Jussi Sipilä

Clinical Profile and Influences on Outcomes in Patients Hospitalized for Acute Pericarditis

Background— The clinical profile with regard to sex and the influences on outcomes in patients who have been hospitalized for acute pericarditis is largely uncharacterized. Methods and Results— We studied all patients aged ≥16 years admitted to the hospital because of acute pericarditis (postpericardiotomy and myocardial infarction associated pericarditis were excluded). Data were collected from a Finnish national registry that included data on all cardiovascular admissions (670 409) during 9.5 years in 29 hospitals nationwide. During the study period, there were 1361 admissions for acute pericarditis. Pericarditis patients were more likely to be male (64.9% of patients) than female (35.1%), with an age-adjusted likelihood ratio of 1.85 (95% confidence interval [CI], 1.65–2.06; P<0.0001) for male sex. The standardized incidence rate of hospitalizations for acute pericarditis was 3.32 per 100 000 person-years. Men 16 to 65 years of age were at higher risk for pericarditis (relative risk, 2.02; 95% CI, 1.81–2.26; P<0.0001) than women in the general admitted population, with the highest risk difference among young adults. Acute pericarditis caused 0.20% (95% CI, 0.19%–0.22%) of all cardiovascular admissions. The proportion of pericarditis-caused admissions declined by an estimated 51% per 10-year increase in age. The in-hospital mortality rate for acute pericarditis was 1.1% (95% CI, 0.6%–1.8%). Mortality increased with age (hazard ratio, 3.26; 95% CI, 1.78–5.95 per 10-year increase in age; P=0.0001) and severe coinfection (pneumonia or septicemia; hazard ratio, 13.46; 95% CI, 2.26–80.01; P<0.005) but was not associated with sex in multivariate analysis. Conclusions— Patients hospitalized for acute pericarditis are more commonly male. Increasing age and severe coinfection are associated with greater in-hospital mortality in hospitalized acute pericarditis patients.

Gender and In-hospital Mortality of ST-Segment Elevation Myocardial Infarction (from a Multihospital Nationwide Registry Study of 31,689 Patients)

Previous studies have suggested that women may be at higher risk of death after ST-segment elevation myocardial infarction (STEMI). We studied potential associations of gender and age with in-hospital mortality using a registry of 31,689 consecutive patients with STEMI aged ≥30 years (66.3% men, mean age 67.8 years) treated in 22 hospitals. Total in-hospital mortality rate of STEMI was 11.2%. Women had higher unadjusted mortality rate compared with men (17.5% vs 8.0%; hazard ratio 1.65; 95% confidence interval [CI] 1.54 to 1.76, p <0.0001). However, when adjusted for age and co-morbidities, there was no difference in mortality between genders overall (hazard ratio 1.04; 95% CI 0.97 to 1.12, p = 0.2303) or at any age group. Mortality rate was highly dependent of age with an estimated increase of 86% (95% CI 80% to 92%) per 10-year increase in age (p <0.0001). Chronic coronary, peripheral, or cerebral artery disease, diabetes, renal insufficiency, malignancy, and severe infection were independent predictors of mortality in multivariate analysis. Atrial fibrillation was associated with survival in multivariate model. Anterior location of STEMI was not independently associated with in-hospital mortality. In conclusion, although women have higher total in-hospital mortality rate than men after STEMI, this difference does not appear to be caused by gender itself but to be due to of differences in age and co-morbidities.

The effects of gender and age on occurrence of clinically suspected myocarditis in adulthood

Objective To study the effects of gender and age on occurrence of myocarditis. Design Nationwide, multicentre registry study in Finland. Setting All medical hospital admissions (n=1 698 397) of patients aged ≥16 years during 9.5 years in 29 hospitals. Patients 3198 myocarditis patients. Results Myocarditis was more common in men (76.61%; 95% CI 75.11% to 78.05%) than in women (23.39%; 95% CI 21.95% to 24.89%, p<0.0001). Median age of patients was 33 years (IQR 23–50 years). Male patients were significantly younger than females (mean age 34.1±SD 15.1 vs 49.0±18.7 years, p<0.0001). In men, occurrence was highest at 16–20 yrs of age, with a linear decline to elderliness (r=−0.95, p<0.0001). By contrast, myocarditis affected women more evenly at all ages with highest occurrence at the age of 56–60 years. Myocarditis caused 0.19% (95% CI 0.18% to 0.19%) of all medical admissions, and 0.48% (95% CI 0.46% to 0.49%) of admissions due to cardiovascular reasons with an inverse logarithmic association with age (r=−0.97, p<0.0001). Admissions were more commonly caused by myocarditis in men (risk ratio 3.11; 95% CI 2.87 to 3.38, p<0.0001). Conclusions Men are significantly more susceptible to myocarditis than women. Young men are especially at risk for acquiring myocarditis, while women are affected most commonly at the postmenopausal age. The proportion of hospital admissions caused by myocarditis has an inverse, logarithmic association with age.

Presenting symptoms of glioma in adults

Studies on the presenting symptoms of glioma in adults in the age of readily available MRI imaging are scarce. This study investigates presenting symptoms of glioma and assesses the correlations of the presenting symptoms with patient age and histopathological class of the tumor.

Seasonality of stroke in Finland

Abstract Introduction: The burden of stroke is increasing globally. Reports on seasonal variations in stroke occurrence are conflicting and long-term data are absent. Methods: A retrospective cohort study using discharge registry data of all acute stroke admissions in Finland during 2004–2014 for patients ≥18 years age. A total of 97,018 admissions for ischemic stroke (IS) were included, 18,252 admissions for intracerebral hemorrhage (ICH) and 11,271 admissions for subarachnoid hemorrhage (SAH). Results: The rate of IS admissions increased (p = 0.025) while SAH admission rate decreased (p < 0.0001), and ICH admission rate remained stable during the study period. The lowest seasonal admission rates were detected in summer and the highest in autumn for all stroke subtypes. Seasonal variation of IS was more pronounced in men (p = 0.020), while no sex difference was detected in ICH or SAH. The seasonal patterns of in-hospital mortality and length of stay (LOS) differed markedly by stroke subtype. Diagnoses of hypertension, atrial fibrillation, or diabetes showed no seasonality. Conclusions: All major stroke subtypes occurred most commonly in autumn and most infrequently in summer. Seasonality of in-hospital mortality and length of hospital stay appears to vary by stroke subtype. The seasonal pattern of ischemic stroke occurrence appears to have changed during the past decades. Key messages All major stroke subtypes (ischemic stroke, intracerebral hemorrhage, subarachnoid hemorrhage) occurred most frequently in autumn and least frequently in summer. Seasonal patterns of in-hospital mortality and length of stay differed markedly by stroke subtype. The seasonal pattern of ischemic stroke occurrence in Finland seems to have changed compared to 1982–1992.

Association of age and gender with risk for non-ST-elevation myocardial infarction.

Background Age and gender associated risks for non-ST-elevation myocardial infarction (NSTEMI) at the population level are largely uncharacterized. Design Nationwide, population (26,724,165 person-years) based eight-year registry-study in Finland. Methods Gender- and age-associated frequency and incidence of NSTEMI were studied using a nationwide, population based registry of hospital admissions in patients aged ≥30 years during 2001–2008. Patients with NSTEMI as primary (88%), secondary (10%) or tertiary (2%) discharge diagnosis were included. Data was collected nationwide from all 22 hospitals with a coronary angiolaboratory. Results The study period included 48,584 NSTEMI admissions of which 55.3% (95% confidence interval (CI) 54.6–56.0%) were of men and 44.7% (CI 44.1–45.3%) were of women, with age-adjusted relative risk of 1.86 (CI 1.60–2.16, p < 0.0001) for male gender. Female patients were significantly older than males (77.8 SD 10.2 vs. 70.2 SD 11.9 years, p < 0.0001). Standardized incidence rate of NSTEMI was 20.6 (CI 20.4–20.8)/10,000 person-years overall, 28.7 (CI 28.3–29.0)/10,000 in men and 15.0 (CI 14.7–15.2)/10,000 in women. Men had a 2.36-fold (CI 2.23–2.49; p < 0.0001) age-adjusted relative risk for NSTEMI compared with women, with highest risk difference in population under 40 years of age (relative risk 4.48; CI 3.10–6.48, p < 0.0001). Incidence increased with age by an estimated gender-adjusted increase rate of 61% (CI 59–62%; p < 0.0001) per five-year increase in age. Conclusions Men have a 2.4-fold overall risk for NSTEMI compared with women, with highest relative risk in young adults. Incidence rate of non-ST-elevation myocardial infarction increases by an estimated 61% per five-year increase in age.

Gender, age and risk of ST segment elevation myocardial infarction

Exact associations of gender and age with occurrence of ST segment elevation myocardial infarction are inadequately known.

Somatostatin receptor 2A in gliomas: Association with oligodendrogliomas and favourable outcome

Somatostatin receptor subtype 2A (SSTR2A) is a potential therapeutic target in gliomas. Data on SSTR2A expression in different glioma entities, however, is particularly conflicting. Our objective was to characterize SSTR2A status and explore its impact on survival in gliomas classified according to the specific molecular signatures of the updated WHO classification. In total, 184 glioma samples were retrospectively analyzed for SSTR2A expression using immunohistochemistry with monoclonal antibody UMB-1. Double staining with CD68 was used to exclude microglia and macrophages from analyses. SSTR2A staining intensity and its localization in tumor cells was evaluated and correlated with glioma entities and survival. Diagnoses included 101 glioblastomas (93 isocitrate dehydrogenase (IDH) -wildtype, 3 IDH-mutant, 5 not otherwise specified (NOS)), 60 astrocytomas (22 IDH-wildtype, 37 IDH-mutant, 1 NOS), and 23 oligodendrogliomas (19 IDH-mutant and 1p/19q-codeleted, 4 NOS). SSTR2A expression significantly associated with oligodendrogliomas (79% SSTR2A positive) compared to IDH-mutant or IDH-wildtype astrocytomas (27% and 23% SSTR2A positive, respectively), and especially glioblastomas of which only 13% were SSTR2A positive (p < 0.001, Fishers exact test). The staining pattern in glioblastomas was patchy whereas more homogeneous membranous and cytoplasmic staining was detected in oligodendrogliomas. Positive SSTR2A was related to longer overall survival in grade II and III gliomas (HR 2.7, CI 1.2–5.8, p = 0.013). In conclusion, SSTR2A expression is infrequent in astrocytomas and negative in the majority of glioblastomas where it is of no prognostic significance. In contrast, oligodendrogliomas show intense membranous and cytoplasmic SSTR2A expression, which carries potential diagnostic, prognostic, and therapeutic value.

Association of daylight saving time transitions with incidence and in-hospital mortality of myocardial infarction in Finland.

ABSTRACT Introduction Circadian rhythm disturbance increases cardiovascular risk but the effects of daylight saving time (DST) transitions on the risk of myocardial infarction (MI) are unclear. Methods We studied association of DST transitions in 2001–2009 with incidence and in-hospital mortality of MI admissions nationwide in Finland. Incidence rations (IR) of observed incidences on seven days following DST transition were compared to expected incidences. Results Incidence of MI increased on Wednesday (IR 1.16; CI 1.01–1.34) after spring transition (6298 patients’ cohort). After autumn transition (8161 patients’ cohort), MI incidence decreased on Monday (IR 0.85; CI 0.74–0.97) but increased on Thursday (IR 1.15; CI 1.02–1.30). The overall incidence of MI during the week after each DST transition did not differ from control weeks. Patient age or gender, type of MI or in-hospital mortality were not associated with transitions. Renal insufficiency was more common among MI patients after spring transition (OR 1.81; CI 1.06–3.09; p < 0.05). Diabetes was less common after spring transition (OR 0.71; CI 0.55–0.91; p = 0.007), but more common after autumn transition (OR 1.21; 1.00–1.46; p < 0.05). Conclusions DST transitions are followed by changes in the temporal pattern but not the overall rate of MI incidence. Comorbidities may modulate the effects DST transitions. KEY MESSAGES Both spring and autumn daylight saving time transitions changed the temporal occurrence pattern but not the overall incidence of myocardial infarction occurrence on the week following the clock shift. The age or gender distribution of patients, ratio of different types of myocardial infarctions or in-hospital mortality were not affected by clock shifts. The effect of daylight saving time transitions on MI incidence may be modified by the presence of diabetes.

Likelihood and Predictors of ST-Elevation in Patients Hospitalized for Myocardial Infarction

Importance Emergency treatment options in myocardial infarction are guided by presence or absence of ST-elevations in electrocardiography. Occurrence and factors associated with ST-presentation in different population groups are however inadequately known. Objective To determine likelihood and patient features associated with ST-elevations in myocardial infarction. Design Nationwide registry study including 22 hospitals with angiolaboratory during an eight year period in Finland. Setting Hospitalized care. Participants 68,162 consecutive patients aged ≥30 with myocardial infarction. Measures Likelihood and patient features associated with presence of ST-elevations. Results Myocardial infarction presented with ST-elevation in 37.5% (CI 37.0–37.9%) and without in 62.5% (CI 61.9–63.1%) of patients, p<0.0001. Majority of patients aged 30–59 years with myocardial infarction had ST-elevation, but among octogenarians ST-elevations were present in only 24.7%. Presence of ST-elevations decreased with age by estimated 15.6% (CI 15.0–16.2%) per 10 year increase (p<0.0001). Men aged 40–79 years had significantly higher rate for ST-elevation myocardial infarction compared to women. Sex-based difference in presentation of myocardial infarction declined with increasing age. Overall, men had a 13% (CI 11–15%, p<0.0001) higher relative risk for ST-elevations compared to women when adjusted for age and co-morbidities. Diabetes, atrial fibrillation, peripheral or cerebral artery disease, chronic pulmonary disease, malignancy, and renal insufficiency were associated with absence of ST-elevations in myocardial infarction in multivariate analysis. Conclusions and Relevance Myocardial infarction presents with ST-elevations more commonly in men. Presence of ST-elevations decreases with increasing age. Diabetes, atrial fibrillation, peripheral or cerebral artery disease, chronic pulmonary disease, malignancy, and renal insufficiency are associated with absence of ST-elevations in myocardial infarction. These findings may help to predict likelihood of ST-elevations in a patient with myocardial infarction.