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  • 1.
    Calais, Fredrik
    Örebro University, School of Medical Sciences.
    Coronary artery disease and prognosis in relation to cardiovascular risk factors, interventional techniques and systemic atherosclerosis2018Doctoral thesis, comprehensive summary (Other academic)
    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.

    List of papers
    1. Proximal coronary artery intervention: Stent thrombosis, restenosis and death
    Open this publication in new window or tab >>Proximal coronary artery intervention: Stent thrombosis, restenosis and death
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    2013 (English)In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 170, no 2, p. 227-232Article in journal (Refereed) Published
    Abstract [en]

    Background: Percutaneous coronary intervention (PCI) of lesions in the proximal left anterior descending coronary artery (LAD) may confer a worse prognosis compared with the proximal right coronary artery (RCA) and left circumflex coronary artery (LCX). Methods: From May 2005, to May 2011 we identified all PCIs for proximal, one-vessel coronary artery disease in the Swedish Coronary Angiography and Angioplasty Registry (SCAAR). We evaluated restenosis, stent thrombosis (ST) and mortality in the LAD as compared to the RCA and LCX according to stent type, bare metal (BMS) or drug-eluting stents (DES). Results: 7840 single vessel proximal PCI procedures were identified. Mean follow-up time was 792 days. No differences in restenosis or ST were seen between the LAD and the RCA. The frequency of restenosis and ST was higher in the proximal LAD compared to the proximal LCX (restenosis: hazard ratio (HR) 2.28, confidence interval (CI) 1.56-3.34 p < 0.001; ST: HR 2.32, CI 1.11-4.85 p = 0.024). We found no difference in mortality related to coronary artery. In the proximal LAD, DES implantation was associated with a lower restenosis rate (HR 0.39, CI 0.27-0.55 < 0.001) and mortality (HR 0.58, CI 0.41-0.82 p = 0.002) compared with BMS. In the proximal RCA and LCX, DES use was not associated with lower frequency of clinical restenosis or mortality. Conclusions: Following proximal coronary artery intervention restenosis was more frequent in the LAD than in the LCX. Solely in the proximal LAD we found DES use to be associated with a lower risk of restenosis and death weighted against BMS. (C) 2013 Elsevier Ireland Ltd. All rights reserved.

    Keywords
    Angioplasty, Coronary artery disease, Drug-eluting stents
    National Category
    Cardiac and Cardiovascular Systems
    Identifiers
    urn:nbn:se:oru:diva-56452 (URN)10.1016/j.ijcard.2013.10.060 (DOI)000327889200032 ()24211065 (PubMedID)
    Available from: 2017-03-16 Created: 2017-03-16 Last updated: 2018-05-28Bibliographically approved
    2. Leisure-time physical inactivity and risk of myocardial infarction and all-cause mortality: A case-control study
    Open this publication in new window or tab >>Leisure-time physical inactivity and risk of myocardial infarction and all-cause mortality: A case-control study
    Show others...
    2014 (English)In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 177, no 2, p. 599-600Article in journal (Refereed) Published
    Place, publisher, year, edition, pages
    Elsevier, 2014
    Keywords
    Exercise, Cardiovascular diseases, Myocardial infarction, Peripheral artery disease
    National Category
    Cardiac and Cardiovascular Systems
    Identifiers
    urn:nbn:se:oru:diva-56360 (URN)10.1016/j.ijcard.2014.08.137 (DOI)000345232200087 ()25223818 (PubMedID)2-s2.0-84913582534 (Scopus ID)
    Available from: 2017-03-15 Created: 2017-03-15 Last updated: 2018-06-19Bibliographically approved
    3. ST-Elevation Myocardial Infarction, Thrombus Aspiration, and Different Invasive Strategies: A TASTE Trial Substudy
    Open this publication in new window or tab >>ST-Elevation Myocardial Infarction, Thrombus Aspiration, and Different Invasive Strategies: A TASTE Trial Substudy
    2015 (English)In: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, ISSN 2047-9980, E-ISSN 2047-9980, Vol. 4, no 6, article id e001755Article in journal (Refereed) 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.

    Keywords
    angioplasty, myocardial infarction, stenting, thrombus aspiration
    National Category
    Cardiac and Cardiovascular Systems
    Research subject
    Cardiology
    Identifiers
    urn:nbn:se:oru:diva-45542 (URN)10.1161/JAHA.114.001755 (DOI)000357025100014 ()26077585 (PubMedID)
    Funder
    Swedish Research CouncilSwedish Heart Lung Foundation, 20100178 B0010401
    Note

    Funding Agencies:

    Swedish Association of Local Authorities and Regions

    Terumo Medical Corporation

    Medtronic Solution

    Svenska Hjartförbundet

    Vascular Solution

    Available from: 2015-08-12 Created: 2015-08-12 Last updated: 2018-07-01Bibliographically approved
    4. Thrombus aspiration in patients with large anterior myocardial infarction: A Thrombus Aspiration in ST-Elevation myocardial infarction in Scandinavia trial substudy
    Open this publication in new window or tab >>Thrombus aspiration in patients with large anterior myocardial infarction: A Thrombus Aspiration in ST-Elevation myocardial infarction in Scandinavia trial substudy
    Show others...
    2016 (English)In: American Heart Journal, ISSN 0002-8703, E-ISSN 1097-6744, Vol. 172, no 2, p. 129-134Article in journal (Refereed) 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.

    Place, publisher, year, edition, pages
    Elsevier, 2016
    National Category
    Cardiac and Cardiovascular Systems
    Research subject
    Cardiology
    Identifiers
    urn:nbn:se:oru:diva-48941 (URN)10.1016/j.ahj.2015.11.012 (DOI)000369659400016 ()26856224 (PubMedID)
    Note

    Funding Agencies:

    Medtronic

    Vascular solutions

    Terumo

    Biosensors 

    Biotronik

    Available from: 2016-03-07 Created: 2016-03-04 Last updated: 2019-02-13Bibliographically approved
    5. Prognostic impact of subclinical or manifest extracoronary artery diseases after acute myocardial infarction
    Open this publication in new window or tab >>Prognostic impact of subclinical or manifest extracoronary artery diseases after acute myocardial infarction
    Show others...
    2017 (English)In: Atherosclerosis, ISSN 0021-9150, E-ISSN 1879-1484, Vol. 263, p. 53-59Article in journal (Refereed) 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.

    Place, publisher, year, edition, pages
    Elsevier, 2017
    Keywords
    Extracoronary artery disease, Myocardial infarction, Prognosis
    National Category
    Cardiac and Cardiovascular Systems
    Identifiers
    urn:nbn:se:oru:diva-60724 (URN)10.1016/j.atherosclerosis.2017.05.027 (DOI)000407634000884 ()28599258 (PubMedID)2-s2.0-85020304353 (Scopus ID)
    Note

    Funding Agencies:

    Sparbanksstiftelsen Nya  552  693  0932  2297 

    County of Västmanland  

    Swedish Medical Association

    Available from: 2017-09-11 Created: 2017-09-11 Last updated: 2018-08-06Bibliographically approved
    6. Incremental prognostic value of coronary and systemic atherosclerosis aftermyocardial infarction
    Open this publication in new window or tab >>Incremental prognostic value of coronary and systemic atherosclerosis aftermyocardial infarction
    Show others...
    (English)Manuscript (preprint) (Other academic)
    National Category
    General Practice Cardiac and Cardiovascular Systems
    Identifiers
    urn:nbn:se:oru:diva-65425 (URN)
    Available from: 2018-03-02 Created: 2018-03-02 Last updated: 2018-03-02Bibliographically approved
  • 2.
    Calais, Fredrik
    et al.
    Örebro University, School of Medical Sciences.
    Eriksson Östman, Maja
    Örebro University, Faculty of Health, Department of Cardiology, Sweden.
    Hedberg, Pär
    Centre for Clinical Research, Uppsala University and Department of Clinical Physiology, Västmanland County Hospital, Västerås, Sweden.
    Rosenblad, Andreas
    Centre for Clinical Research, Uppsala University Västmanland County Hospital, Västerås, Sweden.
    Leppert, Jerzy
    Centre for Clinical Research, Uppsala University Västmanland County Hospital, Västerås, Sweden.
    Fröbert, Ole
    Örebro University, School of Medical Sciences. Örebro University Hospital.
    Incremental prognostic value of coronary and systemic atherosclerosis aftermyocardial infarctionManuscript (preprint) (Other academic)
  • 3.
    Calais, Fredrik
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Lagerqvist, Bo
    University Hospital Uppsala, Uppsala, Sweden.
    Leppert, Jerzy
    Uppsala University, Västerås, Sweden.
    James, Stefan
    Uppsala Clinical Research Center, Uppsala, Sweden.
    Fröbert, Ole
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital, Örebro, Sweden.
    Thrombus aspiration in patients with large anterior myocardial infarction: a TASTE trial substudy2015In: Journal of the American College of Cardiology, ISSN 0735-1097, E-ISSN 1558-3597, Vol. 66, no 15, p. B2-B2Article in journal (Other academic)
  • 4.
    Calais, Fredrik
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Cardiology, Örebro University Hospital, Örebro, Sweden.
    Lagerqvist, Bo
    Department of Medical Sciences, Cardiology, and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden.
    Leppert, Jerzy
    Centre for Clinical Research, Uppsala University, Central Hospital, Västerås, Sweden.
    James, Stefan K.
    Department of Medical Sciences, Cardiology, and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden.
    Fröbert, Ole
    Department of Cardiology, Faculty of Health, Örebro University, Örebro, Sweden.
    Thrombus aspiration in patients with large anterior myocardial infarction: A Thrombus Aspiration in ST-Elevation myocardial infarction in Scandinavia trial substudy2016In: American Heart Journal, ISSN 0002-8703, E-ISSN 1097-6744, Vol. 172, no 2, p. 129-134Article in journal (Refereed)
    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.

  • 5.
    Escaned, Javier
    et al.
    Hospital Clínico San Carlos, IDISSC, Madrid, Spain; Universidad Complutense de Madrid, Madrid, Spain.
    Calais, Fredrik
    Department of Cardiology, Faculty of Health, Örebro University, Örebro, Sweden.
    Fröbert, Ole
    Örebro University, School of Medical Sciences.
    Davies, Justin E.
    Hammersmith Hospital, Imperial College London, London, United Kingdom.
    Götberg, Matthias
    Skåne University Hospital, Lund University, Lund, Sweden.
    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 Syndromes2018In: JACC: Cardiovascular Interventions, ISSN 1936-8798, E-ISSN 1876-7605, Vol. 11, no 15, p. 1437-1449Article in journal (Refereed)
    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.

  • 6.
    Fokkema, Marieke L.
    et al.
    Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands; Department of Medical Sciences, Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden.
    James, Stefan K.
    Department of Medical Sciences, Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden.
    Albertsson, Per
    Department of Cardiology, Sahlgrenska University Hospital, Göteborg, Sweden.
    Aasa, Mikael
    Department of Cardiology, Södersjukhuset, Stockholm, Sweden.
    Åkerblom, Axel
    Department of Medical Sciences, Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden.
    Calais, Fredrik
    Örebro University, School of Medical Sciences. Department of Cardiology.
    Eriksson, Peter
    Department of Cardiology, Umeå University Hospital, Umeå, Sweden.
    Jensen, Jens
    Department of Medicine, Sundsvall-Härnösand County Hospital, Karolinska Institutet, Stockholm, Sweden.
    Schersten, Fredrik
    Department of Cardiology, Skåne University Hospital, Lund University, Lund, Sweden.
    de Smet, Bart J.
    Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands; Department of Cardiology, Meander Medisch Centrum, Amersfoort, Netherlands.
    Sjögren, Iwar
    Department of Cardiology, Falun Lasarett, Falun, Sweden.
    Tornvall, Per
    Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden.
    Lagerqvist, Bo
    Department of Medical Sciences, Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden.
    Outcome after percutaneous coronary intervention for different indications: long-term results from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR)2016In: EuroIntervention, ISSN 1774-024X, E-ISSN 1969-6213, Vol. 12, no 3, p. 303-311Article in journal (Refereed)
    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.

  • 7.
    Fröbert, Ole
    et al.
    Faculty of Health, Department of Cardiology, Örebro University, Örebro, Sweden.
    Arevström, Lilith
    Faculty of Health, Department of Cardiology, Örebro University, Örebro, Sweden.
    Calais, Fredrik
    Örebro University, School of Medical Sciences.
    James, Stefan K.
    Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden; Uppsala Clinical research center, Uppsala University, Uppsala, Sweden.
    Lagerqvist, Bo
    Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden; Uppsala Clinical research center, Uppsala University, Uppsala, Sweden.
    Height and prognosis following percutaneous coronary intervention2016In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 224, p. 188-190Article in journal (Refereed)
  • 8.
    Fröbert, Ole
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Calais, Fredrik
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    James, Stefan K.
    Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden; Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden.
    Lagerqvist, Bo
    Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden; Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden.
    ST-Elevation Myocardial Infarction, Thrombus Aspiration, and Different Invasive Strategies: A TASTE Trial Substudy2015In: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, ISSN 2047-9980, E-ISSN 2047-9980, Vol. 4, no 6, article id e001755Article in journal (Refereed)
    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.

  • 9.
    Götberg, Matthias
    et al.
    Department of Cardiology, Clinical Sciences, Skåne University Hospital, Lund, Sweden.
    Christiansen, Evald H.
    Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
    Gudmundsdottir, Ingibjörg J.
    Department of Cardiology, Reykjavik University Hospital, Reykjavik, Iceland.
    Sandhall, Lennart
    Departments of Cardiology and Radiology, Helsingborg Hospital, Helsingborg, Sweden.
    Danielewicz, Mikael
    Department of Cardiology, Karlstad Hospital, Karlstad, Sweden.
    Jakobsen, Lars
    Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
    Olsson, Sven-Erik
    Departments of Cardiology and Radiology, Helsingborg Hospital, Helsingborg, Sweden.
    Öhagen, Patrik
    Uppsala Clinical Research Center, Uppsala, Sweden.
    Olsson, Hans
    Department of Cardiology, Karlstad Hospital, Karlstad, Sweden.
    Omerovic, Elmir
    Department of Cardiology, Sahlgrenska University, Gothenburg, Sweden.
    Calais, Fredrik
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Cardiology, Örebro University Hospital, Örebro, Sweden.
    Lindroos, Pontus
    Department of Cardiology, St. Göran Hospital, Stockholm, Sweden.
    Maeng, Michael
    Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
    Tödt, Tim
    Department of Cardiology, Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden.
    Venetsanos, Dimitrios
    Departments of Cardiology and of Medical and Health Sciences, Linköping University, Linköping, Sweden.
    James, Stefan K.
    Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
    Kåregren, Amra
    Department of Internal Medicine, Västmanland Hospital, Västerås, Sweden.
    Nilsson, Margareta
    Department of Cardiology, Clinical Sciences, Skåne University Hospital, Lund University, Lund, Sweden.
    Carlsson, Jörg
    Department of Cardiology, Kalmar County Hospital, Kalmar, Sweden; Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden.
    Hauer, Dario
    Departments of Cardiology and of Medical and Health Sciences, Linköping University, Linköping, Sweden.
    Jensen, Jens
    Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet,Stockholm, Sweden; Unit of Cardiology, Capio St. Görans Sjukhus, Stockholm, Sweden; Department of Medicine, Sundsvall Hospital, Sundsvall, Sweden.
    Karlsson, Ann-Charlotte
    Department of Cardiology, Halmstad Hospital, Halmstad, Sweden.
    Panayi, Georgios
    Departments of Cardiology and of Medical and Health Sciences, Linköping University, Linköping, Sweden.
    Erlinge, David
    Department of Cardiology, Clinical Sciences, Skåne University Hospital, Lund University, Lund, Sweden.
    Fröbert, Ole
    Örebro University Hospital. Örebro University, School of Medical Sciences. Department of Cardiology, Örebro University Hospital, Örebro, Sweden .
    iFR-SWEDEHEART Investigators, Group author
    Instantaneous Wave-free Ratio versus Fractional Flow Reserve to Guide PCI2017In: New England Journal of Medicine, ISSN 0028-4793, E-ISSN 1533-4406, Vol. 376, no 19, p. 1813-1823Article in journal (Refereed)
    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.

  • 10.
    Lindholm, Daniel
    et al.
    Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden; Uppsala Clinical Research Center, Uppsala, Sweden.
    Alfredsson, Joakim
    Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
    Angeras, Oskar
    Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Böhm, Felix
    Division of Cardiology, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
    Calais, Fredrik
    Örebro University, School of Medical Sciences. Department of Cardiology, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Koul, Sasha
    Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden.
    Lagerqvist, Bo
    Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden; Uppsala Clinical Research Center, Uppsala, Sweden.
    Renlund, Henrik
    Uppsala Clinical Research Center, Uppsala, Sweden.
    Sarno, Giovanna
    Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden; Uppsala Clinical Research Center, Uppsala, Sweden.
    Varenhorst, Christoph
    Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden; Uppsala Clinical Research Center, Uppsala, Sweden.
    Timing of percutaneous coronary intervention in patients with non-ST-elevation myocardial infarction: a SWEDEHEART study2017In: European Heart Journal - Quality of Care and Clinical Outcomes, ISSN 2058-5225, E-ISSN 2058-1742, Vol. 3, no 1, p. 53-60Article in journal (Refereed)
    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.

  • 11.
    Sarno, Giovanna
    et al.
    Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden; Uppsala Clinical Research Center, Uppsala University Hospital, Uppsala University, Uppsala, Sweden .
    Lagerqvist, Bo
    Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden; Uppsala Clinical Research Center, Uppsala University Hospital, Uppsala University, Uppsala, Sweden .
    Carlsson, Jörg
    Department of Medicine, Länssjukhuset, Kalmar, Sweden .
    Olivecrona, Göran
    Department of Cardiology, Lund University Hospital, Lund, Sweden.
    Nilsson, Johan
    Department of Cardiology, Norrlands University Hospital, Umeå, Sweden .
    Calais, Fredrik
    Department of Cardiology, Örebro University Hospital, Örebro, Sweden .
    Götberg, Matthias
    Department of Cardiology, Lund University Hospital, Lund, Sweden .
    Nilsson, Tage
    Department of Cardiology, Karlstad Hospital, Karlstad, Sweden .
    Sjögren, Iwar
    Department of Cardiology, Falun Lasarett, Falun, Sweden .
    James, Stefan
    Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden; University Hospital, Uppsala Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden .
    Initial clinical experience with an everolimus eluting platinum chromium stent (Promus Element) in unselected patients from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR)2013In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 167, no 1, p. 146-150Article in journal (Refereed)
    Abstract [en]

    Background: The safety and efficacy of the Promus Element stent have been recently demonstrated in a selected population from one randomized trial. The aim of this study was to describe the initial clinical experience with the everolimus eluting platinum chromium stent (Promus Element) in unselected patients from a real life nationwide registry.

    Methods: The Promus Element DES was compared to all other DES implanted in Sweden (with more than 500 implants) from November 2009 to March 2011. The results were assessed using Cox regression.

    Results: A total of 13,577 stents (Promus Element, n = 2724, Cypher, n = 782; Endeavor, n = 747; Taxus Liberte, n = 1393, Xience V/Promus, n = 4832, Resolute, n = 1566, Xience Prime, n = 4832) were implanted at 8375 procedures. At one year the restenosis rate in the Promus Element was not significantly different from the overall DES group (2.8% vs. 2.7%, adjusted HR: 1.17, 95% CI: 0.75-1.75). A significantly lower restenosis rate was observed in the Promus Element when compared with Endeavor (2.8% vs. 5.8%; adjusted HR: 0.44; 95% CI: 0.26-0.74). The stent thrombosis (ST) rate at one year was not significantly different in the Promus Element as compared with the overall DES group (0.2% vs. 0.5% adjusted HR: 0.59; 95% CI: 025-1.40). ST rate was significantly lower as compared with Endeavor stent (0.2% vs. 0.8%; HR: 0.24; 95% CI: 0.08-0.67).

    Conclusions: In a large unselected population the Promus Element stent appears to be safe and effective with a low risk of restenosis and ST. (C) 2011 Elsevier Ireland Ltd. All rights reserved.

  • 12.
    Velders, Matthijs A.
    et al.
    Department of Medicine, Västmanland County Hospital, Västerås, Sweden.
    Calais, Fredrik
    Örebro University, School of Medical Sciences. Department of Cardiology.
    Dahle, Nina
    Centre for Clinical Research, Uppsala University, Falun, Dalarna, Sweden.
    Fall, Tove
    Department of Medical Sciences, Molecular Epidemiology and SciLife Laboratory, Uppsala University, Uppsala, Sweden.
    Hagström, Emil
    Department of Medical Sciences, Molecular Epidemiology and SciLife Laboratory, Uppsala University, Uppsala, Sweden; Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden.
    Leppert, Jerzy
    Centre for Clinical Research, Uppsala University, Västmanland County Hospital, Västerås, Sweden.
    Nowak, Christoph
    Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Huddinge, Sweden.
    Tenerz, Åke
    Department of Medicine, Västmanland County Hospital, Västerås, Sweden.
    Ärnlöv, Johan
    Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Huddinge, Sweden; School of Health and Social Studies, Dalarna University, Falun, Sweden.
    Hedber, Par
    Centre for Clinical Research, Uppsala University, Västmanland County Hospital, Västerås, Sweden; Department of Clinical Physiology, Västmanland County Hospital, Västerås, Sweden.
    Cathepsin D improves the prediction of undetected diabetes in patients with myocardial infarction2019In: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967Article in journal (Refereed)
    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.

  • 13.
    Östman, Maja Eriksson
    et al.
    Department of Cardiology, , Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Calais, Fredrik
    Örebro University, School of Medical Sciences. Department of Cardiology, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Rosenblad, Andreas
    Centre for Clinical Research, Västmanland County Hospital, Uppsala University, Västerås, Sweden.
    Fröbert, Ole
    Örebro University, School of Medical Sciences. Department of Cardiology, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Leppert, Jerzy
    Centre for Clinical Research, Västmanland County Hospital, Uppsala University, Västerås, Sweden.
    Hedberg, Pär
    Centre for Clinical Research, Västmanland County Hospital, Uppsala University, Västerås, Sweden.
    Prognostic impact of subclinical or manifest extracoronary artery diseases after acute myocardial infarction2017In: Atherosclerosis, ISSN 0021-9150, E-ISSN 1879-1484, Vol. 263, p. 53-59Article in journal (Refereed)
    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.

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