Ändra sökning
Avgränsa sökresultatet
1 - 28 av 28
RefereraExporteraLänk till träfflistan
Permanent länk
Referera
Referensformat
  • apa
  • harvard1
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Annat format
Fler format
Språk
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Annat språk
Fler språk
Utmatningsformat
  • html
  • text
  • asciidoc
  • rtf
Träffar per sida
  • 5
  • 10
  • 20
  • 50
  • 100
  • 250
Sortering
  • Standard (Relevans)
  • Författare A-Ö
  • Författare Ö-A
  • Titel A-Ö
  • Titel Ö-A
  • Publikationstyp A-Ö
  • Publikationstyp Ö-A
  • Äldst först
  • Nyast först
  • Skapad (Äldst först)
  • Skapad (Nyast först)
  • Senast uppdaterad (Äldst först)
  • Senast uppdaterad (Nyast först)
  • Disputationsdatum (tidigaste först)
  • Disputationsdatum (senaste först)
  • Standard (Relevans)
  • Författare A-Ö
  • Författare Ö-A
  • Titel A-Ö
  • Titel Ö-A
  • Publikationstyp A-Ö
  • Publikationstyp Ö-A
  • Äldst först
  • Nyast först
  • Skapad (Äldst först)
  • Skapad (Nyast först)
  • Senast uppdaterad (Äldst först)
  • Senast uppdaterad (Nyast först)
  • Disputationsdatum (tidigaste först)
  • Disputationsdatum (senaste först)
Markera
Maxantalet träffar du kan exportera från sökgränssnittet är 250. Vid större uttag använd dig av utsökningar.
  • 1. Dellborg, M
    et al.
    Karlson, BW
    Herlitz, Johan
    [external].
    Lindqvist, J
    Karlsson, T
    Sandén, W
    Sjölin, M
    Wedel, H
    Changes in the use of medication after acute myocardial infarction: Possible impact on post-myocardial infarction mortality and long-term outcome2001Ingår i: Coronary Artery Disease, ISSN 0954-6928, E-ISSN 1473-5830, Vol. 12, nr 1, s. 61-67Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: To describe the change in the use of medication after acute myocardial infarction (AMI) and discuss its possible impact on risk and risk indicators for death. Patients: All patients discharged alive after hospitalization for AMI at Sahlgrenska Hospital (covering half the community of Goteborg, i.e. 250 000 of 500 000 inhabitants) during 1986-1987 (period I) and at Sahlgrenska Hospital and Ostra Hospital (covering the whole community of Goteborg, 500 000 inhabitants) during 1990-1991 (period II). Methods: Overall mortality was retrospectively evaluated during 5 years of follow-up. Results: In all, 740 patients were included in the study during period I and 1448 during period II. The 5-year mortalities were 44.1% for period I patients and 39.3% for period II patients (P = 0.036). The relative risk of death for period II patients was 0.78 [95% confidence interval (CI) 0.67-0.89, P = 0.0005] after adjustment for differences at baseline. There was a significant interaction with a history of congestive heart failure; improvement in duration of survival was found only for patients without such a history. During period I, only 3% of patients were administered fibrinolytic agents, compared with 33% of patients during period II (P < 0.0001). During period I, aspirin was prescribed for 13% of patients discharged from hospital compared with 79% during period II. Other changes in treatment on going from period I to period II included increases in prescription of [beta]-blockers and angiotensin converting enzyme inhibitors. After adjustment for various risk indicators for death, relative risk of death for those administered fibrinolytic agents was 0.60 (95% CI 0.18-2.02) for patients in the period-I cohort and 0.68% (95% CI 0.51-0.91) for those in the period-II cohort. Adjusted relative risk of death for those prescribed aspirin upon discharge from hospital was 0.81 (95% CI 0.52-1.25) for period-I patients and 0.71 (95% CI 0.56-0.91) for period-II patients. The adjusted relative risk of death for those administered [beta]-blockers was 0.72 (95% CI 0.55-0.96) for period-I patients and 0.70 (95% CI 0.55-0.90) for period-II patients. Conclusion: Increased use of fibrinolytic agents and aspirin for AMI as well as a moderate increase in use of [beta]-blockers and angiotensin converting enzyme inhibitors was associated with a parallel reduction in age-adjusted mortality during the 5 years after discharge from hospital. However, this improvement was seen only for patients without histories of congestive heart failure.

  • 2.
    Herlitz, Johan
    et al.
    [external].
    Brandrup-Wognsen, G
    Caidahl, K
    Haglid Evander, M
    Karlson, BW
    Hartford, M
    Karlsson, T
    Sjöland, H
    Predictors of death during 10 years after coronary artery bypass grafting with particular emphasis on age2004Ingår i: Coronary Artery Disease, ISSN 0954-6928, E-ISSN 1473-5830, Vol. 15, nr 3, s. 163-170Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVES: To describe predictors of death during 10 years of follow-up after coronary artery bypass grafting (CABG); to evaluate whether age interacts with the influence of various predictors on outcome; and to compare the mortality during 10 years after CABG with the mortality in an age- and sex-matched control population. DESIGN: Prospective, observational study. SETTING: Department of Thoracic and Cardiovascular Surgery at Sahlgrenska University Hospital and Scandinavian Heart Centre in Göteborg, Sweden. PARTICIPANTS: All patients from western Sweden who underwent CABG between 1 June 1988 and 1 June 1991 without simultaneous valve surgery and with no previous CABG. MAIN OUTCOME MEASUREMENTS: All-cause mortality during 10 years but more than 30 days after CABG. RESULTS: In all, 2000 patients participated in the survey. The following factors appeared as independent predictors of death: preoperative factors-age, history of congestive heart failure, cerebrovascular disease, history of intermittent claudication, current smoking, degree of left ventricular impairment, valvular disease and duration of angina pectoris; peroperative factors-ventilator time and neurological complications; postoperative factors-arrhythmia, requirement of digitalis and requirement of antidiabetics. There was an interaction between age and history of cerebrovascular disease with a stronger impact on outcome in younger patients. The late (>30 days after CABG) 10-year mortality in the study cohort was 29.6% compared with 25.9% in the control population (P=0.02). CONCLUSION: Among patients who underwent CABG, 13 independent predictors for mortality were found, mainly among preoperative factors but also among peroperative factors, postoperative complications and medication requirement after CABG.

  • 3.
    Herlitz, Johan
    et al.
    [external].
    Brandrup-Wognsen, G
    Caidahl, K
    Haglid, M
    Albertsson, P
    Karlson, BW
    Lurje, L
    Karlsson, T
    Hjalmarson, Å
    Death, mode of death, morbidity and requirement for rehospitalization during 2 years after coronary artery bypass grafting in relation to preoperative ejection fraction1996Ingår i: Coronary Artery Disease, ISSN 0954-6928, E-ISSN 1473-5830, Vol. 7, nr 11, s. 807-812Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: To describe the impact of ejection fraction on the prognosis during 2 years after coronary artery bypass grafting (CABG). PATIENTS: All patients in western Sweden who underwent CABG without concomitant valve surgery between June 1988 and June 1991. RESULTS: In all, 2121 patients were operated upon and information on ejection fraction was available for 1961 patients (92%). Of these patients, 178 (9%) had an ejection fraction < 40%, 517 (26%) an ejection fraction of 40-59% and 1266 (65%) an ejection fraction > or = 60%. In these groups the mortalities during the first 30 days after CABG were 5.1, 4.3 and 2.2%, respectively (P < 0.01). The corresponding values for mortalities between 30 days and 2 years were 7.7, 4.3 and 3.3%, respectively (P < 0.01). Patients with a lower ejection fraction were more frequently men and more frequently had a history of cardiovascular disease. In multivariate analysis the preoperative ejection fraction was an independent predictor for total 2-year mortality. Patients with a low ejection fraction died more frequently in association with ventricular fibrillation. Morbidity was, with the exception of that for rehospitalization due to heart failure and infection, not associated significantly with the preoperative ejection fraction. CONCLUSION: During the 2 years after CABG a low preoperative ejection fraction was associated with a higher mortality, but the association with morbidity was more complex.

  • 4.
    Herlitz, Johan
    et al.
    [external].
    Brandrup-Wognsen, G
    Caidahl, K
    Haglid, M
    Karlson, BW
    Hartford, M
    Karlsson, T
    Sjöland, H
    Improvement and factors associated with improvement in quality of life during 10 years after coronary artery bypass grafting2003Ingår i: Coronary Artery Disease, ISSN 0954-6928, E-ISSN 1473-5830, Vol. 14, nr 7, s. 509-517Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIM: To describe (1) the improvement in various aspects of quality of life (QoL) and (2) predictors of improvement, during 10 years after coronary artery bypass grafting (CABG). PATIENTS AND METHODS: All patients who underwent CABG in western Sweden between June 1988 and June 1991 without simultaneous valve surgery and with no previous CABG were approached with an inquiry prior to and 5 and 10 years after the operation. QoL was measured with three different instruments: (1) Nottingham health profile (NHP), (2) psychological general well-being index (PGWBI) and (3) physical activity score (PAS). RESULTS: There was a significant improvement in QoL with all three instruments from before to 10 years after the operation. The mean improvements +/-SD were for NHP, - 4.2+/-17.0 (P<0.0001), for PGWBI, +9.7+/-17.6 (P<0.0001) and for PAS, -0.96+/-1.23 (P<0.0001). However, there was also a deterioration with all three instruments between 5 and 10 years after surgery. The mean deteriorations +/-SD were for NHP, +4.4+/-12.8 (P<0.0001), for PGWBI, -4.6+/-14.8 (P<0.0001) and for PAS, +0.44+/-0.94 (P<0.0001). Independent predictors for an improvement in QoL with at least one of the instruments were low preoperative QoL, a younger age, being a man, high functional class (New York Heart Association), no hypertension, proximal left anterior descending coronary artery stenosis, short extracorporeal circulation time, use of internal mammary artery and a short postoperative time in the intensive care unit. CONCLUSION: There is a higher estimated QoL 10 years after CABG than before, despite the fact that the patients are 10 years older. However, there is also a deterioration in QoL between 5 and 10 years after surgery. Predictors of improvement during the 10 years included age, sex, previous history, localization of stenosis, type of graft and preoperative and postoperative factors.

  • 5.
    Herlitz, Johan
    et al.
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Brandrup-Wognsen, G
    Evander, MH
    Libungan, B
    Sjoland, H
    Caidahl, K
    Hartford, M
    Karlson, BW
    Karlsson, T
    Karason, K
    Quality of Life 15 Years after Coronary Artery Bypass Grafting2009Ingår i: Coronary Artery Disease, ISSN 0954-6928, E-ISSN 1473-5830, Vol. 20, nr 6, s. 363-369Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVES: To describe changes in quality of life (QoL) during 15 years after coronary artery bypass grafting (CABG) and prediction of impaired QoL after 15 years. METHODS: All patients in western Sweden who underwent primary CABG without simultaneous valve surgery between 1988 and 1991 were included. QoL during a period of 15 years after CABG was evaluated with three instruments: the Nottingham Health Profile, the Psychological General Well-Being Index, and the Physical Activity Score. RESULTS: A total of 2000 patients took part in the survey, (none excluded) of whom 808 were still alive after 15 years and 79% answered the inquiry. Despite an ongoing decline in QoL over the years, an improvement in QoL was maintained in most sub-dimensions at the 15-year follow-up compared with that prior to surgery. Seven factors emerged as predictors of impaired QoL 15 years after CABG. They are as follows: (i) high age, (ii) female sex, (iii) history of diabetes, (iv) obesity, (v) prolonged stay in the intensive care unit, (vi) prolonged treatment on a ventilator, (vii) need for inotropic drugs at the time of surgery; of which the latter three might be secondary to left ventricular dysfunction. CONCLUSION: Despite an ongoing decline in QoL over the years, there was still an improvement in most aspects of QoL 15 years after CABG compared with that before surgery. Intensified early treatment of diabetes, obesity, and left ventricular dysfunction in CABG patients might allow an even better long-term QoL.

  • 6.
    Herlitz, Johan
    et al.
    [external].
    Brandrup-Wognsen, G
    Haglid Evander, M
    Libungan, B
    Sjöland, H
    Caidahl, K
    Hartford, M
    Karlsson, T
    Karlson, BW
    Karason, K
    Quality of life 15 years after coronary artery bypass grafting.2009Ingår i: Coronary Artery Disease, ISSN 0954-6928, E-ISSN 1473-5830, Vol. 20, nr 6, s. 363-369Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVES: To describe changes in quality of life (QoL) during 15 years after coronary artery bypass grafting (CABG) and prediction of impaired QoL after 15 years. METHODS: All patients in western Sweden who underwent primary CABG without simultaneous valve surgery between 1988 and 1991 were included. QoL during a period of 15 years after CABG was evaluated with three instruments: the Nottingham Health Profile, the Psychological General Well-Being Index, and the Physical Activity Score. RESULTS: A total of 2000 patients took part in the survey, (none excluded) of whom 808 were still alive after 15 years and 79% answered the inquiry. Despite an ongoing decline in QoL over the years, an improvement in QoL was maintained in most sub-dimensions at the 15-year follow-up compared with that prior to surgery. Seven factors emerged as predictors of impaired QoL 15 years after CABG. They are as follows: (i) high age, (ii) female sex, (iii) history of diabetes, (iv) obesity, (v) prolonged stay in the intensive care unit, (vi) prolonged treatment on a ventilator, (vii) need for inotropic drugs at the time of surgery; of which the latter three might be secondary to left ventricular dysfunction. CONCLUSION: Despite an ongoing decline in QoL over the years, there was still an improvement in most aspects of QoL 15 years after CABG compared with that before surgery. Intensified early treatment of diabetes, obesity, and left ventricular dysfunction in CABG patients might allow an even better long-term QoL.

  • 7.
    Herlitz, Johan
    et al.
    [external].
    Brandrup-Wognsen, G
    Karlson, BW
    Sjöland, H
    Karlsson, T
    Caidahl, K
    Hartford, M
    Haglid, M
    Mortality, mode of death and risk indicators for death during 5 years after coronary artery bypass grafting among patients with and without a history of diabetes mellitus2000Ingår i: Coronary Artery Disease, ISSN 0954-6928, E-ISSN 1473-5830, Vol. 11, nr 4, s. 339-346Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: To describe mortality, mode of death, risk indicators for death and symptoms of angina pectoris among survivors during 5 years after coronary artery bypass grafting (CABG) among patients with and without a history of diabetes mellitus. METHODS: All patients in western Sweden who underwent CABG without concomitant valve surgery and who had no previous CABG between June 1988 and June 1991 were entered prospectively in this study. After 5 years, information on deaths that had occurred was obtained for the analysis. RESULTS: In all, 1998 patients were included in the analysis; 242 (12%) had a history of diabetes. Among the non-diabetic patients, 5-year mortality was 12.5%; the corresponding relative risk for diabetic patients was 2.1 (95% confidence interval 1.6 to 2.9). A history of diabetes was an independent risk indicator of death; there was no significant interaction between any other risk indicator and diabetes. Independent risk indicators for death among diabetic patients were: current smoking, renal dysfunction and left ventricular ejection fraction < 0.40. Compared with non-diabetic patients, those with diabetes more frequently died in hospital, died a cardiac death, or had death associated with the development of acute myocardial infarction and with symptoms of congestive heart failure. Among survivors, diabetic patients tended to have more angina pectoris 5 years after CABG than did those without diabetes. CONCLUSION: During a period of 5 years after CABG, diabetic patients had a mortality twice that of non-diabetic patients. The increased risk included death in hospital, cardiac death and death associated with development of acute myocardial infarction and with symptoms of congestive heart failure.

  • 8.
    Herlitz, Johan
    et al.
    [external].
    Ekström, L
    Wennerblom, B
    Axelsson, Å
    Bång, A
    Holmberg, S
    Risk indicators for, and symptoms associated with, death among patients hospitalized after out-of-hospital cardiac arrest1994Ingår i: Coronary Artery Disease, ISSN 0954-6928, E-ISSN 1473-5830, Vol. 5, nr 5, s. 407-414Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: An increasing proportion of patients who have an out-of-hospital cardiac arrest are initially successfully resuscitated and thus hospitalized. AIMS: To define risk indicators for, and to describe the mode of, in-hospital death among patients hospitalized after an out-of-hospital cardiac arrest. SETTING: Göteborg, Sweden. PATIENTS: All patients hospitalized after out-of-hospital cardiac arrest between 1980 and 1992. RESULTS: A total of 707 out of 3434 patients were hospitalized after out-of-hospital cardiac arrest, of whom 278 (39%) were discharged alive. Independent risk indicators for in-hospital death were: type of initial arrhythmia on the scene, age, interval between cardiac arrest and arrival of first ambulance, bystander-initiated cardiopulmonary resuscitation and history of diabetes mellitus. Of the patients who died in hospital, 88% had brain damage and 43% myocardial damage. CONCLUSION: Risk indicators for hospital death can be defined. The majority of in-hospital deaths were associated with brain damage.

  • 9.
    Herlitz, Johan
    et al.
    [external].
    Engdahl, J
    Svensson, L
    Young, M
    Ängquist, KA
    Holmberg, S
    Changes in demographic factors and mortality after out-of-hospital cardiac arrest in Sweden2005Ingår i: Coronary Artery Disease, ISSN 0954-6928, E-ISSN 1473-5830, Vol. 16, nr 1, s. 51-57Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective To describe changes between 1992 and 2003 in age, sex, factors at resuscitation and survival among patients suffering from out-of-hospital cardiac arrest in Sweden. Methods This was a prospective observational study including various ambulance organizations in Sweden. Patients suffering from out-of-hospital cardiac arrest between 1992 and 2003 included in the Swedish Cardiac Arrest Registry were followed for survival to 1 month. Results In all 19 791 cases took part in the survey. There was a slight increase in mean age from 68 to 70 years (P=0.025) and an increase of females from 29 to 32% (P=0.0001). There was a change in witnessed status (P<0.0001) with an increase in crew-witnessed cases and a decrease in non-witnessed cases. There was a decrease in cases of a cardiac etiology from 75 to 61% (P<0.0001) and a decrease in the percentage found in ventricular fibrillation from 36 to 25% (P<0.0001). When crew-witnessed cases were excluded the proportion receiving bystander cardiopulmonary resuscitation (CPR) increased from 30 to 42% (P<0.0001). There was a slight increase in the overall proportion of patients hospitalized alive from 16 to 20% (P=0.032). There was no significant change in the overall proportion of survivors at 1 month after cardiac arrest (4.5% in 1992 and 5.0% in 2003). Conclusions Among patients suffering from out-of-hospital cardiac arrest in Sweden some changes took place. The most important ones were a decrease in the proportion of patients found in ventricular fibrillation and an increase in the proportion of patients receiving bystander CPR. The proportion of patients admitted alive to hospital increased moderately, whereas the proportion of patients alive after 1 month remained unchanged.

  • 10.
    Herlitz, Johan
    et al.
    [external].
    Haglid, M
    Wiklund, I
    Caidahl, K
    Karlson, BW
    Sjöland, H
    Karlsson, T
    Improvement in Quality of Life during 5 years after coronary artery bypass grafting1998Ingår i: Coronary Artery Disease, ISSN 0954-6928, E-ISSN 1473-5830, Vol. 9, nr 8, s. 519-526Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: To describe the changes in various aspects of quality of life (QOL) from before coronary artery bypass grafting (CABG) to 5 years after the procedure. PATIENTS AND METHODS: Patients who underwent CABG in the western region of Sweden in 1988-1991 were approached with questionnaires evaluating their QOL prior to and 3 months and 1, 2, and 5 years after the operation. Three different instruments were used: the Nottingham Health Profile, the Psychological General Well-Being Index, and the Physical Activity Score. RESULTS: In all 2121 patients underwent CABG, of whom 310 died during 5 years of follow-up. With all three instruments QOL had improved 5 years after CABG compared with prior to the operation. However, all three instruments revealed a slight but significant deterioration in estimated QOL between 2 and 5 years after CABG. CONCLUSIONS: QOL 5 years after CABG is better than that prior to the operation, but between 2 and 5 years after the operation a slight deterioration in QOL is observed.

  • 11.
    Herlitz, Johan
    et al.
    [external].
    Karlson, BW
    Hjalmarson, Å
    Causes of death in patients presenting to hospital with symptoms suggestive of acute myocardial infarction: a one-year follow-up study with autopsy results1994Ingår i: Coronary Artery Disease, ISSN 0954-6928, E-ISSN 1473-5830, Vol. 5, nr 1, s. 51-60Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: About 20% of patients admitted to a medical emergency room have chest pain or other symptoms raising suspicion of acute myocardial infarction. AIM: To describe the place and mode of death in such patients during 1 year of follow-up. PATIENTS: All patients (n = 5362) admitted to a single hospital during 21 months because of such symptoms. RESULTS: In all, 565 patients (11%) died. Death rate was directly related to the initial degree of suspicion of acute myocardial infarction. Of these patients, 196 (35%) died during initial hospitalization and only 89 (16%) died outside the hospital. The overall autopsy rate was 53%. Of the deaths that occurred during initial hospitalization, the majority were judged as cardiac, most being due to acute myocardial infarction, particularly if the patients died in the coronary care unit. Among patients who died after discharge from hospital, non-cardiac factors contributed more substantially to death, particularly in patients who died during rehospitalization. The cause of death was not established in a high proportion of patients who died outside hospital. CONCLUSION: The results suggest that, among patients admitted to the emergency room because of suspected acute myocardial infarction, causes of death other than a documented cardiac event become increasingly important when the interval between admittance to the emergency room and death increases.

  • 12.
    Herlitz, Johan
    et al.
    [external].
    Karlson, BW
    Hjalmarson, Å
    Predictors of death and ventricular fibrillation in acute myocardial infarction1992Ingår i: Coronary Artery Disease, ISSN 0954-6928, E-ISSN 1473-5830, Vol. 3, nr 7, s. 651-658Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: The aim of this study is to describe predictors of death and ventricular fibrillation during hospitallzation and predictors of death during the first year after hospital discharge in patients having suffered from acute myocardial infarction (AMI). Methods: Seven hundred seventy-nine consecutive patients admitted to the coronary care unit in one single hospital are included in the analysis. Results: Predictors of death during hospitalization in order of significance were: 1) age (P< 0.001); 2) Q-wave on admission (P< 0.01); 3) a previous history of diabetes mellitus (P< 0.01); 4) arrhythmia at onset of symptoms (P< 0.05); and 5) S-enzyme maximum activity (P< 0.05). The only risk indicator for ventricular fibrillation was enzyme-estimated infarct size (P< 0.001). Risk indications for death after hospital discharge were: 1) age (P< 0.001); 2) acute congestive heart failure on admission (P< 0.01); 3) previous history of hypertension (P< 0.01); and 4) previous history of myocardial infarction (P< 0.05). Patients in whom [beta]-blockers were prescribed at discharge had a 1-year mortality rate of 10% versus 24% for those in whom p-blockers were not prescribed (P< 0.001). Conclusions: With the exception of age, risk indicators for death during hospitalization differ from risk indicators for death after hospital discharge among patients admitted to the coronary care unit due to AMI.

  • 13.
    Herlitz, Johan
    et al.
    [external].
    Karlson, BW
    Hjalmarson, Å
    Prognosis of acute myocardial infarction in relation to age1993Ingår i: Coronary Artery Disease, ISSN 0954-6928, E-ISSN 1473-5830, Vol. 1, s. 23-28Artikel i tidskrift (Refereegranskat)
  • 14.
    Herlitz, Johan
    et al.
    [external].
    Karlson, BW
    Hjalmarson, Å
    Ten-year mortality rate after development of acute myocardial infarction in relation to clinical history and observations during hospital stay1993Ingår i: Coronary Artery Disease, ISSN 0954-6928, E-ISSN 1473-5830, Vol. 4, nr 12, s. 1077-1083Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Previous studies on the prognosis after acute myocardial infarction (AMI) have mainly focused on the first few years. In this study, we aimed to describe the mortality rate during 10 years of follow-up after development of AMI in relation to clinical history and observations during the hospital stay. METHODS: We prospectively followed for 10 years all patients with suspected AMI, enrolled between 1976 and 1981, participating in an early intervention trial with metoprolol who fulfilled given criteria for AMI. RESULTS: A total of 809 patients developed AMI during the first 3 days in hospital, of whom 399 were randomly assigned to receive metoprolol and 410 to receive placebo. The overall 10-year mortality rate, including initial in-hospital mortality, was 51%. In a multivariate analysis considering age, sex, history of cardiovascular diseases, estimated infarct size, and the occurrence of various complications during initial hospitalization (i.e. congestive heart failure, severe ventricular arrhythmias, tachycardia, hypotension, high-degree atrioventricular block and severity of pain) the following appeared as independent predictors of death: a history of diabetes mellitus (P < 0.001), congestive heart failure during hospitalization (P < 0.001), age (P < 0.001), and a history of previous myocardial infarction (P < 0.001). CONCLUSION: Independent predictors of death during the first 10 years after AMI were a history of diabetes mellitus, congestive heart failure during hospitalization, age, and previous myocardial infarction.

  • 15.
    Herlitz, Johan
    et al.
    [external].
    Karlson, BW
    Lindqvist, J
    Sjölin, M
    Characteristics and long term outcome of patients with acute chest pain or other symptoms raising suspicion of acute infarction in relation to whether they were hospitalized or directly discharged from the emergency department2002Ingår i: Coronary Artery Disease, ISSN 0954-6928, E-ISSN 1473-5830, Vol. 13, nr 1, s. 37-43Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIM: To describe the characteristics and outcome of patients who came to the emergency department due to chest pain or other symptoms raising suspicion of acute myocardial infarction (AMI) in relation to whether they were hospitalized or directly discharged from the emergency department. METHODS: All patients arriving to the emergency department in one single hospital due to chest pain or other symptoms raising suspicion of AMI during a period of 21 months were followed for 10 years. RESULTS: In all, 5362 patients fulfilled the given criteria on 7157 occasions; 3381 (63%) were hospitalized and 1981 (37%) were directly discharged. Patients who were hospitalized were older and had a higher prevalence of previous cardiovascular diseases. The mortality during the subsequent 10 years was 52.1% among those hospitalized and 22.3% among those discharged (P < 0.0001). Risk indicators for death were similar in the two cohorts. However, many of these risk indicators including age, a history of myocardial infarction, angina pectoris, congestive heart failure, hypertension, initial degree of suspicion of AMI, a pathologic electrocardiogram on admission and a confirmed AMI as underlying etiology were more strongly associated with the prognosis among patients directly discharged than among those hospitalized. Ten (0.5%) of the patients who were directly discharged from the emergency department were found to have a diagnosis of confirmed or possible AMI, making up 1% of all patients given such a diagnosis. These patients had a 10-year mortality of 80.0% compared with 65.7% among patients with a confirmed or possible AMI who were hospitalized. CONCLUSION: Of patients who came to the emergency department with acute chest pain or other symptoms suggestive of AMI about a third were directly discharged. Their mortality during the subsequent 10 years was half that of patients hospitalized. Various risk indicators for death were more strongly associated with prognosis in the patients who were directly discharged from the emergency department compared to those hospitalized. Of all patients given a diagnosis of confirmed or possible AMI, 1% were discharged from the emergency department. Their long-term mortality was high, maybe even higher than among AMI patients hospitalized.

  • 16.
    Herlitz, Johan
    et al.
    [external].
    Karlson, BW
    Pettersson, P
    Strömbom, U
    Liljeqvist, J-Å
    Hjalmarson, Å
    Risk factors for death and mode of death after acute myocardial infarction in relation to age1992Ingår i: Coronary Artery Disease, ISSN 0954-6928, E-ISSN 1473-5830, Vol. 3, nr 11, s. 1055-1063Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: This study aims to describe independent risk indicators for death and mode of death after development of acute myocardial infarction in relation to age. Methods: Nine hundred twenty-one consecutive patients admitted to Sahlgrenska Hospital, Goteborg, Sweden, suffering from acute myocardial infarction were prospectively followed for 1 year. The patients were divided into two age groups, 76 years old and above or below 76 years old, because there was an equal number of deaths in these two groups. Results: In the older group, the following were independent risk indicators for death at 1 year of follow-up, in order of significance: 1) previous infarction (P< 0.01); 2) ST-segment elevation on admission (P< 0.01); 3) arrhythmia at onset of infarction (P< 0.05); and 4) age (P< 0.05). In patients 76 years old or less the following were risk indicators: 1) age (P < 0.001); 2) history of congestive heart failure (P< 0.01); 3) loss of consciousness at onset of infarction (P< 0.01); 4) acute congestive heart failure at onset of infarction (P< 0.05); 5) unspecific symptoms at onset of infarction (P< 0.05); and 6) history of hypertension (P< 0.05). In both age groups risk indicators for death during hospitalization differed from risk indicators for death after discharge from the hospital. During hospitalization, the elderly more frequently died in association with congestive heart failure and less frequently in association with ventricular fibrillation as compared with younger patients. Conclusions: In the elderly (>76 y) with acute myocardial infarction, risk indicators for death differ from those in younger patients. Symptoms associated with death are also not the same in patients 76 years old as compared with younger patients.

  • 17. Holmgren, CM
    et al.
    Nystrom, BM
    Karlsson, TK
    Herlitz, Johan
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Edvardsson, NG
    Presumed Arrhytmic Death in Consecutive Survivors of Acute Myocardial Infarction: Implications for Primary Implantable Cardioverter Defibrillator Implantation2009Ingår i: Coronary Artery Disease, ISSN 0954-6928, E-ISSN 1473-5830, Vol. 20, nr 2, s. 155-62Artikel i tidskrift (Refereegranskat)
  • 18. Holmgren, CM
    et al.
    Nyström, BM
    Karlsson, TK
    Herlitz, Johan
    Högskolan i Borås, Institutionen för Vårdvetenskap. [external].
    Edvardsson, NG
    Presumed arrhythmic death in consecutive survivors of acute myocardial infarction--implications for primary implantable cardioverter defibrillator implantation.2009Ingår i: Coronary Artery Disease, ISSN 0954-6928, E-ISSN 1473-5830, Vol. 20, nr 2, s. 155-162Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIM: To describe the occurrence of arrhythmic death among survivors of acute myocardial infarction (AMI) and the availability of a primary implantable cardioverter defibrillator (ICD). METHODS: Consecutive patients who fulfilled the criteria for AMI admitted to the Sahlgrenska University Hospital during 21 months were prospectively followed for 2 years with a focus on echocardiography and mode of death. RESULTS: Among the 471 patients, for whom information on ejection fraction (EF) was available and who survived the first week, 10 patients died between days 7 and 30 - of whom one had an arrhythmic death. Among the 461 survivors on day 30, 34 patients (7.4%) had an EF of 30% or less. Among these, 24 were judged to be available for ICD implantation, of whom one died an arrhythmic death during follow-up. Among the remaining 10 patients who were excluded from ICD indication because of either high age and/or severe comorbidity, two patients died an arrhythmic death. Among the remaining 427 patients who had an EF greater than 30%, six died an arrhythmic death. Thus, 10 patients, with EF assessed, died an arrhythmic death between day 7 and 2 years after AMI, but only one would have received an ICD according to the Multicenter Automatic Defibrillator Implantation Trial II criteria and clinical judgement. CONCLUSION: Of the 471 consecutive survivors of AMI, 10 (2%) died an arrhythmic death, of whom only one would have received an ICD according to current guidelines and clinical judgement. Predictors of subsequent arrhythmic death after an AMI, useful on a per patient basis, remain an unmet need.

  • 19. Karlson, BW
    et al.
    Herlitz, Johan
    [external].
    Hospitalisations, infarct development and mortality in patients with chest pain or other symptoms suggestive of acute myocardial infarction and a normal admission electrocardiogram in relation to gender1996Ingår i: Coronary Artery Disease, ISSN 0954-6928, E-ISSN 1473-5830, Vol. 7, nr 3, s. 231-237Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: The aim of this study was to compare the outcome for men and women with chest pain or other symptoms suggestive of acute myocardial infarction (AMI) and a normal ECG on admission. METHODS: All patients who presented to our emergency room over a 21-month period with chest pain or other symptoms suggestive of AMI were prospectively followed for 1 year, whether they were hospitalised or not. RESULTS: Of 5201 registered patients a normal ECG was found in 2691, of whom 700 men and 559 women were hospitalised while 752 men and 680 women were not hospitalised. As many women (45%) as men (48%) were hospitalised, but fewer women were admitted to the coronary care unit in the first instance (8.6% versus 15.2%; P < 0.001). More men than women (9.3% versus 2.7%; P < 0.001) who were hospitalised developed AMI during hospitalisation, but there was no difference during 1 year between men and women who were not hospitalised regarding AMI development (1.5% versus 1.4%; NS). There was no difference in in-hospital complications between men and women. Mortality for men and women during hospitalisation (1.6% versus 1.1%) or during 1 year (4.2% versus 4.5% for hospitalised and 1.2% versus 1.2% for not hospitalised patients) did not differ. CONCLUSIONS: Among patients with suspected AMI and a normal ECG on admission women were less often admitted to the coronary care unit and less often developed AMI during hospitalisation than men. Men and women had the same mortality during hospitalization and during 1 year.

  • 20. Karlson, BW
    et al.
    Herlitz, Johan
    [external].
    Hartford, M
    Hjalmarson, Å
    Prognosis in men and women coming to the emergency room with chest pain or other sympotms suggestive to acute myocardial infarction1993Ingår i: Coronary Artery Disease, ISSN 0954-6928, E-ISSN 1473-5830, Vol. 4, nr 9, s. 761-767Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Previous studies suggest a gender-related difference in prognosis among patients with ischaemic heart disease. In the present study, we aimed to describe the characteristics and prognosis among patients with suspected ischaemic heart disease in relation to gender. METHODS: During the 21 months of the study, all patients who came to the medical emergency room of one single hospital as a result of chest pain or other symptoms suggestive of acute myocardial infarction were prospectively followed for 1 year. RESULTS: A total of 5362 patients were admitted on 7157 occasions; men accounted for 55% of the admissions. The 1-year mortality rate was 11% for men compared with 10% for women. The women were older and had a higher prevalence of known congestive heart failure and hypertension, whereas the prevalence of previous myocardial infarction was higher in men. When correcting for the dissimilarities in age and history of cardiovascular diseases, male gender appeared as an independent predictor of death. Development of myocardial infarction occurred in 25% of the men and 16% of the women (P < 0.001) during 1 year. The symptoms that brought patients to the emergency room were interpreted as being caused by myocardial infarction or myocardial ischemia in 29% of men compared with 21% of women (P < 0.001). CONCLUSIONS: In a consecutive series of patients with chest pain or other symptoms suggesting acute myocardial infarction in the emergency room, male gender was an independent risk indicator for death during 1 year. This might be explained by a higher occurrence of coronary artery disease in men than in women in this patient population.

  • 21. Karlson, BW
    et al.
    Hjalmarson, Å
    Herlitz, Johan
    [external].
    Does a history of diabetes mellitus adversely affect the outcome in hypertensive patients with acute chest pain?1995Ingår i: Coronary Artery Disease, ISSN 0954-6928, E-ISSN 1473-5830, Vol. 6, nr 1, s. 49-56Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: We evaluated the impact of diabetes mellitus on the prognosis in hypertensive patients admitted to hospital as a result of acute chest pain. PATIENTS: All patients in this study had a history of hypertension and were admitted to the Emergency Department at Sahlgrenska Hospital, Göteborg, Sweden, complaining of chest pain, or other symptoms suggestive of acute myocardial infarction, between 15 February 1986 and 9 November 1987. METHODS: All patients were prospectively registered on admission to the Emergency Department and followed for 1 year in terms of mortality and morbidity. RESULTS: Of the 1274 patients who fulfilled the inclusion criteria, 187 (15%) had a history of diabetes mellitus. The 1-year mortality rate for all hypertensive patients was 18%, whereas it was 24% for those who also had diabetes mellitus, and 16% for hypertensive patients without diabetes mellitus (P < 0.05). However, in a multivariate analysis considering age, sex, and history of cardiovascular diseases, the following appeared as independent predictors of death in the hypertensive patients: age (P < 0.001), a history of congestive heart failure (P < 0.001), and male sex (P < 0.01). CONCLUSION: Hypertensive patients who were admitted to the Emergency Department of Sahlgrenska Hospital with acute chest pain had a poor prognosis, which was even worse if they also had a history of diabetes mellitus. The relationship between diabetes mellitus and hypertension could not, however, be clearly defined.

  • 22. Perers, E
    et al.
    Abrahamsson, P
    Bång, A
    [external].
    Engdahl, J
    Karlson, BW
    Lindqvist, J
    Waagstein, L
    Herlitz, Johan
    [external].
    Outcomes of patients hospitalized after out-of-hospital cardiac arrest in relation to sex1999Ingår i: Coronary Artery Disease, ISSN 0954-6928, E-ISSN 1473-5830, Vol. 10, nr 7, s. 509-514Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: To describe characteristics and outcomes of patients hospitalized after out-of-hospital cardiac arrest in relation to sex. PATIENTS: All patients in the community of Göteborg who between 1980 and 1996 suffered out-of-hospital cardiac arrest and were hospitalized alive. METHODS: We calculated age-adjusted P values. RESULTS: In all 1038 patients were hospitalized alive of whom 29% were women. Women differed from men by being older and there being lower prevalences of previous acute myocardial infarction (AMI) and smoking and a higher prevalence of bronchial asthma among them. They had less commonly received cardio-pulmonary resuscitation (CPR) from bystanders (16 versus 25% of cases; P = 0.002) and were less commonly found to be in ventricular fibrillation when the ambulance crew arrived (55 versus 73% of cases; P < 0.0001). They were less commonly judged to have a cardiac etiology behind the arrest (87 versus 92% of cases; P = 0.016). Of women 31.3% could be discharged alive from hospital, compared with 41.8% of men (P = 0.001). While they were in hospital, women were less commonly subjected to exercise tests, coronary angiography, and coronary artery bypass grafting. CONCLUSION: Among patients who suffered out-of-hospital cardiac arrest and were hospitalized alive, women had less commonly received CPR from bystanders, were less commonly found in ventricular fibrillation, less commonly underwent coronary angiography and coronary artery bypass grafting and had a lower survival rate than did men.

  • 23. Perers, E
    et al.
    From Attebring, M
    Caidahl, K
    Herlitz, Johan
    [external].
    Karlsson, T
    Währborg, P
    Low risk is associated with poorer quality of life than high risk following acute coronary syndrome.2006Ingår i: Coronary Artery Disease, ISSN 0954-6928, E-ISSN 1473-5830, Vol. 17, nr 6, s. 501-510Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Morbidity after acute coronary syndromes includes both physical and mental disorders affecting quality of life. The aim of this investigation was to study quality of life at a 3-month follow-up in patients with acute coronary syndrome, with the main objective of exploring whether unstable angina pectoris and myocardial infarction (MI) patients differ in this respect. METHODS: This investigation was part of a prospective risk stratification study of consecutive patients with acute coronary syndrome of whom 814 below the age of 75 years (278 diagnosed with unstable angina pectoris and 536 with myocardial infarction) accepted an invitation to a follow-up visit 3 months after discharge. At follow-up, the patients completed the Cardiac Health Profile, a disease-specific quality of life questionnaire, designed to evaluate perceived cognitive, emotional, social and physical function. RESULTS: Quality of life was mainly influenced by patient characteristics and previous history. The Cardiac Health Profile scores in unstable angina pectoris patients were significantly higher (i.e. poorer quality of life) than myocardial infarction patients at the 3-month visit (34, 22, 50; median, 25th, 75th percentile and 30, 19, 44; median, 25th, 75th percentile, respectively, P=0.006). The adjusted odds ratio for a poorer quality of life in unstable angina pectoris patients in relation to myocardial infarction patients was 1.39 (95% confidence interval 1.03, 1.87; P=0.03). The highest Cardiac Health Profile scores were seen in the unstable angina pectoris patients without electrocardiogram signs of ongoing ischemia and/or elevated markers of myocardial necrosis. CONCLUSION: Patients with unstable angina pectoris, especially of the low-risk type, and therefore treated accordingly, are more likely to experience poorer quality of life following an acute hospitalization than patients with other types of acute coronary syndrome. Once myocardial infarction or high-risk unstable angina pectoris has been ruled out, these patients still require a careful and systematic follow-up.

  • 24. Perers, E
    et al.
    From Attebring, M
    Caidahl, K
    Herlitz, Johan
    Högskolan i Borås, Institutionen för Vårdvetenskap. [external].
    Karlsson, T
    Währborg, P
    Hartford, M
    Low risk is associated with poorer quality of life than high risk following acute coronary syndrome.2006Ingår i: Coronary Artery Disease, ISSN 0954-6928, E-ISSN 1473-5830, Vol. 17, nr 6, s. 501-510Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Morbidity after acute coronary syndromes includes both physical and mental disorders affecting quality of life. The aim of this investigation was to study quality of life at a 3-month follow-up in patients with acute coronary syndrome, with the main objective of exploring whether unstable angina pectoris and myocardial infarction (MI) patients differ in this respect. METHODS: This investigation was part of a prospective risk stratification study of consecutive patients with acute coronary syndrome of whom 814 below the age of 75 years (278 diagnosed with unstable angina pectoris and 536 with myocardial infarction) accepted an invitation to a follow-up visit 3 months after discharge. At follow-up, the patients completed the Cardiac Health Profile, a disease-specific quality of life questionnaire, designed to evaluate perceived cognitive, emotional, social and physical function. RESULTS: Quality of life was mainly influenced by patient characteristics and previous history. The Cardiac Health Profile scores in unstable angina pectoris patients were significantly higher (i.e. poorer quality of life) than myocardial infarction patients at the 3-month visit (34, 22, 50; median, 25th, 75th percentile and 30, 19, 44; median, 25th, 75th percentile, respectively, P=0.006). The adjusted odds ratio for a poorer quality of life in unstable angina pectoris patients in relation to myocardial infarction patients was 1.39 (95% confidence interval 1.03, 1.87; P=0.03). The highest Cardiac Health Profile scores were seen in the unstable angina pectoris patients without electrocardiogram signs of ongoing ischemia and/or elevated markers of myocardial necrosis. CONCLUSION: Patients with unstable angina pectoris, especially of the low-risk type, and therefore treated accordingly, are more likely to experience poorer quality of life following an acute hospitalization than patients with other types of acute coronary syndrome. Once myocardial infarction or high-risk unstable angina pectoris has been ruled out, these patients still require a careful and systematic follow-up.

  • 25. Petursson, P
    et al.
    Herlitz, J
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Lindqvist, J
    Sjöland, H
    Gudbjörnsdottir, S
    Prevalence and severity of abnormal glucose regulation and its relation to long-term prognosis after coronary artery bypass grafting.2013Ingår i: Coronary Artery Disease, ISSN 0954-6928, E-ISSN 1473-5830, Vol. 24, nr 7, s. 577-582Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Diabetes is a strong predictor of a poor outcome after coronary artery bypass grafting (CABG). The prevalence of prediabetes and its impact on the prognosis after CABG is not well described. In this study, we evaluated the prevalence and prognostic impact of the different states of abnormal glucose regulation (AGR) after CABG. PATIENTS AND METHODS: In this prospective study, we included 244 patients undergoing CABG. An oral glucose tolerance test was used to stratify patients into three groups: normoglycaemia, prediabetes and diabetes. The primary outcome was a composite of all-cause mortality and hospitalization for a nonfatal cardiovascular event. RESULTS: Among the patients, 86 (35%) were normoglycaemic and 58 (24%) had prediabetes; 100 (41%) patients had diabetes, of whom 28 (28%) had newly diagnosed diabetes on the basis of oral glucose tolerance test. During a mean follow-up period of 5.3 years, 25% of the study population suffered the primary outcome. There was a successive increase in the primary outcome rate from normoglycaemia through prediabetes to diabetes (adjusted hazard ratio 1.40; 95% confidence interval 1.01-1.96; P=0.045). CONCLUSION: With increasing severity of AGR, there is an increasing risk of new cardiovascular events after CABG. AGR is prevalent and predicts a poor outcome after CABG. Systematic screening for AGR seems reasonable to identify these high-risk patients.

  • 26. Sjöland, H
    et al.
    Herlitz, Johan
    [external].
    Karlson, BW
    Karlsson, T
    Caidahl, K
    Influence of patients sex and clinical history on working capacity and myocardial ischemia after coronary artery bypass surgery1995Ingår i: Coronary Artery Disease, ISSN 0954-6928, E-ISSN 1473-5830, Vol. 6, nr 7, s. 561-571Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Coronary artery bypass grafting (CABG) is generally accepted as effective in relieving patients from angina pectoris, and in improving survival in subgroups. However, subset evaluations of myocardial ischemia and exercise capacity after CABG are scarce. The aim of this study was to determine the outcome of CABG in terms of exercise capacity and stress ECG findings in subgroups of patients. METHODS: A stepwise bicycle exercise ECG (in most cases computerized) was performed on 362 patients within 1 year before and 2 years after CABG. RESULTS: Exercise capacity increased from a median value of 90 to 130 W (P < 0.0001), more marked (P < 0.0001) in men (100-140 W) than in women (75-90 W). Improvement was not significantly related to age. Occurrence of ST-segment depression at exercise decreased, 76% showing ST-segment depression of at least 1 mm before the operation and 35% (P < 0.0001) 2 years after. Exercise-induced signs of ischemia on ECG did not differ between men and women. Maximum heart rate increased from a median value of 109 to one of 133 beats/min (P < 0.0001), and maximum systolic blood pressure from 170 to 210 mmHg (P < 0.0001). Termination of exercise because of chest pain decreased from 48 to 6% (P < 0.0001). Most subsets of patients improved exercise capacity with a reduction of ST-segment depression irrespective of their previous history and manifestations of cardiovascular disease. CONCLUSIONS: CABG caused a marked increase in exercise capacity and reduced signs of myocardial ischemia. Although men increased their working capacity by a greater extent than women, reduction in signs of myocardial ischemia was similar in both sexes.

  • 27. Svensson, L
    et al.
    Isaksson, L
    Axelsson, Christer
    [external].
    Nordlander, R
    Herlitz, Johan
    [external].
    Predictors of myocardial damage prior to hospital admission among patients with acute chest pain or other symptoms raising a suspicion of acute coronary syndrome.2003Ingår i: Coronary Artery Disease, ISSN 0954-6928, E-ISSN 1473-5830, Vol. 14, nr 3, s. 225-231Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIM: To evaluate factors which, prior to hospital admission, predict the development of acute coronary syndrome or acute myocardial infarction among patients who call for an ambulance due to suspected acute coronary syndrome. DESIGN: Prospective observational study. METHODS: All the patients who called for an ambulance due to suspected acute coronary syndrome in South Hospital's catchment area in Stockholm and in the Municipality of Göteborg between January and November 2000, were included. On arrival of the ambulance crew, a blood sample was drawn for bedside analysis of serum myoglobin, creatine kinase (CK)MB and troponin-I. A 12-lead electrocardiogram (ECG) was simultaneously recorded. RESULTS: In all, 538 patients took part in the survey. Their mean age was 69 years and 58% were men. In all, 307 patients (57.3%) had acute coronary syndrome and 158 (29.5%) had acute myocardial infarction. Independent predictors of the development of acute coronary syndrome were a history of myocardial infarction (P=0.006), angina pectoris (P=0.005) or hypertension (P=0.017), ECG changes with ST elevation (P<0.0001), ST depression (P<0.0001) or T-wave inversion (P=0.012) and the elevation of CKMB (P=0.005). Predictors of acute myocardial infarction were being a man (P=0.011), ECG changes with ST elevation (P<0.0001) or ST depression (P<0.0001), the elevation of CKMB (P<0.0001) and a short interval between the onset of symptoms and blood sampling (P=0.010). CONCLUSION: Among patients transported by ambulance due to suspected acute coronary syndrome, predictors of myocardial damage can be defined prior to hospital admission on the basis of previous history, sex, ECG changes, the elevation of biochemical markers and the interval from the onset of symptoms until the ambulance reaches the patient.

  • 28. Zedigh, C
    et al.
    Alho, A
    Hammar, E
    Karlsson, Thomas
    Kellerth, T
    Svensson, L
    Grimbrandt, E
    Herlitz, Johan
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Aspects on the intensity and the relief of pain in the prehospital phase of acute coronary syndrome: experiences from a randomized clinical trial2010Ingår i: Coronary Artery Disease, ISSN 0954-6928, E-ISSN 1473-5830, Vol. 21, nr 2, s. 113-120Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The primary aim of this study was to evaluate the pain relief and tolerability of two pain-relieving strategies in the prehospital phase of presumed acute coronary syndrome (ACS), and the secondary aim was to assess the relationship between the intensity and relief of pain and heart rate, blood pressure, and ST deviation. Patients with chest pain judged as caused by ACS were randomized (open) to either metoprolol 5 mg intravenously (i.v.) three times at 2-min intervals (n = 84; metoprolol group) or morphine 5 mg i.v. followed by metoprolol 5 mg three times i.v (n = 80; morphine group). Pain was assessed on a 10-grade scale before randomization and 10, 20, and 30 min thereafter. The mean pain score decreased from 6.5 at randomization to 2.8 30 min later, with no significant difference between groups. The percentages with complete pain relief (pain score <=1) after 10, 20, and 30 min were 11, 16, and 21%, respectively, with no difference between groups. Hypotension was less frequent in the metoprolol group compared with the morphine group (0 vs. 6.3%; P=0.03), as was nausea/vomiting (7.2 vs. 24.0%; P=0.004). At randomization intensity of pain was associated with degree of ST elevation (P=0.009). The degree of pain relief over 30 min was associated with decrease in heart rate (P=0.03) and decrease in ST elevation (P=0.01). In conclusion, in the prehospital phase of presumed ACS, neither a pain-relieving strategy including an anti-ischemic agent alone nor an analgesic plus anti-ischemic strategy in combination resulted in complete pain relief. Fewer side effects were found with the former strategy. Other pain-relieving strategies need to be evaluated.

1 - 28 av 28
RefereraExporteraLänk till träfflistan
Permanent länk
Referera
Referensformat
  • apa
  • harvard1
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Annat format
Fler format
Språk
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Annat språk
Fler språk
Utmatningsformat
  • html
  • text
  • asciidoc
  • rtf