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Johnston, Nina
Publications (10 of 40) Show all publications
Jönelid, B., Kragsterman, B., Berglund, L., Andrén, B., Johnston, N., Lindahl, B., . . . Christersson, C. (2019). Low Walking Impairment Questionnaire score after a recent myocardial infarction identifies patients with polyvascular disease. JRSM Cardiovascular Disease, 8, 1-9
Open this publication in new window or tab >>Low Walking Impairment Questionnaire score after a recent myocardial infarction identifies patients with polyvascular disease
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2019 (English)In: JRSM Cardiovascular Disease, ISSN 2048-0040, Vol. 8, p. 1-9Article in journal (Refereed) Published
Abstract [en]

Objectives: To evaluate whether the Walking Impairment Questionnaire score could identify patients with polyvascular disease in a population with recent myocardial infarction and their association with cardiovascular events during two-year follow-up.

Design: A prospective observational study.

Setting: Patients admitted to the acute coronary care unit, the Department of Cardiology, Uppsala University Hospital.

Participants: Patients admitted with acute Non-STEMI- or STEMI-elevation myocardial infarction.

Main outcome measures: The Walking Impairment Questionnaire, developed as a self-administered instrument to assess walking distance, speed, and stair climbing in patients with peripheral artery disease, predicts future cardiovascular events and mortality. Two hundred and sixty-three patients with recent myocardial infarction answered Walking Impairment Questionnaire. Polyvascular disease was defined as abnormal findings in the coronary- and carotid arteries and an abnormal ankle-brachial index. The calculated score for each of all three categories were divided into quartiles with the lowest score in first quartile.

Results: The lowest (worst) quartile in all three Walking Impairment Questionnaire categories was associated with polyvascular disease, fully adjusted; distance, odds ratio (OR) 5.4 (95% confidence interval (CI) 1.8-16.1); speed, OR 7.4 (95% CI 1.5-36.5); stair climbing, OR 8.4 (95% CI 1.0-73.6). In stair climbing score, patients with the lowest (worst) score had a higher risk for the composite cardiovascular endpoint compared to the highest (best) score; hazard ratio 5.3 (95% CI 1.5-19.0). The adherence to medical treatment was high (between 81.7% and 99.2%).

Conclusions: The Walking Impairment Questionnaire is a simple tool to identify myocardial infarction patients with more widespread atherosclerotic disease and although well treated medically, stair climbing predicts cardiovascular events.

Keywords
Peripheral vascular disease, cardiovascular disease, coronary artery disease, polyvascular disease
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-382843 (URN)10.1177/2048004019841971 (DOI)000464951000001 ()31019682 (PubMedID)
Available from: 2019-05-24 Created: 2019-05-24 Last updated: 2019-10-24Bibliographically approved
Johnston, N., Bergdahl, E., Samnegard, A., Kenttä, L., Holm, A., Petursson, P. & Bäck, M. (2018). [ST-elevation myocardial infarction and dual antiplatelet therapy: new guidelines].. Läkartidningen, 115, Article ID E7UI.
Open this publication in new window or tab >>[ST-elevation myocardial infarction and dual antiplatelet therapy: new guidelines].
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2018 (Swedish)In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 115, article id E7UIArticle in journal (Refereed) Published
Abstract [sv]

This report summarizes some of the most important changes and new recommendations from the ESC ST-elevation myocardial infarction and double antiplatelet therapy guidelines for 2017, which are of interest for physicians managing patients with coronary artery disease.

National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-374954 (URN)29969143 (PubMedID)
Available from: 2019-01-24 Created: 2019-01-24 Last updated: 2019-05-29Bibliographically approved
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, p. 210-216Article 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
Varenhorst, C. & Johnston, N. (2017). RE: Letter to the editor, Dr Cheng et al: "Smartphone apps and secondary prevention after myocardial infarction-How can long-term usage be improved?" [Letter to the editor]. American Heart Journal, 184, e2-e2
Open this publication in new window or tab >>RE: Letter to the editor, Dr Cheng et al: "Smartphone apps and secondary prevention after myocardial infarction-How can long-term usage be improved?"
2017 (English)In: American Heart Journal, ISSN 0002-8703, E-ISSN 1097-6744, Vol. 184, p. e2-e2Article in journal, Letter (Other academic) Published
Place, publisher, year, edition, pages
Elsevier, 2017
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-343499 (URN)10.1016/j.ahj.2016.10.022 (DOI)000396389000002 ()28224935 (PubMedID)
Available from: 2018-02-27 Created: 2018-02-27 Last updated: 2019-02-26Bibliographically 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, p. 46-70Article, review/survey (Refereed) Published
Keywords
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
Johnston, N. & Schenck-Gustafsson, K. (2017). Spontaneous coronary artery dissection: A need for raised awareness among healthcare professionals evaluating pregnant and post-partum women with chest pain. Maturitas, 104, 123-124
Open this publication in new window or tab >>Spontaneous coronary artery dissection: A need for raised awareness among healthcare professionals evaluating pregnant and post-partum women with chest pain
2017 (English)In: Maturitas, ISSN 0378-5122, E-ISSN 1873-4111, Vol. 104, p. 123-124Article in journal, Editorial material (Other academic) Published
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-343498 (URN)10.1016/j.maturitas.2017.06.032 (DOI)000413132100015 ()28789878 (PubMedID)
Available from: 2018-02-27 Created: 2018-02-27 Last updated: 2018-03-29Bibliographically 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, p. 55-60Article 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: 2019-10-24Bibliographically 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, p. 442-443Article 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, p. 751-756Article 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.

Keywords
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, p. 1661-1666Article 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
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