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PubMed · 4096072

Risk stratification after myocardial infarction.

J T Bigger
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Abstract

Functional risk stratification has been a fruitful new approach to classification and management of patients with acute myocardial infarction. Risk is divided into the functional categories: (1) left ventricular dysfunction; (2) ventricular arrhythmias; and (3) ischemia. Diastolic and systolic left ventricular dysfunction and perhaps aneurysm formation are independent indicators of death. Holter ECG recording of spontaneous ventricular arrhythmias or ventricular arrhythmias induced by programmed ventricular stimulation can identify patients who have a higher risk of dying. Ischemic risk can be identified with accuracy in patients with first inferior myocardial infarction. Coronary angiography is indicated to establish ischemic risk for the following situations (1) angina pectoris with ST depression; (2) non-Q wave infarction (3) inferior infarct with positive exercise test; and (4) anterior infarction with left ventricular ejection fraction between 20% and 40%.

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Angina PectorisAngiographyArrhythmias, CardiacCoronary AngiographyElectrocardiographyHeartHeart AneurysmHeart VentriclesHumansMonitoring, PhysiologicMyocardial InfarctionRadionuclide ImagingRiskComparative StudyJournal ArticleResearch Support, Non-U.S. Gov'tResearch Support, U.S. Gov't, P.H.S.

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J T Bigger. 1985. Risk stratification after myocardial infarction.. https://pubmed.ncbi.nlm.nih.gov/4096072/

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PubMed2007

Effect of a hypoglycemic agent on ischemic preconditioning in patients with type 2 diabetes and stable angina pectoris.

OBJECTIVE: Ischemic preconditioning is an increased tolerance to myocardial ischemia during the second of two consecutive exercise tests. ATP-sensitive K(+) channel blockers, such as glinides and sulfonylurea drugs, can induce loss of ischemic preconditioning. This study aimed to investigate the effects of repaglinide, a hypoglycemic agent with an affinity for myocardial ATP-sensitive K (+)channels, on the results of consecutive exercise tests in patients with diabetes and multivessel coronary artery disease. METHODS: Forty-two patients with type 2 diabetes and chronic stable angina pectoris, and two-vessel or three-vessel disease participated in this study. The patients underwent two consecutive treadmill exercise tests (phase 1). On the day after these exercise tests, 2 mg of oral repaglinide was given to the patients. One week later, two exercise tests were repeated consecutively (phase 2). RESULTS: All patients achieved 1.0-mm ST-segment depression during the four exercise tests (T1, T2, T3, and T4). In phase 2, seven patients improved in time to onset of 1.0-mm ST-segment depression. The worsening of the time to onset of 1.0-mm ST-segment depression in phase 2 demonstrated ischemic preconditioning block in 83.3% of patients (P=0.0001). Even the postexercise electrocardiographic parameters (ST-segment depression morphology and magnitude and arrhythmias) were significantly different between the groups with and without pharmacologic ischemic preconditioning block (P=0.031). CONCLUSIONS: Repaglinide, an oral hypoglycemic agent with ATP-sensitive K(+) channel-blocker activity, eliminated the myocardial ischemic preconditioning in patients with coronary disease and diabetes.

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