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Bráð kransæðastífla á Íslandi 1982-1983 : horfur og áhrifaþættir fyrir daga seglaleysandi meðferðar

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Authors
Uggi Agnarsson
Nikulás Sigfússon
Inga Ingibjörg Guðmundsdóttir
Ingibjörg Stefánsdóttir
Issue Date
1996-04-01

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Other Titles
Acute myocardial infarction in Iceland 1982-1983. Prognosis and risk factors in the pre-thrombolytic era
Citation
Læknablaðið 1996, 82(4):276-85
Abstract
This nationwide study describes the short- and longterm outcome of acute myocardial infarction in Iceland 1982-83 prior to the routine use of aspirin and thrombolytic therapy. The material consists of 486 cases of acute myocardial infarction, 390 men and 96 women aged 25-64 years. Death prior to hospitalization occured in 124 cases but hospital treatment was given to 287 men and 75 women. Evidence of a previous myocardial infarction was found in 22%. An anterior myocardial infarction was present in 29% and an inferior myocardial infarction was present in 31%. The 28 day mortality was 12.4% but the long-term mortality over a mean of 7.1 year was 35.9%. The principal determinants of the risk of death in both sexes were ST-segmentelevation on admission ECG with a relative risk of 1.78, the use of digitalis and diuretics prior to the onset of an acute myocardial infarction with a relative risk of 1.89 and 1.72. Those treated with inotrophics in hospital had a relative risk of 2.81 but patients treated with anticoagulants in hospital had an improved prognosis with a relative risk of 0.45 but nitrates and b-blockers did not affect the outcome.
Rannsókn þessi nær til allra skráðra tilfella af kransæðastíflu á Íslandi fyrir árin 1982-1983. Á þeim tíma var meðferð með segaleysandi lyfjum og acetýlsalícýlsýru ekki hafin hér á landi. Alls voru skráðir 486 sjúklingar með bráða kransæðastíflu, 390 karlar og 96 konur á aldrinum 25-64 ára. Þá létust 124 sjúklingar áður en tókst að flytja þá á sjúkrahús en 287 karlar og 75 konur voru lagðar inn á sjúkrahús. Vísbendingar um fyrri kransæðastíflu voru taldar vera fyrir hendi í 22% tilfella. Áverki á framvegg hjartans var talinn vera til staðar hjá 29% sjúklinga, en áverki á undirvegg hjá 31% sjúklinga. Dánartíðni inniliggjandi sjúklinga var 12,4% innan 28 daga frá byrjun einkenna en dánartíðni yfir lengra tímabil (að meðaltali 7,1 ár) var 35,9%. Helstu áhrifaþættir á horfur voru metnir. Meðferð með þvagræsilyfjum og digitalis við upphaf einkenna og ST-bil hækkun á hjartariti við komu sýndu allir fylgni við aukna áhættu með hlutfallsstuðlum 1,72, 1,89 og 1,78 fyrir hvern þátt um sig. Þá var fylgni við notkun hjartastyrkjandi lyfja á sjúkrahúsi með áhættustuðli 2,81 en hins vegar reiknaðist áhættustuðull 0,45 hjá þeim sem fengu blóðþynnandi meðferð á sjúkrahúsi. Notkun B-blokka og nítrata virtust ekki hafa áhrif á horfur.
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