Advertisement

Post-Hospital Management of Myocardial Infarction

  • Elliott M. Antman
  • John D. Rutherford

Abstract

Over the last decade there has been considerable interest in analyzing differences in outcome among patients with “nontransmural” versus “transmural” infarction [1–10]. Although these terms have been used for many years to classify patients after serial electrocardiographic evaluation, the correlation between “transmural” and Q-wave infarction or between “nontransmural” and non-Q-wave infarction with regard to pathological findings is imperfect [11]. Infarctions found to be transmural on pathological examination can occur in the absence of Q waves on the ECG, while those found to be nontransmural may be associated with the appearance of new Q waves [12]. We prefer to describe infarcts as being either Q-wave or non-Q-wave on the basis of serial ECG evaluation. In most instances of Q-wave infarction, the infarct will most likely, but not necessarily, be transmural.

Keywords

Myocardial Infarction Acute Myocardial Infarction Sudden Death Beta Blocker Acute Infarction 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Madias JE, Chahine RA, Gorlin R, Blacklow DJ: A comparison of transmural and nontransmural acute myocardial infarction. Circulation 49: 498–507, 1974.PubMedGoogle Scholar
  2. 2.
    Rigo P, Murray M, Taylor DR, Weisfeldt ML, Strauss HW, Pitt B: Hemodynamic and prognostic findings in patients with transmural and nontransmural infarction. Circulation 51: 1064–1070, 1975.PubMedGoogle Scholar
  3. 3.
    Cannom DS, Levy W, Cohen LS: The short-and long-term prognosis of patients with transmural and nontransmural myocardial infarction. Am J Med 61: 452–458, 1976.PubMedCrossRefGoogle Scholar
  4. 4.
    Szklo M, Goldberg R, Kennedy HL, Tonascia JA: Survival of patients with nontransmural myocardial infarction: A population-based study. Am J Cardiol 42: 648–652, 1978.PubMedCrossRefGoogle Scholar
  5. 5.
    Fabricius-Bierre N, Munkvad M, Knudsen JB: Subendocardial and transmural myocardial infarction. A five year survival study. Am J Med 66: 986–990, 1979.CrossRefGoogle Scholar
  6. 6.
    Boxall J, Saltups A: A comparison of nontransmural and transmural myocardial infarction. Aust NZ J Med 10: 176–179, 1980.CrossRefGoogle Scholar
  7. 7.
    Hutter AM, DeSanctis RW, Flynn T, Yeatman LA: Nontransmural myocardial infarction: A comparison of hospital and late clinical course of patients with that of matched patients with trans-mural anterior and transmural inferior myocardial infarction. Am J Cardiol 48: 595–602, 1981.PubMedCrossRefGoogle Scholar
  8. 8.
    Marmor A, Geltman EM, Schechtman K, Sobel BE, Roberts R: Recurrent myocardial infarction: Clinical predictors and prognostic implications. Circulation 66(2): 415–421, 1982.Google Scholar
  9. 9.
    Thanavaro S, Krone RJ, Kleiger RE, Province MA, Miller JP, DeMello VR, Oliver GC: In-hospital prognosis of patients with first nontransmural and transmural infarctions. Circulation 61: 29–33, 1980.PubMedGoogle Scholar
  10. 10.
    Krone RJ, Friedman E, Thanavaro S, Miller JP, Kleiger RE, Oliver GC: Long-term prognosis after first Q-wave (transmural) or non-Q-wave (nontransmural) myocardial infarction: Analysis of 593 patients. Am J Cardiol 52: 234–239, 1983.PubMedCrossRefGoogle Scholar
  11. 11.
    Spodick DH: Q-wave infarction versus ST infarction: Non-specificity of electrocardiographic criteria for differentiating transmural from nontransmural lesions. Am J Cardiol 51: 913–915, 1983.PubMedCrossRefGoogle Scholar
  12. 12.
    Sullivan W, Vlodaver Z, Tuna N, Long L, Edwards JE: Correlation of electrocardiographic and pathologic findings in healed myocardial infarctions. Am J Cardiol 42: 724–732, 1978.PubMedCrossRefGoogle Scholar
  13. 13.
    Schulze RA, et al: Coronary angiography and left ventriculography in survivors of transmural and non-transmural myocardial infarction. Am J Med 64: 108–113, 1978.PubMedCrossRefGoogle Scholar
  14. 14.
    Madigan NP, Rutherford BD, Frye RL: The clinical course, early prognosis and coronary anatomy of subendocardial infarction: Am J Med 60: 634–641, 1976.PubMedCrossRefGoogle Scholar
  15. 15.
    Mahoney C, Hindman MC, Aronin N, Wagner GS: Prognostic differences in subgroups of patients with electrocardiographic evidence of subendocardial or transmural myocardial infarction. The favorable outlook for patients with initially normal QRS complex. Am J Med 69: 183–186, 1980.CrossRefGoogle Scholar
  16. 16.
    Gordon T, Castelli WP, Hjortland MC, Kannel WB, Dawber TR: High density lipoprotein as a protective factor against coronary heart disease: The Framingham Study. Am J Med 62: 707–714, 1977.PubMedCrossRefGoogle Scholar
  17. 17.
    Kannel WB, Castelli WP, Gordon T: Cholesterol in the prediction of atherosclerotic disease. New perspectives based on the Framingham Study. Ann Intern Med 90: 85–91, 1979.PubMedGoogle Scholar
  18. 18.
    Coronary Drug Project Research Group: Natural history of myocardial infarction in the Coronary Drug Project: Long term prognostic importance of serum lipid levels. Am J Cardiol 42: 489–198, 1978.CrossRefGoogle Scholar
  19. 19.
    Schlant RC, Forman S, Stamler J, Canner PL: The natural history of coronary heart disease: Prognostic factors after recovery from myocardial infarction in 2,789 men. The five year findings of the Coronary Drug Project. Circulation 66: 401–414, 1982.PubMedCrossRefGoogle Scholar
  20. 20.
    Kallio V, Hamalainen H, Hakkila J, Luurila OJ: Reduction in sudden deaths by multifactorial intervention program after acute myocardial infarction. Lancet 2: 1091–1094, 1979.PubMedCrossRefGoogle Scholar
  21. 21.
    Vedin A, Wilhelmsson C, Tibblin G, Wilhelmsen L: The Post-infarction Clinic in Goteborg, Sweden. A controlled trial of a therapeutic organization. Acta Med Scand 200: 453–456, 1976.PubMedCrossRefGoogle Scholar
  22. 22.
    May GS, et al: Secondary prevention after myocardial infarction: A review of long term results. Progr Cardiovas Dis 24: 331–352, 1982.CrossRefGoogle Scholar
  23. 23.
    The Pooling Project Research Group: Relationship of blood pressure, serum cholesterol, smoking habit, relative weight and ECG abnormalities to incidence of major coronary events: Final report of Pooling Project. J Chron Dis 31: 201–306, 1978.CrossRefGoogle Scholar
  24. 24.
    Gordon T, Kannel WB, McGee D, Dawber TR: Death and coronary attacks in men after giving up cigarette smoking. Lancet 2: 1345–1348, 1974.PubMedCrossRefGoogle Scholar
  25. 25.
    Seltzer C: Smoking and coronary disease: What are we to believe: Am Heart J 100: 275–280, 1980.PubMedCrossRefGoogle Scholar
  26. 26.
    Wilhelmsson C, Vedin JA, Elmfeldt D, Tibblin G, Wilhelmsen L: Smoking and myocardial infarction. Lancet 1: 415–419, 1975.PubMedCrossRefGoogle Scholar
  27. 27.
    Salonen JT: Stopping smoking and long term mortality after acute myocardial infarction. Br Heart J 43: 463–469, 1980.PubMedCrossRefGoogle Scholar
  28. 28.
    Sparrow D, Dawber TR, Colton T: The influence of cigarette smoking on prognosis after first myocardial infarction. A report from the Framingham Study. J Chron Dis 31: 425–432, 1978.PubMedCrossRefGoogle Scholar
  29. 29.
    Morris JN, Heady JA, Raffle PAB, Roberts CG, Parks JW: Coronary heart disease and physical activity of work. Lancet 2: 1053–1057 and 1111-1120, 1953.CrossRefGoogle Scholar
  30. 30.
    Taylor HL, Klepetar E, Keyes A, Parlin W, Blackburn H, Puchner T: Death rate among physically active and sedentary employees of the Railroad Industry. Am J Pub Health 53:1697, 1962.Google Scholar
  31. 31.
    Kahn HA: The relationship of reported coronary heart disease mortality to physical activity of work. Am J Pub Health 53:1058, 1963.Google Scholar
  32. 32.
    Shapiro S, Weinblatt E, Frank CW, Sager RV: Incidence of coronary heart disease in a population insured for medical care ((H.I.P.). Am J Pub Health 59 (Suppl), 1969.Google Scholar
  33. 33.
    Cassel J, Heyden S, Bartel AG, Kaplin BH, Tyroler HA, Coroni JC, Harnes CG: Occupation and physical activity and coronary heart disease. Arch Intern Med 128: 920–928, 1971.PubMedCrossRefGoogle Scholar
  34. 34.
    Brunner D, Manelis G, Mordan M, Levin S: Physical activity at work and the incidence of myocardial infarction, angina pectoris, and death due to Ischemic heart disease. J Chron Dis 27: 217–233, 1974.PubMedCrossRefGoogle Scholar
  35. 35.
    Paffenbarger RS, Hale WE: Work activity and coronary heart mortality. N Engl J Med 292: 545–550, 1975.PubMedCrossRefGoogle Scholar
  36. 36.
    Morris JN, Everitt MG, Pollard R, Chave SPW: Vigorous exercise in leisure time: Protection against coronary heart disease. Lancet 2: 1207–1210, 1980.PubMedCrossRefGoogle Scholar
  37. 37.
    Miller NE, Rad S, Lewis B, Bjorsvik G, Myhre K, Mjos OD: High density lipoproteins and physical activity. Lancet 1:111, 1979.Google Scholar
  38. 38.
    Ronnemaa T, Lehtonen A, Tammi N, Vihersaar IT, Viikari J: Running, HDL-cholesterol and atherosclerosis. Lancet 2: 1261–1262, 1978.PubMedCrossRefGoogle Scholar
  39. 39.
    La Rosa JC, Cleary P, Muesing RA, Gorman P, Hellerstein HK, Naughton J: Effective long term moderate physical exercise on plasma lipoproteins: The National Exercise and Heart Disease Project. Arch Intern Med 142: 2269–2274, 1982.CrossRefGoogle Scholar
  40. 40.
    Sedgwich AW, Brotherhood JR, Harris-Davidson A, Taplin RE, Thomas DW: Long-term effects of physical training programme on risk factors for coronary heart disease in otherwise sedentary men. Br Med J 281: 7–10, 1980.CrossRefGoogle Scholar
  41. 41.
    Brownwell KD, Bachorik PS, Ayerle RS: Changes in plasma lipid and lipoprotein levels in men and women after a program of moderate exercise. Circulation 65: 477–484, 1982.CrossRefGoogle Scholar
  42. 42.
    Bruce EH, Frederick R, Bruce RA, Fitcher LD: Comparisons on active participants and dropouts in the CAPRI cardiopulmonary rehabilitation program. Am J Cardiol 37: 53–60, 1976.PubMedCrossRefGoogle Scholar
  43. 43.
    Ashley FW, Kannel WB: Relation of weight change to changes in atherogenic traits. The Framingham Study. J Chron Dis 27: 103–114, 1974.PubMedCrossRefGoogle Scholar
  44. 44.
    Gordon T, Kannel WB, et al: Diabetes, blood lipids and the role of obesity in coronary heart disease risks for women: The Framingham Study. Ann Intern Med 87: 393–397, 1977.PubMedGoogle Scholar
  45. 45.
    Rosenberg L, et al: Myocardial infarction in women under 50 years of age. JAMA 250: 2801–2806, 1983.PubMedCrossRefGoogle Scholar
  46. 46.
    Glover MU, Kuber MT, Warren SE, Vieweg WVR: Myocardial infarction before age 36: Risk factor and arteriographic analysis. Am J Cardiol 49: 1600–1603, 1982.PubMedCrossRefGoogle Scholar
  47. 47.
    Morris DC, Hurst JW, Logue RB: Myocardial infarction in young women. Am J Cardiol 38: 299–304, 1976.PubMedCrossRefGoogle Scholar
  48. 48.
    Nixon JV, et al: Myocardial infarction in men in the third decade of life (Letter). Ann Intern Med 85: 759–760, 1976.PubMedGoogle Scholar
  49. 49.
    Simonson E, Berman R: Myocardial infarction in young people — experience in USSR. Am Heart J 84: 814–822, 1972.PubMedCrossRefGoogle Scholar
  50. 50.
    Salel AF, Riggs K, Mason DT, et al: The importance of type IV hyperlipoproteinemia as a predisposing factor in coronary artery disease. Am. J Med 57: 897–903, 1974.PubMedCrossRefGoogle Scholar
  51. 51.
    Elwood PC, Cochrane AL, Burr ML, et al: A randomized controlled trial of acetylsalicylic acid in the secondary prevention of mortality from myocardial infarction. Br Med J 1: 436–440, 1974.PubMedCrossRefGoogle Scholar
  52. 52.
    The Coronary Drug Project Research Group: Aspirin in coronary heart disease. J Chron Dis 29: 625–642, 1976.CrossRefGoogle Scholar
  53. 53.
    Breddin K, Loew D, Lechner K, Uberla K, Walter E: Secondary prevention of myocardial infarction. Comparison of acetylsalicylic acid, phenprocoumon and placebo. A multicenter two-year prospective study. Thromb Haemostas 41: 225–236, 1979.Google Scholar
  54. 54.
    Elwood PC, Sweetman PM: Aspirin and secondary mortality after myocardial infarction. Lancet 2: 1313–1321, 1979.PubMedCrossRefGoogle Scholar
  55. 55.
    Aspirin Myocardial Infarction Study Research Group: A randomized controlled trial of aspirin in persons recovered from myocardial infarction. JAMA 243: 661–669, 1980.CrossRefGoogle Scholar
  56. 56.
    The Persantine Aspirin Reinfarction Trial Research Group: Persantine and aspirin in coronary heart disease. Circulation 62: 449–461, 1980.Google Scholar
  57. 57.
    The Anturane Reinfarction Trial Research Group: Sulfinpyrazone in the prevention of sudden death after myocardial infarction. N Engl J Med 302: 250–256, 1980.CrossRefGoogle Scholar
  58. 58.
    The Anturane Reinfarction Trial Policy Committee. The Anturane Reinfarction Trial: Re-evaluation of outcome. N Engl J Med 306: 1005–1008, 1982.CrossRefGoogle Scholar
  59. 59.
    The Anturane Reinfarction Italian Study: Sulfinpyrazone and post-myocardial infarction. Lancet 1: 237–242, 1982.Google Scholar
  60. 60.
    The EPSIN Research Group: A controlled comparison of aspirin and oral anticoagulants in prevention of death after myocardial infarction. N Engl J Med 307: 701–708, 1982.CrossRefGoogle Scholar
  61. 61.
    Collaborative Group: Phenytoin after recovery from myocardial infarction: Controlled trial in 568 patients. Lancet 2: 1055–1057, 1971.Google Scholar
  62. 62.
    Ryden L, Amman K, Conradson T-B, et al: Prophylaxis of ventricular tachyarrhythmias with intravenous and oral tocainide in patients with and recovering from acute myocardial infarction. Am Heart J 100: 1006–1012, 1980.PubMedCrossRefGoogle Scholar
  63. 63.
    Bastian BC, McFarland PW, McLauchlan JH, et al: A prospective randomized trial of tocainide in patients following myocardial infarction. Am Heart J 100: 1017–1022, 1980.PubMedCrossRefGoogle Scholar
  64. 64.
    Chamberlain DA, Jewitt DE, Julian DG, et al: Oral mexiletine in high-risk patients after myocardial infarction. Lancet 2: 1324–1327, 1980.PubMedCrossRefGoogle Scholar
  65. 65.
    Van Durme JP, Hagemeijer F, Bogaert M, et al: Chronic antidysrhythmic treatment after myocardial infarction. Design of the Ghent-Rotterdam Aprindine Study. In Boissel JP, Klimt CR (eds): Multicenter Controlled Trials: Principles and Problems. INSERM, Paris, 1977, p. 43.Google Scholar
  66. 66.
    Turi ZG, Braunwald E: The use of beta blockers after myocardial infarction. JAMA 249: 2512–2516, 1983.PubMedCrossRefGoogle Scholar
  67. 67.
    Baber NS, Lewis JA: Confidence in results of beta blocker postinfarction trials. Br Med J 285: 37–39, 1982.CrossRefGoogle Scholar
  68. 68.
    Hampton JR: Should every survivor of a heart attack be given a beta blocker? Part 1: Evidence from clinical trials. Br Med J 285: 33–36, 1982; Breckenridge A: Should every survivor of a heart attack be given a beta blocker? Part 2: Evidence from a clinical pharmacological standpoint. Br Med J 285:37-39, 1982.CrossRefGoogle Scholar
  69. 69.
    The Norwegian Multicenter Study Group: Timolol-induced reduction in mortality and reinfarction in patients surviving acute myocardial infarction. N Engl J Med 304: 801–807, 1981.CrossRefGoogle Scholar
  70. 70.
    Hjalmarson A, Herlitz J, Malek I, Ryden L, Vedin A, Waidenstrom A, Wedel H, Elmfeldt D, Holmberg S, Nyberg G, Swedberg K, Waagstein F, Waidenstrom J, Wilhelmsen L, Wilhelmsson C: Effect on mortality of metoprolol in acute myocardial infarction. A double-blind, randomized trial. Lancet 2: 823–827, 1981.PubMedCrossRefGoogle Scholar
  71. 71.
    Beta-Blocker Heart Attack Trial Research Group: A randomized trial of propranolol in patients with acute myocardial infarction. 1. Mortality results. JAMA 247: 1707–1714, 1982.CrossRefGoogle Scholar
  72. 72.
    Shand DG: Beta adrenergic blocking drugs after acute infarction. Mod Conc Cardiovasc Dis 51: 103–106, 1982.Google Scholar
  73. 73.
    Hansteen V, et al: One year’s treatment with propranolol after myocardial infarction: Preliminary report of Norwegian Multicentre Trial. Br Med J 284: 155–160, 1982.CrossRefGoogle Scholar
  74. 74.
    Sami M, Kraemer H, De Busk RF: The prognostic significance of serial exercise testing after myocardial infarction. Circulation 60: 1238–1246, 1979.PubMedGoogle Scholar
  75. 75.
    Theroux P, et al: Prognostic value of exercise testing soon after myocardial infarction. N Engl J Med 301: 341–345, 1979.PubMedCrossRefGoogle Scholar
  76. 76.
    Starling MR, et al: Exercise testing early after myocardial infarction: Predictive value for subsequent unstable angina and death. Am J Cardiol 46: 909–914, 1980.PubMedCrossRefGoogle Scholar
  77. 77.
    Kopes GM, et al: Response to exercise early after uncomplicated acute myocardial infarction in patients receiving no medication: Long term follow up. Am J Cardiol 46: 764–769, 1980.CrossRefGoogle Scholar
  78. 78.
    Turner JD, Schwartz KM, Logic JR, et al: Detection of residual jeopardized myocardium three weeks after myocardial infarction by exercise testing with thallium-201 myocardial scintigra-phy. Circulation 61: 729–737, 1980.PubMedGoogle Scholar
  79. 79.
    Scheiben HR, et al: Serial measurements of left ventricular ejection fraction by radionuclide angiography early and late after myocardial infarction. Am J Cardiol 38: 407–415, 1976.CrossRefGoogle Scholar
  80. 80.
    Battler RA, et al: Left ventricular ejection fraction and first third ejection fraction early after acute myocardial infarction: Value for predicting mortality and morbidity. Am J Cardiol 45: 197–202, 1980.PubMedCrossRefGoogle Scholar
  81. 81.
    Wasserman AG, et al: Non-invasive detection of multivessel disease after myocardial infarction by exercise radionuclide ventriculography. Am J Cardiol 50: 1242–1247, 1982.PubMedCrossRefGoogle Scholar
  82. 82.
    Schulze RA, Strauss HW, Pitt B: Sudden death in the year following myocardial infarction: Relation to ventricular premature contractions in the late hospital phase in left ventricular ejection fractions. Am J Med 62: 192–199, 1977.PubMedCrossRefGoogle Scholar
  83. 83.
    Cohn PF: Current concepts: The role of non-invasive cardiac testing after an uncomplicated myocardial infarction. N Engl J Med 308: 90–93, 1983.CrossRefGoogle Scholar
  84. 84.
    Epstein SE, Palmen ST, Patterson RE: Current concepts: Evaluation of patients after acute myocardial infarction. Indications for cardiac catheterization and surgical intervention. N Engl J Med 307: 1487–1491, 1982.PubMedCrossRefGoogle Scholar
  85. 85.
    Coronary Artery Surgery Study (CASS): A randomized trial of coronary artery bypass surgery. Survival data. Circulation 68: 939–950, 1983.CrossRefGoogle Scholar
  86. 86.
    Norris RM, Barnaby PF, Brandt PWT, et al: Prognosis after recovery from first acute myocar-dial infarction: Determinants of reinfarction and sudden death. Am J Cardiol 53: 408–413, 1984.PubMedCrossRefGoogle Scholar
  87. 87.
    Dagenais GR, Rouleau JR, Christen A, Fabia J: Survival of patients with a strongly positive exercise electrocardiogram. Circulation 64: 452–456, 1982.CrossRefGoogle Scholar
  88. 88.
    Hecht S, Rahimtoola SH: Unstable angina. A perspective. Chest 82: 466–472, 1982.PubMedCrossRefGoogle Scholar

Copyright information

© Martinus Nijhoff Publishing, Boston. 1986

Authors and Affiliations

  • Elliott M. Antman
    • 1
  • John D. Rutherford
    • 1
    • 2
  1. 1.Cardiovascular DivisionBrigham and Women’s HospitalBostonUSA
  2. 2.CardiologistGreen Lane HospitalAucklandNew Zealand

Personalised recommendations