Long-term survival of Icelandic women following acute myocardial infarction

Publisher Copyright: © 2022 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.Objective. To evaluate the impact of sex on treatment and survival after acute myocardial infarction (AMI) in Iceland. Methods. A retrospective, nationwide cohort study of patients with STEMI (2008–2018) and NSTEMI (2013–2018) and obstructive coronary artery disease. Patient and procedural information were obtained from a registry and electronic health records. Survival was estimated with Kaplan–Meier method and Cox regression analysis used to identify risk factors for long-term mortality. Excess mortality from the AMI episode was estimated by comparing the survival with age- and sex-matched population in Iceland at 30-day interval. Results. A total of 1345 STEMI-patients (24% women) and 1249 NSTEMI-patients (24% women) were evaluated. Women with STEMI (mean age: 71 ± 11 vs. 67 ± 12) and NSTEMI (mean age: 69 ± 13 vs. 62 ± 12) were older and less likely to have previous cardiovascular disease. There was neither sex difference in the extent of coronary artery disease nor treatment. Although crude one-year post-STEMI survival was lower for women (88.7% vs. 93.4%, p =.006), female sex was not an independent risk factor after adjusting for age and co-morbidities after STEMI and was protective for NSTEMI (HR 0.67, 95% CI: 0.46–0.97). There was excess 30-day mortality in both STEMI and NSTEMI for women compared with sex-, age- and inclusion year-matched Icelandic population, but thereafter the mortality rate was similar. Conclusion. Women and men with AMI in Iceland receive comparable treatment including revascularization and long-term survival appears similar. Prognosis after NSTEMI is better in women, whereas higher early mortality after STEMI may be caused by delays in presentation and diagnosis.Peer reviewe

Non-Cardiac Chest Pain as a Persistent Physical Symptom : Psychological Distress and Workability

Funding Information: The authors thank the Graduate Program in Agricultural Engineering of the Federal University of Campina Grande, the National Council for Scientific and Technological Development (CNPq), and the Coordination for the Improvement of Higher Education Personnel (CAPES) for the financial support in carrying out this research. Funding Information: The larger study, which this study is part of, was supported by Icelandic Research Fund under Grant 152207-051 and the University Hospital Science Fund under Grant A-2019-023, A-2018-047 and A-2017-051. Publisher Copyright: © 2023 by the authors.Non-Cardiac Chest Pain (NCCP) is persistent chest pain in the absence of identifiable cardiac pathology. Some NCCP cases meet criteria for Persistent Physical Symptoms (PPS), where the symptoms are both persistent and distressing/disabling. This study aimed to identify patients that might need specialist treatment for PPS by examining cases of NCCP that meet PPS criteria. We analysed data from 285 chest pain patients that had received an NCCP diagnosis after attending an emergency cardiac department. We compared NCCP patients who did and did not meet the additional criteria for heart-related PPS and hypothesised that the groups would differ in terms of psychological variables and workability. We determined that NCCP patients who meet PPS criteria were more likely than other NCCP patients to be inactive or unable to work, reported more general anxiety and anxiety about their health, were more depressed, ruminated more, and, importantly, had a higher number of other PPS. A high proportion of NCCP patients meet PPS criteria, and they are similar to other PPS patients in terms of comorbidity and disability. This highlights the importance of focusing psychological interventions for this subgroup on the interplay between the range of physical and psychological symptoms present.Peer reviewe

Management of patients with left main stem stenosis in Iceland 2010-2020: PCI or CABG

INNGANGUR Kransæðahjáveituaðgerð hefur lengi verið talin kjörmeðferð fyrir sjúklinga með höfuðstofnsþrengingu en rannsóknir síðustu ára hafa sýnt að kransæðavíkkun gefur sambærilegan árangur í ákveðnum sjúklingahópum. Markmið rannsóknarinnar var að kanna hvernig meðferð við höfuðstofnsþrengingu var háttað á Íslandi síðastliðin ár og hvort hún hafi breyst. Einnig voru könnuð áhrif bakgrunnsþátta á meðferðarval og langtímalifun. EFNIVIÐUR OG AÐFERÐIR Rannsóknin náði til sjúklinga með höfuðstofnsþrengingu á Íslandi 2010-2020. Um er að ræða afturskyggna, lýðgrundaða gagnarannsókn þar sem gögn voru færð í SCAAR-SWEDEHEART-gagnagrunninn í rauntíma þegar sjúklingar fóru í kransæðamyndatöku. Sjúklingar með sögu um fyrri hjáveituaðgerð eða frábendingu fyrir aðgerð voru útilokaðir. Langtímalifun var skoðuð með aðferð Kaplan-Meiers og sjálfstæðir forspárþættir lifunar með COX-aðhvarfsgreiningu. NIÐURSTÖÐUR Af 702 höfuðstofnsþrengingum voru 195 meðhöndlaðar með kransæðavíkkun, 460 með hjáveituaðgerð og 47 með lyfjameðferð eingöngu. Mesta spönn á aldri sjúklinga var í víkkunarhóp og meðalaldur lyfjameðferðarhóps var hæstur. Sjúklingar með höfuðstofnsþrengingu og þriggja æða sjúkdóm eða samhliða lokusjúkdóm fóru oftast í hjáveituaðgerð (76,1% og 84,4%). Sjúklingar með höfuðstofnsþrengingu eingöngu voru oftast víkkaðir (62,1%) sem og sjúklingar með hjartadrep með ST-hækkun eða hjartabilunarlost (67,1% og 70,0%). Hlutfall víkkana jókst úr 19,8% á fyrri hluta rannsóknartímabilsins í 42,7% á því síðara. Ekki var marktækur munur á heildarlifun í víkkunarhóp og hjáveituhóp (p=0,41). ÁLYKTUN Þættir sem tengjast meðferðarvali sjúklinga með höfuðstofnsþrengingu eru aldur, útbreiðsla kransæðasjúkdóms og hversu brátt ástand sjúklings er. Veruleg aukning hefur orðið á höfuðstofnsvíkkunum og ekki er marktækur munur á lifun þeirra sem fóru í hjáveituaðgerð og kransæðavíkkun, en sjúklingahóparnir eru ólíkir. Introduction: Coronary artery bypass surgery (CABG) has been standard treatment for patients with left main coronary artery disease (LMCAD) but percutaneous coronary intervention (PCI) can be a good alternative. Our aim was to evaluate revascularization of LMCAD-patients in Iceland and treatment changes in recent years. We also assessed the impact of patient background factors on treatment choice and long-term survival. Methods: This retrospective, population-based registry-study analyzed data from the SCAAR-SWEDEHEART database. Patients with significant LMCAD on coronary angiography in Iceland 2010-2020, without previous history of CABG or contraindication for surgery were enrolled. The Kaplan-Meier method was used to study long-term survival and COX-regression analysis to adjust for predictor variables. Findings: Of 702 LMCAD patients, 195 were treated with PCI, 460 with CABG and 47 with medical therapy. The widest age-range was in the PCI group and the mean age was highest in the medical therapy group. Patients with LMCAD and concomitant three vessel disease or heart valve disese were mostly treated with CABG (76.1% and 84.4%). The majority of patients with LMCAD only were treated with PCI, as well as patients presenting with STEMI or in cardiogenic shock (67.1% and 70.0%). The proportion of patients treated with PCI increased from 19.8% in 2010-2015 to 42.7% in 2016-2020. There was no significant difference in survival between the PCI and CABG-groups (p=0.41). Conclusions: In patients with LMCAD the main factors determining treatment choice are age, anatomical complexity and acuteness. There has been a significant increase in LMCAD patients treated with PCI.Peer reviewe

Management and revascularization of diabetics with coronary artery disease in Iceland

Ágrip INNGANGUR Sykursýki er vaxandi vandamál en sykursjúkir eru í aukinni hættu á æðakölkun og útbreiddum kransæðasjúkdómi miðað við annað fólk. Tilgangur rannsóknarinnar var að kanna hvernig meðferð kransæðasjúkdóms sykursjúkra var háttað á Íslandi frá 2010-2020. Skoðaðir voru áhrifaþættir meðferðarvals, hvort meðferð hefði breyst og langtímalifun sjúklinga. EFNIVIÐUR OG AÐFERÐIR Rannsóknin var afturskyggn lýðgrunduð gagnarannsókn en gagna var aflað í rauntíma með skráningu í SCAAR/SWEDEHEART-gagnagrunninn sem geymir upplýsingar um bakgrunnsþætti sjúklinga, niðurstöður kransæðaþræðinga og -víkkana og meðferðaráform. Meðtaldir voru allir sykursjúkir með kransæðasjúkdóm greindan í kransæðamyndatöku á árunum 2010 til 2020 á Íslandi. Heildarlifun var metin með Kaplan-Meier-aðferð og sjálfstæðir forspárþættir með Cox-aðhvarfsgreiningu. NIÐURSTÖÐUR Af 1905 tilfellum (1485 sjúklingar) voru 1230 (65%) meðhöndluð með kransæðavíkkun, 274 (14%) með kransæðahjáveituaðgerð og 401 (21%) með lyfjameðferð eingöngu. Aldursdreifingin var ólík í meðferðarhópunum þremur: Víkkunarhópurinn var á breiðasta aldursbilinu, hjáveituhópurinn á því þrengsta og meðalaldur lyfjameðferðarhópsins var hæstur. Sjúklingar í STEMI eða hjartabilunarlosti voru frekar víkkaðir og sjúklingar sem voru einnig með hjartalokusjúkdóm fóru frekar í hjáveituaðgerð. Hlutfall hjáveituaðgerða hækkaði eftir því sem kransæðasjúkdómurinn var útbreiddari: 41% sjúklinga með vinstri höfuðstofnsþrengsli og þriggja æða sjúkdóm gengust undir hjáveituaðgerð en aðeins 2% sjúklinga með einnar æðar sjúkdóm. Frá 2010 til 2020 hækkaði hlutfall kransæðavíkkana úr 49% í 72% en hlutfall hjáveituaðgerða og lyfjameðferðar eingöngu lækkaði. Ekki sást munur á heildarlifun sjúklinga eftir kransæðavíkkun og kransæðahjáveituaðgerð (p=1,00). ÁLYKTUN Stærri hópur sykursjúkra er nú meðhöndlaður með kransæðavíkkun en áður (þrír af hverjum fjórum). Ekki sást marktækur munur á lifun sjúklinga eftir víkkun eða hjáveituaðgerð en hóparnir voru þó ekki að fullu sambærilegir. Abstract Background: The incidence of diabetes is growing, and diabetics have increased risk of atherosclerosis and diffuse coronary artery disease (CAD). Our aim was to assess the revascularization treatment of diabetics with CAD in Iceland from 2010-2020, changes in management and long-term survival of patients. Methods: All patients in Iceland with diabetes and CAD on cardiac catheterization 2010-2020 were included in this retrospective, population-based study. We analyzed data from the SCAAR/SWEDEHEART database: patients' background information, findings of cardiac catheterization, planned treatment and results. The Kaplan-Meier method was used to estimate long-term survival and Cox-regression-analysis to adjust for predictor variables. Results: Of 1905 cases (1485 patients), 1230 (65%) underwent PCI, 274 (14%) CABG and 401 (21%) had medical therapy only. The age distribution differed: The PCI group had the widest age bracket, the CABG group the narrowest, and the medical therapy group had the highest mean age. Most patients with STEMI or cardiogenic shock underwent PCI, while most patients with concomitant heart-valve disease underwent CABG. The proportion of patients undergoing CABG increased with more diffuse CAD. 41% of patients with left main- and three-vessel disease underwent CABG while only 2% of those with single-vessel disease. From 2010-2020 the proportion of patients that underwent PCI increased from 49% to 72%. There was no difference in survival between the PCI and CABG groups (p=1.00). Conclusion: Three quarters of patients with diabetes and obstructive CAD are now treated with PCI. The PCI and CABG groups had overall equal survival but the groups had different characteristics. Keywords: CABG; Coronary artery disease; PCI; diabetes mellitus.Peer reviewe