| 1. |
- Milovanovic, Micha, 1966-, et al.
(författare)
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Letter: Atrial fibrillation and platelet reactivity : in International Journal of Cardiology(ISSN 0167-5273)(EISSN 1874-1754)
- 2010
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Ingår i: International Journal of Cardiology. - Ireland : Elsevier. - 0167-5273 .- 1874-1754. ; 145:2, s. 357-358
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- BACKGROUND: The impact of atrial fibrillation (AF) upon platelet reactivity has not been investigated. METHODS: Subjects were 33 individuals with AF who consented to elective electrical cardioversion (ECV) immediately before ECV determination of surface-bound fibrinogen after stimulation i.e. platelet reactivity was carried out. A flow cytometer was employed. ADP (1.7 and 8.5mumol/L) and a thrombin receptor activating peptide (54 and 74mumol/L) were used as agonists. The analyses were repeated after 26+/-8(SD) months. RESULTS: Compared to day 1 subjects with AF (n=18) had a trend towards lower platelet reactivity at study end. It reached significance when using 1.7mumol/L ADP. In contrast, after 26+/-8(SD) months sinus rhythm (SR) (n=15) was associated with significant lower reactivity with all agonists. CONCLUSION: After 26+/-8(SD) months patients returning with AF had higher platelet reactivity than those who remained with SR.
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| 2. |
- Brand, Björn, et al.
(författare)
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Prognostication and risk stratification by assessment of left atrioventricular plane displacement in patients with myocardial infarction.
- 2002
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Ingår i: International Journal of Cardiology. - 0167-5273. ; 83:1, s. 35-41
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Mean left atrioventricular plane displacement is strongly related to prognosis in patients with heart failure. We aimed to examine its value for prognostication and risk stratification in patients hospitalised for acute myocardial infarction. METHODS AND RESULTS: Left atrioventricular plane displacement was assessed by echocardiography in 271 consecutive patients with acute myocardial infarction. Mean prospective follow-up was 628 days. Atrioventricular plane displacement was readily assessed in all patients and was significantly lower in patients who died (n=41, 15.1%) compared to the survivors: 8.2(5.6) v. 10.0(5.5) mm, P<0.0001. Overall mortality was 31.3% in the lowest quartile with regard to atrioventricular plane displacement (<8.00 mm) and 10.1% in the combined upper three quartiles. Thus, the hazard ratio for an atrioventricular plane displacement <8.0 mm compared to 8 mm or more was 3.1, P=0.0001. The combined mortality/heart failure hospitalisation incidence was 43.8% in the lowest and 14.6% in the combined upper three quartiles: Risk ratio 3.0, P<0.0001. In multivariate analysis, including age and history of atrial fibrillation, left atrioventricular plane displacement was an independent prognostic marker. CONCLUSION: In post-myocardial infarction patients, echocardiographic assessment of atrioventricular plane displacement showed a strong, independent prognostic value. Determination of left atrioventricular plane displacement can be readily performed in virtually all patients, and may in clinical practice facilitate identification of high-risk patients.
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| 3. |
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| 4. |
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| 5. |
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| 6. |
- Bukachi, Frederick, et al.
(författare)
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Clinical outcome of coronary angioplasty in patients with ischaemic cardiomyopathy
- 2003
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Ingår i: International Journal of Cardiology. - 0167-5273 .- 1874-1754. ; 88:2-3, s. 167-174
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To assess the clinical outcome of successful percutaneous transluminal coronary angioplasty (PTCA) in patients with poor ventricular function. METHODS: Analysis of angiographic, echocardiographic and clinical records of patients with severe LV dysfunction who underwent PTCA from January 1, 1995 to December 31, 1997 was undertaken. Forty-one patients aged 63+/-10 years, 36 men, all with significant coronary artery disease and impaired LV function (fractional shortening, FS
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| 7. |
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| 8. |
- Dellborg, M, et al.
(författare)
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Electrocardiographic assessment of infarct size : Comparison between QRS scoring of 12-lead electrocardiography and dynamic vectorcardiography
- 1993
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Ingår i: International Journal of Cardiology. - : Elsevier Ireland Ltd. - 0167-5273 .- 1874-1754. ; 40:2, s. 167-172
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Tidskriftsartikel (refereegranskat)abstract
- Myocardial infarct size is one of the most important predictors of prognosis in patients suffering an acute myocardial infarction. It can be assessed by enzymatic and electrocardiographic methods. The present report compares dynamic vectorcardiographic monitoring, serial plasma enzyme activity measurements and QRS scoring according to Palmeri as techniques for infarct size estimation. We report the results from 74 patients with acute myocardial infarction, who participated in a randomized trial of treatment with alteplase. A good correlation was found between myocardial infarct size by estimation from enzymatic measurement and from dynamic vectorcardiography. Dynamic vectorcardiography correlated more closely with enzymatically estimated infarct size in patients with Q-wave infarction, regardless of infarct location, than did QRS scoring of the conventional 12-lead electrocardiogram. Furthermore, dynamic vectorcardiography requires no time-consuming analysis and can be used for on-line monitoring of patients with ongoing infarction to estimate the size of an acute infarction while it is developing.
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| 9. |
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| 10. |
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| 11. |
- Herlitz, Johan, et al.
(författare)
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A description of the characteristics and outcome of patients hospitalized for acute chest pain in relation to whether they were admitted to the coronary care unit or not in the thrombolytic era
- 2002
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Ingår i: International Journal of Cardiology. - : Elsevier Ireland Ltd. - 0167-5273 .- 1874-1754. ; 82:3, s. 279-287
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Tidskriftsartikel (refereegranskat)abstract
- bjectives: To describe the characteristics and outcome of patients hospitalized for acute chest pain in relation to whether they were admitted to the coronary care unit (CCU) or not. Design: Prospective observational study with a follow-up of 2 years. Setting: Sahlgrenska University Hospital in Göteborg, Sweden. Subjects: All patients hospitalized due to acute chest pain during 6 months. Main outcome measures: Mortality, use of medical resources, complications and previous history. Results: In all 1.592 patients were admitted to hospital for chest pain, of whom 1.136 (71%) were not directly admitted to the CCU. These patients differed from those directly admitted to the CCU, being older, including more women, having a higher prevalence of known congestive heart failure and a lower degree of initial suspicion of acute myocardial infarction (AMI). Among all patients with confirmed AMI only 58% were directly admitted to CCU. Overall, the occurrence of complications and the use of medical resources were less frequent in the patients not admitted to the CCU. The mortality during the subsequent 2 years was 16.8% for patients not admitted to the CCU and 18.5% for patients admitted to the CCU. When adjusting for various factors at baseline, patients admitted to the CCU had a relative risk of death during 2 years of follow-up being 1.23 0.87–1.73 (P=0.24) as compared with those not admitted to the CCU. Conclusion: In a Swedish university hospital, more than two thirds of patients hospitalized for acute chest pain were not directly admitted to the CCU. They differed from those admitted to the CCU in several aspects. However, their unadjusted and adjusted mortality during the subsequent 2 years did not significantly differ from those admitted to CCU.
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| 12. |
- Herlitz, Johan, et al.
(författare)
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Body temperature in acute myocardial infarction and its relation to early intervention with metoprolol
- 1988
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Ingår i: International Journal of Cardiology. - : Elsevier Ireland Ltd. - 0167-5273 .- 1874-1754. ; 20:1, s. 65-71
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Tidskriftsartikel (refereegranskat)abstract
- In a subsample of 223 patients participating in a double-blind trial with metoprolol in suspected acute myocardial infarction, body temperature during the first 5 days in hospital was recorded. Patients developing infarction had a mean temperature of 37.3°C compared with 36.8° C for those with no infarction (P < 0.001). A positive association was observed between enzyme-estimated infarct size and body temperature (P < 0.001). Patients given metoprolol had a mean temperature of 37.0° C as compared with 37.2° C in those given placebo (P = 0.03). The most marked difference between metoprolol and placebo was observed among those treated very early. We conclude that early treatment with metoprolol in suspected acute myocardial infarction appears to lower body temperature during the following days. This might reflect limitation of the infarct size.
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| 13. |
- Herlitz, Johan, et al.
(författare)
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Early use of metoprolol and serum potassium in suspected acute myocardial infarction
- 1989
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Ingår i: International Journal of Cardiology. - : Elsevier Ireland Ltd. - 0167-5273 .- 1874-1754. ; 22:2, s. 169-175
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Tidskriftsartikel (refereegranskat)abstract
- In 1350 patients with suspected acute myocardial infarction, serum potassium was analysed in the emergency ward. The effect of metoprolol was compared with placebo in a double-blind randomized trial. Metoprolol increased serum potassium from 4.11 ± 0.02 mmol/l to 4.27 ± 0.02 mmol/l (P<0.001) during the 1st day after hospital admission, whereas serum potassium levels remained fairly constant in patients given placebo during the same time (4.11 ± 0.02 to 4.14 ± 0.02 mmol/l; P>0.2). Similar results were obtained when analysing patients with a confirmed myocardial infarction separately. The effects appeared homogeneously distributed in subgroups related to sex, clinical history, infarct site, infarct size and delay time from onset of symptoms to start of treatment. We conclude that early treatment with the beta-1-selective blocker metoprolol in patients with suspected acute myocardial infarction increases serum potassium.
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| 14. |
- 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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| 15. |
- Herlitz, Johan, et al.
(författare)
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Long term prognosis after CABG in relation to preoperative left ventricular ejection fraction
- 2000
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Ingår i: International Journal of Cardiology. - : Elsevier Ireland Ltd. - 0167-5273 .- 1874-1754. ; 72:2, s. 163-171
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Tidskriftsartikel (refereegranskat)abstract
- AIM: To evaluate the mortality rate, risk indicators for death, mode of death and symptoms of angina pectoris during 5 years after coronary artery by pass grafting (CABG) in relation to the preoperative left ventricular ejection fraction (LVEF). PATIENTS: All patients in western Sweden who underwent CABG without concomitant valve surgery and without previously performed CABG between June 1988 and June 1991. RESULTS: In all 1904 patients were included in the analysis, of whom 173 (9%) had a LVEF < 40%. Patients with LVEF > or = 40% had a 5-year mortality of 12.5%. LVEF < 40% was associated with an increased risk of death (RR 2.3; 95% cl 1.7-3.1). There was no significant interaction between age, sex or any other factor in terms of clinical history and LVEF. However, left main stenosis was a strong independent predictor of death among patients with LVEF < 40% but not in those with a higher LVEF. Patients with a low LVEF more frequently died a cardiac death and a death associated with myocardial infarction (AMI). Furthermore they more frequently died in association with congestive heart failure and ventricular fibrillation. Among survivors, symptoms of angina pectoris were similar regardless of the preoperative LVEF. CONCLUSION: Patients with a low preoperative LVEF have a more than two-fold increased risk of death during 5 years after CABG. Their increased risk of death includes cardiac death, death associated with AMI, congestive heart failure and ventricular fibrillation.
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| 16. |
- Herlitz, Johan, et al.
(författare)
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Predictors of death during 5 years after coronary artery bypass grafting
- 1998
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Ingår i: International Journal of Cardiology. - : Elsevier Ireland Ltd. - 0167-5273 .- 1874-1754. ; 64:1, s. 15-23
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Tidskriftsartikel (refereegranskat)abstract
- Aim: To describe predictors of death during five years of follow-up after coronary artery bypass grafting (CABG). Methods: All patients who underwent CABG during a period of three years in Western Sweden were included in the analysis and were prospectively followed for five years. Mortality was related to preoperative and peroperative factors as well as findings at physical examination and medication 4–7 days after the operation. Results: In all 2121 patients underwent CABG without simultaneous valve surgery during the study period. The overall five-year mortality was 14.6%. The following appeared as independent predictors of death during five years but >30 days after CABG: Current smoking (relative risk ratio 2.43 [95% Ci 1.64–3.61]) degree of impairment of left ventricular function (1.51 [1.23–1.86]), a history of congestive heart failure (1.91 [1.35–2.70]), age (1.04 [1.02–1.06]) arrhythmia 4–7 days after CABG (1.89 [1.26–2.83]), intermittent claudication (1.73 [1.19–2.52]), a history of diabetes (1.71 [1.16–2.51]), time in respirator (1.43 [1.13–1.81]), a history of cerebrovascular disease (1.72 [1.13–2.64]), treatment with digitalis at day 4–7 (1.48 [1.07–2.05]), enzyme release (1.49 [1.03–2.16]). Conclusion: Among patients who underwent CABG 11 independent predictors for mortality were found including smoking habits at CABG, history of cardiovascular diseases, left ventricular dysfunction, age, post operative complications and medication after CABG.
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| 17. |
- Herlitz, Johan, et al.
(författare)
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Predictors of death during 5 years after hospital discharge among patients with a suspected acute coronary syndrome with particular emphasis on whether an infarction was developed
- 1998
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Ingår i: International Journal of Cardiology. - : Elsevier Ireland Ltd. - 0167-5273 .- 1874-1754. ; 66:1, s. 73-80
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Tidskriftsartikel (refereegranskat)abstract
- Aim: To describe predictors of death after hospital discharge during 5 years of follow-up in a consecutive series of patients surviving hospitalization for symptoms and signs of a confirmed or suspected acute coronary syndrome. Patients and methods: All patients who between February 15, 1986 and November 9, 1987, were hospitalized at Sahlgrenska University Hospital in Göteborg, Sweden, and fulfilled the above given criteria. Results: In all, 1948 patients were included of whom 731 (38%) had a confirmed acute myocardial infarction (AMI). Independent risk indicators for death were: age (P=0.0001); male sex (P=0.005); a history of previous AMI (P=0.0001), diabetes mellitus (P=0.003) and smoking (P=0.0001); development of AMI during first 3 days in hospital (P=0.0001); in-hospital signs of congestive heart failure (P=0.0001); prescription of digitalis (P=0.001) and diuretics (P=0.02) at hospital discharge. A history of smoking interacted significantly (P=0.02) with the relationship between development of AMI and prognosis. Thus, the difference between patients who did and who did not develop an AMI was more pronounced among non-smokers than smokers. Other factors which interacted significantly with this relationship were a history of angina pectoris, and development of ventricular fibrillation and hypotension while in hospital. Conclusion: Among hospital survivors of a confirmed or suspected acute coronary syndrome predictors of death during 5 years were: age, male sex, history of AMI, diabetes mellitus and smoking, development of AMI and congestive heart failure while in hospital and prescription of digitalis and diuretics at hospital discharge. A history of smoking and angina pectoris as well as development of hypotension and ventricular fibrillation while in hospital interacted significantly with the relationship between development of AMI and prognosis.
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| 18. |
- Herlitz, Johan, et al.
(författare)
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Prognosis and risk indicators of death during a period of 10 years for women admitted to the emergency department with a suspected acute coronary syndrome
- 2002
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Ingår i: International Journal of Cardiology. - : Elsevier Ireland Ltd. - 0167-5273 .- 1874-1754. ; 82:3, s. 259-268
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Tidskriftsartikel (refereegranskat)abstract
- Aim: To describe the 10-year prognosis and risk indicators of death in women admitted to the emergency department with acute chest pain or other symptoms raising a suspicion of acute myocardial infarction (AMI). Particular interest was paid to women of ≤75 years of age surviving 1 month after admission, who were judged to have suffered a possible or confirmed acute ischemic event with signs of either minor or no myocardial damage. Patients: All women admitted to the emergency department at Sahlgrenska University Hospital, Göteborg, during a period of 21 months, due to acute chest pain or other symptoms raising a suspicion of AMI. Methods: All the women were followed prospectively for 10 years. The subset described previously underwent a bicycle exercise tolerance test and metabolic screening 3 and 4 weeks, respectively, after admission to the emergency department. Results: In all, 5362 patients were admitted to the emergency department on 7157 occasions during the time of the survey and 2387 (45%) of them were women. Of these women, 61% were hospitalised and 39% were sent home directly. The overall 10-year mortality for women was 42.5% (55.5% among those hospitalised and 21.8% among those not hospitalised). Of the variables recorded at the emergency department, the following were independently associated with 10-year mortality: age, history of angina pectoris, history of hypertension, history of diabetes, history of congestive heart failure, pathological ECG on admission, degree of initial suspicion of AMI on admission, symptoms of congestive heart failure on admission and other non-specific symptoms on admission. The majority of these risk factors were more markedly associated with prognosis in women discharged directly from the emergency department than in those hospitalised. In the subset aged ≤75 years defined above (n=241), the following were independent predictors of death: a history of AMI and working capacity in a bicycle exercise tolerance test. Conclusion: Among women admitted to hospital due to chest pain or other symptoms raising a suspicion of AMI, 42.5% had died after 10 years. Major risk indicators of death were age, history of cardiovascular disease, pathological ECG on admission and symptoms of congestive heart failure on admission. Women presenting with an acute coronary syndrome but minimal myocardial damage, work capacity and a history of AMI predicted a poor outcome.
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| 19. |
- Herlitz, Johan, et al.
(författare)
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Relationship between infarct size and incidence of severe ventricular arrhythmias in a double-blind trial with metoprolol in acute myocardial infarction
- 1984
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Ingår i: International Journal of Cardiology. - : Elsevier Ireland Ltd. - 0167-5273 .- 1874-1754. ; 6:1, s. 47-60
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Tidskriftsartikel (refereegranskat)abstract
- In 585 patients having an acute myocardial infarction for the first time the relationship was investigated between estimated infarct size and the incidence of ventricular fibrillation and treated ventricular tachycardia during hospitalization. The size of the infarct was estimated from analyses of heat stable lactate dehydrogenase (LD) (EC 1.1.1.27.) in serum collected every 12 hr for 48–108 hr. All patients participated in a double-blind comparison of the β1-selective blocker metoprolol with placebo in suspected acute myocardial infarction. A correlation was observed between the enzymatically estimated infarct size and the incidence of ventricular fibrillation and treated ventricular tachycardia in patients on placebo (P < 0.001), while this could not be demonstrated in patients on the beta-blocker (P > 0.2). In placebo treated patients there was a correlation between the maximum heat stable LD activity and early ventricular fibrillation (P = 0.034), late ventricular fibrillation (P < 0.001), primary ventricular fibrillation (P = 0.002) as well as secondary ventricular fibrillation (P = 0.034). It is concluded that there seems to be a relatively strong correlation between the final size of the infarction and the occurrence of severe ventricular arrhythmias. Treatment with beta-blockade appeared to disturb this correlation.
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| 20. |
- Herlitz, Johan, et al.
(författare)
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Variability of chest pain in suspected acute myocardial infarction according to subjective assessment and requirement of narcotic analgesics
- 1986
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Ingår i: International Journal of Cardiology. - : Elsevier Ireland Ltd. - 0167-5273 .- 1874-1754. ; 13:1, s. 9-22
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Tidskriftsartikel (refereegranskat)abstract
- In 653 patients with suspected acute myocardial infarction the course of pain according to subjective assessment and morphine requirement is described. Patients were asked to score pain from 0-10 until a pain-free interval of 12 hours appeared. Different categories of patients constructed from clinical aspects were compared. Although the variability between groups was fairly small, subgroups were found in which the initial intensity of pain was more marked and the duration of pain was longer. Thus patients with larger infarcts according to maximum serum enzyme activity and patients with Q-wave infarction had more severe pain initially and also a longer duration and a higher morphine requirement compared with patients with a lower serum enzyme activity or a non-Q-wave infarction. Other groups with a more severe course of chest pain were those with more intensive pain at home, electrocardiographic signs of acute myocardial infarction on admission to hospital, and finally those with a high systolic blood pressure or a high rate-pressure product on admission to the Coronary Care Unit. We thus conclude that there is a variability of chest pain in suspected acute myocardial infarction and that there are defined groups of patients in which a more severe course of chest pain could be expected.
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| 21. |
- James, Stefan K., et al.
(författare)
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A rapid troponin I assay is not optimal for determination of troponin status and prediction of subsequent cardiac events at suspicion of unstable coronary syndromes.
- 2004
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Ingår i: International Journal of Cardiology. - 0167-5273 .- 1874-1754. ; 93:2-3, s. 113-120
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Troponin is a specific marker of myocardial damage. For early prediction of coronary events in patients with suspicion of acute coronary syndromes the assay also needs to be highly sensitive. METHODS AND RESULTS: A rapid troponin I assay was performed prior to inclusion in 4447 acute coronary syndrome patients in the GUSTO-IV trial. A quantitative troponin T analysis was later performed on blood samples obtained at randomization by a central laboratory. There was an agreement between the rapid troponin I assay and troponin T (< or =/>0.1 microg/l) in 3596 (80.9%) patients. A positive rapid troponin I was identifying any elevation of troponin T (>0.01 microg/l) in 1990 patients (90.4%) whereas a negative rapid troponin I was corresponding to negative troponin T (< or =0.01 microg/l) in only 1217 patients (54.2%). Patients with a positive versus negative rapid troponin I had an increased risk of death or myocardial infarction at 30 days (9.3 vs. 5.9%; odds ratio, O.R. 1.64; 95% confidence interval, 1.31-2.06). Troponin T elevation (>0.1 microg/l) provided a better (10.5 v. 4.9%, O.R. 2.26; C.I. 1.79-2.85) risk stratification. Regardless of a positive or a negative rapid troponin I, the troponin T result (>0.1 vs. < or =0.1 microg/l) stratified the patients into high and low risk of events at 30 days, (10.3 vs. 5.7%, P=0.002) and (11.5 vs. 4.8%, P<0.001), respectively. CONCLUSION: In a population with non-ST elevation acute coronary syndrome a positive rapid troponin I assay is a specific indicator of troponin elevation and a predictor of early outcome. However, a negative rapid troponin I is not a reliable indicator of the absence of myocardial damage and does not indicate a low risk of subsequent cardiac events. A rapid troponin I assay was performed prior to inclusion in 4447 acute coronary syndrome patients in the GUSTO-IV trial and related to a centrally analyzed quantitative troponin T test. A positive rapid troponin I was well corresponding to any elevation of troponin T (>0.01 microg/l) and predicted an unfavorable outcome at 30 days. However, a negative rapid troponin I was corresponding to troponin T < or =0.01 microg/l in only half of the patients. Troponin T >0.1 microg/l vs. < or =0.1 microg/l provided a better risk stratification than the rapid troponin I result. For patients with troponin T elevation (>0.1 microg/l) the 30 day event rate was high regardless of the rapid troponin I result.
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| 22. |
- Karlson, BW, et al.
(författare)
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Use of medical resources complications and long-term outcome in patients hospitalized with acute chest pain. A comparison between a city university hospital and a county hospital
- 2002
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Ingår i: International Journal of Cardiology. - : Elsevier Ireland Ltd. - 0167-5273 .- 1874-1754. ; 85:2-3, s. 229-238
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The primary aim was to test the hypothesis that there is a difference in long-term outcome after hospital discharge among patients hospitalized with acute chest pain in a university hospital and a county hospital. Secondary aims were to compare these two hospitals with regard to use of medical resources, occurrence of complications and risk indicators for death. Patients: All patients hospitalized at Sahlgrenska University Hospital in Göteborg (with a catchment population of 706 inhabitants/km2) and Uddevalla County Hospital (with a catchment population of 34 inhabitants/km2) due to symptoms of acute chest pain during a period of 6 months. Results: Complications, use of medical resources and mortality during the subsequent 2 years after discharge were compared among 1592 hospitalizations in a city hospital and 822 in a county hospital due to acute chest pain. Angina pectoris after the first event, congestive heart failure and various arrhythmias were more frequently reported in the county hospital. The use of medical resources differed. Thus, the use of betablockers, heparin, antiarrhythmics, diuretics and nipride was more frequent in the county hospital, whereas the use of nitrates, digitalis, coronary angiography, percutaneous transluminal coronary angioplasty (PTCA) and coronary artery bypass grafting (CABG) was more frequent in the city hospital. Despite these differences, the mortality 2 years after hospital discharge was similar (14.7% in the city hospital and 12.8% in the county hospital, P=0.26). Two factors, intravenous digitalis in hospital and a prescription of insulin at discharge, were significantly more associated with death in the county hospital compared with the city hospital. Conclusions: When comparing a city university hospital with a county hospital with regard to patients admitted with chest pain, major differences in terms of complications and use of medical resources were found. Thus, various complications were reported more frequently in the county hospital. The use of medical resources varied, some being used more frequently in the county hospital, whereas others were used more frequently in the university hospital. Despite these differences the mortality 2 years after hospital discharge was similar in the two cohorts.
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| 23. |
- Karlson, BW, et al.
(författare)
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Which factors determine the long-term outcome among patients with a very small or non confirmed AMI
- 2001
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Ingår i: International Journal of Cardiology. - : Elsevier Ireland Ltd. - 0167-5273 .- 1874-1754. ; 78:3, s. 265-275
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Tidskriftsartikel (refereegranskat)abstract
- Aim: To describe various factors associated with the very long-term prognosis for patients with a very small or an unconfirmed acute myocardial infarction (AMI). Methods: Patients below 76 years of age, hospitalized due to suspected AMI who either developed a very small AMI (enzyme elevation
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| 24. |
- Karlsson, BW, et al.
(författare)
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One-year mortality rate after disharge from hospital in relation to whether or not a confirmed myocardial infarction was developed
- 1991
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Ingår i: International Journal of Cardiology. - : Elsevier Ireland Ltd. - 0167-5273 .- 1874-1754. ; 32:3, s. 381-388
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Tidskriftsartikel (refereegranskat)abstract
- Consecutive patients admitted to our hospital with suspected acute myocardial infarction during 21 months were prospectively evaluated. One-year mortality after discharge from hospital was related to whether or not an infarction developed (infarct versus non-infarct patients). Of patients discharged alive after developing an infarct, there was a mortality of 17% (n = 777) versus 12% (n = 1830) (P < 0.001) for all patients not developing infarction. In a high risk group (any of the following: age ≥ 75 years, previous history of myocardial infarction, diabetes mellitus or congestive heart failure) patients developing infarction had a mortality of 24% (n = 457) versus 17% (n = 1221) for those who did not (P < 0.001). In a low risk group (none of the high risk criteria), the corresponding mortality was 8% (n = 316) for patients suffering infarction and 3% (n = 603) for those not having infarction (P < 0.001). The difference in mortality between patients with and without infarction was most marked in women (21% vs 11%; P < 0.01) and in hypertensives (25% vs 12%; P < 0.001), but less marked in men (16% vs 13%; NS) and in patients without hypertension (13% vs 12%; NS). Among patients not suffering infarction, mortality was particularly high in those with previous congestive heart failure (23%) and diabetes mellitus (21%).
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| 25. |
- Karlsson, BW, et al.
(författare)
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The prognosis of patients suspected of having acute myocardial infarction subsequent to its exclusion as the diagnosis
- 1990
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Ingår i: International Journal of Cardiology. - : Elsevier Ireland Ltd. - 0167-5273 .- 1874-1754. ; 26:3, s. 251-257
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Tidskriftsartikel (refereegranskat)abstract
- This review of the literature concerns the prognosis of patients suspected of having myocardial infarction subsequent to its exclusion as the diagnosis. Several investigations show a surprisingly bad prognosis for patients in this category, almost comparable to that of patients with a confirmed infarction. When the results of the different studies are pooled, however, there is a significant difference between those patients with true infarction, and those in whom infarction was excluded, in terms of overall mortality (12% and 7%; P < 0.0001) and the development of subsequent non-fatal infarction (11% and 6%; P < 0.05) when the results are analysed for a period of follow-up of one year. The difference was significant even when both fatal and non-fatal infarctions were taken into account over the one-year period of follow-up (13% and 8%; P < 0.0001). The analysis shows that electrocardiographic ST-T changes are a risk factor for coronary events, but the results are conflicting for other possible risk factors. The selection of patients varies between the different studies, which probably contributes to the different results reported. Prospective studies with well defined groups of patients large enough to permit analysis of subgroupings will be needed to resolve the outstanding questions.
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