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Abstract Background Acquired loss of the largest von Willebrand factor multimers is a common hemostatic disturbance in patients with aortic valve stenosis (AS), resulting in impaired platelet adhesion and increased bleeding risk. AS is also associated with atherosclerosis and myocardial infarction (MI). Our aim was to study the clinical outcomes associated with AS in MI patients treated with dual antiplatelet therapy (DAPT) in a nationwide hospital-based register study. Methods Based on nationwide hospital discharge registers from Sweden (2005–2010) and Denmark (2005–2015), we calculated 1-year incidence rates and hazard ratios of bleeding, recurrent MI, and all-cause mortality in MI patients with and without AS treated with DAPT. Results from both countries were also combined in a meta-analysis. Results We included 50,460 MI patients from Sweden and 50,307 MI patients from Denmark, of which 3% had AS. The bleeding rates (per 100 person-years) in Sweden and Denmark were 3.2 and 3.3 among patients without AS vs. 9.2 and 8.3 among patients with AS. All-cause mortality rates were 7.1 vs. 28.7 in Sweden and 5.8 vs. 30.7 in Denmark among patients without and with AS, respectively. Patients with AS had an increased risk of bleeding, recurrent MI and all-cause mortality. Combined results from both countries were similar for bleeding (hazard ratio 1.59 [0.98–2.59]), recurrent MI (1.78 [1.25–2.54]), and all-cause mortality (1.76 [1.26–2.47]). Conclusion AS was associated with an increased risk of bleeding, recurrent MI and mortality after MI when treated with DAPT. Individualized selection of antiplatelet therapy may be warranted in this high-risk population. Highlights • Bleeding was more common in AS patients treated with DAPT after MI. • Recurrent MI and all-cause mortality were more frequent in AS patients. • Patients with AS represent a group with high risk after incident MI. [ABSTRACT FROM AUTHOR]

Abstract: Aim: To describe differences in treatment and delay times in acute chest pain at the three hospitals in Göteborg, Sweden. Methods: All patients admitted to the three hospitals within Sahlgrenska University (SU) (Sahlgrenska: SU/S, Östra: SU/Ö and Mölndal: SU/M) with acute chest pain during 3months in 2008 were evaluated for diagnosis, early treatment and outcome. Results: In all, 2588 visits by 2393 patients were included (visits n=1253 SU/S; n=853 SU/Ö; n=482 SU/M) of which 50%, 63% and 51% were hospitalised (p<0.0001). Among hospitalised patients, a diagnosis of ACS was reported in 26%, 9% and 22% respectively (p<0.0001). Among ACS patients, 83%, 66% and 57% respectively underwent coronary angiography (p=0.004). The median delay to coronary angiography in ST-elevation myocardial infarction (STEMI) was 42min at SU/S, 3h 47min at SU/Ö and 2h 34min at SU/M (p=0.008). The corresponding values for coronary angiography in unstable coronary artery disease were 42h 7min, 48h 35min and 123h 42min (p=0.007). Overall mortality at 30days was 3.6%, 3.2% and 1.5% (NS) and, at 1year, it was 9.9%, 9.6% and 7.3% respectively (NS). Conclusion: In acute chest pain in the Municipality of Göteborg, there was a marked difference between hospitals in: 1) the percentage of hospitalised patients, 2) the percentage of ACS among hospitalised patients and 3) the delay to and rate of coronary angiography. The clinical consequences of these deviations remain to be proven. [Copyright &y& Elsevier]

Abstract: Background: Recent population-based estimates for long-term cardiovascular disease (CVD) mortality after hospitalization for a first acute myocardial infarction (AMI) are not well established. Methods: Data from the Swedish hospital discharge and death registries were used to record all first-ever hospital admissions in patients (n=348,772) 35–84years with AMI from 1987 to 2006 and subsequent all-cause and CVD case fatality during up to 5years. Results: During the 20-year period, 28-day case fatality was reduced by almost two thirds in patients aged <75years. For cases with a first AMI 1999–2002 long-term case fatality for men surviving the first 28days and <55years was 10.3/1000 person years, with rates of 23.6, 58.0 and 137.0 for men aged 55–64, 65–74 and 75–84years. Corresponding figures for women were 10.5, 24.3, 51.8, 124.1 deaths/1000years. In 1999–2002 estimated long-term risk of fatal CVD (based on survival until 2007) for men below 55years was 6.1/1000years, and 13.8, 34.6, 92.9 for men aged 55–64, 65–74, and 75–84years, respectively. Corresponding figures for women were 4.8, 11.9, 30.1, 86.2/1000years. The total reduction in CVD case fatality was two thirds among patients aged <55 and approximately one third among those aged 75–84. Conclusions: Long-term case fatality after hospitalization for AMI decreased markedly from 1987 to 2006, particularly with respect to CVD mortality and in younger patients. However, because of a steep increase in case fatality with age and a large proportion of older patients, long-term prognosis overall still remains poor. [Copyright &y& Elsevier]