| 1. |
- Herlitz, Johan, 1949, et al.
(författare)
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Impact of early thrombolysis on chest pain score reflecting myocardial ischemia in relation to various markers of ischemic damage. TEAHAT Study Group.
- 1993
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Ingår i: International journal of cardiology. - : Elsevier Ireland Ltd. - 0167-5273 .- 1874-1754. ; 41:2, s. 123-31
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Tidskriftsartikel (refereegranskat)abstract
- We randomized 352 patients with pain suggestive of acute myocardial infarction who were seen less than 3 h after onset of symptoms to either tissue plasminogen activator or placebo. The impact of treatment on chest pain score was assessed during the first 24 h and related to limitation of final myocardial damage as assessed by various indirect markers. The most marked effect of tissue plasminogen activator was observed in the chest pain score being reduced by 43% in the tissue plasminogen activator group as compared with placebo. Limitation of infarct size with tissue plasminogen activator reached the following percentage values when various methods were used: maximum serum lactate dehydrogenase I activity, 32%; vectorcardiography (QRS vector difference), 20%; electrocardiography (Palmeri score), 20%; ejection fraction, 9%. We conclude that early thrombolysis in acute myocardial infarction reduces the severity of chest pain by nearly 50%. The effect on chest pain is much more marked as compared with the effect on various markers of the final ischemic damage.
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| 2. |
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| 3. |
- Adielsson, Anna, 1973, et al.
(författare)
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A 20-year perspective of in hospital cardiac arrest : Experiences from a university hospital with focus on wards with and without monitoring facilities.
- 2016
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Ingår i: International Journal of Cardiology. - : Elsevier BV. - 0167-5273 .- 1874-1754. ; 216, s. 194-199
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Knowledge about change in the characteristics and outcome of in hospital cardiac arrests (IHCAs) is insufficient.AIM: To describe a 20year perspective of in hospital cardiac arrest (IHCA) in wards with and without monitoring capabilities.SETTINGS: Sahlgrenska University Hospital (800 beds). The number of beds varied during the time of survey from 850-746 TIME: 1994-2013.METHODS: Retrospective registry study. Patients were assessed in four fiveyear intervals.INCLUSION CRITERIA: Witnessed and nonwitnessed IHCAs when cardiopulmonary resuscitation (CPR) was attempted.EXCLUSION CRITERIA: Age below 18years.RESULTS: In all, there were 2340 patients with IHCA during the time of the survey. 30-Day survival increased significantly in wards with monitoring facilities from 43.5% to 55.6% (p=0.002) for trend but not in wards without such facilities (p=0.003 for interaction between wards with/without monitoring facilities and time period). The CPC-score among survivors did not change significantly in any of the two types of wards. In wards with monitoring facilities there was a significant reduction of the delay time from collapse to start of CPR and an increase in the proportion of patients who were defibrillated before the arrival of the rescue team. In wards without such facilities there was a significant reduction of the delay from collapse to defibrillation. However, the latter observation corresponds to a marked decrease in the proportion of patients found in ventricular fibrillation.CONCLUSION: In a 20year perspective the treatment of in hospital cardiac arrest was characterised by a more rapid start of treatment. This was reflected in a significant increase in 30-day survival in wards with monitoring facilities. In wards without such facilities there was a decrease in patients found in ventricular fibrillation.
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| 4. |
- Bengtson, Ann, 1947, et al.
(författare)
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On the waiting list for possible coronary revascularisation. Symptoms relief during the first year and association between quality of life and the very long-term mortality risk
- 2008
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Ingår i: International Journal of Cardiology. - : Elsevier BV. - 1874-1754 .- 0167-5273. ; 123:3, s. 271-6
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Tidskriftsartikel (refereegranskat)abstract
- AIM: To describe: a/ the improvement in quality of life (QoL) among patients on the waiting list for coronary revascularisation and b/ the association between QoL and very long-term mortality. PATIENTS: All patients on the waiting list for possible coronary revascularisation in western Sweden during one week in September 1990. METHODS: QoL was assessed at the start of the survey and one year later among patients who both were and were not revascularised. Survival data were gathered for the subsequent 14 years. RESULTS: From the start, 883 patients were evaluated in the survey. Among patients who were revascularised, an improvement was seen in all the aspects of QoL that were studied during the first year as compared with patients who were not revascularised, in whom only minor changes in QoL were seen during the first year. After one year, there were seven aspects of QoL which were significantly associated with the risk of death during the subsequent 14 years, when adjusting for age, sex, previous history and extent of coronary artery disease. They were: tiredness (OR=1.4), weakness (OR=1.5), lack of energy (OR=1.5), inability to react (OR=1.7), use of sedatives (OR=3.2), dyspnea when dressing (OR=2.1) and chest pain when dressing (OR=1.9). CONCLUSION: Among patients on the waiting list for possible coronary revascularisation, there was a marked improvement in QoL among those who were revascularised. In a variety of aspects of QoL, an association with the very long-term risk of death was observed.
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| 5. |
- Bång, Angela, et al.
(författare)
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Lower mortality after prehospital recognition and treatment followed by fast tracking to coronary care compared with admittance via emergency department in patients with ST-elevation myocardial infarction.
- 2008
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Ingår i: International journal of cardiology. - : Elsevier BV. - 1874-1754 .- 0167-5273. ; 129:3, s. 325-332
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To describe the short-and long-term outcome among patients with an ST-elevation myocardial infarction (STEMI), assessed and treated by the emergency medical services (EMS) in relation to whether they were fast tracked to a coronary care unit (CCU) or admitted via the emergency department (ED). METHODS: Consecutive patients admitted to the CCU at Sahlgrenska University Hospital with ST elevations on admission ECG were analysed with respect to whether they by the EMS were fast tracked to the CCU or the adjacent coronary angiography laboratory (direct CCU group; n=261) or admitted via the ED (ED group; n=235). RESULTS: Whereas the two groups were similar with regard to age and previous history, those who were fast tracked to CCU were more frequently than the ED patients diagnosed and treated as STEMI already prior to hospital admission. Reperfusion therapy was more commonly applied in the CCU group compared with the ED group (90% vs 67%; <0.0001). The delay times (median) were shorter in the direct CCU group than in the ED group, with a difference of 10 min from the onset of symptoms to arrival in hospital and 25 min from hospital arrival to the start of reperfusion treatment (primary PCI or in-hospital fibrinolysis). Patients in the direct CCU group had lower 30-day mortality (7.3% vs. 15.3%; p=0.004), as well as late mortality (>30 days to five years) (11.6% vs. 20.6%; p=0.008). CONCLUSION: Among patients transported with ambulance due to STEMI there was a significant association between early recognition and treatment followed by fast tracking to the CCU and long term survival. A higher rate of and a more rapid revascularisation were probably of significant importance for the outcome.
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| 7. |
- Caidahl, Kenneth, 1949, et al.
(författare)
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IgM-phosphorylcholine autoantibodies and outcome in acute coronary syndromes.
- 2012
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Ingår i: International Journal of Cardiology. - : Elsevier BV. - 0167-5273 .- 1874-1754. ; 167:2, s. 464-469
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Tidskriftsartikel (refereegranskat)abstract
- Abstract BACKGROUND: Antibodies against proinflammatory phosphorylcholine (anti-PC) seem to be protective and reduce morbidity. We sought to determine whether low levels of immunoglobulin-M (IgM) autoantibodies against PC add prognostic information in acute coronary syndromes (ACS). METHODS: IgM anti-PC titers were measured in serum obtained within 24h of admission from 1185 ACS patients (median age 66years, 30% women). We evaluated major acute cardiovascular events (MACE) and all-cause mortality short- (6months), intermediate- (18months) and long- (72months) terms. RESULTS: Low anti-PC titers were associated with MACE and all-cause mortality at all follow-up times. After adjusting for clinical variables, plasma troponin-I, proBNP and CRP levels, associations remained at all times with MACE, short and intermediate terms also with all-cause mortality. With anti-PC titers below median, adjusted hazard ratios at 18months were for MACE 1.79 (95% confidence interval [CI]: 1.31 to 2.44; p=0.0002) and for all-cause mortality 2.28 (95% CI: 1.32 to 3.92; p=0.003). Anti-PC and plasma CRP were unrelated and added to risk prediction. CONCLUSIONS: Serum IgM anti-PC titers provide prognostic information above traditional risk factors in ACS. The ease of measurement and potential therapeutic perspective indicate that it may be a valuable novel biomarker in ACS.
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| 8. |
- Hartford, Marianne, 1944, et al.
(författare)
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CRP, interleukin-6, secretory phospholipase A(2) group IIA, and intercellular adhesion molecule-1 during the early phase of acute coronary syndromes and long-term follow-up
- 2006
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Ingår i: Int J Cardiol. - : Elsevier Ireland Ltd. ; 108:1, s. 55-62
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: The objectives of this study were to examine the time course of the inflammatory response in acute coronary syndromes (ACS) and to assess the markers of inflammation and their relation to disease severity. METHODS: We prospectively studied 134 patients with ACS who survived for at least 30 months. The patients were divided into four groups: acute myocardial infarction (MI) with (n=54) or without (n=46) ST-segment elevation and unstable angina with (n=14) or without (n=20) increased risk. Plasma levels of C-reactive protein (CRP), interleukin-6 (IL-6), secretory phospholipase A(2) group IIA (sPLA(2)-IIA), and intercellular adhesion molecule-1 (ICAM-1) were measured on days 1 and 4 and after 3 and 30 months. RESULTS: The highest levels of CRP and sPLA(2)-IIA were seen on day 4 but for IL-6 on day 1. These three markers, but not ICAM-1, were significantly related to disease severity, CKMB, and ejection fraction. Patients in Killip class II-IV had higher levels than those in Killip class I. The individual acute-phase responses correlated with marker levels at 3 and 30 months. ICAM-1 correlated with the development of congestive heart failure. CONCLUSIONS: In ACS there seems to be an individual predisposition to inflammatory response. Plasma IL-6 is the first marker to rise, while sPLA(2)-IIA and CRP peak later. All three markers, especially CRP, may discriminate between MI and non-MI. ICAM-1 seems to reflect other aspects of the inflammatory processes than the other markers. The results emphasize the complexity of the inflammatory response in ACS and stress the need for further studies involving multiple markers.
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| 9. |
- Hartford, Marianne, 1944, et al.
(författare)
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Plasma renin activity has a complex prognostic role in patients with acute coronary syndromes.
- 2021
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Ingår i: International Journal of Cardiology. - : Elsevier BV. - 0167-5273 .- 1874-1754. ; 329, s. 198-204
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Plasma renin activity (PRA) has been related to all-cause mortality and cardiovascular events in patients with cardiovascular disease. However, data from patients with acute coronary syndromes (ACS) are sparse.METHODS: Determination of PRA was made in 550 patients with ACS, including a subgroup of 287 patients not on treatment with angiotensin converting enzyme inhibitors, angiotensin receptor blockers or diuretics, and without heart failure. We evaluated the relations between PRA and all-cause mortality after three years and long-term, and to cardiovascular events after median 8.7 years. Adjustments were made for variables that influenced the hazard ratio (HR) > 5% for the relation between PRA and outcome.RESULTS: Baseline PRA was associated with all-cause mortality during three-years (unadjusted HR 1.74 per 1 SD increase in logarithmically transformed PRA; 95% confidence interval (CI) 1.39-2.16, p < 0.0001) and long-term (HR 1.12, CI 1.00-1.25, p = 0.046). After adjustments, only the three-year association remained significant. In unadjusted analyses, PRA was associated with cardiovascular death, but not with nonfatal cardiovascular events. In the subgroup there was an inverse relation between PRA and long-term all-cause mortality.CONCLUSION: Higher PRA was a significant independent predictor of all-cause mortality after three years, but not at long-term follow-up and not significantly associated with cardiovascular incidence. The renin-angiotensin-system pathophysiology is of great interest, not least due to its association with the COVID-19 pandemic. Our findings indicate a need for further research on the prognostic/predictive aspects of the renin-angiotensin-system in ACS.
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