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- Redfors, Björn, et al.
(författare)
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Prognosis is similar for patients who undergo primary PCI during regular-hours and off-hours: A report from SCAAR.
- 2018
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Ingår i: Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions. - : Wiley. - 1522-726X. ; 91:7, s. 1240-1249
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Tidskriftsartikel (refereegranskat)abstract
- Timely percutaneous coronary intervention (PCI) improves prognosis in ST-elevation myocardial infarction (STEMI). However, recent reports indicate that patients with STEMI who present during non-regular working hours (off-hours) have a worse prognosis. The aim of this study was to compare outcome between patients with STEMI who underwent primary PCI during off-hours and regular hours.We retrieved data from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR) for all patients who underwent primary PCI in Region Västra Götaland due to STEMI between January 2004 and May 2013. We modeled unadjusted and adjusted Cox proportional-hazards regression and logistic regression models for the outcomes death, cardiogenic shock, stent thrombosis and in-stent restenosis. A propensity score-adjusted Cox proportional-hazards model, which adjusted for traditional cardiovascular risk factors was predefined as the primary statistical model. Death at any time during the study period was pre-specified as primary end-point.During the study period 4.611 (65%) patients underwent primary PCI due to STEMI during off-hours and 2,525 (35%) during regular hours. The risk of dying was similar among the groups for the primary endpoint death at any time during the study period (HR 1.00, 95% CI 0.89-1.12, P = 0.991) and for secondary end-point death within 30 days (HR 1.03; 95% CI 0.85-1.25, P = 0.735). The risks of developing cardiogenic shock, stent thrombosis, or in-stent restenosis were similar between the groups.In our region, short- and long-term prognosis for patients with STEMI who undergo primary PCI is similar for patients presenting during off-hours and regular hours.
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| 2. |
- Völz, Sebastian, 1980
(författare)
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Renal denervation in patients with resistant hypertension
- 2018
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- BACKGROUND Catheter-based renal denervation (RDN) is a potential modality in the treatment of patients with resistant hypertension (RH). The biological effects of RDN are not fully comprehended and studies examining its impact on blood pressure (BP) and other cardiovascular surrogate markers have generated conflicting results. AIMS Study I aimed to assess coronary flow reserve (CFR) in patients with RH. Study II was performed in order to estimate the effect of RDN on CFR. In Study III, we examined the safety and efficacy of RDN in a real-world setting. Study IV aimed to estimate the impact of RDN on muscle sympathetic nerve activity (MSNA). METHODS We assessed CFR in 25 patients with RH and matched controls with controlled hypertension in Study I. In Study II, we used the same modality in 26 patients with RH, before and six months after RDN. In Study III, we used data from the Swedish Registry for Renal Denervation. In Study IV, we assessed MSNA at rest and during mental stress in patients with RH before and six months after intervention. RESULTS RH was associated with impaired CFR as compared to patients with controlled hypertension (I). Despite a significant reduction in BP, we did not detect any significant changes in CFR six months after RDN (II). Registry analysis showed significant reduction in office and ambulatory blood pressure six months after RDN. The procedure proved feasible and was associated with a low complication rate (III). No signifi-cant changes in MSNA at rest and mental stress were noted at six-month follow-up (IV). CONCLUSIONS RH is associated with an impairment of the coronary microcirculation, which may contribute to the in-creased risk of cardiovascular events in this patient group. RDN did not change the course of CFR, despite a significant reduction in BP. Registry data suggest a sustained reduction in both office and ambulatory BP. MSNA was unchanged at follow-up, which raises questions about the biological effects of RDN and its impact on the autonomous nervous system.
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| 3. |
- Völz, Sebastian, 1980, et al.
(författare)
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Renal sympathetic denervation in Sweden : a report from the Swedish registry for renal denervation
- 2018
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Ingår i: Journal of Hypertension. - : Lippincott Williams & Wilkins. - 0263-6352 .- 1473-5598. ; 36:1, s. 151-158
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Tidskriftsartikel (refereegranskat)abstract
- Background: Renal denervation (RDN) is a catheter-based intervention to treat patients with resistant hypertension. The biological effects of RDN are not fully understood, and randomized controlled trials have generated conflicting evidence. This report presents data from the Swedish Registry for Renal Denervation, an investigator-driven nationwide registry. Purpose: To assess the safety and efficacy of RDN on patients with resistant hypertension in a real-world clinical setting. Methods: This nationwide database contains patient characteristics, procedural details, and follow-up data on all RDN procedures performed in Sweden. Consecutive procedures between 2011 and 2015 were included. Results: The data analysis consists of 252 patients (mean age 61 +/- 10 years, 38% women; mean 4.5 +/- 1.5 antihypertensive drugs). Office SBP and DBP and 24-h ambulatory blood pressure (BP) decreased 6 months after RDN (176 +/- 23/97 +/- 17 to 161 +/- 26/91 +/- 16 mmHg, both P<0.001; and 155 +/- 17/89 +/- 14 to 147 +/- 18/82 +/- 12 mmHg, both P<0.001). Significant office and ambulatory BP reductions persisted throughout the observation period of 36 months. Major procedure-related vascular complications occurred in four patients. Renal function and number of antihypertensive drugs were unchanged during follow-up. Conclusion: In this complete national cohort, RDN was associated with a sustained reduction in office and ambulatory BP in patients with resistant hypertension. The procedure proved to be feasible and associated with a low-complication rate, including long-term adverse events.
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