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Van Echelpoel C, Van Haudt L, Verschueren C, De Roeck F, Argacha JF, Brasseur O, Fierens F, Heidbuchel H, Claeys MJ. Impact of recurrent COVID-19 disease waves on acute myocardial infarction epidemics: results from a regional network. Acta Cardiol 2024:1-6. [PMID: 38563518 DOI: 10.1080/00015385.2024.2327147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 09/13/2022] [Accepted: 02/29/2024] [Indexed: 04/04/2024]
Abstract
Aims: To assess the impact of COVID-19 related public containment measures during recurrent COVID-19 waves on hospital admission rate for acute myocardial infarction (AMI).Methods and results: Clinical characteristics, reperfusion therapy modalities, COVID-19 status and in-hospital mortality of consecutive AMI patients who were admitted in a regional AMI network were recorded during one year starting in March 2020 and were compared with the year before. The COVID-19 study period encompassed two waves: the first in March-May 2020 and the second in October-December 2020. A total of 1349 AMI patients were hospitalised of which 725 during the pre-COVID period and 624 during the COVID period (incidence rate ratio of 1.16, p = 0,006). The impact was predominantly present in the first wave (32% reduction: n = 204 vs 152) and evanished during the second wave (3% increase (152 vs 156). A similar pattern was observed for ACS with cardiac arrest with a 92% reduction (n = 36 vs 3) during the first wave and no change during the second wave (18 vs 18). After correction for temperature and air quality, COVID-19 epidemic remained associated with a decrease of AMI hospitalisation (p = 0.046). Reperfusion strategy for AMI patients, were comparable between both study periods. The in-hospital mortality between the two periods was comparable (2.6% versus 1.9%), but COVID-19 positive ACS patients (n = 7) had a high mortality rate (14%).Conclusion: COVID-19 related public containment measures resulted during the first wave in a 32% reduction of AMI hospitalisation, but this impact was not visible anymore during the second wave.
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Affiliation(s)
| | | | | | | | | | - Olivier Brasseur
- Laboratory of Environmental Research, Brussels Environment, Brussels, Belgium
| | - F Fierens
- Belgian Interregional Environment Agency, Brussels, Belgium
| | | | - Marc J Claeys
- Department of Cardiology, Hospital Antwerp, Edegem, Belgium
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2
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Byrne RA, Rossello X, Coughlan JJ, Barbato E, Berry C, Chieffo A, Claeys MJ, Dan GA, Dweck MR, Galbraith M, Gilard M, Hinterbuchner L, Jankowska EA, Jüni P, Kimura T, Kunadian V, Leosdottir M, Lorusso R, Pedretti RFE, Rigopoulos AG, Rubini Gimenez M, Thiele H, Vranckx P, Wassmann S, Wenger NK, Ibanez B. 2023 ESC Guidelines for the management of acute coronary syndromes. Eur Heart J Acute Cardiovasc Care 2024; 13:55-161. [PMID: 37740496 DOI: 10.1093/ehjacc/zuad107] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/24/2023]
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3
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Claeys MJ, Aminian A, Bartunek J, Bennett J, Buysschaert I, Claeys M, De Bock D, Delodder L, Debonnaire P, Dewilde W, Ferdinande B, Geerinck S, Goetschalckx K, Lambrechts O, Lochy S, Paelinck BP, Rosseel L, Stroobants D, Vanderheyden M, Van der Heyden J, Verbrugghe P, Verheye S, Dubois C. Bleeding and thrombotic risk of different antiplatelet regimens posttranscatheter edge-to-edge mitral valve repair in patients with an indication for oral anticoagulation: Results from an all-comers national registry. Catheter Cardiovasc Interv 2024; 103:382-388. [PMID: 38078877 DOI: 10.1002/ccd.30931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 09/01/2023] [Accepted: 11/23/2023] [Indexed: 01/31/2024]
Abstract
BACKGROUND Evidence-based recommendations for antithrombotic treatment in patients who have an indication for oral anticoagulation (OAC) after transcatheter edge-to-edge mitral valve repair (TEER) are lacking. AIMS To compare bleeding and thrombotic risk for different antithrombotic regimens post-TEER with MitraClip in an unselected population with the need for OACs. METHODS Bleeding and thrombotic complications (stroke and myocardial infarction) up to 3 months after TEER with mitraclip were evaluated in 322 consecutive pts with an indication for OACs. These endpoints were defined by the Mitral Valve Academic Research Consortium criteria and were compared between two antithrombotic regimens: single antithrombotic therapy with OAC (single ATT) and double/triple ATT with a combination of OAC and aspirin and/or clopidogrel (combined ATT). RESULTS Collectively, 108 (34%) patients received single ATT, 203 (63%) received double ATT and 11 (3%) received triple ATT. Bleeding events occurred in 67 patients (20.9%), with access site related events being the most frequent cause (37%). Bleeding complications were observed more frequently in the combined ATT group than in the single ATT group: 24% versus 14% [p = 0.03, adjusted RR: 0.55 (0.3-0.98)]. Within the combined group, the bleeding risk was 23% in the double ATT and 45% in the triple ATT group. Thrombotic complications occurred in only three patients (0.9%), and all belonged to the combined ATT group. CONCLUSIONS In patients with an indication for OACs, withholding of antiplatelet therapy post-TEER with Mitraclip was associated with a 45% reduction in bleeding and without a signal of increased thrombotic risk.
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Affiliation(s)
- Marc J Claeys
- Department of Cardiology, Antwerp University Hospital, Edegem, Belgium
| | - Adel Aminian
- Department of Cardiology, Centre Hospitalier, Universitaire de Charleroi, Charleroi, Belgium
| | - Jozef Bartunek
- Department of Cardiology, OLV Hospital Aalst, Aalst, Belgium
| | - Johan Bennett
- Department of Cardiovascular Medicine, UZ Leuven and Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Ian Buysschaert
- Department of Cardiology, Hospital Sint-Jan Brugge, Bruges, Belgium
| | - Mathias Claeys
- Department of Cardiology, Hospital Sint-Jan Brugge, Bruges, Belgium
| | - Dina De Bock
- Deptartment of Cardiovascular Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Lies Delodder
- Department of Cardiology, Antwerp University Hospital, Edegem, Belgium
| | | | - Willem Dewilde
- Department of Cardiology, Imelda Hospital Bonheiden, Bonheiden, Belgium
| | - Bert Ferdinande
- Department of Cardiology, Hospital Oost-Limburg, Genk, Belgium
| | | | - Kaatje Goetschalckx
- Department of Cardiovascular Medicine, UZ Leuven and Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | | | - Stijn Lochy
- Department of Cardiology, Brussels University Hospital, Brussels, Belgium
| | | | | | | | | | | | - Peter Verbrugghe
- Department of Cardiovascular Medicine, UZ Leuven and Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Stefan Verheye
- Department of Cardiology, ZAS Hospital, Antwerp, Belgium
| | - Christophe Dubois
- Department of Cardiovascular Medicine, UZ Leuven and Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
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Byrne RA, Rossello X, Coughlan JJ, Barbato E, Berry C, Chieffo A, Claeys MJ, Dan GA, Dweck MR, Galbraith M, Gilard M, Hinterbuchner L, Jankowska EA, Jüni P, Kimura T, Kunadian V, Leosdottir M, Lorusso R, Pedretti RFE, Rigopoulos AG, Rubini Gimenez M, Thiele H, Vranckx P, Wassmann S, Wenger NK, Ibanez B. [2023 ESC Guidelines for the management of acute coronary syndromes]. G Ital Cardiol (Rome) 2024; 25:e1-e112. [PMID: 38291910 DOI: 10.1714/4191.41785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
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5
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Byrne RA, Rossello X, Coughlan JJ, Barbato E, Berry C, Chieffo A, Claeys MJ, Dan GA, Dweck MR, Galbraith M, Gilard M, Hinterbuchner L, Jankowska EA, Jüni P, Kimura T, Kunadian V, Leosdottir M, Lorusso R, Pedretti RFE, Rigopoulos AG, Rubini Gimenez M, Thiele H, Vranckx P, Wassmann S, Wenger NK, Ibanez B. 2023 ESC Guidelines for the management of acute coronary syndromes. Eur Heart J 2023; 44:3720-3826. [PMID: 37622654 DOI: 10.1093/eurheartj/ehad191] [Citation(s) in RCA: 309] [Impact Index Per Article: 309.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/26/2023] Open
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Van Assche L, Peeters B, Vorlat A, Monsieurs K, Heidbuchel H, Claeys MJ. Safety and effectiveness of the short (0-1h) high sensitive troponin protocol in real-life practice. Acta Cardiol 2023; 78:937-944. [PMID: 37264905 DOI: 10.1080/00015385.2023.2218028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 05/19/2023] [Indexed: 06/03/2023]
Abstract
AIM Recent guidelines recommend the use of a short 0-1h high sensitive cardiac troponin (hs-cTn) algorithm in patients presenting with chest pain at the emergency department (ED). This retrospective observational study evaluates the safety and effectiveness of the new 0-1h hs-cTn I protocol in comparison with the standard 0-3h cTn I protocol for the diagnosis of acute myocardial infarction (AMI). METHODS A total of two times 100 consecutive chest pain patients presenting at the ED in November/December 2018 (standard 0-3h cTn I group) and in November/December 2020 (short 0-1h hs-cTn I group) were enrolled. Decision making was based upon validated assay-specific cut-off values. RESULTS The new 0-1h hs-cTn I protocol had a sensitivity of 100% (95% CI 83.2-100) and a negative predictive value of 100% to rule out AMI. The accuracy of rule-in was slightly lower with a specificity of 92.5% (95% CI 84.4-97.2). The overall protocol accuracy was 94% (95% CI 87.4-97.8) in the short 0-1h hs-cTn I group compared to 88% (95% CI 80.0-93.6) in the standard 0-3h cTn I group (p-value 0.14). The 0-1h hs-cTn I protocol was associated with a numerically higher rate of early hospital discharge compared to the conventional 0-3h cTn I protocol (47% versus 59%; p-value 0.09) and with a shorter median length of stay for those patients (mean 316 min versus 289 min; p-value 0.09). CONCLUSION The abbreviated protocol based on the 0-1h hs-cTn I assays is effective and safe for the exclusion of AMI at the ED.
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Affiliation(s)
| | - Bart Peeters
- Department of Clinical Biology, Antwerp University Hospital, Antwerp, Belgium
| | - Anne Vorlat
- Department of Cardiology, Antwerp University Hospital, Antwerp, Belgium
| | - Koen Monsieurs
- Department of Emergency Medicine, Antwerp University Hospital, Antwerp, Belgium
| | - Hein Heidbuchel
- Department of Cardiology, Antwerp University Hospital, Antwerp, Belgium
| | - Marc J Claeys
- Department of Cardiology, Antwerp University Hospital, Antwerp, Belgium
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Krychtiuk KA, Claeys MJ, Gencer B, Mach F. In-hospital initiation of PCSK9 inhibitors in ACS: pros and cons. EUROINTERVENTION 2023; 19:e283-e285. [PMID: 37458121 PMCID: PMC10333913 DOI: 10.4244/eij-e-23-00014] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Affiliation(s)
- Konstantin A Krychtiuk
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
- Duke Clinical Research Institute, Durham, NC, USA
| | - Marc J Claeys
- Department of Cardiology, Antwerp University Hospital, Edegem, Belgium
| | - Baris Gencer
- Department of Cardiology, Geneva University Hospital (HUG), University of Geneva, Geneva, Switzerland
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - François Mach
- Department of Cardiology, Geneva University Hospital (HUG), University of Geneva, Geneva, Switzerland
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Kayaert P, Coeman M, Ghafari C, Drieghe B, Gheeraert P, Bennett J, McCutcheon K, Ungureanu C, Vandeloo B, Floré V, Hermans K, Dens J, Saad G, Janssens L, Xaplanteris P, Bataille Y, Semeraro O, Kefer J, Gevaert S, De Pauw M, Carlier S, Claeys MJ, Haine S. iFR/FFR/IVUS Discordance and Clinical Implications: Results From the Prospective Left Main Physiology Registry. J Invasive Cardiol 2023; 35:E234-E247. [PMID: 37219850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVES This study aimed to assess discordance between results of instantaneous wave-free ratio (iFR), fractional flow reserve (FFR), and intravascular ultrasound (IVUS) in intermediate left main coronary (LM) lesions, and its impact on clinical decision making and outcome. METHODS We enrolled 250 patients with a 40%-80% LM stenosis in a prospective, multicenter registry. These patients underwent both iFR and FFR measurements. Of these, 86 underwent IVUS and assessment of the minimal lumen area (MLA), with a 6 mm2 cutoff for significance. RESULTS Isolated LM disease was recognized in 95 patients (38.0%), while 155 patients (62.0%) had both LM disease and downstream disease. In 53.2% of iFR+ and 56.7% of FFR+ LM lesions, the measurement was positive in only one daughter vessel. iFR/FFR discordance occurred in 25.0% of patients with isolated LM disease and 36.2% of patients with concomitant downstream disease (P=.049). In patients with isolated LM disease, discordance was significantly more common in the left anterior descending artery and younger age was an independent predictor of iFR-/FFR+ discordance. iFR/MLA and FFR/MLA discordance occurred in 37.0% and 29.4%, respectively. Within 1 year of follow-up, major cardiac adverse events (MACE) occurred in 8.5% and 9.7% (P=.763) of patients whose LM lesion was deferred or revascularized, respectively. Discordance was not an independent predictor of MACE. CONCLUSIONS Current methods of estimating LM lesion significance often yield discrepant findings, complicating therapeutic decision-making.
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Affiliation(s)
- Peter Kayaert
- Department of Cardiology, Jessa Hospital, Stadsomvaart 11, 3500 Hasselt, Belgium.
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9
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Claeys MJ. Reperfusion injury in STEMI patients: another piece of the puzzle. Acta Cardiol 2023; 78:162-163. [PMID: 35042434 DOI: 10.1080/00015385.2022.2027636] [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] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Marc J Claeys
- Department of Cardiology, Antwerp University Hospital, Edegem, Belgium
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10
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Krychtiuk KA, Ahrens I, Drexel H, Halvorsen S, Hassager C, Huber K, Kurpas D, Niessner A, Schiele F, Semb AG, Sionis A, Claeys MJ, Barrabes J, Montero S, Sinnaeve P, Pedretti R, Catapano A. Acute LDL-C reduction post ACS: strike early and strike strong: from evidence to clinical practice. A clinical consensus statement of the Association for Acute CardioVascular Care (ACVC), in collaboration with the European Association of Preventive Cardiology (EAPC) and the European Society of Cardiology Working Group on Cardiovascular Pharmacotherapy. Eur Heart J Acute Cardiovasc Care 2022; 11:939-949. [PMID: 36574353 DOI: 10.1093/ehjacc/zuac123] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 10/02/2022] [Indexed: 12/28/2022]
Abstract
After experiencing an acute coronary syndrome (ACS), patients are at a high risk of suffering from recurrent ischaemic cardiovascular events, especially in the very early phase. Low density lipoprotein-cholesterol (LDL-C) is causally involved in atherosclerosis and a clear, monotonic relationship between pharmacologic LDL-C lowering and a reduction in cardiovascular events post-ACS has been shown, a concept termed 'the lower, the better'. Current ESC guidelines suggest an LDL-C guided, step-wise initiation and escalation of lipid-lowering therapy (LLT). Observational studies consistently show low rates of guideline-recommended LLT adaptions and concomitant low rates of LDL-C target goal achievement, leaving patients at residual risk, especially in the vulnerable post-ACS phase. In addition to the well-established 'the lower, the better' approach, a 'strike early and strike strong' approach in the early post-ACS phase with upfront initiation of a combined lipid-lowering approach using high-intensity statins and ezetimibe seems reasonable. We discuss the rationale, clinical trial evidence and experience for such an approach and highlight existing knowledge gaps. In addition, the concept of acute initiation of PCSK9 inhibition in the early phase is reviewed. Ultimately, we focus on hurdles and solutions to provide high-quality, evidence-based follow-up care in post-ACS patients.
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Affiliation(s)
- Konstantin A Krychtiuk
- Department of Internal Medicine II-Division of Cardiology, Medical University of Vienna, 1180 Vienna, Austria.,Duke Clinical Research Institute, Durham, NC 27701, USA
| | - Ingo Ahrens
- Department of Cardiology and Medical Intensive Care, Augustinerinnen Hospital Cologne, Academic Teaching Hospital University of Cologne, 50678 Cologne, Germany
| | - Heinz Drexel
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Carinagasse 47, AT-6800 Feldkirch, Austria.,Private University of the Principality of Liechtenstein, Dorfstrasse 24, FL-9495 Triesen, Liechtenstein.,Department of Medicine I, Academic Teaching Hospital Feldkirch, Carinagasse 47, AT-6800 Feldkirch, Austria
| | - Sigrun Halvorsen
- Institute of Clinical Medicine, University of Oslo, 0372 Oslo, Norway.,Department of Cardiology, Oslo University Hospital Ullevål, Oslo, Norway
| | - Christian Hassager
- Department of Cardiology, Rigshospitalet and Department of Clinical Medicine, University of Copenhagen, 2100 Copenhagen, Denmark
| | - Kurt Huber
- 3rd Department of Internal Medicine, Cardiology and Intensive Care Unit, Wilhelminenhospital, 1160 Vienna, Austria.,Ludwig Boltzmann Institute for Cardiovascular Research, 1090 Vienna, Austria.,Medical School, Sigmund Freud University, 1020 Vienna, Austria
| | - Donata Kurpas
- Family Medicine Department, Wroclaw Medical University, 50-367 Wroclaw, Poland
| | - Alexander Niessner
- Department of Internal Medicine II-Division of Cardiology, Medical University of Vienna, 1180 Vienna, Austria
| | - Francois Schiele
- Department of Cardiology, University Hospital Besancon, University of Franche-Comté, France and EA3920, Besancon, France
| | - Anne Grete Semb
- Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Division of Innovation and Research, Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Alessandro Sionis
- Intensive Cardiac Care Unit, Cardiology Department, Hospital de Sant Pau, IIB-Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.,CIBER-CV, Centro de investigación Biomédica en Red de Enfermedades Cardiovasculares, 28029 Madrid, Spain
| | - Marc J Claeys
- Department of Cardiology, Antwerp University Hospital, 2650 Edegem, Belgium
| | - José Barrabes
- Acute Cardiac Care Unit, Cardiology Service, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Barcelona, Spain.,CIBERC-V, Centro de investigación Biomédica en Red de Enfermedades Cardiovasculares, Madrid, Spain
| | - Santiago Montero
- Acute Cardiovascular Care Unit, Cardiology, Hospital Germans Trias i Pujol. Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Peter Sinnaeve
- Department of Cardiology, University Hospital Leuven, Leuven, Belgium
| | - Roberto Pedretti
- Director of Cardiovascular Department, Head of Cardiology Unit, IRCCS MultiMedica, Milan, Italy
| | - Alberico Catapano
- Professor of Pharmacology, Director Center of Epidemiology and Preventive Pharmacology, Director Laboratory of Lipoproteins, Immunity and Atherosclerosis Department of Pharmacological and Biomolecular Sciences Director Center for the Study of Atherosclerosis at Bassini Hospital University of Milan, Milan, Italy
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11
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Nadarajah R, Ludman P, Appelman Y, Brugaletta S, Budaj A, Bueno H, Huber K, Kunadian V, Leonardi S, Lettino M, Milasinovic D, Gale CP, Budaj A, Dagres N, Danchin N, Delgado V, Emberson J, Friberg O, Gale CP, Heyndrickx G, Iung B, James S, Kappetein AP, Maggioni AP, Maniadakis N, Nagy KV, Parati G, Petronio AS, Pietila M, Prescott E, Ruschitzka F, Van de Werf F, Weidinger F, Zeymer U, Gale CP, Beleslin B, Budaj A, Chioncel O, Dagres N, Danchin N, Emberson J, Erlinge D, Glikson M, Gray A, Kayikcioglu M, Maggioni AP, Nagy KV, Nedoshivin A, Petronio AP, Roos-Hesselink JW, Wallentin L, Zeymer U, Popescu BA, Adlam D, Caforio ALP, Capodanno D, Dweck M, Erlinge D, Glikson M, Hausleiter J, Iung B, Kayikcioglu M, Ludman P, Lund L, Maggioni AP, Matskeplishvili S, Meder B, Nagy KV, Nedoshivin A, Neglia D, Pasquet AA, Roos-Hesselink JW, Rossello FJ, Shaheen SM, Torbica A, Gale CP, Ludman PF, Lettino M, Bueno H, Huber K, Leonardi S, Budaj A, Milasinovic (Serbia) D, Brugaletta S, Appelman Y, Kunadian V, Al Mahmeed WAR, Kzhdryan H, Dumont C, Geppert A, Bajramovic NS, Cader FA, Beauloye C, Quesada D, Hlinomaz O, Liebetrau C, Marandi T, Shokry K, Bueno H, Kovacevic M, Crnomarkovic B, Cankovic M, Dabovic D, Jarakovic M, Pantic T, Trajkovic M, Pupic L, Ruzicic D, Cvetanovic D, Mansourati J, Obradovic I, Stankovic M, Loh PH, Kong W, Poh KK, Sia CH, Saw K, Liška D, Brozmannová D, Gbur M, Gale CP, Maxian R, Kovacic D, Poznic NG, Keric T, Kotnik G, Cercek M, Steblovnik K, Sustersic M, Cercek AC, Djokic I, Maisuradze D, Drnovsek B, Lipar L, Mocilnik M, Pleskovic A, Lainscak M, Crncic D, Nikojajevic I, Tibaut M, Cigut M, Leskovar B, Sinanis T, Furlan T, Grilj V, Rezun M, Mateo VM, Anguita MJF, Bustinza ICM, Quintana RB, Cimadevilla OCF, Fuertes J, Lopez F, Dharma S, Martin MD, Martinez L, Barrabes JA, Bañeras J, Belahnech Y, Ferreira-Gonzalez I, Jordan P, Lidon RM, Mila L, Sambola A, Orvin K, Sionis A, Bragagnini W, Cambra AD, Simon C, Burdeus MV, Ariza-Solé A, Alegre O, Alsina M, Ferrando JIL, Bosch X, Sinha A, Vidal P, Izquierdo M, Marin F, Esteve-Pastor MA, Tello-Montoliu A, Lopez-Garcia C, Rivera-Caravaca JM, Gil-Pérez P, Nicolas-Franco S, Keituqwa I, Farhan HA, Silva L, Blasco A, Escudier JM, Ortega J, Zamorano JL, Sanmartin M, Pereda DC, Rincon LM, Gonzalez P, Casado T, Sadeghipour P, Lopez-Sendon JL, Manjavacas AMI, Marin LAM, Sotelo LR, Rodriguez SOR, Bueno H, Martin R, Maruri R, Moreno G, Moris C, Gudmundsdottir I, Avanzas P, Ayesta A, Junco-Vicente A, Cubero-Gallego H, Pascual I, Sola NB, Rodriguez OA, Malagon L, Martinez-Basterra J, Arizcuren AM, Indolfi C, Romero J, Calleja AG, Fuertes DG, Crespín Crespín M, Bernal FJC, Ojeda FB, Padron AL, Cabeza MM, Vargas CM, Yanes G, Kitai T, Gonzalez MJG, Gonzalez Gonzalez J, Jorge P, De La Fuente B, Bermúdez MG, Perez-Lopez CMB, Basiero AB, Ruiz AC, Pamias RF, Chamero PS, Mirrakhimov E, Hidalgo-Urbano R, Garcia-Rubira JC, Seoane-Garcia T, Arroyo-Monino DF, Ruiz AB, Sanz-Girgas E, Bonet G, Rodríguez-López J, Scardino C, De Sousa D, Gustiene O, Elbasheer E, Humida A, Mahmoud H, Mohamed A, Hamid E, Hussein S, Abdelhameed M, Ali T, Ali Y, Eltayeb M, Philippe F, Ali M, Almubarak E, Badri M, Altaher S, Alla MD, Dellborg M, Dellborg H, Hultsberg-Olsson G, Marjeh YB, Abdin A, Erglis A, Alhussein F, Mgazeel F, Hammami R, Abid L, Bahloul A, Charfeddine S, Ellouze T, Canpolat U, Oksul M, Muderrisoglu H, Popovici M, Karacaglar E, Akgun A, Ari H, Ari S, Can V, Tuncay B, Kaya H, Dursun L, Kalenderoglu K, Tasar O, Kalpak O, Kilic S, Kucukosmanoglu M, Aytekin V, Baydar O, Demirci Y, Gürsoy E, Kilic A, Yildiz Ö, Arat-Ozkan A, Sinan UY, Dagva M, Gungor B, Sekerci SS, Zeren G, Erturk M, Demir AR, Yildirim C, Can C, Kayikcioglu M, Yagmur B, Oney S, Xuereb RG, Sabanoglu C, Inanc IH, Ziyrek M, Sen T, Astarcioglu MA, Kahraman F, Utku O, Celik A, Surmeli AO, Basaran O, Ahmad WAW, Demirbag R, Besli F, Gungoren F, Ingabire P, Mondo C, Ssemanda S, Semu T, Mulla AA, Atos JS, Wajid I, Appelman Y, Al Mahmeed WAR, Atallah B, Bakr 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Potpara T, Marinkovic M, Mihajlovic M, Mujovic N, Kocijancic A, Mijatovic Z, Radovanovic M, Matic D, Milosevic A, Savic L, Subotic I, Uscumlic A, Zlatic N, Antonijevic J, Vesic O, Vucic R, Martinovic SS, Kostic T, Atanaskovic V, Mitic V, Stanojevic D, Petrovic M. Cohort profile: the ESC EURObservational Research Programme Non-ST-segment elevation myocardial infraction (NSTEMI) Registry. Eur Heart J Qual Care Clin Outcomes 2022; 9:8-15. [PMID: 36259751 DOI: 10.1093/ehjqcco/qcac067] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 10/11/2022] [Indexed: 11/12/2022]
Abstract
AIMS The European Society of Cardiology (ESC) EURObservational Research Programme (EORP) Non-ST-segment elevation myocardial infarction (NSTEMI) Registry aims to identify international patterns in NSTEMI management in clinical practice and outcomes against the 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without ST-segment-elevation. METHODS AND RESULTS Consecutively hospitalised adult NSTEMI patients (n = 3620) were enrolled between 11 March 2019 and 6 March 2021, and individual patient data prospectively collected at 287 centres in 59 participating countries during a two-week enrolment period per centre. The registry collected data relating to baseline characteristics, major outcomes (in-hospital death, acute heart failure, cardiogenic shock, bleeding, stroke/transient ischaemic attack, and 30-day mortality) and guideline-recommended NSTEMI care interventions: electrocardiogram pre- or in-hospital, pre-hospitalization receipt of aspirin, echocardiography, coronary angiography, referral to cardiac rehabilitation, smoking cessation advice, dietary advice, and prescription on discharge of aspirin, P2Y12 inhibition, angiotensin converting enzyme inhibitor (ACEi)/angiotensin receptor blocker (ARB), beta-blocker, and statin. CONCLUSION The EORP NSTEMI Registry is an international, prospective registry of care and outcomes of patients treated for NSTEMI, which will provide unique insights into the contemporary management of hospitalised NSTEMI patients, compliance with ESC 2015 NSTEMI Guidelines, and identify potential barriers to optimal management of this common clinical presentation associated with significant morbidity and mortality.
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Affiliation(s)
- Ramesh Nadarajah
- Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, LS2 9JT Leeds, UK.,Leeds Institute of Data Analytics, University of Leeds, LS2 9JT Leeds, UK.,Department of Cardiology, Leeds Teaching Hospitals NHS Trust, LS1 3EX Leeds, UK
| | - Peter Ludman
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Yolande Appelman
- Department of Cardiology, Amsterdam UMC-Vrije Universiteit, Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands
| | - Salvatore Brugaletta
- Hospital Clinic de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Andrzej Budaj
- Department of Cardiology, Center of Postgraduate Medical Education, Grochowski Hospital, Warsaw, Poland
| | - Hector Bueno
- Cardiology Department, Hospital Universitario 12 de Octubre and Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain.,Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.,Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Kurt Huber
- 3rd Medical Department, Cardiology and Intensive Care Medicine, Clinic Ottakring (Wilhelminenhospital), Vienna, Austria.,Medical Faculty, Sigmund Freud University, Vienna, Austria
| | - Vijay Kunadian
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.,Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Sergio Leonardi
- University of Pavia, Pavia, Italy.,Fondazione IRCCS Policlinico S.Matteo, Pavia, Italy
| | - Maddalena Lettino
- Cardio-Thoracic and Vascular Department, San Gerardo Hospital, ASST-Monza, Monza, Italy
| | - Dejan Milasinovic
- Department of Cardiology, University Clinical Center of Serbia and Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Chris P Gale
- Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, LS2 9JT Leeds, UK.,Leeds Institute of Data Analytics, University of Leeds, LS2 9JT Leeds, UK.,Department of Cardiology, Leeds Teaching Hospitals NHS Trust, LS1 3EX Leeds, UK
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Claeys MJ, Bondue A, Lancellotti P, De Pauw M. Summary of 2020 ESC guidelines on non-STE ACS, adult congenital heart disease, sports cardiology and atrial fibrillation. Acta Cardiol 2022; 77:864-872. [PMID: 34821204 DOI: 10.1080/00015385.2021.2003062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
During the ESC congress in September 2020, the new ESC guidelines were presented and are available on the ESC website. The new guidelines describe management recommendations on following cardiovascular diseases: non-STE ACS, adult congenital heart disease, sports cardiology and atrial fibrillation. The present document gives a summary of these guidelines and highlights the most important recommendations and changes in the management of these diseases. It will help to increase awareness about the new guidelines and may stimulate to consult the full document for specific items. Ultimately, the authors hope that this document will enhance implementation of new ESC guidelines in daily clinical practice.
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Affiliation(s)
- Marc J Claeys
- Department of Cardiology, Antwerp University Hospital, Antwerpen, Belgium
| | - Antoine Bondue
- Department of Cardiology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | | | - Michel De Pauw
- Department of Cardiology, Ghent University hospital, Ghent, Belgium
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13
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De Schutter S, Van Damme E, Van Hout G, Pype LL, Claeys MJ, Van De Heyning CM. Atrial functional mitral regurgitation during exercise is associated with impaired longitudinal left ventricular systolic function and annular dilation: an exercise echocardiographic study. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.141] [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
Atrial functional mitral regurgitation (AF-MR) has recently been recognized as a new disease entity in patients with atrial fibrillation (AF) and heart failure with preserved ejection fraction (HFpEF). This MR subtype is characterised by structurally normal leaflets, normal left ventricular size and mitral annular dilation. It is hypothesised that AF-MR results from mitral annulus area/leaflet area imbalance caused by annular dilation and impaired mitral annular dynamics, but precise mechanisms and determinants remain unclear. Also, very little is known about the influence of exercise.
Purpose
To investigate the impact of exercise on the severity of AF-MR and to identify its determinants by exercise echocardiography.
Methods
Patients with HFpEF and/or AF were scheduled for a symptom-limited exercise echocardiography. We assessed mitral annular dimensions (antero-lateral diameter), AF-MR severity (multi-integrative approach), and parameters of systolic and diastolic function at rest and during maximal exercise.
Results
47 patients with HFpEF (n=39) and/or AF (n=22) were enrolled. As compared to rest, we noticed an increase in AF-MR severity of ≥1 grade in 20 patients (43%) during maximal exercise. Patients with progression of AF-MR at maximal exercise had significantly less progression of tissue Doppler-derived imaging peak systolic velocity at the medial mitral annulus (Med S') compared to patients without AF-MR progression (+1.1±1.7 cm/s vs +2.7±1.9 cm/s; p-value 0.005). This was accompanied by a greater systolic mitral annular diameter at maximal exercise (+0,5±4,2 mm), while the systolic annular diameter generally decreased in patients without AF-MR progression (−1,6±3,9 mm). Furthermore, patients with ≥moderate AF-MR during exercise (n=19; 40%) had lower Med S' (6.9±1.7 cm/s vs 8.9±2.6 cm/s; p-value 0.013), a greater systolic mitral annular diameter (26.0±4.3 mm vs 23.2±4.3 mm; p-value 0.042), reduced TAPSE (19.4±3.7 mm vs 24.3±3.2 mm; p-value 0.001) and a greater prevalence of ≥moderate TR (93% vs 45%; p-value 0.047) compared to patients with no or mild MR during exercise. No significant correlation was found between AF-MR severity at exercise and blood pressures, LVEF or parameters of diastolic function.
Conclusions
AF-MR is a dynamic condition which may worsen during exercise. Deterioration of AF-MR at maximal exercise was associated with impaired longitudinal left ventricular contractile reserve and greater mitral annular dimensions. As impaired left ventricular longitudinal function may influence systolic mitral annular dynamics, this attributes to the hypothesis that AF-MR results from mitral annulus area/leaflet area imbalance caused by both annular dilation and impaired mitral annular dynamics.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
| | | | - G Van Hout
- University of Antwerp , Antwerp , Belgium
| | - L L Pype
- University Hospital Antwerp, Cardiology department , Antwerp , Belgium
| | - M J Claeys
- University Hospital Antwerp, Cardiology department , Antwerp , Belgium
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14
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Claeys MJ, De Pauw M, Lancellotti P, Pierard L. Review article: the best of 2019. Acta Cardiol 2022:1-4. [PMID: 35147066 DOI: 10.1080/00015385.2021.2003060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
In 2019, a total of 70 original scientific papers or reviews were published in Acta Cardiologica. In this paper, we focus on the 10 best papers that we selected based upon the innovative character and/or upon the clinical relevance of their research. In different domains of cardiology, we highlight the most important findings from these 10 best research papers.
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Affiliation(s)
- Marc J. Claeys
- Department of Cardiology, Antwerp University Hospital, Edegem, Belgium
| | - Michel De Pauw
- Department of Cardiology, Ghent University Hospital, Ghent, Belgium
| | | | - Luc Pierard
- Centre Hospitalier Universitaire de Liege, Liege, Belgium
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15
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Spera F, Rodriguez-Mañero M, Baluja A, Saenen J, Huybrechts W, Miljoen H, Tijskens M, Vandaele L, Wittock A, Claeys MJ, Heidbuchel H, Sarkozy A. Reproducibility and predictive value of a simple novel method to measure atrial fibrillation cycle length in persistent atrial fibrillation - FARS-AF study. J Cardiovasc Electrophysiol 2022; 33:641-650. [PMID: 35132713 DOI: 10.1111/jce.15401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Received: 10/03/2021] [Revised: 12/15/2021] [Accepted: 12/31/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Different methods are used for atrial fibrillation (AF) cycle length (CL) measurement with variable results. Previous studies of pulmonary vein (PV) CL measurement showed contradictory results on predicting PV isolation (PVI) efficacy. A novel simple method of measuring the average of 10 consecutive Fastest Atrial Repetitive Similar morphology signal (FARS10 )-CL to characterize local atrial activity rate was evaluated prospectively. METHODS The intra-observer reproducibility of FARS10 -CL and traditional AF-CL measurement of continuously fragmented coronary sinus (CS) signals were tested. We prospectively enrolled 100 consecutive patients (62±10 years, 72% male) undergoing wide antral PVI only ablation for persistent AF, measured PV-FARS10 -CLs and evaluated long-term outcome. RESULTS The Kendall area correlation between repeated traditional AF-CL measurements was -0.006 and between repeated FARS10 -CL measurements in the right and left atrial appendages, CS and PVs were 0.944, 0.859, 0.882, 0.675-0.955, respectively. Patients with recurrent atrial tachyarrhythmia had significantly longer Fastest PV-FARS10 -CL (172±41 vs. 156±41 ms, p=0.047). Patients with high burden of spontaneous low voltage zone (LVZ) had significantly longer Fastest PV-FARS10 -CL. Freedom from recurrent tachyarrhythmia at 24 months was 85% vs. 59% in patients with Fastest PV-FARS10 -CL≤140 vs. >140 ms, p=0.0018, respectively. In multivariable analysis Fastest PV-FARS10 -CL≤140 ms was the only significant predictor of freedom from recurrent tachyarrhythmia. CONCLUSIONS FARS10 -CL measurements have a high reproducibility in contrast to traditional AF-CL measurement of continuously fragmented CS signals. Patients with high burden of LVZ have longer Fastest PV-FARS10 -CLs. Fastest PV-FARS10 -CL≤140 ms is associated with a high success of wide antral PVI-only ablation approach in persistent AF. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Francesco Spera
- Cardiology Department, University Hospital of Antwerp, Antwerp, Belgium
| | - Moises Rodriguez-Mañero
- Cardiology Department, Hospital Universitario Santiago de Compostela, Santiago de Compostela, IDIS, CIBERCV, Spain
| | - Aurora Baluja
- Critical Patient Translational Research Group, Department of Anesthesiology, Intensive Care and Pain Management, Hospital Clínico Universitario, Santiago de Compostela, Spain
| | - Johan Saenen
- Cardiology Department, University Hospital of Antwerp, Antwerp, Belgium
| | - Wim Huybrechts
- Cardiology Department, University Hospital of Antwerp, Antwerp, Belgium
| | - Hielko Miljoen
- Cardiology Department, University Hospital of Antwerp, Antwerp, Belgium
| | - Maxime Tijskens
- Cardiology Department, University Hospital of Antwerp, Antwerp, Belgium
| | - Lien Vandaele
- Cardiology Department, University Hospital of Antwerp, Antwerp, Belgium
| | - Anouk Wittock
- Anesthesiology Department, University Hospital Antwerp, Antwerp, Belgium
| | - Marc J Claeys
- Cardiology Department, University Hospital of Antwerp, Antwerp, Belgium.,University of Antwerp, Antwerp, Belgium
| | - Hein Heidbuchel
- Cardiology Department, University Hospital of Antwerp, Antwerp, Belgium.,University of Antwerp, Antwerp, Belgium
| | - Andrea Sarkozy
- Cardiology Department, University Hospital of Antwerp, Antwerp, Belgium.,University of Antwerp, Antwerp, Belgium
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Kayaert P, Coeman M, Hanet C, Claeys MJ, Desmet W, De Pauw M, Haine S, Taeymans Y. Practice and long-term outcome of unprotected left main PCI: real-world data from a nationwide registry. Acta Cardiol 2022; 77:51-58. [PMID: 33683172 DOI: 10.1080/00015385.2021.1876402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Percutaneous coronary intervention (PCI) is increasingly performed in significant left main (LM) lesions. Left untreated, the prognosis is poor, but PCI and coronary bypass surgery (CABG) behold risks as well. Additional long-term outcome data might guide future treatment decisions. METHODS Between 2012 and 2019, all 6783 patients who underwent LM PCI were prospectively enrolled in a national registry. Patients with prior CABG or prior LM PCI, and patients presenting in cardiogenic shock or after out-of-hospital cardiac arrest were excluded. From the remaining 5284 patients, baseline and procedural data as well as long-term survival were assessed. RESULTS The annual rate of LM PCI increased from 422 (2.2% of PCIs) in 2012 to 868 in 2018 (3.0%). By 2018, 71% of the interventional cardiologists performed at least 1 LM PCI a year, though only 5 on average. Use of transradial access (TRA) in LM PCI increased from 20.4% in 2012 to 59.5% in 2019. All-cause mortality was 6.0% at 30 days and 18.5% at a mean follow-up of 33.5 months. Independent predictors of higher long-term mortality were older age, diabetes, multivessel disease, an urgent indication, a suboptimal angiographical result, and non-exclusive use of drug-eluting stents. TRAand higher operator and centre LM PCI experience were independent predictors of a lower long-term mortality. CONCLUSION LM PCI is associated with high short- and long-term mortality. Use of TRA and higher expertise in LM PCI were associated with better survival.
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Affiliation(s)
- Peter Kayaert
- Department of Cardiology, Universitair Ziekenhuis Gent, Ghent, Belgium
| | - Mathieu Coeman
- Department of Cardiology, Jan Yperman Ziekenhuis, Ypres, Belgium
| | - Claude Hanet
- Department of Cardiology, Clinique Universitaire de l’université catholique de Louvain, Namur, Belgium
| | - Marc J. Claeys
- Department of Cardiology, Antwerp University Hospital, Antwerp, Belgium
- Department of Cardiovascular Diseases, University of Antwerp, Antwerp, Belgium
| | - Walter Desmet
- Department of Cardiovascular Diseases, University Hospital Leuven, Leuven, Belgium
| | - Michel De Pauw
- Department of Cardiology, Universitair Ziekenhuis Gent, Ghent, Belgium
| | - Steven Haine
- Department of Cardiology, Antwerp University Hospital, Antwerp, Belgium
- Department of Cardiovascular Diseases, University of Antwerp, Antwerp, Belgium
| | - Yves Taeymans
- Department of Cardiology, Universitair Ziekenhuis Gent, Ghent, Belgium
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Kayaert P, Coeman M, Demolder A, Gevaert S, Schaubroeck H, Claeys MJ, Hanet C, Beauloye C, Desmet W, De Pauw M, Haine S, Taeymans Y. Mortality in STEMI Patients With Cardiogenic Shock: Results From a Nationwide PCI Registry and Focus on Left Main PCI. J Invasive Cardiol 2022; 34:E142-E148. [PMID: 35100557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND The study aims to assess real-life short- and long-term outcomes of patients undergoing primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) complicated with cardiogenic shock (CS). Outcome after left main (LM) PCI is of particular interest. METHODS Procedural, 30-day, and >30-day mortality rates were assessed in 2744 CS-STEMI patients enrolled between 2012 and 2019 in a nationwide registry involving 49 centers. RESULTS Procedural, 30-day, and >30-day mortality rates were 6.9%, 39.8%, and 12.6%, respectively. The mortality rates were significantly higher in the 348 patients (12.7%) who underwent LM-PCI (13.5%, 59.5%, and 18.4%, respectively). LM-PCI, a suboptimal PCI result, and transfemoral access were independent predictors of procedural and 30-day mortality. Operator experience was an independent predictor of procedural mortality, but not 30-day mortality. CONCLUSIONS Mortality remains high in CS-STEMI patients, especially within the first month. Patients undergoing LM-PCI are particularly at risk. Operator experience is predictive of procedural mortality.
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Affiliation(s)
- Peter Kayaert
- Dienst Cardiologie Universitair Ziekenhuis Gent, Corneel Heymanslaan 10, 9000 Gent, Belgium.
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Cenko E, Badimon L, Bugiardini R, Claeys MJ, De Luca G, de Wit C, Derumeaux G, Dorobantu M, Duncker DJ, Eringa EC, Gorog DA, Hassager C, Heinzel FR, Huber K, Manfrini O, Milicic D, Oikonomou E, Padro T, Trifunovic-Zamaklar D, Vasiljevic-Pokrajcic Z, Vavlukis M, Vilahur G, Tousoulis D. Cardiovascular disease and COVID-19: a consensus paper from the ESC Working Group on Coronary Pathophysiology & Microcirculation, ESC Working Group on Thrombosis and the Association for Acute CardioVascular Care (ACVC), in collaboration with the European Heart Rhythm Association (EHRA). Cardiovasc Res 2021; 117:2705-2729. [PMID: 34528075 PMCID: PMC8500019 DOI: 10.1093/cvr/cvab298] [Citation(s) in RCA: 74] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 09/10/2021] [Indexed: 01/08/2023] Open
Abstract
The cardiovascular system is significantly affected in coronavirus disease-19 (COVID-19). Microvascular injury, endothelial dysfunction, and thrombosis resulting from viral infection or indirectly related to the intense systemic inflammatory and immune responses are characteristic features of severe COVID-19. Pre-existing cardiovascular disease and viral load are linked to myocardial injury and worse outcomes. The vascular response to cytokine production and the interaction between severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and angiotensin-converting enzyme 2 receptor may lead to a significant reduction in cardiac contractility and subsequent myocardial dysfunction. In addition, a considerable proportion of patients who have been infected with SARS-CoV-2 do not fully recover and continue to experience a large number of symptoms and post-acute complications in the absence of a detectable viral infection. This conditions often referred to as 'post-acute COVID-19' may have multiple causes. Viral reservoirs or lingering fragments of viral RNA or proteins contribute to the condition. Systemic inflammatory response to COVID-19 has the potential to increase myocardial fibrosis which in turn may impair cardiac remodelling. Here, we summarize the current knowledge of cardiovascular injury and post-acute sequelae of COVID-19. As the pandemic continues and new variants emerge, we can advance our knowledge of the underlying mechanisms only by integrating our understanding of the pathophysiology with the corresponding clinical findings. Identification of new biomarkers of cardiovascular complications, and development of effective treatments for COVID-19 infection are of crucial importance.
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Affiliation(s)
- Edina Cenko
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Via Giuseppe Massarenti 9, 40134 Bologna, Italy
| | - Lina Badimon
- Cardiovascular Program ICCC-Research Institute Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, CiberCV, Barcelona, Spain
| | - Raffaele Bugiardini
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Via Giuseppe Massarenti 9, 40134 Bologna, Italy
| | - Marc J Claeys
- Department of Cardiology, University Hospital Antwerp, Edegem, Belgium
| | - Giuseppe De Luca
- Cardiovascular Department of Cardiology, Ospedale “Maggiore della Carità”, Eastern Piedmont University, Novara, Italy
| | - Cor de Wit
- Institut für Physiologie, Universität zu Lübeck, Lübeck, Germany
- Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK) e.V. (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Geneviève Derumeaux
- IMRB U955, UPEC, Créteil, France
- Department of Physiology, AP-HP, Henri-Mondor Teaching Hospital, Créteil, France
- Fédération Hospitalo-Universitaire « SENEC », Créteil, France
| | - Maria Dorobantu
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - Dirk J Duncker
- Division of Experimental Cardiology, Department of Cardiology, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Etto C Eringa
- Department of Physiology, Amsterdam Cardiovascular Science Institute, Amsterdam University Medical Centres, Amsterdam, The Netherlands
- Department of Physiology, Maastricht University, Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Diana A Gorog
- Faculty of Medicine, National Heart and Lung Institute, Imperial College, London, UK
- Department of Postgraduate Medicine, University of Hertfordshire, Hatfield, UK
| | - Christian Hassager
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Frank R Heinzel
- Department of Cardiology, Charité-Universitaetsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
- Berlin Institute of Health, Berlin, Germany
| | - Kurt Huber
- 3rd Medical Department, Cardiology and Intensive Care Medicine, Wilhelminen Hospital, Vienna, Austria
- Medical School, Sigmund Freud University, Vienna, Austria
| | - Olivia Manfrini
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Via Giuseppe Massarenti 9, 40134 Bologna, Italy
| | - Davor Milicic
- Department of Cardiovascular Diseases, University Hospital Centre Zagreb, University of Zagreb, Zagreb, Croatia
| | - Evangelos Oikonomou
- Department of Cardiology, ‘Hippokration’ General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Teresa Padro
- Cardiovascular Program ICCC-Research Institute Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, CiberCV, Barcelona, Spain
| | - Danijela Trifunovic-Zamaklar
- Cardiology Department, Clinical Centre of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | | | - Marija Vavlukis
- University Clinic of Cardiology, Medical Faculty, Ss' Cyril and Methodius University in Skopje, Skopje, Republic of Macedonia
| | - Gemma Vilahur
- Cardiovascular Program ICCC-Research Institute Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, CiberCV, Barcelona, Spain
| | - Dimitris Tousoulis
- Department of Cardiology, ‘Hippokration’ General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
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Claeys MJ, Debonnaire P, Bracke V, Bilotta G, Shkarpa N, Vanderheyden M, Coussement P, Vanderheyden J, de Heyning CMV, Cosyns B, Pouleur AC, Lancellotti P, Paelinck BP, Ferdinande B, Dubois C. Clinical and Hemodynamic Effects of Percutaneous Edge-to-Edge Mitral Valve Repair in Atrial Versus Ventricular Functional Mitral Regurgitation. Am J Cardiol 2021; 161:70-75. [PMID: 34794621 DOI: 10.1016/j.amjcard.2021.08.062] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 07/15/2021] [Revised: 08/24/2021] [Accepted: 08/27/2021] [Indexed: 11/18/2022]
Abstract
The present study aims to assess the clinical and hemodynamic impact of percutaneous edge-to-edge mitral valve repair with MitraClip in patients with atrial functional mitral regurgitation (A-FMR) compared with ventricular functional mitral regurgitation (V-FMR). Mitral regurgitation (MR) grade, functional status (New York Heart Association class), and major adverse cardiac events (MACE; all-cause mortality or hospitalization for heart failure) were evaluated in 52 patients with A-FMR and in 307 patients with V-FMR. In 56 patients, hemodynamic assessment during exercise echocardiography was performed before and 6 months after intervention. MR reduction after MitraClip implantation was noninferior in A-FMR compared with V-FMR (MR grade ≤2 at 6 months in 94% vs 82%, respectively, p <0.001 for noninferiority) and was associated with improvement of functional status (New York Heart Association class ≤2 at 6 months in 90% vs 80%, respectively, p = 0.2). Hemodynamic assessment revealed that cardiac output at 6 months was higher in A-FMR at rest (5.1 ± 1.5 L/min vs 3.8 ± 1.5 L/min, p = 0.002) and during peak exercise (7.9 ± 2.4 L/min vs 6.1 ± 2.1 L/min, p = 0.02). In addition, the reduction in systolic pulmonary artery pressure at rest was more pronounced in A-FMR: Δ SPAP -13.1 ± 15.1 mm Hg versus -2.2 ± 13.3 mm Hg (p = 0.03). MACE rate at follow-up was significantly lower in A-FMR versus V-FMR, with an adjusted odds ratio of 0.46 (95% confidence interval 0.24 to 0.88), which was caused by a reduction in hospitalization for heart failure. In conclusion, percutaneous edge-to-edge mitral valve repair with MitraClip is at least as effective in A-FMR as in V-FMR in reducing MR. However, the hemodynamic improvement and reduction of MACE were significantly better in A-FMR.
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Affiliation(s)
- Marc J Claeys
- Dept of cardiology, Antwerp University Hospital, Edegem, Belgium.
| | | | - Veronique Bracke
- Dept of cardiology, Antwerp University Hospital, Edegem, Belgium
| | - Giada Bilotta
- Dept of cardiology, Antwerp University Hospital, Edegem, Belgium
| | - Nikol Shkarpa
- Dept of cardiology, Antwerp University Hospital, Edegem, Belgium
| | | | | | | | | | - Bernard Cosyns
- Dept of cardiology, Brussels University Hospital, Brussels, Belgium
| | | | | | | | - Bert Ferdinande
- Dept of Cardiology, University Hospital Leuven, Katholieke Universiteit Leuven, Leuven, Belgium
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20
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Bosmans S, Sluyts Y, Lysens de Oliveira E Silva-Van Acker J, Van Caenegem O, Sinnaeve PR, Dubois P, Vranckx P, Gevaert S, Coussement P, Beauloye C, Evrard P, Argacha JF, De Raedt H, Wouters K, Claeys MJ. Adherence to quality indicators for ST-elevation myocardial infarction and its relation to mortality: a hospital network analysis from the Belgian STEMI database. Eur Heart J Qual Care Clin Outcomes 2021; 7:601-607. [PMID: 32941605 DOI: 10.1093/ehjqcco/qcaa067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 03/24/2020] [Indexed: 06/11/2023]
Abstract
AIMS To assess the adherence to established quality indicators (QIs) for ST-elevation myocardial infarction (STEMI) at the hospital-network level and its relation to outcome. METHODS AND RESULTS The data of 7774 STEMI patients admitted to 32 STEMI networks during the period 2014-18 were extracted from the Belgian STEMI database. Five QIs [primary percutaneous coronary intervention use, diagnosis-to-balloon time (DiaTB) <90 min, door-to-balloon time (DoTB) <60 min, P2Y12 inhibitor and statin prescription at discharge, and a composite QI score ranging from 0 to 10] were correlated with in-hospital mortality adjusted for differences in baseline risk profile (TIMI risk score). The median composite QI score was 6.5 [interquartile range (IQR) 6-8]. The most important gaps in quality adherence were related to time delays: the recommended DiaTB and DoTB times across the different networks were achieved in 68% (IQR 53-71) and 67% (IQR 50-78), respectively. Quality adherence was better in networks taking care of more high-risk STEMI patients. The median in-hospital mortality among the STEMI networks was 6.4% (IQR 4.1-7.9%). There was a significant independent inverse correlation between the composite QI score and in-hospital mortality (partial correlation coefficient: -0.45, P = 0.013). Stepwise regression analysis revealed that among the individual QIs, prolonged DiaTB was the most important independent outcome predictor. CONCLUSION Among established STEMI networks, the time delay between diagnosis and treatment was the most variable and the most relevant prognostic QI, underscoring the importance of assessing quality of care throughout the whole network.
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Affiliation(s)
- Sara Bosmans
- Department of Cardiology, University Hospital Antwerp, Wilrijkstraat 10, 2650 Edegem, Belgium
| | - Yasmine Sluyts
- Department of Cardiology, University Hospital Antwerp, Wilrijkstraat 10, 2650 Edegem, Belgium
| | | | | | - Peter R Sinnaeve
- Department of Cardiology, UZ Leuven, Ottignies-Louvain-la-Neuve, Belgium
| | | | - Pascal Vranckx
- Department of Cardiology, Virga Jesse Hasselt, Hasselt, Belgium
| | | | | | | | - Patrick Evrard
- Department of Intensive Care, UCL Mont-Godinne, Mont-Godinne, Belgium
| | | | | | - Kristien Wouters
- Clinical Trial Center (CTC), CRC Antwerp, Antwerp University Hospital, University of Antwerp, Antwerpen, Belgium
| | - Marc J Claeys
- Department of Cardiology, University Hospital Antwerp, Wilrijkstraat 10, 2650 Edegem, Belgium
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21
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Claeys MJ, Debonnaire P, Bracke V, Bilotta G, Shkarpa N, Vanderheyden M, Coussement P, Vanderheyden J, Van De Heyning C, Cosyns B, Pouleur AC, Lancellotti P, Paelinck B, Ferdinande B, Dubois C. Clinical and haemodynamic effects of percutaneous edge-to-edge mitral valve repair in atrial versus ventricular functional mitral regurgitation. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1628] [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: 11/13/2022] Open
Abstract
Abstract
Background
Atrial functional mitral regurgitation (A-FMR) is a novel entity characterized by a MR due to atrial remodeling but with preserved left ventricular (LV) systolic function.
Purpose
To assess the clinical and haemodynamic impact of percutaneous edge-to-edge mitral valve repair with MitraClip in patients with A-FMR as compared to ventricular (V)-FMR.
Methods
MR grade, functional status (NYHA class), and major adverse cardiac events (MACE= all-cause mortality or hospitalization for heart failure (HF)) were evaluated in 52 A-FMR patients (pts.) and in 307 V-FMR pts. who underwent MitraClip implantation in 7 Belgian centers. In a subgroup of 56 pts (10 A-FMR and 46 V-FMR) haemodynamic assessment during a symptom-limited exercise echocardiography was performed before and 6-month after intervention.
Results
MitraClip implantation resulted in similar MR reductions in A-FMR and V-FMR (MR grade ≤2 at 6-month in 94% versus 82%, respectively (p=0.08)) and was associated with improvement of functional status in both groups (NYHA class ≤2 at 6 months in 90% versus 80%, respectively (p=0.2)). Serial haemodynamic assessment revealed that the cardiac output at 6-month was significantly higher in A-FMR pts. both at rest (5.1±1.5 L/min versus 3.8±1.5 L/min, p=0.002) and during peak exercise (7.9±2.4 L/min versus 6.1±2.1 L/min, p=0.02). Also the reduction in systolic pulmonary artery pressure (sPAP) was more pronounced in A-FMR: Δ sPAP at rest – 13.1±15.1 mmHg versus – 2.2±13.3 mmHg (p=0.03). During a follow-up period of 1.3±1.2 years MACE rate was significantly lower in A-FMR versus V-FMR with an adjusted OR of 0.46 (95% CI 0.24–0.88, see figure), which was mainly driven by a reduction in HF hospitalization.
Conclusion
Percutaneous edge-to-edge mitral valve repair with MitraClip is at least as effective in A-FMR as in V-FMR in reducing MR. But, the haemodynamic and clinical impact is stronger in A-FMR pts.
Funding Acknowledgement
Type of funding sources: None. MACE in A-FMR versus V-FMR pts
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Affiliation(s)
- M J Claeys
- University of Antwerp Hospital, Antwerp, Belgium
| | | | - V Bracke
- University of Antwerp Hospital, Antwerp, Belgium
| | - G Bilotta
- University of Antwerp Hospital, Antwerp, Belgium
| | - N Shkarpa
- University of Antwerp Hospital, Antwerp, Belgium
| | | | | | | | | | - B Cosyns
- University Hospital (UZ) Brussels, Brussels, Belgium
| | - A C Pouleur
- Catholic University of Louvain, Brussels, Belgium
| | | | - B Paelinck
- University of Antwerp Hospital, Antwerp, Belgium
| | | | - C Dubois
- University Hospitals (UZ) Leuven, Leuven, Belgium
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22
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Claeys MJ, Argacha JF, Collart P, Carlier M, Van Caenegem O, Sinnaeve PR, Desmet W, Dubois P, Stammen F, Gevaert S, Pourbaix S, Coussement P, Beauloye C, Evrard P, Brasseur O, Fierens F, Marechal P, Schelfaut D, Floré V, Hanet C. Impact of COVID-19-related public containment measures on the ST elevation myocardial infarction epidemic in Belgium: a nationwide, serial, cross-sectional study. Acta Cardiol 2021; 76:863-869. [PMID: 32727305 DOI: 10.1080/00015385.2020.1796035] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
AIMS The current study assessed the impact of COVID-19-related public containment measures (i.e. lockdown) on the ST elevation myocardial infarction (STEMI) epidemic in Belgium. METHODS AND RESULTS Clinical characteristics, reperfusion therapy modalities, COVID-19 status and in-hospital mortality of consecutive STEMI patients who were admitted to Belgian hospitals for percutaneous coronary intervention (PCI) were recorded during a three-week period starting at the beginning of the lockdown period on 13 March 2020. Similar data were collected for the same time period for 2017-2019. An evaluation of air quality revealed a 32% decrease in ambient NO2 concentrations during lockdown (19.5 µg/m³ versus 13.2 µg/m³, p < .001). During the three-week period, there were 188 STEMI patients admitted for PCI during the lockdown versus an average 254 STEMI patients before the lockdown period (incidence rate ratio = 0.74, p = .001). Reperfusion strategy was predominantly primary PCI in both time periods (96% versus 95%). However, there was a significant delay in treatment during the lockdown period, with more late presentations (>12 h after onset of pain) (14% versus 7.6%, p = .04) and with longer door-to-balloon times (median of 45 versus 39 min, p = .02). Although the in-hospital mortality between the two periods was comparable (5.9% versus 6.7%), 5 of the 7 (71%) COVID-19-positive STEMI patients died. CONCLUSION The present study revealed a 26% reduction in STEMI admissions and a delay in treatment of STEMI patients. Less exposure to external STEMI triggers (such as ambient air pollution) and/or reluctance to seek medical care are possible explanations of this observation.
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Affiliation(s)
- Marc J. Claeys
- Department of Cardiology, University Hospital Antwerp, Antwerp, Belgium
| | | | - Philippe Collart
- Centre de recherche en Epidémiologie, Biostatistiques et Recherche Clinique, School of Public Health, Université Libre de Bruxelles, Brussels, Belgium
| | - Marc Carlier
- Department of Cardiology, GHDC, Charleroi, Belgium
| | - Olivier Van Caenegem
- Division of Cardiovascular Intensive Care, Cliniques universitaires Saint Luc, Brussels, Belgium
| | - Peter R. Sinnaeve
- Department of Cardiology, University Hospital Leuven, Leuven, Belgium
| | - Walter Desmet
- Department of Cardiology, University Hospital Leuven, Leuven, Belgium
| | | | - Francis Stammen
- Department of Cardiology, Hospital Roeselare, Roeselare, Belgium
| | - Sofie Gevaert
- Department of Cardiology, Ghent University Hospital, Ghent, Belgium
| | | | | | - Christophe Beauloye
- Division of Cardiology and Pole of Cardiovascular Research, Institut de Recherche Experimentale et Clinique, Cliniques universitaires Saint Luc, Brussels, Belgium
| | - Patrick Evrard
- Department of Intensive Care, Belgium Catholic University Hospital Mont-Godinne, Brussels, Belgium
| | - Olivier Brasseur
- Laboratory of Environmental Research, Brussels Environment, Brussels, Belgium
| | - Frans Fierens
- Belgian Interregional Environment Agency, Brussels, Belgium
| | - Patrick Marechal
- Department of Cardiology, University hospital of Liege, Liège, Belgium
| | | | - Vincent Floré
- Department of Cardiology, Hospital Maria Middelares, Ghent, Belgium
| | - Claude Hanet
- Department of Cardiology, Catholic University Hospital Mont-Godinne, Brussels, Belgium
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23
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Van De Heyning CM, Claeys MJ. Annular Dynamics in Patients With Atrial Fibrillation and AFMR: The Next Piece of the Puzzle. JACC Cardiovasc Imaging 2021; 15:14-16. [PMID: 34419397 DOI: 10.1016/j.jcmg.2021.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 07/01/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Caroline M Van De Heyning
- Department of Cardiology, Antwerp University Hospital, Antwerp, Belgium; Department of Cardiovascular Diseases, Department of Genetics, Pharmacology, and Physiopathology of Heart, Blood Vessels, and Skeleton, Antwerp University, Antwerp, Belgium
| | - Marc J Claeys
- Department of Cardiology, Antwerp University Hospital, Antwerp, Belgium; Department of Cardiovascular Diseases, Department of Genetics, Pharmacology, and Physiopathology of Heart, Blood Vessels, and Skeleton, Antwerp University, Antwerp, Belgium.
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24
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Van Laer SL, Winkler KM, Verreyen S, Miljoen H, Sarkozy A, Heuten H, Saenen J, Van Herck P, Van De Heyning CM, Heidbuchel H, Claeys MJ. Mitral regurgitation attenuates thrombotic risk in nonrheumatic atrial fibrillation: a new CHA2DS2-VASc score risk modifier? Europace 2021. [DOI: 10.1093/europace/euab116.264] [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: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background/Introduction: Atrial fibrillation (AF) carries a thrombotic risk related to left atrial blood stasis. Many risk scores, such as the CHA2DS2-VASc score, have been developed to guide physicians in initiating anticoagulant therapy. However, the risk prediction with these models is modest at best (C-statistic = 0.6). The presence of mitral regurgitation (MR) has been shown to reduce thrombotic risk in patients with rheumatic AF. In nonrheumatic AF, direct evidence of a lower thrombotic risk in patients with MR is still controversial.
Purpose
The current study assessed the effect of MR on thrombotic risk in nonrheumatic AF patients.
Methods
The prevalence of atrial thrombosis, defined as the presence of left atrial appendage thrombus (LAAT) and/or left atrial spontaneous echo contrast (LASEC) grade >2, was determined in 686 consecutive nonrheumatic AF patients without (adequate) anticoagulation scheduled for transoesophageal echocardiography before electrical cardioversion and was related to the severity of MR adjusted for the CHA2DS2-VASc score. The independent predictors of atrial thrombosis were assessed by stepwise multiple logistic regression analysis.
Results
A total of 103 (15%) patients had severe MR, 210 (31%) had moderate MR, and 373 (54%) had no-mild MR; the median CHA2DS2-VASc score was 3.0 (IQR 2.0-4.0). Atrial thrombosis (LAAT and/or LASEC grade >2) was observed in 118 patients (17%). The prevalence of atrial thrombosis decreased with increasing MR severity: 19.9% versus 15.2% versus 11.6% for no-mild, moderate, and severe MR, respectively (p for trend = 0.03) (Figure 1). Patients with moderate and severe MR had a lower risk of atrial thrombosis than patients with no-mild MR, with adjusted odds ratios (ORs) of 0.51 (95% CI 0.31-0.84) and 0.24 (95% CI 0.11-0.49), respectively. The other independent predictors of atrial thrombosis were: the CHA2DS2-VASc score with an adjusted OR of 1.25 (95% CI 1.10-1.42), poor left ventricular ejection fraction (LVEF, <40%) with an adjusted OR of 4.08 (95% CI 2.56-6.50), and large left atrial volume index (LAVI, >37 ml/m²) with an adjusted OR of 1.90 (95% CI 1.19-3.03) (Figure 1, upper right corner). The C-statistic of the regression model increased significantly (p = 0.0003) from 0.62 to 0.75 by adding MR grade, LVEF, and LAVI to the univariate CHA2DS2-VASc score model. The protective effect of MR was present across all levels of the CHA2DS2-VASc score and the presence of moderate-severe MR in patients with an intermediate CHA2DS2-VASc score (2-3) lowered the atrial thrombotic risk to the level of patients with a low CHA2DS2-VASc score (0-1).
Conclusion
Our data show that the presence of MR attenuated the atrial thrombotic risk by more than 50% in patients with nonrheumatic AF, independent of the CHA2DS2-VASc risk score. Moderate to severe MR can therefore be considered a new risk modifier of the CHA2DS2-VASc score, which might help refine the indication of anticoagulants in AF patients. Abstract Figure 1. Thrombotic risk per MR grade.
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Affiliation(s)
- SL Van Laer
- Antwerp University Hospital, Department of Cardiology, Edegem, Belgium
| | - KM Winkler
- Antwerp University Hospital, Department of Cardiology, Edegem, Belgium
| | - S Verreyen
- Antwerp University Hospital, Department of Cardiology, Edegem, Belgium
| | - H Miljoen
- Antwerp University Hospital, Department of Cardiology, Edegem, Belgium
| | - A Sarkozy
- Antwerp University Hospital, Department of Cardiology, Edegem, Belgium
| | - H Heuten
- Antwerp University Hospital, Department of Cardiology, Edegem, Belgium
| | - J Saenen
- Antwerp University Hospital, Department of Cardiology, Edegem, Belgium
| | - P Van Herck
- Antwerp University Hospital, Department of Cardiology, Edegem, Belgium
| | - CM Van De Heyning
- Antwerp University Hospital, Department of Cardiology, Edegem, Belgium
| | - H Heidbuchel
- Antwerp University Hospital, Department of Cardiology, Edegem, Belgium
| | - MJ Claeys
- Antwerp University Hospital, Department of Cardiology, Edegem, Belgium
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25
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Van Laer SL, Verreyen S, Winkler KM, Miljoen H, Sarkozy A, Heuten H, Saenen J, Van Herck P, Van de Heyning CM, Heidbuchel H, Claeys MJ. Effect of Mitral Regurgitation on Thrombotic Risk in Patients With Nonrheumatic Atrial Fibrillation: A New CHA 2DS 2-VASc Score Risk Modifier? Am J Cardiol 2021; 145:69-76. [PMID: 33454347 DOI: 10.1016/j.amjcard.2021.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 12/30/2020] [Accepted: 01/05/2021] [Indexed: 11/26/2022]
Abstract
The current study assessed the effect of mitral regurgitation (MR) on thrombotic risk in nonrheumatic atrial fibrillation (AF). AF carries a thrombotic risk related to left atrial blood stasis. The prevalence of atrial thrombosis, defined as the presence of left atrial appendage thrombus and/or left atrial spontaneous echo contrast grade >2, was determined in 686 consecutive nonrheumatic AF patients without (adequate) anticoagulation scheduled for transesophageal echocardiography before electrical cardioversion and was related to the severity of MR adjusted for the CHA2DS2-VASc score. A total of 103 (15%) patients had severe MR, 210 (31%) had moderate MR, and 373 (54%) had no-mild MR; the median CHA2DS2-VASc score was 3.0 (interquartile range 2.0 to 4.0). Atrial thrombosis was observed in 118 patients (17%). The prevalence of atrial thrombosis decreased with increasing MR severity: 19.9% versus 15.2% versus 11.6% for no-mild, moderate, and severe MR, respectively (p value for trend = 0.03). Patients with moderate and severe MR had a lower risk of atrial thrombosis than patients with no-mild MR, with adjusted odds ratios of 0.51 (95% confidence interval 0.31 to 0.84) and 0.24 (95% confidence interval 0.11 to 0.49), respectively. The protective effect of MR was present across all levels of the CHA2DS2-VASc risk score and the presence of moderate-severe MR in patients with an intermediate CHA2DS2-VASc score (2 to 3) lowered the atrial thrombotic risk to the level of patients with a low CHA2DS2-VASc score (0 to 1). In conclusion, our data show that the presence of MR attenuated the atrial thrombotic risk by more than 50% in patients with nonrheumatic AF.
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26
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Schiele F, Aktaa S, Rossello X, Ahrens I, Claeys MJ, Collet JP, Fox KAA, Gale CP, Huber K, Iakobishvili Z, Keys A, Lambrinou E, Leonardi S, Lettino M, Masoudi FA, Price S, Quinn T, Swahn E, Thiele H, Timmis A, Tubaro M, Vrints CJM, Walker D, Bueno H, Halvorsen S, Jernberg T, Jortveit J, Blöndal M, Ibanez B, Hassager C. 2020 Update of the quality indicators for acute myocardial infarction: a position paper of the Association for Acute Cardiovascular Care: the study group for quality indicators from the ACVC and the NSTE-ACS guideline group. Eur Heart J Acute Cardiovasc Care 2021; 10:224-233. [PMID: 33550362 DOI: 10.1093/ehjacc/zuaa037] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 12/10/2020] [Indexed: 12/18/2022]
Abstract
AIMS Quality indicators (QIs) are tools to improve the delivery of evidence-base medicine. In 2017, the European Society of Cardiology (ESC) Association for Acute Cardiovascular Care (ACVC) developed a set of QIs for acute myocardial infarction (AMI), which have been evaluated at national and international levels and across different populations. However, an update of these QIs is needed in light of the accumulated experience and the changes in the supporting evidence. METHODS AND RESULTS The ESC methodology for the QI development was used to update the 2017 ACVC QIs. We identified key domains of AMI care, conducted a literature review, developed a list of candidate QIs, and used a modified Delphi method to select the final set of indicators. The same seven domains of AMI care identified by the 2017 Study Group were retained for this update. For each domain, main and secondary QIs were developed reflecting the essential and complementary aspects of care, respectively. Overall, 26 QIs are proposed in this document, compared to 20 in the 2017 set. New QIs are proposed in this document (e.g. the centre use of high-sensitivity troponin), some were retained or modified (e.g. the in-hospital risk assessment), and others were retired in accordance with the changes in evidence [e.g. the proportion of patients with non-ST segment elevation myocardial infarction (NSTEMI) treated with fondaparinux] and the feasibility assessments (e.g. the proportion of patients with NSTEMI whom risk assessment is performed using the GRACE and CRUSADE risk scores). CONCLUSION Updated QIs for the management of AMI were developed according to contemporary knowledge and accumulated experience. These QIs may be applied to evaluate and improve the quality of AMI care.
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Affiliation(s)
- François Schiele
- University Hospital Besancon, Boulevard Fleming, 25000 Besancon, France
| | | | - Xavier Rossello
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.,Cardiology Department, Hospital Universitari Son Espases & Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain.,CIBER de enfermedades CardioVasculares (CIBERCV), Madrid, Spain
| | - Ingo Ahrens
- Cardiology and Medical Intensive Care, Augustinerinnen Hospital Cologne, Cologne, Germany
| | | | - Jean-Philippe Collet
- Sorbonne Université, ACTION Study Group, Paris, France.,INSERM UMRS 1166, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France
| | - Keith A A Fox
- University and Royal Infirmary of Edinburgh, Edinburgh, UK
| | | | - Kurt Huber
- 3rd Department of Medicine, Cardiology and Intensive Care Medicine, Wilhelminenhospital, Sigmund Freud University, Medical Faculty, Vienna, Austria
| | - Zaza Iakobishvili
- Department of Community Cardiology, Clalit Health Services, Jaffa District, Tel Aviv, Israel
| | | | - Ekaterini Lambrinou
- Department of Nursing, School of Health Sciences, Cyprus University of Technology, Limassol, Cyprus
| | - Sergio Leonardi
- University of Pavia and Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
| | - Maddalena Lettino
- Cardio-Thoracic-Vascular Department, San Gerardo Hospital, Monza, Italy
| | | | - Susanna Price
- Royal Brompton & Harefield NHS Foundation Trust, Imperial College, London, UK
| | - Tom Quinn
- Kingston University & St. George's, University of London, London, UK
| | - Eva Swahn
- Linkoping University, Linkoping, Sweden
| | - Holger Thiele
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Adam Timmis
- Barts Heart Centre and Queen Mary University London, London, UK
| | | | - Christiaan J M Vrints
- Antwerp University Hospital, Antwerp, Belgium.,University of Antwerp, Antwerp, Belgium
| | | | - Hector Bueno
- CIBER de enfermedades CardioVasculares (CIBERCV), Madrid, Spain.,Cardiology Department, Hospital Universitario 12 de Octubre and Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain.,Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | | | - Sigrun Halvorsen
- Department of Cardiology, Oslo University Hospital Ullevål, University of Oslo, Oslo, Norway
| | - Tomas Jernberg
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Jarle Jortveit
- Department of Cardiology, Sørlandet Hospital Arendal, Arendal, Norway
| | - Mai Blöndal
- Department of Cardiology, Tartu University, Estonia
| | - Borja Ibanez
- Department of Cardiology, Hospital Fundación Jiménez Díaz, Madrid, Spain
| | - Christian Hassager
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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27
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Claeys MJ, Vandekerckhove Y, Cosyns B, Van de Borne P, Lancellotti P. Summary of 2019 ESC Guidelines on chronic coronary syndromes, acute pulmonary embolism, supraventricular tachycardia and dislipidaemias. Acta Cardiol 2021; 76:1-8. [PMID: 31920149 DOI: 10.1080/00015385.2019.1699282] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
During the ESC congress in September 2019 in Paris, the new ESC guidelines were presented and are now available on the ESC website. The new guidelines describe management recommendations on following cardiovascular diseases: chronic coronary syndromes, acute pulmonary embolism, supraventricular tachycardia and dislipidaemias. The present document gives a summary of these guidelines and highlights the most important recommendations and changes in the management of these diseases. It will help to increase awareness about the new guidelines and may stimulate to consult the full document for specific items. Ultimately, the authors hope that this document will enhance implementation of new ESC guidelines in daily clinical practice.
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Affiliation(s)
| | | | - Bernard Cosyns
- Centrum voor Hart en vaatziekten. UZB. Brussels, Brussels, Belgium
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28
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Claeys MJ, Roubille F, Casella G, Zukermann R, Nikolaou N, De Luca L, Gierlotka M, Iakobishvili Z, Thiele H, Koutouzis M, Sionis A, Monteiro S, Beauloye C, Held C, Tint D, Zakke I, Serpytis P, Babic Z, Belohlavev J, Magdy A, Sivagowry Rasalingam M, Daly K, Arroyo D, Vavlukis M, Radovanovic N, Trendafilova E, Marandi T, Hassenger C, Lettino M, Price S, Bonnefoy E. Organization of intensive cardiac care units in Europe: Results of a multinational survey. European Heart Journal. Acute Cardiovascular Care 2020; 9:993-1001. [DOI: 10.1177/2048872619883997] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background:
The present survey aims to describe the intensive cardiac care unit organization and admission policies in Europe.
Methods:
A total of 228 hospitals (61% academic) from 27 countries participated in this survey. In addition to the organizational aspects of the intensive cardiac care units, including classification of the intensive cardiac care unit levels, data on the admission diagnoses were gathered from consecutive patients who were admitted during a two-day period. Admission policies were evaluated by comparing illness severity with the intensive cardiac care unit level. Gross national income was used to differentiate high-income countries (n=13) from middle-income countries (n=14).
Results:
A total of 98% of the hospitals had an intensive cardiac care unit: 70% had a level 1 intensive cardiac care unit, 76% had a level 2 intensive cardiac care unit, 51% had a level 3 intensive cardiac care unit, and 60% of the hospitals had more than one intensive cardiac care unit level. High-income countries tended to have more level 3 intensive cardiac care units than middle-income countries (55% versus 41%, p=0.07). A total of 5159 admissions were scored on illness severity: 63% were low severity, 24% were intermediate severity, and 12% were high severity. Patients with low illness severity were predominantly admitted to level 1 intensive cardiac care units, whereas patients with high illness severity were predominantly admitted to level 2 and 3 intensive cardiac care units. A policy mismatch was observed in 12% of the patients; some patients with high illness severity were admitted to level 1 intensive cardiac care units, which occurred more often in middle-income countries, whereas some patients with low illness severity were admitted to level 3 intensive cardiac care units, which occurred more frequently in high-income countries.
Conclusion:
More than one-third of the admitted patients were considered intermediate or high risk. Although patients with higher illness severity were mostly admitted to high-level intensive cardiac care units, an admission policy mismatch was observed in 12% of the patients; this mismatch was partly related to insufficient logistic intensive cardiac care unit capacity.
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Affiliation(s)
- MJ Claeys
- Department of Cardiology, Antwerp University Hospital, Belgium
| | - F Roubille
- Department of Cardiology, University Hospital of Montpellier, France
| | - G Casella
- Department of Cardiology, Ospedale Maggiore, Italy
| | | | - N Nikolaou
- Department of Cardiology, Konstantopouleio General Hospital, Greece
| | - L De Luca
- Department of Cardiology, S. Giovanni Evangelista Hospital, Italy
| | - M Gierlotka
- Department of Cardiology, University of Opole, Poland
| | | | - H Thiele
- Heart Center Leipzig, University Hospital, Germany
| | | | - A Sionis
- Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Spain
| | | | - C Beauloye
- Cliniques Universitaires Saint Luc, UCLouvain, Belgium
| | - C Held
- Department of Medical Sciences, Uppsala Clinical Research Center, Sweden
| | - D Tint
- ICCO Clinics, Transilvania University, Romania
| | - I Zakke
- Pauls Stradins Clinical University Hospital, Latvia
| | - P Serpytis
- Faculty of Medicine, Vilnius University, Lithuania
| | - Z Babic
- University Hospital Centre, Sisters of Mercy, Croatia
| | - J Belohlavev
- 2nd Department of Medicine, Charles University, Czech Republic
| | - A Magdy
- National Heart Institution, Egypt
| | | | - K Daly
- University College Hospital, Ireland
| | - D Arroyo
- Hôpital Cantonal Fribourg, Switzerland
| | - M Vavlukis
- PHO University Clinic of Cardiology, Macedonia
| | | | | | - T Marandi
- North Estonia Medical Centre, Estonia
- Department of Cardiology, University of Tartu, Estonia
| | - C Hassenger
- Department of Cardiology, Rigshospitalet, Denmark
- Department of Clinical Medicine, University of Copenhagen, Denmark
| | - M Lettino
- Division of Cardiology, San Gerardo Hospital, Italy
| | - S Price
- Adult Intensive Care Unit, Royal Brompton Hospital, London
| | - E Bonnefoy
- Intensive Cardiac Care Unit, Hospices Civils de Lyon, France
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29
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Claeys MJ, Roubille F, Casella G, Zukermann R, Nikolaou N, De Luca L, Gierlotka M, Iakobishvili Z, Thiele H, Koutouzis M, Sionis A, Monteiro S, Beauloye C, Held C, Tint D, Zakke I, Serpytis P, Babic Z, Belohlavev J, Magdy A, Sivagowry Rasalingam M, Daly K, Arroyo D, Vavlukis M, Radovanovic N, Trendafilova E, Marandi T, Hassenger C, Lettino M, Price S, Bonnefoy E. Organization of intensive cardiac care units in Europe: Results of a multinational survey. European Heart Journal. Acute Cardiovascular Care 2020; 9:993-1001. [DOI: mj claeys, f roubille, g casella, r zukermann, n nikolaou, l de luca, m gierlotka, z iakobishvili, h thiele, m koutouzis, a sionis, s monteiro, c beauloye, c held, d tint, i zakke, p serpytis, z babic, j belohlavev, a magdy, m sivagowry rasalingam, k daly, d arroyo, m vavlukis, n radovanovic, e trendafilova, t marandi, c hassenger, m lettino, s price, e bonnefoy, organization of intensive cardiac care units in europe: results of a multinational survey, european heart journal.acute cardiovascular care, volume 9, issue 8, 1 december 2020, pages 993–1001, https:/doi.org/10.1177/2048872619883997] [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] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Abstract
Background:
The present survey aims to describe the intensive cardiac care unit organization and admission policies in Europe.
Methods:
A total of 228 hospitals (61% academic) from 27 countries participated in this survey. In addition to the organizational aspects of the intensive cardiac care units, including classification of the intensive cardiac care unit levels, data on the admission diagnoses were gathered from consecutive patients who were admitted during a two-day period. Admission policies were evaluated by comparing illness severity with the intensive cardiac care unit level. Gross national income was used to differentiate high-income countries (n=13) from middle-income countries (n=14).
Results:
A total of 98% of the hospitals had an intensive cardiac care unit: 70% had a level 1 intensive cardiac care unit, 76% had a level 2 intensive cardiac care unit, 51% had a level 3 intensive cardiac care unit, and 60% of the hospitals had more than one intensive cardiac care unit level. High-income countries tended to have more level 3 intensive cardiac care units than middle-income countries (55% versus 41%, p=0.07). A total of 5159 admissions were scored on illness severity: 63% were low severity, 24% were intermediate severity, and 12% were high severity. Patients with low illness severity were predominantly admitted to level 1 intensive cardiac care units, whereas patients with high illness severity were predominantly admitted to level 2 and 3 intensive cardiac care units. A policy mismatch was observed in 12% of the patients; some patients with high illness severity were admitted to level 1 intensive cardiac care units, which occurred more often in middle-income countries, whereas some patients with low illness severity were admitted to level 3 intensive cardiac care units, which occurred more frequently in high-income countries.
Conclusion:
More than one-third of the admitted patients were considered intermediate or high risk. Although patients with higher illness severity were mostly admitted to high-level intensive cardiac care units, an admission policy mismatch was observed in 12% of the patients; this mismatch was partly related to insufficient logistic intensive cardiac care unit capacity.
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Affiliation(s)
- MJ Claeys
- Department of Cardiology, Antwerp University Hospital, Belgium
| | - F Roubille
- Department of Cardiology, University Hospital of Montpellier, France
| | - G Casella
- Department of Cardiology, Ospedale Maggiore, Italy
| | | | - N Nikolaou
- Department of Cardiology, Konstantopouleio General Hospital, Greece
| | - L De Luca
- Department of Cardiology, S. Giovanni Evangelista Hospital, Italy
| | - M Gierlotka
- Department of Cardiology, University of Opole, Poland
| | | | - H Thiele
- Heart Center Leipzig, University Hospital, Germany
| | | | - A Sionis
- Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Spain
| | | | - C Beauloye
- Cliniques Universitaires Saint Luc, UCLouvain, Belgium
| | - C Held
- Department of Medical Sciences, Uppsala Clinical Research Center, Sweden
| | - D Tint
- ICCO Clinics, Transilvania University, Romania
| | - I Zakke
- Pauls Stradins Clinical University Hospital, Latvia
| | - P Serpytis
- Faculty of Medicine, Vilnius University, Lithuania
| | - Z Babic
- University Hospital Centre, Sisters of Mercy, Croatia
| | - J Belohlavev
- 2nd Department of Medicine, Charles University, Czech Republic
| | - A Magdy
- National Heart Institution, Egypt
| | | | - K Daly
- University College Hospital, Ireland
| | - D Arroyo
- Hôpital Cantonal Fribourg, Switzerland
| | - M Vavlukis
- PHO University Clinic of Cardiology, Macedonia
| | | | | | - T Marandi
- North Estonia Medical Centre, Estonia
- Department of Cardiology, University of Tartu, Estonia
| | - C Hassenger
- Department of Cardiology, Rigshospitalet, Denmark
- Department of Clinical Medicine, University of Copenhagen, Denmark
| | - M Lettino
- Division of Cardiology, San Gerardo Hospital, Italy
| | - S Price
- Adult Intensive Care Unit, Royal Brompton Hospital, London
| | - E Bonnefoy
- Intensive Cardiac Care Unit, Hospices Civils de Lyon, France
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30
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Claeys MJ, De Pauw M, Geelen P, Lancellotti P, Pierard L. Review article: the best of 2018. Acta Cardiol 2020; 75:383-387. [PMID: 31131711 DOI: 10.1080/00015385.2019.1611190] [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] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Marc J Claeys
- Department of Cardiology, Antwerp University Hospital, Edegem, Belgium
| | - Michel De Pauw
- Department of Cardiology, Ghent University Hospital, Ghent, Belgium
| | - Peter Geelen
- Department of Cardiology, OLV Hospital Aalst, Aalst, Belgium
| | | | - Luc Pierard
- Centre Hospitalier Universitaire de Liège, Liège, Belgium
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31
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Claeys MJ, Coussement P, Pasquet A, De Backer T, De Pauw M. Summary of 2018 ESC Guidelines on definition of myocardial infarction, myocardial revascularisation, cardiovascular disease during pregnancy and on arterial hypertension. Acta Cardiol 2020; 75:179-185. [PMID: 31124757 DOI: 10.1080/00015385.2019.1569315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
During the ESC congress in September 2018 in Munich, the new ESC guidelines were presented and are now available on the ESC website. The new guidelines describe the definition of myocardial infarction and covers management recommendations on following cardiovascular items: myocardial revascularisaton, cardiovascular disease during pregnancy and arterial hypertension. The present document gives a summary of these guidelines and highlights the most important recommendations and changes in the management of these diseases. It will help to increase awareness about the new guidelines and may stimulate to consult the full document for specific items. Ultimately, the authors hope that this document will enhance the implementation of new ESC guidelines in daily clinical practice.
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Affiliation(s)
| | | | - Agnes Pasquet
- Cliniques Universitaires Saint-Luc, Brussels, Belgium
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32
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Jogani S, Van de Heyning CM, Paelinck BP, De Bock D, Mertens P, Heidbuchel H, Claeys MJ. Afterload Mismatch After MitraClip Implantation: Intraoperative Assessment and Prognostic Implications. J Invasive Cardiol 2020; 32:88-93. [PMID: 32024805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
AIM To evaluate the acute hemodynamic effects after MitraClip implantation and to identify predictors of afterload mismatch and its prognostic implications. METHODS Acute hemodynamic effects were assessed intraoperatively by right heart catheterization and by transesophageal echocardiography before and after MitraClip implantation in 62 consecutive patients with severe mitral regurgitation (MR) (functional MR, 73.8%; EuroScore 2, 7.1 ± 4.9%; left ventricular ejection fraction [LVEF], 36 ± 15%; New York Heart Association class III/IV, 65%). Afterload mismatch was defined as a >15% decrease in LVEF (acute LV depression) or a >15% increase in LV end-diastolic volume (acute adverse LV remodeling). Patients were followed over a period of 24 months (mean, 18 ± 3 months) with all-cause mortality as the primary endpoint. RESULTS Successful MitraClip implantation with residual MR ≤2 was achieved in 85% of patients. Acute LV depression was observed in 23% of patients, and acute adverse LV remodeling was observed in 15% of patients. Acute adverse LV remodeling occurred in 40% of patients with EuroScores >12 vs in 10% of patients with EuroScores ≤12 (P=.02). Although acute adverse LV remodeling was well tolerated in the acute phase, it was associated with a higher mortality rate during follow-up (62% vs 26%; log-rank P=.04). In a multivariate model, EuroScore 2, but not afterload mismatch, was the most important prognostic risk factor, with an adjusted hazard ratio of 1.1 (95% confidence interval, 1.0-1.2). CONCLUSION Afterload mismatch, as assessed intraoperatively, is not uncommon after MitraClip implantation in patients with impaired LV function and is a risk marker of poor clinical outcome.
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Affiliation(s)
| | | | | | | | | | | | - Marc J Claeys
- Department of Cardiology, University of Antwerp Hospital (Edegem), Wilrijkstraat 10 2650 Edegem, Belgium.
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33
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De Luca L, Zeymer U, Claeys MJ, Dörler J, Erne P, Matter CM, Radovanovic D, Weidinger F, Lüscher TF, Jukema JW. Comparison of P2Y12 receptor inhibitors in patients with ST-elevation myocardial infarction in clinical practice: a propensity score analysis of five contemporary European registries. Eur Heart J Cardiovasc Pharmacother 2020; 7:94-103. [PMID: 31965164 PMCID: PMC7957904 DOI: 10.1093/ehjcvp/pvaa002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 12/13/2019] [Accepted: 01/13/2020] [Indexed: 01/12/2023]
Abstract
Aims Among acute coronary syndromes (ACS), ST-segment elevation myocardial infarction (STEMI) has the most severe early clinical course. Recent randomized clinical trials have demonstrated that novel antithrombotic therapies improve in-hospital outcomes in STEMI patients. We aimed to describe the effectiveness and safety of P2Y12 receptor inhibitors in clinical practice in patients with STEMI based on data from contemporary European ACS registries. Methods and results Five registries from the PIRAEUS initiative (AAPCI/ADPAT, ALKK-PIC, AMIS Plus, Belgium STEMI, and EYESHOT) provided data for the assessment of P2Y12 receptor inhibitor-based dual antiplatelet therapy. Registries were heterogeneous in terms of setting, patient characteristics, and treatment selection. Matched pair analysis and propensity score matching were used to assess all-cause in-hospital death rates based on data from 25 250 patients (8577 patients on prasugrel, 5995 on ticagrelor, and 10 678 on clopidogrel). The odds ratio (OR) for the death of any cause when compared with clopidogrel was 0.72 [95% confidence interval (CI) 0.62–0.84, P < 0.001] in favour of the new P2Y12 receptor inhibitors (prasugrel and ticagrelor combined). In the comparison between prasugrel and ticagrelor, there were no relevant differences (OR 0.97, 95% CI 0.77–1.23; P = 0.81). Event rates of cardiovascular death and stroke were also substantially lower for the new P2Y12 receptor inhibitors. The differences between clopidogrel and prasugrel or ticagrelor on major bleeding were numerically in the same order as for death of any cause but were not statistically significant. No differences in ischaemic and bleeding outcomes were observed between prasugrel and ticagrelor. Conclusion This analysis suggests that the prasugrel or ticagrelor compared with clopidogrel have favourable outcomes in clinical practice while not being inferior in terms of safety.
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Affiliation(s)
- Leonardo De Luca
- Interventional Cardiology Unit, Division of Cardiology, San Giovanni Evangelista Hospital, Via A. Parrozzani 3, I-00019 Tivoli, Rome, Italy
| | - Uwe Zeymer
- Interventional Cardiology, Institut für Herzinfarktforschung, Ludwigshafen, Germany
| | - Marc J Claeys
- Department of Cardiology, University Hospital Antwerp, Edegem, Belgium
| | - Jakob Dörler
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Paul Erne
- Faculty of Biomedical Science, Università della Svizzera italiana, Lugano, Switzerland
| | - Christian M Matter
- Cardiology Department, University Heart Center, AQ8University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Dragana Radovanovic
- AMIS Plus Data Center, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Franz Weidinger
- 2nd Department of Medicine with Cardiology and Intensive Care, Hospital Rudolfstiftung, Vienna, Austria
| | - Thomas F Lüscher
- Heart Division, Royal Brompton & Harefield Hospital, Imperial College London, London, UK.,Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland
| | - Johan Wouter Jukema
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
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34
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Van De Heyning CM, Debonnaire P, Bertrand PB, Mortelmans P, Deferm S, Paelinck BP, De Bock D, Coussement P, Vandervoort PM, Claeys MJ. P1525 Residual functional mitral regurgitation post-MitraClip is associated with worse hemodynamics and predicts poor outcome at 2-year follow-up. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.947] [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
Percutaneous mitral valve repair using MitraClip offers symptomatic benefit and improves rest and exercise hemodynamics in patients with severe functional mitral regurgitation (MR). Recent randomized trials have shown contradictory results regarding the impact of MitraClip on mid-term survival in functional MR. It is unknown whether improved hemodynamics are related to patients" outcome.
Purpose
To assess whether residual MR and altered resting and exercise hemodynamics are predictors of outcome in patients with functional MR treated with MitraClip.
Methods
Consecutive patients (n = 45, 72 ± 10years, left ventricular ejection fraction (LVEF) 34 ± 9%) with symptomatic severe functional MR were prospectively evaluated by Doppler echocardiography at rest and during symptom-limited exercise on a semi-supine bicycle pre- and 6 months post-MitraClip procedure. LVEF, MR severity, cardiac output (CO), systolic pulmonary artery pressure (SPAP) and a flow-corrected SPAP/CO ratio were assessed at rest and peak exercise. 2-year follow-up clinical data were collected from patient records.
Results
During 2-year follow-up post-MitraClip, 15 patients (33%) experienced major cardiac events (hospitalization for heart failure (n = 14) and/or cardiac death (n = 5)). Age, gender, a history of coronary artery disease, diabetes, baseline MR severity and baseline SPAP/CO ratio at rest and during exercise were not related to a worse event-free survival. In contrast, patients with events at 2-year follow up had more often a history of hospitalization for heart failure (73 vs. 37%, p = 0.029), lower baseline LVEF (30 ± 8 vs. 36 ± 10%, p = 0.041), more residual MR at 6 months post-MitraClip (MR jet area/left atrial area 27 ± 14 vs. 15 ± 10%, p = 0.004) and higher SPAP/CO ratios at rest and during exercise 6 months post-MitraClip (13.9 ± 5.3 vs. 9.9 ± 3.4mmHg/L/min, p = 0.007 and 13.6 ± 4.9 vs. 9.4 ± 4.6mmHg/L/min, p = 0.009, respectively). When corrected for baseline LVEF, residual MR 6 months post-MitraClip remained an independent predictor for worse 2-year outcome. Residual MR was moderately correlated to a worse SPAP/CO ratio 6 months post-MitraClip (Pearson Rho 0.518, p < 0.001).
Conclusions
In patients with functional MR treated with MitraClip, residual MR at 6-month follow-up is associated with impaired hemodynamics, and is an independent predictor of cardiac events at 2-year follow-up.
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Affiliation(s)
| | - P Debonnaire
- St-Jan Hospital, Department of Cardiology, Brugge, Belgium
| | - P B Bertrand
- Hospital Oost-Limburg (ZOL), Department of Cardiology, Genk, Belgium
| | - P Mortelmans
- Antwerp University Hospital, Department of Cardiology, Edegem, Belgium
| | - S Deferm
- Hospital Oost-Limburg (ZOL), Department of Cardiology, Genk, Belgium
| | - B P Paelinck
- Antwerp University Hospital, Department of Cardiac Surgery, Edegem, Belgium
| | - D De Bock
- Antwerp University Hospital, Department of Cardiac Surgery, Edegem, Belgium
| | - P Coussement
- St-Jan Hospital, Department of Cardiology, Brugge, Belgium
| | - P M Vandervoort
- Hospital Oost-Limburg (ZOL), Department of Cardiology, Genk, Belgium
| | - M J Claeys
- Antwerp University Hospital, Department of Cardiology, Edegem, Belgium
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35
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Mortelmans P, Debonnaire P, Paelinck BP, De Bock D, Coussement P, Claeys MJ, Van De Heyning CM. P1364 Contractile reserve predicts reverse remodelling after successful percutaneous mitral valve repair in patients with functional mitral regurgitation. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.799] [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
Recent randomised trials have shown conflicting results regarding the usefulness of percutaneous mitral valve repair using MitraClip in patients with severe functional mitral regurgitation (FMR). At present, it remains unclear whether patients with FMR and advanced heart failure might benefit from MitraClip therapy. Moreover, it has been shown that left ventricular reverse remodelling (LVRR) post-MitraClip is associated with a favourable outcome.
Purpose
We sought to assess whether baseline contractile reserve (CR) can predict LVRR and improvement of LV ejection fraction (EF) in FMR patients undergoing MitraClip therapy.
Methods
Consecutive patients with symptomatic severe FMR referred for MitraClip were recruited in two tertiary centres. All patients were scheduled for a semi-supine bicycle exercise echocardiography before and 6 months after the intervention. Patients who were not able to perform an exercise test and who did not complete 6 month follow up were excluded from further analysis. Baseline CR was obtained by subtracting peak exercise LVEF from LVEF at rest. LVRR was defined as a 10% decrease in LV end systolic volume (ESV) at follow-up.
Results
34 patients completed 6 month follow up (61% male, age 71 ± 10 years, LVEF 32 ± 8%). LVRR was observed in 15 patients (44%). We found a trend towards a moderate correlation between baseline CR and relative decrease in LVESV at 6 months (Pearson Rho -0.321, p = 0.064). This correlation became significant in a sub-analysis considering only patients with post-procedural FMR grade ≤2 (n = 27; Pearson Rho -0.444, p = 0.020). In contrast, LVRR was not related to baseline LVEF, LV dimensions or volumes. Furthermore, baseline CR was strongly correlated with an increase of LVEF at 6 months post-MitraClip in these patients (Pearson Rho 0.653, p < 0.001).
Conclusion
CR predicts LVRR and improvement of LVEF in patients with FMR after successful MitraClip therapy (reduction of FMR towards grade ≤2), in contrast to resting indices of LV dysfunction and dilatation. More studies with outcome data are needed to determine whether CR is a useful parameter to identify patients with FMR who might benefit from MitraClip therapy.
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Affiliation(s)
- P Mortelmans
- Antwerp University Hospital, Department of Cardiology, Edegem, Belgium
| | - P Debonnaire
- St-Jan Hospital, Department of Cardiology, Brugge, Belgium
| | - B P Paelinck
- Antwerp University Hospital, Department of Cardiac Surgery, Edegem, Belgium
| | - D De Bock
- Antwerp University Hospital, Department of Cardiac Surgery, Edegem, Belgium
| | - P Coussement
- St-Jan Hospital, Department of Cardiology, Brugge, Belgium
| | - M J Claeys
- Antwerp University Hospital, Department of Cardiology, Edegem, Belgium
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Bochaton T, Claeys MJ, Garcia-Dorado D, Mewton N, Bergerot C, Jossan C, Amaz C, Boussaha I, Thibault H, Ovize M. Importance of infarct size versus other variables for clinical outcomes after PPCI in STEMI patients. Basic Res Cardiol 2019; 115:4. [PMID: 31832789 DOI: 10.1007/s00395-019-0764-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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] [Received: 08/28/2019] [Accepted: 11/21/2019] [Indexed: 12/16/2022]
Abstract
Despite promising experimental studies and encouraging proof-of-concept clinical trials, interventions aimed at limiting infarct size have failed to improve clinical outcomes in patients with ST-elevation myocardial infarction (STEMI). Our objective was to examine whether variables (cardiovascular risk factors, comorbidities, post-procedural variables, cotreatments) might be associated with clinical outcomes in STEMI patients independently from infarct size reduction. The present study was based on a post hoc analysis of the CIRCUS trial database (Clinicaltrials.gov NCT01502774) that assessed the clinical benefit of a single intravenous bolus of cyclosporine in 969 patients with anterior STEMI. Since cyclosporine had no detectable effect on clinical outcomes as well as on any measured variable, we here considered the whole study population as one group. Multivariate analysis was performed to address the respective weight of infarct size and variables in clinical outcomes. Multivariate analysis revealed that several variables (including gender, hypertension, renal dysfunction, TIMI flow grade post-PCI < 3, and treatment administered after PCI with betablockers and angiotensin-converting enzyme inhibitors) had per se a significant influence on the occurrence of [death or hospitalization for heart failure] at 1 year. The relative weight of infarct size and variables on the composite endpoint of [death or hospitalization for heart failure] at 1 year was 18% and 82%, respectively. Several variables contribute strongly to the clinical outcomes of STEMI patients suggesting that cardioprotective strategy might not only focus on infarct size reduction.
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Affiliation(s)
- Thomas Bochaton
- INSERM UMR 1060, CarMeN Laboratory, University Claude Bernard Lyon1, IHU OPeRa, Hôpital Louis Pradel, Hospices Civils de Lyon, 69677, Lyon, France
| | - Marc J Claeys
- Department of Cardiology, Antwerp University Hospital, Antwerp, Belgium
| | - David Garcia-Dorado
- Hospital Universitari Vall d´Hebron, Department of Cardiology, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red-CV, Barcelona, Spain
| | - Nathan Mewton
- INSERM UMR 1060, CarMeN Laboratory, University Claude Bernard Lyon1, IHU OPeRa, Hôpital Louis Pradel, Hospices Civils de Lyon, 69677, Lyon, France
| | - Cyrille Bergerot
- INSERM UMR 1060, CarMeN Laboratory, University Claude Bernard Lyon1, IHU OPeRa, Hôpital Louis Pradel, Hospices Civils de Lyon, 69677, Lyon, France.,Service d'Explorations Fonctionnelles Cardiovasculaires CIC 1407 de Lyon, Hôpital Louis Pradel, Hospices Civils de Lyon, 69677, Lyon, France
| | - Claire Jossan
- Service d'Explorations Fonctionnelles Cardiovasculaires CIC 1407 de Lyon, Hôpital Louis Pradel, Hospices Civils de Lyon, 69677, Lyon, France
| | - Camille Amaz
- Service d'Explorations Fonctionnelles Cardiovasculaires CIC 1407 de Lyon, Hôpital Louis Pradel, Hospices Civils de Lyon, 69677, Lyon, France
| | - Inesse Boussaha
- Service d'Explorations Fonctionnelles Cardiovasculaires CIC 1407 de Lyon, Hôpital Louis Pradel, Hospices Civils de Lyon, 69677, Lyon, France
| | - Hélène Thibault
- INSERM UMR 1060, CarMeN Laboratory, University Claude Bernard Lyon1, IHU OPeRa, Hôpital Louis Pradel, Hospices Civils de Lyon, 69677, Lyon, France.,Service d'Explorations Fonctionnelles Cardiovasculaires CIC 1407 de Lyon, Hôpital Louis Pradel, Hospices Civils de Lyon, 69677, Lyon, France
| | - Michel Ovize
- INSERM UMR 1060, CarMeN Laboratory, University Claude Bernard Lyon1, IHU OPeRa, Hôpital Louis Pradel, Hospices Civils de Lyon, 69677, Lyon, France. .,Service d'Explorations Fonctionnelles Cardiovasculaires CIC 1407 de Lyon, Hôpital Louis Pradel, Hospices Civils de Lyon, 69677, Lyon, France. .,Service d'Explorations Fonctionnelles Cardiovasculaires, Hôpital Louis Pradel, 59 Bd Pinel, 69394, Bron, France.
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de Framond Y, Schaaf M, Pichot-Lamoureux S, Range G, Dubreuil O, Angoulvant D, Claeys MJ, Dorado DG, Bochaton T, Rioufol G, Jossan C, Boussaha I, Ovize M, Mewton N. Regression of Q waves and clinical outcomes following primary PCI in anterior STEMI. J Electrocardiol 2019; 73:131-136. [PMID: 31668455 DOI: 10.1016/j.jelectrocard.2019.09.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 08/19/2019] [Accepted: 09/20/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Pathological Q waves are correlated with infarct size, and Q-wave regression is associated with left ventricular ejection fraction improvement. There are limited data regarding the association of Q-wave regression and clinical outcomes. Our main objective was to assess the association of pathological Q wave evolution after reperfusion with clinical outcomes after anterior STEMI. METHODS Standard 12-lead electrocardiograms (ECGs) were recorded in 780 anterior STEMI patients treated with primary percutaneous coronary intervention (PCI) from the CIRCUS trial. ECGs were recorded before and 90 min following PCI, as well as at hospitalization discharge and 12 months of follow-up. The number of classic ECG criteria Q waves was scored for each ECG. Patients were classified in the Q wave regression group if they had regression of at least one Q wave between the post-PCI, the discharge and/or one year ECGs. Patients were classified in the Q wave persistent group if they had the same number or greater between the post-PCI, the discharge and/or 1 and one year ECGs. All-cause death and heart failure events were assessed for all patients at one year. RESULTS There were 323(43%) patients with persistent Q waves (PQ group), 378(49%) patients with Q wave regression (RQ group) and 60(8%) patients with non-Q wave MI (NQ group). Infarct size as measured by the peak creatine kinase was significantly greater in the PQ group compared to the RQ and NQ groups (4633 ± 2784 IU/l vs. 3814 ± 2595 IU/l vs. 1733 ± 1583 IU/l respectively, p < 0.0001). At one year, there were 22 deaths (7%) in the PQ-group, 15 (4%) in the RQ-group and none in the NQ-group (p = 0.04). There was a 4-fold increase in the risk of death or heart failure in the PQ compared to the NQ group (HR 4.7 [1.1; 19.3]; p = 0.03), but there was no significant difference between NQ and RQ groups (HR 3.3 [0.8; 13.8]; p = 0.09). CONCLUSION In a population of anterior STEMI patients, persistent Q waves defined according to the classic ECG criteria after reperfusion was associated with a 4-fold increase in the risk of heart failure or death compared to non-Q-wave MI, while Q-wave regression was associated with significantly lower risk of events.
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Affiliation(s)
- Yuni de Framond
- Hopital Cardiovasculaire Louis Pradel, Hospices Civils de Lyon, Lyon, France, Centre d'Investigation Clinique de Lyon, Université Claude Bernard Lyon 1, France
| | | | - Sophie Pichot-Lamoureux
- Hopital Cardiovasculaire Louis Pradel, Hospices Civils de Lyon, Lyon, France, Centre d'Investigation Clinique de Lyon, Université Claude Bernard Lyon 1, France
| | | | | | | | | | - David Garcia Dorado
- Vall d'Hebron University Hospital and Research Institut and CIBERC, Universtitat Autonoma de Barcelona, Spain
| | - Thomas Bochaton
- Hopital Cardiovasculaire Louis Pradel, Hospices Civils de Lyon, Lyon, France, Centre d'Investigation Clinique de Lyon, Université Claude Bernard Lyon 1, France
| | - Gilles Rioufol
- Hopital Cardiovasculaire Louis Pradel, Hospices Civils de Lyon, Lyon, France, Centre d'Investigation Clinique de Lyon, Université Claude Bernard Lyon 1, France
| | - Claire Jossan
- Hopital Cardiovasculaire Louis Pradel, Hospices Civils de Lyon, Lyon, France, Centre d'Investigation Clinique de Lyon, Université Claude Bernard Lyon 1, France
| | - Inesse Boussaha
- Hopital Cardiovasculaire Louis Pradel, Hospices Civils de Lyon, Lyon, France, Centre d'Investigation Clinique de Lyon, Université Claude Bernard Lyon 1, France
| | - Michel Ovize
- Hopital Cardiovasculaire Louis Pradel, Hospices Civils de Lyon, Lyon, France, Centre d'Investigation Clinique de Lyon, Université Claude Bernard Lyon 1, France
| | - Nathan Mewton
- Hopital Cardiovasculaire Louis Pradel, Hospices Civils de Lyon, Lyon, France, Centre d'Investigation Clinique de Lyon, Université Claude Bernard Lyon 1, France.
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Claeys MJ, Coussement P, Dubois P, Garcia-Dorado D, Mewton N, Amaz C, Ovize M. Clinical effects of cyclosporine in acute anterior myocardial infarction complicated by heart failure: A subgroup analysis of the CIRCUS Trial. Am Heart J 2019; 216:147-149. [PMID: 31255244 DOI: 10.1016/j.ahj.2019.05.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 05/13/2019] [Indexed: 11/24/2022]
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Salah M, Gevaert S, Coussement P, Beauloye C, Sinnaeve PR, Convens C, De Raedt H, Dens J, Pourbaix S, Saenen J, Claeys MJ. Vulnerability to cardiac arrest in patients with ST elevation myocardial infarction: Is it time or patient dependent? Results from a nationwide observational study. Eur Heart J Acute Cardiovasc Care 2019; 9:S153-S160. [PMID: 31452398 DOI: 10.1177/2048872619872127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIM Cardiac arrest is a common complication of ST elevation myocardial infarction and is associated with high mortality. We evaluated whether vulnerability to cardiac arrest follows a circadian rhythm and whether it is related to specific patient characteristics. METHODS A total of 24,164 ST elevation myocardial infarction patients who were admitted to 60 Belgian hospitals between 2008-2017 were analysed. The proportion of patients with cardiac arrest before initiation of reperfusion therapy was calculated for different time periods (hour of the day, months, seasons) and related to patient characteristics using stepwise logistic regression analysis. RESULTS Cardiac arrest occurred in 10.8% of the ST elevation myocardial infarction patients at a median of 65 min (interquartile range 33-138 min) after onset of pain. ST elevation myocardial infarction patients with cardiac arrest showed a biphasic pattern with one peak in the morning and one peak in the late afternoon. Multivariate analysis identified the following independent factors associated with cardiac arrest: cardiogenic shock (odds ratio=28), left bundle branch block (odds ratio=3.7), short (<180 min) ischaemic period (odds ratio=2.2), post-meridiem daytime presentation (odds ratio=1.4), anterior infarction (odds ratio=1.3). Overall in-hospital mortality was 30% for cardiac arrest patients versus 3.7% for non-cardiac arrest patients (p<0.0001). CONCLUSION In the present study population, cardiac arrest in ST elevation myocardial infarction showed an atypical circadian rhythm with not only a morning peak but also a second peak in the late afternoon, suggesting that cardiac arrest and ST elevation myocardial infarction triggers are, at least partially, different. In addition, specific patient characteristics, such as short ischaemic period, cardiogenic shock and left bundle branch block, increase the vulnerability to cardiac arrest.
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Affiliation(s)
- Mahadi Salah
- Department of Cardiology, University Hospital Antwerp, Belgium
| | - Sofie Gevaert
- Department of Cardiology, Ghent University Hospital, Belgium
| | | | | | | | - Carl Convens
- Department of Cardiology, ZNA Antwerpen, Belgium
| | | | - Jo Dens
- Department of Cardiology, ZOL Genk, Belgium
| | | | - Johan Saenen
- Department of Cardiology, University Hospital Antwerp, Belgium
| | - Marc J Claeys
- Department of Cardiology, University Hospital Antwerp, Belgium
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40
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Vorlat A, De Hous N, Vervaecke AJ, Vermeulen T, Van Craenenbroeck E, Heidbuchel H, Rodrigus I, Van Donink W, Ancion A, Van Cleemput J, Van Hoof VO, Claeys MJ. Biomarkers and Donor Selection in Heart Transplantation. Transplant Proc 2019; 51:1673-1678. [PMID: 31307770 DOI: 10.1016/j.transproceed.2019.04.041] [Citation(s) in RCA: 5] [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] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 03/19/2019] [Accepted: 04/05/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Previously, we showed that B-type natriuretic peptide (BNP) measured in the donor was related to cardiac performance after cardiac transplantation. The present study assesses the value of 3 biomarkers in the selection of donor hearts in a larger cohort. METHODS Blood samples were prospectively obtained in 105 brain-dead patients scheduled for heart donation. BNP, soluble suppressor of tumorigenicity 2 (ST2), and troponin of heart donors were correlated with hemodynamic parameters early after transplantation as well as with the mortality of the recipients. RESULTS A significant inverse relationship was found between donor BNP measured at the time of donation and recipient cardiac index and cardiac output at day 13 post-transplantation (r = -0.31, P = .005, and r = -0.34, P = .0016, respectively). Logistic regression analysis-including BNP, ST2, and troponin-showed that donor BNP was a predictor of a poor cardiac index (< 2.2 L/min/m2) in the recipient (P = .04). A donor BNP > 132 pg/mL has a sensitivity of 56% (95% confidence interval 21-86) and a specificity of 86% (95% confidence interval 77-93) to predict poor cardiac performance in the recipient. When the donor BNP is ≤ 132 pg/mL, the risk of a poor cardiac function in the recipient is very low (negative predictive value 94%). Mortality at 30 days was also correlated to donor BNP (r = 0.29, P = .0029). Long-term survival of the recipient was not correlated to the biomarkers measured in the donor. CONCLUSION Donor BNP, but not donor ST2 or high-sensitivity troponin, provides information on the donor heart and early post-transplant performance, including 1-month mortality.
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Affiliation(s)
- Anne Vorlat
- Department of Cardiology, University Hospital of Antwerp, Edegem, Belgium.
| | - Nicolas De Hous
- Department of Cardiology, University Hospital of Antwerp, Edegem, Belgium
| | | | - Tom Vermeulen
- Department of Cardiology, University Hospital of Antwerp, Edegem, Belgium
| | | | - Hein Heidbuchel
- Department of Cardiology, University Hospital of Antwerp, Edegem, Belgium
| | - Inez Rodrigus
- Department of Cardiac Surgery, University Hospital of Antwerp, Edegem, Belgium
| | - Walter Van Donink
- Department of Cardiac Surgery, University Hospital of Antwerp, Edegem, Belgium
| | - Arnaud Ancion
- Department of Cardiology, University Hospital Sart Tilman, Liege, Belgium
| | - Johan Van Cleemput
- Department of Cardiology, University Hospital of Leuven, Leuven, Belgium
| | - Viviane O Van Hoof
- Department of Clinical Chemistry, Antwerp University Hospital, Edegem, Belgium; Translational Pathophysiological Research Group, University of Antwerp, Edegem, Belgium
| | - Marc J Claeys
- Department of Cardiology, University Hospital of Antwerp, Edegem, Belgium
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Paelinck BP, Laga S, De Bock D, Bosmans JM, Claeys MJ, Haine S, Vermeulen T, Parizel PM, Rodrigus IE. P458Multimodality imaging and long-term outcome after pericardiectomy for constrictive pericarditis: a single center case series. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez118.041] [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)
| | - S Laga
- Antwerp University Hospital, Edegem, Belgium
| | - D De Bock
- Antwerp University Hospital, Edegem, Belgium
| | - J M Bosmans
- Antwerp University Hospital, Edegem, Belgium
| | - M J Claeys
- Antwerp University Hospital, Edegem, Belgium
| | - S Haine
- Antwerp University Hospital, Edegem, Belgium
| | - T Vermeulen
- Antwerp University Hospital, Edegem, Belgium
| | - P M Parizel
- Antwerp University Hospital, Edegem, Belgium
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Ammirati E, Van De Heyning CM, Musca F, Brambatti M, Perna E, Cipriani M, Cannata A, Mondino M, Moreo A, De Bock D, Pretorius V, Claeys MJ, Adler ED, Russo CF, Frigerio M. Safety of centrifugal left ventricular assist device in patients previously treated with MitraClip system. Int J Cardiol 2019; 283:131-133. [PMID: 30833105 DOI: 10.1016/j.ijcard.2019.02.039] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Revised: 01/14/2019] [Accepted: 02/18/2019] [Indexed: 11/17/2022]
Abstract
INTRODUCTION No data regarding the safety of continuous-flow left ventricular assist device (CF-LVAD) implantation in patients with previous MitraClip have been reported. Thus, it remains unknown whether an initial treatment strategy with MitraClip therapy might complicate future heart failure management in patients who are also considered for CF-LVAD. METHODS We retrospectively identified 6 patients (median age of 62 years; 2 women) who had been treated with MitraClip, that were eventually implanted with a CF-LVAD (all Heartware HVAD) in 3 hospitals between 2013 and 2018. RESULTS Patients were treated in 4 cases with 2 clips, and in 2 cases with 1 clip. Median time from MitraClip implantation to CF-LVAD implant was 282 days (interquartile range 67 to 493), and median time on CF-LVAD support was 401 days (interquartile range 105 to 492 days). Two patients underwent a heart transplant, 3 patients died on support, and 1 is alive on support. In all cases, there was a reduction of functional mitral regurgitation without MitraClip-related complications. CONCLUSIONS Based on this small case series, implantation of a CF-LVAD appears safe in patients with a previously positioned MitraClip system, at least, with 1 or 2 clips in place, with no need for additional mitral valve surgery.
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Affiliation(s)
| | | | | | - Michela Brambatti
- Division of Cardiology, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Enrico Perna
- De Gasperis Cardio Center, Niguarda Hospital, Milan, Italy
| | | | - Aldo Cannata
- De Gasperis Cardio Center, Niguarda Hospital, Milan, Italy
| | | | | | - Dina De Bock
- Department of Cardiac Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Victor Pretorius
- Division of Cardiothoracic Surgery, University of California San Diego, La Jolla, CA, USA
| | - Marc J Claeys
- Department of Cardiology, Antwerp University Hospital, Edegem, Belgium
| | - Eric D Adler
- Division of Cardiology, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | | | - Maria Frigerio
- De Gasperis Cardio Center, Niguarda Hospital, Milan, Italy
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Van Camp G, De Backer T, Beauloye C, Desmet W, Claeys MJ. Summary of 2017 ESC guidelines on valvular heart disease, peripheral artery disease, STEMI and on dual antiplatelet therapy. Acta Cardiol 2018; 73:419-425. [PMID: 29228859 DOI: 10.1080/00015385.2017.1410352] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
During the ESC congress in September 2017 in Barcelona, the new ESC guidelines were presented and are now available on the ESC website. The new guidelines cover management recommendations on following cardiovascular items: valvular heart disease, peripheral artery disease, ST elevation myocardial infarction (STEMI) and on dual antiplatelet therapy. The present document gives a summary of these guidelines and highlights the most important recommendations and changes in the management of these diseases. It will help to increase awareness about the new guidelines and may stimulate to consult the full document for specific items. Ultimately, the authors hope that this document will enhance implementation of new ESC guidelines in daily clinical practice.
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Affiliation(s)
- Guy Van Camp
- Department of Cardiology, OLV Aalst , Aalst , Belgium
| | | | - Christophe Beauloye
- Department of Cardiology, Cliniques Universitaires Saint-Luc , Brussels , Belgium
| | - Walter Desmet
- Department of Cardiology, UZ Leuven , Leuven , Belgium
| | - Marc J. Claeys
- Department of Cardiology, Antwerp University Hospital , Edegem , Belgium
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Thygesen K, Alpert JS, Jaffe AS, Chaitman BR, Bax JJ, Morrow DA, White HD, Thygesen K, Alpert JS, Jaffe AS, Chaitman BR, Bax JJ, Morrow DA, White HD, Mickley H, Crea F, Van de Werf F, Bucciarelli-Ducci C, Katus HA, Pinto FJ, Antman EM, Hamm CW, De Caterina R, Januzzi JL, Apple FS, Alonso Garcia MA, Underwood SR, Canty JM, Lyon AR, Devereaux PJ, Zamorano JL, Lindahl B, Weintraub WS, Newby LK, Virmani R, Vranckx P, Cutlip D, Gibbons RJ, Smith SC, Atar D, Luepker RV, Robertson RM, Bonow RO, Steg PG, O’Gara PT, Fox KAA, Hasdai D, Aboyans V, Achenbach S, Agewall S, Alexander T, Avezum A, Barbato E, Bassand JP, Bates E, Bittl JA, Breithardt G, Bueno H, Bugiardini R, Cohen MG, Dangas G, de Lemos JA, Delgado V, Filippatos G, Fry E, Granger CB, Halvorsen S, Hlatky MA, Ibanez B, James S, Kastrati A, Leclercq C, Mahaffey KW, Mehta L, Müller C, Patrono C, Piepoli MF, Piñeiro D, Roffi M, Rubboli A, Sharma S, Simpson IA, Tendera M, Valgimigli M, van der Wal AC, Windecker S, Chettibi M, Hayrapetyan H, Roithinger FX, Aliyev F, Sujayeva V, Claeys MJ, Smajić E, Kala P, Iversen KK, El Hefny E, Marandi T, Porela P, Antov S, Gilard M, Blankenberg S, Davlouros P, Gudnason T, Alcalai R, Colivicchi F, Elezi S, Baitova G, Zakke I, Gustiene O, Beissel J, Dingli P, Grosu A, Damman P, Juliebø V, Legutko J, Morais J, Tatu-Chitoiu G, Yakovlev A, Zavatta M, Nedeljkovic M, Radsel P, Sionis A, Jemberg T, Müller C, Abid L, Abaci A, Parkhomenko A, Corbett S. Fourth universal definition of myocardial infarction (2018). Eur Heart J 2018; 40:237-269. [DOI: 10.1093/eurheartj/ehy462] [Citation(s) in RCA: 1047] [Impact Index Per Article: 174.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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Aeyels D, Bruyneel L, Sinnaeve PR, Claeys MJ, Gevaert S, Schoors D, Panella M, Sermeus W, Vanhaecht K. Care Pathway Effect on In-Hospital Care for ST-Elevation Myocardial Infarction. Cardiology 2018; 140:163-174. [PMID: 30099470 DOI: 10.1159/000488932] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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] [Received: 12/14/2017] [Accepted: 04/03/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To study the care pathway effect on the percentage of patients with ST-elevation myocardial infarction -(STEMI) receiving timely coronary reperfusion and the percentage of STEMI patients receiving optimal secondary prevention. METHODS A care pathway was implemented by the Collaborative Model for Achieving Breakthrough Improvement. One pre-intervention and 2 post-intervention audits included all adult STEMI patients admitted within 24 h after onset and eligible for reperfusion. Adjusted (hospital random intercepts and controls for transfer and out-of-office admission) differences in composite outcomes were analyzed by a multilevel logistic regression. RESULTS Significant improvements in intervals between the first medical contact (FMC) to percutaneous coronary intervention (PCI) and between the door to PCI were shown between post-intervention audit II and post-intervention audit I. Secondary prevention significantly deteriorated at post-intervention audit I but improved significantly between both post-intervention audits. Six out of nine outcomes were significantly poorer in the case of transfer. The interval from FMC to PCI was significantly poorer for patients admitted during out-of-office hours. CONCLUSIONS After care pathway implementation, composite outcomes improved for in-hospital STEMI care. Collaborative efforts exploited heterogeneity in performance between hospitals. Iterative and incremental care pathway implementation maximized performance improvement.
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Affiliation(s)
- Daan Aeyels
- Leuven Institute for Healthcare Policy, University of Leuven, Leuven, Belgium
| | - Luk Bruyneel
- Leuven Institute for Healthcare Policy, University of Leuven, Leuven, Belgium
| | - Peter R Sinnaeve
- Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Marc J Claeys
- Department of Cardiology, Antwerp University Hospital, Edegem, Belgium
| | - Sofie Gevaert
- Department of Cardiology, University Hospital Ghent, Ghent, Belgium
| | - Danny Schoors
- Department of Cardiology, University Hospitals Brussels, Jette, Belgium
| | - Massimiliano Panella
- Department of Clinical and Experimental Medicine, Amedeo Avogadro University of Eastern Piedmont, Vercelli, Italy
| | - Walter Sermeus
- Leuven Institute for Healthcare Policy, University of Leuven, Leuven, Belgium
| | - Kris Vanhaecht
- Leuven Institute for Healthcare Policy, University of Leuven, Leuven, Belgium.,Department of Quality Management, University Hospitals Leuven, Leuven, Belgium
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Salah M, Gevaert S, Coussement P, Beauloye C, Sinnaeve P, Convens C, De Raedt H, Dens J, Saenen J, Claeys MJ. 468Vulnerability for cardiac arrest in patients with ST elevation myocardial infarction: Is it time or patient dependent? Results from a nationwide observational study. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.468] [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 Salah
- University of Antwerp Hospital, Antwerp, Belgium
| | - S Gevaert
- Ghent University Hospital (UZ), Ghent, Belgium
| | | | - C Beauloye
- Catholic University of Louvain (UCL), Leuven, Belgium
| | - P Sinnaeve
- University Hospital Leuven, Leuven, Belgium
| | - C Convens
- ZNA Middelheim Hospital, Antwerp, Belgium
| | - H De Raedt
- Cardiovascular Center Aalst, Aalst, Belgium
| | - J Dens
- Hospital Oost-Limburg (ZOL), Genk, Belgium
| | - J Saenen
- University of Antwerp Hospital, Antwerp, Belgium
| | - M J Claeys
- University of Antwerp Hospital, Antwerp, Belgium
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Abstract
BACKGROUND The recent increase in the number of interventional cathlabs that followed a moratorium of several years has resulted in an abrupt increase in the number of PCI and a dilution of the experience per centre and per operator. METHODS Based on data extracted from the national "Quality Oriented Electronic Registration of Medical Implant Devices" (QERMID) database, we compared the characteristics and outcome of patients treated in 2015 in the 21 newly (<3 years) approved PCI centres with those of patients treated in the 28 historical PCI centres. RESULTS The proportion of acute coronary syndromes was slightly higher in new than in historical centres (48% vs. 44%; p < 0.01) but few differences in co-morbidities were observed. Considering separately the patients treated for an acute coronary syndrome or for stable ischaemia, no significant difference in the overall in-hospital or 30-days mortality and in the proportion of same week bypass surgery was observed between newly approved and historical centres. In a substantial proportion (39%) of patients treated for stable angina or silent ischaemia, no test confirming the presence of ischaemia before PCI is reported, without significant difference between new and historical centres. CONCLUSIONS Pending the limitations of the QERMID database, including a limited dataset and the absence of systematic on-site monitoring, no significant difference in the rate of major complications was identified between new and historical Belgian PCI centres.
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Affiliation(s)
- Claude Hanet
- Department of Cardiology, CHU UCL Namur, Mont-Godinne, Yvoir, Belgium
| | - Marc J. Claeys
- Department of Cardiology, Antwerp University Hospital, Antwerp, Belgium
| | - Marc Carlier
- Department of Cardiology, GHDC, Charleroi, Belgium
| | - Walter Desmet
- Department of Cardiovascular medicine, University Hospitals Leuven, Leuven, Belgium
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48
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Brouwer HJ, Den Heijer MC, Paelinck BP, Debonnaire P, Vanderheyden M, Van De Heyning CM, De Bock D, Coussement P, Saad G, Ferdinande B, Pouleur AC, Claeys MJ. Left ventricular remodelling patterns after MitraClip implantation in patients with severe mitral valve regurgitation: mechanistic insights and prognostic implications. Eur Heart J Cardiovasc Imaging 2018; 20:307-313. [DOI: 10.1093/ehjci/jey088] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [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: 04/15/2018] [Revised: 06/03/2018] [Accepted: 06/07/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- Hiske J Brouwer
- Department of Cardiology, Antwerp University Hospital, Antwerpen, Wilrijkstraat 10, Edegem, Belgium
| | - Marc C Den Heijer
- Department of Cardiology, Antwerp University Hospital, Antwerpen, Wilrijkstraat 10, Edegem, Belgium
| | - Bernard P Paelinck
- Department of Cardiology, Antwerp University Hospital, Antwerpen, Wilrijkstraat 10, Edegem, Belgium
| | - Philippe Debonnaire
- Department of Cardiology, Hospital Sint-Jan Brugge, Ruddershove 10, Brugge, Belgium
| | - Marc Vanderheyden
- Department of Cardiology, Hospital OLV ziekenhuis, Moorselbaan 164, Aalst, Belgium
| | | | - Dina De Bock
- Department of Cardiology, Antwerp University Hospital, Antwerpen, Wilrijkstraat 10, Edegem, Belgium
| | - Patrick Coussement
- Department of Cardiology, Hospital Sint-Jan Brugge, Ruddershove 10, Brugge, Belgium
| | - Georges Saad
- Department of Cardiology, Centre Hospitalier Régional de la Citadelle, Boulevard du 12ème de Ligne, 1, Liège, Belgium
| | - Bert Ferdinande
- Department of Cardiology, Hospital Oost Limburg, Schiepse Bos 6, Genk, Belgium
| | - Anne-Catherine Pouleur
- Cardiovascular Department, Cliniques Universitaires Saint-Luc, & Institut de Recherche Expérimentale et Clinique (IREC), Université catholique de Louvain, Place de l'Université 1, Louvain-la-Neuve, Brussels, Belgium
| | - Marc J Claeys
- Department of Cardiology, Antwerp University Hospital, Antwerpen, Wilrijkstraat 10, Edegem, Belgium
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Téblick A, Vanderbruggen W, Vandendriessche T, Bosmans J, Haine SEF, Miljoen H, Segers V, Wouters K, Vrints C, Claeys MJ. Comparison of radial access versus femoral access with the use of a vascular closure device for the prevention of vascular complications and mortality after percutaneous coronary intervention. Acta Cardiol 2018; 73:241-247. [PMID: 28851255 DOI: 10.1080/00015385.2017.1363947] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Radial access (RA) and vascular closure devices (VCD) have been shown to be superior to transfemoral access (TFA) with regard to the prevention of vascular complications after percutaneous coronary intervention (PCI). OBJECTIVE The present study evaluates whether RA is associated with less vascular complications and a lower mortality than VCD. METHODS A total of 6999 consecutive PCI patients were studied through a single-centre prospective registry from January 2011 to August 2015. RA was applied in 1385 patients (20%), VCDs with Angio-Seal were implanted in 2145 patients (30%) and manual compression of TFA was performed in 3468 patients (50%). RESULTS RA and VCD patients had comparable baseline risk profiles. The overall vascular complication rate was 2.0% (n = 137) and was composed of false aneurysms (n = 85), clinically relevant haematomas (n = 27), arteriovenous fistulas (n = 12), arterial occlusions (n = 11) and local infections (n = 2). Vascular complications occurred in 0.6% of RA patients, 1.8% of VCD patients and 2.6% of TFA patients (p < .01). In-hospital mortality was 0.8% in RA patients, 0.8% in VCD patients and 3.8% in TFA patients (p < .01). In a multivariate logistic regression model, RA, compared to VCD, was found to be independently associated with a lower rate of vascular complications (OR: 0.34, 95% CI: 0.16-0.75), but not with lower mortality rates (OR: 1.20, 95% CI: 0.51-2.85). CONCLUSION In this large all-comers PCI population, the radial approach, compared to the femoral approach with VCD use (Angio-Seal), was independently associated with a reduction of vascular complications, but not with lower mortality rates.
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Affiliation(s)
- Arno Téblick
- Department of Cardiology, Antwerp University Hospital, Antwerp, Belgium
| | | | | | - Johan Bosmans
- Department of Cardiology, Antwerp University Hospital, Antwerp, Belgium
| | | | - Hielko Miljoen
- Department of Cardiology, Antwerp University Hospital, Antwerp, Belgium
| | - Vincent Segers
- Department of Cardiology, Antwerp University Hospital, Antwerp, Belgium
| | - Kristien Wouters
- Department of Statistics, University Hospital of Antwerp, Antwerp, Belgium
| | - Christiaan Vrints
- Department of Cardiology, Antwerp University Hospital, Antwerp, Belgium
| | - Marc J. Claeys
- Department of Cardiology, Antwerp University Hospital, Antwerp, Belgium
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50
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Aeyels D, Seys D, Sinnaeve PR, Claeys MJ, Gevaert S, Schoors D, Sermeus W, Panella M, Bruyneel L, Vanhaecht K. Managing in-hospital quality improvement: An importance-performance analysis to set priorities for ST-elevation myocardial infarction care. Eur J Cardiovasc Nurs 2018; 17:535-542. [PMID: 29448818 DOI: 10.1177/1474515118759065] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 01/11/2023]
Abstract
BACKGROUND A focus on specific priorities increases the success rate of quality improvement efforts for broad and complex-care processes. Importance-performance analysis presents a possible approach to set priorities around which to design and implement effective quality improvement initiatives. Persistent variation in hospital performance makes ST-elevation myocardial infarction care relevant to consider for importance-performance analysis. AIMS The purpose of this study was to identify quality improvement priorities in ST-elevation myocardial infarction care. METHODS Importance and performance levels of ST-elevation myocardial infarction key interventions were combined in an importance-performance analysis. Content validity indexes on 23 ST-elevation myocardial infarction key interventions of a multidisciplinary RAND Delphi Survey defined importance levels. Structured review of 300 patient records in 15 acute hospitals determined performance levels. The significance of between-hospital variation was determined by a Kruskal-Wallis test. A performance heat-map allowed for hospital-specific priority setting. RESULTS Seven key interventions were each rated as an overall improvement priority. Priority key interventions related to risk assessment, timely reperfusion by percutaneous coronary intervention and secondary prevention. Between-hospital performance varied significantly for the majority of key interventions. The type and number of priorities varied strongly across hospitals. CONCLUSIONS Guideline adherence in ST-elevation myocardial infarction care is low and improvement priorities vary between hospitals. Importance-performance analysis helps clinicians and management in demarcation of the nature, number and order of improvement priorities. By offering a tailored improvement focus, this methodology makes improvement efforts more specific and achievable.
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Affiliation(s)
- Daan Aeyels
- 1 Leuven Institute for Healthcare Policy, University of Leuven, Belgium
| | - Deborah Seys
- 1 Leuven Institute for Healthcare Policy, University of Leuven, Belgium
| | - Peter R Sinnaeve
- 2 Department of Cardiology, University Hospitals Leuven, Belgium
| | - Marc J Claeys
- 3 Department of Cardiology, Antwerp University Hospital, Belgium
| | - Sofie Gevaert
- 4 Department of Cardiology, University Hospital Ghent, Belgium
| | - Danny Schoors
- 5 Department of Cardiology, University Hospitals Brussels, Belgium
| | - Walter Sermeus
- 1 Leuven Institute for Healthcare Policy, University of Leuven, Belgium
| | - Massimiliano Panella
- 6 Department of Clinical and Experimental Medicine, Amedeo Avogadro University of Eastern Piedmont, Italy
| | - Luk Bruyneel
- 1 Leuven Institute for Healthcare Policy, University of Leuven, Belgium.,7 Department of Quality Management, University Hospitals Leuven, Belgium
| | - Kris Vanhaecht
- 1 Leuven Institute for Healthcare Policy, University of Leuven, Belgium.,7 Department of Quality Management, University Hospitals Leuven, Belgium
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