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Velders, M. A., Calais, F., Dahle, N., Fall, T., Hagström, E., Leppert, J., . . . Hedber, P. (2019). Cathepsin D improves the prediction of undetected diabetes in patients with myocardial infarction. Upsala Journal of Medical Sciences, 124(3), 187-192
Öppna denna publikation i ny flik eller fönster >>Cathepsin D improves the prediction of undetected diabetes in patients with myocardial infarction
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2019 (Engelska)Ingår i: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 124, nr 3, s. 187-192Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Background: Newer therapeutic agents for type 2 diabetes mellitus can improve cardiovascular outcomes, but diabetes remains underdiagnosed in patients with myocardial infarction (MI). We sought to identify proteomic markers of undetected dysglycaemia (impaired fasting glucose, impaired glucose tolerance, or diabetes mellitus) to improve the identification of patients at highest risk for diabetes.

Materials and methods: In this prospective cohort, 626 patients without known diabetes underwent oral glucose tolerance testing (OGTT) during admission for MI. Proximity extension assay was used to measure 81 biomarkers. Multivariable logistic regression, adjusting for risk factors, was used to evaluate the association of biomarkers with dysglycaemia. Subsequently, lasso regression was performed in a 2/3 training set to identify proteomic biomarkers with prognostic value for dysglycaemia, when added to risk factors, fasting plasma glucose, and glycated haemoglobin A1c. Determination of discriminatory ability was performed in a 1/3 test set.

Results: In total, 401/626 patients (64.1%) met the criteria for dysglycaemia. Using multivariable logistic regression, cathepsin D had the strongest association with dysglycaemia. Lasso regression selected seven markers, including cathepsin D, that improved prediction of dysglycaemia (area under the receiver operator curve [AUC] 0.848 increased to 0.863). In patients with normal fasting plasma glucose, only cathepsin D was selected (AUC 0.699 increased to 0.704).

Conclusions: Newly detected dysglycaemia, including manifest diabetes, is common in patients with acute MI. Cathepsin D improved the prediction of dysglycaemia, which may be helpful in the a priori risk determination of diabetes as a motivation for confirmatory OGTT.

Ort, förlag, år, upplaga, sidor
Taylor & Francis, 2019
Nyckelord
Acute myocardial infarction, biomarkers, diabetes mellitus, proteomics
Nationell ämneskategori
Endokrinologi och diabetes Kardiologi
Identifikatorer
urn:nbn:se:oru:diva-76184 (URN)10.1080/03009734.2019.1650141 (DOI)000482489400001 ()31429631 (PubMedID)
Anmärkning

Funding Agency:

Regional Research Council Uppsala-Örebro, Sweden  RFR-743621

Tillgänglig från: 2019-09-10 Skapad: 2019-09-10 Senast uppdaterad: 2019-11-22Bibliografiskt granskad
Calais, F. (2018). Coronary artery disease and prognosis in relation to cardiovascular risk factors, interventional techniques and systemic atherosclerosis. (Doctoral dissertation). Örebro: Örebro University
Öppna denna publikation i ny flik eller fönster >>Coronary artery disease and prognosis in relation to cardiovascular risk factors, interventional techniques and systemic atherosclerosis
2018 (Engelska)Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
Abstract [en]

Aim: To evaluate the prognosis associated with location and severity of coronary and systemic atherosclerosis in patients with coronary artery disease (CAD) in relation to risk factors and interventional techniques.

Methods: The thesis comprised six longitudinal studies based on three patient cohorts: The Swedish Coronary Angiography and Angioplasty Registry, the Västmanland Myocardial Infarction Survey, and the Thrombus Aspiration in ST-Elevation myocardial infarction in Scandinavia study, to evaluate clinical outcome relative to coronary lesion location and severity, extracoronary artery disease (ECAD), intervention techniques, and leisuretime physical inactivity (LTPI).

Results: Stent placement in the proximal left anterior descending artery (LAD) was more often associated with restenosis than was stenting in the other coronary arteries. The use of drug-eluting stents in the LAD was associated with a lower risk of restenosis and death compared to baremetal stents. Thrombus aspiration in in the LAD during acute ST elevation myocardial infarction (MI) did not improve clinical outcome, irrespective of adjunct intervention technique. Clinical, but not subclinical, ECAD was associated with poor prognosis in patients with MI. Longitudinal extent of CAD at the time of MI was a predictor of ECAD, and coexistence of extensive CAD and ECAD was associated with particularly poor prognosis following MI. Self-reported LTPI was associated with MI and all-cause mortality independent of ECAD.

Conclusions: Drug-eluting stents, but not thrombus aspiration, improved prognosis following percutaneous coronary intervention in the proximal LAD. Self- reported LTPI, clinical ECAD, and systemic atherosclerosis defined groups with poor prognosis after MI.

Ort, förlag, år, upplaga, sidor
Örebro: Örebro University, 2018. s. 78
Serie
Örebro Studies in Medicine, ISSN 1652-4063 ; 173
Nyckelord
Atherosclerosis, Myocardial infarction, Coronary artery disease, Extra-cardiac artery disease, Coronary stent, Thrombus aspiration, physical inactivity, Prognosis
Nationell ämneskategori
Allmänmedicin Kardiologi
Identifikatorer
urn:nbn:se:oru:diva-64410 (URN)978-91-7529-232-8 (ISBN)
Disputation
2018-03-23, Örebro universitet, Campus USÖ, hörsal C3, Södra Grev Rosengatan 32, Örebro, 09:00 (Engelska)
Opponent
Handledare
Tillgänglig från: 2018-01-19 Skapad: 2018-01-19 Senast uppdaterad: 2018-03-02Bibliografiskt granskad
Escaned, J., Calais, F., Fröbert, O., Davies, J. E. & Götberg, M. (2018). Safety of the Deferral of Coronary Revascularization on the Basis of Instantaneous Wave-Free Ratio and Fractional Flow Reserve Measurements in Stable Coronary Artery Disease and Acute Coronary Syndromes. JACC: Cardiovascular Interventions, 11(15), 1437-1449
Öppna denna publikation i ny flik eller fönster >>Safety of the Deferral of Coronary Revascularization on the Basis of Instantaneous Wave-Free Ratio and Fractional Flow Reserve Measurements in Stable Coronary Artery Disease and Acute Coronary Syndromes
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2018 (Engelska)Ingår i: JACC: Cardiovascular Interventions, ISSN 1936-8798, E-ISSN 1876-7605, Vol. 11, nr 15, s. 1437-1449Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

OBJECTIVES: The aim of this study was to investigate the clinical outcomes of patients deferred from coronary revascularization on the basis of instantaneous wave-free ratio (iFR) or fractional flow reserve (FFR) measurements in stable angina pectoris (SAP) and acute coronary syndromes (ACS).

BACKGROUND: Assessment of coronary stenosis severity with pressure guidewires is recommended to determine the need for myocardial revascularization.

METHODS: The safety of deferral of coronary revascularization in the pooled per-protocol population (n = 4,486) of the DEFINE-FLAIR (Functional Lesion Assessment of Intermediate Stenosis to Guide Revascularisation) and iFR-SWEDEHEART (Instantaneous Wave-Free Ratio Versus Fractional Flow Reserve in Patients With Stable Angina Pectoris or Acute Coronary Syndrome) randomized clinical trials was investigated. Patients were stratified according to revascularization decision making on the basis of iFR or FFR and to clinical presentation (SAP or ACS). The primary endpoint was major adverse cardiac events (MACE), defined as the composite of all-cause death, nonfatal myocardial infarction, or unplanned revascularization at 1 year.

RESULTS: Coronary revascularization was deferred in 2,130 patients. Deferral was performed in 1,117 patients (50%) in the iFR group and 1,013 patients (45%) in the FFR group (p < 0.01). At 1 year, the MACE rate in the deferred population was similar between the iFR and FFR groups (4.12% vs. 4.05%; fully adjusted hazard ratio: 1.13; 95% confidence interval: 0.72 to 1.79; p = 0.60). A clinical presentation with ACS was associated with a higher MACE rate compared with SAP in deferred patients (5.91% vs. 3.64% in ACS and SAP, respectively; fully adjusted hazard ratio: 0.61 in favor of SAP; 95% confidence interval: 0.38 to 0.99; p = 0.04).

CONCLUSIONS: Overall, deferral of revascularization is equally safe with both iFR and FFR, with a low MACE rate of about 4%. Lesions were more frequently deferred when iFR was used to assess physiological significance. In deferred patients presenting with ACS, the event rate was significantly increased compared with SAP at 1 year.

Ort, förlag, år, upplaga, sidor
Elsevier, 2018
Nyckelord
ACS, FFR, SAP, coronary physiology, deferral of revascularization, iFR
Nationell ämneskategori
Kardiologi
Identifikatorer
urn:nbn:se:oru:diva-68506 (URN)10.1016/j.jcin.2018.05.029 (DOI)000440859800006 ()30093050 (PubMedID)2-s2.0-85050687646 (Scopus ID)
Anmärkning

Funding Agencies:

Philips  

Upsala Clinical Research Centre  

Volcano  

Imperial College  

Philips Volcano  

Imperial College London  

Medical Research Council 

Tillgänglig från: 2018-08-17 Skapad: 2018-08-17 Senast uppdaterad: 2018-09-04Bibliografiskt granskad
Götberg, M., Christiansen, E. H., Gudmundsdottir, I. J., Sandhall, L., Danielewicz, M., Jakobsen, L., . . . iFR-SWEDEHEART Investigators, G. a. (2017). Instantaneous Wave-free Ratio versus Fractional Flow Reserve to Guide PCI. New England Journal of Medicine, 376(19), 1813-1823
Öppna denna publikation i ny flik eller fönster >>Instantaneous Wave-free Ratio versus Fractional Flow Reserve to Guide PCI
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2017 (Engelska)Ingår i: New England Journal of Medicine, ISSN 0028-4793, E-ISSN 1533-4406, Vol. 376, nr 19, s. 1813-1823Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Background: The instantaneous wave-free ratio (iFR) is an index used to assess the severity of coronary-artery stenosis. The index has been tested against fractional flow reserve (FFR) in small trials, and the two measures have been found to have similar diagnostic accuracy. However, studies of clinical outcomes associated with the use of iFR are lacking. We aimed to evaluate whether iFR is noninferior to FFR with respect to the rate of subsequent major adverse cardiac events.

Methods: We conducted a multicenter, randomized, controlled, open-label clinical trial using the Swedish Coronary Angiography and Angioplasty Registry for enrollment. A total of 2037 participants with stable angina or an acute coronary syndrome who had an indication for physiologically guided assessment of coronary-artery stenosis were randomly assigned to undergo revascularization guided by either iFR or FFR. The primary end point was the rate of a composite of death from any cause, nonfatal myocardial infarction, or unplanned revascularization within 12 months after the procedure.

Results: A primary end-point event occurred in 68 of 1012 patients (6.7%) in the iFR group and in 61 of 1007 (6.1%) in the FFR group (difference in event rates, 0.7 percentage points; 95% confidence interval [CI], -1.5 to 2.8%; P=0.007 for noninferiority; hazard ratio, 1.12; 95% CI, 0.79 to 1.58; P=0.53); the upper limit of the 95% confidence interval for the difference in event rates fell within the prespecified noninferiority margin of 3.2 percentage points. The results were similar among major subgroups. The rates of myocardial infarction, target-lesion revascularization, restenosis, and stent thrombosis did not differ significantly between the two groups. A significantly higher proportion of patients in the FFR group than in the iFR group reported chest discomfort during the procedure.

Conclusions: Among patients with stable angina or an acute coronary syndrome, an iFR-guided revascularization strategy was noninferior to an FFR-guided revascularization strategy with respect to the rate of major adverse cardiac events at 12 months.

Ort, förlag, år, upplaga, sidor
Massachussetts Medical Society, 2017
Nationell ämneskategori
Kardiologi
Forskningsämne
Kardiologi
Identifikatorer
urn:nbn:se:oru:diva-57370 (URN)10.1056/NEJMoa1616540 (DOI)000400891100007 ()28317438 (PubMedID)2-s2.0-85019438253 (Scopus ID)
Anmärkning

Funding Agency:

Philips Volcano

Tillgänglig från: 2017-05-15 Skapad: 2017-05-15 Senast uppdaterad: 2018-07-31Bibliografiskt granskad
Östman, M. E., Calais, F., Rosenblad, A., Fröbert, O., Leppert, J. & Hedberg, P. (2017). Prognostic impact of subclinical or manifest extracoronary artery diseases after acute myocardial infarction. Atherosclerosis, 263, 53-59
Öppna denna publikation i ny flik eller fönster >>Prognostic impact of subclinical or manifest extracoronary artery diseases after acute myocardial infarction
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2017 (Engelska)Ingår i: Atherosclerosis, ISSN 0021-9150, E-ISSN 1879-1484, Vol. 263, s. 53-59Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Background and aims: In patients with coronary artery disease (CAD), clinically overt extracoronary artery diseases (ECADs), including claudication or previous strokes, are associated with poor outcomes. Subclinical ECADs detected by screening are common among such patients. We aimed to evaluate the prognostic impact of subclinical versus symptomatic ECADs in patients with acute myocardial infarction (AMI).

Methods: In a prospective observational study, 654 consecutive patients diagnosed with AMI underwent ankle brachial index (ABI) measurements and ultrasonographic screening of the carotid arteries and abdominal aorta. Clinical ECADs were defined as prior strokes, claudication, or extracoronary artery intervention. Subclinical ECADs were defined as the absence of a clinical ECAD in combination with an ABI <= 0.9 or >1.4, carotid artery stenosis, or an abdominal aortic aneurysm.

Results: At baseline, subclinical and clinical ECADs were prevalent in 21.6% and 14.4% of the patients, respectively. Patients with ECADs received evidence-based medication more often at admission but similar medications at discharge compared with patients without ECADs. During a median follow-up of 5.2 years, 166 patients experienced endpoints of hospitalization for AMI, heart failure, stroke, or cardiovascular death. With ECAD-free cases as reference and after adjustment for risk factors, a clinical ECAD (hazard ratio [HR] 2.10, 95% confidence interval [CI] 1.34-3.27, p = 0.001), but not a subclinical ECAD (HR 1.35, 95% CI 0.89-2.05, p = 0.164), was significantly associated with worse outcomes.

Conclusions: Despite receiving similar evidence-based medication at discharge, patients with clinical ECAD, but not patients with a subclinical ECAD, had worse long-term prognosis than patients without an ECAD after AMI. (C) 2017 The Authors. Published by Elsevier Ireland Ltd.

Ort, förlag, år, upplaga, sidor
Elsevier, 2017
Nyckelord
Extracoronary artery disease, Myocardial infarction, Prognosis
Nationell ämneskategori
Kardiologi
Identifikatorer
urn:nbn:se:oru:diva-60724 (URN)10.1016/j.atherosclerosis.2017.05.027 (DOI)000407634000884 ()28599258 (PubMedID)2-s2.0-85020304353 (Scopus ID)
Anmärkning

Funding Agencies:

Sparbanksstiftelsen Nya  552  693  0932  2297 

County of Västmanland  

Swedish Medical Association

Tillgänglig från: 2017-09-11 Skapad: 2017-09-11 Senast uppdaterad: 2018-08-06Bibliografiskt granskad
Lindholm, D., Alfredsson, J., Angeras, O., Böhm, F., Calais, F., Koul, S., . . . Varenhorst, C. (2017). Timing of percutaneous coronary intervention in patients with non-ST-elevation myocardial infarction: a SWEDEHEART study. European Heart Journal - Quality of Care and Clinical Outcomes, 3(1), 53-60
Öppna denna publikation i ny flik eller fönster >>Timing of percutaneous coronary intervention in patients with non-ST-elevation myocardial infarction: a SWEDEHEART study
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2017 (Engelska)Ingår i: European Heart Journal - Quality of Care and Clinical Outcomes, ISSN 2058-5225, E-ISSN 2058-1742, Vol. 3, nr 1, s. 53-60Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Aims: Although routine invasive management is recommended in NSTEMI patients, the optimal timing of the procedure is not defined. The aim of this study was to assess outcomes in relation to timing of PCI in NSTEMI patients.

Methods and results: This was an observational, prospective, multicentre cohort study from the SWEDEHEART registry including all Swedish PCI centres. We included 40 494 consecutive PCI-treated patients who were admitted to any coronary care unit from 2006 to 2013. The primary outcome was all-cause death, and secondary outcomes were recurrent myocardial infarction (MI), stent thrombosis, and severe in-hospital bleeding. Outcomes were assessed within 1 year from admission in relation to pre-specified cut-offs to define early PCI: within 1, 2, or 3 days. Patients who received delayed PCI, compared with those who did not, were older, and had a higher prevalence of comorbidities (hypertension, hyperlipidaemia, diabetes, and prior stroke) but showed similar angiographic findings. Cox mixed-effects models showed a lower risk of all-cause death with early PCI across all three cut-offs: HR (95% CI) of 0.88 (0.80-0.98), 0.78 (0.71-0.86), and 0.75 (0.68-0.84), for the 1-, 2-, and 3-day cut-offs, respectively. Early PCI was associated with lower risk of recurrent MI for the 2-and 3-day cut-offs, but not for the 1-day cut-off. The reported rates of severe in-hospital bleeding were low, but tended to be higher in patients receiving delayed PCI.

Conclusion: In patients undergoing PCI for NSTEMI, early invasive treatment is associated with lower risk of ischaemic outcomes.

Ort, förlag, år, upplaga, sidor
Oxford University Press, 2017
Nyckelord
Percutaneous coronary intervention, NSTEMI
Nationell ämneskategori
Kardiologi
Identifikatorer
urn:nbn:se:oru:diva-64832 (URN)10.1093/ehjqcco/qcw044 (DOI)000422956400009 ()28927193 (PubMedID)
Anmärkning

Funding Agency:

AstraZeneca within the Externally Sponsored Research Programme  ESR-14-10720

Tillgänglig från: 2018-02-06 Skapad: 2018-02-06 Senast uppdaterad: 2018-08-14Bibliografiskt granskad
Fröbert, O., Arevström, L., Calais, F., James, S. K. & Lagerqvist, B. (2016). Height and prognosis following percutaneous coronary intervention. International Journal of Cardiology, 224, 188-190
Öppna denna publikation i ny flik eller fönster >>Height and prognosis following percutaneous coronary intervention
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2016 (Engelska)Ingår i: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 224, s. 188-190Artikel i tidskrift (Refereegranskat) Published
Ort, förlag, år, upplaga, sidor
Clare, Ireland: Elsevier, 2016
Nyckelord
Angioplasty, height, prognosis
Nationell ämneskategori
Kardiologi
Forskningsämne
Kardiologi
Identifikatorer
urn:nbn:se:oru:diva-53766 (URN)10.1016/j.ijcard.2016.09.049 (DOI)000390471300037 ()27657472 (PubMedID)2-s2.0-84988382956 (Scopus ID)
Tillgänglig från: 2016-12-05 Skapad: 2016-12-05 Senast uppdaterad: 2018-07-17Bibliografiskt granskad
Fokkema, M. L., James, S. K., Albertsson, P., Aasa, M., Åkerblom, A., Calais, F., . . . Lagerqvist, B. (2016). Outcome after percutaneous coronary intervention for different indications: long-term results from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR). EuroIntervention, 12(3), 303-311
Öppna denna publikation i ny flik eller fönster >>Outcome after percutaneous coronary intervention for different indications: long-term results from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR)
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2016 (Engelska)Ingår i: EuroIntervention, ISSN 1774-024X, E-ISSN 1969-6213, Vol. 12, nr 3, s. 303-311Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Aims: The aim of this study was to evaluate clinical outcome for different indications for PCI in an unselected, nationwide PCI population at short- and long-term follow-up.

Methods and results: We evaluated clinical outcome up to six years after PCI in all patients undergoing a PCI procedure for different indications in Sweden between 2006 and 2010. A total of 70,479 patients were treated for stable coronary artery disease (CAD) (21.0%), unstable angina (11.0%), non-ST-elevation myocardial infarction (NSTEMI) (36.6%) and ST-elevation myocardial infarction (STEMI) (31.4%). Mortality was higher in STEMI patients at one year after PCI (9.6%) compared to NSTEMI (4.7%), unstable angina (2.2%) and stable CAD (2.0%). At one year after PCI until the end of follow-up, the adjusted mortality risk (one to six years after PCI) and the risk of myocardial infarction were comparable between NSTEMI and STEMI patients and lower in patients with unstable angina and stable CAD. The adjusted risk of stent thrombosis and heart failure was highest in STEMI patients.

Conclusions: The risk of short-term mortality, heart failure and stent thrombosis is highest for STEMI patients after PCI. Therapies to reduce stent thrombosis and heart failure appear to be most important in decreasing mortality in patients with STEMI or NSTEMI undergoing PCI.

Ort, förlag, år, upplaga, sidor
Toulouse, France: Europa Edition, 2016
Nyckelord
coronary artery disease, indications, myocardial infarction, percutaneous coronary intervention, prognosis
Nationell ämneskategori
Kardiologi
Forskningsämne
Kardiologi
Identifikatorer
urn:nbn:se:oru:diva-51850 (URN)10.4244/EIJY15M10_07 (DOI)000380083100005 ()26485732 (PubMedID)2-s2.0-84975806577 (Scopus ID)
Anmärkning

Funding Agencies:

Swedish Health Authorities

Stichting Jo Kolk Studiefonds

Tillgänglig från: 2016-08-29 Skapad: 2016-08-29 Senast uppdaterad: 2018-07-16Bibliografiskt granskad
Calais, F., Lagerqvist, B., Leppert, J., James, S. K. & Fröbert, O. (2016). Thrombus aspiration in patients with large anterior myocardial infarction: A Thrombus Aspiration in ST-Elevation myocardial infarction in Scandinavia trial substudy. American Heart Journal, 172(2), 129-134
Öppna denna publikation i ny flik eller fönster >>Thrombus aspiration in patients with large anterior myocardial infarction: A Thrombus Aspiration in ST-Elevation myocardial infarction in Scandinavia trial substudy
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2016 (Engelska)Ingår i: American Heart Journal, ISSN 0002-8703, E-ISSN 1097-6744, Vol. 172, nr 2, s. 129-134Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Background: The TASTE trial did not demonstrate clinical benefit of thrombus aspiration (TA). High-risk patients might benefit from TA.

Methods: The TASTE trial was a multicenter, randomized, controlled, open-label trial obtaining end points from national registries. Patients (n = 7,244) with ST-segment elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI) were randomly assigned 1: 1 to TA and PCI or to PCI alone. We assessed the 1-year clinical effect of TA in a subgroup with potentially large anterior STEMI: mid or proximal left anterior descending coronary artery infarct lesion, thrombolysis in myocardial infarction 0 to 2 flow, and symptom onset to PCI time = 5 hours. In this substudy, patient eligibility criteria corresponded to that of the INFUSE-AMI study.

Results: In total, 1,826 patients fulfilled inclusion criteria. All-cause mortality at 1 year of patients randomized to TA did not differ from those randomized to PCI only (hazard ratio [HR] 1.05, 95% CI 0.74-1.49, P = .77). Rates of rehospitalization for myocardial infarction, heart failure, and stent thrombosis did not differ between groups (HR 0.87, 95% CI 0.51-1.46, P = .59; HR 1.10 95% CI 0.77-1.58, P = .58; and HR 0.75, 95% CI 0.30-1.86, P = .53, respectively). This was also the case for the combined end point of all-cause mortality and rehospitalization for myocardial infarction, heart failure, or stent thrombosis (HR 1.00, 95% CI 0.79-1.26, P = .99).

Conclusion: In patients with STEMI and large area of myocardium at risk, TA did not affect outcome within 1 year.

Ort, förlag, år, upplaga, sidor
Elsevier, 2016
Nationell ämneskategori
Kardiologi
Forskningsämne
Kardiologi
Identifikatorer
urn:nbn:se:oru:diva-48941 (URN)10.1016/j.ahj.2015.11.012 (DOI)000369659400016 ()26856224 (PubMedID)
Anmärkning

Funding Agencies:

Medtronic

Vascular solutions

Terumo

Biosensors 

Biotronik

Tillgänglig från: 2016-03-07 Skapad: 2016-03-04 Senast uppdaterad: 2019-02-13Bibliografiskt granskad
Fröbert, O., Calais, F., James, S. K. & Lagerqvist, B. (2015). ST-Elevation Myocardial Infarction, Thrombus Aspiration, and Different Invasive Strategies: A TASTE Trial Substudy. Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, 4(6), Article ID e001755.
Öppna denna publikation i ny flik eller fönster >>ST-Elevation Myocardial Infarction, Thrombus Aspiration, and Different Invasive Strategies: A TASTE Trial Substudy
2015 (Engelska)Ingår i: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, ISSN 2047-9980, E-ISSN 2047-9980, Vol. 4, nr 6, artikel-id e001755Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Background: The clinical effect of thrombus aspiration in ST-elevation myocardial infarction may depend on the type of aspiration catheter and stenting technique.

Methods and Results: The multicenter, prospective, randomized, open-label trial Thrombus Aspiration in ST-Elevation myocardial infarction in Scandinavia (TASTE) did not demonstrate a clinical benefit of thrombus aspiration compared to percutaneous coronary intervention alone. We assessed the effect of type of aspiration device, stent type, direct stenting, and postdilatation on outcomes at 1 year. There was no difference in all-cause mortality, between the 3 most frequently used aspiration catheters (Eliminate [Terumo] 5.4%, Export [Medtronic] 5.0%, Pronto [Vascular Solutions] 4.5%) in patients randomized to thrombus aspiration. There was no difference in mortality between directly stented patients randomized to thrombus aspiration compared to patients randomized to percutaneous coronary intervention only (risk ratio 1.08, 95% CI 0.70 to 1.67, P=0.73). Similarly, there was no difference in mortality between the 2 randomized groups for patients receiving drug-eluting stents (risk ratio 0.89, 95% CI 0.63 to 1.26, P=0.50) or for those treated with postdilation (risk ratio 0.72, 95% CI 0.49 to 1.07, P=0.11). Furthermore, there was no difference in rehospitalization for myocardial infarction or stent thrombosis between the randomized arms in any of the subgroups.

Conclusions: In patients with ST-elevation myocardial infarction randomized to thrombus aspiration, the type of aspiration catheter did not affect outcome. Stent type, direct stenting, or postdilation did not affect outcome irrespective of treatment with thrombus aspiration and percutaneous coronary intervention or percutaneous coronary intervention alone.

Nyckelord
angioplasty, myocardial infarction, stenting, thrombus aspiration
Nationell ämneskategori
Kardiologi
Forskningsämne
Kardiologi
Identifikatorer
urn:nbn:se:oru:diva-45542 (URN)10.1161/JAHA.114.001755 (DOI)000357025100014 ()26077585 (PubMedID)
Forskningsfinansiär
VetenskapsrådetHjärt-Lungfonden, 20100178 B0010401
Anmärkning

Funding Agencies:

Swedish Association of Local Authorities and Regions

Terumo Medical Corporation

Medtronic Solution

Svenska Hjartförbundet

Vascular Solution

Tillgänglig från: 2015-08-12 Skapad: 2015-08-12 Senast uppdaterad: 2018-07-01Bibliografiskt granskad
Organisationer
Identifikatorer
ORCID-id: ORCID iD iconorcid.org/0000-0002-9821-0510

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