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Kofoed KF, Engstroem T, Sigvardsen P, Torp-Pedersen C, Linde J, Riis Hansen P, Holmvang L, Hofsten D, Elming H, Gislason G, Kelbaek H, Kober L. 3335First-line coronary computed tomography predicts long-term clinical outcome in patients with Non-ST-segment elevation acute coronary syndrome - The VERDICT trial. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
In patients with non-ST segment elevation acute coronary syndrome (NSTE-ACS) coronary pathology may range from structurally normal vessels to severe coronary artery disease. Current guidelines recommend early invasive coronary angiography (ICA) for risk assessment and choice of treatment strategy.
Purpose
We tested the hypothesis that 1) a first-line coronary computed tomography angiography (CCTA) predicts long term clinical outcome in patients with NSTE-ACS and 2) adding ICA to CCTA does not improve prediction of cardiovascular events.
Methods
We included patients with NSTE-ACS confirmed by ischaemic ECG changes and/or elevated biomarkers of myocardial ischaemia, in whom both CCTA and ICA were feasible within 12 hours. According to the VERDICT study protocol (ClinicalTrials.gov number NCT02061891) patients were randomised 1:1 to evaluation within 12 hours (Very Early) or 48–72 hours (Standard). CCTA was conducted prior to ICA and patients with an event between tests were excluded. Based on CCTA and ICA, patients were categorized according to European Society of Cardiology (ESC) guidelines as having prognostic indication for coronary revascularization ESCprog (left main stenosis, proximal left anterior descending artery stenosis or multivessel disease) or no prognostic indication – ESCnon-prog. The primary endpoint was a combined endpoint of all-cause mortality, non-fatal recurrent myocardial infarction, hospital admission for refractory myocardial ischemia or hospital admission for left sided heart failure. Discrimination of 1.5-year outcomes was assessed by time-dependent area under the receiver operating characteristic curve (AUC).
Results
CCTA and ICA was conducted in 979 patients. During a median follow-up time of 4.2 (IQR 2.7–5.5) years the primary endpoint occurred in 209 (21.3%) patients. Patients with ESCprog as defined by CCTA had a hazard ratio of 1.53 (95% CI 1.16–2.03) for occurrence of the primary endpoint. AUC for the prediction of the primary endpoint by CCTA was 68.6 (95% CI: 62.7–74.5) as compared to 68.6 (95% CI: 62.8–74.5), when adding ICA to the model. Similar findings were noted in patients randomized to either Very Early or Standard treatment strategy.
Conclusions
Long-term risk assessment in patients with NSTE-ACS may be conducted using a first-line CCTA strategy and may thus potentially guide patient management. Adding invasive coronary angiography to CCTA does not improve risk assessment.
Acknowledgement/Funding
This study was funded by the Danish Agency for Science, Technology, and Innovation and the Danish Council for Strategic Research (grant no. 09–066994)
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Modin D, Pedersen S, Fritz-Hansen T, Gislason G, Biering-Soerensen T. P6399Left atrial function determined by echocardiography predicts incident heart failure in STEMI patients treated with primary percutaneous coronary intervention. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objectives
To assess the comparative effectiveness of LA functional parameters (LAEF and MinLAVI) with that of LA volume index (LAVI) in predicting HF following STEMI.
Background
Heart failure (HF) is common following STEMI. Enlarged left atrial (LA) volume determined by echocardiography is associated with adverse outcome following STEMI. However, whether echocardiographic parameters of LA function, such as the LA emptying fraction (LAEF) and the minimal LA volume index (MinLAVI), are superior to LAVI for predicting prognosis following STEMI is unknown.
Methods
A total of 369 STEMI patients without atrial fibrillation or heart failure treated with primary percutaneous coronary intervention (pPCI) were prospectively enrolled in the period September 2006 to December 2008. Patients underwent echocardiography shortly after STEMI. The maximal and minimal LA volume were measured using the biplane area-length method. LAVI, MinLAVI (minimal LA volume indexed to body surface area) and LAEF [(maximal LA volume − minimal LA volume) / maximal LA volume] were calculated. End-point was incident HF.
Results
During a median follow-up of 66 months (interquartile-range: 50–73 months), 68 patients (18%) were admitted for HF. In univariable analysis, both reduced LAEF and increased MinLAVI were significantly associated with an increased risk of HF (LAEF: HR 1.18, 95% CI 1.08–1.29, per 5% decrease, p<0.001) (MinLAVI: HR 1.35, 95% CI 1.09–1.67, per 5 mL/m2 increase, p=0.006) (Figure). In contrast, LAVI was not significantly associated with the development of HF (HR 1.03, 95% CI 0.87–1.22, per 5 mL/m2 increase, p=0.73) (Figure). Following adjustment for clinical, biochemical and echocardiographic variables, LAEF and MinLAVI remained independent predictors of HF, while the lack of association between LAVI and HF persisted (LAEF: HR 1.14, 95% CI 1.02–1.27, per 5% decrease, p=0.019) (MinLAVI: HR 1.31, 95% CI 1.02–1.69, per 5 mL/m2 increase, p=0.036) (LAVI: HR 1.05, 95% CI 0.86–1.29, per 5 mL/m2 increase, p=0.61). These results were replicated when treating death from all causes as a competing event in competing risk regression.
PY, person-years
Conclusion
In STEMI patients treated with pPCI, LAEF and MinLAVI measured by echocardiography shortly after infarction are superior to LAVI for predicting incident HF.
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Aagaard DT, Fosbol EL, De Backer O, Borgersen E, Gislason G, Torp-Pedersen CT, Sondergaard L, Kober L, Butt J. 93The high burden of rehospitalisations following transcatheter aortic valve implantation. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Transcatheter aortic valve implantation (TAVI) is a treatment option for severe symptomatic aortic stenosis in patients at increased surgical risk. Rehospitalisations following surgical aortic valve replacement are a strain on patients and society. However, data on the extent of the burden and cause of hospitalisations following TAVI are sparse.
Purpose
To examine rehospitalisations and factors associated with rehospitalisations in a one-year period following TAVI.
Methods
In this Danish nationwide observational cohort study, we identified all patients who underwent TAVI from January 2008 through June 2016 and were discharged alive by Danish nationwide health- and administrative registries. Subsequent rehospitalisations, defined as a hospital admission for at least one overnight stay, were classified as either cardiovascular or non-cardiovascular according to the discharge diagnosis codes. Factors associated with any rehospitalisation were identified using Cox regression.
Results
In total, 2,390 patients undergoing TAVI were included. The median age was 81 years (25th-75thpercentile 77–85 years of age) and men comprised 52% of the study population. Of all patients undergoing TAVI, 24% were hospitalised during the first 30 days after the procedure, while 54% were hospitalised during the first year. Among patients surviving the first year after the procedure, 25% were admitted to a hospital once, 14% were admitted twice, 8% were admitted three times, and 10% were admitted at least four times. Of all hospitalisations, 34% were due to a cardiovascular cause and 10% died during the one-year follow-up. Factors associated with any hospitalisation were chronic kidney disease (HR 1.72 [95% CI, 1.48–2.00]), peripheral vascular disease (HR 1.36 [95% CI, 1.16–1.59]), atrial fibrillation (HR 1.28 [95% CI 1.14–1.43]), ischemic heart disease (hazard ratio [HR] 1.23 [95% confidence interval [95% CI], 1.09–1.38]), and chronic obstructive pulmonary disease (HR 1.16 [95% CI, 1.02–1.33] (Figure).
Forrest plot
Conclusions
In a nationwide, all-comers cohort of patients undergoing TAVI, 57% of patients were hospitalised at least once during the first-year post-procedure and approximately one-third of all hospitalisations was due to a cardiovascular cause. Focus on patient selection and prevention of readmissions after TAVI is warranted.
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Hamann CR, Egeberg A, Silverberg JI, Gislason G, Skov L, Thyssen JP. Association between parental autoimmune disease and atopic dermatitis in their offspring: a matched case-control study. J Eur Acad Dermatol Venereol 2019; 33:1143-1151. [PMID: 30779234 DOI: 10.1111/jdv.15413] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 11/09/2018] [Indexed: 01/09/2023]
Abstract
BACKGROUND Atopic dermatitis (AD) is associated with many autoimmune diseases, in part due to overlapping genetic risk loci. While parental atopic disease is an important risk for AD in the offspring, little is known on the putative associations between parental autoimmune disease and AD in their children. MATERIALS AND METHODS All children born between 1996 and 2011 who received a diagnosis of AD in the hospital system before their fifth birthday were matched 1 : 10 with children from the general population. Maternal and paternal autoimmune diseases were assessed using registry-based data. Conditional logistic regression was performed on the relationships between parental autoimmune diseases and AD in their children. RESULTS A total of 8589 children with AD were matched with controls. One or more autoimmune disease was identified in 5.89% (506/8589) of mothers to AD children and 3.67% (315/8589) of fathers to AD children compared to 4.85% (4163/85 890) and 3.28% (2816/85 890) in parents of control children. Maternal autoimmune disease but not paternal autoimmune disease was associated with AD in the offspring (odds ratio [OR] 1.20 [95% confidence interval (CI) 1.20-1.32] and OR 1.08 [0.96-1.22], respectively), Two or more maternal autoimmune diseases, maternal dermatologic autoimmune disease and maternal digestive autoimmune disease were all also associated with AD development in her children (1.96 [95% CI 1.36-2.84], OR 1.60 [95% CI 1.24-2.07] and OR 1.24 [95% CI 1.06-1.45], respectively). CONCLUSIONS The risk of AD is influenced by many factors including atopy status and filaggrin gene mutations. In this matched case-control study, maternal autoimmune disease was associated with AD diagnosis in the offspring. Maternal dermatologic and digestive autoimmune diseases were most closely associated with subsequent AD diagnosis in the offspring.
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105
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Hamann C, Egeberg A, Silverberg J, Gislason G, Skov L, Thyssen J. Exploring the association between parental psychiatric disease and childhood atopic dermatitis: a matched case–control study. J Eur Acad Dermatol Venereol 2018; 33:725-734. [DOI: 10.1111/jdv.15321] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 10/01/2018] [Indexed: 02/02/2023]
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106
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Hesselvig J, Egeberg A, Kofoed K, Gislason G, Dreyer L. Increased risk of depression in patients with lupus erythematosus. Br J Dermatol 2018. [DOI: 10.1111/bjd.17216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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107
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Hesselvig J, Egeberg A, Kofoed K, Gislason G, Dreyer L. 红斑狼疮患者中的抑郁风险增高. Br J Dermatol 2018. [DOI: 10.1111/bjd.17230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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108
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Hamann CR, Egeberg A, Wollenberg A, Gislason G, Skov L, Thyssen JP. Pregnancy complications, treatment characteristics and birth outcomes in women with atopic dermatitis in Denmark. J Eur Acad Dermatol Venereol 2018; 33:577-587. [PMID: 30242910 DOI: 10.1111/jdv.15256] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Accepted: 08/20/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND The risk of prenatal, obstetric and birth complications in mothers with atopic dermatitis (AD), along with treatment use during pregnancy, is unknown. OBJECTIVES To examine the associations between prenatal, obstetric and birth complications in mothers with AD and describe the dermatologic care received during pregnancy. METHODS Mother-child pairs, in which the mother had a history of AD, were identified through the Danish Medical Birth Registry and matched 1 : 10 with non-AD pairs. Data on dermatologic treatment and prenatal, obstetric and birth complications were obtained through linkage via nationwide registers. Multiple logistic regression was performed. RESULTS We identified 10 668 births from 1997 through 2014 to women with AD. Women with a hospital/ambulatory contact for AD during pregnancy had increased topical corticosteroid and ultraviolet therapy use during pregnancy compared to prior. However, overall, women with AD received decreased dermatologic therapy during pregnancy compared to prior. In adjusted analysis, maternal AD was inversely associated with gestational diabetes [OR 0.79, 95% CI (0.68-0.92)], but positively associated with premature rupture of membranes [1.15 (1.05-1.27)] and staphylococcal neonatal septicemia [2.45 (1.33-4.49)]-albeit the latter was rare. These associations did not meet statistical significance in sub-analysis where body mass index data were available. No associations were found with preeclampsia, prematurity or non-staphylococcal neonatal septicaemia. CONCLUSIONS Women with AD during pregnancy mainly used topical corticosteroids and ultraviolet therapy to control their disease. While premature rupture of membranes and staphylococcal neonatal septicaemia were over-represented in maternal AD, no associations were found with any other significant prenatal, obstetric or birth outcome.
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Hesselvig J, Egeberg A, Kofoed K, Gislason G, Dreyer L. Increased risk of depression in patients with cutaneous lupus erythematosus and systemic lupus erythematosus: a Danish nationwide cohort study. Br J Dermatol 2018; 179:1095-1101. [DOI: 10.1111/bjd.16831] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2018] [Indexed: 12/19/2022]
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110
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Nissen Bonde A, Lip GYH, Kamper AL, Gislason G, Torp-Pedersen C, Hlatky M, Olesen JB. P3845Use of oral anticoagulation and association to outcomes in atrial fibrillation patients who develop chronic kidney disease: a nationwide cohort study. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3845] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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111
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Mohr GH, Barcella CA, Kragholm K, Sondergaard KB, Pallisgaard JL, Moller SG, Karlsson L, Wissenberg M, Hansen SM, Lippert FK, Folke F, Torp-Pedersen C, Gislason G, Rajan S. P1752Differences in post-resuscitation care between patients with and without diabetes following out-of-hospital cardiac arrest - a nationwide study. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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112
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Malmborg M, Schmiegelow M, Gerds T, Schou M, Hlatky M, Kistorp C, Gislason G. 2361Sex differences in mortality and rates of cardiovascular disease in patients with diabetes. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.2361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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113
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Dalgaard F, Pallisgaard JL, Gislason G, Nume AK, Lindhardt TB, Ruwald MH. P5794Antiarrhythmic drugs increase the risk of fall-related injuries and syncope in patients with atrial fibrillation - a nationwide cohort study. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Aagaard DT, Nielsen Christiansen M, Madvig Mogensen U, Bundgaard J, Rorth R, Madelaire C, Loldrup Fosbol E, Schou M, Torp-Pedersen C, Gislason G, Kober L, Lund Kristensen S. P2523Cardiovascular risk according to add-on therapy in patients with type 2 diabetes. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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115
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Von Kappelgaard L, Davidsen M, Zwisler AD, Juel K, Gislason G. P6305Socioeconomic gradient in the incidence of aortic stenosis - a nationwide study. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Hagengaard L, Tayal B, Schou M, Gislason G, Riahi S, Torp-Pedersen C, Soegaard P, Kragholm K. P6587Return to work and maintenance of work after first time hospitalization for atrial fibrillation or flutter. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Andreasen C, Gislason G, Koeber L, Abdulla J, Torp-Pedersen C, Andersson C. P4516Incidence of ischemic and hemorrhagic stroke in patients with aortic valve stenosis. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p4516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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118
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Xing LY, Barcella CA, Sindet-Pedersen C, Bonde AN, Gislason G, Olesen JB. P3841Dose adjustment of non-vitamin K antagonist oral anticoagulants following acute coronary syndrome and percutaneous coronary intervention in patients with atrial fibrillation. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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119
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Lamberts M, Zareini B, Holt A, Bjerre J, Sindet-Petersen C, Staerk L, Hansen ML, Olesen JB, Schou M, Gislason G. P6073Increased major bleeding risk with use of topical miconazole agents among users of oral anticoagulation: A population-level safety study. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Thyssen JP, Andersen YMF, Zhang H, Gislason G, Skov L, Egeberg A. Incidence of pediatric atopic dermatitis following thymectomy: A Danish register study. Allergy 2018; 73:1741-1743. [PMID: 29660152 DOI: 10.1111/all.13457] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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121
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Lee CY, Ozenne B, Olesen JB, Gislason G, Torp-Pedersen C, Gerds TA. P4817The individual stroke risk in patients with atrial fibrillation. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p4817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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122
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Havers-Borgersen E, Haider Butt J, Vinding NE, Torp-Pedersen C, Gislason G, Koeber L, Fosboel EL. P4512Time in therapeutic range and risk of thromboembolism and bleeding in patients with mechanical heart valve prosthesis. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p4512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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123
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Kuhr Skals R, Lukacs Krogager M, Rosenbaum Appel EV, Schnurr TM, Theil Have C, Gislason G, Enghusen H, Koeber L, Engstroem T, Stender S, Hansen T, Grarup N, Andersson C, Torp-Pedersen C, Weeke PE. P3630Genetic risk score of insulin resistance risk variants is associated with increased risk of coronary artery disease in patients referred to coronary angiography. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Aslam M, Oestergaard L, Bonde L, Gimbel H, Havers-Borgersen E, Bundgaard H, Gislason G, Torp-Pedersen C, Kober L, Fosbol EL. P3536Risk of infective endocarditis in women undergoing hysterectomy: a nationwide register-based cohort study. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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125
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Modin D, Jorgensen ME, Gislason G, Jensen JS, Koeber L, Torp-Pedersen C, Biering-Sorensen T. P5349The CHA2DS2-VASc risk score predicts all-cause and cardiovascular mortality following first myocardial infarction. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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