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  • 1.
    Bueno, Hector
    et al.
    Ctr Nacl Invest Cardiovasc, Melchor Fernandez Almagro 3, Madrid 28029, Spain;Hosp Univ 12 Octubre, Cardiol Dept, Madrid, Spain;Univ Complutense Madrid, Madrid, Spain.
    de Graeff, Pieter
    Univ Groningen, Dept Clin Pharm & Pharmacol, Groningen, Netherlands;Dutch Med Evaluat Board, Utrecht, Netherlands.
    Richard-Lordereau, Isabelle
    Bristol Myers Squibb, Rueil Malmaison, France.
    Emmerich, Joseph
    Univ Paris 05, Cochin Hotel Dieu Hosp, French Natl Agcy Med & Hlth Prod Safety, Paris, France.
    Fox, Keith A. A.
    Univ Edinburgh, Ctr Cardiovasc Sci, Edinburgh, Midlothian, Scotland;Royal Infirm Edinburgh NHS Trust, Edinburgh, Midlothian, Scotland.
    Friedman, Carola P.
    Novartis Pharmaceut, E Hanover, NJ USA.
    Gaudin, Christophe
    Sanofi, Paris, France.
    El-Gazayerly, Amany
    Dutch Med Evaluat Board, Utrecht, Netherlands.
    Goldman, Samantha
    Daiichi Sankyo Dev Ltd, Gerrards Cross, England.
    Hemmrich, Melanie
    Bayer Pharma AG Inc, Berlin, Germany.
    Henderson, Robert A.
    Nottingham Univ Hosp, Trent Cardiac Ctr, Nottingham, England.
    Himmelmann, Anders
    AstraZeneca R&D, Molndal, Sweden.
    Irs, Alar
    Univ Tartu, Dept Cardiol, Tartu, Estonia;Estonian State Agcy Med, Tartu, Estonia.
    Jackson, Neville
    Pfizer Inc, Richmond, VA USA.
    James, Stefan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology.
    Katus, Hugo A.
    Univ Klinikum Heidelberg, Med Klin, Heidelberg, Germany.
    Laslop, Andrea
    Austrian Agcy Hlth & Food Safety, Vienna, Austria.
    Laws, Ian
    GlaxoSmithKline, London, England.
    Mehran, Roxana
    Zena & Michael A Wiener Cardiovasc Inst, New York, NY USA.
    Ong, Seleen
    Pfizer Inc, Sandwich, Kent, England.
    Prasad, Krishna
    Med & Healthcare Prod Regulatory Agcy, London, England;Univ London, St Thomas Hosp, London, England.
    Roffi, Marco
    Univ Hosp, Dept Cardiol, Geneva, Switzerland.
    Rosano, Giuseppe M. C.
    San Raffaele Hosp Roma, IRCCS, Rome, Italy;Univ London, Cardiovasc & Cell Sci Inst, London, England.
    Rose, Martin
    US FDA, Rockville, MD 20857 USA.
    Sinnaeve, Peter R.
    Univ Leuven, Dept Cardiovasc Sci, Leuven, Belgium.
    Stough, Wendy Gattis
    Campbell Univ, Coll Pharm & Hlth Sci, Buies Creek, NC 27506 USA.
    Thygesen, Kristian
    Aarhus Univ Hosp, Dept Cardiol, Aarhus, Denmark.
    Van de Werf, Frans
    Univ Leuven, Dept Cardiovasc Sci, Leuven, Belgium.
    Varin, Claire
    Inst Rech Int Servier, Suresnes, France.
    Verheugt, Freek W. A.
    OLVG, Amsterdam, Netherlands.
    Garcia, Maria de los Angeles Alonso
    European Med Agcy, Sci Advice Working Party, London, England;Imperial Coll Healthcare, Cardiol, London, England.
    Report of the European Society of Cardiology Cardiovascular Round Table regulatory workshop update of the evaluation of new agents for the treatment of acute coronary syndrome: Executive summary2019In: European heart journal. Acute cardiovascular care., ISSN 2048-8726, Vol. 8, no 8, p. 745-754Article in journal (Refereed)
    Abstract [en]

    Regulatory authorities interpret the results of randomized controlled trials according to published principles. The European Medicines Agency (EMA) is planning a revision of the 2000 and 2003 guidance documents on clinical investigation of new medicinal products for the treatment of acute coronary syndrome (ACS) to achieve consistency with current knowledge in the field. This manuscript summarizes the key output from a collaborative workshop, organized by the Cardiovascular Round Table and the European Affairs Committee of the European Society of Cardiology, involving clinicians, academic researchers, trialists, European and US regulators, and pharmaceutical industry researchers. Specific questions in four key areas were selected as priorities for changes in regulatory guidance: patient selection, endpoints, methodologic issues and issues related to the research for novel agents. Patients with ST-segment elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI) should be studied separately for therapies aimed at the specific pathophysiology of either condition, particularly for treatment of the acute phase, but can be studied together for other treatments, especially long-term therapy. Unstable angina patients should be excluded from acute phase ACS trials. In general, cardiovascular death and reinfarction are recommended for primary efficacy endpoints; other endpoints may be considered if specifically relevant for the therapy under study. New agents or interventions should be tested against a background of evidence-based therapy with expanded follow-up for safety assessment. In conclusion, new guidance documents for randomized controlled trials in ACS should consider changes regarding patient and endpoint selection and definitions, and trial designs. Specific requirements for the evaluation of novel pharmacological therapies need further clarification.

  • 2.
    Erlinge, David
    et al.
    Lund Univ, Dept Cardiol, Lund, Sweden.
    Koul, Sasha
    Lund Univ, Dept Cardiol, Lund, Sweden.
    Omerovic, Elmir
    Sahlgrens Univ Hosp, Dept Cardiol, Gothenburg, Sweden.
    Fröbert, Ole
    Örebro Univ, Dept Cardiol, Örebro, Sweden.
    Linder, Rikard
    Danderyd Hosp, Dept Cardiol, Danderyd, Sweden.
    Danielewicz, Mikael
    Karlstad Hosp, PCI Unit, Karlstad, Sweden.
    Hamid, Mehmet
    Mälarsjukhuset, Dept Cardiol, Eskilstuna, Sweden.
    Venetsanos, Dimitrios
    Karolinska Univ Hosp, Dept Cardiol, Solna, Sweden.
    Henareh, Loghman
    Karolinska Univ Hosp, Dept Cardiol, Solna, Sweden.
    Pettersson, Björn
    Umeå Univ, Dept Cardiol, Umeå, Sweden.
    Wagner, Henrik
    Helsingborg Lasarett, Dept Cardiol, Helsingborg, Sweden.
    Grimfjärd, Per
    Västmanlands Sjukhus, Dept Internal Med, Köping, Sweden.
    Jensen, Jens
    Capio St Görans Hosp AB, Dept Cardiol, Stockholm, Sweden.
    Hofmann, Robin
    Södersjukhuset, Dept Clin Sci & Educ, Stockholm, Sweden.
    Ulvenstam, Anders
    Östersund Hosp, Dept Cardiol, Östersund, Sweden.
    Völz, Sebastian
    Sahlgrens Univ Hosp, Dept Cardiol, Gothenburg, Sweden.
    Petursson, Petur
    Sahlgrens Univ Hosp, Dept Cardiol, Gothenburg, Sweden.
    Östlund, Olof Petter
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.
    Sarno, Giovanna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology.
    Wallentin, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.
    Scherstén, Fredrik
    Lund Univ, Dept Cardiol, Lund, Sweden.
    Eriksson, Peter
    Umeå Univ, Dept Cardiol, Umeå, Sweden.
    James, Stefan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.
    Bivalirudin versus heparin monotherapy in non-ST-segment elevation myocardial infarction2019In: European heart journal. Acute cardiovascular care., ISSN 2048-8726, Vol. 8, p. 492-501, article id 2048872618805663Article in journal (Refereed)
    Abstract [en]

    Background: The optimal anti-coagulation strategy for patients with non-ST-elevation myocardial infarction treated with percutaneous coronary intervention is unclear in contemporary clinical practice of radial access and potent P2Y12-inhibitors. The aim of this study was to investigate whether bivalirudin was superior to heparin monotherapy in patients with non-ST-elevation myocardial infarction without routine glycoprotein IIb/IIIa inhibitor use.

    Methods: In a large pre-specified subgroup of the multicentre, prospective, randomised, registry-based, open-label clinical VALIDATE-SWEDEHEART trial we randomised patients with non-ST-elevation myocardial infarction undergoing percutaneous coronary intervention, treated with ticagrelor or prasugrel, to bivalirudin or heparin monotherapy with no planned use of glycoprotein IIb/IIIa inhibitors during percutaneous coronary intervention. The primary endpoint was the rate of a composite of all-cause death, myocardial infarction or major bleeding within 180 days.

    Results: A total of 3001 patients with non-ST-elevation myocardial infarction, were enrolled. The primary endpoint occurred in 12.1% (182 of 1503) and 12.5% (187 of 1498) of patients in the bivalirudin and heparin groups, respectively (hazard ratio of bivalirudin compared to heparin treatment 0.96, 95% confidence interval 0.78–1.18, p=0.69). The results were consistent in all major subgroups. All-cause death occurred in 2.0% versus 1.7% (hazard ratio 1.15, 0.68–1.94, p=0.61), myocardial infarction in 2.3% versus 2.5% (hazard ratio 0.91, 0.58–1.45, p=0.70), major bleeding in 8.9% versus 9.1% (hazard ratio 0.97, 0.77–1.24, p=0.82) and definite stent thrombosis in 0.3% versus 0.2% (hazard ratio 1.33, 0.30–5.93, p=0.82).

    Conclusion: Bivalirudin as compared to heparin during percutaneous coronary intervention for non-ST-elevation myocardial infarction did not reduce the composite of all-cause death, myocardial infarction or major bleeding in non-ST-elevation myocardial infarction patients receiving current recommended treatments with modern P2Y12-inhibitors and predominantly radial access.

  • 3. Giannitsis, Evangelos
    et al.
    Mair, Johannes
    Christersson, Christina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology.
    Siegbahn, Agneta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Huber, Kurt
    Jaffe, Allan S
    Peacock, W Frank
    Plebani, Mario
    Thygesen, Kristian
    Möckel, Martin
    Mueller, Christian
    Lindahl, Bertil
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    How to use D-dimer in acute cardiovascular care2017In: European heart journal. Acute cardiovascular care., ISSN 2048-8726, Vol. 6, no 1, p. 69-80Article in journal (Refereed)
    Abstract [en]

    D-dimer testing is important to aid in the exclusion of venous thromboembolic events (VTEs), including deep venous thrombosis and pulmonary embolism, and it may be used to evaluate suspected aortic dissection. D-dimer is produced upon activation of the coagulation system with the generation and subsequent degradation of cross-linked fibrin by plasmin. Many different assays for D-dimer testing are currently used in routine care. However, these tests are neither standardized nor harmonized. Consequently, only clinically validated assays and assay specific decision limits should be used for routine testing. For the exclusion of pulmonary embolism/deep vein thrombosis, age-adjusted cut-offs are recommend. Clinicians must be aware of the validated use of their hospital's D-dimer assay to avoid inappropriate use of this biomarker in routine care.

  • 4. Gorenek, Bulent
    et al.
    Lundqvist, Carina Blomström
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology-Arrhythmia.
    Terradellas, Josep Brugada
    Camm, A John
    Hindricks, Gerhard
    Huber, Kurt
    Kirchhof, Paulus
    Kuck, Karl-Heinz
    Kudaiberdieva, Gulmira
    Lin, Tina
    Raviele, Antonio
    Santini, Massimo
    Tilz, Roland Richard
    Valgimigli, Marco
    Vos, Marc A
    Vrints, Christian
    Zeymer, Uwe
    Cardiac arrhythmias in acute coronary syndromes: position paper from the joint EHRA, ACCA, and EAPCI task force2015In: European heart journal. Acute cardiovascular care., ISSN 2048-8726, Vol. 4, no 4, article id 386Article in journal (Refereed)
  • 5.
    Harskamp, Ralf E.
    et al.
    Univ Amsterdam, Acad Med Ctr, Ctr Heart, Amsterdam, Netherlands..
    Clare, Robert M.
    Duke Clin Res Inst, Box 3850,2400 Pratt St, Durham, NC 27705 USA..
    Ambrosio, Giuseppe
    Univ Perugia, Sch Med, Div Cardiol, Perugia, Italy..
    Held, Claes
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.
    Lokhnygina, Yuliya
    Duke Clin Res Inst, Box 3850,2400 Pratt St, Durham, NC 27705 USA..
    Moliterno, David J.
    Univ Kentucky, Gill Heart Inst, Lexington, KY USA.;Univ Kentucky, Div Cardiovasc Med, Lexington, KY USA..
    White, Harvey D.
    Auckland City Hosp, Green Lane Cardiovasc Serv, Auckland, New Zealand.;Univ Auckland, Auckland, New Zealand..
    Aylward, Philip E.
    Flinders Univ & Med Ctr, SAHMRI, Adelaide, SA, Australia..
    Armstrong, Paul W.
    Univ Alberta, Div Cardiol, Edmonton, AB, Canada..
    Mahaffey, Kenneth W.
    Stanford Univ, Dept Med, Stanford, CA 94305 USA..
    Harrington, Robert A.
    Stanford Univ, Dept Med, Stanford, CA 94305 USA..
    Van de Werf, Frans
    Univ Hosp, Dept Cardiol, Leuven, Belgium..
    Wallentin, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.
    Strony, John
    Johnson & Johnson, New Brunswick, NJ USA.;Merck, Whitehouse Stn, NJ USA..
    Tricoci, Pierluigi
    Duke Clin Res Inst, Box 3850,2400 Pratt St, Durham, NC 27705 USA..
    Use of thienopyridine prior to presentation with non-ST-segment elevation acute coronary syndrome and association with safety and efficacy of vorapaxar: insights from the TRACER trial2017In: European heart journal. Acute cardiovascular care., ISSN 2048-8726, Vol. 6, no 2, p. 155-163Article in journal (Refereed)
    Abstract [en]

    Background: Vorapaxar is effective in the prevention of secondary atherothrombotic events, although the efficacy/safety balance appears less favorable in the treatment of patients with non-ST-segment elevation (NSTE) acute coronary syndrome (ACS). We hypothesized that patients with NSTE ACS already receiving thienopyridine prior to the ACS event may show differential efficacy/safety effects with vorapaxar vs. placebo added to their standard care. Methods: We studied 12,944 patients from the Thrombin Receptor Antagonist for Clinical Event Reduction in Acute Coronary Syndrome (TRACER) trial with respect to thienopyridine use before admission for the index NSTE ACS event. The primary endpoint was a composite of cardiovascular death, myocardial infarction, stroke, rehospitalization for ischemia, and urgent revascularization. The key secondary endpoint was a composite of cardiovascular death, myocardial infarction, and stroke. Safety endpoints were bleeding complications. Results: Only 1513 patients (11.7%) were receiving thienopyridine before admission for the index NSTE ACS event. In these patients, Global Use of Strategies to Open Occluded Coronary Arteries (GUSTO) moderate/severe bleeding occurred in 5.7% treated with vorapaxar and 5.3% treated with a placebo (hazards ratio (HR) 1.10, 95% confidence interval (CI) 0.70-1.71); in thienopyridine-naive patients, the rates were 5.7% and 4.1%, respectively (HR 1.32, 95% CI 1.11-1.57; P-int=0.45). GUSTO severe bleeding in the prior thienopyridine group occurred in 0.5% of patients treated with vorapaxar and 1.3% of patients treated with placebo (HR 0.34, 95% CI 0.09-1.30); in thienopyridine-naive patients, the rates were 2.0% and 1.0%, respectively (HR 1.89, 95% CI 1.36-2.62; P-int=0.01). No interaction was observed between vorapaxar efficacy and prior thienopyridine use on the primary (adjusted P-int=0.53) or key secondary endpoints (P-int=0.61). Conclusions: TRACER was largely conducted in thienopyridine-naive patients with unknown tolerance to multiple antiplatelet treatments. Patients receiving thienopyridine before the index event may have had an attenuated increase in bleeding when adding vorapaxar, whereas concomitantly adding vorapaxar and thienopyridine in naive patients may have uncovered a latent susceptibility to bleeding.

  • 6.
    Held, Claes
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology.
    Tricoci, Pierluigi
    Huang, Zhen
    Van de Werf, Frans
    White, Harvey D
    Armstrong, Paul W
    Ambrosio, Giuseppe
    Aylward, Philip E
    Moliterno, David J
    Wallentin, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology.
    Chen, Edmond
    Erkan, Aycan
    Jiang, Lixin
    Strony, John
    Harrington, Robert A
    Mahaffey, Kenneth W
    Vorapaxar, a platelet thrombin-receptor antagonist, in medically managed patients with non-ST-segment elevation acute coronary syndrome:: results from the TRACER trial2014In: European heart journal. Acute cardiovascular care., ISSN 2048-8726, Vol. 3, no 3, p. 246-256Article in journal (Refereed)
    Abstract [en]

    Background: This study characterized a medically managed population in a non-ST-segment elevation acute coronary syndrome (NSTEACS) cohort and evaluated prognosis and outcomes of vorapaxar vs. placebo.

    Methods: In the TRACER study, 12,944 NSTEACS patients were treated with standard care and vorapaxar (a novel platelet protease-activated receptor-1 antagonist) or placebo. Of those, 4194 patients (32.4%) did not undergo revascularization during index hospitalization, and 8750 (67.6%) underwent percutaneous coronary intervention or coronary artery bypass grafting. Patients managed medically were heterogeneous with different risk profiles, including 1137 (27.1%) who did not undergo coronary angiography. Patients who underwent angiography but were selected for medical management included those without evidence of significant coronary artery disease (CAD), with prior CAD but no new significant lesions, and with significant lesions who were not treated with revascularization.

    Results: Cardiovascular event rates were highest among those without angiography and lowest in the group with angiography but without CAD. In the medically managed cohort, 2-year primary outcome (cardiovascular death, myocardial infarction, stroke, recurrent ischaemia with rehospitalization, urgent coronary revascularization) event rates were 16.3% with vorapaxar and 17.0% with placebo (HR 0.99, 95% CI 0.83–1.17), with no interaction between drug and management strategy (p=0.75). Key secondary endpoint (cardiovascular death, myocardial infarction, stroke) rates were 13.4% with vorapaxar and 14.9% with placebo (HR 0.89, 95% CI 0.74–1.07), with no interaction (p=0.58). Vorapaxar increased GUSTO moderate/severe bleeding numerically in medically managed patients (adjusted HR 1.46, 95% CI 0.99–2.15).

    Conclusions: NSTEACS patients who were initially medically managed had a higher risk-factor burden, and one-third had normal coronary arteries. Outcome in the medically managed cohort was significantly related to degree of CAD, highlighting the importance of coronary angiography. Efficacy and safety of vorapaxar appeared consistent with the overall trial results.

  • 7. Jaffe, AS
    et al.
    Moeckel, M
    Giannitsis, E
    Huber, K
    Mair, J
    Mueller, C
    Plebani, M
    Thygesen, K
    Lindahl, Bertil
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.
    In search for the Holy Grail: Suggestions for studies to define delta changes to diagnose or exclude acute myocardial infarction: a position paper from the study group on biomarkers of the Acute Cardiovascular Care Association2014In: European heart journal. Acute cardiovascular care., ISSN 2048-8726, Vol. 3, no 4, p. 313-316Article in journal (Refereed)
  • 8.
    Johnston, Nina
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.
    Bornefalk-Hermansson, Anna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.
    Schenck-Gustafsson, Karin
    Held, Claes
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology.
    Goodman, Shaun G
    Yan, Andrew T
    Bierman, Arlene S
    Do clinical factors explain persistent sex disparities in the use of acute reperfusion therapy in STEMI in Sweden and Canada?2013In: European heart journal. Acute cardiovascular care., ISSN 2048-8726, Vol. 2, no 4, p. 350-358Article in journal (Refereed)
    Abstract [en]

    AIMS:

    This study examined clinical factors associated with sex differences in the use of acute reperfusion therapy (fibrinolysis or primary percutaneous coronary intervention) in ST-elevation myocardial infarction (STEMI) patients, and the interaction between sex and these factors in Sweden and Canada.

    METHODS:

    Patients with STEMI in Sweden (n=32,676 from the Register of Information and Knowledge about Swedish Heart Intensive Care Admissions) were compared with similar patients in Canada (n=3375 from the Canadian Global Registry of Acute Coronary Events) for the period 2004-2008.

    RESULTS:

    Unadjusted vs. age-adjusted odds ratios (OR) for no reperfusion (women vs. men) were for Sweden 1.57 (95% CI 1.49-1.64) vs. 1.14 (95% CI 1.08-1.20), and for Canada 1.61 (95% CI 1.39-1.87) vs. OR 1.18 (95% CI 1.01-1.39). Sex differences persisted after multivariable adjustments (including prehospital delay, atypical symptoms, diabetes), factors for which no interaction with sex was found. Among women <60 years, adjusting for atypical symptoms in Canada and angiographic data in Sweden made the greatest contribution to explaining observed sex differences.

    CONCLUSIONS:

    In both countries, acute reperfusion therapy in STEMI was used less often in women than in men. Factors associated with these sex differences appear to differ between older and younger women. Targeted interventions are needed to optimize care for women with STEMI, as well as sex- and age-stratified reporting of quality indicators to assess their effectiveness.

  • 9.
    Karlsson, Sofia
    et al.
    Lund Univ, Skane Univ Hosp, Dept Cardiol, Clin Sci, S-22185 Lund, Sweden.
    Andell, Pontus
    Lund Univ, Skane Univ Hosp, Dept Cardiol, Clin Sci, S-22185 Lund, Sweden.
    Mohammad, Moman A
    Lund Univ, Skane Univ Hosp, Dept Cardiol, Clin Sci, S-22185 Lund, Sweden.
    Koul, Sasha
    Lund Univ, Skane Univ Hosp, Dept Cardiol, Clin Sci, S-22185 Lund, Sweden.
    Olivecrona, Göran K
    Lund Univ, Skane Univ Hosp, Dept Cardiol, Clin Sci, S-22185 Lund, Sweden.
    James, Stefan K
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology.
    Fröbert, Ole
    Orebro Univ, Fac Hlth, Dept Cardiol, Orebro, Sweden.
    Erlinge, David
    Lund Univ, Skane Univ Hosp, Dept Cardiol, Clin Sci, S-22185 Lund, Sweden.
    Heparin pre-treatment in patients with ST-segment elevation myocardial infarction and the risk of intracoronary thrombus and total vessel occlusion: Insights from the TASTE trial2019In: European heart journal. Acute cardiovascular care., ISSN 2048-8726, Vol. 8, no 1, p. 15-23Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Pre-treatment with unfractionated heparin is common in ST-segment elevation myocardial infarction (STEMI) protocols, but the effect on intracoronary thrombus burden is unknown. We studied the effect of heparin pre-treatment on intracoronary thrombus burden and Thrombolysis in Myocardial Infarction (TIMI) flow prior to percutaneous coronary intervention in patients with STEMI.

    METHODS: The Thrombus Aspiration in ST-Elevation Myocardial Infarction in Scandinavia (TASTE) trial angiographically assessed intracoronary thrombus burden and TIMI flow, prior to percutaneous coronary intervention, in patients with STEMI. In this observational sub-study, patients pre-treated with heparin were compared with patients not pre-treated with heparin. Primary end points were a visible intracoronary thrombus and total vessel occlusion prior to percutaneous coronary intervention. Secondary end points were in-hospital bleeding, in-hospital stroke and 30-day all-cause mortality.

    RESULTS: Heparin pre-treatment was administered in 2898 out of 7144 patients (41.0%). Patients pre-treated with heparin less often presented with an intracoronary thrombus (61.3% vs. 66.0%, p<0.001) and total vessel occlusion (62.9% vs. 71.6%, p<0.001). After adjustments, heparin pre-treatment was independently associated with a reduced risk of intracoronary thrombus (odds ratio (OR) 0.73, 95% confidence interval (CI)=0.65-0.83) and total vessel occlusion (OR 0.64, 95% CI=0.56-0.73), prior to percutaneous coronary intervention. There were no significant differences in secondary end points of in-hospital bleeding (OR 0.84, 95% CI=0.55-1.27), in-hospital stroke (OR 1.17, 95% CI=0.48-2.82) or 30-day all-cause mortality (hazard ratio 0.88, 95% CI=0.60-1.30).

    CONCLUSIONS: Heparin pre-treatment was independently associated with a lower risk of intracoronary thrombus and total vessel occlusion before percutaneous coronary intervention in patients with STEMI, without evident safety concerns, in this large multi-centre observational study.

  • 10.
    Lancellotti, Patrizio
    et al.
    Univ Hosp Sart Tilman, Dept Cardiol, Univ Liege Hosp, Cardiol Care Unit,GIGA Cardiovasc Sci, Liege, Belgium..
    Price, Susanna
    Royal Brompton Hosp, Adult Intens Care Unit, London SW3 6LY, England..
    Edvardsen, Thor
    Oslo Univ Hosp, Dept Cardiol, Oslo, Norway.;Univ Oslo, N-0316 Oslo, Norway..
    Cosyns, Bernard
    UZ Brussel, Ctr Hart En Vaatziekten CHVZ, Dept Cardiol, Brussels, Belgium..
    Neskovic, Aleksandar N.
    Univ Belgrade, Fac Med, Clin Hosp Ctr Zemun, Belgrade 11001, Serbia..
    Dulgheru, Raluca
    Univ Hosp Sart Tilman, Dept Cardiol, Univ Liege Hosp, Cardiol Care Unit,GIGA Cardiovasc Sci, Liege, Belgium..
    Flachskampf, Frank A.
    Uppsala Univ, Inst Med Vetenskaper, Uppsala, Sweden..
    Hassager, Christian
    Univ Copenhagen, Rigshosp, Dept Cardiol, DK-1168 Copenhagen, Denmark..
    Pasquet, Agnes
    Catholic Univ Louvain, Pole Rech Cardiovasc, Inst Rech Expt & Clin, B-1200 Brussels, Belgium.;Clin Univ St Luc, Div Cardiol, B-1200 Brussels, Belgium..
    Gargani, Luna
    CNR, Inst Clin Physiol, Pisa, Italy..
    Galderisi, Maurizio
    Federico II Univ Hosp, Dept Med Translat Sci, Naples, Italy..
    Cardim, Nuno
    Hosp Luz, Echocardiog Lab, Lisbon, Portugal..
    Haugaa, Kristina H.
    Oslo Univ Hosp, Dept Cardiol, Oslo, Norway.;Univ Oslo, N-0316 Oslo, Norway..
    Ancion, Arnaud
    Univ Hosp Sart Tilman, Dept Cardiol, Univ Liege Hosp, Cardiol Care Unit,GIGA Cardiovasc Sci, Liege, Belgium..
    Zamorano, Jose-Luis
    Univ Alcala de Henares, Hosp Ramon y Cajal, Madrid, Spain..
    Donal, Erwan
    CHU Rennes, Dept Cardiol, Rennes, France.;Univ Rennes 1, INSERM, U1099, LTSI, F-35014 Rennes, France..
    Bueno, Hector
    Hosp Gen Univ Gregorio Maranon, Dept Cardiol, Inst Invest Sanitaria Gregorio Maranon, Barcelona, Spain.;Univ Complutense Madrid, E-28040 Madrid, Spain..
    Habib, Gilbert
    Aix Marseille Univ, La Timone Hosp, APHM, Dept Cardiol, Marseille, France..
    The use of echocardiography in acute cardiovascular care: Recommendations of the European Association of Cardiovascular Imaging and the Acute Cardiovascular Care Association2015In: European heart journal. Acute cardiovascular care., ISSN 2048-8726, Vol. 4, no 1, p. 3-5Article in journal (Refereed)
    Abstract [en]

    Echocardiography is one of the most powerful diagnostic and monitoring tools available to the modern emergency/critical care practitioner. Currently, there is a lack of specific European Association of Cardiovascular Imaging/Acute Cardiovascular Care Association recommendations for the use of echocardiography in acute cardiovascular care. In this document, we describe the practical applications of echocardiography in patients with acute cardiac conditions, in particular with acute chest pain, acute heart failure, suspected cardiac tamponade, complications of myocardial infarction, acute valvular heart disease including endocarditis, acute disease of the ascending aorta and post-intervention complications. Specific issues regarding echocardiography in other acute cardiac care scenarios are also described.

  • 11.
    Lancellotti, Patrizio
    et al.
    Univ Liege Hosp, Univ Hosp Sart Tilman, Dept Cardiol, Cardiol Care Unit,GIGA Cardiovasc Sci, Liege, Belgium.
    Price, Susanna
    Royal Brompton Hosp, Adult Intens Care Unit, London SW3 6LY, England.
    Edvardsen, Thor
    Oslo Univ Hosp, Dept Cardiol, Oslo, Norway; Univ Oslo, N-0316 Oslo, Norway.
    Cosyns, Bernard
    Univ Ziekenhuis, Dept Cardiol, Centrum Voor Hart en Vaatziekten CHVZ, VUB, Brussels, Belgium.
    Neskovic, Aleksandar N
    Univ Belgrade, Fac Med, Clin Hosp Ctr Zemun, Belgrade 11001, Serbia.
    Dulgheru, Raluca
    Univ Liege Hosp, Univ Hosp Sart Tilman, Dept Cardiol, Cardiol Care Unit,GIGA Cardiovasc Sci, Liege, Belgium.
    Flachskampf, Frank A
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology.
    Hassager, Christian
    Univ Copenhagen, Rigshosp, Dept Cardiol, DK-2100 Copenhagen, Denmark.
    Pasquet, Agnes
    Catholic Univ Louvain, Pole Rech Cardiovasc, Inst Rech Expt & Clin, B-1200 Brussels, Belgium; Clin Univ St Luc, Div Cardiol, B-1200 Brussels, Belgium.
    Gargani, Luna
    CNR, Inst Clin Physiol, Pisa, Italy.
    Galderisi, Maurizio
    Federico II Univ Hosp, Dept Med Translat Sci, Naples, Italy.
    Cardim, Nuno
    Hosp da Luz, Echocardiog Lab, Lisbon, Portugal.
    Haugaa, Kristina H
    Oslo Univ Hosp, Dept Cardiol, Oslo, Norway; Univ Oslo, N-0316 Oslo, Norway.
    Ancion, Arnaud
    Univ Liege Hosp, Univ Hosp Sart Tilman, Dept Cardiol, Cardiol Care Unit,GIGA Cardiovasc Sci, Liege, Belgium.
    Zamorano, Jose-Luis
    Univ Alcala De Henares, Hosp Ramon y Cajal, Madrid, Spain.
    Donal, Erwan
    Univ Rennes 1, CHU Rennes, Dept Cardiol, F-35014 Rennes, France; Univ Rennes 1, LTSI, F-35014 Rennes, France.
    Bueno, Héctor
    Hosp Gen Univ Gregorio Maranon, Dept Cardiol, Inst Invest Sanitaria Gregorio Maranon, Madrid, Spain; Univ Complutense Madrid, E-28040 Madrid, Spain.
    Habib, Gilbert
    Aix Marseille Univ, La Timone Hosp, APHM, Dept Cardiol, Marseille, France.
    The use of echocardiography in acute cardiovascular care: Recommendations of the European Association of Cardiovascular Imaging and the Acute Cardiovascular Care Association2015In: European heart journal. Acute cardiovascular care., ISSN 2048-8726, Vol. 16, no 2, p. 119-146Article in journal (Refereed)
    Abstract [en]

    Echocardiography is one of the most powerful diagnostic and monitoring tools available to the modern emergency/ critical care practitioner. Currently, there is a lack of specific European Association of Cardiovascular Imaging/Acute Cardiovascular Care Association recommendations for the use of echocardiography in acute cardiovascular care. In this document, we describe the practical applications of echocardiography in patients with acute cardiac conditions, in particular with acute chest pain, acute heart failure, suspected cardiac tamponade, complications of myocardial infarction, acute valvular heart disease including endocarditis, acute disease of the ascending aorta and post-intervention complications. Specific issues regarding echocardiography in other acute cardiovascular care scenarios are also described.

  • 12.
    Ljung, Lina
    et al.
    Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Sweden; Department of Cardiology, Södersjukhuset, Sweden .
    Sundqvist, Martin
    Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Sweden; Department of Cardiology, Södersjukhuset, Sweden.
    Jernberg, Tomas
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Sweden; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Sweden.
    Eggers, Kai M.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.
    Ljunggren, Gunnar
    Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Sweden; Public Healthcare Services Committee Administration, Stockholm County Council, Sweden.
    Frick, Mats
    Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Sweden; Department of Cardiology, Södersjukhuset, Sweden.
    The value of predischarge exercise ECG testing in chest pain patients in the era of high-sensitivity troponins2018In: European heart journal. Acute cardiovascular care., ISSN 2048-8726, Vol. 7, no 3, p. 278-284Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    The aim of this study was to examine the value of predischarge exercise electrocardiogram (ECG) testing of chest pain patients in whom acute myocardial infarction (MI) had been ruled out by means of high-sensitivity troponins, ECG and history.

    METHODS:

    All patients hospitalised for chest pain who underwent exercise ECG testing before discharge from the Department of Cardiology, Södersjukhuset, Stockholm, Sweden from January 2011 to June 2012 were included. Endpoints were death, MI and post-discharge revascularisation within 90 and 365 days, respectively. The background one-year risk of death and MI for a corresponding age, gender and calendar time-matched Swedish population was also examined.

    RESULTS:

    A total of 951 patients were included. In 585 patients (61.5%) the exercise ECG test was negative, in 94 (9.9%) positive and in 272 (28.6%) inconclusive. There were no significant differences regarding death or MI between patients with a positive or a negative test, neither at 90 ( n=1 (1.1%) vs. n=1 (0.2%)) nor at 365 days ( n=2 (2.1%) vs. n=4 (0.7%)) of follow-up. In total there were nine (0.9%) deaths and 10 (1.1%) MIs within 365 days. The one-year rates of death (1.3%) and MI (0.5%) in a matched Swedish population were comparable.

    CONCLUSIONS:

    Predischarge exercise ECG testing after rule out of MI did not predict subsequent death or MI in a population of patients hospitalised for chest pain. Furthermore, the risks of death and MI in this population were comparable to a matched Swedish population. These findings suggest that patients could be discharged without this test.

  • 13.
    Mair, Johannes
    et al.
    Med Univ Innsbruck, Dept Internal Med Cardiol & Angiol 3, Innsbruck, Austria..
    Lindahl, Bertil
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.
    Giannitsis, Evangelos
    Heidelberg Univ, Med Klin 3, Heidelberg, Germany..
    Huber, Kurt
    Wilhelminen Hosp, Dept Med Cardiol & Intens Care Med, Vienna, Austria..
    Thygesen, Kristian
    Aarhus Univ Hosp, Dept Cardiol, Aarhus, Denmark..
    Plebani, Mario
    Univ Hosp Padova, Dept Lab Med, Padua, Italy..
    Moeckel, Martin
    Charite Univ Med Berlin, Div Emergency Med, Berlin, Germany.;Charite Univ Med Berlin, Dept Cardiol, Berlin, Germany..
    Mueller, Christian
    Univ Hosp Basel, Dept Cardiol, Basel, Switzerland.;Univ Hosp Basel, Cardiovasc Res Inst Basel, Basel, Switzerland..
    Jaffe, Allan S.
    Will sacubitril-valsartan diminish the clinical utility of B-type natriuretic peptide testing in acute cardiac care?2017In: European heart journal. Acute cardiovascular care., ISSN 2048-8726, Vol. 6, no 4, p. 321-328Article in journal (Refereed)
    Abstract [en]

    Since the approval of sacubitril-valsartan for the treatment of chronic heart failure with reduced ejection fraction, a commonly raised suspicion is that a wider clinical use of this new drug may diminish the clinical utility of B-type natriuretic peptide testing as sacubitril may interfere with B-type natriuretic peptide clearance. In this education paper we critically assess this hypothesis based on the pathophysiology of the natriuretic peptide system and the limited published data on the effects of neprilysin inhibition on natriuretic peptide plasma concentrations in humans. As the main clinical application of B-type natriuretic peptide testing in acute cardiac care is and will be the rapid rule-out of suspected acute heart failure there is no significant impairment to be expected for B-type natriuretic peptide testing in the acute setting. However, monitoring of chronic heart failure patients on sacubitril-valsartan treatment with B-type natriuretic peptide testing may be impaired. In contrast to N-terminal-proBNP, the current concept that the lower the B-type natriuretic peptide result in chronic heart failure patients, the better the prognosis during treatment monitoring, may no longer be true.

  • 14.
    Mair, Johannes
    et al.
    Med Univ Innsbruck, Heart Ctr, Dept Internal Med Cardiol & Angiol 3, Innsbruck, Austria.
    Lindahl, Bertil
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.
    Hammarsten, Ola
    Univ Gothenburg, Dept Clin Chem & Transfus Med, Gothenburg, Sweden.
    Mueller, Christian
    Univ Hosp Basel, Dept Cardiol, Basel, Switzerland; Univ Hosp Basel, Cardiovasc Res Inst Basel, Basel, Switzerland.
    Giannitsis, Evangelos
    Heidelberg Univ, Med Klin 3, Dept Cardiol, Heidelberg, Germany.
    Huber, Kurt
    Wilhelminen Hosp, Dept Med Cardiol & Intens Care Med, Vienna, Austria; Sigmund Freud Univ, Med Sch, Vienna, Austria.
    Moeckel, Martin
    Charite Univ Med Berlin, Div Emergency Med, Berlin, Germany; Charite Univ Med Berlin, Dept Cardiol, Berlin, Germany.
    Plebani, Mario
    Univ Hosp Padova, Dept Lab Med, Padua, Italy.
    Thygesen, Kristian
    Aarhus Univ Hosp, Dept Cardiol, Aarhus, Denmark.
    Jaffe, Allan S.
    Mayo Clin, Rochester, MN USA; Med Sch, Rochester, MN USA.
    How is cardiac troponin released from injured myocardium?2018In: European heart journal. Acute cardiovascular care., ISSN 2048-8726, Vol. 7, no 6, p. 553-560Article in journal (Refereed)
    Abstract [en]

    Cardiac troponin I and cardiac troponin T are nowadays the criterion biomarkers for the laboratory diagnosis of acute myocardial infarction due to their very high sensitivities and specificities for myocardial injury. However, still many aspects of their degradation, tissue release and elimination from the human circulation are incompletely understood. Myocardial injury may be caused by a variety of different mechanisms, for example, myocardial ischaemia, inflammatory and immunological processes, trauma, drugs and toxins, and myocardial necrosis is preceded by a substantial reversible prelethal phase. Recent experimental data in a pig model of myocardial ischaemia demonstrated cardiac troponin release into the circulation from apoptotic cardiomyocytes as an alternative explanation for clinical situations with increased cardiac troponin without any other evidence for myocardial necrosis. However, the comparably lower sensitivities of all currently available imaging modalities, including cardiac magnetic resonance imaging for the detection of particularly non-focal myocardial necrosis in patients, has to be considered for cardiac troponin test result interpretation in clinical settings without any other evidence for myocardial necrosis apart from increased cardiac troponin concentrations as well.

  • 15.
    Mair, Johannes
    et al.
    Med Univ Innsbruck, Heart Ctr, Dept Internal Med Cardiol & Angiol 3, Innsbruck, Austria.
    Lindahl, Bertil
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.
    Müller, Christian
    Univ Basel Hosp, Dept Cardiol, Basel, Switzerland; Univ Basel Hosp, Cardiovasc Res Inst Basel, Basel, Switzerland.
    Giannitsis, Evangelos
    Heidelberg Univ, Dept Cardiol, Med Klin 3, Heidelberg, Germany.
    Huber, Kurt
    Wilhelminen Hosp, Dept Med Cardiol & Intens Care Med, Vienna, Austria.
    Möckel, Martin
    Charite Univ Med Berlin, Div Emergency Med, Berlin, Germany; Charite Univ Med Berlin, Dept Cardiol, Berlin, Germany.
    Plebani, Mario
    Univ Hosp Padova, Dept Lab Med, Padua, Italy.
    Thygesen, Kristian
    Aarhus Univ Hosp, Dept Cardiol, Aarhus, Denmark.
    Jaffe, Allan S.
    Mayo Clin & Mayo Grad Sch Med, Rochester, MN USA.
    Editor's Choice-What to do when you question cardiac troponin values2018In: European heart journal. Acute cardiovascular care., ISSN 2048-8726, Vol. 7, no 6, p. 577-586Article in journal (Refereed)
    Abstract [en]

    High-sensitivity cardiac troponin assays enable cardiac troponin measurement with a high degree of analytical sensitivity and a low level of analytical imprecision at the low measuring range. One of the most important advantages of these new assays is that they allow novel, more rapid approaches for ruling in or ruling out acute myocardial infarctions. The increase in the early diagnostic sensitivity of high-sensitivity cardiac troponin assays comes at the cost of a reduced acute myocardial infarction specificity of the biomarker, because more patients with other causes of acute or chronic myocardial injury without overt myocardial ischaemia are detected than with previous cardiac troponin assays. Increased troponin concentrations that do not fit with the clinical presentation are seen in the daily routine, mainly as a result of a variety of pathologies, and if tested in the same sample, even discrepancies between high-sensitivity cardiac troponin I and troponin T test results may sometimes be found as well. In addition, analytically false-positive test results occasionally may occur since no assay is perfect. In this review, we summarise the biochemical, pathophysiological and analytical background of the work-up for such a clinical setting.

  • 16.
    Mueller, Christian
    et al.
    Univ Basel Hosp, Dept Cardiol, Basel, Switzerland.;Univ Basel Hosp, Cardiovasc Res Inst Basel, Basel, Switzerland..
    Giannitsis, Evangelos
    Heidelberg Univ, Med Klin III, Heidelberg, Germany..
    Möckel, Martin
    Univ Med Berlin, Div Emergency Med, Berlin, Germany.;Univ Med Berlin, Dept Cardiol Charite, Berlin, Germany..
    Huber, Kurt
    Wilhelminen Hosp, 3rd Dept Med Cardiol & Intens Care Med, Vienna, Austria..
    Mair, Johannes
    Med Univ Innsbruck, Dept Internal Med III Cardiol & Angiol, Innsbruck, Austria..
    Plebani, Mario
    Univ Hosp Padova, Dept Lab Med, Padua, Italy..
    Thygesen, Kristian
    Aarhus Univ Hosp, Dept Cardiol, Aarhus, Denmark..
    Jaffe, Allan S.
    Mayo Clin, Rochester, MN 55905 USA.;Sch Med, Rochester, MN 55905 USA..
    Lindahl, Bertil
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.
    Rapid rule out of acute myocardial infarction: novel biomarker-based strategies2017In: European heart journal. Acute cardiovascular care., ISSN 2048-8726, Vol. 6, no 3, p. 218-222Article in journal (Refereed)
  • 17.
    Mueller, Christian
    et al.
    Univ Hosp Basel, Dept Cardiol, Basel, Switzerland; Univ Hosp Basel, Cardiovasc Res Inst Basel, Basel, Switzerland.
    Möckel, Martin
    Charite Univ Med Berlin, Div Emergency Med, Berlin, Germany.
    Giannitsis, Evangelos
    Heidelberg Univ, Med Klin 3, Heidelberg, Germany.
    Huber, Kurt
    Wilhelminen Hosp, Dept Med Cardiol & Intens Care Med, Vienna, Austria.
    Mair, Johannes
    Innsbruck Med Univ, Dept Internal Med Cardiol & Angiol 3, Innsbruck, Austria.
    Plebani, Mario
    Univ Hosp Padova, Dept Lab Med, Padua, Italy.
    Thygesen, Kristian
    Aarhus Univ Hosp, Dept Cardiol, Aarhus, Denmark.
    Jaffe, Allan S
    Mayo Clin, Rochester, MN USA; Med Sch, Rochester, MN USA.
    Lindahl, Bertil
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.
    Use of copeptin for rapid rule-out of acute myocardial infarction2018In: European heart journal. Acute cardiovascular care., ISSN 2048-8726, Vol. 7, no 6, p. 570-576, article id 2048872617710791Article in journal (Refereed)
    Abstract [en]

    Copeptin is currently understood as a quantitative marker of endogenous stress. It rises rapidly in multiple acute disorders including acute myocardial infarction. As a single variable, it has only modest diagnostic accuracy for acute myocardial infarction. However, the use of copeptin within a dual-marker strategy together with conventional cardiac troponin increases the diagnostic accuracy and particularly the negative predictive value of cardiac troponin alone for acute myocardial infarction. The rapid rule-out of acute myocardial infarction is the only application in acute cardiac care mature enough to merit consideration for routine clinical care. However, the dual-marker approach seems to provide only very small incremental value when used in combination with sensitive or high-sensitivity cardiac troponin assays. This review aims to update and educate regarding the potential and the procedural details, as well as the caveats and challenges of using copeptin in clinical practice.

  • 18.
    Möckel, Martin
    et al.
    Univ Berlin, Div Emergency Med, Berlin, Germany.;Univ Berlin, Dept Cardiol Charite, Berlin, Germany..
    Giannitsis, Evangelos
    Heidelberg Univ, Med Klin 3, Heidelberg, Germany..
    Mueller, Christian
    Univ Basel Hosp, Dept Cardiol, Basel, Switzerland.;Univ Basel Hosp, Cardiovasc Res Inst Basel, Basel, Switzerland..
    Huber, Kurt
    Wilhelminen Hosp, 3rd Dept Med Cardiol & Intens Care Med, Vienna, Austria..
    Jaffe, Allan S.
    Mayo Clin, Dept Lab Med & Pathol, Rochester, MN 55905 USA.;Mayo Clin, Cardiovasc Div, Rochester, MN 55905 USA.;Sch Med, Rochester, MN 55905 USA..
    Mair, Johannes
    Med Univ Innsbruck, Dept Internal Med Cardiol & Angiol 3, Innsbruck, Austria..
    Plebani, Mario
    Univ Hosp Padova, Dept Lab Med, Padua, Italy..
    Thygesen, Kristian
    Aarhus Univ Hosp, Dept Cardiol, Aarhus, Denmark..
    Lindahl, Bertil
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.
    Editor's Choice-Rule-in of acute myocardial infarction: Focus on troponin2017In: European heart journal. Acute cardiovascular care., ISSN 2048-8726, Vol. 6, no 3, p. 212-217Article in journal (Refereed)
  • 19. Puymirat, E
    et al.
    Battler, A
    Birkhead, J
    Bueno, H
    Clemmensen, P
    Cottin, Y
    Fox, Keith AA
    Gorenek, B
    Hamm, C
    Huber, Kurt
    Lettino, M
    Lindahl, Bertil
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.
    Mueller, C
    Parkhomenko, A
    Price, S
    Quinn, T
    Schiele, F
    Simoons, M
    Tatu-Chitoiu, G
    Tubaro, M
    Vrints, C
    Zahger, D
    Zeymer, U
    Danchin, N
    Euro Heart Survey 2009 Snapshot: regional variations in presentation and management of patients with AMI in 47 countries2013In: European heart journal. Acute cardiovascular care., ISSN 2048-8726, Vol. 2, no 4, p. 359-370Article in journal (Refereed)
    Abstract [en]

    AIMS:

    Detailed data on patients admitted for acute myocardial infarction (AMI) on a European-wide basis are lacking. The Euro Heart Survey 2009 Snapshot was designed to assess characteristics, management, and hospital outcomes of AMI patients throughout European Society of Cardiology (ESC) member countries in a contemporary 'real-world' setting, using a methodology designed to improve the representativeness of the survey.

    METHODS:

    Member countries of the ESC were invited to participate in a 1-week survey of all patients admitted for documented AMI in December 2009. Data on baseline characteristics, type of AMI, management, and complications were recorded using a dedicated electronic form. In addition, we used data collected during the same time period in national registries in Sweden, England, and Wales. Data were centralized at the European Heart House.

    RESULTS:

    Overall, 4236 patients (mean age 66±13 years; 31% women) were included in the study in 47 countries. Sixty per cent of patients had ST-segment elevation myocardial infarction, with 50% having primary percutaneous coronary intervention and 21% fibrinolysis. Aspirin and thienopyridines were used in >90%. Unfractionated and low-molecular-weight heparins were the most commonly used anticoagulants. Statins, beta-blockers, and angiotensin-converting enzyme inhibitors were used in >80% of the patients. In-hospital mortality was 6.2%. Regional differences were observed, both in terms of population characteristics, management, and outcomes.

    CONCLUSIONS:

    In-hospital mortality of patients admitted for AMI in Europe is low. Although regional variations exist in their presentation and management, differences are limited and have only moderate impact on early outcomes.

  • 20. Raskovalova, T
    et al.
    Twerenbold, R
    Collinson, PO
    Keller, T
    Bouvaist, H
    Folli, C
    Giavarina, D
    Lotze, U
    Eggers, Kai
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.
    Dupuy, AM
    Chenevier-Gobeaux, C
    Meune, C
    Maisel, A
    Mueller, C
    Labarère, J
    Diagnostic accuracy of combined cardiac troponin and copeptin assessment for early rule-out of myocardial infarction:: a systematic review and meta-analysis2014In: European heart journal. Acute cardiovascular care., ISSN 2048-8726, Vol. 3, no 1, p. 18-27Article in journal (Refereed)
    Abstract [en]

    AIMS: This systematic review aimed to investigate the diagnostic accuracy of combined cardiac troponin (cTn) and copeptin assessment in comparison to cTn alone for early rule-out of acute myocardial infarction (AMI).

    METHODS: Primary studies were eligible if they evaluated diagnostic accuracy for cTn with and without copeptin in patients with symptoms suggestive of AMI. AMI was defined according to the universal definition, using detection of cTn as a marker for myocardial necrosis. Eligible studies were identified by searching electronic databases (Medline, EMBASE, Science Citation Index Expanded, CINAHL, Pascal, and Cochrane) from inception to March 2013, reviewing conference proceedings and contacting field experts and the copeptin manufacturer.

    RESULTS: In 15 studies totalling 8740 patients (prevalence of AMI 16%), adding copeptin improved the sensitivity of cTn assays (from 0.87 to 0.96, p=0.003) at the expense of lower specificity (from 0.84 to 0.56, p<0.001). In 12 studies providing data for 6988 patients without ST-segment elevation, the summary sensitivity and specificity estimates were 0.95 (95% CI 0.89 to 0.98) and 0.57 (95% CI 0.49 to 0.65) for the combined assessment of cTn and copeptin. When a high-sensitivity cTnT assay was used in combination with copeptin, the summary sensitivity and specificity estimates were 0.98 (95% CI 0.96 to 1.00) and 0.50 (95% CI 0.42 to 0.58).

    CONCLUSION: Despite substantial between-study heterogeneity, this meta-analysis demonstrates that copeptin significantly improves baseline cTn sensitivity. Management studies are needed to establish the effectiveness and safety of measuring copeptin in combination with high-sensitivity cTnT for early rule-out of AMI without serial testing.

  • 21.
    Schiller, Petter
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Thoracic Surgery.
    Hellgren, Laila
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Thoracic Surgery.
    Vikholm, Per
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Thoracic Surgery.
    Survival after refractory cardiogenic shock is comparable in patients with Impella and veno-arterial extracorporeal membrane oxygenation when adjusted for SAVE score2019In: European heart journal. Acute cardiovascular care., ISSN 2048-8726, Vol. 8, no 4, p. 329-337Article in journal (Refereed)
    Abstract [en]

    Objectives: Survival after different short-term mechanical circulatory support is difficult to compare because various systems are used and patient disease severity is most often not adjusted for. This study compares the outcome after the use of Impella and veno-arterial extracorporeal membrane oxygenation (VA-ECMO) in refractory cardiogenic shock, adjusted for disease severity through the survival after the VA-ECMO (SAVE) score.Methods: Patients with refractory shock treated with either VA-ECMO or Impella between January 2003 and August 2015 were included. Data were analysed to assess short and long-term survival and complications. The SAVE score was calculated for the two groups and outcome was compared adjusted for the SAVE score.Results: There was no difference between VA-ECMO patients (n=46) and Impella patients (n=48) in mean age or renal failure. ECMO patients were more often intubated and had lower diastolic blood pressure at device implantation. ECMO patients had a lower SAVE score (–0.4 (6.5)) compared to Impella patients (4.1 (5.4)). There was no difference in intensive care unit survival between ECMO patients 65% (52–80) or Impella patients 63% (55–79), or long-term survival between groups. When stratified into worse (III–IV) or better SAVE class (I–II) there was no difference in survival between the groups.Conclusions: Short and long-term survival is not measurably different among patients treated with Impella or VA-ECMO due to refractory cardiogenic shock, after adjustment for disease severity through the SAVE score.

  • 22.
    Venetsanos, D.
    et al.
    Linkoping Univ, Dept Cardiol, SE-58183 Linkoping, Sweden;Linkoping Univ, Dept Med & Hlth Sci, SE-58183 Linkoping, Sweden.
    Lawesson, S. Sederholm
    Linkoping Univ, Dept Cardiol, SE-58183 Linkoping, Sweden;Linkoping Univ, Dept Med & Hlth Sci, SE-58183 Linkoping, Sweden.
    Frobert, O.
    Orebro Univ, Dept Cardiol, Orebro, Sweden.
    Omerovic, E.
    Sahlgrens Univ Hosp, Dept Cardiol, Gothenburg, Sweden.
    Henareh, L.
    Karolinska Inst, Dept Med, Solna, Sweden.
    Robertsson, L.
    Sodra Alvsborgs Sjukhus, Dept Cardiol, Boras, Sweden.
    Linder, R.
    Danderyd Hosp, Dept Cardiol, Danderyd, Sweden.
    Gotberg, M.
    Skane Univ Hosp, Dept Cardiol, Lund, Sweden.
    James, Stefan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology.
    Alfredsson, J.
    Linkoping Univ, Dept Cardiol, SE-58183 Linkoping, Sweden;Linkoping Univ, Dept Med & Hlth Sci, SE-58183 Linkoping, Sweden.
    Erlinge, D.
    Skane Univ Hosp, Dept Cardiol, Lund, Sweden.
    Swahn, E.
    Linkoping Univ, Dept Cardiol, SE-58183 Linkoping, Sweden;Linkoping Univ, Dept Med & Hlth Sci, SE-58183 Linkoping, Sweden.
    Sex-related response to bivalirudin and unfractionated heparin in patients with acute myocardial infarction undergoing percutaneous coronary intervention: A subgroup analysis of the VALIDATE-SWEDEHEART trial2019In: European heart journal. Acute cardiovascular care., ISSN 2048-8726, Vol. 8, no 6, p. 502-509Article in journal (Refereed)
    Abstract [en]

    Aims: Our aim was to study the impact of sex on anticoagulant treatment outcomes during percutaneous coronary intervention in acute myocardial infarction patients. Methods: This study was a prespecified analysis of the 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 (VALIDATE-SWEDEHEART) trial, in which patients with myocardial infarction were randomised to bivalirudin or unfractionated heparin during percutaneous coronary intervention. The primary outcome was the composite of death, myocardial infarction or major bleeding at 180 days. Results: There was a lower risk of the primary outcome in women assigned to bivalirudin than to unfractionated heparin (13.6% vs 17.1%, hazard ratio 0.78, 95% confidence interval (0.60-1.00)) with no significant difference in men (11.8% vs 11.2%, hazard ratio 1.06 (0.89-1.26), p for interaction 0.05). The observed difference was primarily due to lower risk of major bleeding (Bleeding Academic Research Consortium definition 2, 3 or 5) associated with bivalirudin in women (8.9% vs 11.8%, hazard ratio 0.74 (0.54-1.01)) but not in men (8.5% vs 7.3%, hazard ratio 1.16 (0.94-1.43) in men, p for interaction 0.02). Conversely, no significant difference in the risk of Bleeding Academic Research Consortium 3 or 5 bleeding, associated with bivalirudin, was found in women 4.5% vs 5.4% (hazard ratio 0.84 (0.54-1.31)) or men 2.9% vs 2.1% (hazard ratio 1.36 (0.93-1.99)). Bleeding Academic Research Consortium 2 bleeding occurred significantly less often in women assigned to bivalirudin than to unfractionated heparin. The risk of death or myocardial infarction did not significantly differ between randomised treatments in men or women. Conclusion: In women, bivalirudin was associated with a lower risk of adverse outcomes, compared to unfractionated heparin, primarily due to a significant reduction in Bleeding Academic Research Consortium 2 bleeds.

  • 23.
    Volz, Sebastian
    et al.
    Sahlgrens Univ Hosp, Dept Cardiol, Gothenburg, Sweden.
    Angeras, Oskar
    Sahlgrens Univ Hosp, Dept Cardiol, Gothenburg, Sweden.
    Koul, Sasha
    Lund Univ, Dept Cardiol, Lund, Sweden.
    Haraldsson, Inger
    Sahlgrens Univ Hosp, Dept Cardiol, Gothenburg, Sweden.
    Sarno, Giovanna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Venetsanos, Dimitrios
    Karolinska Univ Hosp, Dept Cardiol, Solna, Sweden.
    Grimfard, Per
    Vastmanlands Sjukhus, Dept Internal Med, Koping, Sweden.
    Ulvenstam, Anders
    Ostersund Hosp, Dept Cardiol, Ostersund, Sweden.
    Hofmann, Robin
    Karolinska Inst, Dept Clin Sci & Educ, Solna, Sweden.
    Hamid, Mehmet
    Malarsjukhuset, Dept Cardiol, Eskilstuna, Sweden.
    Henareh, Loghman
    Karolinska Univ Hosp, Dept Cardiol, Solna, Sweden.
    Wagner, Henrik
    Helsingborg Lasarett, Dept Cardiol, Helsingborg, Sweden.
    Jensen, Jens
    Karolinska Inst, Dept Clin Sci & Educ, Solna, Sweden;Capio St Gorans Sjukhus, Unit Cardiol, Stockholm, Sweden.
    Danielewicz, Mikael
    Karlstad Hosp, Dept Cardiol, Karlstad, Sweden.
    Östlund, Ollie
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.
    Eriksson, Peter
    Umea Univ, Dept Cardiol, Umea, Sweden.
    Schersten, Fredrik
    Lund Univ, Dept Cardiol, Lund, Sweden.
    Linder, Rickard
    Danderyd Hosp, Dept Cardiol, Danderyd, Sweden.
    Ramunddal, Truls
    Arhus Univ Hosp, Dept Cardiol, Arhus, Sweden.
    Petursson, Petur
    Sahlgrens Univ Hosp, Dept Cardiol, Gothenburg, Sweden.
    Frobert, Ole
    Orebro Univ, Dept Cardiol, Orebro, Sweden.
    James, Stefan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.
    Erlinge, David
    Lund Univ, Dept Cardiol, Lund, Sweden.
    Omerovic, Elmir
    Sahlgrens Univ Hosp, Dept Cardiol, Gothenburg, Sweden.
    Radial versus femoral access in patients with acute coronary syndrome undergoing invasive management: A prespecified subgroup analysis from VALIDATE-SWEDEHEART2019In: European heart journal. Acute cardiovascular care., ISSN 2048-8726, Vol. 8, no 6, p. 510-519Article in journal (Refereed)
    Abstract [en]

    Aims: In the 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 (VALIDATE-SWEDEHEART), bivalirudin was not superior to unfractionated heparin in patients with acute coronary syndrome undergoing invasive management. We assessed whether the access site had an impact on the primary endpoint of death, myocardial infarction or major bleeding at 180 days and whether it interacted with bivalirudin/unfractionated heparin. Methods and results: A total of 6006 patients with acute coronary syndrome planned for percutaneous coronary intervention were randomised to either bivalirudin or unfractionated heparin. Arterial access was left to the operator discretion. Overall, 90.5% of patients underwent transradial access and 9.5% transfemoral access. Baseline risk was higher in transfemoral access. The unadjusted hazard ratio for the primary outcome was lower with transradial access (hazard ratio 0.53, 95% confidence interval 0.43-0.67, p<0.001) and remained lower after multivariable adjustment (hazard ratio 0.56, 95% confidence interval 0.52-0.84, p<0.001). Transradial access was associated with lower risk of death (hazard ratio 0.41, 95% confidence interval 0.28-0.60, p<0.001) and major bleeding (hazard ratio 0.57, 95% confidence interval 0.44-0.75, p<0.001). There was no interaction between treatment with bivalirudin and access site for the primary endpoint (p=0.976) or major bleeding (p=0.801). Conclusions: Transradial access was associated with lower risk of death, myocardial infarction or major bleeding at 180 days. Bivalirudin was not associated with less bleeding, irrespective of access site.

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