1
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Tjerkaski J, Jernberg T, Szummer K. Balancing the risks of bleeding and ischaemia in myocardial infarction patients at high bleeding risk. Eur Heart J Cardiovasc Pharmacother 2023; 9:770-771. [PMID: 37740444 PMCID: PMC10719447 DOI: 10.1093/ehjcvp/pvad068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 09/18/2023] [Indexed: 09/24/2023]
Affiliation(s)
- J Tjerkaski
- Department of Clinical Sciences, Danderyd University Hospital, Karolinska Institute, Stockholm 182 88, Sweden
| | - T Jernberg
- Department of Clinical Sciences, Danderyd University Hospital, Karolinska Institute, Stockholm 182 88, Sweden
| | - K Szummer
- Section of Cardiology, Department of Medicine, Karolinska Institutet, Huddinge, Stockholm 171 77, Sweden
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2
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Vavilis G, Back M, Barany P, Ruck A, Szummer K. Prognosis after aortic valve replacement in dialysis patients: results from the Swedish Renal Registry. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The choice of aortic valve prosthesis in aortic stenosis patients is based on patient preference, preoperative age, life expectancy, need for anticoagulant therapy and valve durability. Major uncertainties remain regarding optimal prosthetic valve choice in dialysis patients.
Objectives
The aim of the study was to compare the clinical outcomes after aortic valve replacement with mechanical (MAV) or bioprosthetic valves (BAV) in dialysis patients.
Methods
We used the observational, prospective, multicenter cohort from the Swedish Renal Registry, which includes all dialysis patients in Sweden. The study included 294 dialysis patients with aortic stenosis who underwent aortic valve replacement with MAV or BAV (obtained from surgical procedure codes) between 2005 and 2018, either before (n=155) or after dialysis start (n=139). Comorbidities and net adverse clinical events (bleeding events, stroke and reoperation) were obtained from national registries and defined by International Classification of Diseases codes (ICD-10). The incidence rate (IR) of primary endpoint comprised of all-cause death, bleeding events, stroke and aortic valve reoperation, as well as only all-cause death rates between recipients of MAV or BAV were estimated with Kaplan – Meier curves.
Results
The median age was 72 years (interquartile range [IQR]: 63.9, 77.3), 77% were males and 60% received mechanical valves. During a median follow-up of 1.49 years (IQR: 0.66–2.83), the primary endpoint occurred in 202 patients. Compared to BAV-recipients, those who received MAV had comparable IR of the primary end-point (40.1/100 person-years; [95% Confidence Interval (CI): 33.7–47.7], vs 36.2/100 person-years; [95% CI: 28.9–45.4], P=0.322) (Figure 1).
Mortality rate at 1-year of follow-up was 28.9% without difference between recipients of MAV or BAV (68.8% in MAV-group and 57.6% with BAV; mortality rate MAV 33.3/100 person-year; (95% CI: 27.9–39.8) vs BAV 27.3/100 person-year; (95% CI: 21.5–34.6), P=0. 183)), (Figure 2). Additional statistical analysis of the secondary endpoint based on the occurrence of aortic valve intervention before or after dialysis start, was consistent with the main results.
Conclusion
There is no difference in mortality and complication rates in dialysis patients who underwent aortic valve replacement with MAV or BAV.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- G Vavilis
- Department of Medicine, Huddinge, Karolinska Institutet, Theme Heart and Vessels, Division of Coronary and Valvular Diseases; Karolinska University Hospital , Stockholm , Sweden
| | - M Back
- Karolinska University Hospital, Theme Heart and Vessels, Division of Coronary and Valvular Heart Disease, , Stockholm , Sweden
| | - P Barany
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet , Stockholm , Sweden
| | - A Ruck
- Karolinska University Hospital, Theme Heart and Vessels, Division of Coronary and Valvular Heart Disease, , Stockholm , Sweden
| | - K Szummer
- Department of Medicine, Huddinge, Karolinska Institutet, Theme Heart and Vessels, Division of Coronary and Valvular Diseases; Karolinska University Hospital , Stockholm , Sweden
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3
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Simonsson M, Alfredsson J, Szummer K, Jernberg T, Ueda P. Association of ischemic and bleeding events with mortality in patients with a recent acute myocardial infarction. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background/Introduction
Duration and intensity of antithrombotic treatment after myocardial infarction should be individualized based on a patient's ischemic and bleeding risk [1,2]. While such strategies are typically based on calculations that give equal weight to both types of events, uncertainty remains regarding their relative importance.
Purpose
To describe the incidence of ischemic and bleeding events in patients with a recent myocardial infarction, to compare the association of an ischemic vs bleeding event with mortality and to assess whether this association had changed over the past two decades.
Methods
Patients with acute myocardial infarction enrolled in the SWEDEHEART registry and discharged alive with antithrombotic treatment (aspirin, P2Y12 inhibitor, or oral anticoagulant) from January 2012 to December 2017 were followed from discharge until an ischemic event (recurrent myocardial infarction or ischemic stroke) or bleeding event. Cox regression adjusted for demographic factors, comedications and comorbidities, was used to estimate hazard ratios (HR) for time to death after an ischemic and bleeding event as compared with no event (in a model using time-varying exposure definition) and for an ischemic vs bleeding event in a direct comparison. We then assessed whether the adjusted HR for mortality of an ischemic vs bleeding event had changed across three time-periods (1997–2000, 2001–2011 and 2012–2017) by using an interaction term between time period and type of event.
Results
From January 2012 until December 2017 86, 736 patients were discharged alive with antithrombotic treatment after a myocardial infarction. Of these, 4,039 patients experienced a first ischemic event (incidence rate 5.7 events per 100 person-years), and 3,399 a first bleeding event (incidence rate 4.8 events per 100 person-years). As compared with no event, both ischemic events (adjusted HR 4.16, 95% CI 3.91 to 4.43) and bleeding events (adjusted HR 3.43, 95% CI 3.17 to 3.71) were associated with an increased risk of death. In the direct comparison, ischemic events were associated with a higher risk of death than bleeding events (adjusted HR 1.27, 95% CI 1.15 to 1.40). There was no evidence of a change in the aHR across the three time periods (aHR; 1.17, 95% CI 1.02 to 1.35 in 1997–2000 and 1.18, 95% CI, 1.11 to 1.27 in 2001–2011, p for interaction between time period and type of event ≥0.646).
Conclusion
In this nationwide study of patients with a recent MI, post-discharge ischemic events were more common and associated with higher mortality risk as compared with bleeding events.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Swedish Heart and Lung FoundationSwedish Diabetes Foundation
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Affiliation(s)
- M Simonsson
- Karolinska Institutet Danderyd Hospital, Department of Clinical Sciences, Cardiology , Stockholm , Sweden
| | - J Alfredsson
- Linkoping University Hospital, Department of Health, Medicine and Caring Sciences and Department of Cardiology , Linkoping , Sweden
| | - K Szummer
- Karolinska Institute, Department of Medicine, Huddinge , Stockholm , Sweden
| | - T Jernberg
- Karolinska Institutet Danderyd Hospital, Department of Clinical Sciences, Cardiology , Stockholm , Sweden
| | - P Ueda
- Karolinska Institutet, Department of Medicine, Solna , Stockholm , Sweden
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4
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Tjerkaski J, Jernberg T, Alfredsson J, Erlinge D, James S, Lindahl B, Mohammad MA, Omerovic E, Venetsanos D, Szummer K. Comparison between ticagrelor and clopidogrel in high bleeding risk patients with acute coronary syndrome. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Potent antiplatelet agents such as ticagrelor are associated with a lower risk of ischemic events than clopidogrel in patients with acute coronary syndrome (ACS). However, it is uncertain whether the benefits of more intensive anti-ischemic therapy outweigh the risks of major bleeding in individuals who have a high bleeding risk (HBR). This study aimed to assess treatment outcomes following dual antiplatelet therapy (DAPT) using either ticagrelor or clopidogrel in ACS patients with HBR.
Methods
All HBR patients enrolled in the SWEDEHEART registry who were discharged with DAPT using ticagrelor or clopidogrel following ACS between 2010 and 2017 were included in this study. Bleeding risk was assessed using the 4-item PRECISE-DAPT score, which consists of age, prior bleeding, haemoglobin concentration and creatinine clearance. HBR was defined as a PRECISE-DAPT score ≥25. Inverse-probability of treatment weighting was used to adjust for baseline differences between the treatment groups. The main analysis consisted of a doubly robust estimation of causal effect using Cox proportional hazards models. Data on major bleeding, recurrent myocardial infarction (MI), ischemic stroke and all-cause mortality was obtained from national registries, with 365 days of follow-up. Additional outcomes include major adverse cardiovascular events (MACE), a composite of MI, ischemic stroke and all-cause mortality, and net adverse clinical events (NACE), a composite of MACE and major bleeding.
Results
Of all ACS patients, 36% (n=25,042) had a PRECISE-DAPT score ≥25. Approximately half of the study participants were treated with ticagrelor (n=11,848). Ticagrelor reduced the risk of MI (hazard ratio [HR], 0.82 [95% CI 0.74–0.91]), ischemic stroke (HR, 0.73 [95% CI 0.60–0.88]) and MACE (HR, 0.90 [95% CI 0.84–0.97]), while also increasing the risk of major bleeding compared to clopidogrel (HR, 1.30 [95% CI 1.16–1.47]). We found no significant differences in all-cause mortality (HR 1.02 [95% CI 0.92–1.12]) and NACE (HR 0.98 [95% CI 0.92–1.05]).
Conclusions
Ticagrelor was associated with a lower risk of recurrent ischemic events, but a higher risk of major bleeding compared to clopidogrel. There were no significant differences in all-cause mortality and NACE between the treatment groups. These results suggest that more potent antiplatelet agents might not be superior to clopidogrel in ACS patients with HBR.
Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): Stockholm county council
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Affiliation(s)
| | - T Jernberg
- Karolinska Institutet Danderyd Hospital , Stockholm , Sweden
| | - J Alfredsson
- Department of Medical and Health Sciences Linkoping University , Linkoping , Sweden
| | - D Erlinge
- Lund University, Department of Clinical Sciences, Cardiology , Lund , Sweden
| | - S James
- Uppsala University Hospital and Uppsala Clinical Research Center , Uppsala , Sweden
| | - B Lindahl
- Uppsala University Hospital and Uppsala Clinical Research Center , Uppsala , Sweden
| | - M A Mohammad
- Lund University, Department of Clinical Sciences, Cardiology , Lund , Sweden
| | - E Omerovic
- Institute of Medicine - Sahlgrenska Academy - University of Gothenburg , Gothenburg , Sweden
| | - D Venetsanos
- Karolinska Institutet, Section of Cardiology, Department of Medicine, Solna, Stockholm, Sweden , Stockholm , Sweden
| | - K Szummer
- Karolinska Institutet, Section of Cardiology, Department of Medicine, Huddinge , Stockholm , Sweden
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5
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Ekberg S, Harrysson S, Jernberg T, Szummer K, Andersson PO, Jerkeman M, Smedby KE, Eloranta S. Myocardial infarction in diffuse large B-cell lymphoma patients - a population-based matched cohort study. J Intern Med 2021; 290:1048-1060. [PMID: 34003533 DOI: 10.1111/joim.13303] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 03/27/2021] [Accepted: 03/31/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND The outcome for diffuse large B-cell lymphoma (DLBCL) patients has improved with the immunochemotherapy combination R-CHOP. An increased rate of heart failure is well documented following this treatment, whereas incidence and outcome of other cardiac complications, for example myocardial infarction, are less well known. METHOD We identified 3548 curatively treated DLBCL patients in Sweden diagnosed between 2007 and 2014, and 35474 matched lymphoma-free general population comparators. The incidence, characteristics and outcome of acute myocardial infarctions (AMIs) were assessed using population-based registers up to 11 years after diagnosis. The rate of AMI was estimated using flexible parametric models. RESULTS Overall, a 33% excess rate of AMI was observed among DLBCL patients compared with the general population (HR: 1.33, 95% CI: 1.14-1.55). The excess rate was highest during the first year after diagnosis and diminished after 2 years. High age, male sex and comorbidity were the strongest risk factors for AMI. Older patients (>70 years) with mild comorbidities (i.e. hypertension or diabetes) had a 61% higher AMI rate than comparators (HR: 1.61, 95% CI: 1.10-2.35), whereas the corresponding excess rate was 28% for patients with severe comorbidities (HR: 1.28, 95% CI: 1.01-1.64). Among younger patients (≤70), a short-term excess rate of AMI was limited to those with severe comorbidities. There was no difference in AMI characteristics, pharmacological treatment or 30-day survival among patients and comparators. CONCLUSION DLBCL patients have an increased risk of AMI, especially during the first 2 years, which calls for improved cardiac monitoring guided by age and comorbidities. Importantly, DLBCL was not associated with differential AMI management or survival.
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Affiliation(s)
- S Ekberg
- From the, Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - S Harrysson
- From the, Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.,Department of Hematology, Karolinska University Hospital, Solna, Sweden
| | - T Jernberg
- Department of Clinical Sciences, Danderyd University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - K Szummer
- Section of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - P-O Andersson
- Department of Hematology, South Älvsborg Hospital, Borås, Sweden.,Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - M Jerkeman
- Division of Oncology, Lund University and Skane University Hospital, Lund, Sweden
| | - K E Smedby
- From the, Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.,Department of Hematology, Karolinska University Hospital, Solna, Sweden
| | - S Eloranta
- From the, Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
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6
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Von Renteln F, Hassan S, Szummer K, Edfors R, Venetsanos D, Kober L, Braunschweig F, Lewinter C. Immediate versus staged revascularisation in multivessel coronary disease: an updated meta-analysis. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Percutaneous coronary interventions (PCIs) are often aimed at the culprit vessel in acute coronary syndromes (ACSs) followed by revascularisation of other stenoses later in the index hospitalisation or shortly after discharge. PCI delay of non-culprit coronary vessels stenoses is supported by lower contrast fluid use and thrombocyte aggregation. Distinct coronary interventions increase the risk of both non- and coronary artery complications, e.g. acute abdominal and periphery artery bleeding, suggesting undertaking all PCIs at the same time.
Purpose
To assess the effect on mortality and re-myocardial infarction (MI) of immediate versus staged revascularisation in multivessel coronary disease, with the latter constrained to initial PCI of the culprit coronary vessel.
Methods
The syntax of “randomised controlled trial (RCT) & acute coronary syndrome & complete revascularisation” was undertaken in PubMed.
Clinical characteristics were gathered at the index hospitalisation. The intervention scenario was acute coronary syndrome or not.
Meta-analyses calculated relative risk (RR) reductions on outcomes of 1) mortality and 2) re-MI. Meta-regression assessed linear difference between interventional treatment benefits and baseline characteristics.
Results
A total of 148 studies was found. Of those, 8 was found eligible for further analyses and their baseline characteristics are shown in Table 1.
Comparison of immediate versus staged revascularisation on mortality was nonsignificant (RR, 1.19; 95% CI: 0.78–1.81, p=0.43) (Figure 1). The impact of Immediate vs staged revascularisation on re-MI was also nonsignificant (RR, 0.83; 95% CI: 0.44–1.55, p=0.56). Meta-regression found no associations between the outcomes and study characteristics (not shown).
Conclusion
The intervention of immediate compared to staged revascularisation assessed on outcomes of all-cause mortality and re-MI were nonsignificant.
Figure 1
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
| | - S Hassan
- Karolinska University Hospital, Stockholm, Sweden
| | - K Szummer
- Karolinska University Hospital, Stockholm, Sweden
| | - R Edfors
- Karolinska University Hospital, Stockholm, Sweden
| | - D Venetsanos
- Karolinska University Hospital, Stockholm, Sweden
| | - L Kober
- Rigshospitalet - Copenhagen University Hospital, Heart Centre, Copenhagen, Denmark
| | | | - C Lewinter
- Karolinska University Hospital, Stockholm, Sweden
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7
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Edfors R, Lindhagen L, Spaak J, Evans M, Andell P, Baron T, Mörtberg J, Rezeli M, Salzinger B, Lundman P, Szummer K, Tornvall P, Wallén HN, Jacobson SH, Kahan T, Marko-Varga G, Erlinge D, James S, Lindahl B, Jernberg T. Use of proteomics to identify biomarkers associated with chronic kidney disease and long-term outcomes in patients with myocardial infarction. J Intern Med 2020; 288:581-592. [PMID: 32638487 DOI: 10.1111/joim.13116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 04/30/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Patients with chronic kidney disease (CKD) have poor outcomes following myocardial infarction (MI). We performed an untargeted examination of 175 biomarkers to identify those with the strongest association with CKD and to examine the association of those biomarkers with long-term outcomes. METHODS A total of 175 different biomarkers from MI patients enrolled in the Swedish Web-System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies (SWEDEHEART) registry were analysed either by a multiple reaction monitoring mass spectrometry assay or by a multiplex assay (proximity extension assay). Random forests statistical models were used to assess the predictor importance of biomarkers, CKD and outcomes. RESULTS A total of 1098 MI patients with a median estimated glomerular filtration rate of 85 mL min-1 /1.73 m2 were followed for a median of 3.2 years. The random forests analyses, without and with adjustment for differences in demography, comorbidities and severity of disease, identified six biomarkers (adrenomedullin, TNF receptor-1, adipocyte fatty acid-binding protein-4, TNF-related apoptosis-inducing ligand receptor 2, growth differentiation factor-15 and TNF receptor-2) to be strongly associated with CKD. All six biomarkers were also amongst the 15 strongest predictors for death, and four of them were amongst the strongest predictors of subsequent MI and heart failure hospitalization. CONCLUSION In patients with MI, a proteomic approach could identify six biomarkers that best predicted CKD. These biomarkers were also amongst the most important predictors of long-term outcomes. Thus, these biomarkers indicate underlying mechanisms that may contribute to the poor prognosis seen in patients with MI and CKD.
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Affiliation(s)
- R Edfors
- From the, Department of Clinical Sciences, Division of Cardiovascular Medicine, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.,Bayer AB, Solna, Sweden
| | - L Lindhagen
- Uppsala Clinical Research Center, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - J Spaak
- From the, Department of Clinical Sciences, Division of Cardiovascular Medicine, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - M Evans
- Department of Clinical Science, Intervention and Technology (CLINTEC), Division of Renal Medicine, Karolinska Institutet, Stockholm, Sweden
| | - P Andell
- Department of Medicine, Unit of Cardiology, Karolinska Institutet, Stockholm, Sweden
| | - T Baron
- Uppsala Clinical Research Center, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - J Mörtberg
- Department of Clinical Sciences, Division of Renal Medicine, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - M Rezeli
- Department of Biomedical Engineering, Lund University, Lund, Sweden
| | - B Salzinger
- Department of Clinical Sciences, Division of Renal Medicine, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - P Lundman
- From the, Department of Clinical Sciences, Division of Cardiovascular Medicine, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - K Szummer
- Department of Medicine, Unit of Cardiology, Karolinska Institutet, Stockholm, Sweden
| | - P Tornvall
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
| | - H N Wallén
- From the, Department of Clinical Sciences, Division of Cardiovascular Medicine, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - S H Jacobson
- Department of Clinical Sciences, Division of Renal Medicine, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - T Kahan
- From the, Department of Clinical Sciences, Division of Cardiovascular Medicine, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - G Marko-Varga
- Department of Biomedical Engineering, Lund University, Lund, Sweden
| | - D Erlinge
- Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden
| | - S James
- Uppsala Clinical Research Center, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - B Lindahl
- Uppsala Clinical Research Center, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - T Jernberg
- From the, Department of Clinical Sciences, Division of Cardiovascular Medicine, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
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8
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Benedek P, Eriksson M, Duvefelt K, Freyschuss A, Frick M, Lundman P, Nylund L, Szummer K. Genetic testing for familial hypercholesterolemia among survivors of acute coronary syndrome. J Intern Med 2018; 284:674-684. [PMID: 29974534 DOI: 10.1111/joim.12812] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Familial hypercholesterolemia could be prevalent among patients with acute coronary syndrome. OBJECTIVE To investigate both the frequency of causative mutations for familial hypercholesterolemia (FH) and the optimal selection of patients for genetic testing among patients with an acute coronary syndrome (ACS). METHODS One hundred and sixteen patients with an ACS during 2009-2015 were identified through the SWEDEHEART registry. Patients who had either a high total cholesterol level ≥7 mmol L-1 combined with a triglyceride level ≤2.6 mmol L-1 , or were treated with lipid-lowering medication and had a total cholesterol level >4.9 mmol L-1 and a triglyceride level ≤2.6 mmol L-1 were included. Genetic testing was performed first with a regionally designed FH mutation panel (118 mutations), followed by testing with a commercially available FH genetic analysis (Progenika Biopharma). RESULTS A total of 6.9% (8/116) patients had a FH-causative mutation, all in the LDL-receptor. Five patients were detected on the panel, and further testing of the remaining 111 patients detected an additional 3 FH-causative mutations. Baseline characteristics were similar in FH-positive and FH-negative patients with respect to age, gender, prior ACS and diabetes. Patients with a FH-causative mutation had higher Dutch Lipid Clinical Network (DLCN) score (5.5 (5.0-6.5) vs 3.0 (2.0-5.0), P < 0.001) and a higher low-density lipoprotein level (5.7 (4.7-6.5) vs 4.9 (3.5-5.4), P = 0.030). The Dutch Lipid Clinical Network (DLCN) score had a good discrimination with an area under the curve of 0.856 (95% CI 0.763-0.949). CONCLUSION Genetic testing for FH should be considered in patients with ACS and high DLCN score.
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Affiliation(s)
- P Benedek
- Department of Medicine, Karolinska Institutet, Huddinge, Stockholm, Sweden.,Department of Endocrinology, Karolinska University Hospital, Stockholm, Sweden
| | - M Eriksson
- Department of Medicine, Karolinska Institutet, Huddinge, Stockholm, Sweden.,Department of Endocrinology, Karolinska University Hospital, Stockholm, Sweden
| | - K Duvefelt
- Mutation Analysis Facility, Clinical Research Center, Karolinska University Hospital, Stockholm, Sweden
| | - A Freyschuss
- Department of Medicine, Section of Cardiology, Karolinska Institutet, Huddinge, Stockholm, Sweden.,Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - M Frick
- Department of Cardiology, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - P Lundman
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - L Nylund
- Department of Medicine, Section of Cardiology, Karolinska Institutet, Huddinge, Stockholm, Sweden.,Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - K Szummer
- Department of Medicine, Section of Cardiology, Karolinska Institutet, Huddinge, Stockholm, Sweden.,Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
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9
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Faxen J, Xu H, Jernberg T, Szummer K, Carrero J. P3017Serum potassium levels and risk of in-hospital arrhythmias and mortality in patients admitted with suspicion of acute coronary syndrome. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p3017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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10
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Lofman I, Szummer K, Olsson H, Carrerro J, Evans M, Lund L, Jernberg T. 249Long-term outcome in myocardial infarction patients with heart failure treated with aldosterone receptor antagonist in relation to ejection fraction and kidney function. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx501.249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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11
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Simonsson M, Olsson H, Winell H, Szummer K, Alfredsson J, Jernberg T. 255Development and validation of a new in-hospital bleeding risk model for patients with acute coronary syndrome - the SWEDEHEARTscore. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx501.255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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12
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Szummer K, Trevisan M, Barany P, Xu H, Evans M, Carrero J. P4598Incident atrial fibrillation and the risk of stroke in patients with chronic kidney disease. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p4598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Szummer K, Janosi A, Breuer T, Ofner P, Sundstrom J, Jernberg T. Comparison of 30-day outcome in ST-elevation myocardial infarction patients treated in Sweden or Hungary: results from SWEDEHEART and the Hungarian myocardial infarction registry. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht307.p457] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Carrero JJ, Evans M, Szummer K, Spaak J, Lindhagen L, Edfors R, Stenvinkel P, Jacobsson S, Jernberg T. Warfarin treatment, kidney dysfunction and outcome in acute myocardial infarction patients with a history of atrial fibrillation. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht308.1076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Edfors R, Szummer K, Evans M, Carrero-Roig JJ, Spaak J, James SJ, Lagerqvist B, Jernberg T. Renal function and outcome in patients with stable coronary artery disease undergoing coronary angiography. Data from 6 years of consecutive patients in a nationwide registry. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.p3986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Szummer K, Lundman P, Jacobson SH, Schön S, Lindbäck J, Stenestrand U, Wallentin L, Jernberg T. Relation between renal function, presentation, use of therapies and in-hospital complications in acute coronary syndrome: data from the SWEDEHEART register. J Intern Med 2010; 268:40-9. [PMID: 20210836 DOI: 10.1111/j.1365-2796.2009.02204.x] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To examine clinical characteristics, presenting symptoms, use of therapy and in-hospital complications in relation to renal function in patients with myocardial infarction (MI). DESIGN Observational study. SETTING Nationwide coronary care unit registry between 2003-2006 in Sweden. SUBJECTS Consecutive MI patients with available creatinine (n = 57,477). RESULTS Glomerular filtration rate was estimated with the Modification of Diet in Renal Disease Study formula. With declining renal function patients were older, had more co-morbidities and more often used cardio-protective medication on admission. Compared to patients with normal renal function, fewer with renal failure presented with chest pain (90% vs. 67%, P < 0.001), Killip I (89% vs. 58%, P < 0.001) and ST-elevation myocardial infarction (STEMI) (41% vs. 22%, P < 0.001). In a logistic regression model lower renal function was independently associated with a less frequent use of anticoagulant and revascularization in non-ST-elevation MI. The likelihood of receiving reperfusion therapy for STEMI was similar in patients with normal-to-moderate renal dysfunction, but decreased in severe renal dysfunction or renal failure. Reperfusion therapy shifted from primary percutaneous coronary intervention in 71% of patients with normal renal function to fibrinolysis in 58% of those with renal failure. Renal function was associated with a higher rate of complications and an exponential increase in in-hospital mortality from 2.5% to 24.2% across the renal function groups. CONCLUSION Renal insufficiency influences the presentation and reduces the likelihood of receiving treatment according to current guidelines. Short-term prognosis remains poor.
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Affiliation(s)
- K Szummer
- Department of Medicine, Section of Cardiology, Huddinge, Karolinska Institute, Karolinska University Hospital, Stockholm.
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