Eve Weinblatt

Psychosocial interviews with 2320 male survivors of acute myocardial infarction, participants in the beta-Blocker Heart Attack Trial, permitted the definition of two variables strongly associated with an increased three-year mortality risk. With other important prognostic factors controlled for, the patients classified as being socially isolated and having a high degree of life stress had more than four times the risk of death of the men with low levels of both stress and isolation. An inverse association of education with mortality in this population reflected the gradient in the prevalence of the defined psychosocial characteristics. High levels of stress and social isolation were most prevalent among the least-educated men and least prevalent among the best-educated. The increase in risk associated with stress and social isolation applied both to total deaths and to sudden cardiac deaths and was noted among men with both high and low levels of ventricular ectopy during hospitalization for the acute infarction.

To assess the role of ventricular premature beats in influencing mortality of coronary patients, 1739 men with prior myocardial infarction were monitored for ectopic activity for one hour at a standard base-line examination, and followed for mortality for periods up to four years (average, 24.4 months). Analyses of survival taking into account other important prognostic variables establish that the presence of complex premature beats (R on T, runs of 2 or more, multiform or bigeminal premature beats) in the monitoring hour is associated with a risk of sudden coronary death three times that of the men free of complex ventricular premature beats. The corresponding risk of death from any cause is twice that of men without such complex beats in the hour. These arrhythmias make an independent contribution to increased risk of death that persists over the length of this observation period.

Among 1739 male survivors of myocardial infarction, mortality over 5 years was examined in relation to presence of complex ventricular premature complexes (R on T, runs of two or more, multiform or bigeminal complexes) identified during 1 hour of monitoring. Such arrhythmia was associated with excess risk of death over the entire period. Men with R on T or runs during the hour show a 5-year sudden coronary death rate of 25%, compared with 6% of men free of premature complexes. Men with complex ventricular premature complexes are also at relatively higher risk for nonsudden cardiac death than the other men (5-year mortality 15% and 7%, respectively), but no additional disadvantage was associated with the presence of R on T or runs. Multivariate survival analyses, controlling simultaneously for other important clinical factors, identify complex ventricular premature complexes as the strongest influence on risk of sudden coronary death and congestive heart failure as the strongest influence on risk of other cardiac death.

Prognosis of men after first myocardial infarction: mortality and first recurrence in relation to selected parameters. E Weinblatt, S Shapiro, C W Frank, and R V SagerCopyRight https://doi.org/10.2105/AJPH.58.8.1329 Published Online: August 29, 2011

Abstract Preliminary findings in the H.I.P. study of incidence and prognosis of CHD have been presented. The data shown are restricted to incidence of MI and angina as related to age and sex, smoking practices, and physical activities on the job and off the job. Comparisons are made between the results of the H.I.P. study and those of other studies, principally the Framingham and Albany studies, when data are available. Age-sex differentials in MI rates obtained in the H.I.P. study are similar to those observed in other studies except for a comparatively small increase between ages 45–54 and 55–64 years in the MI rates for men. Age-sex rates for angina are lower in the H.I.P. study than in the other investigations. The association between cigarette smoking and MI among men reported by the Framingham and Albany investigators was observed in the current study. A similar association was detected for women. The H.I.P. study also found an association among men between cigarette smoking and angina. In the other studies no such association was detected. Physical activities off the job and on the job have been combined to form a three class gradient of ‘light’, ‘intermediate’ and ‘heavy’ activities. Men with ‘light’ physical Activities have an elevated risk for MI; men with ‘heavy’ physical activities seem to have a comparatively high risk for angina. No directly comparable data are available from other studies.