| 1. |
- Berglund, Lars, 1955-, et al.
(författare)
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Repeated measures of body mass index and waist circumference in the assessment of mortality risk in patients with myocardial infarction
- 2019
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Ingår i: Upsala Journal of Medical Sciences. - : TAYLOR & FRANCIS LTD. - 0300-9734 .- 2000-1967. ; 124:1, s. 78-82
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Tidskriftsartikel (refereegranskat)abstract
- Aims: Weight loss is recommended for myocardial infarction (MI) patients with overweight or obesity. It has, however, been suggested that obese patients have better prognosis than normal-weight patients have, but also that central obesity is harmful. The aim of this study was to examine associations between repeated measures of body mass index (BMI) and waist circumference (WC), and all-cause mortality.Methods and results: A total of 14,224 MI patients aged <75 years in Sweden between the years 2004 and 2013 had measurements of risk factors at hospital discharge. The patients' BMI and WC were recorded in secondary prevention clinics two months and one year after hospital discharge. We collected mortality data up to 8.3 years after the last visit. There were 721 deaths. We used anthropometric measures at the two-month visit and the change from the two-month to the one-year visit. With adjustments for risk factors and the other anthropometric measure the hazard ratio (HR) per standard deviation in a Cox proportional hazard regression model for mortality was 0.64 (95% confidence interval [CI] 0.56-0.74) for BMI and 1.55 (95% CI 1.34-1.79) for WC, and 1.43 (95% CI 1.17-1.74) for a BMI decrease from month two to one year of more than 0.6 kg/m(2). Low BMI and high WC were associated with the highest mortality.Conclusion: High WC is harmful regardless of BMI in MI patients. Reduced BMI during the first year after MI is, however, associated with higher mortality, potentially being an indicator of deteriorated health.
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| 2. |
- Hambræus, Kristina, 1970-
(författare)
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From Stenting to Preventing : Invasive and Long-term Treatment for Coronary Artery Disease in Sweden
- 2014
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Coronary artery disease (CAD) is the leading cause of death worldwide. Treatment with coronary interventions, long-term treatment and life style changes can reduce symptoms and improve prognosis. The aim of this thesis was to investigate aspects of invasive treatment for multivessel coronary artery disease, and to investigate adherence to prevention guidelines one year after myocardial infarction. We used the national quality registry SWEDEHEART to collect data on long term treatment one year after myocardial infarction for 51 620 patients < 75 years of age. For 17 236 of the patients, we collected LDL-cholesterol measurements from SWEDEHEART and defined use of lipid lowering drugs from the Prescribed Drug Register. We developed a questionnaire for post-PCI-patients to investigate patients’ understanding of cause and treatment of coronary artery disease. For 23 342 PCI-patients with multivessel coronary artery disease, SWEDEHEART-data was linked to Swedish health data registries to determine one year outcome for patients undergoing incomplete vs. complete revascularization. Lipid control (LDL-cholesterol < 1.8 mmol/L) was attained by one in four patients one year after myocardial infarction, whereas blood pressure control (< 140 mmHg) was attained by two thirds of patients. Lipid and blood pressure control was lower for women but there was no gender difference in smoking cessation rate: 56 %. Over 90 % of patients were treated with a statin after myocardial infarction but treatment was intensified for only one in five patients with LDL-cholesterol above target.The questionnaire study revealed that non-modifiable factors such as age and heredity were more often seen as cause of coronary artery disease than modifiable life style factors. Only one in five patients perceived CAD as a chronic illness, requiring life style changes.Two thirds of PCI-patients with multivessel disease underwent incomplete revascularisation, and this was associated with a twofold risk for the combination of death, myocardial infarction and repeat revascularization up to one year, compared to patients who underwent complete revascularization.We conclude that long term treatment after myocardial infarction is suboptimal in relation to guideline recommendations. Assessment of patients’ views on CAD and better health education post PCI may facilitate life style changes. Further studies need to investigate whether complete revascularization will improve outcome for PCI-patients with multivessel disease.
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| 3. |
- Hambraeus, Kristina, 1970-, et al.
(författare)
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Long-Term Outcome of Incomplete Revascularization After Percutaneous Coronary Intervention in SCAAR (Swedish Coronary Angiography and Angioplasty Registry)
- 2016
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Ingår i: JACC. - : Elsevier BV. - 1936-8798 .- 1876-7605. ; 9:3, s. 207-215
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- OBJECTIVES The aim of this study was to describe current practice regarding completeness of revascularization in patients with multivessel disease undergoing percutaneous coronary intervention (PCI) and to investigate the association of incomplete revascularization (IR) with death, repeat revascularization, and myocardial infarction (MI) in a large nationwide registry. BACKGROUND The benefits of multivessel PCI are controversial. METHODS Between 2006 and 2010 we identified 23,342 patients with multivessel disease in the SCAAR (Swedish Coronary Angiography and Angioplasty Registry) and merged data with official Swedish health data registries. IR was defined as any nontreated significant (60%) stenosis in a coronary artery supplying > 10% of the myocardium. RESULTS Patients with IR (n = 15,165) were older, had more extensive coronary disease, and more often had ST-segment elevation MI at presentation than those with complete revascularization (CR) (n = 8,177). All-cause 1-year mortality, MI, and repeat revascularization were higher in IR than CR: 7.1% versus 3.8%, 10.4% versus 6.0%, and 20.5% versus 8.5%, respectively. Propensity score methodology was used in the adjusted analyses. Adjusted hazard ratio (HR) for the composite of death, MI, or repeat revascularization at 1 year was higher in IR than CR: 2.12 (95% confidence interval [CI]: 1.98 to 2.28; p < 0.0001). Adjusted HR for death and the combination of death/MI were 1.29 (95% CI: 1.12 to 1.49; p = 0.0005) and 1.42 (95% CI: 1.30 to 1.56; p < 0.0001), respectively. CONCLUSIONS Incomplete revascularization at the time of hospital discharge in patients with multivessel disease undergoing PCI is associated with a high risk of recurrent 1-year adverse cardiac events.
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| 4. |
- Hambraeus, Kristina, 1970-, et al.
(författare)
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Target-Attainment Rates of Low-Density Lipoprotein Cholesterol Using Lipid-Lowering Drugs One Year After Acute Myocardial Infarction in Sweden
- 2014
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Ingår i: American Journal of Cardiology. - : Elsevier BV. - 1879-1913 .- 0002-9149. ; 113:1, s. 17-22
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Tidskriftsartikel (refereegranskat)abstract
- The objective of this prospective cohort study was to describe real-life use of lipid-lowering drugs and low-density lipoprotein cholesterol (LDL-C) target-attainment rates 1 year after acute myocardial infarction (AMI). LDL-C was recorded at hospital admission for AMI and at follow-up at 2 and 12 months after AMI in 17,236 patients in the Swedish heart registry, SWEDEHEART, from 2004 through 2009. Lipid-lowering treatments were identified using the Swedish Prescribed Drug Register. More than 90% of patients received statins after ANT. Simvastatin <= 40 mg was used by 80% of patients at discharge and at 2 months and 68% at 1 year after AMI. Intensive statin therapy (LDL-C-lowering capacity >40%) was prescribed for 8.4%, 11.9%, and 12.2% at these time points, and combinations of statin/ezetimibe for 1.1%, 2.8%, and 5.0%, respectively. The LDL-C target of <2.5 mmol/L (97 mg/dl) was achieved in 74.5% of patients at 2 months and 72.3% at 12 months after AMI. Treatment was intensified for only 21.3% of patients with LDL-C above target at 2 months. In multivariate analysis, higher LDL-C levels at admission and at 2 months correlated to increased risk for under treatment at 12 months after AMI. In conclusion, statin treatment after AMI in Sweden has become standard, but titration to reach recommended LDL-C levels is still suboptimal. Strategies to further improve implementation of guidelines are needed. (C) 2014 Elsevier Inc. All rights reserved.
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| 5. |
- Hambraeus, Kristina, 1970-, et al.
(författare)
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Time Trends and Gender Differences in Prevention Guideline Adherence and Outcome after Myocardial Infarction : Data from the SWEDEHEART-registry
- 2016
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Ingår i: European Journal of Preventive Cardiology. - : Oxford University Press (OUP). - 2047-4873 .- 2047-4881. ; 23:4, s. 340-348
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Tidskriftsartikel (refereegranskat)abstract
- Background While secondary prevention improves prognosis after acute myocardial infarction (AMI), previous studies have suggested suboptimal guideline adherence, lack of improvement over time and gender differences. This study contributes contemporary data from a large national cohort. Method We identified 51,620 patients <75 years examined at two and/or twelve months post AMI in the Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies (SWEDEHEART). Risk factor control and readmissions at one year were compared between the 2005 and 2012 cohorts, and between genders. Results Lipid control (LDL-cholesterol <2.5mmol/L) improved from 67.9% to 71.1% (p=0.016) over time, achieved by 67.9% vs 63.3%, p<0.001 of men vs women. Blood pressure control (<140mmHg systolic) increased over time (59.1% vs 69.5%, p<0.001 in 2005 and 2012 cohorts) and was better in men (66.4% vs 61.9%, p<0.001). Smoking cessation rate was 55.6% without differences between genders or over time. Cardiac readmissions occurred in 18.2% of women and 15.5% of men, decreasing from 2005 to 2012 (20.8% vs 14.9%). Adjusted odds ratio was 1.22 (95% CI 1.14-1.32) for women vs men and 0.94 (95% CI 0.92-0.96) for the 2012 vs the 2005 cohort. Conclusions Although this study compares favourably to previous studies of risk factor control post AMI, improvement over time was mainly seen regarding blood pressure, revealing substantial remaining preventive potential. The reasons for gender differences seen in risk factor control and readmissions require further analysis.
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| 6. |
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| 7. |
- Kolte, Dhaval, et al.
(författare)
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Culprit Vessel-Only Versus Multivessel Percutaneous Coronary Intervention in Patients With Cardiogenic Shock Complicating ST-Segment-Elevation Myocardial Infarction : A Collaborative Meta-Analysis
- 2017
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Ingår i: Circulation. Cardiovascular Interventions. - : LIPPINCOTT WILLIAMS & WILKINS. - 1941-7640 .- 1941-7632. ; 10:11
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Tidskriftsartikel (refereegranskat)abstract
- Background The optimal revascularization strategy in patients with multivessel disease presenting with cardiogenic shock complicating ST-segment-elevation myocardial infarction remains unknown. Methods and Results Databases were searched from 1999 to October 2016. Studies comparing immediate/single-stage multivessel percutaneous coronary intervention (MV-PCI) versus culprit vessel-only PCI (CO-PCI) in patients with multivessel disease, ST-segment-elevation myocardial infarction, and cardiogenic shock were included. Primary end point was short-term (in-hospital or 30 days) mortality. Secondary end points included long-term mortality, cardiovascular death, reinfarction, and repeat revascularization. Safety end points were in-hospital stroke, renal failure, and major bleeding. The meta-analysis included 11 nonrandomized studies and 5850 patients (1157 MV-PCI and 4693 CO-PCI). There was no significant difference in short-term mortality with MV-PCI versus CO-PCI (odds ratio [OR], 1.08; 95% confidence interval [CI], 0.81-1.43; P=0.61). Similarly, there were no significant differences in long-term mortality (OR, 0.84; 95% CI, 0.54-1.30; P=0.43), cardiovascular death (OR, 0.72; 95% CI, 0.42-1.23; P=0.23), reinfarction (OR, 1.65; 95% CI, 0.84-3.26; P=0.15), or repeat revascularization (OR, 1.13; 95% CI, 0.76-1.69; P=0.54) between the 2 groups. There was a nonsignificant trend toward higher in-hospital stroke (OR, 1.64; 95% CI, 0.98-2.72; P=0.06) and renal failure (OR, 1.30; 95% CI, 0.98-1.72; P=0.06), with no difference in major bleeding (OR, 1.47; 95% CI, 0.39-5.63; P=0.57) with MV-PCI when compared with CO-PCI. Conclusions This meta-analysis of nonrandomized studies suggests that in patients with cardiogenic shock complicating ST-segment-elevation myocardial infarction, there may be no significant benefit with single-stage MV-PCI compared with CO-PCI. Given the limitations of observational data, randomized trials are needed to determine the role of MV-PCI in this setting.
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| 8. |
- Svedberg, Niclas, et al.
(författare)
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Long-Term Incidence of Atrial Fibrillation and Stroke Among Cross-Country Skiers Cohort Study of Endurance-Trained Male and Female Athletes
- 2019
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Ingår i: Circulation. - 0009-7322 .- 1524-4539. ; 140:11, s. 910-920
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Tidskriftsartikel (refereegranskat)abstract
- Background: Studies have revealed a higher incidence of atrial fibrillation among well-trained athletes. We aim to investigate associations of endurance training with incidence of atrial fibrillation and stroke and to establish potential sex differences of such associations in a cohort of endurance trained athletes. Methods: All Swedish skiers (208 654) completing 1 or more races in the 30 to 90 km cross-country skiing event Vasaloppet (1989-2011) and a matched sample (n=527 448) of nonskiers were followed until first event of atrial fibrillation or stroke. Cox regression was used to investigate associations of number of completed races and finishing time with incidence of atrial fibrillation and stroke. Results: Female skiers in Vasaloppet had a lower incidence of atrial fibrillation than did female nonskiers (hazard ratio [HR], 0.55; 95% CI, 0.48-0.64), independent of finishing time and number of races. Male skiers had a similar incidence to that of nonskiers (HR, 0.98; 95% CI, 0.93-1.03). Skiers with the highest number of races or fastest finishing times had the highest incidence. Skiers of either sex had a lower incidence of stroke than did nonskiers (HR, 0.64; 95% CI, 0.60-0.67), independent of the number of races and finishing time. Skiers with atrial fibrillation had higher incidence of stroke than did skiers and nonskiers without atrial fibrillation (men: HR, 2.28; 95% CI, 1.93-2.70; women: HR, 3.51; 95% CI, 2.17-5.68; skiers with atrial fibrillation vs. skiers without atrial fibrillation). After diagnosis of atrial fibrillation, skiers with atrial fibrillation had a lower incidence of stroke (HR, 0.73; 95% CI, 0.50-0.91) and lower mortality compared with nonskiers with atrial fibrillation (HR, 0.57; 95% CI, 0.49-0.65). Conclusions: Female skiers in Vasaloppet had lower incidence of atrial fibrillation and stroke. Male skiers had similar incidence of atrial fibrillation and lower risk of stroke. Men with higher number of races and faster finishing times had the highest incidence of atrial fibrillation. After diagnosis of atrial fibrillation, skiers had lower incidence of stroke and death than did nonskiers with atrial fibrillation. This indicates that although on an individual level atrial fibrillation in well-trained individuals is associated with higher incidence of stroke, on population level, risk of stroke is low and that exercise should not be avoided.
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| 9. |
- Vixner, Linda, et al.
(författare)
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High Self‐Reported Levels of Pain 1 Year After a Myocardial Infarction Are Related to Long‐Term All‐Cause Mortality : A SWEDEHEART Study Including 18 376 Patients
- 2023
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Ingår i: Journal of the American Heart Association. - : John Wiley & Sons. - 2047-9980. ; 12:17
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundPain increases the risk for cardiovascular diseases, including myocardial infarction (MI). However, the impact of pain on mortality after MI has not yet been investigated in large studies with long‐term follow‐up periods. Thus, we aimed to examine various levels of pain severity 1 year after an MI as a potential risk for all‐cause mortality.Methods and ResultsWe collected data from 18 376 patients, aged <75 years, who had a registered MI event during the period from 2004 to 2013 and with measurements of potential cardiovascular risk indicators at hospital discharge from the Swedish quality register SWEDEHEART (Swedish Web System for Enhancement and Development of Evidence‐Based Care in Heart Disease Evaluated According to Recommended Therapies). Self‐reported levels of experienced pain according to EuroQol‐5 dimension instrument were recorded in secondary prevention clinics 1 year after hospital discharge. We collected all‐cause mortality data up to 8.5 years (median, 3.4 years) after the 1‐year visit. The Cox proportional hazard regression was used to estimate hazard ratio (HR) and 95% CI. Moderate pain and extreme pain were reported by 38.2% and 4.5%, respectively, of included patients. There were 1067 deaths. Adjusted HR was 1.35 (95% CI, 1.18–1.55) and 2.06 (95% CI, 1.63–2.60) for moderate and extreme pain, respectively. Pain was a stronger mortality predictor than smoking.ConclusionsPain 1 year after MI is highly prevalent, and its effect on mortality 1 year after MI was found to be more pronounced than smoking. Clinicians managing patients after MI should recognize the need to consider experienced pain when making prognosis or treatment decisions.
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