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Petursson P, Oštarijaš E, Redfors B, Råmunddal T, Angerås O, Völz S, Rawshani A, Hambraeus K, Koul S, Alfredsson J, Hagström H, Loghman H, Hofmann R, Fröbert O, Jernberg T, James S, Erlinge D, Omerovic E. Effects of pharmacological interventions on mortality in patients with Takotsubo syndrome: a report from the SWEDEHEART registry. ESC Heart Fail 2024. [PMID: 38454651 DOI: 10.1002/ehf2.14713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 12/17/2023] [Accepted: 01/18/2024] [Indexed: 03/09/2024] Open
Abstract
AIMS Takotsubo syndrome (TS) is a heart condition mimicking acute myocardial infarction. TS is characterized by a sudden weakening of the heart muscle, usually triggered by physical or emotional stress. In this study, we aimed to investigate the effect of pharmacological interventions on short- and long-term mortality in patients with TS. METHODS AND RESULTS We analysed data from the SWEDEHEART (the Swedish Web System for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies) registry, which included patients who underwent coronary angiography between 2009 and 2016. In total, we identified 1724 patients with TS among 228 263 individuals in the registry. The average age was 66 ± 14 years, and 77% were female. Nearly half of the TS patients (49.4%) presented with non-ST-elevation acute coronary syndrome, and a quarter (25.9%) presented with ST-elevation myocardial infarction. Most patients (79.1%) had non-obstructive coronary artery disease on angiography, while 11.7% had a single-vessel disease and 9.2% had a multivessel disease. All patients received at least one pharmacological intervention; most of them used beta-blockers (77.8% orally and 8.3% intravenously) or antiplatelet agents [aspirin (66.7%) and P2Y12 inhibitors (43.6%)]. According to the Kaplan-Meier estimator, the probability of all-cause mortality was 2.5% after 30 days and 16.6% after 6 years. The median follow-up time was 877 days. Intravenous use of inotropes and diuretics was associated with increased 30 day mortality in TS [hazard ratio (HR) = 9.92 (P < 0.001) and HR = 3.22 (P = 0.001), respectively], while angiotensin-converting enzyme inhibitors and statins were associated with decreased long-term mortality [HR = 0.60 (P = 0.025) and HR = 0.62 (P = 0.040), respectively]. Unfractionated and low-molecular-weight heparins were associated with reduced 30 day mortality [HR = 0.63 (P = 0.01)]. Angiotensin receptor blockers, oral anticoagulants, P2Y12 antagonists, aspirin, and beta-blockers did not statistically correlate with mortality. CONCLUSIONS Our findings suggest that some medications commonly used to treat TS are associated with higher mortality, while others have lower mortality. These results could inform clinical decision-making and improve patient outcomes in TS. Further research is warranted to validate these findings and to identify optimal pharmacological interventions for patients with TS.
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Affiliation(s)
- Petur Petursson
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | - Björn Redfors
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Truls Råmunddal
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Oskar Angerås
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Sebastian Völz
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Araz Rawshani
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | | | - Sasha Koul
- Department of Cardiology, Skåne University Hospital, Lund, Sweden
| | - Joakim Alfredsson
- Department of Cardiology, Linköping University Hospital, Linköping, Sweden
| | - Henrik Hagström
- Department of Cardiology, Umeå University Hospital, Umeå, Sweden
| | - Henareh Loghman
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Robin Hofmann
- Department of Cardiology, Södra Hospital, Stockholm, Sweden
| | - Ole Fröbert
- Department of Cardiology, Örebro University Hospital, Örebro, Sweden
| | - Tomas Jernberg
- Department of Cardiology, Danderyd University Hospital, Stockholm, Sweden
| | - Stefan James
- Department of Cardiology, Uppsala University Hospital, Uppsala, Sweden
| | - David Erlinge
- Department of Cardiology, Skåne University Hospital, Lund, Sweden
| | - Elmir Omerovic
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
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2
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Råmunddal T, Dworeck C, Torild P, Andréen S, Gan LM, Hirlekar G, Ioanes D, Myredal A, Odenstedt J, Petursson P, Pylova T, Töpel F, Völz S, Hilmersson M, Redfors B, Angerås O. Safety and Feasibility Using a Fluid-Filled Wire to Avoid Hydrostatic Errors in Physiological Intracoronary Measurements. Cardiol Res Pract 2024; 2024:6664482. [PMID: 38204600 PMCID: PMC10776192 DOI: 10.1155/2024/6664482] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 12/13/2023] [Accepted: 12/18/2023] [Indexed: 01/12/2024] Open
Abstract
Background Using a fluid-filled wire with a pressure sensor outside the patient compared to a conventional pressure wire may avoid the systematic error introduced by the hydrostatic pressure within the coronary circulation. Aims To assess the safety and effectiveness of the novel fluid-filled wire, Wirecath (Cavis Technologies, Uppsala, Sweden), as well as its ability to avoid the hydrostatic pressure error. Methods and Results The Wirecath pressure wire was used in 45 eligible patients who underwent invasive coronary angiography and had a clinical indication for invasive coronary pressure measurement at Sahlgrenska University Hospital, Gothenburg, Sweden. In 29 patients, a simultaneous measurement was performed with a conventional coronary pressure wire (PressureWire X, Abbott Medical, Plymouth, MN, USA), and in 19 patients, the vertical height difference between the tip of the guide catheter and the wire measure point was measured in a 90-degree lateral angiographic projection. No adverse events caused by the pressure wires were reported. The mean Pd/Pa and mean FFR using the fluid-filled wire and the sensor-tipped wire differed significantly; however, after correcting for the hydrostatic effect, the sensor-tipped wire pressure correlated well with the fluid-filled wire pressure (R = 0.74 vs. R = 0.89 at rest and R = 0.89 vs. R = 0.98 at hyperemia). Conclusion Hydrostatic errors in physiologic measurements can be avoided by using the fluid-filled Wirecath wire, which was safe to use in the present study. This trial is registered with NCT04776577 and NCT04802681.
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Affiliation(s)
- Truls Råmunddal
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Molecular and Clinical Medicine, Institute of Medicine, Gothenburg University, Gothenburg, Sweden
| | - Christian Dworeck
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Molecular and Clinical Medicine, Institute of Medicine, Gothenburg University, Gothenburg, Sweden
| | - Petronella Torild
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Sofie Andréen
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Li-Ming Gan
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Molecular and Clinical Medicine, Institute of Medicine, Gothenburg University, Gothenburg, Sweden
| | - Geir Hirlekar
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Molecular and Clinical Medicine, Institute of Medicine, Gothenburg University, Gothenburg, Sweden
| | - Dan Ioanes
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Anna Myredal
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Molecular and Clinical Medicine, Institute of Medicine, Gothenburg University, Gothenburg, Sweden
| | - Jacob Odenstedt
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Molecular and Clinical Medicine, Institute of Medicine, Gothenburg University, Gothenburg, Sweden
| | - Petur Petursson
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Molecular and Clinical Medicine, Institute of Medicine, Gothenburg University, Gothenburg, Sweden
| | - Tetiana Pylova
- Department of Molecular and Clinical Medicine, Institute of Medicine, Gothenburg University, Gothenburg, Sweden
| | - Fanny Töpel
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Sebastian Völz
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Molecular and Clinical Medicine, Institute of Medicine, Gothenburg University, Gothenburg, Sweden
| | | | - Björn Redfors
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Molecular and Clinical Medicine, Institute of Medicine, Gothenburg University, Gothenburg, Sweden
| | - Oskar Angerås
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Molecular and Clinical Medicine, Institute of Medicine, Gothenburg University, Gothenburg, Sweden
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Gustafsson L, Rawshani A, Råmunddal T, Redfors B, Petursson P, Angerås O, Hirlekar G, Omerovic E, Dworeck C, Völz S, Herlitz J, Hjalmarsson C, Holmqvist LD, Myredal A. Characteristics, survival and neurological outcome in out-of-hospital cardiac arrest in young adults in Sweden: A nationwide study. Resusc Plus 2023; 16:100503. [PMID: 38026135 PMCID: PMC10665903 DOI: 10.1016/j.resplu.2023.100503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 10/19/2023] [Accepted: 10/30/2023] [Indexed: 12/01/2023] Open
Abstract
Aim The aim of this study was to present a comprehensive overview of out-of-hospital cardiac arrests (OHCA) in young adults. Methods The data set analyzed included all cases of OHCA from 1990 to 2020 in the age-range 16-49 years in the Swedish Registry of Cardiopulmonary Resuscitation (SRCR). OHCA between 2010 and 2020 were analyzed in more detail. Clinical characteristics, survival, neurological outcomes, and long-time trends in survival were studied. Logistic regression was used to study 30-days survival, neurological outcomes and Utstein determinants of survival. Results Trends were assessed in 11,180 cases. The annual increase in 30-days survival during 1990-2020 was 5.9% with no decline in neurological function among survivors. Odds ratio (OR) for heart disease as the cause was 0.55 (95% CI 0.44 to 0.67) in 2017-2020 compared to 1990-1993. Corresponding ORs for overdoses and suicide attempts were 1.61 (95% CI 1.23-2.13) and 2.06 (95% CI 1.48-2.94), respectively. Exercise related OHCA was noted in roughly 5%. OR for bystander CPR in 2017-2020 vs 1990-1993 was 3.11 (95% CI 2.57 to 3.78); in 2020 88 % received bystander CPR. EMS response time increased from 6 to 10 minutes. Conclusion Survival has increased 6% annually, resulting in a three-fold increase over 30 years, with stable neurological outcome. EMS response time increased with 66% but the majority now receive bystander CPR. Cardiac arrest due to overdoses and suicide attempts are increasing.
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Affiliation(s)
- Linnea Gustafsson
- University of Gothenburg, Institute of Medicine, Department of Molecular and Clinical Medicine, Sweden
- Sahlgrenska University Hospital, Department of Emergency Medicine, Gothenburg, Sweden
| | - Araz Rawshani
- University of Gothenburg, Institute of Medicine, Department of Molecular and Clinical Medicine, Sweden
- Sahlgrenska University Hospital, Department of Cardiology, Gothenburg, Sweden
- The Swedish Cardiopulmonary Resuscitation Registry, Centre of Registries, Västra Götaland, Gothenburg, Sweden
| | - Truls Råmunddal
- University of Gothenburg, Institute of Medicine, Department of Molecular and Clinical Medicine, Sweden
- Sahlgrenska University Hospital, Department of Cardiology, Gothenburg, Sweden
| | - Björn Redfors
- University of Gothenburg, Institute of Medicine, Department of Molecular and Clinical Medicine, Sweden
- Sahlgrenska University Hospital, Department of Cardiology, Gothenburg, Sweden
| | - Petur Petursson
- University of Gothenburg, Institute of Medicine, Department of Molecular and Clinical Medicine, Sweden
- Sahlgrenska University Hospital, Department of Cardiology, Gothenburg, Sweden
| | - Oskar Angerås
- University of Gothenburg, Institute of Medicine, Department of Molecular and Clinical Medicine, Sweden
- Sahlgrenska University Hospital, Department of Cardiology, Gothenburg, Sweden
| | - Geir Hirlekar
- University of Gothenburg, Institute of Medicine, Department of Molecular and Clinical Medicine, Sweden
- Sahlgrenska University Hospital, Department of Cardiology, Gothenburg, Sweden
| | - Elmir Omerovic
- University of Gothenburg, Institute of Medicine, Department of Molecular and Clinical Medicine, Sweden
- Sahlgrenska University Hospital, Department of Cardiology, Gothenburg, Sweden
| | - Christian Dworeck
- University of Gothenburg, Institute of Medicine, Department of Molecular and Clinical Medicine, Sweden
- Sahlgrenska University Hospital, Department of Cardiology, Gothenburg, Sweden
| | - Sebastian Völz
- University of Gothenburg, Institute of Medicine, Department of Molecular and Clinical Medicine, Sweden
- Sahlgrenska University Hospital, Department of Cardiology, Gothenburg, Sweden
| | - Johan Herlitz
- The Swedish Cardiopulmonary Resuscitation Registry, Centre of Registries, Västra Götaland, Gothenburg, Sweden
| | - Clara Hjalmarsson
- University of Gothenburg, Institute of Medicine, Department of Molecular and Clinical Medicine, Sweden
- Sahlgrenska University Hospital, Department of Cardiology, Gothenburg, Sweden
| | - Lina Dahlén Holmqvist
- University of Gothenburg, Institute of Medicine, Department of Molecular and Clinical Medicine, Sweden
- Sahlgrenska University Hospital, Department of Emergency Medicine, Gothenburg, Sweden
| | - Anna Myredal
- University of Gothenburg, Institute of Medicine, Department of Molecular and Clinical Medicine, Sweden
- Sahlgrenska University Hospital, Department of Cardiology, Gothenburg, Sweden
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Hjärtstam N, Rawshani A, Hellsén G, Råmunddal T. Comorbidities prior to out-of-hospital cardiac arrest and diagnoses at discharge among survivors. Open Heart 2023; 10:e002308. [PMID: 37963682 PMCID: PMC10649799 DOI: 10.1136/openhrt-2023-002308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 10/26/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND Out-of-hospital cardiac arrest (OHCA) has a dismal prognosis with overall survival around 10%. Previous studies have shown conflicting results regarding the prevalence and significance of comorbidities in OHCA, as well as the underlying causes. Previously, 80% of sudden cardiac arrest have been attributed to coronary artery disease. We studied comorbidities and discharge diagnoses in OHCA in all of Sweden. METHODS We used the Swedish Registry of Cardiopulmonary Resuscitation, merged with the Inpatient Registry and Outpatient Registry to identify patients with OHCA from 2010 to 2020 and to collect all their comorbidities as well as discharge diagnoses (among those admitted to hospital). Patient characteristics were described using means, medians and SD. Survival curves were performed among hospitalised patients with acute myocardial infarction (AMI) as well as heart failure. RESULTS A total of 54 484 patients with OHCA were included, of whom 35 894 (66%) were men. The most common comorbidities prior to OHCA were hypertension (43.6%), heart failure (23.6%), chronic ischaemic heart disease (23.6%) and atrial fibrillation (22.0%). Previous AMI was prevalent in 14.8% of men and 10.9% of women. Among women, 18.0% had type 2 diabetes, compared with 19.6% of the men. Among hospitalised patients, 30% were diagnosed with AMI, 27% with hypertension, 20% with ischaemic heart disease and 18% with heart failure as discharge diagnoses. CONCLUSION In summary, we find evidence that nowadays a minority of cardiac arrests are due to coronary artery disease and AMIs and its complications. Only 30% of all cases of OHCA admitted to hospital were diagnosed with AMI. Coronary artery disease is now likely in the minority with regard to causes of OHCA.
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Affiliation(s)
- Nellie Hjärtstam
- Department of Molecular and Clinical Medicine, University of Gothenburg, Goteborg, Sweden
| | - Araz Rawshani
- Department of Molecular and Clinical Medicine, University of Gothenburg, Goteborg, Sweden
- Cardiology, Sahlgrenska University Hospital, Goteborg, Sweden
| | - Gustaf Hellsén
- Department of Molecular and Clinical Medicine, University of Gothenburg, Goteborg, Sweden
- Cardiology, Sahlgrenska University Hospital, Goteborg, Sweden
| | - Truls Råmunddal
- Department of Molecular and Clinical Medicine, University of Gothenburg, Goteborg, Sweden
- Cardiology, Sahlgrenska University Hospital, Goteborg, Sweden
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Hjalmarsson A, Rawshani A, Råmunddal T, Rawshani A, Hjalmarsson C, Myredal A, Höskuldsdottir G, Hessulf F, Hirlekar G, Angerås O, Petursson P. No obesity paradox in out-of-hospital cardiac arrest: Data from the Swedish registry of cardiopulmonary resuscitation. Resusc Plus 2023; 15:100446. [PMID: 37601410 PMCID: PMC10432953 DOI: 10.1016/j.resplu.2023.100446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 07/25/2023] [Accepted: 07/28/2023] [Indexed: 08/22/2023] Open
Abstract
Background Although an "obesity paradox", which states an increased chance of survival for patients with obesity after myocardial infarction has been proposed, it is less clear whether this phenomenon even exists in patients suffering out-of-hospital cardiac arrest (OHCA) and if diabetes, which is often associated with obesity, implies an additional risk. Objective To investigate if and how obesity, with or without diabetes, affects the survival of patients with OHCA. Methods This study included 55,483 patients with OHCA reported to the Swedish Registry of Cardiopulmonary Resuscitation between 2010 and 2020. Patients were classified in five groups: obesity only (Ob), type 1 diabetes only (T1D), type 2 diabetes only (T2D), obesity and any diabetes (ObD), or belonging to the group other (OTH). Patient characteristics and outcomes were studied using descriptive statistics, logistic, and Cox proportional regression. Results Obesity only was found in 2.7% of the study cohort, while 3.2% had obesity and any type of diabetes. Ob patients were significantly younger than all other patients (p ≤ 0.001); the 30 day-survival was 9.6% in Ob, and 10.6%, 7.3%, 6.9%, and 12.7% in T1D, T2D, ObD, and OTH, respectively, with OR (95% CI) of 0.69 (0.57-0.82), 0.78 (0.56-1.05), 0.65 (0.59-0.71), and 0.55 (0.45-0.66) for Ob, T1D, T2D, and ObD, respectively (reference group OTH). No time-related trends in 30-days survival were found. Conclusion Obesity was present in 6% of the population and was associated with younger age and a 30% reduction in survival; a combination of obesity and diabetes further reduced the survival rate.
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Affiliation(s)
- Alfred Hjalmarsson
- Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Araz Rawshani
- Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- The Swedish Cardiopulmonary Resuscitation Registry, Västra Götaland County, Gothenburg, Sweden
| | - Truls Råmunddal
- Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Aidin Rawshani
- Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Clara Hjalmarsson
- Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Anna Myredal
- Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Gudrun Höskuldsdottir
- Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Fredrik Hessulf
- Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Anaesthesiology and Intensive Care Medicine, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Geir Hirlekar
- Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Oskar Angerås
- Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Petur Petursson
- Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Andersen BK, Sejr-Hansen M, Westra J, Campo G, Efterkhari A, Tu S, Escaned J, Koltowski L, Stähli BE, Erglis A, Jaruševičius G, Žiubrytė G, Råmunddal T, Liu T, Wijns W, Landmesser U, Maillard L, Matsuo H, Christiansen EH, Holm NR. Quantitative flow ratio versus fractional flow reserve for guiding percutaneous coronary intervention: design and rationale of the randomised FAVOR III Europe Japan trial. EUROINTERVENTION 2023; 18:e1358-e1364. [PMID: 36648404 PMCID: PMC10068862 DOI: 10.4244/eij-d-21-00214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 10/28/2022] [Indexed: 01/18/2023]
Abstract
Quantitative flow ratio (QFR) is a computation of fractional flow reserve (FFR) based on invasive coronary angiographic images. Calculating QFR is less invasive than measuring FFR and may be associated with lower costs. Current evidence supports the call for an adequately powered randomised comparison of QFR and FFR for the evaluation of intermediate coronary stenosis. The aim of the FAVOR III Europe Japan trial is to investigate if a QFR-based diagnostic strategy yields a non-inferior 12-month clinical outcome compared with a standard FFR-guided strategy in the evaluation of patients with intermediary coronary stenosis. FAVOR III Europe Japan is an investigator-initiated, randomised, clinical outcome, non-inferiority trial scheduled to randomise 2,000 patients with either 1) stable angina pectoris and intermediate coronary stenosis, or 2) indications for functional assessment of at least 1 non-culprit lesion after acute myocardial infarction. Up to 40 international centres will randomise patients to either a QFR-based or a standard FFR-based diagnostic strategy. The primary endpoint of major adverse cardiovascular events is a composite of all-cause mortality, any myocardial infarction, and any unplanned coronary revascularisation at 12 months. QFR could emerge as an adenosine- and wire-free alternative to FFR, making the functional evaluation of intermediary coronary stenosis less invasive and more cost-effective.
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Affiliation(s)
| | | | - Jelmer Westra
- Department of Cardiology, Aarhus University Hospital, Skejby, Denmark
| | - Gianluca Campo
- Cardiology Unit, Azienda Ospedaliera Universitaria di Ferrara, Ferrara, Italy and Maria Cecilia Hospital, GVM Care & Research, Cotignola (RA), Italy
| | - Ashkan Efterkhari
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Shengxian Tu
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Javier Escaned
- Hospital Clinico San Carlos IdISSC, Complutense University of Madrid, Madrid, Spain
| | - Lukasz Koltowski
- Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Barbara E Stähli
- Department of Cardiology, University Heart Center, University Hospital Zürich, Zürich, Switzerland
| | - Andrejs Erglis
- Department of Cardiology, Riga Stradiņš University, Riga, Latvia
| | - Gediminas Jaruševičius
- Department of Cardiology, Hospital of Lithuanian University of Health Sciences Kauno Klinikos, Kaunas, Lithuania and Institute of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Greta Žiubrytė
- Department of Cardiology, Hospital of Lithuanian University of Health Sciences Kauno Klinikos, Kaunas, Lithuania and Institute of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Truls Råmunddal
- Department of Cardiology, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Tommy Liu
- Department of Cardiology, HagaZiekenhuis, The Hague, the Netherlands
| | - William Wijns
- The Lambe Institute for Translational Medicine and Curam, National University of Ireland, Galway, Ireland
| | - Ulf Landmesser
- Department of Cardiology (CBF), Charite - Universitätsmedizin Berlin, Berlin, Germany
| | - Luc Maillard
- GCS ES Axium Rambot, Clinique Axium, Aix-en-Provence, France
| | - Hitoshi Matsuo
- Department of Cardiovascular Medicine, Gifu Heart Center, Gifu, Japan
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7
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Hellsén G, Rawshani A, Skoglund K, Bergh N, Råmunddal T, Myredal A, Helleryd E, Taha A, Mahmoud A, Hjärtstam N, Backelin C, Dahlberg P, Hessulf F, Herlitz J, Engdahl J, Rawshani A. Predicting recurrent cardiac arrest in individuals surviving Out-of-Hospital cardiac arrest. Resuscitation 2023; 184:109678. [PMID: 36581182 DOI: 10.1016/j.resuscitation.2022.109678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/16/2022] [Accepted: 12/18/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND Despite improvements in short-term survival for Out-of-Hospital Cardiac Arrest (OHCA) in the past two decades, long-term survival is still not well studied. Furthermore, the contribution of different variables on long-term survival have not been fully investigated. AIM Examine the 1-year prognosis of patients discharged from hospital after an OHCA. Furthermore, identify factors predicting re-arrest and/or death during 1-year follow-up. METHODS All patients 18 years or older surviving an OHCA and discharged from the hospital were identified from the Swedish Register for Cardiopulmonary Resuscitation (SRCR). Data on diagnoses, medications and socioeconomic factors was gathered from other Swedish registers. A machine learning model was constructed with 886 variables and evaluated for its predictive capabilities. Variable importance was gathered from the model and new models with the most important variables were created. RESULTS Out of the 5098 patients included, 902 (∼18%) suffered a recurrent cardiac arrest or death within a year. For the outcome death or re-arrest within 1 year from discharge the model achieved an ROC (receiver operating characteristics) AUC (area under the curve) of 0.73. A model with the 15 most important variables achieved an AUC of 0.69. CONCLUSIONS Survivors of an OHCA have a high risk of suffering a re-arrest or death within 1 year from hospital discharge. A machine learning model with 15 different variables, among which age, socioeconomic factors and neurofunctional status at hospital discharge, achieved almost the same predictive capabilities with reasonable precision as the full model with 886 variables.
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Affiliation(s)
- Gustaf Hellsén
- Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden.
| | - Aidin Rawshani
- Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Kristofer Skoglund
- Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Niklas Bergh
- Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Truls Råmunddal
- Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Anna Myredal
- Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Edvin Helleryd
- Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Amar Taha
- Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Ahmad Mahmoud
- Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Nellie Hjärtstam
- Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Charlotte Backelin
- Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Pia Dahlberg
- Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Fredrik Hessulf
- Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Johan Herlitz
- Research Centre PreHospen, University of Borås, Borås, Sweden
| | - Johan Engdahl
- Karolinska Institutet, Department of Clinical Sciences, Danderyds Hospital, Stockholm, Sweden
| | - Araz Rawshani
- Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden
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8
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Råmunddal T, Holck EN, Karim S, Eftekhari A, Escaned J, Ioanes D, Walsh S, Spratt J, Veien K, Jensen LO, Tilsted HH, Terkelsen CJ, Havndrup O, Olsen NT, Kajander OA, Faurie B, Lanematt P, Jakobsen L, Christiansen EH. International randomized trial on the effect of revascularization or optimal medical therapy of chronic total coronary occlusions with myocardial ischemia - ISCHEMIA-CTO trial - rationale and design. Am Heart J 2023; 257:41-50. [PMID: 36423733 DOI: 10.1016/j.ahj.2022.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 11/11/2022] [Accepted: 11/15/2022] [Indexed: 05/11/2023]
Abstract
BACKGROUND Chronic total occlusions (CTO) are frequent among patients with coronary artery disease. Revascularization with percutaneous coronary intervention (PCI) is safe and feasible in experienced hands. However, randomized data are needed to demonstrate symptomatic as well as prognostic effect of CTO-PCI compared to optimal medical therapy alone. METHODS This trial aims to evaluate the effect of CTO PCI in patients with a CTO lesion and target vessel diameter ≥ 2.5 mm, and myocardial ischemia in the relevant territory. First, all patients are subjected to optimal medical therapy (OMT) for at least for 3 months and non-CTO lesions are managed according to guidelines. Subsequently, prior to randomization myocardial ischemia and quality of life (Seattle Questionnaire (SAQ)) is assessed. Patients are divided into two cohorts based on their SAQ score and randomized to either OMT alone or OMT and CTO-PCI. Cohort A is defined as Low- or asymptomatic patients with a quality-of-life score > 60 and/or CCS class < 2, and more than 10 % ischemia in the left ventricle (LV). Cohort B is symptomatic patients with a quality-of-life score < 60 or CCS class angina > 1 and at least ischemia in 5% of the LV. The primary end-point in cohort A is a composite of major adverse cardiac and cerebral events, hospitalization for heart failure and malignant ventricular arrhythmias. The primary endpoint in cohort B is difference in quality of life 6 months after randomization. IMPLICATIONS This trial is designed to investigate if CTO-PCI improves QoL and MACCE. Both positive and negative outcome of the trial will affect future guidelines and recommendations on how to treat patients with CTO.
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Affiliation(s)
| | | | - Salma Karim
- Dept. Cardiology Aarhus University Hospital, Skejby, Denmark
| | - Ashkan Eftekhari
- Dept. of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Javier Escaned
- Hospital Universitario Clíníco San Carlos, Madrid, Spain
| | - Dan Ioanes
- Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Simon Walsh
- Cardiology Department, Belfast Health & Social Care Trust Belfast, Northern Ireland, United Kingdom
| | - James Spratt
- Edinburgh Royal Infirmary, Edinburgh, United Kingdom
| | | | | | | | | | | | - Niels Thue Olsen
- Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
| | - Olli A Kajander
- Tays Heart Hospital and Tampere University, Tampere, Finland
| | - Benjamin Faurie
- Cardiovascular Institute, Groupe Hospitalier Mutualiste, Grenoble, France
| | | | - Lars Jakobsen
- Dept. Cardiology Aarhus University Hospital, Skejby, Denmark
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9
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Zeijlon R, Jha S, Le V, Chamat J, Shekka Espinosa A, Poller A, Thorleifsson S, Bobbio E, Mellberg T, Pirazzi C, Gudmundsson T, Martinsson A, Angerås O, Råmunddal T, Omerovic E, Redfors B. Temporal electrocardiographic changes in anterior ST elevation myocardial infarction versus the Takotsubo syndrome. Int J Cardiol Heart Vasc 2023; 45:101187. [PMID: 36861065 PMCID: PMC9969279 DOI: 10.1016/j.ijcha.2023.101187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 02/07/2023] [Accepted: 02/12/2023] [Indexed: 02/22/2023]
Abstract
Background Electrocardiography (ECG) on admission is similar in ST elevation myocardial infarction (STEMI) and Takotsubo syndrome (TTS). ECG on admission has been extensively investigated and compared between STEMI and TTS, however, only a few studies have compared temporal ECG. Our aim was to compare ECG in anterior STEMI versus female TTS from admission to day 30. Methods Adult patients with anterior STEMI or TTS treated at Sahlgrenska University Hospital (Gothenburg, Sweden) from December 2019 to June 2022 were prospectively enrolled. Baseline characteristics, clinical variables and ECGs from admission to day 30 were analyzed. Using a mixed effects model, we compared temporal ECG between female patients with anterior STEMI or TTS, as well as between female and male patients with anterior STEMI. Results A total of 101 anterior STEMI patients (31 female, 70 male) and 34 TTS patients (29 female, 5 male) were included. The temporal pattern of T wave inversion was similar between female anterior STEMI and female TTS, as well as between female and male anterior STEMI. ST elevation was more common, whereas QT prolongation was less common, in anterior STEMI compared with TTS. Q wave pathology was more similar between female anterior STEMI and female TTS than between female and male anterior STEMI. Conclusions The pattern of T wave inversion and Q wave pathology from admission to day 30 was similar in female patients with anterior STEMI and female patients with TTS. Temporal ECG in female patients with TTS may be interpreted as following a "transient ischemic" pattern.
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Affiliation(s)
- Rickard Zeijlon
- Department of Cardiology, Sahlgrenska University Hospital/S, Gothenburg, Sweden,Department of Internal Medicine, Sahlgrenska University Hospital/S, Gothenburg, Sweden,Department of Molecular and Clinical Medicine/Wallenberg laboratory, Institute of Medicine, Sahlgrenska Academy/University of Gothenburg, Sweden,Corresponding author at: Department of Internal Medicine, Sahlgrenska University Hospital/S, 413 45 Gothenburg, Sweden.
| | - Sandeep Jha
- Department of Cardiology, Sahlgrenska University Hospital/S, Gothenburg, Sweden,Department of Molecular and Clinical Medicine/Wallenberg laboratory, Institute of Medicine, Sahlgrenska Academy/University of Gothenburg, Sweden
| | - Vina Le
- Department of Molecular and Clinical Medicine/Wallenberg laboratory, Institute of Medicine, Sahlgrenska Academy/University of Gothenburg, Sweden
| | - Jasmina Chamat
- Department of Cardiology, Sahlgrenska University Hospital/Ö, Gothenburg, Sweden,Department of Molecular and Clinical Medicine/Wallenberg laboratory, Institute of Medicine, Sahlgrenska Academy/University of Gothenburg, Sweden
| | - Aaron Shekka Espinosa
- Department of Cardiology, Sahlgrenska University Hospital/S, Gothenburg, Sweden,Department of Molecular and Clinical Medicine/Wallenberg laboratory, Institute of Medicine, Sahlgrenska Academy/University of Gothenburg, Sweden
| | - Angela Poller
- Department of Cardiology, Sahlgrenska University Hospital/S, Gothenburg, Sweden,Department of Molecular and Clinical Medicine/Wallenberg laboratory, Institute of Medicine, Sahlgrenska Academy/University of Gothenburg, Sweden
| | - Sigurdur Thorleifsson
- Department of Cardiology, Sahlgrenska University Hospital/S, Gothenburg, Sweden,Department of Molecular and Clinical Medicine/Wallenberg laboratory, Institute of Medicine, Sahlgrenska Academy/University of Gothenburg, Sweden
| | - Emanuele Bobbio
- Department of Cardiology, Sahlgrenska University Hospital/S, Gothenburg, Sweden
| | - Tomas Mellberg
- Department of Cardiology, Sahlgrenska University Hospital/S, Gothenburg, Sweden
| | - Carlo Pirazzi
- Department of Cardiology, Sahlgrenska University Hospital/S, Gothenburg, Sweden
| | | | - Andreas Martinsson
- Department of Cardiology, Sahlgrenska University Hospital/S, Gothenburg, Sweden
| | - Oskar Angerås
- Department of Cardiology, Sahlgrenska University Hospital/S, Gothenburg, Sweden,Department of Molecular and Clinical Medicine/Wallenberg laboratory, Institute of Medicine, Sahlgrenska Academy/University of Gothenburg, Sweden
| | - Truls Råmunddal
- Department of Cardiology, Sahlgrenska University Hospital/S, Gothenburg, Sweden,Department of Molecular and Clinical Medicine/Wallenberg laboratory, Institute of Medicine, Sahlgrenska Academy/University of Gothenburg, Sweden
| | - Elmir Omerovic
- Department of Cardiology, Sahlgrenska University Hospital/S, Gothenburg, Sweden,Department of Molecular and Clinical Medicine/Wallenberg laboratory, Institute of Medicine, Sahlgrenska Academy/University of Gothenburg, Sweden
| | - Björn Redfors
- Department of Cardiology, Sahlgrenska University Hospital/S, Gothenburg, Sweden,Department of Molecular and Clinical Medicine/Wallenberg laboratory, Institute of Medicine, Sahlgrenska Academy/University of Gothenburg, Sweden,Clinical Trial Center, Cardiovascular Research Foundation, NY, USA,Department of Cardiology, New York-Presbyterian Hospital/Columbia University Medical Center, New York, USA
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10
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Jonasson MP, Töpel F, Redfors B, Råmunddal T, Angerås O, Larsson M. RADIATION PROTECTION IN CARDIAC INTERVENTIONS. Phys Med 2022. [DOI: 10.1016/s1120-1797(22)02196-2] [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: 12/15/2022] Open
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11
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Rawshani A, Hessulf F, Völz S, Dworeck C, Odenstedt J, Råmunddal T, Hirlekar G, Petursson P, Angerås O, Ioanes D, Myredal A. Characteristics, survival and neurological outcome in out-of-hospital cardiac arrest: A nationwide study of 56,203 cases with emphasis on cardiovascular comorbidities. Resusc Plus 2022; 11:100294. [PMID: 36059386 PMCID: PMC9428786 DOI: 10.1016/j.resplu.2022.100294] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 08/04/2022] [Accepted: 08/08/2022] [Indexed: 11/28/2022] Open
Abstract
Background We studied clinical characteristics, survival and neurological outcomes in patients with pre-existing cardiovascular (CV) conditions who experienced an out-of-hospital cardiac arrest (OHCA). Methods We studied all cases of OHCA in the Swedish Registry for Cardiopulmonary Resuscitation (2010–2020). Patients were grouped according to the following pre-existing CV conditions prior: hypertension (HT), heart failure (HF) with HT, HF with ischemic heart disease (IHD), HF without HT or IHD, IHD, myocardial infarction (MI) and diabetes mellitus (DM), with groups being mutually exclusive. We studied 30-day survival and neurological outcomes using logistic and Cox regression. Results A total of 56,203 patients were included. The lowest rates of shockable rhythm occurred in cases with HT (19%), HF and HT (18%) and DM (18%). Median time to OHCA from diagnosis of HT was 2.0 years in cases aged 0–40 years at diagnosis of HT, 4.4 years in those aged 41–60 at diagnosis, 5.0 years in those aged 61–70 years, 5.6 years in those aged 71–80 years and 6.0 years in those aged 81 years or older. The lowest survival was noted for patients with HF and HT. Age and sex adjusted OR for CPC score 1 did not differ in any group. Conclusion The combination of HT and HF has the lowest survival of all cardiovascular comorbidities. Early onset of hypertension is a predictor for early cardiac arrest.
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Affiliation(s)
- Araz Rawshani
- University of Gothenburg, Institute of Medicine, Department of Molecular and Clinical Medicine, Sweden
- Sahlgrenska University Hospital, Department of Cardiology, Gothenburg, Sweden
- The Swedish Cardiopulmonary Resuscitation Registry, Centre of Registries, Västra Götaland, Gothenburg, Sweden
| | - Fredrik Hessulf
- University of Gothenburg, Institute of Medicine, Department of Molecular and Clinical Medicine, Sweden
- Department of Anesthesiology and Intensive Care Medicine, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Sebastian Völz
- University of Gothenburg, Institute of Medicine, Department of Molecular and Clinical Medicine, Sweden
- Sahlgrenska University Hospital, Department of Cardiology, Gothenburg, Sweden
| | - Christian Dworeck
- University of Gothenburg, Institute of Medicine, Department of Molecular and Clinical Medicine, Sweden
- Sahlgrenska University Hospital, Department of Cardiology, Gothenburg, Sweden
| | - Jacob Odenstedt
- University of Gothenburg, Institute of Medicine, Department of Molecular and Clinical Medicine, Sweden
- Sahlgrenska University Hospital, Department of Cardiology, Gothenburg, Sweden
| | - Truls Råmunddal
- University of Gothenburg, Institute of Medicine, Department of Molecular and Clinical Medicine, Sweden
- Sahlgrenska University Hospital, Department of Cardiology, Gothenburg, Sweden
| | - Geir Hirlekar
- University of Gothenburg, Institute of Medicine, Department of Molecular and Clinical Medicine, Sweden
- Sahlgrenska University Hospital, Department of Cardiology, Gothenburg, Sweden
| | - Petur Petursson
- University of Gothenburg, Institute of Medicine, Department of Molecular and Clinical Medicine, Sweden
- Sahlgrenska University Hospital, Department of Cardiology, Gothenburg, Sweden
| | - Oskar Angerås
- University of Gothenburg, Institute of Medicine, Department of Molecular and Clinical Medicine, Sweden
- Sahlgrenska University Hospital, Department of Cardiology, Gothenburg, Sweden
| | - Dan Ioanes
- University of Gothenburg, Institute of Medicine, Department of Molecular and Clinical Medicine, Sweden
| | - Anna Myredal
- University of Gothenburg, Institute of Medicine, Department of Molecular and Clinical Medicine, Sweden
- Sahlgrenska University Hospital, Department of Cardiology, Gothenburg, Sweden
- Corresponding author at: University of Gothenburg, Institute of Medicine, Department of Molecular and Clinical Medicine, Sweden.
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12
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Angerås O, Töpel F, Jonasson P, Larsson M, Redfors B, Råmunddal T. Radiation Protection in Cardiac Interventions Using the Rampart® System. Cardiovascular Revascularization Medicine 2022. [DOI: 10.1016/j.carrev.2022.06.117] [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] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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13
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Zeijlon R, Chamat J, Le V, Wågerman J, Enabtawi I, Jha S, Mohammed MM, Shekka Espinosa A, Angerås O, Råmunddal T, Omerovic E, Redfors B. ECG differences and ECG predictors in patients presenting with ST segment elevation due to myocardial infarction versus takotsubo syndrome. IJC Heart & Vasculature 2022; 40:101047. [PMID: 35573653 PMCID: PMC9096129 DOI: 10.1016/j.ijcha.2022.101047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 04/22/2022] [Accepted: 04/28/2022] [Indexed: 11/30/2022]
Abstract
Takotsubo syndrome and myocardial infarction can present with ST segment elevation. ECG in Takotsubo resembles left anterior descending artery myocardial infarction. Ventricular arrhythmia or death occur in both Takotsubo and myocardial infarction. ST segment changes predict ventricular arrhythmia or death in myocardial infarction. ST segment changes do not predict ventricular arrhythmia in Takotsubo syndrome.
Background Previous studies comparing electrocardiogram (ECG) in Takotsubo syndrome (TS) versus ST elevation myocardial infarction (STEMI) included TS patients without ST elevation, did not consider the culprit lesion in STEMI or had groups that were unbalanced regarding sex and age. Accounting for these factors, we sought to conduct a more reliable comparison of ECG in TS with ST-elevation (STE-TS) versus STEMI. The secondary aim was to investigate if ST segment changes, T wave inversion or prolonged QT interval predicted ventricular arrhythmia or death in STE-TS and STEMI. Methods All STE-TS patients who presented at Sahlgrenska University Hospital between 2008 and 2019 were matched by sex and age to STEMI patients. STEMI patients were subcategorized according to whether or not the culprit lesion was located in the left anterior descending artery (LAD). Baseline characteristics, in‐hospital outcomes and admission ECGs were analyzed. Results 104 STE-TS patients were sex- and age-matched with 274 STEMI patients (113 LAD-STEMI, 161 non-LAD STEMI). Admission ECG in STE-TS was more similar to LAD STEMI than non-LAD STEMI. Reciprocal ST depression was less common in STE-TS (7/104, 6.7%) compared with STEMI (112/274, 41%; p= < 0.001). The sum of all ST elevations and the sum of all ST-deviations predicted life-threatening ventricular arrhythmia (LTVA) or death in LAD STEMI but not in STE-TS. Conclusions In conclusion, admission ECG in STE-TS was similar to LAD STEMI but reciprocal ST depression was less common in STE-TS compared with STEMI overall. ST segment changes predicted LTVA or death in STEMI but not in STE-TS.
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14
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Bollano E, Redfors B, Rawshani A, Venetsanos D, Völz S, Angerås O, Ljungman C, Alfredsson J, Jernberg T, Råmunddal T, Petursson P, Smith JG, Braun O, Hagström H, Fröbert O, Erlinge D, Omerovic E. Temporal trends in characteristics and outcome of heart failure patients with and without significant coronary artery disease. ESC Heart Fail 2022; 9:1812-1822. [PMID: 35261201 PMCID: PMC9065869 DOI: 10.1002/ehf2.13875] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 01/27/2022] [Accepted: 02/22/2022] [Indexed: 01/23/2023] Open
Abstract
AIMS Ischaemic coronary artery disease (CAD) remains the leading cause of mortality globally due to sudden death and heart failure (HF). Invasive coronary angiography (CAG) is the gold standard for evaluating the presence and severity of CAD. Our objective was to assess temporal trends in CAG utilization, patient characteristics, and prognosis in HF patients undergoing CAG at a national level. METHODS AND RESULTS We used data from the Swedish Coronary Angiography and Angioplasty Registry. Data on all patients undergoing CAG for HF indication in Sweden between 2000 and 2018 were collected and analysed. Long-term survival was estimated with multivariable Cox proportional hazards regression adjusted for differences in patient characteristics. In total, 22 457 patients (73% men) with mean age 64.2 ± 11.3 years were included in the study. The patients were increasingly older with more comorbidities over time. The number of CAG specifically for HF indication increased by 5.5% per calendar year (P < 0.001). No such increase was seen for indications angina pectoris and ST-elevation myocardial infarction. A normal CAG or non-obstructive CAD was reported in 63.2% (HF-NCAD), and 36.8% had >50% diameter stenosis in one or more coronary arteries (HF-CAD). The median follow-up time was 3.6 years in HF-CAD and 5 years in HF-NCAD. Age and sex-adjusted survival improved linearly by 1.3% per calendar year in all patients. Compared with HF-NCAD, long-term mortality was higher in HF-CAD patients. The risk of death increased with the increasing severity of CAD. Compared with HF-NCAD, the risk estimate in patients with a single-vessel disease was higher [hazard ratio (HR) 1.3; 95% confidence interval (CI) 1.20-1.41; P < 0.001], a multivessel disease without the involvement of left main coronary artery (HR 1.72; 95% CI 1.58-1.88; P < 0.001), and with left main disease (HR 2.02; 95% CI 1.88-2.18; P < 0.001). The number of HF patients undergoing revascularization with percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) increased by 7.5% (P < 0.001) per calendar year. The majority (53.4%) of HF-CAD patients were treated medically, while a minority (46.6%) were referred for revascularization with PCI or CABG. Compared with patients treated with PCI, the proportion of patients treated medically or with CABG decreased substantially (P < 0.001). CONCLUSIONS Over 18 years, the number of patients with HF undergoing CAG has increased substantially. Expanded utilization of CAG increased the number of HF patients treated with percutaneous coronary intervention and coronary artery bypass surgery. Long-term survival improved in all HF patients despite a steady increase of elderly patients with comorbidities.
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Affiliation(s)
- Entela Bollano
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, 413 45, Sweden.,Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Björn Redfors
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, 413 45, Sweden.,Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Araz Rawshani
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, 413 45, Sweden.,Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Dimitrios Venetsanos
- Department of Cardiology, and Department of Health, Medicine and Caring Sciences, Unit of Cardiovascular Sciences, Linköping University, Linköping, Sweden
| | - Sebastian Völz
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, 413 45, Sweden.,Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Oskar Angerås
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, 413 45, Sweden
| | - Charlotta Ljungman
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, 413 45, Sweden.,Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Joakim Alfredsson
- Department of Cardiology, and Department of Health, Medicine and Caring Sciences, Unit of Cardiovascular Sciences, Linköping University, Linköping, Sweden
| | - Tomas Jernberg
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd Hospital, Stockholm, Sweden
| | - Truls Råmunddal
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, 413 45, Sweden
| | - Petur Petursson
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, 413 45, Sweden
| | - J Gustav Smith
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, 413 45, Sweden.,Department of Cardiology, Clinical Sciences, Lund University, and Skåne University Hospital, Lund, Sweden.,Wallenberg Center for Molecular Medicine and Lund University Diabetes Center, Lund University, Lund, Sweden
| | - Oscar Braun
- Department of Cardiology, Clinical Sciences, Lund University, and Skåne University Hospital, Lund, Sweden
| | - Henrik Hagström
- Department of Public Health and Clinical Medicine, Umeå University, and Heart Centre, Umeå University Hospital, Umeå, Sweden
| | - Ole Fröbert
- Department of Cardiology, Faculty of Health, Örebro University, Örebro, Sweden
| | - David Erlinge
- Department of Cardiology, Clinical Sciences, Lund University, and Skåne University Hospital, Lund, Sweden
| | - Elmir Omerovic
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, 413 45, Sweden.,Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
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15
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James S, Koul S, Andersson J, Angerås O, Bhiladvala P, Calais F, Danielewicz M, Fröbert O, Grimfjärd P, Götberg M, Henareh L, Ioanes D, Jensen J, Linder R, Lindroos P, Omerovic E, Panayi G, Råmunddal T, Sarno G, Ulvenstam A, Völtz S, Wagner H, Wikström H, Östlund O, Erlinge D. Bivalirudin Versus Heparin Monotherapy in ST-Segment-Elevation Myocardial Infarction. Circ Cardiovasc Interv 2021; 14:e008969. [PMID: 34903034 DOI: 10.1161/circinterventions.120.008969] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 11/16/2022]
Abstract
BACKGROUND Bivalirudin was not superior to unfractionated heparin in patients with myocardial infarction (MI) treated with percutaneous coronary intervention and no planned use of GPI (glycoprotein IIb/IIIa inhibitors) in contemporary clinical practice of radial access and potent P2Y12-inhibitors in the VALIDATE-SWEDEHEART randomized clinical trial (Bivalirudin Versus Heparin in STEMI and NSTEMI Patients on Modern Antiplatelet Therapy-Swedish Web-System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies Registry). METHODS In this prespecified separately powered subgroup analysis, we included patients with ST-segment-elevation MI undergoing primary percutaneous coronary intervention with the primary composite end point of all-cause death, MI, or major bleeding event within 180 days. RESULTS Among the 6006 patients enrolled in the trial, 3005 patients with ST-segment-elevation MI were randomized to receive bivalirudin or heparin. The mean age was 66.8 years. According to protocol recommendations, 87% were treated with potent oral P2Y12-inhibitors before start of angiography and radial access was used in 90%. GPI was used in 51 (3.4%) and 74 (4.9%) of patients randomized to receive bivalirudin and heparin, respectively. The primary end point occurred in 12.5% (187 of 1501) and 13.0% (196 of 1504; hazard ratio [HR], 0.95 [95% CI, 0.78-1.17], P=0.64) with consistent results in all major subgroups. All-cause death occurred in 3.9% versus 3.9% (HR, 1.00 [0.70-1.45], P=0.98), MI in 1.7% versus 2.2% (HR, 0.76 [0.45-1.28], P=0.30), major bleeding in 8.3% versus 8.0% (HR, 1.04 [0.81-1.33], P=0.78), and definite stent thrombosis in 0.5% versus 1.3% (HR, 0.42 [0.18-0.96], P=0.04). CONCLUSIONS In patients with ST-segment-elevation MI undergoing primary percutaneous coronary intervention with radial access and receiving current recommended treatments with potent P2Y12-inhibitors rate of the composite of all-cause death, MI, or major bleeding was not lower in those randomized to receive bivalirudin as compared with heparin. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02311231.
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Affiliation(s)
- Stefan James
- Department of Medical Sciences (S.J., G.S.), Uppsala University, Sweden
| | - Sasha Koul
- Department of Cardiology, Clinical Sciences, Lund University, Sweden (S.K., P.B., M.G., D.E.)
| | | | - Oskar Angerås
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden (O.A., D.I., E.O., T.R., S.V.)
| | - Pallonji Bhiladvala
- Department of Cardiology, Clinical Sciences, Lund University, Sweden (S.K., P.B., M.G., D.E.)
| | - Fredrik Calais
- Department of Cardiology, Faculty of Health, Örebro University, Sweden (F.C., O.F.)
| | | | - Ole Fröbert
- Department of Cardiology, Faculty of Health, Örebro University, Sweden (F.C., O.F.)
| | - Per Grimfjärd
- Department of Internal Medicine, Västmanlands Sjukhus, Västerås, Sweden (P.G.)
| | - Matthias Götberg
- Department of Cardiology, Clinical Sciences, Lund University, Sweden (S.K., P.B., M.G., D.E.)
| | - Loghman Henareh
- Department of Cardiology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden (L.H.)
| | - Dan Ioanes
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden (O.A., D.I., E.O., T.R., S.V.)
| | - Jens Jensen
- Department of Cardiology, Capio St Görans Hospital AB, Stockholm, Sweden (J.J., P.L.)
| | - Rikard Linder
- Department of Cardiology, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden (R.L.)
| | - Pontus Lindroos
- Department of Cardiology, Capio St Görans Hospital AB, Stockholm, Sweden (J.J., P.L.)
| | - Elmir Omerovic
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden (O.A., D.I., E.O., T.R., S.V.)
| | - Georgios Panayi
- Department of Cardiology, Linköping University, Sweden (G.P.)
| | - Truls Råmunddal
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden (O.A., D.I., E.O., T.R., S.V.)
| | - Giovanna Sarno
- Department of Medical Sciences (S.J., G.S.), Uppsala University, Sweden
| | | | - Sebastian Völtz
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden (O.A., D.I., E.O., T.R., S.V.)
| | - Henrik Wagner
- Department of Cardiology, Helsingborg Lasarett, Sweden (H. Wagner)
| | - Helena Wikström
- Department of Cardiology, Kristianstad Hospital, Sweden (H. Wikström)
| | - Ollie Östlund
- Uppsala Clinical Research Center (O.Ö.), Uppsala University, Sweden
| | - David Erlinge
- Department of Cardiology, Clinical Sciences, Lund University, Sweden (S.K., P.B., M.G., D.E.)
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16
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Wu EB, Brilakis ES, Mashayekhi K, Tsuchikane E, Alaswad K, Araya M, Avran A, Azzalini L, Babunashvili AM, Bayani B, Behnes M, Bhindi R, Boudou N, Boukhris M, Bozinovic NZ, Bryniarski L, Bufe A, Buller CE, Burke MN, Buttner A, Cardoso P, Carlino M, Chen JY, Christiansen EH, Colombo A, Croce K, de Los Santos FD, de Martini T, Dens J, di Mario C, Dou K, Egred M, Elbarouni B, ElGuindy AM, Escaned J, Furkalo S, Gagnor A, Galassi AR, Garbo R, Gasparini G, Ge J, Ge L, Goel PK, Goktekin O, Gonzalo N, Grancini L, Hall A, Hanna Quesada FL, Hanratty C, Harb S, Harding SA, Hatem R, Henriques JPS, Hildick-Smith D, Hill JM, Hoye A, Jaber W, Jaffer FA, Jang Y, Jussila R, Kalnins A, Kalyanasundaram A, Kandzari DE, Kao HL, Karmpaliotis D, Kassem HH, Khatri J, Knaapen P, Kornowski R, Krestyaninov O, Kumar AVG, Lamelas PM, Lee SW, Lefevre T, Leung R, Li Y, Li Y, Lim ST, Lo S, Lombardi W, Maran A, McEntegart M, Moses J, Munawar M, Navarro A, Ngo HM, Nicholson W, Oksnes A, Olivecrona GK, Padilla L, Patel M, Pershad A, Postu M, Qian J, Quadros A, Rafeh NA, Råmunddal T, Prakasa Rao VS, Reifart N, Riley RF, Rinfret S, Saghatelyan M, Sianos G, Smith E, Spaedy A, Spratt J, Stone G, Strange JW, Tammam KO, Thompson CA, Toma A, Tremmel JA, Trinidad RS, Ungi I, Vo M, Vu VH, Walsh S, Werner G, Wojcik J, Wollmuth J, Xu B, Yamane M, Ybarra LF, Yeh RW, Zhang Q. Global Chronic Total Occlusion Crossing Algorithm: JACC State-of-the-Art Review. J Am Coll Cardiol 2021; 78:840-853. [PMID: 34412818 DOI: 10.1016/j.jacc.2021.05.055] [Citation(s) in RCA: 83] [Impact Index Per Article: 27.7] [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: 03/19/2021] [Revised: 04/16/2021] [Accepted: 05/17/2021] [Indexed: 11/16/2022]
Abstract
The authors developed a global chronic total occlusion crossing algorithm following 10 steps: 1) dual angiography; 2) careful angiographic review focusing on proximal cap morphology, occlusion segment, distal vessel quality, and collateral circulation; 3) approaching proximal cap ambiguity using intravascular ultrasound, retrograde, and move-the-cap techniques; 4) approaching poor distal vessel quality using the retrograde approach and bifurcation at the distal cap by use of a dual-lumen catheter and intravascular ultrasound; 5) feasibility of retrograde crossing through grafts and septal and epicardial collateral vessels; 6) antegrade wiring strategies; 7) retrograde approach; 8) changing strategy when failing to achieve progress; 9) considering performing an investment procedure if crossing attempts fail; and 10) stopping when reaching high radiation or contrast dose or in case of long procedural time, occurrence of a serious complication, operator and patient fatigue, or lack of expertise or equipment. This algorithm can improve outcomes and expand discussion, research, and collaboration.
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Affiliation(s)
- Eugene B Wu
- Prince of Wales Hospital, Chinese University Hong Kong, Hong Kong.
| | - Emmanouil S Brilakis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Kambis Mashayekhi
- Department of Cardiology and Angiology, II University Heart Center Freiburg, Bad Krozingen, Germany
| | | | - Khaldoon Alaswad
- Edith and Benson Ford Heart and Vascular Institute, Henry Ford Hospital, Henry Ford Health System, Wayne State University, Detroit, Michigan, USA
| | - Mario Araya
- Clinica Alemana, Hospital Militar de Santiago, Santiago, Chile
| | | | - Lorenzo Azzalini
- Division of Cardiology, VCU Health Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA
| | | | | | - Michael Behnes
- First Department of Medicine, University Medical Centre Mannheim, Faculty of Medicine Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Ravinay Bhindi
- Royal North Shore Hospital, University of Sydney, Sydney, Australia
| | - Nicolas Boudou
- Interventional Cardiology, Clinique Saint Augustin, Bordeaux, France
| | - Marouane Boukhris
- Cardiology Department, Abderrahment Mami Hospital, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | | | - Leszek Bryniarski
- II Department of Cardiology and Cardiovascular Interventions, Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - Alexander Bufe
- Heart Center Krefeld, University Witten/Herdecke, Witten, Germany
| | - Christopher E Buller
- Teleflex, Markham, Ontario, Canada; St. Michael's Hospital, Toronto, Ontario, Canada
| | - M Nicholas Burke
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | | | - Pedro Cardoso
- Santa Maria University Hospital, Lisbon Academic Medical Centre and Centro Cardiovascular da Universidade de Lisboa, Lisbon, Portugal
| | - Mauro Carlino
- Interventional Cardiology Unit, Cardio-Thoracic-Vascular Department, IRCCS, San Raffaele Scientific Institute, Milan, Italy
| | - Ji-Yan Chen
- Guangdong General Hospital, Guangdong, China
| | | | - Antonio Colombo
- Cardiology, Humanitas University, Humanitas IRCCS, Rozzano, Milan, Italy
| | - Kevin Croce
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | | | | | - Carlo di Mario
- Department of Clinical & Experimental Medicine, University Hospital Careggi, Florence, Italy
| | - Kefei Dou
- Research Center for Coronary Heart Disease, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Mohaned Egred
- Freeman Hospital & Newcastle University, Newcastle upon Tyne, UK
| | - Basem Elbarouni
- St. Boniface Hospital & University of Manitoba, Winnipeg, Manitoba, Canada
| | - Ahmed M ElGuindy
- Department of Cardiology, Aswan Heart Centre, Magdi Yacoub Foundation, Aswan, Egypt
| | - Javier Escaned
- Hospital Clinico San Carlos, IdISSC, Complutense University of Madrid, Madrid, Spain
| | - Sergey Furkalo
- National Institute of Surgery and Transplantology NAMS, Kiev, Ukraine
| | - Andrea Gagnor
- Department of Invasive Cardiology, Maria Vittoria Hospital, Turin, Italy
| | - Alfredo R Galassi
- Cardiovascular Medicine Department of PROMISE University of Palermo, Palermo, Italy
| | - Roberto Garbo
- Maria Pia Hospital, GVM Care & Research, Turin, Italy
| | - Gabriele Gasparini
- Department of Invasive Cardiology, Humanitas Clinical and Research Center, IRCCS, Rozzano, Italy
| | - Junbo Ge
- Zhongshan Hospital, Fudan University, Shanghai, China
| | - Lei Ge
- Zhongshan Hospital, Fudan University, Shanghai, China
| | - Pravin Kumar Goel
- Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | | | - Nieves Gonzalo
- Interventional Cardiology, Hospital Clinico San Carlos, IdISSC, Universidad Complutense, Madrid, Spain
| | | | - Allison Hall
- Eastern Health/Memorial University of Newfoundland, St. John's, Newfoundland, Canada
| | | | | | - Stefan Harb
- Medical University of Graz, University Heart Center, Graz, Austria
| | - Scott A Harding
- Wellington Hospital, Capital and Coast District Health Board, Wellington, New Zealand
| | - Raja Hatem
- Hôpital du Sacré-Coeur de Montréal Université de Montréal, Montréal, Québec, Canada
| | | | | | | | - Angela Hoye
- Centre for Atherothrombosis and Metabolic Disease, Hull York Medical School, University of Hull, Hull, UK
| | | | - Farouc A Jaffer
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Yangsoo Jang
- Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Risto Jussila
- Interventional Cardiology, Helsinki Heart Hospital, Helsinki, Finland
| | - Artis Kalnins
- Clinic of Cardiovascular Diseases, Riga East Clinical University Hospital, Riga, Latvia
| | | | - David E Kandzari
- Piedmont Heart Institute and Cardiovascular Services, Atlanta, Georgia, USA
| | - Hsien-Li Kao
- Department of Internal Medicine, Cardiology Division, Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan
| | | | - Hussien Heshmat Kassem
- Kasr Alainy Medical School, Cairo University, Cairo, Egypt, and Fujairah Hospital, Ministry of Health, Fujairah, United Arab Emirates
| | | | - Paul Knaapen
- Heart Center of the Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Ran Kornowski
- Department of Cardiology, Rabin Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - A V Ganesh Kumar
- Department of Cardiology, Dr. L.H. Hiranandani Hospital, Mumbai, India
| | - Pablo Manuel Lamelas
- Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina, and Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Seung-Whan Lee
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Thierry Lefevre
- Institut Cardiovasculaire Paris Sud, Hôpital Prive Jacques Cartier, Massy, France
| | - Raymond Leung
- C.K. Hui Heart Centre, Royal Alexandra Hospital, Edmonton, Alberta, Canada
| | - Yu Li
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yue Li
- Department of Cardiology, First Affiliated Hospital of Harbin Medical University, Harbin, China
| | | | - Sidney Lo
- Department of Cardiology, Liverpool Hospital and The University of New South Wales, Sydney, Australia
| | | | - Anbukarasi Maran
- Medical University of South Carolina, Ralph H. Johnson VA Medical Center, Charleston, South Carolina, USA
| | | | - Jeffrey Moses
- NewYork-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA
| | - Muhammad Munawar
- Binawaluya Cardiac Center and Department of Cardiology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia, and Department of Cardiology, Faculty of Medicine, Universitas Gadjahmada, Yogyakarta, Indonesia
| | - Andres Navarro
- Hospital de los Valles, Hospital de Especialidades Eugenio Espejo, Universidad San Francisco de Quito, Quito, Ecuador
| | - Hung M Ngo
- Choray University Hospital, Hochiminh City, Vietnam
| | | | - Anja Oksnes
- Heart Department, Haukeland University Hospital, Bergen, Norway
| | | | - Lucio Padilla
- Department of Interventional Cardiology and Endovascular Therapeutics, ICBA, Instituto Cardiovascular, Buenos Aires, Argentina
| | - Mitul Patel
- Division of Cardiovascular Medicine, University of California, San Diego, School of Medicine, San Diego, California, USA
| | - Ashish Pershad
- Chandler Regional Medical Center, Chandler, Arizona, USA
| | - Marin Postu
- Cardiology Department, University of Medicine and Pharmacy "Carol Davila," Institute of Cardiovascular Diseases "Prof Dr C.C. Iliescu," Bucharest, Romania
| | - Jie Qian
- Beijing Fuwai Hospital, Beijing, China
| | - Alexandre Quadros
- Interventional Cardiology Division and Post Graduate Course of Cardiology, Instituto de Cardiologia do Rio Grande do Sul, Porto Alegre, Brazil
| | - Nidal Abi Rafeh
- St. George Hospital University Medical Center, Beirut, Lebanon, and North Oaks Healthcare System, Hammond, Louisiana, USA
| | - Truls Råmunddal
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | - Nicolaus Reifart
- Department of Cardiology, Main Taunus Heart Institute, Bad Soden, Germany
| | - Robert F Riley
- The Christ Hospital Health Network, Cincinnati, Ohio, USA
| | | | | | | | - Elliot Smith
- Department of Cardiology, Barts Heart Centre, St. Bartholomew's Hospital, London, UK
| | | | - James Spratt
- St. George's University Hospital NHS Foundation Trust, London, UK
| | - Gregg Stone
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Julian W Strange
- Bristol Royal Infirmary, University Hospital Bristol NHS Trust, Bristol, UK
| | - Khalid O Tammam
- Department at the International Medical Center, Jeddah, Saudi Arabia
| | | | - Aurel Toma
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | | | | | - Imre Ungi
- University of Szeged, Department of Invasive Cardiology, Szeged, Hungary
| | - Minh Vo
- Royal Columbian Hospital, Vancouver, British Columbia, Canada
| | - Vu Hoang Vu
- Heart Center University Medical Center, Ho Chi Minh City, Vietnam
| | - Simon Walsh
- Belfast Health and Social Care Trust, Belfast, UK
| | - Gerald Werner
- Medizinische Klinik I Klinikum Darmstadt, Darmstadt, Germany
| | - Jaroslaw Wojcik
- Hospital of Invasive Cardiology IKARDIA, Nałęczów/Lublin, Poland
| | - Jason Wollmuth
- Providence Heart and Vascular Institute, Portland, Oregon, USA
| | - Bo Xu
- Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | | | - Luiz F Ybarra
- London Health Sciences Centre, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Robert W Yeh
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Qi Zhang
- Shanghai East Hospital, Tongji University, Shanghai, China
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17
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Völz S, Redfors B, Angerås O, Ioanes D, Odenstedt J, Koul S, Valeljung I, Dworeck C, Hofmann R, Hansson E, Venetsanos D, Ulvenstam A, Jernberg T, Råmunddal T, Pétursson P, Fröbert O, Erlinge D, Jeppsson A, Omerovic E. Long-term mortality in patients with ischaemic heart failure revascularized with coronary artery bypass grafting or percutaneous coronary intervention: insights from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR). Eur Heart J 2021; 42:2657-2664. [PMID: 34023903 PMCID: PMC8282315 DOI: 10.1093/eurheartj/ehab273] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 09/15/2020] [Accepted: 04/23/2021] [Indexed: 01/17/2023] Open
Abstract
Aims To compare coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) for treatment of patients with heart failure due to ischaemic heart disease. Methods and results We analysed all-cause mortality following CABG or PCI in patients with heart failure with reduced ejection fraction and multivessel disease (coronary artery stenosis >50% in ≥2 vessels or left main) who underwent coronary angiography between 2000 and 2018 in Sweden. We used a propensity score-adjusted logistic and Cox proportional-hazards regressions and instrumental variable model to adjust for known and unknown confounders. Multilevel modelling was used to adjust for the clustering of observations in a hierarchical database. In total, 2509 patients (82.9% men) were included; 35.8% had diabetes and 34.7% had a previous myocardial infarction. The mean age was 68.1 ± 9.4 years (47.8% were >70 years old), and 64.9% had three-vessel or left main disease. Primary designated therapy was PCI in 56.2% and CABG in 43.8%. Median follow-up time was 3.9 years (range 1 day to 10 years). There were 1010 deaths. Risk of death was lower after CABG than after PCI [odds ratio (OR) 0.62; 95% confidence interval (CI) 0.41–0.96; P = 0.031]. The risk of death increased linearly with quintiles of hospitals in which PCI was the preferred method for revascularization (OR 1.27, 95% CI 1.17–1.38, P
trend < 0.001). Conclusion In patients with ischaemic heart failure, long-term survival was greater after CABG than after PCI.
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Affiliation(s)
- Sebastian Völz
- Department of Cardiology, Sahlgrenska University Hospital, University of Gothenburg, Bruna straket 16, 413 45 Gothenburg, Sweden.,Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Bruna straket 16, 413 45 Gothenburg, Sweden
| | - Björn Redfors
- Department of Cardiology, Sahlgrenska University Hospital, University of Gothenburg, Bruna straket 16, 413 45 Gothenburg, Sweden.,Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Bruna straket 16, 413 45 Gothenburg, Sweden
| | - Oskar Angerås
- Department of Cardiology, Sahlgrenska University Hospital, University of Gothenburg, Bruna straket 16, 413 45 Gothenburg, Sweden.,Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Bruna straket 16, 413 45 Gothenburg, Sweden
| | - Dan Ioanes
- Department of Cardiology, Sahlgrenska University Hospital, University of Gothenburg, Bruna straket 16, 413 45 Gothenburg, Sweden.,Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Bruna straket 16, 413 45 Gothenburg, Sweden
| | - Jacob Odenstedt
- Department of Cardiology, Sahlgrenska University Hospital, University of Gothenburg, Bruna straket 16, 413 45 Gothenburg, Sweden.,Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Bruna straket 16, 413 45 Gothenburg, Sweden
| | - Sasha Koul
- Department of Cardiology, Skåne University Hospital, 22242 Lund, Sweden
| | - Inger Valeljung
- Department of Cardiology, Sahlgrenska University Hospital, University of Gothenburg, Bruna straket 16, 413 45 Gothenburg, Sweden.,Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Bruna straket 16, 413 45 Gothenburg, Sweden
| | - Christian Dworeck
- Department of Cardiology, Sahlgrenska University Hospital, University of Gothenburg, Bruna straket 16, 413 45 Gothenburg, Sweden.,Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Bruna straket 16, 413 45 Gothenburg, Sweden
| | - Robin Hofmann
- Division of Cardiology, Department of Clinical Science and Education, Karolinska Institute, Södersjukhuset, 11861 Stockholm, Sweden
| | - Emma Hansson
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Bruna straket 16, 413 45 Gothenburg, Sweden.,Department of Cardiothoracic Surgery, Sahlgrenska University Hospital and Institute of Medicine, University of Gothenburg, 413 45 Gothenburg, Sweden
| | - Dimitrios Venetsanos
- Division of Cardiology, Department of Medicine, Karolinska Institute and Karolinska University Hospital, Karolinska Solna, 171 76 Stockholm, Sweden
| | - Anders Ulvenstam
- Department of Cardiology, Östersund Hospital, 831 83 Östersund, Sweden
| | - Tomas Jernberg
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Karolinska Institute, Danderyd Hospital, 182 88 Stockholm, Sweden
| | - Truls Råmunddal
- Department of Cardiology, Sahlgrenska University Hospital, University of Gothenburg, Bruna straket 16, 413 45 Gothenburg, Sweden.,Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Bruna straket 16, 413 45 Gothenburg, Sweden
| | - Pétur Pétursson
- Department of Cardiology, Sahlgrenska University Hospital, University of Gothenburg, Bruna straket 16, 413 45 Gothenburg, Sweden.,Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Bruna straket 16, 413 45 Gothenburg, Sweden
| | - Ole Fröbert
- Department of Cardiology, Örebro University, Faculty of Health, 781 85 Örebro, Sweden
| | - David Erlinge
- Department of Cardiology, Skåne University Hospital, 22242 Lund, Sweden
| | - Anders Jeppsson
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Bruna straket 16, 413 45 Gothenburg, Sweden.,Department of Cardiothoracic Surgery, Sahlgrenska University Hospital and Institute of Medicine, University of Gothenburg, 413 45 Gothenburg, Sweden
| | - Elmir Omerovic
- Department of Cardiology, Sahlgrenska University Hospital, University of Gothenburg, Bruna straket 16, 413 45 Gothenburg, Sweden.,Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Bruna straket 16, 413 45 Gothenburg, Sweden
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18
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Kolk MZH, van Veelen A, Agostoni P, van Houwelingen GK, Ouweneel DM, Hoebers LP, Råmunddal T, Laanmets P, Eriksen E, Bax M, Suttorp MJ, Claessen BEPM, van der Schaaf RJ, Elias J, van Dongen IM, Henriques JPS. Predictors and outcomes of procedural failure of percutaneous coronary intervention of a chronic total occlusion-A subanalysis of the EXPLORE trial. Catheter Cardiovasc Interv 2021; 97:1176-1183. [PMID: 32294316 DOI: 10.1002/ccd.28904] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 11/05/2019] [Revised: 03/25/2020] [Accepted: 03/30/2020] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To evaluate predictors of procedural success of percutaneous coronary intervention (PCI) of chronic total coronary occlusions (CTOs) in a non-infarct-related artery following ST-segment elevation myocardial infarction (STEMI), and demonstrate the effect on left ventricular functionality (LVF), infarct size (IS), and pro-arrhythmic electrocardiogram (ECG) parameters. BACKGROUND Predictors of unsuccessful revascularization of a CTO are numerous, although following STEMI, these are lacking. Besides, effects of failed CTO PCI (FPCI) on the myocardium are unknown. METHODS This is a subanalysis of the EXPLORE trial, in which 302 STEMI patients with a concurrent CTO were randomized to CTO PCI (n = 147) or no-CTO PCI (NPCI, n = 154). For the purpose of this subanalysis, we divided patients into successful CTO PCI (SPCI, n = 106), FPCI (n = 41), and NPCI (n = 154) groups. Cardiac magnetic resonance imaging and angiographic data were derived from the EXPLORE database, combined with ECG parameters. To gain more insight, all outcomes were compared with patients that did not undergo CTO PCI. RESULTS In multivariate regression, only CTO lesion length >20 mm was an independent predictor of procedural failure (OR 3.31 [1.49-7.39]). No significant differences in median left ventricular ejection fraction, left ventricular end-diastolic volume, IS, and the pro-arrhythmic ECG parameters such as QT-dispersion, QTc-time, and TpTe-intervals were seen between the SPCI and FPCI groups at 4 months follow-up. CONCLUSION This subanalysis of the EXPLORE trial has demonstrated that a CTO lesion length >20 mm is an independent predictor of CTO PCI failure, whereas procedural failure did not lead to any adverse effects on LVF nor pro-arrhythmic ECG parameters.
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Affiliation(s)
- Maarten Z H Kolk
- Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Anna van Veelen
- Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | | | | | - Dagmar M Ouweneel
- Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Loes P Hoebers
- Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Truls Råmunddal
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Peep Laanmets
- Department of Cardiology, North Estonia Medical Center, Tallinn, Estonia
| | - Erlend Eriksen
- Department of Cardiology, Haukeland University Hospital, Bergen, Norway
| | - Matthijs Bax
- Department of Cardiology, Haga Teaching Hospital, The Hague, The Netherlands
| | - Maarten J Suttorp
- Department of Cardiology, Ziekenhuis Netwerk Antwerpen (ZNA), Antwerp, Belgium
| | - Bimmer E P M Claessen
- Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,The Zena and Michael A. Wiener Cardiovascular Institute, The Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | | | - Joëlle Elias
- Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Ivo M van Dongen
- Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - José P S Henriques
- Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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19
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Dworeck C, Redfors B, Völz S, Haraldsson I, Angerås O, Råmunddal T, Ioanes D, Myredal A, Odenstedt J, Hirlekar G, Koul S, Fröbert O, Linder R, Venetsanos D, Hofmann R, Ulvenstam A, Petursson P, Sarno G, James S, Erlinge D, Omerovic E. Radial artery access is associated with lower mortality in patients undergoing primary PCI: a report from the SWEDEHEART registry. Eur Heart J Acute Cardiovasc Care 2021; 9:323-332. [PMID: 33025815 PMCID: PMC7756052 DOI: 10.1177/2048872620908032] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES The purpose of this observational study was to evaluate the effects of radial artery access versus femoral artery access on the risk of 30-day mortality, inhospital bleeding and cardiogenic shock in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention. METHODS We used data from the SWEDEHEART registry and included all patients who were treated with primary percutaneous coronary intervention in Sweden between 2005 and 2016. We compared patients who had percutaneous coronary intervention by radial access versus femoral access with regard to the primary endpoint of all-cause death within 30 days, using a multilevel propensity score adjusted logistic regression which included hospital as a random effect. RESULTS During the study period, 44,804 patients underwent primary percutaneous coronary intervention of whom 24,299 (54.2%) had radial access and 20,505 (45.8%) femoral access. There were 2487 (5.5%) deaths within 30 days, of which 920 (3.8%) occurred in the radial access and 1567 (7.6%) in the femoral access group. After propensity score adjustment, radial access was associated with a lower risk of death (adjusted odds ratio (OR) 0.70, 95% confidence interval (CI) 0.55-0.88, P = 0.025). We found no interaction between access site and age, gender and cardiogenic shock regarding 30-day mortality. Radial access was also associated with a lower adjusted risk of bleeding (adjusted OR 0.45, 95% CI 0.25-0.79, P = 0.006) and cardiogenic shock (adjusted OR 0.41, 95% CI 0.24-0.73, P = 0.002). CONCLUSIONS In patients with ST-elevation myocardial infarction, primary percutaneous coronary intervention by radial access rather than femoral access was associated with an adjusted lower risk of death, bleeding and cardiogenic shock. Our findings are consistent with, and add external validity to, recent randomised trials.
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Affiliation(s)
| | - Björn Redfors
- Department of Cardiology, Sahlgrenska University Hospital, Sweden
| | - Sebastian Völz
- Department of Cardiology, Sahlgrenska University Hospital, Sweden
| | - Inger Haraldsson
- Department of Cardiology, Sahlgrenska University Hospital, Sweden
| | - Oskar Angerås
- Department of Cardiology, Sahlgrenska University Hospital, Sweden
| | - Truls Råmunddal
- Department of Cardiology, Sahlgrenska University Hospital, Sweden
| | - Dan Ioanes
- Department of Cardiology, Sahlgrenska University Hospital, Sweden
| | - Anna Myredal
- Department of Cardiology, Sahlgrenska University Hospital, Sweden
| | - Jacob Odenstedt
- Department of Cardiology, Sahlgrenska University Hospital, Sweden
| | - Geir Hirlekar
- Department of Cardiology, Sahlgrenska University Hospital, Sweden
| | - Sasha Koul
- Department of Cardiology, Clinical Sciences, Lund University, Sweden
| | - Ole Fröbert
- Department of Cardiology, Örebro University, Sweden
| | - Rickard Linder
- Department of Cardiology, Karolinska University Hospital, Sweden
| | | | - Robin Hofmann
- Department of Clinical Science and Education, Karolinska Institutet, Sweden
| | | | - Petur Petursson
- Department of Cardiology, Sahlgrenska University Hospital, Sweden
| | - Giovanna Sarno
- Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Sweden
| | - Stefan James
- Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Sweden
| | - David Erlinge
- Department of Cardiology, Clinical Sciences, Lund University, Sweden
| | - Elmir Omerovic
- Department of Cardiology, Sahlgrenska University Hospital, Sweden
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20
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Dworeck C, Redfors B, Angerås O, Haraldsson I, Odenstedt J, Ioanes D, Petursson P, Völz S, Persson J, Koul S, Venetsanos D, Ulvenstam A, Hofmann R, Jensen J, Albertsson P, Råmunddal T, Jeppsson A, Erlinge D, Omerovic E. Association of Pretreatment With P2Y12 Receptor Antagonists Preceding Percutaneous Coronary Intervention in Non-ST-Segment Elevation Acute Coronary Syndromes With Outcomes. JAMA Netw Open 2020; 3:e2018735. [PMID: 33001202 PMCID: PMC7530628 DOI: 10.1001/jamanetworkopen.2020.18735] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
IMPORTANCE Pretreatment of patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) with P2Y12 receptor antagonists is a common practice despite the lack of definite evidence for its benefit. OBJECTIVE To investigate the association of P2Y12 receptor antagonist pretreatment vs no pretreatment with mortality, stent thrombosis, and in-hospital bleeding in patients with NSTE-ACS undergoing percutaneous coronary intervention (PCI). DESIGN, SETTING, AND PARTICIPANTS This cohort study used prospective data from the Swedish Coronary Angiography and Angioplasty Registry of 64 857 patients who underwent procedures between 2010 and 2018. All patients who underwent PCI owing to NSTE-ACS in Sweden were stratified by whether they were pretreated with P2Y12 receptor antagonists. Associations of pretreatment with P2Y12 receptor antagonists with the risks of adverse outcomes were investigated using instrumental variable analysis and propensity score matching. Data were analyzed from March to June 2019. EXPOSURES Pretreatment with P2Y12 receptor antagonists. MAIN OUTCOMES AND MEASURES The primary end point was all-cause mortality within 30 days. Secondary end points were 1-year mortality, stent thrombosis within 30 days, and in-hospital bleeding. RESULTS In total, 64 857 patients (mean [SD] age, 64.7 [10.9] years; 46 809 [72.2%] men) were included. A total of 59 894 patients (92.4%) were pretreated with a P2Y12 receptor antagonist, including 27 867 (43.7%) pretreated with clopidogrel, 34 785 (54.5%) pretreated with ticagrelor, and 1148 (1.8%) pretreated with prasugrel. At 30 days, there were 971 deaths (1.5%) and 101 definite stent thromboses (0.2%) in the full cohort. Pretreatment was not associated with better survival at 30 days (odds ratio [OR], 1.17; 95% CI, 0.66-2.11; P = .58), survival at 1 year (OR, 1.34; 95% CI, 0.77-2.34; P = .30), or decreased stent thrombosis (OR, 0.81; 95% CI, 0.42-1.55; P = .52). However, pretreatment was associated with increased risk of in-hospital bleeding (OR, 1.49; 95% CI, 1.06-2.12; P = .02). CONCLUSIONS AND RELEVANCE This cohort study found that pretreatment of patients with NSTE-ACS with P2Y12 receptor antagonists was not associated with improved clinical outcomes but was associated with increased risk of bleeding. These findings support the argument that pretreatment with P2Y12 receptor antagonists should not be routinely used in patients with NSTE-ACS.
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Affiliation(s)
- Christian Dworeck
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Björn Redfors
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Oskar Angerås
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Inger Haraldsson
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Jacob Odenstedt
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Dan Ioanes
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Petur Petursson
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Sebastian Völz
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Jonas Persson
- Department of Cardiology, Danderyd University Hospital, Stockholm, Sweden
| | - Sasha Koul
- Department of Cardiology, Skåne University Hospital, Lund, Sweden
| | | | | | - Robin Hofmann
- Division of Cardiology, Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
| | - Jens Jensen
- Department of Clinical Science and Education, Karolinska Institutet, Cardiology Capio Sankt Goran Hospital, Stockholm, Sweden
| | - Per Albertsson
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Truls Råmunddal
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Anders Jeppsson
- Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - David Erlinge
- Department of Cardiology, Skåne University Hospital, Lund, Sweden
| | - Elmir Omerovic
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
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21
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Völz S, Petursson P, Odenstedt J, Ioanes D, Haraldsson I, Angerås O, Dworeck C, Hirlekar G, Myredal A, Albertsson P, Råmunddal T, Redfors B, Omerovic E. Ticagrelor is Not Superior to Clopidogrel in Patients With Acute Coronary Syndromes Undergoing PCI: A Report from Swedish Coronary Angiography and Angioplasty Registry. J Am Heart Assoc 2020; 9:e015990. [PMID: 32662350 PMCID: PMC7660716 DOI: 10.1161/jaha.119.015990] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Ticagrelor reduces ischaemic end points in acute coronary syndromes. However, outcomes of ticagrelor versus clopidogrel in real‐world patients with acute coronary syndromes treated with percutaneous coronary intervention (PCI) remain unclear. We sought to examine whether treatment with ticagrelor is superior to clopidogrel in unselected patients with acute coronary syndromes treated with PCI. Methods and Results We used data from SCAAR (Swedish Coronary Angiography and Angioplasty Registry) for PCI performed in Västra Götaland County, Sweden. The database contains information about all PCI performed at 5 hospitals (∼20% of all data in SCAAR). All procedures between January 2005 and January 2015 for unstable angina/non‒ST‐segment‒elevation myocardial infarction and ST‐segment‒elevation myocardial infarction were included. We used instrumental variable 2‐stage least squares regression to adjust for confounders. The primary combined end point was mortality or stent thrombosis at 30 days, secondary end points were mortality at 30 days and 1‐year, stent thrombosis at 30 days, in‐hospital bleeding, in‐hospital neurologic complications and long‐term mortality. A total of 15 097 patients were included in the study of which 2929 (19.4%) were treated with ticagrelor. Treatment with ticagrelor was not associated with a lower risk for the primary end point (adjusted odds ratio [aOR], 1.20; 95% CI, 0.87–1.61; P=0.250). Estimated risk of death at 30 days (aOR, 1.18; 95% CI, 0.88–1.64; P=0.287) and at 1‐year (aOR, 1.28; 95% CI, 0.86–1.64; P=0.556) was not different between the groups. The risk of in‐hospital bleeding was higher with ticagrelor (aOR, 2.88; 95% CI, 1.53–5.44; P=0.001). Conclusions In this observational study, treatment with ticagrelor was not superior to clopidogrel in patients with acute coronary syndromes treated with PCI.
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Affiliation(s)
- Sebastian Völz
- Department of Cardiology Sahlgrenska University Hospital Gothenburg Sweden
| | - Petur Petursson
- Department of Cardiology Sahlgrenska University Hospital Gothenburg Sweden
| | - Jacob Odenstedt
- Department of Cardiology Sahlgrenska University Hospital Gothenburg Sweden
| | - Dan Ioanes
- Department of Cardiology Sahlgrenska University Hospital Gothenburg Sweden
| | - Inger Haraldsson
- Department of Cardiology Sahlgrenska University Hospital Gothenburg Sweden
| | - Oskar Angerås
- Department of Cardiology Sahlgrenska University Hospital Gothenburg Sweden
| | - Christian Dworeck
- Department of Cardiology Sahlgrenska University Hospital Gothenburg Sweden
| | - Geir Hirlekar
- Department of Cardiology Sahlgrenska University Hospital Gothenburg Sweden
| | - Anna Myredal
- Department of Cardiology Sahlgrenska University Hospital Gothenburg Sweden
| | - Per Albertsson
- Department of Cardiology Sahlgrenska University Hospital Gothenburg Sweden
| | - Truls Råmunddal
- Department of Cardiology Sahlgrenska University Hospital Gothenburg Sweden
| | - Björn Redfors
- Department of Cardiology Sahlgrenska University Hospital Gothenburg Sweden
| | - Elmir Omerovic
- Department of Cardiology Sahlgrenska University Hospital Gothenburg Sweden
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22
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van Veelen A, van Dongen IM, Elias J, Råmunddal T, Eriksen E, van der Schaaf RJ, Claessen BEPM, Postema PG, Henriques JPS. Exercise testing after chronic total coronary occlusion revascularization in patients with STEMI and a concurrent CTO: A subanalysis of the EXPLORE-trial. Catheter Cardiovasc Interv 2019; 94:536-545. [PMID: 30968546 DOI: 10.1002/ccd.28282] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 02/14/2019] [Accepted: 03/29/2019] [Indexed: 11/09/2022]
Abstract
OBJECTIVES To assess the effect of chronic total occlusion percutaneous coronary intervention (CTO PCI) on ventricular ectopy (VE) and symptomatology during exercise testing. BACKGROUND During exercise, the hypoxic myocardium in the CTO-territory can act as a substrate for VE and could lead to anginal complaints. METHODS In the EXPLORE-trial, 302 ST-segment elevation myocardial infarction (STEMI)-patients were randomized to CTO PCI or no-CTO PCI. For this sub-study, we analyzed all available exercise electrocardiograms (X-ECGs) at 4 months follow-up on symptoms and electrocardiographic parameters. RESULTS A total of 155 X-ECGs were available, 80 in the CTO PCI group (51.6%) and 75 in the no-CTO PCI group (48.4%). There were no differences regarding exercised time, achieved endurance, ST-deviation nor maximum heart-rate. The percentage of patients experiencing chest-pain during exercise was lower in the CTO PCI group (0% vs. 8.5%, p = .03). Also, there was a trend towards a higher maximum systolic blood pressure (SBP, 185 mmHg vs. 175, p = .09). No difference in VE was found between randomization groups, but patients with successful CTO PCI had a higher frequency of VE, compared to failed and no-CTO PCI (26% vs. 8%, p = .02). This did not result in higher frequencies of sustained ventricular arrhythmias or mortality. CONCLUSION In conclusion, in STEMI-patients, CTO PCI is associated with a small reduction of chest-pain during exercise and tended to be associated with an increase of maximum SBP. The observation that successful CTO PCI was associated with more VE during exercise, compared with failed/no-CTO PCI needs further exploration.
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Affiliation(s)
- Anna van Veelen
- Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Heart Center, The Netherlands
| | - Ivo M van Dongen
- Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Heart Center, The Netherlands.,Department of Cardiology, OLVG Hospital, Amsterdam, The Netherlands
| | - Joëlle Elias
- Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Heart Center, The Netherlands
| | - Truls Råmunddal
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Erlend Eriksen
- Department of Cardiology, Haukeland University Hospital, Bergen, Norway
| | | | - Bimmer E P M Claessen
- Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Heart Center, The Netherlands.,Department of Cardiology, Mount Sinai Hospital, New York City, New York
| | - Pieter G Postema
- Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Heart Center, The Netherlands
| | - José P S Henriques
- Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Heart Center, The Netherlands
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23
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Angerås O, Ioanes D, Rück A, Kellerth T, Nilsson J, Götberg M, Nielsen NE, Gadler F, Szamlewski P, James S, Råmunddal T, Omerovic E, Petursson P. TCT-532 Impact of New Pacemaker in Patients Undergoing TAVR: A Report From the National SWENTRY and Swedish ICD and Pacemaker Registries. J Am Coll Cardiol 2019. [DOI: 10.1016/j.jacc.2019.08.634] [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: 11/26/2022]
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24
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Völz S, Petursson P, Angerås O, Odenstedt J, Ioanes D, Haraldsson I, Dworeck C, Hirlekar G, Redfors B, Myredal A, Libungan B, Albertsson P, Råmunddal T, Omerovic E. Prognostic impact of percutaneous coronary intervention in octogenarians with non-ST elevation myocardial infarction: A report from SWEDEHEART. Eur Heart J Acute Cardiovasc Care 2019; 9:480-487. [PMID: 31517503 DOI: 10.1177/2048872619877287] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIMS Percutaneous coronary intervention (PCI) improves outcomes in non-ST elevation acute coronary syndromes (NSTE-ACSs). Octogenarians, however, were underrepresented in the pivotal trials. This study aimed to assess the effect of PCI in patients ≥80 years old. METHODS AND RESULTS We used data from the SWEDEHEART registry for all hospital admissions at eight cardiac care centres within Västra Götaland County. Consecutive patients ≥80 years old admitted for NSTE-ACS between January 2000 and December 2011 were included. We performed instrumental variable analysis with propensity score. The primary endpoint was all-cause mortality at 30 days and one year after index hospitalization. During the study period 5200 patients fulfilled the inclusion criteria. In total, 586 (11.2%) patients underwent PCI, the remaining 4613 patients were treated conservatively. Total mortality at 30 days was 19.4% (1007 events) and 39.4% (1876 events) at one year. Thirty-day mortality was 20.7% in conservatively treated patients and 8.5% in the PCI group (adjusted odds ratio 0.34; 95% confidence interval 0.12-0.97, p = 0.044). One-year mortality was 42.1% in the conservatively treated group and 16.3% in the PCI group (adjusted odds ratio 0.97; 95% confidence interval 0.36-2.51, p = 0.847). CONCLUSIONS PCI in octogenarians with NSTE-ACS was associated with a lower risk of mortality at 30 days. However, this survival benefit was not sustained during the entire study-period of one-year.
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Affiliation(s)
- Sebastian Völz
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Petur Petursson
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Oskar Angerås
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Jacob Odenstedt
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Dan Ioanes
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Inger Haraldsson
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Christian Dworeck
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Geir Hirlekar
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Björn Redfors
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Anna Myredal
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Berglind Libungan
- Department of Cardiology, Landspitali University Hospital of Iceland, Reykjavik, Iceland
| | - Per Albertsson
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Truls Råmunddal
- Department of Cardiology, Aarhus University Hospital, Denmark
| | - Elmir Omerovic
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
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25
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Haraldsson I, Gan LM, Svedlund S, Torngren K, Westergren HU, Redfors B, Lagerström-Fermér M, Angerås O, Råmunddal T, Petursson P, Odenstedt J, Albertsson P, Erlinge D, Omerovic E. PROspective evaluation of coronary FLOW reserve and molecular biomarkers in patients with established coronary artery disease the PROFLOW-trial: cross-sectional evaluation of coronary flow reserve. Vasc Health Risk Manag 2019; 15:375-384. [PMID: 31695398 PMCID: PMC6718055 DOI: 10.2147/vhrm.s209003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Accepted: 08/13/2019] [Indexed: 12/03/2022] Open
Abstract
Background Survivors of myocardial infarction (MI) are at high risk of new major adverse cardiovascular events (MACE). Coronary flow reserve (CFR) is a strong and independent predictor of MACE. Understanding the prevalence of impaired CFR in this patient group and identifying risk markers for impaired CFR are important steps in the development of personalized and targeted treatment for high-risk individuals with prior MI. Methods PROFLOW is a prospective, exploratory, cross-sectional open study. We used information from the SCAAR (Swedish Coronary Angiography and Angioplasty Registry) to identify high-risk patients with a history of type-1 MI. We measured CFR non-invasively in a left anterior descending artery (LAD) using transthoracic Doppler echocardiography. Coronary flow velocity was measured at rest and at maximal flow after induction of hyperemia by intravenous infusion of adenosine (140 μg/kg/min). Independent predictors of CFR were assessed with multiple linear regression. Results We included 619 patients. The median age was 69 (IQR 65–73), and 114 (18.4%) were women. Almost one-half of the patients, 285 (46.0%) had the multi-vessel disease, and 147 (23.7%) were incompletely revascularized. The majority were on optimal standard treatment eg ASA (93.1%), statins (90.0%), ACEI/ARB (82.6%) and beta-blockers (80.8%). The majority, 547 (88.4%) had no angina pectoris, and 572 (92.2%) were in NYHA class I. Evaluation of CFR was possible in 611 (98.7%) patients. Mean CFR was 2.74 (±0.79 (mean ± SD)). A substantial number of patients (39.7%) had CFR ≤2.5. In a multiple linear regression model age, dyslipidemia, smoking, hypertension, body mass index, incomplete revascularization, and treatment with angiotensin receptor blockers were independent predictors of CFR. Conclusion In this high-risk group of patients with prior MI, the prevalence of impaired CFR was high. Further risk stratification with CFR in addition to traditional cardiovascular risk factors may improve predictive accuracy for future MACE in this patient population.
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Affiliation(s)
- Inger Haraldsson
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Li-Ming Gan
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden.,Early Clinical Development, IMED Biotech Unit, AstraZeneca R&D, Gothenburg, Sweden
| | - Sara Svedlund
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Clinical Physiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Kristina Torngren
- Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden
| | - Helena U Westergren
- Precision Medicine and Genomics, IMED Biotech Unit, AstraZeneca R&D, Gothenburg, Sweden
| | - Björn Redfors
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | - Oskar Angerås
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Truls Råmunddal
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Petur Petursson
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Jacob Odenstedt
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Per Albertsson
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - David Erlinge
- Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden
| | - Elmir Omerovic
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
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26
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Völz S, Angerås O, Koul S, Haraldsson I, Sarno G, Venetsanos D, Grimfärd P, Ulvenstam A, Hofmann R, Hamid M, Henareh L, Wagner H, Jensen J, Danielewicz M, Östlund O, Eriksson P, Scherstén F, Linder R, Råmunddal T, Pétursson P, Fröbert O, James S, Erlinge D, Omerovic E. Radial versus femoral access in patients with acute coronary syndrome undergoing invasive management: A prespecified subgroup analysis from VALIDATE-SWEDEHEART. Eur Heart J Acute Cardiovasc Care 2019; 8:510-519. [PMID: 31237158 DOI: 10.1177/2048872618817217] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIMS In the Bivalirudin versus Heparin in ST-Segment and Non-ST-Segment Elevation Myocardial Infarction in Patients on Modern Antiplatelet Therapy in the Swedish Web System for Enhancement and Development of Evidence-based Care in Heart Disease Evaluated according to Recommended Therapies Registry Trial (VALIDATE-SWEDEHEART), bivalirudin was not superior to unfractionated heparin in patients with acute coronary syndrome undergoing invasive management. We assessed whether the access site had an impact on the primary endpoint of death, myocardial infarction or major bleeding at 180 days and whether it interacted with bivalirudin/unfractionated heparin. METHODS AND RESULTS A total of 6006 patients with acute coronary syndrome planned for percutaneous coronary intervention were randomised to either bivalirudin or unfractionated heparin. Arterial access was left to the operator discretion. Overall, 90.5% of patients underwent transradial access and 9.5% transfemoral access. Baseline risk was higher in transfemoral access. The unadjusted hazard ratio for the primary outcome was lower with transradial access (hazard ratio 0.53, 95% confidence interval 0.43-0.67, p<0.001) and remained lower after multivariable adjustment (hazard ratio 0.56, 95% confidence interval 0.52-0.84, p<0.001). Transradial access was associated with lower risk of death (hazard ratio 0.41, 95% confidence interval 0.28-0.60, p<0.001) and major bleeding (hazard ratio 0.57, 95% confidence interval 0.44-0.75, p<0.001). There was no interaction between treatment with bivalirudin and access site for the primary endpoint (p=0.976) or major bleeding (p=0.801). CONCLUSIONS Transradial access was associated with lower risk of death, myocardial infarction or major bleeding at 180 days. Bivalirudin was not associated with less bleeding, irrespective of access site.
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Affiliation(s)
- Sebastian Völz
- Department of Cardiology, Sahlgrenska University Hospital, Sweden
| | - Oskar Angerås
- Department of Cardiology, Sahlgrenska University Hospital, Sweden
| | - Sasha Koul
- Department of Cardiology, Lund University, Sweden
| | - Inger Haraldsson
- Department of Cardiology, Sahlgrenska University Hospital, Sweden
| | - Giovanna Sarno
- Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Sweden
| | | | - Per Grimfärd
- Department of Internal Medicine, Västmanlands Sjukhus, Sweden
| | | | - Robin Hofmann
- Department of Clinical Science and Education, Karolinska Institutet, Sweden
| | - Mehmet Hamid
- Department of Cardiology, Mälarsjukhuset, Sweden
| | - Loghman Henareh
- Department of Cardiology, Karolinska University Hospital, Sweden
| | - Henrik Wagner
- Department of Cardiology, Helsingborg Lasarett, Sweden
| | - Jens Jensen
- Department of Clinical Science and Education, Karolinska Institutet, Sweden.,Unit of Cardiology, Capio S:t Görans Sjukhus, Sweden
| | | | - Ollie Östlund
- Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Sweden
| | | | | | | | | | - Pétur Pétursson
- Department of Cardiology, Sahlgrenska University Hospital, Sweden
| | - Ole Fröbert
- Department of Cardiology, Örebro University, Sweden
| | - Stefan James
- Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Sweden
| | | | - Elmir Omerovic
- Department of Cardiology, Sahlgrenska University Hospital, Sweden
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27
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van Dongen IM, Elias J, García-García HM, Hoebers LP, Ouweneel DM, Scheunhage EM, Delewi R, Råmunddal T, Eriksen E, Claessen BEPM, van der Schaaf RJ, Henriques JP. Value of the SYNTAX Score in ST-Elevation Myocardial Infarction Patients With a Concomitant Chronic Total Coronary Occlusion(from the EXPLORE Trial). Am J Cardiol 2019; 123:1035-1043. [PMID: 30654929 DOI: 10.1016/j.amjcard.2018.12.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 12/16/2018] [Accepted: 12/19/2018] [Indexed: 01/09/2023]
Abstract
`To analyze the impact of additional coronary artery disease, quantified by the SYNTAX (SYNergy between PCI with TAXus and cardiac surgery) score, on left ventricular ejection fraction (LVEF) and long-term outcomes in a cohort of ST-elevated myocardial infarction (STEMI) patients with a concomitant chronic total coronary occlusion (CTO). A total of 302 STEMI patients were randomized to percutaneous coronary intervention of a CTO (CTO PCI) (n = 148) or conservative CTO treatment (n = 154). SYNTAX scores were calculated by an independent corelab (Cardialysis BV, Rotterdam) at two time-points: (1) at baseline, and (2) after primary PCI in the conservative CTO arm and after CTO PCI in the invasive arm (named 'discharge SYNTAX score'). The population was divided in two groups (below or equal to the median SYNTAX score preprimary PCI, or above the median). At 4-month follow-up, the LVEF was significantly lower in patients in the group with a SYNTAX score above the group median (42.8% vs 48.5%, p = 0.001), and the SYNTAX score was an independent predictor for LVEF at 4 months (β-0.151 (SE 0.068), p = 0.028). In the group with a SYNTAX score above the group median the mortality rate was higher (10.1% vs 3.9%, p = 0.025), and there was a trend towards a higher MACE rate (15.4% vs 8.5%, p = 0.063). In conclusion, in this sub-analysis of the EXPLORE trial we observed a worse LVEF and a higher mortality rate for patients with a SYNTAX score above the median. We found that the SYNTAX score is an independent negative predictor for LVEF and an independent positive predictor for LVEDV at 4-month follow-up.
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Redfors B, Dworeck C, Haraldsson I, Angerås O, Odenstedt J, Ioanes D, Petursson P, Völz S, Albertsson P, Råmunddal T, Persson J, Koul S, Erlinge D, Omerovic E. Pretreatment with P2Y12 receptor antagonists in ST-elevation myocardial infarction: a report from the Swedish Coronary Angiography and Angioplasty Registry. Eur Heart J 2019; 40:1202-1210. [DOI: 10.1093/eurheartj/ehz069] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 03/27/2018] [Accepted: 01/31/2019] [Indexed: 12/19/2022] Open
Affiliation(s)
- Bjorn Redfors
- Department of Cardiology, Sahlgrenska University Hospital, Bruna stråket 16, Gothenburg, Sweden
| | - Christian Dworeck
- Department of Cardiology, Sahlgrenska University Hospital, Bruna stråket 16, Gothenburg, Sweden
| | - Inger Haraldsson
- Department of Cardiology, Sahlgrenska University Hospital, Bruna stråket 16, Gothenburg, Sweden
| | - Oskar Angerås
- Department of Cardiology, Sahlgrenska University Hospital, Bruna stråket 16, Gothenburg, Sweden
| | - Jacob Odenstedt
- Department of Cardiology, Sahlgrenska University Hospital, Bruna stråket 16, Gothenburg, Sweden
| | - Dan Ioanes
- Department of Cardiology, Sahlgrenska University Hospital, Bruna stråket 16, Gothenburg, Sweden
| | - Petur Petursson
- Department of Cardiology, Sahlgrenska University Hospital, Bruna stråket 16, Gothenburg, Sweden
| | - Sebastian Völz
- Department of Cardiology, Sahlgrenska University Hospital, Bruna stråket 16, Gothenburg, Sweden
| | - Per Albertsson
- Department of Cardiology, Sahlgrenska University Hospital, Bruna stråket 16, Gothenburg, Sweden
| | - Truls Råmunddal
- Department of Cardiology, Sahlgrenska University Hospital, Bruna stråket 16, Gothenburg, Sweden
| | - Jonas Persson
- Department of Cardiology, Danderyd University Hospital, Stockholm, Sweden
| | - Sasha Koul
- Department of Cardiology, Skåne University Hospital, Lund, Sweden
| | | | - Elmir Omerovic
- Department of Cardiology, Sahlgrenska University Hospital, Bruna stråket 16, Gothenburg, Sweden
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Holm NR, Andreasen LN, Walsh S, Kajander OA, Witt N, Eek C, Knaapen P, Koltowski L, Gutiérrez-Chico JL, Burzotta F, Kockman J, Ormiston J, Santos-Pardo I, Laanmets P, Mylotte D, Madsen M, Hjort J, Kumsars I, Råmunddal T, Christiansen EH. Rational and design of the European randomized Optical Coherence Tomography Optimized Bifurcation Event Reduction Trial (OCTOBER). Am Heart J 2018; 205:97-109. [PMID: 30205242 DOI: 10.1016/j.ahj.2018.08.003] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 08/09/2018] [Indexed: 12/16/2022]
Abstract
Background Percutaneous coronary intervention in complex bifurcation lesions is prone to suboptimal implantation results and is associated with increased risk of subsequent clinical events. Angiographic ambiguity is high during bifurcation stenting, but it is unknown if procedural guidance by intravascular optical coherence tomography (OCT) improves clinical outcome. Methods and Design OCTOBER is a randomized, investigator-initiated, multicenter trial aimed to show superiority of OCT-guided stent implantation compared to standard angiographic-guided implantation in bifurcation lesions. The primary outcome measure is a 2-year composite end point of cardiac death, target lesion myocardial infarction, and ischemia-driven target lesion revascularization. The calculated sample size is 1,200 patients in total, and allocation is 1:1. Eligible patients have stable or unstable angina pectoris or stabilized non–ST elevation myocardial infarction, and a coronary bifurcation lesion with significant main vessel stenosis and more than 50 % stenosis in a side branch with a reference diameter ≥2.5mm. Treatment is performed by the provisional side branch stenting technique or 2-stent techniques, and the systematic OCT guiding protocol is aimed to evaluate (1) plaque preparation, (2) lesion length, (3) segmental reference sizes, (4) lesion coverage, (5) stent expansion, (6) malapposition, (7) wire positions, and (8) ostial results. Implications A positive outcome of the OCTOBER trial may establish OCT as a routine tool for optimization of complex percutaneous coronary intervention, whereas a negative result would indicate that OCT remains a tool for ad hoc evaluation in selected cases.
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30
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van Dongen IM, Elias J, van Houwelingen KG, Agostoni P, Claessen BEPM, Hoebers LP, Ouweneel DM, Scheunhage EM, Delewi R, Piek JJ, Råmunddal T, Laanmets P, Eriksen E, Bax M, Suttorp MJ, van der Schaaf RJ, Tijssen JGP, Henriques JPS. Impact of collateralisation to a concomitant chronic total occlusion in patients with ST-elevation myocardial infarction: a subanalysis of the EXPLORE randomised controlled trial. Open Heart 2018; 5:e000810. [PMID: 30057768 PMCID: PMC6059304 DOI: 10.1136/openhrt-2018-000810] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 04/09/2018] [Accepted: 04/24/2018] [Indexed: 01/23/2023] Open
Abstract
Objective The impact on cardiac function of collaterals towards a concomitant chronic total coronary occlusion (CTO) in patients with ST-elevation myocardial infarction (STEMI) has not been investigated yet. Therefore, we have evaluated the impact of well-developed collaterals compared with poorly developed collaterals to a concomitant CTO in STEMI. Methods and results In the EXPLORE trial, patients with STEMI and a concomitant CTO were randomised to either CTO percutaneous coronary intervention (PCI) or no-CTO PCI. Collateral grades were scored angiographically using the Rentrop grade classification. Left ventricular ejection fraction (LVEF) and left ventricular end-diastolic volume (LVEDV) at 4 months were measured using cardiac magnetic resonance imaging. Well-developed collaterals (Rentrop grades 2-3) to the CTO were present in 162 (54%) patients; these patients had a significantly higher LVEF at 4 months (46.2±11.4% vs 42.1±12.7%, p=0.004) as well as a trend for a lower LVEDV (208.2±55.7 mL vs 222.6±68.5 mL, p=0.054) when compared with patients with poorly developed collaterals to the CTO. There was no significant difference in the total amount of scar in the two groups. Event rates were statistically comparable between patients with well-developed collaterals and poorly developed collaterals to the CTO at long-term follow-up. Conclusions In patients with STEMI and a concomitant CTO, the presence of well-developed collaterals to a concomitant CTO is associated with a better LVEF at 4 months. However, this effect on LVEF did not translate into improvement in clinical outcome. Therefore, the presence of well-developed collaterals is important, but should not solely guide in the clinical decision-making process regarding any additional revascularisation of a concomitant CTO in patients with STEMI. Clinical trial registration NTR1108.
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Affiliation(s)
- Ivo M van Dongen
- Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Joëlle Elias
- Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | | | | | | | - Loes P Hoebers
- Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Dagmar M Ouweneel
- Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Esther M Scheunhage
- Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Ronak Delewi
- Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Jan J Piek
- Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | | | | | | | - Matthijs Bax
- Haga Teaching Hospital, The Hague, The Netherlands
| | | | | | - Jan G P Tijssen
- Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - José P S Henriques
- Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Völz S, Angerås O, Odenstedt J, Ioanes D, Haraldsson I, Dworeck C, Redfors B, Råmunddal T, Albertsson P, Petursson P, Omerovic E. Sustained risk of stent thrombosis and restenosis in first generation drug-eluting Stents after One Decade of Follow-up: A Report from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR). Catheter Cardiovasc Interv 2018; 92:E403-E409. [DOI: 10.1002/ccd.27655] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Revised: 03/23/2018] [Accepted: 04/15/2018] [Indexed: 11/09/2022]
Affiliation(s)
- Sebastian Völz
- Department of Cardiology; Sahlgrenska University Hospital; Sweden
| | - Oskar Angerås
- Department of Cardiology; Sahlgrenska University Hospital; Sweden
| | - Jacob Odenstedt
- Department of Cardiology; Sahlgrenska University Hospital; Sweden
| | - Dan Ioanes
- Department of Cardiology; Sahlgrenska University Hospital; Sweden
| | - Inger Haraldsson
- Department of Cardiology; Sahlgrenska University Hospital; Sweden
| | | | - Björn Redfors
- Department of Cardiology; Sahlgrenska University Hospital; Sweden
| | - Truls Råmunddal
- Department of Cardiology; Aarhus University Hospital; Denmark
| | - Per Albertsson
- Department of Cardiology; Sahlgrenska University Hospital; Sweden
| | - Petur Petursson
- Department of Cardiology; Sahlgrenska University Hospital; Sweden
| | - Elmir Omerovic
- Department of Cardiology; Sahlgrenska University Hospital; Sweden
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Elias J, van Dongen IM, Råmunddal T, Laanmets P, Eriksen E, Meuwissen M, Michels HR, Bax M, Ioanes D, Suttorp MJ, Strauss BH, Barbato E, Marques KM, Claessen BEPM, Hirsch A, van der Schaaf RJ, Tijssen JGP, Henriques JPS, Hoebers LP. Long-term impact of chronic total occlusion recanalisation in patients with ST-elevation myocardial infarction. Heart 2018; 104:1432-1438. [DOI: 10.1136/heartjnl-2017-312698] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 01/04/2018] [Accepted: 01/13/2018] [Indexed: 01/16/2023] Open
Abstract
BackgroundDuring primary percutaneous coronary intervention (PCI), a concurrent chronic total occlusion (CTO) is found in 10% of patients with ST-elevation myocardial infarction (STEMI). Long-term benefits of CTO-PCI have been suggested; however, randomised data are lacking. Our aim was to determine mid-term and long-term clinical outcome of CTO-PCI versus CTO-No PCI in patients with STEMI with a concurrent CTO.MethodsThe Evaluating Xience and left ventricular function in PCI on occlusiOns afteR STEMI (EXPLORE) was a multicentre randomised trial that included 302 patients with STEMI after successful primary PCI with a concurrent CTO. Patients were randomised to either CTO-PCI or CTO-No PCI. The primary end point of the current study was occurrence of major adverse cardiac events (MACE): cardiac death, coronary artery bypass grafting and MI. Other end points were 1-year left ventricular function (LVF); LV-ejection fraction and LV end-diastolic volume and angina status.ResultsThe median long-term follow-up was 3.9 (2.1–5.0) years. MACE was not significantly different between both arms (13.5% vs 12.3%, HR 1.03, 95% CI 0.54 to 1.98; P=0.93). Cardiac death was more frequent in the CTO-PCI arm (6.0% vs 1.0%, P=0.02) with no difference in all-cause mortality (12.9% vs 6.2%, HR 2.07, 95% CI 0.84 to 5.14; P=0.11). One-year LVF did not differ between both arms. However, there were more patients with freedom of angina in the CTO-PCI arm at 1 year (94% vs 87%, P=0.03).ConclusionsIn this randomised trial involving patients with STEMI with a concurrent CTO, CTO-PCI was not associated with a reduction in long-term MACE compared to CTO-No PCI. One-year LVF was comparable between both treatment arms. The finding that there were more patients with freedom of angina after CTO-PCI at 1-year follow-up needs further investigation.Clinical trial registrationEXPLORE trial number NTR1108 www.trialregister.nl.
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Angerås O, Haraldsson I, Redfors B, Fröbert O, Petursson P, Albertsson P, Ioanes D, Odenstedt J, Olsson H, Witt N, Rück A, Millgård J, Nilsson J, Persson J, Söderbom M, Wedel H, Erlinge D, James S, Råmunddal T, Omerovic E. Impact of Thrombus Aspiration on Mortality, Stent Thrombosis, and Stroke in Patients With ST-Segment-Elevation Myocardial Infarction: A Report From the Swedish Coronary Angiography and Angioplasty Registry. J Am Heart Assoc 2018; 7:JAHA.117.007680. [PMID: 29317403 PMCID: PMC5778972 DOI: 10.1161/jaha.117.007680] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Background Thrombus aspiration is still being used in a substantial number of patients despite 2 large randomized clinical trials showing no favorable effect of routine thrombus aspiration during primary percutaneous coronary intervention in patients with ST‐segment–elevation myocardial infarction. The aim of this observational study was to evaluate the impact of thrombus aspiration on mortality, stent thrombosis, and stroke using all available data from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR). Methods and Results We identified 42 829 consecutive patients registered in SCAAR between January 2005 and September 2014 who underwent percutaneous coronary intervention for ST‐segment–elevation myocardial infarction. Thrombus aspiration was used in 25% of the procedures. We used instrumental variable analysis with administrative healthcare region as the treatment‐preference instrumental variable to evaluate the effect of thrombus aspiration on mortality, stent thrombosis, and stroke. Thrombus aspiration was not associated with mortality at 30 days (risk reduction: −1.2; 95% confidence interval [CI], −5.4 to 3.0; P=0.57) and 1 year (risk reduction: −2.4; 95% CI, −7.6 to 3.0; P=0.37). Thrombus aspiration was associated with a lower risk of stent thrombosis both at 30 days (risk reduction: −2.7; 95% CI, −4.1 to −1.4; P<0.001) and 1 year (risk reduction: −3.5; 95% CI, −5.3 to −1.7; P<0.001). In‐hospital stroke and neurologic complications did not differ between groups (risk reduction: 0.1; 95% CI, −0.8 to 1.1; P=0.76). Conclusions Mortality was not different between the groups. Thrombus aspiration was associated with decreased risk of stent thrombosis. Our study provides important evidence for the external validity of previous randomized studies regarding mortality.
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Affiliation(s)
- Oskar Angerås
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.,Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Inger Haraldsson
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.,Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Björn Redfors
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.,Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ole Fröbert
- Department of Cardiology, Örebro University Hospital, Gothenburg, Sweden
| | - Petur Petursson
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.,Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Per Albertsson
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.,Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Dan Ioanes
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.,Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Jacob Odenstedt
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.,Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Hans Olsson
- Department of Cardiology, Karlstad Hospital, Karlstad, Sweden
| | - Nils Witt
- Department of Cardiology, South Hospital Stockholm, Stockholm, Sweden
| | - Andreas Rück
- Department of Cardiology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Jonas Millgård
- Department of Cardiology, Sunderby Hospital, Sunderbyn, Sweden
| | - Johan Nilsson
- Department of Cardiology, Heart Centre, Umeå University Hospital, Umeå, Sweden
| | - Jonas Persson
- Department of Cardiology, Danderyd University Hospital, Stockholm, Sweden
| | - Måns Söderbom
- Department of Economics, University of Gothenburg, Sweden
| | - Hans Wedel
- Health Metrics, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - David Erlinge
- Department of Cardiology, Lund University, Lund, Sweden
| | - Stefan James
- Department of Medical Sciences, Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Truls Råmunddal
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.,Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Elmir Omerovic
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden .,Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
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Redfors B, Dworeck C, Angerås O, Haraldsson I, Petursson P, Odenstedt J, Ioanes D, Völz S, Hiller M, Fransson P, Stewart J, Fryklund H, Albertsson P, Råmunddal T, Omerovic E. Prognosis is similar for patients who undergo primary PCI during regular-hours and off-hours: A report from SCAAR*. Catheter Cardiovasc Interv 2017; 91:1240-1249. [DOI: 10.1002/ccd.27210] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 05/27/2017] [Accepted: 06/24/2017] [Indexed: 11/06/2022]
Affiliation(s)
- Björn Redfors
- Department of Molecular and Clinical Medicine; Institute of Medicine; Gothenburg Sweden
- Department of Cardiology; Sahlgrenska University Hospital; Gothenburg Sweden
| | - Christian Dworeck
- Department of Molecular and Clinical Medicine; Institute of Medicine; Gothenburg Sweden
- Department of Cardiology; Sahlgrenska University Hospital; Gothenburg Sweden
| | - Oskar Angerås
- Department of Molecular and Clinical Medicine; Institute of Medicine; Gothenburg Sweden
- Department of Cardiology; Sahlgrenska University Hospital; Gothenburg Sweden
| | - Inger Haraldsson
- Department of Molecular and Clinical Medicine; Institute of Medicine; Gothenburg Sweden
- Department of Cardiology; Sahlgrenska University Hospital; Gothenburg Sweden
| | - Petur Petursson
- Department of Molecular and Clinical Medicine; Institute of Medicine; Gothenburg Sweden
- Department of Cardiology; Sahlgrenska University Hospital; Gothenburg Sweden
| | - Jacob Odenstedt
- Department of Molecular and Clinical Medicine; Institute of Medicine; Gothenburg Sweden
- Department of Cardiology; Sahlgrenska University Hospital; Gothenburg Sweden
| | - Dan Ioanes
- Department of Molecular and Clinical Medicine; Institute of Medicine; Gothenburg Sweden
- Department of Cardiology; Sahlgrenska University Hospital; Gothenburg Sweden
| | - Sebastian Völz
- Department of Molecular and Clinical Medicine; Institute of Medicine; Gothenburg Sweden
- Department of Cardiology; Sahlgrenska University Hospital; Gothenburg Sweden
| | - Magnus Hiller
- Department of Molecular and Clinical Medicine; Institute of Medicine; Gothenburg Sweden
- Department of Cardiology; Sahlgrenska University Hospital; Gothenburg Sweden
| | - Per Fransson
- Department of Cardiology; Södra Älvsborgs Sjukhus; Borås Sweden
| | - Jason Stewart
- Department of Cardiology; Skaraborg Hospital; Skövde Sweden
| | - Henrik Fryklund
- Department of Cardiology; Norra Älvsborgs Länssjukhus; Trollhättan Sweden
| | - Per Albertsson
- Department of Molecular and Clinical Medicine; Institute of Medicine; Gothenburg Sweden
- Department of Cardiology; Sahlgrenska University Hospital; Gothenburg Sweden
| | - Truls Råmunddal
- Department of Molecular and Clinical Medicine; Institute of Medicine; Gothenburg Sweden
- Department of Cardiology; Sahlgrenska University Hospital; Gothenburg Sweden
| | - Elmir Omerovic
- Department of Molecular and Clinical Medicine; Institute of Medicine; Gothenburg Sweden
- Department of Cardiology; Sahlgrenska University Hospital; Gothenburg Sweden
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Råmunddal T, Hoebers LP, Henriques JPS, Dworeck C, Angerås O, Odenstedt J, Ioanes D, Olivecrona G, Harnek J, Jensen U, Aasa M, Albertsson P, Wedel H, Omerovic E. Prognostic Impact of Chronic Total Occlusions: A Report From SCAAR (Swedish Coronary Angiography and Angioplasty Registry). JACC Cardiovasc Interv 2017; 9:1535-44. [PMID: 27491603 DOI: 10.1016/j.jcin.2016.04.031] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [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: 09/21/2015] [Revised: 03/28/2016] [Accepted: 04/21/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The aim of this study was to determine the prognostic impact of chronic total occlusion (CTO) on long-term mortality in a large prospective cohort. BACKGROUND CTO is present in many patients with coronary artery disease and is difficult to treat with percutaneous coronary intervention. METHODS The study population consisted of all consecutive patients who underwent coronary angiography in Sweden between January 1, 2005 and January 1, 2012, who were registered in SCAAR (Swedish Coronary Angiography and Angioplasty Registry). The patient population was heterogeneous with regard to indication for angiography (stable angina, ST-segment elevation myocardial infarction [STEMI], unstable angina or non-STEMI, and other) and treatment options. The long-term mortality rates of patients with and without CTO were compared by using shared frailty Cox proportional hazards regression adjusted for confounders. Tests were conducted for interactions between CTO and several pre-specified characteristics: indication for angiography and percutaneous coronary intervention (stable angina, STEMI, unstable angina or non-STEMI, and other), severity of coronary artery disease (1-, 2-, and 3-vessel and/or left main coronary artery disease), age, sex, and diabetes. RESULTS During the study period, 14,441 patients with CTO and 75,431 patients without CTO were registered in SCAAR. CTO was associated with higher mortality (hazard ratio: 1.29; 95% confidence interval: 1.22 to 1.37; p < 0.001). In subgroup analyses, the risk attributable to CTO was lowest in patients with stable angina and highest in those with STEMI. In addition, CTO was associated with highest risk in patients under 60 years of age and with lowest risk in octogenarians. There was no interaction between CTO and either diabetes or sex, suggesting an equally adverse effect in both groups. CONCLUSIONS In this large prospective observational study of patients with coronary artery disease, CTO was associated with increased mortality. This association was most prominent in younger patients and in those with acute coronary syndromes.
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Affiliation(s)
- Truls Råmunddal
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Loes P Hoebers
- Department of Cardiology, Academic Medical Center, Amsterdam, the Netherlands
| | - José P S Henriques
- Department of Cardiology, Academic Medical Center, Amsterdam, the Netherlands
| | - Christian Dworeck
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Oskar Angerås
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Jacob Odenstedt
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Dan Ioanes
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Göran Olivecrona
- Department of Coronary Heart Disease, Skåne University Hospital, Lund, Sweden
| | - Jan Harnek
- Department of Coronary Heart Disease, Skåne University Hospital, Lund, Sweden
| | - Ulf Jensen
- Department of Cardiology, Stockholm South General Hospital, Stockholm, Sweden
| | - Mikael Aasa
- Department of Cardiology, Stockholm South General Hospital, Stockholm, Sweden
| | - Per Albertsson
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Hans Wedel
- Health Metrics, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Elmir Omerovic
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
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Erlinge D, Omerovic E, Fröbert O, Linder R, Danielewicz M, Hamid M, Swahn E, Henareh L, Wagner H, Hårdhammar P, Sjögren I, Stewart J, Grimfjärd P, Jensen J, Aasa M, Robertsson L, Lindroos P, Haupt J, Wikström H, Ulvenstam A, Bhiladvala P, Lindvall B, Lundin A, Tödt T, Ioanes D, Råmunddal T, Kellerth T, Zagozdzon L, Götberg M, Andersson J, Angerås O, Östlund O, Lagerqvist B, Held C, Wallentin L, Scherstén F, Eriksson P, Koul S, James S. Bivalirudin versus Heparin Monotherapy in Myocardial Infarction. N Engl J Med 2017; 377:1132-1142. [PMID: 28844201 DOI: 10.1056/nejmoa1706443] [Citation(s) in RCA: 203] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND The comparative efficacy of various anticoagulation strategies has not been clearly established in patients with acute myocardial infarction who are undergoing percutaneous coronary intervention (PCI) according to current practice, which includes the use of radial-artery access for PCI and administration of potent P2Y12 inhibitors without the planned use of glycoprotein IIb/IIIa inhibitors. METHODS In this multicenter, randomized, registry-based, open-label clinical trial, we enrolled patients with either ST-segment elevation myocardial infarction (STEMI) or non-STEMI (NSTEMI) who were undergoing PCI and receiving treatment with a potent P2Y12 inhibitor (ticagrelor, prasugrel, or cangrelor) without the planned use of glycoprotein IIb/IIIa inhibitors. The patients were randomly assigned to receive bivalirudin or heparin during PCI, which was performed predominantly with the use of radial-artery access. The primary end point was a composite of death from any cause, myocardial infarction, or major bleeding during 180 days of follow-up. RESULTS A total of 6006 patients (3005 with STEMI and 3001 with NSTEMI) were enrolled in the trial. At 180 days, a primary end-point event had occurred in 12.3% of the patients (369 of 3004) in the bivalirudin group and in 12.8% (383 of 3002) in the heparin group (hazard ratio, 0.96; 95% confidence interval [CI], 0.83 to 1.10; P=0.54). The results were consistent between patients with STEMI and those with NSTEMI and across other major subgroups. Myocardial infarction occurred in 2.0% of the patients in the bivalirudin group and in 2.4% in the heparin group (hazard ratio, 0.84; 95% CI, 0.60 to 1.19; P=0.33), major bleeding in 8.6% and 8.6%, respectively (hazard ratio, 1.00; 95% CI, 0.84 to 1.19; P=0.98), definite stent thrombosis in 0.4% and 0.7%, respectively (hazard ratio, 0.54; 95% CI, 0.27 to 1.10; P=0.09), and death in 2.9% and 2.8%, respectively (hazard ratio, 1.05; 95% CI, 0.78 to 1.41; P=0.76). CONCLUSIONS Among patients undergoing PCI for myocardial infarction, the rate of the composite of death from any cause, myocardial infarction, or major bleeding was not lower among those who received bivalirudin than among those who received heparin monotherapy. (Funded by the Swedish Heart-Lung Foundation and others; VALIDATE-SWEDEHEART ClinicalTrialsRegister.eu number, 2012-005260-10 ; ClinicalTrials.gov number, NCT02311231 .).
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Affiliation(s)
- David Erlinge
- From the Department of Cardiology, Clinical Sciences, Lund University, Lund (D.E., P.B., A.L., T.T., M.G., F.S., S.K.), the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (E.O., D.I., T.R., O.A.), the Department of Cardiology, Faculty of Health, Örebro University, Örebro (O.F., T.K., L.Z.), the Department of Cardiology, Danderyd Hospital (R.L.), and the Department of Cardiology, Karolinska University Hospital (L.H.), Karolinska Institutet, the Department of Cardiology, Capio St. Görans Hospital (J.J., P.L.), and the Department of Cardiology, Södersjukhuset AB (M.A.), Stockholm, PCI-Unit at Karlstad Hospital, Karlstad (M.D.), the Department of Cardiology, Mälarsjukhuset, Eskilstuna (M.H.), the Department of Cardiology, Linköping University Hospital, Linköping (E.S.), the Department of Cardiology, Helsingborg Lasarett, Helsingborg (H. Wagner), the Department of Cardiology, Halmstad Hospital, Halmstad (P.H.), the Department of Cardiology, Falun Hospital, Falun (I.S.), the Department of Cardiology, Skaraborgs Hospital, Skövde (J.S.), the Department of Internal Medicine, Västmanlands Sjukhus, Västerås (P.G.), the Department of Cardiology, Södra Älvsborgs Sjukhus, Borås (L.R.), the Department of Cardiology, Sunderby Sjukhus, Luleå (J.H.), the Department of Cardiology, Kristianstad Hospital, Kristianstad (H. Wikström), the Department of Cardiology, Östersund Hospital, Östersund (A.U.), the Department of Cardiology, Sundsvall Hospital, Sundsvall (B. Lindvall), the Department of Cardiology, Umeå University, Umeå (J.A., P.E.), and the Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Uppsala (O.Ö., B. Lagerqvist, C.H., L.W., S.J.) - all in Sweden
| | - Elmir Omerovic
- From the Department of Cardiology, Clinical Sciences, Lund University, Lund (D.E., P.B., A.L., T.T., M.G., F.S., S.K.), the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (E.O., D.I., T.R., O.A.), the Department of Cardiology, Faculty of Health, Örebro University, Örebro (O.F., T.K., L.Z.), the Department of Cardiology, Danderyd Hospital (R.L.), and the Department of Cardiology, Karolinska University Hospital (L.H.), Karolinska Institutet, the Department of Cardiology, Capio St. Görans Hospital (J.J., P.L.), and the Department of Cardiology, Södersjukhuset AB (M.A.), Stockholm, PCI-Unit at Karlstad Hospital, Karlstad (M.D.), the Department of Cardiology, Mälarsjukhuset, Eskilstuna (M.H.), the Department of Cardiology, Linköping University Hospital, Linköping (E.S.), the Department of Cardiology, Helsingborg Lasarett, Helsingborg (H. Wagner), the Department of Cardiology, Halmstad Hospital, Halmstad (P.H.), the Department of Cardiology, Falun Hospital, Falun (I.S.), the Department of Cardiology, Skaraborgs Hospital, Skövde (J.S.), the Department of Internal Medicine, Västmanlands Sjukhus, Västerås (P.G.), the Department of Cardiology, Södra Älvsborgs Sjukhus, Borås (L.R.), the Department of Cardiology, Sunderby Sjukhus, Luleå (J.H.), the Department of Cardiology, Kristianstad Hospital, Kristianstad (H. Wikström), the Department of Cardiology, Östersund Hospital, Östersund (A.U.), the Department of Cardiology, Sundsvall Hospital, Sundsvall (B. Lindvall), the Department of Cardiology, Umeå University, Umeå (J.A., P.E.), and the Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Uppsala (O.Ö., B. Lagerqvist, C.H., L.W., S.J.) - all in Sweden
| | - Ole Fröbert
- From the Department of Cardiology, Clinical Sciences, Lund University, Lund (D.E., P.B., A.L., T.T., M.G., F.S., S.K.), the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (E.O., D.I., T.R., O.A.), the Department of Cardiology, Faculty of Health, Örebro University, Örebro (O.F., T.K., L.Z.), the Department of Cardiology, Danderyd Hospital (R.L.), and the Department of Cardiology, Karolinska University Hospital (L.H.), Karolinska Institutet, the Department of Cardiology, Capio St. Görans Hospital (J.J., P.L.), and the Department of Cardiology, Södersjukhuset AB (M.A.), Stockholm, PCI-Unit at Karlstad Hospital, Karlstad (M.D.), the Department of Cardiology, Mälarsjukhuset, Eskilstuna (M.H.), the Department of Cardiology, Linköping University Hospital, Linköping (E.S.), the Department of Cardiology, Helsingborg Lasarett, Helsingborg (H. Wagner), the Department of Cardiology, Halmstad Hospital, Halmstad (P.H.), the Department of Cardiology, Falun Hospital, Falun (I.S.), the Department of Cardiology, Skaraborgs Hospital, Skövde (J.S.), the Department of Internal Medicine, Västmanlands Sjukhus, Västerås (P.G.), the Department of Cardiology, Södra Älvsborgs Sjukhus, Borås (L.R.), the Department of Cardiology, Sunderby Sjukhus, Luleå (J.H.), the Department of Cardiology, Kristianstad Hospital, Kristianstad (H. Wikström), the Department of Cardiology, Östersund Hospital, Östersund (A.U.), the Department of Cardiology, Sundsvall Hospital, Sundsvall (B. Lindvall), the Department of Cardiology, Umeå University, Umeå (J.A., P.E.), and the Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Uppsala (O.Ö., B. Lagerqvist, C.H., L.W., S.J.) - all in Sweden
| | - Rikard Linder
- From the Department of Cardiology, Clinical Sciences, Lund University, Lund (D.E., P.B., A.L., T.T., M.G., F.S., S.K.), the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (E.O., D.I., T.R., O.A.), the Department of Cardiology, Faculty of Health, Örebro University, Örebro (O.F., T.K., L.Z.), the Department of Cardiology, Danderyd Hospital (R.L.), and the Department of Cardiology, Karolinska University Hospital (L.H.), Karolinska Institutet, the Department of Cardiology, Capio St. Görans Hospital (J.J., P.L.), and the Department of Cardiology, Södersjukhuset AB (M.A.), Stockholm, PCI-Unit at Karlstad Hospital, Karlstad (M.D.), the Department of Cardiology, Mälarsjukhuset, Eskilstuna (M.H.), the Department of Cardiology, Linköping University Hospital, Linköping (E.S.), the Department of Cardiology, Helsingborg Lasarett, Helsingborg (H. Wagner), the Department of Cardiology, Halmstad Hospital, Halmstad (P.H.), the Department of Cardiology, Falun Hospital, Falun (I.S.), the Department of Cardiology, Skaraborgs Hospital, Skövde (J.S.), the Department of Internal Medicine, Västmanlands Sjukhus, Västerås (P.G.), the Department of Cardiology, Södra Älvsborgs Sjukhus, Borås (L.R.), the Department of Cardiology, Sunderby Sjukhus, Luleå (J.H.), the Department of Cardiology, Kristianstad Hospital, Kristianstad (H. Wikström), the Department of Cardiology, Östersund Hospital, Östersund (A.U.), the Department of Cardiology, Sundsvall Hospital, Sundsvall (B. Lindvall), the Department of Cardiology, Umeå University, Umeå (J.A., P.E.), and the Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Uppsala (O.Ö., B. Lagerqvist, C.H., L.W., S.J.) - all in Sweden
| | - Mikael Danielewicz
- From the Department of Cardiology, Clinical Sciences, Lund University, Lund (D.E., P.B., A.L., T.T., M.G., F.S., S.K.), the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (E.O., D.I., T.R., O.A.), the Department of Cardiology, Faculty of Health, Örebro University, Örebro (O.F., T.K., L.Z.), the Department of Cardiology, Danderyd Hospital (R.L.), and the Department of Cardiology, Karolinska University Hospital (L.H.), Karolinska Institutet, the Department of Cardiology, Capio St. Görans Hospital (J.J., P.L.), and the Department of Cardiology, Södersjukhuset AB (M.A.), Stockholm, PCI-Unit at Karlstad Hospital, Karlstad (M.D.), the Department of Cardiology, Mälarsjukhuset, Eskilstuna (M.H.), the Department of Cardiology, Linköping University Hospital, Linköping (E.S.), the Department of Cardiology, Helsingborg Lasarett, Helsingborg (H. Wagner), the Department of Cardiology, Halmstad Hospital, Halmstad (P.H.), the Department of Cardiology, Falun Hospital, Falun (I.S.), the Department of Cardiology, Skaraborgs Hospital, Skövde (J.S.), the Department of Internal Medicine, Västmanlands Sjukhus, Västerås (P.G.), the Department of Cardiology, Södra Älvsborgs Sjukhus, Borås (L.R.), the Department of Cardiology, Sunderby Sjukhus, Luleå (J.H.), the Department of Cardiology, Kristianstad Hospital, Kristianstad (H. Wikström), the Department of Cardiology, Östersund Hospital, Östersund (A.U.), the Department of Cardiology, Sundsvall Hospital, Sundsvall (B. Lindvall), the Department of Cardiology, Umeå University, Umeå (J.A., P.E.), and the Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Uppsala (O.Ö., B. Lagerqvist, C.H., L.W., S.J.) - all in Sweden
| | - Mehmet Hamid
- From the Department of Cardiology, Clinical Sciences, Lund University, Lund (D.E., P.B., A.L., T.T., M.G., F.S., S.K.), the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (E.O., D.I., T.R., O.A.), the Department of Cardiology, Faculty of Health, Örebro University, Örebro (O.F., T.K., L.Z.), the Department of Cardiology, Danderyd Hospital (R.L.), and the Department of Cardiology, Karolinska University Hospital (L.H.), Karolinska Institutet, the Department of Cardiology, Capio St. Görans Hospital (J.J., P.L.), and the Department of Cardiology, Södersjukhuset AB (M.A.), Stockholm, PCI-Unit at Karlstad Hospital, Karlstad (M.D.), the Department of Cardiology, Mälarsjukhuset, Eskilstuna (M.H.), the Department of Cardiology, Linköping University Hospital, Linköping (E.S.), the Department of Cardiology, Helsingborg Lasarett, Helsingborg (H. Wagner), the Department of Cardiology, Halmstad Hospital, Halmstad (P.H.), the Department of Cardiology, Falun Hospital, Falun (I.S.), the Department of Cardiology, Skaraborgs Hospital, Skövde (J.S.), the Department of Internal Medicine, Västmanlands Sjukhus, Västerås (P.G.), the Department of Cardiology, Södra Älvsborgs Sjukhus, Borås (L.R.), the Department of Cardiology, Sunderby Sjukhus, Luleå (J.H.), the Department of Cardiology, Kristianstad Hospital, Kristianstad (H. Wikström), the Department of Cardiology, Östersund Hospital, Östersund (A.U.), the Department of Cardiology, Sundsvall Hospital, Sundsvall (B. Lindvall), the Department of Cardiology, Umeå University, Umeå (J.A., P.E.), and the Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Uppsala (O.Ö., B. Lagerqvist, C.H., L.W., S.J.) - all in Sweden
| | - Eva Swahn
- From the Department of Cardiology, Clinical Sciences, Lund University, Lund (D.E., P.B., A.L., T.T., M.G., F.S., S.K.), the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (E.O., D.I., T.R., O.A.), the Department of Cardiology, Faculty of Health, Örebro University, Örebro (O.F., T.K., L.Z.), the Department of Cardiology, Danderyd Hospital (R.L.), and the Department of Cardiology, Karolinska University Hospital (L.H.), Karolinska Institutet, the Department of Cardiology, Capio St. Görans Hospital (J.J., P.L.), and the Department of Cardiology, Södersjukhuset AB (M.A.), Stockholm, PCI-Unit at Karlstad Hospital, Karlstad (M.D.), the Department of Cardiology, Mälarsjukhuset, Eskilstuna (M.H.), the Department of Cardiology, Linköping University Hospital, Linköping (E.S.), the Department of Cardiology, Helsingborg Lasarett, Helsingborg (H. Wagner), the Department of Cardiology, Halmstad Hospital, Halmstad (P.H.), the Department of Cardiology, Falun Hospital, Falun (I.S.), the Department of Cardiology, Skaraborgs Hospital, Skövde (J.S.), the Department of Internal Medicine, Västmanlands Sjukhus, Västerås (P.G.), the Department of Cardiology, Södra Älvsborgs Sjukhus, Borås (L.R.), the Department of Cardiology, Sunderby Sjukhus, Luleå (J.H.), the Department of Cardiology, Kristianstad Hospital, Kristianstad (H. Wikström), the Department of Cardiology, Östersund Hospital, Östersund (A.U.), the Department of Cardiology, Sundsvall Hospital, Sundsvall (B. Lindvall), the Department of Cardiology, Umeå University, Umeå (J.A., P.E.), and the Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Uppsala (O.Ö., B. Lagerqvist, C.H., L.W., S.J.) - all in Sweden
| | - Loghman Henareh
- From the Department of Cardiology, Clinical Sciences, Lund University, Lund (D.E., P.B., A.L., T.T., M.G., F.S., S.K.), the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (E.O., D.I., T.R., O.A.), the Department of Cardiology, Faculty of Health, Örebro University, Örebro (O.F., T.K., L.Z.), the Department of Cardiology, Danderyd Hospital (R.L.), and the Department of Cardiology, Karolinska University Hospital (L.H.), Karolinska Institutet, the Department of Cardiology, Capio St. Görans Hospital (J.J., P.L.), and the Department of Cardiology, Södersjukhuset AB (M.A.), Stockholm, PCI-Unit at Karlstad Hospital, Karlstad (M.D.), the Department of Cardiology, Mälarsjukhuset, Eskilstuna (M.H.), the Department of Cardiology, Linköping University Hospital, Linköping (E.S.), the Department of Cardiology, Helsingborg Lasarett, Helsingborg (H. Wagner), the Department of Cardiology, Halmstad Hospital, Halmstad (P.H.), the Department of Cardiology, Falun Hospital, Falun (I.S.), the Department of Cardiology, Skaraborgs Hospital, Skövde (J.S.), the Department of Internal Medicine, Västmanlands Sjukhus, Västerås (P.G.), the Department of Cardiology, Södra Älvsborgs Sjukhus, Borås (L.R.), the Department of Cardiology, Sunderby Sjukhus, Luleå (J.H.), the Department of Cardiology, Kristianstad Hospital, Kristianstad (H. Wikström), the Department of Cardiology, Östersund Hospital, Östersund (A.U.), the Department of Cardiology, Sundsvall Hospital, Sundsvall (B. Lindvall), the Department of Cardiology, Umeå University, Umeå (J.A., P.E.), and the Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Uppsala (O.Ö., B. Lagerqvist, C.H., L.W., S.J.) - all in Sweden
| | - Henrik Wagner
- From the Department of Cardiology, Clinical Sciences, Lund University, Lund (D.E., P.B., A.L., T.T., M.G., F.S., S.K.), the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (E.O., D.I., T.R., O.A.), the Department of Cardiology, Faculty of Health, Örebro University, Örebro (O.F., T.K., L.Z.), the Department of Cardiology, Danderyd Hospital (R.L.), and the Department of Cardiology, Karolinska University Hospital (L.H.), Karolinska Institutet, the Department of Cardiology, Capio St. Görans Hospital (J.J., P.L.), and the Department of Cardiology, Södersjukhuset AB (M.A.), Stockholm, PCI-Unit at Karlstad Hospital, Karlstad (M.D.), the Department of Cardiology, Mälarsjukhuset, Eskilstuna (M.H.), the Department of Cardiology, Linköping University Hospital, Linköping (E.S.), the Department of Cardiology, Helsingborg Lasarett, Helsingborg (H. Wagner), the Department of Cardiology, Halmstad Hospital, Halmstad (P.H.), the Department of Cardiology, Falun Hospital, Falun (I.S.), the Department of Cardiology, Skaraborgs Hospital, Skövde (J.S.), the Department of Internal Medicine, Västmanlands Sjukhus, Västerås (P.G.), the Department of Cardiology, Södra Älvsborgs Sjukhus, Borås (L.R.), the Department of Cardiology, Sunderby Sjukhus, Luleå (J.H.), the Department of Cardiology, Kristianstad Hospital, Kristianstad (H. Wikström), the Department of Cardiology, Östersund Hospital, Östersund (A.U.), the Department of Cardiology, Sundsvall Hospital, Sundsvall (B. Lindvall), the Department of Cardiology, Umeå University, Umeå (J.A., P.E.), and the Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Uppsala (O.Ö., B. Lagerqvist, C.H., L.W., S.J.) - all in Sweden
| | - Peter Hårdhammar
- From the Department of Cardiology, Clinical Sciences, Lund University, Lund (D.E., P.B., A.L., T.T., M.G., F.S., S.K.), the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (E.O., D.I., T.R., O.A.), the Department of Cardiology, Faculty of Health, Örebro University, Örebro (O.F., T.K., L.Z.), the Department of Cardiology, Danderyd Hospital (R.L.), and the Department of Cardiology, Karolinska University Hospital (L.H.), Karolinska Institutet, the Department of Cardiology, Capio St. Görans Hospital (J.J., P.L.), and the Department of Cardiology, Södersjukhuset AB (M.A.), Stockholm, PCI-Unit at Karlstad Hospital, Karlstad (M.D.), the Department of Cardiology, Mälarsjukhuset, Eskilstuna (M.H.), the Department of Cardiology, Linköping University Hospital, Linköping (E.S.), the Department of Cardiology, Helsingborg Lasarett, Helsingborg (H. Wagner), the Department of Cardiology, Halmstad Hospital, Halmstad (P.H.), the Department of Cardiology, Falun Hospital, Falun (I.S.), the Department of Cardiology, Skaraborgs Hospital, Skövde (J.S.), the Department of Internal Medicine, Västmanlands Sjukhus, Västerås (P.G.), the Department of Cardiology, Södra Älvsborgs Sjukhus, Borås (L.R.), the Department of Cardiology, Sunderby Sjukhus, Luleå (J.H.), the Department of Cardiology, Kristianstad Hospital, Kristianstad (H. Wikström), the Department of Cardiology, Östersund Hospital, Östersund (A.U.), the Department of Cardiology, Sundsvall Hospital, Sundsvall (B. Lindvall), the Department of Cardiology, Umeå University, Umeå (J.A., P.E.), and the Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Uppsala (O.Ö., B. Lagerqvist, C.H., L.W., S.J.) - all in Sweden
| | - Iwar Sjögren
- From the Department of Cardiology, Clinical Sciences, Lund University, Lund (D.E., P.B., A.L., T.T., M.G., F.S., S.K.), the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (E.O., D.I., T.R., O.A.), the Department of Cardiology, Faculty of Health, Örebro University, Örebro (O.F., T.K., L.Z.), the Department of Cardiology, Danderyd Hospital (R.L.), and the Department of Cardiology, Karolinska University Hospital (L.H.), Karolinska Institutet, the Department of Cardiology, Capio St. Görans Hospital (J.J., P.L.), and the Department of Cardiology, Södersjukhuset AB (M.A.), Stockholm, PCI-Unit at Karlstad Hospital, Karlstad (M.D.), the Department of Cardiology, Mälarsjukhuset, Eskilstuna (M.H.), the Department of Cardiology, Linköping University Hospital, Linköping (E.S.), the Department of Cardiology, Helsingborg Lasarett, Helsingborg (H. Wagner), the Department of Cardiology, Halmstad Hospital, Halmstad (P.H.), the Department of Cardiology, Falun Hospital, Falun (I.S.), the Department of Cardiology, Skaraborgs Hospital, Skövde (J.S.), the Department of Internal Medicine, Västmanlands Sjukhus, Västerås (P.G.), the Department of Cardiology, Södra Älvsborgs Sjukhus, Borås (L.R.), the Department of Cardiology, Sunderby Sjukhus, Luleå (J.H.), the Department of Cardiology, Kristianstad Hospital, Kristianstad (H. Wikström), the Department of Cardiology, Östersund Hospital, Östersund (A.U.), the Department of Cardiology, Sundsvall Hospital, Sundsvall (B. Lindvall), the Department of Cardiology, Umeå University, Umeå (J.A., P.E.), and the Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Uppsala (O.Ö., B. Lagerqvist, C.H., L.W., S.J.) - all in Sweden
| | - Jason Stewart
- From the Department of Cardiology, Clinical Sciences, Lund University, Lund (D.E., P.B., A.L., T.T., M.G., F.S., S.K.), the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (E.O., D.I., T.R., O.A.), the Department of Cardiology, Faculty of Health, Örebro University, Örebro (O.F., T.K., L.Z.), the Department of Cardiology, Danderyd Hospital (R.L.), and the Department of Cardiology, Karolinska University Hospital (L.H.), Karolinska Institutet, the Department of Cardiology, Capio St. Görans Hospital (J.J., P.L.), and the Department of Cardiology, Södersjukhuset AB (M.A.), Stockholm, PCI-Unit at Karlstad Hospital, Karlstad (M.D.), the Department of Cardiology, Mälarsjukhuset, Eskilstuna (M.H.), the Department of Cardiology, Linköping University Hospital, Linköping (E.S.), the Department of Cardiology, Helsingborg Lasarett, Helsingborg (H. Wagner), the Department of Cardiology, Halmstad Hospital, Halmstad (P.H.), the Department of Cardiology, Falun Hospital, Falun (I.S.), the Department of Cardiology, Skaraborgs Hospital, Skövde (J.S.), the Department of Internal Medicine, Västmanlands Sjukhus, Västerås (P.G.), the Department of Cardiology, Södra Älvsborgs Sjukhus, Borås (L.R.), the Department of Cardiology, Sunderby Sjukhus, Luleå (J.H.), the Department of Cardiology, Kristianstad Hospital, Kristianstad (H. Wikström), the Department of Cardiology, Östersund Hospital, Östersund (A.U.), the Department of Cardiology, Sundsvall Hospital, Sundsvall (B. Lindvall), the Department of Cardiology, Umeå University, Umeå (J.A., P.E.), and the Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Uppsala (O.Ö., B. Lagerqvist, C.H., L.W., S.J.) - all in Sweden
| | - Per Grimfjärd
- From the Department of Cardiology, Clinical Sciences, Lund University, Lund (D.E., P.B., A.L., T.T., M.G., F.S., S.K.), the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (E.O., D.I., T.R., O.A.), the Department of Cardiology, Faculty of Health, Örebro University, Örebro (O.F., T.K., L.Z.), the Department of Cardiology, Danderyd Hospital (R.L.), and the Department of Cardiology, Karolinska University Hospital (L.H.), Karolinska Institutet, the Department of Cardiology, Capio St. Görans Hospital (J.J., P.L.), and the Department of Cardiology, Södersjukhuset AB (M.A.), Stockholm, PCI-Unit at Karlstad Hospital, Karlstad (M.D.), the Department of Cardiology, Mälarsjukhuset, Eskilstuna (M.H.), the Department of Cardiology, Linköping University Hospital, Linköping (E.S.), the Department of Cardiology, Helsingborg Lasarett, Helsingborg (H. Wagner), the Department of Cardiology, Halmstad Hospital, Halmstad (P.H.), the Department of Cardiology, Falun Hospital, Falun (I.S.), the Department of Cardiology, Skaraborgs Hospital, Skövde (J.S.), the Department of Internal Medicine, Västmanlands Sjukhus, Västerås (P.G.), the Department of Cardiology, Södra Älvsborgs Sjukhus, Borås (L.R.), the Department of Cardiology, Sunderby Sjukhus, Luleå (J.H.), the Department of Cardiology, Kristianstad Hospital, Kristianstad (H. Wikström), the Department of Cardiology, Östersund Hospital, Östersund (A.U.), the Department of Cardiology, Sundsvall Hospital, Sundsvall (B. Lindvall), the Department of Cardiology, Umeå University, Umeå (J.A., P.E.), and the Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Uppsala (O.Ö., B. Lagerqvist, C.H., L.W., S.J.) - all in Sweden
| | - Jens Jensen
- From the Department of Cardiology, Clinical Sciences, Lund University, Lund (D.E., P.B., A.L., T.T., M.G., F.S., S.K.), the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (E.O., D.I., T.R., O.A.), the Department of Cardiology, Faculty of Health, Örebro University, Örebro (O.F., T.K., L.Z.), the Department of Cardiology, Danderyd Hospital (R.L.), and the Department of Cardiology, Karolinska University Hospital (L.H.), Karolinska Institutet, the Department of Cardiology, Capio St. Görans Hospital (J.J., P.L.), and the Department of Cardiology, Södersjukhuset AB (M.A.), Stockholm, PCI-Unit at Karlstad Hospital, Karlstad (M.D.), the Department of Cardiology, Mälarsjukhuset, Eskilstuna (M.H.), the Department of Cardiology, Linköping University Hospital, Linköping (E.S.), the Department of Cardiology, Helsingborg Lasarett, Helsingborg (H. Wagner), the Department of Cardiology, Halmstad Hospital, Halmstad (P.H.), the Department of Cardiology, Falun Hospital, Falun (I.S.), the Department of Cardiology, Skaraborgs Hospital, Skövde (J.S.), the Department of Internal Medicine, Västmanlands Sjukhus, Västerås (P.G.), the Department of Cardiology, Södra Älvsborgs Sjukhus, Borås (L.R.), the Department of Cardiology, Sunderby Sjukhus, Luleå (J.H.), the Department of Cardiology, Kristianstad Hospital, Kristianstad (H. Wikström), the Department of Cardiology, Östersund Hospital, Östersund (A.U.), the Department of Cardiology, Sundsvall Hospital, Sundsvall (B. Lindvall), the Department of Cardiology, Umeå University, Umeå (J.A., P.E.), and the Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Uppsala (O.Ö., B. Lagerqvist, C.H., L.W., S.J.) - all in Sweden
| | - Mikael Aasa
- From the Department of Cardiology, Clinical Sciences, Lund University, Lund (D.E., P.B., A.L., T.T., M.G., F.S., S.K.), the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (E.O., D.I., T.R., O.A.), the Department of Cardiology, Faculty of Health, Örebro University, Örebro (O.F., T.K., L.Z.), the Department of Cardiology, Danderyd Hospital (R.L.), and the Department of Cardiology, Karolinska University Hospital (L.H.), Karolinska Institutet, the Department of Cardiology, Capio St. Görans Hospital (J.J., P.L.), and the Department of Cardiology, Södersjukhuset AB (M.A.), Stockholm, PCI-Unit at Karlstad Hospital, Karlstad (M.D.), the Department of Cardiology, Mälarsjukhuset, Eskilstuna (M.H.), the Department of Cardiology, Linköping University Hospital, Linköping (E.S.), the Department of Cardiology, Helsingborg Lasarett, Helsingborg (H. Wagner), the Department of Cardiology, Halmstad Hospital, Halmstad (P.H.), the Department of Cardiology, Falun Hospital, Falun (I.S.), the Department of Cardiology, Skaraborgs Hospital, Skövde (J.S.), the Department of Internal Medicine, Västmanlands Sjukhus, Västerås (P.G.), the Department of Cardiology, Södra Älvsborgs Sjukhus, Borås (L.R.), the Department of Cardiology, Sunderby Sjukhus, Luleå (J.H.), the Department of Cardiology, Kristianstad Hospital, Kristianstad (H. Wikström), the Department of Cardiology, Östersund Hospital, Östersund (A.U.), the Department of Cardiology, Sundsvall Hospital, Sundsvall (B. Lindvall), the Department of Cardiology, Umeå University, Umeå (J.A., P.E.), and the Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Uppsala (O.Ö., B. Lagerqvist, C.H., L.W., S.J.) - all in Sweden
| | - Lotta Robertsson
- From the Department of Cardiology, Clinical Sciences, Lund University, Lund (D.E., P.B., A.L., T.T., M.G., F.S., S.K.), the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (E.O., D.I., T.R., O.A.), the Department of Cardiology, Faculty of Health, Örebro University, Örebro (O.F., T.K., L.Z.), the Department of Cardiology, Danderyd Hospital (R.L.), and the Department of Cardiology, Karolinska University Hospital (L.H.), Karolinska Institutet, the Department of Cardiology, Capio St. Görans Hospital (J.J., P.L.), and the Department of Cardiology, Södersjukhuset AB (M.A.), Stockholm, PCI-Unit at Karlstad Hospital, Karlstad (M.D.), the Department of Cardiology, Mälarsjukhuset, Eskilstuna (M.H.), the Department of Cardiology, Linköping University Hospital, Linköping (E.S.), the Department of Cardiology, Helsingborg Lasarett, Helsingborg (H. Wagner), the Department of Cardiology, Halmstad Hospital, Halmstad (P.H.), the Department of Cardiology, Falun Hospital, Falun (I.S.), the Department of Cardiology, Skaraborgs Hospital, Skövde (J.S.), the Department of Internal Medicine, Västmanlands Sjukhus, Västerås (P.G.), the Department of Cardiology, Södra Älvsborgs Sjukhus, Borås (L.R.), the Department of Cardiology, Sunderby Sjukhus, Luleå (J.H.), the Department of Cardiology, Kristianstad Hospital, Kristianstad (H. Wikström), the Department of Cardiology, Östersund Hospital, Östersund (A.U.), the Department of Cardiology, Sundsvall Hospital, Sundsvall (B. Lindvall), the Department of Cardiology, Umeå University, Umeå (J.A., P.E.), and the Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Uppsala (O.Ö., B. Lagerqvist, C.H., L.W., S.J.) - all in Sweden
| | - Pontus Lindroos
- From the Department of Cardiology, Clinical Sciences, Lund University, Lund (D.E., P.B., A.L., T.T., M.G., F.S., S.K.), the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (E.O., D.I., T.R., O.A.), the Department of Cardiology, Faculty of Health, Örebro University, Örebro (O.F., T.K., L.Z.), the Department of Cardiology, Danderyd Hospital (R.L.), and the Department of Cardiology, Karolinska University Hospital (L.H.), Karolinska Institutet, the Department of Cardiology, Capio St. Görans Hospital (J.J., P.L.), and the Department of Cardiology, Södersjukhuset AB (M.A.), Stockholm, PCI-Unit at Karlstad Hospital, Karlstad (M.D.), the Department of Cardiology, Mälarsjukhuset, Eskilstuna (M.H.), the Department of Cardiology, Linköping University Hospital, Linköping (E.S.), the Department of Cardiology, Helsingborg Lasarett, Helsingborg (H. Wagner), the Department of Cardiology, Halmstad Hospital, Halmstad (P.H.), the Department of Cardiology, Falun Hospital, Falun (I.S.), the Department of Cardiology, Skaraborgs Hospital, Skövde (J.S.), the Department of Internal Medicine, Västmanlands Sjukhus, Västerås (P.G.), the Department of Cardiology, Södra Älvsborgs Sjukhus, Borås (L.R.), the Department of Cardiology, Sunderby Sjukhus, Luleå (J.H.), the Department of Cardiology, Kristianstad Hospital, Kristianstad (H. Wikström), the Department of Cardiology, Östersund Hospital, Östersund (A.U.), the Department of Cardiology, Sundsvall Hospital, Sundsvall (B. Lindvall), the Department of Cardiology, Umeå University, Umeå (J.A., P.E.), and the Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Uppsala (O.Ö., B. Lagerqvist, C.H., L.W., S.J.) - all in Sweden
| | - Jan Haupt
- From the Department of Cardiology, Clinical Sciences, Lund University, Lund (D.E., P.B., A.L., T.T., M.G., F.S., S.K.), the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (E.O., D.I., T.R., O.A.), the Department of Cardiology, Faculty of Health, Örebro University, Örebro (O.F., T.K., L.Z.), the Department of Cardiology, Danderyd Hospital (R.L.), and the Department of Cardiology, Karolinska University Hospital (L.H.), Karolinska Institutet, the Department of Cardiology, Capio St. Görans Hospital (J.J., P.L.), and the Department of Cardiology, Södersjukhuset AB (M.A.), Stockholm, PCI-Unit at Karlstad Hospital, Karlstad (M.D.), the Department of Cardiology, Mälarsjukhuset, Eskilstuna (M.H.), the Department of Cardiology, Linköping University Hospital, Linköping (E.S.), the Department of Cardiology, Helsingborg Lasarett, Helsingborg (H. Wagner), the Department of Cardiology, Halmstad Hospital, Halmstad (P.H.), the Department of Cardiology, Falun Hospital, Falun (I.S.), the Department of Cardiology, Skaraborgs Hospital, Skövde (J.S.), the Department of Internal Medicine, Västmanlands Sjukhus, Västerås (P.G.), the Department of Cardiology, Södra Älvsborgs Sjukhus, Borås (L.R.), the Department of Cardiology, Sunderby Sjukhus, Luleå (J.H.), the Department of Cardiology, Kristianstad Hospital, Kristianstad (H. Wikström), the Department of Cardiology, Östersund Hospital, Östersund (A.U.), the Department of Cardiology, Sundsvall Hospital, Sundsvall (B. Lindvall), the Department of Cardiology, Umeå University, Umeå (J.A., P.E.), and the Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Uppsala (O.Ö., B. Lagerqvist, C.H., L.W., S.J.) - all in Sweden
| | - Helena Wikström
- From the Department of Cardiology, Clinical Sciences, Lund University, Lund (D.E., P.B., A.L., T.T., M.G., F.S., S.K.), the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (E.O., D.I., T.R., O.A.), the Department of Cardiology, Faculty of Health, Örebro University, Örebro (O.F., T.K., L.Z.), the Department of Cardiology, Danderyd Hospital (R.L.), and the Department of Cardiology, Karolinska University Hospital (L.H.), Karolinska Institutet, the Department of Cardiology, Capio St. Görans Hospital (J.J., P.L.), and the Department of Cardiology, Södersjukhuset AB (M.A.), Stockholm, PCI-Unit at Karlstad Hospital, Karlstad (M.D.), the Department of Cardiology, Mälarsjukhuset, Eskilstuna (M.H.), the Department of Cardiology, Linköping University Hospital, Linköping (E.S.), the Department of Cardiology, Helsingborg Lasarett, Helsingborg (H. Wagner), the Department of Cardiology, Halmstad Hospital, Halmstad (P.H.), the Department of Cardiology, Falun Hospital, Falun (I.S.), the Department of Cardiology, Skaraborgs Hospital, Skövde (J.S.), the Department of Internal Medicine, Västmanlands Sjukhus, Västerås (P.G.), the Department of Cardiology, Södra Älvsborgs Sjukhus, Borås (L.R.), the Department of Cardiology, Sunderby Sjukhus, Luleå (J.H.), the Department of Cardiology, Kristianstad Hospital, Kristianstad (H. Wikström), the Department of Cardiology, Östersund Hospital, Östersund (A.U.), the Department of Cardiology, Sundsvall Hospital, Sundsvall (B. Lindvall), the Department of Cardiology, Umeå University, Umeå (J.A., P.E.), and the Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Uppsala (O.Ö., B. Lagerqvist, C.H., L.W., S.J.) - all in Sweden
| | - Anders Ulvenstam
- From the Department of Cardiology, Clinical Sciences, Lund University, Lund (D.E., P.B., A.L., T.T., M.G., F.S., S.K.), the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (E.O., D.I., T.R., O.A.), the Department of Cardiology, Faculty of Health, Örebro University, Örebro (O.F., T.K., L.Z.), the Department of Cardiology, Danderyd Hospital (R.L.), and the Department of Cardiology, Karolinska University Hospital (L.H.), Karolinska Institutet, the Department of Cardiology, Capio St. Görans Hospital (J.J., P.L.), and the Department of Cardiology, Södersjukhuset AB (M.A.), Stockholm, PCI-Unit at Karlstad Hospital, Karlstad (M.D.), the Department of Cardiology, Mälarsjukhuset, Eskilstuna (M.H.), the Department of Cardiology, Linköping University Hospital, Linköping (E.S.), the Department of Cardiology, Helsingborg Lasarett, Helsingborg (H. Wagner), the Department of Cardiology, Halmstad Hospital, Halmstad (P.H.), the Department of Cardiology, Falun Hospital, Falun (I.S.), the Department of Cardiology, Skaraborgs Hospital, Skövde (J.S.), the Department of Internal Medicine, Västmanlands Sjukhus, Västerås (P.G.), the Department of Cardiology, Södra Älvsborgs Sjukhus, Borås (L.R.), the Department of Cardiology, Sunderby Sjukhus, Luleå (J.H.), the Department of Cardiology, Kristianstad Hospital, Kristianstad (H. Wikström), the Department of Cardiology, Östersund Hospital, Östersund (A.U.), the Department of Cardiology, Sundsvall Hospital, Sundsvall (B. Lindvall), the Department of Cardiology, Umeå University, Umeå (J.A., P.E.), and the Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Uppsala (O.Ö., B. Lagerqvist, C.H., L.W., S.J.) - all in Sweden
| | - Pallonji Bhiladvala
- From the Department of Cardiology, Clinical Sciences, Lund University, Lund (D.E., P.B., A.L., T.T., M.G., F.S., S.K.), the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (E.O., D.I., T.R., O.A.), the Department of Cardiology, Faculty of Health, Örebro University, Örebro (O.F., T.K., L.Z.), the Department of Cardiology, Danderyd Hospital (R.L.), and the Department of Cardiology, Karolinska University Hospital (L.H.), Karolinska Institutet, the Department of Cardiology, Capio St. Görans Hospital (J.J., P.L.), and the Department of Cardiology, Södersjukhuset AB (M.A.), Stockholm, PCI-Unit at Karlstad Hospital, Karlstad (M.D.), the Department of Cardiology, Mälarsjukhuset, Eskilstuna (M.H.), the Department of Cardiology, Linköping University Hospital, Linköping (E.S.), the Department of Cardiology, Helsingborg Lasarett, Helsingborg (H. Wagner), the Department of Cardiology, Halmstad Hospital, Halmstad (P.H.), the Department of Cardiology, Falun Hospital, Falun (I.S.), the Department of Cardiology, Skaraborgs Hospital, Skövde (J.S.), the Department of Internal Medicine, Västmanlands Sjukhus, Västerås (P.G.), the Department of Cardiology, Södra Älvsborgs Sjukhus, Borås (L.R.), the Department of Cardiology, Sunderby Sjukhus, Luleå (J.H.), the Department of Cardiology, Kristianstad Hospital, Kristianstad (H. Wikström), the Department of Cardiology, Östersund Hospital, Östersund (A.U.), the Department of Cardiology, Sundsvall Hospital, Sundsvall (B. Lindvall), the Department of Cardiology, Umeå University, Umeå (J.A., P.E.), and the Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Uppsala (O.Ö., B. Lagerqvist, C.H., L.W., S.J.) - all in Sweden
| | - Bo Lindvall
- From the Department of Cardiology, Clinical Sciences, Lund University, Lund (D.E., P.B., A.L., T.T., M.G., F.S., S.K.), the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (E.O., D.I., T.R., O.A.), the Department of Cardiology, Faculty of Health, Örebro University, Örebro (O.F., T.K., L.Z.), the Department of Cardiology, Danderyd Hospital (R.L.), and the Department of Cardiology, Karolinska University Hospital (L.H.), Karolinska Institutet, the Department of Cardiology, Capio St. Görans Hospital (J.J., P.L.), and the Department of Cardiology, Södersjukhuset AB (M.A.), Stockholm, PCI-Unit at Karlstad Hospital, Karlstad (M.D.), the Department of Cardiology, Mälarsjukhuset, Eskilstuna (M.H.), the Department of Cardiology, Linköping University Hospital, Linköping (E.S.), the Department of Cardiology, Helsingborg Lasarett, Helsingborg (H. Wagner), the Department of Cardiology, Halmstad Hospital, Halmstad (P.H.), the Department of Cardiology, Falun Hospital, Falun (I.S.), the Department of Cardiology, Skaraborgs Hospital, Skövde (J.S.), the Department of Internal Medicine, Västmanlands Sjukhus, Västerås (P.G.), the Department of Cardiology, Södra Älvsborgs Sjukhus, Borås (L.R.), the Department of Cardiology, Sunderby Sjukhus, Luleå (J.H.), the Department of Cardiology, Kristianstad Hospital, Kristianstad (H. Wikström), the Department of Cardiology, Östersund Hospital, Östersund (A.U.), the Department of Cardiology, Sundsvall Hospital, Sundsvall (B. Lindvall), the Department of Cardiology, Umeå University, Umeå (J.A., P.E.), and the Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Uppsala (O.Ö., B. Lagerqvist, C.H., L.W., S.J.) - all in Sweden
| | - Anders Lundin
- From the Department of Cardiology, Clinical Sciences, Lund University, Lund (D.E., P.B., A.L., T.T., M.G., F.S., S.K.), the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (E.O., D.I., T.R., O.A.), the Department of Cardiology, Faculty of Health, Örebro University, Örebro (O.F., T.K., L.Z.), the Department of Cardiology, Danderyd Hospital (R.L.), and the Department of Cardiology, Karolinska University Hospital (L.H.), Karolinska Institutet, the Department of Cardiology, Capio St. Görans Hospital (J.J., P.L.), and the Department of Cardiology, Södersjukhuset AB (M.A.), Stockholm, PCI-Unit at Karlstad Hospital, Karlstad (M.D.), the Department of Cardiology, Mälarsjukhuset, Eskilstuna (M.H.), the Department of Cardiology, Linköping University Hospital, Linköping (E.S.), the Department of Cardiology, Helsingborg Lasarett, Helsingborg (H. Wagner), the Department of Cardiology, Halmstad Hospital, Halmstad (P.H.), the Department of Cardiology, Falun Hospital, Falun (I.S.), the Department of Cardiology, Skaraborgs Hospital, Skövde (J.S.), the Department of Internal Medicine, Västmanlands Sjukhus, Västerås (P.G.), the Department of Cardiology, Södra Älvsborgs Sjukhus, Borås (L.R.), the Department of Cardiology, Sunderby Sjukhus, Luleå (J.H.), the Department of Cardiology, Kristianstad Hospital, Kristianstad (H. Wikström), the Department of Cardiology, Östersund Hospital, Östersund (A.U.), the Department of Cardiology, Sundsvall Hospital, Sundsvall (B. Lindvall), the Department of Cardiology, Umeå University, Umeå (J.A., P.E.), and the Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Uppsala (O.Ö., B. Lagerqvist, C.H., L.W., S.J.) - all in Sweden
| | - Tim Tödt
- From the Department of Cardiology, Clinical Sciences, Lund University, Lund (D.E., P.B., A.L., T.T., M.G., F.S., S.K.), the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (E.O., D.I., T.R., O.A.), the Department of Cardiology, Faculty of Health, Örebro University, Örebro (O.F., T.K., L.Z.), the Department of Cardiology, Danderyd Hospital (R.L.), and the Department of Cardiology, Karolinska University Hospital (L.H.), Karolinska Institutet, the Department of Cardiology, Capio St. Görans Hospital (J.J., P.L.), and the Department of Cardiology, Södersjukhuset AB (M.A.), Stockholm, PCI-Unit at Karlstad Hospital, Karlstad (M.D.), the Department of Cardiology, Mälarsjukhuset, Eskilstuna (M.H.), the Department of Cardiology, Linköping University Hospital, Linköping (E.S.), the Department of Cardiology, Helsingborg Lasarett, Helsingborg (H. Wagner), the Department of Cardiology, Halmstad Hospital, Halmstad (P.H.), the Department of Cardiology, Falun Hospital, Falun (I.S.), the Department of Cardiology, Skaraborgs Hospital, Skövde (J.S.), the Department of Internal Medicine, Västmanlands Sjukhus, Västerås (P.G.), the Department of Cardiology, Södra Älvsborgs Sjukhus, Borås (L.R.), the Department of Cardiology, Sunderby Sjukhus, Luleå (J.H.), the Department of Cardiology, Kristianstad Hospital, Kristianstad (H. Wikström), the Department of Cardiology, Östersund Hospital, Östersund (A.U.), the Department of Cardiology, Sundsvall Hospital, Sundsvall (B. Lindvall), the Department of Cardiology, Umeå University, Umeå (J.A., P.E.), and the Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Uppsala (O.Ö., B. Lagerqvist, C.H., L.W., S.J.) - all in Sweden
| | - Dan Ioanes
- From the Department of Cardiology, Clinical Sciences, Lund University, Lund (D.E., P.B., A.L., T.T., M.G., F.S., S.K.), the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (E.O., D.I., T.R., O.A.), the Department of Cardiology, Faculty of Health, Örebro University, Örebro (O.F., T.K., L.Z.), the Department of Cardiology, Danderyd Hospital (R.L.), and the Department of Cardiology, Karolinska University Hospital (L.H.), Karolinska Institutet, the Department of Cardiology, Capio St. Görans Hospital (J.J., P.L.), and the Department of Cardiology, Södersjukhuset AB (M.A.), Stockholm, PCI-Unit at Karlstad Hospital, Karlstad (M.D.), the Department of Cardiology, Mälarsjukhuset, Eskilstuna (M.H.), the Department of Cardiology, Linköping University Hospital, Linköping (E.S.), the Department of Cardiology, Helsingborg Lasarett, Helsingborg (H. Wagner), the Department of Cardiology, Halmstad Hospital, Halmstad (P.H.), the Department of Cardiology, Falun Hospital, Falun (I.S.), the Department of Cardiology, Skaraborgs Hospital, Skövde (J.S.), the Department of Internal Medicine, Västmanlands Sjukhus, Västerås (P.G.), the Department of Cardiology, Södra Älvsborgs Sjukhus, Borås (L.R.), the Department of Cardiology, Sunderby Sjukhus, Luleå (J.H.), the Department of Cardiology, Kristianstad Hospital, Kristianstad (H. Wikström), the Department of Cardiology, Östersund Hospital, Östersund (A.U.), the Department of Cardiology, Sundsvall Hospital, Sundsvall (B. Lindvall), the Department of Cardiology, Umeå University, Umeå (J.A., P.E.), and the Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Uppsala (O.Ö., B. Lagerqvist, C.H., L.W., S.J.) - all in Sweden
| | - Truls Råmunddal
- From the Department of Cardiology, Clinical Sciences, Lund University, Lund (D.E., P.B., A.L., T.T., M.G., F.S., S.K.), the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (E.O., D.I., T.R., O.A.), the Department of Cardiology, Faculty of Health, Örebro University, Örebro (O.F., T.K., L.Z.), the Department of Cardiology, Danderyd Hospital (R.L.), and the Department of Cardiology, Karolinska University Hospital (L.H.), Karolinska Institutet, the Department of Cardiology, Capio St. Görans Hospital (J.J., P.L.), and the Department of Cardiology, Södersjukhuset AB (M.A.), Stockholm, PCI-Unit at Karlstad Hospital, Karlstad (M.D.), the Department of Cardiology, Mälarsjukhuset, Eskilstuna (M.H.), the Department of Cardiology, Linköping University Hospital, Linköping (E.S.), the Department of Cardiology, Helsingborg Lasarett, Helsingborg (H. Wagner), the Department of Cardiology, Halmstad Hospital, Halmstad (P.H.), the Department of Cardiology, Falun Hospital, Falun (I.S.), the Department of Cardiology, Skaraborgs Hospital, Skövde (J.S.), the Department of Internal Medicine, Västmanlands Sjukhus, Västerås (P.G.), the Department of Cardiology, Södra Älvsborgs Sjukhus, Borås (L.R.), the Department of Cardiology, Sunderby Sjukhus, Luleå (J.H.), the Department of Cardiology, Kristianstad Hospital, Kristianstad (H. Wikström), the Department of Cardiology, Östersund Hospital, Östersund (A.U.), the Department of Cardiology, Sundsvall Hospital, Sundsvall (B. Lindvall), the Department of Cardiology, Umeå University, Umeå (J.A., P.E.), and the Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Uppsala (O.Ö., B. Lagerqvist, C.H., L.W., S.J.) - all in Sweden
| | - Thomas Kellerth
- From the Department of Cardiology, Clinical Sciences, Lund University, Lund (D.E., P.B., A.L., T.T., M.G., F.S., S.K.), the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (E.O., D.I., T.R., O.A.), the Department of Cardiology, Faculty of Health, Örebro University, Örebro (O.F., T.K., L.Z.), the Department of Cardiology, Danderyd Hospital (R.L.), and the Department of Cardiology, Karolinska University Hospital (L.H.), Karolinska Institutet, the Department of Cardiology, Capio St. Görans Hospital (J.J., P.L.), and the Department of Cardiology, Södersjukhuset AB (M.A.), Stockholm, PCI-Unit at Karlstad Hospital, Karlstad (M.D.), the Department of Cardiology, Mälarsjukhuset, Eskilstuna (M.H.), the Department of Cardiology, Linköping University Hospital, Linköping (E.S.), the Department of Cardiology, Helsingborg Lasarett, Helsingborg (H. Wagner), the Department of Cardiology, Halmstad Hospital, Halmstad (P.H.), the Department of Cardiology, Falun Hospital, Falun (I.S.), the Department of Cardiology, Skaraborgs Hospital, Skövde (J.S.), the Department of Internal Medicine, Västmanlands Sjukhus, Västerås (P.G.), the Department of Cardiology, Södra Älvsborgs Sjukhus, Borås (L.R.), the Department of Cardiology, Sunderby Sjukhus, Luleå (J.H.), the Department of Cardiology, Kristianstad Hospital, Kristianstad (H. Wikström), the Department of Cardiology, Östersund Hospital, Östersund (A.U.), the Department of Cardiology, Sundsvall Hospital, Sundsvall (B. Lindvall), the Department of Cardiology, Umeå University, Umeå (J.A., P.E.), and the Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Uppsala (O.Ö., B. Lagerqvist, C.H., L.W., S.J.) - all in Sweden
| | - Leszek Zagozdzon
- From the Department of Cardiology, Clinical Sciences, Lund University, Lund (D.E., P.B., A.L., T.T., M.G., F.S., S.K.), the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (E.O., D.I., T.R., O.A.), the Department of Cardiology, Faculty of Health, Örebro University, Örebro (O.F., T.K., L.Z.), the Department of Cardiology, Danderyd Hospital (R.L.), and the Department of Cardiology, Karolinska University Hospital (L.H.), Karolinska Institutet, the Department of Cardiology, Capio St. Görans Hospital (J.J., P.L.), and the Department of Cardiology, Södersjukhuset AB (M.A.), Stockholm, PCI-Unit at Karlstad Hospital, Karlstad (M.D.), the Department of Cardiology, Mälarsjukhuset, Eskilstuna (M.H.), the Department of Cardiology, Linköping University Hospital, Linköping (E.S.), the Department of Cardiology, Helsingborg Lasarett, Helsingborg (H. Wagner), the Department of Cardiology, Halmstad Hospital, Halmstad (P.H.), the Department of Cardiology, Falun Hospital, Falun (I.S.), the Department of Cardiology, Skaraborgs Hospital, Skövde (J.S.), the Department of Internal Medicine, Västmanlands Sjukhus, Västerås (P.G.), the Department of Cardiology, Södra Älvsborgs Sjukhus, Borås (L.R.), the Department of Cardiology, Sunderby Sjukhus, Luleå (J.H.), the Department of Cardiology, Kristianstad Hospital, Kristianstad (H. Wikström), the Department of Cardiology, Östersund Hospital, Östersund (A.U.), the Department of Cardiology, Sundsvall Hospital, Sundsvall (B. Lindvall), the Department of Cardiology, Umeå University, Umeå (J.A., P.E.), and the Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Uppsala (O.Ö., B. Lagerqvist, C.H., L.W., S.J.) - all in Sweden
| | - Matthias Götberg
- From the Department of Cardiology, Clinical Sciences, Lund University, Lund (D.E., P.B., A.L., T.T., M.G., F.S., S.K.), the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (E.O., D.I., T.R., O.A.), the Department of Cardiology, Faculty of Health, Örebro University, Örebro (O.F., T.K., L.Z.), the Department of Cardiology, Danderyd Hospital (R.L.), and the Department of Cardiology, Karolinska University Hospital (L.H.), Karolinska Institutet, the Department of Cardiology, Capio St. Görans Hospital (J.J., P.L.), and the Department of Cardiology, Södersjukhuset AB (M.A.), Stockholm, PCI-Unit at Karlstad Hospital, Karlstad (M.D.), the Department of Cardiology, Mälarsjukhuset, Eskilstuna (M.H.), the Department of Cardiology, Linköping University Hospital, Linköping (E.S.), the Department of Cardiology, Helsingborg Lasarett, Helsingborg (H. Wagner), the Department of Cardiology, Halmstad Hospital, Halmstad (P.H.), the Department of Cardiology, Falun Hospital, Falun (I.S.), the Department of Cardiology, Skaraborgs Hospital, Skövde (J.S.), the Department of Internal Medicine, Västmanlands Sjukhus, Västerås (P.G.), the Department of Cardiology, Södra Älvsborgs Sjukhus, Borås (L.R.), the Department of Cardiology, Sunderby Sjukhus, Luleå (J.H.), the Department of Cardiology, Kristianstad Hospital, Kristianstad (H. Wikström), the Department of Cardiology, Östersund Hospital, Östersund (A.U.), the Department of Cardiology, Sundsvall Hospital, Sundsvall (B. Lindvall), the Department of Cardiology, Umeå University, Umeå (J.A., P.E.), and the Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Uppsala (O.Ö., B. Lagerqvist, C.H., L.W., S.J.) - all in Sweden
| | - Jonas Andersson
- From the Department of Cardiology, Clinical Sciences, Lund University, Lund (D.E., P.B., A.L., T.T., M.G., F.S., S.K.), the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (E.O., D.I., T.R., O.A.), the Department of Cardiology, Faculty of Health, Örebro University, Örebro (O.F., T.K., L.Z.), the Department of Cardiology, Danderyd Hospital (R.L.), and the Department of Cardiology, Karolinska University Hospital (L.H.), Karolinska Institutet, the Department of Cardiology, Capio St. Görans Hospital (J.J., P.L.), and the Department of Cardiology, Södersjukhuset AB (M.A.), Stockholm, PCI-Unit at Karlstad Hospital, Karlstad (M.D.), the Department of Cardiology, Mälarsjukhuset, Eskilstuna (M.H.), the Department of Cardiology, Linköping University Hospital, Linköping (E.S.), the Department of Cardiology, Helsingborg Lasarett, Helsingborg (H. Wagner), the Department of Cardiology, Halmstad Hospital, Halmstad (P.H.), the Department of Cardiology, Falun Hospital, Falun (I.S.), the Department of Cardiology, Skaraborgs Hospital, Skövde (J.S.), the Department of Internal Medicine, Västmanlands Sjukhus, Västerås (P.G.), the Department of Cardiology, Södra Älvsborgs Sjukhus, Borås (L.R.), the Department of Cardiology, Sunderby Sjukhus, Luleå (J.H.), the Department of Cardiology, Kristianstad Hospital, Kristianstad (H. Wikström), the Department of Cardiology, Östersund Hospital, Östersund (A.U.), the Department of Cardiology, Sundsvall Hospital, Sundsvall (B. Lindvall), the Department of Cardiology, Umeå University, Umeå (J.A., P.E.), and the Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Uppsala (O.Ö., B. Lagerqvist, C.H., L.W., S.J.) - all in Sweden
| | - Oskar Angerås
- From the Department of Cardiology, Clinical Sciences, Lund University, Lund (D.E., P.B., A.L., T.T., M.G., F.S., S.K.), the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (E.O., D.I., T.R., O.A.), the Department of Cardiology, Faculty of Health, Örebro University, Örebro (O.F., T.K., L.Z.), the Department of Cardiology, Danderyd Hospital (R.L.), and the Department of Cardiology, Karolinska University Hospital (L.H.), Karolinska Institutet, the Department of Cardiology, Capio St. Görans Hospital (J.J., P.L.), and the Department of Cardiology, Södersjukhuset AB (M.A.), Stockholm, PCI-Unit at Karlstad Hospital, Karlstad (M.D.), the Department of Cardiology, Mälarsjukhuset, Eskilstuna (M.H.), the Department of Cardiology, Linköping University Hospital, Linköping (E.S.), the Department of Cardiology, Helsingborg Lasarett, Helsingborg (H. Wagner), the Department of Cardiology, Halmstad Hospital, Halmstad (P.H.), the Department of Cardiology, Falun Hospital, Falun (I.S.), the Department of Cardiology, Skaraborgs Hospital, Skövde (J.S.), the Department of Internal Medicine, Västmanlands Sjukhus, Västerås (P.G.), the Department of Cardiology, Södra Älvsborgs Sjukhus, Borås (L.R.), the Department of Cardiology, Sunderby Sjukhus, Luleå (J.H.), the Department of Cardiology, Kristianstad Hospital, Kristianstad (H. Wikström), the Department of Cardiology, Östersund Hospital, Östersund (A.U.), the Department of Cardiology, Sundsvall Hospital, Sundsvall (B. Lindvall), the Department of Cardiology, Umeå University, Umeå (J.A., P.E.), and the Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Uppsala (O.Ö., B. Lagerqvist, C.H., L.W., S.J.) - all in Sweden
| | - Ollie Östlund
- From the Department of Cardiology, Clinical Sciences, Lund University, Lund (D.E., P.B., A.L., T.T., M.G., F.S., S.K.), the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (E.O., D.I., T.R., O.A.), the Department of Cardiology, Faculty of Health, Örebro University, Örebro (O.F., T.K., L.Z.), the Department of Cardiology, Danderyd Hospital (R.L.), and the Department of Cardiology, Karolinska University Hospital (L.H.), Karolinska Institutet, the Department of Cardiology, Capio St. Görans Hospital (J.J., P.L.), and the Department of Cardiology, Södersjukhuset AB (M.A.), Stockholm, PCI-Unit at Karlstad Hospital, Karlstad (M.D.), the Department of Cardiology, Mälarsjukhuset, Eskilstuna (M.H.), the Department of Cardiology, Linköping University Hospital, Linköping (E.S.), the Department of Cardiology, Helsingborg Lasarett, Helsingborg (H. Wagner), the Department of Cardiology, Halmstad Hospital, Halmstad (P.H.), the Department of Cardiology, Falun Hospital, Falun (I.S.), the Department of Cardiology, Skaraborgs Hospital, Skövde (J.S.), the Department of Internal Medicine, Västmanlands Sjukhus, Västerås (P.G.), the Department of Cardiology, Södra Älvsborgs Sjukhus, Borås (L.R.), the Department of Cardiology, Sunderby Sjukhus, Luleå (J.H.), the Department of Cardiology, Kristianstad Hospital, Kristianstad (H. Wikström), the Department of Cardiology, Östersund Hospital, Östersund (A.U.), the Department of Cardiology, Sundsvall Hospital, Sundsvall (B. Lindvall), the Department of Cardiology, Umeå University, Umeå (J.A., P.E.), and the Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Uppsala (O.Ö., B. Lagerqvist, C.H., L.W., S.J.) - all in Sweden
| | - Bo Lagerqvist
- From the Department of Cardiology, Clinical Sciences, Lund University, Lund (D.E., P.B., A.L., T.T., M.G., F.S., S.K.), the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (E.O., D.I., T.R., O.A.), the Department of Cardiology, Faculty of Health, Örebro University, Örebro (O.F., T.K., L.Z.), the Department of Cardiology, Danderyd Hospital (R.L.), and the Department of Cardiology, Karolinska University Hospital (L.H.), Karolinska Institutet, the Department of Cardiology, Capio St. Görans Hospital (J.J., P.L.), and the Department of Cardiology, Södersjukhuset AB (M.A.), Stockholm, PCI-Unit at Karlstad Hospital, Karlstad (M.D.), the Department of Cardiology, Mälarsjukhuset, Eskilstuna (M.H.), the Department of Cardiology, Linköping University Hospital, Linköping (E.S.), the Department of Cardiology, Helsingborg Lasarett, Helsingborg (H. Wagner), the Department of Cardiology, Halmstad Hospital, Halmstad (P.H.), the Department of Cardiology, Falun Hospital, Falun (I.S.), the Department of Cardiology, Skaraborgs Hospital, Skövde (J.S.), the Department of Internal Medicine, Västmanlands Sjukhus, Västerås (P.G.), the Department of Cardiology, Södra Älvsborgs Sjukhus, Borås (L.R.), the Department of Cardiology, Sunderby Sjukhus, Luleå (J.H.), the Department of Cardiology, Kristianstad Hospital, Kristianstad (H. Wikström), the Department of Cardiology, Östersund Hospital, Östersund (A.U.), the Department of Cardiology, Sundsvall Hospital, Sundsvall (B. Lindvall), the Department of Cardiology, Umeå University, Umeå (J.A., P.E.), and the Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Uppsala (O.Ö., B. Lagerqvist, C.H., L.W., S.J.) - all in Sweden
| | - Claes Held
- From the Department of Cardiology, Clinical Sciences, Lund University, Lund (D.E., P.B., A.L., T.T., M.G., F.S., S.K.), the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (E.O., D.I., T.R., O.A.), the Department of Cardiology, Faculty of Health, Örebro University, Örebro (O.F., T.K., L.Z.), the Department of Cardiology, Danderyd Hospital (R.L.), and the Department of Cardiology, Karolinska University Hospital (L.H.), Karolinska Institutet, the Department of Cardiology, Capio St. Görans Hospital (J.J., P.L.), and the Department of Cardiology, Södersjukhuset AB (M.A.), Stockholm, PCI-Unit at Karlstad Hospital, Karlstad (M.D.), the Department of Cardiology, Mälarsjukhuset, Eskilstuna (M.H.), the Department of Cardiology, Linköping University Hospital, Linköping (E.S.), the Department of Cardiology, Helsingborg Lasarett, Helsingborg (H. Wagner), the Department of Cardiology, Halmstad Hospital, Halmstad (P.H.), the Department of Cardiology, Falun Hospital, Falun (I.S.), the Department of Cardiology, Skaraborgs Hospital, Skövde (J.S.), the Department of Internal Medicine, Västmanlands Sjukhus, Västerås (P.G.), the Department of Cardiology, Södra Älvsborgs Sjukhus, Borås (L.R.), the Department of Cardiology, Sunderby Sjukhus, Luleå (J.H.), the Department of Cardiology, Kristianstad Hospital, Kristianstad (H. Wikström), the Department of Cardiology, Östersund Hospital, Östersund (A.U.), the Department of Cardiology, Sundsvall Hospital, Sundsvall (B. Lindvall), the Department of Cardiology, Umeå University, Umeå (J.A., P.E.), and the Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Uppsala (O.Ö., B. Lagerqvist, C.H., L.W., S.J.) - all in Sweden
| | - Lars Wallentin
- From the Department of Cardiology, Clinical Sciences, Lund University, Lund (D.E., P.B., A.L., T.T., M.G., F.S., S.K.), the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (E.O., D.I., T.R., O.A.), the Department of Cardiology, Faculty of Health, Örebro University, Örebro (O.F., T.K., L.Z.), the Department of Cardiology, Danderyd Hospital (R.L.), and the Department of Cardiology, Karolinska University Hospital (L.H.), Karolinska Institutet, the Department of Cardiology, Capio St. Görans Hospital (J.J., P.L.), and the Department of Cardiology, Södersjukhuset AB (M.A.), Stockholm, PCI-Unit at Karlstad Hospital, Karlstad (M.D.), the Department of Cardiology, Mälarsjukhuset, Eskilstuna (M.H.), the Department of Cardiology, Linköping University Hospital, Linköping (E.S.), the Department of Cardiology, Helsingborg Lasarett, Helsingborg (H. Wagner), the Department of Cardiology, Halmstad Hospital, Halmstad (P.H.), the Department of Cardiology, Falun Hospital, Falun (I.S.), the Department of Cardiology, Skaraborgs Hospital, Skövde (J.S.), the Department of Internal Medicine, Västmanlands Sjukhus, Västerås (P.G.), the Department of Cardiology, Södra Älvsborgs Sjukhus, Borås (L.R.), the Department of Cardiology, Sunderby Sjukhus, Luleå (J.H.), the Department of Cardiology, Kristianstad Hospital, Kristianstad (H. Wikström), the Department of Cardiology, Östersund Hospital, Östersund (A.U.), the Department of Cardiology, Sundsvall Hospital, Sundsvall (B. Lindvall), the Department of Cardiology, Umeå University, Umeå (J.A., P.E.), and the Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Uppsala (O.Ö., B. Lagerqvist, C.H., L.W., S.J.) - all in Sweden
| | - Fredrik Scherstén
- From the Department of Cardiology, Clinical Sciences, Lund University, Lund (D.E., P.B., A.L., T.T., M.G., F.S., S.K.), the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (E.O., D.I., T.R., O.A.), the Department of Cardiology, Faculty of Health, Örebro University, Örebro (O.F., T.K., L.Z.), the Department of Cardiology, Danderyd Hospital (R.L.), and the Department of Cardiology, Karolinska University Hospital (L.H.), Karolinska Institutet, the Department of Cardiology, Capio St. Görans Hospital (J.J., P.L.), and the Department of Cardiology, Södersjukhuset AB (M.A.), Stockholm, PCI-Unit at Karlstad Hospital, Karlstad (M.D.), the Department of Cardiology, Mälarsjukhuset, Eskilstuna (M.H.), the Department of Cardiology, Linköping University Hospital, Linköping (E.S.), the Department of Cardiology, Helsingborg Lasarett, Helsingborg (H. Wagner), the Department of Cardiology, Halmstad Hospital, Halmstad (P.H.), the Department of Cardiology, Falun Hospital, Falun (I.S.), the Department of Cardiology, Skaraborgs Hospital, Skövde (J.S.), the Department of Internal Medicine, Västmanlands Sjukhus, Västerås (P.G.), the Department of Cardiology, Södra Älvsborgs Sjukhus, Borås (L.R.), the Department of Cardiology, Sunderby Sjukhus, Luleå (J.H.), the Department of Cardiology, Kristianstad Hospital, Kristianstad (H. Wikström), the Department of Cardiology, Östersund Hospital, Östersund (A.U.), the Department of Cardiology, Sundsvall Hospital, Sundsvall (B. Lindvall), the Department of Cardiology, Umeå University, Umeå (J.A., P.E.), and the Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Uppsala (O.Ö., B. Lagerqvist, C.H., L.W., S.J.) - all in Sweden
| | - Peter Eriksson
- From the Department of Cardiology, Clinical Sciences, Lund University, Lund (D.E., P.B., A.L., T.T., M.G., F.S., S.K.), the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (E.O., D.I., T.R., O.A.), the Department of Cardiology, Faculty of Health, Örebro University, Örebro (O.F., T.K., L.Z.), the Department of Cardiology, Danderyd Hospital (R.L.), and the Department of Cardiology, Karolinska University Hospital (L.H.), Karolinska Institutet, the Department of Cardiology, Capio St. Görans Hospital (J.J., P.L.), and the Department of Cardiology, Södersjukhuset AB (M.A.), Stockholm, PCI-Unit at Karlstad Hospital, Karlstad (M.D.), the Department of Cardiology, Mälarsjukhuset, Eskilstuna (M.H.), the Department of Cardiology, Linköping University Hospital, Linköping (E.S.), the Department of Cardiology, Helsingborg Lasarett, Helsingborg (H. Wagner), the Department of Cardiology, Halmstad Hospital, Halmstad (P.H.), the Department of Cardiology, Falun Hospital, Falun (I.S.), the Department of Cardiology, Skaraborgs Hospital, Skövde (J.S.), the Department of Internal Medicine, Västmanlands Sjukhus, Västerås (P.G.), the Department of Cardiology, Södra Älvsborgs Sjukhus, Borås (L.R.), the Department of Cardiology, Sunderby Sjukhus, Luleå (J.H.), the Department of Cardiology, Kristianstad Hospital, Kristianstad (H. Wikström), the Department of Cardiology, Östersund Hospital, Östersund (A.U.), the Department of Cardiology, Sundsvall Hospital, Sundsvall (B. Lindvall), the Department of Cardiology, Umeå University, Umeå (J.A., P.E.), and the Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Uppsala (O.Ö., B. Lagerqvist, C.H., L.W., S.J.) - all in Sweden
| | - Sasha Koul
- From the Department of Cardiology, Clinical Sciences, Lund University, Lund (D.E., P.B., A.L., T.T., M.G., F.S., S.K.), the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (E.O., D.I., T.R., O.A.), the Department of Cardiology, Faculty of Health, Örebro University, Örebro (O.F., T.K., L.Z.), the Department of Cardiology, Danderyd Hospital (R.L.), and the Department of Cardiology, Karolinska University Hospital (L.H.), Karolinska Institutet, the Department of Cardiology, Capio St. Görans Hospital (J.J., P.L.), and the Department of Cardiology, Södersjukhuset AB (M.A.), Stockholm, PCI-Unit at Karlstad Hospital, Karlstad (M.D.), the Department of Cardiology, Mälarsjukhuset, Eskilstuna (M.H.), the Department of Cardiology, Linköping University Hospital, Linköping (E.S.), the Department of Cardiology, Helsingborg Lasarett, Helsingborg (H. Wagner), the Department of Cardiology, Halmstad Hospital, Halmstad (P.H.), the Department of Cardiology, Falun Hospital, Falun (I.S.), the Department of Cardiology, Skaraborgs Hospital, Skövde (J.S.), the Department of Internal Medicine, Västmanlands Sjukhus, Västerås (P.G.), the Department of Cardiology, Södra Älvsborgs Sjukhus, Borås (L.R.), the Department of Cardiology, Sunderby Sjukhus, Luleå (J.H.), the Department of Cardiology, Kristianstad Hospital, Kristianstad (H. Wikström), the Department of Cardiology, Östersund Hospital, Östersund (A.U.), the Department of Cardiology, Sundsvall Hospital, Sundsvall (B. Lindvall), the Department of Cardiology, Umeå University, Umeå (J.A., P.E.), and the Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Uppsala (O.Ö., B. Lagerqvist, C.H., L.W., S.J.) - all in Sweden
| | - Stefan James
- From the Department of Cardiology, Clinical Sciences, Lund University, Lund (D.E., P.B., A.L., T.T., M.G., F.S., S.K.), the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (E.O., D.I., T.R., O.A.), the Department of Cardiology, Faculty of Health, Örebro University, Örebro (O.F., T.K., L.Z.), the Department of Cardiology, Danderyd Hospital (R.L.), and the Department of Cardiology, Karolinska University Hospital (L.H.), Karolinska Institutet, the Department of Cardiology, Capio St. Görans Hospital (J.J., P.L.), and the Department of Cardiology, Södersjukhuset AB (M.A.), Stockholm, PCI-Unit at Karlstad Hospital, Karlstad (M.D.), the Department of Cardiology, Mälarsjukhuset, Eskilstuna (M.H.), the Department of Cardiology, Linköping University Hospital, Linköping (E.S.), the Department of Cardiology, Helsingborg Lasarett, Helsingborg (H. Wagner), the Department of Cardiology, Halmstad Hospital, Halmstad (P.H.), the Department of Cardiology, Falun Hospital, Falun (I.S.), the Department of Cardiology, Skaraborgs Hospital, Skövde (J.S.), the Department of Internal Medicine, Västmanlands Sjukhus, Västerås (P.G.), the Department of Cardiology, Södra Älvsborgs Sjukhus, Borås (L.R.), the Department of Cardiology, Sunderby Sjukhus, Luleå (J.H.), the Department of Cardiology, Kristianstad Hospital, Kristianstad (H. Wikström), the Department of Cardiology, Östersund Hospital, Östersund (A.U.), the Department of Cardiology, Sundsvall Hospital, Sundsvall (B. Lindvall), the Department of Cardiology, Umeå University, Umeå (J.A., P.E.), and the Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Uppsala (O.Ö., B. Lagerqvist, C.H., L.W., S.J.) - all in Sweden
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Elias J, van Dongen IM, Hoebers LP, Ouweneel DM, Claessen BEPM, Råmunddal T, Laanmets P, Eriksen E, van der Schaaf RJ, Ioanes D, Nijveldt R, Tijssen JG, Hirsch A, Henriques JPS. Improved recovery of regional left ventricular function after PCI of chronic total occlusion in STEMI patients: a cardiovascular magnetic resonance study of the randomized controlled EXPLORE trial. J Cardiovasc Magn Reson 2017; 19:53. [PMID: 28724418 PMCID: PMC5517806 DOI: 10.1186/s12968-017-0369-z] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 06/29/2017] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The Evaluating Xience and left ventricular function in PCI on occlusiOns afteR STEMI (EXPLORE) trial did not show a significant benefit of percutaneous coronary intervention (PCI) of the concurrent chronic total occlusion (CTO) in ST-segment elevation myocardial infarction (STEMI) patients on global left ventricular (LV) systolic function. However a possible treatment effect will be most pronounced in the CTO territory. Therefore, we aimed to study the effect of CTO PCI compared to no-CTO PCI on the recovery of regional LV function, particularly in the CTO territory. METHODS Using cardiovascular magnetic resonance (CMR) we studied 180 of the 302 EXPLORE patients with serial CMR (baseline and 4 months follow-up). Segmental wall thickening (SWT) was quantified on cine images by an independent core laboratory. Dysfunctional segments were defined as SWT < 45%. Dysfunctional segments were further analyzed by viability (transmural extent of infarction (TEI) ≤50%.). All outcomes were stratified for randomization treatment. RESULTS In the dysfunctional segments in the CTO territory recovery of SWT was better after CTO PCI compared to no-CTO PCI (ΔSWT 17 ± 27% vs 11 ± 23%, p = 0.03). This recovery was most pronounced in the dysfunctional but viable segments(TEI < 50%) (ΔSWT 17 ± 27% vs 11 ± 22%, p = 0.02). Furthermore in the CTO territory, recovery of SWT was significantly better in the dysfunctional segments in patients with Rentrop grade 2-3 collaterals compared to grade 0-1 collaterals to the CTO (16 ± 26% versus 11 ± 24%, p = 0.04). CONCLUSION CTO PCI compared with no-CTO PCI is associated with a greater recovery of regional systolic function in the CTO territory, especially in the dysfunctional but viable segments. Further research is needed to evaluate the use of CMR in selecting post-STEMI patients for CTO PCI and the effect of regional LV function recovery on clinical outcome. TRIAL REGISTRATION Trialregister.nl NTR1108 , Date registered NTR: 30-okt-2007.
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Affiliation(s)
- Joëlle Elias
- Academic Medical Center - University of Amsterdam, Amsterdam, the Netherlands
| | - Ivo M. van Dongen
- Academic Medical Center - University of Amsterdam, Amsterdam, the Netherlands
| | - Loes P. Hoebers
- Academic Medical Center - University of Amsterdam, Amsterdam, the Netherlands
| | - Dagmar M. Ouweneel
- Academic Medical Center - University of Amsterdam, Amsterdam, the Netherlands
| | | | | | | | | | | | - Dan Ioanes
- Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | - Jan G. Tijssen
- Academic Medical Center - University of Amsterdam, Amsterdam, the Netherlands
| | | | - José P. S. Henriques
- Academic Medical Center - University of Amsterdam, Amsterdam, the Netherlands
- Department of Cardiology, Academic Medical Center - University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - on behalf of the EXPLORE investigators
- Academic Medical Center - University of Amsterdam, Amsterdam, the Netherlands
- Sahlgrenska University Hospital, Gothenburg, Sweden
- North Estonia Medical Center, Tallinn, Estonia
- Haukeland University Hospital, Bergen, Norway
- Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands
- VU Medical Center, Amsterdam, the Netherlands
- Erasmus Medical Center, Rotterdam, the Netherlands
- Department of Cardiology, Academic Medical Center - University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
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Sarno G, Lagerqvist B, Olivecrona G, Varenhorst C, Danielewicz M, Hambraeus K, Lindholm D, Råmunddal T, Witt N, James S. Real-life clinical outcomes with everolimus eluting platinum chromium stent with an abluminal biodegradable polymer in patients from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR). Catheter Cardiovasc Interv 2017; 90:881-887. [DOI: 10.1002/ccd.27030] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 02/15/2017] [Accepted: 02/17/2017] [Indexed: 01/12/2023]
Affiliation(s)
- Giovanna Sarno
- Department of Medical Sciences; Cardiology and Uppsala Clinical Research Center, Uppsala University; Uppsala Sweden
- UCR, Uppsala Clinical Research Center; Uppsala Sweden
| | - Bo Lagerqvist
- Department of Medical Sciences; Cardiology and Uppsala Clinical Research Center, Uppsala University; Uppsala Sweden
- UCR, Uppsala Clinical Research Center; Uppsala Sweden
| | | | - Christoph Varenhorst
- Department of Medical Sciences; Cardiology and Uppsala Clinical Research Center, Uppsala University; Uppsala Sweden
- UCR, Uppsala Clinical Research Center; Uppsala Sweden
| | | | | | - Daniel Lindholm
- Department of Medical Sciences; Cardiology and Uppsala Clinical Research Center, Uppsala University; Uppsala Sweden
- UCR, Uppsala Clinical Research Center; Uppsala Sweden
| | - Truls Råmunddal
- Department of Cardiology; Sahlgrenska University Hospital; Göteborg Sweden
| | - Nils Witt
- Department of Cardiology; Södersjukhuset University Hospital; Stockholm Sweden
| | - Stefan James
- Department of Medical Sciences; Cardiology and Uppsala Clinical Research Center, Uppsala University; Uppsala Sweden
- UCR, Uppsala Clinical Research Center; Uppsala Sweden
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Saluveer O, Redfors B, Angerås O, Dworeck C, Haraldsson I, Ljungman C, Petursson P, Odenstedt J, Ioanes D, Lundgren P, Völz S, Råmunddal T, Andersson B, Omerovic E, Bergh N. Hypertension is associated with increased mortality in patients with ischaemic heart disease after revascularization with percutaneous coronary intervention - a report from SCAAR. Blood Press 2017; 26:166-173. [PMID: 28092977 DOI: 10.1080/08037051.2016.1270162] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND The prognostic role of hypertension on long-term survival after percutaneous coronary intervention (PCI) is limited and inconsistent. We hypothesize that hypertension increases long-term mortality after PCI. METHODS We analyzed data from SCAAR (Swedish Coronary Angiography and Angioplasty Registry) for all consecutive patients admitted coronary care units in Sweden between January 1995 and May 2013 and who underwent PCI due to ST-elevation myocardial infarction (STEMI), non-ST-elevation myocardial infarction (NSTEMI)/unstable angina (UA) or stable angina pectoris. We used Cox proportional-hazards regression for statistical modelling on complete-case data as well as on imputed data sets. We used interaction test to evaluate possible effect-modulation of hypertension on risk estimates in several pre-specified subgroups: age categories, gender, diabetes, smoking and indication for PCI (STEMI, NSTEMI/UA and stable angina). RESULTS During the study period, 175,892 consecutive patients underwent coronary angiography due to STEMI, NSTEMI/UA or stable angina. 78,100 (44%) of these had hypertension. Median follow-up was 5.5 years. After adjustment for differences in patient's characteristics, hypertension was associated with increased risk for mortality (HR 1.12, 95% CI 1.09-1.15, p < .001). In subgroup analysis, risk was highest in patients less than 65 years, in smokers and in patients with STEMI. The risk was lowest in patients with stable angina (p < .001 for interaction test). CONCLUSION Hypertension is associated with higher mortality in patients with STEMI, NSTEMI/UA or stable angina who are treated with PCI.
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Affiliation(s)
- Ott Saluveer
- a Department of Cardiology , Sahlgrenska University Hospital , Gothenburg , Sweden
| | - Björn Redfors
- a Department of Cardiology , Sahlgrenska University Hospital , Gothenburg , Sweden
| | - Oskar Angerås
- a Department of Cardiology , Sahlgrenska University Hospital , Gothenburg , Sweden
| | - Christian Dworeck
- a Department of Cardiology , Sahlgrenska University Hospital , Gothenburg , Sweden
| | - Inger Haraldsson
- a Department of Cardiology , Sahlgrenska University Hospital , Gothenburg , Sweden
| | - Charlotta Ljungman
- a Department of Cardiology , Sahlgrenska University Hospital , Gothenburg , Sweden
| | - Petur Petursson
- a Department of Cardiology , Sahlgrenska University Hospital , Gothenburg , Sweden
| | - Jacob Odenstedt
- a Department of Cardiology , Sahlgrenska University Hospital , Gothenburg , Sweden
| | - Dan Ioanes
- a Department of Cardiology , Sahlgrenska University Hospital , Gothenburg , Sweden
| | - Peter Lundgren
- a Department of Cardiology , Sahlgrenska University Hospital , Gothenburg , Sweden
| | - Sebastian Völz
- a Department of Cardiology , Sahlgrenska University Hospital , Gothenburg , Sweden
| | - Truls Råmunddal
- a Department of Cardiology , Sahlgrenska University Hospital , Gothenburg , Sweden
| | - Bert Andersson
- a Department of Cardiology , Sahlgrenska University Hospital , Gothenburg , Sweden
| | - Elmir Omerovic
- a Department of Cardiology , Sahlgrenska University Hospital , Gothenburg , Sweden
| | - Niklas Bergh
- a Department of Cardiology , Sahlgrenska University Hospital , Gothenburg , Sweden
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Dworeck C, Haraldsson I, Angeras O, Odenstedt J, Ioanes D, Petursson P, Volz S, Albertsson P, Persson J, Koul S, Erlinge D, Råmunddal T, Omerovic E. TCT-112 Pretreatment with P2Y12 receptor antagonists is not associated with improved patency of infarct related-artery in NSTEMI – A report from SCAAR. J Am Coll Cardiol 2016. [DOI: 10.1016/j.jacc.2016.09.356] [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: 10/20/2022]
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41
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Volz S, Dworeck C, Angeras O, Haraldsson I, Ioanes D, Odenstedt J, Petursson P, Robertsson L, Stewart J, Wahlin M, Albertsson P, Råmunddal T, Omerovic E. TCT-482 First generation drug-eluting stent is worse than contemporary bare metal stent after long-term follow-up: A report from SCAAR. J Am Coll Cardiol 2016. [DOI: 10.1016/j.jacc.2016.09.618] [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: 11/25/2022]
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Dworeck C, Angeras O, Haraldsson I, Ioanes D, Odenstedt J, Petursson P, Robertsson L, Stewart J, Volz S, Albertsson P, Råmunddal T, Omerovic E. TCT-477 Long-term risk of stent thrombosis and restenosis after treatment with drug-eluting stents: A report from SCAAR. J Am Coll Cardiol 2016. [DOI: 10.1016/j.jacc.2016.09.613] [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: 11/27/2022]
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Råmunddal T, Dworeck C, Angeras O, Odenstedt J, Ioanes D, Olivecrona G, Jensen U, Aasa M, Albertsson P, Omerovic E. TCT-310 Comparative efficacy of drug-eluting stents in chronic total occlusions: A report from the SCAAR. J Am Coll Cardiol 2016. [DOI: 10.1016/j.jacc.2016.09.440] [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: 11/25/2022]
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44
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Sarno G, Lagerqvist B, Olivecrona G, Varenhorst C, Danielewicz M, Hambraeus K, Johansson A, Råmunddal T, Witt N, James S. CRT-200.65 Real-world Clinical Experience With an Everolimus Eluting Platinum Chromium Stent With an Abluminal Biodegradable Polymer - A Report From the Swedish Coronary Angiography and Angioplasty Registry (SCAAR). JACC Cardiovasc Interv 2016. [DOI: 10.1016/j.jcin.2015.12.097] [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: 11/26/2022]
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Henriques JP, Hoebers L, Råmunddal T, Laanmets P, Eriksen E, Bax M, Ioanes D, Suttorp MJ, Strauss B, Barbato E, Nijveldt R, van Rossum AC, Marques K, Tijssen JG, van der Schaaf RJ. TCT-8 First results of the EXPLORE trial, a Global, Randomized, Prospective, Multicenter Trial Investigating the Impact of Recanalization of a Chronic Total Occlusion on Left Ventricular Function in Patients after Primary Percutaneous Coronary Intervention for Acute ST-Elevation Myocardial Infarction. J Am Coll Cardiol 2015. [DOI: 10.1016/j.jacc.2015.08.908] [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: 11/24/2022]
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46
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Redfors B, Råmunddal T, Oras J, Karason K, Ricksten SE, Dellgren G, Omerovic E. Successful heart transplantation from a donor with takotsubo syndrome. Int J Cardiol 2015; 195:82-4. [DOI: 10.1016/j.ijcard.2015.05.137] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 05/17/2015] [Indexed: 10/23/2022]
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47
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Redfors B, Angerås O, Råmunddal T, Petursson P, Haraldsson I, Dworeck C, Odenstedt J, Ioaness D, Ravn-Fischer A, Wellin P, Sjöland H, Tokgozoglu L, Tygesen H, Frick E, Roupe R, Albertsson P, Omerovic E. Trends in Gender Differences in Cardiac Care and Outcome After Acute Myocardial Infarction in Western Sweden: A Report From the Swedish Web System for Enhancement of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies (SWEDEHEART). J Am Heart Assoc 2015; 4:JAHA.115.001995. [PMID: 26175358 PMCID: PMC4608084 DOI: 10.1161/jaha.115.001995] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Cardiovascular disease is the most common cause of death for both genders. Debates are ongoing as to whether gender-specific differences in clinical course, diagnosis, and management of acute myocardial infarction (MI) exist. METHODS AND RESULTS We compared all men and women who were treated for acute MI at cardiac care units in Västra Götaland, Sweden, between January 1995 and October 2014 by obtaining data from the prospective SWEDEHEART (Swedish Web-System for Enhancement of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies) registry. We performed unadjusted and adjusted Cox proportional hazards and logistic regression analyses on complete case data and on imputed data sets. Overall, 48 118 patients (35.4% women) were diagnosed with acute MI. Women as a group had better age-adjusted prognosis than men, but this survival benefit was absent for younger women (aged <60 years) and for women with ST-segment elevation MI. Compared with men, younger women and women with ST-segment elevation MI were more likely to develop prehospital cardiogenic shock (adjusted odds ratio 1.67, 95% CI 1.30 to 2.16, P<0.001 and adjusted odds ratio 1.31, 95% CI 1.16 to 1.48, P<0.001) and were less likely to be prescribed evidence-based treatment at discharge (P<0.001 for β-blockers, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, statins, and P2Y12 antagonists). Differences in treatment between the genders did not decrease over the study period (P>0.1 for all treatments). CONCLUSIONS Women on average have better adjusted prognosis than men after acute MI; however, younger women and women with ST-segment elevation MI have disproportionately poor prognosis and are less likely to be prescribed evidence-based treatment.
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Affiliation(s)
- Björn Redfors
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden (B.R., O.A., T., P.P., I.H., C.D., J.O., D.I., A.R.F., P.W., H.S., P.A., E.O.)
| | - Oskar Angerås
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden (B.R., O.A., T., P.P., I.H., C.D., J.O., D.I., A.R.F., P.W., H.S., P.A., E.O.)
| | - Truls Råmunddal
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden (B.R., O.A., T., P.P., I.H., C.D., J.O., D.I., A.R.F., P.W., H.S., P.A., E.O.)
| | - Petur Petursson
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden (B.R., O.A., T., P.P., I.H., C.D., J.O., D.I., A.R.F., P.W., H.S., P.A., E.O.)
| | - Inger Haraldsson
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden (B.R., O.A., T., P.P., I.H., C.D., J.O., D.I., A.R.F., P.W., H.S., P.A., E.O.)
| | - Christian Dworeck
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden (B.R., O.A., T., P.P., I.H., C.D., J.O., D.I., A.R.F., P.W., H.S., P.A., E.O.)
| | - Jacob Odenstedt
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden (B.R., O.A., T., P.P., I.H., C.D., J.O., D.I., A.R.F., P.W., H.S., P.A., E.O.)
| | - Dan Ioaness
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden (B.R., O.A., T., P.P., I.H., C.D., J.O., D.I., A.R.F., P.W., H.S., P.A., E.O.)
| | - Annika Ravn-Fischer
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden (B.R., O.A., T., P.P., I.H., C.D., J.O., D.I., A.R.F., P.W., H.S., P.A., E.O.)
| | - Peder Wellin
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden (B.R., O.A., T., P.P., I.H., C.D., J.O., D.I., A.R.F., P.W., H.S., P.A., E.O.)
| | - Helen Sjöland
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden (B.R., O.A., T., P.P., I.H., C.D., J.O., D.I., A.R.F., P.W., H.S., P.A., E.O.)
| | - Lale Tokgozoglu
- Department of Cardiology, Hacettepe University Hospital, Ankara, Turkey (L.T.)
| | - Hans Tygesen
- Department of Cardiology, Södra Älvsborgs Sjukhus, Borås, Sweden (H.T.)
| | - Erik Frick
- Department of Cardiology, Skaraborg Hospital, Skövde, Sweden (E.F.)
| | - Rickard Roupe
- Department of Cardiology, Allingsås Hospital, Allingsås, Sweden (R.R.)
| | - Per Albertsson
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden (B.R., O.A., T., P.P., I.H., C.D., J.O., D.I., A.R.F., P.W., H.S., P.A., E.O.)
| | - Elmir Omerovic
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden (B.R., O.A., T., P.P., I.H., C.D., J.O., D.I., A.R.F., P.W., H.S., P.A., E.O.)
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Redfors B, Angerås O, Petursson P, Råmunddal T, Omerovic E. The ATLANTIC trial does not support the safety of prehospital ticagrelor treatment for patients with ST-elevation myocardial infarction. Int J Cardiol 2015; 190:157-8. [DOI: 10.1016/j.ijcard.2015.04.135] [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] [Received: 03/24/2015] [Revised: 04/15/2015] [Accepted: 04/16/2015] [Indexed: 10/23/2022]
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Bergström G, Redfors B, Angerås O, Dworeck C, Shao Y, Haraldsson I, Petursson P, Milicic D, Wedel H, Albertsson P, Råmunddal T, Rosengren A, Omerovic E. Low socioeconomic status of a patient's residential area is associated with worse prognosis after acute myocardial infarction in Sweden. Int J Cardiol 2014; 182:141-7. [PMID: 25577750 DOI: 10.1016/j.ijcard.2014.12.060] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [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: 10/31/2014] [Accepted: 12/21/2014] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Previous studies have established a relationship between socioeconomic status (SES) and survival in coronary heart disease. Acute cardiac care in Sweden is considered to be excellent and independent of SES. We studied the influence of area-level socioeconomic status on mortality after hospitalization for acute myocardial infarction (AMI) between 1995 and 2013 in the Gothenburg metropolitan area, which has little over 800,000 inhabitants and includes three city hospitals. METHODS Data were obtained from the SWEDEHEART registry (Swedish Websystem for Enhancement of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies) and the Swedish Central Bureau of Statistics for patients hospitalized for ST-elevation myocardial infarction (STEMI) and non-STEMI in the city of Gothenburg in Western Sweden. The groups were compared using Cox proportional hazards regression and logistic regression. RESULTS 10,895 (36% female) patients were hospitalized due to AMI during the study period. Patients residing in areas with lower SES had higher rates of smoking and diabetes (P<0.001), and were also at increased risk of developing complications, including heart failure and cardiogenic shock (P<0.05). Living in an area with lower SES associated with increased risk of dying after an AMI also in models adjusted for risk factors (P<0.05). CONCLUSION Also in a country with strong egalitarian traditions, lower SES associates with worse prognosis after AMI, an association that persists after adjustments for differences in traditional cardiovascular risk factors.
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Affiliation(s)
- Göran Bergström
- Department of Molecular and Clinical Medicine, Institute of Medicine, Gothenburg University, Gothenburg, Sweden
| | - Björn Redfors
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Oskar Angerås
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Christian Dworeck
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Yangzhen Shao
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Inger Haraldsson
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Petur Petursson
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Davor Milicic
- Department of Cardiology, University Hospital Centre, Zagreb, Croatia
| | - Hans Wedel
- Department of Molecular and Clinical Medicine, Institute of Medicine, Gothenburg University, Gothenburg, Sweden
| | - Per Albertsson
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Truls Råmunddal
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Annika Rosengren
- Department of Molecular and Clinical Medicine, Institute of Medicine, Gothenburg University, Gothenburg, Sweden
| | - Elmir Omerovic
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
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Råmunddal T, Hoebers L, Henriques JPS, Dworeck C, Angerås O, Odenstedt J, Ioanes D, Olivecrona G, Harnek J, Jensen U, Aasa M, Jussila R, James S, Lagerqvist B, Matejka G, Albertsson P, Omerovic E. Chronic total occlusions in Sweden--a report from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR). PLoS One 2014; 9:e103850. [PMID: 25117457 PMCID: PMC4130518 DOI: 10.1371/journal.pone.0103850] [Citation(s) in RCA: 96] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 07/04/2014] [Indexed: 01/16/2023] Open
Abstract
INTRODUCTION Evidence for the current guidelines for the treatment of patients with chronic total occlusions (CTO) in coronary arteries is limited. In this study we identified all CTO patients registered in the Swedish Coronary Angiography and Angioplasty Registry (SCAAR) and studied the prevalence, patient characteristics and treatment decisions for CTO in Sweden. METHODS AND RESULTS Between January 2005 and January 2012, 276,931 procedures (coronary angiography or percutaneous coronary intervention) were performed in 215,836 patients registered in SCAAR. We identified all patients who had 100% luminal diameter stenosis known or assumed to be ≥ 3 months old. After exclusion of patients with previous coronary artery bypass graft (CABG) surgery or coronary occlusions due to acute coronary syndrome, we identified 16,818 CTO patients. A CTO was present in 10.9% of all coronary angiographies and in 16.0% of patients with coronary artery disease. The majority of CTO patients were treated conservatively and PCI of CTO accounted for only 5.8% of all PCI procedures. CTO patients with diabetes and multivessel disease were more likely to be referred to CABG. CONCLUSION CTO is a common finding in Swedish patients undergoing coronary angiography but the number of CTO procedures in Sweden is low. Patients with CTO are a high-risk subgroup of patients with coronary artery disease. SCAAR has the largest register of CTO patients and therefore may be valuable for studies of clinical importance of CTO and optimal treatment for CTO patients.
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Affiliation(s)
- Truls Råmunddal
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Loes Hoebers
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands
| | | | - Christian Dworeck
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Oskar Angerås
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Jacob Odenstedt
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Dan Ioanes
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Göran Olivecrona
- Department of Coronary Heart Disease, Skåne University Hospital, Scania, Sweden
| | - Jan Harnek
- Department of Coronary Heart Disease, Skåne University Hospital, Scania, Sweden
| | - Ulf Jensen
- Department of Cardiology, Stockholm South General Hospital, Stockholm, Sweden
| | - Mikael Aasa
- Department of Cardiology, Stockholm South General Hospital, Stockholm, Sweden
| | - Risto Jussila
- Department of Cardiology, Stockholm South General Hospital, Stockholm, Sweden
| | - Stefan James
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Bo Lagerqvist
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Göran Matejka
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Per Albertsson
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Elmir Omerovic
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
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