Analysis of possible triggers of acute myocardial infarction (the MILIS study)

https://doi.org/10.1016/0002-9149(90)90729-KGet rights and content

Abstract

Recent documentation of a circadian variation in acute myocardial infarction (AMI) suggests that AMI is not a random event, but may frequently result from identifiable triggering activities. The possible triggers reported by 849 patients enrolled in the Multicenter Investigation of Limitation of Infarct Size were analyzed. Possible triggers were identified by 48.5% of the population; the most common were emotional upset (18.4%) and moderate physical activity (14.1%). Multiple possible triggers were reported by 13% of the population. Younger patients, men and those without diabetes mellitus were more likely to report a possible trigger than were older patients, women and those with diabetes. The likelihood of reporting a trigger was not affected by infarct size. This study suggests that potentially identifiable triggers may play an important role in AMI. Because potential triggering activities are common in persons with coronary artery disease, yet infrequently result in AMI, further studies are needed to identify (1) the circumstances in which a potential trigger may cause an event, (2) the specific nature of potential triggering activites, (3) the frequency of such activities in individuals who do not develop AMI and (4) the presence or absence of identifiable triggers in various subgroups of patients with infarction.

References (16)

  • J Parkinson et al.

    Cardiac infarction and coronary thrombosis

    Lancet

    (1928)
  • JT Willerson et al.

    Conversion from chronic to acute coronary artery disease: speculation regarding mechanisms

    Am J Cardiol

    (1984)
  • JE Muller et al.

    Circadian variation in the frequency of onset of acute myocardial infarction

    N Engl J Med

    (1985)
  • SN Willich et al.

    Increased morning incidence of myocardial infarction in the ISAM Study: absence with prior beta adrenergic blockade

    Circulation

    (1989)
  • JE Muller et al.

    Circadian variation and triggers of onset of acute cardiovascular disease

    Circulation

    (1989)
  • C Phipps

    Contributory causes of coronary thrombosis

    JAMA

    (1936)
  • G Fitzhugh et al.

    Coronary occlusion and fatal angina pectoris. Study of the immediate causes and their prevention

    JAMA

    (1933)
  • AM Master

    The role of effort and occupation (including physicians) in coronary occlusion

    JAMA

    (1960)
There are more references available in the full text version of this article.

Cited by (319)

  • Prothrombotic response to norepinephrine infusion, mimicking norepinephrine stress-reactivity effects, is partly mediated by α-adrenergic mechanisms

    2019, Psychoneuroendocrinology
    Citation Excerpt :

    Between 10% and 50% of patients with an acute coronary syndrome (ACS) report an emotional trigger like mental stress or intense feelings within 2 h before symptom onset (Tofler et al., 1990; Willich et al., 1991; Tofler et al., 2017) with, for instance, outbursts of anger quadrupling the risk (Mostofsky et al., 2014).

  • Acute and Subacute Triggers of Cardiovascular Events

    2018, American Journal of Cardiology
    Citation Excerpt :

    Numerous other acute triggers of CV events have been delineated (Table 4). Acute triggers are common: 48.5% of 849 patients with MI reported at least one possible trigger, including emotional upset (18.4%), moderate physical activity (14.1%), and heavy physical activity (8.7%); and others included lack of sleep and overeating.10 Physical activity increases the risk for MI11 and the increased risk is directly related to the amount of exertion.12

View all citing articles on Scopus

This study was based on research performed by the MILIS Group pursuant to contracts N01-HV-7-2940, 7-2941, 7-2942 and 7-2979 with the National Heart, Lung, and Blood Institute, National Institutes of Health, United States Department of Health and Human Services, Bethesda, Maryland.

View full text