Spiritually ours, factually yours: Karelia and Russia in Finnish public consciousness

Diese Veröffentlichung erforscht auf der Grundlage einer Untersuchung der führenden finnischen Tageszeitung Helsingin Sanomat die Einstellungen und das Verständnis der Finnen zu Russland. Sie beschäftigt sich besonders mit der sogenannten Karelien-Frage und die Art und Weise, wie diese die öffentliche Diskussion in Finnland geprägt hat. Der Artikel versucht, meinungsbildende Verhaltensweisen in den spezifischen sozialen und kulturellen Verhältnissen zu untersuchen und erläutert die Meinungsbildung als gesellschaftliches Verhalten. Er bewertet, wie sich die öffentliche Meinung, wie sie sich auf der Leserbriefseite der Zeitung ausdrückt, entwickelt hat und von den größeren Veränderungen beeinflusst worden ist, die an der Grenze stattgefunden haben. Es gibt im Laufe der Zeit eindeutige Veränderungen sowohl in quantitativem als auch qualitativen Sinn. Dies lässt sich als Darstellung eines Trends zum allgemeinen Verschwinden in der Geschichte zusammenfassen, aber auch als periodisch auftretender Effekt und als Zusammenspiel zwischen bilateralen Beziehungen und allgemeineren geopolitischer Veränderungen.Based on an analysis of the leading Finnish newspaper, Helsingin Sanomat, this paper explores Finnish attitudes towards and understandings of Russia. It pays special attention to the so-called Karelia Question and the way it has shaped public discussion in Finland. The article seeks to investigate human signifying practices in the region’s specific social and cultural circumstances and explains meaning-making as a social practice. It evaluates how public opinion, as expressed in the letters page of the newspaper, has evolved and been affected by the broader changes that have occurred at the border. There are clear changes over time, both in a quantitative and qualitative sense. This may be summarised as representing a trend of general fading into history, but also as a more cyclical effect and as the interplay between bilateral relations and broader geopolitical changes

Long-term clinical outcome of elderly patients with acute coronary syndrome treated with early percutaneous coronary intervention : Insights from the BASE ACS randomized controlled trial Bioactive versus everolimus-eluting stents in elderly patients

Background: The BASE ACS trial demonstrated an outcome of titanium-nitride-oxide-coated bioactive stents (BAS) that was non-inferior to everolimus-eluting stents (EES) in patients presenting with acute coronary syndrome (ACS). We performed a post hoc analysis of elderly versus non-elderly patients from the BASE ACS trial. Methods: We randomized 827 patients (1:1) presenting with ACS to receive either BAS or EES. The primary end-point was major adverse cardiac events (MACE): a composite of cardiac death, non-fatal myocardial infarction (MI), or ischemia-driven target lesion revascularization (TLR). Follow-up was planned at 12 months and yearly thereafter for up to 7 years. Elderly age was defined as >= 65 years. Results: Of the 827 patients enrolled in the BASE ACS trial, 360 (43.5%) were elderly. Mean follow-up duration was 4.2 +/- 1.9 years. MACE was more frequent in elderly versus younger patients (19.7% versus 12.0%, respectively, p = 0.002), probably driven by more frequent cardiac death and non-fatal MI events (5.3% versus 1.5%, and 9.7% versus 4.5%, p = 0.002 and p = 0.003, respectively). The rates of ischemia-driven TLR were comparable (p > 0.05). In propensity score-matched analysis (215 pairs), only cardiac death was more frequent in elderly patients (6% versus 1.4%, respectively, p = 0.01). Diabetes independently predicted both MACE and cardiac death in elderly patients. Conclusions: Elderly patients treated with stent implantation for ACS had worse long-term clinical outcome, compared with younger ones, mainly due to a higher death rate. (C) 2016 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.Peer reviewe

Ten-year experience with transcatheter and surgical aortic valve replacement in Finland

Aim: We investigated the outcomes of transcatheter (TAVR) and surgical aortic valve replacement (SAVR) in Finland during the last decade. Methods: The nationwide FinnValve registry included data from 6463 patients who underwent TAVR or SAVR with a bioprosthesis for aortic stenosis from 2008 to 2017. Results: The annual number of treated patients increased three-fold during the study period. Thirty-day mortality declined from 4.8% to 1.2% for TAVR (p = .011) and from 4.1% to 1.8% for SAVR (p = .048). Two-year survival improved from 71.4% to 83.9% for TAVR (p <.001) and from 87.2% to 91.6% for SAVR (p = .006). During the study period, a significant reduction in moderate-to-severe paravalvular regurgitation was observed among TAVR patients and a reduction of the rate of acute kidney injury was observed among both SAVR and TAVR patients. Similarly, the rate of red blood cell transfusion and severe bleeding decreased significantly among SAVR and TAVR patients. Hospital stay declined from 10.4 +/- 8.4 to 3.7 +/- 3.4 days after TAVR (p <.001) and from 9.0 +/- 5.9 to 7.8 +/- 5.1 days after SAVR (p <.001). Conclusions: In Finland, the introduction of TAVR has led to an increase in the invasive treatment of severe aortic stenosis, which was accompanied by improved early outcomes after both SAVR and TAVR.Peer reviewe

Transcatheter and Surgical Aortic Valve Replacement in Patients with Recent Acute Heart Failure

Background. Patients with severe aortic stenosis and heart failure have poor prognosis, and their outcomes may be suboptimal even after transcatheter (TAVR) and surgical aortic valve replacement (SAVR). Methods. This is an analysis of the nationwide FinnValve registry, which included patients who underwent primary TAVR or SAVR with a bioprothesis for aortic stenosis. We evaluated the outcome of patients with acute heart failure (AHF) within 60 days prior to TAVR or SAVR. Results. The prevalence of recent AHF was 11.4% (484 of 4241 patients) in the SAVR cohort and 11.3% (210 of 1855 patients) in the TAVR cohort. In the SAVR cohort, AHF was associated with lower 30-day survival (91.3% vs 97.0%; adjusted odds ratio 1.801, 95% confidence interval [CI] 1.125-2.882) and 5-year survival (64.0% vs 81.2%; adjusted hazard ratio 1.482, 95% CI 1.207-1.821). SAVR patients with AHF had higher risk of major bleeding, need of mechanical circulatory support, acute kidney injury, prolonged hospital stay, and composite end-point (30-day mortality, stroke and/or acute kidney injury). Patients with AHF had a trend toward lower 30-day survival (crude rates 95.2% vs 97.9%; adjusted odds ratio 2.028, 95% CI 0.908-4.529) as well as significantly lower 5-year survival (crude rates 45.3% vs 58.5%; adjusted hazard ratio 1.530, 95% CI 1.185-1.976) also after TAVR. AHF increased the risk of acute kidney injury, prolonged hospital stay, and composite end-point after TAVR. Conclusions. Recent AHF is associated with increased risk of mortality and morbidity after SAVR and TAVR. These findings suggest that aortic stenosis patients should be referred for invasive treatment before the development of clinically evident heart failure.Peer reviewe

Transcatheter and surgical aortic valve replacement in patients with left ventricular dysfunction

Peer reviewe

Blood Transfusion and Outcome After Transfemoral Transcatheter Aortic Valve Replacement

Objective: To investigate the prognostic impact of red blood cell (RBC) transfusion on the outcome after transfemoral transcatheter aortic valve replacement (TAVR). Design: Nationwide, retrospective multicenter study. Setting: Five University Hospitals. Participants: The nationwide FinnValve registry included data from 2,130 patients who underwent TAVR for aortic stenosis from 2008 to 2017. After excluding patients who underwent TAVR through nontransfemoral accesses, 1,818 patients were selected for this analysis. Intervention: TAVR with or without coronary revascularization. Measurements and Main Results: RBCs were transfused in 293 patients (16.1%). Time-trend analysis showed that the rates of RBC transfusion decreased significantly from 27.5% in 2012 to 10.0% in 2017 (p <0.0001). Among 281 propensity score matched pairs, RBC transfusion was associated with higher 30-day mortality (7.1% v 0%, p <0.0001), late mortality (at 5-year, 59.1% v 43.3%, p = 0.008), as well as increased risk of acute kidney injury (17.0% v 4.4%, p <0.0001), renal replacement therapy (3.6% v 0.4, p <0.0001) and prolonged hospital stay (mean, 8.5 v 4.7 days, p <0.0001) compared with patients who did not receive blood transfusion. In the overall series, the risk of adverse events increased significantly with the increasing amount of transfused RBC units and when operation for excessive bleeding was necessary. Consistently with these findings, postoperative hemoglobin drop and nadir level were associated with higher early and late mortality. Conclusions: Patients who received blood transfusion after TAVR had an increased risk of early and late adverse events. These adverse effects were particularly evident with increasing amount of RBC transfusion and operations for excessive bleeding. (C) 2019 Elsevier Inc. All rights reserved.Peer reviewe

Ten-year experience with transcatheter and surgical aortic valve replacement in Finland

Aim: We investigated the outcomes of transcatheter (TAVR) and surgical aortic valve replacement (SAVR) in Finland during the last decade. Methods: The nationwide FinnValve registry included data from 6463 patients who underwent TAVR or SAVR with a bioprosthesis for aortic stenosis from 2008 to 2017. Results: The annual number of treated patients increased three-fold during the study period. Thirty-day mortality declined from 4.8% to 1.2% for TAVR (p = .011) and from 4.1% to 1.8% for SAVR (p = .048). Two-year survival improved from 71.4% to 83.9% for TAVR (p Conclusions: In Finland, the introduction of TAVR has led to an increase in the invasive treatment of severe aortic stenosis, which was accompanied by improved early outcomes after both SAVR and TAVR.</p

Comparison of Outcomes After Transcatheter Aortic Valve Replacement vs Surgical Aortic Valve Replacement Among Patients With Aortic Stenosis at Low Operative Risk

IMPORTANCE Transcatheter aortic valve replacement (TAVR) has been shown to be a valid alternative to surgical aortic valve replacement (SAVR) in patients at high operative risk with severe aortic stenosis (AS). However, the evidence of the benefits and harms of TAVR in patients at low operative risk is still scarce. OBJECTIVE To compare the short-term and midterm outcomes after TAVR and SAVR in low-risk patients with AS. DESIGN, SETTING, AND PARTICIPANTS This retrospective comparative effectiveness cohort study used data from the Nationwide Finnish Registry of Transcatheter and Surgical Aortic Valve Replacement for Aortic Valve Stenosis of patients at low operative risk who underwent TAVR or SAVR with a bioprosthesis for severe AS from January 1, 2008, to November 30, 2017. Low operative risk was defined as a Society of Thoracic Surgeons Predicted Risk of Mortality score less than 3% without other comorbidities of clinical relevance. One-to-one propensity score matching was performed to adjust for baseline covariates between the TAVR and SAVR cohorts. EXPOSURES Primary TAVR or SAVR with a bioprosthesis for AS with or without associated coronary revascularization. MAIN OUTCOMES AND MEASURES The primary outcomes were 30-day and 3-year survival. RESULTS Overall, 2841 patients (mean [SD] age, 74.0 [6.2] years; 1560 [54.9%] men) fulfilled the inclusion criteria and were included in the analysis; TAVR was performed in 325 patients and SAVR in 2516 patients. Propensity score matching produced 304 pairs with similar baseline characteristics. Third-generation devices were used in 263 patients (86.5%) who underwent TAVR. Among these matched pairs, 30-day mortality was 1.3% after TAVR and 3.6% after SAVR (P=.12). Three-year survival was similar in the study cohorts (TAVR, 85.7%; SAVR, 87.7%; P=.45). Interaction tests found no differences in terms of 3-year survival between the study cohorts in patients younger than vs older than 80 years or in patients who received recent aortic valve prostheses vs those who did not. CONCLUSIONS AND RELEVANCE Transcatheter aortic valve replacement using mostly third-generation devices achieved similar short- and mid-term survival compared with SAVR in low-risk patients. Further studies are needed to assess the long-term durability of TAVR prostheses before extending their use to low-risk patients.Peer reviewe