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  • 1.
    Herlitz, Johan
    et al.
    [external].
    Bengtsson, A
    Hjalmarson, Å
    Karlsson, BW
    Morbidity during five years after myocardial infarction and its relation to infarct size1988In: Clinical Cardiology, ISSN 0160-9289, E-ISSN 1932-8737, Vol. 11, no 10, p. 672-677Article in journal (Refereed)
    Abstract [en]

    In 809 patients with a recent myocardial infarction, morbidity during 5-year follow-up was assessed. The overall 5-year mortality rate was 33% (39% in patients with larger infarcts and 26% in patients with smaller infarcts) as judged from maximum serum enzyme activity (p<.001). In terms of morbidity, no significant association with estimated infarct size was observed. Patients with smaller infarcts tended to have a higher reinfarction rate and were rehospitalized more often, whereas a similar proportion of patients with large and small infarcts developed stroke. Among survivors, chest pain tended to be more common in patients having smaller infarcts, whereas symptoms of dyspnea and claudicatio intermittens were similar in both groups, as were smoking habits, work capability, and varying forms of medication. We thus conclude that during a 5-year follow-up after acute myocardial infarction, mortality, but not morbidity, was related to the original infarct size.

  • 2.
    Herlitz, Johan
    et al.
    [external].
    Blohm, M
    Hartford, M
    Hjalmarson, Å
    Holmberg, S
    Karlsson, BW
    Delay time in suspected acute myocardial infarction and the importance of its modification1989In: Clinical Cardiology, ISSN 0160-9289, E-ISSN 1932-8737, Vol. 12, no 7, p. 370-374Article in journal (Refereed)
    Abstract [en]

    This paper summarizes the present knowledge of delay time in suspected acute myocardial infarction. More than 50% of deaths in acute myocardial infarction occur outside of the hospital setting. Recent experiences indicate that early and even late mortality can be dramatically reduced by intervention in the early phase. This points up the importance of bringing patients with suspected acute myocardial infarction to the hospital as early in the course of MI as possible. The predominating cause of delay is the time it takes for the patient to decide to go to hospital regardless of a previous history of cardiovascular disease. Patients arriving in hospital in later stages of MI are at a very high risk of mortality. Therefore one of the most important problems to be resolved is how to reduce delay time in suspected acute myocardial infarction. Such efforts have been surprisingly few. Limited experiences indicate that public education can reduce delay time dramatically.

  • 3. Herlitz, Johan
    et al.
    Brandrup-Wognsen, G
    Karlson, BW
    Sjöland, H
    Karlsson, T
    Caidahl, K
    Hartford, M
    Haglid, M
    Mortality, risk indicators for death and mode of death in younger and elderly patients during 5 years coronary artery bypass graft.2000In: Clinical Cardiology, ISSN 0160-9289, E-ISSN 1932-8737, Vol. 23, no 6, p. 421-426Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The number of elderly patients who may be candidates for coronary artery bypass graft (CABG) for severe coronary artery disease has increased. Cardiac surgery in the elderly is a high-risk procedure because many of these patients have concomitant systemic disease and other disabilities. HYPOTHESIS: The study was undertaken to evaluate mortality, risk indicators for death, and mode of death in younger and elderly patients during 5 years after CABG. METHODS: The study included all patients in western Sweden who underwent CABG without concomitant valve surgery and without previously performed CABG between June 1988 and June 1991. In all, 2,000 patients, of whom 953 (48%) were > or = 65 years, were divided into two age groups (< 65 years and > or = 65 years). RESULTS: Compared with the younger patients, the elderly had a relative risk of death of 2.3 (95% confidence interval 1.8-3.0). The increased risk of death in the elderly was significantly more marked in men, in patients with more severe angina pectoris, and in patients without a history of cerebrovascular diseases. The mode and place of death appeared similar regardless of age; neither was there marked difference in symptoms of angina pectoris among survivors 5 years after CABG. CONCLUSION: Compared with patients < 65 years, the elderly have more than twice as high a risk of death during the subsequent 5 years, and this risk is higher in men, in patients with severe symptoms of angina pectoris, and in those with no history of cerebrovascular disease.

  • 4.
    Herlitz, Johan
    et al.
    [external].
    Bång, A
    Hartford, M
    Karlson, BW
    Influence of gender on survival, mode of death, reinfarction, use of medication, and aspects of well being during a period of five years after onset of acute myocardial infarction1996In: Clinical Cardiology, ISSN 0160-9289, E-ISSN 1932-8737, Vol. 19, no 7, p. 555-561Article in journal (Refereed)
    Abstract [en]

    BACKGROUND AND HYPOTHESIS: This study was undertaken to describe prognosis during a period of 5 years after an acute myocardial infarction (AMI) in relation to gender. METHODS: All patients studied were hospitalized in a single hospital during a period of 21 months due to AMI, regardless of age and whether they were admitted to the coronary care unit or another ward. A total of 862 AMI patients [581 (67%) men and 281 (33%) women] were prospectively evaluated. Males were younger and less frequently had a history of congestive heart failure and hypertension. RESULTS: The overall 5-year mortality rate was 48% among men compared with 61% among women (p < 0.001). However, in a multivariate analysis considering age, gender, and a previous history of cardiovascular diseases, female gender was not independently associated with death. Revascularization in terms of coronary artery bypass grafting and percutaneous transluminal angioplasty did not differ significantly between men and women. The rate of reinfarction was 34% among men and 38% among women (p > 0.2). CONCLUSION: During 5 years of follow-up in a consecutive series of 862 AMI patients, women had a worse prognosis than men, with a mortality of 61% compared with 48% (p < 0.001). However, after controlling for a number of potentially confounding prognostic factors, female gender was not independently associated with mortality.

  • 5.
    Herlitz, Johan
    et al.
    [external].
    Ekström, L
    Hartford, M
    Karlson, BW
    Karlsson, T
    Grip, L
    Characteristics and outcome of patients with ST-elevation infarction in relation to whether they received thrombolysis or underwent acute coronary angiography: are we selecting the right patients for coronary angiography?2003In: Clinical Cardiology, ISSN 0160-9289, E-ISSN 1932-8737, Vol. 26, no 2, p. 78-84Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: During the last decade, there has been an on-going debate with regard to whether percutaneous coronary intervention (PCI) or thrombolysis should be preferred in patients with ST-elevation acute myocardial infarction (AMI). Some studies clearly advocate PCI, while others do not. HYPOTHESIS: The study aimed to describe the characteristics and to evaluate outcome of patients with suspected ST-elevation or left bundle-branch block infarction in relation to whether they received thrombolysis or had an acute coronary angiography aiming at angioplasty. METHODS: The study included all patients admitted to Sahlgrenska University Hospital in Göteborg, Sweden, with suspected acute myocardial infarction who, during 1995-1999, had ST-elevation or left bundle-branch block on admission electrocardiogram (ECG) requiring either thrombolysis or acute coronary angiography. A retrospective evaluation with a follow-up of 1 year after the intervention was made. RESULTS: In all, 413 patients had thrombolytic treatment and 400 had acute coronary angiography. The patients who received thrombolysis were older (mean age 70.3 vs. 64.1 years). Mortality during 1 year of follow-up was 20.9% in the thrombolysis group and 16.6% in the angiography group (p = 0.12). Among patients in whom acute coronary angiography was performed, only 85% underwent acute percutaneous coronary intervention (PCI). There was a mortality of 12.1 vs. 41.7% among those who did not undergo acute PCI. Development of reinfarction, stroke, and requirement of rehospitalization was similar regardless of type of initial intervention. The thrombolysis group more frequently required new coronary angiography (36.9 vs. 20.6%; p<0.0001) and new PCI (17.8 vs. 11.9%; p = 0.01). Despite this, after 1 year symptoms of angina pectoris were observed in 27% of patients in the thrombolysis group and in only 14% of those in the angiography group (p = 0.0002). CONCLUSION: In a Swedish university hospital with a high volume of coronary angioplasty procedures, we found no significant difference in mortality between patients who had thrombolysis and those who underwent acute coronary angiography. However, requirement of revascularization and symptoms of angina pectoris 1 year later was considerably less frequent in those who had undergone acute coronary angiography. However, distribution of baseline characteristics was skewed and efforts should be focused on the selection of patients for the different reperfusion strategies.

  • 6.
    Herlitz, Johan
    et al.
    [external].
    Emanuelsson, H
    Hjalmarson, Å
    Holmberg, S
    Waagstein, F
    Waldenström, A
    Waldenström, J
    Hemodynamic and clinical findings after combined therapy with metoprolol and nifedipine in acute myocardial infarction1984In: Clinical Cardiology, ISSN 0160-9289, E-ISSN 1932-8737, Vol. 7, no 8, p. 425-432Article in journal (Refereed)
    Abstract [en]

    In a double-blind trial, 30 patients with suspected acute myocardial infarction with onset of symptoms within the previous 24 h were randomized to treatment with 10 mg nifedipine/placebo orally 4 times a day during hospitalization. All patients were given 15 mg metoprolol intravenously 20 min after the initial administration of nifedipine/placebo, and thereafter, 50 mg 4 times a day. The combined therapy resulted only in moderate changes in systolic blood pressure and heart rate compared with metoprolol alone. Three of the 15 patients in the nifedipine group versus 2 of the 15 in the placebo group were withdrawn because of hypotension and/or bradycardia. None was withdrawn because of congestive heart failure or A-V block. It is concluded that the combination of nifedipine and metoprolol seems to be a relatively well-tolerated combination in acute myocardial infarction.

  • 7.
    Herlitz, Johan
    et al.
    [external].
    Hjalmarson, Å
    Appearance of T-wave inversions without raised serum enzyme activity in suspected acute myocardial infarction: clinical outcome in relation to subendocardial infarction1986In: Clinical Cardiology, ISSN 0160-9289, E-ISSN 1932-8737, Vol. 9, no 5, p. 209-214Article in journal (Refereed)
    Abstract [en]

    In 67 patients with a clinical history of suspected acute myocardial infarction (MI) who developed T-wave inversions in standard ECG and had normal serum aspartate aminotransferase activity (possible MI) the clinical outcome was compared with that in patients fulfilling criteria for subendocardial infarction. Patients with possible MI had a lower mortality (p = 0.02) and also a lower reinfarction rate (p = 0.14) during the first 2 years as compared with those with subendocardial MI. Although patients with subendocardial MI had more problems with chest pain in the acute phase, angina pectoris occurred more frequently in patients with possible MI during a longer follow-up period. Congestive heart failure occurred more frequently in patients with subendocardial MI during initial hospitalization, whereas treatment for heart failure appeared similar in the two groups during a longer follow-up time. We conclude that the clinical course in patients with possible MI, here defined as chest pain and appearance of T-wave inversions without elevation of serum enzyme activity, seems to differ from that in patients with subendocardial MI, particularly regarding long-term survival and incidence of angina pectoris.

  • 8.
    Herlitz, Johan
    et al.
    [external].
    Hjalmarson, Å
    Occurence of hypokalemia in suspected acute myocardial infarction and its relation to clinical history and clinical course1988In: Clinical Cardiology, ISSN 0160-9289, E-ISSN 1932-8737, Vol. 11, no 10, p. 678-682Article in journal (Refereed)
    Abstract [en]

    In 1350 patients with suspected acute myocardial infarction, serum potassium levels during the first 3 days in hospital was correlated to clinical history and clinical course. A higher incidence of hypokalemia was observed in women, in patients with hypertension, and in those on chronic diuretic treatment. Patients with anterior infarction had a higher incidence of hypokalemia than those with inferior infarction, as did patients with large as compared with small infarcts. No clear difference was observed between patients whose infarction was confirmed and those in whom the diagnosis was not confirmed. Independent predictors for hypokalemia were treatment with diuretics before admission to hospital, infarct size, and female sex. Hypokalemia during the first 3 days of hospitalization was associated with the occurrence of severe ventricular arrhythmias during hospitalization, but not with survival during a 5-year follow-up.

  • 9.
    Herlitz, Johan
    et al.
    [external].
    Hjalmarson, Å
    Relationship between electrocardiographically estimated infarct size and clinical findings in anterior myocardial infarction1984In: Clinical Cardiology, ISSN 0160-9289, E-ISSN 1932-8737, Vol. 7, no 4, p. 217-227Article in journal (Refereed)
    Abstract [en]

    In 292 patients with anterior myocardial infarction (MI) and no previous MI the electrocardiographically estimated infarct size was correlated with clinical findings during hospitalization and 3-month follow-up. Patients with ECG-defined transmural MI had a higher incidence of different types of complications, such as congestive heart failure (CHF), hypotension, pericarditis, and a longer duration of hospitalization than patients with nontransmural MI. In a subgroup including 182 patients of the total series, a precordial map containing 24 electrodes was used. The sum of R waves (sigma R), the sum of Q waves (sigma Q), the number of Q waves, and sigma R - sigma Q were calculated 4 days after arrival in hospital to estimate the size of infarction. There was generally a correlation between these ECG variables and different clinical findings, such as incidence of CHF, hypotension, pericarditis, and the duration of hospitalization. It is concluded that the ECG determined infarct size in anterior MI in a majority of patients correlates with the incidence of different types of complications in acute myocardial infarction. In the individual patient, however, the risk of developing complications cannot be predicted by ECG changes.

  • 10.
    Herlitz, Johan
    et al.
    [external].
    Hjalmarson, Å
    Relationship between electrocardiographically estimated infarct size and clinical findings in inferior myocardial infarction1984In: Clinical Cardiology, ISSN 0160-9289, E-ISSN 1932-8737, Vol. 7, no 5, p. 267-277Article in journal (Refereed)
    Abstract [en]

    In 270 patients with acute inferior wall myocardial infarction (MI) and no previous MI, Q- and R-wave changes in leads II, III, and aVF in a 12-lead standard ECG were related to the clinical course during hospitalization and 3-month follow-up. Patients with ECG-defined transmural MI showed a higher incidence of tachycardia, high degree of AV block, congestive heart failure (CHF), and pericarditis than patients with nontransmural MI. In a subgroup including 226 patients, the series was divided into quartiles according to the sum of Q- and R-wave changes in leads II, III, and aVF 4 days after arrival in hospital. A weak correlation between ECG-determined infarct size and the incidence of complications such as congestive heart failure (CHF), need for furosemide, and pericarditis, as well as the duration of hospitalization was observed. It is concluded that ECG-determined infarct size from leads II, III, and aVF in inferior MI is associated with the clinical course, although it cannot predict the outcome in the individual patient.

  • 11.
    Herlitz, Johan
    et al.
    [external].
    Hjalmarson, Å
    Relationship between electrocardiographically estimated infarct size and morbidity during a two-year follow-up1985In: Clinical Cardiology, ISSN 0160-9289, E-ISSN 1932-8737, Vol. 8, no 12, p. 630-635Article in journal (Refereed)
    Abstract [en]

    In 587 patients with a first myocardial infarction (MI) the electrocardiographically (ECG) estimated infarct size was related to morbidity during a two-year follow-up. Patients with transmural MI (Q- or R-wave changes in standard ECG) were more often treated for heart failure and returned to work less frequently than patients with subendocardial MI (ST-T-wave changes only). There were trends indicating a higher reinfarction rate in patients with subendocardial MI, whereas angina pectoris was observed as frequently in both groups. In a subset of patients with anterior MI, infarct size was estimated from the total Q- and R-wave amplitude in 24 precordial leads 4 days after arrival in hospital. A positive relationship was observed between ECG-estimated infarct size and treatment for heart failure, and patients with smaller infarctions according to ECG criteria returned to work less frequently. A higher reinfarction rate was observed in patients with smaller infarctions. In patients with inferior MI there were mostly weaker correlations between ECG-estimated infarct size (Q- and R-wave changes in leads II, III, and a VF) and morbidity during the two-year follow-up.

  • 12.
    Herlitz, Johan
    et al.
    [external].
    Hjalmarson, Å
    The relationship between the electrocardiographically estimated infarct size and 1-2 year survival in acute myocardial infarction1985In: Clinical Cardiology, ISSN 0160-9289, E-ISSN 1932-8737, Vol. 8, no 3, p. 141-147Article in journal (Refereed)
    Abstract [en]

    In 587 patients with acute myocardial infarction (AMI) and no previous MI, electrocardiographically estimated infarct size was related to 1 - and 2-year mortality. The overall mortality was higher in patients with transmural MI (Q- or R-wave changes in standard ECG) than in patients with subendocardial infarction (ST-T-wave changes in standard ECG) after 1 year (18.8% compared to 6.5% p<0.001) and after 2 years (22.2% compared to 13.8%, p=0.049). When patients who were alive during primary hospitalization were analyzed separately, slightly higher mortality was found in patients with transmural MI than in subendocardial MI after 1 year (9.6% compared to 4.2%, p =0.076) while no difference was found after 2 years (13.4% as compared to 11.7%, p>0.2). In a subgroup of patients with anterior MI, precordial mapping with 24 chest leads was analyzed 4 days after arrival in hospital (n=197). Patients were divided into quartiles according to the sum of R waves, the sum of Q waves, and the number of Q waves. There was a similar overall mortality in each quartile after 1 year and after 2 years regardless of ECG parameters studied. Neither did we find any correlation between the sum of R waves in leads II, III, and a VF on the fourth day in patients with inferior MI and overall 1 - or 2-year mortality rate, although there was a trend towards higher mortality with more ECG changes.

  • 13. Herlitz, Johan
    et al.
    Hjalmarson, Å
    Holmberg, S
    Swedberg, K
    Vedin, A
    Waagstein, F
    Waldenström, A
    Waldenström, J
    Wilhelmsen, L
    Wilhelmsson, C
    Effects of work and acute beta-receptor blockade on myocardial noradrenaline release in congestive cardiomyopathy1979In: Clinical Cardiology, ISSN 0160-9289, E-ISSN 1932-8737, Vol. 2, no 6, p. 424-430Article in journal (Refereed)
    Abstract [en]

    Systemic hemodynamic changes and noradrenaline concentrations in coronary sinus blood were studied at rest and during work before and after acute beta-receptor blockade. Patients with congestive cardiomyopathy were compared to patients with primary valvular diseases and to healthy subjects. Noradrenaline concentrations were higher in coronary sinus blood than in arterial blood and increased after beta blockade and during work. Noradrenaline concentrations were more increased in patients with more pronounced myocardial failure and did not seem to separate patients with congestive cardiomyopathy from those with valvular disease. Patients with congestive cardiomyopathy showed a good hemodynamic tolerance toward acute beta blockade.

  • 14.
    Herlitz, Johan
    et al.
    [external].
    Hjalmarson, Å
    Karlsson, BW
    Prognosis during one year for patients with myocardial infarction in relation to the development of Q-waves: experiences from the MIAMI Trial1990In: Clinical Cardiology, ISSN 0160-9289, E-ISSN 1932-8737, Vol. 13, no 4, p. 261-264Article in journal (Refereed)
    Abstract [en]

    From a randomized multicenter trial with metoprolol in suspected acute myocardial infarction (n = 5778) we report on the outcome during a one-year follow-up in patients with confirmed infarction (n = 4106) in relation to whether or not they developed Q waves. Patients with Q waves had another pattern of risk factors, including lower age and a lower occurrence of previous infarction, angina pectoris, and congestive heart failure. After one year follow-up, 14.3% of the patients with Q waves had died versus 9.0% of those without Q waves (p less than 0.001). Reinfarction during the first year occurred in 8.2% of patients with Q waves and 12.5% of patients without Q waves (p less than 0.001). After one year, other morbidity aspects appeared relatively independent of the original presence of Q waves. In conclusion, during the first year after development of acute myocardial infarction the appearance of Q waves during the first three days is associated with a higher mortality and a lower reinfarction rate, whereas other morbidity aspects appear to be relatively independent of its presence.

  • 15.
    Herlitz, Johan
    et al.
    [external].
    Hjalmarson, Å
    Karlsson, BW
    Nyberg, G
    Long-term morbidity in patients where the initial suspicion of myocardial infarction was not-confirmed1988In: Clinical Cardiology, ISSN 0160-9289, E-ISSN 1932-8737, Vol. 11, no 4, p. 209-214Article in journal (Refereed)
    Abstract [en]

    The morbidity and mortality during a 5-year follow-up in thcoronary care unit with chest pain presenting an initial suspicion of acute infarction, but in whom the diagnosis could not be confirmed, is reported. They were divided into four groups: Possible myocardial infarction (29%), angina pectoris (24%), chest pain of uncertain origin (32%), and nonischemic cause of chest pain (15%). The overall 5-year mortality rate was 13.3 % and did not differ substantially between the four groups. During the 5-year follow-up a confirmed myocardial infarction developed in 28% and 22% among patients with the diagnosis possible infarction and angina pectoris, respectively, and in about 10% of the remaining patients. Stroke developed in 4% of patients with possible infarction and in 2-3% in the remaining subgroups. In all, 59% of the patients were rehospitalized for a mean duration of 30 days in hospital. Among survivors at 5 years, 54% reported chest pain equivalent to angina pectoris and 25% had chest pain daily. A high prevalence of angina pectoris, a high frequency of rehospitalization due to chest pain, and a high consumption of cardiovascular drugs could be found in all four groups.

  • 16.
    Herlitz, Johan
    et al.
    [external].
    Hjalmarson, Å
    Waagstein, F
    Waldenström, A
    Swedberg, K
    The time course in acute myocardial infarction evaluated with precordial mapping and standard ECG1983In: Clinical Cardiology, ISSN 0160-9289, E-ISSN 1932-8737, Vol. 6, no 10, p. 479-486Article in journal (Refereed)
    Abstract [en]

    Fifty-six patients with acute transmural anterior wall myocardial infarction (MI) were investigated with a 24-electrode grid and 34 patients with an acute transmural inferior wall MI were investigated with standard ECG leads II, III, and a VF in order to study the length of time after the onset of pain during which the development of Q waves and reduction of R waves progress. These ECG changes continued for 18-26 h after onset of pain but the majority appeared during the first 12 h.

  • 17.
    Herlitz, Johan
    et al.
    [external].
    Hjalmarson, Å
    Waldenström, J
    Time lapse from estimated onset of acute myocardial infarction to peak serum enzyme activity1984In: Clinical Cardiology, ISSN 0160-9289, E-ISSN 1932-8737, Vol. 7, no 8, p. 433-440Article in journal (Refereed)
    Abstract [en]

    In 581 patients with acute myocardial infarction (MI), the time lapse from estimated onset of infarction to estimated peak serum (S) enzyme activity was evaluated. Heat-stable lactate dehydrogenase (LD; E.C. 1.1.1.27) was analyzed every 12 h for 48-108 h after arrival in hospital (n = 581) and creatine kinase (CK; E.C. 2.7.3.2.; n = 224), and creatine kinase subunit B (CK-B; n = 211) were analyzed every 6 h for 48 h. Peak S-LD was observed between 14 and 110 h after estimated onset of MI (mean 46.6 +/- 0.6 h), peak S-CK was observed between 8 and 58 h (mean 25.0 +/- 0.6 h), and peak S-CK-B was also observed between 8 and 58 h (mean 22.8 +/- 0.7 h) after onset. In 86% of patients, peak LD was reached within 60 h after onset of MI, in 78%, peak CK was reached within 30 h, and in 82%, peak CK-B was observed within 30 h after onset of MI. A weak correlation was found between duration of pain and time lapse to S peak enzyme activity (r = 0.25 -0.27; p less than 0.001), while there was no correlation between S peak activity and time lapse from onset of MI to S peak activity. It is concluded, that although in the majority of patients with MI, peak serum-enzyme activity is reached within a predictable amount of time after estimated onset of MI there is wide variation, difficult to establish from the clinical course, among individual patients.

  • 18.
    Herlitz, Johan
    et al.
    [external].
    Karlson, BW
    Hjalmarson, Å
    In consecutive patients hospitalized with acute myocardial infarction, infarct location according to routine electrocardiogram is of minor importance for the outcome1995In: Clinical Cardiology, ISSN 0160-9289, E-ISSN 1932-8737, Vol. 18, no 7, p. 385-391Article in journal (Refereed)
    Abstract [en]

    Most studies have suggested that patients with anterior myocardial infarction have an adverse prognosis compared with patients with inferior infarction. The objective of this study was to compare the mortality and morbidity in anterior versus inferior acute myocardial infarction (AMI) during 1 year in a consecutive series of patients hospitalized with AMI. All patients fulfilling the criteria for AMI who were admitted to a single hospital during 21 months (n = 921) participated in the study. Patients with anterior infarction (n = 312) had a 1-year mortality rate of 26% versus a rate of 24% for patients with inferior infarction (n = 269) (p > 0.2). The corresponding figures for patients with no previous infarction who developed Q waves were 27 and 21%, respectively (p > 0.2). Reinfarction, thromboembolic events, and other aspects of morbidity during long-term follow-up appeared with similar frequency in the two groups. Thus, in a nonselected group of patients admitted to a single hospital because of AMI, the prognosis was found to be similar among patients with inferior and those with anterior infarction. In the subset of patients with a first myocardial infarction who developed Q waves, there was a trend indicating higher mortality in anterior infarction.

  • 19.
    Herlitz, Johan
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare. [external].
    Karlson, BW
    Hjalmarson, Å
    Risk indicators for death and prognosis among patients in whom acute myocardial infarction was not confirmed in relation to prescription of beta-blockers at discharge1995In: Clinical Cardiology, ISSN 0160-9289, E-ISSN 1932-8737, Vol. 18, no 1, p. 21-25Article in journal (Refereed)
    Abstract [en]

    A large number of studies have shown the prognosis after acute myocardial infarction (AMI) to be favorably affected by treatment with beta blockers. Whether such treatment also will have a favorable effect on the prognosis in patients in whom AMI was not confirmed has not been shown. A study was undertaken at Sahlgren's Hospital, Göteborg, to determine risk indicators for death and prognosis among 1,443 patients in whom AMI was not confirmed and who survived hospitalization in relation to whether or not beta blockers were prescribed at discharge. One-year mortality was determined and p values were corrected for differences at baseline. Of the 1,443 patients who participated in the analyses, 44% were prescribed beta blockers. They differed from the remaining patients by younger age, predominance of men, a more frequent history of AMI, angina pectoris, and hypertension, and a less frequent history of congestive heart failure. Patients in whom beta blockers were prescribed had a 1-year mortality of 6% compared with 16% in those not on beta blockers (p < 0.001). The difference was similar in various subgroups according to clinical history.

  • 20.
    Herlitz, Johan
    et al.
    [external].
    Karlson, BW
    Lindqvist, J
    Sjölin, M
    Predictors of death and mode of death during long term follow-up among patients with nonconfirmed acute myocardial infarction.1999In: Clinical Cardiology, ISSN 0160-9289, E-ISSN 1932-8737, Vol. 22, no 3, p. 179-183Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Among patients hospitalized with a suspected acute coronary syndrome, a minority will eventually develop a confirmed acute myocardial infarction (AMI). In the remaining patients, coronary artery disease is the underlying cause in a large proportion. HYPOTHESIS: The aim of the study was to determine risk indicators for death and the mode of death during 5 years of follow-up among patients hospitalized and surviving hospitalization, who presented with initially suspected AMI, but in whom infarction was not confirmed. METHODS: Consecutive patients who fulfilled the above criteria and were discharged from Sahlgrenska Hospital alive during 1986 and 1987 were followed for 5 years. RESULTS: In all, 1,227 patients, of whom 396 (34%) died during the 5 years of follow-up, fulfilled the criteria. The following factors appeared to be independent risk indicators for death: age (p < 0.001); male gender (p < 0.001); a history of either current smoking (p < 0.001), congestive heart failure (p < 0.01), or myocardial infarction (p < 0.05); congestive heart failure during hospital stay (p < 0.01); and prescription of digitalis at discharge (p < 0.05). Among patients who died, only 63% were judged to have been dying a cardiac death. CONCLUSION: Among patients hospitalized with suspected acute coronary syndrome and discharged from hospital without a confirmed AMI, one third had died during the 5 years of follow-up. Risk indicators for death were related to age, male gender, history of current smoking, congestive heart failure or previous AMI, congestive heart failure in hospital, and digitalis medication at discharge.

  • 21.
    Herlitz, Johan
    et al.
    [external].
    Karlson, BW
    Richter, A
    Strömbom, U
    Hjalmarson, Å
    Prognosis for patients with initially suspected acute myocardial infarction in relation to presence of chest pain1992In: Clinical Cardiology, ISSN 0160-9289, E-ISSN 1932-8737, Vol. 15, no 8, p. 570-576Article in journal (Refereed)
    Abstract [en]

    In all 4,232 patients admitted to a single hospital during a 21-month period due to initially suspected acute myocardial infarction (AMI), the prognosis and risk factor pattern were related to whether patients had chest pain or not. Symptoms other than chest pain that raised a suspicion of AMI were mainly acute heart failure, arrhythmia, and loss of consciousness. In 377 patients (9%) symptoms other than chest pain raised an initial suspicion of AMI. These patients developed a confirmed infarction during the first three days in hospital with a similar frequency (22%) as compared with patients having chest pain (22%). However, patients with “other symptoms” had a one-year mortality of 28% versus 15% for chest pain patients (p < 0.001). Patients with “other symptoms” more often died in association with ventricular fibrillation and less often in association with cardiogenic shock as compared with chest pain patients. Among the 921 patients who developed early AMI, 64 (7%) had symptoms other than chest pain. They had a one-year mortality of 48% versus 27% for chest pain patients (p<0.001). We conclude that in a nonselected group of patients hospitalized due to suspected AMI, those with symptoms other than chest pain have a one-year mortality, which is nearly twice that of patients with chest pain.

  • 22.
    Herlitz, Johan
    et al.
    [external].
    Karlson, BW
    Sjölin, M
    Ekvall, H-E
    Hjalmarson, Å
    Prognosis during one year follow-up after acute myocardial infarction with emhpasis on morbidity1994In: Clinical Cardiology, ISSN 0160-9289, E-ISSN 1932-8737, Vol. 17, no 1, p. 15-20Article in journal (Refereed)
    Abstract [en]

    Previous descriptions of the prognosis after acute myocardial infarction (AMI) have mainly included patients admitted to coronary care units, often with an upper age limit. This study describes the prognosis, with emphasis on morbidity, during 1 year in 921 patients admitted to one single hospital with AMI regardless of age and regardless of whether or not they were admitted to the coronary care unit. During the first year, 29% of the patients died and 16% developed a reinfarction. Fifty-four percent required rehospitalization for various reasons, mainly for AMI, chest pain of other origins, and congestive heart failure. After 1 year, 52% of the surviving patients had symptoms of angina pectoris. Among patients younger than 65 years, only 37% were back to work full time after 1 year. Of patients alive after 1 year, 25% fulfilled the following criteria: no reinfarction, no rehospitalization, and no angina pectoris. Of patients aged less than 65 years at follow-up, 12% fulfilled the same criteria and were back to work full time after 1 year. In this unselected, consecutive series of patients with AMI, mortality and morbidity were high during the first year. Only a small percentage of patients were free of events or symptoms of angina pectoris.

  • 23.
    Herlitz, Johan
    et al.
    [external].
    Karlson, BW
    Sjölin, M
    Lindqvist, J
    Karlsson, T
    Caidahl, K
    Five year mortality in patients with acute chest pain in relation to smoking habits2000In: Clinical Cardiology, ISSN 0160-9289, E-ISSN 1932-8737, Vol. 23, no 2, p. 84-90Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Smoking is one of the major risk indicators for development of coronary artery disease, and smokers develop acute myocardial infarction (AMI) approximately a decade earlier than nonsmokers. In smokers with established coronary artery disease, quitting smoking has been associated with a more favorable prognosis. However, most of these studies comprised younger patients, the majority of whom were males. HYPOTHESIS: The purpose of the study was to determine mortality, mode of death, and risk indicators of death in relation to smoking habits among consecutive patients admitted to the emergency department with acute chest pain. METHODS: In all, 4,553 patients admitted with acute chest pain to the emergency department at Sahlgrenska University Hospital during a period of 21 months were included in the analyses and were prospectively followed for 5 years. RESULTS: Of these patients, 36% admitted current smoking. They were younger and had a lower prevalence of previous cardiovascular diseases than did nonsmokers. The 5-year mortality was 19.4% among smokers and 24.9% among non-smokers (p < 0.0001). However, when adjusting for difference in age, smoking was associated with an increased risk [relative risk (RR) 1.51; 95% confidence interval (CI) 1.32-1.74; p < 0.0001]. Among patients presenting originally with chest pain, the increased mortality for smokers was more pronounced in patients with non-acute than acute myocardial infarction (AMI). Among patients who died, death in smokers was less frequently associated with new-onset myocardial infarction (MI) and congestive heart failure. Among those who smoked at onset of symptoms and were alive 1 year later, 25% had stopped smoking. Patients with a confirmed AMI who continued smoking 1 year after onset of symptoms had a higher mortality (28.4%) during the subsequent 4 years than patients who stopped smoking (15.2%; p = 0.049). CONCLUSION: In consecutive patients admitted to the emergency department with acute chest pain, current smoking was significantly associated with an increased risk of death during 5 years of follow-up. Among patients who died, death in smokers was less frequently associated with new-onset MI and congestive heart failure than was death in nonsmokers.

  • 24.
    Herlitz, Johan
    et al.
    [external].
    Karlsson, T
    Dellborg, M
    Karlson, BW
    Engdahl, J
    Sandén, W
    Occurrence, characteristics and outcome of patients hospitalized with diagnosis of acute myocardial infarction who do not fulfil traditional criteria1998In: Clinical Cardiology, ISSN 0160-9289, E-ISSN 1932-8737, Vol. 21, no 6, p. 405-409Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The diagnosis of acute myocardial infarction (AMI) is traditionally based on clinical history, elevation of serum enzyme activity, and typical changes in the electrocardiogram (ECG); however, not all patients who develop AMI fulfill these criteria on discharge from hospital. HYPOTHESIS: The aim of the study was to evaluate (1) the frequency with which the traditional criteria for AMI are not fulfilled among patients diagnosed with AMI on discharge, and (2) whether patients with and without these criteria differ in terms of characteristics, treatment, and outcome. METHODS: All patients aged < 75 years and hospitalized in the municipality of Göteborg with a discharge diagnosis of AMI were included. Fulfillment criteria for AMI were two of the following three points: (1) chest pain, (2) increase in cardiac enzymes, and (3) development of Q waves. RESULTS: In all, 1,188 admitted patients, 27% of whom were women, were included in the analysis. Of these, 193 (16%) did not fulfill the traditional criteria for AMI. These patients had an in-hospital mortality rate of 48%; of these, 59% died a sudden death, and of those who were autopsied (62%), 96% showed signs of a fresh AMI. The most common symptom on admission to hospital in patients who did not fulfill the traditional criteria was chest pain (34%), followed by dyspnea (27%) and fatigue (14%). Of those who died suddenly, fewer than half had been admitted to the coronary care unit. CONCLUSION: Patients diagnosed with AMI who do not fulfill the traditional diagnosis criteria have high mortality. On admission to hospital, the initial suspicion of AMI is often vague. Measures for earlier detection of life-threatening coronary artery disease among these patients are warranted.

  • 25.
    Herlitz, Johan
    et al.
    [external].
    Samuelsson, SO
    Richter, A
    Hjalmarson, Å
    Predicition of rupture in acute myocardial infarction1988In: Clinical Cardiology, ISSN 0160-9289, E-ISSN 1932-8737, Vol. 11, no 2, p. 63-69Article in journal (Refereed)
    Abstract [en]

    In two patient series including 809 and 327 patients, respectively, with acute myocardial infarction we have compared those who died in myocardial rupture (verified at autopsy, Group A) with those who died without rupture (autopsied, Group B), and those who survived hospitalization (Group C) with regard to previous history and clinical course in hospital. Rupture among autopsied patients was observed in 45% and 40% of the cases in the respective studies. Previous infarction was observed in each study as 0% and 0% in Group A compared with 25% and 31% in Group B, and 20% and 34% in Group C. Previous angina pectoris was observed in 26% and 22% in Group A compared with 50% and 54% in Group B and 52% and 54% in Group C. Maximum serum enzyme activity in Group A did not differ from Group B, but was higher than in Group C (p>0.001). Group A patients tended to have a higher initial pain score and a higher requirement of analgesics compared with other groups, whereas initial heart rate or systolic blood pressure did not differ in these patients compared to others. We thus conclude that patients with myocardial rupture have a very low occurrence of previous myocardial infarction and angina pectoris, and that their pain course appears to be particularly severe in the acute phase.

  • 26.
    Herlitz, Johan
    et al.
    [external].
    Wiklund, I
    Sjöland, H
    Karlson, BW
    Karlsson, T
    Haglid, M
    Hartford, M
    Caidahl, K
    Relief of symptoms and improvement of health-related quality of life five years after coronary artery bypass graft in women and men.2001In: Clinical Cardiology, ISSN 0160-9289, E-ISSN 1932-8737, Vol. 24, no 5, p. 385-392Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Severe coronary artery disease can be successfully treated with coronary artery bypass graft (CABG), with considerable improvement in the symptoms of angina pectoris. Approximately three of four patients are free of ischemic events for 5 years; however, increased survival is demonstrated only in selected subgroups with advanced coronary artery disease, and this effect has not been established in elderly patients. HYPOTHESIS: The study was undertaken to determine the relief of symptoms and improvement in other aspects of health-related quality of life (QoL) during 5 years after CABG in women and men. METHODS: Patients who underwent CABG in western Sweden were approached prior to and 5 years after surgery. Health-related QoL was estimated with Physical Activity Score (PAS), Nottingham Health Profile, and Psychological General Well-Being Index. RESULTS: Women (n = 381) had a 5-year mortality of 17% compared with 13% for men (n = 1,619; NS). After 5 years, 1,719 patients (survivors) were available for the survey; of these, 876 (51%) answered the inquiry both prior to and after 5 years. Both women and men improved markedly and highly significantly, both with respect to symptoms and other aspects of health-related QoL. Women suffered more than men in terms of limitation of physical activity, dyspnea, chest pain, and others aspects of health-related QoL. There was a significant interaction between time and gender, with more improvement in men with regard to chest pain when walking uphill or quickly on level ground, when walking on level ground at the speed of other persons their own age, when under stress, and in windy and cold weather. For those parameters as well as for PAS, improvement was more marked in men than in women. In the other aspects of health-related QoL, there was no interaction between time and gender. CONCLUSION: Five years after CABG, limitation of physical activity, symptoms of dyspnea, and chest pain were reduced, and various aspects of health-related QoL had improved in both women and men. In general, women suffered more than men both prior to and after CABG; however, in some aspects the improvement was more pronounced in men. Because of the limited response rate, the results may not be applicable to a nonselected population who had undergone CABG.

  • 27. Hjalmarson, Å
    et al.
    Richter, A
    Herlitz, Johan
    [external].
    Hovgren, C
    Holmberg, S
    Bondestam, E
    Chest pain in acute myocardial infarction: a descriptive study according to subjective assessment and morphine requirement1986In: Clinical Cardiology, ISSN 0160-9289, E-ISSN 1932-8737, Vol. 9, no 9, p. 423-428Article in journal (Refereed)
    Abstract [en]

    In 722 patients with suspected acute myocardial infarction (MI) we have tried to describe the course of chest pain according to their own assessment and morphine requirement. Patients were asked to score pain from 0-10 every second hour after arrival in the coronary care unit (CCU) and also to score their maximal pain at home. A very high intensity of chest pain was observed at home (mean score 7.1). At arrival in the CCU the mean pain score already had declined to 1.8, although 51% still had chest pain. Pain score declined successively during the first 12 hours in the CCU. At 24 hours after arrival, 20% still had some chest discomfort. In one quarter of the series a score of more than 0 was observed later than 24 hours after arrival in CCU. Patients developing definite MI had, as expected, a longer duration of pain and a much higher requirement of morphine compared with those with no MI. The difference between MI and no MI patients regarding subjective assessment of the initial intensity of pain at home and in hospital was, however, surprisingly low.

  • 28. Karlson, BW
    et al.
    Herlitz, Johan
    [external].
    Hjalmarson, Å
    Impact of clinical trials on the use of beta-blockers after acute myocardial infarction and its relation to other risk indicators for death and 1-year mortality rate1994In: Clinical Cardiology, ISSN 0160-9289, E-ISSN 1932-8737, Vol. 17, no 6, p. 311-316Article in journal (Refereed)
    Abstract [en]

    Based on selected patient populations, several randomized trials have shown beta blockers to decrease mortality after acute myocardial infarction (AMI). The purpose of this study was to describe the use of beta blockers in various subsets of patients admitted to Sahlgren's Hospital between February 15, 1986, and November 9, 1987, with AMI, and the relation of AMI to other risk indicators for death and to a 1-year mortality rate. Beta blockers, mainly metoprolol, were prescribed for 66% of all survivors at discharge. They were more frequently prescribed for younger patients and for those with a previous history of AMI and hypertension, but less frequently for those with a history of congestive heart failure and diabetes mellitus. Patients for whom beta blockers were not prescribed had a 1-year mortality of 27% versus 11% for the rest (p < 0.001). Independent predictors of 1 -year mortality after discharge were age (p < 0.001 ), history of hypertension (p < 0.001 ), prescription of beta blockers at discharge (p < 0.001 ), congestive heart failure during hospitalization (p < 0.001), and a history of AMI (p < 0.01 ). P values were corrected for baseline differences. Beta blockers were not prescribed at discharge for one-third of survivors after AMI. This group had a very high mortality during the first year. When simultaneously considering various risk indicators for death, prescription of beta blockers at discharge was associated with an increased rate of survival.

  • 29. Karlson, BW
    et al.
    Herlitz, Johan
    [external].
    Pettersson, P
    Hallgren, P
    Strömbom, U
    Hjalmarson, Å
    One year prognosis in patients hospitalized with a history of unstable angina1993In: Clinical Cardiology, ISSN 0160-9289, E-ISSN 1932-8737, Vol. 16, no 5, p. 397-401Article in journal (Refereed)
    Abstract [en]

    The prognosis during 1 year of follow-up in 715 patients admitted to one single hospital due to suspected acute myocardial infarction (AMI) with a history of unstable angina pectoris immediately preceding hospitalization is described. AMI developed in 192 patients (27%) during the first three days and in 255 patients (38%) during the first year. The mortality during hospitalization was 7% (50 patients) and during 1 year 19% (130 patients). Of the nonsurvivors, 54% died of AMI, 28% of congestive heart failure, and 20% of cardiogenic shock. Based on simple clinical parameters on admission to the emergency room, risk indicators for death during the following year could be identified as follows, in the order of significance: high age (p < 0.001), ST-segment depression on admission (p < 0.001), and a history of diabetes mellitus (p < 0.05). At admission to the emergency room, risk indicators for development of AMI during the following year were as follows: initial degree of suspicion of AMI (p < 0.001), electrocardiographic signs of acute ischemia on admission (p < 0.001), ST-segment elevation on admission (p < 0.01), age (p < 0.05), and lack of a previous history of chronic stable angina pectoris (p < 0.05). We conclude that, among patients admitted to hospital due to suspected AMI with a history of unstable angina pectoris immediately preceding hospitalization, 38% developed a confirmed infarction and 19% died during the following year.

  • 30. Karlson, BW
    et al.
    Strömbom, U
    Ekvall, H-E
    Herlitz, Johan
    [external].
    Prognosis in diabetics in whom the initial suspicion of acute myocardial infarction was not confirmed1993In: Clinical Cardiology, ISSN 0160-9289, E-ISSN 1932-8737, Vol. 16, no 7, p. 559-564Article in journal (Refereed)
    Abstract [en]

    For 2,058 consecutive patients hospitalized for suspected acute myocardial infarction (AMI) but in whom AMI was later ruled out, we describe the prognosis with particular emphasis on diabetics. In all, a previous history of diabetes mellitus occurred in 290 (14%) of the patients. Compared with nondiabetics, they had a longer delay time between onset of symptoms and arrival in hospital. During 1 year of follow-up, their mortality rate was 28% compared with 14% for nondiabetics (p < 0.001), and their reinfarction rate was 20% compared with 10% for nondiabetics. More diabetics died in association with a fatal myocardial infarction and more frequently had ventricular fibrillation preceding death. With the exception of re-infarction, no clear difference in terms of morbidity was observed between the two groups. We conclude that the prognosis in diabetics in whom AMI is ruled out is poor, with between one-quarter and one-third not surviving 1 year.

  • 31. Karlson, BW
    et al.
    Wiklund, I
    Bengtsson, A
    Herlitz, Johan
    [external].
    Prognosis, severity of symptoms, and aspects of well-being among patients in whom myocardial infarction was ruled out1994In: Clinical Cardiology, ISSN 0160-9289, E-ISSN 1932-8737, Vol. 17, no 8, p. 427-431Article in journal (Refereed)
    Abstract [en]

    In a high proportion of patients hospitalized due to suspected acute myocardial infarction (AMI) the diagnosis cannot be confirmed. The majority of these patients have ischemic heart disease and are at risk for subsequent cardiac events. The aim of this study was to describe the severity of symptoms and various aspects of well-being 1 year after hospitalization due to suspected AMI in surviving patients in whom the diagnosis was not confirmed, and to relate the observations to those found among survivors of a confirmed AMI. All patients admitted to Sahlgrenska Hospital, Göteborg, due to suspected AMI and who were alive after 1 year were asked to answer a questionnaire including questions regarding cardiovascular, psychiatric, and psychological symptoms. Patients in whom AMI was not confirmed reported more cardiovascular symptoms, for example, chest pain (p <0.001), dyspnea (p <0.01), palpitations (p <0.001), and fatigue (p <0.01) when compared with patients who suffered confirmed AMI. The majority of psychosomatic and psychological parameters evaluated were also more frequently reported by these patients and their quality of life seems to be worse compared with survivors of AMI.

  • 32. Karlsson, BW
    et al.
    Herlitz, Johan
    [external].
    Edvardsson, N
    Olsson, SB
    Prophylactic treatment after electroconversion of atrial fibrillation1990In: Clinical Cardiology, ISSN 0160-9289, E-ISSN 1932-8737, Vol. 13, no 4, p. 279-286Article in journal (Refereed)
    Abstract [en]

    Atrial fibrillation is a common arrhythmia. Sinus rhythm can often be restored by electroconversion, but the relapse rate is high. Various antiarrhythmic drugs have been used to maintain sinus rhythm after electroconversion. This article reviews the experience with these drugs and suggests a treatment strategy.

  • 33. Karlsson, BW
    et al.
    Herlitz, Johan
    [external].
    Richter, A
    Hjalmarson, Å
    Prognosis in acute myocardial infarction in relation to development of Q-waves1991In: Clinical Cardiology, ISSN 0160-9289, E-ISSN 1932-8737, Vol. 14, no 11, p. 875-880Article in journal (Refereed)
    Abstract [en]

    In a totally nonselected group of patients with acute myocardial infarction (AMI) (n = 921) admitted from the emergency department to the coronary care unit or other hospital ward, the occurrence of non-Q-wave AMI and the prognosis in these patients was determined and compared with those in whom Q waves were developed. Fifty-two percent had AMI without new Q waves. Patients with a non-Q-wave AMI differed from patients with Q-wave AMI, more frequently having a previous history of AMI (p less than 0.001), angina pectoris (p less than 0.01), diabetes mellitus (p less than 0.05), congestive heart failure (p less than 0.001), and a higher mean age (p less than 0.001), whereas smoking was more common in Q-wave AMI. Patients with non-Q-wave AMI had a 1-year mortality of 31% compared with 26% in Q-wave AMI (p greater than 0.2) and a reinfarction rate of 20% compared with 12% for Q-wave AMI (p less than 0.01). Among patients aged less than 75 years without a previous history of AMI, congestive heart failure, and diabetes mellitus, the 1-year mortality rate was 16% for patients with Q waves versus 15% for those without Q waves (NS). Appearance of Q waves was not independently associated with death. We conclude that in a nonselected group of patients with AMI the occurrence of a non-Q-wave AMI is much higher than previously reported. The prognosis in AMI during one year of follow-up is not associated with development of Q waves.

  • 34. Richter, A
    et al.
    Herlitz, Johan
    [external].
    Hjalmarson, Å
    QRS-komplex recovery during one year after acute myocardial infarction1987In: Clinical Cardiology, ISSN 0160-9289, E-ISSN 1932-8737, Vol. 10, no 1, p. 16-20Article in journal (Refereed)
    Abstract [en]

    The recovery of the ECG signs of anterior myocardial infarction has been studied in 70 patients. A significant increase in R-wave amplitude and decrease in Q-wave amplitude on 24-lead precordial mapping was observed during one year after infarction. Patients with lower initial heart rate showed a greater recovery of R-and Q-wave amplitudes, as did patients with smaller infarcts, as assessed by peak heat-stable lactate dehydrogenase (LDH).

1 - 34 of 34
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