| 1. |
- Erlinge, D., et al.
(författare)
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Bivalirudin versus Heparin Monotherapy in Myocardial Infarction
- 2017
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Ingår i: New England Journal of Medicine. - : Massachusetts Medical Society. - 0028-4793 .- 1533-4406. ; 377:12, s. 1132-1142
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Tidskriftsartikel (refereegranskat)abstract
- Background The comparative efficacy of various anticoagulation strategies has not been clearly established in patients with acute myocardial infarction who are undergoing percutaneous coronary intervention (PCI) according to current practice, which includes the use of radial-artery access for PCI and administration of potent P2Y12 inhibitors without the planned use of glycoprotein IIb/IIIa inhibitors. Methods In this multicenter, randomized, registry-based, open-label clinical trial, we enrolled patients with either ST-segment elevation myocardial infarction (STEMI) or non-STEMI (NSTEMI) who were undergoing PCI and receiving treatment with a potent P2Y12 inhibitor (ticagrelor, prasugrel, or cangrelor) without the planned use of glycoprotein IIb/IIIa inhibitors. The patients were randomly assigned to receive bivalirudin or heparin during PCI, which was performed predominantly with the use of radial-artery access. The primary end point was a composite of death from any cause, myocardial infarction, or major bleeding during 180 days of follow-up. Results A total of 6006 patients (3005 with STEMI and 3001 with NSTEMI) were enrolled in the trial. At 180 days, a primary end-point event had occurred in 12.3% of the patients (369 of 3004) in the bivalirudin group and in 12.8% (383 of 3002) in the heparin group (hazard ratio, 0.96; 95% confidence interval [CI], 0.83 to 1.10; P=0.54). The results were consistent between patients with STEMI and those with NSTEMI and across other major subgroups. Myocardial infarction occurred in 2.0% of the patients in the bivalirudin group and in 2.4% in the heparin group (hazard ratio, 0.84; 95% CI, 0.60 to 1.19; P=0.33), major bleeding in 8.6% and 8.6%, respectively (hazard ratio, 1.00; 95% CI, 0.84 to 1.19; P=0.98), definite stent thrombosis in 0.4% and 0.7%, respectively (hazard ratio, 0.54; 95% CI, 0.27 to 1.10; P=0.09), and death in 2.9% and 2.8%, respectively (hazard ratio, 1.05; 95% CI, 0.78 to 1.41; P=0.76). Conclusions Among patients undergoing PCI for myocardial infarction, the rate of the composite of death from any cause, myocardial infarction, or major bleeding was not lower among those who received bivalirudin than among those who received heparin monotherapy. (Funded by the Swedish Heart-Lung Foundation and others; VALIDATE-SWEDEHEART ClinicalTrialsRegister.eu number, 2012-005260-10 ; ClinicalTrials.gov number, NCT02311231 .).
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| 2. |
- Hofmann, Robin, et al.
(författare)
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Oxygen therapy in ST-elevation myocardial infarction.
- 2018
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Ingår i: European Heart Journal. - : Oxford University Press (OUP). - 0195-668X .- 1522-9645. ; 39:29, s. 2730-2739
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Tidskriftsartikel (refereegranskat)abstract
- Aims: To determine whether supplemental oxygen in patients with ST-elevation myocardial infarction (STEMI) impacts on procedure-related and clinical outcomes.Methods and results: The DETermination of the role of Oxygen in suspected Acute Myocardial Infarction (DETO2X-AMI) trial randomized patients with suspected myocardial infarction (MI) to receive oxygen at 6 L/min for 6-12 h or ambient air. In this pre-specified analysis, we included only STEMI patients who underwent percutaneous coronary intervention (PCI). In total, 2807 patients were included, 1361 assigned to receive oxygen, and 1446 assigned to ambient air. The pre-specified primary composite endpoint of all-cause death, rehospitalization with MI, cardiogenic shock, or stent thrombosis at 1 year occurred in 6.3% (86 of 1361) of patients allocated to oxygen compared to 7.5% (108 of 1446) allocated to ambient air [hazard ratio (HR) 0.85, 95% confidence interval (95% CI) 0.64-1.13; P = 0.27]. There was no difference in the rate of death from any cause (HR 0.86, 95% CI 0.61-1.22; P = 0.41), rate of rehospitalization for MI (HR 0.92, 95% CI 0.57-1.48; P = 0.73), rehospitalization for cardiogenic shock (HR 1.05, 95% CI 0.21-5.22; P = 0.95), or stent thrombosis (HR 1.27, 95% CI 0.46-3.51; P = 0.64). The primary composite endpoint was consistent across all subgroups, as well as at different time points, such as during hospital stay, at 30 days and the total duration of follow-up up to 1356 days.Conclusions: Routine use of supplemental oxygen in normoxemic patients with STEMI undergoing primary PCI did not significantly affect 1-year all-cause death, rehospitalization with MI, cardiogenic shock, or stent thrombosis.
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| 3. |
- James, Stefan, 1964-, et al.
(författare)
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Bivalirudin Versus Heparin Monotherapy in ST-Segment-Elevation Myocardial Infarction
- 2021
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Ingår i: Circulation. Cardiovascular Interventions. - : Lippincott Williams & Wilkins. - 1941-7640 .- 1941-7632. ; 14:12
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Bivalirudin was not superior to unfractionated heparin in patients with myocardial infarction (MI) treated with percutaneous coronary intervention and no planned use of GPI (glycoprotein IIb/IIIa inhibitors) in contemporary clinical practice of radial access and potent P2Y12-inhibitors in the VALIDATE-SWEDEHEART randomized clinical trial (Bivalirudin Versus Heparin in STEMI and NSTEMI Patients on Modern Antiplatelet Therapy-Swedish Web-System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies Registry).METHODS: In this prespecified separately powered subgroup analysis, we included patients with ST-segment-elevation MI undergoing primary percutaneous coronary intervention with the primary composite end point of all-cause death, MI, or major bleeding event within 180 days.RESULTS: Among the 6006 patients enrolled in the trial, 3005 patients with ST-segment-elevation MI were randomized to receive bivalirudin or heparin. The mean age was 66.8 years. According to protocol recommendations, 87% were treated with potent oral P2Y12-inhibitors before start of angiography and radial access was used in 90%. GPI was used in 51 (3.4%) and 74 (4.9%) of patients randomized to receive bivalirudin and heparin, respectively. The primary end point occurred in 12.5% (187 of 1501) and 13.0% (196 of 1504; hazard ratio [HR], 0.95 [95% CI, 0.78-1.17], P=0.64) with consistent results in all major subgroups. All-cause death occurred in 3.9% versus 3.9% (HR, 1.00 [0.70-1.45], P=0.98), MI in 1.7% versus 2.2% (HR, 0.76 [0.45-1.28], P=0.30), major bleeding in 8.3% versus 8.0% (HR, 1.04 [0.81-1.33], P=0.78), and definite stent thrombosis in 0.5% versus 1.3% (HR, 0.42 [0.18-0.96], P=0.04).CONCLUSIONS: In patients with ST-segment-elevation MI undergoing primary percutaneous coronary intervention with radial access and receiving current recommended treatments with potent P2Y12-inhibitors rate of the composite of all-cause death, MI, or major bleeding was not lower in those randomized to receive bivalirudin as compared with heparin.REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02311231.
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| 4. |
- James, Stefan, 1964-, et al.
(författare)
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Effect of Oxygen Therapy on Cardiovascular Outcomes in Relation to Baseline Oxygen Saturation.
- 2019
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Ingår i: JACC. - : Elsevier BV. - 1936-8798 .- 1876-7605.
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: The aim of this study was to determine the effect of supplemental oxygen in patients with myocardial infarction (MI) on the composite of all-cause death, rehospitalization with MI, or heart failure related to baseline oxygen saturation. A secondary objective was to investigate outcomes in patients developing hypoxemia.BACKGROUND: In the DETO2X-AMI (Determination of the Role of Oxygen in Suspected Acute Myocardial Infarction) trial, 6,629 normoxemic patients with suspected MI were randomized to oxygen at 6 l/min for 6 to 12 hours or ambient air.METHODS: The study population of 5,010 patients with confirmed MI was divided by baseline oxygen saturation into a low-normal (90% to 94%) and a high-normal (95% to 100%) cohort. Outcomes are reported within 1 year. To increase power, all follow-up time (between 1 and 4 years) was included post hoc, and interaction analyses were performed with oxygen saturation as a continuous covariate.RESULTS: The composite endpoint of all-cause death, rehospitalization with MI, or heart failure occurred significantly more often in patients in the low-normal cohort (17.3%) compared with those in the high-normal cohort (9.5%) (p < 0.001), and most often in patients developing hypoxemia (23.6%). Oxygen therapy compared with ambient air was not associated with improved outcomes regardless of baseline oxygen saturation (interaction p values: composite endpoint, p = 0.79; all-cause death, p = 0.33; rehospitalization with MI, p = 0.86; hospitalization for heart failure, p = 0.35).CONCLUSIONS: Irrespective of oxygen saturation at baseline, we found no clinically relevant beneficial effect of routine oxygen therapy in normoxemic patients with MI regarding cardiovascular outcomes. Low-normal baseline oxygen saturation or development of hypoxemia was identified as an independent marker of poor prognosis. (An Efficacy and Outcome Study of Supplemental Oxygen Treatment in Patients With Suspected Myocardial Infarction; NCT01787110).
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| 5. |
- Lindahl, Bertil, 1957-, et al.
(författare)
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Poor long-term prognosis in patients admitted with strong suspicion of acute myocardial infarction but discharged with another diagnosis
- 2021
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Ingår i: Journal of Internal Medicine. - : Wiley. - 0954-6820 .- 1365-2796. ; 290:2, s. 359-372
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Tidskriftsartikel (refereegranskat)abstract
- Background: Characteristics and prognosis of patients admitted with strong suspicion of myocardial infarction (MI) but discharged without an MI diagnosis are not well-described. Objectives: To compare background characteristics and cardiovascular outcomes in patients discharged with or without MI diagnosis. Methods: The DETermination of the role of Oxygen in suspected Acute Myocardial Infarction (DETO2X-AMI) trial compared 6629 patients with strong suspicion of MI randomized to oxygen or ambient air. The main composite end-point of this subgroup analysis was the incidence of all-cause death, rehospitalization with MI, heart failure (HF) or stroke during a follow-up of 2.1 years (median; range: 1–3.7 years) irrespective of randomized treatment. Results: 1619 (24%) received a non-MI discharge diagnosis, and 5010 patients (76%) were diagnosed with MI. Groups were similar in age, but non-MI patients were more commonly female and had more comorbidities. At thirty days, the incidence of the composite end-point was 2.8% (45 of 1619) in non-MI patients, compared to 5.0% (250 of 5010) in MI patients with lower incidences in all individual end-points. However, for the long-term follow-up, the incidence of the composite end-point increased in the non-MI patients to 17.7% (286 of 1619) as compared to 16.0% (804 of 5010) in MI patients, mainly driven by a higher incidence of all-cause death, stroke and HF. Conclusions: Patients admitted with a strong suspicion of MI but discharged with another diagnosis had more favourable outcomes in the short-term perspective, but from one year onwards, cardiovascular outcomes and death deteriorated to a worse long-term prognosis.
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| 6. |
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| 7. |
- Marin, Gustav, et al.
(författare)
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Stiffness and strength properties of five paperboards and their moisture dependency
- 2019
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Ingår i: Paper Conference and Trade Show, PaperCon 2019. - : TAPPI Press. - 9781510893948 ; , s. 1193-1208
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Konferensbidrag (refereegranskat)abstract
- Five folding box boards made on the same paperboard machine have been analyzed. The paperboards were from the same product series but had different grammage (235, 255, 270, 315, 340 g/m2) and different bending stiffness. The paperboards are normally used to make packages, and since the bending stiffness and grammage varies the packages performance will be different. Finite element simulations can be used to predict these differences. However, the stiffness and strength properties then need to be known. For efficient determination of the three-dimensional properties in MD, CD and ZD, it is proposed that the whole paperboard should be characterized with the following tests: in-plane tension, ZD tension, shear strength profiles and two-point bending. The stiffness and strength properties have with the proposed setups been determined at different relative humidity (20, 50, 70 and 90 % RH), and the mechanical properties have been evaluated as function of moisture ratio. The results showed a linear relation between mechanical properties and moisture ratio for each paperboard. The data was then normalized with data for the standard climate (50 % RH) and investigated as a function of moisture ratio. The results indicated that the normalized mechanical properties for all paperboards coincided along one single line and could therefore be expressed as a linear function of moisture ratio and two constants. Consequently, the study indicates that it is possible to obtain the mechanical properties of a paperboard, by knowing the structural properties for the preferred level of RH and the mechanical property for the standard climate (50 % RH and 23 °C).
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| 8. |
- Marth, Stefan, et al.
(författare)
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Failure Modelling and Experimental Evaluation of a Press-Hardened Laboratory Scale Component with Multi-Phase Microstructure
- 2019
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Ingår i: Hot sheet metal forming of high-performance steel. - : Wissenschaftliche Scripten. ; , s. 39-49
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Konferensbidrag (refereegranskat)abstract
- Hot stamping of boron alloyed steel has become a standard in the automotive industry for safety relevant body in white components. This process allows the design of complex geometries with superior mechanical properties. Special tool design enables to manufacture components with special properties based on varying microstructures in designated areas. This is a challenge for finite element (FE) simulations of deformation and failure for multi-phase microstructure components.In the present work, a laboratory scale test component with multi-phase microstructure is studied from blank to fractured component. Using different tool temperatures and adding an air-cooling step before transfer to the press hardening tool, the microstructure of the component is varied. By this, components with four different multi-phase microstructures are produced. These components are tested under tensile deformation until fracture, where force, elongation and the strain field on the components surface are measured.The laboratory scale test component is evaluated using FE-modelling. The complete production process is modelled starting with the pre-cut austenitized blank, subsequent transfer, air-cooling, forming operation, and the final post-cooling. The resulting multi-phase micro structures are evaluated using manual optical microscope image analysis and compared with the simulated phase composition. Furthermore, the deformation and fracture of the manufactured component under tensional loading is studied using a mean-field homogenization scheme for the multi-phase composition combined with the OPTUS failure model. This finite element investigation is conducted taking the microstructure composition, shape and thickness deviations from the forming simulation into account.The present work shows the feasibility of modelling methods of the complete process chain for press-hardened components with multi-phase microstructures, from blank to fractured component.
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| 9. |
- Marth, Stefan, et al.
(författare)
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From Blank to Fractured Component : Numerical and Experimental Results of a Laboratory Scale Component
- 2018
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Konferensbidrag (refereegranskat)abstract
- Hot stamping of boron alloyed steel has become a standard in the automotive industry for safety relevant chassis components. Hot stamping of ultra-high strength steel allows the design of complex geometries with superior mechanical properties. In the present work, a laboratory scale test component is followed up from blank to fractured component. The production process starts with a pre-cut blank, which then is austenitized, transferred to the press hardening tool, formed and quenched and ends with post-cooling to room temperature. These components are tested under tensile deformation until fracture, where force, elongation and the strain field on the components surface are measured. The strain field measurements are performed by using digital image correlation (DIC). The laboratory scale test component is evaluated using finite element modelling. The production process is modelled starting with a pre-cut austenitized blank, subsequent transfer and forming operation, and ends with post-cooling. Furthermore, the deformation and fracture under tension/bending is studied using the OPTUS damage model. The as-produced component is measured using a three dimensional scanning system. Shape deviation and thickness change are compared to in the forming simulation predicted geometry after post-cooling. A finite element investigation on the deformation and fracture under tensional/bending loading is conducted applying shape and thickness deviations in the model. The majority of industrial components undergo paint curing before they are included in an assembly. Paint baking is a heat treatment at relatively low temperatures and causes relaxation in a martensitic microstructure. The effect of paint baking on the mechanical response of the laboratory scale test component is investigated. In the present work the reliability of modelling tools from blank to fractured component is shown. The possibility is shown to predict the failure of the component, with the specific phase composition after the hot stamping process obtained from simulations. Furthermore, the influence of the paint baking process on the mechanical properties is presented.
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| 10. |
- Abrahamsson, Lars, et al.
(författare)
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An electromechanical moving load fixed node position and fixed node number railway power supply systems optimization model
- 2013
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Ingår i: Transportation Research Part C. - : Elsevier BV. - 0968-090X .- 1879-2359. ; 30, s. 23-40
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Tidskriftsartikel (refereegranskat)abstract
- This paper presents an optimization model for simulations of railway power supply systems. It includes detailed power systems modeling, train movements in discretized time considering running resistance and other mechanical constraints, and the voltage-drop-induced reduction of possible train tractive forces. The model has a fixed number of stationary power system nodes, which alleviates optimized operation overtime. The proposed model uses SOS2 (Special Ordered Sets of type 2) variables to distribute the train loads to the two most adjacent power system nodes available. The impacts of the number of power system nodes along the contact line and the discretized time step length on model accuracy and computation times are investigated. The program is implemented in GAMS. Experiences from various solver choices are also discussed. The train traveling times are minimized in the example. Other studies could e.g. consider energy consumption minimization. The numerical example is representative for a Swedish decentralized, rotary-converter fed railway power supply system. The proposed concept is however generalizable and could be applied for all kinds of moving load power system studies.
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