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- Herlitz, Johan, 1949, et al.
(författare)
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Epidemiology of acute myocardial infarction with the emphasis on patients who did not reach the coronary care unit and non-AMI admissions
- 2008
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Ingår i: International Journal of Cardiology. - : Elsevier Ireland Ltd. - 1874-1754 .- 0167-5273. ; 128:3, s. 342-349
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To describe the characteristics and outcome of patients with acute myocardial infarction (AMI) in a community, with particular emphasis on those who never reached a Coronary Care Unit (CCU) and those in whom the primary diagnosis was something other than a heart attack. METHODS: Patients hospitalised in the city of Goteborg, Sweden, and discharged (dead or alive) with a diagnosis of AMI. RESULTS: Among 1423 patient admissions the mean overall age was 75 years (81 years and 79 years in the two subsets). Among all patients, 33% had a history of heart failure and 20% had a history of cerebrovascular disease. The figures were even higher in the two subsets which were evaluated. In overall terms, an invasive strategy (coronary angiography) was used in 32% (in 5% and 9% in the two subsets respectively). The overall one-year and three-year mortality rate was 30% and 44% respectively. The three-year mortality rate among patients not admitted to a CCU was 65% and, among patients with no suspicion of a heart attack on admission, it was 68%. CONCLUSION: Even in the 21st century, patients with AMI who reach hospital alive run a high risk of death and nearly half are dead within the first three years. In overall terms, patients are characterised by high age and high co-morbidity. Among patients who do not reach a CCU and among patients with no suspicion of AMI on admission, approximately two thirds are dead within the subsequent three years.
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| 3. |
- Svensson, Ann-Marie, 1963, et al.
(författare)
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The influence of a history of diabetes on treatment and outcome in acute myocardial infarction, during two time periods and in two different countries
- 2007
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Ingår i: Int J Cardiol. - : Elsevier Ireland Ltd. - 1874-1754 .- 0167-5273. ; 119:3, s. 319-25
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Tidskriftsartikel (refereegranskat)abstract
- AIMS: The aim of this study was to investigate the influence of diabetes on treatment and outcome in acute myocardial infarction (AMI), during two time periods, in two countries, and to assess whether this influence has changed over the past decades. METHODS: Patients, aged 30 to 74, with a diagnosis of AMI in two urban areas--Goteborg, Sweden and Minneapolis-St. Paul, Minnesota, USA--hospitalized during 1990-1991 and 1995-1996 were included. The primary endpoint was 7-year all-cause mortality. RESULTS: The study included 3824 patients, 734 (19%) had diabetes. Age-adjusted in-hospital mortality of diabetic patients was nearly twofold higher compared with non-diabetic patients (9.8% vs. 5.0%, p<0.05). Between 1990-1991 and 1995-1996 in-hospital mortality declined for both diabetic (11.9% vs. 7.6%, p=0.07) and non-diabetic (6.3% vs. 3.6%, p=0.002) patients. A history of diabetes was associated with nearly twofold higher long-term mortality rate (48.5% vs. 26%, p<0.05). Seven-year mortality was reduced between 1990-1991 and 1995-1996 in both diabetic (51.6% vs. 45.2%, p=0.13) and non-diabetic patients (29.3% vs. 22.1%, p<0.0001) (The results did not reach statistical significance for diabetic patients, due to smaller sample size.) During their hospital stay, diabetic patients received significantly less aspirin, beta-blockers and thrombolysis. After adjustment, a history of diabetes remained significantly associated with 7-year mortality following AMI, doubling the hazard of death (hazard ratio (HR)=2.11; 95% confidence interval (CI): 1.80-2.46). CONCLUSION: A history of diabetes is associated with nearly twofold higher long-term mortality rate and is independently associated with 7-year mortality following AMI. Short- and long-term mortality decreased from 1990 to 1995 in both non-diabetic and diabetic patients. Underutilization of evidence-based treatments contributes to the remaining increased mortality in diabetic patients with acute coronary disease.
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