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Aiming toWards Evidence baSed inTerpretation of Cardiac biOmarkers in patients pResenting with chest pain-the WESTCOR study: study design.

https://arctichealth.org/en/permalink/ahliterature310408
Source
Scand Cardiovasc J. 2019 Oct; 53(5):280-285
Publication Type
Journal Article
Date
Oct-2019
Author
Hilde L Tjora
Ole-Thomas Steiro
Jørund Langørgen
Rune Bjørneklett
Ottar K Nygård
Renate Renstrøm
Øyvind Skadberg
Vernon V S Bonarjee
Bertil Lindahl
Paul Collinson
Torbjørn Omland
Kjell Vikenes
Kristin M Aakre
Author Affiliation
Emergency Care Clinic, Haukeland University Hospital , Bergen , Norway.
Source
Scand Cardiovasc J. 2019 Oct; 53(5):280-285
Date
Oct-2019
Language
English
Publication Type
Journal Article
Keywords
Acute Coronary Syndrome - blood - diagnosis - mortality
Algorithms
Angina, Unstable - blood - diagnosis - mortality
Biomarkers - blood
Computed Tomography Angiography
Coronary Angiography - methods
Cross-Sectional Studies
Humans
Multicenter Studies as Topic
Non-ST Elevated Myocardial Infarction - blood - diagnosis - mortality
Norway
Observational Studies as Topic
Predictive value of tests
Prognosis
Prospective Studies
Reproducibility of Results
Research Design
Troponin - blood
Abstract
Objectives. The main aim of the Aiming toWards Evidence baSed inTerpretation of Cardiac biOmarkers in patients pResenting with chest pain (WESTCOR-study) (Clinical Trials number NCT02620202) is to improve diagnostic pathways for patients presenting to the Emergency department (ED) with acute chest pain. Design. The WESTCOR-study is a two center, cross-sectional and prospective observational study recruiting unselected patients presenting to the ED with suspected non-ST elevation acute coronary syndrome (NSTE-ACS). Patient inclusion started September 2015 and we plan to include 2250 patients, finishing in 2019. The final diagnosis will be adjudicated by two independent cardiologists based on all available information including serial high sensitivity cardiac troponin measurements, coronary angiography, coronary CT angiography and echocardiography. The study includes one derivation cohort (N?=?985) that will be used to develop rule out/rule in algorithms for NSTEMI and NSTE-ACS (if possible) using novel troponin assays, and to validate established NSTEMI algorithms, with and without clinical scoring systems. The study further includes one subcohort (n?=?500) where all patients are examined with coronary CT angiography independent of biomarker status, aiming to assess the associations between biomarkers and the extent and severity of coronary atherosclerosis. Finally, an external validation cohort (N?=?750) will be included at Stavanger University Hospital. Prospective studies will be based on the merged cohorts. Conclusion. The WESTCOR study will provide new diagnostic algorithms for early inclusion and exclusion of NSTE-ACS and insights in the associations between cardiovascular biomarkers, CT-angiographic findings and short and long-term clinical outcomes.
PubMed ID
31216908 View in PubMed
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All types of atrial fibrillation in the setting of myocardial infarction are associated with impaired outcome.

https://arctichealth.org/en/permalink/ahliterature283806
Source
Heart. 2016 Jun 15;102(12):926-33
Publication Type
Article
Date
Jun-15-2016
Author
Batra
Svennblad
Held
Jernberg
Johanson
Wallentin
Oldgren
Source
Heart. 2016 Jun 15;102(12):926-33
Date
Jun-15-2016
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Atrial Fibrillation - diagnosis - epidemiology - mortality - therapy
Brain ischemia - epidemiology
Cause of Death
Comorbidity
Female
Humans
Kaplan-Meier Estimate
Male
Middle Aged
Multivariate Analysis
Non-ST Elevated Myocardial Infarction - diagnosis - epidemiology - mortality - therapy
Prognosis
Proportional Hazards Models
Recurrence
Registries
Retrospective Studies
Risk assessment
Risk factors
ST Elevation Myocardial Infarction - diagnosis - epidemiology - mortality - therapy
Stroke - epidemiology
Sweden - epidemiology
Time Factors
Abstract
To evaluate 90-day cardiovascular outcome in patients after myocardial infarction (MI) in relation to different subtypes of atrial fibrillation (AF) and MI.
We studied 155,071 hospital survivors of MI between 2000 and 2009 in Swedish registries. AF subtypes were defined according to history of AF and in-hospital ECG recordings. Clinical outcomes were evaluated with multivariable Cox models.
AF was documented in 24,023 (15.5%) cases. The AF subtypes were new-onset AF with sinus rhythm at discharge (3.7%), new-onset AF with AF at discharge (3.9%), paroxysmal AF (4.9%) and chronic AF (3.0%). The event rate per 100 person-years for the composite cardiovascular outcome (all-cause mortality, MI or ischaemic stroke) was 90.9 in patients with any type of AF versus 45.2 in patients with sinus rhythm, adjusted hazard ratio with 95% CI (HR) 1.28 (1.19 to 1.37). There were no significant differences in the composite cardiovascular outcome between AF subtypes. AF was associated with higher risk of mortality, HR 1.59 (1.41 to 1.80), reinfarction, HR 1.14 (1.05 to 1.24), and ischaemic stroke, HR 2.29 (1.92 to 2.74), respectively. In subgroup analysis, AF was associated with a higher risk of composite cardiovascular outcome in the non-ST-elevation myocardial infarction (NSTEMI) and ST-elevation myocardial infarction (STEMI) cohort, HR 1.24 (1.13 to 1.36) and HR 1.34 (1.21 to 1.48), respectively, with p value for interaction=0.23.
AF is common in the setting of MI and is associated with a higher risk of composite cardiovascular outcome and the individual components; mortality, reinfarction and ischaemic stroke, respectively. No major difference in outcome was observed between AF subtypes. No difference in outcome for AF was observed between the NSTEMI and STEMI cohort.
PubMed ID
26928408 View in PubMed
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Ankle brachial index most important to identify polyvascular disease in patients with non-ST elevation or ST-elevation myocardial infarction.

https://arctichealth.org/en/permalink/ahliterature284679
Source
Eur J Intern Med. 2016 May;30:55-60
Publication Type
Article
Date
May-2016
Author
Birgitta Jönelid
Nina Johnston
Lars Berglund
Bertil Andrén
Björn Kragsterman
Christina Christersson
Source
Eur J Intern Med. 2016 May;30:55-60
Date
May-2016
Language
English
Publication Type
Article
Keywords
Aged
Ankle Brachial Index
Carotid Arteries - diagnostic imaging
Coronary Angiography
Female
Humans
Logistic Models
Male
Middle Aged
Non-ST Elevated Myocardial Infarction - complications
Peripheral Arterial Disease - diagnosis - epidemiology
Predictive value of tests
Prognosis
Risk factors
ST Elevation Myocardial Infarction - complications
Stroke - epidemiology
Sweden
Ultrasonography
Abstract
Atherosclerosis is a systemic disease. In patients with acute myocardial infarction (MI) the extent of polyvascular disease (PvD) is largely unknown. In this study we investigate the prevalence and clinical characteristics predictive of PvD in patients with non-ST-elevation (NSTEMI) and ST-elevation (STEMI) MI.
375 patients with acute MI included in the REBUS (Relevance of Biomarkers for Future Risk of Thromboembolic Events in Unselected Post-myocardial Infarction Patients) study were examined. Atherosclerotic changes were assessed in three arterial beds by coronary angiography, carotid ultrasound and ankle brachial index (ABI). Results compared findings of atherosclerosis in three arterial beds to fewer than 3 beds. PvD was defined as atherosclerosis in all three arterial beds.
A medical history of MI, peripheral artery disease (PAD) or stroke was reported at admission in 17.9%, 2.1% and 3.7% of the patients, respectively. After evaluation, abnormal ABI was found in 20.3% and carotid artery atherosclerosis in 54.9% of the patients. In the total population, PvD was found in 13.8% of patients with no significant differences observed between NSTEMI and STEMI patients. Age (p
PubMed ID
26776925 View in PubMed
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Answer to Dr. Sabours letter about our article 'the validity of hospital discharge register data on non-ST-elevation and ST-elevation myocardial infarction in Finland'.

https://arctichealth.org/en/permalink/ahliterature305416
Source
Scand Cardiovasc J. 2020 10; 54(5):338
Publication Type
Letter
Comment
Date
10-2020
Author
Marjo Okkonen
Aki S Havulinna
Olavi Ukkola
Veikko Salomaa
Author Affiliation
Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital, and University of Oulu, Oulu, Finland.
Source
Scand Cardiovasc J. 2020 10; 54(5):338
Date
10-2020
Language
English
Publication Type
Letter
Comment
Keywords
Finland - epidemiology
Hospitals
Humans
Non-ST Elevated Myocardial Infarction
Patient Discharge
ST Elevation Myocardial Infarction - diagnosis - epidemiology - therapy
Notes
CommentOn: Scand Cardiovasc J. 2020 Apr;54(2):108-114 PMID 31701776
CommentOn: Scand Cardiovasc J. 2020 Oct;54(5):336-337 PMID 32998593
PubMed ID
32597231 View in PubMed
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Diabetes, metformin and glucose lowering therapies after myocardial infarction: Insights from the SWEDEHEART registry.

https://arctichealth.org/en/permalink/ahliterature304180
Source
Diab Vasc Dis Res. 2020 Nov-Dec; 17(6):1479164120973676
Publication Type
Journal Article
Observational Study
Research Support, Non-U.S. Gov't
Author
Viveca Ritsinger
Bo Lagerqvist
Pia Lundman
Emil Hagström
Anna Norhammar
Author Affiliation
Department of Medicine K2, Cardiology Unit, Karolinska Institutet, Stockholm, Sweden.
Source
Diab Vasc Dis Res. 2020 Nov-Dec; 17(6):1479164120973676
Language
English
Publication Type
Journal Article
Observational Study
Research Support, Non-U.S. Gov't
Keywords
Aged
Biomarkers - blood
Blood Glucose - drug effects - metabolism
Diabetes Mellitus - blood - diagnosis - drug therapy - mortality
Female
Heart Disease Risk Factors
Humans
Hypoglycemic Agents - adverse effects - therapeutic use
Insulin - adverse effects - therapeutic use
Male
Metformin - adverse effects - therapeutic use
Middle Aged
Non-ST Elevated Myocardial Infarction - diagnostic imaging - mortality
Recurrence
Registries
Risk assessment
ST Elevation Myocardial Infarction - diagnostic imaging - mortality
Sweden
Time Factors
Treatment Outcome
Abstract
To explore real-life use of glucose lowering drugs and prognosis after acute myocardial infarction (AMI) with a special focus on metformin.
Patients (n?=?70270) admitted for AMI 2012-2017 were stratified by diabetes status and glucose lowering treatment and followed for mortality and MACE+ (AMI, heart failure (HF), stroke, mortality) until end of 2017 (mean follow-up time 3.4?±?1.4?years) through linkage with national registries and SWEDEHEART. Hazard ratios (HR) were calculated in adjusted Cox proportional hazard regression models.
Mean age was 68?±?11?years and 70% were male. Of patients with diabetes (n?=?16356; 23%), a majority had at least one glucose lowering drug (81%) of whom 51% had metformin (24% monotherapy), 43% insulin and a minority any SGLT2i/GLP-1 RA (5%). Adjusted HR for patients with versus without diabetes was 1.31 (95% CI 1.27-1.36) for MACE+ and 1.48 (1.41-1.56) for mortality. Adjusted HR for MACE+ for diabetes patients on metformin was 0.92 (0.85-0.997), p?=?0.042 compared to diet treated diabetes.
Diabetes still implies a high complication risk after AMI. Metformin and insulin were the most common treatment used in almost half of the diabetes population. Furthermore, patients treated with metformin had a lower cardiovascular risk after AMI and needs to be confirmed in prospective controlled trials.
PubMed ID
33231125 View in PubMed
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Does access to invasive examination and treatment influence socioeconomic differences in case fatality for patients admitted for the first time with non-ST-elevation myocardial infarction or unstable angina?

https://arctichealth.org/en/permalink/ahliterature281609
Source
EuroIntervention. 2016 Apr 20;11(13):1495-502
Publication Type
Article
Date
Apr-20-2016
Author
Solvej Mårtensson
Dorte Gyrd-Hansen
Eva Prescott
Per Kragh Andersen
Gunnar Gislason
Rikke Kart Jacobsen
Merete Osler
Source
EuroIntervention. 2016 Apr 20;11(13):1495-502
Date
Apr-20-2016
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Angina, Unstable - therapy
Coronary Angiography
Coronary Artery Bypass - methods
Denmark
Female
Humans
Male
Middle Aged
Non-ST Elevated Myocardial Infarction - economics - therapy
Percutaneous Coronary Intervention
Socioeconomic Factors
Time Factors
Treatment Outcome
Abstract
Our aim was to investigate whether there is social inequality in access to invasive examination and treatment, and whether access explains social inequality in case fatality in a nationwide sample of patients admitted for the first time with unstable angina or non-ST-elevation myocardial infarction (NSTEMI) in Denmark.
All patients admitted for the first time with NSTEMI (n=16,625) or unstable angina (n=8,800) from 2001 to 2009 in Denmark were included. We measured time from admission to coronary angiography (CAG), percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG). The outcomes were 30-day and one-year case fatality. We found social inequality in access to CAG and one-year case fatality for both NSTEMI and unstable angina patients, but the time waited for CAG did not explain the social inequality in case fatality.
Despite nominal equal access to health care, social inequality in case fatality after NSTEMI and unstable angina exists in Denmark. The patients with the shortest education waited longer for angio-graphy; however, this did not seem to explain inequality in case fatality. This register-based study was approved by the Danish Data Protection Agency (Approval number 2010-41-5263). Register-based studies do not need approval by a medical ethics committee in Denmark.
PubMed ID
26348677 View in PubMed
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Editor's Choice- Gender difference in prognostic impact of in-hospital bleeding after myocardial infarction - data from the SWEDEHEART registry.

https://arctichealth.org/en/permalink/ahliterature281412
Source
Eur Heart J Acute Cardiovasc Care. 2016 Oct;5(6):463-472
Publication Type
Article
Date
Oct-2016
Author
Anna Holm
Sofia Sederholm Lawesson
Eva Swahn
Joakim Alfredsson
Source
Eur Heart J Acute Cardiovasc Care. 2016 Oct;5(6):463-472
Date
Oct-2016
Language
English
Publication Type
Article
Keywords
Adrenergic beta-Antagonists - therapeutic use
Aged
Angiotensin-Converting Enzyme Inhibitors - therapeutic use
Female
Hemorrhage - mortality
Hospital Mortality
Hospitalization
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use
Incidence
Male
Non-ST Elevated Myocardial Infarction - drug therapy - mortality
Platelet Aggregation Inhibitors - therapeutic use
Prognosis
ST Elevation Myocardial Infarction - drug therapy - mortality
Sex Distribution
Sex Factors
Sweden - epidemiology
Warfarin - therapeutic use
Abstract
Bleeding complications increase mortality in myocardial infarction patients. Potential gender difference in bleeding regarding prevalence and prognostic impact is still controversial.
Gender comparison regarding incidence and prognostic impact of bleeding in patients hospitalised with myocardial infarction during 2006-2008.
Observational study from the SWEDEHEART register. Outcomes were in-hospital bleedings, in-hospital mortality and one-year mortality in hospital survivors.
A total number of 50,399 myocardial infarction patients were included, 36.6% women. In-hospital bleedings were more common in women (1.9% vs. 3.1%, p
PubMed ID
26450782 View in PubMed
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Health-related quality of life in older patients with acute coronary syndrome randomised to an invasive or conservative strategy. The After Eighty randomised controlled trial.

https://arctichealth.org/en/permalink/ahliterature294203
Source
Age Ageing. 2018 Jan 01; 47(1):42-47
Publication Type
Comparative Study
Journal Article
Multicenter Study
Randomized Controlled Trial
Date
Jan-01-2018
Author
Nicolai Tegn
Michael Abdelnoor
Lars Aaberge
Anette Hylen Ranhoff
Knut Endresen
Erik Gjertsen
Rita Skårdal
Lars Gullestad
Bjørn Bendz
Author Affiliation
Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
Source
Age Ageing. 2018 Jan 01; 47(1):42-47
Date
Jan-01-2018
Language
English
Publication Type
Comparative Study
Journal Article
Multicenter Study
Randomized Controlled Trial
Keywords
Acute Coronary Syndrome - diagnostic imaging - psychology - therapy
Age Factors
Aged, 80 and over
Angina, Unstable - diagnostic imaging - psychology - therapy
Conservative Treatment - adverse effects
Coronary Angiography
Coronary Artery Bypass - adverse effects
Female
Humans
Male
Non-ST Elevated Myocardial Infarction - diagnostic imaging - psychology - therapy
Norway
Percutaneous Coronary Intervention - adverse effects
Prospective Studies
Quality of Life
Risk factors
Surveys and Questionnaires
Time Factors
Treatment Outcome
Abstract
in the After Eighty study (ClinicalTrials.gov.number, NCT01255540), patients aged 80 years or more, with non-ST-elevation myocardial infarction (NSTEMI), and unstable angina pectoris (UAP), were randomised to either an invasive or conservative management approach. We sought to compare the effects of these management strategies on health related quality of life (HRQOL) after 1 year.
the After Eighty study was a prospective randomised controlled multicenter trial. In total, 457 patients aged 80 or over, with NSTEMI or UAP, were randomised to either an invasive strategy (n = 229, mean age: 84.7 years), involving early coronary angiography, with immediate evaluation for percutaneous coronary intervention, coronary artery bypass graft, optimal medical therapy, or to a conservative strategy (n = 228, mean age: 84.9 years). The Short Form 36 health survey (SF-36) was used to assess HRQOL at baseline, and at the 1-year follow-up.
baseline SF-36 completion was achieved for 208 and 216 patients in the invasive and conservative groups, respectively. A total of 137 in the invasive group and 136 patients in the conservative group completed the SF-36 form at follow-up. When comparing the changes from follow-up to baseline (delta) no significant changes in quality-of-life scores were observed between the two strategies in any of the domains, expect for a small but statistically significant difference in bodily pain. This difference in only one of the SF-36 subscales may not necessarily be clinically significant.
from baseline to the 1 year follow-up, only minor differences in change of HRQOL as measured by SF-36 were seen by comparing an invasive and conservative strategy.
NCT01255540.
PubMed ID
28985265 View in PubMed
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Higher risk of major adverse cardiac events after acute myocardial infarction in patients with schizophrenia.

https://arctichealth.org/en/permalink/ahliterature304684
Source
Open Heart. 2020 09; 7(2):
Publication Type
Journal Article
Observational Study
Date
09-2020
Author
Rubina Attar
Axel Wester
Sasha Koul
Svend Eggert
Christoffer Polcwiartek
Tomas Jernberg
David Erlinge
Pontus Andell
Author Affiliation
Cardiology and Clinical Sciences, Lund University, Lund, Sweden r.attar@rn.dk.
Source
Open Heart. 2020 09; 7(2):
Date
09-2020
Language
English
Publication Type
Journal Article
Observational Study
Keywords
Age Factors
Aged
Aged, 80 and over
Comorbidity
Female
Healthcare Disparities
Heart Failure - epidemiology - therapy
Humans
Male
Middle Aged
Non-ST Elevated Myocardial Infarction - diagnosis - epidemiology - mortality - therapy
Patient Readmission
Prevalence
Recurrence
Registries
Risk assessment
Risk factors
ST Elevation Myocardial Infarction - diagnosis - epidemiology - mortality - therapy
Schizophrenia - diagnosis - epidemiology - mortality - therapy
Secondary Prevention
Stroke - epidemiology - therapy
Sweden - epidemiology
Time Factors
Treatment Outcome
Abstract
Patients with schizophrenia are a high-risk population due to higher prevalences of cardiovascular risk factors and comorbidities that contribute to shorter life expectancy.
To investigate patients with and without schizophrenia experiencing an acute myocardial infarction (AMI) in relation to guideline recommended in-hospital management, discharge medications and 5-year major adverse cardiac events (MACE: composite of all-cause mortality, rehospitalisation for reinfarction, stroke or heart failure).
All patients with schizophrenia who experienced AMI during 2000-2018 were identified (n=1008) from the nationwide Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies registry and compared with AMI patients without schizophrenia (n=2?85?325). Kaplan-Meier survival curves and multivariable Cox regression models were used to compare the populations.
Patients with schizophrenia presented with AMI approximately 10 years earlier (median age 64 vs 73 years), and had higher prevalences of diabetes, heart failure and chronic obstructive pulmonary disease. They were less likely to be invasively investigated or discharged with aspirin, P2Y12 inhibitors, ACE inhibitors/angiotensin II receptor blockers, beta-blockers and statins (all p
PubMed ID
32994353 View in PubMed
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Hospital discharge register data on non-ST-elevation and ST-elevation myocardial infarction in Finland; terminology and statistical issues on validity and agreement to avoid misinterpretation.

https://arctichealth.org/en/permalink/ahliterature304696
Source
Scand Cardiovasc J. 2020 10; 54(5):336-337
Publication Type
Letter
Comment
Date
10-2020
Author
Siamak Sabour
Author Affiliation
Department of Clinical Epidemiology, School of Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Source
Scand Cardiovasc J. 2020 10; 54(5):336-337
Date
10-2020
Language
English
Publication Type
Letter
Comment
Keywords
Finland
Hospitals
Humans
Non-ST Elevated Myocardial Infarction
Patient Discharge
ST Elevation Myocardial Infarction - diagnosis - epidemiology - therapy
Notes
CommentOn: Scand Cardiovasc J. 2020 Apr;54(2):108-114 PMID 31701776
CommentIn: Scand Cardiovasc J. 2020 Oct;54(5):338 PMID 32597231
PubMed ID
32998593 View in PubMed
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17 records – page 1 of 2.