1
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Lahu S, Ndrepepa G, Gewalt S, Schuepke S, Bernlochner I, Aytekin A, Neumann FJ, Menichelli M, Richardt G, Laugwitz KL, Schunkert H, Kastrati A, Mayer K. Efficacy and safety of ticagrelor versus prasugrel in smokers and nonsmokers with acute coronary syndromes. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The efficacy and safety of ticagrelor versus prasugrel according to smoking status in patients with acute coronary syndromes (ACS) are not known.
Purpose
The aim of this study was to assess the efficacy and safety of ticagrelor versus prasugrel according to smoking status in patients with ACS undergoing invasive evaluation.
Methods
This pre-specified analysis of the ISAR-REACT 5 trial included 1349 smokers and 2652 nonsmokers randomised to receive ticagrelor or prasugrel. The primary endpoint was the incidence of death, myocardial infarction, or stroke; the secondary endpoint was the incidence of Bleeding Academic Research Consortium (BARC) type 3 to 5 bleeding. Both endpoints were assessed at 12 months after randomisation.
Results
There was no significant treatment arm-by-smoking status interaction regarding the efficacy outcome. The primary endpoint occurred in 47 patients (7.0%) in the ticagrelor group and 41 patients (6.2%) in the prasugrel group in smokers (hazard ratio [HR]=1.15; 95% confidence interval [CI] 0.76–1.75; P=0.510) and in 133 patients (10.2%) in the ticagrelor group and 94 patients (7.2%) in the prasugrel group in nonsmokers (HR=1.44 [1.10–1.87], P=0.007; Pint=0.378). The secondary endpoint occurred in 27 patients (4.6%) in the ticagrelor group and 33 patients (5.6%) in the prasugrel group in smokers (HR=0.81 [0.49–1.35]; P=0.412) and in 66 patients (6.0%) in the ticagrelor group and 46 patients (4.4%) in the prasugrel group in nonsmokers (HR=1.38 [0.94–2.01]; P=0.097).
Conlusions
Although there was no significant interaction between smoking and treatment effect, the present findings suggest a greater advantage of prasugrel over ticagrelor in nonsmoker vs. smoker patients with ACS.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): German Centre for Cardiovascular Research;Deutsches Herzzentrum München, Germany
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Affiliation(s)
- S Lahu
- German Heart Centre Munich, Munich, Germany
| | - G Ndrepepa
- German Heart Centre Munich, Munich, Germany
| | - S Gewalt
- German Heart Centre Munich, Munich, Germany
| | - S Schuepke
- German Heart Centre Munich, Munich, Germany
| | - I Bernlochner
- Klinikum rechts der Isar, Medizinische Klinik und Poliklinik Innere Medizin I, Munich, Germany
| | - A Aytekin
- German Heart Centre Munich, Munich, Germany
| | - F J Neumann
- University Heart Center Freiburg-Bad Krozingen, Department of Cardiology and Angiology II, Bad Krozingen, Germany
| | - M Menichelli
- Hospital Fabrizio Spaziani, Cardiology, Frosinone, Italy
| | - G Richardt
- Heart Center Bad Segeberg, Bad Segeberg, Germany
| | - K L Laugwitz
- Klinikum rechts der Isar, Medizinische Klinik und Poliklinik Innere Medizin I, Munich, Germany
| | | | - A Kastrati
- German Heart Centre Munich, Munich, Germany
| | - K Mayer
- German Heart Centre Munich, Munich, Germany
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2
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Wohrle J, Seeger J, Lahr S, Mayer K, Bernlochner I, Gewalt S, Hochholzer W, Hemetsberger R, Hapfelmeier A, Sager H, Joner M, Richardt G, Neumann FJ, Schunkert H, Kastrati A. Ticagrelor or prasugrel in patients with acute coronary syndrome in relation to glomerular filtration rate. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Objectives
The aim of this study was to assess the safety and efficacy of ticagrelor versus prasugrel for patients with acute coronary syndrome (ACS) according to their glomerular filtration rate (GFR).
Background
The outcomes of ticagrelor versus prasugrel in patients with ACS according to GFR have not been defined.
Methods
Patients (n=3985) with GFR available were categorized in three groups according to the tertiles of GFR. The primary endpoint was a composite of all-cause death, myocardial infarction and stroke at 1 year.
Results
The primary endpoint occurred significantly more often in patients with low GFR compared to high GFR as well as in patients with low GFR compared to intermediate GFR (picture 1). Patients in the lowest GFR group had significantly higher ischemic and bleeding risks than patients in the intermediate (hazard ratio [HR] 1.93 and 1.68) or high GFR groups (HR 3.52 and 2.96). In the group with low GFR, the primary endpoint occurred in 103 of 677 ticagrelor patients (15.4%) and in 72 of 652 prasugrel patients (11.2%; (HR=1.45, [1.07–1.96], p=.016, picture 2). In addition, each single component of the primary endpoint and stent thrombosis were numerically lower with prasugrel compared with ticagrelor. Occurrence of myocardial infarction was 3.7% with prasugrel compared to 6.6% with ticagrelor (p=0.019). BARC 3–5 bleeding events were similar with ticagrelor and prasugrel (8.8% versus 7.1%, p=0.278). In the intermediate and high GFR group the primary endpoint and bleeding events were similar between prasugrel and ticagrelor.
Conclusions
The incidence of a composite endpoint (all-cause death, myocardial infarction or stroke) occurred less frequently in patients who received prasugrel compared to patients who received ticagrelor in the low GFR population, whereas rate of bleeding events was similar.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Supported by a grant (FKZ 81X1600501) from the German Center for Cardiovascular Research and the Deutsches Herzzentrum München, Germany. Primary endpoint according to GFRLow GFR: Prasugrel versus Ticagrelor
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Affiliation(s)
- J Wohrle
- Medical Campus Lake Constance, Friedrichshafen, Germany
| | - J Seeger
- Medical Campus Lake Constance, Friedrichshafen, Germany
| | - S Lahr
- German Heart Centre Munich, Munich, Germany
| | - K Mayer
- German Heart Centre Munich, Munich, Germany
| | | | - S Gewalt
- German Heart Centre Munich, Munich, Germany
| | - W Hochholzer
- University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | | | | | - H Sager
- German Heart Centre Munich, Munich, Germany
| | - M Joner
- German Heart Centre Munich, Munich, Germany
| | - G Richardt
- Heart Center Bad Segeberg, Bad Segeberg, Germany
| | - F J Neumann
- University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | | | - A Kastrati
- German Heart Centre Munich, Munich, Germany
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3
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Lahu S, Behnes M, Ndrepepa G, Neumann FJ, Sibbing D, Bernlochner I, Menichelli M, Mayer K, Richardt G, Angiolillo DJ, Laugwitz KL, Schunkert H, Schuepke S, Kastrati A, Akin I. Body mass index and efficacy and safety of ticagrelor versus prasugrel in patients with acute coronary syndromes. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The efficacy and safety of ticagrelor versus prasugrel in patients with acute coronary syndromes (ACS) according to body mass index (BMI) remain unknown.
Purpose
To assess the efficacy and safety of ticagrelor versus prasugrel in patients with ACS according to BMI.
Methods
This post-hoc analysis of the ISAR-REACT 5 trial included 3987 patients with BMI data available. BMI was grouped in 3 categories: low (BMI<25 kg/m2, n=1084), intermediate (BMI ≥25 to <30 kg/m2, n=1890) and high (BMI≥30 kg/m2, n=1013). The primary endpoint was the 12-month incidence of all-cause death, myocardial infarction, or stroke. The secondary endpoint was the 12-month incidence of Bleeding Academic Research Consortium (BARC) type 3 to 5 bleeding.
Results
There was no significant treatment arm-by-BMI interaction regarding the primary endpoint (Pint=0.578). However, the primary endpoint occurred in 63 patients assigned to ticagrelor and 39 patients assigned to prasugrel in the low BMI group (11.7% vs. 7.5%; hazard ratio [HR]=1.62; 95% confidence interval [CI], 1.09–2.42; P=0.018), 78 patients assigned to ticagrelor and 58 patients assigned to prasugrel in the intermediate BMI group (8.3% vs. 6.2%; HR=1.36 [0.97–1.91]; P=0.076), and 43 patients assigned to ticagrelor and 37 patients assigned to prasugrel in the high BMI group (8.6% vs. 7.3%; HR=1.18 [0.76–1.84]; P=0.451). BARC type 3 to 5 bleeding events did not differ between ticagrelor and prasugrel in patients with low (6.5% vs. 6.6%), intermediate (5.6% vs. 5.0%), or high (4.4% vs. 2.8%) BMI.
Conclusions
BMI of patients with ACS did not impact significantly on the treatment effect of ticagrelor vs. prasugrel in terms of both efficacy and safety.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): German Center for Cardiovascular Research;Deutsches Herzzentrum München, Germany
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Affiliation(s)
- S Lahu
- German Heart Centre Munich, Munich, Germany
| | - M Behnes
- University Medical Centre of Mannheim, First Department of Medicine, Mannheim, Germany
| | - G Ndrepepa
- German Heart Centre Munich, Munich, Germany
| | - F J Neumann
- University Heart Center Freiburg-Bad Krozingen, Department of Cardiology and Angiology II, Bad Krozingen, Germany
| | - D Sibbing
- Ludwig Maximilians University Hospital, Munich, Germany
| | - I Bernlochner
- Klinikum rechts der Isar, Medizinische Klinik und Poliklinik Innere Medizin I, Munich, Germany
| | - M Menichelli
- Hospital Fabrizio Spaziani, Cardiology, Frosinone, Italy
| | - K Mayer
- German Heart Centre Munich, Munich, Germany
| | - G Richardt
- Heart Center Bad Segeberg, Bad Segeberg, Germany
| | - D J Angiolillo
- University of Florida College of Medicine, Jacksonville, United States of America
| | - K L Laugwitz
- Klinikum rechts der Isar, Medizinische Klinik und Poliklinik Innere Medizin I, Munich, Germany
| | | | - S Schuepke
- German Heart Centre Munich, Munich, Germany
| | - A Kastrati
- German Heart Centre Munich, Munich, Germany
| | - I Akin
- University Medical Centre of Mannheim, First Department of Medicine, Mannheim, Germany
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4
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Olliges E, Burgdorf C, Ladwig KH, Moeller C, Deftu-Kloes D, Pohl S, Ruettner B, Richardt G, Meissner K, Steger A, Goetzmann L, Ronel J. Psychosocial and physical long-term outcome in patients with a history of takotsubo cardiomyopathy or myocardial infarction - a multi-centered case control study. PSYCHOL HEALTH MED 2020; 25:989-1003. [PMID: 32000523 DOI: 10.1080/13548506.2020.1722315] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Physical long-term impacts of Takotsubo Cardiomyopathy (TTC) remain controversial and an underestimation of their severity becomes increasingly evident. Even less is known about mental long-term impacts of TTC. This study aims at a better understanding of the physical and mental long-term effects of TTC in comparison to myocardial infarctions (MI). On average 5 years after disease onset, 68 TTC patients and 68 age- and sex-matched MI patients were assessed for disease-related quality of life, depression, anxiety, chronic stress, social support, resilience, and life events prior to disease onset. Scores of TTC and MI patients were compared to each other and to normative references values. Regression analyses were used to evaluate the predictive value of the number of life events prior to disease onset for physical and mental long-term outcomes. Both groups displayed higher scores in depression and anxiety, higher levels of chronic stress, and lower scores in physical and mental quality of life in comparison to norm samples, while social support did not differ from norms. No differences between the two patient groups were observed. Within both groups, the majority of patients (TTC: 69.1%; MI: 60.3%) reported stressful life events prior to disease onset. In TTCs and MIs, the number of events had a significant impact on long-term mental health and chronic stress. Notably, both patient collectives scored higher in resilience than healthy controls. Results suggest negative long-term impacts of TTC on mental and physical wellbeing, comparable to those of MI. Besides a good somatic-medical care, psychotherapeutic support, including the development of functional coping strategies, might be warranted for TTC patients. The long-term impact of TTC should be taken as serious as that of MI.
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Affiliation(s)
- E Olliges
- Institute of Medical Psychology, Faculty of Medicine, LMU Munich , Munich, Germany.,Division of Health Promotion, Coburg University of Applied Sciences , Coburg, Germany
| | - C Burgdorf
- Department of Cardiology, Heart and Vascular Centre Bad Bevensen , Bad Bevensen, Germany
| | - K H Ladwig
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Techni- sche Universitaet Muenchen , Munich, Germany.,Department of Epidemiology II, Helmholtz Zentrum , Munich, Germany
| | - C Moeller
- Medical Clinic II, Luebeck, Universitaetsklinikum Schleswig-Holstein , Germany
| | - D Deftu-Kloes
- Department of Psychosomatic Medicine and Psychotherapy, Segeberger Kliniken , Bad Seg- eberg, Germany
| | - S Pohl
- Psychiatric Day-care Hospital, Klinikum Frankfurt (Oder) , Frankfurt Oder, Germany
| | - B Ruettner
- Department of Psychology, Medical School Hamburg , Germany
| | - G Richardt
- Department of Cardiology, Segeberger Kliniken , Bad Segeberg, Germany
| | - K Meissner
- Institute of Medical Psychology, Faculty of Medicine, LMU Munich , Munich, Germany.,Division of Health Promotion, Coburg University of Applied Sciences , Coburg, Germany
| | - A Steger
- Klinik und Poliklinik fuer Innere Medizin I, Klinikum rechts der Isar, Technische Universitaet Muenchen , Munich, Germany
| | - L Goetzmann
- Department of Psychosomatic Medicine and Psychotherapy, Segeberger Kliniken , Bad Seg- eberg, Germany
| | - J Ronel
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Techni- sche Universitaet Muenchen , Munich, Germany.,Department of Psychosomatic Medicine and Psychotherapy, Klinik Barmelweid AG , Barmel- weid, Switzerland
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5
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Iden L, Groschke S, Weinert R, Toelg R, Richardt G, Borlich M. 1203Typical atrial flutter is a manifestation of previously silent coronary artery disease. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Long-term mortality after ablation of typical atrial flutter has been found to be increased two fold in comparison to atrial fibrillation ablations through a period of five years with unclear mechanism.
Methods
We analysed 189 consecutive patients who underwent ablation for typical atrial flutter (AFL), in which the incidence of atrial flutter was the first manifestation of cardiac disease.
According to clinical standards of our center, the routine recommendation was to evaluate for CAD by invasive angiogram or CT-scan.
We compared the AFL patients to 141 patients with paroxysmal atrial fibrillation (AFIB) without known structural heart disease who underwent ablation in the same period and who had routine coronary angiograms performed.
Results
Out of 189 patients who presented with AFL, coronary status was available in 152 patients (80.4%). Both groups were balanced for mean age (64.9 years in AFL vs. 63.2 years in AFIB; p=0.15), body-mass-index (BMI; 28.8 vs. 28.5 kg/m2; p=0.15), CHA2DS2-VASc-Score (2.20 vs. 2.04; p=0.35), smoking status (22.2% smokers vs. 28.4%; p=0.23) and renal function (GFR >60 ml/min in 96.7% of all patients vs. 95.7%; p=0.76). There were significantly lower values for left-ventricular ejection fraction (52.5% vs. 59.7%; p<0.001), female sex (17.0% vs. 47.5%; p<0.001), hyperlipidemia (37.9% vs. 58.9%; p<0.001) and family history of cardiovascular disease (15.0 vs. 31.9%; p=0.001) in the AFL vs. AFIB cohorts.
CAD with stenoses >50% was found in 26.3% of all patients with available coronary status in AFL and in 7.0% in AFIB (p<0.001). CAD with stenoses >75% in 16.4% in AFL whereas only in 1.4% in AFIB (p<0.001). Multivessel disease was detected in 10.5% in AFL and 0.7% in AFIB (p<0.001).
After correction for age, LVEF, BMI, CHA2DS2-VASc-Score and it's individual components, smoking status, hyperlipidemia and family history of cardiovascular disease, there was a more than five-fold increase in the likelihood of CAD with stenosis >50% in AFL as compared to AFIB (OR 5.26).
A multivariate analysis was performed in the AFL group. Patients with clinically relevant stenoses (>75%) were older (70.6 years vs. 63.8 years; p=0.001), had a higher number of risk factors (3.08 vs. 2.24; p≤0.0016) and a higher CHA2DS2-VASc-Score (3.20 vs 2.00; p<0.0001). With logistic regression, significant CAD could be predicted by higher values for CHA2DS2-VASc-Score with an exponential rise to a pretest-probability of 42.1% at a value of 4 points.
Odds ratios of CAD with AFL vs AFIB
Discussion
This data suggests that typical atrial flutter constitutes a manifestation for previously asymptomatic CAD. Due to the inclusion criteria, CAD has to be considered silent and stable in most of the patients. Therefore, the presence of typical atrial flutter in formerly healthy patients should raise suspicion of otherwise silent CAD and initiate further investigations and risk-stratification with particular emphasis on the individual CHA2DS2-VASc-Scores.
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Affiliation(s)
- L Iden
- Heart Center Bad Segeberg, Bad Segeberg, Germany
| | - S Groschke
- Heart Center Bad Segeberg, Bad Segeberg, Germany
| | - R Weinert
- Heart Center Bad Segeberg, Bad Segeberg, Germany
| | - R Toelg
- Heart Center Bad Segeberg, Bad Segeberg, Germany
| | - G Richardt
- Heart Center Bad Segeberg, Bad Segeberg, Germany
| | - M Borlich
- Heart Center Bad Segeberg, Bad Segeberg, Germany
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6
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Haeck JD, Zimmermann FM, Van 'T Veer M, Neumann FJ, Triantafyllis AS, Abdel-Wahab M, Omerovic E, Boxma-De Klerk BM, Pijls NH, Richardt G, Tonino PA, Johnson NP, Smits PC. P1251Percutaneous coronary intervention versus medical therapy for coronary lesions with positive fractional flow reserve (FFR) but preserved coronary flow reserve (CFR). A substudy of the COMPARE-ACUTE. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
International guidelines recommend performing percutaneous coronary intervention (PCI) on stable coronary lesions with a positive fractional flow reserve (FFR) to improve clinical outcomes. It remains unclear if FFR positive lesions with preserved coronary flow reserved (CFR) might be better treated medically.
Purpose
This study compared clinical outcomes between PCI and medical therapy for stable FFR-positive lesions with preserved CFR.
Methods
We performed a substudy of the randomized, multicenter COMPARE-ACUTE trial in which treated ST-elevation myocardial infarction patients with stable non-culprit lesions were randomized to either FFR-guided PCI or medical therapy. Based on baseline and hyperaemic pressure gradients, we computed the so-called pressure bounded-CFR (pb-CFR) and classified lesions as low (<2) or preserved (≥2). Our primary end point was a composite of death from any cause, non-fatal myocardial infarction, revascularization, or cerebrovascular events (MACCE) at 12 months.
Results
A total of 980 lesions from 885 subjects were included in this sub-study due to availability of baseline and hyperaemic pressure gradients. For the 462 lesions with FFR≤0.80, 249 had a pb-CFR<2 while 29 had a preserved CFR (pb-CFR≥2). The rate of MACCE at 1 year did not differ significantly between subjects with FFR≤0.80 and pb-CFR<2 versus FFR≤0.80 and pb-CFR≥2 (24% vs. 30%, p=0.44). Because of randomization, baseline characteristics were well balanced between subjects with FFR≤0.80 and pb-CFR≥2 who were treated by PCI or medical therapy. Importantly for subjects with FFR≤0.80 and pb-CFR≥2, MACCE occurred more frequently when treated medically compared with PCI (50% vs. 0% respectively, p=0.01).
Conclusions
In this post-hoc substudy from a large randomized controlled trial of 885 subjects with 980 lesions, a preserved pb-CFR≥2 did not associate with an improved clinical outcome when FFR≤0.80. Subjects with FFR-positive coronary lesions but a preserved pb-CFR experienced significantly worse clinical outcomes when treated medically instead of with PCI. These data suggest that a stenosis with a FFR≤0.80, even when pb-CFR remains preserved, benefits from treatment with PCI.
Acknowledgement/Funding
Maasstad Cardiovascular Research, Abbott Vascular and St. Jude Medical
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Affiliation(s)
- J D Haeck
- Medical Center Leeuwarden, Cardiology, Leeuwarden, Netherlands (The)
| | - F M Zimmermann
- Catharina Hospital, Cardiology, Eindhoven, Netherlands (The)
| | - M Van 'T Veer
- Catharina Hospital, Cardiology, Eindhoven, Netherlands (The)
| | - F J Neumann
- University Heart Center Freiburg-Bad Krozingen, Cardiology, Bad Krozingen, Germany
| | | | | | - E Omerovic
- University of Gothenburg, Cardiology, Gothenburg, Sweden
| | | | - N H Pijls
- Catharina Hospital, Cardiology, Eindhoven, Netherlands (The)
| | - G Richardt
- Heart Center Bad Segeberg, Bad Segeberg, Germany
| | - P A Tonino
- Catharina Hospital, Cardiology, Eindhoven, Netherlands (The)
| | - N P Johnson
- McGovern Medical School at UTHealth, Medicine, Houston, United States of America
| | - P C Smits
- Maasstad Hospital, Cardiology, Rotterdam, Netherlands (The)
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7
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Smits PC, Abdel-Wahab M, Neumann FJ, Boxma-De Klerk BM, Laforgia PL, Schotborgh CE, Wlodarczak A, Hambrecht R, Angeras O, Fischer H, Richardt G, Omerovic E. 467FFR guided acute complete revascularization versus culprit lesion only treatment in patients presenting with STEMI; 3-year cost-analysis data from COMPARE-ACUTE trial. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Compare-Acute trial showed a 1-year superior outcome of FFR-guided acute complete revascularization (FFR-CR) compared to culprit-lesion-only revascularization (CLO) in patients presenting with ST-segment elevation myocardial infarction (STEMI) and multi-vessel disease (MVD). Long-term results and financial impact of this strategy are unknown.
Purpose
To evaluate if FFR-CR strategy is superior to CLO strategy in terms of health care costs at 3 year follow-up.
Methods
Compare-Acute is a multicenter, investigator-initiated prospective randomized controlled trial that involved 24 sites. Patients with STEMI and MVD were randomized 1:2 after successful primary PCI, towards FFR-CR or CLO treatment strategies (295 vs 590 pts). All stenosis ≥50% by angiography in the non-infarct artery were investigated by FFR in both arms. In the FFR-CR arm, all non-culprit (NC) lesions with a FFR ≤0.80 were treated by PCI. In the CLO arm pts underwent blinded FFR procedure of the NC lesions. Further treatment of these lesions was based on symptoms and/or ischemia testing during follow-up with an allowed treatment window of 45 days. The primary endpoint was defined as a composite of all-cause mortality, non-fatal myocardial infarction, any revascularization and cerebrovascular events (MACCE) at 12 months. The major secondary endpoints are MACCE and health care costs from both strategies up to 3-year follow-up. Cost-analysis is done from an insurance/governmental perspective in countries that use Diagnosis Related Group (DRG) costs: the Netherlands, Germany, Sweden and Poland.
Results
1-year results have already been published and showed superior outcome of patients in the FFR-CR arm. According to the Dutch system, at 1 year of follow-up the average cost per patient was 8.150€ in the FFR-CR arm, and 10.319€ in the CLO arm (−21%). The better cost-effectiveness of FFR-CR strategy remained at 3 years of follow-up: average cost per patient was 8.653€ in the FFR-CR arm and 11.100€ in the CLO arm (−22%). Same 3-year data was confirmed using DRG analysis according to the German system (FFR-CR 4.887€ vs CLO 5.200€; −6.0%) and the Swedish system (FFR-CR 6.205€ vs CLO 8.133€; −23.7%). FFR-CR strategy was not more costly according to the Polish system (FFR-CR 3.704€ vs CLO 3.685€; +0.5%). Moreover, the better outcome of the FFR-CR group was mantained at 3 year follow-up (data not shown).
Figure 1
Conclusion
Our cost-analysis of the Compare Acute Trial shows that the strategy of FFR-guided complete revascularization in patients with STEMI and MVD is not only superior in terms of outcome, but also in terms of health care costs at 1 year. This benefit is maintained at 3 years follow-up.
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Affiliation(s)
- P C Smits
- Maasstad Ziekenhuis, Rotterdam, Netherlands (The)
| | | | - F J Neumann
- University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | | | - P L Laforgia
- Maasstad Ziekenhuis, Rotterdam, Netherlands (The)
| | | | | | | | - O Angeras
- Gothenburg University Hospital, Gothenburg, Sweden
| | - H Fischer
- Abbott Vascular, Hoofddorp, Netherlands (The)
| | - G Richardt
- Heart Center Bad Segeberg, Bad Segeberg, Germany
| | - E Omerovic
- Gothenburg University Hospital, Gothenburg, Sweden
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8
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Smits PC, Abdel-Wahab M, Neumann FJ, Boxma-De Klerk BM, Laforgia PL, Lunde K, Schotborgh CE, Piroth Z, Horak D, Wlodarczak A, Ong PJ, Hambrecht R, Angeras O, Richardt G, Omerovic E. 1154FFR guided acute complete revascularization versus culprit lesion only treatment in patients presenting with STEMI and multi vessel disease; final 3-year outcome data from Compare-Acute trial. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Compare-Acute trial showed a 1-year superior outcome of FFR-guided acute complete revascularization (FFR-CR) compared to culprit-lesion-only revascularization (CLO) in patients presenting with ST-segment elevation myocardial infarction (STEMI) and multi-vessel disease (MVD). Long-term outcome results are unknown.
Purpose
To evaluate if FFR-CR strategy is superior to CLO strategy in terms of outcome at 3 year follow-up.
Methods
Compare-Acute is a multicenter, investigator-initiated prospective randomized controlled trial that involved 24 sites. Patients with STEMI and MVD were randomized, after successful primary PCI towards FFR-CR or CLO treatment strategies with a 1:2 ratio (295 pts vs 590 pts). All stenosis ≥50% in the non-infarct artery were investigated by FFR in both arms. In the FFR-CR arm, all non-culprit (NC) lesions with a FFR ≤0.80 were treated by PCI. In the CLO arm pts underwent blinded FFR procedure of the NC lesions. Further treatment of these lesions was based on symptoms and/or ischemia testing during follow-up with an allowed treatment window of 45 days. The primary endpoint was defined as a composite of all-cause mortality, non-fatal myocardial infarction, any revascularization and cerebrovascular events (MACCE) at 12 months. The major secondary endpoint is MACCE from both strategies up to 3-year follow-up.
Results
1-year clinical outcomes have already been presented and published. At 36 months the composite end-point of MACCE occurred in 46 patients in the FFR-CR group vs 178 patients in the CLO group (15.6% vs 30.2%; HR 0.46, 95% CI 0.29–0.59; p<0.01), as shown in Fig. 1. The incidence of death (4 pts vs 10 pts; 1.4% vs 1.7%; HR 0.86, 95% CI 0.39–1.8; p=0.71), MI (20 pts vs 53 pts; 7.1% vs 9.3%; HR 0.74, 95% CI 0.44–1.24; p=0.25) and stroke (1 pt vs 7 pts; 0.3% vs 1.2%; HR 0.29, 95% CI 0.03–2.3; p=0.24) was not significantly different in the two groups, but revascularizations were significantly higher in the CLO group: 37 patients in the FFR-CR group vs 149 patients in the CLO group (13.0% vs 26.0%; HR 0.45; 95% CI 0.31–0.64; p<0.01). Furthermore, in a subgroup analysis, when we considered only patients with FFR positive non-culprit lesions in both arms, we found a higher incidence of MI at follow-up in the CLO arm compared to the FFR-CR arm: 30/224 vs 13/194 (13.4% vs 6.7%; p 0.03).
MACCE-free survival at 3 years
Conclusion
With this analysis of the Compare-Acute trial we confirm that the benefit of a FFR-guided complete revascularization strategy in patients with STEMI and MVD is maintained at 3 years of follow-up. This difference is mainly driven by increased revascularizations in the CLO arm, but also by increased incidence of MI in the CLO subgroup with FFR+ lesions that were left untreated.
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Affiliation(s)
- P C Smits
- Maasstad Ziekenhuis, Rotterdam, Netherlands (The)
| | | | - F J Neumann
- University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | | | - P L Laforgia
- Maasstad Ziekenhuis, Rotterdam, Netherlands (The)
| | - K Lunde
- Oslo University Hospital, Oslo, Norway
| | | | - Z Piroth
- Gottsegen Gyorgy Hungarian Institute of Cardiology, Budapest, Hungary
| | - D Horak
- Regional Hospital Liberec, Liberec, Czechia
| | | | - P J Ong
- Tan Tock Seng Hospital, Singapore, Singapore
| | | | - O Angeras
- Gothenburg University Hospital, Gothenburg, Sweden
| | - G Richardt
- Heart Center Bad Segeberg, Bad Segeberg, Germany
| | - E Omerovic
- Gothenburg University Hospital, Gothenburg, Sweden
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9
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Abdelghani M, Landt M, Abdel-Wahab M, Richardt G. P1484The modified natural history of mitral regurgitation in patients undergoing transcatheter aortic valve implantation. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- M Abdelghani
- Heart Center Bad Segeberg, Cardiology, Bad Segeberg, Germany
| | - M Landt
- Heart Center Bad Segeberg, Cardiology, Bad Segeberg, Germany
| | - M Abdel-Wahab
- Heart Center Bad Segeberg, Cardiology, Bad Segeberg, Germany
| | - G Richardt
- Heart Center Bad Segeberg, Cardiology, Bad Segeberg, Germany
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10
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Abdelghani M, Merten C, Landt M, Beurich HW, Zachow D, Richardt G, Abdel-Wahab M. 4285Impact of prosthetic valve regurgitation quantified by cardiac magnetic resonance imaging on long-term mortality after TAVI. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.4285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- M Abdelghani
- Heart Center Bad Segeberg, Cardiology, Bad Segeberg, Germany
| | - C Merten
- Heart Center Bad Segeberg, Cardiology, Bad Segeberg, Germany
| | - M Landt
- Heart Center Bad Segeberg, Cardiology, Bad Segeberg, Germany
| | - H.-W Beurich
- Heart Center Bad Segeberg, Cardiology, Bad Segeberg, Germany
| | - D Zachow
- Heart Center Bad Segeberg, Cardiology, Bad Segeberg, Germany
| | - G Richardt
- Heart Center Bad Segeberg, Cardiology, Bad Segeberg, Germany
| | - M Abdel-Wahab
- Heart Center Bad Segeberg, Cardiology, Bad Segeberg, Germany
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11
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Abdel-Wahab M, Holy E, Kebernik J, Abdelghani M, Stampfli S, Allali A, El-Mawardy M, Sachse S, Luscher T, Tanner F, Richardt G. P2260Long-term durability and hemodynamic performance of a self-expanding transcatheter heart valve beyond 5 years after implantation: a prospective observational study applying the standardized definition. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- M Abdel-Wahab
- Heart Center Bad Segeberg, Cardiology, Bad Segeberg, Germany
| | - E Holy
- Heart Center Bad Segeberg, Cardiology, Bad Segeberg, Germany
| | - J Kebernik
- Heart Center Bad Segeberg, Cardiology, Bad Segeberg, Germany
| | - M Abdelghani
- Heart Center Bad Segeberg, Cardiology, Bad Segeberg, Germany
| | - S Stampfli
- University Heart Center, Cardiology, Zurich, Switzerland
| | - A Allali
- Heart Center Bad Segeberg, Cardiology, Bad Segeberg, Germany
| | - M El-Mawardy
- Heart Center Bad Segeberg, Cardiology, Bad Segeberg, Germany
| | - S Sachse
- Heart Center Bad Segeberg, Cardiology, Bad Segeberg, Germany
| | - T Luscher
- University Heart Center, Cardiology, Zurich, Switzerland
| | - F Tanner
- University Heart Center, Cardiology, Zurich, Switzerland
| | - G Richardt
- Heart Center Bad Segeberg, Cardiology, Bad Segeberg, Germany
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12
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Kelm M, Kastrati A, Nef H, Richardt G, Zeymer U, Bauersachs J. Kommentar zu den Leitlinien 2017 der Europäischen Gesellschaft für Kardiologie (ESC) zur Therapie des akuten Herzinfarktes bei Patienten mit ST-Streckenhebung. Kardiologe 2018. [DOI: 10.1007/s12181-018-0237-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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13
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Abdel-Wahab M, Werner N, Linke A, Sievert H, Kahlert P, Hambrecht R, Nickenig G, Hauptmann K, Sack S, Schneider S, Gerckens U, Richardt G, Zahn R. 1280Long-term impact of prosthetic valve regurgitation after transcatheter aortic valve implantation: a 5-year follow-up analysis from the German TAVI registry. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.1280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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14
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Colleran R, Kufner S, Rosenbeiger C, Joner M, Cassese S, Ott I, Fusaro M, Ibrahim T, Laugwitz KL, Abdel-Wahab M, Neumann F, Richardt G, Kastrati A, Byrne R. 3122Longterm comparative efficacy of drug-eluting stents versus bare metal stents in saphenous vein graft lesions: 5-year clinical follow-up of a randomized trial. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.3122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- R. Colleran
- Deutsches Herzzentrum Technische Universitat, Munich, Germany
| | - S. Kufner
- Deutsches Herzzentrum Technische Universitat, Munich, Germany
| | - C. Rosenbeiger
- Deutsches Herzzentrum Technische Universitat, Munich, Germany
| | - M. Joner
- Deutsches Herzzentrum Technische Universitat, Munich, Germany
| | - S. Cassese
- Deutsches Herzzentrum Technische Universitat, Munich, Germany
| | - I. Ott
- Deutsches Herzzentrum Technische Universitat, Munich, Germany
| | - M. Fusaro
- Deutsches Herzzentrum Technische Universitat, Munich, Germany
| | - T. Ibrahim
- 1. medizinische Klinik, Klinikum rechts der Isar, Technische Universität, Munich, Germany
| | - K.-L. Laugwitz
- 1. medizinische Klinik, Klinikum rechts der Isar, Technische Universität, Munich, Germany
| | | | - F.J. Neumann
- University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | | | - A. Kastrati
- Deutsches Herzzentrum Technische Universitat, Munich, Germany
| | - R.A. Byrne
- Deutsches Herzzentrum Technische Universitat, Munich, Germany
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15
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Abdelghani M, Abdel-Wahab M, Miyazaki Y, Holy E, Merten C, Zachow D, Tonino P, Rutten M, Van De Vosse F, Morel M, Onuma Y, Serruys P, Richardt G, Soliman O. P2966Quantitative assessment of prosthetic valve regurgitation after TAVI by angiography and cardiac magnetic resonance imaging. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p2966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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16
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Schwarz B, Abdel-Wahab M, Robinson DR, Richardt G. Predictors of mortality in patients with cardiogenic shock treated with primary percutaneous coronary intervention and intra-aortic balloon counterpulsation. Med Klin Intensivmed Notfmed 2015; 111:715-722. [PMID: 26596273 DOI: 10.1007/s00063-015-0118-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 08/11/2015] [Accepted: 09/30/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Cardiogenic shock remains the most serious complication of patients hospitalized with acute myocardial infarction (AMI). Early revascularization is the cornerstone of invasive therapy, while mechanical support with intra-aortic balloon pump (IABP) is debatable. From our institutional shock registry we sought to determine predictors of in-hospital mortality-including the aspect of IABP timing-and to develop a clinical risk score for shock patients with AMI. METHODS From January 2005 till December 2010, 102 patients with cardiogenic shock due to AMI treated with primary percutaneous coronary intervention (PCI) and IABP were analyzed. Univariate and multivariate logistic regression analyses were used to identify independent predictors of in-hospital mortality. Logistic regression analysis and receiver-operating curves were used to generate a mortality risk score. RESULTS The mean age of the cohort was 70.1 ± 11.0 years and 70 % were men. One third of patients had a non-ST segment elevation myocardial infarction and 30 % had to be resuscitated before coronary intervention. Mean left ventricular ejection fraction was 25 %. After admission, 23 % of patients developed an acute renal failure and 10 % needed renal dialysis during hospital stay. In 52 % of patients IABP therapy was initiated after primary PCI, while the remaining patients had an IABP-assisted primary PCI. All-cause in-hospital mortality was 40.2 %. Using multivariate analysis, age (odds ratio [OR] 1.08, p = 0.006), resuscitation before PCI (OR 3.46, p = 0.045), vasopressor use (OR 7.88, p = 0.003), acute renal failure (OR 11.18, p = 0.001), and IABP implantation after PCI (OR 4.36, p = 0.011) were independently associated with in-hospital mortality. Based on these predictors, a mortality-risk score was calculated as follows: 1.5 × IABP timing before PCI + 0.1 × age + resuscitation before PCI + 2 × vasopressor use + 2.5 × acute renal failure. Using a cut-off value of 10.4, this score had a specificity of 83 % and a sensitivity of 82 % for prediction of in-hospital death. CONCLUSIONS We identified age, vasopressor use, resuscitation before PCI, acute renal failure and IABP implantation after PCI as independent predictors of in-hospital mortality in patients with cardiogenic shock due to AMI. The timing of IABP insertion was the only modifiable factor predicting in-hospital mortality in our cohort. Consequently, balloon pumping should be started before PCI to improve outcome of cardiogenic shock patients.
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Affiliation(s)
- B Schwarz
- Heart Center, Herzzentrum, Segeberger Kliniken GmbH (Academic Teaching Hospital of the Universities of Kiel and Hamburg), Am Kurpark 1, 23795, Bad Segeberg, Germany.
| | - M Abdel-Wahab
- Heart Center, Herzzentrum, Segeberger Kliniken GmbH (Academic Teaching Hospital of the Universities of Kiel and Hamburg), Am Kurpark 1, 23795, Bad Segeberg, Germany
| | - D R Robinson
- Mathematics Department, University of Sussex, Brighton, UK
| | - G Richardt
- Heart Center, Herzzentrum, Segeberger Kliniken GmbH (Academic Teaching Hospital of the Universities of Kiel and Hamburg), Am Kurpark 1, 23795, Bad Segeberg, Germany
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17
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Jochheim D, Abdel-Wahab M, Mehilli J, Ellert J, Wübken-Kleinfeld N, El-Mawardy M, Pache J, Massberg S, Kastrati A, Richardt G. Significant aortic regurgitation after transfemoral aortic valve implantation: patients' gender as independent risk factor. Minerva Cardioangiol 2015; 63:371-379. [PMID: 25812583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
AIM Significant aortic regurgitation (AR) has been reported in 20% of patients undergoing transfemoral aortic valve implantation (TAVI) and has been associated with increased mortality. Depending on the population included and the type of implanted prosthesis, several anatomical and procedural factors have been linked with increased risk of post-TAVI AR. While the impact of patients' gender on this complication, is still contradictory. We sought to assess the impact of patients' gender on the risk of significant AR after TAVI. METHODS We included 323 consecutive patients (136 men) who underwent transfemoral implantation of either self-expandable or balloon-expandable prostheses for treatment of symptomatic aortic stenosis. RESULTS After TAVI 52 patients (16.1%) had AR grade ≥ 2/4 as evaluated by angiography. They were more frequently male (59.6% vs. 40.4%, P = 0.005), received self-expandable (94.2% vs. 63.5%, P < 0.001) and bigger size prostheses (28 ± 1.9 vs. 27.3 ± 2.1 mm, P = 0.028) and had reduced left ventricular ejection fraction (45.3% ± 14.2% vs. 51.2% ± 13%, P = 0.003) compared to patients with AR grade < 2/4 (N. = 271). In multivariate analysis, men (OR 2.13 [95% CI, 1.08-4.18]) and prosthesis type (OR 13.17 [95% CI, 3.24-57.97]) were identified as independent predictors of AR grade ≥ 2/4. CONCLUSION Alongside with the implantation of self-expandable aortic prosthesis, male gender independently increases the risk of significant AR in patients undergoing TAVI. The question if this finding is related to gender biology itself or to gender-related aggregation of subtle anatomic characteristics needs further investigations.
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Affiliation(s)
- D Jochheim
- Munich University Clinic, Munich, Germany -
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18
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Orvin K, Carrie D, Richardt G, Desmet W, Assali A, Werner G, Ikari Y, Fujii K, Goicolea J, Dangoisse V, Manari A, Saito S, Wijns W, Kornowski R. Comparison of sirolimus eluting stent with bioresorbable polymer to everolimus eluting stent with permanent polymer in bifurcation lesions: Results from CENTURY II trial. Catheter Cardiovasc Interv 2015; 87:1092-100. [DOI: 10.1002/ccd.26150] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 07/21/2015] [Indexed: 11/10/2022]
Affiliation(s)
- K Orvin
- Cardiology Department; Rabin Medical Center, Petah Tikva, Israel and Sackler Faculty of Medicine, Tel Aviv University; Tel Aviv Israel
| | - D. Carrie
- Department of Cardiology; University Toulouse-Rangueil Hospital; France
| | - G. Richardt
- Segeberger Kliniken GmbH; Bad Segeberg Germany
| | - W. Desmet
- Department of Cardiovascular Medicine; University Hospitals Leuven; Leuven Belgium
| | - A. Assali
- Cardiology Department; Rabin Medical Center, Petah Tikva, Israel and Sackler Faculty of Medicine, Tel Aviv University; Tel Aviv Israel
| | - G. Werner
- Medizinische Klinik I; Klinikum Darmstadt GmbH; Darmstadt Germany
| | - Y. Ikari
- Department of Cardiology; Tokai University School of Medicine; Kanagawa Japan
| | - K. Fujii
- Department of Cardiology; Sakurabashi-Watanabe Hospital; Osaka Japan
| | - J. Goicolea
- Interventional Cardiology; Hospital Universitario Puerta De Hierro/Majadahonda; Madrid Spain
| | | | - A. Manari
- Department of Interventional Cardiology; Azienda Ospedaliera-IRCCS S. Maria Nuova; Viale Risorgimento Italy
| | - S. Saito
- Shonan Kamakura General Hospital; Kanagawa Japan
| | - W. Wijns
- Cardiovascular Centre Aalst; OLV Hospital; Belgium
| | - R. Kornowski
- Cardiology Department; Rabin Medical Center, Petah Tikva, Israel and Sackler Faculty of Medicine, Tel Aviv University; Tel Aviv Israel
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19
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Sato T, Abdel-Wahab M, Richardt G. Very late thrombosis observed on optical coherence tomography 22 months after the implantation of a polymer-based bioresorbable vascular scaffold. Eur Heart J 2015; 36:1273. [DOI: 10.1093/eurheartj/ehv046] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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20
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de Waha S, Thiele H, Richardt G. [Antiplatelet therapy and anticoagulation in acute coronary syndrome: current evidence]. Herz 2014; 39:692-701. [PMID: 25081127 DOI: 10.1007/s00059-014-4132-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
In recent years, the prognosis of patients with an acute coronary syndrome (ACS) has significantly improved. This can mainly be attributed to the implementation of primary percutaneous coronary intervention (PCI). Apart from mechanical reperfusion, an optimal medical strategy is of great importance. Antiplatelet and antithrombotic therapies in particular play a crucial role in the management of patients with ACS. New options in antiplatelet therapy are more potent P2Y12 inhibitors in addition to acetylsalicylic acid and clopidogrel. Furthermore, anticoagulant therapy before, during and after PCI can be performed by the use of unfractionated heparin, low molecular weight heparins, such as enoxaparin, the synthetic pentasaccharide fondaparinux and the direct thrombin inhibitor bivalirudin with or without additional administration of glycoprotein IIb/IIIa inhibitors. In this article, data on antiplatelet and anticoagulant therapy are presented and the current evidence is discussed.
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Affiliation(s)
- S de Waha
- Department of Cardiology and Angiology, Heart Center Bad Segeberg, Am Kurpark 1, 23795, Bad Segeberg, Deutschland,
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21
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Schulz S, Richardt G, Laugwitz KL, Morath T, Neudecker J, Hoppmann P, Mehran R, Gershlick AH, Tolg R, Anette Fiedler K, Abdel-Wahab M, Kufner S, Schneider S, Schunkert H, Ibrahim T, Mehilli J, Kastrati A, Kastrati A, Mehilli J, Richardt G, Mehran R, Gershlick A, Mehilli J, Burgdorf C, Byrne RA, Cassese S, Fusaro M, Hausleiter J, Hengstenberg C, Joner M, Kasel M, Kastrati A, Massberg S, Ott I, Pache J, Schunkert H, Seyfarth M, Sibbing D, Tiroch K, Laugwitz KL, Ibrahim T, Hoppmann P, Schneider S, Bradaric C, Richardt G, Abdel-Wahab M, Geist V, Schwarz B, Sulimov D, Tolg R, Schulz S, Schomig G, von Merzljak B, Luckmann J, Ruf J, Morath T, Holle H, Paul H, Vogel J, Hoesl K, Rifatov N, Pastor I, Maimer-Rodrigues F, Schulz M, Neudecker J, Mayer K, Hofmann F, Mann J, Hauschke D, Schmitt C, Poci D, Barthel P, Ndrepepa G, Keta D, Byrne RA, Kufner S, Piniek S, Hurt S, Kastrati S, Anette Fiedler K. Prasugrel plus bivalirudin vs. clopidogrel plus heparin in patients with ST-segment elevation myocardial infarction. Eur Heart J 2014; 35:2285-94. [DOI: 10.1093/eurheartj/ehu182] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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22
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Conradi L, Maisano F, Franzen O, Baldus S, Schäfer U, Hausleiter J, Butter C, Ussia G, Sievert H, Richardt G, Widder J, Moccetti T, Schillinger W, Reichenspurner H. Percutaneous MitraClip therapy: Early and one year results from the ACCESS-EU prospective, multicenter, non randomized post-approval study in Europe. Thorac Cardiovasc Surg 2014. [DOI: 10.1055/s-0034-1367181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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23
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Abdel-Wahab M, Neumann FJ, Windecker S, Richardt G. Incidence and predictors of unplanned non-target lesion revascularization after drug-eluting stent implantation: insights from a pooled analysis of the global RESOLUTE clinical trial program. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht310.p4832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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24
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Sherif M, Zahn R, Gerckens U, Sievert H, Eggebrecht H, Hambrecht R, Sack S, Richardt G, Senges J, Brachmann J. Effect of sex differences on one-year mortality after transcatheter aortic valve implantation for severe aortic stenosis: results from a multi-centre real-world registry. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht310.p5413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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25
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Waltenberger J, Hoffmann S, Brachmann J, Van Der Heijden J, Richardt G, Froebert O, Seige M, Pachinger O, Erglis A, De Wilde W. Bioflow-III: one year target lesion failure data of an all-comers registry with a drug eluting stent. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.p3036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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26
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Merten C, Beurich HW, Zachow D, Abdel-Wahab M, Arndt F, Moosig F, Gross W, Richardt G. Cardiac involvement in hypereosinophilic syndromes detected by cardiac magnetic resonance imaging. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.3501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Kukreja N, Serruys PW, De Bruyne B, Colombo A, Macaya C, Richardt G, Fajadet J, Hamm C, Goedhart D, Macours N, Stoll HP. Sirolimus-eluting stents, bare metal stents or coronary artery bypass grafting for patients with multivessel disease including involvement of the proximal left anterior descending artery: analysis of the Arterial Revascularization Therapies study part 2 (ARTS-II). Heart 2009; 95:1061-6. [PMID: 19304671 DOI: 10.1136/hrt.2008.157735] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE The The Arterial Revascularization Therapies Study (ARTS)-II trial found no differences in survival or overall adverse events between sirolimus-eluting stents (SES) and the surgical arm of ARTS-I. Nevertheless, existing data suggest that patients with disease of the proximal left anterior descending artery (LAD) may derive particular benefit from coronary artery bypass grafting (CABG). We therefore analysed the clinical outcome of patients in ARTS-I and ARTS-II with proximal LAD involvement. DESIGN Multicentre observational study. SETTING Forty-five European academic hospitals. PATIENTS Patients with multivessel coronary artery disease. INTERVENTIONS Patients in ARTS-II with proximal LAD disease treated with SES (289/607, 48%) were compared with 187/600 (31%) bare metal stent patients (ARTS-I BMS) and 206/605 (34%) surgical patients (ARTS-I CABG) with proximal LAD involvement from ARTS-I. MAIN OUTCOME MEASURES Major adverse cardiac and cerebrovascular events after 3 years. RESULTS The Arterial Revascularization Therapies study part 2 (ARTS-II) subgroup had better survival than both ARTS-I groups (ARTS-II 98.6% vs ARTS-I BMS 95.7%, p = 0.05 and vs ARTS-I CABG 94.7%, p = 0.01) and lower rates of the hard clinical composite endpoint of death or non-fatal myocardial infarction (ARTS-II 3.1% vs ARTS-I BMS 9.6%, p = 0.002 and vs ARTS-I CABG 9.7%, p = 0.002). Although the ARTS-I CABG patients had a lower need for repeat revascularisation than ARTS-II (5.3% vs 13.1%, p = 0.002), the overall composite adverse event rates (death, myocardial infarction, stroke or any repeat revascularisation) were not significantly different between the ARTS-I CABG and ARTS-II patients (15.0% vs 18.0%, p = 0.4). CONCLUSIONS SES are not inferior to CABG or bare metal stents for the treatment of patients with multivessel coronary disease including involvement of the proximal LAD.
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Affiliation(s)
- N Kukreja
- Thoraxcenter, Ba-583, 's Gravendijkwal 230, Rotterdam 3015 CE, The Netherlands.
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Iijima R, Ndrepepa G, Mehilli J, Byrne RA, Schulz S, Neumann FJ, Richardt G, Berger PB, Schomig A, Kastrati A. Profile of bleeding and ischaemic complications with bivalirudin and unfractionated heparin after percutaneous coronary intervention. Eur Heart J 2008; 30:290-6. [DOI: 10.1093/eurheartj/ehn586] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Khattab AA, Richardt G. Rotational atherectomy followed by drug-eluting stent implantation (Rota-DES): a rational approach for complex calcified coronary lesions. Minerva Cardioangiol 2008; 56:107-115. [PMID: 18432173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Rotational atherectomy has been regaining interest over the last couple of years after it almost has disappeared from most interventional catheterization laboratories for several years due to failure to prove its original concept of improving long term results of percutaneous coronary interventions (PCI) as was repeatedly shown in studies in the 1990s. Its revival coupled the introduction of drug-eluting stents (DES); these devices have led to treating much more complex lesions and high-risk patients by PCI. However, real-world experience suggested that off-label use of DES is associated with a higher rate of early and late stent thrombosis. Therefore, more attention is now being paid to the initial implantation technique of DES including aggressive lesion preparation to facilitate stent delivery and expansion. The limited studies with rot-ablation and DES showed promising results with no long term safety concerns. In these studies, a subtle observation was made suggesting that rot-ablation prior to DES implantation in such lesions may have an add-on effect on long term outcome compared to DES alone. An ongoing multicenter study is investigating such effect among complex calcified coronary lesions. Even if this additive benefit does not prove true, rot-ablation remains an efficient tool for preparing certain lesions to facilitate effective and safe DES implantation. Therefore, interventional training programs should focus on this difficult technique to bridge the gap of experience which resulted from neglecting it for several years. In this regard, dedicated courses at experienced sites as well as medical simulation may be appropriate.
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Affiliation(s)
- A A Khattab
- The Heart and Vascular Center, Segeberger Kliniken GmbH, Bad Segeberg, Germany.
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Khattab AA, Abdel-Wahab M, Röther C, Liska B, Toelg R, Kassner G, Geist V, Richardt G. Multi-vessel stenting during primary percutaneous coronary intervention for acute myocardial infarction. A single-center experience. Clin Res Cardiol 2007; 97:32-8. [PMID: 17694377 DOI: 10.1007/s00392-007-0570-4] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2007] [Accepted: 07/02/2007] [Indexed: 11/27/2022]
Abstract
BACKGROUND Recanalization of the culprit lesion is the main goal of primary angioplasty for acute ST-segment elevation myocardial infarction (STEMI). Patients presenting with acute myocardial infarction and multivessel disease are, therefore, usually subjected to staged procedures, with the primary percutaneous coronary intervention (PCI) confined to recanalization of the infarct-related artery (IRA). Theoretically at least, early relief of stenoses of non-infarct-related arteries could promote collateral circulation, which could help to limit the infarct size. However, the safety and feasibility of such an approach has not been adequately established. METHODS In this single-center prospective study we examined 73 consecutive patients who had an acute STEMI and at least one or more lesions > or = 70% in a major epicardial vessel other than the infarct-related artery. In the first 28 patients, forming the multi-vessel (MV) PCI group, all lesions were treated during the primary procedure. In the following 45 patients, forming the culprit-only (CO) PCI group, only the culprit lesion was treated during the initial procedure, followed by either planned-staged or ischemia-driven revascularization of the non-culprit lesions. Fluoroscopy time and contrast dye amount were compared between both groups, and patients were followed up for one year for major adverse cardiac events (MACE) and other significant clinical events. RESULTS The two groups were well balanced in terms of clinical characteristics, number of diseased vessels and angiographic characteristics of the culprit lesion. In the MV-PCI group, 2.51 lesions per patient were treated using 2.96 +/- 1.34 stents (1.00 lesions and 1.76 +/- 1.17 stents in the CO-PCI group, both p < 0.001). The fluoroscopy time increased from 10.3 (7.2-16.9) min in the CO-PCI group to 12.5 (8.5-19.3) min in the MV-PCI group (p = 0.22), and the amount of contrast used from 200 (180-250) ml to 250 (200-300) ml, respectively (p = 0.16). Peak CK and CK-MB were significantly lower in patients of the MV-PCI group (843 +/- 845 and 135 +/- 125 vs 1652 +/- 1550 and 207 +/- 155 U/l, p < 0.001 and 0.01, respectively). Similar rates of major adverse cardiac events at one year were observed in the two groups (24% and 28% in multi-vessel and culprit treatment groups, p = 0.73). The incidence of new revascularization in both infarct- and non-infarct-related arteries was also similar (24% and 28%, respectively, p = 0.73). CONCLUSION We may state from this limited experience that a multi-vessel stenting approach for patients with acute STEMI and multi-vessel disease is feasible and probably safe during routine clinical practice. Our data suggest that this approach may help to limit the infarct size. However, larger studies, perhaps using drug-eluting stents, are still needed to further evaluate the safety and efficiency of this procedure, and whether it is associated with a lower need of subsequent revascularization and lower costs.
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Affiliation(s)
- A A Khattab
- Herz-Kreislauf-Zentrum, Segeberger Kliniken, GmbH, Am Kurpark 1, 23795, Bad Segeberg, Germany.
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Zahn R, Hamm CW, Schneider S, Zeymer U, Richardt G, Kelm M, Levenson B, Bonzel T, Tebbe U, Sabin G, Nienaber CA, Pfannebecker T, Senges J. The Sirolimus-eluting coronary stent in daily routine practice in Germany: trends in indications over the years. Results from the prospective multi-centre German Cypher Stent Registry. Clin Res Cardiol 2007; 96:548-56. [PMID: 17534566 DOI: 10.1007/s00392-007-0531-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2007] [Accepted: 04/03/2007] [Indexed: 10/23/2022]
Abstract
BACKGROUND Drugeluting coronary stents (DES) are increasingly used during percutaneous coronary interventions (PCI). Due to limited budgets in Germany, no special reimbursement has been given for their use and therefore they were mainly used in selected patients. METHODS In order to determine the change in indications in patients treated with a Sirolimus-eluting stent (SES) in daily clinical practice between 2002 and 2005, we analysed data from a prospective multi-centre DES registry, the German Cypher Stent Registry. RESULTS From April 2002 until September 2005, 11 507 patients at 132 hospitals, who received at least one SES during their PCI, were included. Between 2002 and 2005, the median age of patients increased from 63 years to 66 years (p for trend <0.0001), whereas the prevalence of prior coronary bypass surgery (p<0.0001) and prior PCI (p<0.001) significantly decreased. Initial presentation of patients was stable over time, with a small increase of patients treated for non-ST elevation myocardial infarction (p=0.05). We found a significant increase in the treatment of complex stenoses (p<0.0001) as well as an increase in the proportion of chronic total occlusions (p<0.01). There was a steady increase in the proportion of patients treated for de novo lesions (p<0.0001), which was accompanied by a relative decrease in the proportion of patients treated for in-stent restenosis (p<0.0001). Concerning interventional characteristics a significant increase in the length of SES implanted per lesion, the numbers of SES implanted per lesion as well as an increase of the proportion of patients treated for more than one stenosis during one intervention could be observed (all p<0.0001). There was a significant decrease in the use of glycoprotein II b/IIIa antagonists during the PCI (2002: 26.5 to 14.2% in 2005, p<0.0001). MACE rates until hospital discharge did not change significantly over time. CONCLUSIONS Between 2002 and 2005 there were two trends in the use of SES: a) a significant increase in the use of SES for de novo lesions and b) a significant trend to use SES for longer lesions, smaller arteries, more complex lesions and more SES per lesion. In summary these findings indicate that still SES are mainly used in patients with lesions that are at high risk for restenosis.
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Affiliation(s)
- Ralf Zahn
- Med. Klinik 8, Kardiologie/Angiologie/Internistische Intensivmedizin, Klinikum Nürnberg Süd, Breslauer Strasse 201, 90471, Nürnberg, Germany.
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Schaefer U, Kurz T, Bonnemeier H, Dendorfer A, Hartmann F, Schunkert H, Richardt G. Intracoronary enalaprilat during angioplasty for acute myocardial infarction: alleviation of postischaemic neurohumoral and inflammatory stress? J Intern Med 2007; 261:188-200. [PMID: 17241184 DOI: 10.1111/j.1365-2796.2006.01757.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
AIM Reperfusion after myocardial ischaemia is associated with a distinct ischaemia/reperfusion injury. Since ACE-inhibition, beyond its influence on cardiac angiotensin II formation and kinin metabolism, has been shown to be cardioprotective by decreasing leucocyte adhesion and endothelin-1 (ET-1) release, we investigated the effects of intracoronary (i.c.) enalaprilat during primary angioplasty in acute myocardial infarction. METHODS AND RESULTS Twenty-two patients were randomized to receive i.c. enalaprilat (50 micro g) or placebo immediately after reopening of the infarct-related artery (IRA). Plasma concentrations of soluble L-selectin, P-selectin, intercellular adhesion molecule-1 (sICAM-1), vascular cell adhesion molecule-1 (sVCAM-1), ET-1 and nitric oxide metabolite concentrations (NOx) were measured in pulmonary arterial blood. Coronary blood flow was assessed using corrected thrombolysis in myocardial infarction (TIMI) frame counts (CTFC). During reperfusion, there was a significant increase in sL-selectin, sP-selectin and ET-1 in the placebo group, which was greatly diminished by enalaprilat. Levels of sVCAM-1 and sICAM-1 were not affected in either group. CTFC in the placebo group remained higher than normal in both the IRA and nonculprit vessels, whereas myocardial blood flow improved with enalaprilat. CONCLUSION Enalaprilat as adjunct to primary angioplasty might be a protective approach to prevent leucocyte adhesion and the release of ET-1, thereby improving coronary blood flow.
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Affiliation(s)
- U Schaefer
- Medizinische Klinik II, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Germany.
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Meyborg P, Abdel-Wahab M, Herrmann G, Geist V, Khattab AA, Krüger D, Lins M, Toelg R, Simon R, Richardt G. Relationship between therapeutic time intervals and intermediate term left ventricular systolic function in patients treated with facilitated percutaneous coronary intervention for acute myocardial infarction. Clin Res Cardiol 2006; 96:94-102. [PMID: 17160565 DOI: 10.1007/s00392-007-0465-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2006] [Accepted: 10/02/2006] [Indexed: 10/23/2022]
Abstract
BACKGROUND The concept of initiating fibrinolytic therapy in patients who cannot undergo immediate percutaneous coronary intervention (PCI) in the setting of acute ST-segment-elevation myocardial infarction (STEMI) has been proposed as a strategy to improve outcomes. However, evidence supporting the use of this strategy is not conclusive, and the results of recent randomized controlled trials are apparently contradictory. Probably, the time points of administration of the adjunctive thrombolytics and antiplatelet agents and the time loss until coronary intervention have a major influence on the discrepancy of outcomes in different trials. Therefore, the relationship between therapeutic time intervals and outcome in patients treated with facilitated PCI has been analyzed. METHODS In this single center retrospective study, 131 patients with STEMI were treated with a combined pharmaco-mechanical reperfusion strategy using half-dose r-tPA combined with a glycoprotein (GP) IIb/IIIa antagonist prior to PCI. Specific time points were recorded for each patient, including the time of symptom onset, the time of first medical contact, the start of intravenous thrombolysis, the time of administration of the GP IIb/IIIa antagonist and the start of coronary intervention. We then examined the relationship between the time delay from symptom onset to the initiation of various steps of treatment and the residual myocardial damage as expressed by the severity of both global and regional myocardial dysfunction calculated from a left ventriculography study performed 3 months later. RESULTS The median time from symptom onset to the first medical contact, with 25th and 75th percentiles in parentheses, was 1.25 h (0.75, 3), from symptom onset to initiation of thrombolytic therapy 2.25 h (1.25, 3), to initiation of GP IIb/ IIIa inhibitor therapy 3.5 h (2, 5.69), and to the start of coronary intervention 4.81 h (2.85, 7.91). The time between symptom onset and initiation of both thrombolytic therapy and coronary intervention was significantly related to the global ejection fraction and to the extent of regional hypokinesia at the 3-month follow-up (p<0.05). The time to the initiation of GP IIb/IIIa inhibitors was only significantly related to the global ejection fraction (p<0.05), while the time to the first medical contact did not show a similar relationship (p>0.05). Furthermore, we observed a significant relationship between the infarct-related artery (IRA) patency at the initial angiogram and the residual regional myocardial damage at follow-up; normokinesia at follow-up was found in 61.3% of patients with an initially patent IRA and in 41.2% of patients with an initially occluded IRA, whereas severe hypokinesia was found in 13.8% and 37.3%, respectively (p<0.05). CONCLUSION In patients with STEMI treated with a facilitated PCI strategy using half dose r-tPA in combination with a glycoprotein IIb/IIIa receptor blocker, the 3-month global and regional residual myocardial dysfunction is significantly related to the time elapsed between the onset of symptoms and the start of both fibrinolytic therapy and coronary intervention.
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Affiliation(s)
- P Meyborg
- Herz-Kreislauf-Zentrum, Segeberger Kliniken GmbH (Akademisches Lehrkrankenhaus der Universität Kiel), Am Kurpark 1, 23795, Bad-Segeberg, Germany.
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Tölg R, Witt M, Schwarz B, Kurz T, Kurowski V, Hartmann F, Geist V, Richardt G. Comparison of carvedilol and metoprolol in patients with acute myocardial infarction undergoing primary coronary intervention. Clin Res Cardiol 2006; 95:31-41. [PMID: 16598443 DOI: 10.1007/s00392-006-0317-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2005] [Accepted: 08/24/2005] [Indexed: 11/26/2022]
Abstract
BACKGROUND The value of early therapy with beta-blocking agents in acute myocardial infarction (AMI) undergoing reperfusion is not yet well established. Newer beta-blocking agents such as carvedilol offer potential advantages in the setting of ischemia and reperfusion injury. METHODS We randomized 100 patients with acute ST-elevation myocardial infarction (STEMI) to receive either 12.5 mg carvedilol or 50 mg metoprolol tartrate orally already before percutaneous coronary intervention (PCI) of the infarct-related artery, uptitrating to a daily target dose of 50 mg carvedilol or 150 mg metoprolol during the first week. Pts. were subjected to left ventricular (LV) angiography just before reperfusion and after 14 days to compare ejection fraction (EF) and regional wall motion abnormalities by quantitative LV analysis. Furthermore, kinetics of cardiac troponin T (cTnT), NT-proANP, NT-proBNP, endothelin, argenine vasopressin, epinephrine and norepinephrine were assessed during the first 12 hours and again at 2 weeks. In addition, reperfusion-induced rhythm abnormalities like VT, triplets, couplets, and bradycardic events were assessed continuously during the first 12 hours starting at reperfusion by Holter analysis. RESULTS Both groups did not differ with respect to onset of pain, target vessel, extent of coronary heart disease, age, gender, rate of stenting or use of a GP IIb/IIIa inhibitor, pre- and postinterventional TIMI flow grade, time course of heart rate or blood pressure. There were neither significant differences in the cardiac and neurohumoral markers nor in the occurrence of arrhythmias between both treatment groups. Within 14 days, EF improved by 5.8+/-2.0% (mean+/-SEM) in the metoprolol group and by 5.2+/-2.1% in the carvedilol group (n.s.). Area of infarction was reduced by 6.1+/-2.9% in the metoprolol group and by 12.8+/-3.6% of total LV outline in the carvedilol group (n.s.). Maximum hypokinesia in the central infarcted region was diminished by 0.40+/-0.11 standard deviation (SD) in the metoprolol group and by 0.34+/-0.13 SD in the carvedilol group (n.s.). CONCLUSION In the setting of direct PCI in acute STEMI, administration of carvedilol before reperfusion appears not to be superior to metoprolol with respect to myocardial injury and improvement of global and regional LV function. The study documents equivalent improvement of LV function and similar kinetics of cardiac and neurohumoral markers in pts. with acute STEMI undergoing direct PCI if the pts. were immediately treated with either carvedilol or metoprolol. Thus, superiority of carvedilol in experimental studies did not translate into a clinical benefit.
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Affiliation(s)
- R Tölg
- Herzzentrum Segeberger Klinken GmbH, Am Kurpark 1, 23795 Bad Segeberg, Germany.
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Khattab AA, Hamm CW, Senges J, Toelg R, Geist V, Bonzel T, Kelm M, Levenson B, Nienaber CA, Sabin G, Schneider S, Tebbe U, Richardt G. Sirolimus-eluting stent treatment for isolated proximal left anterior descending artery stenoses. Results from the prospective multi-center German Cypher Registry. ACTA ACUST UNITED AC 2005; 94:187-92. [PMID: 15747041 DOI: 10.1007/s00392-005-0200-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2004] [Accepted: 11/02/2004] [Indexed: 10/25/2022]
Abstract
BACKGROUND Stenting of isolated proximal LAD stenoses is still a controversial issue since it is associated with higher target vessel revascularization (TVR) rate than both bypass surgery using the internal mammary artery, and stenting of other coronary artery territories. The sirolimus- eluting stent (SES) has been reported to significantly reduce restenosis rates in de novo coronary lesions. Therefore, we compared patients from the German Cypher Registry treated with SES for isolated proximal LAD lesions with those stented for isolated lesions in the proximal LCX or RCA. METHODS A total of 349 patients treated with SES were analyzed. 249 patients were treated for proximal LAD stenosis, and 100 for proximal LCX/RCA stenoses. The combined clinical endpoint was MACCE (death of any cause, non-fatal MI and non-fatal stroke) and TVR at 6 months. RESULTS In-hospital events (death, MI and TVR) did not differ significantly between both groups (3.2% for the LAD group vs 2.0% for the LCX/RCA-group, p=0.73). The combined end point of death of any cause, non-fatal MI and non-fatal stroke at six months was 2.6% in the LAD group, and 2.2% in the LCX/RCA group (p=1.0). TVR occurred in 4.8% of the LAD group and in 6.5% of the LCX/RCA group at six months (p=0.58). The percentage of patients free from angina at daily activities was 80.6% in the LAD group, and 77.4% in the LCX/ RCA group (p=0.52). CONCLUSION SES once implanted into isolated proximal LAD stenoses appears as effective as reported in other vessel territories. Accordingly, stenting of the proximal LAD using SES might prove a suitable alternative to surgery.
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Affiliation(s)
- A A Khattab
- Herzzentrum Segeberger Kliniken GmbH, Am Kurpark 1, 23795 Bad Segeberg, Germany.
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Bechtel JFM, Tölg R, Robinson DR, Graf B, Richardt G, Sievers HH, Kraatz EG. The extent of akinesis is predictive of the in-hospital mortality from endoaneurysmorrhaphy. Z Kardiol 2005; 94:121-7. [PMID: 15674742 DOI: 10.1007/s00392-005-0194-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2004] [Accepted: 10/27/2004] [Indexed: 10/25/2022]
Abstract
Endoaneurysmorrhaphy (EAR) has become an important therapeutic option in the treatment of patients with left ventricular (LV) aneurysm and congestive heart failure. Today, more and more patients are referred for EAR with a dilated akinetic LV rather than a classic dyskinetic LV aneurysm. Little is known about the contribution of the extent of akinesis to perioperative mortality. We reviewed the data of 147 patients with anterior left ventricular aneurysms undergoing EAR. Seventy percent of the patients were male; mean age was 62+/-9 years. Demographic, hemodynamic, angiographic and surgical variables were analyzed using univariate statistic tests in order to determine risk factors for in-hospital mortality.Eighty-two percent of the LV aneurysms had at least some dyskinesia, but 70% were mainly akinetic. 133 patients had additional bypass surgery, one had additional mitral valve replacement. In-hospital mortality was 4.1% (n=6). Risk factors for in-hospital mortality were the total extent of akinetic myocardium (p=0.027) in the 30 degrees RAO view and the duration of cardiopulmonary bypass (CPB, p=0.0068) which was itself dependent on the LV ejection fraction (p=0.001), the number of stenosed coronary arteries (p=0.004), and the extent of akinesis (p=0.023). The extent of dyskinesia was not associated with either perioperative mortality (p=0.36) or CPB duration. EAR can be performed with acceptable perioperative results. Because akinesis increases in many patients with time, and because the duration of ECC was dependent on variables reflecting the severity of the underlying heart disease, our findings underscore the importance of optimal timing for the surgical intervention.
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Affiliation(s)
- J F M Bechtel
- Klinik für Herzchirurgie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany
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Zahn R, Hamm CW, Zeymer U, Schneider S, Nienaber CA, Richardt G, Kelm M, Levenson B, Bonzel T, Tebbe U, Sabin G, Senges J. [Cypher stent: the German registry. Results of the German prospective multicenter registry on Cypher]. Ann Cardiol Angeiol (Paris) 2004; 53 Suppl 1:36s-39s. [PMID: 15291160 DOI: 10.1016/s0003-3928(04)90008-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Affiliation(s)
- R Zahn
- Herzzentrum, Kardiologie, Ludwigshafen, Allemagne.
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Lorenzen HP, Geist V, Hartmann F, Sievers H, Richardt G. Endovascular stent-graft implantation in acute traumatic aortic dissection with contained rupture and hemorrhagic shock. ACTA ACUST UNITED AC 2004; 93:317-21. [PMID: 15085377 DOI: 10.1007/s00392-004-0065-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2003] [Accepted: 12/01/2003] [Indexed: 11/25/2022]
Abstract
BACKGROUND Traumatic dissections of the thoracic aorta with consecutive organ ischemia are emergencies with an enormously high mortality despite immediate surgical therapy. Successful therapy of a thoracic aortic aneurysm by percutaneous implantation of a stent graft prosthesis was first reported in 1994. In recent years endovascular methods have been used increasingly for the treatment of acute aortic syndromes. CASE REPORT After a traffic accident, a 33 year old motorcycle rider was admitted to our emergency unit conscious with clinical signs of hemorrhagic shock. His lower extremities were pulseless and paraplegia of the legs had already developed. An immediate angio-CT scan demonstrated a contained rupture of the aortic wall with mediastinal hematoma caused by a dissection beginning in the aortic arch. In the cathlab the right femoral artery was exposed and an angiography was performed showing a complete interruption of aortic blood flow caused by the transection. Under angiographic control an endovascular self-expanding nitinolstent (Talent Stent Graft, Medtronic) was implanted into the descending aorta. After moderate balloon inflation at the proximal entry, the rupture was completely closed and perfusion was restituted. The further clinical course was complicated by rhabdomyolysis necessitating additional subtotal arm amputation. Spinal ischemia resulted in persisting paraplegia of the legs. CONCLUSION An urgent treatment of a contained rupture of the descending aorta with consecutive organ ischemia by endovascular implantation of stent graft prosthesis is technically possible. Advantages are a less invasive procedure and rapid restitution of blood flow.
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Affiliation(s)
- H P Lorenzen
- Medizinische Klinik II, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany
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Zahn R, Hamm CW, Zeymer U, Schneider S, Nienaber CA, Richardt G, Kelm M, Levenson B, Bonzel T, Tebbe U, Schöbel WA, Sabin G, Senges J. ?Real life? use of sirolimus-eluting coronary stents in Germany. ACTA ACUST UNITED AC 2004; 93:287-94. [PMID: 15085373 DOI: 10.1007/s00392-004-0048-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2003] [Accepted: 11/03/2003] [Indexed: 10/26/2022]
Abstract
BACKGROUND Drugeluting stents (DES) are currently judged to be a "break-through" technology for the prevention of restenosis after percutaneous coronary interventions (PCI). However, experience is limited to randomised controlled clinical trials (RCT) in selected lesions and the currently available DES are more expensive compared to conventional "bare" stents. Therefore, actual clinical practice may be very different to RCT. METHODS We analysed the data of the German Cypher trade mark Registry, a nationwide registry which was initiated in parallel to the launch of the first DES, the Cypher trade mark sirolimus-eluting coronary stent, in April 2002. RESULTS From April 2002 until March 2003, 1638 procedures at 88 hospitals were included in the German Cypher trade mark Registry. The mean inclusion rate per centre and month remained low (<3 procedures/month and participating hospital) during the whole inclusion period. Most patients presented with stable angina pectoris (45.8%); however, 6.4% of patients were treated for a non-ST elevation myocardial infarction, 10.3% of patients for ST elevation myocardial infarction and 1.7% in cardiogenic shock. In patients without ST elevation myocardial infarction, a de novo stenosis was treated in 68.4% of cases, a restenosis in 4.1%, and an in-stent restenosis in 25.5% of cases. Chronic total occlusions were treated in 6.1% of patients. Predilatation was performed in 68.3% of patients and 1.05 +/- 0.35 Cypher trade mark stents were implanted per patient with a median (quartiles) stent length of 18 (13-21) mm. PCI-related death occurred in 0.1% of patients and a Q-wave myocardial infarction in 1.1%. Urgent re-PCI before hospital discharge was performed in 1.3% and urgent bypass surgery in 0.1% of cases. CONCLUSIONS The use of the sirolimus-eluting coronary stents in this "real life" registry was found to be safe concerning acute complications. In about one half of the registry patients, the DES was implanted in lesions that were excluded from RCTs.
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Affiliation(s)
- R Zahn
- Herzzentrum Ludwigshafen, Kardiologie, Bremserstrasse 79, 67063 Ludwigshafen, Germany.
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Duebener LF, Geist V, Richardt G, N�tzold A, Misfeld M, Sievers HH, Lorenzen HP. Emergency endovascular stent-grafting for life-threatening acute type B aortic dissections. Thorac Cardiovasc Surg 2004. [DOI: 10.1055/s-2004-816661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Burgdorf C, Richardt D, Kurz T, Adler S, Nötzold A, Kraatz EG, Sievers HH, Richardt G. Norepinephrine release is reduced in cardiac tissue of Type 2 diabetic patients. Diabetologia 2003; 46:520-3. [PMID: 12739025 DOI: 10.1007/s00125-003-1055-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2002] [Revised: 10/11/2002] [Indexed: 10/20/2022]
Abstract
AIMS/HYPOTHESIS The aim of this study was to assess whether cardiac catecholamine release is affected in patients with Type 2 diabetes mellitus. METHODS A trial tissue was obtained from 19 diabetic (Type 2) and 43 non-diabetic patients undergoing coronary surgery. Endogenous norepinephrine release was examined under baseline conditions as well as during electrical field stimulation (effective voltage 5 V, stimulation frequency 4 Hz, pulse width 2 msec) by high performance liquid chromatography and electrochemical detection. Cardiac function and arterial blood pressure was assessed from coronary angiography. RESULTS In atrial tissue from diabetic patients, stimulation-induced norepinephrine release was reduced by 25% compared with non-diabetic patients, while baseline norepinephrine release did not differ between both groups. Preoperative plasma glucose and haemoglobin A(1C) concentrations were increased in patients with diabetes, however, no relation was found to catecholamine release. Diabetic and non-diabetic patients did not differ regarding left ventricular ejection fraction and arterial blood pressure. CONCLUSION/INTERPRETATION Cardiac norepinephrine release is suppressed in patients with Type 2 diabetes which could contribute to sympathetic neuropathy. The difference of norepinephrine release in diabetic and non-diabetic patients was independent of cardiac function and arterial blood pressure.
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Affiliation(s)
- C Burgdorf
- Medizinische Klinik II, Universitätsklinikum Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany.
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Hartmann F, Kurowski V, Maghsoudi A, Kurz T, Schwarz M, Bonnemeier H, Tölg R, Jain D, Wiegand U, Katus H, Richardt G. Plasma catecholamines and N-terminal proBNP in patients with acute myocardial infarction undergoing primary angioplasty. Relation to left ventricular function and clinical outcome. Z Kardiol 2003; 92:73-81. [PMID: 12545304 DOI: 10.1007/s00392-003-0885-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Neither profiles nor prognostic values of neurohormonal markers have been prospectively evaluated in patients with acute myocardial infarction (AMI) undergoing primary angioplasty. METHODS AND RESULTS In 118 consecutive patients with AMI undergoing successful reperfusion (TIMI 2 and 3) by primary angioplasty, plasma concentrations of norepinephrine, epinephrine and N-terminal proBNP (NT-proBNP) were measured before, 60 min and 10 days after angioplasty. Catecholamine concentrations (mean+/-SEM) rose to a maximum in the first hour after angioplasty (norepinephrine: 602+/-44 ng/L, epinephrine: 213+/-24 ng/L) and returned to normal at day 10. Conversely, NT-proBNP levels maintained a further increase from 799+/-44 pmol/L at baseline to 924+/-54 pmol/L at day 10. A NT-proBNP concentration above median at 60 min post-angioplasty predicted major adverse cardiac events (n=27) during the 18-36 month follow-up with an odds ratio of 5.9 (1.7-20.3) and was superior to catecholamines, to left ventricular ejection fraction and to other established postinfarction risk markers. CONCLUSIONS In a low-risk cohort of patients with AMI undergoing successful reperfusion therapy, plasma NT-proBNP concentrations are elevated for at least ten days. The prognostic value of early plasma NT-proBNP should be further evaluated concerning its ability to facilitate risk stratification of infarct patients.
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Affiliation(s)
- F Hartmann
- Medizinische Klinik II, UK Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany.
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Jahn J, Dalhoff K, Richardt G. [Microorganisms and coronary heart disease. Do antibiotics protect against cardiac events?]. MMW Fortschr Med 2002; 144:41-2. [PMID: 12474361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Affiliation(s)
- J Jahn
- Oberarzt Kardiologie, Borromäus-Hospital, Leer.
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Misfeld M, Nötzold A, Geist V, Richardt G, Sievers HH. [Retrograde type A dissection after endovascular stent grafting of type B dissection]. Z Kardiol 2002; 91:274-7. [PMID: 12001546 DOI: 10.1007/s003920200024] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Acute aortic dissection is a disease with high mortality. Whereas acute dissection of the ascending aorta (Standford type A) is treated surgically, acute dissection of Stanford type B (descending aorta) is principally treated conservatively, but surgically in case of complications. Recently, another therapeutical option for the treatment of type B dissection has been developed using endovascular stent-grafts. We report on a 64-year-old woman with typical signs of acute aortic dissection. Computer tomography and transesophageal echocardiography demonstrated Stanford type B dissection. The patient was treated with an endovascular stent-graft, because of malperfusion of the right leg and chest pain. After successful closure of the entry by the stent, the patient developed acute right-sided hemiplegia one day after the intervention due to retrograde dissection into the aortic arch and ascending aorta. Upon immediate operation, the origin of the initially type B dissection was still sufficiently occluded by the endovascular stent-graft; however, there was another entry between the innominate artery and the left carotic artery near one proximal end of the stent's strut. Using deep hypothermia and selective antegrade cerebral perfusion, the ascending aorta and proximal arch were replaced with a 28 mm Dacron-Velour tube and the aortic root was remodelled with a tongue-shaped Dacron graft preserving the valve cusps according to a modified Yacoub procedure. After the operation, neurological symptoms diminished and the patient could walk on the ward on day eleven. This case demonstrates retrograde type A dissection as a complication after interventional treatment of type B dissection using an endovascular stent-graft. The reason for this delayed complication is speculative. Aortic wall damage during stent inserting could be a possible cause. It is also likely that the patient initially had type B dissection with retrograde dissection of the distal part of the aortic arch. Therefore, one of the straight struts of the proximal end of the stent may have caused additional damage to the vulnerable dissected aortic wall in the arch, leading to retrograde type A dissection. Careful patient selection, detailed diagnosis of the aortic arch, improved stent designs and materials, especially regarding the stent's ends and careful insertion of the stent into the aortic arch, could contribute to prevention of the described problems.
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Affiliation(s)
- M Misfeld
- Klinik für Herzchirurgie Universitätsklinikum Lübeck Ratzeburger Allee 160, 23538 Lübeck, Germany
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Affiliation(s)
- G Richardt
- Universitätsklinikum Lübeck, Medizinische Klinik II, Ratzeburger Allee 160, 23538, Lübeck, Germany.
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Kurz T, Schäfer U, Dendorfer A, Hartmann F, Raasch W, Tölg R, Remppis A, Giannitsis E, Dominiak P, Katus HA, Richardt G. Effects of intracoronary low-dose enalaprilat as an adjunct to primary percutaneous transluminal coronary angiography in acute myocardial infarction. Am J Cardiol 2001; 88:1351-7. [PMID: 11741551 DOI: 10.1016/s0002-9149(01)02112-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Bradykinin accumulation is a potent cardioprotective mechanism underlying angiotensin-converting enzyme (ACE) inhibition in ischemia and/or reperfusion injury. There is, however, concern about treatment with ACE inhibitors in the very early phase of acute myocardial infarction (AMI) due to adverse systemic hemodynamic effects. We tested the hypothesis that cardiac bradykinin metabolism can be influenced by very low doses of intracoronary ACE inhibitors without harmful systemic effects in patients with AMI. Twenty-two patients with AMI in Killip classes II to III who underwent primary percutaneous transluminal coronary angiography (PTCA) were randomized to intracoronary enalaprilat (50 microg) or saline, given immediately after reopening of the infarct-related artery. Hemodynamics and electrocardiograms were monitored continuously and samples for determination of ACE activity, angiotensin II, bradykinin, kininogen, and cardiac marker proteins were collected from pulmonary arterial and central venous blood. Enalaprilat had no adverse effects on systemic hemodynamics, but rather stabilized arterial pressure and cardiac rhythm during reperfusion. Enalaprilat induced a 70% reduction of ACE activity and a significant increase of bradykinin in pulmonary arterial blood. Angiotensin II was not significantly affected by enalaprilat either in pulmonary arterial or in central venous blood. Myoglobin release was lower and the duration of reperfusion arrhythmias was significantly reduced in the enalaprilat group (p <0.05). Thus, in this pilot study, intracoronary enalaprilat infusion in the infarct-related artery is feasible in the setting of primary angioplasty and is safe and well tolerated. Effective cardiac ACE inhibition can be achieved by low-dose intracoronary enalaprilat, which primarily causes a potentiation of bradykinin.
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Affiliation(s)
- T Kurz
- Medizinische Klinik II, Universitätsklinikum Lübeck, Lübeck, Germany.
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Richardt G. [Far from verified: the infection hypothesis of arteriosclerosis. Antibiotics for heart patients? (interview by Dipl. Biol. Waltraud Paukstadt)]. MMW Fortschr Med 2001; 143:12. [PMID: 11692837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
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Jain D, Richardt G, Katus HA. Rotational atherectomy of a stent-jailed septal perforator: a good verdict for the prisoner. J Invasive Cardiol 2001; 13:702-4. [PMID: 11581514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
A 61-year-old man is described, in whom percutaneous coronary intervention was done to treat critical ostial stenosis of the first and second septal perforators. The first branch originated from the stented portion of a previously treated left anterior descending artery, while the second branch was distal to the stent. During balloon angioplasty, the balloon catheter could not be delivered to the lesion site in the first branch, although the second branch was easily amenable to balloon dilatation. Rotational atherectomy was done to treat the former. Besides advocating rotational atherectomy as a novel strategy for managing jailed septal perforators, the case presents an insight into the vastly differing interventional situations of stent-jailed branch vis-a-vis de novo branch ostial stenosis.
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Affiliation(s)
- D Jain
- Medizinische Klinik II, Universitatsklinikum Lubeck, Ratzeburger Allee 160, D-23538, Lubeck, Germany.
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