Recurrence of myocardial infarction. Observations on patients participating in the Ontario Multicentre Exercise-Heart Trial.

European journal of cardiology Pub Date : 1980-02-01
R J Shephard
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Abstract

The circumstances attending a fatal or non-fatal recurrence of myocardial infarction have been analysed for participants in the Ontario Multicentre Exercise-Heart Trial. After an average of some 20 mth observations, 51 of the 751 participants had sustained a recurrence (rate 4.07 per 100 participant years). Some 24% of episodes were closely associated with various types of physical activity, and a further 22% noted vigorous exercise (sometimes of an unusual nature) a few hours previously. Exercise-related episodes were associated with poor programme compliance and ST segmental depression during test exercise, but were unrelated to the prescribed regimen (high or low intensity physical activity). Continuing smoking and a history of recent angina were associated with a risk of recurrence; both were seen less commonly with recurrence in high intensity exercisers than in their low intensity exercise counterparts. Exercise-induced ST segmental depression was associated with a higher frequency of fatal recurrences in high than in low intensity exercisers (P less than 0.05); there may thus be a 'high-risk' subgroup for whom vigorous exercise is contraindicated, and the existence of such a group could confound therapeutic trials of exercise-centred rehabilitation.

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心肌梗死复发。安大略省多中心运动-心脏试验患者观察
在安大略省多中心运动-心脏试验中,研究人员分析了心肌梗死致死性或非致死性复发的情况。在平均20个月的观察后,751名参与者中有51人持续复发(每100名参与者年的复发率为4.07)。约24%的发作与各种类型的体育活动密切相关,另有22%的发作与几小时前的剧烈运动(有时是不寻常的运动)有关。运动相关的发作与试验运动期间较差的方案依从性和ST段抑郁有关,但与规定的方案(高强度或低强度的身体活动)无关。持续吸烟和近期心绞痛病史与复发风险相关;高强度锻炼者与低强度锻炼者相比,这两种疾病的复发率都较低。运动诱发的ST段抑郁与高强度运动者的致命复发率相关(P < 0.05);因此,可能存在一个“高危”亚组,对他们来说剧烈运动是禁忌的,这样一个群体的存在可能会混淆以运动为中心的康复治疗试验。
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