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Featured researches published by Petur Petursson.


Journal of the American College of Cardiology | 2015

Transcatheter Versus Surgical Aortic Valve Replacement in Patients With Severe Aortic Valve Stenosis 1-Year Results From the All-Comers NOTION Randomized Clinical Trial

Hans Gustav Hørsted Thyregod; Daniel A. Steinbrüchel; Nikolaj Ihlemann; Henrik Nissen; Bo Juel Kjeldsen; Petur Petursson; Yanping Chang; Olaf Franzen; Thomas Engstrøm; Peter Clemmensen; Peter Bo Hansen; Lars Willy Andersen; Peter Skov Olsen; Lars Søndergaard

BACKGROUND Transcatheter aortic valve replacement (TAVR) is an option in certain high-risk surgical patients with severe aortic valve stenosis. It is unknown whether TAVR can be safely introduced to lower-risk patients. OBJECTIVES The NOTION (Nordic Aortic Valve Intervention Trial) randomized clinical trial compared TAVR with surgical aortic valve replacement (SAVR) in an all-comers patient cohort. METHODS Patients ≥ 70 years old with severe aortic valve stenosis and no significant coronary artery disease were randomized 1:1 to TAVR using a self-expanding bioprosthesis versus SAVR. The primary outcome was the composite rate of death from any cause, stroke, or myocardial infarction (MI) at 1 year. RESULTS A total of 280 patients were randomized at 3 Nordic centers. Mean age was 79.1 years, and 81.8% were considered low-risk patients. In the intention-to-treat population, no significant difference in the primary endpoint was found (13.1% vs. 16.3%; p = 0.43 for superiority). The result did not change in the as-treated population. No difference in the rate of cardiovascular death or prosthesis reintervention was found. Compared with SAVR-treated patients, TAVR-treated patients had more conduction abnormalities requiring pacemaker implantation, larger improvement in effective orifice area, more total aortic valve regurgitation, and higher New York Heart Association functional class at 1 year. SAVR-treated patients had more major or life-threatening bleeding, cardiogenic shock, acute kidney injury (stage II or III), and new-onset or worsening atrial fibrillation at 30 days than did TAVR-treated patients. CONCLUSIONS In the NOTION trial, no significant difference between TAVR and SAVR was found for the composite rate of death from any cause, stroke, or MI after 1 year. (Nordic Aortic Valve Intervention Trial [NOTION]; NCT01057173).


Journal of Clinical Investigation | 2011

The VLDL receptor promotes lipotoxicity and increases mortality in mice following an acute myocardial infarction

Jeanna Perman; Pontus Boström; Malin Lindbom; Ulf Lidberg; Marcus Ståhlman; Daniel Hägg; Henrik Lindskog; Margareta Scharin Täng; Elmir Omerovic; Lillemor Mattsson Hultén; Anders Jeppsson; Petur Petursson; Johan Herlitz; Dudley K. Strickland; Kim Ekroos; Sven-Olof Olofsson; Jan Borén

Impaired cardiac function is associated with myocardial triglyceride accumulation, but it is not clear how the lipids accumulate or whether this accumulation is detrimental. Here we show that hypoxia/ischemia-induced accumulation of lipids in HL-1 cardiomyocytes and mouse hearts is dependent on expression of the VLDL receptor (VLDLR). Hypoxia-induced VLDLR expression in HL-1 cells was dependent on HIF-1α through its interaction with a hypoxia-responsive element in the Vldlr promoter, and VLDLR promoted the endocytosis of lipoproteins. Furthermore, VLDLR expression was higher in ischemic compared with nonischemic left ventricles from human hearts and was correlated with the total lipid droplet area in the cardiomyocytes. Importantly, Vldlr-/- mice showed improved survival and decreased infarct area following an induced myocardial infarction. ER stress, which leads to apoptosis, is known to be involved in ischemic heart disease. We found that ischemia-induced ER stress and apoptosis in mouse hearts were reduced in Vldlr-/- mice and in mice treated with antibodies specific for VLDLR. These findings suggest that VLDLR-induced lipid accumulation in the ischemic heart worsens survival by increasing ER stress and apoptosis.


International Journal of Cardiology | 2015

Mortality in takotsubo syndrome is similar to mortality in myocardial infarction — A report from the SWEDEHEART1 registry

Björn Redfors; Ramtin Vedad; Oskar Angerås; Truls Råmunddal; Petur Petursson; Inger Haraldsson; Anwar Ali; Christian Dworeck; Jacob Odenstedt; Dan Ioaness; Berglin Libungan; Yangzhen Shao; Per Albertsson; Gregg W. Stone; Elmir Omerovic

BACKGROUND Takotsubo syndrome is an acute cardiovascular condition that predominantly affects women. In this study, we compared patients with takotsubo syndrome and those with acute myocardial infarction with respect to patient characteristics, angiographic findings, and short- and long-term mortality. METHODS From the Swedish Coronary Angiography and Angioplasty Registry (SCAAR) and the Register of Information and Knowledge about Swedish Heart Intensive Care Admissions (RIKS-HIA), we obtained and merged data on patients undergoing coronary angiography in Västra Götaland County in western Sweden between January 2005 and May 2013. Short- and long-term mortality in patients with takotsubo (n=302) and patients with ST-elevation myocardial infarction (STEMI, n=6595) and non-ST-elevation myocardial infarction (NSTEMI, n=8207) were compared by modeling unadjusted and propensity score-adjusted logistic and Cox proportional-hazards regression. RESULTS The proportion of the patients diagnosed with takotsubo increased from 0.16% in 2005 to 2.2% in 2012 (P<0.05); 14% of these patients also had significant coronary artery disease. Cardiogenic shock developed more frequently in patients with takotsubo than NSTEMI (adjusted OR 3.08, 95% CI 1.80-5.28, P<0.001). Thirty-day mortality was 4.1% and was comparable to STEMI and NSTEMI. The long-term risk of dying from takotsubo (median follow-up 25 months) was also comparable to NSTEMI (adjusted HR 1.01, 95% CI 0.70-1.46, P=0.955) STEMI (adjusted HR 0.83, 95% CI 0.57-1.20, P=0.328). CONCLUSIONS The proportion of acute coronary syndromes attributed to takotsubo syndrome in Western Sweden has increased over the last decade. The prognosis of takotsubo syndrome is poor, with similar early and late mortality as STEMI and NSTEMI.


Circulation-cardiovascular Interventions | 2016

Two-Year Outcomes in Patients With Severe Aortic Valve Stenosis Randomized to Transcatheter Versus Surgical Aortic Valve Replacement The All-Comers Nordic Aortic Valve Intervention Randomized Clinical Trial

Lars Søndergaard; Daniel A. Steinbrüchel; Nikolaj Ihlemann; Henrik Nissen; Bo Juel Kjeldsen; Petur Petursson; Anh Thuc Ngo; Niels Thue Olsen; Yanping Chang; Olaf Franzen; Thomas Engstrøm; Peter Clemmensen; Peter Skov Olsen; Hans Gustav Hørsted Thyregod

Background—The Nordic Aortic Valve Intervention (NOTION) trial was the first to randomize all-comers with severe native aortic valve stenosis to either transcatheter aortic valve replacement (TAVR) with the CoreValve self-expanding bioprosthesis or surgical aortic valve replacement (SAVR), including a lower-risk patient population than previous trials. This article reports 2-year clinical and echocardiographic outcomes from the NOTION trial. Methods and Results—Two-hundred eighty patients from 3 centers in Denmark and Sweden were randomized to either TAVR (n=145) or SAVR (n=135) with follow-up planned for 5 years. There was no difference in all-cause mortality at 2 years between TAVR and SAVR (8.0% versus 9.8%, respectively; P=0.54) or cardiovascular mortality (6.5% versus 9.1%; P=0.40). The composite outcome of all-cause mortality, stroke, or myocardial infarction was also similar (15.8% versus 18.8%, P=0.43). Forward-flow hemodynamics were improved following both procedures, with effective orifice area significantly more improved after TAVR than SAVR (effective orifice area, 1.7 versus 1.4 cm2 at 3 months). Mean valve gradients were similar after TAVR and SAVR. When patients were categorized according to Society of Thoracic Surgeons Predicted Risk of Mortality (STS-PROM) (<4% versus ≥4%), there was no statistically significant difference for TAVR and SAVR groups in the composite outcome for low-risk (14.7%, 95% confidence interval, 8.3–21.2 versus 16.8%; 95% confidence interval, 9.7–23.8; P=0.58) or intermediate-risk patients (21.1% versus 27.1%; P=0.59). Conclusions—Two-year results from the NOTION trial demonstrate the continuing safety and effectiveness of TAVR in lower-risk patients. Longer-term data are needed to verify the durability of this procedure in this patient population. Clinical Trial Registration—URL: http://www.clinicaltrials.gov. Unique identifier: NCT01057173.


Circulation-cardiovascular Interventions | 2013

Clinical and Procedural Characteristics Associated With Higher Radiation Exposure During Percutaneous Coronary Interventions and Coronary Angiography

Ronak Delewi; Loes P. Hoebers; Truls Råmunddal; José P.S. Henriques; Oskar Angerås; Jason Stewart; Lotta Robertsson; Magnus Wahlin; Petur Petursson; Jan J. Piek; Per Albertsson; Göran Matejka; Elmir Omerovic

Background—We aim to study the clinical and procedural characteristics associated with higher radiation exposure in patients undergoing percutaneous coronary interventions (PCIs) and coronary angiography. Methods and Results—Our present study included all coronary angiography and PCI procedures in 5 PCI centers in the Western part of Sweden, between January 1, 2008, and January 19, 2012. The radiation exposure and clinical data were collected prospectively in these 5 PCI centers in Sweden as part of the Swedish Coronary Angiography and Angioplasty Registry (SCAAR). A prediction model was made for the radiation exposure (dose–area product) expressed in Gy·cm2. A total of 20 669 procedures were included in the present study, consisting of 9850 PCI and 10 819 coronary angiography procedures. In multivariable analyses, body mass index (&bgr;=1.04; confidence interval [CI], 1.04–1.04; P<0.001); history of coronary artery bypass graft surgery (&bgr;=1.32; CI, 1.28–1.32; P<0.001); 2, 3, or 4 treated lesions (2 treated lesions: &bgr;=1.95; CI, 1.84–2.03; P<0.001; 3 treated lesions: &bgr;=2.34; CI, 2.16–2.53; P<0.001; and 4 treated lesions: &bgr;=2.83; CI, 2.53–3.16; P<0.001); and chronic total occlusion lesions (&bgr;=1.39; CI, 1.31–1.48; P<0.001) were associated with the highest radiation exposure. After adjusting for procedural complexity, radial access route was not associated with increased radiation exposure (&bgr;=1.00; CI, 0.98–1.03; P=0.67). Conclusions—In the largest study population to assess radiation exposure, we found that high body mass index, history of coronary artery bypass graft surgery, number of treated lesions, and chronic total occlusions were associated with the highest patient radiation exposure. Radial access site was not associated with higher radiation exposure when compared with femoral approach.


Journal of the American Heart Association | 2015

Trends in Gender Differences in Cardiac Care and Outcome After Acute Myocardial Infarction in Western Sweden: A Report From the Swedish Web System for Enhancement of Evidence‐Based Care in Heart Disease Evaluated According to Recommended Therapies (SWEDEHEART)

Björn Redfors; Oskar Angerås; Truls Råmunddal; Petur Petursson; Inger Haraldsson; Christian Dworeck; Jacob Odenstedt; Dan Ioaness; A Ravn-Fischer; Peder Wellin; H Sjöland; Lale Tokgozoglu; Hans Tygesen; Erik Frick; Rickard Roupe; Per Albertsson; Elmir Omerovic

Background Cardiovascular disease is the most common cause of death for both genders. Debates are ongoing as to whether gender-specific differences in clinical course, diagnosis, and management of acute myocardial infarction (MI) exist. Methods and Results We compared all men and women who were treated for acute MI at cardiac care units in Västra Götaland, Sweden, between January 1995 and October 2014 by obtaining data from the prospective SWEDEHEART (Swedish Web-System for Enhancement of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies) registry. We performed unadjusted and adjusted Cox proportional hazards and logistic regression analyses on complete case data and on imputed data sets. Overall, 48 118 patients (35.4% women) were diagnosed with acute MI. Women as a group had better age-adjusted prognosis than men, but this survival benefit was absent for younger women (aged <60 years) and for women with ST-segment elevation MI. Compared with men, younger women and women with ST-segment elevation MI were more likely to develop prehospital cardiogenic shock (adjusted odds ratio 1.67, 95% CI 1.30 to 2.16, P<0.001 and adjusted odds ratio 1.31, 95% CI 1.16 to 1.48, P<0.001) and were less likely to be prescribed evidence-based treatment at discharge (P<0.001 for β-blockers, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, statins, and P2Y12 antagonists). Differences in treatment between the genders did not decrease over the study period (P>0.1 for all treatments). Conclusions Women on average have better adjusted prognosis than men after acute MI; however, younger women and women with ST-segment elevation MI have disproportionately poor prognosis and are less likely to be prescribed evidence-based treatment.


International Journal of Cardiology | 2015

17-year trends in incidence and prognosis of cardiogenic shock in patients with acute myocardial infarction in western Sweden

Björn Redfors; Oskar Angerås; Truls Råmunddal; Christian Dworeck; Inger Haraldsson; Dan Ioanes; Petur Petursson; Berglind Libungan; Jacob Odenstedt; J. Stewart; E. Lodin; Magnus Wahlin; Per Albertsson; Göran Matejka; Elmir Omerovic

BACKGROUND Cardiogenic shock remains the leading cause of in hospital death in acute myocardial infarction (AMI) and is associated with a mortality rate of approximately 50%. Here we investigated the 17-year trends in incidence and prognosis of AMI-induced cardiogenic shock in Västra Götaland in western Sweden, an area with approximately 1.6 million inhabitants. The study period includes the transition from thrombolysis to primary percutaneous coronary intervention (PCI) as the region-wide therapy of choice for patients with ST-elevation myocardial infarction (STEMI). METHODS Data on patients hospitalized in cardiac care units in Västra Götaland, Sweden between 1995 and 2013 were obtained from the Swedish Websystem for Enhancement of Evidence-based Care in Heart Disease Evaluated According to Recommended Therapies (SWEDEHEART). We determined the incidence of cardiogenic shock among patients diagnosed with AMI and the risk of death associated with developing cardiogenic shock. We fitted logistic regression models to study which factors predicted post-AMI cardiogenic shock. Analyses were performed on complete case data as well as after multiple imputation of missing data. RESULTS Incidence of cardiogenic shock as a complication of AMI declined in western Sweden in the past decade, from 14% in 1995 to 4% in 2012. The risk of dying once cardiogenic shock had developed increased during the study period (p<0.01). Patients presenting with STEMI were more likely to develop cardiogenic shock than patients presenting with non STEMI (p<0.001). CONCLUSIONS The incidence of cardiogenic shock has declined but cardiogenic shock carries a worse prognosis today than in 1995.


International Journal of Cardiology | 2015

Low socioeconomic status of a patient's residential area is associated with worse prognosis after acute myocardial infarction in Sweden.

Göran Bergström; Björn Redfors; Oskar Angerås; Christian Dworeck; Yangzhen Shao; Inger Haraldsson; Petur Petursson; Davor Miličić; Hans Wedel; Per Albertsson; Truls Råmunddal; Annika Rosengren; Elmir Omerovic

INTRODUCTION Previous studies have established a relationship between socioeconomic status (SES) and survival in coronary heart disease. Acute cardiac care in Sweden is considered to be excellent and independent of SES. We studied the influence of area-level socioeconomic status on mortality after hospitalization for acute myocardial infarction (AMI) between 1995 and 2013 in the Gothenburg metropolitan area, which has little over 800,000 inhabitants and includes three city hospitals. METHODS Data were obtained from the SWEDEHEART registry (Swedish Websystem for Enhancement of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies) and the Swedish Central Bureau of Statistics for patients hospitalized for ST-elevation myocardial infarction (STEMI) and non-STEMI in the city of Gothenburg in Western Sweden. The groups were compared using Cox proportional hazards regression and logistic regression. RESULTS 10,895 (36% female) patients were hospitalized due to AMI during the study period. Patients residing in areas with lower SES had higher rates of smoking and diabetes (P<0.001), and were also at increased risk of developing complications, including heart failure and cardiogenic shock (P<0.05). Living in an area with lower SES associated with increased risk of dying after an AMI also in models adjusted for risk factors (P<0.05). CONCLUSION Also in a country with strong egalitarian traditions, lower SES associates with worse prognosis after AMI, an association that persists after adjustments for differences in traditional cardiovascular risk factors.


Resuscitation | 2015

Angiographic findings and survival in patients undergoing coronary angiography due to sudden cardiac arrest in Western Sweden

Björn Redfors; Truls Råmunddal; Oskar Angerås; Christian Dworeck; Inger Haraldsson; Dan Ioanes; Petur Petursson; Berglind Libungan; Jacob Odenstedt; Jason Stewart; Lotta Robertsson; Magnus Wahlin; Per Albertsson; Johan Herlitz; Elmir Omerovic

AIM Sudden cardiac arrest (SCA) accounts for more than half of all deaths from coronary heart disease. Time to return of spontaneous circulation is the most important determinant of outcome but successful resuscitation also requires percutaneous coronary intervention in selected patients. However, proper selection of patients is difficult. We describe data on angiographic finding and survival from a prospectively followed SCA patient cohort. METHODS We merged the RIKS-HIA registry (Register of Information and Knowledge about Swedish Heart Intensive Care Admissions) and SCAAR (Swedish Coronary Angiography and Angioplasty Registry) for patients hospitalized in cardiac care units in Western Sweden between January 2005 and March 2013. We performed propensity score-adjusted logistic and Cox proportional-hazards regression analyses on complete-case data as well as on imputed data sets. RESULTS 638 consecutive patients underwent coronary angiography due to SCA. Severity of coronary artery disease was similar among SCA patients and patients undergoing coronary angiography due to suspected coronary artery disease (n=37,142). An acute occlusion was reported in the majority of SCA patients and was present in 37% of patients who did not have ST-elevation on the post resuscitation ECG. 31% of SCA patients died within 30 days. Long-term risk of death among patients who survived the first 30 days was higher in patients with SCA compared to patients with acute coronary syndromes (P<0.001). CONCLUSIONS Coronary artery disease and acute coronary occlusions are common among patients who undergo coronary angiography after sudden cardiac arrest. These patients have a substantial mortality risk both short- and long-term.


Acute Cardiac Care | 2014

Does the timing of treatment with intra-aortic balloon counterpulsation in cardiogenic shock due to ST-elevation myocardial infarction affect survival?

Niklas Bergh; Oskar Angerås; Per Albertsson; Christian Dworeck; Göran Matejka; Inger Haraldsson; Dan Ioanes; Berglind Libungan; Jacob Odenstedt; Petur Petursson; Wilhelm Ridderstråle; Truls Råmunddal; Elmir Omerovic

Abstract Background: Intra-aortic balloon pump (IABP) counterpulsation and primary percutaneous coronary intervention (PCI) are standard treatment modalities in cardiogenic shock (CS) complicating acute myocardial infarction. The aim of this study was to investigate the impact of the timing of IABP treatment start in relation to PCI procedure. Methods: Data were obtained from the SCAAR registry (Swedish Coronary Angiography and Angioplasty Registry) about 139 consecutive patients with CS due to ST-elevation myocardial infarction (STEMI) who received IABP treatment. The patients were hospitalized at Sahlgrenska University Hospital, Gothenburg, during 2004–2008. The cohort was divided into the two groups: group (A) in whom IABP treatment started before start of PCI (n = 72) and group (B) in whom IABP treatment started after PCI treatment (n = 67). The primary endpoint was 30-day mortality. Propensity score (PS) adjusted Cox proportional hazards regression was used to analyze predictors of 30-day mortality. Results: Mean age was 66.5 ± 12 and 28% were women. All patients have received IABP treatment 30 min before or 30 min after primary PCI. 63% had diabetes and 28% had hypertension. 16% were active tobacco smokers. The mortality rate at 30 days was 38%. IABP treatment commenced before or after PCI was not an independent predictor of mortality (P = 0.72). Conclusion: In this non-randomized trial the treatment with insertion of IABP before primary PCI in patients with CS due to STEMI is not associated with a more favorable outcome as compared with IABP started after primary PCI.

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Elmir Omerovic

Sahlgrenska University Hospital

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Truls Råmunddal

Sahlgrenska University Hospital

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Per Albertsson

Sahlgrenska University Hospital

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Inger Haraldsson

Sahlgrenska University Hospital

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Jacob Odenstedt

Sahlgrenska University Hospital

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Oskar Angerås

Sahlgrenska University Hospital

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Christian Dworeck

Sahlgrenska University Hospital

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Dan Ioanes

Sahlgrenska University Hospital

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Björn Redfors

Sahlgrenska University Hospital

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Sebastian Völz

Sahlgrenska University Hospital

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