| 1. |
- Bajraktari, Gani, et al.
(författare)
-
Complete revascularization for patients with ST-segment elevation myocardial infarction and multivessel coronary artery disease : a meta-analysis of randomized trials
- 2018
-
Ingår i: Coronary Artery Disease. - : Lippincott Williams & Wilkins. - 0954-6928 .- 1473-5830. ; 29:3, s. 204-215
-
Tidskriftsartikel (refereegranskat)abstract
- Introduction: Despite the recent findings in randomized clinical trials (RCTs) with limited sample sizes and the updates in clinical guidelines, the current available data for the complete revascularization (CR) in hemodynamically stable patients with ST-segment elevation myocardial infarction (STEMI) at the time of primary percutaneous coronary intervention (PCI) are still contradictory.Aim: The aim of this meta-analysis of the existing RCTs was to assess the efficacy of the CR versus revascularization of infarct-related artery (IRA) only during primary PCI in patients with STEMI and multivessel disease (MVD).Patients and methods: We searched PubMed, MEDLINE, Embase, Scopus, Google Scholar, Cochrane Central Register of Controlled Trials (CENTRAL), and ClinicalTrials.gov databases aiming to find RCTs for patients with STEMI and MVD which compared CR with IRA-only. Random effect risk ratios (RRs) were calculated for efficacy and safety outcomes.Results: Ten RCTs with 3291 patients were included. The median follow-up duration was 17.5 months. Major adverse cardiac events (RR=0.57; 0.43-0.76; P<0.0001), cardiac mortality (RR=0.52; 0.31-0.87; P=0.014), and repeat revascularization (RR=0.50; 0.30-0.84; P=0.009) were lower in CR compared with IRA-only strategies. However, there was no significant difference in the risk of all-cause mortality, recurrent nonfatal myocardial infarction, stroke, major bleeding events, and contrast-induced nephropathy.Conclusion: For patients with STEMI and MVD undergoing primary PCI, the current evidence suggests that the risk of major adverse cardiac events, repeat revascularization, and cardiac death is reduced by CR. However, the risk for all-cause mortality and PCI-related complications is not different from the isolated culprit lesion-only treatment. Although these findings support the cardiac mortality and safety benefit of CR in stable STEMI, further large trials are required to provide better guidance for optimum management of such patients.
|
|
| 2. |
- Boles, Usama, et al.
(författare)
-
Coronary artery ectasia : remains a clinical dilemma.
- 2010
-
Ingår i: Coronary Artery Disease. - : Lippincott Williams & Wilkins. - 0954-6928 .- 1473-5830. ; 21:5, s. 318-320
-
Tidskriftsartikel (refereegranskat)abstract
- Coronary artery ectasia (CAE) is defined as localized coronary dilatation that exceeds the diameter of normal adjacent segments or the diameter of the patient's largest coronary vessel by 1.5 times. The incidence of CAE varies from 1.5 to 5% in most literature; however, it was reported as high as 10% in some nations. Although, the pathogenesis of CAE is not fully understood, atherosclerosis remains the main association with CAE, in the western world. Kawasaki disease is another common cause of acquired heart disease in children, causing CAE. Kawasaki disease prevalence is overstated by its geographical distribution. Current modalities of investigation looked at the anatomical distribution of the disease and its possible ischemic effects. Biomarkers were studied in depth to explain the active nature of CAE; however, the common association with atherosclerosis weakens its significance. Here we reviewed CAE, its prevalence, relationship to other systemic anomalies in the vascular bed, pathogenesis and diagnostic tools currently in use.
|
|
| 3. |
- Dellborg, M, et al.
(författare)
-
Changes in the use of medication after acute myocardial infarction : Possible impact on post-myocardial infarction mortality and long-term outcome
- 2001
-
Ingår i: Coronary Artery Disease. - : Lippincott Williams & Wilkins. - 0954-6928 .- 1473-5830. ; 12:1, s. 61-67
-
Tidskriftsartikel (refereegranskat)abstract
- Objective: To describe the change in the use of medication after acute myocardial infarction (AMI) and discuss its possible impact on risk and risk indicators for death. Patients: All patients discharged alive after hospitalization for AMI at Sahlgrenska Hospital (covering half the community of Goteborg, i.e. 250 000 of 500 000 inhabitants) during 1986-1987 (period I) and at Sahlgrenska Hospital and Ostra Hospital (covering the whole community of Goteborg, 500 000 inhabitants) during 1990-1991 (period II). Methods: Overall mortality was retrospectively evaluated during 5 years of follow-up. Results: In all, 740 patients were included in the study during period I and 1448 during period II. The 5-year mortalities were 44.1% for period I patients and 39.3% for period II patients (P = 0.036). The relative risk of death for period II patients was 0.78 [95% confidence interval (CI) 0.67-0.89, P = 0.0005] after adjustment for differences at baseline. There was a significant interaction with a history of congestive heart failure; improvement in duration of survival was found only for patients without such a history. During period I, only 3% of patients were administered fibrinolytic agents, compared with 33% of patients during period II (P < 0.0001). During period I, aspirin was prescribed for 13% of patients discharged from hospital compared with 79% during period II. Other changes in treatment on going from period I to period II included increases in prescription of [beta]-blockers and angiotensin converting enzyme inhibitors. After adjustment for various risk indicators for death, relative risk of death for those administered fibrinolytic agents was 0.60 (95% CI 0.18-2.02) for patients in the period-I cohort and 0.68% (95% CI 0.51-0.91) for those in the period-II cohort. Adjusted relative risk of death for those prescribed aspirin upon discharge from hospital was 0.81 (95% CI 0.52-1.25) for period-I patients and 0.71 (95% CI 0.56-0.91) for period-II patients. The adjusted relative risk of death for those administered [beta]-blockers was 0.72 (95% CI 0.55-0.96) for period-I patients and 0.70 (95% CI 0.55-0.90) for period-II patients. Conclusion: Increased use of fibrinolytic agents and aspirin for AMI as well as a moderate increase in use of [beta]-blockers and angiotensin converting enzyme inhibitors was associated with a parallel reduction in age-adjusted mortality during the 5 years after discharge from hospital. However, this improvement was seen only for patients without histories of congestive heart failure.
|
|
| 4. |
- Edfors, Robert, et al.
(författare)
-
SWEDEHEART-1-year data show no benefit of newer generation drug-eluting stents over bare-metal stents in patients with severe kidney dysfunction following percutaneous coronary intervention
- 2020
-
Ingår i: Coronary Artery Disease. - : LIPPINCOTT WILLIAMS & WILKINS. - 0954-6928 .- 1473-5830. ; 31:1, s. 49-58
-
Tidskriftsartikel (refereegranskat)abstract
- Background We hypothesized that the transition from bare-metal stents (BMS) to newer generation drug-eluting stents (n-DES) in clinical practice may have reduced the risk also in patients with kidney dysfunction. Methods: Observational study in the national SWEDEHEART registry, that compared the 1-year risk of in-stent restenosis (RS) and stent thrombosis (ST) in all percutaneous coronary intervention treated patients(n = 92 994) during 2007-2013. Results: N-DES patients were younger than BMS, but had more often diabetes, previous myocardial infarction, previous revascularization and were more often treated with potent platelet inhibition. N-DES versus BMS, was associated with lower 1-year risk of RS in patients with estimated glomerular filtration rate (eGFR) >60 with a cumulative probability of 2.1% versus 5.3%, adjusted hazard ratio 0.30, 95% CI (0.27-0.34) and with eGFR 30-60: 3.0% versus 4.9%; hazard ratio 0.46 (0.36-0.60) but not in patients with eGFR <30: 8.1% versus 6.0%; hazard ratio 1.32 (0.71-2.45) (pinteraction = 0.009) as well as lower risk of ST for eGFR >60 and eGFR 30-60: 0.5% versus 0.9%; hazard ratio 0.52 (0.40-0.68) and 0.6% versus 1.3%; hazard ratio 0.54 (0.54-0.72) but not for eGFR <30; 2.1% versus 1.1%; hazard ratio 1.49 (0.56-3.98) (p(interaction)= 0.027). Conclusion: N-DES is associated with lower 1-year risk of in-stent restenosis and stent thrombosis in patients with normal or moderately reduced kidney function but not in patients with severe kidney dysfunction, where stenting is associated with worse outcomes regardless of stent type.
|
|
| 5. |
- Eggers, Kai M., 1962-, et al.
(författare)
-
Combining different biochemical markers of myocardial ischemia does not improve risk stratification in chest pain patients compared to troponin I alone
- 2005
-
Ingår i: Coronary Artery Disease. - : Ovid Technologies (Wolters Kluwer Health). - 0954-6928 .- 1473-5830. ; 16:5, s. 315-9
-
Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Early evaluation of patients with chest pain is important not only for the detection of acute myocardial infarction (AMI) but also for identification of patients at high risk for future cardiac events. A multimarker strategy applying results of early measurements of different biochemical markers of cardiac necrosis in combination may improve risk prediction in chest pain patients. METHODS: Rapid measurements of troponin I (TnI), creatine kinase MB and myoglobin were performed in 191 consecutive patients with chest pain and a non-diagnostic electrocardiogram for AMI. The prognostic value of these markers and different multimarker strategies was evaluated and compared. RESULTS: Ten (5.2%) patients died during follow-up, which for eight (4.2%) patients was due to cardiac causes. Myocardial reinfarctions occurred in 17 (6.8%) patients. TnI was most predictive for cardiac mortality (TnI>or=0.1 microg/l, 10.7% event rate compared with TnI<0.1 microg/l, 0%, P<0.001) and myocardial reinfarction (14.9% compared with 1.7%, P<0.001). The other markers and multimarker strategies had a lower capacity for predicting adverse events apart from myoglobin and the combination of TnI or myoglobin regarding the endpoint of total mortality. CONCLUSION: The combinations of different markers were prognostically non-superior compared to TnI, which thus, should be preferred as a biochemical marker for risk stratification in patients with chest pain.
|
|
| 6. |
- Eggers, Kai M., 1962-, et al.
(författare)
-
Risk prediction in patients with chest pain : early assessment by the combination of troponin I results and electrocardiographic findings
- 2005
-
Ingår i: Coronary Artery Disease. - : Ovid Technologies (Wolters Kluwer Health). - 0954-6928 .- 1473-5830. ; 16:3, s. 181-9
-
Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To evaluate the prognostic value of point of care troponin I (TnI) results in combination with findings from the admission electrocardiogram (ECG) in patients with chest pain. METHODS: Rapid measurements of TnI were performed in 191 consecutive patients with chest pain and a non-diagnostic ECG for myocardial infarction. RESULTS: Within 6 h from admission, maximum TnI elevations of > or = 0.07 microg/l and > or = 0.1 microg/l were noted in 59 and 39% of all patients, respectively. TnI elevations in the range of 0.07-0.09 microg/l were found in many patients with diagnoses other than acute coronary syndrome. By 6-month follow-up, cardiac death had occurred in 7.1 and 11% of patients with maximum TnI > or = 0.07 microg/l and > or = 0.1 microg/l, respectively and myocardial reinfarction was documented in 12 and 15%, respectively. ST-segment depression on the admission ECG was present in 16% of all patients and was the electrocardiographic abnormality with the highest risk (cardiac death 7.7%, myocardial reinfarction 15%). The combination of TnI > or = 0.1 microg/l and ST-segment depression or an abnormal admission ECG in general allowed the identification of patients at low, intermediate and high cardiac risk, 3 h after admission. CONCLUSION: A threshold of TnI > or = 0.1 microg/l corresponding to the 10% coefficient of variation is prognostically most suitable for prediction of cardiac events in patients with chest pain. The combination of TnI results and findings from the admission ECG improves prognostic assessment and allows early and reliable risk stratification in this patient population.
|
|
| 7. |
- Frostfeldt, Gunnar, et al.
(författare)
-
Possible reasons for the prognostic value of troponin-T on admission in patients with ST-elevation myocardial infarction
- 2001
-
Ingår i: Coronary Artery Disease. - 0954-6928 .- 1473-5830. ; 12:3, s. 227-237
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: In patients with acute myocardial infarction and ST-segment elevation, increased troponin-T (TnT) on admission implies an increased mortality. OBJECTIVE: To elucidate the underlying mechanisms of the prognostic value of TnT. METHODS AND RESULTS: One hundred and one patients were included and all received thrombolytic treatment. The patients were compared according to TnT level on admission (cut-off 0.1 microg/l). Elevation of TnT was associated with long-term mortality and also with longer delay, more episodes of chest pain during the last 24 h and fewer noninvasive signs of reperfusion at 90 min. In the group with elevated TnT, the coronary angiography at 24 h showed a strong trend towards lower patency in the infarct-related artery. TnT was also associated with increased infarct size if a higher cut-off level (0.43 microg/l) was used. In univariate analysis, elevated TnT, longer delay, repeated chest pain, Q-waves on admission and reduced left ventricular (LV) function were significantly associated with long-term mortality. In multivariate models, only reduced LV function and less than TIMI (thrombolysis in myocardial infarction) grade 3 flow turned out to be significant independent risk factors. CONCLUSIONS: The prognostic value of TnT level on admission regarding long-term mortality was confirmed and seems mainly to be explained by its association with longer delay and recent myocardial damage, but its association with reduced effect of thrombolytic treatment, larger infarct size and impaired LV function might also be of importance.
|
|
| 8. |
- Herlitz, Johan, et al.
(författare)
-
Causes of death in patients presenting to hospital with symptoms suggestive of acute myocardial infarction : a one-year follow-up study with autopsy results
- 1994
-
Ingår i: Coronary Artery Disease. - : Lippincott Williams & Wilkins. - 0954-6928 .- 1473-5830. ; 5:1, s. 51-60
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: About 20% of patients admitted to a medical emergency room have chest pain or other symptoms raising suspicion of acute myocardial infarction. AIM: To describe the place and mode of death in such patients during 1 year of follow-up. PATIENTS: All patients (n = 5362) admitted to a single hospital during 21 months because of such symptoms. RESULTS: In all, 565 patients (11%) died. Death rate was directly related to the initial degree of suspicion of acute myocardial infarction. Of these patients, 196 (35%) died during initial hospitalization and only 89 (16%) died outside the hospital. The overall autopsy rate was 53%. Of the deaths that occurred during initial hospitalization, the majority were judged as cardiac, most being due to acute myocardial infarction, particularly if the patients died in the coronary care unit. Among patients who died after discharge from hospital, non-cardiac factors contributed more substantially to death, particularly in patients who died during rehospitalization. The cause of death was not established in a high proportion of patients who died outside hospital. CONCLUSION: The results suggest that, among patients admitted to the emergency room because of suspected acute myocardial infarction, causes of death other than a documented cardiac event become increasingly important when the interval between admittance to the emergency room and death increases.
|
|
| 9. |
- Herlitz, Johan, 1949, et al.
(författare)
-
Changes in demographic factors and mortality after out-of-hospital cardiac arrest in Sweden
- 2005
-
Ingår i: Coron Artery Dis. - : Ovid Technologies (Wolters Kluwer Health). - 0954-6928 .- 1473-5830. ; 16:1, s. 51-7
-
Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To describe changes between 1992 and 2003 in age, sex, factors at resuscitation and survival among patients suffering from out-of-hospital cardiac arrest in Sweden. METHODS: This was a prospective observational study including various ambulance organizations in Sweden. Patients suffering from out-of-hospital cardiac arrest between 1992 and 2003 included in the Swedish Cardiac Arrest Registry were followed for survival to 1 month. RESULTS: In all 19 791 cases took part in the survey. There was a slight increase in mean age from 68 to 70 years (P = 0.025) and an increase of females from 29 to 32% (P = 0.0001). There was a change in witnessed status (P < 0.0001) with an increase in crew-witnessed cases and a decrease in non-witnessed cases. There was a decrease in cases of a cardiac etiology from 75 to 61% (P < 0.0001) and a decrease in the percentage found in ventricular fibrillation from 36 to 25% (P < 0.0001). When crew-witnessed cases were excluded the proportion receiving bystander cardiopulmonary resuscitation (CPR) increased from 30 to 42% (P < 0.0001). There was a slight increase in the overall proportion of patients hospitalized alive from 16 to 20% (P = 0.032). There was no significant change in the overall proportion of survivors at 1 month after cardiac arrest (4.5% in 1992 and 5.0% in 2003). CONCLUSIONS: Among patients suffering from out-of-hospital cardiac arrest in Sweden some changes took place. The most important ones were a decrease in the proportion of patients found in ventricular fibrillation and an increase in the proportion of patients receiving bystander CPR. The proportion of patients admitted alive to hospital increased moderately, whereas the proportion of patients alive after 1 month remained unchanged.
|
|
| 10. |
- Herlitz, Johan, et al.
(författare)
-
Characteristics and long term outcome of patients with acute chest pain or other symptoms raising suspicion of acute infarction in relation to whether they were hospitalized or directly discharged from the emergency department
- 2002
-
Ingår i: Coronary Artery Disease. - : Lippincott Williams & Wilkins. - 0954-6928 .- 1473-5830. ; 13:1, s. 37-43
-
Tidskriftsartikel (refereegranskat)abstract
- AIM: To describe the characteristics and outcome of patients who came to the emergency department due to chest pain or other symptoms raising suspicion of acute myocardial infarction (AMI) in relation to whether they were hospitalized or directly discharged from the emergency department. METHODS: All patients arriving to the emergency department in one single hospital due to chest pain or other symptoms raising suspicion of AMI during a period of 21 months were followed for 10 years. RESULTS: In all, 5362 patients fulfilled the given criteria on 7157 occasions; 3381 (63%) were hospitalized and 1981 (37%) were directly discharged. Patients who were hospitalized were older and had a higher prevalence of previous cardiovascular diseases. The mortality during the subsequent 10 years was 52.1% among those hospitalized and 22.3% among those discharged (P < 0.0001). Risk indicators for death were similar in the two cohorts. However, many of these risk indicators including age, a history of myocardial infarction, angina pectoris, congestive heart failure, hypertension, initial degree of suspicion of AMI, a pathologic electrocardiogram on admission and a confirmed AMI as underlying etiology were more strongly associated with the prognosis among patients directly discharged than among those hospitalized. Ten (0.5%) of the patients who were directly discharged from the emergency department were found to have a diagnosis of confirmed or possible AMI, making up 1% of all patients given such a diagnosis. These patients had a 10-year mortality of 80.0% compared with 65.7% among patients with a confirmed or possible AMI who were hospitalized. CONCLUSION: Of patients who came to the emergency department with acute chest pain or other symptoms suggestive of AMI about a third were directly discharged. Their mortality during the subsequent 10 years was half that of patients hospitalized. Various risk indicators for death were more strongly associated with prognosis in the patients who were directly discharged from the emergency department compared to those hospitalized. Of all patients given a diagnosis of confirmed or possible AMI, 1% were discharged from the emergency department. Their long-term mortality was high, maybe even higher than among AMI patients hospitalized.
|
|
