Myocardial infarction (MI) has the characteristics of high mortality rate, strong suddenness and invisibility. There are problems such as the delayed diagnosis, misdiagnosis and missed diagnosis in clinical practice. Electrocardiogram (ECG) examination is the simplest and fastest way to diagnose MI. The research on MI intelligent auxiliary diagnosis based on ECG is of great significance. On the basis of the pathophysiological mechanism of MI and characteristic changes in ECG, feature point extraction and morphology recognition of ECG, along with intelligent auxiliary diagnosis method of MI based on machine learning and deep learning are all summarized. The models, datasets, the number of ECG, the number of leads, input modes, evaluation methods and effects of different methods are compared. Finally, future research directions and development trends are pointed out, including data enhancement of MI, feature points and dynamic features extraction of ECG, the generalization and clinical interpretability of models, which are expected to provide references for researchers in related fields of MI intelligent auxiliary diagnosis.
Humans ; Electrocardiography ; Myocardial Infarction/diagnosis* ; Recognition, Psychology

This review addresses the importance of psychoneuroimmunology (PNI) studies in understanding the role of acute and chronic psychological stressors on the immune system and development of coronary artery disease (CAD). Firstly, it illustrates how psychological stressors change endothelial function and lead to chemotaxis. Secondly, acute psychological stressors lead to leukocytosis, increased natural killer cell cytotoxicity and reduced proliferative response to mitogens while chronic psychological stressors may lead to adverse health effects. This will result in changes in cardiovascular function and development of CAD. Thirdly, acute and chronic psychological stressors will increase haemostatic factors and acute phase proteins, possibly leading to thrombus formation and myocardial infarction. The evidence for the effects of acute and chronic psychological stress on the onset and progression of CAD is consistent and convincing. This paper also highlights potential research areas and implications of early detection of immunological changes and cardiovascular risk in people under high psychological stress.
Acute-Phase Proteins ; Coronary Artery Disease ; immunology ; psychology ; Humans ; Inflammation ; psychology ; Myocardial Infarction ; immunology ; psychology ; Stress, Psychological ; immunology ; Thrombosis ; immunology ; psychology

BACKGROUNDPrehospital delay remains one of the main causes of reduced benefit of reperfusion therapy for patients with acute myocardial infarction (AMI). The largest proportion of prehospital delay involves the interval between the onset of symptoms and the decision to seek medical treatment. The purpose of this study was to examine the factors associated with the extent of care-seeking delay in Beijing for patients with AMI.

METHODSA structured interview was conducted in 102 patients with AMI in eight hospitals in Beijing.

RESULTSThe mean decision time in patients with AMI was (204 +/- 43) minutes, and prehospital delay time was (311 +/- 54) minutes. Only 34% of patients sought medical care within one hour and a further 36% of patients presented to one of the eight hospitals within two hours after onset. Educational level, atypical presentation of AMI, and family members at the site where AMI occurred were associated with longer delay time in seeking medical assistance (P < 0.05, respectively), whereas the intensity of chest pain was inversely related to patients' delay time (P < 0.01). Patients who perceived their family relationship as good, attributed their symptoms to AMI origin, knew the time-dependent nature of reperfusion therapy, or used emergency medical service tended to seek medical care in a more rapid manner (P < 0.05, respectively).

CONCLUSIONSPatients with AMI in Beijing delay seeking medical care to a great extent. Health education to increase the level of awareness of the target population at increased risk of AMI, including patients and their family members, is probably beneficial to reduce patients' care-seeking delay.

Cognition ; Female ; Humans ; Male ; Myocardial Infarction ; psychology ; therapy ; Patient Acceptance of Health Care ; Regression Analysis ; Time Factors

BACKGROUND AND OBJECTIVES: Contrast-induced nephropathy (CIN) is a common complication of primary percutaneous coronary intervention (pPCI) and is associated with high mortality and morbidity and long hospital stay in patients with ST elevation myocardial infarction (STEMI). The Syntax Score (SS) has previously been studied in STEMI patients, and it was associated with increased CIN development and long-term mortality. This study investigates a possible relationship between CIN development and Syntax Score II (SSII) and compares SS and SSII by assessing CIN risk in STEMI patients treated with pPCI. METHODS: A total of 1,234 patients who underwent pPCI were divided into 2 groups according to CIN development. Patients with CIN were further divided into 2 groups according to whether or not they required hemodialysis. Reclassification tables, net reclassification improvement, and integrated discriminative improvement methods were used to assess the additive predictive value of SSII for predicting CIN. RESULTS: In the present study, 166 patients (13.5%) had CIN. Although both SS and SSII were significantly higher in CIN patients, only SSII was an independent predictor of CIN (odds ratio [OR], 1.031; 95% confidence interval [CI], 1.012–1.051; p < 0.001) and hemodialysis requirement (OR, 1.078; 95% CI, 1.046–1.078; p < 0.001). When comparing SSII and SS in their ability to determine CIN risk, we found SSII to have a reclassification improvement of 27.59% (p < 0.001) and an integrated discrimination improvement of 9.1% (p < 0.001). CONCLUSIONS: The combination of clinical and anatomic variables can more accurately identify patients who are at high risk for CIN after pPCI. While SSII is harder to calculate than SS, it provides better prediction for CIN and hemodialysis requirement than SS.
Discrimination (Psychology) ; Humans ; Length of Stay ; Mortality ; Myocardial Infarction ; Percutaneous Coronary Intervention ; Renal Dialysis

PURPOSE: The purpose of this study was to verify the validity and reliability of the Type D Scale-14 (DS14). METHODS: The participants were 288 patients who were diagnosed with angina pectoris, myocardial infarction, and hypertension. DS14 was developed by Denollet(2005) and consists of two domains, 7 items on negative affectivity (NA) and 7 items on social inhibition (SI). The Korean version of DS14 was developed through translation-reversed translation and a preliminary test. Data were collected using a self-report questionnaire. Cronbach alpha and Guttman split-half were used to test reliability and item analysis and factor analysis for validity. The SPSS program was used. RESULTS: 35.8% of the participants were classified as Type D. Mean score for NA was 16.80 and for SI, 14.10 in Type D participants. For reliability of NA, Cronbach alpha=0.771, and for SI, 0.707. Factor analysis on 12 items(numbers 1 & 3 were excluded as the corrected item-total correlations were below r=0.3) yielded two factors for NA (6 items) and SI (6 items). Number 7 in the NA domain was sorted into the SI domain. CONCLUSION: The results indicate, the cultural differences were between Europeans and Koreans. Repetition of the research is needed for generalization of DS14.
Angina Pectoris ; Cardiovascular Diseases ; Generalization (Psychology) ; Humans ; Hypertension ; Myocardial Infarction ; Surveys and Questionnaires ; Reproducibility of Results

BACKGROUNDAcute myocardial infarction (AMI) is the leading cause of morbidity and disability among Iranian population. Pre-hospital delay is an important cause of increasing early and also late mortality in AMI. Thus the aim of the present study was to identify the factors influencing pre-hospital delay among patients with AMI in Iran.

METHODSBetween August 2010 and May 2011, a cross-sectional and single-center survey was conducted on 162 consecutive patients with ST-elevation myocardial infarction (STEMI) admitted to Cardiac Care Unit (CCU) of Dr. Heshmat Hospital, Rasht. All patients were interviewed by the third author within 7 days after admission by using a four-part questionnaire including socio-demographic, clinical, situational and cognitive factors. Data were analyzed by descriptive and Logistic regression model at P < 0.05 using SPSS 16.

RESULTSMean age was (60.11 ± 12.29) years in all patients. Majority of patients (65.4%) were male. The median of pre-hospital delay was 2 hours, with a mean delay of 7.4 hours (± 16.25 hours). Regression analysis showed that admission in weekend (P < 0.04, OR = 1.033, 95%CI = 1.187 - 2.006) and misinterpretation of symptoms as cardiac origin (P < 0.002, OR = 1.986, 95%CI = 1.254 - 3.155) and perceiving symptoms to not be so serious (P < 0.003, OR = 3.264, 95%CI = 1.492 - 7.142) were factors influencing pre-hospital delay > 2 hours.

CONCLUSIONSOur findings highlight the importance of cognitive factors on decision-making process and pre-hospital delays. Health care providers can educate the public on AMI to enable them recognize the signs and symptoms of AMI correctly and realize the benefits of early treatment.

Acute Disease ; psychology ; Aged ; Cross-Sectional Studies ; Decision Making ; Female ; Humans ; Male ; Middle Aged ; Myocardial Infarction ; psychology ; Time Factors

BACKGROUND: Cardiac troponin T (cTnT) is a new serological marker for use as a diagnostic toots for acute myocardial infarction (AMI). This study was designed to evaluate tee diagnostic efficiency of troponin T in AMI. METHODS: We determined the reference range of troponin T in 20 healthy adults without previous cardiovascular diseases and chest pain. We evaluated troponin-T, CK, LD, AST and CK-MB in serum of 13 AMI and 5 angina pectoris patients. The patients were arrived at the hospital within 3 hours after onset of (most recent) acute symptoms. Samples were drawn individually at the times of 0, 1, 3, 7, 18 and 24 hours after admission and continued at 6-h intervals for 2 days and 24-h intervals fort 2 weeks. Troponin T was determined by an enzyme-linked immuno-sorbent assay (one step sandwich assay) on an ES-300 analyzer. RESULTS: We found that serum troponin-T concentrations in healthy control adults were below 0.07microgram/L. The peak level of troponin-T concentration of patients with AMI was 22.0microgram/L, mean value, at 7 hours after admission and showed 110 times its discrimination limit value (0.2microgram/L). CK-MB value was normalized within 3 days after admission, but cTnT value remained high above its discrimination limit value until 2 weeks after admission during this study. CONCLUSIONS: The data indicate that the measurement of serum cTnT improves efficiency of serological testings of AMI as compared with conventionally used cardiac enzymes.
Adult ; Angina Pectoris ; Cardiovascular Diseases ; Chest Pain ; Discrimination (Psychology) ; Humans ; Myocardial Infarction* ; Reference Values ; Serologic Tests ; Troponin T* ; Troponin*

BACKGROUND: To evaluate the usefulness of admission and daily acute physiology and chronic health evaluation (APACHE) III score in relation to length of stay in the intensive care unit (ICU) for outcome prediction, 4,554 patients were studied. METHODS: These patients were admitted to the ICU from June 6, 1994 to December 31, 2002. Exclusion criteria included patients being treated for burns, having surgery for coronary artery bypass grafts, having a diagnosis of myocardial infarction, being under 16 years of age and being discharged less than 16 hours after admission. To evaluate the discrimination power of admission and daily APACHE III score, the area under the receiver operating characteristic curve was computed for each of the initial 16 days of ICU care. RESULTS: Admission APACHE III score loses discrimination power over time, from admission day to day 4 in the ICU, the area under the receiver operating characteristic curve was above 0.8 and after day 16, it dropped to below 0.7. However, daily APACHE III score maintained discrimination power at about 0.8 over time. CONCLUSIONS: In the early days after ICU admission, admission and daily APACHE III score are useful. With time daily APACHE III scores are more useful than admission APACHE III score.
APACHE* ; Burns ; Coronary Artery Bypass ; Diagnosis ; Discrimination (Psychology) ; Humans ; Intensive Care Units ; Length of Stay* ; Myocardial Infarction ; ROC Curve ; Transplants

BACKGROUND: During and immediately after percutaneous transluminal coronary angioplasty(PTCA), reversible ischemic electrocardiographic change and/of left ventricular dysfunction are developed. But it is not investigated whether there are potential myocardial cell damages following PTCA or not, and the clinical Significance of myocardial cell damage following PTCA. Recently cardiac Troponin-T has been developed as a new myocardial specific marker, especially myocardial damage. The object of this study is to investigate whether potential Myocardial damage following PTCA was occurred and the utility of cardiac Tropoin-T for predicting the complications during and immediately after PTCA. METHODS: The study group comprised 12 patients(M/F;8/4mean age;60 +/- 4year,AMI in 6) undergoing PTCA, Samples for Troponin-T were obtained before, directly after, after 2 hours, 6 hours, and after 12 hours and was determined by enzyme immunoassay on an ES 300 analyzer(Boehringer Mannheim). Discrimination limit for myocardial cell damage is 0.1 ng/ml in normal baseline level but if the baseline level is elevated such as acute myocardial infarction or unstable angina, myocardial cell damage is defined with further increase of cardiac Troponin-T(>0.1 ng/ml) compare to baseline level. RESULTS: 1) The mean duration of total balloon inflation is 10.7 +/- 2(3-22) minutes and the mean duration of single maximal inflation is 3.9 +/- 0.6(1-8) minutes. There are no significant change in concentration of Troponin-T by inflation time. None of the patients showed electroca rdiographic evidence for myocardial infarction. 2) Troponin-T were increased in 2 patients with unstable angina(0.01 vs 0.11 ng/ml) which were developed major dissection including acute closure during PTCA, and 2 patients with acute myocardial infarction(2.37 vs 3.73 ng/ml) which didn't developed dcomplication. The increase of cardiac Troponin-T were observed in 2 of 10 patients with uncomplicated PTCA(20%). 3)The subacute complications were not developed. CONCLUSION: The cardiac Troponin-T were increased significantly in two AMI patients with uncomplicated PTCA(2/10,20%). The increase of cardiac Troponin-T following PTCA is associated with periprocedural complications but the prognostic significance to detect postprocedural complication did not define in this study because there were no subacute complications after PTCA and may be limited value due to time course of complication(usaully within 1 hour after PTCA) and relatively long analytic time.
Angina, Unstable ; Discrimination (Psychology) ; Electrocardiography ; Humans ; Immunoenzyme Techniques ; Inflation, Economic ; Myocardial Infarction ; Troponin T* ; Ventricular Dysfunction, Left

The purpose of this study was to determine the impact of situational, clinical and psychsoical factors on treatment-seeking behavior among those with acute myocardial infarction(AMI). This study used a retrospective, descriptive design. The sample consisted of 72 patients aged over 30 and who were diagnosed with an acute myocardial infarction at two large university-affiliated medical centers from July 1, 1998 to March 30, 2000. But of 72, patients 5 who were an outlier in treatment-seeking time were deleted. Data were collected by using questionnaires, which included demographic data, situational, clinical and psychosocial data. Also patient interviews and chart review were used to obtain information related to treatment-seeking time. The results of this study were summarized as follows; 1. Mean time from the onset of AMI symptoms to arrival at the hospital was 12.09 +/- 11.44 hours; 2. Treatment-seeking time was not significantly different by age, gender, or education; 3. Most(44 or 65.78%) patients were at home when they began having AMI symptoms. The remaining patients were either in a public area, workplace or in a car. Patients at home delayed longer than those who had their first symptoms elsewhere, but not significantly different. Also, most patients were with another person when they began to experience AMI symptoms: a spouse(25 or 37.3%), other family member(31 or 46.3%); the remaining 11 were alone. There were no significant differences in treatment-seeking time based on whether alone or with others. Most patients(46 or 68.7%) used an ambulance rather than taking private transportation, and patients who used an ambulance were delayed longer than those who used private transportation, but there were no significant differences; 4. Time to treatment-seeking was not significantly different by blood pressure, heart rate on admission and the peak CK-MB, CPK and Cholesterol level, Killips class; 5. There were no significant statistical differences in treament-seeking times by anxiety level, mood status or control ability.
Ambulances ; Anxiety ; Blood Pressure ; Cholesterol ; Education ; Heart Rate ; Humans ; Myocardial Infarction* ; Psychology* ; Retrospective Studies ; Transportation ; Surveys and Questionnaires