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  • 1.
    Fabris, Enrico
    et al.
    Cardiology Department, Isala Heart Center, the Netherlands, Cardiovascular Department, University of Trieste, Italy.
    van 't Hof, Arnoud
    Isala Heart Center, Maastricht University Medical Center, Zuyderland Hospital, the Netherlands,.
    Hamm, Christian W
    Kerckhoff Heart and Thorax Center, Germany.
    Lapostolle, Frédéric
    Hôpital Avicenne, France.
    Lassen, Jens F
    Aarhus University Hospital, Denmark.
    Goodman, Shaun G
    Canadian Heart Research Centre, University of Toronto, Canada.
    Ten Berg, Jurriën M
    St Antonius Hospital Nieuwegein, the Netherlands.
    Bolognese, Leonardo
    Cardiovascular and Neurological Department, Azienda Ospedaliera Arezzo, Italy.
    Cequier, Angel
    Heart Disease Institute, University of Barcelona, Spain.
    Chettibi, Mohamed
    Centre Hospito-universitaire Frantz Fanon, Algeria.
    Hammett, Christopher J
    Royal Brisbane and Women's Hospital, Australia.
    Huber, Kurt
    Wilhelminen Hospital, Austria, Sigmund Freud Private University, Austria.
    Janzon, Magnus
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Merkely, Béla
    Heart and Vascular Center, Semmelweis University, Hungary.
    Storey, Robert F
    Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, UK.
    Zeymer, Uwe
    Klinikum Ludwigshafen and Institut für Herzinfarktforschung, Germany.
    Cantor, Warren J
    Southlake Regional Health Centre, University of Toronto, Canada.
    Tsatsaris, Anne
    Astra Zeneca, UK.
    Kerneis, Mathieu
    ACTION Study Group, Sorbonne Université Paris 6, France.
    Diallo, Abdourahmane
    ACTION Study Group, Hospital Lariboisiere, France..
    Vicaut, Eric
    ACTION Study Group, Hospital Lariboisiere, France..
    Montalescot, Gilles
    ACTION Study Group, Sorbonne Université Paris 6, France.
    Clinical impact and predictors of complete ST segment resolution after primary percutaneous coronary intervention: A subanalysis of the ATLANTIC Trial2019In: European heart journal. Acute cardiovascular care., ISSN 2048-8726, Vol. 8, no 3, p. 208-217Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: In the ATLANTIC (Administration of Ticagrelor in the catheterization laboratory or in the Ambulance for New ST elevation myocardial Infarction to open the Coronary artery) trial the early use of aspirin, anticoagulation, and ticagrelor coupled with very short medical contact-to-balloon times represent good indicators of optimal treatment of ST-elevation myocardial infarction and an ideal setting to explore which factors may influence coronary reperfusion beyond a well-established pre-hospital system.

    METHODS: This study sought to evaluate predictors of complete ST-segment resolution after percutaneous coronary intervention in ST-elevation myocardial infarction patients enrolled in the ATLANTIC trial. ST-segment analysis was performed on electrocardiograms recorded at the time of inclusion (pre-hospital electrocardiogram), and one hour after percutaneous coronary intervention (post-percutaneous coronary intervention electrocardiogram) by an independent core laboratory. Complete ST-segment resolution was defined as ≥70% ST-segment resolution.

    RESULTS: Complete ST-segment resolution occurred post-percutaneous coronary intervention in 54.9% ( n=800/1456) of patients and predicted lower 30-day composite major adverse cardiovascular and cerebrovascular events (odds ratio 0.35, 95% confidence interval 0.19-0.65; p<0.01), definite stent thrombosis (odds ratio 0.18, 95% confidence interval 0.02-0.88; p=0.03), and total mortality (odds ratio 0.43, 95% confidence interval 0.19-0.97; p=0.04). In multivariate analysis, independent negative predictors of complete ST-segment resolution were the time from symptoms to pre-hospital electrocardiogram (odds ratio 0.91, 95% confidence interval 0.85-0.98; p<0.01) and diabetes mellitus (odds ratio 0.6, 95% confidence interval 0.44-0.83; p<0.01); pre-hospital ticagrelor treatment showed a favorable trend for complete ST-segment resolution (odds ratio 1.22, 95% confidence interval 0.99-1.51; p=0.06).

    CONCLUSIONS: This study confirmed that post-percutaneous coronary intervention complete ST-segment resolution is a valid surrogate marker for cardiovascular clinical outcomes. In the current era of ST-elevation myocardial infarction reperfusion, patients' delay and diabetes mellitus are independent predictors of poor reperfusion and need specific attention in the future.

  • 2.
    Ängerud, Karin H
    et al.
    Umeå University, Sweden.
    Sederholm Lawesson, Sofia
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Isaksson, Rose-Marie
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Department of Research, Norrbotten County Council, Sweden.
    Thylén, Ingela
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Swahn, Eva
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Differences in symptoms, first medical contact and pre-hospital delay times between patients with ST- and non-ST-elevation myocardial infarction2019In: European heart journal. Acute cardiovascular care., ISSN 2048-8726, Vol. 8, no 3, p. 201-207Article in journal (Refereed)
    Abstract [en]

    AIM: In ST-elevation myocardial infarction, time to reperfusion is crucial for the prognosis. Symptom presentation in myocardial infarction influences pre-hospital delay times but studies about differences in symptoms between patients with ST-elevation myocardial infarction and non-ST-elevation myocardial infarction are sparse and inconclusive. The aim was to compare symptoms, first medical contact and pre-hospital delay times in patients with ST-elevation myocardial infarction and non-ST-elevation myocardial infarction.

    METHODS AND RESULTS: This multicentre, observational study included 694 myocardial infarction patients from five hospitals. The patients filled in a questionnaire about their pre-hospital experiences within 24 h of hospital admittance. Chest pain was the most common symptom in ST-elevation myocardial infarction and non-ST-elevation myocardial infarction (88.7 vs 87.0%, p=0.56). Patients with cold sweat (odds ratio 3.61, 95% confidence interval 2.29-5.70), jaw pain (odds ratio 2.41, 95% confidence interval 1.04-5.58), and nausea (odds ratio 1.70, 95% confidence interval 1.01-2.87) were more likely to present with ST-elevation myocardial infarction, whereas the opposite was true for symptoms that come and go (odds ratio 0.58, 95% confidence interval 0.38-0.90) or anxiety (odds ratio 0.52, 95% confidence interval 0.29-0.92). Use of emergency medical services was higher among patients admitted with ST-elevation myocardial infarction. The pre-hospital delay time from symptom onset to first medical contact was significantly longer in non-ST-elevation myocardial infarction (2:05 h vs 1:10 h, p=0.001).

    CONCLUSION: Patients with ST-elevation myocardial infarction differed from those with non-ST-elevation myocardial infarction regarding symptom presentation, ambulance utilisation and pre-hospital delay times. This knowledge is important to be aware of for all healthcare personnel and the general public especially in order to recognise symptoms suggestive of ST-elevation myocardial infarction and when to decide if there is a need for an ambulance.

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