| 1. |
- Emanuelsson, H, et al.
(author)
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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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In: European Heart Journal. - : Oxford University Press. - 0195-668X .- 1522-9645. ; 15:6, s. 761-768
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Journal article (peer-reviewed)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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| 2. |
- Fransson, Sven-Göran, 1949-, et al.
(author)
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Vascular injury following cardiac catheterization, coronary angiography, and coronary angioplasty
- 1994
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In: European Heart Journal. - : Oxford University Press. - 0195-668X .- 1522-9645. ; 15:2, s. 232-235
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Journal article (peer-reviewed)abstract
- All vascular injuries occurring at this hospital department over a 5-year period (1987-91) as a result of cardiac catheterization, coronary angiography, or coronary angioplasty (PTCA) and requiring transfusion, surgical consultation, or repair, are reviewed. Such complications may occur late and, to detect cases not apparent from the protocol accompanying every examination, a questionnaire was sent to all surgical clinics in the region asking for details of vascular surgical intervention after angiography. The present review of 4879 examinations disclosed 18 patients with 19 vascular injuries (0.39%); four of them were detected by the questionnaire. The types of injury were: pseudoaneurysm (12), thrombembolic episode (4), and excessive bleeding (3). Of the patients with a vascular complication 11 (61%) were receiving anticoagulation treatment, compared to 10% in the whole series; two others suffered from a coagulopathic state. Catheterization was difficult or severe atherosclerosis was present in three, inadvertent mobilization occurred in one, and unintentional puncture distal to the common femoral artery occurred in two patients. With the increasing use of invasive diagnostic and interventional procedures in cardiovascular diseases, knowledge of the type and frequency of possible complications is important, especially of those that may occur late. In the present study anticoagulation, coagulation disorders, and cardiac catheterization combined with brachial puncture and angiography all predisposed to a vascular complication.
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| 3. |
- Herlitz, Johan, et al.
(author)
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Follow-up of a 1-year media campaign on delay times and ambulance use in suspected acute myocardial infarction
- 1992
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In: European Heart Journal. - : Oxford University Press. - 0195-668X .- 1522-9645. ; 13:2, s. 171-177
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Journal article (peer-reviewed)abstract
- In order to reduce the delay times from onset of symptoms to arrival in hospital, and increase the use of ambulance in patients with suspected acute myocardial infarction (AMI), a media campaign was initiated in an urban area. An initial 3-week intense campaign was followed by a maintenance phase of 1 year. Delay times and ambulance use during the campaign were compared with the previous 21 months. Among patients admitted to a coronary care unit (CCU) due to suspected AMI, the median delay time was reduced from 3 h to 2 h 40 min and the mean delay time was reduced from 11 h 33 min to 7 h 42 min (P <0.001). Among patients with confirmed AMI the median delay time was reduced from 3 h to 2 h 20 min and the mean delay time from 10 h to 6 h 27 min (P <0.001). We conclude that a 1-year media campaign can reduce delay times in suspected AMI, and that this effect appears to continue at 1 year, but ambulance use seems to be more djfficult to influence.
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| 4. |
- Herlitz, Johan, et al.
(author)
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Occurrence of angina pectoris prior to acute myocardial infarction and its relation to prognosis
- 1993
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In: European Heart Journal. - : Oxford University Press. - 0195-668X .- 1522-9645. ; 14:4, s. 484-491
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Journal article (peer-reviewed)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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| 5. |
- Herlitz, Johan, 1949, et al.
(author)
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Survival in patients found to have ventricular fibrillation after cardiac arrest witnessed outside hospital.
- 1994
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In: European heart journal. - : Oxford University Press. - 0195-668X .- 1522-9645. ; 15:12, s. 1628-33
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Journal article (peer-reviewed)abstract
- Since 1980 an Emergency Medical Service (EMS) system with a two-tier ambulance service has been operating in Göteborg. During this 12-year period, all cardiac arrests outside hospital have been monitored. Cardiopulmonary resuscitation (CPR) training for the general public began in 1985 and, by the end of 1992, 125 000 persons had been trained. The aim of this study was to define the factors associated with an increased chance of survival after cardiac arrest witnessed out-of-hospital and secondary to ventricular fibrillation. The study group comprises all patients with cardiac arrest witnessed outside hospital in Göteborg between 1980 and 1992, in whom CPR was initiated by our EMS and ventricular fibrillation observed at the first ECG recording. In a multivariate analysis of age, sex, time of collapse, interval between collapse and first defibrillation, bystander-initiated CPR, the following factors were associated with an increased chance of being discharged from hospital: (1) Short interval between collapse and first defibrillation (P < 0.001); (2) Bystander-initiated CPR (P < 0.001); and (3) Age (P < 0.05). Among patients with an out-of-hospital cardiac arrest who were found by the EMS personnel to have ventricular fibrillation, the predictors of survival were: interval between collapse and defibrillation, bystander-initiated CPR and age.
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| 6. |
- Malmberg, C, et al.
(author)
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Effects of metoprolol on mortality and late infarction in diabetics with suspected acute myocardial infarction. Retrospective data from two large studies
- 1990
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In: European Heart Journal. - : Oxford University Press. - 0195-668X .- 1522-9645. ; 10:5, s. 423-428
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Journal article (peer-reviewed)abstract
- From two large scale studies in patients with suspected acute myocardial infarction we report the outcome in diabetics after treatment with either metoprolol or placebo. In the Göteborg Metoprolol Trial mortality at 3 months was reduced by metoprolol from 17.9% to 7.5% and late infarction was reduced from 16.4% to 3.8%. In the MIAMI Trial, mortality was decreased by metoprolol from 11.3% to 5.7% and the occurrence of late infarction was decreased from 4.5% to 3.1% during 15-day follow-up. Compared with the overall results, the effect of metoprolol on mortality appears particularly impressive in diabetics.
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| 7. |
- Nerbrand, Christina, et al.
(author)
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Geographical variation of mortality from cardiovascular diseases. The Project 'Myocardial Infarction in mid-Sweden'
- 1991
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In: European Heart Journal. - 1522-9645. ; 12:1, s. 4-9
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Journal article (peer-reviewed)abstract
- In this study, the geographical variation of the mortality rate in mid-Sweden was studied. Data on mortality from all causes and mortality from cardiovascular diseases, cerebrovascular diseases, ischaemic heart disease (IHD) and non-cardiovascular diseases for men and women 45-74 years of age living in 76 communities in mid-Sweden were obtained from the National Bureau of Statistics. After age standardization, the rates for mortality from all causes and cardiovascular mortality were substantially higher in the Westernmost communities compared with those in the East, whereas for non-cardiovascular mortality there were no systematic differences. The county with the higher rate for IHD had a 60% higher rate for men aged 45-64 years and a 53% higher rate for women aged 45-64 years than the county with the lowest rate. The corresponding excess mortality rates from stroke were 73% for men aged 45-74 and 46% for women aged 45-74 years. The cause of this variation is not known. It is not due to the confounding effect of different age distributions in the communities, differences in the registration of causes of death, or differences in case fatality rate.
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| 8. |
- Olsson, G, et al.
(author)
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Metoprolol-induced reduction in post-infarction mortality : pooled results from five double-blind randomized trials
- 1992
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In: European Heart Journal. - : Oxford University Press. - 0195-668X .- 1522-9645. ; 13:1, s. 28-32
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Journal article (peer-reviewed)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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| 9. |
- Richter, A, et al.
(author)
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Effect of acupuncture in patients with angina pectoris
- 1991
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In: European Heart Journal. - : Oxford University Press. - 0195-668X .- 1522-9645. ; 12:2, s. 175-178
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Journal article (peer-reviewed)abstract
- Twenty-one patients with stable effort angina pectoris were randomized in a crossover study to 4 weeks traditional Chinese acupuncture or placebo tablet treatment. The patients had at least five anginal attacks per week in spite of intensive treatment. Acupuncture was given three times per week at main points Neiguan (Pericardium 6), Tongli (Heart 5), Xinshu (Urinary Bladder 15), Pishu (Urinary Bladder 20) and Zusanli (Stomach 36). Previous antianginal treatment remained unchanged during the whole study. During the acupuncture period, the number of anginal attacks per week was reduced from 10.6 to 6.1 compared with placebo (P less than 0.01). Accordingly, the performance before onset of pain during exercise test increased from 82 W to 94 W (P less than 0.05). However, maximal performance did not increase after acupuncture. Intensity of pain at maximal workload decreased from 1.4 to 0.8 (scale 0-4, P less than 0.01). Further, ST-segment depressions at maximal comparable load decreased from 1.03 to 0.71 mm after acupuncture (P less than 0.01). A life quality questionnaire confirmed improved feeling of well-being. Thus, acupuncture showed an additional beneficial effect in patients with severe, intensively treated angina pectoris.
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| 10. |
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