| 1. |
- Karlson, BW, et al.
(author)
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Emergency room prediction of mortality and severe complications in patients hospitalized for suspected acute myocardial infarction
- 1995
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In: European Heart Journal. - : Oxford University Press. - 0195-668X .- 1522-9645. ; 15:11, s. 1558-1565
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Journal article (peer-reviewed)abstract
- This study aims at describing the in-hospital prognosis of patients admitted with suspected acute myocardial infarction, focusing on the possibility of emergency room prediction of the risk for death and severe complications. From 7157 consecutive patients with chest pain or other symptoms suggestive of acute myocardial infarction in the emergency room, 4690 were hospitalized. Of these, 246 (5%) died in hospital, with a mortality rate among the 921 patients who developed myocardial infarction of 14%, and among those without infarction of 3%. From the clinical history, examination and electrocardiogram in the emergency room, independent predictors of death and death or any severe complication were determined by logistic regression analysis. These included age, initial degree of suspicion of infarction, electrocardiographic pattern, history of diabetes mellitus, history of congestive heart failure and on admission arrhythmias, loss of consciousness, acute congestive heart failure, or unspecific symptoms. From these analyses the probability of death or death or any severe complication can be calculated. Thus, 18% of patients hospitalized due to suspected acute myocardial infarction suffered a severe complication or died in hospital. From a statistical model it is possible to predict the in-hospital prognosis of every such patient.
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| 2. |
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| 3. |
- Brandrup-Wognsen, G, et al.
(author)
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Female sex is associated with increased mortality and morbidity early, but not late, after coronary artery bypass grafting
- 1996
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In: European Heart Journal. - : Oxford University Press. - 0195-668X .- 1522-9645. ; 17:9, s. 1426-1431
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Journal article (peer-reviewed)abstract
- Objective To describe mortality and morbidity during a period of 2 years after coronary artery bypass grafting in relation to gender. Design Prospective follow-up study. Setting Two regional cardiothoracic centres which performed all the coronary artery bypass operations in western Sweden at the time. Sub|ects A total of 2129 (1727 (81%) men and 402 (19%) women) consecutive patients undergoing coronary artery bypass surgery between June 1988 and June 1991 without concomitant procedures. Results Females were older and more frequently had a history of hypertension, diabetes mellitus, congestive heart failure, renal dysfunction and obesity. In a multivariate analysis, taking account of age, history of cardiovascular diseases and renal dysfunction, female sex appeared as a significant independent predictor of mortality during the 30 days after coronary artery bypass grafting (/><0-05), but not thereafter. Various postoperative complications including neurological deficit, hydro- and pneumo-thorax, perioperative myocardial damage and the need for assist devices and prolonged reperfusion were more common in females than males. Conclusion Females run an increased risk of early death and the development of postoperative complications after coronary artery bypass surgery as compared with males. Late mortality does not appear to be influenced by gender and the long-term benefit of the coronary artery bypass graft operation is similar in men and women.
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| 4. |
- Herlitz, Johan, et al.
(author)
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Death, mode of death, morbidity and requirement for rehospitalization during 2 years after coronary artery bypass grafting in relation to preoperative ejection fraction
- 1996
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In: Coronary Artery Disease. - : Lippincott Williams & Wilkins. - 0954-6928 .- 1473-5830. ; 7:11, s. 807-812
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Journal article (peer-reviewed)abstract
- OBJECTIVE: To describe the impact of ejection fraction on the prognosis during 2 years after coronary artery bypass grafting (CABG). PATIENTS: All patients in western Sweden who underwent CABG without concomitant valve surgery between June 1988 and June 1991. RESULTS: In all, 2121 patients were operated upon and information on ejection fraction was available for 1961 patients (92%). Of these patients, 178 (9%) had an ejection fraction < 40%, 517 (26%) an ejection fraction of 40-59% and 1266 (65%) an ejection fraction > or = 60%. In these groups the mortalities during the first 30 days after CABG were 5.1, 4.3 and 2.2%, respectively (P < 0.01). The corresponding values for mortalities between 30 days and 2 years were 7.7, 4.3 and 3.3%, respectively (P < 0.01). Patients with a lower ejection fraction were more frequently men and more frequently had a history of cardiovascular disease. In multivariate analysis the preoperative ejection fraction was an independent predictor for total 2-year mortality. Patients with a low ejection fraction died more frequently in association with ventricular fibrillation. Morbidity was, with the exception of that for rehospitalization due to heart failure and infection, not associated significantly with the preoperative ejection fraction. CONCLUSION: During the 2 years after CABG a low preoperative ejection fraction was associated with a higher mortality, but the association with morbidity was more complex.
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| 5. |
- Herlitz, Johan, et al.
(author)
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Effect of metoprolol on the prognosis among patients with suspected acute myocardial infarction and indirect signs of congestive heart failure. (A subgroup analysis of the Göteborg Metoprolol Trial)
- 1997
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In: American Journal of Cardiology. - : Excerpta Medica, Inc.. - 0002-9149 .- 1879-1913. ; 80:9B, s. 40J-44J
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Journal article (peer-reviewed)abstract
- The aim of this study is to describe the impact of early treatment with metoprolol on prognosis during 1 year of follow-up in patients with suspected acute myocardial infarction (AMI) and indirect signs of congestive heart failure (CHF). Patients aged 40-74 years who presented within 48 hours of onset of symptoms raising suspicion of AMI were assessed for inclusion. All patients participated in the Göteborg Metoprolol Trial and had indirect indices of CHF according to various clinical criteria. As soon as possible after hospital admission, patients received either placebo or metoprolol (15 mg) divided into 3 intravenous injections, then oral treatment, 200 mg daily for 3 months. Thereafter, most patients in both treatment groups received metoprolol in an open manner. Among the 1,395 randomized patients, 262 (19%) had signs of mild-to-moderate CHF before randomization. Of these, 131 were randomized to metoprolol and 131 to placebo. During the first 3 months, mortality was 10% among patients randomized to metoprolol versus 19% among patients randomized to placebo (p = 0.036). The corresponding figures for the first year were 14% and 27%, respectively (p = 0.0099). Patients randomized to placebo who showed signs of CHF had a 1-year mortality rate of 28% compared with 10% among patients without such signs (p <0.001). The results suggest that early treatment with metoprolol markedly reduces mortality in patients having suspected AMI and signs of CHF.
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| 6. |
- Herlitz, Johan, et al.
(author)
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In consecutive patients hospitalized with acute myocardial infarction, infarct location according to routine electrocardiogram is of minor importance for the outcome
- 1995
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In: Clinical Cardiology. - : John Wiley & Sons, Inc.. - 0160-9289 .- 1932-8737. ; 18:7, s. 385-391
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Journal article (peer-reviewed)abstract
- Most studies have suggested that patients with anterior myocardial infarction have an adverse prognosis compared with patients with inferior infarction. The objective of this study was to compare the mortality and morbidity in anterior versus inferior acute myocardial infarction (AMI) during 1 year in a consecutive series of patients hospitalized with AMI. All patients fulfilling the criteria for AMI who were admitted to a single hospital during 21 months (n = 921) participated in the study. Patients with anterior infarction (n = 312) had a 1-year mortality rate of 26% versus a rate of 24% for patients with inferior infarction (n = 269) (p > 0.2). The corresponding figures for patients with no previous infarction who developed Q waves were 27 and 21%, respectively (p > 0.2). Reinfarction, thromboembolic events, and other aspects of morbidity during long-term follow-up appeared with similar frequency in the two groups. Thus, in a nonselected group of patients admitted to a single hospital because of AMI, the prognosis was found to be similar among patients with inferior and those with anterior infarction. In the subset of patients with a first myocardial infarction who developed Q waves, there was a trend indicating higher mortality in anterior infarction.
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| 7. |
- Herlitz, Johan, et al.
(author)
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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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In: Journal of Hypertension. - : Lippincott Williams & Wilkins, Ltd.. - 0263-6352 .- 1473-5598. ; 14:3, s. 309-314
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Journal article (peer-reviewed)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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| 8. |
- Herlitz, Johan, et al.
(author)
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Predictors of hospital readmission two years after coronary artery bypass grafting
- 1997
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In: Heart. - : BMJ Group. - 1355-6037 .- 1468-201X. ; 77:5, s. 437-442
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Journal article (peer-reviewed)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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| 9. |
- Herlitz, Johan, et al.
(author)
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Prognosis in patients with acute chest pain in relation to chronic beta-blocker treatment prior to admission to hospital
- 1995
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In: Cardiology. - : S. Karger AG. - 0008-6312 .- 1421-9751. ; 86:1, s. 56-59
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Journal article (peer-reviewed)abstract
- We evaluated the prognosis among consecutive patients hospitalized for acute chest pain or other symptoms suggestive of acute myocardial infarction (AMI) in relation to whether they were on chronic treatment with beta-blockers at onset of symptoms or not. In all, 3,504 patients were included in the analyses, of whom 936 (27%) were on chronic beta-blockade. Of the patients on beta-blockade, 25% developed AMI as compared with 21% of the remaining patients (p > 0.2). The mortality during the first 28 days was 7% in patients on chronic beta-blockade as compared with 5% in those not on beta-blockade (p > 0.2). When correcting for differences at baseline, chronic treatment with beta-blockers did not significantly influence the outcome.
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| 10. |
- Herlitz, Johan, et al.
(author)
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Risk indicators for cerebrovascular complications after coronary artery bypass grafting
- 1997
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In: The thoracic and cardiovascular surgeon. - : Georg Thieme Verlag. - 0171-6425 .- 1439-1902. ; 46:1, s. 20-24
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Journal article (peer-reviewed)abstract
- All patients from western Sweden were retrospectively studied in whom CABG was performed between June 1, 1988 and June 1, 1991 without simultaneous valve surgery. The aim was to detect clinical factors prior to and at the time of coronary artery bypass grafting (CABG) which were associated with the risk of neurological complications during the postoperative hospital stay. A neurological complication during the hospital stay was registered if a neurological consultation was made and if this consultation diagnosed a neurological deficit. In all, there were 2121 patients in the study, of whom 81 (3.8%) had a neurological complication. 23 of the latter (28%) died before discharge. Among preoperative factors the following appeared as significant independent predictors of a neurological complication: a history of cerebrovascular disease (p < 0.001), diabetes mellitus (p < 0.01), hypertension (p < 0.05), degree of urgency of the operation (p < 0.01), and age (p < 0.01). Among pre- and post-operative events the following predicted a neurological complication: intensive care unit treatment for more than two days (p < 0.001) and respirator required for more than 24 hours (p < 0.001).
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