| 1. |
- Risenfors, M, et al.
(författare)
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Effects on chest pain of early thrombolytic treatment in suspected acute myocardial infarction : results from the TEAHAT Study
- 1991
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Ingår i: Journal of Internal Medicine. - : Wiley-Blackwell Publishing Ltd.. - 0954-6820 .- 1365-2796. ; 734:suppl 1, s. 27-34
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Tidskriftsartikel (refereegranskat)abstract
- In a randomized, double-blind study, in which recombinant tissue plasminogen activator (rt-PA) administered at an early stage was compared with placebo in patients with suspected acute myocardial infarction (AMI), the effects on pain were studied in 312 patients. Inclusion criteria were as follows: (a) chest pain of duration less than 2 h and 45 min; and (b) age less than 75 years. Chest pain was estimated subjectively by the patients, using a 10-point numerical rating scale, at hourly intervals for the first 24 h, and by the requirement for narcotic analgesics. Compared with placebo, rt-PA treatment resulted in a 43% reduction in mean total pain score (P less than 0.0001), a 26% reduction in pain duration (P less than 0.01), and a 33% reduction in morphine requirement (P = 0.01). Fifty-seven per cent of all patients developed a confirmed AMI. In these subjects rt-PA reduced the pain score by 46% (P less than 0.001). Among patients without confirmed AMI, a 37% reduction in pain score was observed (P = 0.05). The effect on pain was most marked in patients with ST-elevation on the initial ECG. We conclude that early treatment with rt-PA in suspected AMI reduces chest pain considerably. The effect is most marked in patients with ST-elevation on the initial ECG.
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| 2. |
- Herlitz, Johan, et al.
(författare)
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Mortality and morbidity during a period of 2 years after coronary artery bypass surgery in patients with and without a history of hypertension
- 1996
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Ingår i: Journal of Hypertension. - : Lippincott Williams & Wilkins, Ltd.. - 0263-6352 .- 1473-5598. ; 14:3, s. 309-314
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To describe mortality and morbidity during a period of 2 years after coronary artery bypass grafting (CABG) in relation to a history of hypertension. PATIENTS: All patients in western Sweden in whom CABG was undertaken between June 1988 and June 1991 and in whom simultaneous valve surgery was not performed were included in the study. DESIGN: A prospective 2-year follow-up study. RESULTS: Patients with a history of hypertension (n = 777) differed from patients without such a history (n = 1348) in that the proportion of women was higher, they were older and more frequently had a history of congestive heart failure, diabetes mellitus, renal dysfunction, cerebro-vascular disease, intermittent claudication and obesity, and the number of smokers and patients with previous CABG was lower. They were also more likely to develop post-operative cerebrovascular complications and signs of myocardia damage. Patients with hypertension tended to have increased mortality during the first 30 days after CABG and the late mortality (between day 30 and 2 years) was significantly higher than in non-hypertensive participants. Whereas the development of myocardial infarction was similar in both groups, the hypertensive study participants more frequently developed stroke during 2 years of follow-up. In a multivariate analysis including age, sex, history of different cardiovascular diseases, smoking, ejection fraction, and the occurrence of three-vessel disease, hypertension did not emerge as an independent predictor of death in the early or late phase or during a total of 2 years of follow-up. CONCLUSION: Among CABG patients, those with a history of hypertension have a different pattern of risk factors. They have a higher mean age, include a higher proportion of women and have a higher prevalence of congestive heart failure, diabetes mellitus, renal dysfunction, cerebro-vascular disease, intermittent claudication, and obesity. They also have an increased frequency of immediate post-operative complications and an increased 2-year mortality, even if a history of hypertension was not an independent predictor of death during 2 years of follow-up.
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| 3. |
- Herlitz, Johan, et al.
(författare)
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Predictors of hospital readmission two years after coronary artery bypass grafting
- 1997
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Ingår i: Heart. - : BMJ Group. - 1355-6037 .- 1468-201X. ; 77:5, s. 437-442
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To determine the clinical factors before, and in association with, coronary artery bypass grafting (CABG) that increase the risk of readmission to hospital in the first two years after surgery. PATIENTS: All patients in western Sweden who had CABG without simultaneous valve surgery between 1 June 1988 and 1 June 1991. METHODS: All patients who were readmitted to hospital were evaluated by postal inquiry and hospital records. RESULTS: A total of 2121 patients were operated on, of whom 2037 were discharged from hospital. Information regarding readmission was missing in four patients, leaving 2033 patients; 44% were readmitted to hospital. The most common reasons for readmission were angina pectoris and congestive heart failure. There were 12 independent significant predictors for readmission: clinical history (a previous history of either congestive heart failure or myocardial infarction, or CABG); acute operation; postoperative complications (time in intensive care unit greater than two days, neurological complications); clinical findings four to seven days after the operation (arrhythmia, systolic murmur equivalent to mitral regurgitation); medication four to seven days after the operation (antidiabetics, diuretics for heart failure, other antiarrhythmics (other than beta blockers, calcium antagonists, and digitalis), and lack of treatment with aspirin). CONCLUSION: 44% of patients were readmitted to hospital two years after CABG. The most common reasons for readmission were angina pectoris and congestive heart failure. Four clinical markers predicted readmission: clinical history; acute operation status; postoperative complications; and clinical findings and medication four to seven days after operation.
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| 4. |
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| 5. |
- Dellborg, M, et al.
(författare)
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ECG changes during myocardial ischemia. Differences between men and women
- 1995
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Ingår i: Journal of Electrocardiology. - : Churchill Livingstone. - 0022-0736 .- 1532-8430. ; 27:suppl., s. 42-45
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Tidskriftsartikel (refereegranskat)abstract
- Women have a higher short-term mortality in acute myocardial infarction (MI) compared with men. This may be partly explained by differences in risk factors such as age and diabetes. However, several reports have focused on the occurrence of a sex bias making women less likely to be subjected to angiography and revascularization as well as aggressive pharmacologic treatment of acute MI. The decision to initiate these procedures is often based on ischemic changes of the electrocardiogram. It was therefore investigated whether differences between men and women in magnitude of electrocardiographic changes during myocardial ischemia could explain some of the differences previously reported. A total of 178 patients with chest pain suggestive of MI (135 men and 43 women) included in a study of thrombolytics were monitored for 24 hours with continuous vectorcardiography. Also, 81 patients with stable angina pectoris undergoing elective angioplasty were monitored during the procedure. In patients admitted with suspicion of MI, the initial summated ST deviation was 178 +/- 146 microV for men as compared with 105 +/- 91 microV for women (P = .002). During angioplasty, men had significantly more pronounced maximum ST deviation during inflation of the balloon (235 +/- 165 vs 156 +/- 89 microV; P = .036). In conclusion, men have more pronounced ST changes than women during myocardial ischemia. When fixed magnitudes of ST deviation are required for initiating therapy such as thrombolytics, this will favor treatment of men. A sex-adjusted limit for administrating thrombolytic drugs may be warranted in the light of the above findings.
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| 6. |
- Herlitz, Johan, et al.
(författare)
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Determinants of time to discharge following coronary artery bypass grafting
- 1997
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Ingår i: European Journal of Cardio-Thoracic Surgery. - : Elsevier BV. - 1010-7940 .- 1873-734X. ; 11:3, s. 533-538
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Tidskriftsartikel (refereegranskat)abstract
- AIM: To describe clinical factors prior to and at the time of coronary artery bypass grafting (CABG) associated with the number of days until hospital discharge. PATIENTS: All patients from western Sweden in whom during the time period June 1 1988-June 1 1991 CABG was performed without simultaneous valve surgery. METHODS: The time between operation and hospital discharge was calculated for every patient and related to various factors prior to and at the operation. RESULTS: Among 2035 patients the time between operation and discharged alive from hospital varied between 2 and 191 days (median 15 days). When simultaneously considering pre-, per- and postoperative factors the following appeared as independent predictors for a longer hospital time: age (years) (P < 0.0001); female sex, (P < 0.0001); time in respirator (P = 0.0004); previous congestive heart failure (P = 0.0007); reoperation (P = 0.0008); neurological complication (P = 0.001); maximum activity of serum aspartate amino transferase (P = 0.002); pneumo/hydrothorax (P = 0.002), previous cerebrovascular disease (P = 0.004), non-smoker (P = 0.006); supraventricular arrhythmia (0.006); time in intensive care unit (P = 0.007); aortic cross-clamp time (P = 0.009); obesity (P = 0.02). CONCLUSION: A large number of pre- and postoperative factors are associated with an increased time between operation and time to discharge.
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| 7. |
- Herlitz, Johan, et al.
(författare)
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Mortality and morbidity in diabetic and non diabetic patients during a 2-year period after coronary artery bypass grafting
- 1996
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Ingår i: Diabetes Care. - : American Diabetes Association. - 0149-5992 .- 1935-5548. ; 19:7, s. 698-703
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To describe mortality and morbidity during a 2-year period after coronary artery bypass grafting (CABG) among diabetic and nondiabetic patients. RESEARCH DESIGN AND METHODS: All the patients in western Sweden in whom CABG was undertaken between June 1988 and June 1991 and in whom concomitant procedures were not performed were registered prospectively. The study was a prospective follow-up. RESULTS: Diabetic patients (n = 268) differed from nondiabetic patients (n = 1,859) in that more women were included, and the patients more frequently had a previous history of myocardial infarction (MI), hypertension, congestive heart failure, intermittent claudication, and obesity. Diabetic patients more frequently required reoperation and had a higher incidence of peri- and postoperative neurological complications. Mortality during the 30 days after CABG was 6.7% in diabetic patients versus 3.0% in nondiabetic patients (P < 0.01). Mortality between day 30 and 2 years was 7.8 and 3.6%, respectively (P < 0.01). During 2 years of follow-up, a history of diabetes appeared to be a significant independent predictor of death. Whereas the development of MI after discharge from the hospital did not significantly differ between the two groups; 6.3% of diabetic patients developed stroke versus 2.5% in nondiabetic patients (P < 0.001). CONCLUSIONS: Diabetic patients have a mortality rate during the 2-year period after CABG that is about twice that of nondiabetic patients during both the early and late phase after the operation.
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| 8. |
- Karlsson, BW, et al.
(författare)
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Eligibility for intravenous thrombolysis in suspected acute myocardinal infarction
- 1990
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Ingår i: Circulation. - : SRDS. - 0569-6704. ; 82:4, s. 1140-1146
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Tidskriftsartikel (refereegranskat)abstract
- Based on the registration of all the 7,157 patients admitted during a 21-month period to the emergency ward of a single hospital in an urban area with chest pain or other symptoms suggestive of acute myocardial infarction, we studied eligibility for intravenous thrombolysis in suspected acute myocardial infarction. We have limited the present analysis to those 1,715 patients with a strong suspicion of myocardial infarction, and for these patients, we have calculated the percentages eligible for thrombolysis when various electrocardiographic and delay time criteria are applied, but we have not considered contraindications to thrombolysis. We have also calculated the proportions of all infarctions in this group that would thereby receive the treatment, and the proportions of patients treated that would develop a confirmed infarction. Using the criteria ST elevation on the initial electrocardiogram and arrival in hospital within 6 hours from onset of symptoms, 18% of patients would have been given early intravenous thrombolysis, 37% of confirmed infarctions would have been treated, and 91% of all treated patients would have developed a confirmed infarction; with a delay time criterion of 12 hours, these percentages would have been 209%, 41%, and 91%, respectively; with a criterion of 24 hours, they would have been 22%, 45%, and 90%, respectively. By not considering the initial electrocardiogram and applying only the criterion of delay time, these percentages would have been 70%, 72%, and 45%, respectively, for a delay time of 6 hours; 83%, 84%, and 45%, respectively, for a delay time of 12 hours; and 91%, 92%, and 44%, respectively, for a delay time of 24 hours. We have also calculated these percentages for two further electrocardiographic criteria, namely, electrocardiogram showing acute ischemia and any form of pathology. We conclude that the percentage of patients with a strong suspicion of myocardial infarction eligible for intravenous thrombolysis varies considerably depending on the electrocardiographic and delay time criteria used. If the delay time is limited to 6 hours and the electrocardiogram is required to show ST elevation, then 37% of patients developing myocardial infarction would receive thrombolytic treatment.
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