| 1. |
- Brandrup-Wognsen, Gunnar, 1958, et al.
(författare)
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Mortality during the two years after coronary artery bypass grafting in relation to perioperative factors and urgency of operation.
- 1995
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Ingår i: European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery. - : Elsevier BV. - 1010-7940 .- 1873-734X. ; 9:12, s. 685-91
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Tidskriftsartikel (refereegranskat)abstract
- The purpose of this study was to describe mortality during the 2-year-period after coronary artery bypass surgery (CABG) in relation to perioperative risk factors and urgency of operation. All the patients in western Sweden were included in whom CABG was performed between June 1988 and June 1991, without concomitant procedures or re-operations. The study was prospective in design. In all, 2000 patients were operated upon and 186 (9.3%) of the operations were acute. There was a significant relationship between the urgency of the operation and mortality. Early mortality was 2.4% in elective operations and 5.4-62.5% in urgent to emergency operations. The 30-day to 2-year mortality was 4.2%. The perioperative risk indicators independently associated with early mortality were neurologic complications, serum-aspartate aminotransferase (S-ASAT) more than 2.0 microkat/l, urgency of operation, the use of circulatory assist devices, re-operation and ventilator time more than 24 h. The risk indicators for mortality after 30 days were pneumothorax, longer intensive care unit (ICU) time, the use of inotropic drugs and neurologic complications. In conclusion, the multivariate analysis reveals the urgency of the operation as a predictor of early mortality after CABG, but no significant association with mortality was found after 30 days. When excluding death within 30 days, three additional independent predictors of mortality were identified.
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| 2. |
- Brandrup-Wognsen, Gunnar, 1958, et al.
(författare)
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Preoperative risk indicators of death at an early and late stage after coronary artery bypass grafting.
- 1995
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Ingår i: The Thoracic and cardiovascular surgeon. - : Georg Thieme Verlag KG. - 0171-6425 .- 1439-1902. ; 43:2, s. 77-82
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Tidskriftsartikel (refereegranskat)abstract
- The aim of the study was to describe mortality during a period of two years after coronary artery bypass surgery (CABG) in relation to preoperative risk factors. Included were all the patients in western Sweden in whom CABG was performed between June 1988 and June 1991, without concomitant procedures or re-operations. The study was prospective in design. In all, 2000 patients with a median age of 64 years were operated upon. Early (within 30 days) mortality was 3.0% and late (30-day-2-year) mortality was 4.2%. Total two-year mortality was 7.1%. For patients undergoing coronary artery bypass grafting, the factors found to be independently predictive of early mortality were female sex, renal dysfunction (creatine clearance < 60ml/min), left main stenosis, number of diseased vessels, previous myocardial infarction, and functional class. We found that a history of congestive heart failure, a history of cerebrovascular disease, diabetes mellitus, renal dysfunction and intermittent claudication were independent risk factors for late mortality. In conclusion, with the exception of renal dysfunction, preoperative risk factors for death within 30 days after CABG differ from risk factors for death between 30 days and two years after CABG.
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| 3. |
- Herlitz, Johan, 1949, et al.
(författare)
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Outcome for patients who call for an ambulance for chest pain in relation to the dispatcher's initial suspicion of acute myocardial infarction.
- 1995
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Ingår i: European journal of emergency medicine : official journal of the European Society for Emergency Medicine. - : Lippincott Williams & Wilkins, Ltd.. - 0969-9546 .- 1473-5695. ; 2:2, s. 75-82
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Tidskriftsartikel (refereegranskat)abstract
- The very early handling of patients with suspected acute myocardial infarction (AMI) is of critical importance to the outcome. The aim of this study was to relate the dispatcher's initial suspicion of AMI, among patients who call for an ambulance due to chest pain, to the subsequent diagnosis and outcome. All patients who called for an ambulance in Gothenburg due to acute chest pain during a 2-month period were included in the study. In all, 503 patients fulfilled the inclusion criteria, and information on the dispatcher's initial suspicion of AMI was available in 484 patients. There was at least a strong suspicion of AMI in 36%, a moderate suspicion of AMI in 34% and only a vague or no suspicion in 30%. Among patients with at least a strong suspicion of AMI, 29% subsequently developed infarcation, compared with 18% among patients with a moderate suspicion of AMI and 15% among patients with only a vague or no suspicion (p < 0.001). However, the priority level was similar in patients with and without a life-threatening condition, and the mortality rate remained similar in patients with a strong suspicion and those without a strong suspicion of AMI. Thus, among patients who called for an ambulance due to acute chest pain there was a direct relationship between the dispatcher's suspicion of AMI and the subsequent diagnosis, but the mortality rate was similar in the different groups.
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| 4. |
- Herlitz, Johan, et al.
(författare)
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Ambulance despatchers´ estimation of intensity of pain and presence of associated symptoms in relation to outcome among patients who call for an ambulance because of acute chest pain
- 1995
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Ingår i: European Heart Journal. - : Oxford University Press. - 0195-668X .- 1522-9645. ; 16:12, s. 1789-1794
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: A large number of patients who call for an ambulance because of acute chest pain have an acute ischaemic event, but some do not. AIM. To relate the ambulance despatcher's estimated severity of pain and presence of associated symptoms, in patients who call for an ambulance because of acute chest pain, to whether they develop acute myocardial infarction (AMI) and to the risk of early death. PATIENTS: All those with acute chest pain who contacted the despatch centre in Göteborg over a 2-month period. RESULTS: In all, 503 patients fulfilled the inclusion criteria. Patients judged as having severe chest pain (68%) developed AMI during the first 3 days in hospital on 26% of occasions as compared with 13% among patients judged as having only vague chest pain (P = 0.0004). The difference was less marked among the elderly and women. The presence of any of the following associated symptoms, dyspnoea, nausea, vertigo, cold sweat or syncope, tended to be associated with a higher infarction rate (24%) than if none of these symptoms was present (17%, P = 0.06). Mortality during the pre-hospital and the hospital phase was not associated with the estimated severity of pain or the presence of associated symptoms. CONCLUSIONS: The despatcher's estimation of the severity of pain and the presence of associated symptoms appears to be associated with the development of AMI but not with early mortality.
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| 5. |
- Herlitz, Johan, 1949, et al.
(författare)
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Hospital mortality after out-of-hospital cardiac arrest among patients found in ventricular fibrillation.
- 1995
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Ingår i: Resuscitation. - : Elsevier Ireland Ltd. - 0300-9572 .- 1873-1570. ; 29:1, s. 11-21
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to describe factors associated with in-hospital mortality among patients being hospitalised after out-of-hospital cardiac arrest and who were found in ventricular fibrillation. The study was set in the community of Göteborg, Sweden. The subjects consisted of all patients who were hospitalised alive after out-of-hospital cardiac arrest, being reached by our mobile coronary care unit and who were found in ventricular fibrillation, between 1981 and 1992. In all, 488 patients fulfilled the inclusion criteria of which 262 (54%) died during initial hospitalization. In a multivariate analysis including age, sex, history of cardiovascular disease, chronic medication prior to arrest and circumstances at the time of arrest, the following appeared as independent predictors of hospital mortality: (1) interval between collapse and first defibrillation (P < 0.001); (2) on chronic medication with diuretics (P < 0.01); (3) age (P < 0.01); (4) bystander initiated CPR (P < 0.05); and (5) a history of diabetes (P < 0.05). In a multivariate analysis considering various aspects of status on admission to hospital, the following were independently associated with death: (1) degree of consciousness (P < 0.001) and (2) systolic blood pressure (P < 0.05). In conclusion, among patients with out of hospital cardiac arrest found in ventricular fibrillation and being hospitalised alive, 54% died in hospital. The in-hospital mortality was related to patient characteristics before the cardiac arrest as well as to factors at the resuscitation itself.
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