| 1. |
- Herlitz, Johan, et al.
(författare)
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Occurrence of angina pectoris prior to acute myocardial infarction and its relation to prognosis
- 1993
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Ingår i: European Heart Journal. - : Oxford University Press. - 0195-668X .- 1522-9645. ; 14:4, s. 484-491
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Tidskriftsartikel (refereegranskat)abstract
- In 917 patients with acute myocardial infarction (AMI) we evaluated the impact of previous angina pectoris on the prognosis. Thirty-four percent of the patients had chronic angina prior to AMI, and 22% had angina pectoris of short duration. Patients with chronic angina pectoris differed from the remaining patients having a more frequent previous history of AMI, diabetes mellitus, hypertension, and congestive heart failure. They less frequently developed a Q-wave AMI, and had smaller infarcts according to maximum serum-enzyme activity as compared with the remaining patients. They had a higher one-year mortality rate (36%) as compared with those having angina pectoris of short duration (22%), and those with no angina pectoris (26%). Their reinfarction rate was also higher (26%) as compared with that in the other two groups (15% and 9% respectively). In a multivariate analysis considering age, sex, clinical history, initial symptoms, initial electrocardiogram and estimated infarct size, previous chronic angina pectoris was not an independent risk factor for death, but was independently associated with the risk of reinfarction (P<0.001) Among patients with a history of angina pectoris the outcome was related to medication prior to onset of AMI and at discharge from hospital. Patients in whom beta-blockers were prescribed at discharge had a one-year mortality of 13% as compared with 30% in the remaining patients
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| 2. |
- Herlitz, Johan, et al.
(författare)
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Relationship between serum enzyme activity in acute myocardial infarction and morbidity during a 2-year follow-up
- 1986
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Ingår i: Cardiology. - : S. Karger AG. - 0008-6312 .- 1421-9751. ; 73:2, s. 85-93
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Tidskriftsartikel (refereegranskat)abstract
- In 585 patients with a first myocardial infarction the enzymatically estimated infarct size was related to the clinical course during a 2-year follow-up. Infarct size was estimated from maximum heat-stable lactate dehydrogenase activity. A higher maximum serum activity was associated with a higher mortality rate, more treatment with diuretics, digitalis and antiarrhythmics and a lower frequency of return to work. Patients with smaller infarcts according to maximum serum activity, however, had a higher incidence of angina pectoris and a higher reinfarction rate. We conclude that although there is a strong association between serum enzyme activity and mortality during a 2-year follow-up, the relation with morbidity appears to be more complex.
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| 3. |
- Herlitz, Johan, et al.
(författare)
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Risk factors for death and mode of death after acute myocardial infarction in relation to age
- 1992
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Ingår i: Coronary Artery Disease. - : Lippincott Williams & Wilkins. - 0954-6928 .- 1473-5830. ; 3:11, s. 1055-1063
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Tidskriftsartikel (refereegranskat)abstract
- Background: This study aims to describe independent risk indicators for death and mode of death after development of acute myocardial infarction in relation to age. Methods: Nine hundred twenty-one consecutive patients admitted to Sahlgrenska Hospital, Goteborg, Sweden, suffering from acute myocardial infarction were prospectively followed for 1 year. The patients were divided into two age groups, 76 years old and above or below 76 years old, because there was an equal number of deaths in these two groups. Results: In the older group, the following were independent risk indicators for death at 1 year of follow-up, in order of significance: 1) previous infarction (P< 0.01); 2) ST-segment elevation on admission (P< 0.01); 3) arrhythmia at onset of infarction (P< 0.05); and 4) age (P< 0.05). In patients 76 years old or less the following were risk indicators: 1) age (P < 0.001); 2) history of congestive heart failure (P< 0.01); 3) loss of consciousness at onset of infarction (P< 0.01); 4) acute congestive heart failure at onset of infarction (P< 0.05); 5) unspecific symptoms at onset of infarction (P< 0.05); and 6) history of hypertension (P< 0.05). In both age groups risk indicators for death during hospitalization differed from risk indicators for death after discharge from the hospital. During hospitalization, the elderly more frequently died in association with congestive heart failure and less frequently in association with ventricular fibrillation as compared with younger patients. Conclusions: In the elderly (>76 y) with acute myocardial infarction, risk indicators for death differ from those in younger patients. Symptoms associated with death are also not the same in patients 76 years old as compared with younger patients.
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| 4. |
- Karlson, BW, et al.
(författare)
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Emergency room prediction of mortality and severe complications in patients hospitalized for suspected acute myocardial infarction
- 1995
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Ingår i: European Heart Journal. - : Oxford University Press. - 0195-668X .- 1522-9645. ; 15:11, s. 1558-1565
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Tidskriftsartikel (refereegranskat)abstract
- This study aims at describing the in-hospital prognosis of patients admitted with suspected acute myocardial infarction, focusing on the possibility of emergency room prediction of the risk for death and severe complications. From 7157 consecutive patients with chest pain or other symptoms suggestive of acute myocardial infarction in the emergency room, 4690 were hospitalized. Of these, 246 (5%) died in hospital, with a mortality rate among the 921 patients who developed myocardial infarction of 14%, and among those without infarction of 3%. From the clinical history, examination and electrocardiogram in the emergency room, independent predictors of death and death or any severe complication were determined by logistic regression analysis. These included age, initial degree of suspicion of infarction, electrocardiographic pattern, history of diabetes mellitus, history of congestive heart failure and on admission arrhythmias, loss of consciousness, acute congestive heart failure, or unspecific symptoms. From these analyses the probability of death or death or any severe complication can be calculated. Thus, 18% of patients hospitalized due to suspected acute myocardial infarction suffered a severe complication or died in hospital. From a statistical model it is possible to predict the in-hospital prognosis of every such patient.
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| 5. |
- Karlsson, BW, et al.
(författare)
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Prognosis in suspected acute myocardial infarction in relation to delay time between onset of symptoms and arrival in hospital
- 1991
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Ingår i: Cardiology. - : S. Karger AG. - 0008-6312 .- 1421-9751. ; 78:2, s. 131-137
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Tidskriftsartikel (refereegranskat)abstract
- During a 21-month period, the prognosis in all patients admitted to a hospital ward from the emergency room with suspected acute myocardial infarction (AMI) was prospectively recorded and related to the time between onset of symptoms and arrival in hospital. They were classified as early arrivers (less than or equal to 2 h), intermediate arrivers (2-8 h) and late arrivers (greater than 8 h). Among patients developing a confirmed AMI (n = 909) the 1-year mortality rate was 26.0% in early arrivers, 28.1% in intermediate arrivers and 32.6% in late arrivers. The corresponding figures for patients in whom AMI was ruled out (n = 2,035) were 15.2, 15.1 and 17.6%, respectively. In AMI patients, various morbidity aspects during hospitalization and 1 year of follow-up appeared mainly independent of delay time, whereas among those in whom AMI was ruled out congestive heart failure during hospitalization was most common in early arrivers. We conclude that patients with suspected AMI who do not arrive early in hospital have a high 1-year mortality rate regardless of whether they develop AMI or not. Whether their prognosis can be improved by shortening of delay time remains to be clarified.
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| 6. |
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| 7. |
- Bengtsson, A, et al.
(författare)
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The appropriateness of performing coronary angiography and coronary artery revascularization in a Swedish population
- 1994
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Ingår i: Journal of the American Medical Association (JAMA). - : American Medical Association. - 0098-7484 .- 1538-3598. ; 271:16, s. 1260-1265
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Tidskriftsartikel (refereegranskat)abstract
- Objective. —To evaluate the appropriateness of performing coronary angiography and revascularization in a Swedish population. Design. —Prospective population study of questionnaires and medical records. Setting. —All the hospitals in southwestern Sweden that perform coronary angiography and revascularization. Patients. —Random sample of 831 patients (with chronic stable angina) on the waiting list for coronary angiography or revascularization in southwestern Sweden in September 1990. Main Outcome Measure. —Percentage of patients referred for coronary angiography or revascularization for appropriate, uncertain, or inappropriate indications. Results. —Of the patients referred for angiography, 89% were classified as appropriate, 9% as uncertain, and 2% as inappropriate. The percentages are similar for patients referred for coronary artery bypass graft surgery and for angioplasty (91% and 86%, respectively, classified as appropriate). The majority of patients had chest pain rated as Canadian Cardiovascular Society classes II through IV (93%), despite maximum anti-ischemic therapy in 90% of these patients. Conclusions. —Few patients were referred for coronary angiography or revascularization for inappropriate or uncertain indications. The percentage of these patients who are from southwestern Sweden is similar to the percentage recently reported from New York State.
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| 8. |
- Bengtsson, A, et al.
(författare)
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The epidemiology of a coronary waiting list. A description of all patients
- 1994
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Ingår i: Journal of Internal Medicine. - : Wiley-Blackwell Publishing Ltd.. - 0954-6820 .- 1365-2796. ; 235:3, s. 263-269
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Tidskriftsartikel (refereegranskat)abstract
- Keywords: cardiac symptoms; chest pain; coronary revascularization; delay; ischaemic heart disease; nervous reactions; waiting list Abstract. Objectives. To describe the characteristics and the severity of symptoms amongst patients on the waiting list for possible coronary revascularization. Design. All the patients were sent a postal questionnaire for symptom evaluation. Setting. All hospitals in western Sweden. Subjects. All patients in western Sweden on the waiting list in September 1990, who had been referred for coronary angiography or revascularization (n = 904) and a sex- and age-matched reference group (n = 809). Results. More than half of the patients had daily attacks of chest pain, whereas 16% reported less than one attack per week or no pain at all. However, other symptoms such as dyspnoea, tachycardia and nervous reactions were also common and 25% of all patients used sedatives. A long waiting time for a given procedure was not associated with more pain but with more nervous symptoms such as restlessness and insomnia (P < 0.0001) and greater use of sedatives and cigarettes (P < 0.05). Conclusions. We conclude that a long waiting time for possible coronary revascularization is associated with more nervous symptoms but not with more pain.
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| 9. |
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| 10. |
- Berggren, H, et al.
(författare)
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Myocardial Protective Effect of Maintained Beta-Blockade in Aorto-Coronary Bypass Surgery
- 1983
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Ingår i: Scandinavian Cardiovascular Journal. - : Informa Healthcare. - 1401-7431 .- 1651-2006. ; 17:1, s. 29-32
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Tidskriftsartikel (refereegranskat)abstract
- Twenty-nine patients were randomly allocated to two groups before undergoing aorto-coronary bypass surgery. In one group the beta-blocking medication was withdrawn three days preoperatively, and in the other group it was maintained. The patients in the latter group were additionally given 100 mg metoprolol per os two hours before surgery. The degree of myocardial injury, as judged from cumulated activity of S-CK B, was less when the beta-blockade was maintained.
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