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 21,142 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A prognostic index for two year survival following recovery from acute myocardial infarction has been verified in an independent group of 105 patients. Five variables comprise the index: systolic blood pressure level on admission, highest blood urea nitrogen level in the cardiac care unit; atrial arrhythmias in the cardiac care unit; angina pectoris for more than three months or a previous myocardial infarction; and more than one ventricular ectopic beat per hour recorded on an 8 hour dynamic electrocardiogram during convalescence just prior to hospital discharge. One hundred twenty-six patients have also been followed for five or more years, and we now report a five year prognostic index. Discriminant analysis indicates that the same five variables, although weighted differently, continue to be significant for prognostic assessment and may be utilized in the identification of patients at high and lower risk.
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PMID:Survival after recovery from acute myocardial infarction. Two and five year prognostic indices. 46 19

Survival of 312 patients with acute myocardial infarction was studied from data collected during the first 48 h in the coronary care unit. Only patients with recent onset of symptoms (48 h), with a 48-h survival, and with evidence of myocardial infarction, were selected. Mortality rate at 1 mth was 15.3% and 24.6% at 6. The following factors were significant for poor survival: increasing age, female sex, diabetes, previous angina, low blood pressure on admission and at the 48th h low average value and the lowest observed value of blood pressure, clinical and radiological left ventricular failure, high level of LDH, increased urea and leukocytosis. Among ECG data, the presence of signs related to extent of infarction, anterior as compared to inferior location, antero-lateral as compared to anterior, QRS frontal axis deviation, absence of sinus rhythm, sinus tachycardia, tachyarrhythmias with wide QRS complex, right bundle branch block, 3rd-degree AV block with wide QRS complex, was associated with significantly worse survival than the absence of these signs. A multivariate analysis of the 42 most significant data, assuming linear regression, was used to establish a discriminant prognostic index. Using this index, survival was predicted correctly in 90.2% of patients at 1 mth and 85.7% at 6 mth. Thus prognosis can be established in nonclear-cut groups of patients with myocardial infarction (severe and benign forms being excluded by criteria) from simple clinical data.
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PMID:Quantitative assessment of myocardial infarction prognosis to 1 and 6 mth--from clinical data. 72

A prognostic index for 2-year survival after recovery from acute myocardial infarction was constructed from variables obtained during its course. One hundred ten of 143 patients survived 2 years, and 27 of 33 patients died of cardiac-related causes. Univariate analysis showed that 12 variables were significantly different between the surviving and nonsurviving groups. Discriminant analysis indicated five variables with meaningful predictive value to be included in a prognostic index: admission systolic blood pressure; highest blood urea nitrogen level in the cardiac care unit: atrial arrhythmias in the cardiac care unit; angina pectoris for more than 3 months or a previous myocardial infarction; and more than one ventricular ectopic beat per hour recorded on a dynamic electrocardiogram during the 17th to 24th hospital day. The prognostic index emphasizes the importance of extensive myocardial impairment and provides a means for identifying patients at risk of early mortality.
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PMID:Acute myocardial infarction: prognosis after recovery. 98 7

To determine whether hemodynamic advantages of continuous ambulatory peritoneal dialysis (CAPD) over intermittent hemodialysis are associated with improved survival and identify cardiac risk factors for early death, 55 patients on CAPD (age 58 +/- 11 years; CAPD duration: 29 +/- 25 months) were followed in a noninvasive prospective analysis over 35 months. At follow-up, 25 patients had died; 16 deaths were related to cardiovascular causes. Nonsurvivors were older (62 +/- 8 vs 55 +/- 12 years; p less than 0.015) and had more angina pectoris (40 vs 20%; p less than 0.05) than survivors, but had comparable CAPD duration, arterial blood pressure, hemoglobin, serum creatinine, urea and parathyroid hormone concentrations. On echocardiography, nonsurvivors had a lower mean left ventricular (LV) ejection fraction (59 +/- 15 vs 66 +/- 9%; p less than 0.03), higher LV end-systolic volume indexes (49 +/- 31 vs 36 +/- 13 ml/m2; p less than 0.03) and a shorter mean LV ejection time (371 +/- 41 vs 390 +/- 22 ms; p less than 0.03). LV muscle mass, LV diastolic and left atrial dimensions, stroke volume and cardiac index were comparable. On pulsed Doppler analysis of a subgroup of 48 patients in sinus rhythm and without valve disease, nonsurvivors (n = 23) had more severely decreased ratios of peak early/atrial filling velocities (0.66 +/- 0.18 vs 0.81 +/- 0.24; p less than 0.03) and increased atrial filling fractions (52 +/- 11 vs 46 +/- 9%; p less than 0.03) than survivors. Mean isovolumic relaxation periods were increased in both groups (135 +/- 39 vs 129 +/- 33 ms; p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Cardiovascular factors influencing survival in end-stage renal disease treated by continuous ambulatory peritoneal dialysis. 153 Aug 99

A previous article (Part I) described the patient population and operative management of 666 patients who had surgery for nonruptured abdominal aortic aneurysms. This article details the perioperative complications and, by chi-square and logistic regression analysis, identifies the variables that are associated with each complication. In summarizing the results (below) the incidence of each complication is listed, along with the predictive risk factors in parentheses that have significance levels less than 0.05. Vascular morbidity data are as follows: intraoperative bleeding, 4.8%; postoperative bleeding requiring transfusion, 2.3% or repeat operation, 1.4% (large volume of blood transfusion and/or use of an autotransfusion device); intraoperative limb ischemia, 3.5%; graft thrombosis, 0.9% (femoropopliteal disease and/or distal anastomosis at the femoral level); distal thromboembolism, 3.3% (male sex, femoral popliteal disease, and/or intraoperative graft thrombosis); amputation, 1.2%; graft infection, 1 case. General morbidity data are as follows: cerebrovascular event, 0.6%; paraplegia, 1 case; cardiac event, 15.1% (age, previous episode of congestive heart failure, and/or electrocardiogram [ECG] evidence of a previous myocardial infarction); myocardial infarction, 5.2% (advancing age, angina, and/or prolonged aortic cross-clamp time); congestive heart failure, 8.9% (previous history of congestive heart failure, ECG evidence of ischemia, and/or chronic obstructive lung disease); arrhythmia requiring treatment, 10.5% (preoperative ventricular premature beats and/or respiratory failure requiring ventilation for more than 48 hours); new arrhythmia, 8.4% (angina and/or chronic obstructive lung disease); respiratory failure, 8.4% (chronic obstructive lung disease, large volume of blood transfused, and/or occurrence of postoperative bleeding, cerebrovascular accident, congestive heart failure, or myocardial infarction); renal damage with rise in creatinine or blood urea nitrogen, 5.4% and/or renal failure requiring dialysis, 0.6% (elevated preoperative creatinine, suprarenal aortic cross-clamping, and/or renal vein ligation); diarrhea without evidence of ischemia colitis, 7.1% and ischemic colitis, 0.6% (pelvic flow interrupted); prolonged ileus, 11.0% (aortoiliac occlusive disease, deterioration of renal function, prolonged ventilation, and/or preoperative history of angina); superficial wound infection, 1.5% and deep infection, 0.5% (femoral anastomosis and/or female sex); coagulopathy, 1.1% (large volume of blood transfused).(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Multicenter prospective study of nonruptured abdominal aortic aneurysm. Part II. Variables predicting morbidity and mortality. 264 60

Serum gamma-glutamyltranspeptidase (GGTP) and alpha-amylase clearance were determined in a total group of 90 patients of whom 60 with renal diseases and 30 with extrarenal diseases. The renal patients were distributed, according to diagnosis in the following groups: acute glomerulonephritis, chronic glomerulonephritis, acute pyelonephritis, chronic pyelonephritis, nephrotic syndrome and manifest chronic renal failure. The 30 controls were hospitalized for different extrarenal diseases such as: pneumonia, gastroduodenal ulcer, arterial hypertension stage I and angina pectoris. Serum GGTP assay was performed in 60 patients (40 renal patients and 20 controls) using Boehringer monotest kits and in 30 patients (20 renal patients and 10 controls) using Romanian kits (I.C.C.F.). No changes suggesting a particular type of nephropathy were observed. The results obtained by using the two types of kits for the serum GGTP assay have proved to be very close. Alpha-amylase clearance was determined in all the patients with Spofa (R.S.C.) tablets concomitantly with the urea and creatinine clearance. Important decreases of alpha-amylase clearance in concordance with decreases of urea and creatinine clearances were observed in all the patients with severe renal failure. More moderate decreases of alpha-amylase clearance were observed in the patients with acute and chronic glomerulonephritis. The utility of this clearance as a test of glomerular filtration and sometimes as a prognostic test, is discussed.
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PMID:Preliminary clinical and methodologic observations on the determination of serum gamma-glutamyltranspeptidase and of the alpha-amylase clearance in nephropathies. 286 37

The mortality of 3783 non-malignant hypertensive patients attending the Glasgow Blood Pressure Clinic between 1968 and 1983 and followed for an average of 6.5 years was compared with that in three control groups: the general population of Strathclyde a group of 15 422 subjects aged 45-64 years and screened in Renfrew and Paisley between 1972 and 1976, and a group of hypertensives seen in a blood pressure clinic based on general practice in Renfrew. Average blood pressure for men at entry to the Glasgow Clinic was 181/111 mmHg falling to 158/96 mmHg during treatment. Corresponding values for women were 185/109 mmHg and 161/96 mmHg. Seven hundred and fifty clinic patients (451 males) died during follow-up, the commonest causes of death in both sexes being myocardial infarction and stroke. All-cause age-adjusted mortality (deaths per 1000 patient-years) was 41.4 for men and 22.1 for women. At all ages in both sexes and for all levels of initial blood pressure mortality was less in patients whose blood pressure was reduced most. Without a randomized control group it is not certain that lower mortality in those with well controlled blood pressure was due to treatment, although this is the most likely explanation. Cigarette smoking, a history of myocardial infarction, angina or stroke, retinal arterio-venous nipping, raised blood urea, an abnormal electrocardiogram (ECG) and secondary hypertension were associated with increased risk, but heavy alcohol intake, obesity, haematocrit greater than 45%, hypokalaemia and social class were not. Life table analysis showed that, despite some reduction of mortality by treatment, the relative risk to men and women in the clinic remained two- to five-times that of the general population. The benefits of treatment were not such as to restore normal expectation of life even when blood pressure was well controlled. Excess mortality in the clinic could not be explained by difference of smoking habit or social class. This suggests that there is in the hypertensive patients of the Glasgow Clinic an element of irreducible risk, that treatment may be beneficial in some respects but harmful in others, or that patients at particularly high risk are selectively referred to the clinic.
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PMID:Mortality in patients of the Glasgow Blood Pressure Clinic. 371 57

Two-hundred ninety-one patients with hypertension and 313 patients with angina pectoris were enrolled and treated with nadolol for up to 2 years. The efficacy of nadolol in hypertension and angina was maintained over the 2-year period. Discontinuation because of an adverse reaction occurred with 8.3% of the hypertensive patients and 8.6% of the angina patients. The observed reactions were typical of those which occur with beta-blocking drugs. Serum creatinine levels fell significantly (p less than 0.05) after 12 months of treatment for both the angina and hypertensive patients. After 24 months of treatment the serum creatinine levels had decreased 20% from baseline (p less than 0.001). Blood urea nitrogen levels fell in the angina patients after 12 months of treatment but not in the hypertensive patients. Nadolol is safe and effective for the long-term treatment of both hypertension and angina. Renal function, as measured by serum creatinine levels, improved with long-term treatment.
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PMID:Long-term experience with nadolol in treatment of hypertension and angina pectoris. 614 74

DT, a 63-year-old white male with insulin-dependent diabetes mellitus and severe peripheral vascular disease, was admitted with a five-day history of vague abdominal pain and diarrhea. On the day of admission he vomited three times, was noted to have a bloody stool, and came to the emergency room. DT denied hematemesis, fever, or chills. He had bilateral leg amputations and had sustained three myocardial infarctions, the last one 15 months before this admission. He had never experienced symptoms of abdominal angina. Of significance was his history of congestive heart failure, mitral regurgitation, and atrial fibrillation. His medications on admission included digoxin 0.25mg per day, furosemide 40mg per day, and NPH insulin 15 units per day. On admission to the hospital his oral temperature was 38 degrees C, pulse was 90/min, respiratory rate was 24/min, and blood pressure was 134/80mmHg. Abdominal examination revealed a distended abdomen with hypoactive bowel sounds and mild tenderness. Chest x ray revealed cardiomegaly. The electrocardiogram demonstrated atrial fibrillation. A plain film of the abdomen was positive for gallstones and edema of the bowel wall (thumb-printing). Laboratory results included blood urea nitrogen 48mg%, creatinine 1.2mg%, hemoglobin 18g/dl, and hematocrit 52.9%. White blood cell count was 11,900 cells/cc with 33% polymorphonuclear leukocytes, 47% bands, 8% lymphocytes, 11% monocytes, and 1% atypical lymphocytes. The prime considerations for differential diagnosis were mesenteric ischemia and infectious gastroenteritis. While it was appreciated that mesenteric ischemia, if present, might warrant surgical intervention, the risk of anesthesia itself in this patient was felt by his attending physicians to exceed 30%. Furthermore, the clinical findings were only "suggestive" of mesenteric eschemia. They were certainly not "diagnostic." In view of this dilemma, a consultation with the Division of Clinical Decision Making was requested.
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PMID:Abdominal pain, atherosclerosis, and atrial fibrillation. The case for mesenteric ischemia. 716 38

The clinical entry characteristics and medical history of 142 resuscitated out-of-hospital cardiac arrest victims with coronary heart disease were studied in order to identify factors that affect their long-term survival. The cardiac arrest event was classified as being secondary to an acute myocardial infarction (AMI) in 44% (62 of 142), an ischemic event (IE) in 34% (49 of 142) and a primary arrhythmic event (PAE) in 22% (31 of 142). The majority of patients in all groups had a history of angina pectoris. Twenty-seven percent of the AMI, 55% of the IE, and 71% of the PAE patients had a history of infarction. Ten percent of the AMI, 31% of the IE, and 55% of the PAE had used digitalis before their cardiac arrest. Cardiac arrest was the first cardiac event in 35% of the AMI, 16% of the IE and 6% of the PAE patients. One year after arrest, 89% of the AMI, 80% of the IE and 71% of the PAE were alive (p less than 0.01). Covariate analysis for more than 40 variables indicates that a high-risk group included 22% (31 of 142) of the cardiac arrest victims had 1- and 2-year survival rates of 71% and 55%, respectively, and was characterized as having used digitalis before arrest, experiencing blood urea nitrogen elevation and pulmonary congestion during the hospitalization for the event, and classification of the cardiac arrest event as a PAE. A low-risk group comprised 78% (111 of 142) of the survivors and had 1- and 2-year survival rates of 85% and 69%, respectively. These data indicate that cardiac arrest due to coronary heart disease is secondary to several mechanisms related to subsequent survival.
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PMID:Characteristics of the resuscitated out-of-hospital cardiac arrest victim with coronary heart disease. 728 12


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