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Starnberg, K., Friden, V., Muslimovic, A., Ricksten, S.-E., Nyström, S., Forsgard, N., . . . Hammarsten, O. (2020). A Possible Mechanism behind Faster Clearance and Higher Peak Concentrations of Cardiac Troponin I Compared with Troponin T in Acute Myocardial Infarction. Clinical Chemistry, 66(2), 333-341
Open this publication in new window or tab >>A Possible Mechanism behind Faster Clearance and Higher Peak Concentrations of Cardiac Troponin I Compared with Troponin T in Acute Myocardial Infarction
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2020 (English)In: Clinical Chemistry, ISSN 0009-9147, E-ISSN 1530-8561, Vol. 66, no 2, p. 333-341Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Although cardiac troponin I (cTnI) and troponin T (cTnT) form a complex in the human myocardium and bind to thin filaments in the sarcomere, cTnI often reaches higher concentrations and returns to normal concentrations faster than cTnT in patients with acute myocardial infarction (MI).

METHODS: We compared the overall clearance of cTnT and cTnI in rats and in patients with heart failure and examined the release of cTnT and cTnI from damaged human cardiac tissue in vitro.

RESULTS: Ground rat heart tissue was injected into the quadriceps muscle in rats to simulate myocardial damage with a defined onset. cTnT and cTnI peaked at the same time after injection. cTnI returned to baseline concentrations after 54 h, compared with 168 h for cTnT. There was no difference in the rate of clearance of solubilized cTnT or cTnI after intravenous or intramuscular injection. Renal clearance of cTnT and cTnI was similar in 7 heart failure patients. cTnI was degraded and released faster and reached higher concentrations than cTnT when human cardiac tissue was incubated in 37 degrees C plasma.

CONCLUSION: Once cTnI and cTnT are released to the circulation, there seems to be no difference in clearance. However, cTnI is degraded and released faster than cTnT from necrotic cardiac tissue. Faster degradation and release may be the main reason why cTnI reaches higher peak concentrations and returns to normal concentrations faster in patients with MI.

Place, publisher, year, edition, pages
OXFORD UNIV PRESS INC, 2020
National Category
Cardiac and Cardiovascular Systems Medical Laboratory and Measurements Technologies
Identifiers
urn:nbn:se:uu:diva-407519 (URN)10.1093/clinchem/hvz003 (DOI)000514385400011 ()32040581 (PubMedID)
Funder
Swedish Cancer SocietySwedish Heart Lung FoundationSwedish Foundation for Strategic Research
Available from: 2020-03-25 Created: 2020-03-25 Last updated: 2020-03-25Bibliographically approved
James, S., Erlinge, D., Herlitz, J., Alfredsson, J., Koul, S., Fröbert, O., . . . Hofmann, R. (2020). Effect of Oxygen Therapy on Cardiovascular Outcomes in Relation to Baseline Oxygen Saturation. JACC: Cardiovascular Interventions, 13(4), 502-513
Open this publication in new window or tab >>Effect of Oxygen Therapy on Cardiovascular Outcomes in Relation to Baseline Oxygen Saturation
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2020 (English)In: JACC: Cardiovascular Interventions, ISSN 1936-8798, E-ISSN 1876-7605, Vol. 13, no 4, p. 502-513Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: The aim of this study was to determine the effect of supplemental oxygen in patients with myocardial infarction (MI) on the composite of all-cause death, rehospitalization with MI, or heart failure related to baseline oxygen saturation. A secondary objective was to investigate outcomes in patients developing hypoxemia.

BACKGROUND: In the DETO2X-AMI (Determination of the Role of Oxygen in Suspected Acute Myocardial Infarction) trial, 6,629 normoxemic patients with suspected MI were randomized to oxygen at 6 l/min for 6 to 12 hours or ambient air.

METHODS: The study population of 5,010 patients with confirmed MI was divided by baseline oxygen saturation into a low-normal (90% to 94%) and a high-normal (95% to 100%) cohort. Outcomes are reported within 1 year. To increase power, all follow-up time (between 1 and 4 years) was included post hoc, and interaction analyses were performed with oxygen saturation as a continuous covariate.

RESULTS: The composite endpoint of all-cause death, rehospitalization with MI, or heart failure occurred significantly more often in patients in the low-normal cohort (17.3%) compared with those in the high-normal cohort (9.5%) (p < 0.001), and most often in patients developing hypoxemia (23.6%). Oxygen therapy compared with ambient air was not associated with improved outcomes regardless of baseline oxygen saturation (interaction p values: composite endpoint, p = 0.79; all-cause death, p = 0.33; rehospitalization with MI, p = 0.86; hospitalization for heart failure, p = 0.35).

CONCLUSIONS: Irrespective of oxygen saturation at baseline, we found no clinically relevant beneficial effect of routine oxygen therapy in normoxemic patients with MI regarding cardiovascular outcomes. Low-normal baseline oxygen saturation or development of hypoxemia was identified as an independent marker of poor prognosis. (An Efficacy and Outcome Study of Supplemental Oxygen Treatment in Patients With Suspected Myocardial Infarction; NCT01787110).

Place, publisher, year, edition, pages
Elsevier, 2020
Keywords
cardiovascular outcomes, myocardial infarction, oxygen therapy, randomized clinical trial, reactive oxygen species
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-401251 (URN)10.1016/j.jcin.2019.09.016 (DOI)000513913200017 ()31838113 (PubMedID)
Funder
Swedish Research Council, 2013-0307Swedish Heart Lung Foundation, 20130262Swedish Heart Lung Foundation, 20160688Swedish Foundation for Strategic Research , KF10-0024
Available from: 2020-01-07 Created: 2020-01-07 Last updated: 2020-03-27Bibliographically approved
Alabas, O. A., Jernberg, T., Pujades-Rodriguez, M., Rutherford, M. J., West, R. M., Hall, M., . . . Gale, C. P. (2020). Statistics on mortality following acute myocardial infarction in 842 897 Europeans. Cardiovascular Research, 116(1), 149-157
Open this publication in new window or tab >>Statistics on mortality following acute myocardial infarction in 842 897 Europeans
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2020 (English)In: Cardiovascular Research, ISSN 0008-6363, E-ISSN 1755-3245, Vol. 116, no 1, p. 149-157Article in journal (Refereed) Published
Abstract [en]

Aims: To compare ST-segment elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI) mortality between Sweden and the UK, adjusting for background population rates of expected death, case mix, and treatments.

Methods and results: National data were collected from hospitals in Sweden [n = 73 hospitals, 180 368 patients, Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies (SWEDEHEART)] and the UK [n = 247, 662 529 patients, Myocardial Ischaemia National Audit Project (MINAP)] between 2003 and 2013. There were lower rates of revascularization [STEMI (43.8% vs. 74.9%); NSTEMI (27.5% vs. 43.6%)] and pharmacotherapies at time of hospital discharge including [aspirin (82.9% vs. 90.2%) and (79.9% vs. 88.0%), beta-blockers (73.4% vs. 86.4%) and (65.3% vs. 85.1%)] in the UK compared with Sweden, respectively. Standardized net probability of death (NPD) between admission and 1 month was higher in the UK for STEMI [8.0 (95% confidence interval 7.4-8.5) vs. 6.7 (6.5-6.9)] and NSTEMI [6.8 (6.4-7.2) vs. 4.9 (4.7-5.0)]. Between 6 months and 1 year and more than 1 year, NPD remained higher in the UK for NSTEMI [2.9 (2.5-3.3) vs. 2.3 (2.2-2.5)] and [21.4 (20.0-22.8) vs. 18.3 (17.6-19.0)], but was similar for STEMI [0.7 (0.4-1.0) vs. 0.9 (0.7-1.0)] and [8.4 (6.7-10.1) vs. 8.3 (7.5-9.1)].

Conclusion: Short-term mortality following STEMI and NSTEMI was higher in the UK compared with Sweden. Mid- and longer-term mortality remained higher in the UK for NSTEMI but was similar for STEMI. Differences in mortality may be due to differential use of guideline-indicated treatments.

Place, publisher, year, edition, pages
OXFORD UNIV PRESS, 2020
Keywords
Mortality, Acute myocardial infarction, SWEDEHEART, MINAP, Sweden, UK
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-404712 (URN)10.1093/cvr/cvz197 (DOI)000506800400023 ()31350550 (PubMedID)
Funder
Swedish Heart Lung FoundationStockholm County Council
Available from: 2020-02-26 Created: 2020-02-26 Last updated: 2020-02-26Bibliographically approved
Ljung, L., Lindahl, B., Eggers, K. M., Frick, M., Linder, R., Löfmark, H. B., . . . Jernberg, T. (2019). A Rule-Out Strategy Based on High-Sensitivity Troponin and HEART Score Reduces Hospital Admissions. Annals of Emergency Medicine, 73(5), 491-499
Open this publication in new window or tab >>A Rule-Out Strategy Based on High-Sensitivity Troponin and HEART Score Reduces Hospital Admissions
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2019 (English)In: Annals of Emergency Medicine, ISSN 0196-0644, E-ISSN 1097-6760, Vol. 73, no 5, p. 491-499Article in journal (Refereed) Published
Abstract [en]

Study objective: We evaluate whether a combination of a 1-hour high-sensitivity cardiac troponin algorithm and History, ECG, Age, Risk Factors, and Troponin (HEART) score reduces admission rate (primary outcome) and affects time to discharge, health care-related costs, and 30-day outcome (secondary outcomes) in patients with symptoms suggestive of an acute coronary syndrome.

Methods: This prospective observational multicenter study was conducted before (2013 to 2014) and after (2015 to 2016) implementation of a strategy including level of high-sensitivity cardiac troponin T or I at 0 and 1 hour, combined with the HEART score. Patients with a nonelevated baseline high-sensitivity cardiac troponin level, a 1-hour change in high-sensitivity cardiac troponin T level less than 3 ng/L, or high-sensitivity cardiac troponin I level less than 6 ng/L and a HEART score less than or equal to 3 were considered to be ruled out of having acute coronary syndrome. A logistic regression analysis was performed to adjust for differences in baseline characteristics.

Results: A total of 1,233 patients were included at 6 centers. There were no differences in regard to median age (64 versus 63 years) and proportion of men (57% versus 54%) between the periods. After introduction of the new strategy, the admission rate decreased from 59% to 33% (risk ratio 0.55 [95% confidence interval {CI} 0.48 to 0.63]; odds ratio 0.33 [95% CI 0.26 to 0.42]; adjusted odds ratio 0.33 [95% CI 0.25 to 0.42]). The median hospital stay was reduced from 23.2 to 4.7 hours (95% CI of difference -20.4 to -11.4); median health care-related costs, from $1,748 to $1,079 (95% CI of difference -$953 to -$391). The number of clinical events was very low.

Conclusion: In this before-after study, clinical implementation of a 1-hour high-sensitivity cardiac troponin algorithm combined with the HEART score was associated with a reduction in admission rate and health care burden, with very low rates of adverse clinical events.

Place, publisher, year, edition, pages
MOSBY-ELSEVIER, 2019
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-383149 (URN)10.1016/j.annemergmed.2018.11.039 (DOI)000465551700019 ()30661856 (PubMedID)
Funder
EU, FP7, Seventh Framework ProgrammeSwedish Heart Lung FoundationStockholm County Council
Available from: 2019-05-10 Created: 2019-05-10 Last updated: 2020-01-07Bibliographically approved
Tjora, H. L., Steiro, O.-T., Langorgen, J., Bjorneklett, R., Nygard, O. K., Renstrom, R., . . . Aakre, K. M. (2019). Aiming toWards Evidence baSed inTerpretation of Cardiac biOmarkers in patients pResenting with chest pain-the WESTCOR study: study design. Scandinavian Cardiovascular Journal, 53(5), 280-285
Open this publication in new window or tab >>Aiming toWards Evidence baSed inTerpretation of Cardiac biOmarkers in patients pResenting with chest pain-the WESTCOR study: study design
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2019 (English)In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 53, no 5, p. 280-285Article in journal (Refereed) Published
Abstract [en]

Objectives. The main aim of the Aiming toWards Evidence baSed inTerpretation of Cardiac biOmarkers in patients pResenting with chest pain (WESTCOR-study) (Clinical Trials number NCT02620202) is to improve diagnostic pathways for patients presenting to the Emergency department (ED) with acute chest pain. Design. The WESTCOR-study is a two center, cross-sectional and prospective observational study recruiting unselected patients presenting to the ED with suspected non-ST elevation acute coronary syndrome (NSTE-ACS). Patient inclusion started September 2015 and we plan to include 2250 patients, finishing in 2019. The final diagnosis will be adjudicated by two independent cardiologists based on all available information including serial high sensitivity cardiac troponin measurements, coronary angiography, coronary CT angiography and echocardiography. The study includes one derivation cohort (N = 985) that will be used to develop rule out/rule in algorithms for NSTEMI and NSTE-ACS (if possible) using novel troponin assays, and to validate established NSTEMI algorithms, with and without clinical scoring systems. The study further includes one subcohort (n = 500) where all patients are examined with coronary CT angiography independent of biomarker status, aiming to assess the associations between biomarkers and the extent and severity of coronary atherosclerosis. Finally, an external validation cohort (N = 750) will be included at Stavanger University Hospital. Prospective studies will be based on the merged cohorts. Conclusion. The WESTCOR study will provide new diagnostic algorithms for early inclusion and exclusion of NSTE-ACS and insights in the associations between cardiovascular biomarkers, CT-angiographic findings and short and long-term clinical outcomes.

Place, publisher, year, edition, pages
TAYLOR & FRANCIS LTD, 2019
Keywords
Chest pain, acute coronary syndrome, cardiovascular biomarkers, rule in, rule out algorithms, troponin, NSTEMI, unstable angina pectoris
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-396148 (URN)10.1080/14017431.2019.1634280 (DOI)000473989000001 ()31216908 (PubMedID)
Available from: 2019-11-04 Created: 2019-11-04 Last updated: 2020-01-07Bibliographically approved
Neumann, J. T., Twerenbold, R., Ojeda, F., Sörensen, N. A., Chapman, A. R., Shah, A. S., . . . Blankenberg, S. (2019). Application of High-Sensitivity Troponin in Suspected Myocardial Infarction. New England Journal of Medicine, 380(26), 2529-2540
Open this publication in new window or tab >>Application of High-Sensitivity Troponin in Suspected Myocardial Infarction
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2019 (English)In: New England Journal of Medicine, ISSN 0028-4793, E-ISSN 1533-4406, Vol. 380, no 26, p. 2529-2540Article in journal (Refereed) Published
Abstract [en]

Background: Data regarding high-sensitivity troponin concentrations in patients presenting to the emergency department with symptoms suggestive of myocardial infarction may be useful in determining the probability of myocardial infarction and subsequent 30-day outcomes.

Methods: In 15 international cohorts of patients presenting to the emergency department with symptoms suggestive of myocardial infarction, we determined the concentrations of high-sensitivity troponin I or high-sensitivity troponin T at presentation and after early or late serial sampling. The diagnostic and prognostic performance of multiple high-sensitivity troponin cutoff combinations was assessed with the use of a derivation-validation design. A risk-assessment tool that was based on these data was developed to estimate the risk of index myocardial infarction and of subsequent myocardial infarction or death at 30 days.

Results: Among 22,651 patients (9604 in the derivation data set and 13,047 in the validation data set), the prevalence of myocardial infarction was 15.3%. Lower high-sensitivity troponin concentrations at presentation and smaller absolute changes during serial sampling were associated with a lower likelihood of myocardial infarction and a lower short-term risk of cardiovascular events. For example, high-sensitivity troponin I concentrations of less than 6 ng per liter and an absolute change of less than 4 ng per liter after 45 to 120 minutes (early serial sampling) resulted in a negative predictive value of 99.5% for myocardial infarction, with an associated 30-day risk of subsequent myocardial infarction or death of 0.2%; a total of 56.5% of the patients would be classified as being at low risk. These findings were confirmed in an external validation data set.

Conclusions: A risk-assessment tool, which we developed to integrate the high-sensitivity troponin I or troponin T concentration at emergency department presentation, its dynamic change during serial sampling, and the time between the obtaining of samples, was used to estimate the probability of myocardial infarction on emergency department presentation and 30-day outcomes.

Place, publisher, year, edition, pages
MASSACHUSETTS MEDICAL SOC, 2019
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-392882 (URN)10.1056/NEJMoa1803377 (DOI)000478840000009 ()31242362 (PubMedID)
Available from: 2019-09-24 Created: 2019-09-24 Last updated: 2020-01-07Bibliographically approved
Batra, G., Ahlsson, A., Lindahl, B., Lindhagen, L., Wickbom, A. & Oldgren, J. (2019). Atrial fibrillation in patients undergoing coronary artery surgery is associated with adverse outcome. Upsala Journal of Medical Sciences, 124(1), 70-77
Open this publication in new window or tab >>Atrial fibrillation in patients undergoing coronary artery surgery is associated with adverse outcome
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2019 (English)In: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 124, no 1, p. 70-77Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The aim was to determine the association between atrial fibrillation (AF) and outcome in patients undergoing coronary artery bypass grafting (CABG).

METHODS: All patients undergoing CABG between January 2010 and June 2013 were identified in the Swedish Heart Surgery Registry. Outcomes studied were all-cause mortality, cardiovascular mortality, myocardial infarction, congestive heart failure, ischemic stroke, and recurrent AF. Patients with history of AF prior to surgery (preoperative AF) and patients without history of AF but with AF episodes post-surgery (postoperative AF) were compared to patients with no AF using adjusted Cox regression models.

RESULTS: Among 9,107 identified patients, 8.1% (n = 737) had preoperative AF, and 25.1% (n = 2,290) had postoperative AF. Median follow-up was 2.2 years. Compared to no AF, preoperative AF was associated with higher risk of all-cause mortality, adjusted hazard ratio with 95% confidence interval (HR) 1.76 (1.33-2.33); cardiovascular mortality, HR 2.43 (1.68-3.50); and congestive heart failure, HR 2.21 (1.72-2.84). Postoperative AF was associated with risk of all-cause mortality, HR 1.27 (1.01-1.60); cardiovascular mortality, HR 1.52 (1.10-2.11); congestive heart failure, HR 1.47 (1.18-1.83); and recurrent AF, HR 4.38 (2.46-7.78). No significant association was observed between pre- or postoperative AF and risk for myocardial infarction and ischemic stroke.

CONCLUSIONS: Approximately 1 in 3 patients undergoing CABG had pre- or postoperative AF. Patients with pre- or postoperative AF were at higher risk of all-cause mortality, cardiovascular mortality, and congestive heart failure, but not of myocardial infarction or ischemic stroke. Postoperative AF was associated with higher risk of recurrent AF.

Keywords
Atrial fibrillation, cardiovascular disease, coronary artery bypass grafting
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-374222 (URN)10.1080/03009734.2018.1504148 (DOI)000461811100015 ()30265179 (PubMedID)
Funder
Swedish Foundation for Strategic Research , KF10-0024
Available from: 2019-01-18 Created: 2019-01-18 Last updated: 2019-04-10Bibliographically approved
Baron, T., Beskow, A. H., James, S. K. & Lindahl, B. (2019). Biobank linked to SWEDEHEART quality registry-routine blood sample collection opens new opportunities for cardiovascular research. Upsala Journal of Medical Sciences, 124(1), 12-15
Open this publication in new window or tab >>Biobank linked to SWEDEHEART quality registry-routine blood sample collection opens new opportunities for cardiovascular research
2019 (English)In: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 124, no 1, p. 12-15Article in journal (Refereed) Published
Abstract [en]

High-quality biobanking within routine health services, through the use of existing health-care practices and infrastructure, with respect to safety and integrity of patients in line with the Swedish Biobank Act, enables large-scale collection of biological material at reasonable costs. Complementing the extensive information on myocardial infarction patients from a national registry gives unique opportunities for research focusing on better understanding of cardiovascular disease occurrence and prognosis, developing of new diagnostic methods, and personalized treatments with greater efficacy and fewer side effects.

Keywords
Biobank, SWEDEHEART, cardiovascular research, quality registry
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-374224 (URN)10.1080/03009734.2018.1498957 (DOI)000461811100004 ()30251587 (PubMedID)
Available from: 2019-01-18 Created: 2019-01-18 Last updated: 2019-04-17Bibliographically approved
Eggers, K. M., Jernberg, T. & Lindahl, B. (2019). Cardiac Troponin Elevation in Patients Without a Specific Diagnosis. Journal of the American College of Cardiology, 73(1), 1-9
Open this publication in new window or tab >>Cardiac Troponin Elevation in Patients Without a Specific Diagnosis
2019 (English)In: Journal of the American College of Cardiology, ISSN 0735-1097, E-ISSN 1558-3597, Vol. 73, no 1, p. 1-9Article in journal (Refereed) Published
Abstract [en]

BACKGROUND Cardiac troponin (cTn) elevation is a common finding in acutely admitted patients, even in the absence of acute coronary syndrome. In some of these patients, no etiology of cTn elevation can be identified. The term troponinemia is sometimes used to describe this scenario.

OBJECTIVES This study aimed to investigate the associations of cTn levels with clinical findings and long-term outcome in acutely admitted patients with suspected acute coronary syndrome who had been discharged without a specified diagnosis.

METHODS Retrospective registry-based cohort study investigating 48,872 patients (SWEDEHEART [Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies] registry). Patients were stratified into cohorts with cTn levels less than or equal to the assay-specific 99th percentile and separated by assay-specific cTn tertiles in case of higher levels.

RESULTS A cTn level >99th percentile was noted in 9,800 (20.1%) patients. The prevalence of cardiovascular risk factors as well as cardiovascular and noncardiovascular comorbidities increased across higher cTn strata. In total, 7,529 (15.4%) patients had a major adverse event (MAE), defined as the composite of all-cause mortality, myocardial infarction, readmission for heart failure, or stroke (median follow-up 4.9 years). MAE risk was associated with higher cTn strata (hazard ratio for highest assay-specific cTn tertile: 2.59; 95% confidence interval: 2.39 to 2.80; hazard ratio in patients without cardiovascular comorbidities, renal dysfunction, left ventricular dysfunction, or significant coronary stenosis: 3.57; 95% confidence interval: 2.30 to 5.54).

CONCLUSIONS cTn elevation is associated with cardiovascular and noncardiovascular comorbidities and predicts major adverse events in acutely admitted patients, in whom no definite diagnosis could have been established. The term troponinemia is trivializing and should be avoided. Instead, careful work-up is required in these patients.

Keywords
cardiac troponin, chest pain, risk prediction, troponinemia
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-374424 (URN)10.1016/j.jacc.2018.09.082 (DOI)000455014900001 ()30621937 (PubMedID)
Funder
Swedish Foundation for Strategic Research
Available from: 2019-01-29 Created: 2019-01-29 Last updated: 2019-01-29Bibliographically approved
Nordenskjöld, A. M., Eggers, K. M., Jernberg, T., Mohammad, M. A., Erlinge, D. & Lindahl, B. (2019). Circadian onset and prognosis of myocardial infarction with non-obstructive coronary arteries (MINOCA). PLoS ONE, 14(4), Article ID e0216073.
Open this publication in new window or tab >>Circadian onset and prognosis of myocardial infarction with non-obstructive coronary arteries (MINOCA)
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2019 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 14, no 4, article id e0216073Article in journal (Refereed) Published
Abstract [en]

Background: Many acute cardiovascular events such as myocardial infarction (MI) follow circadian rhythms. Myocardial infarction with non-obstructive coronary arteries (MINOCA) is a newly noticed entity with limited data on onset pattern and its impact on prognosis.

Material and methods: In this observational study of Swedish MINOCA patients registered in the SWEDEHEART registry between 2003-2013 and followed until December 2013 we identified 9,092 unique patients with MINOCA out of 199,163 MI admissions in total. Incidence rate ratios (IRR) were calculated for whole hours, parts of the day, weekdays, months, seasons and major holidays.

Results: The mean age was 65.5 years, 62.0% were women and 16.6% presented with STEMI. The risk for MINOCA proved to be most common in the morning (IRR = 1.70, 95% CI [1.63-1.84]) with a peak at 08.00 AM (IRR = 2.25, 95% CI [1.96-2.59]) and on Mondays (IRR = 1.28, 95% CI [1.18-1.38]). No altered risk was detected during the different seasons, the Christmas and New Year holidays or the Swedish Midsummer festivities. There was no association between time of onset of MINOCA and short-or long-term prognosis.

Conclusion: The onset of MINOCA shows a circadian and circaseptan variation with increased risk at early mornings and Mondays, similar to previous studies on all MI, suggesting stress related triggering. However, during holidays were traditional MI increase, we did not see any increase for MINOCA. No association was detected between time of onset and prognosis, indicating that the underlying pathological mechanisms of MINOCA and the quality of care are similar at different times of onset but triggering mechanism may be more active early mornings and Mondays.

Place, publisher, year, edition, pages
PUBLIC LIBRARY SCIENCE, 2019
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-385566 (URN)10.1371/journal.pone.0216073 (DOI)000465519100087 ()31022242 (PubMedID)
Available from: 2019-06-19 Created: 2019-06-19 Last updated: 2019-06-19Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-5795-0061

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