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- Armstrong, Paul W., et al.
(author)
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Quantitative ST-depression in Acute Coronary Syndromes : the PLATO Electrocardiographic Substudy
- 2013
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In: American Journal of Medicine. - : Elsevier BV. - 0002-9343 .- 1555-7162. ; 126:8, s. 723-
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Journal article (peer-reviewed)abstract
- BACKGROUND: We evaluated whether electrocardiogram (ECG) characteristics were aligned with clinical outcomes and the effect of ticagrelor within the diverse spectrum of non-ST-elevation acute coronary syndrome patients enrolled in the PLATelet inhibition and patient Outcomes (PLATO) trial. METHODS: There were 8884 PLATO patients who had baseline ECGs assessed by a core laboratory; of these, 4935 had an ECG at hospital discharge that also was assessed. Associations with study treatment on vascular death or myocardial infarction within 1 year were examined. RESULTS: At baseline, most patients had either no or <= 0.5 mm of ST-segment depression (57%); 26% had 1.0 mm, and 17% had more extensive depression (>1.0 mm). Across the baseline ST-segment depression strata, there was a consistent treatment benefit with ticagrelor versus clopidogrel on vascular death/myocardial infarction. The extent of residual ST-segment depression at discharge was similar in the treatment groups, and the treatment effect did not differ by the extent of discharge ST-segment depression. There was a progressive increase in vascular death/myocardial infarction with increasing extent of baseline ST-segment depression (1.0 mm [vs no/0.5 mm]: hazard ratio [HR] 1.22; 95% confidence interval [CI], 1.03-1.45; > 1.0 mm: HR 1.49; 95% CI, 1.24-1.78; P < .001) and at discharge (HR 1.28; 95% CI, 1.02-1.61; HR 2.13; 95% CI, 1.54-2.95; P <. 001). CONCLUSION: The treatment effect of ticagrelor among non-ST-segment-elevation acute coronary syndrome patients was consistently expressed across all baseline ST-segment depression strata. There was no indication of an anti-ischemic benefit of ticagrelor as reflected on the discharge ECG. Our data affirm the independent prognostic relationship of both baseline and hospital discharge ST-segment depression on outcomes within 1 year in non-ST-segment-elevation acute coronary syndrome patients.
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| 3. |
- Lingman, Markus, 1975, et al.
(author)
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The Impact of Hypertension and Diabetes on Outcome in Patients Undergoing Percutaneous Coronary Intervention
- 2011
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In: American Journal of Medicine. - : Elsevier BV. - 0002-9343 .- 1555-7162. ; 124:3, s. 265-275
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Journal article (peer-reviewed)abstract
- OBJECTIVE: Information relating the outcome of percutaneous coronary intervention to diabetes mellitus or hypertension is limited. The study objective was to describe the outcome in patients undergoing percutaneous coronary intervention in relation to diabetes and hypertension. METHODS: Data were extracted from 5 national registers: the Swedish Coronary Angiography and Angioplasty Register (all percutaneous coronary interventions), the Prescribed Drug Registry (all prescribed pharmaceuticals purchased in Swedish pharmacies), the Swedish Hospital Discharge Register (data on myocardial infarction, revascularization, stroke, and congestive heart failure from in-hospital and specialist health care), and the National Population Register and Cause of Death Register (data on death). We included all "first percutaneous coronary interventions" between January 1, 2006, and December 31, 2008 (n = 44,268; followed an average of 1.9 [+/- 0.9] years). RESULTS: Mortality was 6.4% and highest in patients with diabetes plus hypertension. Hypertension per se did not increase mortality or the risk for repeat intervention, but carried a 10% increased risk for subsequent myocardial infarction, increasing to a 4-fold increase when combined with diabetes. Stroke occurred in 2%; the importance of hypertension was evident in nondiabetic patients, but even stronger in diabetic patients. Congestive heart failure caused hospital admission in 8%, with a negative influence from hypertension with and without diabetes. CONCLUSION: After percutaneous coronary intervention and with modern pharmacotherapy, diabetes had a negative effect on the outcome, especially when combined with hypertension. Hypertension per se was not associated with increased mortality but with an increased risk for myocardial infarction, stroke, and congestive heart failure, probably related to widespread coronary artery disease. Improved diabetes care might improve the prognosis.
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| 4. |
- Lopes, Renato D., et al.
(author)
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Warfarin Use and Outcomes in Patients with Atrial Fibrillation Complicating Acute Coronary Syndromes
- 2010
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In: American Journal of Medicine. - : Elsevier BV. - 0002-9343 .- 1555-7162. ; 123:2, s. 134-140
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Journal article (peer-reviewed)abstract
- BACKGROUND: We examined warfarin use at discharge (according to Congestive heart failure, Hypertension, Age > 75 years, Diabetes, Prior Stroke/transient ischemic attack score and bleeding risk) and its association with 6-month death or myocardial infarction in patients with post-acute coronary syndrome atrial fibrillation. METHODS: Of the 23,208 patients enrolled in the Platelet IIb/IIIa in Unstable Angina: Receptor Suppression Using Integrilin Therapy, Platelet IIb/IIIa Antagonist for the Reduction of Acute Coronary Syndrome Events in a Global Organization Network A, and Superior Yield of the New Strategy of Enoxaparin, Revascularization and Glycoprotein IIb/IIIa Inhibitors trials, 4.0% (917 patients) had atrial fibrillation as an in-hospital complication and were discharged alive. Cox proportional hazards models were performed to assess 6-month outcomes after discharge. RESULTS: Overall, 13.5% of patients with an acute coronary syndrome complicated by atrial fibrillation received warfarin at discharge. Warfarin use among patients with atrial fibrillation had no relation with estimated stroke risk; similar rates were observed across Congestive heart failure, Hypertension, Age > 75 years, Diabetes, Prior Stroke/transient ischemic attack (CHADS(2)) scores (0, 13%; 1, 14%: >= 2, 13%) and across different bleeding risk categories (low risk, 11.9%: intermediate risk, 13.3%; high risk, 11.1%). Among patients with in-hospital atrial fibrillation, warfarin use at discharge was independently associated with a lower risk of death or myocardial infarction within 6 months of discharge (hazard ratio 0.39; 95% confidence interval, 0.15-0.98). CONCLUSION: Warfarin is associated with better 6-month outcomes among patients with atrial fibrillation complicating an acute coronary syndrome, but its use is not related to CHADS(2) score or bleeding risk.
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| 5. |
- Rautiainen, Susanne, et al.
(author)
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Total Antioxidant Capacity from Diet and Risk of Myocardial Infarction : A Prospective Cohort of Women
- 2012
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In: American Journal of Medicine. - : ELSEVIER SCIENCE INC. - 0002-9343 .- 1555-7162. ; 125:10, s. 974-980
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Journal article (peer-reviewed)abstract
- BACKGROUND: There are no previous studies investigating the effect of all dietary antioxidants in relation to myocardial infarction. The total antioxidant capacity of diet takes into account all antioxidants and synergistic effects between them. The aim of this study was to examine how total antioxidant capacity of diet and antioxidant-containing foods were associated with incident myocardial infarction among middle-aged and elderly women. METHODS: In the population-based prospective Swedish Mammography Cohort of 49-83-year-old women, 32,561 were cardiovascular disease-free at baseline. Women completed a food-frequency questionnaire, and dietary total antioxidant capacity was calculated using oxygen radical absorbance capacity values. Information on myocardial infarction was identified from the Swedish Hospital Discharge and the Cause of Death registries. Hazard ratios (HR) and 95% confidence intervals (CI) were calculated using Cox proportional hazard models. RESULTS: During the follow-up (September 1997-December 2007), we identified 1114 incident cases of myocardial infarction (321,434 person-years). In multivariable-adjusted analysis, the HR for women comparing the highest quintile of dietary total antioxidant capacity to the lowest was 0.80 (95% CI, 0.67-0.97; P for trend = 0.02). Servings of fruit and vegetables and whole grains were nonsignificantly inversely associated with myocardial infarction. CONCLUSIONS: These data suggest that dietary total antioxidant capacity, based on fruits, vegetables, coffee, and whole grains, is of importance in the prevention of myocardial infarction. (c) 2012 Elsevier Inc. All rights reserved. circle The American Journal of Medicine (2012) 125, 974-980
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| 6. |
- Rautiainen, Susanne, et al.
(author)
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Total Antioxidant Capacity of Diet and Risk of Heart Failure : A Population-based Prospective Cohort of Women
- 2013
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In: American Journal of Medicine. - : ELSEVIER SCIENCE INC. - 0002-9343 .- 1555-7162. ; 126:6, s. 494-500
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Journal article (peer-reviewed)abstract
- BACKGROUND: Few studies have investigated the association between individual antioxidants and risk of heart failure. No previous study has investigated the role of all antioxidants present in diet in relation to heart failure. The aim of this study was to assess the association between total antioxidant capacity of diet, which reflects all of the antioxidant compounds in food and the interactions between them, and the incidence of heart failure among middle-aged and elderly women. METHODS: In September 1997, 33,713 women (aged 49-83 years) from the Swedish Mammography Cohort completed a food-frequency questionnaire. Estimates of dietary total antioxidant capacity were based on the Oxygen Radical Absorbance Capacity assay measurements of foods. Women were followed for incident heart failure (hospitalization or mortality of heart failure as the primary cause) through December 2009 using administrative health registries. Cox proportional hazard models were used to calculate relative risks and 95% confidence intervals. RESULTS: During 11.3 years of follow-up (394,059 person-years), we identified 894 incident cases of heart failure. Total antioxidant capacity of diet was inversely associated with heart failure (the multivariable-adjusted relative risk in the highest quintile compared with the lowest was 0.58 [ 95% confidence interval, 0.47-0.72; P for trend <.001]). The crude incidence rate was 18/10,000 person-years in the highest quintile versus 34/10,000 person-years in the lowest quintile. CONCLUSIONS: The total antioxidant capacity of diet, an estimate reflecting all antioxidants in diet, was associated with lower risk of heart failure. These results indicate that a healthful diet high in antioxidants may help prevent heart failure. (C) 2013 Elsevier Inc. All rights reserved.
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