| 1. |
- Attar, Rubina, et al.
(författare)
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Higher risk of major adverse cardiac events after acute myocardial infarction in patients with schizophrenia
- 2020
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Ingår i: Open Heart. - : BMJ. - 2053-3624. ; 7:2
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Patients with schizophrenia are a high-risk population due to higher prevalences of cardiovascular risk factors and comorbidities that contribute to shorter life expectancy.PURPOSE: To investigate patients with and without schizophrenia experiencing an acute myocardial infarction (AMI) in relation to guideline recommended in-hospital management, discharge medications and 5-year major adverse cardiac events (MACE: composite of all-cause mortality, rehospitalisation for reinfarction, stroke or heart failure).METHODS: All patients with schizophrenia who experienced AMI during 2000-2018 were identified (n=1008) from the nationwide Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies registry and compared with AMI patients without schizophrenia (n=2 85 325). Kaplan-Meier survival curves and multivariable Cox regression models were used to compare the populations.RESULTS: Patients with schizophrenia presented with AMI approximately 10 years earlier (median age 64 vs 73 years), and had higher prevalences of diabetes, heart failure and chronic obstructive pulmonary disease. They were less likely to be invasively investigated or discharged with aspirin, P2Y12 inhibitors, ACE inhibitors/angiotensin II receptor blockers, beta-blockers and statins (all p<0.005). AMI patients with schizophrenia had higher adjusted risk of MACE (aHR=2.05, 95% CI 1.63 to 2.58), mortality (aHR=2.38, 95% CI 1.84 to 3.09) and hospitalisation for heart failure (aHR=1.39, 95% CI 1.04 to 1.86) compared with AMI patients without schizophrenia.CONCLUSION: Patients with schizophrenia experienced an AMI almost 10 years earlier than patients without schizophrenia. They less often underwent invasive procedures and were less likely to be treated with guideline recommended medications at discharge, and had more than doubled risk of MACE and all-cause mortality. Improved primary and secondary preventive measures, including adherence to guideline recommendations, are warranted and may improve outcome.
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| 2. |
- Görtz, Morgan, 1994, et al.
(författare)
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Network model for predicting structural properties of paper
- 2022
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Ingår i: Nordic Pulp & Paper Research Journal. - : Walter de Gruyter GmbH. - 0283-2631 .- 2000-0669. ; 37:4, s. 712-24
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Tidskriftsartikel (refereegranskat)abstract
- Paper simulations that resolve the entire microscopic fiber structure are typically time-consuming and require extensive resources. Several such modeling approaches have been proposed to analyze different properties in paper. However, most use non-linear and time-dependent models resulting in high computational complexity. Resolving these computational issues would increase its usefulness in industrial applications. The model proposed in this work was developed in collaboration with companies in the papermaking industry within the Innovative Simulation of Paper (ISOP) project. A linear network model is used for efficiency, where 1-D beams represent the fibers. Similar models have been proposed in the past. However, in this work, the paper models are three-dimensional, a new dynamic bonding technique is used, and more extensive simulations are evaluated. The model is used to simulate tensile stiffness, tensile strength, and bending resistance. These simulated results are compared to experimental and theoretical counterparts and produce representable results for realistic parameters. Moreover, an off-the-shelf computer accessible to a paper developer can evaluate these models structural properties efficiently.
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| 3. |
- Hegmar, Hannes, et al.
(författare)
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Liver stiffness predicts progression to liver-related events in patients with chronic liver disease - A cohort study of 14 414 patients
- 2024
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Ingår i: Liver international. - : WILEY. - 1478-3223 .- 1478-3231.
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Tidskriftsartikel (refereegranskat)abstract
- Background & Aims: Liver stiffness measurement (LSM) by vibration-controlled transient elastography (VCTE) is a non-invasive diagnostic biomarker of liver fibrosis. It is uncertain if LSM can predict risk for future liver-related outcomes in large, heterogenous populations. Methods: This Swedish multi-centre cohort study included patients (n = 14 414) from 16 sites who underwent LSM by VCTE between 2008 and 2020. Outcomes were ascertained from national registers. We investigated progression to cirrhosis with portal hypertension or hepatocellular carcinoma (HCC), separately. Cox regression was used to obtain hazard ratios (HRs). Harrel's C-index was used to measure discrimination of VCTE. Results: Included patients had a median age of 46 (interquartile range 34-57), median LSM of 5.9 kPa (4.6-8.0), 59% were male, and the majority had hepatitis C (50.1%). During a median follow-up of 5.9 (4.3-8.0) years, 402 patients (2.7%) developed cirrhosis with portal hypertension. In patients with an LSM >= 25 kPa, 28.7% developed cirrhosis with portal hypertension within 5 years of follow-up, while only .6% of patients with an LSM <10 kPa did. This translated to a HR of 48.3 (95% confidence interval = 37.6-62.0). VCTE had a high discriminative ability, with C-indices above .80 for most liver diseases, including .82 for MASLD. Similar findings were seen for incident HCC. Conclusions: Increased LSM by VCTE was associated with an increased risk of progression to both cirrhosis with portal hypertension, and to HCC, and had a high discriminative ability across different aetiologies of chronic liver diseases. These results support the use of VCTE to guide follow-up and treatment decisions.
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| 4. |
- Holmer, Magnus, et al.
(författare)
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Effect of common genetic variants on the risk of cirrhosis in non-alcoholic fatty liver disease during 20 years of follow-up
- 2022
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Ingår i: Liver international (Print). - : Wiley. - 1478-3223 .- 1478-3231. ; 42:12, s. 2769-2780
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Tidskriftsartikel (refereegranskat)abstract
- Background and Aims Several genotypes associate with a worse histopathological profile in patients with non-alcoholic fatty liver disease (NAFLD). Whether genotypes impact long-term outcomes is unclear. We investigated the importance of PNPLA3, TM6SF2, MBOAT7 and GCKR genotype for the development of severe outcomes in NAFLD. Method DNA samples were collected from 546 patients with NAFLD. Advanced fibrosis was diagnosed by liver biopsy or elastography. Non-alcoholic steatohepatitis (NASH) was histologically defined. Additionally, 5396 controls matched for age, sex and municipality were identified from population-based registers. Events of severe liver disease and all-cause mortality were collected from national registries. Hazard ratios (HRs) adjusted for age, sex, body mass index and type 2 diabetes were estimated with Cox regression. Results In NAFLD, the G/G genotype of PNPLA3 was associated with a higher prevalence of NASH at baseline (odds ratio [OR] 3.67, 95% CI = 1.66-8.08), but not with advanced fibrosis (OR 1.81, 95% CI = 0.79-4.14). After up to 40 years of follow-up, the PNPLA3 G/G genotype was associated with a higher rate of severe liver disease (adjusted hazard ratio [aHR] 2.27, 95% CI = 1.15-4.47) compared with the C/C variant. NAFLD patients developed cirrhosis at a higher rate than controls (aHR 9.00, 95% CI = 6.85-11.83). The PNPLA3 G/G genotype accentuated this rate (aHR 23.32, 95% = CI 9.14-59.47). Overall mortality was not affected by any genetic variant. Conclusion The PNPLA3 G/G genotype is associated with an increased rate of cirrhosis in NAFLD. Our results suggest that assessment of the PNPLA3 genotype is of clinical relevance in patients with NAFLD to individualize monitoring and therapeutic strategies.
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| 5. |
- Håkansson, Anton, et al.
(författare)
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Abbreviated versus standard dual antiplatelet therapy times after percutaneous coronary intervention in patients with high bleeding risk with acute coronary syndrome : insights from the SWEDEHEART registry
- 2024
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Ingår i: Journal of the American Heart Association. - : The American Heart Association. - 2047-9980. ; 13:13
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Tidskriftsartikel (refereegranskat)abstract
- Background: Dual antiplatelet therapy (DAPT) reduces ischemic events but increases bleeding risk, especially in patients with high bleeding risk (HBR). This study aimed to compare outcomes of abbreviated versus standard DAPT strategies in patients with HBR with acute coronary syndrome undergoing percutaneous coronary intervention.Methods and results: Patients from the SWEDEHEART (Swedish Web-system for Enhancement and Development of Evidence-Based Bare in Heart Disease Evaluated According to Recommended Therapies) registry with at least 1 HBR criterion who underwent percutaneous coronary intervention for acute coronary syndrome were identified and included. Patients were divided into 2 groups based on their planned DAPT time at discharge: 12-month DAPT or an abbreviated DAPT strategy and matched according to their prescribed P2Y12 inhibitor at discharge. The primary outcome assessed was time to net adverse clinical events at 1 year, which encompassed cardiac death, myocardial infarction, ischemic stroke, or clinically significant bleeding. Time to major adverse cardiovascular events and the individual components of net adverse clinical events were considered secondary end points. A total of 4583 patients were included in each group. The most frequently met HBR criteria was age older than 75 years (65.6%) and Predicting Bleeding Complications in Patients Undergoing Stent Implantation and Subsequent Dual Antiplatelet Therapy score ≥25 (44.6%) in the standard DAPT group and oral anticoagulant therapy (79.6%) and age 75 years and older (55.2%) in the abbreviated DAPT group. There was no statistically significant difference in net adverse clinical events (12.9% versus 13.1%; hazard ratio [HR], 0.99 [95% CI, 0.88-1.11], P=0.83), major adverse cardiovascular events (8.6% versus 7.9%; HR, 1.08 [95% CI, 0.94-1.25]), or their components between groups. The results were consistent among all of the investigated subgroups.Conclusions: In patients with HBR undergoing percutaneous coronary intervention due to acute coronary syndrome, abbreviated DAPT was associated with comparable rates of net adverse clinical events and major adverse cardiovascular events to a DAPT duration of 12 months.
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| 6. |
- Kettil, Gustav, 1990, et al.
(författare)
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A Multiscale Methodology for Simulation of Mechanical Properties of Paper
- 2020
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Ingår i: Proceedings of the 6th European Conference on Computational Mechanics: Solids, Structures and Coupled Problems, ECCM 2018 and 7th European Conference on Computational Fluid Dynamics, ECFD 2018. - 9788494731167 ; 2020, s. 2795-2806
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Konferensbidrag (refereegranskat)abstract
- In this work a multiscale framework developed for simulation of mechanical properties of paper is presented. The framework consists of two major parts. In the first part the forming process of a paper machine is simulated using the fiber suspension model developed in [8]. Fluid dynamics together with an advanced contact calculation method enables detailed simulation of the lay down process. The resulting paper sheet is used as input to the second part of the framework. In the second part the fiber configuration attained from the unique forming simulations is transformed into a network representation, enabling simulation of mechanical properties. The paper mechanics is governed by a fiber network model. To study macroscale properties a novel numerical upscaling method for networks has been developed. In this paper the complete simulation methodology is outlined and discussed.
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| 7. |
- Kettil, Gustav, et al.
(författare)
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Numerical upscaling of discrete network models
- 2020
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Ingår i: BIT (Copenhagen). - : Springer Science and Business Media LLC. - 0006-3835 .- 1572-9125. ; 60:1, s. 67-92
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Tidskriftsartikel (refereegranskat)abstract
- In this paper a numerical multiscale method for discrete networks is presented. The method gives an accurate coarse scale representation of the full network by solving sub-network problems. The method is used to solve problems with highly varying connectivity or random network structure, showing optimal order convergence rates with respect to the mesh size of the coarse representation. Moreover, a network model for paper-based materials is presented. The numerical multiscale method is applied to solve problems governed by the presented network model.
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| 8. |
- Nasr, Patrik, et al.
(författare)
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Misclassified Alcohol-related Liver Disease is Common in Presumed Metabolic Dysfunction-associated Steatotic Liver Disease and Highly Increases Risk for Future Cirrhosis
- 2024
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Ingår i: Clinical Gastroenterology and Hepatology. - : ELSEVIER SCIENCE INC. - 1542-3565 .- 1542-7714. ; 22:5
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND & AIMS: Alcohol overconsumption is a risk factor for disease progression in patients with presumed metabolic dysfunction-associated steatotic liver disease (MASLD). How commonly this occurs and how it affects progression to major adverse liver outcomes (MALOs) is not well known. METHODS: We did a register-based cohort study, including all patients with a diagnosis of MASLD in Sweden between 1987 and 2020. Patients were strati fi ed on co-occurrence of diagnoses of alcohol-related liver disease (ALD) or alcohol use disorder (AUD) prior to MASLD diagnosis. Incident MALOs were derived from national registers. Cox regression was used to calculate hazard ratios (HRs) for incident MALO. RESULTS: A total of 15,107 patients with MASLD were identi fi ed. The median age was 55 years, and 52% were female. Of the patients, 1843 (12%) had a prior diagnosis of ALD or AUD. During followup, a further 787 patients (5.2%) received a diagnosis of ALD or AUD. Patients with previous ALD or AUD diagnoses at or before baseline had considerably higher rates of MALOs compared with patients without (19.5% vs 7.8%; adjusted HR, 3.12; 95% con fi dence interval, 2.74 - 3.55). Acquiring an ALD or AUD diagnosis after MASLD diagnosis was associated with higher rates of MALOs (adjusted HR, 5.81; 95% con fi dence interval, 4.90 - 6.88). CONCLUSIONS: ALD or AUD is commonly diagnosed prior to or after MASLD diagnosis. Such patients have considerably higher rates of progression to MALOs. Correctly separating between MASLD and ALD is vital to assess prognosis.
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| 9. |
- Wester, Axel, et al.
(författare)
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Bivalirudin Versus Heparin Monotherapy in Elderly Patients With Myocardial Infarction : A Prespecified Subgroup Analysis of the VALIDATE-SWEDEHEART Trial
- 2020
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Ingår i: Circulation. Cardiovascular Interventions. - : LIPPINCOTT WILLIAMS & WILKINS. - 1941-7640 .- 1941-7632. ; 13:4
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Tidskriftsartikel (refereegranskat)abstract
- Background: Elderly patients with acute myocardial infarction undergoing percutaneous coronary intervention are at increased risk of both ischemic and bleeding complications. The optimal anticoagulation strategy in these patients is uncertain. Therefore, we compared bivalirudin to heparin monotherapy in a contemporary cohort of such patients.Methods: A prespecified subgroup analysis of elderly patients with myocardial infarction (>= 75 years) from the VALIDATE-SWEDEHEART trial (Bivalirudin Versus Heparin in ST-Segment and Non-ST-Segment Elevation Myocardial Infarction in 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) was performed. In the trial, patients were randomized to either bivalirudin or heparin monotherapy during percutaneous coronary intervention, with mandatory potent P2Y12 inhibition, routine radial artery access, and only bail-out glycoprotein IIb/IIIa inhibition. Kaplan-Meier event rates were assessed for the primary end point, consisting of a composite of all-cause death, myocardial reinfarction, or major bleeding, within 180 days.Results: The elderly (n=1592) had more than twice the risk of all events compared with younger patients (n=4406). Baseline and periprocedural characteristics were equal between bivalirudin (n=799) and heparin (n=793) treated patients >= 75 years. No differences were found in the elderly between bivalirudin and heparin monotherapy regarding the primary end point (180-day all-cause death, myocardial reinfarction, or major bleeding), the individual components of the primary end point, definite stent thrombosis, or stroke.Conclusions: In this prespecified subgroup analysis of the VALIDATE-SWEDEHEART trial, elderly patients with myocardial infarction had a highly increased risk of all events. However, no difference in outcomes could be observed with an anticoagulation strategy with either bivalirudin or heparin as monotherapy in this patient group.
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| 10. |
- Wester, Axel
(författare)
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Myocardial infarction - Risk stratification and evaluation of therapies
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background. Myocardial infarction (MI) remains the leading cause of death worldwide, despite several advances in acute coronary care during the last decades. This thesis assessed different risk stratification tools and evaluated interventional and pharmacological treatment strategies in high-risk patients with MI. Methods. This work comprises four studies. The first and the fourth study extracted data from national registries. The first study evaluated the prognostic value of early percutaneous coronary intervention (PCI) on mortality in 2896 patients with cardiac arrest and no signs of ST-elevation MI (STEMI) undergoing coronary angiography, while the fourth study validated the novel PRECISE-DAPT score for the prediction of post-discharge bleeding in 66295 patients with MI treated with PCI and dual antiplatelet therapy (DAPT). The second and the third study were prespecified subgroup analyses of a recent trial that randomly assigned MI patients to an anticoagulation strategy with bivalirudin or heparin during PCI in a contemporary setting, including routine radial artery access, potent P2Y12 inhibition, and rare use of glycoprotein IIb/IIIa inhibitors. The second study investigated the impact of baseline anemia on clinical outcomes in 5482 of these patients, whereas the third study compared bivalirudin to heparin monotherapy regarding clinical outcomes in 1592 elderly patients (≥75 years). Results. A total of 1271 (43.9%) of resuscitated cardiac arrest patients without STEMI had severe coronary artery stenosis (≥90%) on coronary angiography, of whom 753 (59.2%) underwent PCI but experienced a higher 30-day mortality rate compared to patients undergoing only diagnostic coronary angiography (40.9% vs 32.7%; p=0.011). After adjustments for confounders, there was no association between PCI and mortality (hazard ratio [HR] 1.07; 95% confidence interval [CI] 0.84-1.36). Baseline anemia identified a subset of MI patients undergoing PCI with a higher comorbidity burden. Anemia was associated with increased 180-day rates of death (6.9% vs 2.1%; p<0.001), myocardial reinfarction (4.3% vs 1.9%; p<0.001), major bleeding (13.4% vs 8.2%), and stroke (2.0% vs 0.7%). Results were particularly evident in patients with a hemoglobin value below 100 g/L, who had a tenfold higher mortality rate, sixfold higher MI rate, and threefold higher bleeding rate, compared to patients without anemia. Results were similar after adjustments for confounders. Elderly patients (≥75 years) had a markedly increased risk of adverse outcomes within 180 days after MI and PCI compared to younger patients (<75 years). Elderly patients who received bivalirudin or heparin had similar baseline characteristics. Bivalirudin did not reveal any benefit over heparin monotherapy, regarding 180-day mortality, myocardial reinfarction, major bleeding, stroke, or stent thrombosis. A high PRECISE-DAPT score (≥25) identified a high-risk subset of MI patients with more comorbidities and higher bleeding rates during DAPT. However, the predictive performance for major bleeding was moderate (c-statistic 0.64; 95% CI 0.63-0.66). Furthermore, the discriminatory power of the score was even more limited in patients with pre-existing risk factors for bleeding, especially for patients with advanced age (c-statistic 0.57; 95% CI 0.55-0.60), low body weight (c-statistic 0.56; 95% CI 0.51-0.61), anemia (c-statistic 0.60; 95% CI 0.58-0.63), or cancer (c-statistic 0.59; 95% CI 0.53-0.66). Conclusion. The reported findings in this research on risk stratification tools and therapies have potential implications for a more patient-tailored acute coronary care that may further improve outcomes for patients with MI.
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