Agrárpiaci Jelentések Zöldség, gyümölcs és bor

Kiadványunk a következő témákban ad információkat: gyümölcspiac, zöldségpiac, borpiac, értékesítési árak, termelői árak, nagybani piac, kereslet-kínálat, fogyasztói piac, nemzetközi árinformációk

Outcomes after coronary angiography for unstable angina compared to stable angina, myocardial infarction and an asymptomatic general population

Background: The outcomes of real-world unstable angina (UA) in the high-sensitivity troponin era are unclear. We aimed to investigate the outcomes of UA referred to coronary angiography compared to stable angina (SA), nonST-segment elevation myocardial infarction (NSTEMI), STEMI and a general population. Methods: We included the 9,694 patients with no prior coronary artery disease (CAD) referred to invasive or CT coronary angiography from 2013 to 2018 in Northern Norway (51% SA, 12% UA, 23% NSTEMI and 14% STEMI), and 11,959 asymptomatic individuals recruited from the Tromsø Study. We used Cox models to estimate the hazard ratios (HR) for all-cause mortality and major adverse cardiovascular events (MACE), defined as cardiovascular death, MI or obstructive CAD. Results: The median follow-up time was 2.8 years. The incidence rate of death was 8.5 per 1000 person-years (95 % confidence interval [CI] 8.0–9.0) in the general population, 9.7 (95 % CI 8.3–11.5) in SA, 14.9 (95 % CI 11.4–19.6) in UA, 29.7 (95 % CI 25.6–34.3) in NSTEMI and 36.5 (95 % CI 30.9–43.2) in STEMI. In multivariable adjusted analyses, compared with UA, SA had a 38 % lower risk of death and a non-significant lower risk of MACE (HR 0.62, 95 % CI 0.44–0.89; HR 0.86, 95 % CI 0.66–1.11). NSTEMI had a 2.4-fold higher risk of death (HR 2.39, 95 % CI 1.38–4.14) and a 1.6-fold higher risk of MACE (HR 1.62, 95 % CI 1.11–2.38) compared tox UA during the first year after coronary angiography, but a similar risk thereafter. There was no difference in the risk of death for UA with non-obstructive CAD and obstructive CAD (HR 0.78, 95 % CI 0.39–1.57). Conclusion: UA had a higher risk of death but a similar risk of MACE compared to SA and a lower 1-year risk of death and MACE compared to NSTEMI

Clinical characteristics, mortality and pain tolerance in stable versus acute presentation of coronary heart disease

Despite immense progress in the prevention, diagnosis and treatment of coronary heart disease, several challenges remain. In more than half of patients referred to coronary angiography for stable and unstable angina, no obstructive coronary artery disease (CAD) is found. At the same time, some patients present for the first time with already extensive CAD. Further, the management of unstable angina patients after implementing high-sensitivity troponins is uncertain. We investigated if we could improve the selection of unstable angina patients to coronary angiography, the outcomes of unstable angina compared to stable angina and myocardial infarction (MI), and how pain tolerance affects when and how CAD presents. We applied data from patient hospital records, the local and national coronary angiography registry and the Tromsø Study. Pain tolerance was assessed using a cold pressor test in the Tromsø Study. Paper I is a retrospective cohort study, while papers II and III are prospective cohorts studies. We used logistic regression and Cox proportional hazard regression analyses. In paper I, adding symptom characteristics to cardiovascular risk factors, we created a risk score to predict obstructive CAD in unstable angina patients. This score performed better than guidelines and other risk scores. In paper II, we found that unstable angina patients had a similar risk of cardiovascular events but a higher risk of death than stable angina patients. Unstable angina had a lower 1-year risk of cardiovascular events and death than non-ST segment elevation MI. In paper III, individuals with low pain tolerance had a higher risk of coronary angiography, obstructive CAD and death. Pain tolerance was not associated with the clinical presentation or extent of CAD. Our findings confirm that unstable angina patients have a better prognosis than MI patients and support the newest guidelines recommending fewer invasive coronary angiographies in unstable angina patients. The discrepancy in when and how CAD presents is still unclear, and further studies are warranted

Kan troponiner brukes til å selektere elektive pasienter med nytte av koronar angiografi?

Innledning: På Universitetssykehuset i Nord-Norge (UNN) har andelen obstruktiv koronarsykdom på elektiv invasiv koronar angiografi (IKA) falt fra 76 % i 2012 til 54 % i 2005. Det er behov for å gjøre en bedre forhåndsseleksjon av pasienter for å spare samfunnets ressurser og pasienten fra unødvendige engstelse og komplikasjonsfare. Høysensitiv troponin (hs-cTn) brukes for å diagnostisere akutt hjerteinfarkt, men er også assosiert med plakkutbredelse hos stabile pasienter på CT koronar angiografi. Vi ville undersøke om hs-cTnT kan predikere obstruktiv koronarsykdom og behov for revaskularisering hos elektive pasienter henvist til IKA. Metode: I 2012 ble 748 pasienter henvist til elektiv IKA inkludert i prosjektet ”CT angio i Nord” og registrert i en database med kliniske opplysninger og funn på IKA. Vi inkluderte de 737 pasientene med hs-cTnT-målinger. Obstruktiv koronarsykdom er definert som ≥ 50 % stenose. Analysene ble utført med logistisk regresjon. Resultater: Vi detekterte hs-cTnT hos 72 % av pasientene med et gjennomsnitt på 11,2 og 6,2 ng/L hos henholdsvis de med og uten obstruktiv koronarsykdom. Det er ingen forskjell i hs-cTnT hos de under 50 år. Sjansen for obstruktiv koronarsykdom økte med 9 % per enhet stigning i hs-cTnT (OR 1,09, 95 % konfidensintervall (KI) 1,06-1,12) i en univariabel og 4 % (OR 1,04, 95 % KI 1,01-1,07) i en multivariabel modell. Hs-cTnT var ikke-signifikant assosiert med plakkmengde hos pasienter uten obstruktiv koronarsykdom (OR 1,03, 95 % KI 0,99-1,06). For kvinner uten kjent koronarsykdom og med hs-cTnT ≤ 3,0 ng/L (n=105) var negativ prediktiv verdi (NPV) for obstruktiv koronarsykdom 80 %. Menn og kvinner med kjent koronarsykdom hadde lavere NPV. Hs-cTnT er ikke assosiert med hvilke pasienter med obstruktiv koronarsykdom som ble revaskularisert. Konklusjon: Hs-cTnT predikerer obstruktiv koronarsykdom hos de over 50 år, men ikke hvilke pasienter som blir revaskularisert. Hs-cTnT kan ikke alene utelukke obstruktiv koronarsykdom

Pre-test characteristics of unstable angina patients with obstructive coronary artery disease confirmed by coronary angiography

Objective: Patients referred for acute coronary angiography (CAG) with unstable angina (UA) have low mortality and low rate of obstructive coronary artery disease (CAD). Better pre-test selection criteria are warranted. We aimed to assess the current guidelines against other clinical variables as predictors of obstructive CAD in patients with UA referred for acute CAG. Methods: From 2005 to 2012, all CAGs performed at the University Hospital of North Norway, the sole provider of CAG in the region, were recorded in a registry. We included 979 admissions of UA and retrospectively collected data regarding presenting clinical parameters from patient hospital records. Obstructive CAD was defined as ≥50% stenosis and considered prognostically significant if found in the left main stem, proximal LAD or all three main coronary arteries. Characteristics were analysed by logistic regression analysis. A score was developed using ORs from significant factors in a multivariable model. Results The overall rate of obstructive CAD was 45%, and the rate of prognostically significant CAD was 11%. The risk criteria recommended in American College of Cardiology/American Heart Association and European Society of Cardiology guidelines had an area under the curve (AUC) of 0.58. Adding clinical information increased the AUC to 0.77 (95% CI 0.74 to 0.80). Applying the derived score, we found that 56% (n=546) of patients had a score of Conclusions: The current results suggest that CAG may be postponed or cancelled in more than half of patients with UA by improving pre-test selection criteria with the addition of clinical parameters to current guidelines.</p

Low pain tolerance is associated with coronary angiography, coronary artery disease, and mortality: The TROMSO study

Background The initial presentation to coronary angiography and extent of coronary artery disease (CAD) vary greatly among patients, from ischemia with no obstructive CAD to myocardial infarction with 3‐vessel disease. Pain tolerance has been suggested as a potential mechanism for the variation in presentation of CAD. We aimed to investigate the association between pain tolerance, coronary angiography, CAD, and death. Methods and Results We identified 9576 participants in the Tromsø Study (2007–2008) who completed the cold‐pressor pain test, and had no prior history of CAD. The median follow‐up time was 10.4 years. We applied Cox‐regression models with age as time‐scale to calculate hazard ratios (HR). More women than men aborted the cold pressor test (39% versus 23%). Participants with low pain tolerance had 19% increased risk of coronary angiography (HR, 1.19 [95% CI, 1.03–1.38]) and 22% increased risk of obstructive CAD (HR, 1.22 [95% CI, 1.01–1.47]) adjusted by age as time‐scale and sex. Among women who underwent coronary angiography, low pain tolerance was associated with 54% increased risk of obstructive CAD (HR, 1.54 [95% CI, 1.09–2.18]) compared with high pain tolerance. There was no association between pain tolerance and nonobstructive CAD or clinical presentation to coronary angiography (ie, stable angina, unstable angina, and myocardial infarction). Participants with low pain tolerance had increased risk of mortality after adjustment for CAD and cardiovascular risk factors (HR, 1.40 [95% CI, 1.19–1.64]). Conclusions Low cold pressor pain tolerance is associated with a higher risk of coronary angiography and death