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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 University, School of Health and Medical Sciences.
    Association between objectively measured physical activity and sub-clinical atherosclerosis in young adults2010In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 31, no Suppl 1, p. 388-388Article in journal (Other academic)
  • 2.
    Almroth, Henrik
    et al.
    Örebro University, School of Health and Medical Sciences.
    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 study2009In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 30, no 7, p. 827-833Article in journal (Refereed)
    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 University, School of Medical Sciences. Department of Cardiology.
    Smokeless tobacco, snus, at admission for percutaneous coronary intervention and future risk of death2018In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 39, no Suppl. 1, p. 1364-1365Article in journal (Other academic)
  • 4.
    Andersson, Linda
    et al.
    Department of Molecular and Clinical Medicine/Wallenberg Laboratory, Institute of Medicine, the Sahlgrenska Academy at University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden.
    Cinato, Mathieu
    Department of Molecular and Clinical Medicine/Wallenberg Laboratory, Institute of Medicine, the Sahlgrenska Academy at University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden.
    Mardani, Ismena
    Department of Molecular and Clinical Medicine/Wallenberg Laboratory, Institute of Medicine, the Sahlgrenska Academy at University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden.
    Miljanovic, Azra
    Department of Molecular and Clinical Medicine/Wallenberg Laboratory, Institute of Medicine, the Sahlgrenska Academy at University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden.
    Arif, Muhammad
    Science for Life Laboratory, KTH-Royal Institute of Technology, Stockholm, Sweden.
    Koh, Ara
    Department of Molecular and Clinical Medicine/Wallenberg Laboratory, Institute of Medicine, the Sahlgrenska Academy at University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Precision Medicine, School of Medicine, Sungkyunkwan University (SKKU), Suwon, Republic of Korea.
    Lindbom, Malin
    Department of Molecular and Clinical Medicine/Wallenberg Laboratory, Institute of Medicine, the Sahlgrenska Academy at University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden.
    Laudette, Marion
    Department of Molecular and Clinical Medicine/Wallenberg Laboratory, Institute of Medicine, the Sahlgrenska Academy at University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden.
    Bollano, Entela
    Department of Molecular and Clinical Medicine/Wallenberg Laboratory, Institute of Medicine, the Sahlgrenska Academy at University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden.
    Omerovic, Elmir
    Department of Molecular and Clinical Medicine/Wallenberg Laboratory, Institute of Medicine, the Sahlgrenska Academy at University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden.
    Klevstig, Martina
    Department of Molecular and Clinical Medicine/Wallenberg Laboratory, Institute of Medicine, the Sahlgrenska Academy at University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden.
    Henricsson, Marcus
    Department of Molecular and Clinical Medicine/Wallenberg Laboratory, Institute of Medicine, the Sahlgrenska Academy at University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden.
    Fogelstrand, Per
    Department of Molecular and Clinical Medicine/Wallenberg Laboratory, Institute of Medicine, the Sahlgrenska Academy at University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden.
    Swärd, Karl
    Department of Experimental Medical Science, Lund University, Lund, Sweden.
    Ekstrand, Matias
    Department of Molecular and Clinical Medicine/Wallenberg Laboratory, Institute of Medicine, the Sahlgrenska Academy at University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden.
    Levin, Max
    Department of Molecular and Clinical Medicine/Wallenberg Laboratory, Institute of Medicine, the Sahlgrenska Academy at University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden.
    Wikström, Johannes
    Bioscience, Research and Early Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Mölndal, Sweden.
    Doran, Stephen
    Centre for Host-Microbiome Interactions, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK.
    Hyötyläinen, Tuulia
    Örebro University, School of Science and Technology.
    Sinisalu, Lisanna
    Örebro University, School of Science and Technology.
    Oresic, Matej
    Örebro University, School of Medical Sciences. Turku Bioscience Centre, University of Turku, Turku, Finland.
    Tivesten, Åsa
    Department of Molecular and Clinical Medicine/Wallenberg Laboratory, Institute of Medicine, the Sahlgrenska Academy at University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden.
    Adiels, Martin
    Department of Molecular and Clinical Medicine/Wallenberg Laboratory, Institute of Medicine, the Sahlgrenska Academy at University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden.
    Bergo, Martin O.
    Department of Biosciences and Nutrition, Karolinska Institute, Huddinge, Sweden.
    Proia, Richard
    National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health, Bethesda, MD, USA.
    Mardinoglu, Adil
    Science for Life Laboratory, KTH-Royal Institute of Technology, Stockholm, Sweden; Centre for Host-Microbiome Interactions, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK.
    Jeppsson, Anders
    Department of Molecular and Clinical Medicine/Wallenberg Laboratory, Institute of Medicine, the Sahlgrenska Academy at University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden.
    Borén, Jan
    Department of Molecular and Clinical Medicine/Wallenberg Laboratory, Institute of Medicine, the Sahlgrenska Academy at University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden.
    Levin, Malin C.
    Department of Molecular and Clinical Medicine/Wallenberg Laboratory, Institute of Medicine, the Sahlgrenska Academy at University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden.
    Glucosylceramide synthase deficiency in the heart compromises β1-adrenergic receptor trafficking2021In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 42, no 43, p. 4481-4492Article in journal (Refereed)
    Abstract [en]

    AIMS: Cardiac injury and remodelling are associated with the rearrangement of cardiac lipids. Glycosphingolipids are membrane lipids that are important for cellular structure and function, and cardiac dysfunction is a characteristic of rare monogenic diseases with defects in glycosphingolipid synthesis and turnover. However, it is not known how cardiac glycosphingolipids regulate cellular processes in the heart. The aim of this study is to determine the role of cardiac glycosphingolipids in heart function.

    METHODS AND RESULTS: Using human myocardial biopsies, we showed that the glycosphingolipids glucosylceramide and lactosylceramide are present at very low levels in non-ischaemic human heart with normal function and are elevated during remodelling. Similar results were observed in mouse models of cardiac remodelling. We also generated mice with cardiomyocyte-specific deficiency in Ugcg, the gene encoding glucosylceramide synthase (hUgcg-/- mice). In 9- to 10-week-old hUgcg-/- mice, contractile capacity in response to dobutamine stress was reduced. Older hUgcg-/- mice developed severe heart failure and left ventricular dilatation even under baseline conditions and died prematurely. Using RNA-seq and cell culture models, we showed defective endolysosomal retrograde trafficking and autophagy in Ugcg-deficient cardiomyocytes. We also showed that responsiveness to β-adrenergic stimulation was reduced in cardiomyocytes from hUgcg-/- mice and that Ugcg knockdown suppressed the internalization and trafficking of β1-adrenergic receptors.

    CONCLUSIONS: Our findings suggest that cardiac glycosphingolipids are required to maintain β-adrenergic signalling and contractile capacity in cardiomyocytes and to preserve normal heart function.

  • 5.
    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
    Örebro University Hospital.
    All-cause mortality in 272 186 patients hospitalized with incident atrial fibrillation 1995-2008: a Swedish nationwide long-term case-control study2013In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 34, no 14, p. 1061-1067Article in journal (Refereed)
    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.

  • 6.
    Becher, Nina
    et al.
    Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Luebeck, Hamburg, Germany.
    Toennis, Tobias
    Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Luebeck, Hamburg, Germany.
    Bertaglia, Emanuele
    Department of Cardiac, Vascular, Thoracic and Public Health Sciences, Azienda Ospedaliera, Padua, Italy.
    Blomström-Lundqvist, Carina
    Örebro University, School of Medical Sciences. Department of Medical Science, Uppsala University, Uppsala, Sweden; Department of Cardiology, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Brandes, Axel
    Department of Cardiology, Esbjerg Hospital - University Hospital of Southern Denmark, Esbjerg, and Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.
    Cabanelas, Nuno
    Cardiology Department, Fernando Fonseca Hospital, Amadora, Portugal.
    Calvert, Melanie
    Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, United Kingdom; NIHR Birmingham Biomedical Research Centre and NIHR Applied Research Collaboration West Midlands, University of Birmingham, Edgbaston, Birmingham, UK.
    Camm, A. John
    Cardiovascular and Cell Sciences Research Institute, St George's, University of London, and Imperial College, London, United Kingdom.
    Chlouverakis, Gregory
    Biostatistics Lab, School of Medicine, University of Crete, Crete, Greece.
    Dan, Gheorghe-Andrei
    Medicine University "Carol Davila", Colentina University Hospital, Bucharest, Romania.
    Dichtl, Wolfgang
    Department of Internal Medicine III, Cardiology and Angiology, Innsbruck Medical University, Innsbruck, Austria.
    Diener, Hans Christoph
    Department of Neuroepidemiology, Institute for Medical Informatics, Biometry and Epidemiology (IMIBE), University Duisburg-Essen, Essen, Germany.
    Fierenz, Alexander
    Institute of Medical Biometry and Epidemiology, University Medical Centre Hamburg-Eppendorf, Germany.
    Goette, Andreas
    Department of Cardiology and Intensive Care Medicine, St Vincenz-Hospital Paderborn, Paderborn, Germany; Atrial Fibrillation NETwork (AFNET), Muenster, Germany.
    de Groot, Joris R.
    Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands.
    Hermans, Astrid N. L.
    Departments of Cardiology and Physiology, Maastricht University, Maastricht, The Netherlands.
    Lip, Gregory Y. H.
    Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom; and Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
    Lubinski, Andrzej
    Medical University of Gdańsk, Department of Cardiology and Internal Diseases, Gdańsk, Poland.
    Marijon, Eloi
    Cardiology Division, European Georges Pompidou Hospital, Paris, France.
    Merkely, Béla
    Heart and Vascular Centre, Semmelweis University, Budapest, Hungary.
    Mont, Lluís
    Hospital Clinic, Universtitat de Barcelona, Catalonia, Spain; Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, Catalonia, Spain; Centro de Investigacion Biomedica en Red Cardiovascular (CIBERCV), Madrid, Spain.
    Ozga, Ann-Kathrin
    Institute of Medical Biometry and Epidemiology, University Medical Centre Hamburg-Eppendorf, Germany.
    Rajappan, Kim
    Cardiac Department, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom.
    Sarkozy, Andrea
    HRMC, University Hospital Brussels, VUB, Belgium.
    Scherr, Daniel
    Department of Cardiology, University Hospital Graz, Austria.
    Schnabel, Renate B
    Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Luebeck, Hamburg, Germany.
    Schotten, Ulrich
    Departments of Cardiology and Physiology, Maastricht University, Maastricht, The Netherlands; Atrial Fibrillation NETwork (AFNET), Muenster, Germany.
    Sehner, Susanne
    Institute of Medical Biometry and Epidemiology, University Medical Centre Hamburg-Eppendorf, Germany.
    Simantirakis, Emmanuel
    Department of Cardiology, Heraklion University Hospital, Heraklion, Crete, Greece.
    Vardas, Panos
    Department of Cardiology, Heraklion University Hospital, Heraklion, Crete, Greece; Biomedical Research Foundation Academy of Athens (BRFAA), Greece and Hygeia Hospitals Group, Athens, Greece.
    Velchev, Vasil
    Cardiology Clinic, St. Anna University Hospital, Medical University Sofia, Sofia, Bulgaria.
    Wichterle, Dan
    Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czechia.
    Zapf, Antonia
    Institute of Medical Biometry and Epidemiology, University Medical Centre Hamburg-Eppendorf, Germany.
    Kirchhof, Paulus
    Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Luebeck, Hamburg, Germany; Atrial Fibrillation NETwork (AFNET), Muenster, Germany.
    Anticoagulation with edoxaban in patients with long atrial high-rate episodes ≥24 h2024In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 45, no 10, p. 837-849Article in journal (Refereed)
    Abstract [en]

    BACKGROUND AND AIMS: Patients with long atrial high-rate episodes (AHRE) ≥ 24 hours and stroke risk factors are often treated with anticoagulation for stroke prevention. Anticoagulation has never been compared to no anticoagulation in these patients.

    METHODS: This secondary prespecified analysis of NOAH-AFNET 6 examined interactions between AHRE duration at baseline and anticoagulation with edoxaban compared to placebo in patients with AHRE and stroke risk factors. The primary efficacy outcome was a composite of stroke, systemic embolism, or cardiovascular death. The safety outcome was a composite of major bleeding and death. Key secondary outcomes were components of these outcomes and ECG-diagnosed atrial fibrillation.

    RESULTS: AHRE ≥24 hours were present at baseline in 259/2389 patients enrolled in NOAH-AFNET 6 (11%, 78 ± 7 years old, 28% women, CHA2DS2-VASc score 4). Clinical characteristics were not different from patients with shorter AHRE. During a median follow-up of 1.8 years, the primary outcome occurred in 9/132 patients with AHRE ≥24 hours (4.3%/patient-year, 2 strokes) treated with anticoagulation and in 14/127 patients treated with placebo (6.9%/patient-year, 2 strokes). AHRE duration did not interact with the efficacy (p-interaction = 0.65) or safety (p-interaction = 0.98) of anticoagulation. Analyses including AHRE as a continuous parameter confirmed this. Patients with AHRE ≥24 hours developed more ECG-diagnosed atrial fibrillation (17.0%/patient-year) than patients with shorter AHRE (8.2%/patient-year; p < 0.001).

    CONCLUSIONS: This hypothesis-generating analysis does not find an interaction between AHRE duration and anticoagulation therapy in patients with device-detected AHRE and stroke risk factors. Further research is needed to identify patients with long AHRE at high stroke risk.

  • 7.
    Bergh, Cecilia
    et al.
    Örebro University, School of Medical Sciences. 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 University, School of Medical Sciences. Department of Cardiology.
    Under the weather: acute myocardial infarction and subsequent case fatality with influenza burden - a nationwide observational study2019In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 40, no Suppl. 1, p. 3994-3994Article in journal (Other academic)
    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.

  • 8.
    Bergh, Cecilia
    et al.
    Örebro University, School of Health Sciences.
    Oasti, Zahra
    Örebro University, Örebro, Sweden.
    Montgomery, Scott
    Örebro University, School of Medical Sciences.
    Non-psychotic mental disorders in adolescent men and risk of myocardial infarction: A national cohort study2020In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 41, no Suppl. 2, p. 2812-2812Article in journal (Other academic)
    Abstract [en]

    Background/Purpose: Recent studies show that early life stress is associated with later risk of cardiovascular disease (CVD) and stress may also increase the risk of psychiatric disease. We investigated the association between non-psychotic mental disorders in adolescence and subsequent myocardial infarction, and the role of stress resilience and physical fitness in this association.

    Method: This is a register-based cohort study with 238 013 males born between 1952 and 1956 followed from 1987 to 2010 using information from Swedish registers. Stress resilience was measured at a compulsory military conscription examination using a semi-structured interview with a psychologist. Physical fitness was measured at conscription examination with a cycle ergometer test. A total of 34 503 men were diagnosed with a non-psychotic mental disorder at conscription. Using Cox regression, we estimated the association of mental disorders with myocardial infarction after adjustment for other established CVD risk factors in adolescence. Stress resilience and physical fitness were included in the adjusted model in a second set of analyses.

    Results: A total of 5891 diagnoses of first myocardial infarction were identified. Non-psychotic mental disorders were associated with an increased risk of myocardial infarction, with a hazard ratio (HR) and confidence interval (CI) of 1.51 (1.41–1.62). The association remained statistically significant after adjustment for other important potential confounders in adolescence such as systolic and diastolic blood pressure, body mass index, inflammation, cognitive function, parental socioeconomic index and a summary disease score (HR 1.24 (CI 1.13–1.35)). The association was further explained by stress resilience and lifestyle factors assessed with a cardiovascular fitness test in adolescence, as the association attenuated but remained statistically significant when further adjusting for stress resilience and physical fitness (HR 1.18 (CI 1.08–1.29)).

    Conclusion: A non-psychotic mental disorder in adolescences may increase the risk of developing myocardial infarction later in life. This association was partly but not completely explained by poorer stress resilience and physical fitness. Effective prevention might focus on behaviour/lifestyle and psychosocial stress in early life.

  • 9.
    Björkenheim, Anna
    et al.
    Örebro University, School of Medical Sciences. Örebro University Hospital. 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 University, School of Medical Sciences. Örebro University Hospital. 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 instrument2018In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 39, no Suppl. 1, p. 1415-1415Article in journal (Other academic)
  • 10.
    Bratt, E.
    et al.
    Institute of Health and Care Sciences Sahlgrenska Academy University of Gothenburg, Gothenburg, Sweden.
    Mora, M. Acuna
    Institute of Health and Care Sciences Sahlgrenska Academy University of Gothenburg, Gothenburg, Sweden.
    Sparud-Lundin, C.
    Institute of Health and Care Sciences Sahlgrenska Academy University of Gothenburg, Gothenburg, Sweden.
    Saarijärvi, M.
    Institute of Health and Care Sciences Sahlgrenska Academy University of Gothenburg, Gothenburg, Sweden.
    Skogby, S.
    Institute of Health and Care Sciences Sahlgrenska Academy University of Gothenburg, Gothenburg, Sweden.
    Burström, A.
    Karolinska Institute, Department of Neurobiology, Care Sciences and Society, Stockholm, Sweden.
    Rydberg, A.
    Umeå University, Department of Clinical Sciences, Umeå, Sweden.
    Hanseus, K.
    Skåne University Hospital, Department of Paediatric Cardiology, Lund, Sweden.
    Fernlund, E.
    Department of Public Health and Primary Care, KU Leuven, Linköping, Sweden.
    Fadl, Shalan
    Örebro University, School of Medical Sciences. Örebro University Hospital, Department of Paediatric and Women’s Health Care, Örebro, Sweden.
    Kazamia, K.
    Karolinska Institute, Department of Women’s and Children’s Health, Stockholm, Sweden.
    Moons, P.
    Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.
    The STEPSTONES transition program for adolescents with congenital heart disease is effective in improving patient empowerment: a randomized controlled trial2022In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 43, no Suppl. 2, p. 2745-2745Article in journal (Other academic)
    Abstract [en]

    Background: Congenital heart disease (CHD) is the most common birth defect, with a global birth prevalence of 8.2 per 1000 new-borns. Improvements in the diagnosis and treatment of children with CHD have resulted in increasing life prospects, with more than 90% surviving into adulthood today. To ensure expert lifetime care, patients need to transfer from paediatric-oriented care to adult-oriented care. At the same time, they need to transition from a dependent child with CHD to an independent adult who can manage living with CHD. Thus, during adolescence, patients with CHD need to acquire knowledge and skills to independently manage their health, while simultaneously experiencing a series of physical, cognitive and social changes. To facilitate this phase, transitional care is needed. However, high-level empirical evidence on the effectiveness of transitional care is scarce.

    Purpose: To investigate the empowering effect (primary outcome) of a structured person-centred transition programme for adolescents with CHD, and to study the effectiveness on transition readiness, patient-reported health, quality of life, health behaviours, disease-related knowledge, parental uncertainty, and parental perception of transition readiness (secondary outcomes).

    Methods: The STEPSTONES-CHD trial comprised a hybrid experimental design, in which a randomized controlled trial (RCT) was embedded in a longitudinal, observational study. The trial was conducted in seven CHD centres in Sweden. Two centres were allocated to the RCT-arm, randomising participants to intervention (IG) or control group (CG). The other five centres were intervention-naïve centres and served as contamination check control group (CCCG). Outcomes were measured at the age of 16 y (T0; baseline), 17y (T1) and 18.5y (T2).

    Results: The change in empowerment from T0 to T2 differed significantly between the IG and CG (mean difference=3.44; 95% CI: 0.27–6.65; p=0.036) in favour for IG. For the secondary outcomes, significant differences in change over time were found in parental involvement (p=0.008), CHD-specific knowledge (p=0.0002), and satisfaction with physical appearance (p=0.039). No differences in primary or secondary outcomes were detected between CG and CCCG, indicating that there was no contamination in the CG.

    Conclusion: The STEPSTONES-CHD trial demonstrated the effectiveness of a person-centred transition programme in empowering adolescents with CHD. Furthermore, parental involvement, satisfaction with physical appearance and CHD-related knowledge were positively influenced. This trial provides empirical underpinnings for the implementation of transition programmes for afflicted adolescents.

  • 11.
    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 University, School of Medical Sciences. 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)2019In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 40, no 31, p. 2607-2615Article in journal (Refereed)
    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.

  • 12.
    Djekic, Demir
    et al.
    Örebro University, School of Medical Sciences. 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 University, School of Medical Sciences. Örebro University Hospital. 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 University, School of Medical Sciences. Department of Cardiology.
    VEgetaRian Diet in patients with Ischemic heart disease (VERDI): an open-label, randomized, prospective, cross-over study2019In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 40, no Suppl. 1, p. 3819-3819Article in journal (Other academic)
    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.

  • 13.
    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 University, Department of Nursing and Caring Sciences.
    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 failure1998In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 19, no 8, p. 1254-60Article in journal (Refereed)
    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.

  • 14.
    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 University, Department of Nursing and Caring Sciences.
    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 elderly1999In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 20, no 5, p. 393-4Article in journal (Refereed)
  • 15.
    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 study2011In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 32, no 19, p. 2430-7Article in journal (Refereed)
    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.

  • 16.
    Fröbert, Ole
    et al.
    Örebro University, School of Medical Sciences. Faculty of Health, Department of Cardiology, Örebro University, Örebro, Sweden; Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark; Department of Clinical Pharmacology, Aarhus University Hospital, Aarhus, Denmark; Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark.
    Cajander, Sara
    Örebro University, School of Medical Sciences. Department of Infectious Diseases, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Udell, Jacob A.
    Women's College Hospital and Peter Munk Cardiac Centre, Toronto General Hospital, University of Toronto, Toronto, Canada.
    The ideal vaccine to prevent cardiovascular disease2023In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 44, no 7, p. 621-623Article in journal (Other academic)
  • 17.
    Gudmundsson, T.
    et al.
    Sahlgrenska University Hospital, Gothenburg, Sweden.
    Redfors, B.
    Sahlgrenska University Hospital, Gothenburg, Sweden.
    Angeras, O.
    Sahlgrenska University Hospital, Gothenburg, Sweden.
    Petursson, P.
    Sahlgrenska University Hospital, Gothenburg, Sweden.
    Rawshani, A.
    Sahlgrenska University Hospital, Gothenburg, Sweden.
    Fröbert, Ole
    Örebro University, School of Medical Sciences. Deptartment of Cardiology.
    Alfredsson, J.
    Linköping University Hospital, Linköping, Sweden.
    Henareh, L.
    Karolinska University Hospital, Stockholm, Sweden.
    Skoglund, K.
    Sahlgrenska University Hospital, Gothenburg, Sweden.
    Ljungman, C.
    Sahlgrenska University Hospital, Gothenburg, Sweden.
    Jernberg, T.
    Danderyd University Hospital, Stockholm, Sweden.
    Erlinge, D.
    Skåne University Hospital, Lund, Sweden.
    Omerovic, E.
    Sahlgrenska University Hospital, Gothenburg, Sweden.
    Importance of hospital and clinical factors in predicting of 30-day mortality in Takotsubo syndrome: data from the Swedish Coronary Angiography and Angioplasty Registry2023In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 44, no Suppl. 2, article id ehad655.1566Article in journal (Other academic)
    Abstract [en]

    Background: Takotsubo syndrome (TS) is an acute heart failure condition that presents with symptoms similar to acute myocardial infarction. TS is often triggered by emotional or physical stress and is an important cause of morbidity and mortality but predictors of mortality in TS patients are not well understood. There is a need to identify high-risk patients and tailor treatment accordingly.

    Purpose: The purpose of this study was to assess the importance of various clinical factors in predicting 30-day mortality in TS patients using a machine-learning algorithm capable of identifying complex relationships between variables.

    Methods: We analyzed data from the nationwide Swedish Coronary Angiography and Angioplasty Registry for all TS patients between 2015-2022. Gradient boosting was used to assess the relative importance of variables in predicting 30-day mortality in TS patients.

    Results: Of the 3,180 hospitalized TS patients, 76% were women. The average age was 68.3 ± 11.2 years. The crude all-cause mortality rate was 2.57% at 30 days. The most important variable in predicting 30-day mortality was the hospital where the patient was treated, with a relative importance of 35.5%. This was followed by the clinical presentation for angiography (21.1%), creatinine level (11.9%), Killip class (8.9%), and age at angioplasty (6.5%). Other less important factors included weight, height, and certain medical conditions such as hyperlipidemia, smoking status, and hypertension. Gender and previous stroke history had a low impact on 30-day mortality in TS patients.

    Conclusions: The treating hospital was the most important factor in predicting 30-day mortality in TS. Since the level of evidence for recommended treatments of TS is low, our findings highlight the importance of conducting randomized studies in this patient group to improve care.

  • 18.
    Gudmundsson, T.
    et al.
    Sahlgrenska University Hospital, Gothenburg, Sweden.
    Redfors, B.
    Sahlgrenska University Hospital, Gothenburg, Sweden.
    Ramunddal, T.
    Sahlgrenska University Hospital, Gothenburg, Sweden.
    Rawshani, A.
    Sahlgrenska University Hospital, Gothenburg, Sweden.
    Petursson, P.
    Sahlgrenska University Hospital, Gothenburg, Sweden.
    Fischer, A. R.
    Sahlgrenska University Hospital, Gothenburg, Sweden.
    Erlinge, D.
    Skane Univ Hosp, Lund, Sweden..
    Alfredsson, J.
    Linkoping Univ Hosp, Linkoping, Sweden..
    Mohamman, M. A.
    Lund Univ, Lund, Sweden..
    Angerås, O.
    Sahlgrenska University Hospital, Gothenburg, Sweden.
    Fröbert, Ole
    Örebro University, School of Medical Sciences. Örebro University Hospital, Örebro, Sweden.
    James, S.
    Uppsala University Hospital, Uppsala, Sweden.
    Jernberg, T.
    Danderyd University Hospital, Stockholm, Sweden.
    Omerovic, E.
    Sahlgrenska University Hospital, Gothenburg, Sweden.
    Does the quality index of adherence to the evidence-based guidelines predict mortality in patients with myocardial infarction?2022In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 43, no Suppl. 2, p. 2282-2282Article in journal (Other academic)
    Abstract [en]

    Background: The SWEDEHEART quality index of hospitals’ adherence to the evidence-based (EB) guidelines for myocardial infarction (MI) patients has been continuously used for several decades in Sweden. The grading protocol is based on the consensus among hospitals. The hospitals are awarded points (0, 0.5, 1) for each of the 11 indicators depending on the proportion of patients who received EB treatment and achieved treatment goals. The 11 indicators at present are reperfusion treatment in STEMI (yes/no), time to-reperfusion treatment in STEMI, time to revascularisation in NSTEMI, P2Y12 antagonists at discharge, ACE-inhibitor/ARB at discharge, the proportion of patients at follow-up, smoking cessation at one-year, participation in a physical exercise program, target LDL-cholesteroland target blood pressure at one year.

    Purpose: To evaluate whether the SWEDEHEART quality index predicts mortality in patients with MI.

    Methods: We used data for all MI patients reported to the SWEDEHEAR Tregistry from 72 hospitals in Sweden between 2015–2021. We calculated the difference in quality index between 2021 and 2015. The hospitals were divided into quintiles based on the difference in the score. Logistic regression with log-time offset was used to adjust for confounders (age, gender, diabetes, hypertension, hyperlipidemia, STEMI/NSTEMI, cardiac arrest before admission, occupation status, history of heart failure, prior MI, prior PCI, prior CABG, cardiogenic shock).

    Results: We identified 98,635 patients with MI, 32,608 (33.1%) were women and 34,198 (34.7%) had STEMI. The average age was 70.8±12.2 years. The median follow-up time was 2.7 years (IQR 1.06–4.63). The crude all-cause mortality rate was 5.5% at 30-days and 22.3% after long-term follow-up. Most hospitals (72.1%) improved their quality index on average by 3.4% per year (P<0.001). The increase in the quality index continued during COVID-19 pandemic (2020–2021) with average increase of 8.6%, 95% CI, 0.97–1.02; P<0.001. The median change in SWEDE-HEART quality index score among the quintiles were −1.5 (Q1), 0,5 (Q2), 2,5 (Q3), 3 (Q4), and 4 (Q5). We found no difference in mortality between the quintiles at 30-days (OR 0.99; 95% CI 0.97–1.02; p=1.02) and long-term (OR 1.01; 95% CI 0,99–1.02; p=0.850).

    Conclusion: The SWEDEHEART quality index provides valuable descriptive information about hospitals’ adherence to the guidelines. However, the index, in its current form, does not predict mortality in patients with MI.

  • 19.
    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 study2016In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 37, no 2, p. 189-197Article in journal (Refereed)
    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

  • 20.
    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 University, School of Medical Sciences. Örebro University Hospital. 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 outcomes2019In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 40, no 10, p. 820-830Article in journal (Refereed)
    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.

  • 21.
    Jackson, A.
    et al.
    Department of Cardiology, Örebro University Hospital, Örebro, Sweden.
    Fröbert, Ole
    Örebro University Hospital. Örebro University, School of Medical Sciences. Department of Cardiology.
    Larsen, D. Boye
    Aalborg University, Center for Neuroplasticity and Pain (CNAP), SMI, Faculty of Medicine, Aalborg, Denmark.
    Arendt-Nielsen, L.
    Aalborg University, Center for Neuroplasticity and Pain (CNAP), SMI, Faculty of Medicine, Aalborg, Denmark.
    Björkenheim, Anna
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Cardiology.
    Patients with symptomatic permanent atrial fibrillation show quantitative signs of pain sensitisation2021In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 42, no Suppl. 1, p. 416-416Article in journal (Other academic)
    Abstract [en]

    Background/Introduction: Most patients with atrial fibrillation (AF) report symptoms, while around one-third are asymptomatic. We hypothesized that sensory processing, in particular pain, differs in patients with symptomatic and asymptomatic AF.

    Purpose: To assess differences in pain sensitisation in patients with symptomatic and asymptomatic AF.

    Methods: Thirty individuals with permanent AF (15 symptomatic, 15 asymptomatic) completed the AF6 and SF-36 questionnaires and underwent quantitative pain sensitisation testing using pressure algometry at the sternum (referred pain area) and the tibialis anterior muscle (generalized pain area). The primary objective was to assess differences in pressure pain thresholds (PPT), temporal summation of pain (TSP), and conditioned pain modulation (CPM) in the two groups. The secondary objective was to determine association of demographic and clinical parameters to quantitative measures of pain sensitisation.

    Results: The symptomatic group had lower PPTs at both tibialis (p=0.004) and sternum (p=0.01), as well as impaired CPM (p=0.025) and facilitated TSP (p=0.008) at the tibialis but not sternum, compared to the asymptomatic group. The AF6 sum score was negatively correlated to PPT on both tibialis (r=−0.50, p=0.005) and sternum (r=−0.42, p=0.02) and positively correlated to TSP of both tibialis (r=0.57, p=0.001) and sternum (r=0.45, p=0.01), but not to CPM. The physical component summary score was positively correlated to the PPT on both tibialis (r=0.52, p=0.003) and sternum (r=0.40, p=0.03) and negatively to TSP on the tibialis (r=−0.53, p=0.003) but not sternum.

    Conclusions: Patients with symptomatic AF exhibit lower pain tolerance than patients with asymptomatic AF, as well as impaired pain inhibitory control and facilitated summation of pain, indicating that pain sensitisation may be of importance in symptomatic AF.

  • 22.
    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 cardiomyopathy2012In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 33, no suppl 1, p. 801-801Article in journal (Other academic)
  • 23.
    Leosdottir, M.
    et al.
    Skåne University Hospital, Dept of Cardiology, Malmö, Sweden.
    Warjerstam, S.
    Skåne University Hospital, Dept of Cardiology, Malmö, Sweden.
    Michelsen, H. Ogmundsdottir
    Hospital of Helsingborg, Dept of Internal Medicine, Helsingborg, Sweden.
    Schlyter, M.
    Skåne University Hospital, Dept of Cardiology, Malmö, Sweden.
    Hag, E.
    Ryhov County Hospital, Dept of Internal Medicine, Jonkoping, Sweden.
    Wallert, J.
    Karolinska Institute, Dept of Clinical Neuroscience, Stockholm, Sweden.
    Larsson, Matz
    Örebro University, School of Medical Sciences. Örebro University Hospital. The Heart, Lung and Physiology Clinic.
    Improving smoking cessation after myocardial infarction by systematically implementing evidence-based treatment methods: a prospective observational cohort study2021In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 42, no Suppl. 1, p. 1409-1409Article in journal (Other academic)
    Abstract [en]

    Background: For smokers who suffer a myocardial infarction (MI), smoking cessation is the most effective measure to reduce recurrent event risk. Still, evidence-based treatment methods for aiding smoking cessation post-MI are underused.

    Purpose: To compare the odds of smoking cessation at two-months post-MI before and after implementing a set of pre-specified routines for optimization of evidence-based treatment methods for smoking cessation, with start during admission.

    Methods: Structured routines for early smoking cessation counselling and treatment optimization were implemented at six cardiac rehabilitation (CR) centres in Sweden. The routines included CR nurses providing current smokers hospitalized for acute MI with short consultation, written material, and optimal dosage of nicotine replacement therapy during admission, increasing early prescription of varenicline for eligible patients, and contacting the patients by telephone 3–5 days after discharge, after which usual care CR follow-up commenced. Centres were also encouraged to strive for continuity in nurse-patient care. Patient data was retrieved from the SWEDEHEART registry and medical records. Using logistic regression, we compared the odds for smoking cessation at two-months post-MI for currently smoking patients admitted with MI (a) before (n=188, median age 60 years, 23% females) and (b) after (n=195, median age 60 years, 29% females) routine implementation. Secondary outcomes included adherence to implemented routines and the association of each routine with smoking cessation odds at two-months.

    Results: In total, 159 (85%) and 179 (92%) of enrolled patients attended the two-month CR follow-up, before and after implementation of the new routines. After implementation, a significantly larger proportion of patients (65% vs 54%) were abstinent from smoking at two-months (crude OR 1.60 [1.04–2.48], p=0.034) (Figure 1). Including only those counselled during admission (n=89), 74% (vs 54%) were abstinent at two-months (crude OR 2.50 [1.42–4.41], p=0.002). After the new routine implementation patients were counselled more frequently during admission (50% vs 6%, p<0.001), prescribed varenicline at discharge or during follow-up (23% vs 7%, p<0.001), and contacted by telephone during the first week post-discharge (18% vs 2%, p<0.001), compared to before implementation. Crude and adjusted associations between each routine and smoking cessation at two-months are shown in Table 1. Entering all routines into the regression model simultaneously, being prescribed varenicline before discharge or during follow-up had the strongest independent association with smoking abstinence at two-months (adjusted OR 4.09 [1.68–10.00], p=0.002).

    Conclusion: Our results support that readily available methods for aiding smoking cessation can be implemented effectively in routine practice, with possible beneficial effects on smoking cessation for the high-risk group of smoking MI patients.

  • 24.
    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 University, School of Health and Medical Sciences.
    Jansson, J. H.
    Dept Publ Hlth & Clin Med, Umeå Univ, Umeå, Sweden.
    Von willebrand factor predicts major bleeding and mortality during oral anticoagulant treatment2010In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 31, p. 978-978Article in journal (Refereed)
  • 25.
    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 University, School of Medical Sciences. 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 Collaboration2018In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 39, no 26, p. 2472-2479Article in journal (Refereed)
    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.

  • 26.
    Nordenskjöld, Anna M.
    et al.
    Örebro University, School of Medical Sciences. Örebro University Hospital.
    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 angiography2018In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 39, no Suppl. 1, p. 1256-1256Article in journal (Other academic)
  • 27.
    Omerovic, E.
    et al.
    Sahlgrenska University Hospital, Gothenburg, Sweden.
    Gudmundsson, T.
    Sahlgrenska University Hospital, Gothenburg, Sweden.
    Redfors, B.
    Sahlgrenska University Hospital, Gothenburg, Sweden.
    Angeras, O.
    Sahlgrenska University Hospital, Gothenburg, Sweden.
    Petursson, P.
    Sahlgrenska University Hospital, Gothenburg, Sweden.
    Rawshani, A.
    Sahlgrenska University Hospital, Gothenburg, Sweden.
    Fröbert, Ole
    Örebro University, School of Medical Sciences. Department of Cardiology.
    Alfredsson, J.
    Linköping University Hospital, Linköping, Sweden.
    Ekenbeck, C.
    Danderyd University Hospital, Dept of Cardiology, Stockholm, Sweden.
    Henareh, L.
    Karolinska University Hospital, Dept of Cardiology, Stockholm, Sweden.
    Skoglund, K.
    Sahlgrenska University Hospital, Gothenburg, Sweden.
    Ljungman, C.
    Sahlgrenska University Hospital, Gothenburg, Sweden.
    Mohammad, M.
    Skåne University Hospital, Lund, Sweden.
    Jernberg, T.
    Danderyd University Hospital, Dept of Cardiology, Stockholm, Sweden.
    Erlinge, D.
    Skåne University Hospital, Lund, Sweden.
    Impact of COVID-19 pandemics on the incidence and mortality in Takotsubo syndrome: a report from Swedish Coronary Angiography and Angioplasty Registry2023In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 44, no Suppl. 2Article in journal (Other academic)
    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.

  • 28.
    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 subjects2019In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 40, no Supplement_1, article id ehz748.0548Article in journal (Refereed)
    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.

  • 29.
    Sharma, T.
    et al.
    Lund University, Lund, Sweden.
    Maehara, A.
    Columbia University Medical Center, New York, United States of America.
    Ben-Yehuda, O.
    Cardiovascular Research Foundation, New York, United States of America.
    Maeng, M.
    Aarhus University Hospital, Aarhus, Denmark.
    Kjoller-Hansen, L.
    Aarhus University Hospital, Aarhus, Denmark.
    Engström, T.
    University of Copenhagen, Copenhagen, Denmark.
    Matsumura, M.
    Cardiovascular Research Foundation, New York, United States of America.
    Fröbert, Ole
    Örebro University, School of Medical Sciences.
    Persson, J.
    Danderyd University Hospital, Stockholm, Sweden.
    Wiseth, R.
    St Olavs Hospital, Trondheim, Norway.
    Larsen, A. I.
    Stavanger University Hospital, Stavanger, Norway.
    James, S. K.
    Uppsala University Hospital, Uppsala, Sweden; Uppsala Clinical Research Center, Uppsala, Sweden.
    All, Z. A.
    Columbia University Medical Center, New York, United States of America.
    Stone, G. W.
    The Zena and Michael A. Wiener Cardiovascular Institute, New York, United States of America.
    Erlinge, D.
    Lund University, Lund, Sweden.
    Biomarkers associated with vulnerable plaques2022In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 43, no Suppl. 2, p. 1292-1292Article in journal (Other academic)
    Abstract [en]

    Background: Cardiovascular heart disease is the leading cause of mortality worldwide, with the rupture or thrombosis of an atherosclerotic plaque being the main reason behind an acute coronary syndrome. It has already been established that the morphology of atherosclerotic plaques determine their stability. A lipid rich lesion with a thin fibrous cap is more prone to rupture compared to solid fibrous lesions. In the PROSPECTII study we used Near infrared spectroscopy (NIRS) and Intravascular ultrasound (IVUS) to identify atherosclerotic plaques in the coronary arteries; NIRS-derived lipid core burden index (LCBI) and IVUS-derived plaque burden (PB) identified plaques that caused adverse cardiovascular events.

    Purpose: Our aim is to find biomarkers associated with LCBI or PB, to understand the development of vulnerable plaques.

    Methods: 902 patients were enrolled in this study after successful percutaneous coronary intervention (PCI). A combined NIRS-IVUS catheter was then used to analyze approximately 200m of coronary arteries. Blood samples for biomarker analysis were taken before the PCI procedure and plasma levels of 182 proteins associated with cardiovascular disease were assessed using a novel method for measuring proximity extension assay. Adjusted linear regression models were calculated between the biomarkers and the outcomes of interest, followed by a false discovery rate (FDR) correction.

    Results: We found 24 proteins associated with plaque burden and 28 proteins associated with LCBI after using a cut off of two tailed P value <0.05. An overlap of 8 biomarkers could be seen between the two groups. After adjusting the P values with FDR, Angiopoeitin like 3 (ANGPTL3) retain edits association to LCBI, and Interleukin 18 receptor 1 (IL18R1) and colony stimulating factor 1 (CSF-1) to plaque burden.

    Conclusion: We were able to identify different biomarker patterns associated with plaque burden compared to lipid rich vulnerable plaques. ANGPTL3 was shown to only have an association with lipid rich plaques and not with solid fibrous lesions which further supports its role in vulnerable plaques.

  • 30.
    Sztaniszlav, Aron
    et al.
    Örebro University, School of Medical Sciences.
    Magnuson, A.
    Örebro University, Örebro, Sweden.
    Bryngelsson, I. L.
    Örebro University Hospital, Örebro, Sweden.
    Edvardsson, N.
    Sahlgrenska Academy, Gothenburg, Sweden.
    Sztaniszlav, K.
    Örebro University Hospital, Örebro, Sweden.
    Poçi, Dritan
    Örebro University, School of Medical Sciences.
    Trends in all-cause mortality of atrial fibrillation in hospitalized patients in Sweden between 1995-20082021In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 42, no Suppl. 1, p. 296-296Article in journal (Other academic)
    Abstract [en]

    Introduction: Atrial fibrillation (AF) is the most common arrythmia. Both its incidence and prevalence increased significantly during the last decades. AF is associated with high morbidity and mortality.

    Purpose: The aim of this study was to describe and evaluate the trends of all-cause mortality in patients first-ever hospitalized for AF, and the effect of age, sex, stroke risk, and education level on mortality over time.

    Methods: In this observational retrospective cohort study, we enrolled the patients who were hospitalized primarily and for the first time because of AF between 1st January 1995 and 31st December 2004. In regard to the date of the index admission patients were divided into four cohorts and they were followed up to five years. Patients were compared with an age and sex matched control population. All data were collected from Swedish national registries. Kaplan-Meier plots and Cox regression with trend analysis were used for statistical evaluation.

    Results: In total 64 489 AF patients (mean age 72±10.1 year) were included in this study. The control group comprised 116 893 individuals. 81.9% of the women and 58.5% of the men were older than 65 years of age. 65.5% of women and 58.5% of the men had a stroke risk of CHADS2-VA2Sc ≥2.

    We found a significantly decreasing trend of the relative risk for all-cause mortality in AF patients over time: trend HR: 0.94 (95% CI: 0.92–0.96, p<0.001) in women and trend HR: 0.91 (95% CI: 0.89–0.93 p<0.001) in men. The mortality trends between AF patients and their controls did not show significant difference: trend HR: 0.99 (95% CI: 0.96–1.02, p=0.59) in women and trend HR: 1.00 (95% CI: 0.97–1.03, p=0.98) in men. The subpopulation analysis showed that the mortality risk remained unchanged over the time in women aged 18–69 years (trend HR: 0.91 – 95% CI: 0.82–1.02, p=0.099), in patients with low stroke risk (trend HR: 1.08 – 95% CI: 0.92–1.26, p=0.36 in women and trend HR: 0.95 – 95% CI: 0.87–1.05, p=0.30 in men) and in patients with post-secondary level of education (trend HR: 0.93 – 95% CI 0.83–1.04, p=0.23 in women and trend HR: 1.04 – 95% CI: 0.96–1.12, p=0.32 in men).

    Conclusion: The all-cause mortality risk of the AF hospitalized patients was higher compared to control population and had a decreasing tendency during the time of the study. However, this trend is not significantly different from the control population. We found unchanged mortality trend in younger patients, in those with lower stroke risk, and in patients with higher education level.

  • 31. Tabrizi, Fariborz
    et al.
    Englund, Anders
    Örebro University, School of Health and Medical Sciences.
    Rosenqvist, Mårten
    Wallentin, Lars
    Stenestrand, Ulf
    Influence of left bundle branch block on long-term mortality in a population with heart failure2007In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 28, no 20, p. 2449-2455Article in journal (Refereed)
    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.

  • 32.
    Venetsanos, D.
    et al.
    Karolinska University Hospital, Stockholm, Sweden.
    Erlinge, D.
    Skåne University Hospital, Lund, Sweden.
    Omerovic, E.
    Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Calais, Fredrik
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Cardiology.
    Angeras, O.
    Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Jensen, J.
    Karolinska Institute, Department of Cardiology, Capio St. Görans Hospital, Stockholm, Sweden.
    Henareh, L.
    Karolinska University Hospital, Stockholm, Sweden.
    Todt, T.
    Skåne University Hospital, Lund, Sweden.
    Gotberg, M.
    Skåne University Hospital, Lund, Sweden.
    Sarno, G.
    Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
    Aasa, M.
    Karolinska Institute, Department of Cardiology, Södersjukhuset AB, Stockholm, Sweden.
    Lagerqvist, B.
    Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
    James, S.
    Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
    Alfredsson, J.
    Linköping University Hospital, Cardiology,Linköping, Sweden.
    Utilization and outcomes of rotational atherectomy in Sweden2020In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 41, no Suppl. 2, p. 2528-2528Article in journal (Other academic)
    Abstract [en]

    Aim: To evaluate utilization and outcomes of rotational atherectomy (RA) using data from the Swedish Coronary and Angioplasty Registry (SCAAR).

    Methods: We included 1476 patients with 2218 lesions who underwent RA from 2005 to 2016. To study temporal changes, the study period was divided into three equal time-periods, period A, B and C.

    Results: Although the number of RA procedures increased 3-fold from 2005 to 2016, the rate of RA (of all PCI procedures) remained low (0.5% vs 1.2% in 2005 vs 2016). RA patients consisted a high-risk group, with advanced age and clustering of comorbidities. Over time, included patients were older and had a higher risk profile. Trans-radial access, drug eluting stent (DES) use and use of intravascular imaging significantly increased from period A to C whereas positioning of a temporary pacemaker or intra-aortic balloon pump declined. Unfractionated heparin became the main anticoagulant (52 vs 87%) and use of glycoprotein IIb/IIIa inhibitors declined (31 vs 12%, in period A vs C). Following RA, 11% of lesions were treated without stent (15 vs 15 vs 8%, in period A, B and C) (Rota-only). In lesions treated with a stent, a bare metal stent (BMS) was implanted in 39% vs 12% vs 2% and a new generation DES (N-DES) in 5 vs 75 vs 97% (period A vs B vs C) of lesions.

    The 3-year cumulative rate of restenosis was 6.7% (122 events), (11.1 vs 7.1 vs 4.1% in period A vs B vs C). As compared to DES, rota-only (adjusted HR 2.71; 95% CI 1.69- 4.36) and BMS (adjusted HR 3.63; 95% CI 2.27- 5.81) were associated with significantly higher risk for restenosis. First generation DES were associated with numerically higher but not significantly different risk for restenosis as compared to N-DES (adjusted HR 1.31; 95% CI 0.74- 2.31).

    The 3 year cumulative rate of major adverse cardiac events (MACE), including death, myocardial infarction (MI) or any restenosis was 30.6% (34.2 vs 31.4 vs 28.2%, in period A vs B vs C) and the corresponding numbers for all-cause mortality were 18.1% (18.9 vs 18.4 vs 17.0%). After adjustment for baseline characteristics and angiographic findings, RA in period A was associated with higher risk for MACE as compared to period C (adjusted HR 1.40; 95% CI 1.09- 1.79), due to higher risk for MI and restenosis. The difference disappeared when procedural characteristics, including DES use, were added to the model.

    The rate of major in-hospital complications was 7.0%, including in-hospital death 1.3%, periprocedural MI 2.8%, perforation 1.1%, cardiac tamponade 0.7%, stroke 0.2% and major bleedings 2.1%. We found no significant differences over time.

    Conclusion: During the studied period, RA remained a rare procedure, utilised in a highly selected population. Over time a declining rate of restenosis and MI after RA was observed, a finding that appeared to be mainly driven by an increased use of DES. The rate of major in-hospital complication remained low.

  • 33.
    Volz, S.
    et al.
    Sahlgrenska University Hospital, Gothenburg, Sweden.
    Redfors, B.
    Sahlgrenska University Hospital, Gothenburg, Sweden.
    Dworeck, C.
    Sahlgrenska University Hospital, Gothenburg, Sweden.
    Petursson, P.
    Sahlgrenska University Hospital, Gothenburg, Sweden.
    Gotberg, M.
    Skåne University Hospital, Lund, Sweden.
    Jernberg, T.
    Danderyd University Hospital, Stockholm,Sweden.
    Linder, R.
    Danderyd University Hospital, Stockholm,Sweden.
    Ramunddal, T.
    Sahlgrenska University Hospital, Gothenburg, Sweden.
    Fröbert, Ole
    Örebro University, School of Medical Sciences.
    Witt, N.
    South Hospital Stockholm, Stockholm, Sweden.
    James, S.
    Uppsala University Hospital, Uppsala, Sweden.
    Erlinge, D.
    Skåne University Hospital, Lund, Sweden.
    Omerovic, E.
    Sahlgrenska University Hospital, Gothenburg, Sweden.
    Long-term survival in patients with coronary artery disease undergoing percutaneous coronary intervention with or without intracoronary pressure wire guidance: a report from SCAAR2020In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 41, no Suppl. 2, p. 2507-2507Article in journal (Other academic)
    Abstract [en]

    Background: Intracoronary pressure wire measurements of fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR) provide decision-making guidance during percutaneous coronary intervention (PCI). However, limited data exist on the impact of FFR/iFR on long-term clinical outcomes in patients with stable angina, unstable angina (UA)/non-ST-segment elevation myocardial infarction (NSTEMI), or STEMI.

    Methods: We used data from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR) on all patients in Sweden undergoing PCI (with or without FFR/iFR guidance) for stable angina, UA/NSTEMI, or STEMI between January 2005 and March 2018. The primary endpoint was all-cause mortality and the secondary endpoints were stent thrombosis or restenosis and periprocedural complications. The primary model was multilevel Cox proportional-hazards regression using an instrumental variable (IV) to adjust for known and unknown confounders with treating hospital as a treatment-preference instrument. The following variables were entered into Cox proportional-hazards regression in addition to the IV: age, sex, diabetes, indication for PCI, severity of coronary disease, smoking status, hypertension, hyperlipidemia, previous myocardial infarction, previous PCI, previous coronary artery bypass graft, type of stent.

    Results: In total, 151,001 patients underwent PCI: 31,514 (20.9%) for stable angina, 74,982 (49.6%) for UA/NSTEMI, and 44,505 (29.5%) for STEMI. Of these, FFR/iFR guidance was used in 11,433 patients (7.6%): 5029 (44.0%) with stable angina, 5989 (52.4%) with UA/NSTEMI, and 415 (3.6%) with STEMI; iFR was used in 1156 (10.1%) of these patients. After a median follow-up of 1784 (range 1–4824) days, the FFR/iFR group had lower adjusted risk estimates for all-cause mortality [hazard ratio (HR) 0.79; 95% confidence interval (CI) 0.69–0.91; P=0.001] and stent thrombosis and restenosis (HR 0.13; 95% CI 0.09–0.19; P<0.001). The number of periprocedural complications did not differ significantly between the groups (odds ratio 0.69; 95% CI 0.30–1.55; P=0.368). There was no interaction between FFR/iFR and indication for PCI. We found no difference between FFR and iFR (HR 1.12; 95% CI 0.90–1.59; P=0.216).

    Conclusions: In this observational study, the use of FFR/IFR was associated with a lower risk of long-term mortality in patients undergoing PCI for stable angina, UA/NSTEMI, or STEMI. Our study supports the current European and American guidelines for the use of FFR/iFR during PCI and shows that intracoronary pressure wire guidance has prognostic benefit in patients with stable angina as well as in patients with the acute coronary syndrome.

  • 34.
    Völz, Sebastian
    et al.
    Department of Cardiology, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden; Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Redfors, Björn
    Department of Cardiology, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden; Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Angerås, Oskar
    Department of Cardiology, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden; Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Ioanes, Dan
    Department of Cardiology, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden; Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Odenstedt, Jacob
    Department of Cardiology, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden; Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Koul, Sasha
    Department of Cardiology, Skåne University Hospital, Lund, Sweden.
    Valeljung, Inger
    Department of Cardiology, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden; Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Dworeck, Christian
    Department of Cardiology, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden; Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Hofmann, Robin
    Division of Cardiology, Department of Clinical Science and Education, Karolinska Institute, Södersjukhuset, Stockholm, Sweden.
    Hansson, Emma
    Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Cardiothoracic Surgery, Sahlgrenska University Hospital and Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
    Venetsanos, Dimitrios
    Division of Cardiology, Department of Medicine, Karolinska Institute and Karolinska University Hospital, Karolinska Solna, Stockholm, Sweden.
    Ulvenstam, Anders
    Department of Cardiology, Östersund Hospital, Östersund, Sweden.
    Jernberg, Tomas
    Division of Cardiovascular Medicine, Department of Clinical Sciences, Karolinska Institute, Danderyd Hospital, Stockholm, Sweden.
    Råmunddal, Truls
    Department of Cardiology, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden; Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Pétursson, Pétur
    Department of Cardiology, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden; Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Fröbert, Ole
    Örebro University, School of Medical Sciences. Department of Cardiology.
    Erlinge, David
    Department of Cardiology, Skåne University Hospital, Lund, Sweden.
    Jeppsson, Anders
    Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Cardiothoracic Surgery, Sahlgrenska University Hospital and Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
    Omerovic, Elmir
    Department of Cardiology, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden; Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Long-term mortality in patients with ischaemic heart failure revascularized with coronary artery bypass grafting or percutaneous coronary intervention: insights from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR)2021In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 42, no 27, p. 2657-2664Article in journal (Refereed)
    Abstract [en]

    AIMS: To compare coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) for treatment of patients with heart failure due to ischaemic heart disease.

    METHODS AND RESULTS: We analysed all-cause mortality following CABG or PCI in patients with heart failure with reduced ejection fraction and multivessel disease (coronary artery stenosis >50% in ≥2 vessels or left main) who underwent coronary angiography between 2000 and 2018 in Sweden. We used a propensity score-adjusted logistic and Cox proportional-hazards regressions and instrumental variable model to adjust for known and unknown confounders. Multilevel modelling was used to adjust for the clustering of observations in a hierarchical database. In total, 2509 patients (82.9% men) were included; 35.8% had diabetes and 34.7% had a previous myocardial infarction. The mean age was 68.1 ± 9.4 years (47.8% were >70 years old), and 64.9% had three-vessel or left main disease. Primary designated therapy was PCI in 56.2% and CABG in 43.8%. Median follow-up time was 3.9 years (range 1 day to 10 years). There were 1010 deaths. Risk of death was lower after CABG than after PCI [odds ratio (OR) 0.62; 95% confidence interval (CI) 0.41-0.96; P = 0.031]. The risk of death increased linearly with quintiles of hospitals in which PCI was the preferred method for revascularization (OR 1.27, 95% CI 1.17-1.38, Ptrend < 0.001).

    CONCLUSION: In patients with ischaemic heart failure, long-term survival was greater after CABG than after PCI.

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