Tofler G H, Stone P H, Maclure M, Edelman E, Davis V G, Robertson T, Antman E M, Muller J E
Department of Medicine, New England Deaconess Hospital, Harvard Medical School, Boston, Massachusetts 02215.
Am J Cardiol. 1990 Jul 1;66(1):22-7. doi: 10.1016/0002-9149(90)90729-k.
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.
近期有关急性心肌梗死（AMI）昼夜节律变化的文献表明，AMI并非随机事件，而是可能常常由可识别的触发活动所致。对纳入梗死面积限制多中心研究的849例患者报告的可能触发因素进行了分析。48.5%的研究对象识别出了可能的触发因素；最常见的是情绪波动（18.4%）和适度体力活动（14.1%）。13%的研究对象报告了多种可能的触发因素。与老年患者、女性和糖尿病患者相比，年轻患者、男性以及非糖尿病患者更有可能报告可能的触发因素。报告触发因素的可能性不受梗死面积的影响。本研究提示，潜在的可识别触发因素可能在AMI中起重要作用。由于潜在的触发活动在冠心病患者中很常见，但很少导致AMI，因此需要进一步研究以确定：（1）潜在触发因素可能导致事件发生的情况；（2）潜在触发活动的具体性质；（3）未发生AMI的个体中此类活动的频率；（4）梗死患者各亚组中是否存在可识别的触发因素。
