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30-year trends in asthma and the trends in relation to hospitalization and mortality.

https://arctichealth.org/en/permalink/ahliterature297877
Source
Respir Med. 2018 09; 142:29-35
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Date
09-2018
Author
Margit K Pelkonen
Irma-Leena K Notkola
Tiina K Laatikainen
Pekka Jousilahti
Author Affiliation
Division of Respiratory Medicine, Center for Medicine and Clinical Research, Kuopio University Hospital, Kuopio, Finland. Electronic address: Margit.Pelkonen@kuh.fi.
Source
Respir Med. 2018 09; 142:29-35
Date
09-2018
Language
English
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Keywords
Adult
Age Factors
Asthma - epidemiology - mortality
Cause of Death - trends
Cross-Sectional Studies
Female
Finland - epidemiology
Hospitalization - statistics & numerical data - trends
Humans
Length of Stay - statistics & numerical data - trends
Male
Middle Aged
Prevalence
Risk factors
Smoking
Surveys and Questionnaires
Time Factors
Abstract
The present study examines how trends in the prevalence of asthma during the past three decades associate with hospitalization and mortality during the same period.
Altogether 54?320 subjects aged 25-74 years were examined in seven independent cross-sectional population surveys repeated every five years between 1982 and 2012 in Finland. The study protocol included a standardized questionnaire on self-reported asthma, smoking habits and other risk factors, and clinical measurements at the study site. Data on hospitalizations were obtained from the Care Register for Health Care, and data on mortality from the National Causes of Death register.
During the study, the prevalence of asthma increased - especially in women. In asthmatic compared with non-asthmatic subjects, hospitalization was significantly higher for all causes, respiratory causes, cardiovascular causes and lung cancer. In addition, particularly in asthmatic subjects, mean yearly hospital days in the 5-year periods after each survey diminished. In asthmatic subjects, the decrease in yearly all-cause hospital days was from 4.45 (between 1982 and 1987) to 1.11 (between 2012 and 2015) and in subjects without asthma the corresponding decrease was from 1.77 to 0.60 (p?
PubMed ID
30170798 View in PubMed
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Abdominal Aortic Calcifications Predict Survival in Peritoneal Dialysis Patients.

https://arctichealth.org/en/permalink/ahliterature298110
Source
Perit Dial Int. 2018 Sep-Oct; 38(5):366-373
Publication Type
Journal Article
Multicenter Study
Observational Study
Research Support, Non-U.S. Gov't
Author
Satu Mäkelä
Markku Asola
Henrik Hadimeri
James Heaf
Maija Heiro
Leena Kauppila
Susanne Ljungman
Mai Ots-Rosenberg
Johan V Povlsen
Björn Rogland
Petra Roessel
Jana Uhlinova
Maarit Vainiotalo
Maria K Svensson
Heini Huhtala
Heikki Saha
Author Affiliation
Tampere University Hospital, Tampere, Finland satu.m.makela@pshp.fi.
Source
Perit Dial Int. 2018 Sep-Oct; 38(5):366-373
Language
English
Publication Type
Journal Article
Multicenter Study
Observational Study
Research Support, Non-U.S. Gov't
Keywords
Ankle Brachial Index
Aorta, Abdominal - diagnostic imaging
Aortic Diseases - diagnosis - epidemiology - etiology
Cause of Death - trends
Critical Illness - mortality - therapy
Denmark - epidemiology
Estonia - epidemiology
Female
Finland - epidemiology
Humans
Incidence
Male
Middle Aged
Peritoneal Dialysis - adverse effects - mortality
Prognosis
Prospective Studies
Renal Dialysis
Risk factors
Survival Rate - trends
Sweden - epidemiology
Ultrasonography, Doppler
Vascular Calcification - diagnosis - epidemiology - etiology
Abstract
Peripheral arterial disease and vascular calcifications contribute significantly to the outcome of dialysis patients. The aim of this study was to evaluate the prognostic role of severity of abdominal aortic calcifications and peripheral arterial disease on outcome of peritoneal dialysis (PD) patients using methods easily available in everyday clinical practice.
We enrolled 249 PD patients (mean age 61 years, 67% male) in this prospective, observational, multicenter study from 2009 to 2013. The abdominal aortic calcification score (AACS) was assessed using lateral lumbar X ray, and the ankle-brachial index (ABI) using a Doppler device.
The median AACS was 11 (range 0 - 24). In 58% of the patients, all 4 segments of the abdominal aorta showed deposits, while 19% of patients had no visible deposits (AACS 0). Ankle-brachial index was normal in 49%, low ( 1.3) in 34% of patients. Altogether 91 patients (37%) died during the median follow-up of 46 months. Only 2 patients (5%) with AACS 0 died compared with 50% of the patients with AACS = 7 (p
PubMed ID
29386304 View in PubMed
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Adult but no pediatric anaphylaxis-related deaths in the Finnish population from 1996 to 2013.

https://arctichealth.org/en/permalink/ahliterature294745
Source
J Allergy Clin Immunol. 2016 08; 138(2):630-2
Publication Type
Letter
Research Support, Non-U.S. Gov't
Date
08-2016
Author
Juho E Kivistö
Teija Dunder
Jennifer L P Protudjer
Jussi Karjalainen
Heini Huhtala
Mika J Mäkelä
Author Affiliation
Allergy Centre, Tampere University Hospital, Tampere, Finland; Centre for Child Health Research, Tampere University and University Hospital, Tampere, Finland; Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden. Electronic address: juho.kivisto@uta.fi.
Source
J Allergy Clin Immunol. 2016 08; 138(2):630-2
Date
08-2016
Language
English
Publication Type
Letter
Research Support, Non-U.S. Gov't
Keywords
Adolescent
Adult
Age Factors
Aged
Aged, 80 and over
Anaphylaxis - etiology - mortality
Cause of Death - trends
Child
Drug Hypersensitivity - complications - mortality
Female
Finland - epidemiology
Food Hypersensitivity - complications - mortality
Humans
Incidence
Insect Bites and Stings - complications - mortality
Male
Middle Aged
Young Adult
PubMed ID
27343204 View in PubMed
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Airway obstruction and the risk of myocardial infarction and death from coronary heart disease: a national health examination survey with a 33-year follow-up period.

https://arctichealth.org/en/permalink/ahliterature297762
Source
Eur J Epidemiol. 2018 01; 33(1):89-98
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Date
01-2018
Author
Tiina Mattila
Tuula Vasankari
Harri Rissanen
Paul Knekt
Pauli Puukka
Markku Heliövaara
Author Affiliation
Heart and Lung Center, Helsinki University Hospital, Meilahti Triangle Hospital, HUS, 6th Floor, PO Box 372, 00029, Helsinki, Finland. tiina.m.mattila@fimnet.fi.
Source
Eur J Epidemiol. 2018 01; 33(1):89-98
Date
01-2018
Language
English
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Keywords
Adult
Aged
Airway Obstruction - epidemiology
Cause of Death
Coronary Disease - mortality
Female
Finland - epidemiology
Follow-Up Studies
Health Surveys
Hospitalization
Humans
Male
Middle Aged
Myocardial Infarction - mortality
Proportional Hazards Models
Risk factors
Abstract
Chronic obstructive pulmonary disease (COPD) has been associated with coronary mortality. Yet, data about the association between COPD and acute myocardial infarction (MI) remain scarce. We aimed to study airway obstruction as a predictor of MI and coronary mortality among 5576 Finnish adults who participated in a national health examination survey between 1978 and 1980. Subjects underwent spirometry, had all necessary data, showed no indications of cardiovascular disease at baseline, and were followed up through record linkage with national registers through 2011. The primary outcome consisted of a major coronary event-that is, hospitalization for MI or coronary death, whichever occurred first. We specified obstruction using the lower limit of normal categorization. Through multivariate analysis adjusted for potential confounding factors for coronary heart disease, hazard ratios (HRs) (with the 95% confidence intervals in parentheses) of a major coronary event, MI, and coronary death reached 1.06 (0.79-1.42), 0.84 (0.54-1.31), and 1.40 (1.04-1.88), respectively, in those with obstruction compared to others. However, in women aged 30-49 obstruction appeared to predict a major coronary event, where the adjusted HR reached 4.21 (1.73-10.28). In conclusion, obstruction appears to predict a major coronary event in younger women only, whereas obstruction closely associates with the risk of coronary death independent of sex and age.
PubMed ID
28688065 View in PubMed
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All-cause and cancer-specific mortality in GORD in a population-based cohort study (the HUNT study).

https://arctichealth.org/en/permalink/ahliterature290276
Source
Gut. 2018 02; 67(2):209-215
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Date
02-2018
Author
Eivind Ness-Jensen
Eivind Gottlieb-Vedi
Karl Wahlin
Jesper Lagergren
Author Affiliation
Upper Gastrointestinal Surgery, Department of Molecular medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
Source
Gut. 2018 02; 67(2):209-215
Date
02-2018
Language
English
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Keywords
Adenocarcinoma - mortality
Adult
Aged
Aged, 80 and over
Cause of Death
Esophageal Neoplasms - mortality
Female
Gastroesophageal Reflux - epidemiology - mortality
Head and Neck Neoplasms - mortality
Humans
Lung Neoplasms - mortality
Male
Middle Aged
Norway - epidemiology
Severity of Illness Index
Sex Factors
Young Adult
Abstract
Gastro-oesophageal reflux is a public health concern which could have associated oesophageal complications, including adenocarcinoma, and possibly also head-and-neck and lung cancers. The aim of this study was to test the hypothesis that reflux increases all-cause and cancer-specific mortalities in an unselected cohort.
The Nord-Trøndelag health study (HUNT), a Norwegian population-based cohort study, was used to identify individuals with and without reflux in 1995-1997 and 2006-2008, with follow-up until 2014. All-cause mortality and cancer-specific mortality were assessed from the Norwegian Cause of Death Registry and Cancer Registry. Multivariable Cox regression was used to calculate HRs with 95% CIs for mortality with adjustments for potential confounders.
We included 4758 participants with severe reflux symptoms and 51 381 participants without reflux symptoms, contributing 60 323 and 747 239 person-years at risk, respectively. Severe reflux was not associated with all-cause mortality, overall cancer-specific mortality or mortality in cancer of the head-and-neck or lung. However, for men with severe reflux a sixfold increase in oesophageal adenocarcinoma-specific mortality was found (HR 6.09, 95% CI 2.33 to 15.93) and the mortality rate was 0.27 per 1000 person-years. For women, the corresponding mortality was not significantly increased (HR 3.68, 95% CI 0.88 to 15.27) and the mortality rate was 0.05 per 1000 person-years.
Individuals with severe reflux symptoms do not seem to have increased all-cause mortality or overall cancer-specific mortality. Although the absolute risk is small, individuals with severe reflux symptoms have a clearly increased oesophageal adenocarcinoma-specific mortality.
PubMed ID
27789657 View in PubMed
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Antithrombotic therapy after myocardial infarction in patients with atrial fibrillation undergoing percutaneous coronary intervention.

https://arctichealth.org/en/permalink/ahliterature298134
Source
Eur Heart J Cardiovasc Pharmacother. 2018 01 01; 4(1):36-45
Publication Type
Journal Article
Multicenter Study
Observational Study
Research Support, Non-U.S. Gov't
Date
01-01-2018
Author
Gorav Batra
Leif Friberg
David Erlinge
Stefan James
Tomas Jernberg
Bodil Svennblad
Lars Wallentin
Jonas Oldgren
Author Affiliation
Uppsala Clinical Research Center and Department of Medical Sciences, Cardiology, Uppsala University, Uppsala Science Park, MTC, Dag Hammarskjölds väg 14B, 752 37 Uppsala, Sweden.
Source
Eur Heart J Cardiovasc Pharmacother. 2018 01 01; 4(1):36-45
Date
01-01-2018
Language
English
Publication Type
Journal Article
Multicenter Study
Observational Study
Research Support, Non-U.S. Gov't
Keywords
Aged
Aged, 80 and over
Atrial Fibrillation - complications - drug therapy
Cause of Death - trends
Female
Fibrinolytic Agents - therapeutic use
Humans
Incidence
Male
Myocardial Infarction - complications - therapy
Percutaneous Coronary Intervention
Retrospective Studies
Stroke - epidemiology - etiology - prevention & control
Sweden - epidemiology
Thrombolytic Therapy - methods
Abstract
Optimal antithrombotic therapy after percutaneous coronary intervention (PCI) in patients with myocardial infarction (MI) and atrial fibrillation is uncertain. In this study, we compared antithrombotic regimes with regard to a composite cardiovascular outcome of all-cause mortality, MI or ischaemic stroke, and major bleeds.
Patients between October 2005 and December 2012 were identified in Swedish registries, n?=?7116. Landmark 0-90 and 91-365 days of outcome were evaluated with Cox-regressions, with dual antiplatelet therapy as reference. At discharge, 16.2% received triple therapy (aspirin, clopidogrel, and warfarin), 1.9% aspirin plus warfarin, 7.3% clopidogrel plus warfarin, and 60.8% dual antiplatelets. For cardiovascular outcome, adjusted hazard ratio with 95% confidence interval (HR) for triple therapy was 0.86 (0.70-1.07) for 0-90?days and 0.78 (0.58-1.05) for 91-365?days. A HR of 2.16 (1.48-3.13) and 1.61 (0.98-2.66) during 0-90 and 91-365?days, respectively, was observed for major bleeds. For aspirin plus warfarin, HR 0.82 (0.54-1.26) and 0.62 (0.48-0.79) was observed for cardiovascular outcome and 1.30 (0.60-2.85) and 1.01 (0.63-1.62) for major bleeds during 0-90 and 91-365?days, respectively. For clopidogrel plus warfarin, HR of 0.90 (0.68-1.19) and 0.68 (0.49-0.95) was observed for cardiovascular outcome and 1.28 (0.71-2.32) and 1.08 (0.57-2.04) for major bleeds during 0-90 and 91-365?days, respectively.
Compared to dual antiplatelets, aspirin or clopidogrel plus warfarin therapy was associated with similar 0-90 days and lower 91-365 days of risk of the cardiovascular outcome, without higher risk of major bleeds. Triple therapy was associated with non-significant lower risk of cardiovascular outcome and higher risk of major bleeds.
PubMed ID
29126156 View in PubMed
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Assessing amyotrophic lateral sclerosis prevalence in Norway from 2009 to 2015 from compulsory nationwide health registers.

https://arctichealth.org/en/permalink/ahliterature294815
Source
Amyotroph Lateral Scler Frontotemporal Degener. 2018 05; 19(3-4):303-310
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Date
05-2018
Author
Ola Nakken
Jonas Christoffer Lindstrøm
Ole-Bjørn Tysnes
Trygve Holmøy
Author Affiliation
a Institute of Clinical Medicine , Campus Ahus, University of Oslo , Oslo , Norway.
Source
Amyotroph Lateral Scler Frontotemporal Degener. 2018 05; 19(3-4):303-310
Date
05-2018
Language
English
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Keywords
Age Distribution
Aged
Amyotrophic Lateral Sclerosis - epidemiology - mortality
Cause of Death
Death Certificates
Female
Humans
Male
Middle Aged
Norway - epidemiology
Prevalence
Registries
Retrospective Studies
Risk factors
Sex Distribution
Abstract
In Norway, diagnoses from specialist health care visits, drug prescriptions, and causes of deaths are registered in compulsory health registers. We aimed to determine amyotrophic lateral sclerosis (ALS) prevalence from 2009 to 2015 by combining these registers.
We validated the Norwegian Patient Registry (NPR) through hospital files, and linked it with the Norwegian Cause of Death Registry and the Norwegian Prescription Database. Poisson regression models were fitted for estimating gender ratios, time trends and possible interactions. Similar models were used for mortality data subtracted from the dataset.
Eleven percent of patients with at least one ALS-related entry in NPR did not have ALS. ALS prevalence could nevertheless be reliably estimated through ascertaining cases identified in two separate registers, or with at least two entries in NPR with first entry within four years prior to prevalence date. ALS prevalence remained stable, and was 7.6/100,000 (95% CI 6.9-8.4) at 31st December 2015. Mean male:female ratio was higher for prevalence (1.8; 95% CI 1.6-2.0) than for mortality (1.5; 95% CI 1.2-1.8) (p?=?0.04). There were also significant regional differences in prevalence (p?
PubMed ID
29271248 View in PubMed
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Assessing the degree of residual confounding: a cohort study on the association between disability pension and mortality.

https://arctichealth.org/en/permalink/ahliterature300382
Source
Eur J Public Health. 2018 10 01; 28(5):836-841
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Date
10-01-2018
Author
Daniel Olsson
Kristina Alexanderson
Matteo Bottai
Author Affiliation
Unit of Biostatistics, Department of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
Source
Eur J Public Health. 2018 10 01; 28(5):836-841
Date
10-01-2018
Language
English
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Keywords
Adult
Cause of Death
Cohort Studies
Confounding Factors (Epidemiology)
Disabled persons - statistics & numerical data
Female
Forecasting
Humans
Male
Middle Aged
Mortality - trends
Mortality, Premature
Pensions - statistics & numerical data
Proportional Hazards Models
Prospective Studies
Risk factors
Sweden
Young Adult
Abstract
Previous studies showed that disability pensioners have a higher risk of premature death than others, but residual confounding has been suggested. The aim was to assess the degree of residual confounding of the association between disability pension (DP) and risk of premature death.
Prospective cohort study of everyone aged 19-64 years, living in Sweden 31 December 2004 (n = 5 406 469), followed up through 2010. Mortality hazard rates over time were estimated for three groups; incident disability pensioners during 2005 from start of DP (February-December 2005), prevalent disability pensioners (January 2005 or since before), and individuals not on DP in January 2005, after standardizing populations to characteristics of the incident disability pensioners, stratified by previous hospitalization or not. If DP has no immediate effect on mortality, incident disability pensioners and those not on DP should initially have similar hazard rates, thereby, allowing assessment of the degree of residual confounding.
For those not previously hospitalized, the mortality hazard rate on the first DP day was: 3.07 (95% CI 2.21, 4.36), 2.09 (1.78, 2.48) and 0.78 (0.73, 0.84) per thousand person-years for incident, prevalent, and non DP, respectively. Among previously hospitalized these figures were: 21.67 (17.73, 26.24), 17.00 (15.76, 18.51) and 18.88 (18.14, 19.64) respectively. Hazard ratios were 1.15 (0.94, 1.40) in the strata with and 3.94 (2.78, 5.57) in the strata without, previous hospitalization comparing incident DP with non-DP.
Substantial residual confounding was found in the association between DP and premature death among those not previously hospitalized.
PubMed ID
29514214 View in PubMed
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Assessment of Use vs Discontinuation of Oral Anticoagulation After Pulmonary Vein Isolation in Patients With Atrial Fibrillation.

https://arctichealth.org/en/permalink/ahliterature300413
Source
JAMA Cardiol. 2017 02 01; 2(2):146-152
Publication Type
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't
Date
02-01-2017
Author
Sara Själander
Fredrik Holmqvist
J Gustav Smith
Pyotr G Platonov
Milos Kesek
Peter J Svensson
Carina Blomström-Lundqvist
Fariborz Tabrizi
Jari Tapanainen
Dritan Poci
Anders Jönsson
Anders Själander
Author Affiliation
Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
Source
JAMA Cardiol. 2017 02 01; 2(2):146-152
Date
02-01-2017
Language
English
Publication Type
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't
Keywords
Administration, Oral
Age Factors
Anticoagulants - administration & dosage
Atrial Fibrillation - complications - drug therapy - surgery
Brain Ischemia - epidemiology - etiology - prevention & control
Catheter Ablation - methods
Cause of Death - trends
Female
Follow-Up Studies
Humans
Incidence
Male
Middle Aged
Prognosis
Pulmonary Veins - surgery
Retrospective Studies
Risk Assessment - methods
Risk factors
Survival Rate - trends
Sweden - epidemiology
Time Factors
Warfarin - administration & dosage
Withholding Treatment
Abstract
Pulmonary vein isolation (PVI) is a recommended treatment for patients with atrial fibrillation, but it is unclear whether it results in a lower risk of stroke.
To investigate the proportion of patients discontinuing anticoagulation treatment after PVI in association with the CHA2DS2-VASc (congestive heart failure, hypertension, age =75 years [doubled], diabetes, stroke [doubled], vascular disease, age 65-74 years, sex category [female]) score, identify factors predicting stroke after PVI, and explore the risk of cardiovascular events after PVI in patients with and without guideline-recommended anticoagulation treatment.
A retrospective cohort study was conducted using Swedish national health registries from January 1, 2006, to December 31, 2012, with a mean-follow up of 2.6 years. A total of 1585 patients with atrial fibrillation undergoing PVI from the Swedish Catheter Ablation Register were included, with information about exposure to warfarin in the national quality register Auricula. Data analysis was performed from January 1, 2015, to April 30, 2016.
Warfarin treatment.
Ischemic stroke, intracranial hemorrhage, and death.
In this cohort of 1585 patients, 73.0% were male, the mean (SD) age was 59.0 (9.4) years, and the mean (SD) CHA2DS2-VASc score was 1.5 (1.4). Of the 1585 patients, 1175 were followed up for more than 1 year after PVI. Of these, 360 (30.6%) discontinued warfarin treatment during the first year. In patients with a CHA2DS2-VASc score of 2 or more, patients discontinuing warfarin treatment had a higher rate of ischemic stroke (5 events in 312 years at risk [1.6% per year]) compared with those continuing warfarin treatment (4 events in 1192 years at risk [0.3% per year]) (P?=?.046). Patients with a CHA2DS2-VASc score of 2 or more or those who had previously experienced an ischemic stroke displayed a higher risk of stroke if warfarin treatment was discontinued (hazard ratio, 4.6; 95% CI, 1.2-17.2; P?=?.02 and hazard ratio, 13.7; 95% CI, 2.0-91.9; P?=?.007, respectively).
These findings indicate that discontinuation of warfarin treatment after PVI is not safe in high-risk patients, especially those who have previously experienced an ischemic stroke.
Notes
CommentIn: JAMA Cardiol. 2017 Feb 1;2(2):152-154 PMID 27893050
PubMed ID
27893055 View in PubMed
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Bivalirudin versus heparin with primary percutaneous coronary intervention.

https://arctichealth.org/en/permalink/ahliterature299494
Source
Am Heart J. 2018 07; 201:9-16
Publication Type
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't
Date
07-2018
Author
Dimitrios Venetsanos
Sofia Sederholm Lawesson
Stefan James
Sasha Koul
David Erlinge
Eva Swahn
Joakim Alfredsson
Author Affiliation
Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden. Electronic address: dimitrios.venetsanos@liu.se.
Source
Am Heart J. 2018 07; 201:9-16
Date
07-2018
Language
English
Publication Type
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't
Keywords
Aged
Antithrombins - therapeutic use
Cause of Death - trends
Coronary Angiography
Coronary Restenosis - epidemiology - prevention & control
Female
Fibrinolytic Agents - therapeutic use
Follow-Up Studies
Heparin - therapeutic use
Hirudins
Humans
Incidence
Male
Peptide Fragments - therapeutic use
Percutaneous Coronary Intervention - methods
Recombinant Proteins - therapeutic use
Registries
Retrospective Studies
ST Elevation Myocardial Infarction - diagnosis - surgery
Stents
Sweden - epidemiology
Treatment Outcome
Abstract
Optimal adjunctive therapy in ST-segment elevation myocardial infarction (STEMI) patients treated with primary PCI (PPCI) remains a matter of debate. Our aim was to compare the efficacy and safety of bivalirudin to unfractionated heparin (UFH), with or without glycoprotein IIb/IIIa inhibitors (GPI) in a large real-world population, using data from the Swedish national registry, SWEDEHEART.
From 2008 to 2014 we identified 23,800 STEMI patients presenting within 12?hours from symptom onset treated with PPCI and UFH?±?GPI or bivalirudin±GPI. Primary outcomes included 30-day all-cause mortality and major in-hospital bleeding. Multivariable regression models and propensity score modelling were utilized to study adjusted association between treatment and outcome.
Treatment with UFH?±?GPI was associated with similar risk of 30-day mortality compared to bivalirudin±GPI (5.3% vs 5.5%, adjusted HR 0.94; 95% CI 0.82-1.07). The adjusted risk for 1-year mortality, 30-day and 1-year stent thrombosis and re-infarction did not differ significantly between UFH?±?GPI and bivalirudin±GPI. In contrast, treatment with UFH?±?GPI was associated with a significant higher risk of major in-hospital bleeding (adjusted OR 1.62; 95% CI 1.30-2.03). When including GPI use in the multivariable analysis, the difference was attenuated and no longer significant (adjusted OR 1.25; 95% CI 0.92-1.70).
Bivalirudin±GPI was associated with significantly lower risk for major inhospital bleeding but no significant difference in 30-day or one year mortality, stent thrombosis or re-infarction compared with UFH?±?GPI. The bleeding reduction associated with bivalirudin could be explained by the greater GPI use with UFH.
PubMed ID
29910059 View in PubMed
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59 records – page 1 of 6.