Biomedical subjects

Heli Koukkunen

Publications and source records attributed to Heli Koukkunen.

5 recordsLinked to original sources

PubMed2006

The effect of correcting for troponins on trends in coronary heart disease events in Finland during 1993-2002: the FINAMI study.

AIMS: The object of this study is to analyse the trends in coronary events in Finland during 1993-2002, correcting for the effect of troponins. METHODS AND RESULTS: A population-based myocardial infarction register recorded all coronary events (n=14 782) in four geographical areas of Finland during 1993-2002. Correction coefficients for the effect of troponins were calculated on the basis of 4359 coronary events, with simultaneous determination of troponins and the 'old' enzymatic markers of myocardial injury. Coronary mortality declined steeply, except in women aged > or = 75 years. The incidence of first coronary events declined 2.0% (95% confidence interval -3.0, -0.9%) per year among men and 1.0% (-2.7, 0.6%) per year among women aged 35-74 years. After correcting for the effect of troponins, also the decline among women became statistically significant: 2.7% (-4.5, -0.8%) per year. The effect of troponins tended to be stronger in women and older individuals than in men and younger individuals. The 28-day case fatality declined among men, but not among women. The effect of troponins on case fatality trends was weak. CONCLUSION: Declining trends in the incidence of coronary events in Finland during 1993-2002 were partly hidden by the effect of troponins. Both incidence and case fatality declines have contributed to the decline in mortality.

Adult↗

PubMed2005

A new definition for myocardial infarction: what difference does it make?

AIMS: As a response to changing diagnostic tools of myocardial infarction (MI), new case definitions for acute coronary events were published in 2003 as the American Heart Association Scientific Statement. We assessed the new definition in hospitalized patients in a large population-based MI register study. METHODS AND RESULTS: We identified all suspected acute coronary syndromes with data either on troponin T or on troponin I and at least one of the enzymatic markers of myocardial injury (n=6104). The 2003 definition with the use of troponins identified 83% more definite MIs than the WHO MONICA definition using cardiac enzymes. The additional patients were older, had more often diabetes, and received less often thrombolysis and revascularization than those having MI by both definitions. Adjusting for age, sex, study area, and study year, the additional patients with their first MI aged 25-74 had a higher risk of cardiovascular death within 1 year than patients having definite MI by both definitions (hazard ratio 1.6, 95% CI 1.1-2.2). CONCLUSION: The changing diagnostic criteria present a considerable challenge for the assessment of long-term trends in MI events in the community as well as for longitudinal studies of the natural history of MI. The 2003 definition, when applied using troponins, identified a sizable new group of MI patients, among persons with suspected acute coronary syndrome, at high risk of a recurrent event.

Adult↗

PubMed2005

The validity of the Finnish Hospital Discharge Register and Causes of Death Register data on coronary heart disease.

BACKGROUND AND DESIGN: The recent introduction of sensitive markers of myocardial injury is likely to affect the epidemiology of coronary heart disease (CHD). The American Heart Association together with other societies and research agencies have recently published a new definition on acute CHD to improve consistency in epidemiological and clinical studies (referred here as the '2003 definition'). METHODS: In this study we compare the data on CHD events in the Finnish National Hospital Discharge Register (HDR) and the Causes of Death Register (CDR) with the population-based myocardial infarction (MI) register, FINMONICA/FINAMI. The FINMONICA/FINAMI events were classified according to the 2003 definition. The relevant International Classification of Diseases (ICD) codes from the HDR and CDR were used. RESULTS: Using the 2003 definition as the reference, the overall sensitivity of the ICD codes for MI in the combined HDR and CDR was 83% and the positive predictive value (PPV) was 90%. When the ICD codes for unstable angina were added to the analyses, the sensitivity improved to 85% and the PPV declined to 83%. In the age group 35-74 the sensitivity of the MI codes improved over time, in men from 64% in 1988-1992 to 81% in 1998-2002, and in women from 61 to 78%, respectively. The oldest age group, 75 years or older, had sensitivity and PPV values comparable to those of the younger. CONCLUSION: Diagnoses of fatal and non-fatal CHD events in the Finnish HDR and Causes of Death register were reasonably valid indicators for hard CHD events when compared with the FINMONICA/FINAMI register data.

Adult↗

PubMed2004

Low-risk patients with chest pain and without evidence of myocardial infarction may be safely discharged from emergency department.

AIMS: This study is an audit of the risk stratification of patients admitted to a university hospital emergency department with a suspected acute coronary syndrome (ACS). The main aim of the study was to investigate the prognosis of those patients who were discharged to home from the emergency room (ER) or adjacent chest pain observation unit (CPU). METHODS AND RESULTS: Three thousand one hundred and seven consecutive patients admitted to the ER with a suspected ACS were retrospectively identified. Seven hundred and sixty-four (25%) patients were discharged from the ER and 417 (13%) from the CPU after observation and ruling out myocardial infarction (MI) and high-risk ACS. One thousand seven hundred and two patients were hospitalized. Follow-up end-points were cardiovascular mortality, hospitalization for ACS and incidence of any cardiovascular disease event during 6 months. During 4 weeks after the discharge from the ER and CPU cardiovascular mortality was 0.1% and 0.5% and during 6 months 0.8% and 1.7%, respectively. Within 6 months 4.2% and 8.4% of the patients were hospitalized for ACS and 9.3% and 11.5% had a cardiovascular disease event. CONCLUSIONS: Patients admitted with chest pain may be safely discharged from the emergency department, if there is no evidence of MI or high-risk ACS. However, further examination and appropriate treatment must be arranged.

Adult↗

PubMed2002

Myoglobin, creatine kinase MB isoforms and creatine kinase MB mass in early diagnosis of myocardial infarction in patients with acute chest pain.

OBJECTIVES: Measurements of myoglobin and creatine kinase (CK)-MB isoforms have been suggested to be sensitive tests for the early diagnosis of myocardial infarction (MI). We have investigated the utility of myoglobin, creatine kinase (CK)-MB isoforms and creatine kinase MB mass (CK-MBm) in early diagnosis of MI using cardiac troponin T (cTnT) positivity as a reference. DESIGN AND METHODS: The study population comprised 440 patients who had had chest pain for less than 12 h. Patients were divided into cTnT negative (cTnT-) or cTnT positive (cTnT+) patients (concentration of cTnT >0.1 microg/L at two different time points during 72 h). RESULTS: At the time of admission to the emergency department receiver operating characteristics (ROC) curves of CK-MB isoforms and CK-MBm were not better than that of myoglobin. Six hours after admission CK-MB isoforms and CK-MBm provided statistically significantly larger areas under the curve (AUC) than myoglobin (p < 0.01). When ROC curves were related to the onset of chest pain (< 3 h, 3-6 h, and > 6 h) there were no significant differences between the cardiac markers studied. CONCLUSIONS: According to the present findings, CK-MB isoforms or myoglobin offer no advantage over CK-MBm as early markers of myocardial infarction.

Aged↗