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- 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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| 4. |
- 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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| 5. |
- 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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| 6. |
- 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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| 7. |
- 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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| 8. |
- 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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| 9. |
- 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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| 10. |
- 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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