liu.seSearch for publications in DiVA
Change search
Link to record
Permanent link

Direct link
BETA
Publications (10 of 123) Show all publications
Sandstedt, M., De Geer, J., Henriksson, L., Engvall, J., Janzon, M., Persson, A. & Alfredsson, J. (2019). Long-term prognostic value of coronary computed tomography angiography in chest pain patients.. Acta Radiologica, 60(1), 45-53
Open this publication in new window or tab >>Long-term prognostic value of coronary computed tomography angiography in chest pain patients.
Show others...
2019 (English)In: Acta Radiologica, ISSN 0284-1851, E-ISSN 1600-0455, Vol. 60, no 1, p. 45-53Article in journal (Refereed) Published
Abstract [en]

Background Coronary computed tomography angiography (CCTA) is increasingly used to detect coronary artery disease (CAD), but long-term follow-up studies are still scarce. Purpose To evaluate the prognostic value of CCTA in patients with suspected CAD. Material and Methods A total of 1205 consecutive CCTA patients with chest pain were classified as normal coronary arteries, non-obstructive CAD, or obstructive CAD. The primary outcome was major adverse cardiac event (MACE), defined as a composite outcome including cardiac death, myocardial infarction, unstable angina pectoris, or late revascularization (after >90 days). Results Over 7.5 years follow-up (median = 3.1 years), Kaplan-Meier estimates demonstrated a MACE in 1.0%, 4.6%, and 20.7% in normal coronary arteries, non-obstructive CAD, and obstructive CAD, respectively. Log rank test for pairwise comparisons showed significant differences between non-obstructive CAD and normal coronary arteries ( P = 0.023) and between obstructive CAD and normal coronary arteries ( P < 0.001). In a multivariable analysis, adjusting for classical risk factors, non-obstructive CAD and obstructive CAD were independent predictors of MACE, with hazard ratios (HR) of 3.22 ( P = 0.041) and 25.18 ( P < 0.001), respectively. Conclusion Patients with normal coronary arteries have excellent long-term prognosis, but the risk for MACE increases with non-obstructive and obstructive CAD. Both non-obstructive and obstructive CAD are independently associated with future ischemic events.

Keywords
CT, Cardiac, computed tomography angiography, epidemiology, ischemia/infarction
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:liu:diva-149562 (URN)10.1177/0284185118773551 (DOI)000453211800006 ()29742921 (PubMedID)
Note

Funding  agencies:  ALF Grants, Region Ostergotland

Available from: 2018-07-06 Created: 2018-07-06 Last updated: 2019-01-07
Collet, J.-P., Kerneis, M., Lattuca, B., Yan, Y., Cayla, G., Silvain, J., . . . Montalescot, G. (2018). Impact of age on the effect of pre-hospital P2Y12 receptor inhibition in primary percutaneous coronary intervention for ST-segment elevation myocardial infarction: the ATLANTIC-Elderly analysis. EuroIntervention, 14(7), 789-797, Article ID EIJ-D-18-00182.
Open this publication in new window or tab >>Impact of age on the effect of pre-hospital P2Y12 receptor inhibition in primary percutaneous coronary intervention for ST-segment elevation myocardial infarction: the ATLANTIC-Elderly analysis
Show others...
2018 (English)In: EuroIntervention, ISSN 1774-024X, E-ISSN 1969-6213, Vol. 14, no 7, p. 789-797, article id EIJ-D-18-00182Article in journal (Refereed) Published
Abstract [en]

AIMS: The aim of the study was to examine the main results of the ATLANTIC trial in patients with ST-elevation myocardial infarction (STEMI), randomised to pre- versus in-hospital ticagrelor, according to age.

METHODS AND RESULTS: Patients were evaluated by age class (<75 vs. ≥75 years) for demographics, prior cardiovascular history, risk factors, management, and outcomes. Elderly patients (≥75 years; 304/1,862) were more likely to be women, diabetic, lean, with a prior history of myocardial infarction and CABG, and with comorbidities (p<0.01 for all). Elderly patients presented more frequently with acute heart failure and less frequently had thromboaspiration, a stent implanted (p<0.01) and an aggressive antithrombotic regimen. Elderly patients had lower rates of pre- and post-PCI ≥70% ST-segment elevation resolution (43.9% vs. 51.6%; p=0.035), of pre- and post-PCI TIMI 3 flow (17.1% vs. 27.5%, p=0.0002), and a higher rate of the composite of death/MI/stroke/urgent revascularisation (9.9% vs. 2.9%; OR 3.67, 95% CI [2.27; 5.93], p<0.0001) and mortality (8.5% vs. 1.5%; OR 6.45, 95% CI [2.75; 15.11], p<0.0001). There was a non-significant trend towards more frequent major bleedings among elderly patients (TIMI major 2.3% vs. 1.1%; OR 2.13, 95% CI [0.88; 5.18], p=0.095). There was no significant interaction between time of ticagrelor administration (pre-hospital versus in-lab) and class of age for all outcomes.

CONCLUSIONS: Elderly patients, who represented one sixth of the patients randomised in the ATLANTIC trial, had less successful mechanical reperfusion and a sixfold increase in mortality at 30 days, probably due to comorbidities and possible undertreatment. The effect of early ticagrelor was consistent irrespective of age.

Place, publisher, year, edition, pages
Toulouse, France: Europa Digital & Publishing, 2018
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:liu:diva-155885 (URN)10.4244/EIJ-D-18-00182 (DOI)000445133400015 ()29969431 (PubMedID)2-s2.0-85054360592 (Scopus ID)
Available from: 2019-03-29 Created: 2019-03-29 Last updated: 2019-04-17Bibliographically approved
Sunnerud, S., Nylander, E., Janzon, M., Carlén, A. & Hedman, K. (2018). Låg följsamhet till rekommenderad hjärtscreening av elitidrottare - Lägesanalys i Östergötland. Läkartidningen, 115, 185-187, Article ID EWLM.
Open this publication in new window or tab >>Låg följsamhet till rekommenderad hjärtscreening av elitidrottare - Lägesanalys i Östergötland
Show others...
2018 (Swedish)In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 115, p. 185-187, article id EWLMArticle in journal (Refereed) Published
Abstract [en]

Low adherence to recommended pre-participation cardiac evaluation of Swedish athletes Pre-participation cardiac evaluation of athletes is recommended by international organizations like the European Society of Cardiology and the American Heart Association, as well as by the Swedish Sports Confederation. The purpose of the evaluation is to prevent sudden cardiac death in athletes by early identification of individuals at risk. To our knowledge, no previous study has been made regarding the implementation of pre-participation cardiac evaluation of athletes in Sweden. We performed an electronical survey addressing sports clubs in one out of 21 districts in which the Swedish Sports Confederation is geographically divided. Only four out of 22 responding clubs with elite athletes preformed cardiac evaluation. Lack of knowledge about the recommendations as well as how to perform the evaluation were mentioned as reasons not to evaluate the athletes. Our results indicate the need for more information about pre-participation cardiac evaluation of athletes in Sweden.

National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:liu:diva-152133 (URN)29381184 (PubMedID)
Available from: 2018-10-18 Created: 2018-10-18 Last updated: 2019-08-28Bibliographically approved
Eckard, N., Nedlund, A.-C., Janzon, M. & Levin, L.-Å. (2017). Reaching agreement in uncertain circumstances: the practice of evidence-based policy in the case of the Swedish National Guidelines for heart diseases. Evidence and Policy: A Journal of Research, Debate and Practice (4), 687-707
Open this publication in new window or tab >>Reaching agreement in uncertain circumstances: the practice of evidence-based policy in the case of the Swedish National Guidelines for heart diseases
2017 (English)In: Evidence and Policy: A Journal of Research, Debate and Practice, ISSN 1744-2648, no 4, p. 687-707Article in journal (Refereed) Published
Abstract [en]

This paper explores the practice of evidence-based policy in a Swedish healthcare context. The study focused on how policymakers in the specific working group, the Priority-Setting Group (PSG), handled the various forms of evidence and values and their competing rationalities, when producing the Swedish National Guidelines for heart diseases that are based on both clinical and economic evidence and are established to support explicit priority-setting in healthcare. The study contributes to the theoretical and practical debate on evidence-based policy (EBP) by illustrating how the practical tensions of coming to agreement were managed, to a large extent, through deliberation and by creativity.

Place, publisher, year, edition, pages
Informa Healthcare, 2017
Keywords
cost-effectiveness; evidence-based policy; healthcare; national guidelines; priority setting; sense-making
National Category
Health Care Service and Management, Health Policy and Services and Health Economy Other Health Sciences
Identifiers
urn:nbn:se:liu:diva-121280 (URN)10.1332/174426416X14788795557982 (DOI)000417405400007 ()
Available from: 2015-09-11 Created: 2015-09-11 Last updated: 2017-12-29Bibliographically approved
Wallentin, L., Lindhagen, L., Arnstrom, E., Husted, S., Janzon, M., Paaske Johnsen, S., . . . Lagerqvist, B. (2016). Early invasive versus non-invasive treatment in patients with non-ST-elevation acute coronary syndrome (FRISC-II): 15 year follow-up of a prospective, randomised, multicentre study. The Lancet, 388(10054), 1903-1911
Open this publication in new window or tab >>Early invasive versus non-invasive treatment in patients with non-ST-elevation acute coronary syndrome (FRISC-II): 15 year follow-up of a prospective, randomised, multicentre study
Show others...
2016 (English)In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 388, no 10054, p. 1903-1911Article in journal (Refereed) Published
Abstract [en]

Background The FRISC-II trial was the first randomised trial to show a reduction in death or myocardial infarction with an early invasive versus a non-invasive treatment strategy in patients with non-ST-elevation acute coronary syndrome. Here we provide a remaining lifetime perspective on the effects on all cardiovascular events during 15 years follow-up. Methods The FRISC-II prospective, randomised, multicentre trial was done at 58 Scandinavian centres in Sweden, Denmark, and Norway. Between June 17, 1996, and Aug 28, 1998, we randomly assigned (1:1) 2457 patients with non-ST-elevation acute coronary syndrome to an early invasive treatment strategy, aiming for revascularisation within 7 days, or a non-invasive strategy, with invasive procedures at recurrent symptoms or severe exercise-induced ischaemia. Plasma for biomarker analyses was obtained at randomisation. For long-term outcomes, we linked data with national health-care registers. The primary endpoint was a composite of death or myocardial infarction. Outcomes were compared as the average postponement of the next event, including recurrent events, calculated as the area between mean cumulative count-of-events curves. Analyses were done by intention to treat. Findings At a minimum of 15 years follow-up on Dec 31, 2014, data for survival status and death were available for 2421 (99%) of the initially recruited 2457 patients, and for other events after 2 years for 2182 (89%) patients. During follow-up, the invasive strategy postponed death or next myocardial infarction by a mean of 549 days (95% CI 204-888; p= 0.0020) compared with the non-invasive strategy. This effect was larger in non-smokers (mean gain 809 days, 95% CI 402-1175; p(interaction) = 0.0182), patients with elevated troponin T (778 days, 357-1165; p (interaction) = 0.0241), and patients with high concentrations of growth differentiation factor-15 (1356 days, 507-1650; p (interaction) = 0.0210). The difference was mainly driven by postponement of new myocardial infarction, whereas the early difference in mortality alone was not sustained over time. The invasive strategy led to a mean of 1128 days (95% CI 830-1366) postponement of death or next readmission to hospital for ischaemic heart disease, which was consistent in all subgroups (pamp;lt; 0.0001). Interpretation During 15 years of follow-up, an early invasive treatment strategy postponed the occurrence of death or next myocardial infarction by an average of 18 months, and the next readmission to hospital for ischaemic heart disease by 37 months, compared with a non-invasive strategy in patients with non-ST-elevation acute coronary syndrome. This remaining lifetime perspective supports that an early invasive treatment strategy should be the preferred option in most patients with non-ST-elevation acute coronary syndrome.

Place, publisher, year, edition, pages
ELSEVIER SCIENCE INC, 2016
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:liu:diva-132518 (URN)10.1016/S0140-6736(16)31276-4 (DOI)000385499000034 ()
Note

Funding Agencies|Swedish Heart-Lung Foundation; Swedish Foundation for Strategic Research; Uppsala Clinical Research Center

Available from: 2016-11-14 Created: 2016-11-13 Last updated: 2018-06-05
Montalescot, G., vant Hof, A. W., Bolognese, L., Cantor, W. J., Cequier, A., Chettibi, M., . . . Hamm, C. W. (2016). Effect of Pre-Hospital Ticagrelor During the First 24 h After Primary Percutaneous Coronary Intervention in Patients With ST-Segment Elevation Myocardial Infarction The ATLANTIC-H-24 Analysis. JACC: Cardiovascular Interventions, 9(7), 646-656
Open this publication in new window or tab >>Effect of Pre-Hospital Ticagrelor During the First 24 h After Primary Percutaneous Coronary Intervention in Patients With ST-Segment Elevation Myocardial Infarction The ATLANTIC-H-24 Analysis
Show others...
2016 (English)In: JACC: Cardiovascular Interventions, ISSN 1936-8798, E-ISSN 1876-7605, Vol. 9, no 7, p. 646-656Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES The aim of this landmark exploratory analysis, ATLANTIC-H-24, was to evaluate the effects of pre-hospital ticagrelor during the first 24 h after primary percutaneous coronary intervention (PCI) in the ATLANTIC (Administration of Ticagrelor in the cath Lab or in the Ambulance for New ST elevation myocardial infarction to open the Coronary artery) study. BACKGROUND The ATLANTIC trial in patients with ongoing ST-segment elevation myocardial infarction showed that pre-hospital ticagrelor was safe but did not improve pre-PCI coronary reperfusion compared with in-hospital ticagrelor. We hypothesized that the effect of pre-hospital ticagrelor may not have manifested until after PCI due to the rapid transfer time (31 min). METHODS The ATLANTIC-H-24 analysis included 1,629 patients who underwent PCI, evaluating platelet reactivity, Thrombolysis In Myocardial Infarction flow grade 3, &gt;= 70% ST-segment elevation resolution, and clinical endpoints over the first 24 h. RESULTS Following PCI, largest between-group differences in platelet reactivity occurred at 1 to 6 h; coronary reperfusion rates numerically favored pre-hospital ticagrelor, and the degree of ST-segment elevation resolution was significantly greater in the pre-hospital group (median, 75.0% vs. 71.4%; p = 0.049). At 24 h, the composite ischemic endpoint was lower with pre-hospital ticagrelor (10.4% vs. 13.7%; p = 0.039), as were individual endpoints of definite stent thrombosis (p = 0.0078) and myocardial infarction (p = 0.031). All endpoints except death (1.1% vs. 0.2%; p = 0.048) favored pre-hospital ticagrelor, with no differences in bleeding events. CONCLUSIONS The effects of pre-hospital ticagrelor became apparent after PCI, with numerical differences in platelet reactivity and immediate post-PCI reperfusion, associated with reductions in ischemic endpoints, over the first 24 h, whereas there was a small excess of mortality. (Administration of Ticagrelor in the cath Lab or in the Ambulance for New ST elevation myocardial infarction to open the Coronary artery [ATLANTIC, NCT01347580]) (C) 2016 by the American College of Cardiology Foundation.

Place, publisher, year, edition, pages
ELSEVIER SCIENCE INC, 2016
Keywords
myocardial infarction; platelets; reperfusion; stents; thrombosis
National Category
Health Sciences
Identifiers
urn:nbn:se:liu:diva-127552 (URN)10.1016/j.jcin.2015.12.024 (DOI)000373569700007 ()26952907 (PubMedID)
Note

Funding Agencies|AstraZeneca

Available from: 2016-05-04 Created: 2016-05-03 Last updated: 2017-04-25
Janzon, M., Henriksson, M., Hasvold, P., Hjelm, H., Thuresson, M. & Jernberg, T. (2016). Long-term resource use patterns and healthcare costs after myocardial infarction in a clinical practice setting - results from a contemporary nationwide registry study. European Heart Journal - Quality of Care and Clinical Outcomes, 2, 291-298
Open this publication in new window or tab >>Long-term resource use patterns and healthcare costs after myocardial infarction in a clinical practice setting - results from a contemporary nationwide registry study
Show others...
2016 (English)In: European Heart Journal - Quality of Care and Clinical Outcomes, ISSN 2058-5225, Vol. 2, p. 291-298Article in journal (Refereed) Published
Abstract [en]

Aims Long-term contemporary nationwide data on resource use and healthcare costs after myocardial infarction (MI) in a clinical practice setting are not widely studied, and the aim of this study was to investigate resource use patterns and healthcare costs in patients with MI in a nationwide clinical practice setting.

Methods and results This retrospective cohort study included all patients identified in the compulsory Swedish nationwide patient register with a diagnosis of MI between 1 July 2006 and 30 June 2011. Cardiovascular hospitalization and outpatient visits data from the patient register were combined with data from the cause of death register and the drug utilization register. For a subset of patients, data were also available from a primary care register. Healthcare resource use patterns and annual costs [reported in 2014 euros (€) converted from Swedish kronor (SEK) using the exchange rate €1 = SEK 9.33)] were estimated for the year prior to the occurrence of MI as well as for a maximum follow-up period of 6 years post-MI. The study included 97 252 patients with a diagnosis of MI with a total number of 285 351 observation years. The majority of healthcare consumption occurred within the first year of MI where patients were on average hospitalized 1.55 times, made 1.08 outpatient care visits, and 3.80 primary care visits. In the long term, for the majority of resource use categories, average consumption was higher in the years after MI compared with the year prior to MI. Healthcare costs at 6 years of follow-up were approximately €20 000 of which €12 460 occurred in the first year, and the major part was attributed to hospitalizations.

Conclusion For patients with 6 years of follow-up after MI, healthcare costs were approximately €20 000. The major part of costs occurred in the first year after MI and was driven by hospitalizations

Place, publisher, year, edition, pages
European Society of Cardiology, 2016
National Category
Cardiac and Cardiovascular Systems Surgery
Identifiers
urn:nbn:se:liu:diva-130049 (URN)10.1093/ehjqcco/qcw019 (DOI)
Available from: 2016-07-06 Created: 2016-07-06 Last updated: 2017-03-01
De Geer, J., Sandstedt, M., Björkholm, A., Alfredsson, J., Janzon, M., Engvall, J. & Persson, A. (2016). Software-based on-site estimation of fractional flow reserve using standard coronary CT angiography data.. Acta Radiologica, 57(10), 1186-1192
Open this publication in new window or tab >>Software-based on-site estimation of fractional flow reserve using standard coronary CT angiography data.
Show others...
2016 (English)In: Acta Radiologica, ISSN 0284-1851, E-ISSN 1600-0455, Vol. 57, no 10, p. 1186-1192Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The significance of a coronary stenosis can be determined by measuring the fractional flow reserve (FFR) during invasive coronary angiography. Recently, methods have been developed which claim to be able to estimate FFR using image data from standard coronary computed tomography angiography (CCTA) exams.

PURPOSE: To evaluate the accuracy of non-invasively computed fractional flow reserve (cFFR) from CCTA.

MATERIAL AND METHODS: A total of 23 vessels in 21 patients who had undergone both CCTA and invasive angiography with FFR measurement were evaluated using a cFFR software prototype. The cFFR results were compared to the invasively obtained FFR values. Correlation was calculated using Spearman's rank correlation, and agreement using intraclass correlation coefficient (ICC). Sensitivity, specificity, accuracy, negative predictive value, and positive predictive value for significant stenosis (defined as both FFR ≤0.80 and FFR ≤0.75) were calculated.

RESULTS: The mean cFFR value for the whole group was 0.81 and the corresponding mean invFFR value was 0.84. The cFFR sensitivity for significant stenosis (FFR ≤0.80/0.75) on a per-lesion basis was 0.83/0.80, specificity was 0.76/0.89, and accuracy 0.78/0.87. The positive predictive value was 0.56/0.67 and the negative predictive value was 0.93/0.94. The Spearman rank correlation coefficient was ρ = 0.77 (P < 0.001) and ICC = 0.73 (P < 0.001).

CONCLUSION: This particular CCTA-based cFFR software prototype allows for a rapid, non-invasive on-site evaluation of cFFR. The results are encouraging and cFFR may in the future be of help in the triage to invasive coronary angiography.

Place, publisher, year, edition, pages
Sage Publications, 2016
Keywords
Cardiac; computed tomography angiography (CTA); heart; arteries; adults; computer applications – detection/diagnosis
National Category
Radiology, Nuclear Medicine and Medical Imaging
Identifiers
urn:nbn:se:liu:diva-123579 (URN)10.1177/0284185115622075 (DOI)000382967500007 ()26691914 (PubMedID)
Note

Funding agencies: Department of Radiology, Region Ostergotland; Swedish Heart-Lung-foundation [20120449]

Available from: 2015-12-29 Created: 2015-12-29 Last updated: 2017-12-01Bibliographically approved
Rapsomaniki, E., Thuresson, M., Yang, E., Blin, P., Hunt, P., Chung, S.-C., . . . Hemingway, H. (2016). Using big data from health records from four countries to evaluate chronic disease outcomes: a study in 114 364 survivors of myocardial infarction. European Heart Journal - Quality of Care and Clinical Outcomes, 2(3), 172-183
Open this publication in new window or tab >>Using big data from health records from four countries to evaluate chronic disease outcomes: a study in 114 364 survivors of myocardial infarction
Show others...
2016 (English)In: European Heart Journal - Quality of Care and Clinical Outcomes, ISSN 2058-5225, E-ISSN 2058-1742, Vol. 2, no 3, p. 172-183Article in journal (Refereed) Published
Abstract [en]

Aims To assess the international validity of using hospital record data to compare long-term outcomes in heart attack survivors.

Methods and results We used samples of national, ongoing, unselected record sources to assess three outcomes: cause death; a composite of myocardial infarction (MI), stroke, and all-cause death; and hospitalized bleeding. Patients aged 65 years and older entered the study 1 year following the most recent discharge for acute MI in 2002–11 [n = 54 841 (Sweden), 53 909 (USA), 4653 (England), and 961 (France)]. Across each of the four countries, we found consistent associations with 12 baseline prognostic factors and each of the three outcomes. In each country, we observed high 3-year crude cumulative risks of all-cause death (from 19.6% [England] to 30.2% [USA]); the composite of MI, stroke, or death [from 26.0% (France) to 36.2% (USA)]; and hospitalized bleeding [from 3.1% (France) to 5.3% (USA)]. After adjustments for baseline risk factors, risks were similar across all countries [relative risks (RRs) compared with Sweden not statistically significant], but higher in the USA for all-cause death [RR USA vs. Sweden, 1.14 (95% confidence interval 1.04–1.26)] and hospitalized bleeding [RR USA vs. Sweden, 1.54 (1.21–1.96)].

Conclusion The validity of using hospital record data is supported by the consistency of estimates across four countries of a high adjusted risk of death, further MI, and stroke in the chronic phase after MI. The possibility that adjusted risks of mortality and bleeding are higher in the USA warrants further study.

Place, publisher, year, edition, pages
Oxford University Press, 2016
Keywords
Acute myocardial infarction, Co-morbidities, Healthcare systems, International comparison, Long-term outcomes, EHR
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:liu:diva-130050 (URN)10.1093/ehjqcco/qcw004 (DOI)
Available from: 2016-07-06 Created: 2016-07-06 Last updated: 2017-05-04Bibliographically approved
Jernberg, T., Hasvold, P., Henriksson, M., Hjelm, H., Thuresson, M. & Janzon, M. (2015). Cardiovascular risk in post-myocardial infarction patients: nationwide real world data demonstrate the importance of a long-term perspective.. European Heart Journal, 36(19), 1163-1170
Open this publication in new window or tab >>Cardiovascular risk in post-myocardial infarction patients: nationwide real world data demonstrate the importance of a long-term perspective.
Show others...
2015 (English)In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 36, no 19, p. 1163-1170Article in journal (Refereed) Published
Abstract [en]

AIMS: Long-term disease progression following myocardial infarction (MI) is not well understood. We examined the risk of subsequent cardiovascular events in patients discharged after MI in Sweden.

METHODS AND RESULTS: This was a retrospective, cohort study linking morbidity, mortality, and medication data from Swedish national registries. Of 108 315 patients admitted to hospital with a primary MI between 1 July 2006 and 30 June 2011 (index MI), 97 254 (89.8%) were alive 1 week after discharge and included in this study. The primary composite endpoint of risk for non-fatal MI, non-fatal stroke, or cardiovascular death was estimated for the first 365 days post-index MI and Day 366 to study completion. Risk and risk factors were assessed by Kaplan-Meier analysis and Cox proportional hazards modelling, respectively. Composite endpoint risk was 18.3% during the first 365 days post-index MI. Age [60-69 vs. <60 years: HR (95% CI): 1.37 (1.30-1.45); 70-79 vs. <60 years: 2.13 (2.03-2.24); >80 vs. <60 years: 3.96 (3.78-4.15)], prior MI [1.44 (1.40-1.49)], stroke [1.49 (1.44-1.54)], diabetes [1.37 (1.34-1.40)], heart failure [1.57 (1.53-1.62)] and no index MI revascularisation [1.88 (1.83-1.93)] were each independently associated with a higher risk of ischaemic events or death. For patients without a combined endpoint event during the first 365 days, composite endpoint risk was 20.0% in the following 36 months.

CONCLUSIONS: Risk of cardiovascular events appeared high beyond the first year post-MI, indicating a need for prolonged surveillance, particularly in patients with additional risk factors.

National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:liu:diva-119668 (URN)10.1093/eurheartj/ehu505 (DOI)000356185300014 ()25586123 (PubMedID)
Available from: 2015-06-24 Created: 2015-06-24 Last updated: 2017-12-04
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-9375-5087

Search in DiVA

Show all publications