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Alfredsson, Joakim
Publications (10 of 50) Show all publications
Venetsanos, D., Sederholm Lawesson, S., Fröbert, O., Omerovic, E., Henareh, L., Robertsson, L., . . . Swahn, E. (2018). Sex-related response to bivalirudin and unfractionated heparin in patients with acute myocardial infarction undergoing percutaneous coronary intervention: A subgroup analysis of the VALIDATE-SWEDEHEART trial. European Heart Journal. Acute Cardiovascular Care
Open this publication in new window or tab >>Sex-related response to bivalirudin and unfractionated heparin in patients with acute myocardial infarction undergoing percutaneous coronary intervention: A subgroup analysis of the VALIDATE-SWEDEHEART trial
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2018 (English)In: European Heart Journal. Acute Cardiovascular Care, ISSN 2048-8734Article in journal (Refereed) Epub ahead of print
Abstract [en]

Aims:

Our aim was to study the impact of sex on anticoagulant treatment outcomes during percutaneous coronary intervention in acute myocardial infarction patients.

Methods:

This study was a prespecified analysis of the Bivalirudin versus Heparin in ST-Segment and Non ST-Segment Elevation Myocardial Infarction in Patients on Modern Antiplatelet Therapy in the Swedish Web System for Enhancement and Development of Evidence-based Care in Heart Disease Evaluated according to Recommended Therapies Registry Trial (VALIDATE-SWEDEHEART) trial, in which patients with myocardial infarction were randomised to bivalirudin or unfractionated heparin during percutaneous coronary intervention. The primary outcome was the composite of death, myocardial infarction or major bleeding at 180 days.

Results:

There was a lower risk of the primary outcome in women assigned to bivalirudin than to unfractionated heparin (13.6% vs 17.1%, hazard ratio 0.78, 95% confidence interval (0.60–1.00)) with no significant difference in men (11.8% vs 11.2%, hazard ratio 1.06 (0.89–1.26), p for interaction 0.05). The observed difference was primarily due to lower risk of major bleeding (Bleeding Academic Research Consortium definition 2, 3 or 5) associated with bivalirudin in women (8.9% vs 11.8%, hazard ratio 0.74 (0.54–1.01)) but not in men (8.5% vs 7.3%, hazard ratio 1.16 (0.94–1.43) in men, pfor interaction 0.02). Conversely, no significant difference in the risk of Bleeding Academic Research Consortium 3 or 5 bleeding, associated with bivalirudin, was found in women 4.5% vs 5.4% (hazard ratio 0.84 (0.54–1.31)) or men 2.9% vs 2.1% (hazard ratio 1.36 (0.93–1.99)). Bleeding Academic Research Consortium 2 bleeding occurred significantly less often in women assigned to bivalirudin than to unfractionated heparin. The risk of death or myocardial infarction did not significantly differ between randomised treatments in men or women.

Conclusion:

In women, bivalirudin was associated with a lower risk of adverse outcomes, compared to unfractionated heparin, primarily due to a significant reduction in Bleeding Academic Research Consortium 2 bleeds.

Place, publisher, year, edition, pages
Sage Publications, 2018
Keywords
Gendersex; bivalirudin; heparin, myocardial infarction; percutaneous coronary intervention
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:liu:diva-155803 (URN)10.1177/2048872618803760 (DOI)30351167 (PubMedID)
Available from: 2019-03-28 Created: 2019-03-28 Last updated: 2019-04-02Bibliographically approved
Lindholm, D., Alfredsson, J., Angerås, O., Böhm, F., Calais, F., Koul, S., . . . Varenhorst, C. (2017). Timing of percutaneous coronary intervention in patients with non-ST-elevation myocardial infarction: a SWEDEHEART study. European Heart Journal - Quality of Care and Clinical Outcomes, 3(1), 53-60
Open this publication in new window or tab >>Timing of percutaneous coronary intervention in patients with non-ST-elevation myocardial infarction: a SWEDEHEART study
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2017 (English)In: European Heart Journal - Quality of Care and Clinical Outcomes, ISSN 2058-5225, E-ISSN 2058-1742, Vol. 3, no 1, p. 53-60Article in journal (Refereed) Published
Abstract [en]

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

Place, publisher, year, edition, pages
Oxford University Press, 2017
Keywords
NSTEMI; Percutaneous coronary intervention
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:liu:diva-145039 (URN)10.1093/ehjqcco/qcw044 (DOI)28927193 (PubMedID)
Available from: 2018-02-08 Created: 2018-02-08 Last updated: 2018-02-08
Panayi, G., Wieringa, W. G., Alfredsson, J., Carlsson, J., Karlsson, J.-E., Persson, A., . . . Swahn, E. (2016). Computed tomography coronary angiography in patients with acute myocardial infarction and normal invasive coronary angiography. BMC Cardiovascular Disorders, 16(78)
Open this publication in new window or tab >>Computed tomography coronary angiography in patients with acute myocardial infarction and normal invasive coronary angiography
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2016 (English)In: BMC Cardiovascular Disorders, ISSN 1471-2261, E-ISSN 1471-2261, Vol. 16, no 78Article in journal (Refereed) Published
Abstract [en]

Background: Three to five percent of patients with acute myocardial infarction (AMI) have normal coronary arteries on invasive coronary angiography (ICA). The aim of this study was to assess the presence and characteristics of atherosclerotic plaques on computed tomography coronary angiography (CTCA) and describe the clinical characteristics of this group of patients. Methods: This was a multicentre, prospective, descriptive study on CTCA evaluation in thirty patients fulfilling criteria for AMI and without visible coronary plaques on ICA. CTCA evaluation was performed head to head in consensus by two experienced observers blinded to baseline patient characteristics and ICA results. Analysis of plaque characteristics and plaque effect on the arterial lumen was performed. Coronary segments were visually scored for the presence of plaque. Seventeen segments were differentiated, according to a modified American Heart Association classification. Echocardiography performed according to routine during the initial hospitalisation was retrieved for analysis of wall motion abnormalities and left ventricular systolic function in most patients. Results: Twenty-five patients presented with non ST-elevation myocardial infarction (NSTEMI) and five with ST-elevation myocardial infarction (STEMI). Mean age was 60.2 years and 23/30 were women. The prevalence of risk factors of coronary artery disease (CAD) was low. In total, 452 coronary segments were analysed. Eighty percent (24/30) had completely normal coronary arteries and twenty percent (6/30) had coronary atherosclerosis on CTCA. In patients with atherosclerotic plaques, the median number of segments with plaque per patient was one. Echocardiography was normal in 4/22 patients based on normal global longitudinal strain (GLS) and normal wall motion score index (WMSI); 4/22 patients had normal GLS with pathological WMSI; 3/22 patients had pathological GLS and normal WMSI; 11/22 patients had pathological GLS and WMSI and among them we could identify 5 patients with a Takotsubo pattern on echo. Conclusions: Despite a diagnosis of AMI, 80 % of patients with normal ICA showed no coronary plaques on CTCA. The remaining 20 % had only minimal non-obstructive atherosclerosis. Patients fulfilling clinical criteria for AMI but with completely normal ICA need further evaluation, suggestively with magnetic resonance imaging (MRI).

Place, publisher, year, edition, pages
BIOMED CENTRAL LTD, 2016
Keywords
Acute myocardial infarction; Normal coronary arteries; Computed tomography coronary angiography; MINCA
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:liu:diva-129496 (URN)10.1186/s12872-016-0254-y (DOI)000376723200001 ()27142217 (PubMedID)
Note

Funding Agencies|Swedish Heart and Lung Foundation [20120449]; Region of Ostergotland [437491]; European Union FP 7 [223615]; Medical Research Council of Southeast Sweden [157921]

Available from: 2016-06-20 Created: 2016-06-20 Last updated: 2018-03-23
Alfredsson, J., Stebbins, A., Brennan, J. M., Matsouaka, R., Afilalo, J., Peterson, E. D., . . . Alexander, K. P. (2016). Gait Speed Predicts 30-Day Mortality After Transcatheter Aortic Valve Replacement Results From the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry. Circulation, 133(14), 1351-1359
Open this publication in new window or tab >>Gait Speed Predicts 30-Day Mortality After Transcatheter Aortic Valve Replacement Results From the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry
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2016 (English)In: Circulation, ISSN 0009-7322, E-ISSN 1524-4539, Vol. 133, no 14, p. 1351-1359Article in journal (Refereed) Published
Abstract [en]

Background Surgical risk scores do not include frailty assessments (eg, gait speed), which are of particular importance for patients with severe aortic stenosis considering transcatheter aortic valve replacement. Methods and Results We assessed the association of 5-m gait speed with outcomes in a cohort of 8039 patients who underwent transcatheter aortic valve replacement (November 2011-June 2014) and were included in the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry. We evaluated the association between continuous and categorical gait speed and 30-day all-cause mortality before and after adjustment for Society of Thoracic Surgeons-predicted risk of mortality score and key variables. Secondary outcomes included in-hospital mortality, bleeding, acute kidney injury, and stroke. The overall median gait speed was 0.63 m/s (25th-75th percentile, 0.47-0.79 m/s), with the slowest walkers (<0.5 m/s) constituting 28%, slow walkers (0.5-0.83 m/s) making up 48%, and normal walkers (>0.83 m/s) constituting 24% of the population. Thirty-day all-cause mortality rates were 8.4%, 6.6%, and 5.4% for the slowest, slow, and normal walkers, respectively (P<0.001). Each 0.2-m/s decrease in gait speed corresponded to an 11% increase in 30-day mortality (adjusted odds ratio, 1.11; 95% confidence interval, 1.01-1.22). The slowest walkers had 35% higher 30-day mortality than normal walkers (adjusted odds ratio, 1.35; 95% confidence interval, 1.01-1.80), significantly longer hospital stays, and a lower probability of being discharged to home. Conclusions Gait speed is independently associated with 30-day mortality after transcatheter aortic valve replacement. Identification of frail patients with the slowest gait speeds facilitates preprocedural evaluation and anticipation of a higher level of postprocedural care. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT01737528.

Place, publisher, year, edition, pages
LIPPINCOTT WILLIAMS & WILKINS, 2016
Keywords
aged; aortic valve stenosis; heart valve diseases; transcatheter aortic valve replacement
National Category
Health Sciences
Identifiers
urn:nbn:se:liu:diva-127553 (URN)10.1161/CIRCULATIONAHA.115.020279 (DOI)000373294700004 ()26920495 (PubMedID)
Note

Funding Agencies|STS/ACC TVT Registry

Available from: 2016-05-04 Created: 2016-05-03 Last updated: 2017-04-25
Holm, A., Sederholm-Lawesson, S., Swahn, E. & Alfredsson, J. (2016). Gender difference in prognostic impact of in-hospital bleeding after myocardial infarction - data from the SWEDEHEART registry.. European heart journal. Acute cardiovascular care, 6, 463-472
Open this publication in new window or tab >>Gender difference in prognostic impact of in-hospital bleeding after myocardial infarction - data from the SWEDEHEART registry.
2016 (English)In: European heart journal. Acute cardiovascular care, ISSN 2048-8734, Vol. 6, p. 463-472Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Bleeding complications increase mortality in myocardial infarction patients. Potential gender difference in bleeding regarding prevalence and prognostic impact is still controversial.

OBJECTIVES: Gender comparison regarding incidence and prognostic impact of bleeding in patients hospitalised with myocardial infarction during 2006-2008.

METHODS: Observational study from the SWEDEHEART register. Outcomes were in-hospital bleedings, in-hospital mortality and one-year mortality in hospital survivors.

RESULTS: A total number of 50,399 myocardial infarction patients were included, 36.6% women. In-hospital bleedings were more common in women (1.9% vs. 3.1%, p<0.001) even after multivariable adjustment (odds ratio (OR) 1.17, 95% confidence interval (CI) 1.01-1.37). The increased risk for women was found in ST-elevation myocardial infarction (OR 1.46, 95% CI 1.10-1.94) and in those who underwent percutaneous coronary intervention (OR 1.80, 95% CI 1.45-2.24). In contrast the risk was lower in medically treated women (OR 0.79, 95% CI 0.62-1.00). After adjustment, in-hospital bleeding was associated with higher risk of one-year mortality in men (OR 1.35, 95% CI 1.04-1.74), whereas this was not the case in women (OR 0.97, 95% CI 0.72-1.31).

CONCLUSIONS: Female gender is an independent risk factor of in-hospital bleeding after myocardial infarction. A higher bleeding risk in women appeared to be restricted to invasively treated patients and ST-elevation myocardial infarction patients. Even though women have higher short- and long-term mortality, there was no difference between the genders among bleeders. After multivariable adjustment the prognostic impact of bleeding complications was higher in men.

Place, publisher, year, edition, pages
Sage Publications, 2016
Keywords
Myocardial infarction; bleeding; gender; prognosis
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:liu:diva-124287 (URN)10.1177/2048872615610884 (DOI)000385817800008 ()26450782 (PubMedID)
Available from: 2016-01-25 Created: 2016-01-25 Last updated: 2019-01-10
Alfredsson, J. & Alexander, K. P. (2016). Multiple Chronic Conditions in Older Adults with Acute Coronary Syndromes. Clinics in Geriatric Medicine, 32(2), 291-+
Open this publication in new window or tab >>Multiple Chronic Conditions in Older Adults with Acute Coronary Syndromes
2016 (English)In: Clinics in Geriatric Medicine, ISSN 0749-0690, E-ISSN 1879-8853, Vol. 32, no 2, p. 291-+Article in journal (Refereed) Published
Abstract [en]

Older adults presenting with acute coronary syndromes (ACSs) often have multiple chronic conditions (MCCs). In addition to traditional cardiovascular (CV) risk factors (ie, hypertension, hyperlipidemia, and diabetes), common CV comorbidities include heart failure, stroke, and atrial fibrillation, whereas prevalent non-CV comorbidities include chronic kidney disease, anemia, depression, and chronic obstructive pulmonary disease. The presence of MCCs affects the presentation (eg, increased frequency of type 2 myocardial infarctions [MIs]), clinical course, and prognosis of ACS in older adults. In general, higher comorbidity burden increases mortality following MI, reduces utilization of ACS treatments, and increases the importance of developing individualized treatment plans.

Place, publisher, year, edition, pages
W B SAUNDERS CO-ELSEVIER INC, 2016
Keywords
Acute coronary syndrome; Myocardial infarction (MI); Older adults; Multiple chronic conditions; Type 2 MI
National Category
Pharmacology and Toxicology
Identifiers
urn:nbn:se:liu:diva-129169 (URN)10.1016/j.cger.2016.01.009 (DOI)000376212700007 ()27113147 (PubMedID)
Available from: 2016-06-13 Created: 2016-06-13 Last updated: 2018-01-10
Olsson, A., Alfredsson, J., Håkansson, E., Svedjeholm, R., Berglund, J. & Berg, S. (2016). Protamine reduces whole blood platelet aggregation after cardiopulmonary bypass. Scandinavian Cardiovascular Journal, 50(1), 58-63
Open this publication in new window or tab >>Protamine reduces whole blood platelet aggregation after cardiopulmonary bypass
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2016 (English)In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 50, no 1, p. 58-63Article in journal (Refereed) Published
Abstract [en]

Platelet dysfunction is an important cause of postoperative bleeding after cardiac surgery. Protamine is routinely used for reversal of heparin after cardiopulmonary bypass (CBP), but may affect platelet aggregation. We assessed changes in platelet function in relation to protamine administration. Design: Platelet aggregation was analyzed by impedance aggregometry before and after protamine administration in 25 adult cardiac surgery patients. Aggregation was also studied after in vitro addition of heparin and protamine. The activators adenosine diphosphate (ADP), thrombin receptor activating peptide-6 (TRAP), arachidonic acid (AA) and collagen (COL) were used.Results: Platelet aggregation was reduced by approximately 50% after in vivo protamine administration; ADP 640 +/- 230 (AU*min, mean +/- SD) to 250 +/- 160, TRAP 939 +/- 293 to 472 +/- 260, AA 307 +/- 238 to 159 +/- 143 and COL 1022 +/- 350 to 506 +/- 238 (all p&lt;0.001). Aggregation was also reduced after in vitro addition of protamine alone with activators ADP from 518 +/- 173 to 384 +/- 157 AU*min p&lt;0.001, and AA 449 +/- 311 to 340 +/- 285 (p&lt;0.01) and protamine combined with heparin (1:1 ratio) with activators ADP to 349 +/- 160 and AA to 308 +/- 260 (both p&lt;0.001); and COL from 586 +/- 180 to 455 +/- 172 (p&lt;0.05). Conclusions: Protamine given after CPB markedly reduces platelet aggregation. Protamine added in vitro also reduces platelet aggregation, by itself or in combination with heparin.

Place, publisher, year, edition, pages
TAYLOR & FRANCIS LTD, 2016
Keywords
Cardiopulmonary bypass; platelet aggregation; platelet function tests; protamine
National Category
Surgery
Identifiers
urn:nbn:se:liu:diva-124094 (URN)10.3109/14017431.2015.1099720 (DOI)000365693900009 ()26402229 (PubMedID)
Note

Funding Agencies|Blekinge Institute of Technology, Karlskrona; Department of Cardiothoracic Anaesthesiology and Intensive Care, County Council of Ostergotland [LIO-284621]

Available from: 2016-01-25 Created: 2016-01-19 Last updated: 2018-04-03
De Geer, J., Sandstedt, M., Björkholm, A., Alfredsson, J., Janzon, M., Engvall, J. & Persson, A. (2016). Software-based on-site estimation of fractional flow reserve using standard coronary CT angiography data.. Acta Radiologica, 57(10), 1186-1192
Open this publication in new window or tab >>Software-based on-site estimation of fractional flow reserve using standard coronary CT angiography data.
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2016 (English)In: Acta Radiologica, ISSN 0284-1851, E-ISSN 1600-0455, Vol. 57, no 10, p. 1186-1192Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The significance of a coronary stenosis can be determined by measuring the fractional flow reserve (FFR) during invasive coronary angiography. Recently, methods have been developed which claim to be able to estimate FFR using image data from standard coronary computed tomography angiography (CCTA) exams.

PURPOSE: To evaluate the accuracy of non-invasively computed fractional flow reserve (cFFR) from CCTA.

MATERIAL AND METHODS: A total of 23 vessels in 21 patients who had undergone both CCTA and invasive angiography with FFR measurement were evaluated using a cFFR software prototype. The cFFR results were compared to the invasively obtained FFR values. Correlation was calculated using Spearman's rank correlation, and agreement using intraclass correlation coefficient (ICC). Sensitivity, specificity, accuracy, negative predictive value, and positive predictive value for significant stenosis (defined as both FFR ≤0.80 and FFR ≤0.75) were calculated.

RESULTS: The mean cFFR value for the whole group was 0.81 and the corresponding mean invFFR value was 0.84. The cFFR sensitivity for significant stenosis (FFR ≤0.80/0.75) on a per-lesion basis was 0.83/0.80, specificity was 0.76/0.89, and accuracy 0.78/0.87. The positive predictive value was 0.56/0.67 and the negative predictive value was 0.93/0.94. The Spearman rank correlation coefficient was ρ = 0.77 (P < 0.001) and ICC = 0.73 (P < 0.001).

CONCLUSION: This particular CCTA-based cFFR software prototype allows for a rapid, non-invasive on-site evaluation of cFFR. The results are encouraging and cFFR may in the future be of help in the triage to invasive coronary angiography.

Place, publisher, year, edition, pages
Sage Publications, 2016
Keywords
Cardiac; computed tomography angiography (CTA); heart; arteries; adults; computer applications – detection/diagnosis
National Category
Radiology, Nuclear Medicine and Medical Imaging
Identifiers
urn:nbn:se:liu:diva-123579 (URN)10.1177/0284185115622075 (DOI)000382967500007 ()26691914 (PubMedID)
Note

Funding agencies: Department of Radiology, Region Ostergotland; Swedish Heart-Lung-foundation [20120449]

Available from: 2015-12-29 Created: 2015-12-29 Last updated: 2017-12-01Bibliographically approved
Venetsanos, D., Alfredsson, J., Segelmark, M., Swahn, E. & Lawesson, S. (2015). Glomerular filtration rate (GFR) during and after STEMI: a single-centre, methodological study comparing estimated and measured GFR. BMJ Open, 5(9), 1-8, Article ID e007835.
Open this publication in new window or tab >>Glomerular filtration rate (GFR) during and after STEMI: a single-centre, methodological study comparing estimated and measured GFR
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2015 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 5, no 9, p. 1-8, article id e007835Article in journal (Refereed) Published
Abstract [en]

Objectives: To validate the performance of the most commonly used formulas for estimation of glomerular filtration rate (GFR) against measured GFR during the index hospitalisation for ST-elevation myocardial infarction (STEMI). Setting: Single centre, methodological study. Participants: 40 patients with percutaneous coronary intervention-treated STEMI were included between November 2011 and February 2013. Patients on dialysis, cardiogenic shock or known allergy to iodine were excluded. Outcome measures: Creatinine and cystatin C were determined at admission and before discharge in 40 patients with STEMI. Clearance of iohexol was measured (mGFR) before discharge. We evaluated and compared the Cockcroft-Gault (CG), the Modification of Diet in Renal Disease (MDRD-IDMS), the Chronic Kidney Disease Epidemiology (CKD-EPI) and the Grubb relative cystatin C (rG-CystC) with GFR regarding correlation, bias, precision and accuracy (P30). Agreement between eGFR and mGFR to discriminate CKD was assessed by Cohens. statistics. Results: MDRD-IDMS and CKD-EPI demonstrated good performance to estimate GFR (correlation 0.78 vs 0.81%, bias -1.3% vs 1.5%, precision 17.9 vs 17.1 mL/min 1.73 m(2) and P30 82.5% vs 82.5% for MDRD-IDMS vs CKD-EPI). CKD was best classified by CKD-EPI (. 0.83). CG showed the worst performance (correlation 0.73%, bias -1% to 3%, precision 22.5 mL/min 1.73 m(2) and P30 75%). The rG-CystC formula had a marked bias of -17.8% and significantly underestimated mGFR (p=0.03). At arrival, CKD-EPI and rG-CystC had almost perfect agreement in CKD classification (kappa=0.87), whereas at discharge agreement was substantially lower (kappa=0.59) and showed a significant discrepancy in CKD classification (p=0.02). Median cystatin C concentration increased by 19%. Conclusions: In acute STEMI, CKD-EPI showed the best CKD-classification ability followed by MDRD-IDMS, whereas CG performed the worst. STEMI altered the performance of the cystatin C equation during the acute phase, suggesting that other factors might be involved in the rise of cystatin C.

Place, publisher, year, edition, pages
BMJ PUBLISHING GROUP, 2015
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:liu:diva-122794 (URN)10.1136/bmjopen-2015-007835 (DOI)000363484000021 ()26399570 (PubMedID)
Available from: 2015-11-23 Created: 2015-11-23 Last updated: 2017-12-01
Melki, D., Lugnegard, J., Alfredsson, J., Lind, S., Eggers, K. M., Lindahl, B. & Jernberg, T. (2015). Implications of Introducing High-Sensitivity Cardiac Troponin T Into Clinical Practice Data From the SWEDEHEART Registry. Journal of the American College of Cardiology, 65(16), 1655-1664
Open this publication in new window or tab >>Implications of Introducing High-Sensitivity Cardiac Troponin T Into Clinical Practice Data From the SWEDEHEART Registry
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2015 (English)In: Journal of the American College of Cardiology, ISSN 0735-1097, E-ISSN 1558-3597, Vol. 65, no 16, p. 1655-1664Article in journal (Refereed) Published
Abstract [en]

BACKGROUND Cardiac troponin is the preferred biomarker for diagnosing myocardial infarction (MI). OBJECTIVES The aim of this study was to examine the implications of introducing high-sensitivity cardiac troponin T (hs-cTnT) into clinical practice and to define at what hs-cTnT level risk starts to increase. METHODS We analyzed data from 48,594 patients admitted because of symptoms suggesting an acute coronary syndrome and who were entered into a large national registry. Patients were divided into Group 1, those with hs-cTnT less than6 ng/l; Group 2, those with hs-cTnT 6 to 13 ng/l; Group 3, those with hs-cTnT 14 to 49 ng/l (i.e., a group in which most patients would have had a negative cardiac troponin T with older assays); and Group 4, those with hs-cTnT greater than= 50 ng/l. RESULTS There were 5,790 (11.9%), 6,491 (13.4%), 10,476 (21.6%), and 25,837 (53.2%) patients in Groups 1, 2, 3, and 4, respectively. In Groups 1 to 4, the proportions with MI were 2.2%, 2.6%, 18.2%, and 81.2%. There was a stepwise increase in the proportion of patients with significant coronary stenoses, left ventricular systolic dysfunction, and death during follow-up. When dividing patients into 20 groups according to hs-cTnT level, the adjusted mortality started to increase at an hs-cTnT level of 14 ng/l. CONCLUSIONS Introducing hs-cTnT into clinical practice has led to the recognition of a large proportion of patients with minor cardiac troponin increases (14 to 49 ng/l), the majority of whom do not have MI. Although a heterogeneous group, these patients remain at high risk, and the adjusted mortality rate started to increase at the level of the 99th percentile in healthy controls.

Place, publisher, year, edition, pages
Elsevier, 2015
Keywords
acute coronary syndrome; assay; chest pain; myocardial infarction
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-118046 (URN)10.1016/j.jacc.2015.02.044 (DOI)000353337300009 ()25908071 (PubMedID)
Note

Funding Agencies|Roche Diagnostics

Available from: 2015-05-21 Created: 2015-05-20 Last updated: 2017-12-04
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