| 1. |
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| 2. |
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| 3. |
- Brandrup-Wognsen, G, et al.
(författare)
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Predictors for recurrent chest pain and relationship to myocardial ischaemia during long-term follow-up after coronary artery bypass grafting
- 1997
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Ingår i: European Journal of Cardio-Thoracic Surgery. - : Elsevier BV. - 1010-7940 .- 1873-734X. ; 12:2, s. 304-311
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To describe the impact of coronary artery bypass grafting on chest pain during 2 years of follow-up after the operation and to identify predictors of chest pain and its relationship to myocardial ischaemia 2 years after the operation. Methods: Patients were approached with a questionnaire at the time of coronary angiography (1291) and 3 months (1664), 1 year (1638) and 2 years (1613) after coronary artery bypass grafting. Two years after the operation, a computerised 12-lead electrocardiogram was obtained during a standardised bicycle exercise test (618). Results: Prior to surgery, 37% of the patients were unable to perform physical activity compared with 6% after the operation (PB0.0001 for change in degree of limitation). Only 3% had no chest pain at all prior to the operation, while 58% of the patients were free from chest pain 2 years after surgery (PB0.0001). We found no correlation between patients reporting chest pain and signs of ischaemia at exercise test, but there was a highly significant correlation with chest pain during the exercise test (PB0.0001). Independent predictors of chest pain were severity of preoperative angina (PB0.0001), younger age (P 0.0009), previous coronary artery bypass grafting (P 0.003), duration of symptoms (P 0.005), the need for prolonged cardiopulmonary bypass (P 0.04) and the absence of left main stenosis (P 0.04). Conclusion: Independent predictors of chest pain were identified 2 years after coronary artery bypass grafting. There was a dramatic improvement after coronary artery bypass grafting. However, almost half the patients complained of some kind of chest pain even after the operation. This chest pain correlated well with chest pain during the exercise test but not with signs of myocardial ischaemia.
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| 4. |
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| 5. |
- Herlitz, Johan, et al.
(författare)
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Mortality and morbidity during a period of 2 years after coronary artery bypass surgery in patients with and without a history of hypertension
- 1996
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Ingår i: Journal of Hypertension. - : Lippincott Williams & Wilkins, Ltd.. - 0263-6352 .- 1473-5598. ; 14:3, s. 309-314
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To describe mortality and morbidity during a period of 2 years after coronary artery bypass grafting (CABG) in relation to a history of hypertension. PATIENTS: All patients in western Sweden in whom CABG was undertaken between June 1988 and June 1991 and in whom simultaneous valve surgery was not performed were included in the study. DESIGN: A prospective 2-year follow-up study. RESULTS: Patients with a history of hypertension (n = 777) differed from patients without such a history (n = 1348) in that the proportion of women was higher, they were older and more frequently had a history of congestive heart failure, diabetes mellitus, renal dysfunction, cerebro-vascular disease, intermittent claudication and obesity, and the number of smokers and patients with previous CABG was lower. They were also more likely to develop post-operative cerebrovascular complications and signs of myocardia damage. Patients with hypertension tended to have increased mortality during the first 30 days after CABG and the late mortality (between day 30 and 2 years) was significantly higher than in non-hypertensive participants. Whereas the development of myocardial infarction was similar in both groups, the hypertensive study participants more frequently developed stroke during 2 years of follow-up. In a multivariate analysis including age, sex, history of different cardiovascular diseases, smoking, ejection fraction, and the occurrence of three-vessel disease, hypertension did not emerge as an independent predictor of death in the early or late phase or during a total of 2 years of follow-up. CONCLUSION: Among CABG patients, those with a history of hypertension have a different pattern of risk factors. They have a higher mean age, include a higher proportion of women and have a higher prevalence of congestive heart failure, diabetes mellitus, renal dysfunction, cerebro-vascular disease, intermittent claudication, and obesity. They also have an increased frequency of immediate post-operative complications and an increased 2-year mortality, even if a history of hypertension was not an independent predictor of death during 2 years of follow-up.
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| 6. |
- Herlitz, Johan, et al.
(författare)
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Similar risk reduction of death of extended-release metoprolol once daily and immediate release metoprolol twice daily during 5 years after myocardial infarction
- 1999
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Ingår i: Cardiovascular Drugs and Therapy. - : Springer New York LLC. - 0920-3206 .- 1573-7241. ; 13:2, s. 127-135
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Tidskriftsartikel (refereegranskat)abstract
- The pooled results from five placebo-controlled postinfarction studies with metoprolol have shown a significant reduction in total mortality. All five studies used immediate-release metoprolol twice daily. An extended-release formulation of metoprolol for once-daily use has since been developed. The aim of the present study was to compare the two different forms of metoprolol with regard to the risk reduction of death for 5 years postinfarction and to analyze whether treatment with the beta-blocker metoprolol is associated with a reduced mortality after the introduction of modern therapies such as thrombolysis, aspirin, and ACE inhibitors. All patients discharged after an acute myocardial infarction (AMI) from Sahlgrenska University Hospital (SU) during 1986-1987 (n = 740, Period I) and during 1990-1991 (n = 1446, Period II) from both SU and Ostra Hospital, Göteborg, Sweden, were included in the study. During Period I, 56% were prescribed immediate-release metoprolol compared with 61% prescribed extended-release metoprolol during Period II. Immediate-release metoprolol was not available for outpatient use during Period II. In a multivariate analysis, all variables significantly associated with either increased or decreased postinfarction mortality during Periods I and II (univariate analysis of patient characteristics, medical history, complications during the AMI medication at discharge) studied were with Cox's proportional hazards model. Treatment with immediate-release metoprolol was significantly associated with reduced mortality over 5 years during Period I (relative risk reduction for total mortality, -34%, P = 0.003; 95% CI for RR, 0.51-0.87), and treatment with extended-release metoprolol was significantly associated with reduced mortality during Period II (-34%, P < 0.0001; 95% CI for RR, 0.53-0.82). Thrombolysis and the use of aspirin and ACE inhibitors were more frequently used during Period II. The results showed that postinfarction treatment with extended-release metoprolol given once daily was associated with a similar risk reduction of death over 5 years as immediate-release metoprolol given twice daily. The data, furthermore, indicate that the beta-blocker metoprolol is associated with a reduced risk of death after the introduction of modern therapy such as thrombolysis, aspirin, and ACE inhibitors.
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| 7. |
- Zhou, J. M., et al.
(författare)
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Association of Renal Biochemical Parameters with Left Ventricular Diastolic Dysfunction in a Community-Based Elderly Population in China: A Cross-Sectional Study
- 2014
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Ingår i: Plos One. - : Public Library of Science (PLoS). - 1932-6203. ; 9:2
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Tidskriftsartikel (refereegranskat)abstract
- Background: Relationship of left ventricular diastolic dysfunction (LVDD) with parameters that could provide more information than hemodynamic renal indexes has not been clarified. We aimed to explore the association of comprehensive renal parameters with LVDD in a community-based elderly population. Methods: 1,166 community residents (aged >= 65 years, 694 females) participating in the Shanghai Heart Health Study with complete data of renal parameters were investigated. Echocardiography was used to evaluate diastolic function with conventional and tissue Doppler imaging techniques. Serum urea, creatinine, urea-to-creatinine ratio, estimated glomerular filtration rate (eGFR) and urinary albumin-to-creatinine ratio (UACR) were analyzed on their associations with LVDD. Results: The prevalence of LVDD increased in proportion to increasing serum urea, urea-to-creatinine ratio and UACR. These three renal parameters were found negatively correlated to peak early (E) to late (A) diastolic velocities ratio (E/A), and positively to left atrial volume index; UACR also positively correlated with E to peak early (E') diastolic mitral annular velocity ratio (E/E'). Serum urea, urea-to-creatinine ratio and UACR correlated with LVDD in logistic univariate regression analysis, and urea-to-creatinine ratio remained independently correlated to LVDD [ Odds ratio (OR) 2.82, 95% confidence interval (CI) 1.34-5.95] after adjustment. Serum urea (OR 1.18, 95%CI 1.03-1.34), creatinine (OR 6.53, 95%CI 1.70-25.02), eGFR (OR 0.22, 95%CI 0.07-0.65) and UACR (OR 2.15, 95%CI 1.42-3.24) were revealed independent correlates of advanced (moderate and severe) LVDD. Conclusions: Biochemical parameters of renal function were closely linked with LVDD. This finding described new cardiorenal relationship in the elderly population.
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| 8. |
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| 9. |
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| 10. |
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| 11. |
- Annerstedt, M, et al.
(författare)
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Rhabdomyolysis and acute renal failure associated with influenza virus type A.
- 1999
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Ingår i: Scandinavian journal of urology and nephrology. - 0036-5599. ; 33:4, s. 260-4
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Tidskriftsartikel (refereegranskat)abstract
- Two patients with rhabdomyolysis-induced acute renal failure due to influenza A virus infection are presented. Both had influenza symptoms, with high fever and severe muscular pain leading to walking problems. In addition, they were dehydrated due to vomiting and diarrhoea. Both had evidence of an ongoing influenza infection according to serological tests. Muscle injury due to the viral infection gave rise to rhabdomyolysis with efflux of myoglobin from the muscles, causing renal failure. In conclusion, influenza A virus infection can cause rhabdomyolysis accompanied by reversible acute renal failure.
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| 12. |
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| 13. |
- 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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| 14. |
- Blomberg, S, et al.
(författare)
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Thoracic epidural anaesthesia in patients with unstable angina pectoris
- 1989
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Ingår i: European Heart Journal. - : Oxford University Press. - 0195-668X .- 1522-9645. ; 10:5, s. 437-444
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Tidskriftsartikel (refereegranskat)abstract
- The effect of high thoracic epidural anaesthesia with intermittent epidural bolus injections of bupivacaine (2.5 or 5 mg ml-1) was studied in 28 patients with unstable angina pectoris. The majority of the patients had a history of previous acute myocardial infarction(s) and/or angina pectoris and severe coronary artery disease. All patients were treated wth nitroglycerin infusion for gt;24 h and were included in the study if they had chest pain, not caused by acute myocardial infarction, at bed rest or recurrent anginal pain at rest < 2 days after infarction. 4.4 ± 0.3 ml of bupivacaine induced a blockade of the upper seven sympathetic segments ( Th1-7) for 98 ± 9min. Heart rate decreased significantly from 70 ± 3 to 64 ± 3 beats min-1 while blood pressure was unaffected by thoracic epidural anaesthesia. In 27 patients (96%) the anaesthesia induced complete analgesia. Nitroglycerin infusion was discontinued definitely within 3 h in 26 patients (93%) and pain was thereafter controlled by means of thoracic epidural anaesthesia as the sole treatment in 23 patients (82%) and as the major treatment in 25 patients (89%). Twenty-one patients (75%) were fully mobilized and stabilized. Treatment with thoracic epidural anaesthesia lasted for 6.0 ± 1.1 days. The number of daily epidural injections decreased significantly with time from 2.7 ±0.3 the first day to 0.9 ± 0.3 the fourth day (P>0.01, n = 19). Two patients developed acute myocardial infarction during the anaesthesia treatment period, and one of these patients died. Exercise stress testing was performed on eight patients three to five days after the start of thoracic epidural anaesthesia. At a comparable workload, ST-segment depression was significantly (P>0.05) less pronounced during anaesthesia ( − 0.6 ± 0.1 mm) compared with control ( − 1.3 ± 0.2mm). The respective heart rate values were 95 ± 7 and 107 ± 7 beats min -1 (P > 0.05), while systolic or diastolic blood pressure did not differ between the two conditions. We conclude that blockade of cardiac sympathetic afferents and efferents by means of thoracic epidural anaesthesia can effectively treat pain and stabilize patients with unstable angina pectoris refractory to medical treatment. Furthermore, thoracic epidural anaesthesia attenuates stress-induced myocardial ischaemia; thus, it may be an efficient supplementary treatment for the control of pain and for stabilizing patients with unstable angina pectoris during diagnostic procedures and prior to coronary surgery or angioplasty.
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| 15. |
- Brandrup-Wognsen, G, et al.
(författare)
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Female sex is associated with increased mortality and morbidity early, but not late, after coronary artery bypass grafting
- 1996
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Ingår i: European Heart Journal. - : Oxford University Press. - 0195-668X .- 1522-9645. ; 17:9, s. 1426-1431
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Tidskriftsartikel (refereegranskat)abstract
- Objective To describe mortality and morbidity during a period of 2 years after coronary artery bypass grafting in relation to gender. Design Prospective follow-up study. Setting Two regional cardiothoracic centres which performed all the coronary artery bypass operations in western Sweden at the time. Sub|ects A total of 2129 (1727 (81%) men and 402 (19%) women) consecutive patients undergoing coronary artery bypass surgery between June 1988 and June 1991 without concomitant procedures. Results Females were older and more frequently had a history of hypertension, diabetes mellitus, congestive heart failure, renal dysfunction and obesity. In a multivariate analysis, taking account of age, history of cardiovascular diseases and renal dysfunction, female sex appeared as a significant independent predictor of mortality during the 30 days after coronary artery bypass grafting (/><0-05), but not thereafter. Various postoperative complications including neurological deficit, hydro- and pneumo-thorax, perioperative myocardial damage and the need for assist devices and prolonged reperfusion were more common in females than males. Conclusion Females run an increased risk of early death and the development of postoperative complications after coronary artery bypass surgery as compared with males. Late mortality does not appear to be influenced by gender and the long-term benefit of the coronary artery bypass graft operation is similar in men and women.
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| 16. |
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| 17. |
- Bylow, H, et al.
(författare)
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Characteristics and outcome after out-of-hospital cardiac arrest with the emphasis on workplaces : an observational study from the Swedish Registry of Cardiopulmonary Resuscitation
- 2021
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Ingår i: Resuscitation Plus. - : Elsevier BV. - 2666-5204. ; 5
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Tidskriftsartikel (refereegranskat)abstract
- Background: Characteristics and outcome in out-of-hospital cardiac arrest (OHCA) occurring at workplaces is sparsely studied.Aim: To describe (1) the characteristics and 30-day survival of OHCAs occurring at workplaces in comparison to OHCAs at other places and (2) factors associated with survival after OHCAs at workplaces.Methods: Data on OHCAs were obtained from the Swedish Registry of Cardiopulmonary Resuscitation from 1 January 2008 to 31 December 2018. Characteristics and factors associated with survival were analysed with emphasis on the location of OHCAs.Results: Among 47,685 OHCAs, 529 cases (1%) occurred at workplaces. Overall, in the fully adjusted model, all locations of OHCA, with the exception of crowded public places, displayed significantly lower probability of survival than workplaces. Exhibiting a shockable rhythm was the strongest predictor of survival among patients with OHCAs at workplaces; odds ratio (95% CI) 5.80 (2.92-12.31). Odds ratio for survival for women was 2.08 (95% CI 1.07-4.03), compared with men. At workplaces other than private offices, odds ratio for survival was 0.41 (95% CI 0.16-0.95) for cases who did not receive bystander CPR, as compared to those who did receive CPR. Among patients who were found in a shockable rhythm were 23% defibrillated before arrival of ambulance, which was more frequent than in any other location.Conclusion: Out-of-hospital cardiac arrest occurring at workplaces and crowded public places display the highest probability of survival, as compared with other places outside hospital. An initial shockable cardiac rhythm was the strongest predictor of survival for OHCA at workplaces.
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| 18. |
- Bylow, H., et al.
(författare)
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Learning Outcome After Different Combinations of Seven Learning Activities in Basic Life Support on Laypersons in Workplaces : a Cluster Randomised, Controlled Trial
- 2021
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Ingår i: Medical Science Educator. - : Springer Science and Business Media LLC. - 2156-8650. ; 31:1, s. 161-173
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Tidskriftsartikel (refereegranskat)abstract
- Background: The goal for laypersons after training in basic life support (BLS) is to act effectively in an out-of-hospital cardiac arrest situation. However, it is still unclear whether BLS training targeting laypersons at workplaces is optimal or whether other effective learning activities are possible.Aim: The primary aim was to evaluate whether there were other modes of BLS training that improved learning outcome as compared with a control group, i.e. standard BLS training, six months after training, and secondarily directly after training.Methods: In this multi-arm trial, lay participants (n = 2623) from workplaces were cluster randomised into 16 different BLS interventions, of which one, instructor-led and film-based BLS training, was classified as control and standard, with which the other 15 were compared. The learning outcome was the total score for practical skills in BLS calculated using the modified Cardiff Test.Results: Four different training modes showed a significantly higher total score compared with standard (mean difference 2.3–2.9). The highest score was for the BLS intervention including a preparatory web-based education, instructor-led training, film-based instructions, reflective questions and a chest compression feedback device (95% CI for difference 0.9–5.0), 6 months after training.Conclusion: BLS training adding several different combinations of a preparatory web-based education, reflective questions and chest compression feedback to instructor-led training and film-based instructions obtained higher modified Cardiff Test total scores 6 months after training compared with standard BLS training alone. The differences were small in magnitude and the clinical relevance of our findings needs to be further explored.Trial Registration: ClinicalTrials.gov Identifier: NCT03618888. Registered August 07, 2018—Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03618888 © 2020, The Author(s).
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| 19. |
- Claesson, A, et al.
(författare)
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Cardiac disease and probable intent after drowning
- 2013
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Ingår i: American Journal of Emergency Medicine. - : W.B. Saunders Co.. - 0735-6757 .- 1532-8171. ; 31:7, s. 1073-7
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Tidskriftsartikel (refereegranskat)abstract
- AIM: The aim of this study is to determine the prevalence of cardiac disease and its relationship to the victim's probable intent among patients with cardiac arrest due to drowning. METHOD: Retrospective autopsied drowning cases reported to the Swedish National Board of Forensic Medicine between 1990 and 2010 were included, alongside reported and treated out-of-hospital cardiac arrests due to drowning from the Swedish Out of Hospital Cardiac Arrest Registry that matched events in the National Board of Forensic Medicine registry (n = 272). RESULTS: Of 2166 drowned victims, most (72%) were males; the median age was 58 years (interquartile range, 42-71 years). Drowning was determined to be accidental in 55%, suicidal in 28%, and murder in 0.5%, whereas the intent was unclear in 16%. A contributory cause of death was found in 21%, and cardiac disease as a possible contributor was found in 9% of all autopsy cases. Coronary artery sclerosis (5%) and myocardial infarction (2%) were most frequent. Overall, cardiac disease was found in 14% of all accidental drownings, as compared with no cases (0%) in the suicide group; P = .05. Ventricular fibrillation was found to be similar in both cardiac and noncardiac cases (7%). This arrhythmia was found in 6% of accidents and 11% of suicides (P = .23). CONCLUSION: Among 2166 autopsied cases of drowning, more than half were considered to be accidental, and less than one-third, suicidal. Among accidents, 14% were found to have a cardiac disease as a possible contributory factor; among suicides, the proportion was 0%. The low proportion of cases showing ventricular fibrillation was similar, regardless of the presence of a cardiac disease.
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| 20. |
- Dahlqvist, Johanna, 1979-, et al.
(författare)
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Identification and functional characterization of a novel susceptibility locus for small vessel vasculitis with MPO-ANCA
- 2022
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Ingår i: Rheumatology. - Oxford, United Kingdom : Oxford University Press (OUP). - 1462-0324 .- 1462-0332. ; 61:8, s. 3461-3470
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Tidskriftsartikel (refereegranskat)abstract
- Objective To identify and characterize genetic loci associated with the risk of developing ANCA-associated vasculitides (AAV). Methods Genetic association analyses were performed after Illumina sequencing of 1853 genes and subsequent replication with genotyping of selected single nucleotide polymorphisms in a total cohort of 1110 Scandinavian cases with granulomatosis with polyangiitis or microscopic polyangiitis, and 1589 controls. A novel AAV-associated single nucleotide polymorphism was analysed for allele-specific effects on gene expression using luciferase reporter assay. Results PR3-ANCA(+) AAV was significantly associated with two independent loci in the HLA-DPB1/HLA-DPA1 region [rs1042335, P = 6.3 x 10(-61), odds ratio (OR) 0.10; rs9277341, P = 1.5 x 10(-44), OR 0.22] and with rs28929474 in the SERPINA1 gene (P = 2.7 x 10(-10), OR 2.9). MPO-ANCA(+) AAV was significantly associated with the HLA-DQB1/HLA-DQA2 locus (rs9274619, P = 5.4 x 10(-25), OR 3.7) and with a rare variant in the BACH2 gene (rs78275221, P = 7.9 x 10(-7), OR 3.0), the latter a novel susceptibility locus for MPO-ANCA(+) granulomatosis with polyangiitis/microscopic polyangiitis. The rs78275221-A risk allele reduced luciferase gene expression in endothelial cells, specifically, as compared with the non-risk allele. Conclusion We identified a novel susceptibility locus for MPO-ANCA(+) AAV and propose that the associated variant is of mechanistic importance, exerting a regulatory function on gene expression in specific cell types.
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| 21. |
- Deedwania, P. C., et al.
(författare)
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Efficacy, safety and tolerability of metoprolol CR/XL in patients with diabetes and chronic heart failure: experiences from MERIT-HF
- 2005
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Ingår i: Am Heart J. - : Mosby, Inc.. - 1097-6744 .- 0002-8703. ; 149:1, s. 159-67
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The objective of the current study was to examine the efficacy and tolerability of the beta-blocker metoprolol succinate controlled release/extended release (CR/XL) in patients with diabetes in the Metoprolol CR/XL Randomized Intervention Trial in Chronic Heart Failure (MERIT-HF). METHODS: The Cox proportional hazards model was used to calculate hazard ratios (HR) for convenience expressed as relative risks (risk reduction = 1-HR), and 95% confidence intervals (CI). RESULTS: The risk of hospitalization for heart failure was 76% higher in diabetics compared to non-diabetics (95% CI 38% to 123%). Metoprolol CR/XL was well tolerated and reduced the risk of hospitalization for heart failure by 37% in the diabetic group (95% CI 53% to 15%), and by 35% in the non-diabetic group (95% CI 48% to 19%). Pooling of mortality data from the Cardiac Insufficiency Bisoprolol Study II (CIBIS II), MERIT-HF, and the Carvedilol Prospective Randomized Cumulative Survival Study (COPERNICUS) showed similar survival benefits in patients with diabetes (25%; 95% CI 40% to 4%) and without diabetes (36%; 95% CI 44% to 27%); test of diabetes by treatment interaction was non-significant. Adverse events were reported more often on placebo than on metoprolol CR/XL. CONCLUSIONS: Patients with heart failure and diabetes have a much higher risk of hospitalization than patients without diabetes. Regardless of diabetic status, a highly significant reduction in hospitalizations for heart failure was observed with metoprolol CR/XL therapy, which was very well tolerated also by patients with diabetes. Furthermore, the pooled data showed a statistically significant survival benefit in patients with diabetes.
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| 22. |
- Dellborg, M, et al.
(författare)
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Changes in the use of medication after acute myocardial infarction : Possible impact on post-myocardial infarction mortality and long-term outcome
- 2001
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Ingår i: Coronary Artery Disease. - : Lippincott Williams & Wilkins. - 0954-6928 .- 1473-5830. ; 12:1, s. 61-67
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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.
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| 23. |
- Dellborg, M, et al.
(författare)
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ECG changes during myocardial ischemia. Differences between men and women
- 1995
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Ingår i: Journal of Electrocardiology. - : Churchill Livingstone. - 0022-0736 .- 1532-8430. ; 27:suppl., s. 42-45
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Tidskriftsartikel (refereegranskat)abstract
- Women have a higher short-term mortality in acute myocardial infarction (MI) compared with men. This may be partly explained by differences in risk factors such as age and diabetes. However, several reports have focused on the occurrence of a sex bias making women less likely to be subjected to angiography and revascularization as well as aggressive pharmacologic treatment of acute MI. The decision to initiate these procedures is often based on ischemic changes of the electrocardiogram. It was therefore investigated whether differences between men and women in magnitude of electrocardiographic changes during myocardial ischemia could explain some of the differences previously reported. A total of 178 patients with chest pain suggestive of MI (135 men and 43 women) included in a study of thrombolytics were monitored for 24 hours with continuous vectorcardiography. Also, 81 patients with stable angina pectoris undergoing elective angioplasty were monitored during the procedure. In patients admitted with suspicion of MI, the initial summated ST deviation was 178 +/- 146 microV for men as compared with 105 +/- 91 microV for women (P = .002). During angioplasty, men had significantly more pronounced maximum ST deviation during inflation of the balloon (235 +/- 165 vs 156 +/- 89 microV; P = .036). In conclusion, men have more pronounced ST changes than women during myocardial ischemia. When fixed magnitudes of ST deviation are required for initiating therapy such as thrombolytics, this will favor treatment of men. A sex-adjusted limit for administrating thrombolytic drugs may be warranted in the light of the above findings.
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| 24. |
- Emanuelsson, H, et al.
(författare)
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Characteristics and prognosis of patients with acute myocardial infarction in relation to occurrence of congestive heart failure
- 1994
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Ingår i: European Heart Journal. - : Oxford University Press. - 0195-668X .- 1522-9645. ; 15:6, s. 761-768
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Tidskriftsartikel (refereegranskat)abstract
- Congestive heart failure is one of the major symptoms accompanying acute myocardial infarction (AMI). The study aimed to describe the occurrence, characteristics and prognosis of congestive heart failure in AMI and to compare post-MI patients with and without congestive heart failure. The methods used included baseline characteristics, initial symptoms, electrocardiogram (ECG), mortality during hospitalization and one year follow-up in consecutive patients with AMI admitted to Sahlgrenska Hospital, Göteborg, Sweden. Congestive heart failure was observed in 51% of the cases. Patients with congestive heart failure were older, more frequently had a history of previous cardiovascular disease, and, less frequently had chest pain on admission to hospital. They had a higher occurrence of life-threatening ventricular arrhythmias during initial hospitalization, and their mortality during one year follow-up was 39% as compared to 17% in patients without congestive heart failure (P<0.001). This difference remained significant when correcting for differences at baseline. Patients with severe congestive heart failure had a one year mortality of 47% vs 31% in patients with moderate congestive heart failure (P<0.01). Signs and symptoms of congestive heart failure occur in every second patient admitted to hospital due to AMI, and indicate a bad prognosis, which is directly related to the severity of congestive heart failure.
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| 25. |
- Erhardt, Leif RW, et al.
(författare)
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Task force on the management of chest pain.
- 2002
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Ingår i: European Heart Journal. - : Oxford University Press (OUP). - 1522-9645 .- 0195-668X. ; 23:15, s. 1153-1176
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Forskningsöversikt (refereegranskat)
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| 26. |
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| 27. |
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| 29. |
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| 30. |
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| 31. |
- Friberg, H., et al.
(författare)
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[Therapeutic hypothermia after cardiac arrest--a new link in the chain can save life]
- 2004
-
Ingår i: Lakartidningen. - 0023-7205. ; 101:30-31, s. 2412-6
-
Tidskriftsartikel (refereegranskat)abstract
- Sudden, unexpected cardiac arrest is a common cause of death. Among patients who are successfully resuscitated, a majority dies without regaining consciousness. Therapeutic hypothermia has recently been shown to improve neurological outcome in two randomized studies and to improve survival in one of them. Based on the two studies, international evidence-based recommendations have been proposed and published (ILCOR). In this review we discuss the theoretical background of hypothermic neuroprotection and therapeutic implications. We propose that victims of cardiac arrest with return of spontaneous circulation and persistent unconsciousness are considered for hypothermia treatment and that data from treated patients are collected in a common website database (see: www.scctg.org) to allow further evaluation of the use of ICU resources, efficacy of hypothermia treatment and potential risks.
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| 32. |
- Fu, Michael, 1963, et al.
(författare)
-
Agonist-like activity of antibodies to angiotensin II receptor subtype 1 (AT1) from rats immunized with AT1 receptor peptide.
- 1999
-
Ingår i: Blood pressure. - 0803-7051. ; 8:5-6, s. 317-24
-
Tidskriftsartikel (refereegranskat)abstract
- In the present study, rats were immunized with angiotensin II receptor subtype 1 (AT1) receptor peptides for 3 months to see if the immunization produced specific anti-AT1 receptor antibodies and if continuous stimulation for 3 months affected blood pressure or induced morphological changes in the organs containing AT1 receptors. Our results showed that there were constant high levels of circulating antibodies throughout the study period in all rats of the immunized group, but not in the control rats, and that there were almost no significant cross-reactions of antisera with AT2 receptor peptide and alpha1 adrenoceptor peptide, except in four rats, which showed low cross-reactions with alpha1 adrenoceptor and AT2 receptor peptides. When an affinity-purified anti-AT1 receptor antibody was used, it specifically displayed the AT1-stimulatory positive chronotropic effect and also localized AT1 receptors. However, in the immunized group, saturation binding of AT1 in homogenates from kidneys showed no difference either in maximal binding sites (Bmax) or in antagonist affinity (Kd). No difference in mRNA of AT1a was found in either kidney or heart, and no morphological changes in the organs were observed, as compared with the control group. Furthermore, immunization did not cause hypertension. In conclusion, the synthetic peptide corresponding to the second extra-cellular loop of the human AT1 receptor was able to produce highly specific and functionally active anti-AT1 receptor antibodies, but unable to induce pathological structural changes or hypertension.
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| 33. |
- Gisslen, K, et al.
(författare)
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Relationship between anti-neutrophil cytoplasmic antibody determined with conventional binding and the capture assay, and long-term clinical course in vasculitis
- 2002
-
Ingår i: Journal of Internal Medicine. - : Wiley. - 1365-2796 .- 0954-6820. ; 251:2, s. 129-135
-
Tidskriftsartikel (refereegranskat)abstract
- Objectives. To evaluate the relationship between anti-neutrophil cytoplasmic antibody (ANCA) measured with two different methods and long-term clinical course in vasculitis. Design. Retrospective determination of ANCA with two different assays for detection of PR3-ANCA, conventional direct binding ELISA and capture ELISA using monoclonal antibodies against PR3. The 245 ANCA determinations were performed from frozen blood samples collected three to four times a year in each patient. Setting. Department of Nephrology at a Swedish University Hospital. Subjects. A total of 10 ANCA-positive patients with vasculitis caused by Wegener's granulomatosis (WG) or microscopic polyarteritis (MPA) and a very long follow-up time (mean 9 years, range 5-15.5 years). Results. The total number of episodes with active vasculitis was 29 and all of them (100%) were detected by the capture technique whilst the conventional technique detected 23 (79%). The mean number of episodes with active disease requiring treatment with steroids and cytotoxic drugs was three per patient (range 1-6). At the time of clinical relapse of the vasculitis disease. the ANCA titre using the capture technique was either increasing or showed a very high value in all cases. The pattern of capture ANCA response could be subdivided into three categories: a close (four patients), an intermediate (three patients), and no (three patients) relationship between capture ANCA level and long-term clinical course. Conclusion. Detection of PR3-ANCA by the capture ELISA showed a higher sensitivity than that obtained by the direct ELISA in diagnosing relapse during follow-up of patients with vasculitis. The specificity of the capture ANCA was, however, low. as high levels occurred in patients without clinical disease activity.
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| 34. |
- Glantz, H, et al.
(författare)
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Occurrence and predictors of obstructive sleep apnea in a revascularized coronary artery disease cohort
- 2013
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Ingår i: Annals of the American Thoracic Society. - : American Thoracic Society. - 2329-6933 .- 2325-6621. ; 10:4, s. 350-356
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Knowledge about the prevalence of obstructive sleep apnea (OSA) in coronary artery disease (CAD) is insufficient. The aim of the current report was to evaluate the occurrence and predictors of OSA among revascularized patients with CAD within the framework of a randomized controlled trial (Randomized Intervention with CPAP in Coronary Artery Disease and Sleep Apnea [RICCADSA]), evaluating the impact of continuous positive airway pressure on cardiovascular outcomes in CAD patients with OSA. Material and Methods: All patients undergoing percutaneous coronary intervention or coronary artery bypass grafting between September 2005 and November 2010 (n = 1,291) were invited to participate. Anthropometrics and medical history were obtained, ambulatory sleep recording was performed, and all subjects completed the Epworth Sleepiness Scale (ESS) questionnaire. Results: In total, 662 patients participated in the sleep study. OSA, defined as an apnea–hypopnea index equal to or greater than 15/hour, was found among 422 (63.7%). The prevalence of hypertension was 55.9%; obesity (body mass index ≥ 30 kg/m2), 25.2%; diabetes mellitus, 22.1%; and current smoking, 18.9%. The patients with CAD who did not participate in the study demonstrated an almost similar anthropometric and clinical profile compared with the studied group. The majority (61.8%) of the patients with OSA were nonsleepy (ESS score < 10). Patients with OSA had a higher prevalence of obesity, hypertension, diabetes mellitus, and history of atrial fibrillation, whereas current smoking was more common in the non-OSA group. Age, male sex, body mass index, and ESS score, but not comorbidities, were independent predictors of OSA. Conclusions: The occurrence of unrecognized OSA in this revascularized CAD cohort was higher than previously reported. We suggest that OSA should be considered in the secondary prevention protocols in CAD. Read More: http://www.atsjournals.org/doi/abs/10.1513/AnnalsATS.201211-106OC?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed&
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| 35. |
- Gräsner, Jan-Thorsten, et al.
(författare)
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Survival after out-of-hospital cardiac arrest in Europe - Results of the EuReCa TWO study.
- 2020
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Ingår i: Resuscitation. - : Elsevier BV. - 0300-9572 .- 1873-1570. ; 148, s. 218-226
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The epidemiology and outcome after out-of-hospital cardiac arrest (OHCA) varies across Europe. Following on from EuReCa ONE, the aim of this study was to further explore the incidence of and outcomes from OHCA in Europe and to improve understanding of the role of the bystander.METHODS: This prospective, multicentre study involved the collection of registry-based data over a three-month period (1st October 2017 to 31st December 2017). The core study dataset complied with the Utstein-style. Primary outcomes were return of spontaneous circulation (ROSC) and survival to hospital admission. Secondary outcome was survival to hospital discharge.RESULTS: All 28 countries provided data, covering a total population of 178,879,118. A total of 37,054 OHCA were confirmed, with CPR being started in 25,171 cases. The bystander cardiopulmonary resuscitation (CPR) rate ranged from 13% to 82% between countries (average: 58%). In one third of cases (33%) ROSC was achieved and 8% of patients were discharged from hospital alive. Survival to hospital discharge was higher in patients when a bystander performed CPR with ventilations, compared to compression-only CPR (14% vs. 8% respectively).CONCLUSION: In addition to increasing our understanding of the role of bystander CPR within Europe, EuReCa TWO has confirmed large variation in OHCA incidence, characteristics and outcome, and highlighted the extent to which OHCA is a public health burden across Europe. Unexplained variation remains and the EuReCa network has a continuing role to play in improving the quality management of resuscitation.
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| 36. |
- Hedner, J, et al.
(författare)
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Sleep habits and their association with mortality during 5-year follow-up after coronary artery bypass surgery
- 2002
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Ingår i: Acta Cardiologica. - : La Societe Belge de Cardiologie. - 0001-5385 .- 1784-973X. ; 57:5, s. 341-348
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To study various aspects of sleep quality and sleep patterns prior to and after coronary artery bypass surgery and their implications for 5-year survival. METHODS: All patients from western Sweden who underwent coronary artery bypass grafting (CABG) between 1988 and 1991 (n = 2,121) received a questionnaire addressing sleep habits prior to and I year after surgery. Various symptoms and habits related to sleep at the two evaluations were compared. Symptoms and habits related to sleep prior to CABG were then related to 5-year survival. RESULTS: In all, 1,224 patients took part in the evaluation. A highly significant improvement was observed with regard to the following symptoms and habits related to sleep: feeling refreshed upon awakening, feeling tired during daytime, waking up with headache, nightmares, sweating during night time, medication for pain relief at bedtime, involuntarily falling asleep during daytime, apnoea during sleep and mouth dryness during the night. Various symptoms and habits associated with sleep prior to CABG were generally not strongly related to prognosis. Exceptions were feeling refreshed upon awakening and infrequent consumption of pain relief medication at bedtime which both were associated with an improved long-term survival. CONCLUSIONS: A variety of symptoms associated with sleep improve highly significantly after CABG. The occurrence of these symptoms prior to CABG do not generally seem to influence the long-term prognosis.
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| 37. |
- Herlitz, Johan, et al.
(författare)
-
Clinical observations after treatment with metoprolol in suspected acute myocardial infarction in relation to age
- 1985
-
Ingår i: Acta Medica Scandinavica. - : Wiley-Blackwell Publishing Ltd.. - 0001-6101. ; 217:3, s. 293-298
-
Tidskriftsartikel (refereegranskat)abstract
- A double-blind trial with the beta 1-selective blocker metoprolol in suspected acute myocardial infarction and during 3 months' follow-up included 1395 patients, aged 40-74 years, 698 on metoprolol and 697 on placebo. In order to further evaluate the tolerability to beta-blockade in the elderly, the total series was divided into 2 groups according to median age (61 years) and into quartiles, the lowest quartile (40-57 years) being compared with the highest (67-74 years). The decrease in heart rate and systolic blood pressure after intravenous metoprolol in the acute phase was similar in the elderly and the younger patients. Hypotension was observed more often in the metoprolol-treated than in the placebo-treated younger patients, while no difference was observed in the elderly. Bradycardia was observed more often in the metoprolol group in both age groups, while there was no difference regarding the incidence of congestive heart failure in either the younger or in the elderly patients. The effect on mortality, serious ventricular arrhythmias and chest pain seemed to be similar in different age groups. From the present series we conclude that hemodynamic reactions and tolerability to beta-blockade can be expected to be similar in elderly and younger patients.
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| 38. |
- Herlitz, Johan, et al.
(författare)
-
Determinants of an impaired quality of life five years after coronary artery bypass surgery
- 1999
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Ingår i: Heart. - : B M J Group. - 1355-6037 .- 1468-201X. ; 81:4, s. 342-346
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE—To identify determinants of an inferior quality of life (QoL) five years after coronary artery bypass grafting (CABG). SETTING—University hospital. PARTICIPANTS—Patients from western Sweden who underwent CABG between 1988 and 1991. MAIN OUTCOME MEASURES—Questionnaires for evaluating QoL before CABG and five years after operation. Three different instruments were used: the Nottingham health profile (NHP), the psychological general wellbeing index (PGWI), and the physical activity score (PAS). RESULTS—2121 patients underwent CABG, of whom 310 died during five years' follow up. Information on QoL after five years was available in 1431 survivors (79%). There were three independent predictors for an inferior QoL with all three instruments: female sex, a history of diabetes mellitus, and a history of chronic obstructive pulmonary disease. Multivariate analysis showed that a poor preoperative QoL was a strong independent predictor for an impaired QoL five years after CABG. An impaired QoL was also predicted by previous disease. CONCLUSIONS—Female sex, an impaired QoL before surgery, and other diseases such as diabetes mellitus are independent predictors for an impaired QoL after CABG in survivors five years after operation.
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| 39. |
- Herlitz, Johan, et al.
(författare)
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Determinants of time to discharge following coronary artery bypass grafting
- 1997
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Ingår i: European Journal of Cardio-Thoracic Surgery. - : Elsevier BV. - 1010-7940 .- 1873-734X. ; 11:3, s. 533-538
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Tidskriftsartikel (refereegranskat)abstract
- AIM: To describe clinical factors prior to and at the time of coronary artery bypass grafting (CABG) associated with the number of days until hospital discharge. PATIENTS: All patients from western Sweden in whom during the time period June 1 1988-June 1 1991 CABG was performed without simultaneous valve surgery. METHODS: The time between operation and hospital discharge was calculated for every patient and related to various factors prior to and at the operation. RESULTS: Among 2035 patients the time between operation and discharged alive from hospital varied between 2 and 191 days (median 15 days). When simultaneously considering pre-, per- and postoperative factors the following appeared as independent predictors for a longer hospital time: age (years) (P < 0.0001); female sex, (P < 0.0001); time in respirator (P = 0.0004); previous congestive heart failure (P = 0.0007); reoperation (P = 0.0008); neurological complication (P = 0.001); maximum activity of serum aspartate amino transferase (P = 0.002); pneumo/hydrothorax (P = 0.002), previous cerebrovascular disease (P = 0.004), non-smoker (P = 0.006); supraventricular arrhythmia (0.006); time in intensive care unit (P = 0.007); aortic cross-clamp time (P = 0.009); obesity (P = 0.02). CONCLUSION: A large number of pre- and postoperative factors are associated with an increased time between operation and time to discharge.
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| 40. |
- Herlitz, Johan, et al.
(författare)
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Development of congestive heart failure after treatment with metoprolol in acute myocardial infarction
- 1984
-
Ingår i: British Heart Journal. - : BMJ Group. - 0007-0769. ; 51:5, s. 539-544
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Tidskriftsartikel (refereegranskat)abstract
- In a double blind study of metoprolol in the treatment of suspected acute myocardial infarction 698 patients (study group) received metoprolol and 697 a placebo (control group). Metoprolol was given in an intravenous dose of 15 mg as soon as possible after admission to hospital followed by 50 g by mouth four times a day for two days and thereafter 100 mg twice a day for three months. A placebo was similarly given. Congestive heart failure occurred in a similar percentage of patients in both the study (27%) and the control groups (30%). Its severity was estimated by calculating the total dose of frusemide given during the first four days in hospital. Less frusemide was given to patients treated with metoprolol compared with those given a placebo in the total series. An appreciably lower total dose of frusemide was given to patients included in the trial less than or equal to 12 hours after the onset of pain and treated with metoprolol compared with a placebo, while no difference was seen among patients treated later. The initial heart rate, systolic blood pressure, and infarct site affected the results.
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| 41. |
- Herlitz, Johan, et al.
(författare)
-
Effect of metoprolol on chest pain in acute myocardial
- 1984
-
Ingår i: British Heart Journal. - : BMJ Group. - 0007-0769. ; 51:4, s. 438-444
-
Tidskriftsartikel (refereegranskat)abstract
- A total of 1395 patients aged 40 to 74 years were included in a double blind trial with the beta 1 selective blocker metoprolol in suspected acute myocardial infarction. Metoprolol was given intravenously (15 mg) as soon as possible after admission to hospital followed by 200 mg daily for three months. A placebo was given in the same manner. The severity of chest pain in the acute phase was calculated by recording the number of injections of analgesics given and the time from the start of blind treatment to the time when the last analgesic was given (duration of pain). The patients receiving metoprolol were given a lower mean number of injections of analgesics during the first four days and after randomisation than those receiving a placebo. The estimated duration of pain was shorter in the metoprolol group than in the placebo group. These effects were related to the initial heart rate, the initial systolic blood pressure, and the final site of the infarct as determined electrocardiographically. Thus metoprolol given in the acute phase of suspected or definite myocardial infarction appears to reduce the severity of chest pain.
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| 42. |
- Herlitz, Johan, et al.
(författare)
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Effect of metoprolol on indirect signs of the size and severity of acute myocardial infarction
- 1983
-
Ingår i: American Journal of Cardiology. - : Elsevier Excerpta Medica, Inc.. - 0002-9149 .- 1879-1913. ; 51:8, s. 1282-1288
-
Tidskriftsartikel (refereegranskat)abstract
- In a double-blind randomized trial, 1,395 patients with suspected acute myocardial infarction (MI) were investigated to evaluate the possibility of limiting indirect signs of the size and severity of acute MI with the beta1-selective adrenoceptor antagonist metoprolol. Metoprolol (15 mg) was given intravenously and followed by oral administration for 3 months (200 mg daily). Placebo was given in the same way. The size of the MI was estimated by heat-stable lactate dehydrogenase (LD[EC 1.1.1.27]) analyses and precordial electrocardiographic mapping. Lower maximal enzyme activities compared with placebo were seen in the metoprolol group (11.1 ± 0.5 μkat · liter−1)when the patient was treated within 12 hours of the onset of pain (13.3 ± 0.6 μkat · liter−1; n = 936; p = 0.009). When treatment was started later than 12 hours, no difference was found between the 2 groups. Enzyme analyses were performed in all but 20 patients (n = 1,375). Precordial mapping with 24 chest electrodes was performed in patients with anterior wall MI. The final total R-wave amplitude was higher and the final total Q-wave amplitude lower in the metoprolol group than in the placebo group. Patients treated with metoprolol ≤12 hours also showed a decreased need for furosemide, a shortened hospital stay, and a significantly reduced 1-year mortality compared with the placebo group, whereas no difference was observed among patients treated later on. After 3 months, however, there was a similar reduction in mortality among patients in whom therapy was started 12 hours and >12 hours after the onset of pain. The results support the hypothesis that intravenous metoprolol followed by oral treatment early in the course of suspected myocardial infarction can limit infarct size and improve longterm prognosis.
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| 43. |
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| 44. |
- Herlitz, Johan, et al.
(författare)
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Electrocardiographic changes and their relation to serum enzyme activity after heart surgery
- 1984
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Ingår i: The thoracic and cardiovascular surgeon. - : Georg Thieme Verlag. - 0171-6425 .- 1439-1902. ; 32:6, s. 365-368
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Tidskriftsartikel (refereegranskat)abstract
- In 80 patients who underwent heart surgery the incidence of electrocardiographic (ECG) changes after the operation was analysed. A precordial grid containing 24 leads and leads II, III and aVF was used. Electrocardiographic measurements were taken the day before the operation and again 5 days after the operation. New Q-waves were observed in 2 patients (2.5%) in the 24 precordial leads, in 2 patients in leads II, III and aVF, and in one patient in both precordial leads and leads II, III and aVF. New T-wave inversions were observed in 20 patients (25%) in the 24 precordial leads, in 5 patients (6%) in leads II, III and aVF, and in 3 patients in both precordial leads and leads II, III and aVF. A similar serum enzyme activity was observed both in patients developing Q-waves as well as T-wave inversions compared with cases in whom ECG changes did not appear.
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| 45. |
- Herlitz, Johan, et al.
(författare)
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Goteborg Metoprolol Trial : clinical observations
- 1984
-
Ingår i: American Journal of Cardiology. - : Excerpta Medica, Inc.. - 0002-9149 .- 1879-1913. ; 53:13, s. 37-45
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Tidskriftsartikel (refereegranskat)abstract
- Heart rate, systolic blood pressure and rate-pressure product were analyzed during the first 18 hours and 4 days after intravenous metoprolol or placebo. On injection of metoprolol there was an immediate decrease in mean heart rate from 72.9 0.6 to 62.7 0.4 beats/min, but no change was found in the placebo group. The difference in heart rate remained during the first 4 days. Systolic blood pressure was reduced from 144.1 0.9 to 134.6 0.9 mm Hg after intravenous metoprolol and was lower than that in the placebo group during 4 days of follow-up. Indirect signs of congestive heart failure tended to be less severe in patients given metoprolol within 12 hours of the onset of symptoms than in those given placebo. The duration of hospitalization also tended to be shorter in patients given early metoprolol treatment than in those given placebo early.
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| 46. |
- Herlitz, Johan, et al.
(författare)
-
Göteborg Metoprolol Trial : mortality and causes of death
- 1984
-
Ingår i: American Journal of Cardiology. - : Excerpta Medica, Inc.. - 0002-9149 .- 1879-1913. ; 53:13, s. 9-14
-
Tidskriftsartikel (refereegranskat)abstract
- During the 3-month blind treatment period there were 40 deaths in the metoprolol group compared with 62 deaths in the placebo group (p = 0.024). During the first year (after 3 months the 2 groups were treated similarly) there were 64 deaths in the metoprolol group vs 93 in the placebo group (p = 0.017) and during 2 years 92 patients died in the metoprolol group vs 120 in the placebo group (p = 0.043). The relative incidence of different causes of death did not differ significantly between the 2 treatment groups, indicating that metoprolol reduced all causes of death to the same extent as its effect on overall mortality.
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| 47. |
- Herlitz, Johan, et al.
(författare)
-
Göteborg Metoprolol Trial : tolerance
- 1984
-
Ingår i: American Journal of Cardiology. - : Excerpta Medica, Inc.. - 0002-9149 .- 1879-1913. ; 53:13, s. 46D-50D
-
Tidskriftsartikel (refereegranskat)abstract
- During a 3-month follow-up, 131 patients (19.1%) withdrew from blind treatment in both metoprolol- and placebo-treated groups. More metoprolol-treated than placebo-treated patients withdrew because of cardiovascular adverse experience mainly during the very early phase. In all, 45 (6.5%) metoprolol-treated vs 14 (2.0%) placebo-treated patients were not given either a full intravenous dose or a full oral dose 15 minutes later. Bradycardia and hypotension were more common in the metoprolol group, whereas severe atrioventricular block did occur in a similar number of patients in both groups and severe congestive heart failure was more common in the placebo group. Results indicate that tolerance is generally good after intravenous and oral treatment with metoprolol in patients with suspected acute myocardial infarction.
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| 48. |
- Herlitz, Johan, et al.
(författare)
-
Göteborg Metoprolol Trial : enzyme-estimated infarct size
- 1984
-
Ingår i: American Journal of Cardiology. - : Elsevier. - 0002-9149 .- 1879-1913. ; 53:13, s. 15-21
-
Tidskriftsartikel (refereegranskat)abstract
- In 1,375 patients serum activity of heat-stable lactate dehydrogenase (LD; E.C.1.1.1.27.) was analyzed every twelfth hour for 48 to 108 hours. The mean maximum LD activity was 11.1 +/- 0.4 mu kat X 1(-1) in the metoprolol group vs 12.4 +/- 0.5 mu kat X 1(-1) in the placebo group (p = 0.054). In patients in whom treatment was started 12 hours or less after the onset of pain, a 17% reduction in LD activity was observed (p = 0.009) and similar results were found in patients randomized 8 hours or less. Groups in which the effect after metoprolol treatment was more pronounced were those with an initially higher heart rate and also those with anterior myocardial infarction.
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| 49. |
- Herlitz, Johan, et al.
(författare)
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Göteborg Metoprolol Trial : design, patient characteristics and conduct
- 1984
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Ingår i: American Journal of Cardiology. - : Excerpta Medica, Inc.. - 0002-9149 .- 1879-1913. ; 53:13, s. 3D-8D
-
Tidskriftsartikel (refereegranskat)abstract
- The Göteborg Metoprolol Trial was a double-blind, placebo-controlled, stratified trial aimed at evaluating the effect of the beta 1-selective blocker, metoprolol, in suspected acute myocardial infarction and during 2 years of follow-up. The primary end-point was 3-month mortality (blind treatment period). Secondary end-points were 2-year mortality, indirect signs of infarct size, chest pain, arrhythmias and tolerability. The entry criteria were fulfilled in 2,802 patients, 1,395 of whom were included in the trial. Treatment started as soon as possible after arrival in hospital with intravenous administration followed by oral treatment for 3 months. All patients were randomized 48 hours or less after estimated onset of infarction and 69% were randomized at 12 hours or less. The blind treatment had to be withdrawn in 19% of all randomized patients before the end of the 3-month follow-up.
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| 50. |
- Herlitz, Johan, et al.
(författare)
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Hemodynamic and clinical findings after combined therapy with metoprolol and nifedipine in acute myocardial infarction
- 1984
-
Ingår i: Clinical Cardiology. - : John Wiley & Sons, Inc.. - 0160-9289 .- 1932-8737. ; 7:8, s. 425-432
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Tidskriftsartikel (refereegranskat)abstract
- In a double-blind trial, 30 patients with suspected acute myocardial infarction with onset of symptoms within the previous 24 h were randomized to treatment with 10 mg nifedipine/placebo orally 4 times a day during hospitalization. All patients were given 15 mg metoprolol intravenously 20 min after the initial administration of nifedipine/placebo, and thereafter, 50 mg 4 times a day. The combined therapy resulted only in moderate changes in systolic blood pressure and heart rate compared with metoprolol alone. Three of the 15 patients in the nifedipine group versus 2 of the 15 in the placebo group were withdrawn because of hypotension and/or bradycardia. None was withdrawn because of congestive heart failure or A-V block. It is concluded that the combination of nifedipine and metoprolol seems to be a relatively well-tolerated combination in acute myocardial infarction.
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