Physical exertion as a trigger of acute myocardial infarction. Triggers and Mechanisms of Myocardial Infarction Study Group.
Physical exertion as a trigger of acute myocardial infarction. Triggers and Mechanisms of Myocardial Infarction Study Group.
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体力消耗是急性心肌梗塞的诱因。
DOI：
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发表时间：
1993
影响因子：
158.5
通讯作者：
R. Schröder
中科院分区：
文献类型：
--
作者：
S. Willich;M. Lewis;H. Löwel;H. Arntz;Frauke Schubert;R. Schröder
背景
心肌梗死的发病是随机发生的，还是由可识别的刺激引起的，这是有争议的。以前的研究表明，与劳累相关的心脏事件的风险更高。
方法
连续的急性心肌梗死患者通过记录我们柏林医院的所有入院情况和监测德国奥格斯堡33万居民的一般人口来确定。通过标准化访谈获得有关每一次梗死情况的信息。数据分析包括将患者与匹配的对照组进行比较，并对患者的日常工作频率与心肌梗死发作前的最后一次工作进行病例交叉比较(每个患者作为自己的对照)。
结果
从1989年1月到1991年12月，1194名患者(其中74%是男性；平均年龄[+/-SD]，61+/-9岁)在梗死后13+/-6天完成了访谈。我们发现，7.1%的病例患者在梗死开始时从事体力消耗(或=6代谢当量)，而对照组患者在控制事件开始时的这一比例为3.9%。与匹配的对照组相比，患者在梗死或对照事件发生时从事剧烈体力活动的调整后相对风险为2.1(95%可信区间，1.1至3.6)。病例交叉比较得出心肌梗死前一小时内从事剧烈体力活动的类似相对风险为2.1(95%可信区间，1.6至3.1)。每周定期锻炼次数少于4次和4次或4次以上的患者的相对危险度分别为6.9和1.3(P<；0.01)。
结论
一段时间的剧烈体力活动与心肌梗死风险的暂时增加有关，特别是在不经常锻炼的患者中。这些发现应该有助于识别心肌梗死的触发机制，并改善对这种常见和严重疾病的预防。
BACKGROUND
It is controversial whether the onset of myocardial infarction occurs randomly or is precipitated by identifiable stimuli. Previous studies have suggested a higher risk of cardiac events in association with exertion.
METHODS
Consecutive patients with acute myocardial infarction were identified by recording all admissions to our hospital in Berlin and by monitoring a general population of 330,000 residents in Augsburg, Germany. Information on the circumstances of each infarction was obtained by means of standardized interviews. The data analysis included a comparison of patients with matched controls and a case-crossover comparison (one in which each patient serves as his or her own control) of the patient's usual frequency of exertion with the last episode of exertion before the onset of myocardial infarction.
RESULTS
From January 1989 through December 1991, 1194 patients (74 percent of whom were men; mean age [+/- SD], 61 +/- 9 years) completed the interview 13 +/- 6 days after infarction. We found that 7.1 percent of the case patients had engaged in physical exertion (> or = 6 metabolic equivalents) at the onset of infarction, as compared with 3.9 percent of the controls at the onset of the control event. For the patients as compared with the matched controls, the adjusted relative risk of having engaged in strenuous physical activity at the onset of infarction or the control event was 2.1 (95 percent confidence interval, 1.1 to 3.6). The case-crossover comparison yielded a similar relative risk of 2.1 (95 percent confidence interval, 1.6 to 3.1) for having engaged in strenuous physical activity within one hour before myocardial infarction. Patients whose frequency of regular exercise was less than four and four or more times per week had relative risks of 6.9 and 1.3, respectively (P < 0.01).
CONCLUSIONS
A period of strenuous physical activity is associated with a temporary increase in the risk of having a myocardial infarction, particularly among patients who exercise infrequently. These findings should aid in the identification of the triggering mechanisms for myocardial infarction and improve prevention of this common and serious disorder.
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影响因子：
37.8
作者：
BREZINSKI, DA;TOFLER, GH;WILLIAMS, GH
通讯作者：
WILLIAMS, GH
影响因子：
158.5
作者：
PAFFENBARGER, RS;HYDE, RT;KAMPERT, JB
通讯作者：
KAMPERT, JB
影响因子：
5
作者：
MACLURE, M
通讯作者：
MACLURE, M
影响因子：
37.8
作者：
RIDKER, PM;MANSON, JE;HENNEKENS, CH
通讯作者：
HENNEKENS, CH
影响因子：
158.5
作者：
MITTLEMAN, MA;MACLURE, M;MULLER, JE
通讯作者：
MULLER, JE