Cardiogenic shock remains the leading cause of in hospital death in acute myocardial infarction (AMI) and is associated with a mortality rate of approximately 50%. Here we investigated the 17-year trends in incidence and prognosis of AMI-induced cardiogenic shock in Västra Götaland in western Sweden, an area with approximately 1.6 million inhabitants. The study period includes the transition from thrombolysis to primary percutaneous coronary intervention (PCI) as the region-wide therapy of choice for patients with ST-elevation myocardial infarction (STEMI).
Data on patients hospitalized in cardiac care units in Västra Götaland, Sweden between 1995 and 2013 were obtained from the Swedish Websystem for Enhancement of Evidence-based Care in Heart Disease Evaluated According to Recommended Therapies (SWEDEHEART). We determined the incidence of cardiogenic shock among patients diagnosed with AMI and the risk of death associated with developing cardiogenic shock. We fitted logistic regression models to study which factors predicted post-AMI cardiogenic shock. Analyses were performed on complete case data as well as after multiple imputation of missing data.
Incidence of cardiogenic shock as a complication of AMI declined in western Sweden in the past decade, from 14% in 1995 to 4% in 2012. The risk of dying once cardiogenic shock had developed increased during the study period (p
Panoramic radiographs (PMX)s may provide information about systemic health conditions.
i). To study clinical periodontal conditions and collect self-reported health status in a cohort of 1084 older subjects; ii). to study signs of alveolar bone loss and carotid calcification from panoramic radiographs obtained from these subjects; and iii). to study associations between study parameters.
PMXs from 1064 adults aged 60-75 (mean age 67.6, SD +/- 4.7) were studied. Signs of alveolar bone loss, vertical defects, and molar furcation radiolucencies defined periodontal status. Medical health histories were obtained via self-reports. Signs of carotid calcification were identified from panoramic radiographs.
The PMX allowed assessment of 53% of the films (Seattle 64.5% and Vancouver 48.4%). A self-reported history of a stroke was reported by 8.1% of men in Seattle and 2.9% of men in Vancouver (P
INTRODUCTION: Angiogenesis constitutes the regulation of collateral formation in subjects with ischaemic syndromes and is also a prerequisite for cancer progression. Patients with severe symptomatic ischaemic syndromes may have a reduced ability for angiogenesis and thus a lower risk to develop cancer. SUBJECTS AND METHODS: Patients below 80 years and treated for acute myocardial infarction (AMI), angina pectoris (AP), intermittent claudication (IC) or undergoing revascularization during 1972-1991 in Stockholm county (n=63 921) were followed regarding cancer incidence 1972-2000. Cancer incidence was compared with that of the general population of Stockholm County by standardized incidence ratios (SIR). RESULTS: An increased incidence of cancer overall compared with the general population was seen in patients treated for AMI [SIR men 1.08 (95% Confidence Interval 1.04-1.11) and women 1.15 (1.09-1.21)], AP [men 1.16 (1.11-1.21) and women 1.06 (1.00-1.12)] and IC [men 1.48 (1.31-1.64) and women 1.43 (1.17-1.68)]. This increase was mainly due to an increased incidence of tobacco-related cancer. In patients undergoing revascularization no increase in incidence was seen [SIR men 0.97 (0.91-1.03) and women 1.06 (0.91-1.20)]. CONCLUSION: Patients with mild to moderate symptomatic ischaemic syndromes are, as expected, at increased risk of subsequently develop tobacco-related cancer. A lack of increased cancer risk in patients undergoing revascularization could be due to a reduced ability for angiogenesis in patients with severe atherosclerotic disease but may also be related to lifestyle changes.
The prognostic significance of age and continuous positive airway pressure (CPAP) therapy on cardiovascular disease in patients with sleep apnoea has not been assessed previously.
Using nationwide databases, the entire Danish population was followed from 2000 until 2011. First-time sleep apnoea diagnoses and use of CPAP therapy were determined. Incidence rate ratios (IRRs) of ischaemic stroke and myocardial infarction (MI) were analysed using Poisson regression models.
Amongst 4.5 million individuals included in the study, 33 274 developed sleep apnoea (mean age 53, 79% men) of whom 44% received persistent CPAP therapy. Median time to initiation of CPAP therapy was 88 days (interquartile range 34-346). Patients with sleep apnoea had more comorbidities compared to the general population. Crude rates of MI and ischaemic stroke were increased for sleep apnoea patients (5.4 and 3.6 events per 1000 person-years compared to 4.0 and 3.0 in the general population, respectively). Relative to the general population, risk of MI [IRR 1.71, 95% confidence interval (CI) 1.57-1.86] and ischaemic stroke (IRR 1.50, 95% CI 1.35-1.66) was significantly increased in patients with sleep apnoea, in particular in patients younger than 50 years (IRR 2.12, 95% CI 1.64-2.74 and IRR 2.34, 95% CI 1.77-3.10, respectively). Subsequent CPAP therapy was not associated with altered prognosis.
Sleep apnoea is associated with increased risk of ischaemic stroke and MI, particularly in patients younger than 50 years of age. CPAP therapy was not associated with a reduced rate of stroke or MI.
AIM: To describe the characteristics and outcome among patients suffering in-hospital cardiac arrest in relation to whether the arrest took place in a ward with monitoring facilities. METHODS: All patients who suffered an in-hospital cardiac arrest during a 4-year period in Sahlgrenska Hospital, Göteborg, Sweden and in whom resuscitative efforts were attempted, were prospectively recorded and described in terms of characteristics and outcome. RESULTS: Among 557 patients, 292 (53%) had a cardiac arrest in wards with monitoring facilities. Those in a monitored location more frequently had a confirmed or possible acute myocardial infarction (AMI) as judged to be the cause of arrest (P
Cockcroft-Gault is better than the Modification of Diet in Renal Disease study formula at predicting outcome after a myocardial infarction: data from the Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies (SWEDEHEART).
BACKGROUND: The aim was to examine whether the Modification of Diet in Renal Disease (MDRD) or the Cockcroft-Gault (CG) formula is better at predicting prognosis in myocardial infarction (MI) patients. METHODS: All consecutive MI patients entered in a nationwide registry between 2003 and 2006 with glomerular filtration rate (eGFR) estimated by both the MDRD and CG formula (N = 36,137) were analyzed. RESULTS: Cockcroft-Gault classified a larger proportion of patients as having at least a moderate (39.8% vs 31.1%, P
The severity of coronary atherosclerosis at autopsy was studied in two series comprising 169 cases of coronary death and 231 people who died of violent causes. In the former the fatal attack lasted less than 24 hours from the onset of symptoms in 70% of cases. In only three men did the terminal attack last more than 24 hours, while in the remaining 28% of cases, although death was not witnessed these were also likely to have been sudden deaths. A recent infarct with or without an old myocardial infarct was found at autopsy in 47% of cases and an old infarct alone in 34%. In 19% of coronary deaths no recent or old infarct was detected. The surface areas of the atherosclerotic lesions were assessed in arterial specimens by pointcounting. The degree of stenosis was estimated visually. The mean extent of raised lesions and clacification and the median value of stenosis score, which expressed the degree of stensosi in the coronary arterial tree, were significantly higher in all age groups in persons who died of coronary heart disease than in those who died violently. A marked overlapping between the individuals in the two series was, however, found in both for the exent of raised lesions and the severity of stenosis score. Raised lesions in coronary patients were calcified to about the same extent as those in persons ten years older in the series of violent deaths. Coronary atherosclerosis was most severe in coronary patients who had had symptomatic heart disease and had an old myocardial infarct and least severe in those in whome sudden death was the first manifestation of coronary heart disease from violent deaths as regards the extent of the raised lesions or prevalence of occlusion. The degree of coronary stenosis in coronary patients was closely related to the total extent of advanced coronary atherosclerosis.
AIMS: The authors describe the occurrence of diabetes and obesity in the population of Northern Sweden and the role of diabetes in cardiovascular disease. METHODS: Four surveys of the population aged 25 to 64 years were undertaken during a 14-year time span. Stroke events in subjects 35-74 years during 1985-92 and myocardial infarction in subjects 25-64 years 1989-93 were registered. RESULTS: The prevalence of diagnosed diabetes was 3.1 and 2.0% in men and women, respectively, and 2.6 and 2.7% for previously undiagnosed diabetes. During the 13-year observation period, BMI increased 0.96 kg/m(2) in men and 0.87 in women. The proportion of subjects with obesity (BMI>or=30) increased from 10.3% to 14.6% in men and from 12.5% to 15.7% in women. Hip circumference increased substantially more than waist circumference, leading to a decreasing waits-to-hip ratio (WHR). The relative risk for stroke or myocardial infarction was four to six times higher in a person with diabetes than in those without diabetes. The 28-day case fatality for myocardial infarction, but not for stroke, was significantly higher in both men and women with diabetes. Population-attributable risk for diabetes and stroke was 18% in men and 22% in women and for myocardial infarction it was 11% in men and 17% in women. CONCLUSION: Obesity is becoming more common, although of a more distal than central distribution. The burden of diabetes in cardiovascular diseases in Northern Sweden is high.
The association of dietary glycaemic index (GI) and glycaemic load (GL) with CVD has been examined in several populations with varying results. We tested the hypothesis that women with diets high in GI or GL would have higher rates of myocardial infarction (MI), and the associations would be stronger in overweight women. We measured dietary GI and GL in 36,234 Swedish Mammography Cohort participants aged 48-83 years using FFQ. Cox models were used to calculate incidence rate ratios (RR) and 95 % CI for hospitalisation or death due to MI assessed using the Swedish inpatient and cause-of-death registers from 1 January 1998 until 31 December 2006. Over 9 years of follow-up, 1138 women were hospitalised or died due to a first MI. In multivariable-adjusted models, the RR comparing top to bottom quartile of dietary GI were 1.12 (95 % CI 0.92, 1.35, P-trend = 0.24), and the RR comparing top to bottom quartile of dietary GL were 1.22 (95 % CI 0.90, 1.65, P-trend = 0.23). Among overweight women, the RR comparing top to bottom quartile of dietary GI were 1.20 (95 % CI 0.91, 1.58, P-trend = 0.22), and the RR comparing top to bottom quartile of dietary GL were 1.45 (95 % CI 0.93, 2.25, P-trend = 0.16). There were no statistically significant associations of dietary GI or GL with MI in this population.