Anders Odén

Using a logistic model to identify women with first-trimester spontaneous abortion suitable for expectant management

Objective To design a method to identify women with first trimester spontaneous abortion suitable for expectant management.

Mortality after mitral regurgitation surgery: importance of clinical and echocardiographic variables

OBJECTIVES The management of patients with mitral regurgitation (MR) constitutes a challenge due to its heterogeneity in terms of etiology and possible treatment strategies. In the present study, we sought to describe the importance of preoperative echocardiographic and clinical variables in relation to outcome 5 years after surgical treatment of MR. METHODS The echocardiographic reports (transthoracic) from 298 patients were analyzed and the anatomic lesions were classified into one of three main groups (functional, organic degenerated with hypermobile valve or organic degenerated without hypermobility). 5-year cumulative survival was compared with the expected survival in an age- and gender-matched normal population. Risk functions were determined with a Poisson regression model. RESULTS Operative mortality was 4.4%, with higher mortality in patients with concomitant coronary artery bypass grafting (CABG) (7.6 vs. 2.2%, P=0.03). Survival after 5 years was 65% in patients with concomitant CABG, compared with the expected 86% (P<0.001), 70 vs. 88% (P<0.001) in patients with preoperative NYHA class III/IV, while survival in patients with NYHA class I/II did not differ from the expected (90 vs. 90%, P=0.56). In patients with a hypermobile valve without CABG, postoperative survival did not differ from the expected (91 vs. 89%, P=0.92). The estimated risk ratio for death, repair versus prosthesis, was 0.57 (95% confidence interval 0.32-1.00, P=0.05). CONCLUSIONS The present study shows that it is possible, using transthoracic echocardiography and clinical data, to identify patients with an excellent outcome. The adverse effects of severe symptomatology and replacement compared with repair are demonstrated. The findings encourage early intervention before severe symptoms occur, especially if repair is possible.

Improvement of ED prediction of cardiac mortality among patients with symptoms suggestive of acute myocardial infarction

A study was undertaken to evaluate the 1-year risk of cardiac death for patients with chest pain/suspected acute myocardial infarction in the emergency department (ED) and express the prognosis in a statistical model. Clinical variables and electrocardiogram were correlated to cardiac death during 1 year. Cox regression model was used to estimate the risk of death as a continuous function of a risk score and the time interval. From these, the prognosis for each patient can be calculated. There were 6,794 visits by 5,303 patients followed for 1 year, during which 604 patients died. The absolute risk of cardiac death can be calculated from the independent predictors for cardiac death: age; sex; histories of diabetes mellitus, hypertension, and congestive heart failure; and symptoms, electrocardiographic pattern, and degree of suspicion of acute myocardial infarction on admission. This model allows estimation of the prognosis for every patient with chest pain/suspected acute myocardial infarction from data easily available in the ED.