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1. Randomized evaluation of beta blocker and ACE-inhibitor/angiotensin receptor blocker treatment in patients with myocardial infarction with non-obstructive coronary arteries (MINOCA-BAT): Rationale and design

Author

Chris P Gale, John F. Beltrame, Tomas Jernberg, Harmony R. Reynolds, Bertil Lindahl, Per Tornvall, Annica Ravn-Fisher, Tomasz Baron, J. Somaratne, Javier López-Pais, Olle Bergström, David Erlinge, Dan Atar, Pelle Johansson, Stefan Agewall, and Anna M. Nordenskjöld

Subjects
Male, medicine.medical_specialty, Angiotensin receptor, medicine.drug_class, Adrenergic beta-Antagonists, Myocardial Infarction, Angiotensin-Converting Enzyme Inhibitors, 030204 cardiovascular system & hematology, Patient Readmission, Ventricular Function, Left, law.invention, Angiotensin Receptor Antagonists, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, law, Cause of Death, Multicenter trial, Internal medicine, Atrial Fibrillation, Secondary Prevention, medicine, Humans, Cardiac and Cardiovascular Systems, Angina, Unstable, Prospective Studies, cardiovascular diseases, 030212 general & internal medicine, Myocardial infarction, Beta blocker, Ischemic Stroke, Heart Failure, Sweden, Kardiologi, Ejection fraction, business.industry, Australia, Stroke Volume, Middle Aged, medicine.disease, Coronary Vessels, Sample Size, Heart failure, ACE inhibitor, Cardiology, Female, Cardiology and Cardiovascular Medicine, business, medicine.drug
Abstract

Background Myocardial infarction with non-obstructive coronary arteries (MINOCA) is common and occurs in 6–8% of all patients fulfilling the diagnostic criteria for acute myocardial infarction (AMI). This paper describes the rationale behind the trial ‘Randomized Evaluation of Beta Blocker and ACE-Inhibitor/Angiotensin Receptor Blocker Treatment (ACEI/ARB) of MINOCA patients’ (MINOCA-BAT) and the need to improve the secondary preventive treatment of MINOCA patients. Methods MINOCA-BAT is a registry-based, randomized, parallel, open-label, multicenter trial with 2:2 factorial design. The primary aim is to determine whether oral beta blockade compared with no oral beta blockade, and ACEI/ARB compared with no ACEI/ARB, reduce the composite endpoint of death of any cause, readmission because of AMI, ischemic stroke or heart failure in patients discharged after MINOCA without clinical signs of heart failure and with left ventricular ejection fraction ≥40%. A total of 3500 patients will be randomized into four groups; e.g. ACEI/ARB and beta blocker, beta blocker only, ACEI/ARB only and neither ACEI/ARB nor beta blocker, and followed for a mean of 4 years. Summary While patients with MINOCA have an increased risk of serious cardiovascular events and death, whether conventional secondary preventive therapies are beneficial has not been assessed in randomized trials. There is a limited basis for guideline recommendations in MINOCA. Furthermore, studies of routine clinical practice suggest that use of secondary prevention therapies in MINOCA varies considerably. Thus results from this trial may influence future treatment strategies and guidelines specific to MINOCA patients.

Published
2021
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2. Clinical Frailty Scale classes are independently associated with 6-month mortality for patients after acute myocardial infarction

Author

Niklas Ekerstad, Dariush Javadzadeh, Karen P Alexander, Olle Bergström, Lars Eurenius, Mats Fredrikson, Gudny Gudnadottir, Claes Held, Karin Hellström Ängerud, Radwan Jahjah, Tomas Jernberg, Ewa Mattsson, Kjell Melander, Linda Mellbin, Monica Ohlsson, Annica Ravn-Fischer, Lars Svennberg, Troels Yndigegn, and Joakim Alfredsson

Subjects
Kardiologi, Frailty, Omvårdnad, Frail Elderly, Myocardial Infarction, General Medicine, Nursing, Critical Care and Intensive Care Medicine, Prognosis, Risk prediction, Myocardial infarction, Clinical Frailty Scale, Mortality, Humans, Cardiac and Cardiovascular Systems, Prospective Studies, Cardiology and Cardiovascular Medicine, Aged, Retrospective Studies
Abstract

Aims Data on the prognostic value of frailty to guide clinical decision-making for patients with myocardial infarction (MI) are scarce. To analyse the association between frailty classification, treatment patterns, in-hospital outcomes, and 6-month mortality in a large population of patients with MI. Methods and results An observational, multicentre study with a retrospective analysis of prospectively collected data using the SWEDEHEART registry. In total, 3381 MI patients with a level of frailty assessed using the Clinical Frailty Scale (CFS-9) were included. Of these patients, 2509 (74.2%) were classified as non-vulnerable non-frail (CFS 1–3), 446 (13.2%) were vulnerable non-frail (CFS 4), and 426 (12.6%) were frail (CFS 5–9). Frailty and non-frail vulnerability were associated with worse in-hospital outcomes compared with non-frailty, i.e. higher rates of mortality (13.4% vs. 4.0% vs. 1.8%), cardiogenic shock (4.7% vs. 2.5% vs. 1.9%), and major bleeding (4.5% vs. 2.7% vs. 1.1%) (all P Conclusion Frailty assessed with the CFS was independently and strongly associated with all-cause 6-month mortality, also after comprehensive adjustment for baseline differences in other risk factors. Similarly, non-frail vulnerability was independently associated with higher mortality compared with those with preserved functional ability.

Published
2021

3. Long-Term Effects of Oxygen Therapy on Death or Hospitalization for Heart Failure in Patients With Suspected Acute Myocardial Infarction

Author

Joakim Alfredsson, Carina Nilsson, Bertil Lindahl, Elmir Omerovic, Markus Lingman, Raluca Jumatate, John Pernow, Anders Engström, Stefan James, David Sparv, Ellinor Berglund, David Erlinge, Ollie Östlund, Thomas Kellerth, Lina Ljung, Olle Bergström, Krister Lindmark, Tomas Jernberg, Johan Herlitz, Jörg Lauermann, Annica Ravn-Fischer, Troels Yndigegn, and Robin Hofmann

Subjects
Male, medicine.medical_specialty, Supplemental oxygen, medicine.medical_treatment, Myocardial Infarction, chemistry.chemical_element, Kaplan-Meier Estimate, 030204 cardiovascular system & hematology, Oxygen, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Physiology (medical), Oxygen therapy, Internal medicine, medicine, Humans, In patient, 030212 general & internal medicine, Myocardial infarction, Registries, Aged, Proportional Hazards Models, Heart Failure, business.industry, Oxygen Inhalation Therapy, Middle Aged, medicine.disease, Ambient air, Hospitalization, Treatment Outcome, chemistry, Heart failure, Acute Disease, Cardiology, Female, Cardiology and Cardiovascular Medicine, business
Abstract

Background: In the DETO2X-AMI trial (Determination of the Role of Oxygen in Suspected Acute Myocardial Infarction), we compared supplemental oxygen with ambient air in normoxemic patients presenting with suspected myocardial infarction and found no significant survival benefit at 1 year. However, important secondary end points were not yet available. We now report the prespecified secondary end points cardiovascular death and the composite of all-cause death and hospitalization for heart failure. Methods: In this pragmatic, registry-based randomized clinical trial, we used a nationwide quality registry for coronary care for trial procedures and evaluated end points through the Swedish population registry (mortality), the Swedish inpatient registry (heart failure), and cause of death registry (cardiovascular death). Patients with suspected acute myocardial infarction and oxygen saturation of ≥90% were randomly assigned to receive either supplemental oxygen at 6 L/min for 6 to 12 hours delivered by open face mask or ambient air. Results: A total of 6629 patients were enrolled. Acute heart failure treatment, left ventricular systolic function assessed by echocardiography, and infarct size measured by high-sensitive cardiac troponin T were similar in the 2 groups during the hospitalization period. All-cause death or hospitalization for heart failure within 1 year after randomization occurred in 8.0% of patients assigned to oxygen and in 7.9% of patients assigned to ambient air (hazard ratio, 0.99; 95% CI, 0.84–1.18; P =0.92). During long-term follow-up (median [range], 2.1 [1.0–3.7] years), the composite end point occurred in 11.2% of patients assigned to oxygen and in 10.8% of patients assigned to ambient air (hazard ratio, 1.02; 95% CI, 0.88–1.17; P =0.84), and cardiovascular death occurred in 5.2% of patients assigned to oxygen and in 4.8% assigned to ambient air (hazard ratio, 1.07; 95% CI, 0.87–1.33; P =0.52). The results were consistent across all predefined subgroups. Conclusions: Routine use of supplemental oxygen in normoxemic patients with suspected myocardial infarction was not found to reduce the composite of all-cause mortality and hospitalization for heart failure, or cardiovascular death within 1 year or during long-term follow-up. Clinical Trial Registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT01787110.

Published
2019

4. Annual report SWEDEHEART 2012

Author

Anna-Maria Wahlberg, Magdalena Alenström, Stina Udin, Tore Johansson, Anna Lundgren, Birgitta Romany Johansson, Carin Ekström, Nils Eriksson, Lisbeth Andersson, Hanna Eklund, Lotta Robertsson, Gunilla Bjerhag, Ann-Charlotte Gustavsson, Madelene Israelsson, Sofia Karlsson, Maria Westerlund, Yvonne Ek, Birgitta Stenbäck, Barbro Andersson, Elisabeth Andersson, Kristina Leppämäki, Anette Ramirez, Victoria Wallin, Alexandra Lundberg, Benny Sahlin, Hasse Mälberg, Maria Liljeroos, Caroline Gustafsson, Kerstin Nyström, Susanne Siklo, Eva Zelleroth, Finn Hjortevang, Kamaran Mohammed, Agneta Hellblad, Iwona Schön, Kristina Carlsson, Marita Ole´rs, Pär Lennart Ågren, Iwar Sjögren, Crister Zedigh, Kristina Eriksson, Kristina Sundkvist, Anna-Karin Thorsell, Ann-Kristin Kuoljok, Linda Liinanki, Mona Liljergren, Sara Turtola, Britt-Marie Nylander, Lena Nordvall, Malin Nilsson, Annelie Blomqvist, Håkan Sjöberg, Jenny Nylander, Linda Berglund, Linda Mossberg, Lars Svennberg, Espen Haugen, Lars Hellsten, Staffan Johansson, Birgitta Johansson, Pethra Larsson, Susanne Kellerth, Monika Bergström, Carola Gustafsson, Cecilia Nährström, Eva Evenås, Hanna Sundin, Helena Lönn, Johan Svensson, Moa Kihlgren, Per Larsson, Pirjo Palosaari, Susann Johansson, Malin Cedermark magnusson, Annica Ravn-Fischer, Ann Wittfeldt, Elisabeth Perers, Nina Hellberg, Mikael Holmberg, Bert Andersson, Berit Jangsten, Nedim Selimovic, Anna Enström, Göran Dellgren, Henrik Scherstén, Anna Biveby-Nilsson, Johan Lundberg, Elmir Omerovic, Petur Petursson, Per Albertsson, Carina Ankarstrand, Agneta Flinck, Titti Larsson, Maria Samuelsson, Peter Bergman, Lotten Nyström, Magnus Bågenholm, Anneli Linnér, Björn Hornestam, Helén Sjöland, Anne-Marie Kirkhoff, Hugo Månsson, Ida Karlsson, Maria Olausson, Charlotte Berne, Christina Backe, Ali Tabandeh, Ann-Charlotte Karlsson, Peter Hårdhammar, Sven-Erik Olsson, Henrik Persson, Ole Wagner, Henrik Wagner, Lennart Sandhall, Carina Wåhlander, Kristina Rova, Lina Fischer, Maria Nilsson, Mari Stjernberg, Sylvia Gustavsson, Camilla Hedberg, Jan Thollander, Katarina Collberg, Jörg Lauermann, Werner Puskar, Margareta Larsson, Ann Johansson, Lina Brindstedt, Marina Olofsson, Jörg Carlsson, Katarina Månsson, Ulla Jeppsson, Ingbritt Söderlind, Malinn Hultman, Sara Ronnelin, Carina Fredriksson, Gerd Skogman, Ingela Ågren, Inger Almroth, Sara Trege Nilsson, Gerd Pettersson, Ing-Marie Åkesson, Sofia Carlfelter, Jan Medin, Karim Mokhtar, Carl-Magnus Pripp, Linda Malmsten, Annelie Karlsson, Anna Lenberg, Annika Lettenström, Anna Jost-Widén, Gunilla Johnson, Håkan Ahlmark, Hannah Brevik, IngaLill Nordberg, Jessica Österberg-Persson, Jeanette Smedberg, Maria Eklund, Urban Haaga, Anne-Marie Henriksson, Mats Allared, Hans Olsson, Tage Nilsson, Lisa Juhlin, Karin Eriksson, Leif Hedquist, Ulla Lundin, Christin Jonsson, Monica Pedersen, Julia Marainen, Moa Bylund, Monica Alsterdal, Anna Sjöberg, Ewa Wigenstorp, Gunilla Peterzen, Kerstin Skeppstedt, Anette Berlin, Helena Wikström, Kerstin Pihl, Lehna Ferm, Petra Larsson, Vanja Johansson, Gunvor Finnas, Helen Ahlm, Anders Ekelind, Eva Larsson, Gull-Britt Eriksson, Veronica Sass, Åsa Johansson, Lennart Malmqvist, Lars Westin, Eydis Sigurjonsdottir, Frida Skuladottir, Maria Ottesen, Olga Birgitta Bjarnadottir, Gunnar Myrdal, Edda Traustadottir, Friðrika Sigvaldadóttir, Gerður Garðarsdóttir, Gudrun Valgeirsdottir, Sigurlaug Magnusdottir, Thora Bjornsdottir, Thorarinn Gudnason, Svava Matthiasdottir, Maria Jonsson, Ulrika Pettersson, Magnus Peterson, Karin Molander, Micael Larsson, Berit Samuelsson, Catarina Svensson, Elisabeth Augustsson, Evelin BertilssonFröjd, Joakim Alfredsson, Wolfgang Freter, Linda Lilja, Gunnel Andersson, Dimitrios Venetsanos, Anders Björkholm, Tim Tödt, Ulf Berglund, Niels Erik Nielsen, Jenny Johansson, Johanna Svensson, Rosie-Marie Larsson, Liselotte Lundmark, Gunilla Brolin, Annika Westergren, Anna Duckert, Vesna Steffan, Matthias Götberg, David Erlinge, Fredrik Scherstén, Göran Olivecrona, Jan Harnek, Per Bondesson, Pernilla Knutsson, Evy Stenlund, Peter Thorén, Siv Algotsson, Enisa Durakovic, Lisa Gustafsson, Marie Nilsson, Margareta Nilson, Pallonji Bhiladvala, Monica Håkansson, Carina Svensson, Ingela Olsson, Amelie Kjellstenius, Jenny Åslund, Linnéa Alledal, Nina Varblane, Victoria Nilsson, Maria Thudén, Siv-Britt Jensen, Elisabet Svensson, Maria Pettersson, Sanna Lindgren, Anita Pehrsson, Maria Olsson, Anneli Rudenäs, Eva Öhman, Stig-Åke Falk, Annelie Jaensson, Lena Thell, Annette Billqvist, Barbro Efraimsson-Nilsson, Ingalill Allansson, Malin Jansson, Ann Ingström, Christina Lundqvist, Ingela Nyström, Ingrid Bergman, Johan Ekman, Lena Carlson, Solveig Person, Ingrid Lindberg, Leif Thuesen, Erik Lindberg, Gunnilla Lundberg, Kerstin Hedberg, Inga-Lill Kotka, Anja Fogelberg, Anna Johansson, Lis Ståhl, Anders Kallryd, Agneta Ramén, Henrik Löfmark, Senait Fessahaie, Malin Brandrup-Wognsen, Claire Salomonsson, Petra Ardin, Eva Balcker, Filippa Högberg, Fredrik Högberg, Eva Hultin Ånnegård, Marcus Svensson, Marie Tornestedt, Inge Björkander, Cathrine Edström, Lars Eurenius, Ann Samnegård, Jonas Persson, Nikolaos Östlund Papadogeorgos, Habib Mir-Akbari, Görel Stengård, Elin Bacsovics Brolin, Katarina Brehmer, Fauzia Osman, Marie Törnblom, Katja Sundkvist, Caroline Kumhala, Ellinor Jonsson, Alexandra Yazar, Anwar Siddiqui, Andreas Rück, Loghman Henareh, Kerstin Cederlund, Ewa Lemberg, Elin Larsson, Amanda Persson, Karolin Andersson, Per Svensson, Fauzia A - Moalim, Ann Lundgren, Ellen Gustavsson-segerhag, Agneta Nordvall, Gunnel Söderlund, Christina Jarnert, Linda Mellbin, Torbjörn Ivert, Rikard Linder, Mattias Törnerud, Birgit Edén, Kristina Lockne, Sebastian Rennerskog, Jan Kosmack, Marianne Erlandsson, Pontus Lindroos, Armi Peltonen, Christine Creutziger, Ellinor Berglund, Marie Henriksson, Carina Ingeborn, Olov Collste, Mikael Aasa, Karin Karlsson, Ulla Andersson, Lis Kohlström Englund, Mia Henning, Anna-Greta Vinblad v Walter, Christina Nilsson, Helena Schilken, Inger Johansson, Ingrid Wallgren, Kristina Niemi, Oili Niva, Margareta Dofs, Agneta Johansson, Jan Haupt, Christina Näslund, Henrik Drewsen, Maria Söderlund, Birgitta Berts, Bo Lindvall, Daniel Wadell, Jens Jensen, Åsa Hedh, Karin Johnson, Cecilia Nikitin, Eva-Lena Eriksson, Elisabeth Westlund, Inger Karlsson, Peter Björkdahl, Radim Uher, Ulf Nyman, Troels Yndigegn, Anette Broberg, Linda Lamreus, Alexandra Söderström, Marianne Lång, Henrik Olsson, Madhat Hussien Al-Saadi, Emma Landén, Maria Holmgren, Tomas Rivera San Martin, Karin Nyström, Magnus Wahlin, Oskar Angerås, Johan Nilsson, Peter Eriksson, Anna Sundberg, Inger Sandström, Olov Duvernoy, Maria Andreasson, Johanna Ekström, Marie Essermark, Helena Wall, Elisabeth Marklund, Cecilia Östlund, Maria Willehadson, Christina Björklund, Axel Dimberg, Vitas Zemgulis, Agneta Olsson, Susanne Hagström, Carina Bergman, Annika Gunnarsson, My Huhta, Christina Svensson, Per Hultman, Christoph Varenhorst, Per Kvidal, Annika Stener Bengtsson, Ann-Lis Wännman, Lisbeth Nilsson, Tomas Andersson, Maritha Josefsson, Maria Morén, Lena Hultman-Berg, Anna-Karin Almqwist, Monica Cederblad, Katarina Ekberg, Gunilla Kvarnvik, Eston Jönsson, Annelie Hammerman, Pia Claesson, Gith Widerström, Sandra Pettersson Olsson, Åsa Hofvander, Martin Lindholm, Saman Saidi, Per Grimfjärd, Amra Kåregren, Madeleine Runesson, Anders Josefsson, Lena Henriksson-Fri, Miriam Johansson, Solgärd Gustavsson, Minna Markljung, Olle Bergström, Thomas Aronsson, Ewa Karlsson, Pernilla Boström, Sofia Hansson, Inger Andreasson, Lena Palmqvist, Anders Kähäri, Mats Lidén, Frida Oskarsson, Ingela Östman, Johanna Kronberg, Marie Johansson, Marie Thuresson, Håkan Geijer, Ole Fröbert, Thomas Kellerth, Maud Tillkvist, Kirsti Ajax, Fredrik Björklund, and Anna Björklund

Subjects
business.industry, media_common.quotation_subject, Incidence (epidemiology), Medicine, Infarction, Annual report, Cardiology and Cardiovascular Medicine, business, medicine.disease, Welfare, Deca, Demography, media_common
Abstract

According to Swedish National Board of Health and Welfare statistics, a dramatic decrease in both the incidence of and mortality from acute myo-cardial infarction has been seen in the past two deca...

Published
2014
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5. UNDERTREATMENT OF ELDERLY PATIENTS >80-YEARS WITH ACUTE CORONARY SYNDROME DESPITE HIGH RISK AND SIMILAR BENEFITS FROM EVIDENCE-BASED TREATMENT AS AT YOUNGER AGE: RESULTS FROM SVEDEHEART

Author

Monica Sterner, Annika Edberg, Anette Sandström, Jörgen Cronblad, T. Jernberg, Ewa Mattsson, Johan Lugnegård, Olle Bergström, Per Johanson, Claes Held, Lars Wallentin, Karin Hellström Angerud, and Thomas Kellerth

Subjects
Acute coronary syndrome, Pediatrics, medicine.medical_specialty, Evidence-based practice, Younger age, business.industry, medicine, medicine.disease, business, Cardiology and Cardiovascular Medicine
Abstract

Undertreatment of elderly patients > 80-years with acute coronary syndrome despite high risk and similar benefits from evidence-based treatment as at younger age : results from SVEDEHEART

Published
2013
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