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- Herlitz, Johan, et al.
(författare)
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Early identification of acute myocardial infarction and prognosis in relation to mode of transport
- 1992
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Ingår i: American Journal of Emergency Medicine. - : W.B. Saunders Co.. - 0735-6757 .- 1532-8171. ; 10:5, s. 406-412
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Tidskriftsartikel (refereegranskat)abstract
- Of 2,840 consecutive patients who were admitted to the emergency department of a Swedish university hospital due to suspected acute myocardial infarction (AMI), only 25% were reached by the mobile coronary care unit (MCCU), and only 4% simultaneously fulfilled traditional criteria for prehospital thrombolysis (ie, had ST-segment elevation on admission electrocardiogram and a delay time of less than 6 hours). In the subset of patients who fulfilled criteria for a confirmed AMI, 31% were reached by an MCCU and 11% fulfilled criteria for prehospital thrombolysis. Among patients with confirmed AMI, the hospital mortality rate was highest in patients transported by standard ambulance (19%) versus 15% in those transported by an MCCU and 8% in those transported by other means. The authors conclude that AMI patients transported by ambulance are high-risk patients for early death. Prehospital thrombolysis might reduce their rate of mortality. However, according to the authors' experience only a minor fraction of patients are available for prehospital thrombolysis.
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| 3. |
- Herlitz, Johan, et al.
(författare)
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Occurrence of angina pectoris prior to acute myocardial infarction and its relation to prognosis
- 1993
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Ingår i: European Heart Journal. - : Oxford University Press. - 0195-668X .- 1522-9645. ; 14:4, s. 484-491
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Tidskriftsartikel (refereegranskat)abstract
- In 917 patients with acute myocardial infarction (AMI) we evaluated the impact of previous angina pectoris on the prognosis. Thirty-four percent of the patients had chronic angina prior to AMI, and 22% had angina pectoris of short duration. Patients with chronic angina pectoris differed from the remaining patients having a more frequent previous history of AMI, diabetes mellitus, hypertension, and congestive heart failure. They less frequently developed a Q-wave AMI, and had smaller infarcts according to maximum serum-enzyme activity as compared with the remaining patients. They had a higher one-year mortality rate (36%) as compared with those having angina pectoris of short duration (22%), and those with no angina pectoris (26%). Their reinfarction rate was also higher (26%) as compared with that in the other two groups (15% and 9% respectively). In a multivariate analysis considering age, sex, clinical history, initial symptoms, initial electrocardiogram and estimated infarct size, previous chronic angina pectoris was not an independent risk factor for death, but was independently associated with the risk of reinfarction (P<0.001) Among patients with a history of angina pectoris the outcome was related to medication prior to onset of AMI and at discharge from hospital. Patients in whom beta-blockers were prescribed at discharge had a one-year mortality of 13% as compared with 30% in the remaining patients
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| 4. |
- Herlitz, Johan, et al.
(författare)
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Risk factors for death and mode of death after acute myocardial infarction in relation to age
- 1992
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Ingår i: Coronary Artery Disease. - : Lippincott Williams & Wilkins. - 0954-6928 .- 1473-5830. ; 3:11, s. 1055-1063
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Tidskriftsartikel (refereegranskat)abstract
- Background: This study aims to describe independent risk indicators for death and mode of death after development of acute myocardial infarction in relation to age. Methods: Nine hundred twenty-one consecutive patients admitted to Sahlgrenska Hospital, Goteborg, Sweden, suffering from acute myocardial infarction were prospectively followed for 1 year. The patients were divided into two age groups, 76 years old and above or below 76 years old, because there was an equal number of deaths in these two groups. Results: In the older group, the following were independent risk indicators for death at 1 year of follow-up, in order of significance: 1) previous infarction (P< 0.01); 2) ST-segment elevation on admission (P< 0.01); 3) arrhythmia at onset of infarction (P< 0.05); and 4) age (P< 0.05). In patients 76 years old or less the following were risk indicators: 1) age (P < 0.001); 2) history of congestive heart failure (P< 0.01); 3) loss of consciousness at onset of infarction (P< 0.01); 4) acute congestive heart failure at onset of infarction (P< 0.05); 5) unspecific symptoms at onset of infarction (P< 0.05); and 6) history of hypertension (P< 0.05). In both age groups risk indicators for death during hospitalization differed from risk indicators for death after discharge from the hospital. During hospitalization, the elderly more frequently died in association with congestive heart failure and less frequently in association with ventricular fibrillation as compared with younger patients. Conclusions: In the elderly (>76 y) with acute myocardial infarction, risk indicators for death differ from those in younger patients. Symptoms associated with death are also not the same in patients 76 years old as compared with younger patients.
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| 6. |
- Karlsson, BW, et al.
(författare)
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Evaluation of the antianginal effect of nifedipine : influence of formulation dependent pharmacokinetics
- 1991
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Ingår i: European Journal of Clinical Pharmacology. - : Springer. - 0031-6970 .- 1432-1041. ; 40:5, s. 501-506
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Tidskriftsartikel (refereegranskat)abstract
- Nifedipine capsules t.d.s. and an extended release formulation of nifedipine, nifedipine-ER tablets, given once daily in corresponding daily doses, have been compared with placebo in a double-blind, three-way cross-over study in 24 patients with stable angina pectoris. The objective was to study the influence on the antianginal effect of the different pharmacokinetics of several preparations of nifedipine. All patients received concomitant treatment with beta-adrenoceptor blockers. Antianginal efficacy was assessed by a dynamic exercise test at the end of the dosage intervals, i.e. 8 and 24 h after nifedipine capsules and nifedipine-ER, respectively, as well as 6 h after dosing. Six h after dosing the time of onset of chest pain and total exercise time were longer and total work was significantly higher during both nifedipine-ER (plasma concentration 260 nmol/l) and placebo treatment than after nifedipine capsules (plasma concentration 78 nmol/l). Time to 1 mm ST depression was longer during nifedipine-ER than during nifedipine capsule treatment. No significant difference was seen between nifedipine-ER and placebo. At the end of the dosage interval (24 and 8 h after nifedipine-ER and nifedipine capsules, respectively), no significant difference was found between nifedipine-ER (plasma concentration 75 nmol/l) and the other two treatments. However, placebo was superior to nifedipine capsules (plasma concentration 58 nmol/l) both in the time to onset of chest pain and total exercise time. The lack of effect at the end of the dosage interval was probably due to the subtherapeutic plasma nifedipine level.
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| 7. |
- Karlsson, BW, et al.
(författare)
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Prognosis in suspected acute myocardial infarction in relation to delay time between onset of symptoms and arrival in hospital
- 1991
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Ingår i: Cardiology. - : S. Karger AG. - 0008-6312 .- 1421-9751. ; 78:2, s. 131-137
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Tidskriftsartikel (refereegranskat)abstract
- During a 21-month period, the prognosis in all patients admitted to a hospital ward from the emergency room with suspected acute myocardial infarction (AMI) was prospectively recorded and related to the time between onset of symptoms and arrival in hospital. They were classified as early arrivers (less than or equal to 2 h), intermediate arrivers (2-8 h) and late arrivers (greater than 8 h). Among patients developing a confirmed AMI (n = 909) the 1-year mortality rate was 26.0% in early arrivers, 28.1% in intermediate arrivers and 32.6% in late arrivers. The corresponding figures for patients in whom AMI was ruled out (n = 2,035) were 15.2, 15.1 and 17.6%, respectively. In AMI patients, various morbidity aspects during hospitalization and 1 year of follow-up appeared mainly independent of delay time, whereas among those in whom AMI was ruled out congestive heart failure during hospitalization was most common in early arrivers. We conclude that patients with suspected AMI who do not arrive early in hospital have a high 1-year mortality rate regardless of whether they develop AMI or not. Whether their prognosis can be improved by shortening of delay time remains to be clarified.
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| 8. |
- Olsson, G, et al.
(författare)
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Metoprolol-induced reduction in post-infarction mortality : pooled results from five double-blind randomized trials
- 1992
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Ingår i: European Heart Journal. - : Oxford University Press. - 0195-668X .- 1522-9645. ; 13:1, s. 28-32
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Tidskriftsartikel (refereegranskat)abstract
- Several postinfarction trials have evaluated the effect of secondary prophylaxis with different beta-blockers. Although so called meta-analysis of the results from all the trials have shown a beneficial effect of postinfarction beta-blockade, many of the individual studies have shown inconclusive results, mainly due to low statistical power. In order to obtain an evaluation of the merits of postinfarction therapy with metoprolol, data from the five available studies with metoprolol have been pooled into one database. In the total material 5474 patients (4353 men, 1121 women) have been studied during double-blind therapy with metoprolol 100 mg twice daily or matching placebo. The follow-up ranges from 3 months to 3 years. In total 4732 patient years of observation have been obtained. In total there were 223 deaths in the placebo-treated patients as compared to 188 deaths in the metoprolol-treated patients (P = 0.036), which corresponds to mortality rates of 97.0 and 78.3 per 1000 patient years, respectively. The mortality reduction was found both in men and women. As has been reported from individual postinfarction beta-blocker trials, the pooled results showed a marked reduction in sudden deaths (104 in the placebo group, 62 in the metoprolol group, P = 0.002). In a Cox regression model the influence of sex, age and smoking habits on the effect of metoprolol was evaluated. None of these factors influenced the metoprolol effect significantly. It is concluded that metoprolol therapy after acute myocardial infarction reduces the total number of deaths, and especially sudden cardiac deaths. The mortality reduction was independent of gender, age and smoking habits. Available data support a continuous beneficial effect.
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