| 11. |
- Buccheri, Sergio, et al.
(författare)
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Bioabsorbable polymer everolimus-eluting stents in patients with acute myocardial infarction : A report from the Swedish Coronary Angiography and Angioplasty Registry
- 2018
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Ingår i: EuroIntervention. - 1774-024X .- 1969-6213. ; 14:5, s. 562-569
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Tidskriftsartikel (refereegranskat)abstract
- Aims: The clinical performance of the SYNERGY drug-eluting stent (DES) in patients with acute myocardial infarction (MI) has not been investigated in detail. We sought to report on the outcomes after SYNERGY DES (Boston Scientific, Marlborough, MA, USA) implantation in patients with MI undergoing percutaneous revascularisation (PCI). Methods and results: We included all consecutive patients with MI undergoing PCI with the SYNERGY DES and newer-generation DES (n-DES group) in Sweden. From March 2013 to September 2016, a total of 36,292 patients, of whom 39.7% presented with ST-elevation MI, were included. As compared to patients in the n-DES group (n=31,403), patients in the SYNERGY group (n=4,889) were older and presented more often with left main or three-vessel disease involvement, as well as with restenotic lesions (p<0.001 for all parameters). The Kaplan-Meier estimates of ST at two years in the SYNERGY and n-DES groups were 0.69% and 0.81%, respectively (adjusted HR 1.00, 95% CI: 0.69-1.46; p=0.99). Clinically relevant restenosis was encountered in 1.48% and 1.25% of patients in the SYNERGY and n-DES groups, respectively (adjusted HR 1.05, 95% CI: 0.81-1.37; p=0.72). No differences in the risk of all-cause death and recurrent MI were found between the two groups after adjustment (adjusted HR 1.12, 95% CI: 0.98-1.28; p=0.10, and adjusted HR 0.95, 95% CI: 0.82-1.10; p=0.49, respectively). Conclusions: In a large and unselected cohort of patients with MI undergoing percutaneous revascularisation with the SYNERGY DES, stent performance and clinical outcomes did not differ compared with other n-DES up to two years.
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| 12. |
- Buccheri, Sergio, et al.
(författare)
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Clinical and angiographic outcomes of bioabsorbable vs. permanent polymer drug-eluting stents in Sweden : a report from the Swedish Coronary and Angioplasty Registry (SCAAR)
- 2019
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Ingår i: European Heart Journal. - : Oxford University Press. - 0195-668X .- 1522-9645. ; 40:31, s. 2607-2615
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Tidskriftsartikel (refereegranskat)abstract
- AIMS: Randomized clinical trials have consistently demonstrated the non-inferiority of bioabsorbable polymer drug-eluting stents (BP-DES) with respect to DES having permanent polymers (PP-DES). To date, the comparative performance of BP- and PP-DES in the real world has not been extensively investigated.METHODS AND RESULTS: From October 2011 to June 2016, we analysed the outcomes associated with newer generation DES use in Sweden. After stratification according to the type of DES received at the index procedure, a total of 16 504 and 79 106 stents were included in the BP- and PP-DES groups, respectively. The Kaplan-Meier estimates for restenosis at 2 years were 1.2% and 1.4% in BP- and PP-DES groups, respectively. Definite stent thrombosis (ST) was low in both groups (0.5% and 0.7% in BP- and PP-DES groups, respectively). The adjusted hazard ratio (HR) for either restenosis or definite ST did not differ between BP- and PP-DES [adjusted HR 0.95, 95% confidence interval (CI) 0.74-1.21; P = 0.670 and adjusted HR 0.79, 95% CI 0.57-1.09; P = 0.151, respectively]. Similarly, there were no differences in the adjusted risk of all-cause death and myocardial infarction (MI) between the two groups (adjusted HR for all-cause death 1.01, 95% CI 0.82-1.25; P = 0.918 and adjusted HR for MI 1.05, 95% CI 0.93-1.19; P = 0.404).CONCLUSION: In a large, nationwide, and unselected cohort of patients, percutaneous coronary intervention with BP-DES implantation was not associated with an incremental clinical benefit over PP-DES use at 2 years follow-up.
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| 13. |
- Bäck, Maria, et al.
(författare)
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The remote exercise SWEDEHEART study-Rationale and design of a multicenter registry-based cluster randomized crossover clinical trial (RRCT)
- 2023
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Ingår i: American Heart Journal. - : Elsevier BV. - 0002-8703 .- 1097-6744. ; 262, s. 110-118
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Tidskriftsartikel (refereegranskat)abstract
- Background: Despite proven benefits of exercise-based cardiac rehabilitation (EBCR), few patients with myocardial infarction (MI) participate in and complete these programs.Study design and objectives: The Remote Exercise SWEDEHEART study is a large multicenter registry-based cluster randomized crossover clinical trial with a planned enrollment of 1500 patients with a recent MI. Patients at intervention centers will be offered supervised EBCR, either delivered remotely, center-based or as a combination of both modes, as self -preferred choice. At control centers, patients will be offered supervised center-based EBCR, only. The duration of each time period (intervention/control) for each center will be 15 months and then cross-over occurs. The primary aim is to evaluate if remotely delivered EBCR, offered as an alternative to center-based EBCR, can increase participation in EBCR sessions. The proportion completers in each group will be presented in a supportive responder analysis. The key secondary aim is to investigate if remote EBCR is as least as effective as center-based EBCR, in terms of physical fitness and patient-reported outcome measures. Follow-up of major adverse cardiovascular events (cardiovascular-and all-cause mortality, recurrent hospitalization for acute coronary syndrome, heart failure hospitalization, stroke, and coronary revascularization) will be performed at 1 and 3 years. Safety monitoring of serious adverse events will be registered, and a cost-effectiveness analysis will be conducted to estimate the cost per quality-adjusted life-year (QALY) associated with the intervention compared with control.Conclusions: The cluster randomized crossover clinical trial Remote Exercise SWEDEHEART study is evaluating if par-ticipation in EBCR sessions can be increased, which may contribute to health benefits both on a group level and for individual patients including a more equal access to health care.Trial registration The study is registered atClinicalTrials.gov (Identifier: NCT04260958) (Am Heart J 2023;262:110-118.)
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| 14. |
- Demidova, Marina M., et al.
(författare)
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Prognostic value of early sustained ventricular arrhythmias in ST-segment elevation myocardial infarction treated by primary percutaneous coronary intervention : A substudy of VALIDATE-SWEDEHEART trial
- 2023
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Ingår i: Heart rhythm O2. - : Elsevier. - 2666-5018. ; 4:3, s. 200-206
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Prognostic assessment of ventricular tachycardia (VT) or ventricular fibrillation (VF) in ST-segment elevation myocardial infarction (STEMI) is based mainly on distinguishing between early (<48 hours) and late arrhythmias, and does not take into account its time distribution with regard to reperfusion, or type of arrhythmia.OBJECTIVE: We analyzed the prognostic value of early ventricular arrhythmias (VAs) in STEMI with regard to their type and timing.METHODS: The prespecified analysis of the multicenter prospective Bivalirudin versus Heparin in ST-Segment and Non-ST-Segment Elevation Myocardial Infarctionin Patients on Modern Antiplatelet Therapy in the Swedish Web System for Enhancement and Development of Evidence-based Care in Heart Disease evaluated according to Recommended Therapies Registry Trial included 2886 STEMI patients undergoing primary percutaneous coronary intervention (PCI). VA episodes were characterized regarding their type and timing. Survival status at 180 days was assessed through the population registry.RESULTS: Nonmonomorphic VT or VF was observed in 97 (3.4%) and monomorphic VT in 16 (0.5%) patients. Only 3 (2.7%) early VA episodes occurred after 24 hours from symptom onset. VA was associated with higher risk of death (hazard ratio 3.59; 95% confidence interval [CI] 2.01-6.42) after adjustment for age, sex, and STEMI localization. VA after PCI was associated with an increased mortality compared with VA before PCI (hazard ratio 6.68; 95% CI 2.90-15.41). Early VA was associated with in-hospital mortality (odds ratio 7.39; 95% CI 3.68-14.83) but not with long-term prognosis in patients discharged alive. The type of VA was not associated with mortality.CONCLUSION: VA after PCI was associated with an increased mortality compared with VA before PCI. Long-term prognosis did not differ between patients with monomorphic VT and nonmonomorphic VT or VF, but events were few. VA incidence during 24 to 48 hours of STEMI is negligibly low, thus precluding assessment of its prognostic importance.
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| 15. |
- Ek, Amanda, 1981-, et al.
(författare)
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Association between physical activity level and risk of all-cause mortality after myocardial infarction
- 2017
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Ingår i: European Journal of Preventive Cardiology, Vol 24, Issue 1 Suppl, April 2017.
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Konferensbidrag (refereegranskat)abstract
- Background/Introduction: There is little knowledge of the association between physical activity (PA) level and the mortality risk post myocardial infarction (MI). Steffen/Batey et al (2000), concluded in a smaller study, that individuals who remained active or increased their level of PA after MI had a lower risk of death. However, in order to confirm this and adjust for confounders larger studies are needed. Purpose: Explore any association between PA level after MI and all-cause mortality during follow-up in a large MI-cohort.Methods: A national cohort study including all patients <75 years of age, with a diagnosis of MI between 1991-2014 (Swedish MI register SWEDEHEART). From the register self-reported PA, 6-10 weeks post MI, (i.e. number of sessions during the past seven days with moderate and/or vigorous PA lasting ≥30 minutes) was obtained. The answers were grouped into 0-1 sessions (inactive), 2-4 sessions (moderately active) and 5-7 sessions (regularly active). Associations were first assessed unadjusted, stratified by potential confounders (sex, age, smoking status, ejection fraction, ST-elevation and quality of life). Thereafter, a multiple logistic regression was performed to control for possible confounders.Results: Complete data was obtained from 37 655 individuals (median 63 years, 74 % men). A total of 2512 deaths occurred during a mean of 4.1 years of follow-up. The mortality rate was 17.0 cases/1000 person-years. Moderate and regular activity, was associated with a lower risk of all-cause mortality (OR 0,356 95 %, CI 0,320-0,396 and OR 0,334, 95 % CI 0,305-0,366) compared to being physically inactive. The OR´s remained largely unchanged when stratifying for age, sex, NSTEM/STEMI and ejection fraction. However, active smokers had a lower OR, for subsequent death, as had patients with a low EQ5D. The associations persisted in the multiple logistic regression, after adjustment for confounders (Figure 1).Conclusion(s): A higher level of physical activity seems to be associated with a lower risk of all-cause mortality. These results suggest that physical activity assessment is important post MI, not least as an important predictor.
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| 16. |
- Ek, Amanda, 1981-, et al.
(författare)
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Physical inactivity and smoking after myocardial infarction as predictors for readmission and survival : results from the SWEDEHEART-registry.
- 2019
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Ingår i: Clinical Research in Cardiology. - : Springer. - 1861-0684 .- 1861-0692. ; 108:3, s. 324-332
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Physical activity (PA) and smoking cessation are included in the secondary prevention guidelines after myocardial infarction (MI), but they are still underutilised. This study aims to explore how PA level and smoking status (6-10 weeks post-MI) were associated with 1-year readmission and mortality during full follow-up time, and with the cumulative 5-year mortality.METHODS: A population-based cohort of all hospitals providing MI-care in Sweden (SWEDEHEART-registry) in 2004-2014. PA was expressed as the number of exercise sessions of ≥ 30 min in the last 7 days: 0-1 (low), 2-4 (medium) and 5-7 (high) sessions/week. Individuals were categorised as smokers, former smokers or never-smokers. The associations were analysed by unadjusted and adjusted logistic and Cox regressions.RESULTS: During follow-up (M = 3.58 years), a total of 1702 deaths occurred among 30 644 individuals (14.1 cases per 1000 person-years). For medium and high PA, the hazard ratios (HRs) for mortality were 0.39 and 0.36, respectively, compared with low PA. For never-smokers, the HR was 0.45 and former smokers 0.56 compared with smokers. Compared with low PA, the odds ratios (ORs) for readmission in medium PA were 0.65 and 0.59 for CVD and non-CVD causes, respectively. For high PA, the corresponding ORs were 0.63 and 0.55. The association remained in adjusted models. There were no associations between smoking status and readmission.CONCLUSIONS: The PA level and smoking status are strong predictors of mortality post-MI and the PA level also predicts readmission, highlighting the importance of adherence to the secondary prevention guidelines.
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| 17. |
- Ek, Amanda, 1981-, et al.
(författare)
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Samband mellan fysisk aktivitetsnivå efter hjärtinfarkt och risken för mortalitet : Association between physical activity level and risk of all-cause mortality after myocardial infarction
- 2017
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Ingår i: Fria föredrag, nr 025.
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Konferensbidrag (refereegranskat)abstract
- Background: There is little knowledge of the association between physical activity (PA) level and the mortality risk post myocardial infarction (MI). Steffen/Batey et al (2000), concluded in a smaller study, that individuals who remained active or increased their level of PA post-MI had a lower risk of death. This study aimed to explore any association between PA level post-MI and all-cause mortality during follow-up in a large MI-cohort.Methods: A national cohort study including patients <75 years of age, with a diagnosis of MI between 2005-2014 (SWEDEHEART, SEPHIA-register). Self-reported PA, 6-10 weeks post-MI, (i.e. number of sessions during the past seven days with moderate and/or vigorous PA lasting ≥30 minutes) was obtained. The answers were grouped into 0-1 sessions (inactive), 2-4 sessions (moderately active) and 5-7 sessions (regularly active). First, stratified unadjusted associations were investigated. Thereafter, a multiple logistic regression was performed to control for possible confounders.Results: Complete data was obtained from 37 655 individuals (median age 63 years, 74 % men). A total of 2512 deaths occurred during a mean of 4.1 years of follow-up. The mortality rate was 17.0 cases/1000 person-years. Moderate and regular activity, was associated with a lower risk of all-cause mortality (OR 0.36, 95 % CI: 0.32-0.40 and OR 0.33, 95 % CI: 0.31-0.37) compared to being physically inactive. The OR´s remained largely unchanged when stratifying for age, gender, NSTEM/STEMI and ejection fraction. However, compared to inactive patients, physically active smokers and patients with ≤ 0.85 Eq5D had a higher OR, for subsequent death. The associations persisted in the multiple logistic regression, after adjustment for confounders (Figure 1).Conclusions: A higher level of PA, post-MI was associated with a lower risk of all-cause mortality. These results suggest that PA assessment is important post-MI, not least as an important predictor for risk of death.
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| 18. |
- Ekblom, Örjan, 1971-, et al.
(författare)
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Increased Physical Activity Post-Myocardial Infarction Is Related to Reduced Mortality; Results From the SWEDEHEART Registry
- 2018
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Ingår i: Journal of the American Heart Association. - : American Heart Association. - 2047-9980. ; 7:24
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundWith increasing survival rates among patients with myocardial infarction (MI), more demands are placed on secondary prevention. While physical activity (PA) efforts to obtain a sufficient PA level are part of secondary preventive recommendations, it is still underutilized. Importantly, the effect of changes in PA after MI is largely unknown. Therefore, we sought to investigate the effect on survival from changes in PA level, post‐MI.Methods and ResultsData from Swedish national registries were combined, totaling 22 227 patients with MI. PA level was self‐reported at 6 to 10 weeks post‐MI and 10 to 12 months post‐MI. Patients were classified as constantly inactive, increased activity, reduced activity, and constantly active. Proportional hazard ratios were calculated. During 100 502 person‐years of follow‐up (mean follow‐up time 4.2 years), a total of 1087 deaths were recorded. Controlling for important confounders (including left ventricular function, type of MI, medication, smoking, participation in cardiac rehabilitation program, quality of life, and estimated kidney function), we found lower mortality rates among constantly active (hazard ratio: 0.29, 95% confidence interval: 0.21–0.41), those with increased activity (0.41, 95% confidence interval: 0.31–0.55), and those with reduced activity (hazard ratio: 0.56, 95% confidence interval: 0.45–0.69) during the first year post‐MI, compared with those being constantly inactive. Stratified analyses indicated strong effect of PA level among both sexes, across age, MI type, kidney function, medication, and smoking status.ConclusionsThe present article shows that increasing the PA level, compared with staying inactive the first year post‐MI, was related to reduced mortality.
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| 19. |
- Ekblom, Örjan, 1971-, et al.
(författare)
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Participation in exercise-based cardiac rehabilitation is related to reduced total mortality in both men and women : results from the SWEDEHEART registry.
- 2022
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Ingår i: European Journal of Preventive Cardiology. - : Oxford University Press. - 2047-4873 .- 2047-4881. ; 29:3, s. 485-492
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Tidskriftsartikel (refereegranskat)abstract
- AIMS: Participation in exercise-based cardiac rehabilitation (exCR) increases aerobic capacity and improves outcomes in patients following myocardial infarction (MI) and is therefore universally recommended. While meta-analyses consistently report that participation in exCR reduces cardiovascular mortality, there are conflicting results regarding effects on total mortality. Presently, many eligible patients do not receive exCR in clinical practice. We aimed to investigate the relation between participation in exCR post-MI and total mortality in men and women in a nationwide real-world cohort from the SWEDEHEART registry.DESIGN: Longitudinal, observational cohort study.METHODS AND RESULTS: In total, 20 895 patients from the SWEDEHEART registry were included. Mortality data were obtained from the Swedish National Population Registry. During a mean of 4.55 (±2.33) years of follow-up, 1000 patients died. Using Cox regression for proportional odds and taking a wide range of potential confounders into consideration, participation in exCR was related to significantly lower total mortality [hazard ratio (HR) 0.72, 95% confidence interval 0.62-0.83]. Excluding patients with shorter follow-up than 2 years did not alter the results. Exercise-based CR participation was related to lowered total mortality in most of the investigated subgroups. The risk reduction was more pronounced in women than in men (HR 0.54 vs. 0.81, respectively).CONCLUSION: Participation in exCR was associated with reduced total mortality, and more pronounced in women, compared with men. Our results further support the recommendations to participate in exCR, and hence we argue that exCR should be a mandatory part of comprehensive CR programmes, offered to all patients post-MI.
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| 20. |
- Emilsson, Louise, 1982-, et al.
(författare)
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Follow-up of ischaemic heart disease in patients with coeliac disease
- 2015
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Ingår i: European Journal of Preventive Cardiology. - London, United Kingdom : Sage Publications. - 2047-4873 .- 2047-4881. ; 22:1, s. 83-90
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Tidskriftsartikel (refereegranskat)abstract
- Patients with coeliac disease and myocardial infarction have a more favourable atherosclerotic risk factor profile than controls with myocardial infarction (MI). Therefore, MI prognosis and treatment may differ according to coeliac status. This paper reports on the study of Swedish MI patients with and without coeliac disease (equal to villous atrophy; Marsh histopathology stage 3) based on duodenal or jejunal biopsy data. We used the Swedish Quality Register (SWEDEHEART) to identify individuals with a record of MI from 2005 to 2008 and to obtain data on medication, coronary interventions, and clinical and laboratory parameters at 6–10 weeks and one year after first MI. One-year mortality and coronary interventions were assessed for 430 coeliac patients and 1988 controls. For other outcome variables, we compared 42 coeliac patients with MI and 201 general population controls with MI. Odds ratios (ORs) were calculated by logistic regression. The results showed that compared with controls with MI, coeliac individuals with MI had significantly higher one-year all-cause mortality (OR = 1.43; 95% confidence interval (CI) = 1.04–1.95) but less often underwent a percutaneous coronary intervention (OR = 0.77; 95% CI = 0.61–0.96). Coeliac patients were more often prescribed warfarin but less often aspirin and statins. The readmission rate due to cardiac events in coeliac patients was 15.2% vs. 12.6% in controls (p-value = 0.69). Other clinical and laboratory parameters were similar. We conclude that the follow up of MI does not seem to differ between coeliac patients and controls, and is unlikely to explain the excess mortality from cardiovascular disease noted in Swedish patients with CD.
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