Acute Myocardial Infarction (AMI) Versus Posterior Myocardial Infarction

Gurbir Singh Josan
Kharkov National Medical University

Introduction: It is known that patients with anterior MI usually have worse outcome and prognosis compared with those with inferior (posterior) MI.

To evaluate the outcome and prognostic significance of patients with AMI depending on it’s location (anterior vs inferior), patient’s sex , LVEF and the relation between them.

Material and Methods: 43 patients with diagnosis of AMI were examined and investigated in a period of 3 weeks.
They were all examined with a routine clinical tests and specific methods of investigations were performed to estimate infarction’s location, its complications and the level of LVEF.

Patients were grouped according to location of the infarction(anterior 67% (n=29); inferior 33% (n=14) ), the patient’s sex (men 61% (n=26); woman 39% (n=17) ), the level of LVEF( 61% of patients had EF40%).

Results: It was found that most patients with anterior MI had a substantially worse outcomes and prognosis(60% were presented with complications and low LVEF 38% ) compared with those with inferior MI(16% had complications with LVEF 43.7%).Complications in patients with AMI includes: conduction defects18%; aneurysm 12%;arrhythmia10%;and acute pulmonary edema 4%. Also it was revealed that 80% of men with AMI were having complications compared with woman only 40%.And mostly patients with MI complications(65%) demonstrated a low level of LVEF(33%) which correlates with left ventricular systolic dysfunction.

1. Patients with anterior MI usually have worse outcome and prognosis compared with those with inferior (posterior) MI.
2. Men with AMI develop complications more often than in woman (ratio 2:1).
3. Appearance of complications in patients with AMI is connected with systolic dysfunction of the left ventricle.

The Association Between Serum Total Cholesterol Level and Deaths Caused by Coronary Heart Disease

N. Ghafari1, S. Baghdadi2
1Shahid Beheshti University of Medical Sciences
2Tehran University of Medical Sciences

Introduction: Coronary heart disease is the first cause of death in the whole world. The serum total cholesterol level predicts the risk of coronary heart disease in middle-aged men, but results are inconsistent in studies on serum cholesterol and mortality among the elderly. This study was done to determine the relation between the serum total cholesterol level and the mortality caused by coronary heart disease.

Material and Methods: A surveillance study was done in Tehran to identify cases of the changes in serum cholesterol level and mortality during a 3 year period (2004-2008) among 646 50-75 year old men and women who were asymptomatic of coronary heart disease in 2004. These patients referred to Imam Khomeini hospital for symptoms not related to coronary heart disease. Changes in serum cholesterol level were computed based on measurements made in 2004, 2006 and 2008 and were requested to supply us with their past tests if any. Patients participating in this study were followed by phone to look for any deaths occurring in the time of the study.

Results: 168 patients (26%) died during a 4 year period. 93 deaths (55%) were caused by coronary heart disease, 38 deaths (22%) were caused by cancer and the remaining deaths were related to other causes including traffic accidents, falls, suicide and burns. Among 397 patients aged 50-60, 67 died of coronary heart disease. Among these patients, 63 had cholesterol levels higher than 250 and 27 higher than 400. However, the relation between serum cholesterol levels and the mortality caused by coronary heart disease in elderly patients was not this significant.

Conclusion: There is a significant association between serum total cholesterol level and deaths caused by coronary heart disease in 50-60 year old patients. However, among older patients other factors such as aging and increased incidence of chronic diseases seem to be responsible for a significant proportion of deaths. This study helps to explain why some previous studies have not found an association between serum cholesterol level and deaths caused by coronary heart disease among elderly. We believe that government should take strong actions to reduce the risk factors of coronary heart disease by changing the modern lifestyle, and for these actions to work, they ought to be started from early stages of life.

Genetic Variation in Fibrinogen; its Relation to Fibrinogen Levels and the Risk of Myocardial Infarction and Ischemic Stroke

B. Siegerink, F.R. Rosendaal, A. Algra
Julius Center for Health Sciences and Primary Care, University Medical Center

Introduction: Confounding by common causes and reverse causation have been proposed as explanations of the association of high fibrinogen levels and cardiovascular disease. Genetic variants can alter fibrinogen characteristics and are not subject to these problems.

To determine the fibrinogen plasma levels for genotypic variants in fibrinogen-alpha (FGA6534, Thr312Ala) and fibrinogen-beta (FGB1437, G-455A) and whether these variants are associated with arterial thrombosis.

Material and Methods: Fibrinogen genotypes were determined in a population based case-control study including women aged 18-50 years; 218 cases with myocardial infarction, 192 cases with ischemic stroke and 769 healthy controls. Fibrinogen levels were determined in the control population.

Results: Carriers of the FGB1437 carriers of the rare allele (-455A) had higher fibrinogen levels than carriers of the common allele. For FGA6524 carriers of the common allele (Thr312) fibrinogen levels were also increased, albeit to a minor extent. When comparing the homozygote carriers of the high fibrinogen allele to the homozygote carriers of the low fibrinogen allele the odds ratio and corresponding 95% confidence level of myocardial infarction did not increase (1.22; 0.72 to 2.06 for FGA6534/Thr312 and 0.82; 0.49 to 1.39 for FGB1437/-455A). The risk of ischemic stroke was increased for both the FGA6534/Thr312 (2.32; 1.15 to 4.69) and FGB1437/-455A variant (1.76; 0.7 to 4.03).

Conclusion: With the genetic variations as markers of increased plasma fibrinogen levels (especially FGB1437/-455A) to rule out confounding and reverse causation these results suggest plasma fibrinogen levels are more important as risk factors for ischemic stroke than for myocardial infarction.