Publications by authors named "Ville Kytö"

98 Publications

Cardiovascular Risk Factors in Childhood and Left Ventricular Diastolic Function in Adulthood.

Pediatrics 2021 Mar 8;147(3). Epub 2021 Feb 8.

Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland.

Background And Objectives: Cardiovascular risk factors, such as obesity, blood pressure, and physical inactivity, have been identified as modifiable determinants of left ventricular (LV) diastolic function in adulthood. However, the links between childhood cardiovascular risk factor burden and adulthood LV diastolic function are unknown. To address this lack of knowledge, we aimed to identify childhood risk factors associated with LV diastolic function in the participants of the Cardiovascular Risk in Young Finns Study.

Methods: Study participants ( = 1871; 45.9% men; aged 34-49 years) were examined repeatedly between the years 1980 and 2011. We determined the cumulative risk exposure in childhood (age 6-18 years) as the area under the curve for systolic blood pressure, adiposity (defined by using skinfold and waist circumference measurements), physical activity, serum insulin, triglycerides, total cholesterol, and high- and low-density lipoprotein cholesterols. Adulthood LV diastolic function was defined by using E/é ratio.

Results: Elevated systolic blood pressure and increased adiposity in childhood were associated with worse adulthood LV diastolic function, whereas higher physical activity level in childhood was associated with better adulthood LV diastolic function ( < .001 for all). The associations of childhood adiposity and physical activity with adulthood LV diastolic function remained significant (both < .05) but were diluted when the analyses were adjusted for adulthood systolic blood pressure, adiposity, and physical activity. The association between childhood systolic blood pressure and adult LV diastolic function was diluted to nonsignificant ( = .56).

Conclusions: Adiposity status and the level of physical activity in childhood are independently associated with LV diastolic function in adulthood.
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http://dx.doi.org/10.1542/peds.2020-016691DOI Listing
March 2021

Women have a higher resection rate for lung cancer and improved survival after surgery.

Interact Cardiovasc Thorac Surg 2021 Feb 1. Epub 2021 Feb 1.

Heart Center, Turku University Hospital, Turku, Finland.

Objectives: Surgery is the standard treatment in early-stage non-small-cell lung cancer and select cases of small-cell lung cancer, but gender differences in its use and outcome are poorly known. Gender differences in surgical resection rates and long-term survival after lung cancer surgery were therefore investigated.

Methods: In Finland, 3524 patients underwent resection for primary lung cancer during 2004-2014. Surgical rate and mortality data were retrospectively retrieved from 3 nationwide compulsory registries. Survival was studied by comparing propensity-matched cohorts. Median follow-up was 8.6 years.

Results: Surgery rate was higher in women (15.9% vs 12.3% in men, P < 0.0001). Overall survival was 85.3% 1 year, 51.4% 5 years, 33.4% 10 years and 24.2% at 14 years from surgery. In matched groups, survival after resection was better in women after 1 year (91.3% vs 83.3%), 5 years (60.2% vs 48.6%), 10 years (43.7% vs 27.9%) and 14 years (29.0% vs 21.1%) after surgery [hazard ratio (HR) 0.66; confidence interval (CI) 0.58-0.75; P < 0.0001]. Of all first-year survivors, 39.1% were alive 10 years and 28.3% 14 years after surgery. Among these matched first-year survivors, women had higher 14-year survival (36.9% vs 25.3%; HR 0.75; CI 0.65-0.87; P = 0.0002).

Conclusions: Surgery is performed for lung cancer more often in women. Women have more favourable short- and long-term outcome after lung cancer surgery. Gender discrepancy in survival continues to increase beyond the first year after surgery.
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http://dx.doi.org/10.1093/icvts/ivab006DOI Listing
February 2021

Sex-based outcomes after coronary artery bypass grafting.

Ann Thorac Surg 2021 Jan 20. Epub 2021 Jan 20.

Heart Center, Turku University Hospital and University of Turku, Turku, Finland; Department of Surgery, University of Turku, Turku, Finland.

Background: Sex is suggested to influence outcomes after coronary artery bypass grafting (CABG) although evidence on long-term mortality is controversial and cardiovascular outcome data is lacking. We studied sex differences in outcomes after isolated CABG.

Methods: Consecutive patients with first-time isolated CABG for stable coronary artery disease between 2004-2014 in Finland were retrospectively recognized from national registry (n=14681, 21% women). Propensity scoring and inverse probability weighting were used to adjust for baseline features. Median follow-up was 10.0 (max 14.6) years.

Results: Cumulative major adverse cardiovascular event (MACE; myocardial infarction, stroke, or cardiovascular death) rate was 44.5% in men and 49.9% in women during the follow-up (Hazard ratio [HR] 0.98; p=0.633). All-cause mortality was 48.5 % in men vs. 46.0% in women (HR 1.20; CI 1.11-1.30; p<0.0001) and cardiovascular mortality 29.5% vs. 31.3% (p=0.625). Stroke rate was comparable between men and women (19.4% vs. 23.6%; p=0.625). Myocardial infarction occurred more frequently in women (20.0% vs. 23.6%; HR 0.84; CI 0.75-0.95; p=0.005). Redo revascularization was performed to 12.8% of women and 12.6% of men (p=0.100). Anticoagulation was more frequently used by men and adenosine diphosphate-inhibitors and diuretics by women after CABG. Usage of statins, angiotensin-converting-enzyme-inhibitors/angiotensin-blockers, beta-blockers, ca-blockers, or nitrates did not differ between sexes after CABG.

Conclusions: Sex was not an independent predictor of long-term MACE after CABG in this population-based cohort study. Men had however higher long-term all-cause mortality and women higher risk of myocardial infarction. Long-term outcomes should be accounted for when considering sex as a risk factor for CABG.
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http://dx.doi.org/10.1016/j.athoracsur.2021.01.014DOI Listing
January 2021

Surgical aortic valve replacement and infective endocarditis.

Eur J Clin Invest 2020 Dec 16:e13476. Epub 2020 Dec 16.

Heart Center, Turku University Hospital and University of Turku, Turku, Finland.

Background: We wanted to investigate the influence of native-valve infective endocarditis (IE) on long-term outcomes of surgical aortic valve replacement (SAVR).

Methods: Native-valve patients with IE (n = 191) were compared to propensity score-matched patients without IE (n = 191), all treated with SAVR, in a multicentre, population-based cohort register study in Finland. The median follow-up was 6.2 years.

Results: Infective endocarditis as the indication for SAVR was associated with an increased hazard of 10-year mortality (37.1% vs 24.2%; HR 1.83; CI 1.03-3.26; P = .039). Ischaemic stroke was also more frequent in IE patients during 10-year follow-up (15.8% vs 7.5%; HR 3.80; CI 1.42-10.18; P = .008). Major bleeding within first year after SAVR was more frequent in patients with IE (7.0% vs 2.9%; P = .038). Ten-year major bleeding rate was 32.4% in IE vs 24.5% in non-IE groups (P = .174). Aortic valve re-operation rate was 4.3% in IE vs 8.4% in non-IE groups (P = .975). Admission duration after SAVR was longer in IE (median 29 vs 9 days; P < .0001). There was no difference in 30-day mortality after SAVR.

Conclusions: Patients with native-valve IE have a higher risk of death, ischaemic stroke, and early major bleeding after SAVR than matched patients without IE. Results confirm the high risk for complications of IE patients after SAVR and highlight the importance of vigorous prevention of both stroke and bleeding after SAVR in these patients.
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http://dx.doi.org/10.1111/eci.13476DOI Listing
December 2020

Cerebral Venous Thrombosis: Finnish Nationwide Trends.

Stroke 2021 Jan 4;52(1):335-338. Epub 2020 Dec 4.

Neurocenter, Department of Neurology, Clinical Neurosciences (J.O.R., J.O.T.S.), University of Turku, Finland.

Background And Purpose: Epidemiology of cerebral venous thrombosis (CVT) has been reported to be changing. Because long-term nationwide data are needed to confirm this, we studied CVT occurrence between 2005 and 2014 in Finland.

Methods: All acute CVT admissions were retrieved from a mandatory registry covering mainland Finland. Patients aged ≥18 years were included. One admission per patient was allowed.

Results: We identified 563 patients with CVT (56.5% women). Overall incidence was 1.32/100 000 (95% CI, 1.21-1.43) per year with a 5.0% annual increase. In people <55 years of age, incidence was 0.92/100 000 (0.76-1.10) for men and 1.65/100 000 (1.43-1.89) for women, whereas for those 55 years or older incidence was 1.61 (1.34-1.91) for men and 1.17 (0.96-1.41) for women. In-hospital mortality was 2.1% with no sex difference. One-year mortality was 7.9%. Long-term mortality was higher in men (adjusted hazard ratio, 1.61 [1.09-2.38]) and in older patients (1.95 [1.69-2.24]; per 10-year increment).

Conclusions: Overall incidence of CVT in Finland was similar to that reported in the Netherlands and in Australia. There was a 5.0% yearly increase in the rate of admissions while in-hospital mortality was low. Sex-specific incidence rates differed markedly between younger and older people. Long-term mortality increased with age and was higher in men.
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http://dx.doi.org/10.1161/STROKEAHA.120.031026DOI Listing
January 2021

Trends in the surgical management of vesicoureteral reflux in Finland in 2004-2014.

Scand J Urol 2021 Feb 26;55(1):67-71. Epub 2020 Nov 26.

Department of Pediatric Surgery, Turku University Hospital, Turku, Finland.

Objectives: Previous data on the trends of surgical treatment of vesicoureteral reflux outside USA are scarce. The aim of this study was to clarify the national trends of operative treatment of vesicoureteral reflux (VUR) in Finland.

Methods: We analyzed national data from Finnish Care Register for Health Care on children (<16 years of age) surgically treated for VUR in 2004-2014.

Results: Endoscopic injections of the ureteral orifices were primarily performed for 1212 and open ureteral reimplantation for 272 children. The use of both types of surgery decreased during the study period ( = 0.0043 and  < 0.001, respectively). The median age at surgery for VUR was lower in those treated with open ureteral reimplantation than those with endoscopic injections of the ureteral orifices [3 and 4 years, respectively] ( = 0.0001). The length of hospital stay was significantly longer (median 9.9 days) with open ureteral reimplantation compared to that (median 1.3 days) with endoscopic injections ( < 0.0001) and did not change during the study period. Reoperations were significantly more common in patients who were primarily treated with endoscopic injections ( = 146/1072, 14%) than with ureteral reimplantation ( = 7/230, 3%) ( < 0.0001).

Conclusions: While the best treatment options for VUR remain debatable, operative treatment of VUR has become less common in Finland. HIGHLIGHTS Recent data on the trends of treatment of vesicoureteral reflux outside USA are scarce. Surgical treatment for vesicoureteral reflux decreased in Finland during the study period. The length of stay was longer but reoperations were needed less often with ureteral reimplantation compared to endoscopic injections.
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http://dx.doi.org/10.1080/21681805.2020.1849387DOI Listing
February 2021

Unverricht-Lundborg disease (EPM1) in Finland: A nationwide population-based study.

Neurology 2020 12 17;95(23):e3117-e3123. Epub 2020 Sep 17.

From the Division of Clinical Neurosciences (J.O.T.S.), Heart Center (V.K.), and Center for Population Health Research (V.K.), Turku University Hospital and University of Turku; Department of Neurology (J.O.T.S.), Siun Sote North Karelia Central Hospital, Joensuu; Kuopio Epilepsy Center, Department of Clinical Neurophysiology (J.H.), and Epilepsy Center, Neuro Center (R.K.), Kuopio University Hospital, Member of the European Reference Network for Rare and Complex Epilepsies EpiCARE; Administrative Center (V.K.), Hospital District of Southwest Finland, Turku; and Institute of Clinical Medicine (R.K.), University of Eastern Finland, Kuopio.

Objective: To investigate the epidemiology and prognosis of Unverricht-Lundborg disease (EPM1) in a nationwide, population-based setting.

Methods: Data from multiple registries were combined and analyzed. Clinical data were obtained from medical records. All patients treated for EPM1 in Finland between January 1, 1998, and December 31, 2016 were included.

Results: A total of 135 persons with EPM1 (54% women) were identified and 105 were alive on December 31, 2016 (point prevalence 1.91/100,000 persons). The age-standardized (European Standard Population 2013) prevalence was 1.53/100,000 persons. Annual incidence during the study period was 0.022/100,000 person-years, with a mean age at onset of 9.4 ± 2.3 years (range 7.0-14.6 years, no sex difference). The median age at death (n = 34) was 53.9 years (interquartile range 46.4, 60.3; range 23.2-63.8), with no sex differences. The immediate cause of death was a lower respiratory tract infection in 56% of deaths. The survival rates of the patients were comparable to matched controls up to 40 years of age, but poorer during long-term follow-up (cumulative survival 26.4% vs 78.0%), with a hazard ratio (HR) for death of 4.61. The risk of death decreased with increasing age at onset (HR 0.76 per year, 95% confidence interval 0.65-0.89). In approximately 10% of all cases, the disease progression appeared very mild; some patients retained functional independence for decades.

Conclusions: Unverricht-Lundborg disease is rare in Finland but still more common than anywhere else in the world. The disease course appears somewhat more severe than elsewhere, disability mounts early, and death occurs prematurely.
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http://dx.doi.org/10.1212/WNL.0000000000010911DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7734927PMC
December 2020

Outcome of acute myocardial infarction versus stable coronary artery disease patients treated with coronary bypass surgery.

Ann Med 2021 12 14;53(1):70-77. Epub 2020 Sep 14.

Center for Population Health Research, Turku University Hospital and University of Turku, Turku, Finland.

Objective: To study the long-term outcome differences between acute myocardial infarction (MI) and stable coronary artery disease (CAD) patients treated with coronary artery bypass grafting (CABG).

Methods: We studied retrospectively patients with MI ( = 1882) or stable CAD ( = 13117) treated with isolated CABG between 2004 and 2014. Inverse propensity probability weight adjustment for baseline features was used. Median follow-up was 7.9 years.

Results: In-hospital mortality (8.6% vs. 1.6%; OR 5.94;  < .0001) and re-sternotomy (5.5% vs. 2.7%; OR 2.07;  < .0001) were more common in MI patients compared to stable CAD patients. Hospital surviving MI patients had higher all-cause mortality (28.2% vs. 22.2%; HR 1.37;  = .002) and MACE rate (34.4% vs. 27.4%; HR 1.22; CI 1.00-1.50;  = .049) at 10-year follow-up. Cardiovascular mortality (15.9% vs. 12.7%; HR 1.36;  = .017) and rate of new myocardial infarction (12.0% vs. 9.8%; HR 1.40;  = .034) were also higher in MI patients during follow-up. In follow-up of stabilized first-year survivors, the difference in all-cause (26.5% vs. 20.7%; HR 1.40;  = .003) and cardiovascular (14.2% vs. 11.4%; HR 1.37;  = .027) mortality continued to increase between MI and stable CAD patients.

Conclusion: MI patients have poorer short- and long-term outcomes compared to stable CAD patients after CABG and risk difference continues to increase with time. Key Messages Patients with myocardial infarction have poorer short- and long-term outcomes compared to stable coronary artery disease patients after coronary artery bypass grafting (CABG). Higher risk of death continues also in stabilized first-year myocardial infarct survivors. The importance of efficient secondary prevention and follow-up highlights in post-myocardial infarct population after CABG.
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http://dx.doi.org/10.1080/07853890.2020.1818118DOI Listing
December 2021

Outcomes After ST-Segment Versus Non-ST-Segment Elevation Myocardial Infarction Revascularized by Coronary Artery Bypass Grafting.

Am J Cardiol 2020 11 29;135:17-23. Epub 2020 Aug 29.

Heart Center, Turku University Hospital and University of Turku, Turku, Finland; Research Center of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland; Center for Population Health Research, Turku University Hospital and University of Turku, Turku, Finland; Administative Center, Hospital District of Southwest Finland, Turku, Finland.

The objectives of this study were to investigate the outcome differences between ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI) patients treated with coronary artery bypass grafting surgery (CABG). We conducted a multicenter, retrospective cohort follow-up study of consecutive patients with STEMI (surgery ≤48 hours of admission; n = 348) or NSTEMI (n = 1,160) revascularized with first-time isolated CABG in Finland using nationwide registries (median age 68 years, 24% women). The short- and long-term (10-year) outcomes were studied with inverse propensity probability weight adjustment for baseline features. The median follow-up was 5.2 years. In-hospital mortality (11.4% vs 5.3%; adj. odds ratio [OR] 2.27; confidence interval [CI] 1.41 to 3.66; p = 0.001) and re-sternotomy rates (6.9% vs 3.5%; adj. OR 2.07; CI 1.22 to 3.51; p = 0.007) were higher in STEMI patients. Long-term all-cause mortality did not differ between STEMI and NSTEMI patients among all operated patients (30.2% vs 28.3%; adj. HR 1.30; CI 0.97 to 1.75; p = 0.080) or hospital survivors (21.6 vs 24.3%; HR 0.93; CI 0.64 to 1.36; p = 0.713). Occurrence of major adverse cardiovascular event in hospital survivors within 10 years was 34.7% in STEMI versus 29.6% in NSTEMI (adj. HR 1.24; CI 0.88 to 1.76; p = 0.220). Occurrences of cardiovascular death (14.6% vs 14.4%; p = 0.773), myocardial infarction (MI; 15.2% vs 10.3%; p = 0.203), and stroke (10.8% vs 14.8%; p = 0.242) were also comparable. In conclusion, patients with STEMI have poorer short-term outcome compared to NSTEMI patients after revascularization by CABG, but the long-term outcomes are comparable regardless of MI type. Thus, both short- and long-term risks should be considered when evaluating patient´s for CABG eligibility by MI type.
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http://dx.doi.org/10.1016/j.amjcard.2020.08.042DOI Listing
November 2020

Wilson's Disease in Finland: A Nationwide Population-Based Study.

Mov Disord 2020 12 2;35(12):2323-2327. Epub 2020 Jul 2.

Clinical Neurosciences, University of Turku and Turku University Hospital, Turku, Finland.

Background: Data on the epidemiology and prognosis of Wilson's disease are scarce, and no clinical data are available from Finland.

Methods: All persons diagnosed and treated for Wilson's disease in Finnish hospitals in 1998 to 2017 were identified. Data were collected from national registries and patient charts.

Results: The point prevalence was 0.45/100,000 (95% confidence interval, 0.29-0.67) on December 31, 2017, but no more than 0.35/100,000 (95% confidence interval, 0.21-0.55) among native Finns. Annual incidence was 0.016/100,000 (95% confidence interval, 0.0093-0.026). Median age at diagnosis was 15.8 years (interquartile range, 8.3-32.2; range, 3.8-48.1 years). Upon presentation, liver damage was observed in 58%, neurological signs and symptoms (most often tremor and dysarthria) in 40%, and 32% of patients were asymptomatic. Patients had poorer long-term survival (hazard ratio, 2.92 for death; P = 0.005) compared with matched controls.

Conclusions: Wilson's disease is very rare in Finland. Patients have an increased risk of death indicating an unmet treatment need. © 2020 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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http://dx.doi.org/10.1002/mds.28207DOI Listing
December 2020

Folate Receptor β-Targeted PET Imaging of Macrophages in Autoimmune Myocarditis.

J Nucl Med 2020 11 13;61(11):1643-1649. Epub 2020 Apr 13.

Turku PET Centre, University of Turku, Turku, Finland

Currently available imaging techniques have limited specificity for the detection of active myocardial inflammation. Aluminum F-labeled 1,4,7-triazacyclononane--triacetic acid conjugated folate (F-FOL) is a PET tracer targeting folate receptor β (FR-β), which is expressed on activated macrophages at sites of inflammation. We evaluated F-FOL PET for the detection of myocardial inflammation in rats with autoimmune myocarditis and studied the expression of FR-β in human cardiac sarcoidosis specimens. Myocarditis was induced by immunizing rats ( = 18) with porcine cardiac myosin in complete Freund adjuvant. Control rats ( = 6) were injected with Freund adjuvant alone. F-FOL was intravenously injected, followed by imaging with a small-animal PET/CT scanner and autoradiography. Contrast-enhanced high-resolution CT or F-FDG PET images were used for coregistration. Rat tissue sections and myocardial autopsy samples from 6 patients with cardiac sarcoidosis were studied for macrophages and FR-β. The myocardium of 10 of 18 immunized rats showed focal macrophage-rich inflammatory lesions, with FR-β expression occurring mainly in M1-polarized macrophages. PET images showed focal myocardial F-FOL uptake colocalizing with inflammatory lesions (SUV, 2.1 ± 1.1), whereas uptake in the remote myocardium of immunized rats and controls was low (SUV, 0.4 ± 0.2 and 0.4 ± 0.1, respectively; < 0.01). Ex vivo autoradiography of tissue sections confirmed uptake of F-FOL in myocardial inflammatory lesions. Uptake of F-FOL in inflamed myocardium was efficiently blocked by a nonlabeled FR-β ligand folate glucosamine in vivo. The myocardium of patients with cardiac sarcoidosis showed many FR-β-positive macrophages in inflammatory lesions. In a rat model of autoimmune myocarditis, F-FOL shows specific uptake in inflamed myocardium containing macrophages expressing FR-β, which were also present in human cardiac sarcoid lesions. Imaging of FR-β expression is a potential approach for the detection of active myocardial inflammation.
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http://dx.doi.org/10.2967/jnumed.119.241356DOI Listing
November 2020

Sex Differences in Outcomes Following Acute Coronary Syndrome Treated With Coronary Artery Bypass Surgery.

Heart Lung Circ 2021 Jan 20;30(1):100-107. Epub 2020 Mar 20.

Heart Center, Turku University Hospital and University of Turku, Turku, Finland.

Background: A person's sex is suggested to impact their outcome after acute coronary syndrome (ACS) and cardiac surgery, although evidence in controversial. This study examined sex differences in outcomes of ACS patients treated with coronary artery bypass grafting (CABG).

Methods: Patients aged ≥18 year with ACS and treated with first-time isolated CABG in Finland between 2004-2014 were retrospectively identified from a national registry (n=6,683, 24% women). Propensity score matching (1:1) was used to identify 1,607 women and 1,607 men with comparable baseline features (mean age 71 years and follow-up 7.1 years). In-hospital outcomes of all matched patients and long-term (10-year) outcomes of hospital survivors were studied.

Results: Women had higher in-hospital mortality (4.5 vs 2.6%; HR, 1.83; 95% CI, 1.18-2.86; p=0.008) but lower long-term all-cause mortality (28.3 vs 34.4%; HR, 0.70; 95% CI, 0.58-0.84; p<0.0001) and cardiovascular mortality (19.5 vs 23.7%; HR, 0.69; 95% CI, 0.55-0.86; p=0.001) as well as long-term major bleeding (11.6 vs 13.6%; HR, 0.69; 95% CI, 0.49-0.97; p=0.032). Re-sternotomy was also less common among women (3.7 vs 5.4%; OR 0.69; CI 0.49-0.96; p=0.029). There were no differences in length of stay (8.8 days in women vs 9.0 days in men) or in the occurrence of a composite major adverse cardiovascular event (MACE) in long-term follow-up (43.0% in women vs 46.5% in men; p=0.800).

Conclusions: Outcomes after CABG-treated ACS differed between sexes. Women had higher in-hospital mortality, while men had higher long-term mortality and occurrence of major bleeding. The long-term risk of combined MACE was comparable between sexes.
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http://dx.doi.org/10.1016/j.hlc.2020.02.009DOI Listing
January 2021

A decade of geriatric traumatic brain injuries in Finland: population-based trends.

Age Ageing 2020 08;49(5):779-785

Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland.

Background: we investigated trends of traumatic brain injury (TBI)-related hospitalisations, deaths, acute neurosurgical operations (ANO), and lengths of hospital stay (LOS) in patients aged ≥70 years in Finland using a population-based cohort.

Methods: nationwide databases were searched for all admissions with a TBI diagnosis as well as later deaths for persons ≥70 years of age during 2004-2014.

Results: the study period included 20,259 TBI-related hospitalisations (mean age = 80.7 years, men = 48.9%). The incidence of TBI-related hospitalisations was 283/100,000 person-years with an estimated overall annual increase of 2.9% (95% CI: 0.4-5.9%). There was an annual decrease of 2.2% in in-hospital mortality (IHM) in men (95% CI: 0.1-4.3%), with no change in women or overall. There was an annual decrease of 1.1% in odds for ANOs among hospitalised overall (95% CI: 0.1-2.1%) and of 1.4% in men (95% CI: 0.0-2.7%), while no change was observed in women. LOS decreased annually by 2.5% (95% CI: 2.1-2.9%). The incidence of TBI-related deaths was 70/100,000 person-years with an estimated annual increase of 1.6% in women (95% CI: 0.2-2.9%), but no change in men or overall. Mean ages of TBI-related admissions and deaths increased (P < 0.001).

Interpretation: the incidence rate of geriatric TBI-related hospitalisations increased, especially in women, but LOS and the rate of ANOs among hospitalised decreased. The overall TBI-related mortality remained stable, and IHM decreased in men, while in women, the overall mortality increased and IHM remained stable. However, the overall incidence rates of TBI-related hospitalisations and deaths and the number of cases of IHM were still higher in men.
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http://dx.doi.org/10.1093/ageing/afaa037DOI Listing
August 2020

Adverse events and survival with postpericardiotomy syndrome after surgical aortic valve replacement.

J Thorac Cardiovasc Surg 2020 Dec 28;160(6):1446-1456. Epub 2020 Jan 28.

Heart Center, Turku University Hospital and University of Turku, Turku, Finland; Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass.

Objectives: Postpericardiotomy syndrome (PPS) is a relatively common complication after cardiac surgery. However, long-term follow-up data on the adverse events and mortality of PPS patients requiring invasive interventions are scarce.

Methods: We sought to assess the occurrence of mortality, new-onset atrial fibrillation (AF), cerebrovascular events, and major bleeds in PPS patients requiring medical attention in a combination database of 671 patients who underwent isolated surgical aortic valve replacement with a bioprosthesis (n = 361) or mechanical prosthesis (n = 310) between 2002 and 2014 (Cardiovascular Research Consortium-A Prospective Project to Identify Biomarkers of Morbidity and Mortality in Cardiovascular Interventional Patients [CAREBANK] 2016-2018). PPS was defined as moderate if it resulted in delayed hospital discharge, readmission, or medical therapy because of the symptoms; and severe if it required interventions for the evacuation of pleural or pericardial effusion.

Results: The overall incidence of PPS was 11.2%. Median time to diagnosis was 16 (interquartile range, 11-36) days. Severe PPS was diagnosed in 3.6% of patients. Severe PPS seemed to be associated with higher mortality (hazard ratio, 2.01; 95% confidence interval, 1.03-3.91; P = .040). Moderate or severe PPS increased the risk of new-onset AF during the early postoperative period (hazard ratio, 1.72; 95% confidence interval, 1.12-2.63; P = .012). No significant associations were found between PPS and cerebrovascular events or major bleeds during the follow-up.

Conclusions: Patients with PPS requiring invasive interventions are at increased risk for mortality unlike those with mild to moderate forms of the disease. PPS requiring medical attention is associated with a higher AF rate during the early postoperative period but has no significant effect on the occurrence of major stroke, stroke or transient ischemic attack, or major bleeds during long-term follow-up.
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http://dx.doi.org/10.1016/j.jtcvs.2019.12.114DOI Listing
December 2020

Adult Migraine Hospital Admission Trends in Finland: A Nationwide Registry Study.

J Clin Med 2020 Jan 23;9(2). Epub 2020 Jan 23.

Heart Center, Turku University Hospital, 20521 Turku, Finland.

Population-level data on migraine hospital admission trends are unavailable. Changes in stroke care may have influenced these, since migraine is one of the most common stroke mimics. In this study, all hospital admissions on neurological, internal medicine, and pediatric wards in Finland with migraine as the primary diagnosis for persons at least 16 years of age in 2004-2014 were studied, resulting in an analysis of 6195 individuals with 7764 migraine discharges. The number of discharges increased by 4.2% annually ( = 0.000084), with no change in age of the admitted patients. Comorbidity burden was low but increased during the study period ( < 0.0001). The frequency of common vascular risk factors as comorbidities increased by 11-19% annually. Admission duration shortened by 2% annually ( < 0.0001). An intravenous thrombolysis was given in four admissions. It seems that migraine hospital admissions have become more frequent and the patients more often have cardiovascular risk factors, suggesting increased awareness and more aggressive acute evaluation of suspected stroke as the cause.
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http://dx.doi.org/10.3390/jcm9020320DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7073942PMC
January 2020

Comparison of Long-Term Outcomes of Patients Having Surgical Aortic Valve Replacement With Versus Without Simultaneous Coronary Artery Bypass Grafting.

Am J Cardiol 2020 03 28;125(6):964-969. Epub 2019 Dec 28.

Heart Center, Turku University Hospital and University of Turku, Turku, Finland; Research Center of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland; Center for Population Health Research, Turku University Hospital and University of Turku, Turku, Finland; Administative Center, Hospital District of Southwest Finland, Turku, Finland. Electronic address:

Coronary artery disease is a common co-morbidity of aortic stenosis. When needed, adding coronary artery bypass grafting (CABG) to surgical aortic valve replacement (SAVR) is the standard treatment method, but the impact of concomitant CABG on long-term outcomes is uncertain. We compared long-term outcomes of SAVR patients with and without CABG. Hospital survivors aged ≥50 years discharged after SAVR ± CABG in Finland between 2004 and 2014 (n = 6,870) were retrospectively studied using nationwide registries. Propensity score matching (1:1) was used to identify patients with comparable baseline features (n = 2,188 patient pairs, mean age 73 years). The end points were postoperative 10-year major adverse cardiovascular outcome (MACE), all-cause mortality, stroke, major bleeding, and myocardial infarction. Median follow-up was 6 years. Cumulative MACE rate (39.5% vs 35.6%; hazard ratio [HR] 1.04; p = 0.677) and mortality (32.7% vs 31.0%; HR 1.03; p = 0.729) after SAVR were comparable with or without CABG. Myocardial infarction was more common in patients with CABG (13.4% vs 6.9%; HR 1.47; p = 0.0495). Occurrence of stroke (15.1% vs 13.5%; p = 0.998) and major bleeding (20.0% vs 21.9%; p = 0.569) were comparable. There was no difference in gastrointestinal (8.1% vs 10.3%; p = 0.978) or intracranial bleeds (6.0% vs 5.5%; p = 0.794). The use of internal mammary artery in CABG did not have an impact on the results. In conclusion, matched patients with and without concomitant CABG had comparable long-term MACE, mortality, stroke, and major bleeding rates after SAVR. In conclusion, our results indicate that need for concomitant CABG has limited impact on long-term outcomes after initially successful SAVR.
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http://dx.doi.org/10.1016/j.amjcard.2019.12.015DOI Listing
March 2020

Childhood risk factors and carotid atherosclerotic plaque in adulthood: The Cardiovascular Risk in Young Finns Study.

Atherosclerosis 2020 01 30;293:18-25. Epub 2019 Nov 30.

Research Center of Applied and Preventive Cardiovascular Medicine, University of Turku, Kiinamyllynkatu 10, 20520, Turku, Finland; Department of Clinical Physiology and Nuclear Medicine, University of Turku, Kiinamyllynkatu 10, 20520, Turku, Finland; Centre for Population Health Research, University of Turku, Kiinamyllynkatu 10, 20520, Turku, Finland.

Background And Aims: Carotid plaque is a specific sign of atherosclerosis and adults with carotid plaque are at increased risk for cardiovascular outcomes. Atherosclerosis has roots in childhood and pediatric guidelines provide cut-off values for cardiovascular risk factors. However, it is unknown whether these cut-offs predict adulthood advanced atherosclerosis.

Methods: The Cardiovascular Risk in Young Finns Study is a follow-up of children that begun in 1980 when 2653 participants with data for the present analyses were aged 3-18 years. In 2001 and 2007 follow-ups, in addition to adulthood cardiovascular risk factors, carotid ultrasound data was collected. Long-term burden, as the area under the curve, was evaluated for childhood (6-18 years) risk factors. To study the associations of guideline-based cut-offs with carotid plaque, both childhood and adult risk factors were classified according to clinical practice guidelines.

Results: Carotid plaque, defined as a focal structure of the arterial wall protruding into lumen >50% compared to adjacent intima-media thickness, was present in 88 (3.3%) participants. Relative risk for carotid plaque, when adjusted for age and sex, was 3.03 (95% CI, 1.76-5.21) for childhood dyslipidemia, 1.51 (95% CI, 0.99-2.32) for childhood elevated systolic blood pressure, and 1.93 (95% CI, 1.26-2.94) for childhood smoking. Childhood dyslipidemia and smoking remained independent predictors of carotid plaque in models additionally adjusted for adult risk factors and family history of coronary heart disease. Carotid plaque was present in less than 1% of adults with no childhood risk factors.

Conclusions: Findings reinforce childhood prevention efforts and demonstrate the utility of guideline-based cut-offs in identifying children at increased risk for adulthood atherosclerosis.
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http://dx.doi.org/10.1016/j.atherosclerosis.2019.11.029DOI Listing
January 2020

Mechanical Versus Biologic Prostheses for Surgical Aortic Valve Replacement in Patients Aged 50 to 70.

Ann Thorac Surg 2020 07 28;110(1):102-110. Epub 2019 Nov 28.

Heart Center, Turku University Hospital and University of Turku, Turku, Finland.

Background: The use of biologic prosthesis is increasing in surgical aortic valve replacement (SAVR). Recent US guidelines recommend either biologic or mechanical prosthesis for SAVR in patients aged 50 to 70 years. We set out to study long-term outcomes of mechanical versus biologic prosthetic valves in this patient group.

Methods: All patients (excluding infective endocarditis and concomitant surgery other than coronary artery bypass grafting) aged 50 to 70 with first-time SAVR in Finland between 2004 and 2014 were retrospectively studied (N = 2928). Propensity score matching (1:1) was used to identify patients with comparable baseline features (n = 1152). Outcomes were 10-year all-cause mortality, aortic valve reoperation, major bleeding, ischemic stroke, and infective endocarditis. Mean follow-up was 6.7 years.

Results: Ten-year all-cause mortality was 18.6% with mechanical valves and 27.6% with biologic valves (hazard ratio [HR], 0.72; 95% confidence interval [CI], 0.54-0.97; P = .028). Prosthetic valve reoperation was performed in 1.4% with mechanical valves and in 8.5% with bioprosthetic valves (HR, 0.30; 95% CI, 0.12-0.74; P = .009). Major bleeding occurred in 21.5% with mechanical valves and in 16.9% with biologic prostheses (HR, 1.19; P = .402). Rates of intracranial bleeding were also comparable. Ischemic stroke rates within 10 years were 12.7% with mechanical valves and 9.3% with biologic valves (HR, 1.29; P = .316). Infective endocarditis occurred in 3.7% of mechanical valves and in 7.3% of biologic valves (HR, 0.46; 95% CI, 0.24-0.88; P = .018).

Conclusions: Mechanical valve prostheses were associated with lower mortality, lower rates of reoperation, and lower occurrence of infective endocarditis compared with bioprostheses within 10 years after SAVR in matched patients aged 50 to 70 years. Our results do not support the routine use of biologic valve prostheses in this patient group.
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http://dx.doi.org/10.1016/j.athoracsur.2019.10.027DOI Listing
July 2020

Concomitant use of drugs known to cause interactions with oral antiplatelets-polypharmacy in acute coronary syndrome outpatients in Finland.

Eur J Clin Pharmacol 2020 Feb 26;76(2):257-265. Epub 2019 Nov 26.

Heart Center, Turku University Hospital, PO Box 52, FI-20521, Turku, Finland.

Purpose: Use of oral antiplatelets (OAPs) is essential for preventing thrombotic events in patients with acute coronary syndrome (ACS). Effects of clopidogrel, prasugrel, and ticagrelor may be enhanced due to pharmacodynamic interactions, but as CYP substrates, they are prone to pharmacokinetic interactions too. The aim was to study polypharmacy in ACS patients following hospital discharge.

Methods: This observational drug utilization study linked patient-level data from nationwide registers. The study population consisted of adult ACS patients discharged from Finnish hospitals in 2009-2013. Logistic regression was used to model the probability of drug-drug interactions with odd ratios for predefined predictors such as age, gender, and ACS type.

Results: In the cohort of 54,416 ACS patients, 91% of those treated with OAP received clopidogrel. Of clopidogrel-treated patients, 12% purchased warfarin at least once while on clopidogrel treatment. Old age, male sex, ST-elevation myocardial infarction as index event, and a history of previous ACS events were associated with an increased risk of warfarin-OAP interaction (p < 0.001 for all). Ibuprofen, and serotonergic drugs tramadol, citalopram, and escitalopram were the next most common drugs causing pharmacodynamic interactions. In general, concomitant use of drugs known to cause pharmacokinetic interactions was rare, but both esomeprazole and omeprazole were prescribed in more than 6% of clopidogrel-treated patients.

Conclusions: Warfarin and ibuprofen were the most commonly used concomitant medications causing pharmacodynamic interactions and potentially increasing the risk of bleeding in OAP-treated patients. Esomeprazole and omeprazole were used in clopidogrel-treated patients although there are alternatives available for gastric protection.
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http://dx.doi.org/10.1007/s00228-019-02777-zDOI Listing
February 2020

Occurrence of fatal infective endocarditis: a population-based study in Finland.

BMC Infect Dis 2019 Nov 21;19(1):987. Epub 2019 Nov 21.

Heart Center, Turku University Hospital and University of Turku, PO Box 52, 20521, Turku, Finland.

Background: Infective endocarditis (IE) is a serious mainly bacterial infection associated with high mortality. Epidemiology of fatal IE is however largely unknown. We studied occurrence and trends of fatal IE in a population-based setting.

Methods: All adults (≥18 years of age) who deceased due to IE in Finland during 2004-2016 were studied. Data was collected from the nationwide, obligatory Cause of Death Registry. Background population consisted of 28,657,870 person-years and 651,556 deaths.

Results: Infective endocarditis contributed to death in 754 cases and was the underlying cause of death in 352 cases. The standardized incidence rate of deaths associated with IE was 1.42 (95% confidence interval (CI): 1.32-1.52) per 100,000 person-years. Incidence rate increased progressively with aging from 50 years of age. Men had a two-fold risk of acquiring fatal infective endocarditis compared to women (risk ratio (RR) 1.95; 95% CI: 1.71-2.22; P < 0.0001). On average, IE contributed to 1.16 (95% CI: 1.08-1.24) out of 1000 deaths in general adult population. The proportionate amount of deaths with IE was highest in population aged < 40 years followed by gradual decrease with aging. Incidence rate and proportion of deaths caused by IE remained stable during the study period.

Conclusions: Our study describes for the first time the population-based epidemiology of fatal IE in adults. Men had a two-fold risk of acquiring fatal IE compared to women. Although occurrence of fatal IE increased with aging, the proportion of deaths to which IE contributed was highest in young adult population.
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http://dx.doi.org/10.1186/s12879-019-4620-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6873758PMC
November 2019

Sex Differences in Long-Term Outcomes After Surgical Aortic Valve Replacement: A Nationwide Propensity-matched Study.

J Cardiothorac Vasc Anesth 2020 Apr 11;34(4):932-939. Epub 2019 Oct 11.

Heart Center, Turku University Hospital and University of Turku, Turku, Finland; Research Center of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland; Center for Population Health Research, Turku University Hospital and University of Turku, Turku, Finland; Administrative Center. Hospital District of Southwest Finland, Turku, Finland.

Objectives: Women are considered to have poorer prognoses after cardiac surgery, although evidence is scarce. The authors studied sex differences and long-term outcomes after surgical aortic valve replacement (SAVR).

Design: Nationwide retrospective cohort study.

Setting: Six public hospitals and 2 private hospitals.

Participants: All first-time SAVR (±coronary artery bypass surgery) patients (excluding endocarditis) aged ≥18 with a prosthetic valve were retrospectively identified from a national registry (n = 7616). Propensity score matching identified 2814 men and 2814 women with comparable baseline features.

Interventions: No intervention.

Measurements And Main Results: Outcomes were survival, major bleeding, ischemic stroke, infective endocarditis, and reoperation. Ten-year survival was 66.8% in men and 67.5% in women (hazard ratio [HR] 1.09; p = 0.107). Major bleeding occurred in 21.5% of men and 19.7% of women (HR 1.36; confidence interval [CI] 1.13-1.63; p = 0.0009) within 10 years, with similar results for mechanical and biological prosthesis. Bleeding was gastrointestinal in 38.5%, intracranial in 27.6%, and 33.9% in other sites with no sex difference in location. Ischemic stroke occurred in 12.5% of men and 13.3% of women within 10 years (HR 1.06; p = 0.614), and 4.7% of men and 2.6% of women (HR 1.77; CI 1.24-2.51; p = 0.001) had infective endocarditis, but association was present only with biological prosthesis (interaction p = 0.02). Aortic valve re-surgery was more common in men at 1 (HR 2.98; CI 1.27-7.00; p = 0.013) and 5 years after SAVR, but not at 10 years (2.4% v 3.8%; p = 0.189).

Conclusions: Baseline-matched long-term survival after SAVR is similar between sexes. Men had increased risk of bleeding, early re-surgery after SAVR, and infective endocarditis when using biological prosthesis.
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http://dx.doi.org/10.1053/j.jvca.2019.10.011DOI Listing
April 2020

Occurrence and mortality of vasospastic angina pectoris hospitalised patients in Finland: a population-based registry cohort study.

BMJ Open 2019 11 3;9(11):e030768. Epub 2019 Nov 3.

Heart Centre, Turku University Hospital, Turku, Finland.

Objectives: The occurrence and mortality of vasospastic angina pectoris (VAP) is largely unknown in western countries. Our objective was to clarify the occurrence, gender-distribution and mortality of VAP in Finland using a population-based hospital registry.

Methods: We studied consecutive patients aged ≥18 years hospitalized with VAP as the primary cause of admission in Finland during 2004-2014. The data were collected from obligatory nationwide registries. During the study period 1762 admissions were recorded.

Results: Majority of all VAP patients were male (59.7%) and mean age was 65.7±12.0 years. Annual admission rate for VAP was 2.29/100 000 person-years. Men were in higher risk for VAP than women (admission rate 3.00/100 000 vs 1.68/100 000; RR 1.70; p<0.0001). Gender difference was not modified by age. Likelihood of VAP was highest in population aged 70-84 years. Admission rate for VAP decreased notably during the study period. One-year all-cause mortality was 8.0% and 3-year mortality was 15.5% (cardiac mortality 11.1%). Mortality was associated with increasing age, comorbidity burden and lack of detected coronary artery obstruction, but was similar between genders and during the study period.

Conclusions: Men have higher risk for vasospastic angina caused admissions. Likelihood of vasospastic angina admission was highest in aged population. The 3-year all-cause mortality was 15.5%. Mortality was associated with increasing age, comorbidities and non-obstructive VAP diagnosis but was similar between genders.
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http://dx.doi.org/10.1136/bmjopen-2019-030768DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6858179PMC
November 2019

Population trends in aortic valve surgery in Finland between 2001 and 2016.

Scand Cardiovasc J 2020 Feb 25;54(1):47-53. Epub 2019 Oct 25.

Department of Anesthesiology, Intensive Care, Emergency Care and Pain Medicine, University of Turku, Turku, Finland.

. To investigate nationwide changes in procedure rates, patient selection, and prognosis after all surgical aortic valve replacements. . Patients undergoing primary surgical aortic valve replacement between 2001 and 2016 were identified from three nationwide registers with compulsory reporting to examine trends in aortic valve surgery over four four-year time periods. . A total of 12,139 surgical aortic valve replacement procedures (mean age 61.9 ± 11.8 years, 39.1% women) were performed. The total number of biological valves increased from 1001 (42.9%) to 2526 (75.5%) from 2001-2004 to 2013-2016 ( .001). During the first and last time periods the comorbidity burden increased; share of patients with hypertension increased from 37.5% to 46.9% ( .001), diabetes from 14% to 16.5% ( .01) and previous stroke from 5.2% to 7.2% ( .01). The proportion of women undergoing surgery decreased from 40% to 36.1% from 2001-2004 to 2013-2016, respectively ( .01). Overall 28-day mortality was 3.5%. In patients with biologic valve the multivariable-adjusted risk of short-term mortality decreased steadily in every four-year period from 2001-2004 to 2005-2008 (HR, 0.66; 95% CI 0.47-9.92), 2009-2012 (HR, 0.54; 95% CI, 0.39-0.75) and 2013-2016 (HR, 0.41; 95% CI, 0.29-0.58), whereas short-term mortality remained similar in patients with mechanical valve. The risk of four-year postoperative mortality after all surgical aortic valve replacements stayed constant. . The use of biologic aortic valve prosthesis has increased from 2001 to 2016. The proportion of women has declined markedly. The short-term mortality has decreased and the long-term mortality has stayed constant despite increasing comorbidity burden.
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http://dx.doi.org/10.1080/14017431.2019.1679875DOI Listing
February 2020

Hospital admission and prevalence trends of adult myasthenia gravis in Finland in 2004-2014: A retrospective national registry study.

J Neurol Sci 2019 Dec 17;407:116520. Epub 2019 Oct 17.

Heart Center, Turku University Hospital, Turku, Finland, Research Center of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland, Center for Population Health Research, Turku University Hospital and University of Turku, Turku, Finland.

Hospital admission trends in Myasthenia Gravis are largely unknown, so they were here investigated in Finland between 2004 and 2014 using national mandatory registry data. There were 2989 hospital admissions (59.7% for women) for 861 individuals (median 2 admissions/individual) The annual number of admissions (p = .56), the age of admitted patients (p = .24) or length of stay (p = .20) showed no change during the study period. The proportion of infections as the primary diagnosis increased from 4.5% to 10.4% (p = .0056). These admissions lasted longer than admissions with a non-infectious primary diagnosis (median 6 vs. 4 days, p < .0001). In-hospital mortality rate was 1.0%, predicted by age over 65 (HR 8.8; p = .0034) and infection as the primary diagnosis (HR 6.9; p < .0001). Annual frequencies of thymectomies (p = .66) or plasmaphereses (p = .12) remained unchanged. Myasthenia drug reimbursement data suggested increasing MG prevalence during the study period (p < .00001). Considering that the annual hospitalisation frequency remained stable, this would suggest decreased need of hospitalisations per patient. The importance of infections as causes of myasthenia hospitalisations merits further study.
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http://dx.doi.org/10.1016/j.jns.2019.116520DOI Listing
December 2019

Trends and results of oesophageal cancer surgery in Finland between 2004 and 2014.

Eur J Cardiothorac Surg 2020 01;57(1):107-113

Heart Center, Turku University Hospital, University of Turku, Turku, Finland.

Objectives: Few population-based studies reporting trends in oesophageal cancer surgery exist. The aim of this study was to assess the incidence of oesophageal cancer, changes in resection rates, patient demographics and short- and long-term outcomes of oesophagectomy at the population level in Finland.

Methods: All Finnish patients diagnosed with cancer of the oesophagus or gastrooesophageal junction between 1 January 2004 and 31 December 2014 identified from the nationwide registries were included. The follow-up ended on 31 December 2016. For evaluation of changes in demographics and treatment, data were divided into 2 periods: 2004-2009 and 2010-2014. For comparison of short-and long-term outcomes, adjustments for age, sex, comorbidity, tumour stage and histology were used.

Results: The number of diagnosed oesophageal cancers was 4266. Of these, 740 underwent oesophagectomy. Resection rate increased from 15.2% in 2004-2009 to 19.6% in 2010-2014. The median number of oesophagectomies in Finnish hospitals increased from 1.9 to 3.7 per hospital per year. At the same time, minimally invasive surgery became more common (6.3% vs 35.1%, P < 0.0001) and a trend for increase in neoadjuvant treatment was observed (46.8% vs 53.8%, P = 0.0582). The rate of type III anastomosis leaks and conduit necroses was 5.1% without differences in time periods. Three-year [52.4% vs 61.6%, adjusted hazard ratio (HR) 0.75, 95% confidence interval (CI) 0.59-0.95] and 5-year survival (42.1% vs 56.5%, adjusted HR 0.70, 95% CI 0.57-0.87) improved.

Conclusions: This nationwide population-based study demonstrates an increase in resection rate, use of neoadjuvant treatment and minimally invasive surgery together with an improvement in long-term outcome after oesophageal cancer surgery.
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http://dx.doi.org/10.1093/ejcts/ezz189DOI Listing
January 2020

Thoracoscopic surgery for lung cancer is associated with improved survival and shortened admission length: a nationwide propensity-matched study.

Eur J Cardiothorac Surg 2020 01;57(1):100-106

Heart Center, Turku University Hospital, Turku, Finland.

Objectives: Population-based studies comparing long-term survival after minimally invasive and open surgery for lung cancer are lacking. The aim of this study was to compare long-term survival rates between minimally invasive [video-assisted thoracoscopic surgery (VATS)] and open surgery for lung cancer in an unselected nationwide setting.

Methods: Patients undergoing minimally invasive (n = 710) or open (n = 2814) lung resection for lung cancer between 2004 and 2014 were identified from nationwide complete registries in Finland. Propensity score matching resulted in groups of 632 patients who had VATS and 632 who had a thoracotomy. The primary outcome was the 1-year survival rate. Secondary outcomes were 30-day, 90-day and 5-year survival rates and the length of surgical admission. Cox models were adjusted for sex, age, comorbidity, centre size, year of surgery, histological diagnosis, stage and adjuvant therapy.

Results: In the propensity-matched cohort, the 1-year survival rate was 90.8% [confidence interval (CI) 88.3-92.8%] after VATS and 87.1% (CI 84.3-89.6%) after open surgery. The 5-year survival rate in the propensity-matched cohort was 59.6% (CI 54.9-63.9%) after VATS and 53.3% (CI 48.6-57.7%) after open surgery. The 30-day mortality rates showed no differences between approaches, but the 90-day mortality rate was better after VATS when adjusted for patient-, tumour- and operation-specific features (hazard ratio 0.56, 95% CI 0.30-0.92; P = 0.024).

Conclusions: According to this population-based nationwide study from Finland, minimally invasive surgery for lung cancer is associated with improved long- and short-term survival rates, supporting the use of VATS as a primary surgical method for treating lung cancer. Due to the complexity of confounding factors in this study, one should, however, interpret the results critically. Additional studies are needed.
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http://dx.doi.org/10.1093/ejcts/ezz194DOI Listing
January 2020

Ga-DOTA chelate, a novel imaging agent for assessment of myocardial perfusion and infarction detection in a rodent model.

J Nucl Cardiol 2020 06 29;27(3):891-898. Epub 2019 May 29.

Turku PET Centre, University of Turku, Kiinamyllynkatu 4-8, 20521, Turku, Finland.

Background: Magnetic resonance imaging (MRI) with Gadolinium 1,4,7,10-tetraazacyclododecane-N',N″,N''',N″″-tetraacetic acid (Gd-DOTA) enables assessment of myocardial perfusion during first-pass of the contrast agent, while increased retention can signify areas of myocardial infarction (MI). We studied whether Gallium-68-labeled analog, Ga-DOTA, can be used to assess myocardial perfusion on positron emission tomography/computed tomography (PET/CT) in rats, comparing it with C-acetate.

Methods: Rats were studied with C-acetate and Ga-DOTA at 24 hours after permanent ligation of the left coronary artery or sham operation. One-tissue compartmental models were used to estimate myocardial perfusion in normal and infarcted myocardium. After the PET scan, hearts were sectioned for autoradiographic detection of Ga-DOTA distribution.

Results: C-acetate PET showed perfusion defects and histology showed myocardial necrosis in all animals after coronary ligation. Kinetic modeling of Ga-DOTA showed significantly higher k values in normal myocardium than in infarcted areas. There was a significant correlation (r = 0.82, P = 0.001) between k values obtained with Ga-DOTA and C-acetate. After 10 minutes of tracer distribution, the Ga-DOTA concentration was significantly higher in the infarcted than normal myocardium on PET imaging and autoradiography.

Conclusions: Our results indicate that acute MI can be detected as reduced perfusion, as well as increased late retention of Ga-DOTA.
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http://dx.doi.org/10.1007/s12350-019-01752-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7326802PMC
June 2020

Mechanical versus biological valve prosthesis for surgical aortic valve replacement in patients with infective endocarditis.

Interact Cardiovasc Thorac Surg 2019 09;29(3):386-392

Heart Center, Turku University Hospital, University of Turku, Turku, Finland.

Objectives: The optimal choice of valve prosthesis in surgical aortic valve replacement for infective endocarditis (IE) is controversial. We studied outcomes after mechanical versus biological prosthetic valve surgical aortic valve replacement in IE patients.

Methods: All patients with native-valve IE aged 16-70 years undergoing mechanical or biological surgical aortic valve replacement in Finland, between 2004 and 2014, were retrospectively studied (n = 213). Outcomes were all-cause mortality, ischaemic stroke, major bleeding and aortic valve reoperation at 1 year and 5 years. Results were adjusted for baseline features (age, sex, comorbidity burden, atrial fibrillation, valvular stenosis, concomitant coronary artery bypass grafting, extension, urgency, year and centre of operation). Median follow-up was 5 years.

Results: The 5-year mortality rate was 19.0% with mechanical prostheses and 34.8% with biological prostheses [hazard ratio (HR) 0.47, 95% confidence interval (CI) 0.23-0.92; P = 0.03]. Ischaemic stroke rates were 8.3% with mechanical prostheses and 16.8% with biological prostheses at 5 years (HR 0.21, CI 0.06-0.79; P = 0.01). Results were comparable in patients aged 16-59 and 60-70 years (interaction P = 0.84). Major bleeding within 5 years was similar between mechanical (11.3%) and biological valve (13.4%) groups (P = 0.95) with comparable rates of both gastrointestinal and intracranial bleeds. Reoperation rates at 5 years were 5.0% for mechanical prostheses and 9.2% for biological prostheses (P = 0.14). The 1-year ischaemic stroke rate was lower with mechanical prostheses (3.6% vs 11.6%, P =0.03), whereas mortality, major bleeding and reoperation rates were similar between groups.

Conclusions: The use of mechanical aortic valve is associated with lower mid-term mortality compared to biological prosthesis in patients with native-valve IE aged ≤70 years. Our results do not support the routine choice of a biological aortic valve prosthesis in this patient group.
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http://dx.doi.org/10.1093/icvts/ivz122DOI Listing
September 2019

Usage of PCI and long-term cardiovascular risk in post-myocardial infarction patients: a nationwide registry cohort study from Finland.

BMC Cardiovasc Disord 2019 05 22;19(1):123. Epub 2019 May 22.

Turku University Hospital and University of Turku, Heart Center, PO Box 52, 20521, Turku, Finland.

Background: Despite currently available treatments, the burden of myocardial infarction (MI) morbidity and mortality remains prominent. The aim of this was to investigate the risk of developing subsequent cardiovascular events in MI patients.

Methods: This was an observational, retrospective cohort database linkage study using patient level data from Finland. Cox proportional hazards models were used to assess the association of risk between the preselected covariates and incidence of specific outcomes. The primary endpoints were new MI, stroke, cardiovascular mortality and overall mortality.

Results: Finnish adult MI patients alive 7 days after discharge in 2009-2012 were included. The study cohort consisted of 32,909 MI patients, of whom 25,875 (79%) survived 12 months without subsequent MI or stroke. ST-elevation MI (STEMI) was associated with lower risk of subsequent MI and overall mortality compared to non-STEMI patients. Percutaneous coronary intervention (PCI) was used two times more often in STEMI patients, but patients with prior stroke were more than two times less likely to have PCI. Dementia/Alzheimer's disease decreased the use of PCI as much as age over 85 years. Female sex was an independent factor for not undergoing PCI (OR 0.75, P < 0.001 compared to men) but was nevertheless associated with lower risk of new MI and mortality (HR 0.8-0.9, P < 0.001 for all). Increased age was associated with increased event risk and PCI with decreased event risk.

Conclusions: Risk of cardiovascular events and mortality after MI increases steeply with age. Although at higher risk, aging patients and those with cardiovascular comorbidities are less likely to receive PCI after MI. Female sex is associated with better survival after MI regardless of less intensive treatment in women.
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http://dx.doi.org/10.1186/s12872-019-1101-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6532224PMC
May 2019

Long-term Outcomes of Mechanical Vs Biologic Aortic Valve Prosthesis in Patients Older Than 70 Years.

Ann Thorac Surg 2019 11 10;108(5):1354-1360. Epub 2019 May 10.

Heart Center, Turku University Hospital and University of Turku, Turku, Finland.

Background: Biologic prostheses are preferred for surgical aortic valve replacement (SAVR) in patients more than 70 years of age in clinical practice. This study investigated differences in long-term outcomes between SAVR-treated patients more than 70 years of age who received mechanical or biologic prosthetic valves.

Methods: All patients (excluding those with endocarditis) who were more than 70 years of age and who underwent isolated first-time SAVR (with or without coronary artery bypass grafting) in Finland between 2004 and 2014 were retrospectively studied (n = 4227). Propensity score matching (1:3) was used to account for baseline differences (n = 296 with mechanical prostheses and n = 888 with biologic prostheses). Outcomes were 10-year survival, major bleeding (all, gastrointestinal, intracranial), ischemic stroke, infective endocarditis, and aortic valve reoperation. Mean age was 75.8 years, and mean follow-up was 8.3 years.

Results: Survival at 10 years was 46.1% with mechanical prostheses and 57.8% with biologic prostheses (hazard ratio [HR], 1.48; 95% confidence interval [CI], 1.21 to 1.80; P < .001; number needed to harm = 7.0). The 10-year major bleeding rates were 37.0% with mechanical valves and 18.8% with biologic valves (HR, 1.77; 95% CI, 1.25 to 2.49; P = .001; number needed to harm = 7.4). Both gastrointestinal bleeding (26.5% vs 8.9%; HR, 2.63; 95% CI, 1.63 to 4.23; P < .001) and intracranial bleeding (8.8% vs 6.0%; HR, 2.12; 95% CI, 1.09 to 4.15; P = .028) were significantly more frequent with mechanical valve prosthesis. Occurrence of ischemic stroke (18.9% with mechanical prosthesis vs 16.1% with biologic prosthesis; P = .341), infective endocarditis (3.7% vs 2.8%; P = .242), or aortic valve reoperation (0.8% vs 2.8%; P = .707) did not differ between study groups.

Conclusions: Mechanical aortic valve prosthesis is associated with worse long-term survival and increased bleeding after SAVR in patients more than 70 years old. The study results suggest caution when considering mechanical aortic valve prostheses in elderly patients.
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http://dx.doi.org/10.1016/j.athoracsur.2019.04.012DOI Listing
November 2019