Publications by authors named "Redfors B"

Background: Baseline systemic inflammation is associated with worse long-term outcomes after coronary artery bypass grafting [CABG], but the mechanisms of this association are unclear. This study aims to explore the association between pre-operative white blood cell [WBC] count and CABG graft failure.

Methods: We pooled individual patient data from two randomized clinical trials with systematic CABG graft imaging.

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Purpose: We examined whether end-to-end deep-learning models could detect moderate (≥50%) or severe (≥70%) stenosis in the left anterior descending artery (LAD), right coronary artery (RCA) or left circumflex artery (LCX) in iodine contrast-enhanced ECG-gated coronary CT angiography (CCTA) scans.

Methods: From a database of 6293 CCTA scans, we used pre-existing curved multiplanar reformations (CMR) images of the LAD, RCA and LCX arteries to create end-to-end deep-learning models for the detection of moderate or severe stenoses. We preprocessed the images by exploiting domain knowledge and employed a transfer learning approach using EfficientNet, ResNet, DenseNet and Inception-ResNet, with a class-weighted strategy optimised through cross-validation.

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  • The study investigates the relationship between cardiac damage (classified by hospital discharge codes) and in-hospital outcomes for patients with aortic stenosis (AS) using data from a large national sample.
  • It analyzed nearly 3 million hospital admissions from 2016 to 2021, noting significant impacts of cardiac damage on mortality, length of stay, and costs, particularly for those undergoing surgical aortic valve replacement (SAVR).
  • Findings indicate that patients with higher stages of cardiac damage experience worse in-hospital outcomes, with those receiving SAVR showing the most dramatic differences compared to other treatment options like transcatheter aortic valve replacement (TAVR) and conservative management.
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Background: Current guidelines recommend a strategy of clinical surveillance (CS) for patients with asymptomatic severe aortic stenosis (AS) and a normal left ventricular ejection fraction.

Objectives: The aim of this study was to conduct a study-level meta-analysis of randomized controlled trials (RCTs) evaluating the effect of early aortic valve replacement (AVR) compared with CS in patients with asymptomatic severe AS.

Methods: Studies were quantitatively assessed in a meta-analysis using random-effects modeling.

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Background: The incidence and prognostic impact of major bleeding (MB) after percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) for left main coronary artery disease (LMCAD) are unknown.

Objectives: The goal of this study was to investigate the rates and outcomes of MB after LMCAD revascularization.

Methods: In the EXCEL (Evaluation of XIENCE versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization) trial, 1,905 patients with unprotected LMCAD were randomized to undergo PCI (n = 948) or CABG (n = 957) and followed up for 5 years.

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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.

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  • The BIONICS and NIREUS trials compared the ridaforolimus-eluting stent (RES) and zotarolimus-eluting stent (ZES), showing that RES was noninferior to ZES for 1-year target-lesion failure and 6-month lumen loss.
  • A pooled analysis of 2221 patients over 5 years found similar rates of target-lesion failure (12.2% for RES vs 11.3% for ZES), with no significant differences in other outcomes like myocardial infarction or stent thrombosis.
  • Although the RES group had higher rates of target-vessel revascularization and cardiac death, these differences were not significant after adjusting for patient characteristics, indicating long-term
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Background: There is concern that left internal thoracic artery (LITA)-to diagonal (D)-to left anterior descending artery (LAD) grafts may be more susceptible to failure compared with single LITA-LAD grafts.

Methods: Pooled individual patient data from 8 clinical trials with systematic graft imaging were analyzed to assess the incidence of sequential LITA-D-LAD vs single LITA-LAD grafts. Mixed-effects multivariable logistic regression, adjusting for patient characteristics and clustering within trials, was used.

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Background: ST-elevation myocardial infarction (STEMI) and Takotsubo syndrome (TS) are two distinct cardiac conditions that both result in sudden loss of cardiac dysfunction and that are difficult to distinguish clinically. This study compared plasma protein changes in 24 women with STEMI and 12 women with TS in the acute phase (days 0-3 post symptom onset) and the stabilization phase (days 7, 14, and 30) to examine the molecular differences between these conditions.

Methods: Plasma proteins from STEMI and TS patients were extracted during the acute and stabilization phases and analyzed via quantitative proteomics.

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  • - This study examined the effects of transcatheter aortic valve replacement (TAVR) on patients with heart failure and moderate aortic stenosis, comparing TAVR with clinical surveillance followed by valve replacement if the condition worsened.
  • - A total of 178 patients were randomly assigned to either TAVR or surveillance, and results indicated that TAVR was associated with better clinical outcomes, though the statistical significance was borderline.
  • - TAVR led to a more substantial improvement in heart failure symptoms, as measured by the Kansas City Cardiomyopathy Questionnaire, compared to the surveillance group after one year of follow-up.
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Background: Drug-eluting stents (DESs) with controlled antiproliferative drug release reduce restenosis risk, but durable polymers can delay healing and inhibit reendothelialization. The Firehawk biodegradable polymer sirolimus-eluting stent (BP-SES) has a fully biodegradable sirolimus-containing polymer coating localized to recessed abluminal grooves on the stent surface and delivers roughly one-third the drug dose of other DESs.

Objectives: We report the primary results of the TARGET-IV NA (Firehawk Rapamycin Target Eluting Coronary Stent North American Trial) randomized controlled trial comparing clinical outcomes with BP-SES vs currently used second-generation DESs.

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Background: For patients with asymptomatic severe aortic stenosis and preserved left ventricular ejection fraction, current guidelines recommend routine clinical surveillance every 6 to 12 months. Data from randomized trials examining whether early intervention with transcatheter aortic-valve replacement (TAVR) will improve outcomes in these patients are lacking.

Methods: At 75 centers in the United States and Canada, we randomly assigned, in a 1:1 ratio, patients with asymptomatic severe aortic stenosis to undergo early TAVR with transfemoral placement of a balloon-expandable valve or clinical surveillance.

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  • 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.
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  • Researchers developed a predictive model called the Pre-ECPR score to enhance patient selection for extracorporeal cardiopulmonary resuscitation (ECPR), which currently only has a favorable outcome rate of about 20%.
  • The study analyzed data from 120 normothermic ECPR patients at a single hospital and found that the Pre-ECPR score, using various health indicators, outperformed existing selection criteria from the Extracorporeal Life Support Organization (ELSO).
  • The Pre-ECPR score achieved a strong predictive ability (AUC of 0.87) for identifying patients likely to have good outcomes, significantly boosting the chances of successful ECPR treatment over traditional methods.
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  • * Among 239 patients assessed, 124 had RVD, which was linked to factors like lower left ventricular ejection fraction and higher blood urea nitrogen levels, but did not significantly affect certain immediate procedural outcomes.
  • * RVD was found to be a strong predictor of worse long-term outcomes, with higher rates of major adverse cardiac and cerebrovascular events (MACCE) at 90 days and increased mortality at one year post-procedure.
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  • - The BRIGHT-4 study showed that using bivalirudin with a high-dose infusion after PCI led to lower overall mortality and bleeding risks compared to heparin, without raising rates of reinfarction or stent thrombosis in STEMI patients.
  • - A meta-analysis of six trials involving over 15,000 patients found that while bivalirudin reduced overall and cardiac mortality and major bleeding, it was associated with higher rates of reinfarction and stent thrombosis compared to heparin.
  • - When specifically looking at a subset of trials similar to the BRIGHT-4 approach, bivalirudin also showed a decrease in 30-day mortality and major bleeding, with comparable rates of reinfar
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Background: The implications of pulmonary vein (PV) flow patterns in patients with heart failure (HF) and mitral regurgitation (MR) are uncertain. We examined PV flow patterns in the Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients With Functional Mitral Regurgitation (COAPT) trial (NCT01626079), in which patients with HF and moderate-to-severe or severe functional MR were randomized to transcatheter edge-to-edge repair (TEER) with the MitraClip device plus guideline-directed medical therapy (GDMT) vs. GDMT alone.

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Background: Mitral valve regurgitation (MR) is associated with worse outcomes in patients undergoing percutaneous coronary intervention (PCI). We sought to evaluate outcomes of Impella-supported high-risk PCI (HRPCI) patients according to MR severity.

Methods: Patients from the PROTECT III study undergoing Impella-supported HRPCI were stratified into 4 groups according to MR severity: No or trace MR, mild MR, moderate MR, and severe MR.

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  • The review highlights a lack of evidence in coronary revascularization decisions specifically for women and minorities and introduces the RECHARGE trial program aimed at addressing this gap.
  • The RECHARGE program includes two trials: one focused on women and the other on Black or Hispanic patients, comparing CABG and PCI treatments over a follow-up period of up to 10 years.
  • Key outcomes will assess quality of life and mortality, with a focus on patient-centered measures, making these trials unique in their approach to these underrepresented populations.
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  • The study analyzed data from 7 trials with 1,774 STEMI patients to understand how the location of the infarct artery affects heart injury and outcomes after primary coronary intervention.
  • Results showed that patients with anterior STEMI (affecting the left anterior descending artery) had a larger median infarct size and were at a higher risk for mortality and heart failure hospitalization compared to those with nonanterior STEMI.
  • The research concluded that anterior STEMI leads to more severe heart damage and worse overall prognosis, highlighting the importance of infarct location in patient outcomes.
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Background: Supersaturated oxygen (SSO) delivered into the left anterior descending coronary artery after percutaneous coronary intervention (PCI) for anterior ST-segment elevation myocardial infarction (STEMI) has been shown to reduce infarct size, but its effects on microvascular obstruction (MVO) are unknown. The aim of this study was to compare MVO in patients with anterior STEMI treated with SSO after successful primary PCI from 2 studies (the optimized SSO pilot and IC-HOT) with similar patients from 7 randomized trials who underwent primary PCI without SSO treatment.

Methods: A total of 874 patients with anterior STEMI who underwent MVO assessment using cardiac magnetic resonance imaging within 10 days after primary PCI were included, of whom 90 patients (10.

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  • Risk scores like MitraScore and COAPT help identify patients with mitral regurgitation (MR) who are at risk of adverse events but may still benefit from transcatheter edge-to-edge repair (TEER).
  • The study validated MitraScore in the COAPT trial with 614 patients and the COAPT risk score in the MIVNUT registry with 1007 patients, both focusing on predicting all-cause mortality over approximately 2 years.
  • Results indicated that both scores had fair to good predictive accuracy for mortality, with higher effectiveness seen in TEER patients, confirming the benefits of combining TEER with guideline-directed medical therapy (GDMT) across different risk levels.
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  • Neurocognitive dysfunction affects 30% to 80% of heart failure patients, impacting memory, attention, and other cognitive areas due to factors like reduced cardiac output and brain injury.
  • Cognitive impairment is linked to worse health outcomes, such as higher mortality and rehospitalization rates, especially in patients struggling with treatment adherence.
  • While coronary revascularization may improve heart function, it poses risks for cognitive decline; thus, alternative less-invasive methods, like percutaneous coronary intervention, need further evaluation to better manage neurocognitive health in these patients.
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  • Anemia is common among patients with cardiovascular disease, particularly those undergoing high-risk percutaneous coronary intervention (HRPCI) with Impella support, and is linked to worse outcomes.
  • The study evaluated patients' hemoglobin levels to categorize them into no anemia, mild anemia, and moderate/severe anemia, revealing that anemic patients tended to be older and had more health issues.
  • Results showed that anemia significantly increased rates of major adverse cardiovascular events and major bleeding at 30 and 90 days, highlighting the need for focused strategies to manage anemia's impact on patient outcomes after HRPCI.
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