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- Alfredsson, Joakim, et al.
(författare)
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Similar outcome with an invasive strategy in men and women with Non ST-Elevation Acute Coronary Syndromes
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Background: Gender differences in benefit from an early invasive strategy in patients with Non ST-elevation Acute Coronary Syndromes (NSTE ACS) have been debated and results are conflicting. Some studies have even indicated harm for women associated with a routine invasive strategy. Method: We included 46 455 patients ( 14 819 women (32%) and 31 636 men (68%)) from The Register of Information and Knowledge about Swedish Heart Intensive care Admissions (RIKS-HIA), with a diagnosis of either unstable angina pectoris or non-ST-elevation myocardial infarction. All patients were admitted to intensive coronary care units in Sweden, between 2000 and 2006, and followed for 1 year. Adjustment for baseline differences between the genders was made. Results: In the non-invasive strategy arm relative risk (RR) of death was (women vs. men) 1.02 (95% CI, 0.94-1.11) and in the invasive strategy arm 1.12 (95% CI, 0.96-1.29). After adjustment for baseline differences between the genders with propensity score and discharge medication there was a trend towards lower mortality among women, RR 0.90 (95% CI, 0.82-0.99) in the early non-invasive group but still no difference in the early invasive cohort RR 0.90 (95% CI, 0.76-1.06). Results were similar with the combined end-point death/MI. The risk reduction with an invasive strategy was similar in women (RR 0.46 (95% CI 0.38-0.55)) and men (RR 0.45 (95% CI 0.40-0.52). Conclusion: In this large cohort of patients with NSTE ACS, reflecting real life management, women and men had similar outcome and similar benefit with an early invasive strategy.
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| 2. |
- Ekerstad, Niklas, 1969-, et al.
(författare)
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Frailty as a Predictor of Short-Term Outcomes for Elderly Patients with non-ST-Elevation Myocardial Infarction (NSTEMI)
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Background – For the large and growing population of elderly patients with cardiovascular disease it is important to identify clinically relevant measures of biological age and their contribution to risk. Frailty is an emerging concept in medicine denoting increased vulnerability and decreased physiologic reserves. We analyzed how the variable frailty predicts short-term outcomes for elderly NSTEMI patients. Methods and Results – Patients, aged 75 years or older, with diagnosed NSTEMI were included at three centers, and clinical data including judgement of frailty were collected prospectively. Frailty was defined according to the Canadian Study of Health and Aging (CSHA) Clinical Frailty Scale (CFS). Of 307 patients, 150 (48.5%) were considered frail. Frail patients were slightly older and presented with a greater burden of comorbidity. By multiple logistic regression, frailty was found to be a strong independent risk factor for inhospital mortality, one-month mortality (OR 3.8, 95% CI 1.3 to 10.8) and the primary composite outcome (OR 2.2, 95% CI 1.3 to 3.7). Particularly frail patients with a high comorbidity burden manifested a markedly increased risk for the primary composite outcome. By multiple linear regression, frailty was identified as a strong independent predictor for prolonged hospital care (frail 13.4 bed days, non-frail 7.5 bed days; P<0.0001). Conclusions - Frailty is a strong independent predictor of in-hospital mortality, one-month mortality, prolonged hospital care and the primary composite outcome. The combined use of frailty and comorbidity may constitute an ultimate risk prediction concept regarding cardiovascular patients with complex needs.
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| 3. |
- Sederholm Lawesson, Sofia, et al.
(författare)
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Prevalence and prognostic impact of renal insufficiency in STEMI from a gender perspective : data from a large prospective cohort
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Background: Data indicate that female gender may be associated with increased risk of RI in MI but also that presence of RI has higher prognostic impact in women. In case of ST-elevation MI [STEMI], women have higher adjusted mortality compared to men but RI has seldom been taken into account. Methods and Results: All STEMI patients registered in the Swedish national quality register SWEDEHEART between 2003 and 2009 were included (37991 patients, 66% men). Based on s-creatinine on admission, glomerular filtration rate [GFR] was estimated according to MDRD and Cockcroft-Gault [CG]. RI was defined as eGFR below 60 mL/min. Women had 1.6-2.2 times higher multivariable adjusted risk of RI and half of all women had RI according to CG. RI was associated with 2-2.5 times higher risk of in-hospital and approximately 1.5 times higher risk of long-term mortality in both genders. Each 10 mL/min decline of eGFR was associated with 22-33% and 9-16% increased risk of in-hospital and. long-term mortality, respectively. There was no significant interaction between gender and eGFR regarding outcome. Both in-hospital and long-term mortality was twice as high in women but after adjusting for eGFR according to CG, there was no longer any gender difference in early outcome and long term outcome was better in women. Conclusions: Among STEMI patients 1) Female sex was independently associated with RI 2) Reduced eGFR regardless of used formula was a strong independent risk factor for mortality without a significant gender difference in prognostic impact. 3) Reduced eGFR (according to CG) appeared to be a main explanatory variable to the higher mortality in women.
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