Publications by authors named "Angeras O"
Background: Transcatheter aortic valve implantation (TAVI) has shown similar or improved clinical outcomes compared with surgical aortic valve replacement (SAVR) in patients with symptomatic severe aortic stenosis at low risk for surgical mortality. This cost-utility analysis compared TAVI with SAPIEN 3 versus SAVR in symptomatic severe aortic stenosis patients at low risk of surgical mortality from the perspective of the Swedish healthcare system.
Methods: A published, two-stage, Markov-based cost-utility model that captured clinical outcomes from the (SWEDEHEART) registry (2018-2020) was adapted from the perspective of the Swedish healthcare system using local general population mortality, utility and costs data.
Background And Aims: The long-term outcomes of percutaneous coronary intervention (PCI) vs. coronary artery bypass grafting (CABG) in patients with non-ST-segment elevation myocardial infarction (NSTEMI) and multivessel disease remain debated.
Methods: The Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies registry was used to analyse 57 097 revascularized patients with NSTEMI with multivessel disease in Sweden from January 2005 to June 2022.
Article Synopsis
- The LANDMARK trial compared the balloon-expandable Myval transcatheter heart valve (THV) series to the SAPIEN and Evolut THV series in 768 patients to evaluate safety and effectiveness.
- Results showed that Myval achieved non-inferiority to SAPIEN (24.7% vs 24.1%) and Evolut (24.7% vs 30.0%) regarding a primary composite safety endpoint.
- Additionally, while Myval had better pressure gradient metrics compared to SAPIEN, Evolut showed slightly higher rates of prosthetic valve regurgitation compared to Myval but no significant difference between Myval and SAPIEN.
Background: Transcatheter aortic valve implantation (TAVI) is expanding to younger patients, and the management of valve failure is a growing clinical problem. The transcatheter heart valve (THV) of choice for redo-TAVI is a complex decision, and first reports have examined the use of the Sapien 3™ THV (Edwards Lifesciences; Irvine, CA, USA) in failed Evolut™ (Medtronic, Minneapolis, MN, USA) THV. However, several different technical approaches may be worth consideration, and the subject remains a matter of debate.
View Article and Find Full Text PDFInotropes and mortality in patients with cardiogenic shock: an instrumental variable analysis from the SWEDEHEART registry.
Eur Heart J Cardiovasc Pharmacother
October 2024
Article Synopsis
- This study examines the impact of inotropic agents on 30-day mortality rates in patients suffering from cardiogenic shock (CS), using data from the SWEDEHEART registry in Sweden.
- The research involved 16,214 CS patients, indicating that those treated with inotropes generally faced higher mortality risks compared to those who did not, with an adjusted hazard ratio of 1.72.
- The findings suggest that inotropes may be associated with increased mortality, particularly influenced by factors like age and the underlying cause of CS.
Aims: There is scarce knowledge about the association between social factors and mid-term outcome in older patients undergoing transaortic valve implantation (TAVI). Our aim in this study is to explore associations between marital status, educational level, and mortality risk in patients after TAVI.
Methods And Results: Patients aged ≥65 who underwent TAVI in Sweden during 2014-2020 were identified from the SWEDEHEART registry.
Article Synopsis
- * In a trial with 455 patients, those who received PCI had a lower rate of major adverse cardiac events (26%) compared to those with conservative treatment (36%) at a two-year follow-up.
- * However, the PCI group experienced a higher rate of bleeding events (28% vs. 20%) and had some minor procedure-related complications, indicating that while PCI may reduce cardiac risks, it also carries potential safety concerns.
Sex differences in prevalence and characteristics of imaging-detected atherosclerosis: a population-based study.
Eur Heart J Cardiovasc Imaging
November 2024
Article Synopsis
- The study aimed to explore sex differences in the prevalence of imaging-detected atherosclerosis in men and women, revealing that men are more likely to experience cardiovascular issues such as myocardial infarction.
- Participants aged 50-65 from the SCAPIS study underwent advanced imaging, finding significantly higher rates of coronary and carotid atherosclerosis in men compared to women (e.g., 56.2% vs. 29.5% for coronary atherosclerosis).
- Even after adjusting for factors like hypertension and diabetes, these sex differences in atherosclerosis prevalence persisted, indicating a greater cardiovascular risk for men, with older women showing comparable rates to younger men.
Coronary angiography following transcatheter aortic valve replacement: Insights from the SWEDEHEART registry.
Catheter Cardiovasc Interv
September 2024
Article Synopsis
- * Out of 9806 TAVR patients analyzed from 2008 to 2022, 566 required coronary angiography afterward, with younger age and more extensive coronary disease linked to higher risks.
- * The findings suggest that while the need for coronary angiography post-TAVR is low, procedural complexity increases with certain valve types and in patients with previous valve replacements, emphasizing the need for good coronary access in future TAVR procedures.
Article Synopsis
- The study investigates the characteristics and survival rates of patients with Type 1 diabetes (T1D) and those without T1D who experienced out-of-hospital cardiac arrest (OHCA) in Sweden from 2010 to 2020.
- It included a total of 54,568 cases, identifying 448 patients with T1D using specific diagnostic coding.
- Results showed no significant differences in survival outcomes, such as discharge status and neurological function, between the two groups, suggesting that T1D does not adversely affect survival rates in OHCA cases when other factors are considered.
Article Synopsis
- Takotsubo syndrome (TTS) is a serious condition mimicking heart attacks, often triggered by stress, and has high rates of morbidity and mortality.
- This study utilized data from the Swedish Coronary Angiography and Angioplasty Registry between 2015-2022, employing machine learning (specifically gradient boosting) to identify factors predicting 30-day mortality in TTS patients.
- Results revealed that the treating hospital was the strongest predictor of mortality, followed by factors like the clinical reason for angiography, creatinine levels, Killip class, and patient age, highlighting the need for tailored treatments based on these predictors.
Background: Transcatheter aortic valve implantation is an established, guideline-endorsed treatment for severe aortic stenosis. Precise sizing of the balloon-expandable Myval transcatheter heart valve (THV) series with the aortic annulus is facilitated by increasing its diameter in 1·5 mm increments, compared with the usual 3 mm increments in valve size. The LANDMARK trial aimed to show non-inferiority of the Myval THV series compared with the contemporary THVs Sapien Series (Edwards Lifesciences, Irvine, CA, USA) or Evolut Series (Medtronic, Minneapolis, MN, USA).
View Article and Find Full Text PDFBackground And Aims: Transcatheter aortic valve implantation (TAVI) has become the first choice to treat older patients with severe symptomatic aortic stenosis (AS). This study aimed to compare TAVI with surgery in low-risk patients ≤75 years of age, including both tricuspid and bicuspid AS.
Methods: The Nordic Aortic Valve Intervention (NOTION)-2 trial enrolled and 1:1 randomized low-risk patients aged ≤75 years with severe symptomatic AS to TAVI or surgery.
Article Synopsis
- - The study investigated whether fractional flow reserve (FFR)-guided complete revascularization improved outcomes compared to treating only the culprit lesion in patients with STEMI or high-risk NSTEMI and multivessel coronary artery disease.
- - A total of 1542 patients participated, with similar rates of adverse event occurrences (death, myocardial infarction, or unplanned revascularization) between the complete revascularization group (19.0%) and the culprit-lesion-only group (20.4%) over a median follow-up of 4.8 years.
- - The findings suggest that FFR-guided complete revascularization did not significantly reduce the risk of major adverse outcomes compared to only addressing the culprit lesion, indicating
Background: The registry-based randomized VALIDATE-SWEDEHEART trial (NCT02311231) compared bivalirudin vs. heparin in patients undergoing percutaneous coronary intervention (PCI) for myocardial infarction (MI). It showed no difference in the composite primary endpoint of death, MI, or major bleeding at 180 days.
View Article and Find Full Text PDFArticle Synopsis
- - The study examined breathlessness among middle-aged adults (50-64 years) in Sweden, focusing on various medical conditions and their contributions to this issue.
- - Out of nearly 26,000 participants, 3.7% experienced breathlessness, with major contributing factors identified as overweight/obesity, stress, respiratory disease, and depression.
- - The findings suggest that lifestyle interventions targeting weight management and stress reduction could significantly alleviate the burden of breathlessness in this population.
Article Synopsis
- Takotsubo syndrome (TS) is a heart condition that imitates a heart attack, often triggered by stress, leading to weakened heart muscles; the study aimed to explore how different medications impact mortality rates in TS patients.
- The analysis included 1,724 TS patients from the SWEDEHEART registry, predominantly older women, with a significant portion presenting types of acute coronary syndrome and most showing non-obstructive coronary artery disease.
- Findings indicated that certain medications, like intravenous inotropes and diuretics, increased 30-day mortality, while long-term use of angiotensin-converting enzyme inhibitors and statins improved survival rates.
Article Synopsis
- A new fluid-filled pressure wire, Wirecath, was tested to see if it could reduce measurement errors caused by hydrostatic pressure in the coronary system.
- The study involved 45 patients undergoing coronary angiography, comparing Wirecath with a conventional pressure wire and measuring their effectiveness and safety.
- Results showed that, while mean pressures differed significantly between the two wires, the Wirecath wire accurately avoided hydrostatic errors and was deemed safe for use.
Article Synopsis
- Subjects with type 2 diabetes (T2D) were studied to see if the GLP-1R agonist exenatide could improve stent performance after angioplasty compared to standard treatment.
- 38 participants were randomly assigned to either receive exenatide weekly along with standard treatment or just standard treatment for 12 weeks, with outcomes measured through coronary angiography.
- The results showed no significant differences in stent coverage, neo-intima thickness, or obstruction rates between the two groups, indicating exenatide did not enhance stent outcomes in T2D patients.
Article Synopsis
- This study examines out-of-hospital cardiac arrests (OHCA) in young adults (ages 16-49) in Sweden from 1990 to 2020, focusing on survival rates and causes of cardiac arrests.
- Over the 30-year period, there was a notable annual increase of 5.9% in 30-day survival rates without decline in neurological function, despite rising cases related to overdoses and suicides.
- By 2020, an impressive 88% of OHCA cases received bystander CPR, while EMS response times increased from 6 to 10 minutes, indicating both improvement in immediate care and challenges in emergency response.
Article Synopsis
- The study aimed to explore the connections between different levels of physical activity—sedentary behavior (SED), low-intensity physical activity (LIPA), and moderate-to-vigorous intensity physical activity (MVPA)—and the prevalence of subclinical atherosclerosis in the coronary and carotid arteries among 22,670 participants from a Swedish study.
- Findings indicated that high levels of sedentary time were linked to an increased risk of significant coronary atherosclerosis, while MVPA was associated with a lower risk of both coronary and carotid atherosclerosis.
- Theoretical shifts from sedentary behavior to moderate-to-vigorous activity could lower the risk of significant coronary atherosclerosis, particularly in participants with high sedentary time
Article Synopsis
- - The IAMI trial studied 2571 patients with acute myocardial infarction to assess the impact of influenza vaccination on cardiovascular events, comparing outcomes between early and late season vaccinations over a 12-month period.
- - Results showed no significant difference in the effectiveness of the vaccine whether given early or late, with similar percentages of primary composite endpoints observed in both groups (6% early, 4.7% late for vaccinated participants).
- - Although early vaccination demonstrated a potentially greater effect on overall mortality, the findings were not statistically significant; thus, the study reinforces recommending influenza vaccination for all cardiovascular patients, regardless of timing.
Article Synopsis
- - The study aimed to assess the prevalence of atherosclerosis in coronary and carotid arteries among individuals with prediabetes and diabetes compared to those without diabetes, involving over 30,000 participants aged 50-64.
- - The findings revealed that participants with prediabetes or diabetes had significantly higher levels of coronary artery plaque, stenosis, and calcium scores compared to normoglycaemic individuals, indicating a greater cardiovascular risk.
- - Notably, the prevalence of coronary atherosclerosis was highest in those with known diabetes, while both prediabetic and diabetic participants showed increased plaque in carotid arteries compared to normoglycaemic individuals.
Article Synopsis
- There has been a significant increase in the use of transcatheter aortic valve implantation (TAVI) to treat symptomatic severe aortic stenosis, prompting the need for streamlined procedures in specialized Heart Valve Centres.
- The 2022 European TAVI Pathway Survey collected input from 147 TAVI centres in 26 countries, revealing details about their procedural practices and patient management.
- Findings indicate that while minimalist TAVI methods are widely adopted, many patients still experience longer hospital stays, suggesting room for improvement in discharge processes.