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Ozaki, Y., Hong, S.-J., Heg, D., Frigoli, E., Vranckx, P., Morice, M.-C., . . . Valgimigli, M. (2024). Geographical variations in the effectiveness and safety of abbreviated or standard antiplatelet therapy after PCI in patients at high bleeding risk. Canadian Journal of Cardiology
Open this publication in new window or tab >>Geographical variations in the effectiveness and safety of abbreviated or standard antiplatelet therapy after PCI in patients at high bleeding risk
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2024 (English)In: Canadian Journal of Cardiology, ISSN 0828-282X, E-ISSN 1916-7075Article in journal (Refereed) Epub ahead of print
Abstract [en]

In high-bleeding risk (HBR) patients, non-inferiority of 1-month dual antiplatelet therapy (APT) to treatment continuation for ≥2 additional months for the occurrence of net and major adverse clinical events after drug-eluting stent implantation was showed in the MASTER DAPT trial.1 A significant reduction in bleeding was also noted. However, whether these treatment effects of APT are consistent across geographical regions remains uncertain. In the present analyses, the effects of abbreviated or standard APT on the 1-year occurrence of net and major adverse clinical events and bleeding were consistent across geographical regions (Europe, East Asia, and others) [NCT03023020].

Place, publisher, year, edition, pages
Elsevier, 2024
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:oru:diva-111382 (URN)10.1016/j.cjca.2024.01.032 (DOI)38309468 (PubMedID)
Note

The study was sponsored by the European Cardiovascular Research Institute, a nonprofit organization, and received grant support from Terumo. 

Available from: 2024-02-05 Created: 2024-02-05 Last updated: 2024-02-05Bibliographically approved
Evans, A. L., Fuchs, B., Singh, N. J., Thiel, A., Giroud, S., Blanc, S., . . . Arnemo, J. M. (2023). Body mass is associated with hibernation length, body temperature, and heart rate in free-ranging brown bears. Frontiers in Zoology, 20(1), Article ID 27.
Open this publication in new window or tab >>Body mass is associated with hibernation length, body temperature, and heart rate in free-ranging brown bears
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2023 (English)In: Frontiers in Zoology, E-ISSN 1742-9994, Vol. 20, no 1, article id 27Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Despite centuries of research, debate remains on the scaling of metabolic rate to mass especially for intraspecific cases. The high variation of body mass within brown bears presents a unique opportunity to study the intraspecific effects of body mass on physiological variables. The amplitude of metabolic rate reduction in hibernators is dependent on body mass of the species. Small hibernators have high metabolic rates when euthermic but experience a drastic decrease in body temperature during torpor, which is necessary to reach a very low metabolic rate. Conversely, large hibernators, such as the brown bear (Ursus arctos), show a moderate decrease in temperature during hibernation, thought to be related to the bear's large size. We studied body mass, abdominal body temperature, heart rate, and accelerometer-derived activity from 63 free-ranging brown bears (1-15 years old, 15-233 kg). We tested for relationships between body mass and body temperature, heart rate, and hibernation duration.

RESULTS: The smallest individuals maintained lower body temperatures during hibernation, hibernated longer, and ended hibernation later than large bears. Unlike body temperature, winter heart rates were not associated with body mass. In summer, the opposite pattern was found, with smaller individuals having higher body temperature and daytime heart rates. Body mass was associated with body temperature in the winter hypometabolic state, even in a large hibernating mammal. Smaller bears, which are known to have higher thermal conductance, reached lower body temperatures during hibernation. During summer, smaller bears had higher body temperatures and daytime heart rates, a phenomenon not previously documented within a single mammalian species.

CONCLUSION: We conclude that the smallest bears hibernated more deeply and longer than large bears, likely from a combined effect of basic thermodynamics, the higher need for energy savings, and a lower cost of warming up a smaller body.

Place, publisher, year, edition, pages
BioMed Central (BMC), 2023
Keywords
Brown bears, Heart rate, Hibernation, Metabolic rate, Thermal conductance, Thermoregulation
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:oru:diva-107663 (URN)10.1186/s12983-023-00501-3 (DOI)001048627600001 ()37587452 (PubMedID)2-s2.0-85168582404 (Scopus ID)
Available from: 2023-08-17 Created: 2023-08-17 Last updated: 2024-01-17Bibliographically approved
Fröbert, O., Götberg, M., Erlinge, D., Akhtar, Z., Christiansen, E. H., MacIntyre, C. R., . . . Pernow, J. (2023). Clinical Impact of Influenza Vaccination after ST- and Non-ST-segment elevation Myocardial Infarction Insights from the IAMI trial. American Heart Journal, 255, 82-89
Open this publication in new window or tab >>Clinical Impact of Influenza Vaccination after ST- and Non-ST-segment elevation Myocardial Infarction Insights from the IAMI trial
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2023 (English)In: American Heart Journal, ISSN 0002-8703, E-ISSN 1097-6744, Vol. 255, p. 82-89Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Influenza vaccination early after myocardial infarction (MI) improves prognosis but vaccine effectiveness may differ dependent on type of MI.

METHODS: A total of 2571 participants were prospectively enrolled in the IAMI trial and randomly assigned to receive in-hospital inactivated influenza vaccine or saline placebo. The trial was conducted at 30 centers in 8 countries from October 1, 2016 to March 1, 2020. Here we report vaccine effectiveness in the 2467 participants with ST-segment elevation MI (STEMI, n=1348) or non-ST-segment elevation MI (NSTEMI, n=1119). The primary endpoint was the composite of all-cause death, MI, or stent thrombosis at 12 months. Cumulative incidence of the primary and key secondary endpoints by randomized treatment and NSTEMI/STEMI was estimated using the Kaplan-Meier method. Treatment effects were evaluated with formal interaction testing to assess for effect modification.

RESULTS: Baseline risk was higher in participants with NSTEMI. In the NSTEMI group the primary endpoint occurred in 6.5% of participants assigned to influenza vaccine and 10.5% assigned to placebo (hazard ratio [HR], 0.60; 95% CI, 0.39-0.91), compared to 4.1% assigned to influenza vaccine and 4.5% assigned to placebo in the STEMI group (HR, 0.90; 95% CI, 0.54-1.50, P=0.237 for interaction). Similar findings were seen for the key secondary endpoints of all-cause death and cardiovascular death. The Kaplan-Meier risk difference in all-cause death at 1 year was more pronounced in participants with NSTEMI (NSTEMI: HR, 0.47; 95% CI 0.28-0.80, STEMI: HR, 0.86; 95% CI, 0.43-1.70, interaction P=0.028).

CONCLUSIONS: The beneficial effect of influenza vaccination on adverse cardiovascular events may be enhanced in patients with NSTEMI compared to those with STEMI.

Place, publisher, year, edition, pages
Elsevier, 2023
Keywords
Influenza vaccination, Myocardial infarction, Percutaneous coronary intervention
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:oru:diva-101909 (URN)10.1016/j.ahj.2022.10.005 (DOI)000888092200001 ()36279930 (PubMedID)2-s2.0-85141247086 (Scopus ID)
Funder
Swedish Heart Lung Foundation, 20150284NyckelfondenRegion Örebro County
Note

Funding agencies:

Danish Heart Foundation 16-R107-A6596-22958

ALF Grants

SanofiPasteurr, Lyon, France

Available from: 2022-10-25 Created: 2022-10-25 Last updated: 2024-01-31Bibliographically approved
Gyldenkerne, C., Maeng, M., Kjøller-Hansen, L., Maehara, A., Zhou, Z., Ben-Yehuda, O., . . . Erlinge, D. (2023). Coronary Artery Lesion Lipid Content and Plaque Burden in Diabetic and Nondiabetic Patients: PROSPECT II. Circulation, 147(6), 469-481
Open this publication in new window or tab >>Coronary Artery Lesion Lipid Content and Plaque Burden in Diabetic and Nondiabetic Patients: PROSPECT II
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2023 (English)In: Circulation, ISSN 0009-7322, E-ISSN 1524-4539, Vol. 147, no 6, p. 469-481Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Patients with diabetes have increased rates of major adverse cardiac events (MACEs). We hypothesized that this is explained by diabetes-associated differences in coronary plaque morphology and lipid content.

METHODS: In PROSPECT II (Providing Regional Observations to Study Predictors of Events in the Coronary Tree), 898 patients with acute myocardial infarction with or without ST-segment elevation underwent 3-vessel quantitative coronary angiography and coregistered near-infrared spectroscopy and intravascular ultrasound imaging after successful percutaneous coronary intervention. Subsequent MACEs were adjudicated to either treated culprit lesions or untreated nonculprit lesions. This substudy stratified patients by diabetes status and assessed baseline culprit and nonculprit prevalence of high-risk plaque characteristics defined as maximum plaque burden ≥70% and maximum lipid core burden index ≥324.7. Separate covariate-adjusted multivariable models were performed to identify whether diabetes was associated with nonculprit lesion-related MACEs and high-risk plaque characteristics.

RESULTS: Diabetes was present in 109 of 898 patients (12.1%). During a median 3.7-year follow-up, MACEs occurred more frequently in patients with versus without diabetes (20.1% versus 13.5% [odds ratio (OR), 1.94 (95% CI, 1.14-3.30)]), primarily attributable to increased risk of myocardial infarction related to culprit lesion restenosis (4.3% versus 1.1% [OR, 3.78 (95% CI, 1.12-12.77)]) and nonculprit lesion-related spontaneous myocardial infarction (9.3% versus 3.8% [OR, 2.74 (95% CI, 1.25-6.04)]). However, baseline prevalence of high-risk plaque characteristics was similar for patients with versus without diabetes concerning culprit (maximum plaque burden ≥70%: 90% versus 93%, P=0.34; maximum lipid core burden index ≥324.7: 66% versus 70%, P=0.49) and nonculprit lesions (maximum plaque burden ≥70%: 23% versus 22%, P=0.37; maximum lipid core burden index ≥324.7: 26% versus 24%, P=0.47). In multivariable models, diabetes was associated with MACEs in nonculprit lesions (adjusted OR, 2.47 [95% CI, 1.21-5.04]) but not with prevalence of high-risk plaque characteristics (adjusted OR, 1.21 [95% CI, 0.86-1.69]).

CONCLUSIONS: Among patients with recent myocardial infarction, both treated and untreated lesions contributed to the diabetes-associated ≈2-fold increased MACE rate during the 3.7-year follow-up. Diabetes-related plaque characteristics that might underlie this increased risk were not identified by multimodality imaging.

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2023
Keywords
coronary artery disease, diabetes mellitus, myocardial infarction, spectroscopy, near-infrared
National Category
Endocrinology and Diabetes
Identifiers
urn:nbn:se:oru:diva-102763 (URN)10.1161/CIRCULATIONAHA.122.061983 (DOI)000931323600006 ()36524476 (PubMedID)2-s2.0-85147536520 (Scopus ID)
Funder
Novo Nordisk Foundation, NNFOC0074083
Note

Funding agencies:

Abbott Laboratories

Infraredx Inc, Bedford, MA

Medicines Company, Basel, Switzerland

Danish Diabetes Association

Available from: 2022-12-19 Created: 2022-12-19 Last updated: 2023-03-15Bibliographically approved
Strandvik, B., Qureshi, A. R., Painer, J., Backman-Johansson, C., Engvall, M., Fröbert, O., . . . Giroud, S. (2023). Elevated plasma phospholipid n-3 docosapentaenoic acid concentrations during hibernation. PLOS ONE, 18(6), Article ID e0285782.
Open this publication in new window or tab >>Elevated plasma phospholipid n-3 docosapentaenoic acid concentrations during hibernation
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2023 (English)In: PLOS ONE, E-ISSN 1932-6203, Vol. 18, no 6, article id e0285782Article in journal (Refereed) Published
Abstract [en]

Factors for initiating hibernation are unknown, but the condition shares some metabolic similarities with consciousness/sleep, which has been associated with n-3 fatty acids in humans. We investigated plasma phospholipid fatty acid profiles during hibernation and summer in free-ranging brown bears (Ursus arctos) and in captive garden dormice (Eliomys quercinus) contrasting in their hibernation patterns. The dormice received three different dietary fatty acid concentrations of linoleic acid (LA) (19%, 36% and 53%), with correspondingly decreased alpha-linolenic acid (ALA) (32%, 17% and 1.4%). Saturated and monounsaturated fatty acids showed small differences between summer and hibernation in both species. The dormice diet influenced n-6 fatty acids and eicosapentaenoic acid (EPA) concentrations in plasma phospholipids. Consistent differences between summer and hibernation in bears and dormice were decreased ALA and EPA and marked increase of n-3 docosapentaenoic acid and a minor increase of docosahexaenoic acid in parallel with several hundred percent increase of the activity index of elongase ELOVL2 transforming C20-22 fatty acids. The highest LA supply was unexpectantly associated with the highest transformation of the n-3 fatty acids. Similar fatty acid patterns in two contrasting hibernating species indicates a link to the hibernation phenotype and requires further studies in relation to consciousness and metabolism.

Place, publisher, year, edition, pages
Public Library of Science (PLoS), 2023
National Category
Nutrition and Dietetics
Identifiers
urn:nbn:se:oru:diva-106370 (URN)10.1371/journal.pone.0285782 (DOI)001006016600039 ()37294822 (PubMedID)2-s2.0-85161886467 (Scopus ID)
Funder
Swedish Heart Lung Foundation
Note

Funding agencies:

Westman Foundation

CIMED

University of Veterinary Medicine Vienna and the Austria Science Fund (FWF) P27267-B25 P31577-B25

 

Available from: 2023-06-26 Created: 2023-06-26 Last updated: 2024-01-16Bibliographically approved
Abawi, A., Magnuson, A., Fröbert, O. & Samano, N. (2023). Five-Year Follow-Up After Transcatheter Aortic Valve Implantation in Patients with Severe Aortic Stenosis and Concomitant Coronary Artery Disease: A Single-Center Experience. Brazilian Journal of Cardiovascular Surgery, 39(1), Article ID e20220461.
Open this publication in new window or tab >>Five-Year Follow-Up After Transcatheter Aortic Valve Implantation in Patients with Severe Aortic Stenosis and Concomitant Coronary Artery Disease: A Single-Center Experience
2023 (English)In: Brazilian Journal of Cardiovascular Surgery, ISSN 0102-7638, E-ISSN 1678-9741, Vol. 39, no 1, article id e20220461Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION: There is no consensus on the impact of coronary artery disease in patients undergoing transcatheter aortic valve implantation. Therefore, the objective of this study was, in a single-center setting, to evaluate the five-year outcome of transcatheter aortic valve implantation patients with or without coronary artery disease.

METHODS: All transcatheter aortic valve implantation patients between 2009 and 2019 were included and grouped according to the presence or absence of coronary artery disease. The primary endpoint, five-year all-cause mortality, was evaluated using Cox regression adjusted for age, sex, procedure years, and comorbidities. Comorbidities interacting with coronary artery disease were evaluated with interaction tests. In-hospital complications was the secondary endpoint.

RESULTS: In total, 176 patients had aortic stenosis and concomitant coronary artery disease, while 170 patients had aortic stenosis only. Mean follow-up was 2.2±1.6 years. There was no difference in the adjusted five-year all-cause mortality between transcatheter aortic valve implantation patients with and without coronary artery disease (hazard ratio 1.00, 95% confidence interval 0.59-1.70, P=0.99). In coronary artery disease patients, impaired renal function, peripheral arterial disease, or ejection fraction < 50% showed a significant interaction effect with higher five-year all-cause mortality. No significant differences in complications between the groups were found.

CONCLUSION: Five-year mortality did not differ between transcatheter aortic valve implantation patients with or without coronary artery disease. However, in patients with coronary artery disease and impaired renal function, peripheral arterial disease, or ejection fraction < 50%, we found significantly higher five-year all-cause mortality.

Place, publisher, year, edition, pages
Sociedade Brasileira de Cirurgia Cardiovascular, 2023
Keywords
Aortic Stenosis, Coronary Artery Bypass Grafting, Coronary Artery Disease, Percutaneous Coronary Intervention, Transcatheter Aortic Valve Implantation
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:oru:diva-109504 (URN)001094178200003 ()37889212 (PubMedID)2-s2.0-85175194857 (Scopus ID)
Available from: 2023-11-01 Created: 2023-11-01 Last updated: 2024-01-16Bibliographically approved
Kalogeropoulu, S. K., Rauch-Schmücking, H., Lloyd, E. J., Stenvinkel, P., Shiels, P. G., Johnson, R. J., . . . Painer-Gigler, J. (2023). Formerly bile-farmed bears as a model of accelerated ageing. Scientific Reports, 13(1), Article ID 9691.
Open this publication in new window or tab >>Formerly bile-farmed bears as a model of accelerated ageing
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2023 (English)In: Scientific Reports, E-ISSN 2045-2322, Vol. 13, no 1, article id 9691Article in journal (Refereed) Published
Abstract [en]

Bear bile-farming is common in East and Southeast Asia and this farming practice often results in irreversible health outcomes for the animals. We studied long-term effects of chronic bacterial and sterile hepatobiliary inflammation in 42 Asiatic black bears (Ursus thibetanus) rescued from Vietnamese bile farms. The bears were examined under anesthesia at least twice as part of essential medical interventions. All bears were diagnosed with chronic low-grade sterile or bacterial hepatobiliary inflammation along with pathologies from other systems. Our main finding was that the chronic low-grade inflammatory environment associated with bile extraction in conjunction with the suboptimal living conditions on the farms promoted and accelerated the development of age-related pathologies such as chronic kidney disease, obese sarcopenia, cardiovascular remodeling, and degenerative joint disease. Through a biomimetic approach, we identified similarities with inflammation related to premature aging in humans and found significant deviations from the healthy ursid phenotype. The pathological parallels with inflammageing and immuno-senescence induced conditions in humans suggest that bile-farmed bears may serve as animal models to investigate pathophysiology and deleterious effects of lifestyle-related diseases.

Place, publisher, year, edition, pages
Nature Publishing Group, 2023
National Category
Rheumatology and Autoimmunity
Identifiers
urn:nbn:se:oru:diva-106386 (URN)10.1038/s41598-023-36447-z (DOI)001012136600012 ()37322151 (PubMedID)2-s2.0-85161989607 (Scopus ID)
Available from: 2023-06-26 Created: 2023-06-26 Last updated: 2024-01-16Bibliographically approved
Frøbert, A. M., Nielsen, C. G., Brohus, M., Kindberg, J., Fröbert, O. & Overgaard, M. T. (2023). Hypothyroidism in hibernating brown bears. Thyroid Research, 16(1), Article ID 3.
Open this publication in new window or tab >>Hypothyroidism in hibernating brown bears
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2023 (English)In: Thyroid Research, ISSN 1756-6614, Vol. 16, no 1, article id 3Article in journal (Refereed) Published
Abstract [en]

Brown bears hibernate throughout half of the year as a survival strategy to reduce energy consumption during prolonged periods with scarcity of food and water. Thyroid hormones are the major endocrine regulators of basal metabolic rate in humans. Therefore, we aimed to determine regulations in serum thyroid hormone levels in hibernation compared to the active state to investigate if these are involved in the adaptions for hibernation.We used electrochemiluminescence immunoassay to quantify total triiodothyronine (T3) and thyroxine (T4) levels in hibernation and active state in paired serum samples from six subadult Scandinavian brown bears. Additionally, we determined regulations in the liver mRNA levels of three major thyroid hormone-binding proteins; thyroxine-binding globulin (TBG), transthyretin (TTR), and albumin, by analysis of previously published grizzly bear RNA sequencing data.We found that bears were hypothyroid when hibernating with T4 levels reduced to less than 44% (P = 0.008) and T3 levels reduced to less than 36% (P = 0.016) of those measured in the active state. In hibernation, mRNA levels of TBG and albumin increased to 449% (P = 0.031) and 121% (P = 0.031), respectively, of those measured in the active state. TTR mRNA levels did not change.Hibernating bears are hypothyroid and share physiologic features with hypothyroid humans, including decreased basal metabolic rate, bradycardia, hypothermia, and fatigue. We speculate that decreased thyroid hormone signaling is a key mediator of hibernation physiology in bears. Our findings shed light on the translational potential of bear hibernation physiology to humans for whom a similar hypometabolic state could be of interest in specific conditions.

Place, publisher, year, edition, pages
BioMed Central (BMC), 2023
Keywords
Hibernation, Hypothyroidism, Metabolism, Thyroid hormone, Thyroxine, Thyroxine-binding globulin (TBG), Triiodothyronine, Ursus arctos
National Category
Biochemistry and Molecular Biology
Identifiers
urn:nbn:se:oru:diva-103974 (URN)10.1186/s13044-022-00144-2 (DOI)000922622200001 ()36721203 (PubMedID)2-s2.0-85147149936 (Scopus ID)
Available from: 2023-02-02 Created: 2023-02-02 Last updated: 2024-01-31Bibliographically approved
Thienel, M., Müller-Reif, J. B., Zhang, Z., Ehreiser, V., Huth, J., Shchurovska, K., . . . Petzold, T. (2023). Immobility-associated thromboprotection is conserved across mammalian species from bear to human. Science, 380(6641), 178-187
Open this publication in new window or tab >>Immobility-associated thromboprotection is conserved across mammalian species from bear to human
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2023 (English)In: Science, ISSN 0036-8075, E-ISSN 1095-9203, Vol. 380, no 6641, p. 178-187Article in journal (Refereed) Published
Abstract [en]

Venous thromboembolism (VTE) comprising deep venous thrombosis and pulmonary embolism is a major cause of morbidity and mortality. Short-term immobility-related conditions are a major risk factor for the development of VTE. Paradoxically, long-term immobilized free-ranging hibernating brown bears and paralyzed spinal cord injury (SCI) patients are protected from VTE. We aimed to identify mechanisms of immobility-associated VTE protection in a cross-species approach. Mass spectrometry-based proteomics revealed an antithrombotic signature in platelets of hibernating brown bears with heat shock protein 47 (HSP47) as the most substantially reduced protein. HSP47 down-regulation or ablation attenuated immune cell activation and neutrophil extracellular trap formation, contributing to thromboprotection in bears, SCI patients, and mice. This cross-species conserved platelet signature may give rise to antithrombotic therapeutics and prognostic markers beyond immobility-associated VTE.

Place, publisher, year, edition, pages
American Association for the Advancement of Science (AAAS), 2023
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:oru:diva-105529 (URN)10.1126/science.abo5044 (DOI)000986061000013 ()37053338 (PubMedID)2-s2.0-85152454110 (Scopus ID)
Funder
Max Planck SocietySwedish Environmental Protection Agency, 403584255EU, Horizon 2020, 833440
Note

Funding agencies:

German Research Foundation (DFG) PE2704/2-1 PE2704/3-1

DZHK (German Center for Cardiovascular Research) 80JSC018P0078 80JSC019P0010 100378833 806 32 006

LMU Munich's Clinician scientist program in vascular medicine (PRIME)

LMU Munich's institutional Forderprogramm fur Forschung und Lehre (FuFoLe)

European Research Council (ERC) IFF 2020-26

Helmholtz Association

German Aerospace Centre (DLR)

National Aeronautics & Space Administration (NASA)

Faculty of Health at Witten/Herdecke University, Germany

British Heart Foundation FS/17/31/32848 SFB 1123

Norwegian Environment Agency TRR267

LMU Munich's Institutional Strategy LMU excellent

Available from: 2023-04-17 Created: 2023-04-17 Last updated: 2023-06-02Bibliographically approved
Omerovic, E., Gudmundsson, T., Redfors, B., Angeras, O., Petursson, P., Rawshani, A., . . . Erlinge, D. (2023). Impact of COVID-19 pandemics on the incidence and mortality in Takotsubo syndrome: a report from Swedish Coronary Angiography and Angioplasty Registry. Paper presented at Annual Meeting of the European-Society-of-Cardiology (ESC), Amsterdam, Netherlands, August 25-28, 2023. European Heart Journal, 44(Suppl. 2)
Open this publication in new window or tab >>Impact of COVID-19 pandemics on the incidence and mortality in Takotsubo syndrome: a report from Swedish Coronary Angiography and Angioplasty Registry
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2023 (English)In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 44, no Suppl. 2Article in journal, Meeting abstract (Other academic) Published
Abstract [en]

Background: The COVID-19 pandemic resulted in severe psychological, social, and economic stress. Countries applied different anti-pandemic strategies that substantially impacted citizens' psychosocial stress and health. Takotsubo syndrome (TS) is frequently triggered by emotional stress. Previous studies from the USA have reported a severalfold increase in TS incidence during pandemics.

Purpose: To determine the incidence and outcomes of TS in Sweden before (2015-March 2020) and during (April 2020-December 2022) the pandemic.

Methods: We assessed the incidence rate ratio (IRR) for all patients with TS referred for coronary angiography in Sweden using the nationwide Swedish Coronary Angiography and Angioplasty Registry. Incidence rate ratios (IRRs) before and during the pandemic were calculated with Poisson regression adjusted for age and sex. We evaluated mortality with multivariable Cox proportional hazards regression, which accounted for clustering of patients within hospitals. The following variables were used for adjustment: age, sex, diabetes, smoking status, hypertension, hyperlipidemia, previous myocardial infarction, and Killip class.

Results: We identified 3,180 patients (2,128 [76.0%] women) hospitalized with TS during the study period; 2,189 (69%) pre-pandemic and 991 (31%) during the pandemic. The average age was 68.3 ± 11.2 years. The median follow-up time was 1250 days (IQR 562-1995). The crude all-cause mortality rate was 2.57% at 30 days and 15.5% after long-term follow-up. The incidence of TS was 11% lower during the pandemic compared with the pre-pandemic period (IRR 0.90, 95% CI 0.83-0.98, P=0.009, Fig. 1). We found no difference in 30-day mortality (adjusted HR 1.12, 95% CI 0.69-1.78, P= 0.642) or long-term mortality (adjusted HR 0.96, 95% CI 0.73-1.28, P= 0.816) among patients with TS between the pre-pandemic and pandemic periods. When only data after 2016 are used, we found no difference in TS incidence (IRR 1.00, 95% CI 0.92-1.08, P=1.00).

Conclusions: In this observational study, the incidence of TS was lower during than before the pandemic but mortality was unchanged. The lower incidence of TS could be related to the specific anti-pandemic strategies applied at the national level in Sweden.

Place, publisher, year, edition, pages
Oxford University Press, 2023
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:oru:diva-110888 (URN)10.1093/eurheartj/ehad655.1565 (DOI)001115619402386 ()
Conference
Annual Meeting of the European-Society-of-Cardiology (ESC), Amsterdam, Netherlands, August 25-28, 2023
Funder
Swedish Heart Lung FoundationSwedish Research Council
Note

Funding agencies:

The Swedish Heart and Lung Foundation, the Swedish Research Council, the Swedish state under the agreement between the Swedish government and the county councils (the ALF-agreement).

Available from: 2024-02-02 Created: 2024-02-02 Last updated: 2024-02-06Bibliographically approved
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