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dc.contributor.authorGudnadottir, Gudny Stella
dc.contributor.authorJames, Stefan Karl
dc.contributor.authorAndersen, Karl
dc.contributor.authorLagerqvist, Bo
dc.contributor.authorThrainsdottir, Inga Sigurros
dc.contributor.authorRavn-Fischer, Annica
dc.contributor.authorVarenhorst, Christoph
dc.contributor.authorGudnason, Thorarinn
dc.date.accessioned2019-06-05T15:03:14Z
dc.date.available2019-06-05T15:03:14Z
dc.date.issued2019-05
dc.date.submitted2019-06
dc.identifier.citationOutcomes after STEMI in old multimorbid patients with complex health needs and the effect of invasive management. 2019, 211:11-21 Am Heart Jen_US
dc.identifier.issn1097-6744
dc.identifier.pmid30831330
dc.identifier.doi10.1016/j.ahj.2019.01.008
dc.identifier.urihttp://hdl.handle.net/2336/620932
dc.descriptionTo access publisher's full text version of this article click on the hyperlink belowen_US
dc.description.abstractThe aim of this study was to assess one-year outcomes of invasive and non-invasive strategies in ST-elevation myocardial infarction (STEMI) among multimorbid older people with complex health needs. We included patients, registered between 2006 and 2013 in the SWEDEHEART registry, who were 70 years old or older with STEMI, had multimorbidity and complex health needs and were discharged alive. The one-year outcomes of patients who underwent invasive strategy (examined with coronary angiography ≤14 days) were compared to those who did not. The primary event was a composite of all-cause death, admission due to new acute coronary syndrome, stroke or transient ischemic attack. We identified patients, and 1089 were managed invasively and 570 non-invasively. The mean age was 79 years and 83 years in the 2 groups, respectively. After multivariable adjustment for baseline differences between the groups, including propensity scores, the primary event occurred in 31% of patients in the invasive group and 55% in the non-invasive group, adjusted hazard ratio (95% confidence intervals): 0.67 (0.54-0.83). One-year mortality was 18% in the invasive group and 45% in the non-invasive group, adjusted hazard ratio 0.51 (0.39-0.65). Multimorbid older people with complex health needs and STEMI had high rates of new ischemic events and death. In this cohort of older, high risk STEMI patients, an invasive strategy was associated with lower event rates. Randomized studies are needed to clarify whether these high risk patients who might benefit from invasive care are being managed too conservatively.en_US
dc.language.isoenen_US
dc.publisherMosby-Elsevieren_US
dc.relation.urlhttps://www.sciencedirect.com/science/article/pii/S0002870319300195en_US
dc.subjectHjartadrepen_US
dc.subjectAldraðiren_US
dc.subjectLífslíkuren_US
dc.subjectKransæðasjúkdómar
dc.subject.meshST Elevation Myocardial Infarctionen_US
dc.subject.meshMyocardial Infarctionen_US
dc.subject.meshAged, 80 and overen_US
dc.subject.meshAgeden_US
dc.subject.meshSurvivalen_US
dc.titleOutcomes after STEMI in old multimorbid patients with complex health needs and the effect of invasive management.en_US
dc.typeArticleen_US
dc.contributor.department1 Department of Geriatrics, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Cardiology and Cardiovascular Research Centre, Landspitali University Hospital, Reykjavik, Iceland; School of Health Sciences, University of Iceland, Reykjavik, Iceland. Electronic address: gudnystella@gmail.com. 2 Uppsala Clinical Research Centre (UCR); Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden. 3 Department of Cardiology and Cardiovascular Research Centre, Landspitali University Hospital, Reykjavik, Iceland; School of Health Sciences, University of Iceland, Reykjavik, Iceland. 4 Department of Cardiology and Cardiovascular Research Centre, Landspitali University Hospital, Reykjavik, Iceland. 5 Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden. 6 Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden; Pfizer AB, Sollentuna, Sweden.en_US
dc.identifier.journalAmerican Heart Journalen_US
dc.rights.accessNational Consortium - Landsaðganguren_US
dc.departmentcodeCAR12
dc.source.journaltitleAmerican heart journal


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