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Background: Gender differences in outcome and its predictors in patients with acute coronary syndrome (ACS) continue to be debated., Objectives: To assess long-term mortality and explore its association with the baseline variables in women and men., Methods: We followed 2,176 consecutive patients (665 women and 1,511 men) with ACS admitted to a single hospital and still alive after 30 days for a median of 16 years 8 months., Results: At the end of the follow-up, 415 (62.4%) women and 849 (56.2%) men had died (unadjusted hazard ratio [HR] for women/men 1.18 (95% confidence interval [CI], 1.05-1.33, p =0.005). After adjustment for age, the HR was reversed to 0.88 (95% CI, 0.78-1.00, p =0.04). Additional adjustment for potential confounders yielded a HR of 0.86 (95% CI, 0.76-0.98, p = 0.02). Using multivariable Cox regression, previous heart failure, previous or new-onset atrial fibrillation, and psychotropic drugs at discharge were significantly associated with increased long-term mortality in men only. Known hypertension, elevated creatinine, and inhospital Killip class >1/cardiogenic shock were significantly associated with mortality only in women. For late mortality, hypertension and inhospital Killip class >1/cardiogenic shock interacted significantly with gender., Conclusion: For patients with ACS surviving the first 30 days, late mortality was lower in women than in men after adjusting for age. The effects of several baseline characteristics on late outcome differed between women and men. Gender-specific strategies for long-term follow-up of ACS patients should be considered., (© 2019 S. Karger AG, Basel.)

We describe the incidence of acute chest pain (requiring admission to the emergency department) and the prognosis during two time periods in all patients admitted to the emergency department at Sahlgrenska University Hospital in Göteborg, Sweden, with acute chest pain 1986 and 1987 (period 1) and 1996 and 1997 (period 2). The rate of admission for chest pain/100,000 inhabitants was 4.7/day during period 1 and 5.0/day during period 2. The risk ratio for death adjusted for eight risk factors during period 2 in relation to period 1 was 0.88 (95% CI 0.79-0.97). There was a significant interaction between time period and the severity of the final diagnosis (p=0.02), indicating a greater reduction in mortality among patients with acute myocardial infarction., (Copyright (c) 2005 S. Karger AG, Basel.)

Objectives: To study sex-based differences in the clinical presentation in relation to age and type of acute coronary syndrome (ACS) in patients under 80 years of age., Methods: The study includes 1,744 consecutive patients with the full spectrum of ACS (ST elevation myocardial infarction (MI), non-ST elevation MI, and unstable angina of high- and low-risk types) admitted to the coronary care unit in a university hospital., Results: The women were older than the men and were as likely to present with ST elevation MI. They had lower rates of prior MI and prior coronary artery bypass surgery than men but similar rates of percutaneous coronary interventions. Further, women were less likely to have a short delay before admission to hospital and they were attended to less rapidly in the emergency department. The prevalence of risk factors, prior cardiovascular disease and ongoing treatment with cardiovascular drugs were strongly associated with less severe type of ACS with no significant sex interaction. Presentation with non-ST elevation MI was significantly associated with older age while the opposite was true for unstable low-risk angina. ECG signs of acute ischemia were not associated with age. Significant interactions between age and sex were observed for the prevalence of treatment with diuretics as well as hypotension at presentation, both more prevalent among women than men below 65 years of age., Conclusions: Women are struck by ACS at a higher age than men, are less likely to present early for hospital care, and at younger age women are more likely to present with hypotension. There is a striking difference in risk factors and previous history depending on type of ACS in both sexes., (Copyright 2004 S. Karger AG, Basel)

We describe the mortality during the subsequent 5 years after development of acute myocardial infarction prior to and after the introduction of a more widespread use of thrombolytic agents and aspirin in the community of Göteborg. During period I, 4% received thrombolysis as compared with 32% during period II (p < 0.0001). The corresponding figures for prescription of aspirin at discharge were 14 and 84%, respectively (p < 0.0001). The overall 5-year mortality was 48% during period I and 46% during period II (p = 0.09). However, the age-adjusted mortality during period II was significantly reduced (risk ratio 0.86; 95% confidence interval 0.78-0.95; p = 0. 004). There was no significant interaction between improvement in survival and sex or any other parameter reflecting patients' clinical history.

Patients in western Sweden who underwent CABG from 1988 to 1991 received prior to coronary angiography and 2 and 5 years after CABG a questionnaire, in which they were asked about symptoms of chest pain and dyspnea. In all, 1,226 patients answered the inquiry prior to CABG, 1,531 patients 2 years and 1,359 patients 5 years after surgery. Both in terms of chest pain and dyspnea there was a marked improvement 2 and 5 years after CABG as compared with prior to surgery. However, between 2 and 5 years after surgery there was a minor deterioration, both regarding chest pain and dyspnea. The most statistically significant preoperative predictors for the occurrence of chest pain more than twice a week 5 years after surgery were concomitant valvular heart disease and obesity.

Results: In 1,841 patients who underwent coronary artery bypass grafting (CABG) we evaluated risk indicators for death and other cardiac events during 2 years of follow-up. Independent predictors of death were: a history of congestive heart failure, diabetes mellitus and renal dysfunction prior to CABG. Independent predictors of death, acute myocardial infarction (AMI), CABG or percutaneous transluminal coronary angioplasty (PTCA) were: a small body surface area, a history of congestive heart failure, diabetes mellitus and smoking prior to CABG. Independent predictors of death, AMI, CABG, PTCA or rehospitalization for a cardiac reason were: angina functional class, previous AMI, a history of congestive heart failure and renal dysfunction prior to CABG., Conclusion: When using various definitions of a cardiac event after CABG, various risk indicators for death or such an event can be found. Our data suggest that anamnestic information prior to CABG indicating a depressed myocardial function or severe myocardial ischemia are more important predictors of outcome than the information gained from cardioangiography.

Unlabelled: During 1 year of follow-up, we compared the mortality after acute myocardial infarction (AMI) prior to and after the introduction of a more widespread use of thrombolytic agents and aspirin., Study Period: Two periods (I = 1986-1987 and II = 1989-1990) were compared., Patients: All patients admitted to the coronary care units at the two city hospitals in the community of Goteborg who fulfilled the criteria for development of AMI participated in the evaluation., Results: The overall 1-year mortality rate was 27% [corrected] during period I and 23% during period II (NS). However, among patients up to 70 years of age, the mortality was reduced from 15 to 11% (p < 0.05), whereas among patients aged over 70 years the mortality remained almost unchanged (34 vs. 35%; NS)., Conclusion: The introduction of a more widespread use of thrombolytic agents and aspirin has not substantially changed the overall mortality in AMI. However, among younger patients, the mortality appears to have been reduced but not among the elderly.

Aim: To determine the diagnostic accuracy of physicians for identifying patients with acute myocardial infarction (AMI) without an electrocardiogram (ECG)., Patients: All patients in Göteborg with suspected AMI below 75 years of age who called for an ambulance or came directly to one of the two city hospitals with a delay time of less than 2 h 45 min from the start of symptoms., Methods: As part of the TEAHAT study (comparing rt-PA and placebo in AMI), we asked physicians to judge on a 1-5 scale (1 = no suspicion; 5 = convinced) how strong their suspicion of AMI was prior to interpreting the ECG., Results: Among patients evaluated outside hospital with 4 or 5 on the scale, i.e. either a strong suspicion of AMI or the physician felt convinced about the diagnosis, 45% had ST elevation and 48% developed AMI during the first 3 days in hospital. The corresponding values for patients evaluated in hospital were 67 and 70%, respectively., Conclusion: We found that physicians could not accurately distinguish patients with AMI from those without based on clinical criteria without the help of an ECG.

In 292 patients with suspected acute myocardial infarction given thrombolytic agents, we describe the delay time between the onset of pain and the start of thrombolysis and relate the observations to the prognosis. In 3%, treatment was started 1 h or less and in 22% 2 h or less after onset of symptoms. The median delay time between onset of symptoms and arrival in hospital was 1 h 38 min, and the median delay time between the arrival in hospital and start of thrombolysis was 1 h 25 min. A very strong association between delay time to thrombolysis and mortality during 2 weeks and 1 year of follow-up was observed.