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[Myocardial infarction--important field for control of quality of health care and therapeutic results]

https://arctichealth.org/en/permalink/ahliterature55081
Source
Lakartidningen. 1992 Oct 28;89(44):3653-4
Publication Type
Article
Date
Oct-28-1992
Author
L. Wallentin
Author Affiliation
Kardiologsektionen, medicinska kliniken, Akademiska sjukhuset, Uppsala.
Source
Lakartidningen. 1992 Oct 28;89(44):3653-4
Date
Oct-28-1992
Language
Swedish
Publication Type
Article
Keywords
Aged
Comparative Study
Coronary Care Units - standards
Female
Humans
Male
Middle Aged
Myocardial Infarction - mortality - therapy
Prognosis
Quality of Health Care
Retrospective Studies
Sweden - epidemiology
PubMed ID
1460974 View in PubMed
Less detail

Low-molecular-weight heparin as a bridge to timely revascularization in unstable coronary artery disease -- an update of the Fragmin during Instability in Coronary Artery Disease II Trial.

https://arctichealth.org/en/permalink/ahliterature195380
Source
Haemostasis. 2000;30 Suppl 2:108-13; discussion 106-7
Publication Type
Article
Date
2000
Author
L. Wallentin
Author Affiliation
Department of Cardiology, Cardiothoracic Centre, Uppsala University Hospital, Uppsala, Sweden. Lars.Wallentin@card.uas.lul.se
Source
Haemostasis. 2000;30 Suppl 2:108-13; discussion 106-7
Date
2000
Language
English
Publication Type
Article
Keywords
Algorithms
Angina, Unstable - drug therapy - mortality - radiography - surgery
Anticoagulants - administration & dosage - adverse effects - therapeutic use
Biological Markers - blood
Combined Modality Therapy
Coronary Angiography
Dalteparin - administration & dosage - adverse effects - therapeutic use
Electrocardiography
Female
Humans
Male
Myocardial Infarction - etiology - mortality - prevention & control
Myocardial Revascularization
Postoperative Complications - mortality
Preoperative Care
Recurrence
Research Design
Risk factors
Scandinavia - epidemiology
Time Factors
Treatment Outcome
Troponin T - blood
Abstract
This article summarizes the design and findings -- both at 3 months and at 1 year follow-up -- of the Fragmin during Instability in Coronary Artery Disease (FRISC) II trial. This multicentre randomized trial compared both an early invasive with an early non-invasive stategy, and prolonged treatment with dalteparin as opposed to placebo, in patients with unstable coronary artery disease. The results show that an early invasive strategy with coronary angiography and, if appropriate, revascularization procedures within 7 days after admission reduces the subsequent rate of mortality and myocardial infarction. The benefits of the invasive treatment were noticeably more marked in patients with any high-risk indicator -- for example, male gender, age above 65 years, previous severe angina, or signs of ischaemia (ST depression on ECG) or of myocardial damage (elevated levels of troponin T). Treatment with dalteparin reduced the risk of death and myocardial infarction in high-risk (i.e. troponin-positive) patients, particularly during the first month of treatment. However, continuation with dalteparin therapy after revascularization procedures conferred no benefit. It is concluded that extended treatment with dalteparin is useful as a bridge to revascularization in this high-risk subgroup of patients with unstable coronary artery disease.
PubMed ID
11251353 View in PubMed
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[Swedish heart transplantation patients--background, choice, long-term results].

https://arctichealth.org/en/permalink/ahliterature233079
Source
Lakartidningen. 1988 May 4;85(18):1589-95
Publication Type
Article
Date
May-4-1988
Author
L. Wallentin
Source
Lakartidningen. 1988 May 4;85(18):1589-95
Date
May-4-1988
Language
Swedish
Publication Type
Article
Keywords
Follow-Up Studies
Heart Transplantation
Humans
Sweden
PubMed ID
3283481 View in PubMed
Less detail

Early statin treatment following acute myocardial infarction and 1-year survival.

https://arctichealth.org/en/permalink/ahliterature53959
Source
JAMA. 2001 Jan 24-31;285(4):430-6
Publication Type
Article
Author
U. Stenestrand
L. Wallentin
Author Affiliation
Department of Cardiology, University Hospital of Linköping, SE 581 85 Linköping, Sweden. stenestrand@riks-hia.c.se
Source
JAMA. 2001 Jan 24-31;285(4):430-6
Language
English
Publication Type
Article
Keywords
Aged
Anticholesteremic Agents - therapeutic use
Cause of Death
Enzyme Inhibitors - therapeutic use
Female
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use
Male
Middle Aged
Myocardial Infarction - drug therapy - mortality
Proportional Hazards Models
Prospective Studies
Registries
Research Support, Non-U.S. Gov't
Risk
Survival Analysis
Sweden - epidemiology
Abstract
CONTEXT: Randomized trials have established statin treatment as secondary prevention in coronary artery disease, but it is unclear whether early treatment with statins following acute myocardial infarction (AMI) influences survival. OBJECTIVE: To evaluate the association between statin treatment initiated before or at the time of hospital discharge and 1-year mortality after AMI. DESIGN AND SETTING: Prospective cohort study using data from the Swedish Register of Cardiac Intensive Care on patients admitted to the coronary care units of 58 Swedish hospitals in 1995-1998. One-year mortality data were obtained from the Swedish National Cause of Death Register. PATIENTS: Patients with first registry-recorded AMI who were younger than 80 years and who were discharged alive from the hospital, including 5528 who received statins at or before discharge and 14 071 who did not. MAIN OUTCOME MEASURE: Relative risk of 1-year mortality according to statin treatment. RESULTS: At 1 year, unadjusted mortality was 9.3% (1307 deaths) in the no-statin group and 4.0% (219 deaths) in the statin treatment group. In regression analysis adjusting for confounding factors and propensity score for statin use, early statin treatment was associated with a reduction in 1-year mortality (relative risk, 0.75; 95% confidence interval, 0.63-0.89; P =.001) in hospital survivors of AMI. This reduction in mortality was similar among all subgroups based on age, sex, baseline characteristics, previous disease manifestations, and medications. CONCLUSIONS: Early initiation of statin treatment in patients with AMI is associated with reduced 1-year mortality. These results emphasize the importance of implementing the results of randomized statin trials in unselected AMI patients.
PubMed ID
11242427 View in PubMed
Less detail

Prevention of serious cardiac events by low-dose aspirin in patients with silent myocardial ischaemia. The Research Group on Instability in Coronary Artery Disease in Southeast Sweden.

https://arctichealth.org/en/permalink/ahliterature46602
Source
Lancet. 1992 Aug 29;340(8818):497-501
Publication Type
Article
Date
Aug-29-1992
Author
I. Nyman
H. Larsson
L. Wallentin
Author Affiliation
Department of Internal Medicine, District Hospital, Eksjö, Sweden.
Source
Lancet. 1992 Aug 29;340(8818):497-501
Date
Aug-29-1992
Language
English
Publication Type
Article
Keywords
Aged
Aspirin - therapeutic use
Coronary Disease - prevention & control
Double-Blind Method
Electrocardiography
Humans
Male
Middle Aged
Research Support, Non-U.S. Gov't
Abstract
On exercise testing after an episode of unstable coronary artery disease (CAD; unstable angina or non-Q-wave myocardial infarction), a proportion of patients show ST-segment depression, indicating myocardial ischaemia, but do not report concomitant symptoms of angina. Treatment of such "silent" ischaemia aims mainly to reduce the risk of subsequent cardiac events. We have studied the effect of low-dose aspirin in patients with myocardial ischaemia defined at the predischarge test as silent (though patients might have had symptomatic ischaemia at other times) or symptomatic. 740 men with unstable CAD aged 70 years or less underwent symptom-limited exercise testing before hospital discharge; 144 showed ST depression without pain and 230 ST depression with simultaneous chest pain. Of the silent ischaemia group, 67 were randomly assigned placebo and 77 aspirin (75 mg daily); the corresponding numbers in the symptomatic group were 125 and 105. Angina symptoms were less common in the silent than in the symptomatic ischaemia group both before inclusion and during follow-up, and a greater proportion of the silent ischaemia group were included because of myocardial infarction. In both ischaemia groups aspirin treatment reduced the risk of subsequent myocardial infarction or death by 3 months' follow-up (silent 4% of aspirin-treated vs 21% of placebo-treated patients, p = 0.004; symptomatic 9% vs 18%, p = 0.05); at 12 months' follow-up a significant benefit of aspirin was still apparent in the silent ischaemia group (9% vs 28%, p = 0.005) but not in the symptomatic group (13% vs 22%, p = 0.109). Low-dose aspirin reduced the risk of subsequent myocardial infarction at least as well in silent as in symptomatic myocardial ischaemia. Since improvement of outlook is the main treatment objective in symptom-free patients, aspirin should be a mainstay of their treatment.
PubMed ID
1354274 View in PubMed
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The combination of a continuous 12-lead ECG and troponin T; a valuable tool for risk stratification during the first 6 hours in patients with chest pain and a non-diagnostic ECG.

https://arctichealth.org/en/permalink/ahliterature54048
Source
Eur Heart J. 2000 Sep;21(17):1464-72
Publication Type
Article
Date
Sep-2000
Author
T. Jernberg
B. Lindahl
L. Wallentin
Author Affiliation
Department of Cardiology, Cardiothoracic Center, University Hospital, Uppsala, Sweden.
Source
Eur Heart J. 2000 Sep;21(17):1464-72
Date
Sep-2000
Language
English
Publication Type
Article
Keywords
Aged
Angina, Unstable - diagnosis - mortality
Electrocardiography
Female
Humans
Male
Middle Aged
Myocardial Infarction - diagnosis - mortality
Predictive value of tests
Prognosis
Prospective Studies
Registries
Research Support, Non-U.S. Gov't
Survival Analysis
Sweden - epidemiology
Time Factors
Troponin T - blood
Abstract
AIMS: The aim was to examine the early prognostic value of a combination of a continuous 12-lead ECG and troponin T in patients with chest pain and an ECG non-diagnostic for acute myocardial infarction. METHODS AND RESULTS: ST monitoring was performed and samples for analysis of troponin T were collected from admission for 12 h from 598 patients. After 6 h, the peak value of troponin T in 27% was > or = 0.10 microg.l(- 1), while 15% had had ST episodes, defined as transient ST deviations of at least 0.1 mV. Both a troponin T > or = 0.10 microg. l(-1) and ST episodes predicted worsening outcome. After 30 days, there were 6.8% and 1.4% (P or = 0.10 microg.l(-1), respectively. The corresponding event rates in patients with and without ST episodes were 10% and 1.6% (P
Notes
Comment In: Eur Heart J. 2000 Sep;21(17):1403-510952833
PubMed ID
10952839 View in PubMed
Less detail

[Emergency coronary care--successful, but unequaly distributed]

https://arctichealth.org/en/permalink/ahliterature54383
Source
Lakartidningen. 1998 Jun 10;95(24):2812-8
Publication Type
Article
Date
Jun-10-1998
Author
U. Stenestrand
L. Wallentin
C. Sonnhag
Author Affiliation
Kardiologiska kliniken, hjärtcentrum, Universitetssjukhuset, Linköping.
Source
Lakartidningen. 1998 Jun 10;95(24):2812-8
Date
Jun-10-1998
Language
Swedish
Publication Type
Article
Keywords
Acute Disease
Angina Pectoris - diagnosis - mortality - therapy
Comparative Study
Coronary Care Units - standards
Coronary Disease - diagnosis - mortality - therapy
Emergency Medical Services - standards
Emergency Service, Hospital - standards
English Abstract
Health Care Rationing
Humans
Length of Stay
Prognosis
Registries
Sweden
Abstract
The need of acute coronary care is increasing because of an increase in the incidence of severe angina pectoris, and despite a reduction in that of acute myocardial infarction. Patients with acute myocardial infarction are characterised by continuously increasing age, lower mortality, and shorter hospitalisation. The improvement in acute care is related to increased use of expensive drugs, new diagnostic methods, and an increasing coronary revascularisation rate. However, there is still inequality in the utilisation of cardiac care, and in order to further enhance its quality and equality of utilisation, there is an emphatic need of common registries.
PubMed ID
9656636 View in PubMed
Less detail

[Uniform diagnosis of myocardial infarction. Rapid development at Swedish hospitals]

https://arctichealth.org/en/permalink/ahliterature54426
Source
Lakartidningen. 1998 Feb 4;95(6):515-20
Publication Type
Article
Date
Feb-4-1998
Author
T. Jernberg
B. Lindahl
L. Wallentin
Author Affiliation
Kardiologkliniken, Akademiska sjukhuset, Uppsala.
Source
Lakartidningen. 1998 Feb 4;95(6):515-20
Date
Feb-4-1998
Language
Swedish
Publication Type
Article
Keywords
Biological Markers - analysis
Coronary Care Units - standards
Creatine Kinase - blood
Electrocardiography
English Abstract
Humans
Isoenzymes
Monitoring, Physiologic
Myocardial Infarction - diagnosis - enzymology
Myocardial Ischemia - diagnosis
Physician's Practice Patterns
Point-of-Care Systems
Quality Assurance, Health Care
Questionnaires
Sweden
Troponin - analysis
Abstract
Criteria for the diagnosis of myocardial infarction vary not only from one cardiac intensive care unit (CICU) to another, but also from one study to another. Even the appropriate juncture for ECG, the type of biochemical markers used and blood sampling times vary. Thus, epidemiological studies comparing results over time or between various regions or hospitals tend to be misleading. Reported results are difficult to interpret and to apply to one's own CICU. In order to survey myocardial infarction diagnosis in Sweden and planned future changes, in February-March 1997 a questionnaire was sent to all 82 CICUs in the country. Of the 74 (90%) responders, 72% (53/74) reported formalized printed criteria for myocardial diagnosis to be available at the unit. Eight different biochemical markers of myocardial injury were in use; CK-MB (creatine kinase and its cardio-specific isoenzyme) was the most common, being used at 64% (47/74) of the units; CK and CK-B were used at 32%, and troponin T or I at 53%. Myoglobulin has not been very widely used. If planned changes are carried out, 86% of the units will soon be using CK-MB, and 79% troponin T och I. Cut-off levels of biochemical markers of myocardial infarction varied. Of the 47 units where CK-MB was used, the cut-off level was 10 micrograms/L at 10 (28%) of the units, 15 micrograms/L at 31 (66%) units, and a higher level in a smaller group of units. Cut-off levels for CK-B manifested a similar lack of uniformity. The greatest difference was manifested by troponin levels; of the 28 units using quantitative tests and that cited their cut-off levels, three (11%) used 0.10 microgram/L, 12 (43%) used 0.20 microgram/L, and the remaining 13 (46%) used 0.50 microgram/L. The use of ischaemia monitoring in conjunction with diagnosis and prognosis of myocardial infarction has increased, 72% of the units reporting that they used some form of monitoring, and a further 13% that they planned to introduce it in the near future. Thus, the questionnaire study showed marked differences in myocardial infarction diagnosis to exist in Sweden, although a manifest trend toward increasing uniformity was also seen, and the outlook for the standardisation of diagnostic criteria is good.
PubMed ID
9494354 View in PubMed
Less detail

[Why was myocardial infarction missed? 5 years of reports to the HSAN give a hint]

https://arctichealth.org/en/permalink/ahliterature54661
Source
Lakartidningen. 1996 May 8;93(19):1827-9
Publication Type
Article
Date
May-8-1996

[Pediatric coronary care remains in the region of Mälardalen. Pediatric surgery should carry on in Uppsala]

https://arctichealth.org/en/permalink/ahliterature35888
Source
Lakartidningen. 1994 Feb 16;91(7):572-3
Publication Type
Article
Date
Feb-16-1994

19 records – page 1 of 2.