TY  - JOUR
T1  - CLinical and angiographic characteristics of exertion-related acute myocardial infarction
AU  - Giri S, Thompson PD, Kiernan FJ, et al
Y1  - 1999/11/10
N1  - 10.1001/jama.282.18.1731
JO  - JAMA
SP  - 1731
EP  - 1736
VL  - 282
IS  - 18
N2  - Context 
                  Vigorous physical exertion transiently increases the risk of acute myocardial
infarction (MI), but little is known about the clinical characteristics of
exertion-related MI.Objective 
                  To compare the clinical and angiographic characteristics of patients
who had an exertion-related acute MI vs those who experienced an MI not related
to exertion.Design and Setting 
                  Prospective observational cohort study of patients with an acute MI
referred to a tertiary care hospital for primary angioplasty.Patients 
                  Of 1048 patients with acute MI, 640 (64 who experienced an exertion-related
MI and 576 who did not) were selected for treatment with primary angioplasty
and admitted between August 1995 and November 1998.Main Outcome Measures 
                  Clinical characteristics of the patients, including their habitual physical
activity (determined by the Framingham Physical Activity Index and the Lipid
Research Clinic Physical Activity Questionnaire), angiographic findings during
coronary angiography, and the relative risk (RR) of MI during exertion.Results 
                  Patients who experienced exertion-related MI were more frequently men
(86% vs 68%), hyperlipidemic (62% vs 40%), and smokers (59% vs 37%), were
more likely to present with ventricular fibrillation (20% vs 11%), Killip
classification III or IV heart failure (44% vs 22%), single-vessel disease
(50% vs 28%), and a large thrombus in the infarct artery (64% vs 35%) and
were more likely to be classified as having very low or low activity (84%
vs 66%). The RR of experiencing an MI during exertion was 10.1 times greater
than the risk at other times (95% confidence interval [CI], 1.6-65.6), with
the highest risk among patients classified as very low active (RR, 30.5; 95%
CI, 4.4-209.9) and low active (RR, 20.9; 95% CI, 3.1-142.1).Conclusion 
                  These results show that exertion-related MIs occur in habitually inactive
people with multiple cardiac risk factors. These individuals may benefit from
modest exercise training and aggressive risk-factor modification before they
perform vigorous physical activity.
SN  - 0098-7484
M3  - doi: 10.1001/jama.282.18.1731
UR  - http://dx.doi.org/10.1001/jama.282.18.1731
ER  -