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  • 1.
    Ahmed, K.
    et al.
    School of Health and Medical Science, Clinical Medicine, Örebro University, Örebro, Sweden.
    Hurtig-Wennlöf, Anita
    Örebro universitet, Hälsoakademin.
    Association between objectively measured physical activity and sub-clinical atherosclerosis in young adults2010Inngår i: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 31, nr Suppl 1, s. 388-388Artikkel i tidsskrift (Annet vitenskapelig)
  • 2.
    Almroth, Henrik
    et al.
    Örebro universitet, Hälsoakademin.
    Höglund, Niklas
    Boman, Kurt
    Englund, Anders
    Jensen, Steen
    Kjellman, Björn
    Tornvall, Per
    Rosenqvist, Mårten
    Atorvastatin and persistent atrial fibrillation following cardioversion: a randomized placebo-controlled multicentre study2009Inngår i: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 30, nr 7, s. 827-833Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    AIMS: To evaluate the effect of atorvastatin in achieving stable sinus rhythm (SR) 30 days after electrical cardioversion (CV) in patients with persistent atrial fibrillation (AF). METHODS AND RESULTS: The study included 234 patients. The patients were randomized to treatment with atorvastatin 80 mg daily (n = 118) or placebo (n = 116) in a prospective, double-blinded fashion. Treatment was initiated 14 days before CV and was continued 30 days after CV. The two groups were well-balanced with respect to baseline characteristics. Mean age was 65 +/- 10 years, 76% of the patients were male and 4% had ischaemic heart disease. Study medication was well-tolerated in all patients but one. Before primary endpoint 12 patients were excluded. In the atorvastatin group 99 patients (89%) converted to SR at electrical CV compared with 95 (86%) in the placebo group (P = 0.42). An intention-to-treat analysis with the available data, by randomization group, showed that 57 (51%) in the atorvastatin group and 47 (42%) in the placebo group were in SR 30 days after CV (OR 1.44, 95%CI 0.85-2.44, P = 0.18). CONCLUSION: Atorvastatin was not statistically superior to placebo with regards to maintaining SR 30 days after CV in patients with persistent AF.

  • 3.
    Andell, P.
    et al.
    Department of Cardiology, Skåne University Hospital, Lund University, Lund, Sweden.
    Omerovic, E.
    Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Fröbert, Ole
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Cardiology.
    Smokeless tobacco, snus, at admission for percutaneous coronary intervention and future risk of death2018Inngår i: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 39, nr Suppl. 1, s. 1364-1365Artikkel i tidsskrift (Annet vitenskapelig)
  • 4.
    Andersson, Tommy
    et al.
    Dept Cardiology, Örebro Univ Hospital, Örebro, Sweden.
    Magnuson, Anders
    Bryngelsson, Ing-Liss
    Dept. Occupational & Environmental Medicine, Örebro Univ Hospital, Örebro, Sweden.
    Fröbert, Ole
    Örebro University Hospital, Örebro, Sweden.
    Henriksson, Karin M.
    Dept. Laboratory Medicine, Lund Univ, Lund, Sweden; The Sahlgrenska Academy, Sahlgrenska Univ. Hospital, Gothenburg, Sweden.
    Edvardsson, Nils
    The Sahlgrenska Academy, Sahlgrenska Univ. Hospital, Gothenburg, Sweden.
    Poci, Dritan
    Region Örebro län.
    All-cause mortality in 272 186 patients hospitalized with incident atrial fibrillation 1995-2008: a Swedish nationwide long-term case-control study2013Inngår i: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 34, nr 14, s. 1061-1067Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aims To evaluate long-term all-cause risk of mortality in women and men hospitalized for the first time with atrial fibrillation (AF) compared with matched controls. Methods and results A total of 272 186 patients (44% women) <= 85 years at the time of hospitalization with incidental AF 1995-2008 and 544 344 matched controls free of in-hospital diagnosis of AF were identified. Patients were followed via record linkage of the Swedish National Patient Registry and the Cause of Death Registry. Using Cox regression models, the long-term relative all-cause mortality risk, adjusted for concomitant diseases, in women vs. controls was 2.15, 1.72, and 1.44 (P < 0.001) in the age categories <= 65, 65-74, and 75-85 years, respectively. The corresponding figures for men were 1.76, 1.36, and 1.24 (P < 0.001). Among concomitant diseases, neoplasm, chronic renal failure, and chronic obstructive pulmonary disease contributed most to the increased all-cause mortality vs. controls. In patients with AF as the primary diagnosis, the relative risk of mortality was 1.63, 1.46, and 1.28 (P < 0.001) in women and 1.45, 1.17, and 1.10 (P < 0.001) in men. Conclusion Atrial fibrillation was an independent risk factor of all-cause mortality in patients with incident AF. The concomitant diseases that contributed most were found outside the thromboembolic risk scores. The highest relative risk of mortality was seen in women and in the youngest patients compared with controls, and the differences between genders in each age category were statistically significant.

  • 5.
    Bergh, Cecilia
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. Clinical Epidemiology and Biostatistics.
    Mohammad, M. A.
    Lund University, Department of Cardiology, Clinical Sciences, Lund, Sweden.
    Tham, J.
    Lund University, Infectious Diseases Unit, Department of Clinical Sciences, Lund, Sweden.
    Koul, S.
    Lund University, Department of Cardiology, Clinical Sciences, Lund, Sweden.
    Rylance, R.
    Lund University, Department of Cardiology, Clinical Sciences, Lund, Sweden.
    Erlinge, D.
    Lund University, Department of Cardiology, Clinical Sciences, Lund, Sweden.
    Fröbert, Ole
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Cardiology.
    Under the weather: acute myocardial infarction and subsequent case fatality with influenza burden - a nationwide observational study2019Inngår i: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 40, nr Suppl. 1, s. 3994-3994Artikkel i tidsskrift (Annet vitenskapelig)
    Abstract [en]

    Background: Influenza may precipitate cardiovascular disease but influenza typically peaks in winter coinciding with other triggers of myocardial infarction (MI) such as low air temperature, high wind velocity, low air pressure and short sunshine duration. We aimed to study week-to-week variation in influenza cases and acute MI after meteorological confounder adjustment in a nationwide setting.

    Methods: Weekly laboratory-confirmed influenza case reports were obtained from the Public Health Agency of Sweden from 2009 to 2016 and merged with the nationwide SWEDEHEART MI registry. Weekly counts of MI were studied with regard to influenza cases stratified into tertiles, 0–16, 17–164 and>164 influenza cases/week. Incidence rate ratios were calculated for each category and compared to a reference period of the year with no influenza. A negative binomial regression model was applied to adjust for weather parameters.

    Results: A total of 133 562 MIs were reported to the registry during the study period of which 44 055 were ST-elevation MIs. Weeks with influenza cases were associated with higher risk of MI. For 0–16 influenza cases/week the unadjusted incidence rate ratio (IRR) for MI was 1.04 (95% confidence interval [CI] 1.01–1.07, p=0.007); for 17–163 cases/week the IRR=1.07 (95% CI 1.04–1.10, p≤0.001) and for≥164 cases/week the IRR=1.08 (95% CI 1.05–1.11, p≤0.001). Results were consistent across a large range of subgroups and after adjusting for confounders. In addition, all-cause mortality was higher in weeks with highest reported rates of influenza cases.

    Conclusion: In this nationwide observational study, we found an association between occurrence of MI and number of influenza cases beyond what could be explained by meteorological factors.

  • 6.
    Björkenheim, Anna
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Cardiology.
    Brandes, A.
    Odense University Hospital, Odense, Denmark.
    Magnuson, A.
    Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden.
    Chemnitz, A.
    Odense University Hospital, Odense, Denmark.
    Edvardsson, N.
    Sahlgrenska University Hospital, Gothenburg, Sweden.
    Poçi, Dritan
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Cardiology.
    Patient-reported outcomes in relation to continuously monitored rhythm before and during two years after atrial fibrillation ablation using a disease-specific and a generic instrument2018Inngår i: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 39, nr Suppl. 1, s. 1415-1415Artikkel i tidsskrift (Annet vitenskapelig)
  • 7.
    Buccheri, Sergio
    et al.
    Department of Medical Sciences, Cardiology and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden.
    James, Stefan
    Department of Medical Sciences, Cardiology and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden.
    Lindholm, Daniel
    Department of Medical Sciences, Cardiology and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden.
    Fröbert, Ole
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Cardiology.
    Olivecrona, Göran K.
    Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden.
    Persson, Jonas
    Department of Cardiology, Danderyd University Hospital, Stockholm, Sweden.
    Hambraeus, Kristina
    Department of Cardiology, Falu Lasarett, Falun, Sweden.
    Witt, Nils
    Unit of Cardiology, Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden.
    Erlinge, David
    Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden.
    Angerås, Oskar
    Department of Cardiology, Sahlgrenska University Hospital, Göteborg, Sweden.
    Lagerqvist, Bo
    Department of Medical Sciences, Cardiology and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden.
    Sarno, Giovanna
    Department of Medical Sciences, Cardiology and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden.
    Clinical and angiographic outcomes of bioabsorbable vs. permanent polymer drug-eluting stents in Sweden: a report from the Swedish Coronary and Angioplasty Registry (SCAAR)2019Inngår i: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 40, nr 31, s. 2607-2615Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    AIMS: Randomized clinical trials have consistently demonstrated the non-inferiority of bioabsorbable polymer drug-eluting stents (BP-DES) with respect to DES having permanent polymers (PP-DES). To date, the comparative performance of BP- and PP-DES in the real world has not been extensively investigated.

    METHODS AND RESULTS: From October 2011 to June 2016, we analysed the outcomes associated with newer generation DES use in Sweden. After stratification according to the type of DES received at the index procedure, a total of 16 504 and 79 106 stents were included in the BP- and PP-DES groups, respectively. The Kaplan-Meier estimates for restenosis at 2 years were 1.2% and 1.4% in BP- and PP-DES groups, respectively. Definite stent thrombosis (ST) was low in both groups (0.5% and 0.7% in BP- and PP-DES groups, respectively). The adjusted hazard ratio (HR) for either restenosis or definite ST did not differ between BP- and PP-DES [adjusted HR 0.95, 95% confidence interval (CI) 0.74-1.21; P = 0.670 and adjusted HR 0.79, 95% CI 0.57-1.09; P = 0.151, respectively]. Similarly, there were no differences in the adjusted risk of all-cause death and myocardial infarction (MI) between the two groups (adjusted HR for all-cause death 1.01, 95% CI 0.82-1.25; P = 0.918 and adjusted HR for MI 1.05, 95% CI 0.93-1.19; P = 0.404).

    CONCLUSION: In a large, nationwide, and unselected cohort of patients, percutaneous coronary intervention with BP-DES implantation was not associated with an incremental clinical benefit over PP-DES use at 2 years follow-up.

  • 8.
    Djekic, Demir
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Cardiology.
    Carlsson, F.
    Swedish University of Agricultural Sciences,­ Uppsala, Sweden,.
    Landberg, R.
    Swedish University of Agricultural Sciences,­ Uppsala, Sweden,.
    Särnqvist, C.
    Örebro University Hospital, Örebro University, Department of Cardiology, ­Örebro, Sweden.
    Cao, Yang
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Karolinska Institute, Unit of Biostatistics, Institute of Environmental Medicine, Stockholm, Sweden.
    Tremaroli, V.
    Sahlgrenska Academy, Department of Molecular and Clinical Medicine,,The Sahlgrenska Academy at University of Gothenburg, Gothenburg,­ Sweden.
    Backhed, F.
    Sahlgrenska Academy, Department of Molecular and Clinical Medicine,,The Sahlgrenska Academy at University of Gothenburg, Gothenburg,­ Sweden.
    Fröbert, Ole
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Cardiology.
    VEgetaRian Diet in patients with Ischemic heart disease (VERDI): an open-label, randomized, prospective, cross-over study2019Inngår i: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 40, nr Suppl. 1, s. 3819-3819Artikkel i tidsskrift (Annet vitenskapelig)
    Abstract [en]

    Background: A vegetarian diet (VD) in patients diagnosed with ischemic heart disease (IHD) may reduce future cardiovascular risk.

    Purpose: The study hypothesis was that patients diagnosed with IHD can benefit from a VD assessed by multiple risk markers for this type of disease.

    Methods: In a crossover study patients diagnosed with IHD, treated by percutaneous coronary intervention and on optimal medical therapy were randomly allocated to a 4-week intervention with ready-made (lunch and dinner) isocaloric VD or meat diet (MD). The primary outcome was change in oxidized low-density lipoprotein cholesterol (LDL-C) levels. Secondary outcomes were difference in changes of blood lipids, weight, body mass index (BMI), blood pressure, heart rate, glycated haemoglobin (HbA1c), number of participants reaching guideline target values, quality of life, gut microbiota, and trimethylamine N-oxide between the two interventions.

    Results: 31 participants were recruited (median age: 67 years, male sex: 93.5%). Significant between-intervention differences (VD vs MD) were found in oxidized LDL-C (-2.73 U/L; p=.015), total cholesterol (TC) (-0.13 mmol/L, p=.01), LDL-C (-0.10 mmol/L; p=.02), weight (-0.67 kg, p=.008) and BMI (-0.21 kg/m2, p=.009). After VD, numerically more subjects reached guideline LDL-C target values (87% vs 77%) but this did not reach statistical significance (p=.07). During VD intervention the diet led to a significant reduction in oxidized LDL-C, TC, LDL-C, HDL-C, ApoB, and ApoB/ApoA1 ratio.

    Conclusions: Our results suggest that in patients with IHD a VD compared to a MD, lowers oxidative stress, improves lipid profile and lowers BMI.

  • 9.
    Ekman, Inger
    et al.
    Department of Nursing, Umeå University, Umeå; University College of Health and Caring Sciences, Göteborg.
    Andersson, B.
    Department of Medicine, Sahlgrenska University Hospital, Göteborg.
    Ehnfors, Margareta
    Örebro universitet, Institutionen för vårdvetenskap och omsorg.
    Matejka, G.
    Department of Medicine, Sahlgrenska University Hospital, Göteborg.
    Persson, B.
    Department of Medicine, Sahlgrenska University Hospital, Göteborg.
    Fagerberg, B.
    Department of Medicine, Sahlgrenska University Hospital, Göteborg.
    Feasibility of a nurse-monitored, outpatient-care programme for elderly patients with moderate-to-severe, chronic heart failure1998Inngår i: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 19, nr 8, s. 1254-60Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aims: To evaluate the feasibility of a nurse-monitored, outpatient-care program for elderly patients previously hospitalized with chronic heart failure.

    Methods and results: Patients with chronic heart failure hospitalized in the medical wards were screened to find those eligible for a randomized study to compare the effect of a nurse-monitored, outpatient-care programme aiming at symptom management, with conventional care. The inclusion criteria were patients classified in New York Heart Association classes III-IV, age 65 years, and eligibility for an outpatient follow-up programme. The total in-hospital population of patients discharged with a heart-failure diagnosis was surveyed. Eighty-nine per cent of all the hospitalized patients (n=1541) were 65 years old. Of these, 69% (n=1058) were treated in the medical wards which were screened. The study criteria were met by 158 patients (15%). No visits to the nurse occurred in 23 cases among the 79 patients randomized to the structured-care group (29%), mainly on account of death or fatigue. The numbers of hospitalizations and hospital days did not differ between the structured-care and the usual-care groups.

    Conclusions: Given the selection criteria and the outline of the interventions, the outpatient, nurse-monitored, symptom-management programme was not feasible for the majority of these elderly patients with moderate-to-severe, chronic heart failure, mainly because of the small proportion of eligible patients and the high drop-out rate. Management of these patients would have to be more adjusted to their home situation.

  • 10.
    Ekman, Inger
    et al.
    Department of Advanced Nursing, Umeå University, Umeå; University College of Health and Caring Sciences, Göteborg.
    Andersson, B.
    Department of Medicine, Sahlgrenska University Hospital, Göteborg.
    Ehnfors, Margareta
    Örebro universitet, Institutionen för vårdvetenskap och omsorg.
    Matejka, G.
    Department of Medicine, Sahlgrenska University Hospital, Göteborg.
    Persson, B.
    Department of Medicine, Sahlgrenska University Hospital, Göteborg.
    Fagerberg, B.
    Department of Medicine, Sahlgrenska University Hospital, Göteborg.
    Outpatient care programmes for the elderly1999Inngår i: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 20, nr 5, s. 393-4Artikkel i tidsskrift (Fagfellevurdert)
  • 11.
    Emilsson, Louise
    et al.
    Arvika Hospital, Värmland County, Arvika, Sweden.
    Smith, J Gustav
    Department of Cardiology, Lund University, Lund, Sweden; Broad Institute of Harvard and MIT, Cambridge MA, USA; Department of Clinical Sciences, Lund University, Malmö, Sweden.
    West, Joe
    Division of Epidemiology and Public Health, Nottingham City Hospital, University of Nottingham, Nottingham, UK; NIHR Biomedical Research Unit, Nottingham Digestive Diseases Centre, Nottingham, UK.
    Melander, Olle
    Department of Clinical Sciences, Lund University, Malmö, Sweden.
    Ludvigsson, Jonas F.
    Department of Pediatrics, Örebro University Hospital, Örebro, Sweden; Department of Pediatrics, Örebro University Hospital, Örebro, Sweden; Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Medicine, Karolinska University Hospital, Stockholm, Sweden.
    Increased risk of atrial fibrillation in patients with coeliac disease: a nationwide cohort study2011Inngår i: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 32, nr 19, s. 2430-7Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aims: Inflammatory markers are established risk factors for atrial fibrillation (AF), but the role of autoimmune diseases is unknown. The aim of the study was to examine the association between coeliac disease (CD) and AF in a large cohort of patients with biopsy-verified CD.

    Metods and results: We identified 28,637 patients with CD through biopsy reports (defined as Marsh 3: villous atrophy) from all pathology departments (n = 28) in Sweden. Biopsies had been performed between 1969 and 2008. Age- and sex-matched reference individuals (n = 141,731) were identified from the Swedish Total Population Register. Data on AF were obtained from the Swedish Hospital Discharge Register, the Hospital Outpatient Register, and the Cause of Death Register. Hazard ratios (HRs) for AF were estimated using Cox regression. In the CD cohort, 941 individuals developed AF (vs. 2918 reference individuals) during a median follow-up of 9 years. The corresponding adjusted HR for AF was 1.34 (95% CI = 1.24-1.44). The absolute risk of AF in CD was 321 of 100,000 person-years, with an excess risk of 81 of 100,000. A prior AF diagnosis was also associated with an increased risk of subsequent CD (odds ratio = 1.45, 95% CI = 1.31-1.62).

    Conclusions Atrial fibrillation is more common both before and after CD diagnosis in patients with CD though the excess risk is small. Potential explanations for the increased risk of AF in CD include chronic inflammation and shared risk factors, but ascertainment bias may also have contributed.

    CLINICAL IMPLICATIONS: Coeliac disease affects 1-2% of the Western population. Our results indicate that patients with coeliac disease, verified by intestinal biopsy, are at increased risk of atrial fibrillation. This observation is consistent with previous findings that elevation of inflammatory markers predicts atrial fibrillation. Additional studies are needed to clarify the mechanistic link between atrial fibrillation and autoimmune diseases such as coeliac disease.

  • 12.
    Hansson, Emma C.
    et al.
    Dept Cardiothorac Surg, Sahlgrenska Univ Hosp, Gothenburg, Sweden.
    Jideus, Lena
    Dept Cardiothorac Surg, Univ Uppsala Hosp, Uppsala, Sweden.
    Aberg, Bengt
    Dept Cardiothorac Surg, Blekinge Hosp, Karlskrona, Sweden.
    Bjursten, Henrik
    Dept Cardiothorac Surg, Skåne Univ Hosp, Lund, Sweden.
    Dreifaldt, Mats
    Dept Cardiothorac; Univ Hlth Care Res Ctr, Region Örebro County, Örebro, Sweden.
    Holmgren, Anders
    Dept Cardiothorac Surg, Univ Umeå Hosp, Umeå, Sweden.
    Ivert, Torbjorn
    Karolinska Univ Hosp, Stockholm, Sweden; Dept Mol Med & Surg, Karolinska Institute, Stockholm, Sweden.
    Nozohoor, Shahab
    Dept Cardiothorac Surg, Skåne Univ Hosp, Lund, Sweden.
    Barbu, Mikael
    Dept Cardiothorac Surg, Blekinge Hosp, Karlskrona, Sweden.
    Svedjeholm, Rolf
    Dept Cardiothorac Surg, Linköping Univ Hosp, Linköping, Sweden.
    Jeppsson, Anders
    Dept Cardiothorac Surg, Sahlgrenska Univ Hosp, Gothenburg, Sweden; Inst Med, Dept Mol & Clin Med, Sahlgrenska Acad, Univ Gothenburg, Gothenburg, Sweden.
    Coronary artery bypass grafting-related bleeding complications in patients treated with ticagrelor or clopidogrel: a nationwide study2016Inngår i: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 37, nr 2, s. 189-197Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aims Excessive bleeding impairs outcome after coronary artery bypass grafting (CABG). Current guidelines recommend withdrawal of clopidogrel and ticagrelor 5 days (120 h) before elective surgery. Shorter discontinuation would reduce the risk of thrombotic events and save hospital resources, but may increase the risk of bleeding. We investigated whether a shorter discontinuation time before surgery increased the incidence of CABG-related major bleeding complications and compared ticagrelor-and clopidogrel-treated patients. Methods and results All acute coronary syndrome patients in Sweden on dual antiplatelet therapy with aspirin and ticagrelor (n = 1266) or clopidogrel (n = 978) who underwent CABG during 2012-13 were included in a retrospective observational study. The incidence of major bleeding complications according to the Bleeding Academic Research Consortium-CABG definition was 38 and 31%, respectively, when ticagrelor/clopidogrel was discontinued <24 h before surgery. Within the ticagrelor group, there was no significant difference between discontinuation 72-120 or >120 h before surgery [odds ratio (OR) 0.93 (95% confidence interval, CI, 0.53-1.64), P = 0.80]. In contrast, clopidogrel-treated patients had a higher incidence when discontinued 72-120 vs..120 h before surgery (OR 1.71 (95% CI 1.04-2.79), P = 0.033). The overall incidence of major bleeding complications was lower with ticagrelor [12.9 vs. 17.6%, adjusted OR 0.72 (95% CI 0.56-0.92), P = 0.012]. Conclusion The incidence of CABG-related major bleeding was high when ticagrelor/clopidogrel was discontinued,24 h before surgery. Discontinuation 3 days before surgery, as opposed to

  • 13.
    Holmqvist, Fredrik
    et al.
    Department of Cardiology, Skåne University Hospital, Lund University, Lund, Sweden .
    Kesek, Milos
    Department of Cardiology, Umeå University Hospital, Umeå, Sweden .
    Englund, Anders
    Department of Clinical Sciences, South Hospital, Arrhythmia Center, Karolinska Institute, Stockholm, Sweden.
    Blomström-Lundqvist, Carina
    Department of Cardiology, Uppsala University Hospital, Uppsala, Sweden .
    Karlsson, Lars O.
    Department of Cardiology, Linköping University Hospital, Linköping, Sweden .
    Kennebäck, Goran
    Department of Cardiology, Karolinska University Hospital, Solna, Sweden.
    Poçi, Dritan
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Cardiology.
    Samo-Ayou, Romeo
    Department of Cardiology, Skaraborg Hospital, Skövde, Sweden.
    Sigurjónsdóttir, Runa
    Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Ringborn, Michael
    Thoracic Center, Blekinge County Hospital, Karlskrona, Sweden.
    Herczku, Csaba
    Department of Cardiology, Norra Älvsborg County Hospital, Trollhättan, Sweden.
    Carlson, Jonas
    Department of Cardiology, Ska ̊ne University Hospital, Lund University, Lund, Sweden.
    Fengsrud, Espen
    Department of Cardiology, University Hospital Örebro, Örebro, Sweden.
    Tabrizi, Fariborz
    Department of Clinical Sciences, South Hospital, Arrhythmia Center, Karolinska Institute, Stockholm, Sweden.
    Höglund, Niklas
    Department of Cardiology, Umeå University Hospital, Umeå, Sweden.
    Lönnerholm, Stefan
    Department of Cardiology, Uppsala University Hospital, Uppsala, Sweden.
    Kongstad, Ole
    Department of Cardiology, Skåne University Hospital, Lund University, Lund, Sweden.
    Jönsson, Anders
    Department of Cardiology, Linköping University Hospital, Linköping, Sweden.
    Insulander, Per
    Department of Cardiology, Karolinska University Hospital, Solna, Sweden.
    A decade of catheter ablation of cardiac arrhythmias in Sweden: ablation practices and outcomes2019Inngår i: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 40, nr 10, s. 820-830Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aims: Catheter ablation is considered the treatment of choice for many tachyarrhythmias, but convincing real-world' data on efficacy and safety are lacking. Using Swedish national registry data, the ablation spectrum, procedural characteristics, as well as ablation efficacy and reported adverse events are reported.

    Methods and Results: Consecutive patients (18years of age) undergoing catheter ablation in Sweden between 01 January 2006 and 31 December 2015 were included in the study. Follow-up (repeat ablation and vital status) was collected through 31 December 2016. A total of 26642 patients (5715years, 62% men), undergoing a total of 34428 ablation procedures were included in the study. In total, 4034 accessory pathway/Wolff-Parkinson-White syndrome (12%), 7358 AV-nodal re-entrant tachycardia (21%), 1813 atrial tachycardia (5.2%), 5481 typical atrial flutter (16%), 11916 atrial fibrillation (AF, 35%), 2415 AV-nodal (7.0%), 581 premature ventricular contraction (PVC, 1.7%), and 964 ventricular tachycardia (VT) ablations (2.8%) were performed. Median follow-up time was 4.7years (interquartile range 2.7-7.0). The spectrum of treated arrhythmias changed over time, with a gradual increase in AF, VT, and PVC ablation (P<0.001). Decreasing procedural times and utilization of fluoroscopy with time, were seen for all arrhythmia types. The rates of repeat ablation differed between ablation types, with the highest repeat ablation seen in AF (41% within 3years). The rate of reported adverse events was low (n=595, 1.7%). Death in the immediate period following ablation was rare (n=116, 0.34%).

    Conclusion: Catheter ablations have shifted towards more complex procedures over the past decade. Fluoroscopy time has markedly decreased and the efficacy of catheter ablation seems to improve for AF.

  • 14.
    Kumar, Sanyay
    et al.
    State University of New York Health Science Center, New York, United States of America;.
    Waldenborg, Micael
    Örebro University Hospital, Örebro, Sweden.
    Bhumireddy, P.
    New York Methodist Hospital, Brooklyn, United States of America.
    Ramkissoon, K.
    State University of New York Health Science Center, New York, United States of America;.
    Innasimuthu, A. L.
    State University of New York Health Science Center, New York, United States of America;.
    Loiske, K.
    Örebro University Hospital, Örebro, Sweden.
    Emilsson, Kent
    Örebro University Hospital, Örebro, Sweden.
    Lazar, J. M.
    State University of New York Health Science Center, New York, United States of America;.
    Diastolic function improves after resolution of takotsubo cardiomyopathy2012Inngår i: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 33, nr suppl 1, s. 801-801Artikkel i tidsskrift (Annet vitenskapelig)
  • 15.
    Lind, M.
    et al.
    Dept Publ Hlth & Clin Med, Umeå Univ, Umeå, Sweden.
    Johansson, L.
    Dept Publ Hlth & Clin Med, Umeå Univ, Umeå, Sweden.
    Boman, K.
    Dept Publ Hlth & Clin Med, Umeå Univ, Umeå, Sweden.
    Birgander, L. Slunga
    Dept Publ Hlth & Clin Med, Umeå Univ, Umeå, Sweden.
    Nilsson, Torbjörn K.
    Örebro universitet, Hälsoakademin.
    Jansson, J. H.
    Dept Publ Hlth & Clin Med, Umeå Univ, Umeå, Sweden.
    Von willebrand factor predicts major bleeding and mortality during oral anticoagulant treatment2010Inngår i: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 31, s. 978-978Artikkel i tidsskrift (Fagfellevurdert)
  • 16.
    Mahmoud, Karim D.
    et al.
    Department of Cardiology, Thorax Center, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Cardiology, Sint Franciscus Gasthuis, Rotterdam, The Netherlands.
    Jolly, Sanjit S.
    Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton Ontario, Canada.
    James, Stefan
    Department of Medical Science, Uppsala University and Uppsala Clinical Research Centre, Uppsala, Sweden.
    Dzavik, Vladimir
    Peter Munk Cardiac Centre, University Health Network, Toronto Ontario, Canada.
    Cairns, John A.
    University of British Columbia, Vancouver British Columbia, Canada.
    Olivecrona, Göran K.
    Skåne University Hospital, Lund University, Lund, Sweden.
    Renlund, Henrik
    Department of Medical Science, Uppsala University and Uppsala Clinical Research Centre, Uppsala, Sweden.
    Gao, Peggy
    Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton Ontario, Canada.
    Lagerqvist, Bo
    Department of Medical Science, Uppsala University and Uppsala Clinical Research Centre, Uppsala, Sweden.
    Alazzoni, Ashraf
    Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton Ontario, Canada.
    Kedev, Sasko
    University Clinic of Cardiology, Sts. Cyril and Methodius University, Skopje, Macedonia.
    Stankovic, Goran
    Department of Cardiology, Clinical Center of Serbia and Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
    Meeks, Brandi
    Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton Ontario, Canada.
    Fröbert, Ole
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Cardiology.
    Zijlstra, Felix
    Department of Cardiology, Thorax Center, Erasmus Medical Center, Rotterdam, The Netherlands.
    Clinical impact of direct stenting and interaction with thrombus aspiration in patients with ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention: Thrombectomy Trialists Collaboration2018Inngår i: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 39, nr 26, s. 2472-2479Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aims: Preliminary studies suggest that direct stenting (DS) during percutaneous coronary intervention (PCI) may reduce microvascular obstruction and improve clinical outcome. Thrombus aspiration may facilitate DS. We assessed the impact of DS on clinical outcome and myocardial reperfusion and its interaction with thrombus aspiration among ST-segment elevation myocardial infarction (STEMI) patients undergoing PCI.

    Methods and results: Patient-level data from the three largest randomized trials on routine manual thrombus aspiration vs. PCI only were merged. A 1:1 propensity matched population was created to compare DS and conventional stenting. Synergy between DS and thrombus aspiration was assessed with interaction P-values in the final models. In the unmatched population (n= 17329), 32% underwent DS and 68% underwent conventional stenting. Direct stenting rates were higher in patients randomized to thrombus aspiration as compared with PCI only (41% vs. 22%; P < 0.001). Patients undergoing DS required less contrast (162 mL vs. 172 mL; P < 0.001) and had shorter fluoroscopy time (11.1 min vs. 13.3 min; P < 0.001). After propensity matching (n = 10944), no significant differences were seen between DS and conventional stenting with respect to 30-day cardiovascular death [1.7% vs. 1.9%; hazard ratio 0.88, 95% confidence interval (CI) 0.55-1.41; P=0.60; P-interaction = 0.96) and 30-day stroke or transient ischaemic attack (0.6% vs. 0.4%; odds ratio 1.02; 95% CI 0.14-7.54; P= 0.99; P-interaction = 0.81). One-year results were similar. No significant differences were seen in electrocardiographic and angiographic myocardial reperfusion measures.

    Conclusion: Direct stenting rates were higher in patients randomized to thrombus aspiration. Clinical outcomes and myocardial reperfusion measures did not differ significantly between DS and conventional stenting and there was no interaction with thrombus aspiration.

  • 17.
    Nordenskjöld, Anna M.
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län.
    Lagerqvist, B.
    Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden.
    Baron, T.
    Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden.
    Jernberg, T.
    Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden.
    Tornvall, P.
    Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
    Lindahl, B.
    Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden.
    Reinfarction in patients with previous myocardial infarction with non-obstructive coronary arteries (MINOCA), findings at coronary angiography2018Inngår i: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 39, nr Suppl. 1, s. 1256-1256Artikkel i tidsskrift (Annet vitenskapelig)
  • 18.
    Sandberg, C
    et al.
    Heart centre and Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
    Crenshaw, A G
    Department of Occupational and Public Health Sciences, Gävle University, Gävle, Sweden.
    Elcadi, G H
    Department of Occupational and Public Health Sciences, Gävle University, Gävle, Sweden.
    Christersson, C
    Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
    Hlebowicz, J
    Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden.
    Thilen, U
    Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden.
    Johansson, B
    Heart centre and Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
    Adults with congenital heart disease have impaired calf muscle oxygenation compared to control subjects2019Inngår i: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 40, nr Supplement_1, artikkel-id ehz748.0548Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background

    Peripheral muscle factors are presumed to be important contributors to the reduced exercise capacity in congenital heart disease (CHD), but the mechanisms are poorly understood.

    Purpose

    To investigate if muscle oxygenation in the calf muscle is impaired in adults with complex CHD in comparison to controls.

    Method

    Seventy-four adults with complex CHD (35.6±14.3 years, females n=22) were recruited from centers specialized in adult CHD. Seventy-four age and gender matched subjects were recruited as controls. Muscle oxygenation was successfully determined using near-infrared spectroscopy on the medial portion of m. gastrocnemiusin 63 patients and 67 controls. Measurements were made at rest, during venous occlusion to estimate blood flow (BF – indicated by the slope increase of total haemoglobin, HbT), at the start of isotonic unilateral heel-lifts to exhaustion, and immediately after exercise.

    Results

    In comparison to controls, patients had a lower muscle saturation (StO2) at rest, albeit not statistically significant, (66±17% vs. 60±19%, p=0.07), and a lower BF (0.38±0.21 vs. 0.31±0.21 HbTx3.5sec–1, p=0.07). For exercise, compared to the controls, patients had a slower desaturation rate at exercise onset (−11.7±5.8% vs. −7.7±4.3%. StO2x3.5sec–1, p<0.001), and both a slower resaturation rate (6.1±3.8% vs. 3.9±3.7% StO2x3.5sec–1, p=0.002) and a slower half recovery time (16.8±11.1 vs. 28.6±21.2 sec, p<0.001) post exercise.

    Conclusion

    The lower muscle oxygenation and blood flow at rest, and the slower oxygenation kinetics during exercise may give insight to the mechanism for the reduced exercise capacity commonly found in adults with complex CHD. This finding may also provide implications for design of rehabilitation programs for these patients.

  • 19. Tabrizi, Fariborz
    et al.
    Englund, Anders
    Örebro universitet, Hälsoakademin.
    Rosenqvist, Mårten
    Wallentin, Lars
    Stenestrand, Ulf
    Influence of left bundle branch block on long-term mortality in a population with heart failure2007Inngår i: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 28, nr 20, s. 2449-2455Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: The purpose of this study was to assess the independent contribution of left bundle branch block (LBBB) on long-term mortality in a large cohort with symptomatic heart failure (HF) requiring hospitalization. METHODS AND RESULTS: We studied a prospective cohort of 21 685 cases of symptomatic HF requiring hospitalization in the Register of Information and Knowledge about Swedish Heart Intensive care Admissions in 1995-2003. Long-term mortality was evaluated by Logistic regression analysis, adjusted for multiple covariates that could influence long-term prognosis. LBBB was present in 20% (4395 of 21 685) of HF admissions. Patients with LBBB had a higher prevalence of cardiac comorbid conditions than patients with no LBBB. 1-, 5-, and 10-year mortality was 31.5 vs. 28.4%, 69.3 vs. 61.3%, and 90.1 vs. 84.7% for HF patients with and without respectively LBBB. When adjusting for comorbidity, LBBB was associated with increased 5-year mortality (OR, 1.21; 95% CI, 1.10-1.35; P < 0.001). When left ventricular ejection fraction was included in the analysis LBBB had no longer any independent influence on 5-mortality (OR, 0.99; 95% CI, 0.62-1.56; P = 0.953). CONCLUSION: LBBB occurs in 1/5 in HF patients requiring hospitalization and is associated with a very high mortality. However, the high long-term mortality appears to be caused by cardiac comorbidities and myocardial dysfunction rather than the LBBB per se.

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