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Sederholm Lawesson, Sofia
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Publications (10 of 34) Show all publications
Venetsanos, D., Sederholm Lawesson, S., Fröbert, O., Omerovic, E., Henareh, L., Robertsson, L., . . . Swahn, E. (2019). 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, 8(6), 502-509
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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2019 (English)In: European Heart Journal. Acute Cardiovascular Care, ISSN 2048-8734, Vol. 8, no 6, p. 502-509Article in journal (Refereed) Published
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, 2019
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)000484942800003 ()30351167 (PubMedID)
Note

Funding agencies: Swedish Heart-Lung FoundationSwedish Heart-Lung Foundation; Swedish Research CouncilSwedish Research Council; AstraZenecaAstraZeneca; the Medicines Company; Swedish Foundation for Strategic Research (as part of the Tailoring of treatment in all comers wit

Available from: 2019-03-28 Created: 2019-03-28 Last updated: 2019-09-30Bibliographically approved
Venetsanos, D., Sederholm Lawesson, S., James, S., Koul, S., Erlinge, D., Swahn, E. & Alfredsson, J. (2018). Bivalirudin versus heparin with primary percutaneous coronary intervention. American Heart Journal, 201, 9-16
Open this publication in new window or tab >>Bivalirudin versus heparin with primary percutaneous coronary intervention
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2018 (English)In: American Heart Journal, ISSN 0002-8703, E-ISSN 1097-6744, Vol. 201, p. 9-16Article in journal (Refereed) Published
Abstract [en]

Background: Optimal adjunctive therapy in ST-segment elevation myocardial infarction (STEMI) patients treated with primary PCI (PPCI) remains a matter of debate. Our aim was to compare the efficacy and safety of bivalirudin to unfractionated heparin (UFH), with or without glycoprotein IIb/IIIa inhibitors (GPI) in a large real-world population, using data from the Swedish national registry, SWEDEHEART. Method: From 2008 to 2014 we identified 23,800 STEMI patients presenting within 12 hours from symptom onset treated with PPCI and UFH +/- GPI or bivalirudin +/- GPI. Primary outcomes included 30-day all-cause mortality and major in-hospital bleeding. Multivariable regression models and propensity score modelling were utilized to study adjusted association between treatment and outcome. Results: Treatment with UFH +/- GPI was associated with similar risk of 30-day mortality compared to bivalirudin +/- GPI (5.3% vs 5.5%, adjusted HR 0.94; 95% CI 0.82-1.07). The adjusted risk for 1-year mortality, 30-day and 1-year stent thrombosis and re-infarction did not differ significantly between UFH +/- GPI and bivalirudin +/- GPI. In contrast, treatment with UFH +/- GPI was associated with a significant higher risk of major in-hospital bleeding (adjusted OR 1.62; 95% CI 1.30-2.03). When including GPI use in the multivariable analysis, the difference was attenuated and no longer significant (adjusted OR 1.25; 95% CI 0.92-1.70). Conclusion: Bivalirudin +/- GPI was associated with significantly lower risk for major in hospital bleeding but no significant difference in 30-day or one year mortality, stent thrombosis or re-infarction compared with UFH +/- GPI. The bleeding reduction associated with bivalirudin could be explained by the greater GPI use with UFH. (C) 2018 Elsevier Inc. All rights reserved.

Place, publisher, year, edition, pages
Philadelphia, United States: Mosby, Inc., 2018
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:liu:diva-149694 (URN)10.1016/j.ahj.2018.03.014 (DOI)000436562100002 ()29910059 (PubMedID)2-s2.0-85046083385 (Scopus ID)
Note

Funding Agencies|ALF Grants, Region Ostergotland

Available from: 2018-07-18 Created: 2018-07-18 Last updated: 2019-05-01Bibliographically approved
Holm, A., Sederholm Lawesson, S., Zolfagharian, S., Swahn, E., Ekstedt, M. & Alfredsson, J. (2018). Bleeding complications after myocardial infarction in a real world population - An observational retrospective study with a sex perspective. Thrombosis Research, 167, 156-163
Open this publication in new window or tab >>Bleeding complications after myocardial infarction in a real world population - An observational retrospective study with a sex perspective
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2018 (English)In: Thrombosis Research, ISSN 0049-3848, E-ISSN 1879-2472, Vol. 167, p. 156-163Article in journal (Refereed) Published
Abstract [en]

Introduction: The aim of the current study was to assess bleeding events, including severity, localisation and prognostic impact, in a real world population of men and women with myocardial infarction (MI). Methods and results: In total 850 consecutive patients were included during 2010 and followed for one year. Bleeding complications were identified by searching of each patients medical records and characterised according to the TIMI criteria. For this analysis, only the first event was calculated. The total incidence of bleeding events was 24.4% (81 women and 126 men, p=ns). The incidence of all inhospital bleeding events was 13.2%, with no sex difference. Women had significantly more minor non-surgery related bleeding events than men (5% vs 2.2%, p=0.02). During follow-up, 13.5% had a bleeding, with more non-surgery related bleeding events among women, 14.7% vs 9.7% (p=0.03). The most common bleeding localisation was the gastrointestinal tract, more in women than men (12.1% vs 7.6%, p=0.03). Women had also more access site bleeding complications (4% vs 1.7%, p=0.04), while men had more surgery related bleeding complications (6.4% vs 0.9%, p=0.001). Increased mortality was found only in men with non-surgery related bleeding events (p=0.008). Conclusions: Almost one in four patients experienced a bleeding complication through 12 months follow-up after a myocardial infarction. Women experienced more non-surgery related minor/minimal bleeding complications than men, predominantly GI bleeding events and access site bleeding events, with no apparent impact on outcome. In contrast men with non-surgery related bleeding complications had higher mortality. Improved bleeding prevention strategies are warranted for both men and women.

Place, publisher, year, edition, pages
PERGAMON-ELSEVIER SCIENCE LTD, 2018
Keywords
Myocardial infarction; Bleeding; Sex; Mortality
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:liu:diva-149865 (URN)10.1016/j.thromres.2018.05.023 (DOI)000437845800027 ()29857272 (PubMedID)
Note

Funding Agencies|Ostergotland County Council [LIO610841]

Available from: 2018-08-02 Created: 2018-08-02 Last updated: 2019-04-12
Andersson, P., Sederholm Lawesson, S., Karlsson, J.-E., Nilsson, S. & Thylén, I. (2018). Characteristics of patients with acute myocardial infarction contacting primary healthcare before hospitalisation: a cross-sectional study. BMC Family Practice, 19, Article ID 167.
Open this publication in new window or tab >>Characteristics of patients with acute myocardial infarction contacting primary healthcare before hospitalisation: a cross-sectional study
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2018 (English)In: BMC Family Practice, ISSN 1471-2296, E-ISSN 1471-2296, Vol. 19, article id 167Article in journal (Refereed) Published
Abstract [en]

Background: The characteristics of patients with on-going myocardial infarction (MI) contacting the primary healthcare (PHC) centre before hospitalisation are not well known. Prompt diagnosis is crucial in patients with MI, but many patients delay seeking medical care. The aims of this study was to 1) describe background characteristics, symptoms, actions and delay times in patients contacting the PHC before hospitalisation when falling ill with an acute MI, 2) compare those patients with acute MI patients not contacting the PHC, and 3) explore factors associated with a PHC contact in acute MI patients. Methods: This was a cross-sectional multicentre study, enrolling consecutive patients with MI within 24 hours of admission to hospital from Nov 2012 until Feb 2014. Results: A total of 688 patients with MI, 519 men and 169 women, were included; the mean age was 66 +/- 11 years. One in five people contacted PHC instead of the recommended emergency medical services (EMS), and 94% of these patients experienced cardinal symptoms of an acute MI; i.e., chest pain, and/or radiating pain in the arms, and/or cold sweat. Median delay time from symptom-onset-to-decision-to-seek-care was 2:15 hours in PHC patients and 0:40 hours in non-PHC patients (pamp;lt;0.01). The probability of utilising the PHC before hospitalisation was associated with fluctuating symptoms (OR 1.74), pain intensity (OR 0.90) symptoms during off-hours (OR 0.42), study hospital (OR 3.49 and 2.52, respectively, for two of the county hospitals) and a final STEMI diagnosis (OR 0.58). Conclusions: Ambulance services are still underutilized in acute MI patients. A substantial part of the patients contacts their primary healthcare centre before they are diagnosed with MI, although experiencing cardinal symptoms such as chest pain. There is need for better knowledge in the population about symptoms of MI and adequate pathways to qualified care. Knowledge and awareness amongst primary healthcare professionals on the occurrence of MI patients is imperative.

Place, publisher, year, edition, pages
BMC, 2018
Keywords
Chest pain; Myocardial infarction; Primary healthcare; Pre-hospital delay
National Category
General Practice
Identifiers
urn:nbn:se:liu:diva-152382 (URN)10.1186/s12875-018-0849-8 (DOI)000447149900001 ()30305077 (PubMedID)
Note

Funding Agencies|Medical Research Council of Southeast Sweden (FORSS); Region Ostergotland, ALF

Available from: 2018-10-30 Created: 2018-10-30 Last updated: 2019-05-02
Sederholm Lawesson, S., Isaksson, R.-M., Thylén, I., Ericsson, M., Angerud, K. & Swahn, E. (2018). Gender differences in symptom presentation of ST-elevation myocardial infarction - An observational multicenter survey study. International Journal of Cardiology, 264
Open this publication in new window or tab >>Gender differences in symptom presentation of ST-elevation myocardial infarction - An observational multicenter survey study
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2018 (English)In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 264Article in journal (Refereed) Published
Abstract [en]

Background: Symptom presentation has been sparsely studied from a gender perspective restricting the inclusion to ST elevation myocardial infarction (STEMI) patients. Correct symptom recognition is vital in order to promptly seek care in STEMI where fast reperfusion therapy is of utmost importance. Female gender has been found associated with atypical presentation in studies on mixed MI populations but it is unclear whether this is valid also in STEMI. Objectives: We assessed whether there are gender differences in symptoms and interpretation of these in STEMI, and if this is attributable to sociodemographic and clinical factors. Methods: SymTime was a multicenter observational study including a validated questionnaire and data from medical records. Eligible STEMI patients (n = 532) were enrolled within 24 h after admittance at five Swedish hospitals. Results: Women were older, more often single and had lower educational level. Chest pain was less prevalent in women (74 vs 93%, p amp;lt; 0.001), whereas shoulder (33 vs 15%, p amp;lt; 0.001), throat/neck (34 vs 18%, p amp;lt; 0.001), back pain (29 versus 12%, p amp;lt; 0.001) and nausea (49 vs 29%, p amp;lt; 0.001) were more prevalent. Women less often interpreted their symptoms as of cardiac origin (60 vs 69%, p = 0.04). Female gender was the strongest independent predictor of non-chest pain presentation, odds ratio 5.29, 95% confidence interval 2.85-9.80. Conclusions: A striking gender difference in STEMI symptoms was found. As women significantly misinterpreted their symptoms more often, it is vital when informing about MI to the society or to high risk individuals, to highlight also other symptoms than just chest pain. (C) 2018 Elsevier B.V. All rights reserved.

Place, publisher, year, edition, pages
ELSEVIER IRELAND LTD, 2018
Keywords
ST-elevation myocardial infarction; Gender; Clinical presentation; Symptoms; Chest pain
National Category
General Practice
Identifiers
urn:nbn:se:liu:diva-148360 (URN)10.1016/j.ijcard.2018.03.084 (DOI)000432918500002 ()29642997 (PubMedID)
Note

Funding Agencies|Medical Research Council of South-east Sweden (FORSS); County Council of Ostergotland; County Council of Norrbotten

Available from: 2018-06-15 Created: 2018-06-15 Last updated: 2019-05-02
Sederholm Lawesson, S., Isaksson, R.-M., Ericsson, M., Angerud, K. & Thylén, I. (2018). Gender disparities in first medical contact and delay in ST-elevation myocardial infarction: a prospective multicentre Swedish survey study. BMJ Open, 8(5), Article ID e020211.
Open this publication in new window or tab >>Gender disparities in first medical contact and delay in ST-elevation myocardial infarction: a prospective multicentre Swedish survey study
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2018 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 8, no 5, article id e020211Article in journal (Refereed) Published
Abstract [en]

Objectives Compare gender disparities in ST-elevation myocardial infarction (STEMI) regarding first medical contact (FMC) and prehospital delay times and explore factors associated with prehospital delay in men and women separately. Design Cross-sectional study based on medical records and a validated questionnaire. Eligible patients were enrolled within 24 hours after admittance to hospital. Setting Patients were included from November 2012 to January 2014 from five Swedish hospitals with catheterisation facilities 24/7. Participants 340 men and 109 women aged between 31 and 95 years completed the survey. Main outcome measures FMC were divided into five possible contacts: primary healthcare centre by phone or directly, national advisory nurse by phone, emergency medical services (EMS) and emergency room directly. Two parts of prehospital delay times were studied: time from symptom onset to FMC and time from symptom onset to diagnostic ECG. Results Women more often called an advisory nurse as FMC (28% vs 18%, p=0.02). They had a longer delay until FMC, 90 (IOR 39-221) vs 66 (28-161) min, p=0.04 and until ECG, 146 (68-316) vs 103 (61-221) min, p=0.03. Men went to hospital because of believing they were stricken by an MI to a higher extent than women did (25% vs 15%, p=0.04) and were more often recommended to call EMS by bystanders (38% vs 22%, pamp;lt;0.01). Hesitating about going to hospital and experiencing pain in the stomach/back/shoulders were factors associated with longer delays in women. Believing the symptoms would disappear or interpreting them as nothing serious were corresponding factors in men. In both genders bystanders acting by contacting EMS explained shorter prehospital delays. Conclusions In STEMI, women differed from men in FMC and they had longer delays. This was partly due to atypical symptoms and a longer decision time. Bystanders acted more promptly when men than when women fell ill. Public knowledge of MI symptoms, and how to act properly, still seems insufficient.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2018
National Category
General Practice
Identifiers
urn:nbn:se:liu:diva-149740 (URN)10.1136/bmjopen-2017-020211 (DOI)000435567200080 ()29724738 (PubMedID)
Note

Funding Agencies|Medical Research Council of Southeast Sweden (FORSS); County Council of Ostergotland; County Council of Norrbotten

Available from: 2018-07-18 Created: 2018-07-18 Last updated: 2019-05-02Bibliographically approved
Venetsanos, D., Sederholm Lawesson, S., Panayi, G., Todt, T., Berglund, U., Swahn, E. & Alfredsson, J. (2018). Long-term efficacy of drug coated balloons compared with new generation drug-eluting stents for the treatment of de novo coronary artery lesions. Catheterization and cardiovascular interventions, 92(5), E317-E326
Open this publication in new window or tab >>Long-term efficacy of drug coated balloons compared with new generation drug-eluting stents for the treatment of de novo coronary artery lesions
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2018 (English)In: Catheterization and cardiovascular interventions, ISSN 1522-1946, E-ISSN 1522-726X, Vol. 92, no 5, p. E317-E326Article in journal (Refereed) Published
Abstract [en]

Background Studies comparing drug coated balloons (DCB) with new generation drug-eluting stents (nDES) for the treatment of de novo coronary artery lesions are lacking. Methods From 2009 to 2016, DCB or nDES used for treatment of de novo coronary lesions at our institution were included, in total 1,197 DEB and 6,458 nDES. We evaluated target lesions restenosis (TLR) and definite target lesion thrombosis (TLT). Propensity score modeling were utilized to study adjusted associations between treatment and outcomes. Results Median follow-up was 901days. DCB patients were older, with higher cardiovascular risk profile. Bailout stenting after DCB was performed in 8% of lesions. The cumulative rate of TLR and TLT was 7.0 vs. 4.9% and 0.2 vs. 0.8% for DCB vs. nDES, respectively. Before adjustment, DCB was associated with a higher risk of TLR [hazard ratio (HR) 1.44; 95% confidence interval (CI) 1.07-1.94] and a non-significantly lower risk of TLT (HR 0.30; 95% CI 0.07-1.24), compared to nDES. In the propensity matched population consisted of 1,197 DCB and 1,197 nDES, treatment with DCB was associated with similar risk for TLR (adjusted HR 1.05; 95% CI 0.72-1.53) but significantly lower risk for TLT (adjusted HR 0.18; 95% CI 0.04-0.82) compared to nDES. Conclusions Treatment with DCB was associated with a similar risk of TLR and a lower risk of definite TLT compared with nDES. In selected cases, DCB appears as a good alternative to nDES for the treatment of de novo coronary lesions.

Place, publisher, year, edition, pages
WILEY, 2018
Keywords
de novo lesions; drug-coated balloon; drug-eluting balloon; restenosis; stent thrombosis
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:liu:diva-153177 (URN)10.1002/ccd.27548 (DOI)000450359400003 ()29481718 (PubMedID)
Note

Funding Agencies|This research received no specific grant from any funding agency in the public commercial or not-for-profit sectors.

Available from: 2018-12-03 Created: 2018-12-03 Last updated: 2019-05-01
Venetsanos, D., Lindahl, T., Sederholm Lawesson, S., Gustafsson, K., Wallen, H., Erlinge, D., . . . Alfredsson, J. (2018). Pretreatment with ticagrelor may offset additional inhibition of platelet and coagulation activation with bivalirudin compared to heparin during primary percutaneous coronary intervention. Thrombosis Research, 171, 38-44
Open this publication in new window or tab >>Pretreatment with ticagrelor may offset additional inhibition of platelet and coagulation activation with bivalirudin compared to heparin during primary percutaneous coronary intervention
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2018 (English)In: Thrombosis Research, ISSN 0049-3848, E-ISSN 1879-2472, Vol. 171, p. 38-44Article in journal (Refereed) Published
Abstract [en]

Background

It remains unknown if bivalirudin compared to heparin confers any additional inhibition of platelet and coagulation activation during primary percutaneous coronary intervention(PPCI) after pretreatment with ticagrelor.

Methods

In this substudy of VALIDATE-SWEDEHEART trial, 103 patients pretreated with ticagrelor were randomized before PPCI to heparin or bivalirudin. Blood samples were collected before and 1 and 12 h after PPCI. We measured platelet reactivity (PR) using Multiplate, soluble P-selectin, thrombin-antithrombin complexes (TAT) and prothrombin fragments 1 + 2 (F1 + 2) as markers of platelet and coagulation activation.

Results

The median (IQR) time from ticagrelor administration to randomization was 63 (29) vs 60 (24) minutes, p = 0.28. ADP-induced PR did not significantly differ between groups over time (heparin vs bivalirudin, AUC 73 (62) vs 74 (68), p = 0.74, 32 (42) vs 43 (51), p = 0.38, 15 (15) vs 19 (15), p = 0.29, before, 1 and 12 h after PPCI). Soluble P-selectin did not significantly differ between groups. At 1 h TAT significantly increased with bivalirudin (3.0 (1.3) to 4.3 (4.2) ug/L; p < 0.01), but not with UFH (3.1 (2.1) to 3.5 (1.6) ug/L, p = 0.24). F1 + 2 increased in both groups but the rise was numerically higher with bivalirudin (170 (85) to 213 (126) pmol/L vs 168 (118) to 191 (103) pmol/L). At 12 h, a comparable significant increase in thrombin generation was observed in both groups.

Conclusion

In patients treated with ticagrelor, we found no major differences between bivalirudin and heparin in platelet aggregation or coagulation markers, which is in agreement with the neutral clinical results of the VALIDATE-SWEDEHEART study.

Place, publisher, year, edition, pages
Pergamon Press, 2018
Keywords
Bivalirudin; Heparin; Coagulation; Platelet; Aggregation; Thrombin
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:liu:diva-153386 (URN)10.1016/j.thromres.2018.09.046 (DOI)000450362200006 ()30248659 (PubMedID)2-s2.0-85053795837 (Scopus ID)
Note

Funding Agencies|AstraZeneca

Available from: 2018-12-13 Created: 2018-12-13 Last updated: 2019-05-02Bibliographically approved
Venetsanos, D., Sederholm Lawesson, S., Alfredsson, J., Janzon, M., Cequier, A., Chettibi, M., . . . Swahn, E. (2017). Association between gender and short-term outcome in patients with ST elevation myocardial infraction participating in the international, prospective, randomised Administration of Ticagrelor in the catheterisation Laboratory or in the Ambulance for New ST elevation myocardial Infarction to open the Coronary artery (ATLANTIC) trial: a prespecified analysis. BMJ Open, 7(9), Article ID e015241.
Open this publication in new window or tab >>Association between gender and short-term outcome in patients with ST elevation myocardial infraction participating in the international, prospective, randomised Administration of Ticagrelor in the catheterisation Laboratory or in the Ambulance for New ST elevation myocardial Infarction to open the Coronary artery (ATLANTIC) trial: a prespecified analysis
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2017 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 7, no 9, article id e015241Article in journal (Refereed) Published
Abstract [en]

Objectives To evaluate gender differences in outcomes in patents with ST-segment elevation myocardial infarction (STEMI) planned for primary percutaneous coronary intervention (PPCI). Settings A prespecified gender analysis of the multicentre, randomised, double-blind Administration of Ticagrelor in the catheterisation Laboratory or in the Ambulance for New ST elevation myocardial Infarction to open the Coronary artery. Participants Between September 2011 and October 2013, 1862 patients with STEMI and symptom duration amp;lt;6 hours were included. Interventions Patients were assigned to prehospital versus in-hospital administration of 180 mg ticagrelor. Outcomes The main objective was to study the association between gender and primary and secondary outcomes of the main study with a focus on the clinical efficacy and safety outcomes. Primary outcome: the proportion of patients who did not have 70% resolution of ST-segment elevation and did not meet the criteria for Thrombolysis In Myocardial Infarction (TIMI) flow 3 at initial angiography. Secondary outcome: the composite of death, MI, stent thrombosis, stroke or urgent revascularisation and major or minor bleeding at 30 days. Results Women were older, had higher TIMI risk score, longer prehospital delays and better TIMI flow in the infarct-related artery. Women had a threefold higher risk for all-cause mortality compared with men (5.7% vs 1.9%, HR 3.13, 95% CI 1.78 to 5.51). After adjustment, the difference was attenuated but remained statistically significant (HR 2.08, 95% CI 1.03 to 4.20). The incidence of major bleeding events was twofold to threefold higher in women compared with men. In the multivariable model, female gender was not an independent predictor of bleeding (Platelet Inhibition and Patient Outcomes major HR 1.45, 95% CI 0.73 to 2.86, TIMI major HR 1.28, 95% CI 0.47 to 3.48, Bleeding Academic Research Consortium type 3-5 HR 1.45, 95% CI 0.72 to 2.91). There was no interaction between gender and efficacy or safety of randomised treatment. Conclusion In patients with STEMI planned for PPCI and treated with modern antiplatelet therapy, female gender was an independent predictor of short-term mortality. In contrast, the higher incidence of bleeding complications in women could mainly be explained by older age and clustering of comorbidities.

Place, publisher, year, edition, pages
BMJ PUBLISHING GROUP, 2017
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:liu:diva-142436 (URN)10.1136/bmjopen-2016-015241 (DOI)000412650700040 ()28939567 (PubMedID)
Note

Funding Agencies|AstraZeneca

Available from: 2017-10-31 Created: 2017-10-31 Last updated: 2018-05-03
Alabas, O. A., Gale, C. P., Hall, M., Rutherford, M. J., Szummer, K., Sederholm Lawesson, S., . . . Jernberg, T. (2017). Sex Differences in Treatments, Relative Survival, and Excess Mortality Following Acute Myocardial Infarction: National Cohort Study Using the SWEDEHEART Registry. Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, 6(12), Article ID e007123.
Open this publication in new window or tab >>Sex Differences in Treatments, Relative Survival, and Excess Mortality Following Acute Myocardial Infarction: National Cohort Study Using the SWEDEHEART Registry
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2017 (English)In: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, ISSN 2047-9980, E-ISSN 2047-9980, Vol. 6, no 12, article id e007123Article in journal (Refereed) Published
Abstract [en]

Background-This study assessed sex differences in treatments, all-cause mortality, relative survival, and excess mortality following acute myocardial infarction. Methods and Results-A population-based cohort of all hospitals providing acute myocardial infarction care in Sweden (SWEDEHEART [Swedish Web System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies]) from 2003 to 2013 was included in the analysis. Excess mortality rate ratios (EMRRs), adjusted for clinical characteristics and guideline-indicated treatments after matching by age, sex, and year to background mortality data, were estimated. Although there were no sex differences in all-cause mortality adjusted for age, year of hospitalization, and comorbidities for ST-segment-elevation myocardial infarction (STEMI) and non-STEMI at 1 year (mortality rate ratio: 1.01 [95% confidence interval (CI), 0.96-1.05] and 0.97 [95% CI, 0.95-.99], respectively) and 5 years (mortality rate ratio: 1.03 [95% CI, 0.99-1.07] and 0.97 [95% CI, 0.95-.99], respectively), excess mortality was higher among women compared with men for STEMI and non-STEMI at 1 year (EMRR: 1.89 [95% CI, 1.66-2.16] and 1.20 [95% CI, 1.16-1.24], respectively) and 5 years (EMRR: 1.60 [95% CI, 1.48-1.72] and 1.26 [95% CI, 1.21-1.32], respectively). After further adjustment for the use of guideline-indicated treatments, excess mortality among women with non-STEMI was not significant at 1 year (EMRR: 1.01 [95% CI, 0.97-1.04]) and slightly higher at 5 years (EMRR: 1.07 [95% CI, 1.02-1.12]). For STEMI, adjustment for treatments attenuated the excess mortality for women at 1 year (EMRR: 1.43 [95% CI, 1.26-1.62]) and 5 years (EMRR: 1.31 [95% CI, 1.19-1.43]). Conclusions-Women with acute myocardial infarction did not have statistically different all-cause mortality, but had higher excess mortality compared with men that was attenuated after adjustment for the use of guideline-indicated treatments. This suggests that improved adherence to guideline recommendations for the treatment of acute myocardial infarction may reduce premature cardiovascular death among women.

Place, publisher, year, edition, pages
WILEY, 2017
Keywords
excess mortality; mortality; non-ST-segment-elevation acute coronary syndrome; relative survival; sex; ST-segment-elevation myocardial infarction; survival
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:liu:diva-144571 (URN)10.1161/JAHA.117.007123 (DOI)000418951100041 ()29242184 (PubMedID)
Note

Funding Agencies|Swedish Heart and Lung Foundation; Stockholm County Council; Karolinska Institute; British Heart Foundation [PG/13/81/30474]

Available from: 2018-01-29 Created: 2018-01-29 Last updated: 2018-04-18
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