgroups. Positive association of VT with higher atmospheric temperature or pressure was observed in women and elderly. After adjustment for external triggers, a circadian variation in VT episodes persisted in women (p = 0.01) and those aged <65 years (p < 0.0001) only. A protective effect of β-blockers and anxiolytics was especially apparent for men and elderly, as well as an adverse effect of digitalis in women. Results suggest that meteorologic and emotional stress could be considered external triggers of VT, with age- and sex-dependent susceptibility.
Objectives The purpose of this study was to examine the symptomatology of onset of acute myocardial infarction (AMI) in patients according to sex, age, and existence of conventional risk factors. ...Background Some studies have suggested that sex and other patient characteristics may influence symptoms in AMI, but data were limited and conflicting. Methods This was a prospective, observational study of a large number of symptoms in 1996 patients admitted to Clinical Hospital Split between January 1990 and July 1995 as the result of a first AMI. For each patient, the structured data form covering experience of pain at 10 body locations and 11 other symptoms, baseline characteristics, risk factors, and peak cardiac enzyme levels was completed a median of 3 days after AMI. Results Any pain, and specifically chest pain, was more often reported by male patients, smokers, hypertensive patients, nondiabetic patients, and hypercholesterolemic patients. Women were more likely to report nonchest pain other than epigastric and right shoulder pain, as well as various nonpain symptoms. The independent predictors of atypical AMI presentation (ie, absence of pain) in both men and women were lower levels of creatine kinase-MB fraction (P <.0001 and P =.0003, respectively), diabetes mellitus (P =.0002 and P =.002, respectively), older age (P =.001 and P =.01, respectively), and absence of smoking in men (P =.005). The independent predictors of presence of nonpain symptoms in both men and women were higher levels of creatine kinase-MB fraction (P =.01 and P =.049, respectively) and diabetes mellitus (P =.048 and P =.005, respectively); in men, it was hypercholesterolemia (P =.01). Conclusions Our results suggest that sex, age, smoking, hypertension, diabetes, and hypercholesterolemia may affect the symptoms in AMI. Women with diabetes represent a high-risk subgroup for painless onset followed by various other symptoms. (Am Heart J 2002;144:1012-7.)
Background: Although it is well known that the acute myocardial infarction can be triggered by events such as physical activity, emotional stress, sexual activity or eating, the observed frequencies ...of these events preceding the onset of myocardial infarction vary between published reports.
Methods: A meta-analysis of 17 seldom population-based studies that included data on frequency of external triggers or onsets during sleep was performed. In each analysis, the data were combined only from the studies reporting on a particular trigger.
Results: Of the 10
519 patients, heavy physical activity was recorded before the onset of myocardial infarction in 6.1%, whereas mild-to-moderate physical activity was recorded in 28.6% of 7517 patients. Eating preceded the onset in 8.2% of 4785 patients, various kinds of emotional stress in 6.8% of 2565 (particularly anger in 2.1% of 2283), meteorologic stress in 3.7% of 3371, and sexual activity in 1.1% of 3406 patients. Out of 11
778 patients, 20.7% had infarction onset during sleep. Triggers in general (OR=1.45, 95%CI=1.21–1.76;
p<0.0001), heavy physical activity (OR=6.21, 95%CI=3.77–10.23;
p<0.0001) and eating (OR=1.70, 95%CI=1.14–2.53;
p=0.0008) were more likely to precede the infarction onset in men while women were more likely to report emotional stress (OR=0.66, 95%CI=0.50–0.86;
p=0.002).
Conclusions: The present meta-analysis defines the occurrence of possible external triggers before the onset of myocardial infarction in general population, but their actual contribution to the very onset is somewhat less frequent. Future investigation should identify other eventual triggers unrecognized as yet, asses the risk of triggering myocardial infarction among patients with defined levels of ischemic heart disease or plaque vulnerability, and further elucidate the pathophysiologic mechanisms of gender differences and beneficial effect of habitual physical activity.
Differing circadian patterns and occurrence of external triggers suggest the association of sustained cornary occlusion with Q-wave acute myocardial infarction (AMI), and nonsustained occulsion with ...non-Q-wave AMI. Most of the differences in symptom presentaiton and in-hospital outcome between 2 AMI types are influenced by patients' preinfarction characteristics and greater area of Q-wave infarction.
There are conflicting data about gender differences in short-term mortality after acute myocardial infarction (AMI) after adjusting for age and other prognostic factors. Therefore, we investigated ...the risk profile, clinical presentation, in-hospital mortality and mechanisms of death in women and men after the first AMI.
The data were obtained from a chart review of 3382 consecutive patients, 1184 (35%) women (69.7+/-10.9 years) and 2198 (65%) men (63.5+/-11.8 years) with a first AMI. The effect of gender and its interaction with age, risk factors and thrombolytic therapy on overall mortality and mechanisms of death were examined using logistic regression.
Unadjusted in-hospital mortality was higher in women (OR 1.77, 95% CI 1.47-2.15). Adjustment that included both age only and age and other baseline differences (hypertension, diabetes mellitus, hypercholesterolemia, smoking, AMI type, AMI site, mean peak CK value, thrombolytic therapy) decreased the magnitude of the relative risk of women to men but did not eliminate it (OR 1.26, 95% CI 1.03-1.54 and OR 1.31 95% CI 1.03-1.66, respectively). Multivariate analysis revealed that female gender was an independent predictor of in-hospital mortality after the first AMI. Women were dying more often because of mechanical complications - refractory pulmonary edema and cardiogenic shock (P=0.02) or electromechanical dissociation (P=0.03), and men were dying mostly by arrhythmic death, primary ventricular tachycardia/fibrillation (P=0.002). Female gender was independently associated with mechanical death (OR 1.56, 95% CI 1.35-2.58; P=0.01) and anterior AMI was independently associated with arrhythmic death (OR 0.54, 95% CI 0.34-0.86; P=0.01).
Our results demonstrate significant differences in mechanisms of in-hospital death after the first AMI in women and men, suggesting the possibility that higher in-hospital mortality in women exists primarily because of the postponing AMI death due to the gender-related differences in susceptibility to cardiac arrhythmias following acute coronary events.
Objective: We determined the occurrence of presenting symptoms in patients with different sites of acute myocardial infarction after controlling for age and conventional risk factors.
Methods: ...Hospital-based study of patients hospitalized because of first anterior (
n=731), inferior (
n=719) and lateral (
n=96) infarction in Clinical Hospital Split between 1990 and 1994. Data form about presenting symptoms and clinical profile was completed for each patient.
Results: Anterior infarctions were more often presented by headache (adjusted odds ratio (OR)=1.67, 95%CI=1.06–2.62), weakness (OR=1.60, 95%CI=1.31–1.96), dyspnea (OR=1.40, 95%CI=1.14–1.72), cough (OR=2.24, 95%CI=1.59–3.16), vertigo (OR=2.04, 95%CI=1.40–2.99) and tinnitus (OR=2.09, 95%CI=1.06–4.14). Inferior infarctions were more often associated with epigastric (OR=1.71, 95%CI=1.30–2.24), neck (OR=1.47, 95%CI=1.10–1.98) and jaw pain (OR=2.16, 95%CI=1.42–3.27), sweating (OR=1.56, 95%CI=1.27–1.92), nausea (OR=2.01, 95%CI=l.64–2.46), vomiting (OR=1.55, 95%CI=1.22–1.97), belching (OR=1.57, 95%CI=1.21–2.03) and hiccups (OR=2.88, 95%CI=1.53–5.42). Patients with lateral infarctions were more likely to complain of left arm (OR=1.80, 95%CI=1.07–3.05), left shoulder (OR=1.82, 95%CI=1.19–2.79) and back pain (OR=2.40, 95%CI=1.28–4.46). Pain was less frequently reported by hypercholesterolemic (
P=l.4×10
−7), patients over 70 years (
P=0.002), women (
P=0.0007) and those with non-triggered infarction (
P=0.0009), whereas those over 70 (
P=1.7×10
−6) and men (
P=0.0003) were less likely to report other relevant symptoms.
Conclusions: Our study suggests a linkage between different infarction sites and specific groups of symptoms. Furthermore, coronary patients should give their full attention to non-specific symptoms and any kind of discomfort.
While differences between anterior and inferior acute myocardial infarction have been observed, clinical features of lateral infarction are poorly investigated. However, the impact of gender on ...clinical course and prognosis after myocardial infarction is not fully understood. Electrocardiographically determined infarct site, demographic and clinical variables were prospectively recorded for 1623 consecutive patients admitted to Clinical Hospital Split between 1990 and 1994 due to a first Q-wave acute myocardial infarction. Anterior infarctions were correlated with a higher prevalence of diabetes (
P=4×10
−6) or pulmonary venous congestion (
P=2×10
−12); inferior infarctions were correlated with a lower prevalence of hypertension (
P=0.001), hypercholesterolemia (
P=0.02) or diabetes (
P=10
−5), and a higher prevalence of smoking (
P=0.001); lateral infarctions were characterized by a smaller infarction size and lower prevalence of pulmonary congestion (
P=0.002). Among men under the age of 50 with inferior infarction there were 90% smokers, which was significantly more than among their gender (
P=0.005) or infarct site (
P=2×10
−5) counterparts. After adjustment for age and other confounding factors, the prevalence of inferior infarction was higher in men (
P=0.002). Increased age (
P=0.002), female gender (
P=0.0006), anterior site (
P=10
−5), diabetes (
P=0.0003), greater creatine kinase-MB fraction level (
P=0.001) and pulmonary congestion (
P=9×10
−6) were independent predictors of an adverse hospital outcome. Each site of acute myocardial infarction has relatively specific preinfarction and clinical features. Our results suggest a greater importance of vasoconstriction in the pathophysiology of inferior infarction, especially in young male smokers, and greater importance of advanced atherosclerotic process in occurrence of anterior infarction.
The importance of pathophysiological mechanisms involved in onset of acute myocardial infarction (AMI) differs with age, gender, and risk profiles. Diversity in the triggering of cardiovascular ...events has been observed, particularly between men and women. Therefore, we investigated the relationship between age, gender, and risk factors and location of AMI and the presence of Q waves in ECG.
Data was obtained from a chart review of 2958 patients with first AMI: 770 (26%) patients with non-Q-wave AMI and 2188 (74%) patients with Q-wave AMI. Four clinical groups were formed by predetermined criteria (anterior Q-wave, anterior non-Q-wave, inferior Q-wave, inferior non-Q-wave). A logistic regression was performed to assess independent predictors of AMI type and site.
Key findings were: 1) inferior non-Q-wave AMI was more frequent in young women (P<0.001); 2) inferior Q-wave AMI was more common in young men (P<0.001); 3) anterior non-Q-wave AMI was more common in older men (P<0.001). Multivariate analysis revealed that independent predictors of anterior non-Q-wave AMI were age over 65 (P=0.002), male gender (P=0.04) and hypercholesterolemia (P=0.0003), and that predictors of inferior Q-wave AMI were male gender (P<0.0001), smoking (P=0.04) and diabetes (P=0.049). In the gender-subgroup analyses, age <45 years (P=0.04), hypecholesterolemia (P=0.02) and smoking (P=0.01) were independent predictors of inferior Q-wave AMI whereas age >65 years (P<0.0001) and smoking (P=0.0003) were predictors of anterior non-Q-wave AMI in men. In women, age <45 years (P<0.0001) and smoking (P=0.02) were independent predictors of non-Q-wave AMI and hypercholesterolemia (P=0.02) was a predictor of inferior Q-wave AMI.
The link between particular types and the site of AMI and age, gender and risk factors suggest that the importance of pathophysiological mechanisms for onset of AMI differs according to sex and age subgroup.
There are conflicting reports in the literature regarding the role of sex on the in-hospital mortality of patients with acute myocardial infarction. The objective of this study is to determine ...whether there are gender differences in in-hospital mortality and angiographic findings of patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI). We conducted a prospective study of all patients admitted to University Hospital Center Split, Croatia with STEMI from 2004 to 2008 who underwent PCI. From March 2004 throughout September 2008, 488 patients with STEMI underwent PCI (364 men, 74.6%; 124 women, 25.4%). Compared with men, women were significantly older (mean age, 67.3 vs. 60.3 years; p < 0.001). Men had a significantly higher proportion of circumflex artery occlusion (19.5% vs. 10.5%, p = 0.022). A higher proportion of men had a multivessel disease than women (56.8% vs. 41.9%; p = 0.004). In-hospital mortality was significantly higher among women (11.3% vs. 4.6%; p = 0.002) but after adjustment for the baseline difference in age, the female sex was not an independent predictor of in-hospital mortality (adjusted OR 1.15; 95% CI 0.82-1.84). In men, occlusions of left anterior descending artery showed higher mortality rate than occlusions of other coronary arteries (LM 0%, LAD 7.3%, Cx 2.8%, RCA 0.7%, p = 0.03). According to our results female gender is not an independent predictor of in-hospital mortality after percutaneous coronary intervention. In men, occlusions of left anterior descending arteries are associated with higher mortality rate comparing to occlusions of other coronary arteries.
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