Analysis of possible triggers of acute myocardial infarction (the MILIS study)
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.
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It is estimated that more than 1.5 million myocardial infarctions occur annually in the United States, and at least 75,000 of these infarcts, which lead to 25,000 deaths, may occur soon after exertion.
“First, it is estimated that more than 1.5 million myocardial infarctions occur annually in the United States,4 and at least 75,000 of these infarcts — which lead to 25,000 deaths — may occur soon after exertion.1,3”
From Triggering of Acute Myocardial Infarction by Heavy Physical Exertion -- Protection against Triggering by Regular Exertion (1993) · cites this paper as [1]
In approximately 5 percent of patients with myocardial infarction, heavy physical exertion immediately precedes the onset of symptoms.
“Descriptive studies have established that in approximately 5 percent of patients with myocardial infarction, such exertion immediately precedes the onset of symptoms.”
From Triggering of Acute Myocardial Infarction by Heavy Physical Exertion -- Protection against Triggering by Regular Exertion (1993) · cites this paper as [1]
Other potential triggers, such as psychological stress or anger, which produce similar physiologic responses, are more common than heavy exertion before myocardial infarction and may be more frequent triggers.
“Furthermore, other potential triggers, such as psychological stress or anger, which produce similar physiologic 38-41 are more common than heavy exertion responses,3 before myocardial infarction¹,³ and may be more frequent triggers.”
From Triggering of Acute Myocardial Infarction by Heavy Physical Exertion -- Protection against Triggering by Regular Exertion (1993) · cites this paper as [1]
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- Authors
- Tofler, G. H., Stone, P. H., Maclure, M., Edelman, E., Davis, V. G., Robertson, T., Antman, E. M., & Muller, J. E.
- Affiliations
- Harvard University (US)
- Corresponding author
- Tofler, Geoffrey H.
- ORCID
- Venue
- The American Journal of Cardiology
- Publisher
- Elsevier BV
- Published
- 1990-07
- Volume
- 66
- Issue
- 1
- Pages
- 22-27
- ISSN
- 0002-9149 (ISSN-L)
- OpenAlex
- W2125565293
- Cited by
- 356
- References
- 1
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 3 · 2023: 3 · 2022: 4 · 2021: 2 · 2020: 8 · 2019: 7 · 2018: 8 · 2017: 5 · 2016: 7 · 2015: 12 · 2014: 3 · 2013: 7 · 2012: 11
- FWCI
- 10.72
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The American Journal of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Heart, Lung, and Blood Institute (N01-HV-7-2941, N01-HV72942, N01-HV-7-2940)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Acute Myocardial Infarction Research
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
- Keywords
- acute myocardial infarction, emotional stress, physical activity, circadian variation, coronary artery disease, infarct size, diabetes mellitus, sex differences, age differences
- MeSH terms
- Aged, Eating, Female, Humans, Male, Middle Aged, Myocardial Infarction, Risk Factors, Sleep Deprivation, Stress, Psychological, Time Factors, Multicenter Studies as Topic, Exercise
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