Mai Blöndal

Sex-specific outcomes of diabetic patients with acute myocardial infarction who have undergone percutaneous coronary intervention: a register linkage study

BackgroundThe presence of diabetes mellitus poses a challenge in the treatment of patients with acute myocardial infarction (AMI). We aimed to evaluate the sex-specific outcomes of diabetic and non-diabetic patients with AMI who have undergone percutaneous coronary intervention (PCI).MethodsData of the Estonian Myocardial Infarction Registry for years 2006–2009 were linked with the Health Insurance Fund database and the Population Registry. Hazard ratios (HRs) with the 95% confidence intervals (CIs) for the primary composite outcome (non-fatal AMI, revascularization, or death whichever occurred first) and for the secondary outcome (all cause mortality) were calculated comparing diabetic with non-diabetic patients by sex.ResultsIn the final study population (n = 1652), 14.6% of the men and 24.0% of the women had diabetes. Overall, the diabetics had higher rates of cardiovascular risk factors, co-morbidities, and 3–4 vessel disease among both men and women (p < 0.01). Among women, the diabetic patients were younger, they presented later and less often with typical symptoms of chest pain than the non-diabetics (p < 0.01). Women with diabetes received aspirin and reperfusion for ST-segment elevation AMI less often than those without diabetes (p < 0.01). During a follow-up of over two years, in multivariate analysis, diabetes was associated with worse outcomes only in women: the adjusted HR for the primary outcome 1.44 (95% CI 1.05 − 1.96) and for the secondary outcome 1.83 (95% CI 1.17 − 2.89). These results were largely driven by a high (12.0%) mortality during hospitalization of diabetic women.ConclusionsDiabetic women with AMI who have undergone PCI are a high-risk group warranting special attention in treatment strategies, especially during hospitalization. There is a need to improve the expertise to detect AMI earlier, decrease disparities in management, and find targeted PCI strategies with adjunctive antithrombotic regimes in women with diabetes.

Effects of a long-term military mission on arterial stiffness, inflammation markers, and vitamin D level

vitamin D level Erik Salum ⁎, Mihkel Zilmer , Priit Kampus , Jaak Kals , Eve Unt , Martin Serg , Maksim Zagura , Mai Blöndal , Kersti Zilmer , Jaan Eha a,b a Department of Cardiology, University of Tartu, 8 Puusepa Street, Tartu 51014, Estonia b Endothelial Centre, University of Tartu, 8 Puusepa Street, Tartu 51014, Estonia c Department of Biochemistry, Centre of Excellence for Translational Medicine, University of Tartu, 19 Ravila Street, Tartu 50411, Estonia d Department of Vascular Surgery, Tartu University Hospital, 8 Puusepa Street, Tartu 51014, Estonia e Institute of Exercise Biology and Physiotherapy, University of Tartu, 14a Ravila Street, Tartu 50411, Estonia f Department of Sports Medicine and Rehabilitation, University of Tartu, 5 Jakobi Street, Tartu 50090, Estonia

Changes in treatment and mortality of acute myocardial infarction in Estonian tertiary and secondary care hospitals in 2001 and 2007

BackgroundHigh quality care for acute myocardial infarction (AMI) improves patient outcomes. Still, AMI patients are treated in hospitals with unequal access to percutaneous coronary intervention. The study compares changes in treatment and 30-day and 3-year mortality of AMI patients hospitalized into tertiary and secondary care hospitals in Estonia in 2001 and 2007.ResultsFinal analysis included 423 cases in 2001 (210 from tertiary and 213 from secondary care hospitals) and 687 cases in 2007 (327 from tertiary and 360 from secondary care hospitals). The study sample in 2007 was older and had twice more often diabetes mellitus. The patients in the tertiary care hospitals underwent reperfusion for ST-elevation myocardial infarction, cardiac catheterization and revascularisation up to twice as often in 2007 as in 2001. In the secondary care, patient transfer for further invasive treatment into tertiary care hospitals increased (P < 0.001). Prescription rates of evidence-based medications for in-hospital and for outpatient use were higher in 2007 in both types of hospitals. However, better treatment did not improve significantly the short- and long-term mortality within a hospital type in crude and baseline-adjusted analysis. Still, in 2007 a mortality gap between the two hospital types was observed (P < 0.010).ConclusionsAMI treatment improved in both types of hospitals, while the improvement was more pronounced in tertiary care. Still, better treatment did not result in a significantly lower mortality. Higher age and cardiovascular risk are posing a challenge for AMI treatment.

Müokardiinfarkti diagnoosimise kriteeriumid 2007

Muokardiinfarkt (MI) on uks sagedasemaid surma ja toovoimetuse pohjuseid maailmas ning seega on diagnoosi kriteeriumite tapne maaratlemine ja rahvusvaheline uhtlustamine oluline nii haige kui ka uhiskonna seisukohast. Muokardiinfarkt on epidemioloogiliselt uhe peamise terviseprobleemi indikaator ning laialdaselt kasutusel kliinilistesse uuringutesse kaasamise kriteeriumi ja tulemusnaitajana. Uhtne arusaam diagnoosist voimaldab teadusuuringuid paremini omavahel vorrelda ja teha erinevate uuringute tulemuste analuuse. Eesti Arst 2008; 87(6):411−416