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[A controlled trial with prolonged follow up: percutaneous intervention in acute myocardial infarction is equivalent to thrombolytic therapy]

https://arctichealth.org/en/permalink/ahliterature53870
Source
Lakartidningen. 2001 Aug 8;98(32-33):3397-9
Publication Type
Article
Date
Aug-8-2001
Author
P. Tornvall
M. Johansson
I. Herzfeld
T. Nilsson
Author Affiliation
Kardiologiska kliniken, Karolinska sjukhuset, Stockholm. per.tornvall@ks.se
Source
Lakartidningen. 2001 Aug 8;98(32-33):3397-9
Date
Aug-8-2001
Language
Swedish
Publication Type
Article
Keywords
Aged
Angioplasty, Transluminal, Percutaneous Coronary
Case-Control Studies
Comparative Study
English Abstract
Female
Follow-Up Studies
Humans
Male
Middle Aged
Myocardial Infarction - drug therapy - mortality - therapy
Myocardial Reperfusion - methods
Shock - drug therapy - therapy
Thrombolytic Therapy - contraindications
Abstract
Previous studies comparing percutaneous coronary intervention (PCI) with thrombolysis for treatment of myocardial infarction with ST-elevation have in meta-analyses but not in randomized trials shown that PCI is more effective. Despite a large volume of primary PCI performed in Sweden no controlled trials have been carried out. The present study included 96 patients with myocardial infarction with ST-segment elevation treated with primary PCI 1995-1998. The main indications were shock (15 cases), contraindication to thrombolysis (24 cases), as an alternative to thrombolysis (57 cases), with a mortality in the respective groups of 67, 25 and 10 percent. Controls matched for age and infarct location and treated with thrombolysis could be identified for 55 of the patients treated with PCI. After four years 40 percent and 52 percent of the patients treated with PCI and thrombolysis respectively reached the combined endpoint of death/myocardial infarction/revascularization/angina pectoris (not significant). In conclusion, the study shows that primary PCI in patients with myocardial infarction with ST-segment elevation can be performed safely also in Sweden.
PubMed ID
11526657 View in PubMed
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[Acute coronary syndrome: regional experience of rendering urgent aid at prehospital stage in Khanty-Mansi Autonomous Okrug--Yugra].

https://arctichealth.org/en/permalink/ahliterature117732
Source
Kardiologiia. 2013;53(11):17-20
Publication Type
Article
Date
2013
Author
I A Urvantseva
L V Salamatina
I A Andreeva
E V Milovanova
S I Mamedova
O R Ibragimov
A A Seitov
Source
Kardiologiia. 2013;53(11):17-20
Date
2013
Language
Russian
Publication Type
Article
Keywords
Acute Coronary Syndrome - epidemiology - therapy
Ambulatory Care - methods
Electrocardiography
Emergency Medical Services - methods
Female
Fibrinolytic Agents - therapeutic use
Follow-Up Studies
Humans
Incidence
Male
Middle Aged
Prognosis
Retrospective Studies
Russia - epidemiology
Survival Rate - trends
Thrombolytic Therapy - methods
Time Factors
Abstract
Aim of the study was assessment of efficacy of rendering urgent aid to patients with acute coronary syndrome (ACS) at prehospital stage on the territory of Khanty-Mansi Autonomous Okrug (KhMAO). The analysis showed that yearly about 5000 inhabitants of KhMAO-Yugra received prehospital medical care (30% because of acute myocardial infarction, 70% because of unstable angina). Over 3 years portion of persons requesting medical aid during first 3 hours after onset of pain attack increased 6.1%. Rate of prehospital fibrinolysis did not exceed 6.5%. Alteplase was used most often (79.7%). Late patient's appeal was among causes of rare application of thrombolytic therapy (41.8%). Most physicians responsible for prehospital care considered it necessary to refer patients with ACS directly to centers of interventional cardiology. The data obtained would promote improvement of quality of medical aid to ACS patients at prehospital stage.
PubMed ID
24654430 View in PubMed
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Acute iliofemoral venous thrombosis in patients with atresia of the inferior vena cava can be treated successfully with catheter-directed thrombolysis.

https://arctichealth.org/en/permalink/ahliterature135647
Source
J Vasc Interv Radiol. 2011 Jun;22(6):801-5
Publication Type
Article
Date
Jun-2011
Author
Rikke Broholm
Maja Jørgensen
Sven Just
Leif P Jensen
Niels Bækgaard
Author Affiliation
Department of Vascular Surgery, Rigshospitalet and Gentofte Hospital, University of Copenhagen, Denmark. rbroholm@dadlnet.dk
Source
J Vasc Interv Radiol. 2011 Jun;22(6):801-5
Date
Jun-2011
Language
English
Publication Type
Article
Keywords
Acute Disease
Adolescent
Adult
Anticoagulants - administration & dosage
Catheterization, Peripheral
Denmark
Female
Femoral Vein - radiography
Fibrinolytic Agents - administration & dosage - adverse effects
Heparin - administration & dosage
Humans
Iliac Vein - radiography
Male
Middle Aged
Phlebography
Popliteal Vein
Retrospective Studies
Stockings, Compression
Thrombolytic Therapy - adverse effects
Time Factors
Tissue Plasminogen Activator - administration & dosage - adverse effects
Tomography, X-Ray Computed
Treatment Outcome
Vascular Malformations - complications - diagnosis
Vena Cava, Inferior - abnormalities - radiography - ultrasonography
Venous Thrombosis - complications - diagnosis - drug therapy
Warfarin - administration & dosage
Young Adult
Abstract
To assess the effectiveness and clinical outcomes of catheter-directed thrombolysis in patients with atresia of the inferior vena cava (IVC) and acute iliofemoral deep vein thrombosis (DVT).
From 2001 to 2009, 11 patients (median age, 32 y) with atresia of the IVC and acute iliofemoral DVT in 13 limbs were admitted for catheter-directed thrombolysis. Through a multiple-side hole catheter inserted in the popliteal vein, continuous pulse-spray infusion of tissue plasminogen activator and heparin was performed. Thrombolysis was terminated when all thrombus was resolved and venous outflow through the paravertebral collateral vessels was achieved. After thrombolysis, all patients received lifelong anticoagulation and compression stockings and were followed up at regular intervals.
Ultrasound or computed tomography revealed absence of the suprarenal segment of the IVC in two patients, and nine were diagnosed with absence of the infrarenal segment of the IVC. Median treatment time was 58 hours (range, 42-95 h). No deaths or serious complications occurred. Overall, complications were observed in four patients, one of whom required blood transfusion. Three patients were diagnosed with thrombophilia. Median follow-up was 37 months (range, 51 d to 96 mo). All patients had patent deep veins and one developed reflux in the popliteal fossa after 4 years. No thromboembolic recurrences were observed during follow-up.
Catheter-directed thrombolysis of patients with acute iliofemoral DVT and atresia of the IVC is a viable treatment option, as reasonable clinical outcomes can be obtained.
PubMed ID
21459610 View in PubMed
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Acute ischemic stroke and long-term outcome after thrombolysis: nationwide propensity score-matched follow-up study.

https://arctichealth.org/en/permalink/ahliterature260040
Source
Stroke. 2014 Oct;45(10):3070-2
Publication Type
Article
Date
Oct-2014
Author
Marie Louise Schmitz
Claus Z Simonsen
Heidi Hundborg
Hanne Christensen
Karsten Ellemann
Karin Geisler
Helle Iversen
Charlotte Madsen
Mary-Jette Rasmussen
Karsten Vestergaard
Grethe Andersen
Soeren P Johnsen
Source
Stroke. 2014 Oct;45(10):3070-2
Date
Oct-2014
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Denmark
Female
Fibrinolytic Agents - therapeutic use
Follow-Up Studies
Humans
Male
Middle Aged
Propensity Score
Proportional Hazards Models
Recurrence
Registries
Stroke - complications - drug therapy - mortality
Thrombolytic Therapy
Tissue Plasminogen Activator - therapeutic use
Treatment Outcome
Young Adult
Abstract
Data on long-term outcome after intravenous tissue-type plasminogen activator (tPA) in ischemic stroke are limited. We examined the risk of long-term mortality, recurrent ischemic stroke, and major bleeding, including intracranial and gastrointestinal bleeding, in intravenous tPA-treated patients when compared with intravenous tPA eligible but nontreated patients with ischemic stroke.
We conducted a register-based nationwide propensity score-matched follow-up study among patients with ischemic stroke in Denmark (2004-2011). Cox regression analysis was used to compute adjusted hazard ratios for all outcomes.
Among 4292 ischemic strokes (2146 intravenous tPA-treated and 2146 propensity score-matched nonintravenous tPA-treated patients), with a follow-up for a median of 1.4 years, treatment with intravenous tPA was associated with a lower risk of long-term mortality (adjusted hazard ratio, 0.66; 95% confidence interval, 0.49-0.88). The long-term risk of recurrent ischemic stroke (adjusted hazard ratio, 1.05; 95% confidence interval, 0.68-1.64) and major bleeding (adjusted hazard ratio, 0.59; 95% confidence interval, 0.24-1.47) did not differ significantly between the intravenous tPA-treated and nontreated patients.
Treatment with intravenous tPA in patients with ischemic stroke was associated with improved long-term survival.
PubMed ID
25190440 View in PubMed
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Acute myocardial infarction in Canada: improvement with time.

https://arctichealth.org/en/permalink/ahliterature197737
Source
CMAJ. 2000 Jul 11;163(1):41-2
Publication Type
Article
Date
Jul-11-2000
Author
A. Dodek
Author Affiliation
Cardiac Catheterization Laboratories, St. Paul's Hospital, Vancouver, BC.
Source
CMAJ. 2000 Jul 11;163(1):41-2
Date
Jul-11-2000
Language
English
Publication Type
Article
Keywords
Adrenergic beta-Antagonists - therapeutic use
Angioplasty, Balloon, Coronary
Angiotensin-Converting Enzyme Inhibitors - therapeutic use
Cardiovascular Agents - therapeutic use
Databases as Topic
Humans
Hypolipidemic Agents - therapeutic use
Myocardial Infarction - therapy
Outcome Assessment (Health Care)
Quebec
Survival Rate
Thrombolytic Therapy
Treatment Outcome
Notes
Cites: N Engl J Med. 1994 Oct 27;331(17):1130-57935638
Cites: N Engl J Med. 1999 Aug 26;341(9):625-3410460813
Cites: J Am Coll Cardiol. 1998 Aug;32(2):360-79708461
Cites: N Engl J Med. 1999 Nov 4;341(19):1413-910547403
Cites: J Am Coll Cardiol. 1999 Nov 1;34(5):1388-9410551683
Cites: CMAJ. 2000 Jul 11;163(1):31-610920727
Cites: N Engl J Med. 1993 Mar 18;328(11):779-848123063
Cites: Can J Cardiol. 1999 Oct;15(10):1095-10210523476
Cites: Can J Cardiol. 1995 Jun;11(6):477-867780868
Cites: N Engl J Med. 1996 Oct 3;335(14):1001-98801446
Cites: N Engl J Med. 1996 Oct 17;335(16):1198-2058815943
Cites: N Engl J Med. 1996 Dec 19;335(25):1888-968948565
Cites: Am J Cardiol. 1997 Jun 1;79(11):1441-69185630
Comment In: CMAJ. 2001 Feb 6;164(3):323-411232128
Comment In: CMAJ. 2001 Feb 6;164(3):323; author reply 32411232129
Comment On: CMAJ. 2000 Jul 11;163(1):31-610920727
PubMed ID
10920730 View in PubMed
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[Acute myocardial infarction in Mid-Norway: transportation for thrombolytic treatment or primary percutaneous coronary intervention?].

https://arctichealth.org/en/permalink/ahliterature140877
Source
Tidsskr Nor Laegeforen. 2010 Sep 9;130(17):1714-6
Publication Type
Article
Date
Sep-9-2010
Author
Hanne Saettem Beltesbrekke
Mari Bergan Husa
Harald Vik-Mo
Author Affiliation
Institutt for sirkulasjon og bildediagnostikk, Norges teknisk-naturvitenskapelige universitet og Hjertemedisinsk avdeling, St. Olavs hospital, 7006 Trondheim, Norway.
Source
Tidsskr Nor Laegeforen. 2010 Sep 9;130(17):1714-6
Date
Sep-9-2010
Language
Norwegian
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Air Ambulances
Angioplasty, Balloon, Coronary
Cohort Studies
Female
Humans
Male
Middle Aged
Myocardial Infarction - drug therapy - therapy
Norway
Physician's Practice Patterns
Prognosis
Thrombolytic Therapy
Time Factors
Transportation of Patients
Treatment Outcome
Abstract
Occluded coronary arteries should be opened urgently in patients who have acute myocardial infarction and ST-elevation in ECG. When transport times are long, thrombolytic treatment is a good alternative to primary percutaneous coronary intervention (PCI). The purpose of this study was to assess choice of treatment strategy in cases where time after start of symptoms and transport time are decisive for the outcome.
A cohort study of 379 patients, who had myocardial infarction and ST-elevation, and were admitted to St. Olav's Hospital, Trondheim, Norway in the period 1.11.2007-31.1.2009.
268 patients (71 %) were treated with PCI, and 111 patients (29 %) with thrombolytic treatment. 173 patients (46 %) were transported by helicopter. The counties in Mid-Norway used markedly different treatment strategies for these patients.
Great regional differences were observed in the use of PCI and thrombolytic treatment in Mid-Norway.
PubMed ID
20835281 View in PubMed
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Age disparities in stroke quality of care and delivery of health services.

https://arctichealth.org/en/permalink/ahliterature149008
Source
Stroke. 2009 Oct;40(10):3328-35
Publication Type
Article
Date
Oct-2009
Author
Gustavo Saposnik
Sandra E Black
Antoine Hakim
Jiming Fang
Jack V Tu
Moira K Kapral
Author Affiliation
Stroke Research Unit, Division of Neurology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada. saposnikg@smh.toronto.on.ca
Source
Stroke. 2009 Oct;40(10):3328-35
Date
Oct-2009
Language
English
Publication Type
Article
Keywords
Activities of Daily Living
Aged
Aged, 80 and over
Aging - physiology - psychology
Atrial Fibrillation - drug therapy - prevention & control
Cohort Studies
Cost of Illness
Deglutition Disorders - diagnosis - prevention & control - therapy
Emergency Medical Services - standards - statistics & numerical data - trends
Female
Health Policy
Health Services - economics
Hospital Units - standards - statistics & numerical data - trends
Hospitalization - economics
Humans
Longevity
Male
Middle Aged
Mortality - trends
Ontario
Outcome Assessment (Health Care) - economics
Patient Discharge - economics
Pneumonia - epidemiology
Prospective Studies
Quality of Health Care - statistics & numerical data - trends
Quality of Life
Severity of Illness Index
Stroke - complications - mortality - therapy
Thrombolytic Therapy - statistics & numerical data - trends
Warfarin - therapeutic use
Abstract
Limited information is available on the effect of age on stroke management and care delivery. Our aim was to determine whether access to stroke care, delivery of health services, and clinical outcomes after stroke are affected by age.
This was a prospective cohort study of patients with acute ischemic stroke in the province of Ontario, Canada, admitted to stroke centers participating in the Registry of the Canadian Stroke Network between July 1, 2003 and March 31, 2005. Primary outcomes were the following selected indicators of quality stroke care: (1) use of thrombolysis; (2) dysphagia screening; (3) admission to a stroke unit; (4) carotid imaging; (5) antithrombotic therapy; and (6) warfarin for atrial fibrillation at discharge. Secondary outcomes were risk-adjusted stroke fatality, discharge disposition, pneumonia, and length of hospital stay.
Among 3631 patients with ischemic stroke, 1219 (33.6%) were older than 80 years. There were no significant differences in stroke care delivery by age group. Stroke fatality increased with age, with a 30-day risk adjusted fatality of 7.1%, 6.5%, 8.8%, and 14.8% for those aged 59 or younger, 60 to 69, 70 to 79, and 80 years or older, respectively. Those aged older than 80 years had a longer length of hospitalization, increased risk of pneumonia, and higher disability at discharge compared to those younger than 80. This group was also less likely to be discharged home.
In the context of a province-wide coordinated stroke care system, stroke care delivery was similar across all age groups with the exception of slightly lower rates of investigations in the very elderly. Increasing age was associated with stroke severity and stroke case-fatality.
PubMed ID
19696418 View in PubMed
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Age-related differences in in-hospital mortality and the use of thrombolytic therapy for acute myocardial infarction.

https://arctichealth.org/en/permalink/ahliterature194746
Source
CMAJ. 2001 May 1;164(9):1285-90
Publication Type
Article
Date
May-1-2001
Author
J M Boucher
N. Racine
T H Thanh
E. Rahme
J. Brophy
J. LeLorier
P. Théroux
Author Affiliation
Département de Médecine, Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montreal, Que.
Source
CMAJ. 2001 May 1;164(9):1285-90
Date
May-1-2001
Language
English
Publication Type
Article
Keywords
Age Distribution
Aged
Aged, 80 and over
Analysis of Variance
Comorbidity
Confounding Factors (Epidemiology)
Drug Utilization
Electrocardiography
Female
Guideline Adherence - statistics & numerical data
Hospital Mortality
Humans
Logistic Models
Male
Middle Aged
Myocardial Infarction - diagnosis - drug therapy - etiology - mortality
Patient Selection
Physician's Practice Patterns - statistics & numerical data
Practice Guidelines as Topic
Predictive value of tests
Prospective Studies
Quebec - epidemiology
Registries
Risk factors
Thrombolytic Therapy - utilization
Abstract
Recent guidelines have acknowledged that thrombolysis decreases mortality from acute myocardial infarction (AMI) independently of age. The purpose of this study was to determine the age-related rates of thrombolytic administration and in-hospital mortality and the variables related to the use of thrombolytic therapy for patients with AMI.
A prospective cohort analysis involved a registry of 44 acute care Quebec hospitals that enrolled 3741 patients with AMI between January 1995 and May 1996. The main outcomes of interest were crude and adjusted age-related in-hospital mortality rates and rates of use of thrombolytic therapy.
In-hospital mortality rates increased dramatically with age from 2.1% in patients with AMI who were less than 55 years of age to 26.3% in those who were 85 years of age or older. Overall, 35.8% of the patients received thrombolysis. There was a pronounced inverse gradient in the use of thrombolysis with age, ranging from 46.2% in the youngest age group ( or = 85 years). After adjustment for potential confounders, the older patients remained significantly less likely to receive thrombolytic therapy. Compared with patients who were less than 55 years of age, the odds ratio of receiving thrombolytic therapy was 0.68 (95% confidence interval [CI] 0.52-0.89) for patients aged 65-74 years, 0.48 (95% CI 0.35-0.65) for patients aged 75-84 years and 0.13 (95% CI 0.06-0.26) for patients aged 85 years or more. Other variables related to thrombolytic therapy were diabetes (odds ratio [OR] 0.77, 95% CI 0.59-1.00), cerebrovascular disease (OR 0.46, 95% CI 0.30-0.72), angina (OR 0.73, 95% CI 0.56-0.95), typical chest pain (OR 2.56, 95% CI 1.88-3.47); ST elevation (OR 8.93, 95% CI 7.24-11.00), Q wave MI (OR 5.26, 95% CI 4.20-6.60) and increased length of time between onset of symptoms and arrival at hospital.
Age is an important independent predictor of in-hospital mortality and lower thrombolytic use following AMI. Other studies are required to further evaluate the appropriateness of thrombolytic therapy for elderly patients.
Notes
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Cites: J Am Coll Cardiol. 1996 Nov 1;28(5):1328-4288890834
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Cites: N Engl J Med. 1993 Nov 11;329(20):1442-88413454
Comment In: CMAJ. 2001 May 1;164(9):1301-311341140
PubMed ID
11341137 View in PubMed
Less detail

Age-related differences in the management and outcome of patients with acute coronary syndromes.

https://arctichealth.org/en/permalink/ahliterature170984
Source
Am Heart J. 2006 Feb;151(2):352-9
Publication Type
Article
Date
Feb-2006
Author
Raymond T Yan
Andrew T Yan
Mary Tan
Chi-Ming Chow
David H Fitchett
Frank L Ervin
James Y M Cha
Anatoly Langer
Shaun G Goodman
Author Affiliation
Division of Cardiology, Terrence Donnelly Heart Centre, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
Source
Am Heart J. 2006 Feb;151(2):352-9
Date
Feb-2006
Language
English
Publication Type
Article
Keywords
Age Factors
Aged
Angina, Unstable - mortality - therapy
Canada
Comorbidity
Epidemiologic Methods
Evidence-Based Medicine - statistics & numerical data
Female
Fibrinolytic Agents - administration & dosage
Hospital Mortality
Humans
Male
Middle Aged
Myocardial Infarction - mortality - therapy
Myocardial Revascularization - methods - utilization
Registries
Syndrome
Thrombolytic Therapy - utilization
Treatment Outcome
Abstract
Age-related differences in patients with an acute coronary syndrome (ACS) have not been well characterized in prior observational studies that often included only certain age groups or subjects with myocardial infarction (MI).
We stratified 4627 patients admitted with an ACS across 9 provinces between 1999 and 2001 enrolled in the Canadian ACS Registry into 3 age groups ( or = 75 years) to evaluate differences in clinical characteristics, management, and 1-year outcome.
Older patients more frequently had previous angina, MI, or heart failure and were less likely to have positive cardiac markers, ST elevation, and Q-wave MI or to receive thrombolytics, beta-blockers, and cholesterol-lowering and antiplatelet agents in hospital, at discharge, and at 1 year. In multivariable analyses controlling for patient factors, every decade increase in age was independently associated with reduced use of coronary angiography (odds ratio [OR] 0.79, 95% CI 0.74-0.84, P
PubMed ID
16442898 View in PubMed
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413 records – page 1 of 42.