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Johnston, Nina
Publications (10 of 35) Show all publications
Kunadian, V., Qiu, W., Lagerqvist, B., Johnston, N., Sinclair, H., Tan, Y., . . . Sarno, G. (2017). Gender Differences in Outcomes and Predictors of All-Cause Mortality After Percutaneous Coronary Intervention (Data from United Kingdom and Sweden). American Journal of Cardiology, 119(2), 210-216.
Open this publication in new window or tab >>Gender Differences in Outcomes and Predictors of All-Cause Mortality After Percutaneous Coronary Intervention (Data from United Kingdom and Sweden)
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2017 (English)In: American Journal of Cardiology, ISSN 0002-9149, E-ISSN 1879-1913, Vol. 119, no 2, 210-216 p.Article in journal (Refereed) Published
Abstract [en]

To determine gender differences and predictors of all-cause mortality (30 days and 1 year) after percutaneous coronary intervention (PCI) in patients with stable angina pectoris and acute coronary syndrome (non ST-elevation myocardial infarction/unstable angina pectoris and ST-elevation myocardial infarction) in the British Cardiovascular Intervention Society (BCIS) and Swedish Coronary Angiography and Angioplasty Registry (SCAAR) data sets, an analysis of prospectively collected data from 2007 to 2011 was performed. In total, 458,261 patients (BCIS: n = 368,492 [25.9% women]; Sweden: n = 89,769 [27.2% women]) who underwent PCI were included in this analysis. Using multiple regression analysis, in the BCIS registry, female gender was an independent predictor of all-cause mortality at 30 days (odds ratio [OR] 1.15, 95% CI 1.10 to 1.22, p <0.0001) and at 1 year (OR 1.08, 95% CI 1.04 to 1.12, p <0.0001) after PCI for all patients. Likewise, in the SCAAR registry, female gender was an independent predictor of all-cause mortality at 30 days (OR 1.15, 95% CI 1.05 to 1.26, p = 0.002) and 1 year (OR 1.09, 95% CI 1.03 to 1.17, p = 0.006) after PCI for all patients. In both data sets, there was no statistically significant interaction between age and gender for all-cause mortality at 30 days (BCIS, p = 0.59; SCAAR, p = 0.40) and at 1 year (BCIS, p = 0.11; SCAAR, p = 0.83). In conclusion, despite advances in care, women compared with men continue to experience higher all cause mortality after PCI for coronary artery disease. The patient's age at the time of PCI remains a strong predictive factor of mortality in this population. Strategies and further research are warranted to better address the management of coronary artery disease in women with possibly earlier diagnosis and more tailored treatments.

National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-316948 (URN)10.1016/j.amjcard.2016.09.052 (DOI)000392896900007 ()27816119 (PubMedID)
Available from: 2017-03-08 Created: 2017-03-08 Last updated: 2017-11-29Bibliographically approved
Humphries, K. H., Izadnegandar, M., Sedlak, T., Saw, J., Johnston, N., Schenck-Gustafsson, K., . . . Merz, C. N. (2017). Sex differences in cardiovascular disease: Impact on care and outcomes. Frontiers in neuroendocrinology (Print), 46, 46-70.
Open this publication in new window or tab >>Sex differences in cardiovascular disease: Impact on care and outcomes
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2017 (English)In: Frontiers in neuroendocrinology (Print), ISSN 0091-3022, E-ISSN 1095-6808, Vol. 46, 46-70 p.Article, review/survey (Refereed) Published
Keyword
Women, Cardiovascular disease, Sex, Gender
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-333823 (URN)10.1016/j.yfrne.2017.04.001 (DOI)000404421500004 ()28428055 (PubMedID)
Available from: 2017-11-29 Created: 2017-11-29 Last updated: 2017-11-29Bibliographically approved
Jönelid, B., Johnston, N., Berglund, L., Andrén, B., Kragsterman, B. & Christersson, C. (2016). Ankle brachial index most important to identify polyvascular disease in patients with non-ST elevation or ST-elevation myocardial infarction. European journal of internal medicine, 30, 55-60.
Open this publication in new window or tab >>Ankle brachial index most important to identify polyvascular disease in patients with non-ST elevation or ST-elevation myocardial infarction
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2016 (English)In: European journal of internal medicine, ISSN 0953-6205, E-ISSN 1879-0828, Vol. 30, 55-60 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Atherosclerosis is a systemic disease. In patients with acute myocardial infarction (MI) the extent of polyvascular disease (PvD) is largely unknown. In this study we investigate the prevalence and clinical characteristics predictive of PvD in patients with non-ST-elevation (NSTEMI) and ST-elevation (STEMI) MI.

METHOD: 375 patients with acute MI included in the REBUS (Relevance of Biomarkers for Future Risk of Thromboembolic Events in Unselected Post-myocardial Infarction Patients) study were examined. Atherosclerotic changes were assessed in three arterial beds by coronary angiography, carotid ultrasound and ankle brachial index (ABI). Results compared findings of atherosclerosis in three arterial beds to fewer than 3 beds. PvD was defined as atherosclerosis in all three arterial beds.

RESULTS: A medical history of MI, peripheral artery disease (PAD) or stroke was reported at admission in 17.9%, 2.1% and 3.7% of the patients, respectively. After evaluation, abnormal ABI was found in 20.3% and carotid artery atherosclerosis in 54.9% of the patients. In the total population, PvD was found in 13.8% of patients with no significant differences observed between NSTEMI and STEMI patients. Age (p<0.001), diabetes (p=0.039), previous PAD (p=0.009) and female gender (p=0.016) were associated with PvD. ABI was the most important predictor of PvD with a positive predictive value of 68.4% (95% CI 57.7-79.2%) and specificity of 92.4% (95% CI 89.5-95.4%).

CONCLUSIONS: PvD is underdiagnosed in patients suffering from MI, both NSTEMI and STEMI. ABI is a useful and simple measurement that appears predictive of widespread atherosclerosis in these patients.

National Category
General Practice
Identifiers
urn:nbn:se:uu:diva-274195 (URN)10.1016/j.ejim.2015.12.016 (DOI)000375919800022 ()26776925 (PubMedID)
Available from: 2016-01-20 Created: 2016-01-20 Last updated: 2018-01-10Bibliographically approved
Johnston, N. & Christersson, C. (2016). Sex-Specific Research: A Key Component in Improving Prognosis After Transcatheter Aortic Valve Replacement. Annals of Internal Medicine, 164(6), 442-443.
Open this publication in new window or tab >>Sex-Specific Research: A Key Component in Improving Prognosis After Transcatheter Aortic Valve Replacement
2016 (English)In: Annals of Internal Medicine, ISSN 0003-4819, E-ISSN 1539-3704, Vol. 164, no 6, 442-443 p.Article in journal, Editorial material (Other academic) Published
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-296892 (URN)10.7326/M16-0105 (DOI)000372207200018 ()26903210 (PubMedID)
Available from: 2016-07-05 Created: 2016-06-20 Last updated: 2017-11-28Bibliographically approved
Eggers, K. M., Johnston, N., Lind, L., Venge, P. & Lindahl, B. (2015). Cardiac troponin I levels in an elderly population from the community - The implications of sex. Clinical Biochemistry, 48(12), 751-756.
Open this publication in new window or tab >>Cardiac troponin I levels in an elderly population from the community - The implications of sex
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2015 (English)In: Clinical Biochemistry, ISSN 0009-9120, E-ISSN 1873-2933, Vol. 48, no 12, 751-756 p.Article in journal (Refereed) Published
Abstract [en]

Objectives: The importance of sex on cardiac troponin levels is increasingly recognized. We investigated whether the entities associated with troponin leakage and the prognostic consequences thereof would differ between elderly men and women from the community. Design and methods: Cardiac troponin I (cTnI) levels were measured using a high-sensitivity assay (Abbott Laboratories) in 70-year old men (n = 502) and women (n = 502) from the PIVUS study. All study participants were followed up for 10 years regarding all-cause mortality and incident cardiovascular (CV) disease. Results: Median cTnI levels were 4.1 and 3.0 ng/L in men and women, respectively (p < 0.001). By multiple linear regression, the relative contribution of lower left-ventricular ejection fraction and ischemic ECG changes to cTnI levels was greater in men compared to women. For other clinical and echocardiographic variables, similar associations were found. cTnI independently predicted all-cause mortality in men (n = 93 [18.5%]; hazard ratio [HR] 1.38 [1.12-1.70]) and women (n = 62 [12.4%]; HR 1.59 [1.11-2.28]) but not incident CV disease in subjects being CV healthy at baseline (n = 163/857). The interaction terms of sex on the associations of cTnI with both outcomes were non-significant. Sex-specific cut-offs did not improve prognostication. Variations in the pattern of entities associated with cTnI leakage had no impact on event rates. Conclusions: We found some differences in the entities associated with higher cTnI levels in elderly community-dwelling men and women. However, this did not translate into differences in the associations of cTnI with adverse outcome.

Keyword
Cardiac troponin, Sex, Cardiovascular disease, Prognosis
National Category
Medical Laboratory and Measurements Technologies Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-261247 (URN)10.1016/j.clinbiochem.2015.04.013 (DOI)000359180000003 ()25916815 (PubMedID)
Funder
Swedish Heart Lung Foundation, 20100947Swedish Society of Medicine, SLS-248691
Available from: 2015-09-07 Created: 2015-08-31 Last updated: 2017-12-04Bibliographically approved
Johnston, N., Jönelid, B., Christersson, C., Kero, T., Renlund, H., Schenck-Gustafsson, K. & Lagerqvist, B. (2015). Effect of Gender on Patients With ST-Elevation and Non-ST-Elevation Myocardial Infarction Without Obstructive Coronary Artery Disease. American Journal of Cardiology, 115(12), 1661-1666.
Open this publication in new window or tab >>Effect of Gender on Patients With ST-Elevation and Non-ST-Elevation Myocardial Infarction Without Obstructive Coronary Artery Disease
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2015 (English)In: American Journal of Cardiology, ISSN 0002-9149, E-ISSN 1879-1913, Vol. 115, no 12, 1661-1666 p.Article in journal (Refereed) Published
Abstract [en]

The aim of this study was to compare the prognoses of patients with ST-segment elevation myocardial infarction (STEMI) and those with non-ST-segment elevation myocardial infarction (NSTEMI) without obstructive coronary artery disease (CAD) and the risk associated with gender for future cardiovascular events. The study population was selected from 95,849 patients who underwent coronary angiography for myocardial infarction from 2005 to 2010 and registered in the Swedish Coronary Angiography and Angioplasty Registry (SCAAR). Outcome analyses, including all-cause death, myocardial infarction, congestive heart failure, stroke, and revascularization, were performed in 2,268 patients with STEMI and 10,904 with NSTEMI without obstructive CAD (<50% stenosis). Hazard ratios and 95% confidence intervals comparing women with men were calculated for events, adjusting for cardiovascular risk factors and age. Nonobstructive CAD was found in 7% of patients with STEMI (6% men, 10% women) and in 17% of those with NSTEMI (11% men, 28% women). During a median follow-up of 2.6 years, 8% of patients with STEMI and 5% of those with NSTEMI died. Gender-associated differences in risk were observed in patients with NSTEMI, with adjusted hazard ratios lower in women than men for mortality (hazard ratio 0.90, 95% confidence interval 0.50 to 0.73) and congestive heart failure (hazard ratio 0.61, 95% confidence interval 0.52 to 0.72). In the 2 groups, women underwent less revascularization. In conclusion, nonobstructive CAD was more common in patients with NSTEMI than those with STEMI, as well as in women compared with men. Long-term mortality in patients with nonobstructive CAD was higher after STEMI than NSTEMI. The gender differences in outcomes suggest gender differences in the underlying pathogenesis of myocardial infarction without obstructive CAD.

National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-252759 (URN)10.1016/j.amjcard.2015.03.006 (DOI)000357702300006 ()25900352 (PubMedID)
Available from: 2015-05-11 Created: 2015-05-11 Last updated: 2017-12-04Bibliographically approved
Varenhorst, C., Bodegard, J., Jerstrom, S., Akesson, J., Brorsson, H., Alfredsson, J., . . . Johnston, N. (2015). Effects of interactive patient support with a smartphone app on drug adherence and lifestyle changes in myocardial infarction patients. Paper presented at Congress of the European-Society-of-Cardiology (ESC), AUG 29-SEP 02, 2015, London, ENGLAND. European Heart Journal, 36(1 Supplement), 1202-1202.
Open this publication in new window or tab >>Effects of interactive patient support with a smartphone app on drug adherence and lifestyle changes in myocardial infarction patients
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2015 (English)In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 36, no 1 Supplement, 1202-1202 p.Article in journal, Meeting abstract (Other academic) Published
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-266281 (URN)000361205108044 ()
Conference
Congress of the European-Society-of-Cardiology (ESC), AUG 29-SEP 02, 2015, London, ENGLAND
Available from: 2015-11-06 Created: 2015-11-06 Last updated: 2017-12-01Bibliographically approved
Henriksson, C., Hallberg, T. & Johnston, N. (2015). Quality of Life in Patients under Investigation for Unclear Chest Pain: Before and After Coronary Angiography. Journal of Cardiovascular Diseases & Diagnosis, 3, Article ID 230.
Open this publication in new window or tab >>Quality of Life in Patients under Investigation for Unclear Chest Pain: Before and After Coronary Angiography
2015 (English)In: Journal of Cardiovascular Diseases & Diagnosis, ISSN 2329-9517, Vol. 3, 230Article in journal (Refereed) Published
Abstract [en]

Background

Patients with unclear chest pain experience more anxiety compared to those receiving a clear diagnosis, and they also report lower quality of life (QoL) than a general population. The aim was to investigate if there were differences in QoL before coronary angiography compared to six months later.

Methods

This was a quantitative study using the questionnaire EQ-5D. The study population consisted of patients (N=150) with unclear chest pain, referred for elective coronary angiography. They were asked to complete a questionnaire the day before coronary angiography and six months later.

Results

Significant improvements were seen regarding usual activities, pain/discomfort and total health status on the day before coronary angiography compared to at six months follow up.

Conclusions

Patients with unclear chest pain seem to estimate their total health status before coronary angiography worse than both the general population and myocardial infarction patients. Those with coronary artery disease CAD rated better total health status in comparison to those with a final diagnosis of no CAD. However, six months later significant improvements were seen.

National Category
Clinical Medicine
Identifiers
urn:nbn:se:uu:diva-277225 (URN)10.4172/2329-9517.1000230 (DOI)
Available from: 2016-02-18 Created: 2016-02-18 Last updated: 2017-04-26Bibliographically approved
Johnston, N., Sarno, G., Larsson, B., Tornvall, P. & Varenhorst, C. (2015). Spontan kranskärls­dissektion kan orsaka akut koronart syndrom: ovanligt tillstånd som kräver genomtänkt handläggning och mer forskning. Läkartidningen, 112, Article ID DRFW.
Open this publication in new window or tab >>Spontan kranskärls­dissektion kan orsaka akut koronart syndrom: ovanligt tillstånd som kräver genomtänkt handläggning och mer forskning
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2015 (Swedish)In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 112, DRFWArticle in journal (Refereed) Published
Abstract [en]

Spontaneous coronary artery dissection (SCAD) is a non-traumatic and non-iatrogenic injury occurring in the vessel wall caused by either a primary intimal dissection or a primary hematoma in the medial layer. SCAD is more common among women than men and accounts for a small minority of acute coronary syndromes. The causes of SCAD are multifactorial. Peripartum SCAD is most common. Fibromuscular dysplasia has a strong association with SCAD. As spontaneous healing is common in SCAD and PCI is associated with complications an initial conservative approach should always be considered. Medical treatment is based on the underlying cause. Beta blockers are recommended to all patients. The prognosis varies; the highest mortality is reported among women suffering peripartum SCAD. Quality of life is often affected in SCAD patients and accompanied by a high rate of rehospitalizations. More research which focuses on the underlying causes, optimal treatment and rehabilitation is needed.

National Category
Clinical Medicine
Identifiers
urn:nbn:se:uu:diva-278526 (URN)26625103 (PubMedID)
Note

Title in English: [Spontaneous coronary artery dissection can cause acute coronary syndrome. Unusual condition that requires thoughtful management and more research]

Available from: 2016-02-24 Created: 2016-02-24 Last updated: 2017-05-10Bibliographically approved
Eggers, K. M., Aldous, S., Greenslade, J. H., Johnston, N., Lindahl, B., Parsonage, W. A., . . . Cullen, L. (2015). Two-hour diagnostic algorithms for early assessment of patients with acute chest pain - Implications of lowering the cardiac troponin I cut-off to the 97.5th percentile. Clinica Chimica Acta, 445, 19-24.
Open this publication in new window or tab >>Two-hour diagnostic algorithms for early assessment of patients with acute chest pain - Implications of lowering the cardiac troponin I cut-off to the 97.5th percentile
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2015 (English)In: Clinica Chimica Acta, ISSN 0009-8981, E-ISSN 1873-3492, Vol. 445, 19-24 p.Article in journal (Refereed) Published
Abstract [en]

Aims: Assessment of patients with suspected non-ST elevation myocardial infarction (NSTEMI) is based on cardiac troponin (cTn) levels with the 99th percentile as cut-off. However, cardiovascular risk starts already at lower troponin concentrations. We therefore, aimed to investigate the utility of 2-hour algorithms using the high-sensitivity cardiac troponin I (hs-cTnI) 97.5th percentile as cut-off which corresponds to the standard URL for most biomarkers. Methods: Hs-cTnI was measured at presentation and 2 h in 1624 chest pain patients. Diagnostic algorithms were developed applying hs-cTnI levels dichotomized at the 99th and 97.5th percentiles combined with hs-cTnI changes and/or ECG findings. Results: The prevalence of NSTEMI was 13.9%. The adjusted odds ratios for 1-year mortality were 2.7(95% CI 1.4-5.1) for the 99th percentile and 3.1 (95% CI 1.6-5.9) for the 97.5th percentile. The best-performing 99th percentile-based algorithms provided a positive predictive value (PPV) of 863% and a negative predictive value (NPV) of 993%. Using 97.5th percentile-based algorithms to define NSTEMI resulted in few reclassifications and yielded similar diagnostic estimates (PPV 85.4%, NPV 99.4%). Conclusion: The hs-cTnI 97.5th percentile integrated into 2-hour algorithms provided high diagnostic estimates and could, due to better prognostic properties serve as an alternative to the 99th percentile.

Keyword
Cardiac troponin, Chest pain, Myocardial infarction, Emergency department, Diagnosis
National Category
Biomedical Laboratory Science/Technology
Identifiers
urn:nbn:se:uu:diva-256231 (URN)10.1016/j.cca.2015.03.002 (DOI)000355024100005 ()25771107 (PubMedID)
Available from: 2015-06-25 Created: 2015-06-22 Last updated: 2017-12-04Bibliographically approved
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