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Relations between i...
Relations between implementation of new treatments and improved outcomes in patients with non-ST-elevation myocardial infarction during the last 20 years : experiences from SWEDEHEART registry 1995 to 2014
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- Szummer, Karolina (author)
- Karolinska Institutet,Karolinska Institute,Karolinska University Hospital
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- Wallentin, Lars C., 1943- (author)
- Uppsala University,Uppsala universitet,Institutionen för medicinska vetenskaper,Uppsala kliniska forskningscentrum (UCR),UCR,Uppsala Univ, Sweden
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- Lindhagen, Lars (author)
- Uppsala University,Uppsala universitet,Uppsala kliniska forskningscentrum (UCR),Kardiologi,Uppsala Univ, Sweden
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- Alfredsson, Joakim (author)
- Linköping University,Linköpings universitet,Avdelningen för kardiovaskulär medicin,Medicinska fakulteten,Region Östergötland, Kardiologiska kliniken US
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- Erlinge, David (author)
- Lund University,Lunds universitet,Molekylär kardiologi,Forskargrupper vid Lunds universitet,Molecular Cardiology,Lund University Research Groups,Skåne University Hospital
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- Held, Claes, 1956- (author)
- Uppsala University,Uppsala universitet,Uppsala kliniska forskningscentrum (UCR),Kardiologi,Uppsala Univ, Sweden
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- James, Stefan K, 1964- (author)
- Uppsala University,Uppsala universitet,Uppsala kliniska forskningscentrum (UCR),Kardiologi,Uppsala Univ, Sweden
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- Kellerth, Thomas (author)
- Orebro Univ Hosp, Dept Cardiol, S-70185 Orebro, Sweden,Örebro University Hospital
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- Lindahl, Bertil, 1957- (author)
- Uppsala University,Uppsala universitet,Kardiologi,Uppsala kliniska forskningscentrum (UCR),Uppsala Univ, Sweden; Uppsala Univ, Sweden
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- Ravn-Fischer, Annica (author)
- Sahlgrens Univ Hosp, Dept Mol & Clin Med, Inst Med, S-41345 Gothenburg, Sweden,Sahlgrenska University Hospital
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- Rydberg, Erik (author)
- Lund University,Lunds universitet,Kardiologi,Sektion II,Institutionen för kliniska vetenskaper, Lund,Medicinska fakulteten,Cardiology,Section II,Department of Clinical Sciences, Lund,Faculty of Medicine,Skåne University Hospital
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- Yndigegn, Troels (author)
- Lund University,Lunds universitet,Kardiologi,Sektion II,Institutionen för kliniska vetenskaper, Lund,Medicinska fakulteten,Cardiology,Section II,Department of Clinical Sciences, Lund,Faculty of Medicine,Skåne University Hospital
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- Jernberg, Tomas (author)
- Karolinska Institutet,Karolinska Institute,Danderyd Hospital
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(creator_code:org_t)
- 2018-09-19
- 2018
- English.
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In: European Heart Journal. - : OXFORD UNIV PRESS. - 0195-668X .- 1522-9645. ; 39:42, s. 3766-3776
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Abstract
Subject headings
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- Aims We assessed the changes in short- and long-term outcomes and their relation to implementation of new evidence- based treatments in all patients with non-ST-elevation myocardial infarction (NSTEMI) in Sweden over 20 years. Methods and results Cases with NSTEMI (n = 205 693) between 1995 and 2014 were included from the nationwide Swedish Web-System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies (SWEDEHEART) registry. During 20 years in-hospital invasive procedures increased from 1.9% to 73.2%, percutaneous coronary intervention or coronary artery bypass grafting 6.5% to 58.1%, dual antiplatelet medication 0% to 72.7%, statins 13.3% to 85.6%, and angiotensin-converting enzyme inhibitors/angiotensin II receptor blocker 36.8% to 75.5%. The standardized 1-year mortality ratio compared with a control population decreased from 5.53 [95% confidence interval (CI) 5.30-5.75] to 3.03 (95% CI 2.89-3.19). If patients admitted the first 2 years were modelled to receive the same invasive treatments as the last 2 years the expected mortality/ myocardial infarction (MI) rate would be reduced from 33.0% to 25.0%. After adjusting for differences in baseline characteristics, the change of 1-year cardiovascular death/MI corresponded to a linearly decreasing odds ratio trend of 0.930 (95% CI 0.926-0.935) per 2-year period. This trend was substantially attenuated [0.970 (95% CI 0.964-0.975)] after adjusting for changes in coronary interventions, and almost eliminated [0.988 (95% CI 0.982-0.994)] after also adjusting for changes in discharge medications. Conclusion In NSTEMI patients during the last 20 years, there has been a substantial improvement in long-term survival and re- duction in the risk of new cardiovascular events. These improvements seem mainly explained by the gradual uptake and widespread use of in-hospital coronary interventions and evidence-based long-term medications.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Kardiologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Cardiac and Cardiovascular Systems (hsv//eng)
Keyword
- Registry
- Myocardial infarction
- Time-trends
- Outcomes
Publication and Content Type
- ref (subject category)
- art (subject category)
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Szummer, Karolin ...
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Wallentin, Lars ...
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Lindhagen, Lars
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Alfredsson, Joak ...
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Erlinge, David
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Held, Claes, 195 ...
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James, Stefan K, ...
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Kellerth, Thomas
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Lindahl, Bertil, ...
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Ravn-Fischer, An ...
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Rydberg, Erik
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Yndigegn, Troels
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Jernberg, Tomas
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- About the subject
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- MEDICAL AND HEALTH SCIENCES
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MEDICAL AND HEAL ...
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and Clinical Medicin ...
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and Cardiac and Card ...
- Articles in the publication
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European Heart J ...
- By the university
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Uppsala University
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Linköping University
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Lund University
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Karolinska Institutet