Publications by authors named "Truls Ramunddal"
Article Synopsis
- Guidelines for cardiac arrest management were analyzed to assess the strength and quality of the evidence supporting them, revealing both strengths and significant gaps in knowledge.
- The review of the 2020 American Heart Association (AHA) Guidelines identified 254 recommendations, mostly classified under advanced life support (ALS) and basic life support (BLS), but only 1% of recommendations were based on the strongest level of evidence (LOE A).
- Only 32% of the highest class recommendations were backed by strong evidence (LOE A or B), highlighting the need for more rigorous research, especially randomized trials, to improve the quality of guidelines.
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.
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 PDFBackground: Fractional flow reserve (FFR) or non-hyperaemic pressure ratios are recommended to assess functional relevance of intermediate coronary stenosis. Both diagnostic methods require the placement of a pressure wire in the coronary artery during invasive coronary angiography. Quantitative flow ratio (QFR) is an angiography-based computational method for the estimation of FFR that does not require the use of pressure wires.
View Article and Find Full Text PDFArticle Synopsis
- * A study analyzed 15,856 ECGs from emergency patients in Sweden and trained a convolutional neural network (ResNet) to predict troponin elevation, achieving an accuracy of 71.43% and a high negative predictive value of 0.8660.
- * The model's promising performance suggests that similar neural networks could be used in emergency settings for rapid triage of patients suspected of having heart issues.
Inotropes 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.
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.
Article Synopsis
- - The EXPLORE trial was a 10-year study comparing chronic total occlusion (CTO) percutaneous coronary intervention (PCI) to no-CTO PCI in patients who had a ST-segment-elevation myocardial infarction (STEMI).
- - The trial found that after a median follow-up of 10 years, there was no significant difference in major adverse cardiac events or overall mortality between the two groups, but the CTO PCI group experienced higher cardiovascular mortality.
- - Although the CTO PCI group had more effective relief from dyspnea (83% vs. 65%), the findings suggest that the benefits of symptom relief should be carefully considered against the increased risk of cardiovascular mortality.
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
- 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
- Out-of-hospital cardiac arrest (OHCA) has a very low survival rate of about 10%, with a study examining the prevalence and significance of comorbidities among OHCA patients in Sweden from 2010 to 2020.
- Among 54,484 patients studied, common comorbidities included hypertension (43.6%), heart failure (23.6%), and chronic ischaemic heart disease (23.6%), highlighting a diverse range of health issues preceding cardiac arrests.
- The findings suggest that coronary artery disease is becoming less common as a cause of OHCA, with only 30% of hospitalized patients being diagnosed with acute myocardial infarction (AMI), indicating a shift in the
Article Synopsis
- The study investigates how obesity, with or without diabetes, affects the survival rates of patients who experience out-of-hospital cardiac arrest (OHCA).
- The research analyzed data from over 55,000 patients in Sweden from 2010 to 2020, categorizing them into groups based on obesity and diabetes status.
- Findings indicate that obesity is linked to a younger patient demographic and a significant decrease in 30-day survival rates, especially when combined with diabetes.
Article Synopsis
- The study compares ECG changes over 30 days between female patients with anterior STEMI (a type of heart attack) and female patients with Takotsubo syndrome (a stress-induced heart condition).
- It found that T wave inversion patterns were similar in both groups, but ST elevation was more common in STEMI, while QT prolongation was less frequent.
- Overall, the ECG patterns suggest that TTS may show a temporary ischemic-like pattern, indicating similarities in heart stress responses between these conditions.
Quantitative flow ratio (QFR) is a computation of fractional flow reserve (FFR) based on invasive coronary angiographic images. Calculating QFR is less invasive than measuring FFR and may be associated with lower costs. Current evidence supports the call for an adequately powered randomised comparison of QFR and FFR for the evaluation of intermediate coronary stenosis.
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- Despite advances in short-term survival rates for Out-of-Hospital Cardiac Arrest (OHCA), long-term survival remains under-researched, particularly concerning factors influencing it.
- A study analyzed 1-year outcomes of patients who survived OHCA and were released from hospitals, using a machine learning model that considered 886 factors to predict re-arrest or death.
- Results showed that around 18% of the 5098 patients experienced either a re-arrest or death within a year, and a simplified model with 15 key variables provided predictive capabilities nearly equivalent to the comprehensive model.
Article Synopsis
- Chronic total occlusions (CTO) are common in patients with coronary artery disease, and while percutaneous coronary intervention (PCI) is a viable treatment, more randomized studies are needed to compare its effectiveness against optimal medical therapy (OMT) alone.
- This trial assesses the impact of CTO-PCI on patients with myocardial ischemia and determines effects on quality of life and major adverse cardiac and cerebral events (MACCE) through a randomized approach following an initial period of OMT.
- The results will provide insights that could influence future guidelines on the treatment of chronic total occlusions, depending on whether CTO-PCI shows significant benefits.
Article Synopsis
- The study investigated the clinical characteristics and outcomes of patients with pre-existing cardiovascular conditions who suffered an out-of-hospital cardiac arrest (OHCA) using a large Swedish registry from 2010-2020.
- Researchers identified various cardiovascular conditions like hypertension, heart failure, and diabetes, and analyzed their impact on survival rates and neurological outcomes.
- Results showed that patients with the combination of hypertension and heart failure had the lowest survival rates, and earlier onset of hypertension correlated with a shorter time to cardiac arrest.
Article Synopsis
- A study was conducted to compare the electrocardiogram (ECG) results of Takotsubo syndrome (STE-TS) patients with those diagnosed with ST elevation myocardial infarction (STEMI), ensuring balanced age and sex groups and considering the specific locations of blockages in STEMI patients.
- The analysis included 104 STE-TS patients matched to 274 STEMI patients, revealing that STE-TS ECGs closely resembled those of patients with left anterior descending artery (LAD) STEMI, but with significantly less occurrence of reciprocal ST depression.
- Findings indicated that while certain ST segment changes were predictive of life-threatening ventricular arrhythmia and death in LAD STEMI patients, these changes did not demonstrate predictive value
Aims: Ischaemic coronary artery disease (CAD) remains the leading cause of mortality globally due to sudden death and heart failure (HF). Invasive coronary angiography (CAG) is the gold standard for evaluating the presence and severity of CAD. Our objective was to assess temporal trends in CAG utilization, patient characteristics, and prognosis in HF patients undergoing CAG at a national level.
View Article and Find Full Text PDFBivalirudin 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.
Article Synopsis
- The study focused on how the right ventricle (RV) functions in STEMI patients with concurrent chronic total occlusion (CTO) in the right coronary artery (RCA).
- It involved analyzing RV performance in three patient groups using various measurements over a 4-month period, revealing that RV function improved in those with RCA-related issues but not in those without RCA involvement.
- Additionally, while some RV parameters did not predict long-term mortality, right ventricular global longitudinal strain (RV GLS) was found to be a useful indicator for functional status post-treatment.
The authors developed a global chronic total occlusion crossing algorithm following 10 steps: 1) dual angiography; 2) careful angiographic review focusing on proximal cap morphology, occlusion segment, distal vessel quality, and collateral circulation; 3) approaching proximal cap ambiguity using intravascular ultrasound, retrograde, and move-the-cap techniques; 4) approaching poor distal vessel quality using the retrograde approach and bifurcation at the distal cap by use of a dual-lumen catheter and intravascular ultrasound; 5) feasibility of retrograde crossing through grafts and septal and epicardial collateral vessels; 6) antegrade wiring strategies; 7) retrograde approach; 8) changing strategy when failing to achieve progress; 9) considering performing an investment procedure if crossing attempts fail; and 10) stopping when reaching high radiation or contrast dose or in case of long procedural time, occurrence of a serious complication, operator and patient fatigue, or lack of expertise or equipment. This algorithm can improve outcomes and expand discussion, research, and collaboration.
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