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Outcome of ST-elevation myocardial infarction treated with thrombolysis in the unselected population is vastly different from samples of eligible patients in a large-scale clinical trial
Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Medical Sciences.
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2004 In: American Heart Journal, ISSN 0002-8703, Vol. 148, no 4, 566-573 p.Article in journal (Refereed) Published
Place, publisher, year, edition, pages
2004. Vol. 148, no 4, 566-573 p.
URN: urn:nbn:se:uu:diva-93681OAI: oai:DiVA.org:uu-93681DiVA: diva2:167230
Available from: 2005-11-03 Created: 2005-11-03Bibliographically approved
In thesis
1. Early Risk Stratification, Treatment and Outcome in ST-elevation Myocardial Infarction
Open this publication in new window or tab >>Early Risk Stratification, Treatment and Outcome in ST-elevation Myocardial Infarction
2005 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

We evaluated, in patients with ST-elevation myocardial infarction (STEMI) treated with thrombolytics, admission Troponin T (tnT), ST-segment resolution and admission N-terminal pro-brain natriuretic peptide (NT-proBNP) for early risk stratification as well as time delays and outcome in real life patients according to prehospital or in-hospital thrombolytic treatment. Also, baseline characteristics, treatments and outcome in patients enrolled in the ASSENT-2 trial in Sweden and in patients not enrolled were evaluated.

TnT (n=881) and NT-proBNP (n=782) on admission and ST-resolution at 60 minutes (n=516) in patients from the ASSENT-2 and ASSENT-PLUS trials were analysed. Elevated levels of NT-proBNP and tnT on admission were both independently related to one-year mortality. However, when adding information on ST-resolution (</≥50%) 60 minutes after initiation of thrombolytic treatment, tnT no longer contributed independently to mortality prediction. High and low risk patients were best identified by a combination of NT-proBNP and ST-resolution at 60 minutes.

We investigated consecutive STEMI patients included in the RIKS-HIA registry between 2001 and 2004, if they were ambulance transported and had received prehospital (n=1690) or in-hospital (n=3685) thrombolytic treatment. Prehospital diagnosis and thrombolysis reduced the time to thrombolysis by almost one hour, were associated with better left ventricular function and fewer complications and reduced the adjusted one-year mortality by 30% compared with in-hospital thrombolysis.

Prospective data from the RIKS-HIA registry on STEMI patients treated with thrombolytics were linked to data on trial participants in the ASSENT-2 trial of thrombolytic agents and used for direct comparisons. Patients treated with thrombolytics and not enrolled in a clinical trial at trial hospitals (n=2048) had higher risk characteristics, more early complications and twice as high adjusted one-year mortality compared to those enrolled (n=729). One major reason for the difference in outcome appeared to be the selection of less critically ill patients to the trial.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2005. 70 p.
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 81
Medicine, Acute myocardial infarction, Thrombolysis, Troponin, Electrocardiography, Natriuretic peptide, Prognosis, Prehospital thrombolysis, Treatment delay, Mortality, Registry, Clinical trial, Medicin
National Category
Dermatology and Venereal Diseases
urn:nbn:se:uu:diva-6050 (URN)91-554-6384-3 (ISBN)
Public defence
2005-11-25, Robergsalen, Ingång 40, Akademiska sjukhuset, Uppsala, 13:15
Available from: 2005-11-03 Created: 2005-11-03 Last updated: 2013-06-20Bibliographically approved

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