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Egypt Heart J. 2017 Dec;69(4):223-228. doi: 10.1016/j.ehj.2017.03.003. Epub 2017 Apr 6.

Acute triggers of myocardial infarction: A case-crossover study.

Author information

Guilan Social Security Organization, Rasool-e-Akram Hospital, Rasht, Iran.
Department of Disaster Public Health, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
Department of Nursing (Medical-Surgical), Instructor, Social Determinants of Health Research Center (SDHRC), School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran.
Department of Operating Room & Anesthesia, Paramedical School, Guilan University of Medical Sciences, Rasht, Iran.
Nursing and Midwifery Faculty, Guilan University of Medical Sciences, Rasht, Iran.



Acute myocardial infarction (AMI) is one of the most preventable non-communicable diseases in human. Identifying triggers of myocardial infarction (MI) and prevention ways of exposure-induced complications can reduce morbidity and mortality in people at risk.


The aim of this study was to identify the emotional, environmental, physical and chemical dimensions of acute triggers in patients with AMI.


This case-crossover study was conducted on 269 patients with AMI, hospitalized at two remedial centers in Rasht in 2015. The study samples were selected by convenient sampling method. Data were collected using researcher-made questionnaire through interviews. Hazard and control periods for each trigger and its effects on the development of MI were studied. The collected data were analyzed using descriptive and analytical statistical methods, Cochran test, and generalized estimating equation (GEE) model with logistics function default in SPSS version 21, and p < 0.05 was considered statistically significant.


The results showed that quarrel (P = 0.008, OR = 2.01) and hearing the sudden news (P = 0.001, OR = 2.19) were the most common emotional triggers. Respiratory infections (P = 0.0001, OR = 6.78) and exposure to hot or cold weather (P = 0.005, OR = 2.19) were the most frequent environmental triggers. Doing heavy activities (P = 0.005, OR = 1.66) and sexual activities (P = 0.003, OR = 2.36) were among the most common physical triggers. High-fat foods consumption and overeating (P = 0.0001, OR = 3.79) were the most frequent chemical triggers of AMI.


It seems that given the importance of the triggers in the incidence of AMI, planning is necessary to train vulnerable individuals to reduce exposure to triggers.


Control period; Hazard period; Myocardial infarction; Triggers

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