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Early Risk Stratifi...
Early Risk Stratification, Treatment and Outcome in ST-elevation Myocardial Infarction
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- Björklund, Erik, 1967- (author)
- Uppsala universitet,Institutionen för medicinska vetenskaper
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Lindahl, Bertil (thesis advisor)
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Wallentin, Lars (thesis advisor)
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- Näslund, Ulf, Docent (opponent)
- Institutionen för folkhälsa och klinisk medicin, Umeå
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(creator_code:org_t)
- ISBN 9155463843
- Uppsala : Acta Universitatis Upsaliensis, 2005
- English 70 s.
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Series: Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, 1651-6206 ; 81
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Abstract
Subject headings
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- We evaluated, in patients with ST-elevation myocardial infarction (STEMI) treated with thrombolytics, admission Troponin T (tnT), ST-segment resolution and admission N-terminal pro-brain natriuretic peptide (NT-proBNP) for early risk stratification as well as time delays and outcome in real life patients according to prehospital or in-hospital thrombolytic treatment. Also, baseline characteristics, treatments and outcome in patients enrolled in the ASSENT-2 trial in Sweden and in patients not enrolled were evaluated.TnT (n=881) and NT-proBNP (n=782) on admission and ST-resolution at 60 minutes (n=516) in patients from the ASSENT-2 and ASSENT-PLUS trials were analysed. Elevated levels of NT-proBNP and tnT on admission were both independently related to one-year mortality. However, when adding information on ST-resolution (We investigated consecutive STEMI patients included in the RIKS-HIA registry between 2001 and 2004, if they were ambulance transported and had received prehospital (n=1690) or in-hospital (n=3685) thrombolytic treatment. Prehospital diagnosis and thrombolysis reduced the time to thrombolysis by almost one hour, were associated with better left ventricular function and fewer complications and reduced the adjusted one-year mortality by 30% compared with in-hospital thrombolysis.Prospective data from the RIKS-HIA registry on STEMI patients treated with thrombolytics were linked to data on trial participants in the ASSENT-2 trial of thrombolytic agents and used for direct comparisons. Patients treated with thrombolytics and not enrolled in a clinical trial at trial hospitals (n=2048) had higher risk characteristics, more early complications and twice as high adjusted one-year mortality compared to those enrolled (n=729). One major reason for the difference in outcome appeared to be the selection of less critically ill patients to the trial.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Dermatologi och venereologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Dermatology and Venereal Diseases (hsv//eng)
Keyword
- Medicine
- Acute myocardial infarction
- Thrombolysis
- Troponin
- Electrocardiography
- Natriuretic peptide
- Prognosis
- Prehospital thrombolysis
- Treatment delay
- Mortality
- Registry
- Clinical trial
- Medicin
- Dermatology and venerology,clinical genetics, internal medicine
- Dermatologi och venerologi, klinisk genetik, invärtesmedicin
Publication and Content Type
- vet (subject category)
- dok (subject category)
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