| 41. |
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| 42. |
- Herlitz, Johan, 1949, et al.
(författare)
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Treatment and outcome in acute myocardial infarction in a community in relation to gender
- 2008
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Ingår i: International Journal of Cardiology. - : Elsevier BV. - 1874-1754 .- 0167-5273. ; 135:3, s. 315-22
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Tidskriftsartikel (refereegranskat)abstract
- AIM: To describe treatment and outcome in all patients in a community with acute myocardial infarction (AMI) in relation to gender. METHODS: All patients discharged from hospital between 2001 and 2002 in Goteborg, Sweden, with a diagnosis of AMI underwent a survey to find possible gender differences. All p-values are age adjusted. RESULTS: Among 1423 admissions, women comprised 41% and were older than men (mean 79 versus mean 72 years). Women were admitted to a coronary care unit less frequently than men (49% versus 67%; p=0.005). Women underwent coronary angiography less frequently (21% versus 40%; p=0.02). Percutaneous coronary intervention (PCI) was performed in 10% of the women and 18% of the men (p=0.36). Coronary artery bypass grafting (CABG) was performed in 2% of the women and in 9% of the men (p<0.0001). Female gender was associated with a lower risk of reinfarction during first year after hospital discharge (12% versus 16%; p=0.003). The cumulative three-year mortality was 49% in women and 41% in men. However, when adjusting for age, admittance to CCU, coronary angiography and coronary revascularisation, risk of death during 3 years was lower in women than men (odds ratio 0.72; 95% confidence interval 0.60-0.85; p=0.0001). CONCLUSION: In the community of Goteborg women (mean age 79 years) with AMI are prioritised differently than men (mean age 72 years), prior to admission to a CCU. This results in a less invasive strategy in women, particularly with regard to CABG. When adjusting for difference in age, admittance to CCU and coronary revascularisation female gender was associated with a low risk of death during the subsequent 3 years.
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| 43. |
- Lingman, Markus, 1975, et al.
(författare)
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Acute coronary syndromes - The prognostic impact of hypertension, diabetes and its combination on long-term outcome.
- 2009
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Ingår i: International journal of cardiology. - : Elsevier BV. - 1874-1754 .- 0167-5273. ; 137:1, s. 29-36
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Knowledge about the simultaneous influence of diabetes and hypertension on outcome among patients with ischemic heart disease is limited. The objective of this survey was to describe the characteristics, treatment and outcome among patients with acute coronary syndromes (ACS) in relation to previous history of hypertension (HT), diabetes mellitus (DM) or a combination of the two. METHODS: Consecutive patients admitted to the Coronary Care Unit, Sahlgrenska University Hospital, Goteborg Sweden aged <80 years fulfilling criteria for ACS during 1995 until 2001 were followed for a median of 8 years. RESULTS: A history of HT was found in 974 (42%) of 2329 patients and a history of DM in 446 (19%). Patients with DM or HT were older, more often female and more frequently had previous atherosclerotic manifestations. Patients with DM, irrespective of HT, had a higher prevalence of prior heart failure, as well as higher Killip class and heart rate at admission. Signs of myocardial ischemia on the admission electrocardiogram (ECG) were more prevalent without HT or DM. While HT was weakly associated with impaired long-term prognosis (HR 1.18; 95% CI 1.02-1.37), DM was a strong predictor of death (HR 1.79; 95% CI 1.52-2.10) and the combination was even additive (HR 2.10, 95% CI 1.71-2.57). CONCLUSION: ACS patients with a history of HT and DM had a higher age-adjusted, long-term mortality risk than ACS patients without such a history. DM appeared to be more strongly associated with mortality than HT, but its combination was additive.
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| 44. |
- Omland, Torbjörn, et al.
(författare)
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Circulating osteoprotegerin levels and long-term prognosis in patients with acute coronary syndromes.
- 2008
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Ingår i: Journal of the American College of Cardiology. - : Elsevier BV. - 1558-3597 .- 0735-1097. ; 51:6, s. 627-33
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: This study was designed to assess the association between osteoprotegerin (OPG) levels on admission and long-term prognosis in patients with acute coronary syndromes (ACS). BACKGROUND: Osteoprotegerin, a member of the tumor necrosis factor receptor superfamily, has pleiotropic effects on bone metabolism, endocrine function, and the immune system. METHODS: Serum samples for OPG analysis were obtained within 24 h of admission in 897 ACS patients (median age 66 years, 71% men) and related to the incidence of death, heart failure (HF) hospitalizations, myocardial infarction (MI), and stroke. RESULTS: A total of 261 patients died during a median follow-up of 89 months. The baseline OPG concentration was strongly associated with increased long-term mortality (hazard ratio [HR] for HR per 1 SD increase in logarithmically transformed OPG level 1.7 [range 1.5 to 1.9] p < 0.0001) and HF hospitalizations (HR 2.0 [range 1.6 to 2.5]; p < 0.0001) but weaker with recurrent MI (HR 1.3 [range 1.0 to 1.5]; p = 0.02) and not with stroke (HR 1.2 [range 0.9 to 1.6]; p = 0.35). After adjustment for conventional risk markers, including troponin I, C-reactive protein (CRP), B-type natriuretic peptide (BNP), and ejection fraction, the association remained significant for mortality (HR 1.4 [range 1.2 to 1.7]; p < 0.0001) and HF hospitalization (HR 1.6 [range 1.2 to 2.1]; p = 0.0002), but not recurrent MI. By comparison of the area under the receiver-operating characteristics curves, OPG performed similarly to BNP and ejection fraction and significantly better than CRP and troponin I as a predictor of death. CONCLUSIONS: Serum OPG is strongly predictive of long-term mortality and HF development in patients with ACS, independent of conventional risk markers.
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| 45. |
- Omland, Torbjørn, et al.
(författare)
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N-terminal pro-B-type natriuretic peptide and long-term mortality in acute coronary syndromes.
- 2002
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Ingår i: Circulation. - 1524-4539. ; 106:23, s. 2913-8
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Tidskriftsartikel (refereegranskat)abstract
- B-type natriuretic peptide (BNP) is a predictor of short- and medium-term prognosis across the spectrum of acute coronary syndromes (ACS). The N-terminal fragment of the BNP prohormone, N-BNP, may be an even stronger prognostic marker. We assessed the relation between subacute plasma N-BNP levels and long-term, all-cause mortality in a large, contemporary cohort of patients with ACS.
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| 46. |
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| 47. |
- Perers, Elisabeth, 1952, et al.
(författare)
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Impact of diagnosis and sex on long-term prognosis in acute coronary syndromes
- 2007
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Ingår i: Am Heart J. - : Mosby, Inc.. - 1097-6744 .- 0002-8703. ; 154:3, s. 482-8
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: There is limited information on long-term outcome in patients surviving the acute phase of an acute coronary syndrome (ACS). As yet, the effects of the type of syndrome and sex on mortality and morbidity in the long run have not been well described. METHODS: We studied 1618 patients <80 years old with ACS and alive 30 days after hospitalization in a coronary care unit. The patients were followed for 5 years. They were divided into 4 groups according to the type of ACS (ST-segment elevation myocardial infarction [STEMI], non-STEMI, unstable angina pectoris high risk, and unstable angina pectoris low risk). RESULTS: There was no significant sex difference in unadjusted 5-year mortality (P = .20). After adjustment for age, the hazard ratio with the corresponding 95% CI for a higher late 5-year mortality in women in relation to men was 0.89 (0.70-1.13, P = .34). Women were hospitalized for heart failure significantly more frequently during follow-up, a significance that disappeared after adjustment for age. Non-STEMI was associated with a significantly higher long-term mortality than STEMI, before but not after adjustment for covariates (hazard ratio [95% CI] 1.02 [0.75-1.37], P = .92). Of these, age, ST depression on admission, and early revascularization with percutaneous coronary intervention appeared to be of particular importance. Non-STEMI had a significantly higher rate of acute/subacute revascularization during follow-up, even after adjustment for age. CONCLUSIONS: Before, but not after, adjustment for covariates, a diagnosis of non-STEMI was associated with a poorer prognosis than other types of ACS. Small sex differences in long-term outcome in survivors of ACS were found.
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| 48. |
- Perers, Elisabeth, 1952, et al.
(författare)
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Low risk is associated with poorer quality of life than high risk following acute coronary syndrome
- 2006
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Ingår i: Coron Artery Dis. - : Lippincott Williams & Wilkins. - 0954-6928 .- 1473-5830. ; 17:6, s. 501-10
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Morbidity after acute coronary syndromes includes both physical and mental disorders affecting quality of life. The aim of this investigation was to study quality of life at a 3-month follow-up in patients with acute coronary syndrome, with the main objective of exploring whether unstable angina pectoris and myocardial infarction (MI) patients differ in this respect. METHODS: This investigation was part of a prospective risk stratification study of consecutive patients with acute coronary syndrome of whom 814 below the age of 75 years (278 diagnosed with unstable angina pectoris and 536 with myocardial infarction) accepted an invitation to a follow-up visit 3 months after discharge. At follow-up, the patients completed the Cardiac Health Profile, a disease-specific quality of life questionnaire, designed to evaluate perceived cognitive, emotional, social and physical function. RESULTS: Quality of life was mainly influenced by patient characteristics and previous history. The Cardiac Health Profile scores in unstable angina pectoris patients were significantly higher (i.e. poorer quality of life) than myocardial infarction patients at the 3-month visit (34, 22, 50; median, 25th, 75th percentile and 30, 19, 44; median, 25th, 75th percentile, respectively, P=0.006). The adjusted odds ratio for a poorer quality of life in unstable angina pectoris patients in relation to myocardial infarction patients was 1.39 (95% confidence interval 1.03, 1.87; P=0.03). The highest Cardiac Health Profile scores were seen in the unstable angina pectoris patients without electrocardiogram signs of ongoing ischemia and/or elevated markers of myocardial necrosis. CONCLUSION: Patients with unstable angina pectoris, especially of the low-risk type, and therefore treated accordingly, are more likely to experience poorer quality of life following an acute hospitalization than patients with other types of acute coronary syndrome. Once myocardial infarction or high-risk unstable angina pectoris has been ruled out, these patients still require a careful and systematic follow-up.
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| 49. |
- Perers, Elisabeth, 1952, et al.
(författare)
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Spectrum of acute coronary syndromes: history and clinical presentation in relation to sex and age
- 2004
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Ingår i: Cardiology. - : S. Karger AG. - 0008-6312 .- 1421-9751. ; 102:2, s. 67-76
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To study sex-based differences in the clinical presentation in relation to age and type of acute coronary syndrome (ACS) in patients under 80 years of age. METHODS: The study includes 1,744 consecutive patients with the full spectrum of ACS (ST elevation myocardial infarction (MI), non-ST elevation MI, and unstable angina of high- and low-risk types) admitted to the coronary care unit in a university hospital. RESULTS: The women were older than the men and were as likely to present with ST elevation MI. They had lower rates of prior MI and prior coronary artery bypass surgery than men but similar rates of percutaneous coronary interventions. Further, women were less likely to have a short delay before admission to hospital and they were attended to less rapidly in the emergency department. The prevalence of risk factors, prior cardiovascular disease and ongoing treatment with cardiovascular drugs were strongly associated with less severe type of ACS with no significant sex interaction. Presentation with non-ST elevation MI was significantly associated with older age while the opposite was true for unstable low-risk angina. ECG signs of acute ischemia were not associated with age. Significant interactions between age and sex were observed for the prevalence of treatment with diuretics as well as hypotension at presentation, both more prevalent among women than men below 65 years of age. CONCLUSIONS: Women are struck by ACS at a higher age than men, are less likely to present early for hospital care, and at younger age women are more likely to present with hypotension. There is a striking difference in risk factors and previous history depending on type of ACS in both sexes.
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| 50. |
- Perers, Elisabeth, 1952, et al.
(författare)
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Treatment and short-term outcome in women and men with acute coronary syndromes
- 2005
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Ingår i: Int J Cardiol. - : Elsevier BV. - 0167-5273 .- 1874-1754. ; 103:2, s. 120-7
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To study differences in treatment and early morbidity and mortality in relation to gender, type of acute coronary syndrome (ACS) and age in patients under 80 years of age. METHODS: We studied 1744 consecutive patients with ACS with assumed decreasing order of severity [ST-elevation myocardial infarction (MI), non-ST-elevation MI and unstable angina of high- and low-risk types] admitted to the coronary care unit at Sahlgrenska University Hospital. RESULTS: The use of thrombolysis and percutaneous coronary interventions (PCI) did not differ significantly between gender groups and women did not suffer from more severe complications than men. Treatment with beta-blockers, ACE inhibitors and aspirin was used on a similar scale among women and men. In-hospital complications and use of intravenous drugs were strongly associated with severity of disease in a similar way among women and men. The mortality rates at 30 days were 12.4% and 7.4% in MI with and without ST-segment elevation, but only 1.3% and 1.0% in unstable angina of high- and low-risk types. The use of primary PCI decreased with age, as did coronary angiography and PCI in the subacute phase, irrespective of gender. CONCLUSION: Among patients <80 years with ACS admitted to a coronary care unit, the suspicion that women are treated less aggressively than men could not be verified. Nor did women suffer from more complications or have a significantly higher 30-day mortality than men. Elderly patients were significantly less likely to undergo invasive procedures than those of a younger age, irrespective of gender.
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