| 1. |
- Desta, Liyew, et al.
(författare)
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Transradial versus trans-femoral access site in high-speed rotational atherectomy in Sweden
- 2022
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Ingår i: International Journal of Cardiology. - : Elsevier BV. - 0167-5273 .- 1874-1754. ; 352, s. 45-51
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Tidskriftsartikel (refereegranskat)abstract
- Background: Radial artery is the preferred access site in contemporary percutaneous coronary intervention (PCI). However, limited data exist regarding utilization pattern, safety, and long-term efficacy of transradial artery access (TRA) PCI in heavily calcified lesions using high-speed rotational atherectomy (HSRA). Methods: All patients who underwent HSRA-PCI in Sweden between 2005 and 2016 were included. Outcomes were major adverse cardiac events (MACE, including death, myocardial infarction (MI) or target vessel revascularisation (TVR)), in-hospital bleeding and restenosis. Inverse probability of treatment weighting was used to adjust for the non-randomized access site selection. Results: We included 1479 patients of whom 649 had TRA and 782 transfemoral artery access (TFA) HSRA-PCI. The rate of TRA increased significantly by 18% per year but remained lower in HSRA-PCI (60%) than in the overall PCI population (85%) in 2016. TRA was associated with comparable angiographic success but significantly lower risk for major (adjusted OR 0.16; 95% CI 0.05–0.47) or any in-hospital bleeding (adjusted OR 0.32; 95% CI 0.13–0.78). At one year, the adjusted risk for MACE (HR 0.87; 95% CI 0.67–1.13) and its individual components did not differ between TRA and TFA patients. The risk for restenosis did not significantly differ between TRA and TFA HSRA-PCI treated lesions (adjusted HR 0.92; 95% CI 0.46–1.81). Conclusion: HSRA-PCI by TRA was associated with significantly lower risk for in-hospital bleeding and equivalent long-term efficacy when compared with TFA. Our data support the feasibility and superior safety profile of TRA in HSRA-PCI.
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| 2. |
- Jurga, Juliane, et al.
(författare)
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Does Coronary Angiography and Percutaneous Coronary Intervention Affect Cognitive Function?
- 2016
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Ingår i: American Journal of Cardiology. - : Elsevier. - 0002-9149 .- 1879-1913. ; 118:10, s. 1437-1441
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Tidskriftsartikel (refereegranskat)abstract
- Cerebral microemboli are frequently observed during coronary angiography (CA) and percutaneous coronary intervention (PCI), and their numbers have been related to the vascular access site used. Although cerebral microemboli can cause silent cerebral lesions, their clinical impact is debated. To study this, 93 patients referred for CA or PCI underwent serial cognitive testing using the Montreal Cognitive Assessment (MoCA) test to detect postprocedural cognitive impairment. Patients were randomized to radial or femoral access. In a subgroup of 35 patients, the number of cerebral microemboli was monitored with transcranial Doppler technique. We found the median precatheterization result of the MoCA test to be 27, and it did not change significantly 4 and 31 days, respectively, after the procedure. There was no significant correlation between the number of cerebral microemboli and the difference between preprocedural and postprocedural MoCA tests. The test results did not differ between vascular access sites. One-third of the patients had a precatheterization median MoCA test result <26 corresponding to mild cognitive impairment. In conclusion, using the MoCA test, we could not detect any cognitive impairment after CA or PCI, and no significant correlations were found between the results of the MoCA test and cerebral microemboli or vascular access site, respectively. In patients with suspected coronary heart disease, mild cognitive impairment was common.
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| 3. |
- Jurga, Juliane, et al.
(författare)
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Pretreatment With P2Y12 Inhibitors in Patients With Chronic Coronary Syndrome Undergoing Percutaneous Coronary Intervention : A Report From the Swedish Coronary Angiography and Angioplasty Registry
- 2021
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Ingår i: Circulation. Cardiovascular Interventions. - : NLM (Medline). - 1941-7640 .- 1941-7632. ; 14:11, s. 1086-1093
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: In patients with chronic coronary syndrome undergoing percutaneous coronary intervention, the optimal timing of P2Y12 inhibitors' administration is uncertain. We compared pretreatment versus treatment in the catheterization laboratory (In-Cathlab) in a real-world population.METHODS: In Swedish Coronary Angiography and Angioplasty Registry, all patients with chronic coronary syndrome undergoing coronary angiography and ad hoc percutaneous coronary intervention, between 2006 and 2017 were identified. Pretreatment was defined as P2Y12 inhibitor administration before coronary angiography, outside the catheterization laboratory. Outcomes were net adverse clinical events including death, myocardial infarction, stroke, or bleeding within 30 days of the index procedure and in-hospital bleeding.RESULTS: We included 26 814 patients, 8237 in the In-Cathlab, and 18 577 in the pretreatment group. In-Cathlab treatment compared with pretreatment was associated with lower risk for net adverse clinical event (4.2 versus 5.1%, adjusted hazard ratio 0.79 [0.63-0.99]), bleeding (2.3 versus 2.6%, adjusted hazard ratio, 0.76 [0.57-1.01]). and in-hospital bleeding (1.9 versus 2.1%, adjusted odds ratio, 0.70 [0.51-0.96]). The risk for death, myocardial infarction, or stroke did not significantly differ between the groups. Among the In-Cathlab treated patients, 41% received ticagrelor or prasugrel and 59% clopidogrel. Treatment with ticagrelor or prasugrel was associated with higher risk for net adverse clinical events (5.4% versus 3.4%, adjusted hazard ratio, 1.66 [1.12-2.48]), bleeding (3.4 versus 1.6%, adjusted hazard ratio, 2.14 [1.34-3.42]), and in-hospital bleeding (2.9 versus 1.2%, adjusted odds ratio, 2.24 [1.29-3.90]) but similar risk for death, myocardial infarction, or stroke, compared with clopidogrel.CONCLUSIONS: In patients with chronic coronary syndrome undergoing coronary angiography and ad hoc percutaneous coronary intervention, pretreatment with P2Y12 inhibitors, before arrival to the catheterization laboratory, was not associated with improved clinical outcomes but was associated with increased risk for bleeding. Our data support clopidogrel administration in the catheterization laboratory as the standard of care. Graphic Abstract: A graphic abstract is available for this article.
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| 4. |
- Jurga, Juliane
(författare)
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The impact of different techniques used for coronary angiography and percutaneous coronary intervention on the occurrence of procedure-related ischemic cerebral complications
- 2016
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Coronary angiography (CA) is the gold standard in diagnosing and determining the treatment of patients with coronary heart disease. Procedure-related neurological complications are rare; 0.1-0.4% for CA and percutaneous coronary intervention (PCI). In contrast, the incidence of procedure-related silent cerebral lesions, shown with diffusion-weighted magnetic resonance tomography, is considerably higher (2-35%). Cerebral microemboli have been observed during different vascular procedures and are related to new silent cerebral lesions but their clinical impact is debated. CA and PCI can be performed with different techniques, i.e. with the radial or the femoral access. As procedure-related stroke is associated with high mortality, considerable morbidity and suffering it is important to study which technique entails the lowest risk for patient injury. Methods and results: Study I. Fifty-one patients with stable angina pectoris were randomised to CA with the radial or the femoral access and the number of cerebral microemboli was assessed with bilateral transcranial Doppler technique of the middle cerebral arteries (MCAs). The number of particulate cerebral microemboli was signifiantly higher with the radial compared to the femoral access. The number of cerebral microemboli was higher for both access sites during catheter exchanges compared with other specifi procedural steps during CA, with most cerebral microemboli detected in the right MCA in the radial group. This indicates a causal anatomical link, as the catheter is advanced from the right radial artery through the brachiocephalic trunk before it bends into the ascending aorta to reach the coronary ostia. Study II. Forty-one patients with stable angina pectoris or non-ST-segment-elevation myocardial infarction scheduled for CA were randomised to two different guidewire techniques with the femoral access involving catheter advancement with or without a leading guidewire over the aortic arch. After the CA was completed, including contrast injections, the opposite technique was used on the same patient without further contrast injections. At the same time, the number of cerebral microemboli was registered using bilateral transcranial Doppler technique. The number of cerebral microemboli was higher when the catheter was advanced with, rather than without a leading guidewire over the aortic arch, independent of whether a complete CA was performed or if a catheter was placed in the vicinity of the coronary ostia only. Study III. All CAs and PCIs reported between 2003 and 2011, n= 336,836, to the Swedish Coronary Angiography and Angioplasty Register with information on access site were retrospectively analysed regarding the association between access site and procedure-related stroke or transient ischemic attack (TIA). After cross-checking the reported neurological complications with the corresponding medical records the incidence of procedure-related stroke or TIA was 0.16%. After multivariable adjustment, the radial access was associated with a higher risk for procedure-related stroke or TIA (risk ratio 1.30, 95% confience interval 1.04-1.62) compared with the femoral access. Parallel to the increased use of the radial access over time, the risk for procedure-related stroke or TIA also increased, although there was no signifiant interaction between the different time intervals observed. Study IV. Ninety-three patients with suspected or stable angina pectoris scheduled for CA or PCI were tested with Montreal Cognitive Assessment (MoCA) before and twice after the coronary procedure to study postprocedural cognitive impairment. A subgroup was monitored with bilateral transcranial Doppler technique to explore the relationship between cerebral microemboli and cognitive function. The patients were also randomised to radial or femoral vascular access site to study if the access site used was related to postprocedural cognitive impairment. Cognitive function assessed with the MoCA test was not impaired after the coronary procedure. There was no signifiant correlation between the results of the MoCA test and cerebral microemboli or vascular access site. Conclusions: The choice of access site and guidewire technique used for CA and PCI had an impact on the occurrence of cerebral microemboli. There may be an association between the radial access and increased risk for procedure-related stroke or TIA, which should be studied further. Earlier studies have shown that cerebral microemboli are related to new silent cerebral lesions, but we found no cognitive impairment after coronary procedures using the MoCA test. Further studies are needed to explore the clinical impact of cerebral microemboli and to minimise or prevent the occurrence of procedure-related ischemic cerebral lesions in patients undergoing CA and PCI.
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| 5. |
- Lund, Larrs H., et al.
(författare)
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Prevalence, correlates, and prognostic significance of QRS prolongation in heart failure with reduced and preserved ejection fraction
- 2013
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Ingår i: European Heart Journal. - : Oxford University Press. - 0195-668X .- 1522-9645. ; 34:7, s. 529-539
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Tidskriftsartikel (refereegranskat)abstract
- AimsThe independent clinical correlates and prognostic impact of QRS prolongation in heart failure (HF) with reduced and preserved ejection fraction (EF) are poorly understood. The rationale for cardiac resynchronization therapy (CRT) in preserved EF is unknown. The aim was to determine the prevalence of, correlates with, and prognostic impact of QRS prolongation in HF with reduced and preserved EF.Methods and resultsWe studied 25 171 patients (age 74.6 ± 12.0 years, 39.9% women) in the Swedish Heart Failure Registry. We assessed QRS width and 40 other clinically relevant variables. Correlates with QRS width were assessed with multivariable logistic regression, and the association between QRS width and all-cause mortality with multivariable Cox regression. Pre-specified subgroup analyses by EF were performed. Thirty-one per cent had QRS ≥120 ms. Strong predictors of QRS ≥120 ms were higher age, male gender, dilated cardiomyopathy, longer duration of HF, and lower EF. One-year survival was 77% in QRS ≥120 vs. 82% in QRS <120 ms, and 5-year survival was 42 vs. 51%, respectively (P < 0.001). The adjusted hazard ratio for all-cause mortality was 1.11 (95% confidence interval 1.04-1.18, P = 0.001) for QRS ≥120 vs. <120 ms. There was no interaction between QRS width and EF.ConclusionQRS prolongation is associated with other markers of severity in HF but is also an independent risk factor for all-cause mortality. The risk associated with QRS prolongation may be similar regardless of EF. This provides a rationale for trials of CRT in HF with preserved EF.
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| 6. |
- Shahim, Bahira, et al.
(författare)
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Cholinesterase inhibitors are associated with reduced mortality in patients with Alzheimer's disease and previous myocardial infarction
- 2024
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Ingår i: EUROPEAN HEART JOURNAL-CARDIOVASCULAR PHARMACOTHERAPY. - 2055-6837 .- 2055-6845.
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Tidskriftsartikel (refereegranskat)abstract
- Background Cholinesterase inhibitors (ChEIs) are the first-line symptomatic pharmacologic treatment for patients with mild-to-moderate Alzheimer's disease (AD). Although the target organ for this group of drugs is the brain, inhibition of the enzyme may affect cardiac function through vagotonic and anti-inflammatory effects.Objective To assess the impact of ChEIs on outcomes in patients with AD who have experienced myocardial infarction (MI) prior to the AD diagnosis.Methods Patients who had experienced MI before they were diagnosed with AD or Alzheimer's mixed dementia between 2008 and 2018 were identified from the Swedish Dementia Registry (SveDem, www.svedem.se), which was linked to the National Patient Registry to obtain data on MI and mortality. Cox proportional hazards regression model among a propensity score-matched dataset was performed to assess the association between ChEI treatment and clinical outcomes.Results Of 3198 patients with previous MI and a diagnosis of AD or mixed dementia, 1705 (53%) were on treatment with ChEIs. Patients treated with ChEIs were more likely to be younger and have a better overall cardiovascular (CV) risk profile. The incidence rate of all-cause death (per 1000 patient-years) in the propensity-matched cohort of 1016 ChEI users and 1016 non-users was 168.6 in patients on treatment with ChEIs compared with 190.7 in patients not on treatment with ChEIs. In this propensity-matched cohort, treatment with ChEIs was associated with a significantly lower risk of all-cause death (adjusted hazard ratio 0.81, 95% confidence interval 0.71-0.92) and a greater reduction with higher doses of ChEIs. While in the unadjusted analysis, ChEIs were associated with a lower risk of both CV and non-CV death, only the association with non-CV death remained significant after accounting for baseline differences.Conclusion Treatment with ChEIs was associated with a significantly reduced risk of all-cause death, driven by lower rates of non-CV death in a nationwide cohort of patients with previous MI and a diagnosis of AD or mixed dementia. These associations were greater with higher ChEI doses.Condensed Abstract We assessed the association between cholinesterase inhibitors (ChEIs) and clinical outcomes in a nationwide cohort of patients with previous myocardial infarction (MI) and a diagnosis of Alzheimer's disease (AD) or mixed dementi. In propensity-matched analysis, treatment with ChEIs was associated with a 19% reduction in all-cause death driven by non-cardiovascular death. The reduction in all-cause death was greater with the higher doses of ChEIs.
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