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Ibanez, B., James, S. K., Agewall, S., Antunes, M. J., Bucciarelli-Ducci, C., Bueno, H., . . . Widimsky, P. (2018). 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Kardiologia polska, 76(2), 229-313
Open this publication in new window or tab >>2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation
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2018 (English)In: Kardiologia polska, ISSN 0022-9032, E-ISSN 1897-4279, Vol. 76, no 2, p. 229-313Article in journal (Refereed) Published
Place, publisher, year, edition, pages
VIA MEDICA, 2018
National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:uu:diva-348931 (URN)10.5603/KP.2018.0041 (DOI)000425965300001 ()29457615 (PubMedID)
Available from: 2018-04-26 Created: 2018-04-26 Last updated: 2018-04-26Bibliographically approved
Ibanez, B., James, S. K., Agewall, S., Antunes, M. J., Bucciarelli-Ducci, C., Bueno, H., . . . Widimsky, P. (2018). 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). European Heart Journal, 39(2), 119-177
Open this publication in new window or tab >>2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC)
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2018 (English)In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 39, no 2, p. 119-177Article in journal (Refereed) Published
Place, publisher, year, edition, pages
OXFORD UNIV PRESS, 2018
Keywords
Guidelines, Acute coronary syndromes, Acute myocardial infarction, Antithrombotic therapy, Antithrombotics, Emergency medical system, Evidence, Fibrinolysis, Ischaemic heart disease, Primary percutaneous coronary intervention, Quality indicators, MINOCA, Reperfusion therapy, Risk assessment, Secondary prevention, ST-segment elevation
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-341578 (URN)10.1093/eurheartj/ehx393 (DOI)000419700900010 ()28886621 (PubMedID)
Note

De två första författarna delar förstaförfattarskapet.

Also published in:

Kardiologia polska, DOI:10.5603/KP.2018.0041

Revista espanola de cardiologia, DOI 10.1016/j.rec.2017.11.010

Available from: 2018-02-14 Created: 2018-02-14 Last updated: 2018-03-15Bibliographically approved
Batra, G., Friberg, L., Erlinge, D., James, S. K., Jernberg, T., Svennblad, B., . . . Oldgren, J. (2018). Antithrombotic therapy after myocardial infarction in patients with atrial fibrillation undergoing percutaneous coronary intervention. European Heart Journal - Cardiovascular Pharmacotherapy, 4(1), 36-45
Open this publication in new window or tab >>Antithrombotic therapy after myocardial infarction in patients with atrial fibrillation undergoing percutaneous coronary intervention
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2018 (English)In: European Heart Journal - Cardiovascular Pharmacotherapy, ISSN 2055-6837, E-ISSN 2055-6845, Vol. 4, no 1, p. 36-45Article in journal (Refereed) Published
Abstract [en]

Aims: Optimal antithrombotic therapy after percutaneous coronary intervention (PCI) in patients with myocardial infarction (MI) and atrial fibrillation is uncertain. In this study, we compared antithrombotic regimes with regard to a composite cardiovascular outcome of all-cause mortality, MI or ischaemic stroke, and major bleeds.

Methods and results: Patients between October 2005 and December 2012 were identified in Swedish registries, n = 7116. Landmark 0-90 and 91-365 days of outcome were evaluated with Cox-regressions, with dual antiplatelet therapy as reference. At discharge, 16.2% received triple therapy (aspirin, clopidogrel, and warfarin), 1.9% aspirin plus warfarin, 7.3% clopidogrel plus warfarin, and 60.8% dual antiplatelets. For cardiovascular outcome, adjusted hazard ratio with 95% confidence interval (HR) for triple therapy was 0.86 (0.70-1.07) for 0-90 days and 0.78 (0.58-1.05) for 91-365 days. A HR of 2.16 (1.48-3.13) and 1.61 (0.98-2.66) during 0-90 and 91-365 days, respectively, was observed for major bleeds. For aspirin plus warfarin, HR 0.82 (0.54-1.26) and 0.62 (0.48-0.79) was observed for cardiovascular outcome and 1.30 (0.60-2.85) and 1.01 (0.63-1.62) for major bleeds during 0-90 and 91-365 days, respectively. For clopidogrel plus warfarin, HR of 0.90 (0.68-1.19) and 0.68 (0.49-0.95) was observed for cardiovascular outcome and 1.28 (0.71-2.32) and 1.08 (0.57-2.04) for major bleeds during 0-90 and 91-365 days, respectively.

Conclusion: Compared to dual antiplatelets, aspirin or clopidogrel plus warfarin therapy was associated with similar 0-90 days and lower 91-365 days of risk of the cardiovascular outcome, without higher risk of major bleeds. Triple therapy was associated with non-significant lower risk of cardiovascular outcome and higher risk of major bleeds.

National Category
Clinical Medicine
Identifiers
urn:nbn:se:uu:diva-320310 (URN)10.1093/ehjcvp/pvx033 (DOI)000419693700010 ()29126156 (PubMedID)
Funder
Swedish Foundation for Strategic Research , KF10-0024
Available from: 2017-04-19 Created: 2017-04-19 Last updated: 2018-02-20Bibliographically approved
Sherwood, M. W., Lopes, R. D., Sun, J. L., Liaw, D., Harrington, R. A., Wallentin, L., . . . Alexander, J. H. (2018). Apixaban following acute coronary syndromes in patients with prior stroke: Insights from the APPRAISE-2 trial. American Heart Journal, 197, 1-8
Open this publication in new window or tab >>Apixaban following acute coronary syndromes in patients with prior stroke: Insights from the APPRAISE-2 trial
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2018 (English)In: American Heart Journal, ISSN 0002-8703, E-ISSN 1097-6744, Vol. 197, p. 1-8Article in journal (Refereed) Published
Abstract [en]

BACKGROUND AND PURPOSE: Patients with prior stroke are at greater risk for recurrent cardiovascular events post-acute coronary syndromes (ACS) and may have a different risk/benefit profile with antithrombotic therapy than patients without prior stroke.

METHODS: We studied 7391 patients with ACS from APPRAISE-2, stratified by the presence or absence of prior stroke. Baseline characteristics and outcomes of cardiovascular death, myocardial infarction (MI), or stroke were compared between groups. Interactions between prior stroke, treatment assignment (apixaban vs placebo), and outcomes were tested before and after multivariable adjustment with Cox proportional hazards models.

RESULTS: A total of 902 patients (12%) had prior stroke. Those with prior stroke were older (69 vs 67 years), had more hypertension (91% vs 77%), peripheral vascular disease (22% vs18%), and impaired renal function (38% vs 30%) but less diabetes (44% vs 48%) than those without prior stroke. Patients with prior stroke vs no prior stroke had higher unadjusted rates of cardiovascular death (4.8% vs 4.0%), MI (11.2% vs 7.1%), and ischemic stroke (3.2% vs 0.9%). Patients with prior stroke assigned to apixaban had similar rates of the composite of cardiovascular death, MI, or stroke compared with those assigned to placebo (HR 1.39; 95% CI 0.92-2.08). Patients without prior stroke assigned to apixaban had similar rates of cardiovascular death, MI, or ischemic stroke compared with those assigned to placebo (HR 0.87; 95% CI 0.73-1.04; P-interaction=.041). Median follow-up was 240 days.

CONCLUSIONS: Patients with prior stroke are at higher risk for recurrent cardiovascular events post-ACS and had a differential risk/benefit profile with oral anticoagulation.

National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-342516 (URN)10.1016/j.ahj.2017.09.020 (DOI)000425723700001 ()29447769 (PubMedID)
Available from: 2018-02-21 Created: 2018-02-21 Last updated: 2018-05-03Bibliographically approved
Wester, A., Mohammad, M. A., Andell, P., Rylance, R., Dankiewicz, J., Friberg, H., . . . Koul, S. (2018). Coronary angiographic findings and outcomes in patients with sudden cardiac arrest without ST-elevation myocardial infarction: A SWEDEHEART study. Resuscitation, 126, 172-178
Open this publication in new window or tab >>Coronary angiographic findings and outcomes in patients with sudden cardiac arrest without ST-elevation myocardial infarction: A SWEDEHEART study
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2018 (English)In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 126, p. 172-178Article in journal (Refereed) Published
Abstract [en]

Background/aim: Sudden cardiac arrest (SCA) has a substantial mortality rate and the acute coronary syndrome constitutes the major cause. Post-resuscitation electrocardiogram ST-elevation SCA (STE-SCA) is a strong indication for emergency coronary angiography, but the role of early angiography and PCI in patients without STelevation (NSTE-SCA) remains to be established. This paper aimed to describe this patient group and evaluate the prognostic effect of early PCI in a large nationwide cohort of NSTE-SCA patients undergoing coronary angiography. Methods: Data from SCAAR (Swedish Coronary Angiography and Angioplasty Registry) and RIKS-HIA (Register of Information and Knowledge about Swedish Heart Intensive Care Admissions) on 4308 SCA patients in Sweden between 2005 and 2016 were descriptively analyzed and related to mortality within 30-days in both unadjusted and adjusted analyses using Cox proportional hazard models. Results: NSTE-SCA patients had more often serious comorbidities than STE-SCA patients. Among NSTE-SCA patients, 36.4% had no significant coronary artery stenosis while severe coronary stenosis (>= 90%) was present in 43.9% (1271/2896). In NSTE-SCA patients with significant stenosis (>= 90%), PCI was performed in 59.2% (753/1271) with an increased unadjusted 30-day mortality (40.9% vs. 32.7%; p =. 011). However, after adjustments for confounders, no difference in mortality was observed (hazard ratio 1.07; 95% CI 0.84-1.36; p =. 57). Conclusion: In resuscitated SCA patients without ST-elevation who underwent coronary angiography, this large retrospective study found severe coronary artery stenosis in 43.9% but found no clear benefit of early PCI. Prospective randomized controlled trials are needed to accurately define the role of coronary angiography and PCI in post-resuscitation care.

Place, publisher, year, edition, pages
ELSEVIER IRELAND LTD, 2018
Keywords
Sudden cardiac arrest, Sudden cardiac arrest without STEMI, SWEDEHEART, Coronary angiography, PCI
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-352567 (URN)10.1016/j.resuscitation.2018.01.044 (DOI)000430076700044 ()29410284 (PubMedID)
Funder
Swedish Research CouncilSwedish Foundation for Strategic Research Knut and Alice Wallenberg Foundation
Available from: 2018-08-07 Created: 2018-08-07 Last updated: 2018-08-07Bibliographically approved
Erlinge, D. & James, S. K. (2018). Correspondence: Bivalirudin versus Heparin Monotherapy in Myocardial Infarction [Letter to the editor]. New England Journal of Medicine, 378(3), 300-300
Open this publication in new window or tab >>Correspondence: Bivalirudin versus Heparin Monotherapy in Myocardial Infarction
2018 (English)In: New England Journal of Medicine, ISSN 0028-4793, E-ISSN 1533-4406, Vol. 378, no 3, p. 300-300Article in journal, Letter (Refereed) Published
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-350090 (URN)10.1056/NEJMc1714520 (DOI)000422888400021 ()
Note

WoS title: Bivalirudin versus Heparin Monotherapy in Myocardial Infarction Reply

Available from: 2018-05-04 Created: 2018-05-04 Last updated: 2018-05-04Bibliographically approved
Varenhorst, C., Hasvold, P., Johansson, S., Janzon, M., Albertsson, P., Leosdottir, M., . . . Lagerqvist, B. (2018). Culprit and Nonculprit Recurrent Ischemic Events in Patients With Myocardial Infarction: Data From SWEDEHEART (Swedish Web System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies). Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, 7(1), Article ID e007174.
Open this publication in new window or tab >>Culprit and Nonculprit Recurrent Ischemic Events in Patients With Myocardial Infarction: Data From SWEDEHEART (Swedish Web System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies)
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2018 (English)In: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, ISSN 2047-9980, E-ISSN 2047-9980, Vol. 7, no 1, article id e007174Article in journal (Refereed) Published
Abstract [en]

Background-Long-term disease progression after myocardial infarction (MI) is inadequately understood. We evaluated the pattern and angiographic properties (culprit lesion [CL]/non-CL [NCL]) of recurrent MI (re-MI) in a large real-world patient population. Methods and Results-Our observational study used prospectively collected data in 108 615 patients with first-occurrence MI enrolled in the SWEDEHEART (Swedish Web System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies) between July 1, 2006 and November 29, 2014. During follow-up (median, 3.2 years), recurrent hospitalization for MI occurred in 11 117 patients (10.2%). Of the patients who underwent coronary angiography for the index MI, a CL was identified in 44 332 patients. Of those patients, 3464 experienced an re-MI; the infarct originated from the NCL in 1243 patients and from the CL in 655 patients. In total, 1566 re-MIs were indeterminate events and could not be classified as NCL or CL re-MIs. The risk of re-MI within 8 years related to the NCL was 0.06 (95% confidence interval [CI], 0.05-0.06), compared with 0.03 (95% CI, 0.02-0.03) for the CL. There were no large differences in baseline characteristics of patients with subsequent NCL versus CL re-MIs. Independent predictors of NCL versus CL re-MI were multivessel disease (odds ratio, 2.29; 95% CI, 1.87-2.82), male sex (odds ratio, 1.36; 95% CI, 1.09-1.71), and a prolonged time between the index and re-MI (odds ratio, 1.16; 95% CI, 1.10-1.22). Conclusions-In a large cohort of patients with first-occurrence MI undergoing percutaneous coronary intervention, the risk of re-MI originating from a previously untreated lesion was twice higher than the risk of lesions originating from a previously stented lesion.

Place, publisher, year, edition, pages
WILEY, 2018
Keywords
culprit artery, myocardial infarction, nonculprit artery, percutaneous coronary intervention, prognosis
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-351063 (URN)10.1161/JAHA.117.007174 (DOI)000428139900013 ()
Funder
AstraZeneca
Available from: 2018-05-30 Created: 2018-05-30 Last updated: 2018-05-30Bibliographically approved
Lagedal, R., Elfwén, L., James, S. K., Oldgren, J., Erlinge, D., Östlund, O., . . . Nordberg, P. (2018). Design of DISCO-Direct or Subacute Coronary Angiography in Out-of-Hospital Cardiac Arrest study. American Heart Journal, 197, 53-61, Article ID S0002-8703(17)30376-9.
Open this publication in new window or tab >>Design of DISCO-Direct or Subacute Coronary Angiography in Out-of-Hospital Cardiac Arrest study
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2018 (English)In: American Heart Journal, ISSN 0002-8703, E-ISSN 1097-6744, Vol. 197, p. 53-61, article id S0002-8703(17)30376-9Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Acute coronary syndrome is a common cause of out-of-hospital cardiac arrest (OHCA). In patients with OHCA presenting with ST elevation, immediate coronary angiography and potential percutaneous coronary intervention (PCI) after return of spontaneous circulation are recommended. However, the evidence for this invasive strategy in patients without ST elevation is limited. Observational studies have shown a culprit coronary artery occlusion in about 30% of these patients, indicating the electrocardiogram's (ECG's) limited sensitivity. The aim of this study is to determine whether immediate coronary angiography and subsequent PCI will provide outcome benefits in OHCA patients without ST elevation.

METHODS/DESIGN: We describe the design of the DIrect or Subacute Coronary angiography in Out-of-hospital cardiac arrest study (DISCO)-a pragmatic national, multicenter, randomized, clinical study. OHCA patients presenting with no ST elevation on their first recorded ECG will be randomized to a strategy of immediate coronary angiography or to standard of care with admission to intensive care and angiography after 3days at the earliest unless the patient shows signs of acute ischemia or hemodynamic instability. Primary end point is 30-day survival. An estimated 1,006 patients give 80% power (α = .05) to detect a 20% improved 30-day survival rate from 45% to 54%. Secondary outcomes include good neurologic recovery at 30days and 6months, and cognitive function and cardiac function at 6months.

CONCLUSION: This randomized clinical study will evaluate the effect of immediate coronary angiography after OHCA on 30-day survival in patients without ST elevation on their first recorded ECG.

National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-342766 (URN)10.1016/j.ahj.2017.11.009 (DOI)000425723700007 ()29447784 (PubMedID)
Available from: 2018-02-23 Created: 2018-02-23 Last updated: 2018-05-03Bibliographically approved
Raposeiras-Roubin, S., Faxen, J., Iniguez-Romo, A., Henriques, J. P., D'Ascenzo, F., Saucedo, J., . . . Abu-Assi, E. (2018). Development and external validation of a post-discharge bleeding risk score in patients with acute coronary syndrome: The BleeMACS score. International Journal of Cardiology, 254, 10-15
Open this publication in new window or tab >>Development and external validation of a post-discharge bleeding risk score in patients with acute coronary syndrome: The BleeMACS score
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2018 (English)In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 254, p. 10-15Article in journal (Refereed) Published
Abstract [en]

Background: Accurate 1-year bleeding risk estimation after hospital discharge for acute coronary syndrome(ACS) may help clinicians guide the type and duration of antithrombotic therapy. Currently there are no predictive models for this purpose. The aim of this study was to derive and validate a simple clinical tool for bedside risk estimation of 1-year post-discharge serious bleeding in ACS patients.

Methods: The risk score was derived and internally validated in the BleeMACS (Bleeding complications in a Multicenter registry of patients discharged with diagnosis of Acute Coronary Syndrome) registry, an observational international registry involving 15,401 patients surviving admission for ACS and undergoing percutaneous coronary intervention (PCI) from 2003 to 2014, engaging 15 hospitals from 10 countries located in America, Europe and Asia. External validation was conducted in the SWEDEHEART population, with 96,239 ACS patients underwent PCI and 93,150 without PCI.

Results: Seven independent predictors of bleeding were identified and included in the BleeMACS score: age, hypertension, vascular disease, history of bleeding, malignancy, creatinine and hemoglobin. The BleeMACS risk score exhibited a C-statistic value of 0.71 (95% CI 0.68-0.74) in the derivation cohort and 0.72 (95% CI 0.67-0.76) in the internal validation sample. In the SWEDEHEART external validation cohort, the C-statistic was 0.65 (95% CI 0.64-0.66) for PCI patients and 0.63 (95% CI 0.62-0.64) for non-PCI patients. The calibration was excellent in the derivation and validation cohorts.

Conclusions: The BleeMACS bleeding risk score is a simple tool useful for identifying those ACS patients at higher risk of serious 1-year post-discharge bleeding.

Place, publisher, year, edition, pages
ELSEVIER IRELAND LTD, 2018
Keywords
Bleeding, Acute coronary syndrome, Risk score, Percutaneous coronary intervention
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-347552 (URN)10.1016/j.ijcard.2017.10.103 (DOI)000424514800002 ()29407077 (PubMedID)
Available from: 2018-04-04 Created: 2018-04-04 Last updated: 2018-04-04Bibliographically approved
Sumaya, W., Wallentin, L., James, S. K., Siegbahn, A., Gabrysch, K., Bertilsson, M., . . . Storey, R. F. (2018). Fibrin clot properties independently predict adverse clinical outcome following acute coronary syndrome: a PLATO substudy. European Heart Journal, 39(13), 1078-1085
Open this publication in new window or tab >>Fibrin clot properties independently predict adverse clinical outcome following acute coronary syndrome: a PLATO substudy
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2018 (English)In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 39, no 13, p. 1078-1085Article in journal, Editorial material (Other academic) Published
Abstract [en]

Aims To determine whether fibrin clot properties are associated with clinical outcomes following acute coronary syndrome (ACS). Methods and results Plasma samples were collected at hospital discharge from 4354 ACS patients randomized to clopidogrel or ticagrelor in the PLATelet inhibition and patient Outcomes (PLATO) trial. A validated turbidimetric assay was employed to study plasma clot lysis time and maximum turbidity (a measure of clot density). One-year rates of cardiovascular (CV) death, spontaneous myocardial infarction (MI) and PLATO-defined major bleeding events were assessed after sample collection. Hazard ratios (HRs) were estimated using Cox proportional hazards models. After adjusting for CV risk factors, each 50% increase in lysis time was associated with CV death/spontaneous MI [HR 1.17, 95% confidence interval (CI) 1.05-1.31; P < 0.01] and CV death alone (HR 1.36, 95% CI 1.17-1.59; P < 0.001). Similarly, each 50% increase in maximum turbidity was associated with increased risk of CV death (HR 1.24, 95% CI 1.03-1.50; P = 0.024). After adjustment for other prognostic biomarkers (leukocyte count, high-sensitivity C-reactive protein, high-sensitivity troponin T, cystatin C, N-terminal pro B-type natriuretic peptide, and growth differentiation factor15), the association with CV death remained significant for lysis time (HR 1.2, 95% CI 1.01-1.42; P = 0.042) but not for maximum turbidity. These associations were consistent regardless of randomized antiplatelet treatment (all interaction P > 0.05). Neither lysis time nor maximum turbidity was associated with major bleeding events. Conclusion Fibrin clots that are resistant to lysis independently predict adverse outcome in ACS patients. Novel therapies targeting fibrin clot properties might be a new avenue for improving prognosis in patients with ACS.

Place, publisher, year, edition, pages
OXFORD UNIV PRESS, 2018
Keywords
Acute coronary syndrome, Fibrin clot, Lysis time, Biomarker
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-357171 (URN)10.1093/eurheartj/ehy013 (DOI)000429350500010 ()29390064 (PubMedID)
Available from: 2018-08-14 Created: 2018-08-14 Last updated: 2018-08-14Bibliographically approved
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ORCID iD: ORCID iD iconorcid.org/0000-0003-4413-9736

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