In patients with acute myocardial infarction(MI), mortality can be predicted by risk scoring systems, but the impact of therapy recommended by guidelines is poorly documented. The aim of this study was to determine, t...In patients with acute myocardial infarction(MI), mortality can be predicted by risk scoring systems, but the impact of therapy recommended by guidelines is poorly documented. The aim of this study was to determine, taking into account the patient’ s condition at admission, to what extent the degree of guideline compliance influences the 1- year survival of patients admitted for acute MI.Methods and results: A 6- month registry was carried out in a geographically limited area, prospectively including all patients with acute MI. A risk score based on initial presentation, and a compliance index based on patient characteristics, type of MI, in-hospital management(including revascularization strategies and use of recommended drugs)were established. Patients were clinically followed at 1 year. A total of 754 patients, 333 ST elevation MI and 421 non-ST elevation MI, were included. The median compliance index(percentage of optimal compliance with guidelines) was 0.66(95% CI 0.5;8.3). One-year mortality rate was 11.5% . By logistic regression, three variables were independently related to mortality: type of MI[OR=2.6(1.5;4.3)], risk score[OR=2.4(1.9;3.1) per additional 10% ], and compliance index[OR=0.8(0.7;0.9) per additional 10% ]. Conclusion: A clear relationship between the extent of guideline implementation,and 1-year mortality was shown and this relationship remained strong after stratification on the risk score at admission and the type of MI. These data emphasize the need for thorough implementation of guidelines to improve the outcome of patients suffering from acute MI.展开更多
Background:No previous correlation between phenotype at diagnosis of Crohn’ disease(CD)and mortality has been performed.We assessed the predictive value of phenotype at diagnosis on overall and disease related mortal...Background:No previous correlation between phenotype at diagnosis of Crohn’ disease(CD)and mortality has been performed.We assessed the predictive value of phenotype at diagnosis on overall and disease related mortality in a European cohort of CD patients.Methods:Overall and disease related mortality were recorded 10 years after diagnosis in a prospectively assembled,uniformly diagnosed European population based inception cohort of 380 CD patients diagnosed between 1991 and 1993.Standardised mortality ratios(SMRs)were calculated for geographic and phenotypic subgroups at diagnosis.Results:Thirty seven deaths were observed in the entire cohort whereas 21.5 deaths were expected(SMR 1.85(95%Cl 1.30-2.55)).Mortality risk was significantly increased in both females(SMR 1.93(95%Cl 1.10-3.14))and males(SMR 1.79(95%Cl 1.11-2.73)).Patients from northern European centres had a significant overall increased mortality risk(SMR 2.04(95%Cl 1.32-3.01))whereas a tendency towards increased overall mortality risk was also observed in the south(SMR 1.55(95%Cl 0.80-2.70)).Mortality risk was increased in patients with colonic disease location and with inflammatory disease behaviour at diagnosis.Mortality risk was also increased in the age group above 40 years at diagnosis for both total and CD related causes.Excess mortality was mainly due to gastrointestinal causes that were related to CD.Conclusions:This European multinational population based study revealed an increased overall mortality risk in CD patients 10 years after diagnosis,and age above 40 years at diagnosis was found to be the sole factor associated with increased mortality risk.展开更多
To compare the long-term prognostic value of troponins (Tn) vs. conventional cardiac biomarker creatine kinase (CK) and CK-MB across the spectrum of acute coronary syndromes(ACS). In the prospective, observational Can...To compare the long-term prognostic value of troponins (Tn) vs. conventional cardiac biomarker creatine kinase (CK) and CK-MB across the spectrum of acute coronary syndromes(ACS). In the prospective, observational Canadian ACS Registry, 4627 patients with ACS were enrolled from 51 centres. The CK, CK-MB, Tn samples were analysed in each hospital clinical laboratory and the results related to the reference levels of the individual laboratories. The study cohort comprised 3138 (67.8%) patients who had both CK (or CK-MB) and Tn measurements during the first 24 h of hospitalisation. Vital status at one-year was determined by standardized telephone interview. 61.2%and 59.0%of patients had abnormal Tn and CK(or CK-MB) levels, respectively. Vital status at one-year was ascertained for 2950 patients(6%lost to follow-up). Among patients with normal CK (or CK-MB) levels, elevated Tn was associated with increased one-year mortality (odds ratio[OR]-2.06; 95%CI 1.37-3.11; P=0.001). Similarly, among patients with abnormal CK (or CK-MB) levels, abnormal Tn predicted higher one-year mortality(OR 1.83; 95%CI 1.14-2.93; P=0.01). In contrast, abnormal CK(or CK-MB) was not predictive of mortality after stratification by Tn status. In multivariable analysis controlling for other known prognosticators including creatinine, abnormal Tn (adjusted OR 1.78; 95%CI 1.30-2.44; P< 0.001) but not CK/CK-MB was independently associated with increased one-year mortality. Elevated Tn was independently associated with worse outcome at one-year, while CK or CK-MB status did not provide incremental prognostic information. Our findings support the use of Tn in the risk stratification of unselected ACS patients.展开更多
文摘In patients with acute myocardial infarction(MI), mortality can be predicted by risk scoring systems, but the impact of therapy recommended by guidelines is poorly documented. The aim of this study was to determine, taking into account the patient’ s condition at admission, to what extent the degree of guideline compliance influences the 1- year survival of patients admitted for acute MI.Methods and results: A 6- month registry was carried out in a geographically limited area, prospectively including all patients with acute MI. A risk score based on initial presentation, and a compliance index based on patient characteristics, type of MI, in-hospital management(including revascularization strategies and use of recommended drugs)were established. Patients were clinically followed at 1 year. A total of 754 patients, 333 ST elevation MI and 421 non-ST elevation MI, were included. The median compliance index(percentage of optimal compliance with guidelines) was 0.66(95% CI 0.5;8.3). One-year mortality rate was 11.5% . By logistic regression, three variables were independently related to mortality: type of MI[OR=2.6(1.5;4.3)], risk score[OR=2.4(1.9;3.1) per additional 10% ], and compliance index[OR=0.8(0.7;0.9) per additional 10% ]. Conclusion: A clear relationship between the extent of guideline implementation,and 1-year mortality was shown and this relationship remained strong after stratification on the risk score at admission and the type of MI. These data emphasize the need for thorough implementation of guidelines to improve the outcome of patients suffering from acute MI.
文摘Background:No previous correlation between phenotype at diagnosis of Crohn’ disease(CD)and mortality has been performed.We assessed the predictive value of phenotype at diagnosis on overall and disease related mortality in a European cohort of CD patients.Methods:Overall and disease related mortality were recorded 10 years after diagnosis in a prospectively assembled,uniformly diagnosed European population based inception cohort of 380 CD patients diagnosed between 1991 and 1993.Standardised mortality ratios(SMRs)were calculated for geographic and phenotypic subgroups at diagnosis.Results:Thirty seven deaths were observed in the entire cohort whereas 21.5 deaths were expected(SMR 1.85(95%Cl 1.30-2.55)).Mortality risk was significantly increased in both females(SMR 1.93(95%Cl 1.10-3.14))and males(SMR 1.79(95%Cl 1.11-2.73)).Patients from northern European centres had a significant overall increased mortality risk(SMR 2.04(95%Cl 1.32-3.01))whereas a tendency towards increased overall mortality risk was also observed in the south(SMR 1.55(95%Cl 0.80-2.70)).Mortality risk was increased in patients with colonic disease location and with inflammatory disease behaviour at diagnosis.Mortality risk was also increased in the age group above 40 years at diagnosis for both total and CD related causes.Excess mortality was mainly due to gastrointestinal causes that were related to CD.Conclusions:This European multinational population based study revealed an increased overall mortality risk in CD patients 10 years after diagnosis,and age above 40 years at diagnosis was found to be the sole factor associated with increased mortality risk.
文摘To compare the long-term prognostic value of troponins (Tn) vs. conventional cardiac biomarker creatine kinase (CK) and CK-MB across the spectrum of acute coronary syndromes(ACS). In the prospective, observational Canadian ACS Registry, 4627 patients with ACS were enrolled from 51 centres. The CK, CK-MB, Tn samples were analysed in each hospital clinical laboratory and the results related to the reference levels of the individual laboratories. The study cohort comprised 3138 (67.8%) patients who had both CK (or CK-MB) and Tn measurements during the first 24 h of hospitalisation. Vital status at one-year was determined by standardized telephone interview. 61.2%and 59.0%of patients had abnormal Tn and CK(or CK-MB) levels, respectively. Vital status at one-year was ascertained for 2950 patients(6%lost to follow-up). Among patients with normal CK (or CK-MB) levels, elevated Tn was associated with increased one-year mortality (odds ratio[OR]-2.06; 95%CI 1.37-3.11; P=0.001). Similarly, among patients with abnormal CK (or CK-MB) levels, abnormal Tn predicted higher one-year mortality(OR 1.83; 95%CI 1.14-2.93; P=0.01). In contrast, abnormal CK(or CK-MB) was not predictive of mortality after stratification by Tn status. In multivariable analysis controlling for other known prognosticators including creatinine, abnormal Tn (adjusted OR 1.78; 95%CI 1.30-2.44; P< 0.001) but not CK/CK-MB was independently associated with increased one-year mortality. Elevated Tn was independently associated with worse outcome at one-year, while CK or CK-MB status did not provide incremental prognostic information. Our findings support the use of Tn in the risk stratification of unselected ACS patients.
