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Kardiovaskulära händelser i MKC

MDC Cardiovascular endpoint report 2017

Malmö Diet and Cancer Study
incl. CV-cohort

Cardiovascular Endpoints

End of follow-up: 31 December 2016
Report: 4 April 2018

By 
Anders Dahlin (data manager)
Bo Hedblad (coronary events and stroke)
Gunnar Engström (heart failure)
Olle Melander (atrial fibrillation and flutter)
Gustav Smith (CABG, PCI, MACE, aortic stenosis)
 


General information

All cardiovascular disease groups, except atrial fibrillation and flutter events, can have both prevalent and incident outcomes at the individual level.

Prevalent: date of diagnosis ≤ date of entry
Incident: date of diagnosis > date of entry

Abbreviations:
CABG = Coronary Artery Bypass Graft surgery
MACE = Major Adverse Coronary Events
PCI = Percutaneous Coronary artery Intervention

Amendments and implementation of new procedures

Year* Description

2017
- Added the variables cgdat_ep, fucg, pcdat_ep, fupc
- Included all secondary diagnoses (currently max 31) in the Patient Register and added two more groups of the source-variables for the disease groups CABG, atrial fibrillation/flutter, aortic stenosis (both "as" and "ay")
- Removed events which have occurred after the date of emigration (if available)
2015
- Validation of stroke events by means of the Stroma register started in 1989 and ceased in year 2013, the latest year with complete validated data was 2010. New non-validated stroke events from hospitals in Malmö were included as endpoints, but only events after 2010.
- Atrial fibrillation and flutter events from the Hospital-based outpatient care (Öppenvårdsregistret) were included as endpoints. Previously only data from the Hospital Discharge Register (Slutenvårdsregistret) and the Cause-of-Death Register were included.
- As a consequence of the amendments above the coding of the source variables pr_stso, stso and afso was changed. The coding of the variable pr_st was also modified.
2014
- Introduced a separate last follow-up date for stroke.
2012
- The original value for the recidive date in the Recidive Registry (part of the Stroma Registry) is composed of year and month (i.e. YYYYMM; day is missing). By default the day has been set to 15 in previous endpoint updates. Nevertheless, a few individuals have died a few days before day 15, which was not taken into account previously. However, in the new update the recidive date has been changed for such cases to date of death.
2011
- Five new endpoints were added to the cardiovascular endpoint update: CABG surgery event, PCI event, MACE event (coronary event, CABG or PCI), Aortic stenosis event (based on ICD code), and Aortic stenosis event (based on surgery code).
- In order to relate the cardiovascular events to the date at rescreening (2007-2012), a new file was created, parallell to the ordinary file with baseline screening date (1991-1996).
- Information of reused (återanvända) Personal Identity Numbers (PIN) was taken into account, diagnoses appearing after the date of death of an MDC participating individual were removed.
- For individuals with changed PINs, data with the new PIN (death, emigration) were included in the endpoint update.
- Date of death as given by SCB has been used (previously dates from SoS were used)
- One individual in the MDC cohort (not in CV cohort) was identified with two different PINs, the latest PIN was removed. The new MDC cohort number is 30 446.

* The year when the endpoint update was made, usually the year after last follow-up year.


1. Cohorts

Baseline 1991-1996
Background population: 74 137
Men: 31 513
Women: 42 624

Malmö Diet and Cancer Study (MDC) cohort
Individuals qualify to the MDC cohort if they participated in at least one part of the Malmö Diet and Cancer Study.
Total: 30 446
Men: 12 120
Women: 18 326

Cardiovascular (CV) cohort
Every other individual in the MDC cohort screened between 1991 to 1994 was invited to a CV project which included a B-mode carotid ultrasound examination for determination of carotid intima-media thickness and plaques. Out of 6 103 individuals which accepted the invitation about 5 500 further participated in an extended examination, including laboratory analyses.
Total: 6 103
Men: 2 572
Women: 3 531

CV-rescreening 2007-2012 (CV-AUS)
All individuals in the CV-cohort, alive, not emigrated, and living in southern Sweden, were invited to rescreening during 2007-2012. In total 3 734 individuals participated in the study out of the original number 6 103.
Total: 3 734
Men: 1 522
Women: 2 212
 

2. Time of follow-up

Number of person-years from date of entry to death, lost to follow-up or to 31 December 2016

 Baseline
MDC (n=30 446)*
CV (n=6103)**Rescreening
CV-AUS (n=3 734)
Total599 738127 60925 618
Men 227 83351 69310 303
Women371 90575 91615 316

* Six individuals (3 males, 3 females) out of 30 446 lack follow-up time due to missing screening date.
** One individual (male) out of 6 103 lack follow-up time due to missing screening date


3. Summary of prevalent and incident events by disease group

Number of individuals with first prevalent and/or first incident cardiovascular disease until 31 December 2016 by cohort and disease group

 BaselineRescreening
 MDC (n=30 446)CV (n=6 103)CV-AUS (n=3 734)
Disease groupPrevIncInc 2016PrevIncInc 2016PrevIncInc 2016
Coronary events6003 8641571027683421921531
Stroke3443 353144486773714221730
Heart failure872 07014213415344715629
Atrial fibrillation or flutter3125 078345581 0798325341868
CABG surgery3352 624100495352422915927
PCI411 6217643262010612323
MACE (coronary events, CABG or PCI)7744 7721901319393930827740
Aortic stenosis (based on ICD code)6486765111751235869
Aortic stenosis (based on surgery code)3030026371424234


REFERENCE TIME POINT AT BASELINE (tables 4-13)


4. Incident cardiovascular events by year of diagnosis – Part 1

Number of individuals with first incident coronary, stroke, heart failure and/or atrial fibrillation/flutter events until 31 December 2016 in the MDC and CV cohorts by year of diagnosis

 Coronary eventsStrokeHeart failure*Atrial fibrillation/ flutter**
YearMDCCVMDCCVMDCCVMDCCV
Pre MIPost MIPre MIPost MI
19913 2     1 
1992  9612422125 
199329102185221166
19945017471791713117
199597197420256724215
19961282494142613726814
199712824103202511618520
1998146251171729146 9216
199915427120253814849518
2000149281443749178110918
200115224146274188 17428
2002165331512949116419848
2003200441513041276420649
20041942613923643114521740
20051954616230593211623349
20062003220030713216327545
2007217391602570266624132
20082094717921894218630465
20092004117851783215735175
20102063812527862726530971
2011192481864110631191135765
20121672917738964519934679
20131764318935923125332975
201418632173381274118832068
201515532159331223323832983
20161573414437954728634583
Total3 8647683 3536771 4945763101055 0781 079

* Incident heart failure events were splitted into following groups:
  Pre MI = heart failure at least one day before a possible acute myocardial infarction
  Post MI = heart failure on the same day or after a non-fatal acute myocardial infarction (incl. possible prevalent MI)
  Acute myocardial infarction were identified through ICD8/9=410 and ICD10=I21 in the Hospital Discharge Register
** No incident atrial fibrillation/flutter event is recorded if the individual has a prevalent event


5. Incident cardiovascular events by year of diagnosis – Part 2

Number of individuals with first incident CABG, PCI, MACE, aortic stenosis (ICD and surgery) events until 31 December 2016 in the MDC and CV cohorts by year of diagnosis

 CABG surgeryPCIMACEAortic stenosis (ICD)Aortic stenosis (surgery)
YearMDCCVMDCCVMDCCVMDCCVMDCCV
19911   4     
199281311871   
1993166624114512 
1994421610476267432
199553941133258232
199679151321783422874
1997851514317832195135
19988917481018633122102
1999106135972173212181
20001032253131983912362
2001123158511218312284 
200214225712093922481
2003152311082624448291132
2004153301051225035307113
200514335932123156408116
2006158271201524844549234
2007145271021724846486167
2008144341102124855386102
20091353210226238535411204
2010137341022724153508277
2011113269622209537313122
201294197012193337115151
201392207620192416013182
2014119198613205325811163
201592237319179395517185
2016100247620190396512264
Total2 6245351 6213264 77293986717530071


6. Coronary events by diagnosis

Number of individuals with first prevalent and/or first incident coronary events until 31 December 2016 in the MDC and CV cohorts by diagnosis group

 MDC cohort (n=30 446)CV cohort (n=6 103)
DiagnosisICD-9      PrevalentIncident  Incident 2016PrevalentIncidentIncident 2016
Acute myocardial infarction4106003 35512410267926
Other acute and subacute forms of ischemic heart disease411 4    
Old myocardial infarction412 10    
Angina pectoris413 2    
Other forms of chronic ischemic heart disease414 49333 898
Total 6003 864   15710276834


7. Incident coronary events by diagnosis and source

Number of individuals with first incident coronary event until 31 December 2016 in the MDC cohort by diagnosis group and source of information

DiagnosisICD-9    Hospital Discharge RegisterCause-of- death RegisterTotal      
Acute myocardial infarction4102 8305253 355
Other acute and subacute forms of ischemic heart disease411 44
Old myocardial infarction412 1010
Angina pectoris413 22
Other forms of chronic ischemic heart disease414 493493
Total 2 8301 0343 864


8. Stroke events by diagnosis

Number of individuals with first prevalent and/or first incident stroke events until 31 December 2016 in the MDC and CV cohorts by diagnosis group

 MDC cohort (n=30 446)CV cohort (n=6 103)
DiagnosisICD-9    PrevalentIncidentIncident 2016PrevalentIncidentIncident 2016
Unknown-1431 36 
Subarachnoid hemorrhage430491083720 
Intracerebral hemorrhage43135415173894
Occlusion of cerebral arteries4342062 7381203055031
Acute, but ill-defined, cerebrovascular disease436406145122
Total 3443 3531444867737


9. Incident stroke events by diagnosis and source

Number of individuals with first incident stroke event until 31 December 2016 in the MDC cohort by diagnosis group and source of information

DiagnosisICD-9     Stroma register (not in HDR*)Stroma register (also in HDR)*HDR*,
outside Malmö
HDR*,
Malmö after 2010
Recidiv registerTotal
Unknown-    3131
Subarachnoid hemorrhage4303542823 108
Intracerebral hemorrhage4311724148109 415
Occlusion of cerebral arteries4342091 572270687 2 738
Acute, but ill-defined, cerebrovascular disease4361071430 61
Total 2391 874360849313 353     


10. Heart failure events by diagnosis

Number of individuals with first prevalent and/or first incident heart failure events until 31 December 2016 in the MDC and CV cohorts by diagnosis group

 MDC cohort (n=30 446)CV cohort (n=6 103)
DiagnosisICD-9/ ICD-10Prevalent*Incident*  Incident
2016
Prevalent*Incident*Incident
2016
  pre MIpost MIpre MI   post MI pre MIpost MIpre MIpost MI 
Heart failure42857301 4795721428530910334
Hypertensive heart disease with (congestive) heart failureI11.0                             154   12 
Total 57301 4945761428531010534

* Prevalent and incident heart failure events were splitted into following groups:
  Pre MI = heart failure at least one day before a possible acute myocardial infarction
  Post MI = heart failure on the same day or after a non-fatal acute myocardial infarction (incl. possible prevalent MI)
  Acute myocardial infarction were identified through ICD8/9=410 and ICD10=I21 in the Hospital Discharge Register


11. Incident heart failure events by diagnosis and source

Number of individuals with first incident heart failure event until 31 December 2016 in the MDC cohort by diagnosis group and source of information

DiagnosisICD-9/
ICD-10
Hospital Discharge Register*Total
                  Pre MI  Post MI 
Heart failure4281 4795722 051
Hypertensive heart disease with 
(congestive) heart failure
I11.015419
Total 1 4945762 070

* Incident heart failure events were splitted into following groups:
  Pre MI = heart failure at least one day before a possible acute myocardial infarction
  Post MI = heart failure on the same day or after a non-fatal acute myocardial infarction (incl. possible prevalent MI)
  Acute myocardial infarction were identified through ICD8/9=410 and ICD10=I21 in the Hospital Discharge Register


12. Atrial fibrillation and flutter events by diagnosis

Number of individuals with first prevalent or first incident atrial fibrillation and flutter events until 31 December 2016 in the MDC and CV cohorts. Only the first event of an individual is recorded, thus no incident event is recorded if the individual has a prevalent event

 MDC cohort (n=30 446)CV cohort (n=6 103)
DiagnosisICD-9PrevalentIncidentIncident 2016PrevalentIncidentIncident 2016
Atrial fibrillation and flutter427D3125 078345581 07983

 

13. Incident atrial fibrillation and flutter events by diagnosis and source

Number of individuals with first incident atrial fibrillation and flutter event until 31 December 2016 in the MDC cohort by diagnosis group and source of information. Only the first event of an individual is recorded, thus no incident event is recorded if the individual has a prevalent event

DiagnosisICD-9Hospital Discharge RegisterHospital-based out-patient careCause-of-death RegisterTotal    
Atrial fibrillation and flutter427D*3 7451 296375 078

* Corresponding code in the Cause-of-death Register is 4273