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  • 101.
    Maret, Eva
    et al.
    Linköping University, Department of Medicine and Health Sciences. Linköping University, Faculty of Health Sciences.
    Brudin, Lars
    Linköping University, Department of Medicine and Health Sciences. Linköping University, Faculty of Health Sciences.
    Janzon, Magnus
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Cardiology . Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Ohlsson, J
    Linköping University, Department of Medicine and Health Sciences. Linköping University, Faculty of Health Sciences.
    Engvall, Jan
    Linköping University, Department of Medicine and Health Sciences, Clinical Physiology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Clinical Physiology.
    High sensitivity and specificity for detecting transmural infarction with a feature tracking software on cine MRI.2009In: ESC Barcelona 2009, 2009Conference paper (Refereed)
  • 102. Mielecki, W
    et al.
    Siudak, Z
    Rakowski, T
    Dziewierz, A
    Janzon, Magnus
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Cardiology . Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Birkemeyer, R
    Dykla, D
    Zdzienicka, J
    Dudek, D
    Early abcizimab administration before primary angioplasty influences 30-day clinical outcome in diabetic patients with ST-elevation myocardial infarction2008In: ESC Congress,2008, 2008Conference paper (Refereed)
  • 103.
    Montalescot, Gilles
    et al.
    University of Paris 06, France.
    van t Hof, Arnoud W.
    Isala Clin, Netherlands.
    Lapostolle, Frederic
    Hop Avicenne, France.
    Silvain, Johanne
    University of Paris 06, France.
    Flensted Lassen, Jens
    Aarhus University Hospital, Denmark.
    Bolognese, Leonardo
    Azienda Osped Arezzo, Italy.
    Cantor, Warren J.
    University of Toronto, Canada.
    Cequier, Angel
    University of Barcelona, Spain.
    Chettibi, Mohamed
    Centre Hospital University of Franz Fanon, Algeria.
    Goodman, Shaun G.
    University of Toronto, Canada.
    Hammett, Christopher J.
    Royal Brisbane and Womens Hospital, Australia.
    Huber, Kurt
    Wilhelminenspital Stadt Wien, Austria.
    Janzon, Magnus
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
    Merkely, Bela
    Semmelweis University, Hungary.
    Storey, Robert F.
    University of Sheffield, England.
    Zeymer, Uwe
    Klinikum Stadt Ludwigshafen, Germany; Institute Herzinfarktforsch Ludwigshafen, Germany.
    Stibbe, Olivier
    Brigade Sapeurs Pompiers Paris, France.
    Ecollan, Patrick
    CHU Pitie Salpetriere, France.
    Heutz, Wim M. J. M.
    Regionale Ambulance Voorziening, Netherlands.
    Swahn, Eva
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
    Collet, Jean-Philippe
    University of Paris 06, France.
    Willems, Frank F.
    Rijnstate Ziekenhuis, Netherlands.
    Baradat, Caroline
    AstraZeneca, France.
    Licour, Muriel
    AstraZeneca, France.
    Tsatsaris, Anne
    AstraZeneca, France.
    Vicaut, Eric
    Hop Lariboisiere, France.
    Hamm, Christian W.
    Kerckhoff Heart Centre, Germany.
    Prehospital Ticagrelor in ST-Segment Elevation Myocardial Infarction2014In: New England Journal of Medicine, ISSN 0028-4793, E-ISSN 1533-4406, Vol. 371, no 11, p. 1016-1027Article in journal (Refereed)
    Abstract [en]

    BACKGROUND The direct-acting platelet P2Y(12) receptor antagonist ticagrelor can reduce the incidence of major adverse cardiovascular events when administered at hospital admission to patients with ST-segment elevation myocardial infarction (STEMI). Whether prehospital administration of ticagrelor can improve coronary reperfusion and the clinical outcome is unknown. METHODS We conducted an international, multicenter, randomized, double-blind study involving 1862 patients with ongoing STEMI of less than 6 hours duration, comparing prehospital (in the ambulance) versus in-hospital (in the catheterization laboratory) treatment with ticagrelor. The coprimary end points were the proportion of patients who did not have a 70% or greater resolution of ST-segment elevation before percutaneous coronary intervention (PCI) and the proportion of patients who did not have Thrombolysis in Myocardial Infarction flow grade 3 in the infarct-related artery at initial angiography. Secondary end points included the rates of major adverse cardiovascular events and definite stent thrombosis at 30 days. RESULTS The median time from randomization to angiography was 48 minutes, and the median time difference between the two treatment strategies was 31 minutes. The two coprimary end points did not differ significantly between the prehospital and in-hospital groups. The absence of ST-segment elevation resolution of 70% or greater after PCI (a secondary end point) was reported for 42.5% and 47.5% of the patients, respectively. The rates of major adverse cardiovascular events did not differ significantly between the two study groups. The rates of definite stent thrombosis were lower in the prehospital group than in the in-hospital group (0% vs. 0.8% in the first 24 hours; 0.2% vs. 1.2% at 30 days). Rates of major bleeding events were low and virtually identical in the two groups, regardless of the bleeding definition used. CONCLUSIONS Prehospital administration of ticagrelor in patients with acute STEMI appeared to be safe but did not improve pre-PCI coronary reperfusion.

  • 104.
    Montalescot, Gilles
    et al.
    University of Paris 06, France.
    vant Hof, Arnoud W.
    Isala Clin, Netherlands.
    Bolognese, Leonardo
    Azienda Osped Arezzo, Italy.
    Cantor, Warren J.
    University of Toronto, Canada.
    Cequier, Angel
    University of Barcelona, Spain.
    Chettibi, Mohamed
    Centre Hospital University of Frantz Fanon, Algeria.
    Collet, Jean-Philippe
    University of Paris 06, France.
    Goodman, Shaun G.
    University of Toronto, Canada.
    Hammett, Christopher J.
    Royal Brisbane and Womens Hospital, Australia.
    Huber, Kurt
    Wilhelminenhosp, Austria.
    Janzon, Magnus
    Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping. Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine.
    Lapostolle, Frederic
    SAMU 93 Hop Avicenne, France.
    Flensted Lassen, Jens
    Aarhus University Hospital, Denmark.
    Licour, Muriel
    AstraZeneca, France.
    Merkely, Bela
    Semmelweis University, Hungary.
    Salhi, Nejoua
    AstraZeneca, England.
    Silvain, Johanne
    University of Paris 06, France.
    Storey, Robert F.
    University of Sheffield, England.
    ten Berg, Jurrien M.
    St Antonius Hospital, Netherlands.
    Tsatsaris, Anne
    AstraZeneca, France.
    Zeymer, Uwe
    Klinikum Ludwigshafen, Germany; Institute Herzinfarktforsch Ludwigshafen, Germany.
    Vicaut, Eric
    University of Paris 07, France.
    Hamm, Christian W.
    Kerckhoff Heart Centre, Germany.
    Effect of Pre-Hospital Ticagrelor During the First 24 h After Primary Percutaneous Coronary Intervention in Patients With ST-Segment Elevation Myocardial Infarction The ATLANTIC-H-24 Analysis2016In: JACC: Cardiovascular Interventions, ISSN 1936-8798, E-ISSN 1876-7605, Vol. 9, no 7, p. 646-656Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES The aim of this landmark exploratory analysis, ATLANTIC-H-24, was to evaluate the effects of pre-hospital ticagrelor during the first 24 h after primary percutaneous coronary intervention (PCI) in the ATLANTIC (Administration of Ticagrelor in the cath Lab or in the Ambulance for New ST elevation myocardial infarction to open the Coronary artery) study. BACKGROUND The ATLANTIC trial in patients with ongoing ST-segment elevation myocardial infarction showed that pre-hospital ticagrelor was safe but did not improve pre-PCI coronary reperfusion compared with in-hospital ticagrelor. We hypothesized that the effect of pre-hospital ticagrelor may not have manifested until after PCI due to the rapid transfer time (31 min). METHODS The ATLANTIC-H-24 analysis included 1,629 patients who underwent PCI, evaluating platelet reactivity, Thrombolysis In Myocardial Infarction flow grade 3, >= 70% ST-segment elevation resolution, and clinical endpoints over the first 24 h. RESULTS Following PCI, largest between-group differences in platelet reactivity occurred at 1 to 6 h; coronary reperfusion rates numerically favored pre-hospital ticagrelor, and the degree of ST-segment elevation resolution was significantly greater in the pre-hospital group (median, 75.0% vs. 71.4%; p = 0.049). At 24 h, the composite ischemic endpoint was lower with pre-hospital ticagrelor (10.4% vs. 13.7%; p = 0.039), as were individual endpoints of definite stent thrombosis (p = 0.0078) and myocardial infarction (p = 0.031). All endpoints except death (1.1% vs. 0.2%; p = 0.048) favored pre-hospital ticagrelor, with no differences in bleeding events. CONCLUSIONS The effects of pre-hospital ticagrelor became apparent after PCI, with numerical differences in platelet reactivity and immediate post-PCI reperfusion, associated with reductions in ischemic endpoints, over the first 24 h, whereas there was a small excess of mortality. (Administration of Ticagrelor in the cath Lab or in the Ambulance for New ST elevation myocardial infarction to open the Coronary artery [ATLANTIC, NCT01347580]) (C) 2016 by the American College of Cardiology Foundation.

  • 105.
    Nikolic, Elisabet
    et al.
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Janzon, Magnus
    Linköping University, Department of Medical and Health Sciences, Cardiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Cardiology UHL.
    Hauch, Ole
    AstraZeneca LP, DE USA .
    Wallentin, Lars
    Uppsala University, Sweden .
    Henriksson, Martin
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Cost-effectiveness of treating acute coronary syndrome patients with ticagrelor for 12 months: results from the PLATO study2013In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 34, no 3, p. 220-228Article in journal (Refereed)
    Abstract [en]

    The efficacy and safety of ticagrelor vs. clopidogrel in patients with acute coronary syndromes (ACS) are well documented in the PLATelet inhibition and patient Outcomes trial (PLATO). The aim of this study was to assess the long-term cost-effectiveness of treating ACS patients for 12 months with ticagrelor compared with generic clopidogrel.less thanbrgreater thanless thanbrgreater thanEvent rates, health-care costs, and health-related quality of life during 12 months of therapy with either ticagrelor or generic clopidogrel were estimated from PLATO. Beyond 12 months, quality-adjusted survival and costs were estimated conditional on whether a non-fatal myocardial infarction (MI), a non-fatal stroke, or no MI or stroke occurred during the 12 months of therapy. Lifetime costs, life expectancy, and quality-adjusted life years (QALYs) were estimated for both treatment strategies. Incremental cost-effectiveness ratios were presented from a health-care perspective in 2010 Euros (Euro) applying unit costs and life tables from a Swedish setting in the base-case analysis. Treatment with ticagrelor was associated with increased health-care costs of Euro362 and a QALY gain of 0.13 compared with generic clopidogrel, yielding a cost per QALY gained with ticagrelor of Euro2753. The cost per life year gained was Euro2372. The results were consistent in major subgroups. Sensitivity analyses showed a cost per QALY gained with ticagrelor of approximate to Euro7300 under certain scenarios.less thanbrgreater thanless thanbrgreater thanBased on clinical and health-economic evidence from the PLATO study, treating ACS patients with ticagrelor for 12 months is associated with a cost per QALY below generally accepted thresholds for cost-effectiveness.less thanbrgreater thanless thanbrgreater thanClinicalTrials.gov Identifier: NCT00391872.

  • 106.
    Nilsson, Staffan
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in East Östergötland, Primary Health Care in Norrköping.
    Andersson, Agneta
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in West Östergötland, Research & Development Unit in Local Health Care.
    Janzon, Magnus
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
    Karlsson, Jan-Erik
    County Hospital Ryhov, Sweden.
    Levin, Lars-Åke
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences.
    Cost consequences of point-of-care troponin T testing in a Swedish primary health care setting2014In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 32, no 4, p. 241-247Article in journal (Refereed)
    Abstract [en]

    Objective. To evaluate the safety and cost-effectiveness of point-of-care troponin T testing (POCT-TnT) for the management of patients with chest pain in primary care. Design. Prospective observational study with follow-up. Setting. Three primary health care (PHC) centres using POCT-TnT and four PHC centres not using POCT-TnT in south-east Sweden. Patients. All patients greater than= 35 years of age, contacting one of the PHC centres for chest pain, dyspnoea on exertion, unexplained weakness and/or fatigue, with no other probable cause than cardiac, were included. Symptoms must have commenced or worsened during the previous seven days. Main outcome measures. Emergency referral rates, diagnoses of acute myocardial infarction (AMI) or unstable angina (UA), and costs were collected for 30 days after the patient sought care at the PHC centre. Results. A total of 196 patients with chest pain were included: 128 in PHC centres with POCT-TnT and 68 in PHC centres without POCT-TnT. Fewer patients from the PHC centres with POCT-TnT (n = 32, 25%) were emergently referred to hospital than from centres without POCT-TnT (n = 29, 43%; p = 0.011). Eight patients (6.2%) from PHC centres with POCT-TnT were diagnosed with AMI or UA compared with six patients (8.8%) from centres without POCT-TnT (p = 0.565). Two patients with AMI or UA were classified as missed cases from PHC centres with POCT-TnT and there were no missed cases from PHC centres without POCT-TnT. SKr290 000 was saved per missed case of AMI or UA. Conclusion. The use of POCT-TnT in primary care may be cost saving but at the expense of missed cases.

  • 107.
    Nilsson, Staffan
    et al.
    Linköping University, Department of Medical and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in East Östergötland, Primary Health Care in Norrköping.
    Andersson, Per O.
    Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Primary Health Care in Central County.
    Borgquist, Lars
    Linköping University, Department of Medical and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in West Östergötland, Research & Development Unit in Local Health Care.
    Grodzinsky, Ewa
    Östergötlands Läns Landsting, Local Health Care Services in West Östergötland, Research & Development Unit in Local Health Care. Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Health Sciences.
    Janzon, Magnus
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
    Kvick, Magnus
    Östergötlands Läns Landsting, Local Health Care Services in East Östergötland, Primary Health Care in Norrköping.
    Landberg, Eva
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Chemistry. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Diagnostics, Department of Clinical Chemistry.
    Nilsson, Håkan
    Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Primary Health Care in Central County.
    Karlsson, Jan-Erik
    Department of Internal Medicine, County Hospital Ryhov, Jönköping.
    Point-of-Care Troponin T Testing in the Management of Patients with Chest Pain in the Swedish Primary Care2013In: International Journal of Family Medicine, ISSN 2090-2042, E-ISSN 2090-2050, Vol. 2013Article in journal (Refereed)
  • 108.
    Nilsson, Staffan
    et al.
    Linköping University, Department of Medical and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in the East of Östergötland, East County Primary Health Care.
    Andersson, Pär
    Janzon, Magnus
    Linköping University, Department of Medical and Health Sciences, Cardiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Cardiology UHL.
    Karlsson, Jan-Erik
    Department of Internal Medicine, Ryhov County Hospital, Jönköping, Sweden.
    Borgquist, Lars
    Linköping University, Department of Medical and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Unit of Research and Development in Local Health Care, County of Östergötland.
    Efficiency of point-of-care Troponin-T testing in a Swedish primary care setting2011Conference paper (Other academic)
    Abstract [en]

    Rationale Swedish general practitioners and cardiologists are concerned of the use of point-of-care Troponin-T testing (PCTT) in primary care i.e. the risk of overlooking a recent acute myocardial infarction (AMI) or unstable angina (UA) relaying too much on a laboratory finding. In this study we aimed to evaluate both missed and properly managed AMI or UA in relation to the use of PCTT. Methods & Results Setting: Seven primary health care centres (PHCC) in southeast Sweden participated. In three of the PHCCs, PCTT was analysed in conjunction with clinical assessment of all study patients, i.e. PCTT-PHCCs. In four of the PHCCs, PCTT was not used, i.e. Control-PHCCs. All patients ≥ 35 years old consulting for chest pain, having commenced or aggravated the last seven days, were included in the study. A systematic review of hospital medical records was done of all patients hospitalised the same day as inclusion or within 30 days there after. In patients who were sent home from the PHCC and hospitalised for any reason within thirty days, the PHCC medical records were systematically reviewed, by one GP and one cardiologist. 196 patients were included, 128 patients in the three PCTT-PHCCs and 68 patients in the four Control-PHCCs. In the PCTT-PHCCs two patients were identified as missed AMI or UA and none in the Control-PHCCs. Properly managed patients with AMI or UA were five in the PCTT-PHCCs and six in the Control-PHCCs. Conclusion The use of PCTT in primary care does not seem to enhance a total safety manageing of chest pain patients. Clinical Relevance The use of PCTT in primary care could be discussed due to the risk of false safety.

  • 109. Rakowski, Tomasz
    et al.
    Dziewierz, Artur
    Siudak, Zbigniew
    Mielecki, Waldemar
    Legutko, Jacek
    Janzon, Magnus
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Cardiology . Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Birkemeyer, Ralf
    Depukat, Rafal
    Dudek, Dariusz
    Early Abciximab administration before primary percutaneous coronary interventions reduces mortality but not in low-risk patients. Results from EUROTRANSFER registry on ST-elevation myocardial infarction patients.2008In: ACC - 57th Annual Scientific Session,2008, 2008Conference paper (Refereed)
  • 110.
    Rakowski, Tomasz
    et al.
    Jagiellonian University, Krakow, Poland.
    Siudak, Zbigniew
    Jagiellonian University, Krakow, Poland.
    Dziewierz, Artur
    Jagiellonian University, Krakow, Poland.
    Birkemeyer, Ralf
    Schwarzwald-Baar Klinikum, Villingen-Schwenningen, Germany.
    Janzon, Magnus
    Linköping University, Department of Medical and Health Sciences, Cardiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Cardiology UHL.
    Mielecki, Waldemar
    Jagiellonian University, Krakow, Poland.
    Zmudka, Krzysztof
    Jagiellonian University, Krakow, Poland.
    S Dubiel, Jacek
    Jagiellonian University, Krakow, Poland.
    Dudek, Dariusz
    Jagiellonian University, Krakow, Poland.
    Impact of infarct related artery patency after early abciximab administration on one-year mortality in patients with ST-segment elevation myocardial infarction (data from the EUROTRANSFER Registry)2012In: Kardiologia polska, ISSN 0022-9032, E-ISSN 1897-4279, Vol. 70, no 3, p. 215-221Article in journal (Refereed)
    Abstract [en]

    Background: Spontaneous early infarct related artery (IRA) recanalisation before primary percutaneous coronary intervention (pPCI) has a favourable impact on outcome. However, the role played by pharmacotherapy driven patency prior to pPCI is still a matter of debate. less thanbrgreater than less thanbrgreater thanAim: To assess the role of early IRA patency (TIMI flow 2 or 3) after early abciximab administration in patients with ST-segment elevation myocardial infarction (STEM!) transferred for pPCI. less thanbrgreater than less thanbrgreater thanMethods: Data was gathered for 1,650 consecutive sTEMI patients transferred for pPCI from hospital networks in seven countries in Europe between November 2005 and January 2007. We identified 691 patients who were pretreated with abciximab before transportation to a cathlab hospital and underwent PCI. less thanbrgreater than less thanbrgreater thanResults: Angiography showed early IRA patency (TIMI flow 2 or 3) in 233 (33.7%) patients, and occluded IRA (TIMI flow 0 or 1) in 458 (66.3%) patients. In patients with patent IRA, in baseline angiography the rate of TIMI 3 flow and ECG ST-segment resolution andgt; 50% after PCI was higher compared to patients with occluded IRA. One year mortality was significantly lower in patients with patent IRA, 1.3% vs 7% (OR 0.17; CI 0.05-0.6; p = 0.001). In multivariable Cox regression analysis, IRA patency at baseline was identified as an independent predictor of one-year mortality. less thanbrgreater than less thanbrgreater thanConclusions: Infarct related artery recanalisation after early pharmacological pretreatment in STEMI patients undergoing transportation for pPCI is associated with better post-procedural myocardial perfusion and lower one-year mortality.

  • 111.
    Rakowski, Tomasz
    et al.
    Jagiellonian University.
    Siudak, Zbigniew
    Jagiellonian University.
    Dziewierz, Artur
    Jagiellonian University.
    Birkemeyer, Ralf
    Schwarzwald Baar Klinikum Villingen Schwenningen.
    Legutko, Jacek
    Jagiellonian University.
    Mielecki, Waldemar
    Jagiellonian University.
    Depukat, Rafal
    Jagiellonian University.
    Janzon, Magnus
    Linköping University, Department of Medicine and Health Sciences, Cardiology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Stefaniak, Justyna
    Krakow Cardiovasc Research Institute.
    Zmudka, Krzysztof
    Jagiellonian University.
    Dubiel, Jacek S
    Jagiellonian University.
    Partyka, Lukasz
    Krakow Cardiovasc Research Institute.
    Dudek, Dariusz
    Jagiellonian University.
    Early abciximab administration before transfer for primary percutaneous coronary interventions for ST-elevation myocardial infarction reduces 1-year mortality in patients with high-risk profile. Results from EUROTRANSFER Registry2009In: AMERICAN HEART JOURNAL, ISSN 0002-8703, Vol. 158, no 4, p. 569-575Article in journal (Refereed)
    Abstract [en]

    Background There are conflicting data on the clinical benefit from early administration of abciximab from a large randomized trial and a registry. However, both sources suggest that a benefit may depend on the baseline risk profile of the patients. We evaluated the role of early abciximab administration in patients with ST-segment-elevation myocardial infarction (STEMI) referred for primary percutaneous coronary intervention stratified by the STEMI Thrombolysis In Myocardial Infarction (TIMI) risk score. Methods A total of 1,650 patients were enrolled into the EUROTRANSFER Registry. One thousand eighty-six patients received abciximab (66%). Abciximab was administered early in 727 patients (EA) and late in 359 patients (LA). We used the TIMI risk score for risk stratification. Patients with scores 3 constituted the high-risk group of 616 patients (56.7%), whereas 470 patients formed the low-risk cohort. Factoring in the timing of the abciximab administration resulted in 4 groups of patients who were compared for mortality at 1 year: EA/high-risk (n = 413); LA/high-risk (n = 203); EA/low-risk (n = 3 14); LA/low-risk (n = 156). Baseline difference was accounted for by means of propensity score. Results In high-risk patients, 1-year mortality was significantly lower with early abcximab compared to late administration (8.7% vs 15.8%; odds ratio 0.51, CI 0.31-0.85, P = .01). In multivariable Cox regression analysis, both early abciximab administration and patients risk profile (TIMI score :3) were identified as independent predictors of 1-year mortality. Conclusions Early abciximab administration before transfer for percutaneous coronary intervention in STEMI shows lower mortality at 1-year follow-up. This effect is confined to patients with higher risk profile as defined by TIMI risk score andgt;= 3.

  • 112.
    Rapsomaniki, Eleni
    et al.
    Farr Institute of Health Informatics Research, University College London, London, UK.
    Thuresson, Marcus
    Statisticon AB, Uppsala, Sweden.
    Yang, Erru
    Retrospective Observational Studies, Evidera, Lexington, MA, USA.
    Blin, Patrick
    University of Bordeaux, Bordeaux, France.
    Hunt, Phillip
    Retrospective Observational Studies, Evidera, Lexington, MA, USA.
    Chung, Sheng-Chia
    Farr Institute of Health Informatics Research, University College London, London, UK.
    Stogiannis, Dimitris
    University of Athens, Athens, Greece.
    Pujades-Rodriguez, Mar
    Farr Institute of Health Informatics Research, University College London, London, UK.
    Timmis, Adam
    Farr Institute of Health Informatics Research, University College London, London, UK.
    Denaxas, Spiros C
    Farr Institute of Health Informatics Research, University College London, London, UK.
    Danchin, Nicolas
    Hopital Européen Georges Pompidou, Paris, France.
    Stokes, Michael
    Retrospective Observational Studies, Evidera, Lexington, MA, USA.
    Thomas-Delecourt, Florence
    Epidemiology, AstraZeneca Rueil-Malmaison, Rueil-Malmaison, France.
    Emmas, Cathy
    Astra Zeneca Luton, Luton, UK.
    Hasvold, Pål
    Medical Department, AstraZeneca Nordic-Baltic, Oslo, Norway.
    Jennings, Em
    Global Payer Evidence and Pricing, AstraZeneca R&D, Cambridge, UK.
    Johansson, Saga
    Global Medicines Development, AstraZeneca Gothenburg, Mo¨ lndal, Sweden.
    Cohen, David J
    Saint Luke’s Mid America Heart Institute, Kansas City, MO, USA.
    Jernberg, Tomas
    Department of Medicine, Karolinska Institutet, Huddinge, Sweden.
    Moore, Nicholas
    University of Bordeaux, Bordeaux, France.
    Janzon, Magnus
    Linköping University, Faculty of Medicine and Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping. Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine.
    Hemingway, Harry
    Farr Institute of Health Informatics Research, University College London, London, UK.
    Using big data from health records from four countries to evaluate chronic disease outcomes: a study in 114 364 survivors of myocardial infarction2016In: European Heart Journal - Quality of Care and Clinical Outcomes, ISSN 2058-5225, E-ISSN 2058-1742, Vol. 2, no 3, p. 172-183Article in journal (Refereed)
    Abstract [en]

    Aims To assess the international validity of using hospital record data to compare long-term outcomes in heart attack survivors.

    Methods and results We used samples of national, ongoing, unselected record sources to assess three outcomes: cause death; a composite of myocardial infarction (MI), stroke, and all-cause death; and hospitalized bleeding. Patients aged 65 years and older entered the study 1 year following the most recent discharge for acute MI in 2002–11 [n = 54 841 (Sweden), 53 909 (USA), 4653 (England), and 961 (France)]. Across each of the four countries, we found consistent associations with 12 baseline prognostic factors and each of the three outcomes. In each country, we observed high 3-year crude cumulative risks of all-cause death (from 19.6% [England] to 30.2% [USA]); the composite of MI, stroke, or death [from 26.0% (France) to 36.2% (USA)]; and hospitalized bleeding [from 3.1% (France) to 5.3% (USA)]. After adjustments for baseline risk factors, risks were similar across all countries [relative risks (RRs) compared with Sweden not statistically significant], but higher in the USA for all-cause death [RR USA vs. Sweden, 1.14 (95% confidence interval 1.04–1.26)] and hospitalized bleeding [RR USA vs. Sweden, 1.54 (1.21–1.96)].

    Conclusion The validity of using hospital record data is supported by the consistency of estimates across four countries of a high adjusted risk of death, further MI, and stroke in the chronic phase after MI. The possibility that adjusted risks of mortality and bleeding are higher in the USA warrants further study.

  • 113.
    Sandstedt, Mårten
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Radiological Sciences. Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Center for Medical Image Science and Visualization (CMIV). Region Östergötland, Center for Diagnostics, Department of Radiology in Linköping.
    De Geer, Jakob
    Linköping University, Department of Medical and Health Sciences, Division of Radiological Sciences. Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Center for Medical Image Science and Visualization (CMIV). Region Östergötland, Center for Diagnostics, Department of Radiology in Linköping.
    Henriksson, Lilian
    Linköping University, Department of Medical and Health Sciences, Division of Radiological Sciences. Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Center for Medical Image Science and Visualization (CMIV). Region Östergötland, Center for Diagnostics, Department of Radiology in Linköping.
    Engvall, Jan
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Clinical Physiology in Linköping.
    Janzon, Magnus
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Persson, Anders
    Linköping University, Department of Medical and Health Sciences, Division of Radiological Sciences. Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Center for Medical Image Science and Visualization (CMIV). Region Östergötland, Center for Diagnostics, Department of Radiology in Linköping.
    Alfredsson, Joakim
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Long-term prognostic value of coronary computed tomography angiography in chest pain patients.2019In: Acta Radiologica, ISSN 0284-1851, E-ISSN 1600-0455, Vol. 60, no 1, p. 45-53Article in journal (Refereed)
    Abstract [en]

    Background Coronary computed tomography angiography (CCTA) is increasingly used to detect coronary artery disease (CAD), but long-term follow-up studies are still scarce. Purpose To evaluate the prognostic value of CCTA in patients with suspected CAD. Material and Methods A total of 1205 consecutive CCTA patients with chest pain were classified as normal coronary arteries, non-obstructive CAD, or obstructive CAD. The primary outcome was major adverse cardiac event (MACE), defined as a composite outcome including cardiac death, myocardial infarction, unstable angina pectoris, or late revascularization (after >90 days). Results Over 7.5 years follow-up (median = 3.1 years), Kaplan-Meier estimates demonstrated a MACE in 1.0%, 4.6%, and 20.7% in normal coronary arteries, non-obstructive CAD, and obstructive CAD, respectively. Log rank test for pairwise comparisons showed significant differences between non-obstructive CAD and normal coronary arteries ( P = 0.023) and between obstructive CAD and normal coronary arteries ( P < 0.001). In a multivariable analysis, adjusting for classical risk factors, non-obstructive CAD and obstructive CAD were independent predictors of MACE, with hazard ratios (HR) of 3.22 ( P = 0.041) and 25.18 ( P < 0.001), respectively. Conclusion Patients with normal coronary arteries have excellent long-term prognosis, but the risk for MACE increases with non-obstructive and obstructive CAD. Both non-obstructive and obstructive CAD are independently associated with future ischemic events.

  • 114. Shakeri, Zahar
    et al.
    Hammar-Henriksson, Malin
    Alfredsson, Joakim
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Cardiology . Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Janzon, Magnus
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Cardiology . Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Evaluating cardiodetect with card test for early diagnosis of acute myocardial infarction.2008In: X Svenska Kardiovaskulära Vårmöte,2008, 2008, p. 37-Conference paper (Refereed)
  • 115.
    Siudak, Z
    et al.
    Jagiellonian University.
    Birkemeyer, R
    Schwarzwald Baar Hospital Villingen Schwenningen GmbH.
    Rakowski, T
    Jagiellonian University.
    Dziewierz, A
    Jagiellonian University.
    Janzon, Magnus
    Linköping University, Department of Medical and Health Sciences, Cardiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Cardiology UHL.
    Skowronek, J
    Jagiellonian University.
    Ranosz, P
    Jagiellonian University.
    Dubiel, J S
    Jagiellonian University.
    Dudek, D
    Jagiellonian University.
    Out-of-hospital cardiac arrest in patients treated with primary PCI for STEMI. Long-term follow up data from EUROTRANSFER registry in EUROPEAN HEART JOURNAL, vol 31, issue , pp 900-9002010In: EUROPEAN HEART JOURNAL, Oxford University Press , 2010, Vol. 31, p. 900-900Conference paper (Refereed)
    Abstract [en]

    n/a

  • 116. Siudak, Z
    et al.
    Janzon, Magnus
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Cardiology . Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Birkemeyer, R
    Rakowski, T
    Dziewierz, A
    Kleczynski, P
    Mielecki, W
    Dudek, D
    Radial approach in STEMI patients treated with primary PCI with abciximab is safer than femoral in terms of local access site complications. Date from EUROTRANSFER registry.2008In: ESC Congress,2008, 2008Conference paper (Refereed)
    Abstract [en]

      

  • 117.
    Siudak, Zbigniew
    et al.
    Krakow, Poland.
    Dziewierz, Artur
    Krakow, Poland.
    Rakowski, Tomasz
    Krakow, Poland.
    Berti, Sergio
    Massa, Italy.
    Olivari, Zoran
    Treviso, Italy.
    Janzon, Magnus
    Linköping University, Department of Medicine and Health Sciences, Cardiology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Birkemeyer, Ralf
    Villingen, Germany.
    Dudek, Dariusz
    Krakow, Poland.
    By-passing Emergency Room Shortens Time Delays in STEM I Patients Transferred for Primary PCI. Results From EUROTRANSFER Registry, Washington DC, USA2008In: AMERICAN JOURNAL OF CARDIOLOGY,ISSN 0002-9149, Transcatheter Cardiovascular Therapeutics  Abstracts: Volume 102, Issue 8A, 2008, Vol. 102, no 8A, p. 72I-72IConference paper (Refereed)
  • 118.
    Siudak, Zbigniew
    et al.
    Jagiellonian University.
    Rakowski, Tomasz
    Jagiellonian University.
    Dziewierz, Artur
    Jagiellonian University.
    Janzon, Magnus
    Linköping University, Department of Medicine and Health Sciences, Cardiology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Birkemeyer, Ralf
    Villingen Schwenningen, Germany .
    Stefaniak, Justyna
    Krakow Cardiovasc Research Institute.
    Partyka, Lukasz
    Krakow Cardiovasc Research Institute.
    Zmudka, Krzysztof
    Jagiellonian University.
    Dudek, Dariusz
    Jagiellonian University.
    Early abciximab use in ST-elevation myocardial infarction treated with primary percutaneous coronary intervention improves long-term outcome. Data from EUROTRANSFER Registry2010In: KARDIOLOGIA POLSKA, ISSN 0022-9032, Vol. 68, no 5, p. 539-545Article in journal (Refereed)
    Abstract [en]

    Background: Primary percutaneous coronary intervention (PCI) is the preferred method of reperfusion in patients with ST elevation myocardial infarction (STEMI). Abciximab is a well established adjunct to primary PCI. The proper timing of abciximab administration in STEMI patients has been investigated in randomised trials, registries and metanalysis, providing conflicting results. Methods: Consecutive data on STEMI patients, transferred for primary PCI in hospital/ambulance STEMI networks between November 2005 and January 2007, from 15 PCI centres in seven European countries was gathered together for a one-year long-term clinical observation (93% rate of completeness). Results: Data from 1,650 patients was collected in the EUROTRANSFER Registry. Abciximab was administered to 1,086 patients (66%), 727 patients received early (at least 30 minutes prior to first balloon inflation) abciximab (EA), and another 359 patients received late abcixirnab (LA). One year mortality was 5.8% in the EA group vs 10.3% with LA (p = 0.007). Adjustment for propensity score methods for EA administration did not change the results, still providing a favourable outcome for the EA group (p = 0.004). It was also revealed that only a minority of patients (36%) were treated within the 90-minute recommended time window from first medical contact to PCI (and 60% for the 120-min time delay). Conclusions: Patients transferred for primary PCI in STEMI hospital networks showed lower rates of death in long-term one-year clinical follow-up when treatment with abciximab was started early.

  • 119. Siudak, Zbigniew
    et al.
    Rakowski, Tomasz
    Dziewierz, Artur
    Zasada, Wojciech
    Brzezinski, Michal
    Janzon, Magnus
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Cardiology . Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Birkemeyer, Ralf
    Dudek, Darius
    Primary percutaneous coronary intervention performed during nightshift hours was associated with increased in-hospital mortality in patients with ST elevation myocardial infarction. Results from EUROTRANSFER registry.2008In: ACC - 57th Annual Scientific Session,2008, 2008Conference paper (Refereed)
  • 120.
    Studak, Zbigniew
    et al.
    Krakow, Poland.
    Rakowski, Tomasz
    Krakow, Poland.
    Dziewierz, Artur
    Krakow, Poland.
    Janzon, Magnus
    Linköping University, Department of Medicine and Health Sciences, Cardiology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Birkemeyer, Ralf
    Villingen Schwenningen.
    Berti, Sergio
    Massa, Italy .
    Partyka, Lukasz
    Krakow, Poland.
    Zmudka, Krzysztof
    Krakow, Poland.
    Dudek, Dariusz
    Krakow, Poland.
    Primary PCI Performed With Delay > 90 Minutes From Diagnosis Seems Acceptable in Terms of Short- and Long-Term Clinical Outcome. One Year Results From EUROTRANSFER Registry,Washington DC, USA2008In: AMERICAN JOURNAL OF CARDIOLOGY,ISSN 0002-9149 Transcatheter Cardiovascular Therapeutics  Abstracts: Volume 102, Issue 8A, 2008, Vol. 102, no 8A, p. 56I-56IConference paper (Refereed)
  • 121.
    Sunnerud, Sofia
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Nylander, Eva
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Clinical Physiology in Linköping.
    Janzon, Magnus
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Carlén, Anna
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Clinical Physiology in Linköping.
    Hedman, Kristofer
    Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Clinical Physiology in Linköping. Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine.
    Låg följsamhet till rekommenderad hjärtscreening av elitidrottare - Lägesanalys i Östergötland2018In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 115, p. 185-187, article id EWLMArticle in journal (Refereed)
    Abstract [en]

    Low adherence to recommended pre-participation cardiac evaluation of Swedish athletes Pre-participation cardiac evaluation of athletes is recommended by international organizations like the European Society of Cardiology and the American Heart Association, as well as by the Swedish Sports Confederation. The purpose of the evaluation is to prevent sudden cardiac death in athletes by early identification of individuals at risk. To our knowledge, no previous study has been made regarding the implementation of pre-participation cardiac evaluation of athletes in Sweden. We performed an electronical survey addressing sports clubs in one out of 21 districts in which the Swedish Sports Confederation is geographically divided. Only four out of 22 responding clubs with elite athletes preformed cardiac evaluation. Lack of knowledge about the recommendations as well as how to perform the evaluation were mentioned as reasons not to evaluate the athletes. Our results indicate the need for more information about pre-participation cardiac evaluation of athletes in Sweden.

  • 122.
    Szymanowski, Aleksander
    et al.
    Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping. Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Alfredsson, Joakimjoaal38
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Janzon, Magnus
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Lindahl, Tomas L.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Diagnostics, Department of Clinical Chemistry.
    Swahn, Eva
    Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping. Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Jonasson, Lena
    Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping. Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Nilsson, Lennart
    Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping. Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Soluble markers of apoptosis in myocardial infarction patients during acute phase and 6-month follow up2015Manuscript (preprint) (Other academic)
    Abstract [en]

    Objectives

    The aim of the study was to investigate circulating markers of apoptosis in the acute phase and at follow8up in patients with ST8elevation myocardial infarction (STEMI) or non8ST8elevation myocardial infarction (NSTEMI).

    Background

    Myocardial cell death during acute MI results from necrosis, apoptosis and autophagy. An elevated rate of apoptosis can continue for several days after the acute event, contributing to an increased final infarct size. Moreover, a lower but still increased apoptosis can continue for months resulting in left ventricular (LV) dysfunction and heart failure. Few studies have analysed markers of apoptosis longitudinally in MI patients.  Also, it is not known whether STEMI and NSTEMI patients differ in regard to these markers. 

    Methods

    This study is a prespecified substudy of the APACHE trial. We included 61 STEMI and 40 NSTEMI patients. Blood samples for analysis of soluble tumor necrosis factor receptor (sTNFR) 1, sTNFR2, sFas, sFas ligand (sFasL) and IL86 were collected at baseline prior to PCI, at 3 days and at 6 months. High sensitivity troponin T (hsTnT) was measured at 688 hours and echocardiography was performed at 283 days after admission to hospital.

    Results

    STEMI compared to NSTEMI patients showed very similar temporal patterns for each of the markers of apoptosis analyzed. Levels of sTNFRs increased from baseline to day 3 and the absolute increase as well as day 3 levels correlated significantly with TnT. At 6 months, sTNFR1 had returned to baseline whereas levels of sTNFR2 were still elevated. Soluble Fas and sFasL did not change from baseline to day 3, and both markers were significantly lower in the acute phase compared to 6 months. Indeed, sFas at day 3 correlated negatively with TnT. At all time points, plasma sTNFRs were significantly higher in patients with reduced LV function, whereas no such associations with sFas or sFasL was observed. 

    Conclusions

    The TNF and Fas/FasL pathways of apoptosis, as reflected by soluble markers, show markedly different temporal changes after an acute MI, indicating diverse roles of these two systems. STEMI compared to NSTEMI patients showed very similar temporal patterns for all the analyzed markers, suggesting apoptosis to be equally involved in myocardial damage of either infarct type.

  • 123.
    Tödt, Tim
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
    Maret, Eva
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences.
    Alfredsson, Joakim
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
    Janzon, Magnus
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
    Engvall, Jan
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Clinical Physiology in Linköping.
    Swahn, Eva
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
    Relationship between ischemia duration and final infarct size in STEMI patients treated with prehospital abciximab and primary PCI.2011Conference paper (Refereed)
  • 124.
    Tödt, Tim
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
    Maret, Eva
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences.
    Alfredsson, Joakim
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
    Janzon, Magnus
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
    Engvall, Jan
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Clinical Physiology in Linköping.
    Swahn, Eva
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
    Relationship between the duration of ischemia and final infarct size in STEMI patients treated with abciximab and primary PCI.2012Conference paper (Refereed)
  • 125.
    Tödt, Tim
    et al.
    Linköping University, Department of Medical and Health Sciences, Cardiology. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping. Linköping University, Faculty of Health Sciences.
    Maret, Eva
    Ryhov County Hospital, Jönköping.
    Alfredsson, Joakim
    Linköping University, Department of Medical and Health Sciences, Cardiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
    Janzon, Magnus
    Linköping University, Department of Medical and Health Sciences, Cardiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
    Engvall, Jan
    Linköping University, Center for Medical Image Science and Visualization (CMIV). Linköping University, Department of Medical and Health Sciences, Clinical Physiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Clinical Physiology in Linköping.
    Swahn, Eva
    Linköping University, Department of Medical and Health Sciences, Cardiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
    Relationship between treatment delay and final infarct size in STEMI patients treated with abciximab and primary PCI2012In: BMC Cardiovascular Disorders, ISSN 1471-2261, E-ISSN 1471-2261, Vol. 12, no 9, p. 1-9Article in journal (Refereed)
    Abstract [en]

    Background

    Studies on the impact of time to treatment on myocardial infarct size have yielded   conflicting results. In this study of ST-Elevation Myocardial Infarction (STEMI) treated   with primary percutaneous coronary intervention (PCI), we set out to investigate the   relationship between the time from First Medical Contact (FMC) to the demonstration   of an open infarct related artery (IRA) and final scar size.

    Between February 2006 and September 2007, 89 STEMI patients treated with primary PCI   were studied with contrast enhanced magnetic resonance imaging (ceMRI) 4 to 8 weeks   after the infarction. Spearman correlation was computed for health care delay time   (defined as time from FMC to PCI) and myocardial injury. Multiple linear regression   was used to determine covariates independently associated with infarct size.

    Results

    An occluded artery (Thrombolysis In Myocardial Infarction, TIMI flow 0-1 at initial   angiogram) was seen in 56 patients (63%). The median FMC-to-patent artery was 89 minutes.   There was a weak correlation between time from FMC-to-patent IRA and infarct size,   r = 0.27, p = 0.01. In multiple regression analyses, LAD as the IRA, smoking and an occluded vessel   at the first angiogram, but not delay time, correlated with infarct size.

    Conclusions

    In patients with STEMI treated with primary PCI we found a weak correlation between   health care delay time and infarct size. Other factors like anterior infarction, a   patent artery pre-PCI and effects of reperfusion injury may have had greater influence   on infarct size than time-to-treatment per se.

  • 126.
    Tödt, Tim
    et al.
    Linköping University, Department of Medicine and Health Sciences, Cardiology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Sederholm-Lawesson, Sofia
    Linköping University, Department of Medicine and Health Sciences, Cardiology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Stenestrand, Ulf
    Linköping University, Department of Medicine and Health Sciences, Cardiology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Alfredsson, Joakim
    Linköping University, Department of Medicine and Health Sciences, Cardiology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Janzon, Magnus
    Linköping University, Department of Medicine and Health Sciences, Cardiology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Swahn, Eva
    Linköping University, Department of Medicine and Health Sciences, Cardiology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Early treatment with abciximab in patients with ST elevation myocardial infarction results in a high rate of normal or near normal blood flow in the infarct related artery2010In: Acute cardiac care, ISSN 1748-295X, Vol. 12, no 1, p. 10-17Article in journal (Refereed)
    Abstract [en]

    There is debate whether early treatment with GpIIb/IIIa inhibitors is of clinical benefit in primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI). This study explored the effects of early given abciximab on coronary blood flow and major adverse cardiac events (MACE) in patients with STEMI treated with primary PCI and adjunctive abciximab. We studied all consecutive patients from our catchment area with STEMI undergoing acute angiography with the intention of primary PCI during 2005. Abciximab was given as early pre-treatment before, (n = 133) or at the cath. lab. after a diagnostic angiography (n = 109). Pre-procedural TIMI 2-3 flow was observed in 45.9 % of patients in the early group versus 20.2 % in the cath. lab. group, P = 0.0001. Mortality rates were 3.8 % versus 3.7% inhospital and 8.3 % versus 7.3% at one year in the early respectively the cath. lab. group, both P = NS. The MACE rate (death, non fatal myocardial infarction, unplanned revascularization) at one year was 19.5 % (early group) and 26.6 % (cath. lab. group), P = 0.19. CONCLUSION: In this single centre registry study of unselected patients with STEMI early given abciximab was associated with a significantly higher rate of TIMI 2-3 flow compared to abciximab given after the acute angiography.

  • 127.
    Tödt, Tim
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
    Thylén, Ingela
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
    Alfredsson, Joakim
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
    Swahn, Eva
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
    Janzon, Magnus
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
    Strategies TO reduce time delays in patients with AcuTe coronary heart diasease treated with primary PCI - the STOP WATCH study: a multistage action research project2013In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 3, no 3493Article in journal (Refereed)
    Abstract [en]

    Objective

    To identify, evaluate and reduce system delay times in an ST-elevation myocardial infarction (STEMI) network by targeted reorganisation of logistics and personal feedback to staff on time delays.

    Design

    Multistage action research project. Three study phases were used (exploration, tailored intervention and evaluation).

    Setting

    Single centre study, Sweden.

    Patients

    Consecutive patients (N=156) with prehospital STEMI onset treated with primary percutaneous coronary intervention (PCI).

    Interventions

    Areas of delays were identified through participant observations and collaborative discussions. To increase the awareness of delay factors, continuous feedback on time delays was given. Elements of the logistics’ reorganisation were (1) prioritised ECG recording by emergency medical services personnel, (2) central evaluation of ECG in all patients and (3) start of PCI procedure when two of three PCI team members were on site. Multiple key time measurements were made before (N=67) and after (N=89) the intervention.

    Main outcomes

    Time difference (minutes) in system delay between the preintervention and postintervention phases.

    Results

    Time from first medical contact (FMC) to a patent artery and time from FMC-to-catheter laboratory (cath-lab) arrival decreased by 6 and 12 min, respectively (ns). Time from FMC-to-ECG recording remained unchanged after the intervention. Time from ECG to decision for primary PCI was reduced by 6 min, p=0.004 and time from ECG-to-cath-lab arrival by 11 min, p=0.02. Total time from diagnosis to a patent artery decreased by 11 min (ns).

    Conclusions

    Identification of time delays in an STEMI network with awareness of delay factors, reorganisation of logistics and continuous feedback can reduce system delay times significantly.

  • 128.
    Tödt, Tim
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
    Thylén, Ingela
    Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping. Linköping University, Department of Medical and Health Sciences, Division of Nursing Science.
    Alfredsson, Joakim
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
    Swahn, Eva
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
    Janzon, Magnus
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
    Strategies to reduce time delays in patients with acute coronary heart disease treated with primary PCI.2013Conference paper (Refereed)
  • 129.
    Varenhorst, Christoph
    et al.
    Uppsala Clin Res Ctr, Sweden; Uppsala Univ, Sweden.
    Hasvold, Pal
    AstraZeneca Nord Baltic, Sweden; AstraZeneca RandD, Sweden.
    Johansson, Saga
    Uppsala Clin Res Ctr, Sweden; Uppsala Univ, Sweden; AstraZeneca RandD, Sweden.
    Janzon, Magnus
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Albertsson, Per
    Univ Gothenburg, Sweden.
    Leosdottir, Margret
    Lund Univ, Sweden.
    Hambraeus, Kristina
    Falun Cty Hosp, Sweden.
    James, Stefan
    Uppsala Clinical Research Center, Uppsala, Sweden; Uppsala University, Uppsala, Sweden.
    Jernberg, Tomas
    Solna Karolinska Univ Hosp, Sweden.
    Svennblad, Bodil
    Uppsala Clin Res Ctr, Sweden.
    Lagerqvist, Bo
    Uppsala Clin Res Ctr, Sweden; Uppsala Univ, Sweden.
    Culprit and Nonculprit Recurrent Ischemic Events in Patients With Myocardial Infarction: Data From SWEDEHEART (Swedish Web System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies)2018In: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, ISSN 2047-9980, E-ISSN 2047-9980, Vol. 7, no 1, article id e007174Article in journal (Refereed)
    Abstract [en]

    Background-Long-term disease progression after myocardial infarction (MI) is inadequately understood. We evaluated the pattern and angiographic properties (culprit lesion [CL]/non-CL [NCL]) of recurrent MI (re-MI) in a large real-world patient population. Methods and Results-Our observational study used prospectively collected data in 108 615 patients with first-occurrence MI enrolled in the SWEDEHEART (Swedish Web System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies) between July 1, 2006 and November 29, 2014. During follow-up (median, 3.2 years), recurrent hospitalization for MI occurred in 11 117 patients (10.2%). Of the patients who underwent coronary angiography for the index MI, a CL was identified in 44 332 patients. Of those patients, 3464 experienced an re-MI; the infarct originated from the NCL in 1243 patients and from the CL in 655 patients. In total, 1566 re-MIs were indeterminate events and could not be classified as NCL or CL re-MIs. The risk of re-MI within 8 years related to the NCL was 0.06 (95% confidence interval [CI], 0.05-0.06), compared with 0.03 (95% CI, 0.02-0.03) for the CL. There were no large differences in baseline characteristics of patients with subsequent NCL versus CL re-MIs. Independent predictors of NCL versus CL re-MI were multivessel disease (odds ratio, 2.29; 95% CI, 1.87-2.82), male sex (odds ratio, 1.36; 95% CI, 1.09-1.71), and a prolonged time between the index and re-MI (odds ratio, 1.16; 95% CI, 1.10-1.22). Conclusions-In a large cohort of patients with first-occurrence MI undergoing percutaneous coronary intervention, the risk of re-MI originating from a previously untreated lesion was twice higher than the risk of lesions originating from a previously stented lesion.

  • 130.
    Venetsanos, Dimitrios
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Sederholm Lawesson, Sofia
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping. Linköping University, Faculty of Medicine and Health Sciences.
    Alfredsson, Joakim
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Janzon, Magnus
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Cequier, Angel
    University of Barcelona, Spain.
    Chettibi, Mohamed
    CHU Frantz Fanon, Algeria.
    Goodman, Shaun G.
    University of Toronto, Canada.
    vant Hof, Arnoud W.
    Isala Clin, Netherlands.
    Montalescot, Gilles
    Sorbonne University, France.
    Swahn, Eva
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    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 analysis2017In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 7, no 9, article id e015241Article in journal (Refereed)
    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.

  • 131.
    Walfridsson, Håkan
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
    Cosedis Nielsen, J
    Aarhus University Hospital, Denmark.
    Johannessen, A
    Gentofte Hospital, Copenhagen, Denmark .
    Raatikainen, P
    Tampere University Hospital, Finland.
    Hartikainen, J
    Kuopio University Hospital, Finland.
    Walfridsson, Ulla
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
    Levin, Lars-Åke
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences.
    Janzon, Magnus
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
    Aronsson, M
    Hansen, P S
    Varde Heart Center, Denmark.
    Radiofrequency ablation as initial therapy in paroxysmal atrial fibrillation: results on health-related quality of life and symptom burden2013Conference paper (Refereed)
  • 132.
    Walfridsson, Håkan
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Walfridsson, Ulla
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Cosedis Nielsen, J.
    Aarhus University Hospital, Denmark.
    Johannessen, A.
    Gentofte University Hospital, Denmark.
    Raatikainen, P.
    Tampere University Hospital, Finland.
    Janzon, Magnus
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Levin, Lars-Åke
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences.
    Aronsson, Mattias
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences.
    Hindricks, G.
    Leipzig University Hospital, Germany.
    Kongstad, O.
    University of Lund Hospital, Sweden.
    Pehrson, S.
    Rigshosp, Denmark.
    Englund, A.
    University Hospital, Örebro, Sweden.
    Hartikainen, J.
    Kuopio University Hospital, Finland.
    Mortensen, L. S.
    12UNI-C, Danish Information Technology Centre for Education and Research, Denmark.
    Hansen, P. S.
    Aarhus University Hospital, Denmark.
    Radiofrequency ablation as initial therapy in paroxysmal atrial fibrillation: results on health-related quality of life and symptom burden. The MANTRA-PAF trial2015In: Europace, ISSN 1099-5129, E-ISSN 1532-2092, Vol. 17, no 2, p. 215-221Article in journal (Refereed)
    Abstract [en]

    Aims The Medical ANtiarrhythmic Treatment or Radiofrequency Ablation in Paroxysmal Atrial Fibrillation (MANTRA-PAF) trial assessed the long-term efficacy of an initial strategy of radiofrequency ablation (RFA) vs. antiarrhythmic drug therapy (AAD) as first-line treatment for patients with PAF. In this substudy, we evaluated the effect of these treatment modalities on the Health-Related Quality of Life (HRQoL) and symptom burden of patients at 12 and 24 months. Methods and results During the study period, 294 patients were enrolled in the MANTRA-PAF trial and randomized to receive AAD (N = 148) or RFA (N = 146). Two generic questionnaires were used to assess the HRQoL [Short Form-36 (SF-36) and EuroQol-five dimensions (EQ-5D)], and the Arrhythmia-Specific questionnaire in Tachycardia and Arrhythmia (ASTA) was used to evaluate the symptoms appearing during the trial. All comparisons were made on an intention-to-treat basis. Both randomization groups showed significant improvements in assessments with both SF-36 and EQ-5D, at 24 months. Patients randomized to RFA showed significantly greater improvement in four physically related scales of the SF-36. The three most frequently reported symptoms were breathlessness during activity, pronounced tiredness, and worry/anxiety. In both groups, there was a significant reduction in ASTA symptom index and in the severity of seven of the eight symptoms over time. Conclusion Both AAD and RFA as first-line treatment resulted in substantial improvement of HRQoL and symptom burden in patients with PAF. Patients randomized to RFA showed greater improvement in physical scales (SF-36) and the EQ-visual analogue scale.

  • 133.
    Walfridsson, Ulla
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Strömberg, Anna
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Nursing Science. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Janzon, Magnus
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Cardiology . Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Walfridsson, Håkan
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Cardiology . Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Paroxysmal supraventricular tachyarrhythmia in a Swedish population: consequences on health-related quality of life2007In: European Society of Cardiology 2007,2007, 2007Conference paper (Other academic)
    Abstract [en]

    Number: 85989   

  • 134.
    Walfridsson, Ulla
    et al.
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology. Linköping University, Faculty of Health Sciences.
    Strömberg, Anna
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology. Linköping University, Faculty of Health Sciences.
    Janzon, Magnus
    Linköping University, Department of Medicine and Health Sciences, Cardiology . Östergötlands Läns Landsting, Heart Centre, Department of Cardiology. Linköping University, Faculty of Health Sciences.
    Walfridsson, Håkan
    Linköping University, Department of Medicine and Health Sciences, Cardiology . Östergötlands Läns Landsting, Heart Centre, Department of Cardiology. Linköping University, Faculty of Health Sciences.
    Wolff-Parkinson-White Syndrome and Atrioventricular Nodal Re-Entry Tachycardia in a Swedish Population: Consequences on Health-Related Quality of Life2009In: Pacing and Clinical Electrophysiology, ISSN 0147-8389, E-ISSN 1540-8159, Vol. 32, no 10, p. 1299-1306Article in journal (Refereed)
    Abstract [en]

    Background: Living with paroxysmal supraventricular tachycardia affects a patient's whole life situation, but few studies have addressed health-related quality of life (HRQOL) aspects in these patients. The aim was therefore to describe HRQOL in patients with atrioventricular nodal re-entry tachycardia (AVNRT) or Wolff-Parkinson-White (WPW) syndrome, referred for radiofrequency ablation (RF-ablation), compared to age- and gender-matched Swedish reference groups.

    Methods: HRQOL was assessed with SF-36 and EuroQol (EQ-5D and EQ-VAS) and the patients were asked disease-specific questions.

    Results: The 97 patients with AVNRT [53 ± 16 years of age/65 women] and 79 patients with WPW [42 ± 15 years of age/26 women] exhibited significantly lower HRQOL scores in SF-36 in the same seven of the eight scales: Physical functioning (PF), role-physical (RP), social functioning (SF), role-emotional (RE), general health (GH), vitality (VT), and mental health (MH) while there was no difference in bodily pain (BP) compared to their respective age- and gender matched Swedish reference group. HRQOL scores were lower for patients with AVNRT compared to WPW in the areas of PF (P < 0.001), BP (P < 0.05), and GH (P < 0.01) in SF-36, and the same was found in EQ-VAS (64.8 vs. 71.2, P < 0.05). Occurrence of episodes of tachycardia more often than once a month compared to less frequently than once a month was associated with significantly lower HRQOL in all eight scales in SF-36 (GH, RE, MH: P < 0.01 and PF, RP, BP, VT, SF: P < 0.001) and EQ-5D index (P < 0.001) and EQ-VAS (P < 0.05) Arrhythmia duration longer than one hour compared to patients with shorter duration of the tachycardia-affected GH in SF-36 negatively (P < 0.05). Patients who experienced symptoms not only during activity but also at rest scored lower in SF-36 GH (P < 0.01) and SF (P < 0.05).

    Conclusion: Measuring HRQOL in patients with WPW or AVNRT is an important way to evaluate and describe these patients' life situation. These conditions were found to have a pronounced negative impact on HRQOL. The frequency of arrhythmia occurrence is one important factor to consider when setting priorities for treatment with RF-ablation.

  • 135.
    Wallentin, L
    et al.
    Univ Hosp, Dept Cardiol, Uppsala, Sweden Univ Hosp, Dept Cardiol, Linkoping, Sweden Oslo Hosp, Dept Cardiol, Oslo, Norway Aarhus Hosp, Dept Cardiol, Aarhus, Denmark.
    Diderholm, E
    Univ Hosp, Dept Cardiol, Uppsala, Sweden Univ Hosp, Dept Cardiol, Linkoping, Sweden Oslo Hosp, Dept Cardiol, Oslo, Norway Aarhus Hosp, Dept Cardiol, Aarhus, Denmark.
    Janzon, Magnus
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Cardiology . Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Kontny, F
    Univ Hosp, Dept Cardiol, Uppsala, Sweden Univ Hosp, Dept Cardiol, Linkoping, Sweden Oslo Hosp, Dept Cardiol, Oslo, Norway Aarhus Hosp, Dept Cardiol, Aarhus, Denmark.
    Lagerqvist, B
    Univ Hosp, Dept Cardiol, Uppsala, Sweden Univ Hosp, Dept Cardiol, Linkoping, Sweden Oslo Hosp, Dept Cardiol, Oslo, Norway Aarhus Hosp, Dept Cardiol, Aarhus, Denmark.
    Husted, S
    Univ Hosp, Dept Cardiol, Uppsala, Sweden Univ Hosp, Dept Cardiol, Linkoping, Sweden Oslo Hosp, Dept Cardiol, Oslo, Norway Aarhus Hosp, Dept Cardiol, Aarhus, Denmark.
    Swahn, Eva
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Cardiology . Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Elevation of LDL cholesterol and interaction with the cholesterol lowering effect of statins during long-term low-molecular-weight heparin (dalteparin) treatment2000In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 21, p. P1099-Conference paper (Other academic)
  • 136.
    Wallentin, L
    et al.
    Univ Hosp, Dept Cardiol, Uppsala, Sweden Oslo Hosp, Dept Cardiol, Oslo, Norway Aarhaus Hosp, Dept Cardiol, Aarhus, Denmark Univ Hosp, Dept Cardiol, Linkoping, Sweden.
    Diderholm, E
    Univ Hosp, Dept Cardiol, Uppsala, Sweden Oslo Hosp, Dept Cardiol, Oslo, Norway Aarhaus Hosp, Dept Cardiol, Aarhus, Denmark Univ Hosp, Dept Cardiol, Linkoping, Sweden.
    Janzon, Magnus
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Cardiology . Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Kontny, F
    Univ Hosp, Dept Cardiol, Uppsala, Sweden Oslo Hosp, Dept Cardiol, Oslo, Norway Aarhaus Hosp, Dept Cardiol, Aarhus, Denmark Univ Hosp, Dept Cardiol, Linkoping, Sweden.
    Lagerqvist, B
    Univ Hosp, Dept Cardiol, Uppsala, Sweden Oslo Hosp, Dept Cardiol, Oslo, Norway Aarhaus Hosp, Dept Cardiol, Aarhus, Denmark Univ Hosp, Dept Cardiol, Linkoping, Sweden.
    Lindahl, B
    Univ Hosp, Dept Cardiol, Uppsala, Sweden Oslo Hosp, Dept Cardiol, Oslo, Norway Aarhaus Hosp, Dept Cardiol, Aarhus, Denmark Univ Hosp, Dept Cardiol, Linkoping, Sweden.
    Husted, S
    Univ Hosp, Dept Cardiol, Uppsala, Sweden Oslo Hosp, Dept Cardiol, Oslo, Norway Aarhaus Hosp, Dept Cardiol, Aarhus, Denmark Univ Hosp, Dept Cardiol, Linkoping, Sweden.
    Swahn, Eva
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Cardiology . Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    The protective effects of long-term lmw heparin (dalteparin) treatment in unstable CAD is confined to patients not previously treated with statins2000In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 21, p. P1100-Conference paper (Other academic)
  • 137.
    Wallentin, Lars
    et al.
    Uppsala University, Sweden.
    Lindhagen, Lars
    Uppsala University, Sweden.
    Arnstrom, Elisabet
    Uppsala University, Sweden.
    Husted, Steen
    Hospital Unit West, Denmark.
    Janzon, Magnus
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Paaske Johnsen, Soren
    Aarhus University Hospital, Denmark.
    Kontny, Frederic
    Stavanger University Hospital, Norway; Drammen Heart Centre, Norway.
    Kempf, Tibor
    Hannover Medical Sch, Germany.
    Levin, Lars-Åke
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Lindahl, Bertil
    Uppsala University, Sweden.
    Stridsberg, Mats
    Uppsala University, Sweden.
    Stahle, Elisabeth
    Uppsala University, Sweden.
    Venge, Per
    Uppsala University, Sweden.
    Wollert, Kai C.
    Hannover Medical Sch, Germany.
    Swahn, Eva
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Lagerqvist, Bo
    Uppsala University, Sweden.
    Early invasive versus non-invasive treatment in patients with non-ST-elevation acute coronary syndrome (FRISC-II): 15 year follow-up of a prospective, randomised, multicentre study2016In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 388, no 10054, p. 1903-1911Article in journal (Refereed)
    Abstract [en]

    Background The FRISC-II trial was the first randomised trial to show a reduction in death or myocardial infarction with an early invasive versus a non-invasive treatment strategy in patients with non-ST-elevation acute coronary syndrome. Here we provide a remaining lifetime perspective on the effects on all cardiovascular events during 15 years follow-up. Methods The FRISC-II prospective, randomised, multicentre trial was done at 58 Scandinavian centres in Sweden, Denmark, and Norway. Between June 17, 1996, and Aug 28, 1998, we randomly assigned (1:1) 2457 patients with non-ST-elevation acute coronary syndrome to an early invasive treatment strategy, aiming for revascularisation within 7 days, or a non-invasive strategy, with invasive procedures at recurrent symptoms or severe exercise-induced ischaemia. Plasma for biomarker analyses was obtained at randomisation. For long-term outcomes, we linked data with national health-care registers. The primary endpoint was a composite of death or myocardial infarction. Outcomes were compared as the average postponement of the next event, including recurrent events, calculated as the area between mean cumulative count-of-events curves. Analyses were done by intention to treat. Findings At a minimum of 15 years follow-up on Dec 31, 2014, data for survival status and death were available for 2421 (99%) of the initially recruited 2457 patients, and for other events after 2 years for 2182 (89%) patients. During follow-up, the invasive strategy postponed death or next myocardial infarction by a mean of 549 days (95% CI 204-888; p= 0.0020) compared with the non-invasive strategy. This effect was larger in non-smokers (mean gain 809 days, 95% CI 402-1175; p(interaction) = 0.0182), patients with elevated troponin T (778 days, 357-1165; p (interaction) = 0.0241), and patients with high concentrations of growth differentiation factor-15 (1356 days, 507-1650; p (interaction) = 0.0210). The difference was mainly driven by postponement of new myocardial infarction, whereas the early difference in mortality alone was not sustained over time. The invasive strategy led to a mean of 1128 days (95% CI 830-1366) postponement of death or next readmission to hospital for ischaemic heart disease, which was consistent in all subgroups (pamp;lt; 0.0001). Interpretation During 15 years of follow-up, an early invasive treatment strategy postponed the occurrence of death or next myocardial infarction by an average of 18 months, and the next readmission to hospital for ischaemic heart disease by 37 months, compared with a non-invasive strategy in patients with non-ST-elevation acute coronary syndrome. This remaining lifetime perspective supports that an early invasive treatment strategy should be the preferred option in most patients with non-ST-elevation acute coronary syndrome.

  • 138. Wigren, Jan
    et al.
    Carlsson, Christer
    Johansson, Ingela
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Janzon, Magnus
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Broström, Anders
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Nursing Science.
    Patient´s perceptions of prehospital care during acute myocardial infarction2006In: NSFS Landsgruppe av Kardiologiske sykepleiere,2006, 2006Conference paper (Other academic)
  • 139.
    Zachrisson, Helene
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Clinical Physiology . Östergötlands Läns Landsting, Heart Centre, Department of Clinical Physiology.
    Persson, Anders
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Radiology . Östergötlands Läns Landsting, Centre for Medical Imaging, Department of Radiology UHL. Linköping University, Center for Medical Image Science and Visualization, CMIV.
    Engvall, Jan
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Clinical Physiology . Östergötlands Läns Landsting, Heart Centre, Department of Clinical Physiology. Linköping University, Center for Medical Image Science and Visualization, CMIV.
    Stenestrand, Ulf
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Cardiology . Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Janzon, Magnus
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Cardiology . Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    CT angiography - clinical experience from Linköping University Hospital2008In: X Svenska Kardiovaskulära Vårmötet,2008, 2008, p. 40-Conference paper (Refereed)
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