| 1. |
- Sarno, Giovanna, et al.
(författare)
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Initial clinical experience with an everolimus eluting platinum chromium stent (Promus Element) in unselected patients from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR)
- 2013
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Ingår i: International Journal of Cardiology. - : Elsevier BV. - 0167-5273 .- 1874-1754. ; 167:1, s. 146-150
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Tidskriftsartikel (refereegranskat)abstract
- Background: The safety and efficacy of the Promus Element stent have been recently demonstrated in a selected population from one randomized trial. The aim of this study was to describe the initial clinical experience with the everolimus eluting platinum chromium stent (Promus Element) in unselected patients from a real life nationwide registry.Methods: The Promus Element DES was compared to all other DES implanted in Sweden (with more than 500 implants) from November 2009 to March 2011. The results were assessed using Cox regression.Results: A total of 13,577 stents (Promus Element, n = 2724, Cypher, n = 782; Endeavor, n = 747; Taxus Liberte, n = 1393, Xience V/Promus, n = 4832, Resolute, n = 1566, Xience Prime, n = 4832) were implanted at 8375 procedures. At one year the restenosis rate in the Promus Element was not significantly different from the overall DES group (2.8% vs. 2.7%, adjusted HR: 1.17, 95% CI: 0.75-1.75). A significantly lower restenosis rate was observed in the Promus Element when compared with Endeavor (2.8% vs. 5.8%; adjusted HR: 0.44; 95% CI: 0.26-0.74). The stent thrombosis (ST) rate at one year was not significantly different in the Promus Element as compared with the overall DES group (0.2% vs. 0.5% adjusted HR: 0.59; 95% CI: 025-1.40). ST rate was significantly lower as compared with Endeavor stent (0.2% vs. 0.8%; HR: 0.24; 95% CI: 0.08-0.67).Conclusions: In a large unselected population the Promus Element stent appears to be safe and effective with a low risk of restenosis and ST. (C) 2011 Elsevier Ireland Ltd. All rights reserved.
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| 2. |
- Carlsson, Jorg, et al.
(författare)
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Outcome of Drug-Eluting Versus Bare-Metal Stenting Used According to On- and Off-Label Criteria
- 2009
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Ingår i: JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY. - : Elsevier BV. - 0735-1097 .- 1558-3597. ; 53:16, s. 1389-1398
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Tidskriftsartikel (refereegranskat)abstract
- Objectives The aim of this study was to investigate the outcome of bare-metal stents (BMS) versus drug-eluting stents (DES) after on-label as well as off-label use. Background DES lower restenosis rates while not influencing the risk for death and myocardial infarction when used in Federal Food and Drug Administration (FDA)-approved indications. It is debated whether the clinical results of this so-called on-label use might be extrapolated to off-label situations. Methods The SCAAR (Swedish Coronary Angiography and Angioplasty Registry) was used to investigate the outcomes in 17,198 patients who underwent stenting with an on-label indication (10,431 BMS and 6,767 DES patients) and 16,355 patients in the context of an off-label indication (9,907 BMS and 6,448 DES patients). The patients were included from 2003 to 2005 with a minimum follow-up of 1 year and a maximum of 4 years. The analysis was adjusted for differences in baseline characteristics. Results There were not significant differences between on-label DES and BMS (adjusted hazard ratio: 1.02; 95% confidence interval: 0.92 to 1.13) or between off-label DES and BMS (adjusted hazard ratio: 0.95; 95% confidence interval: 0.87 to 1.04) use with regard to the incidence of myocardial infarction and death. Off-label use of DES did not lead to significant differences in the combined risk of death and myocardial infarction compared with BMS throughout the whole spectrum of clinical indications. Conclusions In contemporary Swedish practice, neither on-nor off-label use of DES is associated with worse outcome than use of BMS.
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| 3. |
- Fokkema, Marieke L, et al.
(författare)
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Population Trends in Percutaneous Coronary Intervention 20-Year Results From the SCAAR (Swedish Coronary Angiography and Angioplasty Registry)
- 2013
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Ingår i: Journal of the American College of Cardiology. - : Elsevier BV. - 0735-1097 .- 1558-3597. ; 61:12, s. 1222-1230
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Tidskriftsartikel (refereegranskat)abstract
- Objectives The aim of this study was to describe the characteristics and outcome of all consecutive patients treated with percutaneous coronary intervention (PCI) in an unselected nationwide cohort over the past 2 decades. Background Over the last 20 years, treatment with PCI has evolved dramatically, but the change in patient characteristics has not been well described. Methods We included all patients undergoing a PCI procedure for the first time between January 1990 and December 2010 from the SCAAR (Swedish Coronary Angiography and Angioplasty Registry). Patients were divided into different cohorts on the basis of the year of the first PCI procedure. Results A total of 144,039 patients was included. The mean age increased from 60.1 +/- 9.9 years in 1990 to 1995 to 67.1 +/- 11.2 years in 2009 to 2010. The proportion of patients presenting with unstable coronary artery disease and ST-segment elevation myocardial infarction increased from 27.4% and 6.2% to 47.7% and 32.5%, respectively. Diabetes mellitus and multivessel disease were more often present in the later-year cohorts. The 1-year mortality increased from 2.2% in 1990 to 1995 to 5.9% in 2009 to 2010, but after adjustment for age and indication, a modest decrease was shown, mainly in ST-segment elevation myocardial infarction patients. Conclusions Characteristics of PCI patients have changed substantially over time, reflecting the establishment of new evidence. The increasing age and proportion of patients undergoing PCI for acute coronary syndromes greatly influence outcome. Understanding the changing patient characteristics is important for the translation of evidence to real-world clinical practice. (J Am Coll Cardiol 2013; 61: 1222-30) (C) 2013 by the American College of Cardiology Foundation
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| 4. |
- James, Stefan K., 1964-, et al.
(författare)
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Long-term safety and efficacy of drug-eluting versus bare-metal stents in Sweden
- 2009
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Ingår i: New England Journal of Medicine. - 0028-4793 .- 1533-4406. ; 360:19, s. 1933-1945
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The long-term safety and efficacy of drug-eluting coronary stents have been questioned. METHODS: We evaluated 47,967 patients in Sweden who received a coronary stent and were entered into the Swedish Coronary Angiography and Angioplasty Registry between 2003 and 2006 and for whom complete follow-up data were available for 1 to 5 years (mean, 2.7). In the primary analysis, we compared patients who received one drug-eluting coronary stent (10,294 patients) with those who received one bare-metal stent (18,659), after adjustment for differences in clinical characteristics of the patients and characteristics of the vessels and lesions. RESULTS: Analyses of outcome were based on 2380 deaths and 3198 myocardial infarctions. There was no overall difference between the group that received drug-eluting stents and the group that received bare-metal stents in the combined end point of death or myocardial infarction (relative risk with drug-eluting stents, 0.96; 95% confidence interval [CI], 0.89 to 1.03) or the individual end points of death (relative risk, 0.94; 95% CI, 0.85 to 1.05) and myocardial infarction (relative risk, 0.97; 95% CI, 0.88 to 1.06), and there was no significant difference in outcome among subgroups stratified according to the indication for stent implantation. Patients who received drug-eluting stents in 2003 had a significantly higher rate of late events than patients who received bare-metal stents in the same year, but we did not observe any difference in outcome among patients treated in later years. The average rate of restenosis during the first year was 3.0 events per 100 patient-years with drug-eluting stents versus 4.7 with bare-metal stents (adjusted relative risk, 0.43; 95% CI, 0.36 to 0.52); 39 patients would need to be treated with drug-eluting stents to prevent one case of restenosis. Among high-risk patients, the adjusted risk of restenosis was 74% lower with drug-eluting stents than with bare-metal stents, and only 10 lesions would need to be treated to prevent one case of restenosis. CONCLUSIONS: As compared with bare-metal stents, drug-eluting stents are associated with a similar long-term incidence of death or myocardial infarction and provide a clinically important decrease in the rate of restenosis among high-risk patients.
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| 5. |
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| 6. |
- Lagerqvist, Bo, 1952-, et al.
(författare)
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Long-term outcomes with drug-eluting stents versus bare-metal stents in Sweden
- 2007
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Ingår i: New England Journal of Medicine. - : Massachusetts Medical Society. - 0028-4793 .- 1533-4406. ; 356:10, s. 1009-1019
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Recent reports have indicated that there may be an increased risk of late stent thrombosis with the use of drug-eluting stents, as compared with bare-metal stents. METHODS: We evaluated 6033 patients treated with drug-eluting stents and 13,738 patients treated with bare-metal stents in 2003 and 2004, using data from the Swedish Coronary Angiography and Angioplasty Registry. The outcome analysis covering a period of up to 3 years was based on 1424 deaths and 2463 myocardial infarctions and was adjusted for differences in baseline characteristics. RESULTS: The two study groups did not differ significantly in the composite of death and myocardial infarction during 3 years of follow-up. At 6 months, there was a trend toward a lower unadjusted event rate in patients with drug-eluting stents than in those with bare-metal stents, with 13.4 fewer such events per 1000 patients. However, after 6 months, patients with drug-eluting stents had a significantly higher event rate, with 12.7 more events per 1000 patients per year (adjusted relative risk, 1.20; 95% confidence interval [CI], 1.05 to 1.37). At 3 years, mortality was significantly higher in patients with drug-eluting stents (adjusted relative risk, 1.18; 95% CI, 1.04 to 1.35), and from 6 months to 3 years, the adjusted relative risk for death in this group was 1.32 (95% CI, 1.11 to 1.57). CONCLUSIONS: Drug-eluting stents were associated with an increased rate of death, as compared with bare-metal stents. This trend appeared after 6 months, when the risk of death was 0.5 percentage point higher and a composite of death or myocardial infarction was 0.5 to 1.0 percentage point higher per year. The long-term safety of drug-eluting stents needs to be ascertained in large, randomized trials.
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| 7. |
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| 8. |
- Nilsson, Per Åke, et al.
(författare)
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Public Support for Tourism SMEs in Peripheral Areas : The Arjeplog Project, Northern Sweden
- 2005
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Ingår i: Service Industries Journal. - : Informa UK Limited. - 0264-2069 .- 1743-9507. ; 25:4, s. 579-599
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Tidskriftsartikel (refereegranskat)abstract
- Within the European Union, the tourism issues facing many peripheral areas are similar to those elsewhere in the world. Beginning in the late 1980s, the emphasis of thinking in the Union moved away from large automatic grants to attract inward investment projects, towards small firms and indigenous development. As party of this thinking, tourism SMEs have been assigned an important role in the process of regional convergence. While investment subsidies remain a key instrument, they have been supplemented by technical support to tailor assistance to the need of the individual firm. The latter aspect is an important plank in Swedisdg regional policy, which sees investing in human competencies as the core innovative development at the local level. This paper examines the process and the outcomes of a four-year programme to upgrade the level of business skills in eight tourism SMEs, which are located in the sparesly populated regions of northern Sweden.
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| 9. |
- Nilsson, Tage, et al.
(författare)
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Coronary angiography of patients with a previous coronary artery by-pass operation is associated with a three times increased risk for neurological complications : A report from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR)
- 2009
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Ingår i: Scandinavian Cardiovascular Journal. - : Informa UK Limited. - 1401-7431 .- 1651-2006. ; 43:6, s. 374-379
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: This study aimed to determine the incidence of complications of diagnostic coronary angiography that was not followed by percutaneous coronary interventions and to compare differences in complication rates between patients with or without previous coronary artery by-pass surgery. DESIGN: We evaluated major complications due to diagnostic coronary angiography by merging the Swedish Coronary Angiography and Angioplasty Registry (SCAAR), the Swedish Hospital Discharge Registry and the National Population Registry. RESULTS: A total of 1 115 complications were recorded (2.2%). There was a higher incidence of any complications in patients with a previous coronary by-pass surgery in uni-variable analysis (2.7% vs. 2.1%, p=0.003) but not in multi-variable analysis after adjustment for differences in background and procedural factors. Neurological complications were not common (0.20%) but after adjustment for differences in background and procedural factors, the risk of neurological complications was nearly three times higher in patients with a previous CABG compared to patients without previous CABG, odds ratio 2.89 (95% CI 1.68-4.97). CONCLUSION: Neurological complications are significantly more common in patients with previous by-pass surgery. Considering the risk for neurological complications the risk-benefit ratio may be higher when compared with patients without previous by-pass surgery.
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| 10. |
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| 11. |
- Nilsson, Tage
(författare)
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Pulmonary embolism : validation of diagnostic imaging methods in the clinical setting
- 2002
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Pulmonary embolism (PE) is an elusive diagnosis and none of the existing imaging modalities have a 100% diagnostic specificity or sensitivity. Pulmonary arteriography (PA) is the most specific test although the improvement of computed tomography technique has made this a commonly used method. Lung scintigraphy often gives ambiguous results. Fibrin split products (D-dimer) are released into the blood in PE were elevated levels can be measured. However, D-dimer levels are elevated in venous thromboembolic (VTE) disease as well as in a number of other conditions. The aims of this thesis were to evaluate different radiological methods including pulmonary arteriography, lung scintigraphy and spiral computed tomography for the diagnosis of acute pulmonary embolism and to study if a clinical probability protocol or a simple blood test such as D- dimer could improve the diagnostic accuracy. Study I investigated the complication rate of PA in 707 patients. The overall complication rate was 1.6%, which is lower than previously reported. Study II assessed the interobserver variations in PA in 170 patients and compared the consensus results to a final outcome diagnosis. The mean interobserver agreement was 89%, higher for central vessel emboli, lower for peripheral locations. Study III investigated if the use of a combination of a clinical and scintigraphic protocol in relation to the final outcome could improve the diagnosis in patients with clinical suspicion of acute PE. A low combined probability yielded a negative predictive value (NPV) of 98%. The positive predictive value (PPV) was 100% if the combined probability was high. Study IV compared the diagnostic accuracy of contrast medium enhanced spiral computed tomography of the pulmonary arteries (s-CTPA) and a latex agglutination D-dimer assay in patients with suspected acute PE by using PA and clinical follow up as reference method. sCTPA had 95% NPV and 94% PPV. If a cut off level of 0.25 mg/L was used the corresponding figures for D-dimer were 92% and 63%. Study V investigated if 441 patients with a negative s-CTPA and without DVT symptoms, venous studies or anticoagulant treatment had a new episode of PE during three months follow up. Only 0.9% of the patients had proven PE during the follow up period. To conclude, the results of our studies show that PA is a safe method with good interobserver agreement and low complication rate. By applying a model of combined clinical and scintigraphic probabilities for PE, the diagnosis is ruled in when the combined probability is high, and ruled out when the combined probability is low. However, nearly half of the patients will still have an uncertain diagnosis if lung scintigraphy is used as diagnostic method. A low cut-off level of D-dimer can be used as a screening test to rule out PE, but can not confirm the diagnosis. s-CTPA has a high diagnostic accuracy when compared to PA. The overall results indicate that a negative s-CTPA result safely can rule out the existence of clinically significant, acute PE.
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| 12. |
- Nilsson, Tage, et al.
(författare)
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Value of structured clinical and scintigraphic protocols in acute pulmonary embolism
- 2001
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Ingår i: Journal of Internal Medicine. - : Wiley. - 0954-6820 .- 1365-2796. ; 250:3, s. 213-218
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Tidskriftsartikel (refereegranskat)abstract
- Purpose. To study the use of a combination of a clinical and scintigraphic protocol in relation to the final outcome diagnosis in patients with clinical suspicion of acute pulmonary embolism (PE). Material and methods. A total of 170 patients with clinical suspicion of acute PE were all examined with ECG, blood chemistry, chest X-ray, pulmonary scintigraphy and selective pulmonary arteriography. The scintigraphic and clinical probabilities of PE were estimated on visual analogue scales (VASs) by different readers unaware of each others' results. The follow-up time was 6 months. In order to establish the final diagnosis a final outcome committee was created. They analysed in retrospect all the clinical and laboratory data and established whether the patient had had PE or not. Results. The final outcome committee concluded that 53 patients had PE. When the scintigraphic and clinical probability judgements were congruent, a combined probability of 1-25% (i.e low probability) had a negative predictive value of 98%. When the combined probability was 26-75% (i.e. intermediate) half of the cases had PE. With a combined probability of 76-100% (i.e. high) the positive predictive value was 100%. Conclusion. By applying a model of combined clinical and scintigraphic probabilities for PE, the diagnosis is ruled in when the combined probability is high, and ruled out when the combined probability is low. However, nearly half of the patients will still have an uncertain diagnosis for which further diagnostic procedures may be allocated.
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| 13. |
- Ripsweden, Jonaz, et al.
(författare)
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Impact on image quality and radiation exposure in coronary CT angiography: 100 kVp versus 120 kVp
- 2010
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Ingår i: Acta Radiologica. - : SAGE Publications. - 1600-0455 .- 0284-1851. ; 51:8, s. 903-909
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Tidskriftsartikel (refereegranskat)abstract
- Background: The risk of radiation-induced cancer has become a major concern with the increasing use of computed tomography (CT). Purpose: To compare image quality and radiation doses when decreasing X-ray tube peak kilovoltage (kVp) from 120 to 100 kVp in patients undergoing coronary CT angiography (CCTA). Material and Methods: Patients referred for evaluation of suspected coronary artery disease (CAD) underwent 64-channel detector CCTA using a tube voltage of either 120 kVp (n = 46) or 100 kVp (n = 82). The individual volume CT dose index (CTDIvol) and dose length product (DLP) were recorded and effective radiation dose was estimated on the basis of DLP. Subjective image quality was assessed by two radiologists on per-patient based consensus. Vascular density and image noise were quantified in the left main coronary artery (LMCA) and proximal ascending aorta (AA). Mean density in the adjacent perivascular tissue was also quantified. Contrast-to-noise ratio (CNR) was calculated. Corresponding invasive coronary angiography (ICA) was performed, which constituted the gold standard. Results: Mean values in the 100120 kVp cohorts regarding CNR in the LMCA were 12.716.0 (P < 0.0001)) and in the AA 13.217.2 (P < 0.0001), CTDIvol 34.457.4 mGy (a 40% reduction, P < 0.0001), DLP 5781125 mGy X cm (P < 0.0001), and estimated effective dose 9.620.2 mSv (P < 0.0001). There was no statistically significant difference in subjective image quality between the two cohorts. The sensitivity to detect significant coronary stenoses was 88% (120 kVp) and 84% (100 kVp) and the specificity was 71% (120 kVp) and 74% (100 kVp), respectively. Conclusion: By reduction of tube voltage from 120 to 100 kVp at CCTA, while keeping all other scanning parameters unchanged, the radiation dose to the patient can be almost halved while keeping the diagnostic image quality at a clinically acceptable level.
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| 14. |
- Sehlin, Staffan, 1950-
(författare)
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Förebygger medling återfall i brott bland unga gärningsmän : En återfallsstudie av medlingsverksamheterna i Hudiksvall & Örnsköldsvik
- 2009
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The purpose of this study is to investigate mediation’s crime prevention effects. The question that has been answered is: which crime prevention effects mediation has had on young criminals who have participated in mediation programs? The investigation was made in relation to a comparable control group and included a reoffence analysis based on a multivariate analysis. This reoffence study mainly focuses on that the mediation prevents crime through the feelings of shame that the young perpetrator has due to the fact that the crime has been made clear and reinforced at the mediation meeting. The following hypothesis is addressed in this study: Mediation involves the trust between the young perpetrator and his/her parents and has a conflict-solving and crime-prevention effect. By committing a crime, the youth has broken the trust with his/her parents, who have condemned the action. The parents feel the shame from those around them, and because of this resume their position against the youth. The main conclusion is that the total population of youths who participated in mediation programs relapsed into crime to a lesser extent than the youths who did not participate in mediation. The risk for a relapse was twice as high for the youths who did not participate in mediation. A statistically significant relationship emerged between mediation and relapse with regard to party and person plaintiff status, but it is not possible to draw any conclusions whether mediation has a better or worse effect between plaintiff status. The significant effect of relapse for respective gender showed that girls relapsed to a lesser extent than boys. It was not possible to statistically determine whether the youths who were born abroad respective born i Sweden have relapsed to a greater extent. Regarding the age groups there was no statistically significant relationship as to whether youths relapsed to a greater or lesser extent depending on whether they were under or over fifteen years of age. Furthermore, it has not been possible to statistically determine whether group mediation has had a different outcome in relapse frequency as compared to individual mediation, and it has not been possible to distinguish whether compensation at mediation has had any effect. There emerged significant relationships between mediation and relapse for the crime categories ‘crime against life and health’, ‘crime against freedom and peace’, ‘burglary, robbery and other theft crimes’ and ‘vandalism’.
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| 15. |
- Stenestrand, Ulf, et al.
(författare)
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Safety and efficacy of drug-eluting vs. bare metal stents in patients with diabetes mellitus : long-term follow-up in the Swedish Coronary Angiography and Angioplasty Registry (SCAAR)
- 2010
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Ingår i: European Heart Journal. - : Oxford University Press (OUP). - 0195-668X .- 1522-9645. ; 31:2, s. 177-186
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Tidskriftsartikel (refereegranskat)abstract
- AIMS: Patients with diabetes mellitus have more extensive coronary artery disease, more disease progression, and restenosis. The use of drug-eluting stents (DES) in these patients is widespread, despite uncertain long-term safety and efficacy. METHODS AND RESULTS: All consecutive patients with diabetes mellitus in Sweden who underwent percutaneous coronary intervention were entered into the Swedish Coronary Angiography and Angioplasty Registry (SCAAR) during 2003-06 with complete follow-up for 1-4 years (median 2.5). Patients who received at least one DES (n = 4754) were compared with those who received only bare metal stents (BMS) (n = 4956) at the index procedure. Combined outcome of death or myocardial infarction (MI) showed no difference for DES vs. BMS, relative risk (RR), 0.91 [95% confidence interval (CI), 0.77-1.06]. Myocardial infarction was significantly less common with DES in patients who received only one stent RR, 0.80 (95% CI, 0.66-0.96). The restenosis rate was 50% lower in DES-treated patients RR, 0.50 (95% CI, 0.35-0.70) and was associated with a higher adjusted RR of MI, RR, 5.03 (95% CI, 4.25-5.97). DES was associated with reduced restenosis rates in all subgroups of diabetic patients with the greatest benefit in stent diameters <3 mm or stent length >20 mm. The number of lesions treated with DES to prevent one restenosis ranged from 11 to 47 in various subgroups. CONCLUSION: This real-life registry study shows that restenosis was halved by DES in diabetic patients with stable or unstable coronary disease, with similar risk of death or MI up to 4 years compared with BMS.
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| 16. |
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