Publications by authors named "Sasha Koul"
Background: Long-term data on safety and efficacy of instantaneous wave-free ratio (IFR) vs fractional flow reserve (FFR) in guiding percutaneous coronary intervention (PCI) is lacking.
Objectives: This study sought to evaluate the 5-year clinical outcomes of IFR- vs FFR-guided PCI in a real-world setting.
Methods: We assessed the 5-year outcomes of all patients undergoing IFR or FFR assessment between January 1, 2014, and February 16, 2022, using data from the SWEDEHEART (Swedish Web-System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies) registry.
Background: Intravascular ultrasound (IVUS) guides deferral decision-making regarding the left main coronary artery (LMCA) and improves outcomes. Further studies regarding coronary physiology to guide revascularization in the LMCA are needed. Our aim was to evaluate the outcome of LMCA deferral using IVUS or coronary physiology via instantaneous wave-free ratio (iFR) or fractional flow reserve (FFR).
View Article and Find Full Text PDFOutcome of Saphenous Vein Graft Percutaneous Coronary Intervention Using Contemporary Drug-Eluting Stents: A SCAAR Report.
J Soc Cardiovasc Angiogr Interv
October 2024
Background: Percutaneous coronary intervention (PCI) of saphenous vein grafts (SVG) is associated with poor outcomes and is often regarded as inferior to native vessel PCI. We investigated clinical outcomes of SVG-PCI using contemporary drug-eluting stents (DES), in a complete, nationwide population.
Methods: The complete Swedish Coronary Angiography and Angioplasty Registry (SCAAR) was used to identify all patients in Sweden who underwent SVG-PCI with a contemporary DES between 2013 and 2020.
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.
Article Synopsis
- - The study aimed to explore whether percutaneous coronary intervention (PCI) provides better outcomes than just medical therapy (MT) for patients with chronic coronary syndrome (CCS), analyzing data from the Swedish Coronary Angiography and Angioplasty Registry from 2010 to 2020.
- - Two groups of 7,220 patients each were compared, one receiving PCI along with MT and the other receiving MT alone, using statistical methods to account for differences between the groups.
- - Results indicated that PCI was associated with improved outcomes in terms of net adverse clinical events and major adverse cardiovascular events, particularly for myocardial infarction and urgent revascularization, but there was no notable difference for all-cause mortality or bleeding.
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.
Background: Dual antiplatelet therapy (DAPT) reduces ischemic events but increases bleeding risk, especially in patients with high bleeding risk (HBR). This study aimed to compare outcomes of abbreviated versus standard DAPT strategies in patients with HBR with acute coronary syndrome undergoing percutaneous coronary intervention.
Methods And Results: Patients from the SWEDEHEART (Swedish Web-system for Enhancement and Development of Evidence-Based Bare in Heart Disease Evaluated According to Recommended Therapies) registry with at least 1 HBR criterion who underwent percutaneous coronary intervention for acute coronary syndrome were identified and included.
A study of size-selective renal elimination using a novel human model.
Scand J Clin Lab Invest
April 2024
Article Synopsis
- A new study explored how the kidneys eliminate molecules of different sizes using a human model during Transcatheter Aortic Valve Implantation (TAVI) on 45 patients.
- * Researchers measured the renal elimination ratio (RER) of various molecules, finding that smaller molecules like creatinine had a higher RER compared to larger ones like troponin-T, revealing a threshold for elimination between 36 and 44 kDa.
- * The study concluded that the RERs of creatinine and cystatin C correlate with estimated glomerular filtration rate (eGFR), highlighting the model's usefulness in understanding selective glomerular hypofiltration syndromes.
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 PDFBackground: Transcatheter aortic valve implantation (TAVI) has become a safe procedure. However, complications occur, including uncommon complications such as valve malposition, which requires the implantation of an additional rescue valve (rescue-AV). The aim was to study the occurrence and outcomes of rescue-AV in a nationwide registry.
View Article and Find Full Text PDFArticle 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.
Background: Electrocardiographic detection of patients with occlusion myocardial infarction (OMI) can be difficult in patients with left bundle branch block (LBBB) or ventricular paced rhythm (VPR) and several ECG criteria for the detection of OMI in LBBB/VPR exist. Most recently, the Barcelona criteria, which includes concordant ST deviation and discordant ST deviation in leads with low R/S amplitudes, showed superior diagnostic accuracy but has not been validated externally. We aimed to describe the diagnostic accuracy of four available ECG criteria for OMI detection in patients with LBBB/VPR at the emergency department.
View Article and Find Full Text PDFBackground: Periprocedural stroke during transcatheter aortic valve implantation is a rare but devastating complication. The calcified aortic valve is the most likely source of the emboli in a periprocedural stroke. The total load and distribution of calcium in the leaflets, aortic root, and left ventricular outflow tract varies from patient to patient.
View Article and Find Full Text PDFBackground: Deferral of coronary revascularization is safe whether guided by instantaneous wave-free ratio (iFR) or by fractional flow reserve (FFR). We aimed to assess long-term outcomes in patients deferred from revascularization based on iFR or FFR in a large real-world population.
Methods: From 2013 through 2017, 201,933 coronary angiographies were registered in the Swedish Web-System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies (SWEDEHEART).
Article Synopsis
- The study examined the impact of early ventricular arrhythmias (VAs) on the prognosis of patients with ST-segment elevation myocardial infarction (STEMI), focusing on the type and timing of these arrhythmias.
- Nonmonomorphic VT or VF was rare, occurring in only 3.4% of patients, but early VAs were linked to significantly higher risks of both in-hospital and longer-term mortality.
- Results indicated that VAs occurring after primary percutaneous coronary intervention (PCI) showed greater mortality risk compared to those before PCI, while the type of VA (monomorphic vs. nonmonomorphic) did not significantly influence long-term outcomes.
Intracoronary Imaging of Proximal Coronary Artery Lesions A Nationwide Lesion-Level Analysis From SCAAR.
J Soc Cardiovasc Angiogr Interv
February 2023
Background: Current evidence suggests that use of intracoronary imaging during percutaneous coronary intervention (PCI) of the left main coronary artery (LMCA) reduces mortality. However, there is a scarcity of data on the overall role of intracoronary imaging, particularly in other non-LMCA proximal coronary artery lesions. We aimed to investigate the association of use of intracoronary imaging on outcome in proximal lesions treated with PCI.
View Article and Find Full Text PDFBackground Although physiology-based assessment of coronary artery stenosis using instantaneous wave-free ratio (iFR) and fractional flow reserve (FFR) are established methods of guiding coronary revascularization, its clinical outcome in long-term deferral needs further evaluation, especially with acute coronary syndrome as a clinical presentation. The aim was to evaluate the long-term clinical outcome of deferral of revascularization based on iFR or FFR. Methods and Results This is a substudy of the iFR-SWEDEHEART (Instantaneous Wave-Free Ratio Versus Fractional Flow Reserve in Patients With Stable Angina Pectoris or Acute Coronary Syndrome) randomized clinical trial, where patients deferred from revascularization from each study arm were selected.
View Article and Find Full Text PDFBackground The long-term course of coronary atherosclerosis has not been studied in large nationwide cohorts. Understanding the natural history of coronary atherosclerosis could help identify patients at risk for future coronary events. Methods and Results All coronary artery segments with <50% luminal stenosis in patients with a first-time coronary angiogram between 1989 and 2017 were identified (n=2 661 245 coronary artery segments in 248 736 patients) and followed until a clinically indicated angiography within 15 years was performed or until death or end of follow-up (April 2018) using SCAAR (Swedish Coronary Angiography and Angioplasty Registry).
View Article and Find Full Text PDFBackground: Coronary artery disease (CAD) frequently coexists with severe aortic valve stenosis (AS) in patients planned for transcatheter aortic valve implantation (TAVI). How to manage CAD in this patient population is still an unresolved question. In particular, it is still not known whether fractional flow reserve (FFR) guided revascularization with percutaneous coronary intervention (PCI) is superior to medical treatment for CAD in terms of clinical outcomes.
View Article and Find Full Text PDFBackground: Unfractionated heparin (UFH) is frequently administered before percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI).
Aims: The aim of the study was to investigate if pretreatment with UFH prior to arrival at the catheterisation laboratory affects coronary artery occlusion, mortality, and in-hospital major bleeding in patients with STEMI undergoing PCI.
Methods: Patients with a first STEMI event undergoing PCI between 2008 and 2016 were extracted from the Swedish Coronary Angiography and Angioplasty Registry.
Background: European treatment guidelines recommend prasugrel over ticagrelor for treating patients with non-ST-elevation acute coronary syndrome (ACS), prompting several Swedish administrative regions to transition from ticagrelor to prasugrel as the preferred treatment for patients with ACS. We aim to systematically evaluate this transition to determine the relative efficacy of prasugrel versus ticagrelor in a real-world cohort of patients with ACS.
Study Design And Objectives: The SWITCH SWEDEHEART trial is a prospective, multicenter, open-label, cross-sectional, stepped-wedge cluster-randomized clinical trial, in which administrative regions in Sweden will constitute the clusters.
Background: Instantaneous wave-free ratio (iFR) is a coronary physiology index used to assess the severity of coronary artery stenosis to guide revascularization. iFR has previously demonstrated noninferior short-term outcome compared to fractional flow reserve (FFR), but data on longer-term outcome have been lacking.
Objectives: The purpose of this study was to investigate the prespecified 5-year follow-up of the primary composite outcome of all-cause mortality, myocardial infarction, and unplanned revascularization of the iFR-SWEDEHEART trial comparing iFR vs FFR in patients with chronic and acute coronary syndromes.
Background: Patients have an estimated mortality of 15-20% within the first year following myocardial infarction and one in four patients who survive myocardial infarction will develop heart failure, severely reducing quality of life and increasing the risk of long-term mortality. We aimed to establish the accuracy of an artificial neural network (ANN) algorithm in predicting 1-year mortality and admission to hospital for heart failure after myocardial infarction.
Methods: In this nationwide population-based study, we used data for all patients admitted to hospital for myocardial infarction and discharged alive from a coronary care unit in Sweden (n=139 288) between Jan 1, 2008, and April 1, 2017, from the Swedish Web system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies (SWEDEHEART) nationwide registry; these patients were randomly divided into training (80%) and testing (20%) datasets.
Bivalirudin Versus Heparin Monotherapy in ST-Segment-Elevation Myocardial Infarction.
Circ Cardiovasc Interv
December 2021
Background: Bivalirudin was not superior to unfractionated heparin in patients with myocardial infarction (MI) treated with percutaneous coronary intervention and no planned use of GPI (glycoprotein IIb/IIIa inhibitors) in contemporary clinical practice of radial access and potent P2Y-inhibitors in the VALIDATE-SWEDEHEART randomized clinical trial (Bivalirudin Versus Heparin in STEMI and NSTEMI Patients on Modern Antiplatelet Therapy-Swedish Web-System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies Registry).
Methods: In this prespecified separately powered subgroup analysis, we included patients with ST-segment-elevation MI undergoing primary percutaneous coronary intervention with the primary composite end point of all-cause death, MI, or major bleeding event within 180 days.
Results: Among the 6006 patients enrolled in the trial, 3005 patients with ST-segment-elevation MI were randomized to receive bivalirudin or heparin.