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Carlsson, Jörg
Publications (10 of 31) Show all publications
Danielsson, T., Schreyer, H., Woksepp, H., Johansson, T., Bergman, P., Månsson, A. & Carlsson, J. (2019). Two-peaked increase of serum myosin heavy chain-α after triathlon suggests heart muscle cell death. BMJ Open Sport & Exercise Medicine, 5, Article ID e000486.
Open this publication in new window or tab >>Two-peaked increase of serum myosin heavy chain-α after triathlon suggests heart muscle cell death
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2019 (English)In: BMJ Open Sport & Exercise Medicine, ISSN 2055-7647, Vol. 5, article id e000486Article in journal (Refereed) Published
Abstract [en]

Objective It has been suggested that the mechanism behind cardiac troponin elevation after strenuous exercise is passage through a cell membrane with changed permeability rather than myocardial cell death. We hypothesised that an increase of cardiac specific myosin heavy chain-alpha (MHC-α; 224 kDa compared with cardiac troponin T’s (cTnT) 37 kDa) could hardly be explained by passage through a cell membrane.

Methods Blood samples were collected from 56 athletes (15 female, age 42.5±9.7, range 24–70 years) before, directly after and on days 1–8 after an Ironman. Biomarkers (C reactive protein (CRP), cTnT, creatinekinase (CK), MHC-α, myoglobin (MG), creatinine (C) and N-terminal prohormone of brain natriuretic peptide (NTproBNP) were measured.

Results The course of MHC-α concentration (μg/L) was 1.33±0.53 (before), 2.57±0.78 (directly after), 1.51±0.53 (day 1), 2.74±0.55 (day 4) and 1.83±0.76 (day 6). Other biomarkers showed a one-peaked increase with maximal values either directly after the race or at day 1: cTnT 76 ±80 ng/L (12–440; reference<15), NT-proBNP 776±684 ng/L (92–4700; ref.<300), CK 68±55 μkat/L (5–280; ref.<1.9), MG 2088±2350 μg/L (130–17 000; ref.<72) and creatinine 100±20 μmol/L (74–161; ref.<100), CRP 49±23 mg/L(15–119; ref.<5).

Conclusion MHC-α exhibited a two-peaked increase which could represent a first release from the cytosolic pool and later from cell necrosis. This is the first investigation of MHC-α plasma concentration afterexercise.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2019
Keywords
cardiovascular medicine, physiology, sports and exercise medicine
National Category
Sport and Fitness Sciences Cardiac and Cardiovascular Systems
Research subject
Social Sciences, Sport Science
Identifiers
urn:nbn:se:lnu:diva-79922 (URN)10.1136/ bmjsem-2018-000486 (DOI)30740234 (PubMedID)2-s2.0-85060492223 (Scopus ID)
Available from: 2019-01-25 Created: 2019-01-25 Last updated: 2019-05-23Bibliographically approved
Carlsson, J., Danielsson, T., Bergman, P. & Schreyer, H. (2018). Echocardiographic Findings and Cardiac Biomarkers in Non-Elite Triathletes – Data from the Kalmar Ironwoman Study. In: : . Paper presented at 23rd Annual Congress of the European College of Sport Science, "Sport Science at the cutting edge", 4-7 july 2018, Dublin, Ireland.
Open this publication in new window or tab >>Echocardiographic Findings and Cardiac Biomarkers in Non-Elite Triathletes – Data from the Kalmar Ironwoman Study
2018 (English)Conference paper, Oral presentation with published abstract (Refereed)
Abstract [en]

INTRODUCTION: There is an ongoing debate about the impact of endurance exercise on cardiovascular health. Not at least data on cardiac biomarker changes (e.g. troponin T (cTnT), N-terminal prohormone of brain natriuretic peptide (NT-proBNP) and cardiac specific myosin heavy chain-alpha (MHC-α) have raised questions about exercise related cardiac injury. METHODS: In 52 non-elite athletes (14 female, 38 male; age 41.1 ± 9.7, range 24-70 years; all completed the race) biomarkers were measured by standard laboratory methods 7 days before, directly after, and day 1, 4 and 6 after a full Ironman distance triathlon (Swim 3.9 km, Bike 180 km, Run 42.2 km) . In 19 of these athletes (9 female, 10 male) echocardiography with 30 different standard measurements was performed before and directly after the race. RESULTS: Only MHC-α [µg/L] showed a two-peaked increase directly after (2.57 ± 0.78) and on day 4 (2.74 ± 0.55). Other biomarkers showed a one-peaked increase with maximal values either directly after the race or at day 1: cTnT 76 ± 80 ng/L (12-440; reference <15), NT-proBNP 776 ± 684 ng/L (92-4700; ref. < 300), CK 68 ± 55 µkat/L (5-280; ref. < 1.9), MG 2088 ± 2350 µg/L (130-17000; ref.< 72), and creatinine 100 ± 20 µmol/L (74-161; ref. < 100), CRP 49 ± 23 mg/L (15-119; ref.< 5). No significant echocardiographic changes were recorded. E.g. left ventricular end diastolic diameter (49.0 ± 4.7 mm before, 47.7 ± 5.0 mm after the race, right ventricular end diastolic diameter (34.3 ± 4.3 mm before, 33.3 ± 5.7 mm after the race), right atrial area (17.5 ± 2.9 cm2 before, 17.7 ± 3.6 cm2 after the race) and left atrial area (18.8 ± 3.7 cm2 before, 17.8 ± 2.2 cm2 after the race) did not show any significant acute changes. CONCLUSION: While an Ironman leads to remarkable disturbances in biomarkers as e.g. cTnT after the race was in the range of myocardial infarction in 100% of women and 97% of men, these alterations were not correlated to any acute echocardiographic changes in heart size or function. However, the significance of biochemical evidence of cardiac injury on long-term heart function and cardiovascular health remains unclear.

National Category
Cardiac and Cardiovascular Systems Sport and Fitness Sciences
Research subject
Natural Science, Medicine; Social Sciences, Sport Science
Identifiers
urn:nbn:se:lnu:diva-77240 (URN)
Conference
23rd Annual Congress of the European College of Sport Science, "Sport Science at the cutting edge", 4-7 july 2018, Dublin, Ireland
Available from: 2018-08-23 Created: 2018-08-23 Last updated: 2019-02-22Bibliographically approved
Andersson, M. (2018). Kompressionskläder ger ingen medicinsk effekt. Barometern (September), pp. 4-5
Open this publication in new window or tab >>Kompressionskläder ger ingen medicinsk effekt
2018 (Swedish)In: Barometern, ISSN 1103-906X, no September, p. 4-5Article in journal, News item (Other (popular science, discussion, etc.)) Published
Place, publisher, year, edition, pages
Kalmar: Barometern-OT AB, 2018
National Category
Sport and Fitness Sciences
Research subject
Social Sciences, Sport Science
Identifiers
urn:nbn:se:lnu:diva-79173 (URN)
Available from: 2018-12-13 Created: 2018-12-13 Last updated: 2018-12-13Bibliographically approved
Danielsson, T., Carlsson, J., Bergman, P. & Ahnesjö, J. (2018). Peak oxygen uptake predicts finishing- and segment time in a full distance Ironman. In: Presented at the 23rd annual Congress of the European College of Sport Science (ECSS), Dublin, Ireland, July 4-7, 2018: . Paper presented at 23rd annual Congress of the European College of Sport Science (ECSS), Dublin, Ireland, July 4-7, 2018.
Open this publication in new window or tab >>Peak oxygen uptake predicts finishing- and segment time in a full distance Ironman
2018 (English)In: Presented at the 23rd annual Congress of the European College of Sport Science (ECSS), Dublin, Ireland, July 4-7, 2018, 2018Conference paper, Oral presentation with published abstract (Refereed)
Abstract [en]

INTRODUCTION: Ironman competitions and other extreme endurance events has spread worldwide attracting thousands of endurance-trained athletes, athletes who differ in anthropometric and training characteristics. The relationship between peak oxygen uptake and finishing- and segment time during a full distance IRONMAN competition (Swim 3.9km, Bike 180km and Run 42.2km) has not been examined thoroughly in non-elite athletes.

PURPOSE: The aim of the present study was to investigate the relationship between peak oxygen uptake (VO2peak), finishing time and segment time in non-elite athletes.

METHODS: 39 non-elite athletes (10 female; age 41.1 ± 9.7, range 24-70 years) performed a 20 m shuttle run test to assess VO2peak. Association between VO2 and finishing- and segment time was estimated using bivariate correlation tests. Gender specific analysis was also performed.

RESULTS: VO2peak peak was on average 49.9 ± 6.4 O2 ml/kg/minute, range 36.5-63.9 (pooled genders). Finishing time was on average 11h and 52 min. The average times for the different segments were; Swim 1h 21m, Bike 5h 46min and Run 4h 33min. The relationship between VO2peak and finishing time was significant to p<0.001 and                         0.51. The relationship between segment times were Swim  0.19, Bike  0.37 and Run  0.46 all at p<0.001. Gender specific analyses revealed that the association between VO2peak and finishing time was   0.80 for females and  0.49 for males. 

CONCLUSION: Our results suggest that VO2peak is a good predictor of finishing time (approx. 50%) as well as for segment time with 19%, 37% and 46% for Swim, Bike and Run respectively (pooled genders). For females VO2peak explains as much as 80% of the variation in finishing time.

National Category
Sport and Fitness Sciences
Research subject
Social Sciences, Sport Science
Identifiers
urn:nbn:se:lnu:diva-77097 (URN)
Conference
23rd annual Congress of the European College of Sport Science (ECSS), Dublin, Ireland, July 4-7, 2018
Projects
IRON(WO)MAN
Available from: 2018-08-13 Created: 2018-08-13 Last updated: 2019-02-22Bibliographically approved
Escaned, J., Ryan, N., Mejia-Renteria, H., Cook, C. M., Dehbi, H.-M., Alegria-Barrero, E., . . . Gotberg, M. (2018). Safety of the Deferral of Coronary Revascularization on the Basis of Instantaneous Wave-Free Ratio and Fractional Flow Reserve Measurements in Stable Coronary Artery Disease and Acute Coronary Syndromes. JACC: Cardiovascular Interventions, 11(15), 1437-1449
Open this publication in new window or tab >>Safety of the Deferral of Coronary Revascularization on the Basis of Instantaneous Wave-Free Ratio and Fractional Flow Reserve Measurements in Stable Coronary Artery Disease and Acute Coronary Syndromes
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2018 (English)In: JACC: Cardiovascular Interventions, ISSN 1936-8798, E-ISSN 1876-7605, Vol. 11, no 15, p. 1437-1449Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES The aim of this study was to investigate the clinical outcomes of patients deferred from coronary revascularization on the basis of instantaneous wave-free ratio (iFR) or fractional flow reserve (FFR) measurements in stable angina pectoris (SAP) and acute coronary syndromes (ACS). BACKGROUND Assessment of coronary stenosis severity with pressure guidewires is recommended to determine the need for myocardial revascularization. METHODS The safety of deferral of coronary revascularization in the pooled per-protocol population (n = 4,486) of the DEFINE-FLAIR (Functional Lesion Assessment of Intermediate Stenosis to Guide Revascularisation) and iFR-SWEDEHEART (Instantaneous Wave-Free Ratio Versus Fractional Flow Reserve in Patients With Stable Angina Pectoris or Acute Coronary Syndrome) randomized clinical trials was investigated. Patients were stratified according to revascularization decision making on the basis of iFR or FFR and to clinical presentation (SAP or ACS). The primary endpoint was major adverse cardiac events (MACE), defined as the composite of all-cause death, nonfatal myocardial infarction, or unplanned revascularization at 1 year. RESULTS Coronary revascularization was deferred in 2,130 patients. Deferral was performed in 1,117 patients (50%) in the iFR group and 1,013 patients (45%) in the FFR group (p < 0.01). At 1 year, the MACE rate in the deferred population was similar between the iFR and FFR groups (4.12% vs. 4.05%; fully adjusted hazard ratio: 1.13; 95% confidence interval: 0.72 to 1.79; p = 0.60). A clinical presentation with ACS was associated with a higher MACE rate compared with SAP in deferred patients (5.91% vs. 3.64% in ACS and SAP, respectively; fully adjusted hazard ratio: 0.61 in favor of SAP; 95% confidence interval: 0.38 to 0.99; p = 0.04). CONCLUSIONS Overall, deferral of revascularization is equally safe with both iFR and FFR, with a low MACE rate of about 4%. Lesions were more frequently deferred when iFR was used to assess physiological significance. In deferred patients presenting with ACS, the event rate was significantly increased compared with SAP at 1 year. (C) 2018 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation.

Place, publisher, year, edition, pages
Elsevier, 2018
Keywords
ACS, coronary physiology, deferral of revascularization, FFR, iFR, SAP
National Category
Nursing
Research subject
Health and Caring Sciences, Nursing
Identifiers
urn:nbn:se:lnu:diva-77376 (URN)10.1016/j.jcin.2018.05.029 (DOI)000440859800006 ()30093050 (PubMedID)
Available from: 2018-08-30 Created: 2018-08-30 Last updated: 2018-08-30Bibliographically approved
Varenhorst, C., Lindholm, M., Sarno, G., Olivecrona, G., Jensens, U., Nilsson, J., . . . Lagergvist, B. (2018). Stent thrombosis rates the first year and beyond with new- and old-generation drug-eluting stents compared to bare metal stents. Clinical Research in Cardiology, 107(9), 816-823
Open this publication in new window or tab >>Stent thrombosis rates the first year and beyond with new- and old-generation drug-eluting stents compared to bare metal stents
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2018 (English)In: Clinical Research in Cardiology, ISSN 1861-0684, E-ISSN 1861-0692, Vol. 107, no 9, p. 816-823Article in journal (Refereed) Published
Abstract [en]

Old-generation drug-eluting coronary stents (o-DES) have despite being safe and effective been associated with an increased propensity of late stent thrombosis (ST). We evaluated ST rates in o-DES, new-generation DES (n-DES) and bare metal stents (BMS) the first year (< 1 year) and beyond 1 year (> 1 year). We evaluated all implantations with BMS, o-DES (Cordis Cypher, Boston Scientific Taxus Libert, and Medtronic Endeavor) and n-DES in the Swedish coronary angiography and angioplasty registry (SCAAR) between 1 January 2007 and 8 January 2014 (n = 207 291). All cases of ST (n = 2 268) until 31 December 2014 were analyzed. The overall risk of ST was lower in both n-DES and o-DES compared with BMS up to 1 year (n-DES versus BMS: adjusted risk ratio (RR) 0.48 (0.41-0.58) and o-DES versus BMS: 0.56 (0.46-0.67), both p < 0.001). From 1 year after stent implantation and onward, the risk for ST was higher in o-DES compared with BMS [adjusted RR, 1.82 (1.47-2.25], p < 0.001). N-DES were associated with similar low ST rates as BMS from 1 year and onward [adjusted RR 1.21 (0.94-1.56), p = 0.135]. New-generation DES were associated with lower ST rates in comparison to BMS during the first-year post-stenting. After 1 year, n-DES and BMS were associated with similar ST rates. This study was a retrospective observational study and as such did not require clinical trial database registration.

Place, publisher, year, edition, pages
Springer, 2018
Keywords
Bare metal stents, Drug-eluting stents, Stent thrombosis, Percutaneous coronary intervention
National Category
Nursing
Research subject
Health and Caring Sciences, Nursing
Identifiers
urn:nbn:se:lnu:diva-77726 (URN)10.1007/s00392-018-1252-0 (DOI)000442201300010 ()29667015 (PubMedID)
Available from: 2018-09-13 Created: 2018-09-13 Last updated: 2018-09-13Bibliographically approved
Bertilsson, E., Semark, B., Schildmeijer, K., Bremer, A. & Carlsson, J. (2018). Usage of Do-not-attempt-to resuscitate-orders in a Swedish community hospital: patient involvement, documentation and compliance. Paper presented at The Congress of the European Resuscitation Council, Bologna, Italy, September 20–22, 2018. Resuscitation, 130(s1), e93-e94
Open this publication in new window or tab >>Usage of Do-not-attempt-to resuscitate-orders in a Swedish community hospital: patient involvement, documentation and compliance
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2018 (English)In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 130, no s1, p. e93-e94Article in journal, Meeting abstract (Refereed) Published
Place, publisher, year, edition, pages
Elsevier, 2018
Keywords
Do-not-attempt-to resuscitate-orders, Cardiopulmonary resuscitation, Compliance, Patient involvement, Documentation
National Category
Medical Ethics
Research subject
Natural Science, Medicine
Identifiers
urn:nbn:se:lnu:diva-77920 (URN)10.1016/j.resuscitation.2018.07.193 (DOI)
Conference
The Congress of the European Resuscitation Council, Bologna, Italy, September 20–22, 2018
Note

Part of special issue: RESUSCITATION 2018 - New technologies in resuscitation: Abstracts

Available from: 2018-09-20 Created: 2018-09-20 Last updated: 2019-04-12Bibliographically approved
Carlsson, J., Danielsson, T. & Bergman, P. (2017). A two-peaked increase of serum myosin heavy chain-α after full distance triathlon demonstrates heart muscle cell death. Paper presented at 83th Annual Meeting of the German Cardiac Society – Cardiac and Circulation Research, Mannheim, Germany, April 19-22, 2017. Clinical Research in Cardiology, 106(Suppl 1), Article ID P1159.
Open this publication in new window or tab >>A two-peaked increase of serum myosin heavy chain-α after full distance triathlon demonstrates heart muscle cell death
2017 (English)In: Clinical Research in Cardiology, ISSN 1861-0684, E-ISSN 1861-0692, Vol. 106, no Suppl 1, article id P1159Article in journal, Meeting abstract (Refereed) Published
Abstract [en]

Background: There is an ongoing debate about the significance of cardiac troponin T (cTnT) elevation after strenuous exercise: heart muscle cell death versus physiologic mechanism of release through an intact cell membrane. While cTnT is a small molecule (37 kDa), cardiac specific myosin heavy chain-alpha (MHC-α) is much larger (224 kDa) and an increase after exercise could hardly be explained by passage through an intact cardiac cell membrane. PURPOSE: To measure MHC-α, and other biomarkers (C-reactive protein (CRP); cTnT, creatine kinase (CK), myoglobin (MG), creatinine (C), and N-terminal prohormone of brain natriuretic peptide (NT-proBNP) before and after a full distance Ironman in order to answer the question of heart muscle cell death versus physiologic changes. 

Methods: In 52 non-elite athletes (14 female, 38 male; age 41.1 ± 9.7, range 24-70 years; all completed the race) biomarkers were measured by standard laboratory methods 7 days before, directly after, and day 1, 4 and 6 after the race. MHC-α was measured with a commercially available ELISA with no cross reactivity with other myosins. 

Results: The course of MHC-α concentration [µg/L] was 1.33 ± 0.53 (before), 2.57 ± 0.78 (directly after), 1.51 ± 0.53 (day 1), 2.74 ± 0.55 (day 4) and 1.83 ± 0.76 (day 6). Other biomarkers showed a one-peaked increase with maximal values either directly after the race or at day 1: cTnT 76 ± 80 ng/L (12-440; reference <15), NT-proBNP 776 ± 684 ng/L (92-4700; ref. < 300), CK 68 ± 55 µkat/L (5-280; ref. < 1.9), MG 2088 ± 2350 µg/L (130-17000; ref.< 72), and creatinine 100 ± 20 µmol/L (74-161; ref. < 100), CRP 49 ± 23 mg/L (15-119; ref.< 5). There was a significant correlation between MHC-α and NT-proBNP (R=0.48; p<0.001) but neither between MHC-α and cTnT (R=0.13; p=0.36) nor MHC-α and myoglobin (R=0.18; p=0.2). 

Conclusion: An Ironman leads to remarkable disturbances in biomarkers as e.g. cTnT was in the range of myocardial infarction in 100% of women and 97% of men. This is to our best knowledge the first investigation of MHC-α after strenuous exercise and its two-peaked increase most likely represents first release from the cytosolic pool and later from cell necrosis including the contractile apparatus. However, many questions remain, not at least why MHC-α baseline levels are as high as 1.33 ± 0.53 µg/L. 

Place, publisher, year, edition, pages
Springer, 2017
National Category
Cardiac and Cardiovascular Systems
Research subject
Health and Caring Sciences
Identifiers
urn:nbn:se:lnu:diva-67877 (URN)10.1007/s00392-017-1105-2 (DOI)
Conference
83th Annual Meeting of the German Cardiac Society – Cardiac and Circulation Research, Mannheim, Germany, April 19-22, 2017
Available from: 2017-09-08 Created: 2017-09-08 Last updated: 2018-12-13Bibliographically approved
Danielsson, T., Carlsson, J., Schreyer, H., Ahnesjö, J., ten Siethoff, L., Ragnarsson, T., . . . Bergman, P. (2017). Blood biomarkers in male and female participants after an Ironman-distance triathlon. PLoS ONE, 12(6), 1-9, Article ID e0179324.
Open this publication in new window or tab >>Blood biomarkers in male and female participants after an Ironman-distance triathlon
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2017 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 12, no 6, p. 1-9, article id e0179324Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: While overall physical activity is clearly associated with a better short-term and long-term health, prolonged strenuous physical activity may result in a rise in acute levels of blood-biomarkers used in clinical practice for diagnosis of various conditions or diseases. In this study, we explored the acute effects of a full Ironman-distance triathlon on biomarkers related to heart-, liver-, kidney- and skeletal muscle damage immediately post-race and after one week's rest. We also examined if sex, age, finishing time and body composition influenced the post-race values of the biomarkers.

METHODS: A sample of 30 subjects was recruited (50% women) to the study. The subjects were evaluated for body composition and blood samples were taken at three occasions, before the race (T1), immediately after (T2) and one week after the race (T3). Linear regression models were fitted to analyse the independent contribution of sex and finishing time controlled for weight, body fat percentage and age, on the biomarkers at the termination of the race (T2). Linear mixed models were fitted to examine if the biomarkers differed between the sexes over time (T1-T3).

RESULTS: Being male was a significant predictor of higher post-race (T2) levels of myoglobin, CK, and creatinine levels and body weight was negatively associated with myoglobin. In general, the models were unable to explain the variation of the dependent variables. In the linear mixed models, an interaction between time (T1-T3) and sex was seen for myoglobin and creatinine, in which women had a less pronounced response to the race.

CONCLUSION: Overall women appear to tolerate the effects of prolonged strenuous physical activity better than men as illustrated by their lower values of the biomarkers both post-race as well as during recovery.

National Category
Sport and Fitness Sciences
Research subject
Social Sciences, Sport Science
Identifiers
urn:nbn:se:lnu:diva-65765 (URN)10.1371/journal.pone.0179324 (DOI)000403274700028 ()28609447 (PubMedID)
Available from: 2017-06-22 Created: 2017-06-22 Last updated: 2018-12-13Bibliographically approved
Gotberg, M., Christiansen, E. H., Gudmundsdottir, I. J., Sandhall, L., Danielewicz, M., Jakobsen, L., . . . Frobert, O. (2017). Instantaneous Wave-free Ratio versus Fractional Flow Reserve to Guide PCI. New England Journal of Medicine, 376(19), 1813-1823
Open this publication in new window or tab >>Instantaneous Wave-free Ratio versus Fractional Flow Reserve to Guide PCI
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2017 (English)In: New England Journal of Medicine, ISSN 0028-4793, E-ISSN 1533-4406, Vol. 376, no 19, p. 1813-1823Article in journal (Refereed) Published
Abstract [en]

BACKGROUND The instantaneous wave-free ratio (iFR) is an index used to assess the severity of coronary-artery stenosis. The index has been tested against fractional flow reserve (FFR) in small trials, and the two measures have been found to have similar diagnostic accuracy. However, studies of clinical outcomes associated with the use of iFR are lacking. We aimed to evaluate whether iFR is noninferior to FFR with respect to the rate of subsequent major adverse cardiac events. METHODS We conducted a multicenter, randomized, controlled, open-label clinical trial using the Swedish Coronary Angiography and Angioplasty Registry for enrollment. A total of 2037 participants with stable angina or an acute coronary syndrome who had an indication for physiologically guided assessment of coronary-artery stenosis were randomly assigned to undergo revascularization guided by either iFR or FFR. The primary end point was the rate of a composite of death from any cause, nonfatal myocardial infarction, or unplanned revascularization within 12 months after the procedure. RESULTS A primary end-point event occurred in 68 of 1012 patients (6.7%) in the iFR group and in 61 of 1007 (6.1%) in the FFR group (difference in event rates, 0.7 percentage points; 95% confidence interval [CI], -1.5 to 2.8; P = 0.007 for noninferiority; hazard ratio, 1.12; 95% CI, 0.79 to 1.58; P = 0.53); the upper limit of the 95% confidence interval for the difference in event rates fell within the prespecified noninferiority margin of 3.2 percentage points. The results were similar among major subgroups. The rates of myocardial infarction, target-lesion revascularization, restenosis, and stent thrombosis did not differ significantly between the two groups. A significantly higher proportion of patients in the FFR group than in the iFR group reported chest discomfort during the procedure. CONCLUSIONS Among patients with stable angina or an acute coronary syndrome, an iFR-guided revascularization strategy was noninferior to an FFR-guided revascularization strategy with respect to the rate of major adverse cardiac events at 12 months.

National Category
Cardiac and Cardiovascular Systems
Research subject
Health and Caring Sciences
Identifiers
urn:nbn:se:lnu:diva-64427 (URN)10.1056/NEJMoa1616540 (DOI)000400891100007 ()28317438 (PubMedID)
Available from: 2017-05-29 Created: 2017-05-29 Last updated: 2017-11-01Bibliographically approved
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