Risk for Acute Myocardial Infarction After Ophthalmologic Procedures

Sen, Abhijit; Gémes, Katalin; Stålhammar, Gustav; Svensén, Christer; Tornvall, Per; Jonsson, Magnus; Varmdal, Torunn; Endreseth, Birger Henning; Janszky, Imre; Möller, Jette

doi:10.7326/m20-6618

Cited by 7 publications

(9 citation statements)

References 20 publications

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“…Additionally, a vast majority of immigrants came from the surrounding Scandinavian countries and northern Europe [ 40 ]. The Nordic countries are similar in terms of ethnicity, economy, welfare and health care as well as in life expectancy and distribution of overall disease burden [ 41 , 42 ]. Children of immigrants would be eligible for inclusion, but their effect on the distribution of blue eyes would therefore be marginal even if they were overrepresented in one of the examined regions.…”

Section: Discussionmentioning

confidence: 99%

The prognostic implication of latitude in uveal melanoma: a nationwide observational cohort study of all patients born in Sweden between 1947 and 1989

2022

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Background The incidence of uveal melanoma increases with latitude. In this study, we examine the importance of latitude for uveal melanoma prognosis. Methods All uveal melanoma patients born in Sweden between 1947 and 1990 were included (n = 745). The latitude of patients’ birthplaces and home counties at the time of uveal melanoma diagnosis were collected. For all latitudes, data on sunlight and UV intensity parameters, temperature, daytime length variations, and socioeconomic factors were added. The prognostic implication of birthplace latitude and of moving > 1 degree of latitude was examined with multivariate Cox regressions and competing risk analyses. Findings There were no significant differences in patient sex, age, tumor size, T-category, or BAP-1 immunoexpression between patients born in the south, central or northern regions of Sweden. Decreasing birthplace latitude was a predictor of uveal melanoma-related mortality in multivariate Cox regression. Patients that were born in southern regions or moved > 1 degree south between birth and diagnosis had higher incidence of uveal melanoma-related mortality in competing risk analysis. The sum of yearly sunshine hours, global sunlight radiation, average daily ultraviolet light intensity, average annual temperature, or net wealth were not predictors of uveal melanoma-related mortality. Interpretation Latitude is a prognostic factor in uveal melanoma. This does not seem to be related to variations in patient or tumor characteristics at presentation, in management, in sunlight intensity, in ultraviolet light irradiance, in temperature, or in wealth. Future studies should examine if periodical changes in daylight hours or other factors could explain the prognostic implication.

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Section: Discussionmentioning

confidence: 99%

The prognostic implication of latitude in uveal melanoma: a nationwide observational cohort study of all patients born in Sweden between 1947 and 1989

2022

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“…Naturally, careful evaluation of a patient's health and own wishes, extent of metastatic disease in other parts of the body, concurrent medications, and treatment response to previous regimens is required. Some choroidal metastases require a transvitreal approach, and although complications are rare, intraocular or deep orbital biopsies typically require general anaesthesia, significant resources and technical expertise [25][26][27][28].…”

Section: Discussionmentioning

confidence: 99%

Overrepresentation of human epidermal growth factor receptor 2 positive- and Luminal B breast cancer metastases in the eyes and orbit

Stålhammar

Grossniklaus

2022

Eye

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Background Breast cancer is the most common cancer to spread to the choroid and orbit. Depending on a set of prognostic and predictive biomarkers, breast cancer can be divided into at least four distinct subtypes with separate treatment and clinical course. Subjects Thirty-two patients with metastases to the eye and periocular area diagnosed between 2005 and 2020, of which 11 also had primary tumour tissue available. Expression levels of oestrogen- (ER) and progesterone receptors (PR), Human epidermal growth factor receptor 2 (HER2) and the proliferation marker Ki67 were analysed. Results Twenty-five of 32 patients (78%) had a history of primary breast cancer, whereas the remaining 7 (22%) presented with metastatic disease. Of available metastases, 83% were positive for ER, 37% for PR, 54% for HER2, and 50% for Ki67. Metastases had significantly lower proportions of PR-positive cells than primary tumours, and the distribution of the Luminal A, Luminal B, HER2 enriched and triple-negative subtypes differed between primary tumours and metastases (P = 0.012): Six of 9 patients with a full set of biomarkers on both primary tumours and metastases switched subtype (67%), and 23 of 32 metastases (77%) were of the Luminal B subtype. Conclusions Nearly 4 in 5 breast cancer metastases in the eyes and orbit are of the Luminal B subtype, and a majority are HER2 positive. The breast cancer subtype frequently switches between primary tumours and metastases. Future studies should evaluate these results in larger cohorts.

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“…This study is part of a larger project investigating the association between outpatient procedures and the short-term risk for cardiovascular events using Norwegian and Swedish data 11 12…”

Section: Methodsmentioning

confidence: 99%

“…However, these studies were not based on study designs specifically developed to study the short-term effect of transient exposures. Recently, we published a study suggesting no increased risk for AMI following ophthalmological procedures based on a case-crossover design 11. However, the short-term risk associated with other types of procedures performed in the outpatient setting has not been investigated.…”

Section: Introductionmentioning

confidence: 99%

Risk of myocardial infarction after invasive outpatient procedures

Sen

Gémes

Svensén

et al. 2023

Heart

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ObjectiveTo assess the short-term risk of acute myocardial infarction (AMI) associated with procedures performed at outpatient specialised hospital clinics.MethodsIn this case-crossover, population-based study, we identified first-time AMI cases aged ≥40 years via patient registries and linked them to their surgical intervention in Norway (2008–2016) and Sweden (2001–2014), respectively. The number of individuals with AMI who underwent procedures 0–7 days (hazard period) prior to the AMI diagnosis was compared with cases who were exposed 29–36 days (control period) before the AMI. A total of 6176 patients with AMI who underwent a procedure either during the defined hazard or control period contributed to the analyses. ORs with 95% CIs were computed using conditional logistic regression.ResultsThe mean age of the total population was 74.7 years and 64.6% were male. The relative risk was higher following procedures performed under general/regional anaesthesia for gastrointestinal endoscopy (ORsummary, 4.23, 95% CI 1.58 to 11.31), vascular (ORsummary, 3.12, 95% CI 1.10 to 8.90), urological/gynaecological (ORsummary, 2.30, 95% CI 1.50 to 3.53) and orthopaedic (ORsummary,1.78, 95% CI 1.30 to 2.44) procedures, and for ENT (ear, nose and throat) and mouth procedures (ORsummary,1.53, 95% CI 1.19 to 1.99) performed under local anaesthesia.ConclusionThis large population-based register study from two countries suggests that outpatient procedures are generally safe with regard to the postoperative risk of AMI. However, some procedures, such as gastrointestinal endoscopy, vascular procedures and urological/gynaecological procedures may increase the risk of AMI by twofold or threefold within the first 8 days after the procedures. Further studies are warranted to assess whether the effect is modified by cardiovascular medication or other clinical factors.

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Risk for Acute Myocardial Infarction After Ophthalmologic Procedures

Cited by 7 publications

References 20 publications

The prognostic implication of latitude in uveal melanoma: a nationwide observational cohort study of all patients born in Sweden between 1947 and 1989

The prognostic implication of latitude in uveal melanoma: a nationwide observational cohort study of all patients born in Sweden between 1947 and 1989

Overrepresentation of human epidermal growth factor receptor 2 positive- and Luminal B breast cancer metastases in the eyes and orbit

Risk of myocardial infarction after invasive outpatient procedures

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