Thor Trovik - Academia.edu (original) (raw)

Papers by Thor Trovik

Research paper thumbnail of P3673Differences in mortality between patients referred to coronary angiography with stable angina or unstable angina

European Heart Journal, Aug 1, 2017

Background: The benefits and harms of oral P2Y12 inhibitors in women are not known, particularly ... more Background: The benefits and harms of oral P2Y12 inhibitors in women are not known, particularly for the newer P2Y12 inhibitors Prasugrel and Ticagrelor. Methods: We performed a systematic review of randomised controlled trials of P2Y12 inhibitors and meta-analysed these data to produce gender-specific estimates of relative treatment efficacy for novel P2Y12 inhibitors (prasugrel and ticagrelor) in acute coronary syndrome and stroke. We subsequently combined these estimates with data on event rates in a Scottish population to estimate the absolute treatment effect using a Bayesian framework. Results: From 7,148 articles identified through database searching, 36 potentially relevant articles were reviewed in detail. Of these, we identified 8 that fulfilled our inclusion criteria (CURE, COMMIT, CLARITY-TIMI 28, CHANCE, SPS3, TRITON-TIMI 38, PLATO and TRILOGY ACS). Overall, only 29.7% (32,561/109,570) of trial participants were women. The average gender-treatment interaction indicated lower efficacy for women than men. The rate ratio for interaction was 1.09 (95% CI 1.01-1.18). Women experienced a larger risk of subsequent cardiovascular death following myocardial infarction (22.6% vs 14.8%) but bleeding deaths were similar (1.1% vs 0.8%) using age and sex-specific outcome data for men and women in Scotland. When the small relative difference in treatment effect was applied to data representative of the population, the absolute risk reduction in all-cause mortality at one-year was similar in both sexes (2.30%; 95% CI 1.51 to 3.05 and 2.06%; 95% CI 0.29 to 3.73 in men and women respectively). RR of gender-treatment for MACE Conclusion: In a meta-analysis and modelling study using data from 100,000 participants randomised to P2Y12-inhibitors and over 45,000 patients from the Scottish population hospitalized we have identified that newer P2Y12 inhibitors are less efficacious in women than men (around 1.1-fold lower), but that the absolute risk reduction is similar in both sexes.

Research paper thumbnail of Significant improvement over a year of diagnostic accuracy for coronary artery stenosis with low dose cardiac CT in 420 consecutively referred patients without previous coronary revascularisation

European Heart Journal, 2013

Research paper thumbnail of Age-Stratified Outcome in Treatment of Left Main Coronary Artery Stenosis: A NOBLE Trial Substudy

Cardiology

Background: In the treatment of left main coronary artery (LMCA) disease, patients’ age may affec... more Background: In the treatment of left main coronary artery (LMCA) disease, patients’ age may affect the clinical outcome after percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). This study stratified the clinical outcome according to the age of patients treated for LMCA stenosis with PCI or CABG in the Nordic-Baltic-British Left Main Revascularization (NOBLE) study. Methods: Patients with LMCA disease were enrolled in 36 centers in northern Europe and randomized 1:1 to treatment by PCI or CABG. Eligible patients had stable angina pectoris, unstable angina pectoris, or non-ST elevation myocardial infarction. The primary endpoint was major adverse cardiac or cerebrovascular events (MACCEs), a composite of all-cause mortality, nonprocedural myocardial infarction, any repeat coronary revascularization, and stroke. Age-stratified analysis was performed for the groups younger and older than 67 years and for patients older than 80 years. Results: For patient...

Research paper thumbnail of Low Pain Tolerance Is Associated With Coronary Angiography, Coronary Artery Disease, and Mortality: The Tromsø Study

Journal of the American Heart Association

Background The initial presentation to coronary angiography and extent of coronary artery disease... more Background The initial presentation to coronary angiography and extent of coronary artery disease (CAD) vary greatly among patients, from ischemia with no obstructive CAD to myocardial infarction with 3‐vessel disease. Pain tolerance has been suggested as a potential mechanism for the variation in presentation of CAD. We aimed to investigate the association between pain tolerance, coronary angiography, CAD, and death. Methods and Results We identified 9576 participants in the Tromsø Study (2007–2008) who completed the cold‐pressor pain test, and had no prior history of CAD. The median follow‐up time was 10.4 years. We applied Cox‐regression models with age as time‐scale to calculate hazard ratios (HR). More women than men aborted the cold pressor test (39% versus 23%). Participants with low pain tolerance had 19% increased risk of coronary angiography (HR, 1.19 [95% CI, 1.03–1.38]) and 22% increased risk of obstructive CAD (HR, 1.22 [95% CI, 1.01–1.47]) adjusted by age as time‐scale...

Research paper thumbnail of Percutaneous Coronary Intervention for Vulnerable Coronary Atherosclerotic Plaque

Journal of the American College of Cardiology

Research paper thumbnail of Identification of vulnerable plaques and patients by intracoronary near-infrared spectroscopy and ultrasound (PROSPECT II): a prospective natural history study

Research paper thumbnail of Direct angiography demonstrates equal 8–12 years patency rates of radial artery and saphenous vein grafts

Scandinavian Cardiovascular Journal

Research paper thumbnail of Randomised comparison of provisional side branch stenting versus a two-stent strategy for treatment of true coronary bifurcation lesions involving a large side branch: the Nordic-Baltic Bifurcation Study IV

Open Heart

BackgroundIt is still uncertain whether coronary bifurcations with lesions involving a large side... more BackgroundIt is still uncertain whether coronary bifurcations with lesions involving a large side branch (SB) should be treated by stenting the main vessel and provisional stenting of the SB (simple) or by routine two-stent techniques (complex). We aimed to compare clinical outcome after treatment of lesions in large bifurcations by simple or complex stent implantation.MethodsThe study was a randomised, superiority trial. Enrolment required a SB≥2.75 mm, ≥50% diameter stenosis in both vessels, and allowed SB lesion length up to 15 mm. The primary endpoint was a composite of cardiac death, non-procedural myocardial infarction and target lesion revascularisation at 6 months. Two-year clinical follow-up was included in this primary reporting due to lower than expected event rates.ResultsA total of 450 patients were assigned to simple stenting (n=221) or complex stenting (n=229) in 14 Nordic and Baltic centres. Two-year follow-up was available in 218 (98.6%) and 228 (99.5%) patients, re...

Research paper thumbnail of Percutaneous coronary angioplasty versus coronary artery bypass grafting in the treatment of unprotected left main stenosis: updated 5-year outcomes from the randomised, non-inferiority NOBLE trial

Research paper thumbnail of Calculating the 30-day Survival Rate in Acute Myocardial Infarction: Should we Use the Treatment Chain or the Hospital Catchment Model?

Heart International

Introduction: Acute myocardial infarction (AMI) is a potentially deadly disease and significant e... more Introduction: Acute myocardial infarction (AMI) is a potentially deadly disease and significant efforts have been concentrated on improving hospital performance. A 30-day survival rate has become a key quality of care indicator. In Northern Norway, some patients undergoing AMI are directly transferred to the Regional Cardiac Intervention Center at the University Hospital of North Norway in Tromsø. Here, coronary angiography and percutaneous coronary intervention is performed. Consequently, local hospitals may be bypassed in the treatment chain, generating differences in case mix, and making the treatment chain model difficult to interpret. We aimed to compare the treatment chain model with an alternative based on patients' place of living. Methods: Between 2013 and 2015, a total of 3,155 patients were registered in the Norwegian Patient Registry database. All patients were categorized according to their local hospital's catchment area. The method of Guo-Romano, with an indifference interval of 0.02, was used to test whether a hospital was an outlier or not. We adjusted for age, sex, comorbidity, and number of prior hospitalizations. Conclusions: We revealed the 30-day AMI survival figure ranging between 88.0% and 93.5% (absolute difference 5.5%) using the hospital catchment method. The treatment chain rate ranged between 86.0% and 94.0% (absolute difference 8.0%). The latter figure is the one published as the National Quality of Care Measure in Norway. Local hospitals may get negative attention even though their catchment area is well served. We recommend the hospital catchment method as the first choice when measuring equality of care.

Research paper thumbnail of Changes in symptoms of anxiety and depression following diagnostic angiography: a prospective cohort study

European heart journal. Quality of care & clinical outcomes, Apr 1, 2018

Coronary angiography is the gold standard diagnostic test for coronary artery disease (CAD), and ... more Coronary angiography is the gold standard diagnostic test for coronary artery disease (CAD), and the diagnostic results can have an immediate effect on symptoms. The aim of this study was to explore the long-term impact of diagnostic angiography on symptoms of anxiety and depression in a group of patients without previous CAD. The prospective cohort study included 459 consecutive patients undergoing invasive angiography and was approved by the regional board of ethics. Data were collected at baseline and after 6 and 12 months using self-reports. Symptoms of anxiety and depression were measured with the Hospital Anxiety and Depression Scale (HADS). The sample population had a mean age of 62 years and included 197 (43%) women. Fifty-three percent had hypertension, and 17% had diabetes. The diagnostic results indicated that 41% of patients had normal vessels; 21% had wall changes; and 38% had obstructive stenosis. No significant difference was found between the diagnostic groups at bas...

Research paper thumbnail of Pre-test characteristics of unstable angina patients with obstructive coronary artery disease confirmed by coronary angiography

Open Heart

ObjectivePatients referred for acute coronary angiography (CAG) with unstable angina (UA) have lo... more ObjectivePatients referred for acute coronary angiography (CAG) with unstable angina (UA) have low mortality and low rate of obstructive coronary artery disease (CAD). Better pre-test selection criteria are warranted. We aimed to assess the current guidelines against other clinical variables as predictors of obstructive CAD in patients with UA referred for acute CAG.MethodsFrom 2005 to 2012, all CAGs performed at the University Hospital of North Norway, the sole provider of CAG in the region, were recorded in a registry. We included 979 admissions of UA and retrospectively collected data regarding presenting clinical parameters from patient hospital records. Obstructive CAD was defined as ≥50% stenosis and considered prognostically significant if found in the left main stem, proximal LAD or all three main coronary arteries. Characteristics were analysed by logistic regression analysis. A score was developed using ORs from significant factors in a multivariable model.ResultsThe overa...

Research paper thumbnail of Percutaneous coronary angioplasty versus coronary artery bypass grafting in treatment of unprotected left main stenosis (NOBLE): a prospective, randomised, open-label, non-inferiority trial

The Lancet, 2016

coronary angioplasty versus coronary artery bypass grafting in treatment of unprotected left main... more coronary angioplasty versus coronary artery bypass grafting in treatment of unprotected left main stenosis (NOBLE): a prospective, randomised, open-label, non-inferiority trial.

Research paper thumbnail of Drug-Eluting or Bare-Metal Stents for Coronary Artery Disease

New England Journal of Medicine, 2016

Background Limited data are available on the long-term effects of contemporary drug-eluting stent... more Background Limited data are available on the long-term effects of contemporary drug-eluting stents versus contemporary bare-metal stents on rates of death, myocardial infarction, repeat revascularization, and stent thrombosis and on quality of life. Methods We randomly assigned 9013 patients who had stable or unstable coronary artery disease to undergo percutaneous coronary intervention (PCI) with the implantation of either contemporary drug-eluting stents or bare-metal stents. In the group receiving drug-eluting stents, 96% of the patients received either everolimus- or zotarolimus-eluting stents. The primary outcome was a composite of death from any cause and nonfatal spontaneous myocardial infarction after a median of 5 years of follow-up. Secondary outcomes included repeat revascularization, stent thrombosis, and quality of life. Results At 6 years, the rates of the primary outcome were 16.6% in the group receiving drug-eluting stents and 17.1% in the group receiving bare-metal stents (hazard ratio, 0.98; 95% confidence interval [CI], 0.88 to 1.09; P=0.66). There were no significant between-group differences in the components of the primary outcome. The 6-year rates of any repeat revascularization were 16.5% in the group receiving drug-eluting stents and 19.8% in the group receiving bare-metal stents (hazard ratio, 0.76; 95% CI, 0.69 to 0.85; P<0.001); the rates of definite stent thrombosis were 0.8% and 1.2%, respectively (P=0.0498). Quality-of-life measures did not differ significantly between the two groups. Conclusions In patients undergoing PCI, there were no significant differences between those receiving drug-eluting stents and those receiving bare-metal stents in the composite outcome of death from any cause and nonfatal spontaneous myocardial infarction. Rates of repeat revascularization were lower in the group receiving drug-eluting stents. (Funded by the Norwegian Research Council and others; NORSTENT ClinicalTrials.gov number, NCT00811772 .).

Research paper thumbnail of Return of �-adrenergic sensitivity in a patient with insulinoma after removal of the tumour

Research paper thumbnail of Dysfunction in the p2.adrenergic signal pathway in patients with insulin dependent diabetes mellitus (IDDM) and unawareness of hypoglycaemia

Eur J Clin Pharmacol, 1995

Research paper thumbnail of Nasjonale anbefalinger for tolkning av troponinverdier ved diagnostikk av akutt hjerteinfarkt

Tidsskrift for Den norske legeforening, 2013

Research paper thumbnail of Nye anbefalinger for tolking av troponinverdier

Tidsskrift for Den norske legeforening, 2013

(f. 1969) er spesialist i medisinsk biokjemi og avdelingsoverlege ved Sentrallaboratoriet, Sykehu... more (f. 1969) er spesialist i medisinsk biokjemi og avdelingsoverlege ved Sentrallaboratoriet, Sykehuset i Vestfold. Forfatter har fylt ut ICMJE-skjemaet og oppgir ingen interessekonflikter.

Research paper thumbnail of Catecholamine binding and concentrations in acute phase plasma after surgery

Scandinavian Journal of Clinical and Laboratory Investigation, 1988

The present study was undertaken to decide whether the bound fractions and/or total concentration... more The present study was undertaken to decide whether the bound fractions and/or total concentrations of catecholamines were determinative for the variability of biologically active concentrations in human plasma. The binding and concentrations of noradrenaline (NA) and adrenalin (Adr) were determined in acute phase plasma after major hip surgery in five subjects. The bound fractions before surgery were 23.0% and 18.4% for NA and Adr, respectively. The binding of catecholamines increased in the post-operative period. Five days after surgery the binding of NA and Adr was 30.9% and 24.0%, respectively. The surgical trauma induced an acute phase reaction in plasma with a decrease of albumin (HSA) concentrations whereas the concentrations of alpha-1 acid glycoprotein (AAG) increased. The catecholamine concentrations showed a considerable inter- and intraindividual variability. However, the present work shows that the variability of the biologically active catecholamine concentrations is mainly dependent on the total plasma concentrations and not the plasma protein binding.

Research paper thumbnail of Coronary bypass graft patency cannot be determined by multidetector spiral computed tomography

Scandinavian Cardiovascular Journal, 2006

Angiography by selective catheterization is the reference standard for coronary bypass graft pate... more Angiography by selective catheterization is the reference standard for coronary bypass graft patency assessment but carries a risk of serious complications. We have investigated whether 16-slice multidetector spiral computed tomography (MDCT) can substitute for selective angiography. Two to three years after coronary artery bypass grafting, 45 patients with a total of 156 bypasses (100 single and 28 sequential grafts) were examined with both MDCT and conventional selective angiography on the same day. The bypasses were classified as patent, stenotic or occluded. The likelihood ratio for MDCT-detected occlusion was 40, reflecting a fairly high combined sensitivity and specificity. However, 24% of the distal anastomoses could not be evaluated by MDCT, mainly because of respiratory movements, artifacts due to metal clips, and small vessel dimensions. Moreover, seven out of 117 bypasses (6%) deemed evaluable by MDCT were wrongly classified by this method. At present, 16-slice MDCT cannot replace selective angiography for assessment of coronary bypass graft patency since 24% of bypasses could not be evaluated by this method, and an error rate of 6% is unacceptable.

Research paper thumbnail of P3673Differences in mortality between patients referred to coronary angiography with stable angina or unstable angina

European Heart Journal, Aug 1, 2017

Background: The benefits and harms of oral P2Y12 inhibitors in women are not known, particularly ... more Background: The benefits and harms of oral P2Y12 inhibitors in women are not known, particularly for the newer P2Y12 inhibitors Prasugrel and Ticagrelor. Methods: We performed a systematic review of randomised controlled trials of P2Y12 inhibitors and meta-analysed these data to produce gender-specific estimates of relative treatment efficacy for novel P2Y12 inhibitors (prasugrel and ticagrelor) in acute coronary syndrome and stroke. We subsequently combined these estimates with data on event rates in a Scottish population to estimate the absolute treatment effect using a Bayesian framework. Results: From 7,148 articles identified through database searching, 36 potentially relevant articles were reviewed in detail. Of these, we identified 8 that fulfilled our inclusion criteria (CURE, COMMIT, CLARITY-TIMI 28, CHANCE, SPS3, TRITON-TIMI 38, PLATO and TRILOGY ACS). Overall, only 29.7% (32,561/109,570) of trial participants were women. The average gender-treatment interaction indicated lower efficacy for women than men. The rate ratio for interaction was 1.09 (95% CI 1.01-1.18). Women experienced a larger risk of subsequent cardiovascular death following myocardial infarction (22.6% vs 14.8%) but bleeding deaths were similar (1.1% vs 0.8%) using age and sex-specific outcome data for men and women in Scotland. When the small relative difference in treatment effect was applied to data representative of the population, the absolute risk reduction in all-cause mortality at one-year was similar in both sexes (2.30%; 95% CI 1.51 to 3.05 and 2.06%; 95% CI 0.29 to 3.73 in men and women respectively). RR of gender-treatment for MACE Conclusion: In a meta-analysis and modelling study using data from 100,000 participants randomised to P2Y12-inhibitors and over 45,000 patients from the Scottish population hospitalized we have identified that newer P2Y12 inhibitors are less efficacious in women than men (around 1.1-fold lower), but that the absolute risk reduction is similar in both sexes.

Research paper thumbnail of Significant improvement over a year of diagnostic accuracy for coronary artery stenosis with low dose cardiac CT in 420 consecutively referred patients without previous coronary revascularisation

European Heart Journal, 2013

Research paper thumbnail of Age-Stratified Outcome in Treatment of Left Main Coronary Artery Stenosis: A NOBLE Trial Substudy

Cardiology

Background: In the treatment of left main coronary artery (LMCA) disease, patients’ age may affec... more Background: In the treatment of left main coronary artery (LMCA) disease, patients’ age may affect the clinical outcome after percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). This study stratified the clinical outcome according to the age of patients treated for LMCA stenosis with PCI or CABG in the Nordic-Baltic-British Left Main Revascularization (NOBLE) study. Methods: Patients with LMCA disease were enrolled in 36 centers in northern Europe and randomized 1:1 to treatment by PCI or CABG. Eligible patients had stable angina pectoris, unstable angina pectoris, or non-ST elevation myocardial infarction. The primary endpoint was major adverse cardiac or cerebrovascular events (MACCEs), a composite of all-cause mortality, nonprocedural myocardial infarction, any repeat coronary revascularization, and stroke. Age-stratified analysis was performed for the groups younger and older than 67 years and for patients older than 80 years. Results: For patient...

Research paper thumbnail of Low Pain Tolerance Is Associated With Coronary Angiography, Coronary Artery Disease, and Mortality: The Tromsø Study

Journal of the American Heart Association

Background The initial presentation to coronary angiography and extent of coronary artery disease... more Background The initial presentation to coronary angiography and extent of coronary artery disease (CAD) vary greatly among patients, from ischemia with no obstructive CAD to myocardial infarction with 3‐vessel disease. Pain tolerance has been suggested as a potential mechanism for the variation in presentation of CAD. We aimed to investigate the association between pain tolerance, coronary angiography, CAD, and death. Methods and Results We identified 9576 participants in the Tromsø Study (2007–2008) who completed the cold‐pressor pain test, and had no prior history of CAD. The median follow‐up time was 10.4 years. We applied Cox‐regression models with age as time‐scale to calculate hazard ratios (HR). More women than men aborted the cold pressor test (39% versus 23%). Participants with low pain tolerance had 19% increased risk of coronary angiography (HR, 1.19 [95% CI, 1.03–1.38]) and 22% increased risk of obstructive CAD (HR, 1.22 [95% CI, 1.01–1.47]) adjusted by age as time‐scale...

Research paper thumbnail of Percutaneous Coronary Intervention for Vulnerable Coronary Atherosclerotic Plaque

Journal of the American College of Cardiology

Research paper thumbnail of Identification of vulnerable plaques and patients by intracoronary near-infrared spectroscopy and ultrasound (PROSPECT II): a prospective natural history study

Research paper thumbnail of Direct angiography demonstrates equal 8–12 years patency rates of radial artery and saphenous vein grafts

Scandinavian Cardiovascular Journal

Research paper thumbnail of Randomised comparison of provisional side branch stenting versus a two-stent strategy for treatment of true coronary bifurcation lesions involving a large side branch: the Nordic-Baltic Bifurcation Study IV

Open Heart

BackgroundIt is still uncertain whether coronary bifurcations with lesions involving a large side... more BackgroundIt is still uncertain whether coronary bifurcations with lesions involving a large side branch (SB) should be treated by stenting the main vessel and provisional stenting of the SB (simple) or by routine two-stent techniques (complex). We aimed to compare clinical outcome after treatment of lesions in large bifurcations by simple or complex stent implantation.MethodsThe study was a randomised, superiority trial. Enrolment required a SB≥2.75 mm, ≥50% diameter stenosis in both vessels, and allowed SB lesion length up to 15 mm. The primary endpoint was a composite of cardiac death, non-procedural myocardial infarction and target lesion revascularisation at 6 months. Two-year clinical follow-up was included in this primary reporting due to lower than expected event rates.ResultsA total of 450 patients were assigned to simple stenting (n=221) or complex stenting (n=229) in 14 Nordic and Baltic centres. Two-year follow-up was available in 218 (98.6%) and 228 (99.5%) patients, re...

Research paper thumbnail of Percutaneous coronary angioplasty versus coronary artery bypass grafting in the treatment of unprotected left main stenosis: updated 5-year outcomes from the randomised, non-inferiority NOBLE trial

Research paper thumbnail of Calculating the 30-day Survival Rate in Acute Myocardial Infarction: Should we Use the Treatment Chain or the Hospital Catchment Model?

Heart International

Introduction: Acute myocardial infarction (AMI) is a potentially deadly disease and significant e... more Introduction: Acute myocardial infarction (AMI) is a potentially deadly disease and significant efforts have been concentrated on improving hospital performance. A 30-day survival rate has become a key quality of care indicator. In Northern Norway, some patients undergoing AMI are directly transferred to the Regional Cardiac Intervention Center at the University Hospital of North Norway in Tromsø. Here, coronary angiography and percutaneous coronary intervention is performed. Consequently, local hospitals may be bypassed in the treatment chain, generating differences in case mix, and making the treatment chain model difficult to interpret. We aimed to compare the treatment chain model with an alternative based on patients' place of living. Methods: Between 2013 and 2015, a total of 3,155 patients were registered in the Norwegian Patient Registry database. All patients were categorized according to their local hospital's catchment area. The method of Guo-Romano, with an indifference interval of 0.02, was used to test whether a hospital was an outlier or not. We adjusted for age, sex, comorbidity, and number of prior hospitalizations. Conclusions: We revealed the 30-day AMI survival figure ranging between 88.0% and 93.5% (absolute difference 5.5%) using the hospital catchment method. The treatment chain rate ranged between 86.0% and 94.0% (absolute difference 8.0%). The latter figure is the one published as the National Quality of Care Measure in Norway. Local hospitals may get negative attention even though their catchment area is well served. We recommend the hospital catchment method as the first choice when measuring equality of care.

Research paper thumbnail of Changes in symptoms of anxiety and depression following diagnostic angiography: a prospective cohort study

European heart journal. Quality of care & clinical outcomes, Apr 1, 2018

Coronary angiography is the gold standard diagnostic test for coronary artery disease (CAD), and ... more Coronary angiography is the gold standard diagnostic test for coronary artery disease (CAD), and the diagnostic results can have an immediate effect on symptoms. The aim of this study was to explore the long-term impact of diagnostic angiography on symptoms of anxiety and depression in a group of patients without previous CAD. The prospective cohort study included 459 consecutive patients undergoing invasive angiography and was approved by the regional board of ethics. Data were collected at baseline and after 6 and 12 months using self-reports. Symptoms of anxiety and depression were measured with the Hospital Anxiety and Depression Scale (HADS). The sample population had a mean age of 62 years and included 197 (43%) women. Fifty-three percent had hypertension, and 17% had diabetes. The diagnostic results indicated that 41% of patients had normal vessels; 21% had wall changes; and 38% had obstructive stenosis. No significant difference was found between the diagnostic groups at bas...

Research paper thumbnail of Pre-test characteristics of unstable angina patients with obstructive coronary artery disease confirmed by coronary angiography

Open Heart

ObjectivePatients referred for acute coronary angiography (CAG) with unstable angina (UA) have lo... more ObjectivePatients referred for acute coronary angiography (CAG) with unstable angina (UA) have low mortality and low rate of obstructive coronary artery disease (CAD). Better pre-test selection criteria are warranted. We aimed to assess the current guidelines against other clinical variables as predictors of obstructive CAD in patients with UA referred for acute CAG.MethodsFrom 2005 to 2012, all CAGs performed at the University Hospital of North Norway, the sole provider of CAG in the region, were recorded in a registry. We included 979 admissions of UA and retrospectively collected data regarding presenting clinical parameters from patient hospital records. Obstructive CAD was defined as ≥50% stenosis and considered prognostically significant if found in the left main stem, proximal LAD or all three main coronary arteries. Characteristics were analysed by logistic regression analysis. A score was developed using ORs from significant factors in a multivariable model.ResultsThe overa...

Research paper thumbnail of Percutaneous coronary angioplasty versus coronary artery bypass grafting in treatment of unprotected left main stenosis (NOBLE): a prospective, randomised, open-label, non-inferiority trial

The Lancet, 2016

coronary angioplasty versus coronary artery bypass grafting in treatment of unprotected left main... more coronary angioplasty versus coronary artery bypass grafting in treatment of unprotected left main stenosis (NOBLE): a prospective, randomised, open-label, non-inferiority trial.

Research paper thumbnail of Drug-Eluting or Bare-Metal Stents for Coronary Artery Disease

New England Journal of Medicine, 2016

Background Limited data are available on the long-term effects of contemporary drug-eluting stent... more Background Limited data are available on the long-term effects of contemporary drug-eluting stents versus contemporary bare-metal stents on rates of death, myocardial infarction, repeat revascularization, and stent thrombosis and on quality of life. Methods We randomly assigned 9013 patients who had stable or unstable coronary artery disease to undergo percutaneous coronary intervention (PCI) with the implantation of either contemporary drug-eluting stents or bare-metal stents. In the group receiving drug-eluting stents, 96% of the patients received either everolimus- or zotarolimus-eluting stents. The primary outcome was a composite of death from any cause and nonfatal spontaneous myocardial infarction after a median of 5 years of follow-up. Secondary outcomes included repeat revascularization, stent thrombosis, and quality of life. Results At 6 years, the rates of the primary outcome were 16.6% in the group receiving drug-eluting stents and 17.1% in the group receiving bare-metal stents (hazard ratio, 0.98; 95% confidence interval [CI], 0.88 to 1.09; P=0.66). There were no significant between-group differences in the components of the primary outcome. The 6-year rates of any repeat revascularization were 16.5% in the group receiving drug-eluting stents and 19.8% in the group receiving bare-metal stents (hazard ratio, 0.76; 95% CI, 0.69 to 0.85; P<0.001); the rates of definite stent thrombosis were 0.8% and 1.2%, respectively (P=0.0498). Quality-of-life measures did not differ significantly between the two groups. Conclusions In patients undergoing PCI, there were no significant differences between those receiving drug-eluting stents and those receiving bare-metal stents in the composite outcome of death from any cause and nonfatal spontaneous myocardial infarction. Rates of repeat revascularization were lower in the group receiving drug-eluting stents. (Funded by the Norwegian Research Council and others; NORSTENT ClinicalTrials.gov number, NCT00811772 .).

Research paper thumbnail of Return of �-adrenergic sensitivity in a patient with insulinoma after removal of the tumour

Research paper thumbnail of Dysfunction in the p2.adrenergic signal pathway in patients with insulin dependent diabetes mellitus (IDDM) and unawareness of hypoglycaemia

Eur J Clin Pharmacol, 1995

Research paper thumbnail of Nasjonale anbefalinger for tolkning av troponinverdier ved diagnostikk av akutt hjerteinfarkt

Tidsskrift for Den norske legeforening, 2013

Research paper thumbnail of Nye anbefalinger for tolking av troponinverdier

Tidsskrift for Den norske legeforening, 2013

(f. 1969) er spesialist i medisinsk biokjemi og avdelingsoverlege ved Sentrallaboratoriet, Sykehu... more (f. 1969) er spesialist i medisinsk biokjemi og avdelingsoverlege ved Sentrallaboratoriet, Sykehuset i Vestfold. Forfatter har fylt ut ICMJE-skjemaet og oppgir ingen interessekonflikter.

Research paper thumbnail of Catecholamine binding and concentrations in acute phase plasma after surgery

Scandinavian Journal of Clinical and Laboratory Investigation, 1988

The present study was undertaken to decide whether the bound fractions and/or total concentration... more The present study was undertaken to decide whether the bound fractions and/or total concentrations of catecholamines were determinative for the variability of biologically active concentrations in human plasma. The binding and concentrations of noradrenaline (NA) and adrenalin (Adr) were determined in acute phase plasma after major hip surgery in five subjects. The bound fractions before surgery were 23.0% and 18.4% for NA and Adr, respectively. The binding of catecholamines increased in the post-operative period. Five days after surgery the binding of NA and Adr was 30.9% and 24.0%, respectively. The surgical trauma induced an acute phase reaction in plasma with a decrease of albumin (HSA) concentrations whereas the concentrations of alpha-1 acid glycoprotein (AAG) increased. The catecholamine concentrations showed a considerable inter- and intraindividual variability. However, the present work shows that the variability of the biologically active catecholamine concentrations is mainly dependent on the total plasma concentrations and not the plasma protein binding.

Research paper thumbnail of Coronary bypass graft patency cannot be determined by multidetector spiral computed tomography

Scandinavian Cardiovascular Journal, 2006

Angiography by selective catheterization is the reference standard for coronary bypass graft pate... more Angiography by selective catheterization is the reference standard for coronary bypass graft patency assessment but carries a risk of serious complications. We have investigated whether 16-slice multidetector spiral computed tomography (MDCT) can substitute for selective angiography. Two to three years after coronary artery bypass grafting, 45 patients with a total of 156 bypasses (100 single and 28 sequential grafts) were examined with both MDCT and conventional selective angiography on the same day. The bypasses were classified as patent, stenotic or occluded. The likelihood ratio for MDCT-detected occlusion was 40, reflecting a fairly high combined sensitivity and specificity. However, 24% of the distal anastomoses could not be evaluated by MDCT, mainly because of respiratory movements, artifacts due to metal clips, and small vessel dimensions. Moreover, seven out of 117 bypasses (6%) deemed evaluable by MDCT were wrongly classified by this method. At present, 16-slice MDCT cannot replace selective angiography for assessment of coronary bypass graft patency since 24% of bypasses could not be evaluated by this method, and an error rate of 6% is unacceptable.