Predictors of Acute Myocardial Infarction Development in Personnel of Radiation Dangerous Plants. Medical Radiology and Radiation Safety

2021 ◽  
Vol 66 (1) ◽  
pp. 37-43
Author(s):  
Yu. Semenova ◽  
A. Karpov ◽  
T. Takhauova ◽  
D. Kalinkin ◽  
A. Takhauov ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Radiation Dose ◽  
Risk Groups ◽  
Individual Risk ◽  
Working Age ◽  
The Individual ◽  
Medical Radiology ◽  
Biochemical Indices ◽  
Siberian Group

Purpose: To examine the predictors of acute myocardial infarction development and to evaluate the relationship of the radiation component (external γ-radiation) with the probability of developing acute myocardial infarction in workers of radiation-dangerous plants working age (under 60 for men, 55 for women), by the example of the Siberian Group of Chemical Enterprises personnel. Material and methods: The work is based on the results of a prospective population study (1998–2013). The diagnosis of acute myocardial infarction was verified in 540 people of working age (34 women and 506 men). For each case selected control (n = 1,080) among the employees of the Siberian Group of Chemical Enterprises, passed periodic medical examination in the study period. Every person was described by means of 46 variables including characteristics of social status, a number of risk factors, associated diseases, biochemical indices including the level of general cholesterol, the main clinical data, cumulative dose of external radiation and the amount of 239Pu content in an organism. Results: It was determined that in the group of the personnel of working age the most important traditional predictors of acute myocardial infarction, less important factor in the pathogenesis of the disease are conditions of the individual accumulation of a dose, but not the magnitude of the total external doses in the evaluation range. Conclusion: To improve the system of preventive measures aimed at reducing the level of morbidity and mortality from acute myocardial infarction, it is recommended to form risk groups taking into account the most significant predictors of this disease (age, systolic blood pressure, smoking). For the personnel of radiation dangerous plants working age insignificant conditions for the formation of radiation dose (age of first exposure, the rate of accumulation of radiation dose, duration of exposure) under conditions of trouble-free operation of the equipment. Active measures for the diagnosis of coronary heart disease and targeted correction of detected somatic disorders for the prevention of acute vascular catastrophes are expedient for workers of radiation hazardous industries from 40 to 60 years with an individual risk of acute myocardial infarction less than 50 % using the model described below.

Relationship between degree of heparin anticoagulation and clinical outcome in patients receiving potent P2Y12-inhibitors with no planned glycoprotein IIb/IIIa inhibitor during percutaneous coronary intervention in acute myocardial infarction: a VALIDATE-SWEDEHEART substudy

2019 ◽  
Vol 6 (1) ◽  
pp. 6-13 ◽  
Author(s):  
Tania Sharma ◽  
Rebecca Rylance ◽  
Sofia Karlsson ◽  
Sasha Koul ◽  
Dimitrios Venetsanos ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Stent Thrombosis ◽  
Composite Endpoint ◽  
Coronary Intervention ◽  
Heparin Dose ◽  
P2y12 Inhibitors ◽  
Percutaneous Coronary ◽  
The Individual

Abstract Aims Heparin is the preferred choice of anticoagulant in percutaneous coronary intervention (PCI) for acute myocardial infarction (MI). An established dosage of heparin has not yet been determined, but treatment may be optimized through monitoring of activated clotting time (ACT). The aim of this study was to determine the relationship between heparin dose or ACT with a composite outcome of death, MI, or bleeding using data from the registry-based, randomized, controlled, and open-label VALIDATE-SWEDEHEART trial, although patients were not randomized to heparin dose in this substudy. Methods and results Patients with MI undergoing PCI and receiving treatment with a potent P2Y12-inhibitor and anticoagulation with heparin, without the planned use of glycoprotein IIb/IIIa inhibitor (GPI), were enrolled in this substudy. The primary endpoint was a composite endpoint of death, MI, and bleeding at 30 days. The individual components and stent thrombosis were analysed separately. We divided patients into groups according to the initial dose of unfractionated heparin during PCI (<70 U/kg, 70–100 U/kg, and >100 U/kg) or ACT (ACT <250 s, 250–350 s, and >350 s) as well as investigating them as continuous variables in Cox proportional hazards models using univariable and multivariable analyses. No major differences were noted between heparin stratified in groups (P = 0.22) or heparin as a continuous variable in relation to the primary composite endpoint hazard ratio (HR) 1.0 confidence interval (CI) (0.99–1.01) for heparin dose/kg. No differences were found between ACT stratified in groups (P = 0.453) or ACT in seconds HR 1.0 CI (0.99–1.00) regarding the primary endpoint. The individual components of death, MI, major bleeding, and stent thrombosis were not significantly different across heparin doses or ACT levels either. Conclusion We found no association between heparin dose or ACT levels and death, MI bleeding complications, or stent thrombosis. Therefore, there is no strong support for a specific heparin dose or mandatory ACT monitoring in patients treated with potent P2Y12-inhibitors with no planned GPI.

The impact of smoke-free air laws and conventional cigarette taxes on cardiovascular hospitalizations

2021 ◽  
Author(s):  
Jon F Oliver
Keyword(s):  
Myocardial Infarction ◽  
Older Adults ◽  
Acute Myocardial Infarction ◽  
Cerebrovascular Disease ◽  
Local Level ◽  
National Level ◽  
State Level ◽  
Cigarette Taxes ◽  
Free Air ◽  
Working Age

Abstract Introduction Smoke-free air legislation and conventional cigarette taxes have long been used to reduce smoking initiation, prevalence, and conventional cigarette consumption. However, the extent to which these policies affect population health across a range of diagnoses and age groups remains less well understood. Methods Analyses use 2005-2014 hospital inpatient discharge data from up to 40 US states to estimate the effects of smoke-free air laws and conventional cigarette taxes on cardiovascular hospitalizations among working age and older adults. Results An increase in the percent of a county’s population covered by smoke-free air laws yielded a significant decline of 2.4% (RR: 0.976, 95%CI: 0.954, 0.997) in acute cerebrovascular disease hospitalizations among older adults. Moreover, significant declines of 2.0% (RR: 0.980, 95%CI: 0.967, 0.994) and 2.8% (RR: 0.972, 95%CI:0.949, 0.996) in acute cerebrovascular disease were observed among older adults in the first year and subsequent years after smoke-free air legislation was implemented, respectively. Conventional cigarette taxes did not yield a significant change in acute cerebrovascular disease hospitalizations, nor did either tobacco control policy lead to a significant decline in acute myocardial infarction hospitalizations. Conclusions Smoke-free air laws play an important role in reducing adult cardiovascular hospitalizations. These findings confirm existing research on acute cerebrovascular disease outcomes, as well as the modest effects on acute myocardial infarction hospitalizations observed in state- and national-level analyses. Implications Current research at the local level finds smoke-free air laws yield 40% declines in acute myocardial infarction hospitalizations and 29% declines in acute cerebrovascular disease.State- and national-level analyses find smaller effects of smoke-free air laws, and largely omits analyses of working age adults. Existing research likely suffers from omitted variable bias, including state-level tobacco control funding and local-level conventional cigarette taxes. Using adult hospitalization data from up to 40 states, this study confirms existing evidence at the national and state level, and provides new evidence that smoke-free air laws significantly reduce acute cerebrovascular disease hospitalizations among older adults.

Forecast of Radiation Risks of the Population in the Contaminated 137Cs Territories of Russia, in Accordance with Current ICRP Recommendations

2020 ◽  
Vol 65 (3) ◽  
pp. 45-52
Author(s):  
A. Menyajlo ◽  
V. Kashcheev ◽  
E. Pryakhin ◽  
M. Maksyutov ◽  
K. Tumanov ◽  
...  
Keyword(s):  
Effective Dose ◽  
Environmental Protection Agency ◽  
Radiation Risk ◽  
Risk Groups ◽  
Individual Risk ◽  
Maximum Increase ◽  
Population Groups ◽  
Health Authorities ◽  
The Us ◽  
The Individual

Purpose: Calculations of radiation detriment to the population currently living (in 2020) in the territories of Russia contaminated with 137Cs after the Chernobyl accident in 1986. Material and methods: Radiation detriment was calculated in two ways: according to the original ICRP method, and approximate calculation as the product of the nominal risk factor of RSS-99/2009 by the effective dose (nominal radiation detriment). For ICRP calculations, equivalent doses were estimated using the dose coefficients of the US Environmental Protection Agency (EPA). The number of the studied population at the beginning of 2020 was 142676 people, 65205 men and 77471 women. This is mainly the population of the Bryansk region and Tula region, 85.5 % and 10 % of the total population, respectively. The average accumulated effective dose of the population was 30.6 mSv, and the maximum individual accumulated dose was 707 mSv. Results: In 2020, for men at the age of 44 and for women at the age of 55, the nominal radiation detriment is approximately equal to the value of radiation detriment calculated using the ICRP method. At the same time, the nominal detriment is significantly (up to 2.3 times) underestimated for younger and overestimated for older ages. In 2020, the critical population groups with the highest accumulated doses and maximum radiation detriment are men aged 34 and women aged 35. For these population groups, the average accumulated effective doses were 35.3 mSv and 39.2 mSv, and the average radiation detriment was 2.6×10–3 and 4.2×10–3, for men and women, respectively. For 11.8 % of the population (8.3 % of men and 14.8 % of women), the individual radiation detriment calculated using the ICRP method exceeds the value of 3.5×10–3, which corresponds to the maximum increase in individual risk for the population over 70 years of exposure, established by RSS-99/2009 for normal exposure conditions. The maximum radiation detriment of 3.9×10–2 was found for a woman of the Krasnogorsky district of the Bryansk region at the age of 37 years, with an accumulated effective dose of 392 mSv. Conclusion: The results of this work can be used in preparing recommendations to health authorities on improving medical supervision of exposured citizens living in areas contaminated with radionuclides, as well as in developing regulatory documents for the provision of targeted medical care to people from high radiation risk groups using personalized medicine methods.

scholarly journals Discharge against medical advice after hospitalisation for acute myocardial infarction

Heart ◽  
2018 ◽  
Vol 105 (4) ◽  
pp. 315-321 ◽  
Author(s):  
Chun Shing Kwok ◽  
Mary Norine Walsh ◽  
Annabelle Volgman ◽  
Mirvat Alasnag ◽  
Glen Philip Martin ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Risk Groups ◽  
Medical Advice ◽  
Adverse Outcomes ◽  
Unplanned Readmission ◽  
Crude Rate ◽  
Against Medical Advice ◽  
Discharge Against Medical Advice ◽  
Poor Outcomes

BackgroundDischarge against medical advice (AMA) occurs infrequently but is associated with poor outcomes. There are limited descriptions of discharges AMA in national cohorts of patients with acute myocardial infarction (AMI). This study aims to evaluate discharge AMA in AMI and how it affects readmissions.MethodsWe conducted a cohort study of patients with AMI in USA in the Nationwide Readmission Database who were admitted between the years 2010 and 2014. Descriptive statistics were presented for variables according to discharge home or AMA. The primary end point was all-cause 30-day unplanned readmissions and their causes.Results2663 019 patients were admitted with AMI of which 10.3% (n=162 070) of 1569 325 patients had an unplanned readmission within 30 days. The crude rate of discharge AMA remained stable between 2010 and 2014 at 1.5%. Discharge AMA was an independent predictor of unplanned all-cause readmissions (OR 2.27 95% CI 2.14 to 2.40); patients who discharged AMA had >twofold increased crude rate of readmission for AMI (30.4% vs 13.4%) and higher crude rate of admissions for neuropsychiatric reasons (3.2% vs 1.3%). After adjustment, discharge AMA was associated with increased odds of readmissions for AMI (OR 3.65 95% CI 3.31 to 4.03, p<0.001). We estimate that there are 1420 excess cases of AMI among patients who discharged AMA.ConclusionsDischarge AMA occurs in 1.5% of the population with AMI and these patients are at higher risk of early readmissions for re-infarction. Interventions should be developed to reduce discharge AMA in high-risk groups and initiate interventions to avoid adverse outcomes and readmission.

Factor XIII-A dynamics in acute myocardial infarction: a novel prognostic biomarker?

2015 ◽  
Vol 114 (07) ◽  
pp. 123-132 ◽  
Author(s):  
Giulia Zeri ◽  
Elisa Orioli ◽  
Rosella Mari ◽  
Stefano Moratelli ◽  
Marco Vigliano ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Acute Myocardial Infarction ◽  
Factor Xiii ◽  
Thrombus Formation ◽  
Early Death ◽  
Prognostic Indicators ◽  
Cardiac Events ◽  
Acute Mi ◽  
The Individual

SummaryAfter acute myocardial infarction (MI) the damaged heart has to be repaired. Factor XIII (FXIII) is considered a key molecule in promoting heart healing. FXIII deficiency was associated to cardiac rupture and anomalous remodelling in MI. During MI, FXIII contributes firstly to the intracoronary thrombus formation and shortly after to heal the myocardial lesion. To quantify the real contribution of FXIII in this process, and to explore its possible prognostic role, we monitored the FXIII-A subunit levels in 350 acute MI patients during the first six days (d0-d5) plus a control at 30–60 days (d30). A one-year follow-up was performed for all the patients. A transient drop in the FXIII-A mean level was noted in the whole cohort of patients (FXIII-Ad0 99.48 ± 30.5 vs FXIII-Ad5 76.51 ± 27.02; p< 0.0001). Interestingly, those who developed post-MI heart failure showed the highest drop (FXIII-Ad5 52.1 ± 25.2) and they already presented with low levels at recruitment. Similarly, those who died showed the same FXIII-A dynamic (FXIII-Ad5 54.0 ± 22.5). Conversely, patients who remained free of major adverse cardiac events, had lower consuming (FXIII-Ad0 103.6 ± 29.1 vs FXIII-Ad5 84.4 ± 24.5; p< 0.0001). Interestingly, the FXIII-A drop was independent from the amount of injury assessed by TnT and CKMB levels. The survival analysis ascribed an increased probability of early death or heart failure inversely related to FXIII-A quartiles (FXIII-A25th< 59.5 %; hazard ratio 4.25; 2.2–5.1; p< 0.0001). Different FXIII-A dynamics and levels could be utilised as early prognostic indicators during acute MI, revealing the individual potential to heal and suggesting tailored treatments to avoid heart failure or its extreme consequence.Note: This paper was presented in part at the 14th Congress of the International Society on Thrombosis and Haemostasis, Amsterdam, Netherlands, June 29 – July 24, 2013.

scholarly journals Diabetes mellitus type 2 and acute myocardial infarction: prognostic options for interaction in patients of different age groups

2018 ◽  
Vol 21 (2) ◽  
pp. 105-112 ◽  
Author(s):  
Alla A. Garganeeva ◽  
Elena A. Kuzheleva ◽  
Ksenia N. Borel ◽  
Dina S. Kondratyeva ◽  
Sergey A. Afanasiev
Keyword(s):  
Diabetes Mellitus ◽  
Myocardial Infarction ◽  
Type 2 Diabetes ◽  
Acute Myocardial Infarction ◽  
Type 2 Diabetes Mellitus ◽  
Heart Disease ◽  
Ischaemic Heart Disease ◽  
Working Age

Background. Problems surrounding comorbidities of type 2 diabetes mellitus and coronary heart disease are some of the most important in medical science and practice, given their mutually negative impact on patients prognoses and quality of life. Aims. To study the impact of type 2 diabetes on the long-term prognoses of patients of different age categories, status-post acute myocardial infarction. (Data obtained from the Register of Acute Myocardial Infarction.) Materials and methods. The main data source was the Register of Acute Myocardial Infarction, maintained in Tomsk for more than 30 years. The study included 862 patients with acute myocardial infarction. The patients were monitored for 5 years. The primary endpoint was death from any cause during the observation period. Results. We separated the study cohort into 2 groups depending on patients ages: Group 1 (n = 358) included patients older than working age, Group 2 (n = 504) consisted of younger, employable patients. The combination of ischaemic heart disease and type 2 diabetes mellitus were diagnosed in 208 patients. The combination of ischaemic heart disease and type 2 diabetes was the cause of adverse prognosis among elderly patients and led to increased mortality rate during the 5-year post-infarction period (p = 0.0003). However, among younger, working patients who suffered myocardial infarction, the presence of type 2 diabetes did not have an independent negative effect on long-term disease prognosis. While in employable patients, a long history of diabetes mellitus significantly aggravated the course of the post-infarction period (p = 0.004). Conclusions. These data suggest an ambiguous prognostic effect of type 2 diabetes mellitus among working age and elderly patients status post myocardial infarction, in agreement with experimental studies conducted on laboratory animals. Further comprehensive analyses of the clinical and experimental data are needed to optimise therapies for patients who suffer from type 2 diabetes and comorbid ischaemic heart disease.

scholarly journals Features of psychological status in acute myocardial infarction in women and men

2020 ◽  
pp. 54-62
Author(s):  
Tatiana O. Nikolaeva ◽  
Viktor V. Anikin ◽  
Olga A. Izvarina ◽  
Anna A. Sedova
Keyword(s):  
Quality Of Life ◽  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Psychological Status ◽  
Noticeable Increase ◽  
Personality Research ◽  
Male Patients ◽  
The Individual ◽  
The City

Changes in psychological status undoubtedly have a great impact on the development and course of myocardial infarction (MI). Objective - to study changes in the psychological status in women with acute myocardial infarction (AMI) in comparison with male patients and the reflection of these changes on the quality of life. Materials and methods. A single-stage observational study was performed in the city hospitals of Tver. 120 women with AMI aged 36-74 years and 50 men with AMI aged 37-72 were examined. The main group (women with AMI) was divided into two subgroups: the first - patients under 60 years of age, the second - 60 years and older. The study of psychological characteristics of the individual was carried out using the abbreviated multifactor questionnaire for personality research (the so called “Mini-Mult” or “SMOL”), the personality questionnaire of the Bekhterev Institute (the so called “LOBI”), and the methodology for assessing the quality of life of a patient (QOL) according to V.P. Zaitsev. Results. In women aged 60 years and older, an increase in the profile of pitches on all scales was detected. The most noticeable increase in indicators was observed on the scales of the neurotic triad (1st, 2nd, and 3rd) and the 6th Mini-Mult scale. Analysis of the LOBI test revealed that the level of anxiety, hypochondriac, sensitive, neurasthenic, dysphoric and melancholic types of attitude to the disease prevailed in women, with the greatest severity of changes in the group of women under 60 years of age. In the block of interpsychic orientation, the most significant increase was in the sensitive type of attitude to the disease, which prevailed in both groups of women compared to men. The total indicator of "quality of life" was reduced in all the examined groups, and this decrease was most pronounced in older women. Conclusion. Women with AMI have more pronounced changes in their personal and emotional status than men. This is manifested in an increase in hypochondriac, depressive, emotionally labile symptoms; anxiety, hypochondriac, neurasthenic types of response to the disease and a decrease in the "quality of life".

scholarly journals Features of adverse course and mortality in acute myocardial infarction in women and men

2020 ◽  
pp. 30-36
Author(s):  
Viktor V. Anikin ◽  
Tatiana O. Nikolaeva ◽  
Olga A. Izvarina
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Prognostic Factors ◽  
Causes Of Death ◽  
Pain Syndrome ◽  
Unfavorable Outcome ◽  
Cardiovascular Failure ◽  
Working Age ◽  
The Russian Federation ◽  
Causes Of Deaths

The cause of mortality in the Russian Federation in half of cases is still cardiovascular diseases (CVD), the most prognostically unfavorable variant of which is certainly acute myocardial infarction (AMI). At the same time, there is a steady tendency to increase the frequency of myocardial infarction in women of working age. The frequency and severity of AMI in women is underestimated by many researchers, and the prognostic factors of an unfavorable outcome in comparison of female and male individuals are not determined. Objective. The aim of the study was to compare the immediate prognosis and outcome of AMI in women and men, and to identify possible factors leading to an unfavorable outcome. Materials and methods. The analysis of medical cases and pathoanatomical reports of 196 patients who died from AMI within a 5-year period, among whom there were 107 women (average age 72.1±7.2 years) and 89 men (average age 65.4±11.1 years). The authors compared the case, clinical features of the disease, complications, the presence of comorbidities, the depth and localization of AMI, and the direct causes of deaths. Results. In groups comparable in age, the mortality rate in women over 60 years was 1.6 times higher than that in men. Somewhat more often, women died in this case, whose MI began with a typical pain syndrome or an asthmatic variant of it. Concomitant pathology in women who died from MI was significantly more common than in men: arterial hypertension, diabetes mellitus (1.5 times) and obesity (6.5 times). The unfavorable prognostic factors in MI in men can be the previous stroke. Conclusion. The immediate prognosis of mortality in AMI in women is more unfavorable than in men. The immediate causes of death in women compared to men were more often cardiogenic shock, myocardial ruptures and pulmonary embolism, and in men - acute cardiovascular failure and ventricular fibrillation.

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