Results of percutaneous coronary interventions in Iceland during 1987-1998

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenPurpose: To evaluate potential changes in clinical indications and the composition of the patient population undergoing percutaneous coronary intervention (PCI) in Iceland from 1987 to 1998. Furthermore, to assess changes in success rate and major complications for the procedure during the study interval in a small nation with one PCI centre. Material and methods: The first PCI was performed in Iceland in May 1987. A registry has been kept from the start that includes clinical and procedural data, and records of complications and mortality. During the study interval a total of 2440 PCIs were performed. The annual procedure rate was low at first, with a steep rise during the last years. Based on procedural changes over the years the study interval was divided into three periods: I. 1987-1992 (471 procedures); the learning years, II. 1993-1995 (796 procedures); increasing number of PCIs and the method established, III. 1996-1998 (1173 procedures); increasing use of stents and new antiplatelet regime used. Results: From period I to III, the rate of elective PCI declined from 82% to 52% (p<0.001), subacute procedures increased from 14% to 44% (p<0.001), acute PCI from 0.8% to 3% (p<0.05), and ad hoc procedures from 0.4% to 28% (p<0.001). This reflects an increase in PCI on patients with acute coronary syndromes, as the ratio of patiens with unstable angina increased from 15% to 36% (p<0.001). Also, 1-vessel PCI decreased proportionally from 93% to 83%, while 2 and 3 vessel procedures increased from 7% to 17% (p<0.001). The proportion of patients 70 years or older increased from 7% to 27% (p<0.001). Still, the success rate for PCI increased from 83% to 93% (p<0.001) and the use of stents rose sharply from 0% to 56%. The ratio of PCI due to restenosis declined somewhat between period II and III, from 15% to 12% (p=0.06). Simultaneously, the rate of acute coronary bypass surgery after PCI decreased from 4.2% to 0.2% (p<0.001) and significantly fewer patients had elevated creatinine kinase levels (4.0% vs 2.7%, respectively, p<0.05). However, clinical acute myocardial infarction after PCI remained similar at 1.3% and 0.9%, and the in hospital mortality was 0.6% and 0.4%. Conclusions: On a national basis the rate of PCI in Iceland is amongst the highest in Europe. Thus, in 1998, when the population in Iceland was 275,000, 453 PCIs were done (1647 procedures per million inhabitants). An increased number of subacute and acute PCIs is carried out, more complicated procedures are performed in patients with widespread disease, and the patient population is growing older. Still, the success rate is high and the frequency of complications and mortality relatively low.Markmið: Tilgangur rannsóknarinnar var að meta árangur kransæðavíkkana á Íslandi á tímabilinu 1987-1998. Ennfremur að kanna hugsanlegar breytingar á ábendingum fyrir kransæðavíkkunum og á sjúkdómsbakgrunni þeirra sjúklinga sem komu til aðgerðar og hvort breytingar hefðu orðið á árangri, tíðni fylgikvilla og aðgerðartengdum dauðsföllum. Efniviður og aðferðir: Frá því fyrsta kransæðavíkkunin var gerð hér á landi í maí 1987 hefur nákvæm skrá verið haldin yfir alla sjúklinga. Skráð voru aðalatriði úr sjúkrasögu, klínískt ástand sjúklings og aðalábending fyrir aðgerð, áættuþættir fyrir kransæðasjúkdómi, niðurstöður kransæðamyndatöku, tæknileg framkvæmd aðgerðarinnar, árangur, fylgikvillar og aðgerðartengd dauðsföll. Á árunum 1987-1998 voru alls gerðar 2440 kransæðavíkkanir. Rannsóknartímabilinu var skipt í þrjú tímaskeið: I. 1987-1992 (471 aðgerð); fyrstu lærdómsárin, II. 1993-1995 (796 aðgerðir); aukinn fjöldi aðgerða og aðferðin fest í sessi, III. 1996-1998 (1173 aðgerðir); vaxandi notkun stoðneta og ný blóðflöguhamlandi lyf notuð. Niðurstöður: Frá tímabili I til III minnkaði hlutfall valinna víkkunaraðgerða úr 82% í 52% (p<0,001), hálfbráðum víkkunum fjölgaði úr 14% í 44% (p<0,001), bráðum víkkunum úr 0,8% í 3% (p<0,05), og víkkunum í beinu framhaldi af kransæðamyndatöku fjölgaði úr 0,4% í 28% (p<0,001). Þessar breytingar endurspegla aukningu á víkkunaraðgerðum hjá sjúklingum með bráða kransæðasjúkdóma og hlutfall sjúklinga með hvikula hjartaöng jókst einnig úr 15% í 36% (p<0,001). Ennfremur lækkaði hlutfall víkkunaraðgerða á einni kransæð úr 93% í 83%, en jókst á tveimur og þremur æðum úr 7% í 17% (p<0,001). Sjúklingum 70 ára og eldri fjölgaði úr 7% í 27% (p<0,001). Samtímis jókst tíðni velheppnaðra víkkunaraðgerða úr 83% í 93% (p<0,001) og notkun stoðneta frá því að vera engin í 56%. Hlutfall sjúklinga sem komu til víkkunar vegna endurþrengsla lækkaði úr 15% í 12% (p=0,06). Jafnframt lækkaði tíðni bráðra hjáveituaðgerða vegna fylgikvilla við víkkun úr 4,2% í 0,2% (p<0,001), hækkun á hjartaensímum eftir víkkanir minnkaði úr 4,0% í 2,7% (p<0,05), en tíðni klínískt staðfests hjartadreps eftir víkkunaraðgerð hélst svipuð, 1,3% og 0,9%, svo og dánartíðni á sjúkrahúsi, sem var 0,6% og 0,4%. Ályktanir: Miðað við fólksfjölda er tíðni kransæðavíkkunaraðgerða á Íslandi með því hæsta í Evrópu. Árið 1998, þegar fólksfjöldi var 275.000, voru gerðar 453 aðgerðir, sem samsvarar staðlað 1647 aðgerðum á milljón íbúa. Á undanförnum árum hefur fjöldi hálfbráðra og bráðra víkkunaraðgerða aukist, fleiri æðar eru oftar víkkaðar í einu og hlutfall eldri sjúklinga fer vaxandi. Þrátt fyrir þetta er hlutfall velheppnaðra víkkunaraðgerða hátt og tíðni fylgikvilla og dauðsfalla eftir aðgerð lág

Outcome of mitral valve replacement in Iceland

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/Open Allur texti - Full textIntroduction: Mitral valve replacement (MVR) is the second most common valvular replacement procedure after aortic valve replacement (AVR). Studies on the outcome of MVR in Iceland have been missing. We therefore studied short and long-term results following MVR in Iceland, Material and methods: A retrospective nationwide study on 64 patients (mean age 59 years, 63% males) that underwent 66 MVR procedures in Iceland between 1990-2010. Clinical data was retrieved from patient charts and overall survival estimated. The mean follow-up was 7.4 years. Results: Mitral regurgitation or stenosis was the indication for MVR in 71% and 27% of cases, respectively. Nine patients had endocarditis and 8 a recent myocardial infarction. The mean logEuroSCORE was 14.9% (range 1.5-88.4), 83% of the patients were in NYHA class III/IV preoperatively and 24% had previously undergone cardiac surgery. A biological valve was implanted in six cases and a mechanical valve used in 60 cases. Concomitant CABG was performed in 41% of patients and AVR in 20%. Perioperative myocardial infarction (26%), acute respiratory failure (17%), reoperation for bleeding (15%) and acute renal failure requiring dialysis (9%) were the most common major complications. Three patients required extracorporeal membrane oxygenation (ECMO) and six patients an intra-aortic balloon pump (IABP) postoperatively. Minor complications were noted in 61% of cases. Six patients died within 30 days (9%) and five year survival was 69%. Conclusion: The frequency of complication following MVR was high and represents the severity of the underlying heart disease. The operative mortality in the current study was in the lower range compared to other studies.Inngangur: Míturlokuskipti eru næstalgengasta lokuskiptaaðgerð hér á landi á eftir ósæðarlokuskiptum. Tilgangur rannsóknarinnar var að kanna skammtíma- og langtímaárangur míturlokuskipta á Íslandi en það hefur ekki verið gert áður. Efniviður og aðferðir: Afturskyggn rannsókn á þeim 64 sjúklingum (meðalaldur 59 ár, 63% karlar) sem gengust undir 66 míturlokuskipti á Landspítala frá 1990 til 2010. Klínískar upplýsingar fengust úr sjúkraskrám og var heildarlifun reiknuð út. Meðaleftirfylgd var 7,4 ár. Niðurstöður: Algengasta ábending aðgerðar var lokuleki hjá 47 sjúklingum (71%) en 18 (27%) höfðu lokuþrengsli. Fjórðungur hafði áður gengist undir opna hjartaaðgerð, 9 höfðu virka hjartaþelsbólgu og 8 nýlegt hjartadrep. Meðal logEuroSCORE var 14,9% (bil 1,5-88,4) og 83% sjúklinganna voru í NYHA-flokki III/IV fyrir aðgerð. Sex sjúklingar fengu lífræna loku en hinir gerviloku. Önnur hjartaaðgerð var gerð samtímis hjá tveimur þriðju sjúklinga, oftast kransæðahjáveita (41%) og/eða ósæðarlokuskipti (20%). Hjartadrep í tengslum við aðgerð (26%), öndunarbilun (17%), enduraðgerð vegna blæðingar (15%) og nýrnabilun sem krafðist skilunar (9%) voru algengustu alvarlegu fylgikvillarnir. Að auki þurfti ECMO-dælu í þremur tilfellum vegna hjartabilunar og ósæðardælu hjá 6 sjúklingum. Minniháttar fylgikvillar greindust í 61% tilfella, oftast fleiðruvökvi sem þarfnaðist aftöppunar, nýtilkomið gáttatif og lungnabólga. Sex sjúklingar létust innan 30 daga frá aðgerð (9%) og 5 ára lífshorfur voru 69%. Ályktun: Tíðni fylgikvilla var há eftir míturlokuskipti, enda flestir sjúklinganna með alvarlegan undirliggjandi hjartasjúkdóm. Skurðdauði var lægri hér á landi en í mörgum sambærilegum erlendum rannsóknum

Body Composition and Physical Fitness of Students in High School vs. Students Enrolled in High School Sports Academia Programs

In recent years more and more high schools in Iceland are offering sports academia programs. These programs are intended for teenage athletes in various sports who have the potential of becoming elite athletes. The sports academia programs make it easier for these student athletes to focus on training for their sport while attending high school, and thereby, enable them to get a good education and enhance their athletic potential. These programs also have the potential to reduce drop-out in sports because it is easier for the students to balance athletics and academics. Nevertheless, sports performance is not necessarily linked to better health. The purpose of this study was to compare students enrolled in regular high school tracks to students enrolled in sports academia programs on body composition and physical fitness

The prevalence of sicca symptoms in Iceland

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenObjectives: Sjoegren' syndrome is one of the most common inflammatory systemic rheumatic disorders. The syndrome is characterised by tiredness, pain problems and mucosal dryness. The goal of this study is to elucidate the prevalence of sicca symptoms in the Icelandic population and to calculate the preliminary prevalence value for Sjoegren' syndrome in Iceland. Material and methods: Random sample was retrieved from two age groups; 40-49 and 70-75 years Icelandic inhabitants of Reykjavík and Akureyri. Questionnaire with 14 questions of the most common symptoms of Sjoegren' syndrome was mailed to those sampled. A small sample was evaluated by Schirmer-I test, tear film break up time (BUT) and Rose Bengal score for keratoconjunctivitis sicca (KCS) and unstimulated salivary flow rate was performed. Results: The questionnaire was sent to 621 subjects, 300 male and 321 female. The response rate was 74%. Of those 20.3% had subjective symptoms of dry eyes and 12.0% of dry mouth according to the six questions used in the European classification criteria (EEC). The prevalence of both was higher in females (p<0.05). Of the 23 subjects who reported sicca symptoms, fatigue and pain problems; 26% had abnormal Shirmer-I test, 13% had abnormal BUT and 39% had abnormal salivary flow rate, two of those individuals fulfilled the EEC criteria for Sjoegren' syndrome (0.2%; 0-0.5%, 95% CI). None in the age and sex matched control group fulfilled the EEC criteria. Conclusion: The subjective symptoms of dry eye and dry mouth are common in Iceland, as are the three major symptoms of Sjoegren' syndrome. Standardised objective diagnostic criteria is necessary when the diagnosis of the syndrome is made.Inngangur: Heilkenni Sjögrens er samkvæmt erlendum rannsóknum einn af algengari fjölkerfasjúkdómum. Sjúkdómurinn einkennist af dagsþreytu, stoðkerfisverkjum og þurrkeinkennum frá slímhúðum. Algengi augn- og munnþurrks er ekki þekkt hér á landi né algengi heilkennis Sjögrens. Markmið rannsóknarinnar var að kanna algengi helstu einkenna heilkennis Sjögrens og finna líklegar algengistölur fyrir sjúkdóminn hérlendis. Efniviður og aðferðir: Handahófskennt úrtak var fengið úr tveimur aldurshópum; 40-49 ára og 70-75 ára Íslendingum, búsettum á höfuðborgarsvæðinu og á Akureyri. Notast var við spurningakver með 14 spurningum um algengustu einkenni heilkennis Sjögrens. Völdu úrtaki samkvæmt svarmynstri var boðið til skoðunar með Schirmer-I prófi, mælingu á tárafilmurofstíma og Rose Bengal litun fyrir glæru- og tárabólgu. Ennfremur var gerð munnvatnsrennslismæling í hvíld. Niðurstöður: Í úrtakinu var 621 einstaklingur, 300 karlar og 321 kona. Skilatíðni spurningakversins var 74%. Alls höfðu 20% þátttakenda einhver einkenni augnþurrks og 12% höfðu munnþurrk, hvort tveggja var marktækt algengara hjá konum (p<0,05). Tuttugu og þrír einstaklingar (3%) kvörtuðu um öll þrjú aðaleinkenni heilkennis Sjögrens og var þeim boðið til skoðunar. Af þeim mældust sex (26%) með óeðlilega táraframleiðslu og níu (39%) með óeðlilega lítið munnvatnsrennsli. Tvær konur uppfylltu greiningarskilmerkin um heilkenni Sjögrens eða 0,2% úrtaksins (0-0,5%; 95% öryggisbil). Í einkennalausa samanburðarhópnum höfðu sín hvor 17% hlutlæg einkenni augn- eða munnþurrks og ein kona hafði hvort tveggja. Ályktun: Niðurstöður sýna að einkenni augn- og munnþurrks eru algeng hér á landi, sem og þrjú aðaleinkenni heilkennis Sjögrens. Því er nauðsynlegt að styðjast við ströng greiningarskilmerki þegar staðfesta skal sjúkdómsgreininguna heilkenni Sjögrens. Til að hægt sé að fullyrða um algengi heilkennis Sjögrens á Íslandi verður þó að gera ítarlegri ónæmisfræðilegar rannsóknir með stærri skoðunarhóp

Rate of SARS-CoV-2 Reinfection during an Omicron Wave in Iceland

Funding Information: Funding/Support: This work was supported by the Landspitali University Hospital Research Fund (grant A-2021-051). Neither the authors nor their institutions received payment or services from a third party for any aspect of the submitted work.This cohort study estimates the proportion of persons who became reinfected with SARS-CoV-2 during the Omicron wave in Iceland.Peer reviewe

COPA syndrome in an Icelandic family caused by a recurrent missense mutation in COPA

Background: Rare missense mutations in the gene encoding coatomer subunit alpha (COPA) have recently been shown to cause autoimmune interstitial lung, joint and kidney disease, also known as COPA syndrome, under a dominant mode of inheritance. Case presentation: Here we describe an Icelandic family with three affected individuals over two generations with a rare clinical presentation of lung and joint disease and a histological diagnosis of follicular bronchiolitis. We performed whole-genome sequencing (WGS) of the three affected as well as three unaffected members of the family, and searched for rare genotypes associated with disease using 30,067 sequenced Icelanders as a reference population. We assessed all coding and splicing variants, prioritizing variants in genes known to cause interstitial lung disease. We detected a heterozygous missense mutation, p.Glu241Lys, in the COPA gene, private to the affected family members. The mutation occurred de novo in the paternal germline of the index case and was absent from 30,067 Icelandic genomes and 141,353 individuals from the genome Aggregation Database (gnomAD). The mutation occurs within the conserved and functionally important WD40 domain of the COPA protein. Conclusions: This is the second report of the p.Glu241Lys mutation in COPA, indicating the recurrent nature of the mutation. The mutation was reported to co-segregate with COPA syndrome in a large family from the USA with five affected members, and classified as pathogenic. The two separate occurrences of the p.Glu241Lys mutation in cases and its absence from a large number of sequenced genomes confirms its role in the pathogenesis of the COPA syndrome. Keywords: COPA syndrome, Lung disease, Arthritis, Immune dysregulation, Case reportPeer Reviewe

A homozygous loss-of-function mutation leading to CYBC1 deficiency causes chronic granulomatous disease

Publisher's version (útgefin grein) Publisher’s note: Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.Mutations in genes encoding subunits of the phagocyte NADPH oxidase complex are recognized to cause chronic granulomatous disease (CGD), a severe primary immunodeficiency. Here we describe how deficiency of CYBC1, a previously uncharacterized protein in humans (C17orf62), leads to reduced expression of NADPH oxidase’s main subunit (gp91phox) and results in CGD. Analyzing two brothers diagnosed with CGD we identify a homozygous loss-of-function mutation, p.Tyr2Ter, in CYBC1. Imputation of p.Tyr2Ter into 155K chipgenotyped Icelanders reveals six additional homozygotes, all with signs of CGD, manifesting as colitis, rare infections, or a severely impaired PMA-induced neutrophil oxidative burst. Homozygosity for p.Tyr2Ter consequently associates with inflammatory bowel disease (IBD) in Iceland (P = 8.3 × 10−8; OR = 67.6), as well as reduced height (P = 3.3 × 10−4; −8.5 cm). Overall, we find that CYBC1 deficiency results in CGD characterized by colitis and a distinct profile of infections indicative of macrophage dysfunction.We wish to thank the family of the two probands, as well as all the other individuals who participated in the study and whose contribution made this work possible.Peer Reviewe

Development of a prognostic model of COVID-19 severity : a population-based cohort study in Iceland

© 2022. The Author(s).BACKGROUND: The severity of SARS-CoV-2 infection varies from asymptomatic state to severe respiratory failure and the clinical course is difficult to predict. The aim of the study was to develop a prognostic model to predict the severity of COVID-19 in unvaccinated adults at the time of diagnosis. METHODS: All SARS-CoV-2-positive adults in Iceland were prospectively enrolled into a telehealth service at diagnosis. A multivariable proportional-odds logistic regression model was derived from information obtained during the enrollment interview of those diagnosed between February 27 and December 31, 2020 who met the inclusion criteria. Outcomes were defined on an ordinal scale: (1) no need for escalation of care during follow-up; (2) need for urgent care visit; (3) hospitalization; and (4) admission to intensive care unit (ICU) or death. Missing data were multiply imputed using chained equations and the model was internally validated using bootstrapping techniques. Decision curve analysis was performed. RESULTS: The prognostic model was derived from 4756 SARS-CoV-2-positive persons. In total, 375 (7.9%) only required urgent care visits, 188 (4.0%) were hospitalized and 50 (1.1%) were either admitted to ICU or died due to complications of COVID-19. The model included age, sex, body mass index (BMI), current smoking, underlying conditions, and symptoms and clinical severity score at enrollment. On internal validation, the optimism-corrected Nagelkerke's R2 was 23.4% (95%CI, 22.7-24.2), the C-statistic was 0.793 (95%CI, 0.789-0.797) and the calibration slope was 0.97 (95%CI, 0.96-0.98). Outcome-specific indices were for urgent care visit or worse (calibration intercept -0.04 [95%CI, -0.06 to -0.02], Emax 0.014 [95%CI, 0.008-0.020]), hospitalization or worse (calibration intercept -0.06 [95%CI, -0.12 to -0.03], Emax 0.018 [95%CI, 0.010-0.027]), and ICU admission or death (calibration intercept -0.10 [95%CI, -0.15 to -0.04] and Emax 0.027 [95%CI, 0.013-0.041]). CONCLUSION: Our prognostic model can accurately predict the later need for urgent outpatient evaluation, hospitalization, and ICU admission and death among unvaccinated SARS-CoV-2-positive adults in the general population at the time of diagnosis, using information obtained by telephone interview.Peer reviewe

HLA alleles, disease severity, and age associate with T-cell responses following infection with SARS-CoV-2

Funding Information: We thank all of the participants that contributed samples for this study for their invaluable contribution to the research. We also thank our research staff at the Patient Recruitment Center for their thorough work. Publisher Copyright: © 2022, The Author(s).Memory T-cell responses following SARS-CoV-2 infection have been extensively investigated but many studies have been small with a limited range of disease severity. Here we analyze SARS-CoV-2 reactive T-cell responses in 768 convalescent SARS-CoV-2-infected (cases) and 500 uninfected (controls) Icelanders. The T-cell responses are stable three to eight months after SARS-CoV-2 infection, irrespective of disease severity and even those with the mildest symptoms induce broad and persistent T-cell responses. Robust CD4+ T-cell responses are detected against all measured proteins (M, N, S and S1) while the N protein induces strongest CD8+ T-cell responses. CD4+ T-cell responses correlate with disease severity, humoral responses and age, whereas CD8+ T-cell responses correlate with age and functional antibodies. Further, CD8+ T-cell responses associate with several class I HLA alleles. Our results, provide new insight into HLA restriction of CD8+ T-cell immunity and other factors contributing to heterogeneity of T-cell responses following SARS-CoV-2 infection.Peer reviewe

Physical and cognitive impact following SARS-CoV-2 infection in a large population-based case-control study

© 2023. The Author(s).BACKGROUND: Persistent symptoms are common after SARS-CoV-2 infection but correlation with objective measures is unclear. METHODS: We invited all 3098 adults who tested SARS-CoV-2 positive in Iceland before October 2020 to the deCODE Health Study. We compared multiple symptoms and physical measures between 1706 Icelanders with confirmed prior infection (cases) who participated, and 619 contemporary and 13,779 historical controls. Cases participated in the study 5-18 months after infection. RESULTS: Here we report that 41 of 88 symptoms are associated with prior infection, most significantly disturbed smell and taste, memory disturbance, and dyspnea. Measured objectively, cases had poorer smell and taste results, less grip strength, and poorer memory recall. Differences in grip strength and memory recall were small. No other objective measure associated with prior infection including heart rate, blood pressure, postural orthostatic tachycardia, oxygen saturation, exercise tolerance, hearing, and traditional inflammatory, cardiac, liver, and kidney blood biomarkers. There was no evidence of more anxiety or depression among cases. We estimate the prevalence of long Covid to be 7% at a median of 8 months after infection. CONCLUSIONS: We confirm that diverse symptoms are common months after SARS-CoV-2 infection but find few differences between cases and controls in objective parameters measured. These discrepancies between symptoms and physical measures suggest a more complicated contribution to symptoms related to prior infection than is captured with conventional tests. Traditional clinical assessment is not expected to be particularly informative in relating symptoms to a past SARS-CoV-2 infection.Peer reviewe