| 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. |
- Andersson, Henrik C, et al.
(författare)
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Fiskevårdsplan 2007 - 2010 för Stockholms län
- 2007
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Fiskevårdsbehovet är stort i Stockholms län. Problemen med fiskbestånden täcker hela skalan från gäddans kraftiga beståndsnedgångar med kopplingar till storskaliga miljöproblem i Östersjön till utdikade sjöar och våtmarker iinlandet. Påverkan på länets vattendrag är omfattande. Det finns även stort behov att förbättra förvaltningen av de kommersiella fiskarterna i länet och därigenom skapa underlag för livskraftiga näringar baserade på fisk samtrekreation för länets invånare.Det statliga fiskevårdsbidraget kan omöjligt täcka dessa behov. Det är därför nödvändigt att samordna olika finansieringskällor och intressen. I fiskevårdsplanen finns en översiktlig beskrivning av målen för verksamheten samt strategier för att öka samordning och skapasynergieffekter mellan olika åtgärder. Länsstyrelsen har en ambition att Stockholms skärgård skall bli ett "särskilt fiskeområde" under den innevarande strukturmedelsperioden.För fiskevården inom ramen för det statliga fiskevårdsanslaget beräknas till ca 5,5 kronor miljoner per år. Statsbidraget utgör ca 2,3 miljoner per år. Kostnaderna för åtgärder i skärgården har inte specificerats för åren 2009 och 2010. Under 2007-2008 kommer det att genomföras en förstudie tillsammans med Fiskeriverket för att definiera detta behov på objektsnivå.Målgruppen för planen är centrala verk, kommuner, fiskets organisationer och enskilda. Förhoppningen är att det i det kommande fiskevårdsarbetet sker en ökad integrering av fiskevårdsarbetet med övriga mål för miljö- ochfiskeripolitiken samt den kommunala översiktsplaneringen.
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| 7. |
- Dahlman, Olof, et al.
(författare)
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Processing of xylan from hardwood spent cooking liquors
- 2008
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Ingår i: 2008 Nordic Wood Biorefinery Conference - Proceedings. - 9789186018139 ; , s. 114-119
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Konferensbidrag (refereegranskat)abstract
- The paper reports conditions suitable for recovering and processing 4-O-methylglucuronoxylans from birch and eucalyptus spent kraft cooking liquors. The black liquor originating from the initial heating-up phase in birch kraft cooking exhibits a high xylan and low lignin concentration. The maximum concentration of polymeric xylan was found in the cooking liquor just before the cook reached its final cooking temperature. For eucalyptus kraft cooking, however, lignin was more abundant than xylan in the cooking liquor throughout the whole cook. Birch and eucalyptus xylan, exhibiting good purity, were produced by employing a process chain involving, redrawing of xylan-rich spent liquor early in the cook, upgrading of the spent liquor employing ultrafiltration with diafiltration followed by precipitation and drying.
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| 8. |
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| 9. |
- Mukka, Sebastian, et al.
(författare)
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Study protocol: The DAICY trial-dual versus single-antibiotic impregnated cement in primary hemiarthro-plasty for femoral neck fracture-a register-based cluster-randomized crossover-controlled trial
- 2022
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Ingår i: Acta Orthopaedica. - : Medical Journals Sweden AB. - 1745-3674 .- 1745-3682. ; 93, s. 794-800
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Tidskriftsartikel (refereegranskat)abstract
- Background and purpose - Older patients with a dis-placed femoral neck fracture (FNF) are often treated with a cemented primary hemiarthroplasty (HA). The DAICY trial investigates whether high-dose dual-impregnated antibiotic -loaded cement (DIAC) including gentamicin and clindamy-cin can reduce the risk of periprosthetic joint infection (PJI) in comparison with low-dose single-impregnated gentami-cin antibiotic-loaded cement (SIAC), in patients & GE; 60 years treated with a cemented HA for a displaced FNF. Study design - The trial is a national, multicenter, reg-ister-based, cluster-randomized, crossover trial. Patients & GE; 60 years with a non-pathological, displaced FNF (Type Garden 3-4/AO 31-B2 or B3) suitable for HA according to local guidelines are eligible for inclusion. Participating orthopedic departments will be randomized to start with either SIAC (control group) or DIAC treatment (intervention group) for 2 years. After 2 years, the study departments will then change to the other treatment arm for the remaining 2 years of the study. Approximately 7,000 patients will be included. The study is pragmatic in that the choice of implant brands, sur-gical approach and peri-and postoperative protocols follow the local routines of each participating department. All out-come variables will be retrieved after linkage of the studycohort to the following Swedish registers: the Fracture Reg-ister, the Arthroplasty Register, the National Patient Register and the Prescribed Drug Registry Outcome - The primary outcome will be periprosthetic joint infection of the index joint within 1 year after surgery. Secondary outcomes will be any reoperation on the index joint, mortality within 90 days and 1 year, resistance patterns of causative bacteria in cases of PJI, and health economics. Potential added value - This trial is designed to sup-port or refute the efficacy of DIAC used in patients with a dis-placed FNF, potentially reducing PJI and resource allocation. Start of the trial and estimated duration - The DAICY trial started recruiting patients in January 2022 and will continue recruiting for approximately 4 years. Complete follow-up expected in 5 years.
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| 10. |
- Möller, Per, et al.
(författare)
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Living at the margin of the retreating Fennoscandian ice sheet : the early mesolithic sites at Aareavaara, northernmost Sweden
- 2013
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Ingår i: The Holocene. - : SAGE Publications. - 0959-6836 .- 1477-0911. ; 23:1, s. 104-116
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Tidskriftsartikel (refereegranskat)abstract
- During an archaeological survey in Pajala parish, northernmost Sweden, clusters of quartz waste from knapping and burnt bone were discovered on a glaciofluvial gravel plateau close to Aareavaara village in the Muonio River valley. Sampled materials from a larger area and small-scale excavations (in total 6 m2) are interpreted as resulting from short-stay hunter-gatherer camps. Radiocarbon dating on burnt bones suggest an age of occupancy at ~10,700 cal. yr BP, which is more or less contemporary with ‘Komsa Phase’ sites on the north coast of Norway (~300–360 km northwards). The Aareavaara site should thus be the oldest known archaeological site to date in northern Sweden. A palaeoenvironmental reconstruction, based on pollen analysis of sediment cores from two nearby lakes and radiocarbon dating of macrofossils for construction of time/depth sedimentation curves, suggests a deglaciation age of the area corresponding to occupation by early man (~10,700 cal. yr BP). Aareavaara was at the time of deglaciation situated in a transitional zone between subaqueous and subaerial ice-margin retreat from the northeast towards the southwest, with higher hills and plateaux forming an archipelago in the Ancylus Lake with highest shorelines formed at ~170 m a.s.l. The hunter-gatherer camp sites at Aareavaara were thus, both in time and space, located in close proximity to the retreating ice sheet margin, but also in a waterfront location, in fact on an island in the Ancylus Lake. Our pollen data suggest a subarctic birch woodland tundra landscape characterized by open vegetation, including occasional birch trees and an abundance of willow and dwarf birch.
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