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van den Broek WWA, Gimbel ME, Hermanides RS, Runnett C, Storey RF, Knaapen P, Emans ME, Oemrawsingh RM, Cooke J, Galasko G, Walhout R, Stoel MG, von Birgelen C, van Bergen PFMM, Brinckman SL, Aksoy I, Liem A, Van't Hof AWJ, Jukema JW, Heestermans AACM, Nicastia D, Alber H, Austin D, Nasser A, Deneer V, Ten Berg JM. The impact of patient-reported frailty on cardiovascular outcomes in elderly patients after non-ST-acute coronary syndrome. Int J Cardiol 2024; 405:131940. [PMID: 38458385 DOI: 10.1016/j.ijcard.2024.131940] [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: 01/25/2024] [Revised: 02/20/2024] [Accepted: 03/05/2024] [Indexed: 03/10/2024]
Abstract
BACKGROUND As life expectancy increases, the population of older individuals with coronary artery disease and frailty is growing. We aimed to assess the impact of patient-reported frailty on the treatment and prognosis of elderly early survivors of non-ST-elevation acute coronary syndrome (NSTE-ACS). METHODS Frailty data were obtained from two prospective trials, POPular Age and the POPular Age Registry, which both assessed elderly NSTE-ACS patients. Frailty was assessed one month after admission with the Groningen Frailty Indicator (GFI) and was defined as a GFI-score of 4 or higher. In these early survivors of NSTE-ACS, we assessed differences in treatment and 1-year outcomes between frail and non-frail patients, considering major adverse cardiovascular events (MACE, including cardiovascular mortality, myocardial infarction, and stroke) and major bleeding. RESULTS The total study population consisted of 2192 NSTE-ACS patients, aged ≥70 years. The GFI-score was available in 1320 patients (79 ± 5 years, 37% women), of whom 712 (54%) were considered frail. Frail patients were at higher risk for MACE than non-frail patients (9.7% vs. 5.1%, adjusted hazard ratio [HR] 1.57, 95% confidence interval [CI] 1.01-2.43, p = 0.04), but not for major bleeding (3.7% vs. 2.8%, adjusted HR 1.23, 95% CI 0.65-2.32, p = 0.53). Cubic spline analysis showed a gradual increase of the risk for clinical outcomes with higher GFI-scores. CONCLUSIONS In elderly NSTE-ACS patients who survived 1-month follow-up, patient-reported frailty was independently associated with a higher risk for 1-year MACE, but not with major bleeding. These findings emphasize the importance of frailty screening for risk stratification in elderly NSTE-ACS patients.
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Affiliation(s)
- W W A van den Broek
- St. Antonius Hospital, Department of Cardiology, Nieuwegein, the Netherlands
| | - M E Gimbel
- St. Antonius Hospital, Department of Cardiology, Nieuwegein, the Netherlands
| | - R S Hermanides
- Isala Hospital, Department of Cardiology, Zwolle, the Netherlands
| | - C Runnett
- Northumbria Healthcare NHS Foundation Trust, Department of Cardiology, Newcastle, United Kingdom
| | - R F Storey
- University of Sheffield, Division of Clinical Medicine, Sheffield, United Kingdom
| | - P Knaapen
- Amsterdam University Medical Centre, Department of Cardiology, Amsterdam, the Netherlands
| | - M E Emans
- Ikazia Hospital, Department of Cardiology, Rotterdam, the Netherlands
| | - R M Oemrawsingh
- Albert Schweitzer Hospital, Department of Cardiology, Dordrecht, the Netherlands
| | - J Cooke
- Chesterfield Royal Hospital NHS Foundation Trust, Department of Cardiology, Chesterfield, United Kingdom
| | - G Galasko
- Blackpool Teaching Hospital NHS Foundation Trust, Department of Cardiology, Blackpool, United Kingdom
| | - R Walhout
- Gelderse Vallei Hospital, Department of Cardiology, Ede, the Netherlands
| | - M G Stoel
- Medisch Spectrum Twente, Department of Cardiology, Enschede, the Netherlands
| | - C von Birgelen
- Medisch Spectrum Twente, Department of Cardiology, Enschede, the Netherlands; University of Twente, Department of Health Technology and Services Research, Technical Medical Centre, Enschede, the Netherlands
| | - Paul F M M van Bergen
- Dijklander Hospital, Department of Cardiology, Maelsonstraat 3, 1624 NP Hoorn, the Netherlands
| | - S L Brinckman
- Department of Cardiology, Tergooi MC, Blaricum, the Netherlands
| | - I Aksoy
- Admiraal de Ruyter Hospital, Department of Cardiology, Goes, the Netherlands
| | - A Liem
- Franciscus Gasthuis, Department of Cardiology, Rotterdam, the Netherlands
| | - A W J Van't Hof
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands; Zuyderland Medical Centre, Department of Cardiology, Heerlen, the Netherlands
| | - J W Jukema
- Leids University Medical Centre, Department of Cardiology, Leiden, the Netherlands
| | - A A C M Heestermans
- Department of Cardiology, Noordwest Hospital Group, Alkmaar, the Netherlands
| | - D Nicastia
- Department of Cardiology, Gelre Hospital, Apeldoorn, the Netherlands
| | - H Alber
- KABEG Klinikum, Department for Internal Medicine and Cardiology, Klagenfurt am Wörthersee, Austria
| | - D Austin
- The James Cook University Hospital, Academic Cardiovascular Unit, Middlesbrough, United Kingdom
| | - A Nasser
- South Tyneside and Sunderland NHS Foundation Trust, Department of Cardiology, South Shields, United Kingdom
| | - V Deneer
- Department of Clinical Pharmacy, Division of Laboratories, Pharmacy, and Biomedical Genetics, University Medical Center Utrecht, Utrecht, the Netherlands; Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands
| | - J M Ten Berg
- St. Antonius Hospital, Department of Cardiology, Nieuwegein, the Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands.
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Van Den Broek WW, Gimbel ME, Hermanides RS, Runnet C, Storey RF, Austin D, Oemrawsingh RM, Cooke J, Galasko G, Walhout R, Schellings DAAM, The SHK, Stoel MG, Van 'T Hof AWJ, Ten Berg JM. Treatment and prognosis of elderly patients with non-ST-elevation myocardial infarction. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2541] [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/Introduction
Elderly constitute a large though specific group of patients presenting with non-ST elevation myocardial infarction (NSTEMI), as they are at higher risk of adverse cardiovascular events, as well as treatment-related complications. However as they underrepresented in clinical trials, the optimal management strategy for older patients with NSTEMI remains unclear.
Purpose
The aim of this registry was to capture the medical and invasive treatment of elderly NSTEMI patients, find predictors for major adverse cardiovascular events (MACE) and estimate the impact of invasive management and revascularisation.
Methods
The POPular AGE registry is a prospective, observational multicentre study of patients ≥75 years of age presenting with NSTEMI at multiple sites in the Netherlands, United Kingdom and Austria. Management was at the discretion of the treating physician. MACE consisted of cardiovascular death, acute coronary syndrome (ACS) and stroke. Net adverse clinical events (NACE) was defined as composite of all-cause death, ACS, definite stent thrombosis, stroke, or major bleeding (Bleeding Academic Research Consortium [BARC] bleeding 3 or 5). The population was stratified into an invasively treated group defined as patients who underwent coronary angiography (CAG); and a conservatively-treated group with patients who received medical treatment only. The duration of follow-up was one year. Clinical variables were assessed for their predictive value for MACE and bleeding by means of a Cox proportional hazard regression.
Results
The total study population consisted of 1190 elderly patients with NSTEMI (median age 80 years [IQR 77–84], 43% female). Invasive treatment with CAG was performed in 67% of the population, of which 49% underwent PCI and 14% coronary artery bypass grafting (CABG). At discharge, the majority of patients (55%) were treated with dual antiplatelet therapy (DAPT). MACE occurred in 15% and major bleeding occurred in 5% of the total population. Age (HR 1.06, 95% CI 1.03–1.09), diabetes mellitus (HR 1.62, 95% CI 1.16–2.24), reduced LVEF (<50%) (HR 1.51, 95% CI 1.03–2.20), Killip class (HR 1.58, 95% CI 1.07–2.33) and electrocardiogram (ECG) changes at admission (HR 1.67, 95% CI 1.20–2.31) were predictors for MACE. MACE occurred more frequently in conservatively-treated than invasively-treated patients (20% vs. 12%, HR 0.52, 95% CI 0.38–0.70, p<0.001). Revascularization with PCI or CABG was associated with lower risk of MACE (PCI; HR 0.47, 95% CI 0.30–0.75, p=0.001 and CABG; HR 0.31, 95% CI 0.13– 0.73, p=0.008).
Conclusions
In this prospective registry of NSTEMI patients of ≥75 years, MACE and major bleeding were frequent. Age, diabetes mellitus, reduced LVEF, Killip class and ECG changes at admission were independent predictors for MACE. Although subject to selection bias, undergoing CAG and revascularisation, when indicated, were associated with better outcomes.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): AstraZeneca
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Affiliation(s)
- W W Van Den Broek
- St Antonius Hospital, Department of Cardiology , Nieuwegein , The Netherlands
| | - M E Gimbel
- Heartcenter - Our Lady Hospital, Department of Cardiology , Amsterdam , The Netherlands
| | - R S Hermanides
- Isala Hospital, Department of Cardiology , Zwolle , The Netherlands
| | - C Runnet
- Northumbria Healthcare, Department of Cardiology , Newcastle-Upon-Tyne , United Kingdom
| | - R F Storey
- University of Sheffield, Department of Infection, Immunity and Cardiovascular Disease , Sheffield , United Kingdom
| | - D Austin
- James Cook University Hospital, Academic Cardiovascular Unit , Middlesbrough , United Kingdom
| | - R M Oemrawsingh
- Albert Schweitzer Hospital, Department of Cardiology , Dordrecht , The Netherlands
| | - J Cooke
- Chesterfield Royal Hospital, Department of Cardiology , Chesterfield , United Kingdom
| | - G Galasko
- Blackpool Teaching Hospitals NHS Trust, Department of Cardiology , Blackpool , United Kingdom
| | - R Walhout
- Gelderse Vallei Hospital, Department of Cardiology , Ede , The Netherlands
| | - D A A M Schellings
- Slingeland Hospital, Department of Cardiology , Doetinchem , The Netherlands
| | - S H K The
- Treant Zorggroep, Department of Cardiology , Emmen , The Netherlands
| | - M G Stoel
- Medical Spectrum Twente, Department of Cardiology , Enschede , The Netherlands
| | - A W J Van 'T Hof
- Cardiovascular Research Institute Maastricht (CARIM), Department of Cardiology , Maastricht , The Netherlands
| | - J M Ten Berg
- St Antonius Hospital, Department of Cardiology , Nieuwegein , The Netherlands
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Linschoten M, Uijl A, Schut A, Jakob CEM, Romão LR, Bell RM, McFarlane E, Stecher M, Zondag AGM, van Iperen EPA, Hermans-van Ast W, Lea NC, Schaap J, Jewbali LS, Smits PC, Patel RS, Aujayeb A, van der Harst P, Siebelink HJ, van Smeden M, Williams S, Pilgram L, van Gilst WH, Tieleman RG, Williams B, Asselbergs FW, Al-Ali AK, Al-Muhanna FA, Al-Rubaish AM, Al-Windy NYY, Alkhalil M, Almubarak YA, Alnafie AN, Alshahrani M, Alshehri AM, Anning C, Anthonio RL, Badings EA, Ball C, van Beek EA, ten Berg JM, von Bergwelt-Baildon M, Bianco M, Blagova OV, Bleijendaal H, Bor WL, Borgmann S, van Boxem AJM, van den Brink FS, Bucciarelli-Ducci C, van Bussel BCT, Byrom-Goulthorp R, Captur G, Caputo M, Charlotte N, vom Dahl J, Dark P, De Sutter J, Degenhardt C, Delsing CE, Dolff S, Dorman HGR, Drost JT, Eberwein L, Emans ME, Er AG, Ferreira JB, Forner MJ, Friedrichs A, Gabriel L, Groenemeijer BE, Groenendijk AL, Grüner B, Guggemos W, Haerkens-Arends HE, Hanses F, Hedayat B, Heigener D, van der Heijden DJ, Hellou E, Hellwig K, Henkens MTHM, Hermanides RS, Hermans WRM, van Hessen MWJ, Heymans SRB, Hilt AD, van der Horst ICC, Hower M, van Ierssel SH, Isberner N, Jensen B, Kearney MT, van Kesteren HAM, Kielstein JT, Kietselaer BLJH, Kochanek M, Kolk MZH, Koning AMH, Kopylov PY, Kuijper AFM, Kwakkel-van Erp JM, Lanznaster J, van der Linden MMJM, van der Lingen ACJ, Linssen GCM, Lomas D, Maarse M, Macías Ruiz R, Magdelijns FJH, Magro M, Markart P, Martens FMAC, Mazzilli SG, McCann GP, van der Meer P, Meijs MFL, Merle U, Messiaen P, Milovanovic M, Monraats PS, Montagna L, Moriarty A, Moss AJ, Mosterd A, Nadalin S, Nattermann J, Neufang M, Nierop PR, Offerhaus JA, van Ofwegen-Hanekamp CEE, Parker E, Persoon AM, Piepel C, Pinto YM, Poorhosseini H, Prasad S, Raafs AG, Raichle C, Rauschning D, Redón J, Reidinga AC, Ribeiro MIA, Riedel C, Rieg S, Ripley DP, Römmele C, Rothfuss K, Rüddel J, Rüthrich MM, Salah R, Saneei E, Saxena M, Schellings DAAM, Scholte NTB, Schubert J, Seelig J, Shafiee A, Shore AC, Spinner C, Stieglitz S, Strauss R, Sturkenboom NH, Tessitore E, Thomson RJ, Timmermans P, Tio RA, Tjong FVY, Tometten L, Trauth J, den Uil CA, Van Craenenbroeck EM, van Veen HPAA, Vehreschild MJGT, Veldhuis LI, Veneman T, Verschure DO, Voigt I, de Vries JK, van de Wal RMA, Walter L, van de Watering DJ, Westendorp ICD, Westendorp PHM, Westhoff T, Weytjens C, Wierda E, Wille K, de With K, Worm M, Woudstra P, Wu KW, Zaal R, Zaman AG, van der Zee PM, Zijlstra LE, Alling TE, Ahmed R, van Aken K, Bayraktar-Verver ECE, Bermúdez Jiménes FJ, Biolé CA, den Boer-Penning P, Bontje M, Bos M, Bosch L, Broekman M, Broeyer FJF, de Bruijn EAW, Bruinsma S, Cardoso NM, Cosyns B, van Dalen DH, Dekimpe E, Domange J, van Doorn JL, van Doorn P, Dormal F, Drost IMJ, Dunnink A, van Eck JWM, Elshinawy K, Gevers RMM, Gognieva DG, van der Graaf M, Grangeon S, Guclu A, Habib A, Haenen NA, Hamilton K, Handgraaf S, Heidbuchel H, Hendriks-van Woerden M, Hessels-Linnemeijer BM, Hosseini K, Huisman J, Jacobs TC, Jansen SE, Janssen A, Jourdan K, ten Kate GL, van Kempen MJ, Kievit CM, Kleikers P, Knufman N, van der Kooi SE, Koole BAS, Koole MAC, Kui KK, Kuipers-Elferink L, Lemoine I, Lensink E, van Marrewijk V, van Meerbeeck JP, Meijer EJ, Melein AJ, Mesitskaya DF, van Nes CPM, Paris FMA, Perrelli MG, Pieterse-Rots A, Pisters R, Pölkerman BC, van Poppel A, Reinders S, Reitsma MJ, Ruiter AH, Selder JL, van der Sluis A, Sousa AIC, Tajdini M, Tercedor Sánchez L, Van De Heyning CM, Vial H, Vlieghe E, Vonkeman HE, Vreugdenhil P, de Vries TAC, Willems AM, Wils AM, Zoet-Nugteren SK. Clinical presentation, disease course, and outcome of COVID-19 in hospitalized patients with and without pre-existing cardiac disease: a cohort study across 18 countries. Eur Heart J 2022; 43:1104-1120. [PMID: 34734634 DOI: 10.1093/eurheartj/ehab656] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 06/22/2021] [Accepted: 09/01/2021] [Indexed: 12/25/2022] Open
Abstract
AIMS Patients with cardiac disease are considered high risk for poor outcomes following hospitalization with COVID-19. The primary aim of this study was to evaluate heterogeneity in associations between various heart disease subtypes and in-hospital mortality. METHODS AND RESULTS We used data from the CAPACITY-COVID registry and LEOSS study. Multivariable Poisson regression models were fitted to assess the association between different types of pre-existing heart disease and in-hospital mortality. A total of 16 511 patients with COVID-19 were included (21.1% aged 66-75 years; 40.2% female) and 31.5% had a history of heart disease. Patients with heart disease were older, predominantly male, and often had other comorbid conditions when compared with those without. Mortality was higher in patients with cardiac disease (29.7%; n = 1545 vs. 15.9%; n = 1797). However, following multivariable adjustment, this difference was not significant [adjusted risk ratio (aRR) 1.08, 95% confidence interval (CI) 1.02-1.15; P = 0.12 (corrected for multiple testing)]. Associations with in-hospital mortality by heart disease subtypes differed considerably, with the strongest association for heart failure (aRR 1.19, 95% CI 1.10-1.30; P < 0.018) particularly for severe (New York Heart Association class III/IV) heart failure (aRR 1.41, 95% CI 1.20-1.64; P < 0.018). None of the other heart disease subtypes, including ischaemic heart disease, remained significant after multivariable adjustment. Serious cardiac complications were diagnosed in <1% of patients. CONCLUSION Considerable heterogeneity exists in the strength of association between heart disease subtypes and in-hospital mortality. Of all patients with heart disease, those with heart failure are at greatest risk of death when hospitalized with COVID-19. Serious cardiac complications are rare during hospitalization.
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Arslan F, Damman P, Zwart B, Appelman Y, Voskuil M, de Vos A, van Royen N, Jukema JW, Waalewijn R, Hermanides RS, Woudstra P, Ten Cate T, Lemkes JS, Vink MA, Balder W, van der Wielen MLJ, Vlaar PJ, van der Heijden DJ, Assa S, van 't Hof AW, Ten Berg JM. 2020 ESC Guidelines on acute coronary syndrome without ST-segment elevation : Recommendations and critical appraisal from the Dutch ACS and Interventional Cardiology working groups. Neth Heart J 2021; 29:557-565. [PMID: 34232481 PMCID: PMC8556454 DOI: 10.1007/s12471-021-01593-4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2021] [Indexed: 11/27/2022] Open
Abstract
Recently, the European Society of Cardiology (ESC) has updated its guidelines for the management of patients with acute coronary syndrome (ACS) without ST-segment elevation. The current consensus document of the Dutch ACS working group and the Working Group of Interventional Cardiology of the Netherlands Society of Cardiology aims to put the 2020 ESC Guidelines into the Dutch perspective and to provide practical recommendations for Dutch cardiologists, focusing on antiplatelet therapy, risk assessment and criteria for invasive strategy.
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Affiliation(s)
- F Arslan
- Vivantes Klinikum am Urban, Berlin, Germany.,St. Antonius Hospital, Nieuwegein, The Netherlands
| | - P Damman
- Radboud University Medical Center, Nijmegen, The Netherlands.
| | - B Zwart
- Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
| | - Y Appelman
- Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - M Voskuil
- University Medical Center Utrecht, Utrecht, The Netherlands
| | - A de Vos
- Catharina Hospital, Eindhoven, The Netherlands
| | - N van Royen
- Radboud University Medical Center, Nijmegen, The Netherlands
| | - J W Jukema
- Leiden University Medical Center, Leiden, The Netherlands
| | | | | | - P Woudstra
- Medisch Centrum Leeuwarden, Leeuwarden, The Netherlands
| | - T Ten Cate
- Radboud University Medical Center, Nijmegen, The Netherlands
| | - J S Lemkes
- Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - M A Vink
- Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - W Balder
- University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - P J Vlaar
- Catharina Hospital, Eindhoven, The Netherlands
| | | | - S Assa
- University Medical Center Groningen, Groningen, The Netherlands
| | - A W van 't Hof
- Maastricht University Medical Center, Maastricht, The Netherlands
| | - J M Ten Berg
- St. Antonius Hospital, Nieuwegein, The Netherlands
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Selvarajah A, Tavenier AH, Bor WL, Houben V, Rasoul S, Kaplan E, Teeuwen K, Hofma SH, Lipsic E, Amoroso G, van Leeuwen MAH, Berg JMT, van 't Hof AWJ, Hermanides RS. Feasibility and safety of cangrelor in patients with suboptimal P2Y 12 inhibition undergoing percutaneous coronary intervention: rationale of the Dutch Cangrelor Registry. BMC Cardiovasc Disord 2021; 21:292. [PMID: 34118880 PMCID: PMC8199523 DOI: 10.1186/s12872-021-02093-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 05/17/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Despite the advances of potent oral P2Y12 inhibitors, their onset of action is delayed, which might have a negative impact on clinical outcome in patients undergoing percutaneous coronary intervention (PCI). Trials conducted in the United States of America have identified cangrelor as a potent and rapid-acting intravenous P2Y12 inhibitor, which has the potential of reducing ischemic events in these patients without an increase in the bleeding. As cangrelor is rarely used in The Netherlands, we conducted a nationwide registry to provide an insight into the use of cangrelor in the management of patients with suboptimal platelet inhibition undergoing (primary) PCI (the Dutch Cangrelor Registry). STUDY DESIGN The Cangrelor Registry is a prospective, observational, multicenter, single-arm registry with cangrelor administered pre-PCI in: (1) P2Y12 naive patients with ad-hoc PCI, (2) patients with STEMI/NSTEMI with suboptimal P2Y12 inhibition including (3) stable resuscitated/defibrillated patients with out-of-hospital cardiac arrest (OHCA) due to acute ischemia and (4) STEMI/NSTEMI patients with a high thrombotic burden. Primary endpoint is 48 h Net Adverse Clinical Events (NACE), which is a composite endpoint of all-cause death, recurrent myocardial infarction (MI), target vessel revascularization (TVR), stroke, stent thrombosis (ST) and BARC 2-3-5 bleeding. The Dutch Cangrelor Registry will assess the feasibility and safety of cangrelor in patients with suboptimal P2Y12 inhibition undergoing (primary) PCI in the setting of acute coronary syndrome (ACS) and stable coronary artery disease (CAD) in the Netherlands.
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Affiliation(s)
- A Selvarajah
- Department of Cardiology, Isala Hospital, Zwolle, The Netherlands
| | - A H Tavenier
- Department of Cardiology, Isala Hospital, Zwolle, The Netherlands
| | - W L Bor
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - V Houben
- Department of Cardiology, Zuyderland Medical Center, Heerlen, The Netherlands
| | - S Rasoul
- Department of Cardiology, Zuyderland Medical Center, Heerlen, The Netherlands
| | - E Kaplan
- Department of Cardiology, Venlo VieCuri Medical Center, Venlo, The Netherlands
| | - K Teeuwen
- Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands
| | - S H Hofma
- Department of Cardiology, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - E Lipsic
- Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
| | - G Amoroso
- Department of Cardiology, OLVG Hospital, Amsterdam, The Netherlands
| | | | - J M Ten Berg
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - A W J van 't Hof
- Department of Cardiology, Isala Hospital, Zwolle, The Netherlands
- Department of Cardiology, Zuyderland Medical Center, Heerlen, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - R S Hermanides
- Department of Cardiology, Isala Hospital, Zwolle, The Netherlands.
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Hommels TM, Hermanides RS, Berta B, Fabris E, De Luca G, Ploumen EH, von Birgelen C, Kedhi E. Everolimus-eluting bioresorbable scaffolds and metallic stents in diabetic patients: a patient-level pooled analysis of the prospective ABSORB DM Benelux Study, TWENTE and DUTCH PEERS. Cardiovasc Diabetol 2020; 19:165. [PMID: 33008407 PMCID: PMC7532086 DOI: 10.1186/s12933-020-01116-2] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 09/12/2020] [Indexed: 11/17/2022] Open
Abstract
Background Several studies compared everolimus-eluting bioresorbable scaffolds (EE-BRS) with everolimus-eluting stents (EES), but only few assessed these devices in patients with diabetes mellitus. Aim To evaluate the safety and efficacy outcomes of all-comer patients with diabetes mellitus up to 2 years after treatment with EE-BRS or EES. Methods We performed a post hoc pooled analysis of patient-level data in diabetic patients who were treated with EE-BRS or EES in 3 prospective clinical trials: The ABSORB DM Benelux Study (NTR5447), TWENTE (NTR1256/NCT01066650) and DUTCH PEERS (NTR2413/NCT01331707). Primary endpoint of the analysis was target lesion failure (TLF): a composite of cardiac death, target vessel myocardial infarction or clinically driven target lesion revascularization. Secondary endpoints included major adverse cardiac events (MACE): a composite of all-cause death, any myocardial infarction or clinically driven target vessel revascularization, as well as definite or probable device thrombosis (ST). Results A total of 499 diabetic patients were assessed, of whom 150 received EE-BRS and 249 received EES. Total available follow-up was 222.6 patient years (PY) in the EE-BRS and 464.9 PY in the EES group. The adverse events rates were similar in both treatment groups for TLF (7.2 vs. 5.2 events per 100 PY, p = 0.39; adjusted hazard ratio (HR) = 1.48 (95% confidence interval (CI): 0.77–2.87), p = 0.24), MACE (9.1 vs. 8.3 per 100 PY, p = 0.83; adjusted HR = 1.23 (95% CI: 0.70–2.17), p = 0.47), and ST (0.9 vs. 0.6 per 100 PY, p > 0.99). Conclusion In this patient-level pooled analysis of patients with diabetes mellitus from 3 clinical trials, EE-BRS showed clinical outcomes that were quite similar to EES.
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Affiliation(s)
| | | | - B Berta
- Isala Hospital, Zwolle, The Netherlands
| | - E Fabris
- Cardiovascular Department, University of Trieste, Trieste, Italy
| | - G De Luca
- AOU Maggiore della Carità, Eastern Piedmont University, Novara, Italy
| | - E H Ploumen
- Medisch Spectrum Twente, Thoraxcentrum & University of Twente, Thoraxcentrum, The Netherlands
| | - C von Birgelen
- Medisch Spectrum Twente, Thoraxcentrum & University of Twente, Thoraxcentrum, The Netherlands
| | - E Kedhi
- Department of Cardiology, Hôpital Erasme Université Libre de Bruxelles, Brussels, Belgium.
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Brouwer J, van den Brink FS, Nijenhuis VJ, Vossenberg TN, Delewi R, van Mourik MS, den Heijer P, Tanis W, Kievit PC, Holvoet W, Hermanides RS, Ten Berg JM. Incidence and outcome of prosthetic valve endocarditis after transcatheter aortic valve replacement in the Netherlands. Neth Heart J 2020; 28:520-525. [PMID: 32333256 PMCID: PMC7494686 DOI: 10.1007/s12471-020-01420-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Background Transcatheter aortic valve replacement (TAVR) is increasingly being used as an alternative to conventional surgical valve replacement. Prosthetic valve endocarditis (PVE) is a rare but feared complication after TAVR, with reported first-year incidences varying from 0.57 to 3.1%. This study was performed to gain insight into the incidence and outcome of PVE after TAVR in the Netherlands. Methods A multicentre retrospective registry study was performed. All patients who underwent TAVR in the period 2010–2017 were screened for the diagnosis of infective endocarditis in the insurance database and checked for the presence of PVE before analysis of general characteristics, PVE parameters and outcome. Results A total of 3968 patients who underwent TAVR were screened for PVE. During a median follow-up of 33.5 months (interquartile range (IQR) 22.8–45.8), 16 patients suffered from PVE (0.4%), with a median time to onset of 177 days (IQR 67.8–721.3). First-year incidence was 0.24%, and the overall incidence rate was 0.14 events per 1000 person-years. Overall mortality during follow-up in our study was 31%, of which 25% occurred in hospital. All patients were treated conservatively with intravenous antibiotics alone, and none underwent a re-intervention. Other complications of PVE occurred in 5 patients (31%) and included aortic abscess (2), decompensated heart failure (2) and cerebral embolisation (1). Conclusion PVE in patients receiving TAVR is a relatively rare complication and has a high mortality rate.
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Affiliation(s)
- J Brouwer
- Department of Cardiology, St Antonius Ziekenhuis, Nieuwegein, The Netherlands.
| | - F S van den Brink
- Department of Cardiology, St Antonius Ziekenhuis, Nieuwegein, The Netherlands.,Department of Cardiology, Medisch Centrum Leeuwarden, Leeuwarden, The Netherlands
| | - V J Nijenhuis
- Department of Cardiology, St Antonius Ziekenhuis, Nieuwegein, The Netherlands
| | - T N Vossenberg
- Department of Cardiology, Medisch Centrum Leeuwarden, Leeuwarden, The Netherlands
| | - R Delewi
- Department of Cardiology, Amsterdam Universitair Medisch Centrum, locatie AMC, Amsterdam, The Netherlands
| | - M S van Mourik
- Department of Cardiology, Amsterdam Universitair Medisch Centrum, locatie AMC, Amsterdam, The Netherlands
| | - P den Heijer
- Department of Cardiology, Amphia Ziekenhuis, Breda, The Netherlands
| | - W Tanis
- Department of Cardiology, Haga Ziekenhuis, The Hague, The Netherlands
| | - P C Kievit
- Department of Cardiology, Radboud Medisch Centrum, Nijmegen, The Netherlands
| | - W Holvoet
- Department of Cardiology, Maastricht Universitair Medisch Centrum, Maastricht, The Netherlands
| | - R S Hermanides
- Department of Cardiology, Isala Klinieken, Zwolle, The Netherlands
| | - J M Ten Berg
- Department of Cardiology, St Antonius Ziekenhuis, Nieuwegein, The Netherlands
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Hermanides RS, Tavenier AH, Nierich AP. A rare but devastating cause of cardiac tamponade. Neth Heart J 2019; 27:453. [PMID: 31073741 PMCID: PMC6712154 DOI: 10.1007/s12471-019-1287-5] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- R S Hermanides
- Departments of Cardiology, Isala Hospital, Zwolle, The Netherlands.
| | - A H Tavenier
- Departments of Cardiology, Isala Hospital, Zwolle, The Netherlands
| | - A P Nierich
- Department of Cardiothoracic Intensive Care and OR, Isala Hospital, Zwolle, The Netherlands
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9
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Hommels TM, Hermanides RS, Rasoul S, Berta B, IJsselmuiden AJJ, Jessurun GAJ, Benit E, Pereira B, De Luca G, Kedhi E. The 1‑year safety and efficacy outcomes of Absorb bioresorbable vascular scaffolds for coronary artery disease treatment in diabetes mellitus patients: the ABSORB DM Benelux study. Neth Heart J 2019; 27:541-549. [PMID: 31197750 PMCID: PMC6823340 DOI: 10.1007/s12471-019-1293-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Background Diabetes mellitus (DM) patients show higher rates of repeat revascularisation even in the era of modern drug-eluting stents (DES). The concept of bioresorbable scaffolds is becoming captivating, as it might allow for repeat interventions, prolonging the time span during which patients can be treated by percutaneous coronary intervention (PCI). Aims We intend to evaluate the short- and long-term safety and efficacy of Absorb bioresorbable vascular scaffolds (Absorb BVS) in the treatment of coronary artery disease (CAD) in DM patients for any indication. Methods The ABSORB DM Benelux is an international prospective study in DM patients who have undergone PCI with ≥1 Absorb BVS. Major adverse cardiac events (MACE) at 1 year was the primary endpoint, defined as a composite of all-cause death, any myocardial infarction (MI) and ischaemia-driven target vessel revascularisation (TVR). Secondary endpoints were target lesion failure (TLF) and definite or probable scaffold thrombosis (ScT). Results Between April 2015 and March 2017, 150 DM patients and 188 non-complex lesions were treated. Device implantation was successful in 100%. MACE occurred in 14 (9.5%) patients, with all-cause death occurring in 4 (2.7%), any MI in 6 (4.1%) and ischaemia-driven TVR in 7 (4.8%) respectively. TLF was reported in 11 (7.5%). Definite and probable ScT was observed in 2 (1.4%). Conclusion Absorb BVS for treatment of anatomically low-risk patients with DM show acceptable safety and efficacy outcomes at 1 year. If these promising results are confirmed after a longer follow-up period, new-generation bioresorbable scaffolds combined with refinement of implantation techniques might open new horizons for CAD treatment in DM patients. Electronic supplementary material The online version of this article (10.1007/s12471-019-1293-7) contains supplementary material, which is available to authorised users.
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Affiliation(s)
| | | | - S Rasoul
- Zuyderland Medisch Centrum, Heerlen, The Netherlands
| | - B Berta
- Isala Klinieken, Zwolle, The Netherlands
| | | | | | - E Benit
- Virga Jesse Ziekenhuis, Hasselt, Belgium
| | - B Pereira
- Institut National de Chirurgie Cardiaque et de Cardiologie Interventionnelle, Luxembourg, Luxembourg
| | - G De Luca
- Isala Klinieken, Zwolle, The Netherlands
| | - E Kedhi
- Isala Klinieken, Zwolle, The Netherlands
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Hommels TM, Hermanides RS, Rasoul S, Berta B, IJsselmuiden AJJ, Jessurun GAJ, Benit E, Pereira B, De Luca G, Kedhi E. Everolimus-eluting bioresorbable scaffolds for treatment of coronary artery disease in patients with diabetes mellitus: the midterm follow-up of the prospective ABSORB DM Benelux study. Cardiovasc Diabetol 2019; 18:25. [PMID: 30851731 PMCID: PMC6408833 DOI: 10.1186/s12933-019-0827-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 02/18/2019] [Indexed: 02/07/2023] Open
Abstract
Background Percutaneous coronary intervention (PCI) in patients with diabetes mellitus (DM) remains challenging even with modern drug-eluting stents (DES) due to high rates of repeat revascularization. Everolimus-eluting bioresorbable scaffolds (EE-BRS) might allow for repeat intervention prolonging the time interval of percutaneous treatment options. Methods The ABSORB DM Benelux Study is a dedicated prospective, international study to evaluate the midterm safety and efficacy of EE-BRS in DM patients. All DM patients that received ≥ 1 EE-BRS for any indication were enrolled and prospectively followed. Study endpoints were major adverse cardiac events (MACE): a composite of all-cause death, any myocardial infarction (MI) and ischemic-driven target vessel revascularization (TVR); target lesion failure (TLF): a composite of cardiac death (CD), target vessel MI, and ischemic-driven target lesion revascularization (TLR), as well as definite or probable scaffold thrombosis (ScT). Results Between April 2015 till March 2017, 150 DM patients and 188 lesions were treated and followed up to 3 years. Device implantation success was 100%. MACE occurred in 15.2% (event rate of 8.8 per 100 PY). TLF was reported in 11.7% (7.0 events per 100 PY). CD, target vessel MI, ischemic-driven TLR occurred in 3.4%, 3.6% and 5.5% respectively, while ScT was observed in 1.4%. There were no occurrences of late or very late ScT. Conclusion EE-BRS treatment in DM patients shows comparable midterm safety and efficacy outcomes when historically compared with modern DES. New-generation EE-BRS might offer an attractive alternative to metallic DES in treatment of fast progressing atherosclerosis population as in DM patients. Trial registration NTR5447. Registered 05 October 2015, retrospectively registered
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Affiliation(s)
- T M Hommels
- Isala Klinieken, Isala Hartcentrum, Dokter van Heesweg 2, 8025 AB, Zwolle, The Netherlands
| | - R S Hermanides
- Isala Klinieken, Isala Hartcentrum, Dokter van Heesweg 2, 8025 AB, Zwolle, The Netherlands
| | - S Rasoul
- Zuyderland Medisch Centrum, Heerlen, The Netherlands
| | - B Berta
- Isala Klinieken, Isala Hartcentrum, Dokter van Heesweg 2, 8025 AB, Zwolle, The Netherlands
| | | | | | - E Benit
- Virga Jesse Ziekenhuis, Hasselt, Belgium
| | - B Pereira
- Institut National de Chirurgie Cardiaque et de Cardiologie Interventionnelle, Luxembourg, Luxembourg
| | - G De Luca
- Isala Klinieken, Isala Hartcentrum, Dokter van Heesweg 2, 8025 AB, Zwolle, The Netherlands
| | - E Kedhi
- Isala Klinieken, Isala Hartcentrum, Dokter van Heesweg 2, 8025 AB, Zwolle, The Netherlands. .,, Dokter van Heesweg 2, Postbus 10400, 8000 GK, Zwolle, The Netherlands.
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Badings EA, Hermanides RS, Van Der Sluis A, Dambrink JHE, Gosselink ATM, Kedhi E, Ottervanger JP, Roolvink V, Remkes WS, Van't Riet E, Suryapranata H, Van't Hof AWJ. Use, timing and outcome of coronary angiography in patients with high-risk non-ST-segment elevation acute coronary syndrome in daily clinical practice: insights from a 'real world' prospective registry. Neth Heart J 2018; 27:73-80. [PMID: 30547413 PMCID: PMC6352622 DOI: 10.1007/s12471-018-1212-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background An early invasive strategy (EIS) is recommended in high-risk patients with non-ST-elevation acute coronary syndrome (NSTE-ACS), defined as coronary angiography (CAG), within 24 h of admission. The aim of the present study is to investigate guideline adherence, patient characteristics associated with timing of the intervention and clinical outcome. Methods In a prospective registry, the use and timing of CAG and the characteristics and clinical outcome associated with timing were evaluated in high-risk ACS patients. The outcome of early versus delayed invasive strategy (DIS) was compared. Results Between 2006 and 2014, 2,299 high-risk NSTE-ACS patients were included. The use of CAG increased from 77% in 2006 to 90% in 2014 (p trend <0.001) together with a decrease of median time to CAG from 23.3 to 14.5 h (p trend <0.001) and an increase of patients undergoing EIS from 50 to 60% (p trend = 0.002). Patient factors independently related to DIS were higher GRACE risk score, higher age and the presence of comorbidities. No difference was found in incidence of mortality, reinfarction or bleeding at 30-day follow-up. All-cause mortality at 1‑year follow-up was 4.1% vs 7.0% in EIS and DIS respectively (hazard ratio 1.67, 95% confidence interval 1.12–2.49) but was comparable after adjustment for confounding factors. Conclusion The percentage of high-risk NSTE-ACS patients undergoing CAG and EIS has increased in the last decade. In contrast to the guidelines, patients with a higher risk profile are less likely to undergo EIS. However, no difference in outcome after 30 days and 1 year was found after multivariate adjustment for this higher risk.
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Affiliation(s)
- E A Badings
- Department of Cardiology, Deventer Hospital, Deventer, The Netherlands.
| | | | - A Van Der Sluis
- Department of Cardiology, Deventer Hospital, Deventer, The Netherlands
| | | | | | - E Kedhi
- Isala Heart Centre, Zwolle, The Netherlands
| | | | - V Roolvink
- Isala Heart Centre, Zwolle, The Netherlands
| | - W S Remkes
- Isala Heart Centre, Zwolle, The Netherlands
| | - E Van't Riet
- Teaching Hospital, Deventer Hospital, Deventer, The Netherlands
| | - H Suryapranata
- Isala Heart Centre, Zwolle, The Netherlands
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - A W J Van't Hof
- Isala Heart Centre, Zwolle, The Netherlands
- Department of Cardiology, Maastricht UMC+, Maastricht, The Netherlands
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12
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Berta B, Roleder T, Ijsselmuiden AJ, Alfonso F, Kauer F, Escaned J, Hermanides RS, Wojakowski W, Kedhi E. P6205Diabetic patients with thin-cap fibroatheroma have a higher rate of angiographic hidden plaque rupture in non-ischaemic vessels - Insights from the COMBINE Study. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- B Berta
- Isala Clinics, Hartcentrum, Zwolle, Netherlands
| | - T Roleder
- Medical University of Silesia, Department of Cardiology, SHS, Katowice, Poland
| | | | - F Alfonso
- University Hospital De La Princesa, Madrid, Spain
| | - F Kauer
- Albert Schweitzer Hospital, Dordrecht, Netherlands
| | - J Escaned
- Hospital Clinic San Carlos, Madrid, Spain
| | | | - W Wojakowski
- Medical University of Silesia, Department of Cardiology and Structural Heart Diseases, Katowice, Poland
| | - E Kedhi
- Isala Clinics, Hartcentrum, Zwolle, Netherlands
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13
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Berta B, Roleder T, Ijsselmuiden AJ, Alfonso F, Kauer F, Escaned J, Hermanides RS, Wojakowski W, Kedhi E. 2360Impact of statin treatment on the prevalence of lesion vulnerability and instability features in patients with diabetes mellitus - Insights from the COMBINE (FFR-OCT) Study. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.2360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- B Berta
- Isala Clinics, Hartcentrum, Zwolle, Netherlands
| | - T Roleder
- Medical University of Silesia, Department of Cardiology, SHS, Katowice, Poland
| | | | - F Alfonso
- University Hospital De La Princesa, Madrid, Spain
| | - F Kauer
- Albert Schweitzer Hospital, Dordrecht, Netherlands
| | - J Escaned
- Hospital Clinic San Carlos, Madrid, Spain
| | | | - W Wojakowski
- Medical University of Silesia, Department of Cardiology and Structural Heart Diseases, Katowice, Poland
| | - E Kedhi
- Isala Clinics, Hartcentrum, Zwolle, Netherlands
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14
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Hermanides RS, Kilic S, van 't Hof AWJ. Optimal pharmacological therapy in ST-elevation myocardial infarction-a review : A review of antithrombotic therapies in STEMI. Neth Heart J 2018; 26:296-310. [PMID: 29687412 PMCID: PMC5967999 DOI: 10.1007/s12471-018-1112-6] [Citation(s) in RCA: 8] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Antithrombotic therapy is an essential component in the optimisation of clinical outcomes in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention. There are currently several intravenous anticoagulant drugs available for primary percutaneous coronary intervention. Dual antiplatelet therapy comprising aspirin and P2Y12 inhibitor represents the cornerstone treatment for STEMI. However, these effective treatment strategies may be associated with bleeding complications. Compared with clopidogrel, prasugrel and ticagrelor are more potent and predictable, which translates into better clinical outcomes. Therefore, these agents are the first-line treatment in primary percutaneous coronary intervention. However, patients can still experience adverse ischaemic events, which might be in part attributed to alternative pathways triggering thrombosis. In this review, we provide a critical and updated review of currently available antithrombotic therapies used in patients with STEMI undergoing primary PCI. Finding a balance that minimises both thrombotic and bleeding risk is difficult, but crucial. Further randomised trials for this optimal balance are needed.
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Affiliation(s)
| | - S Kilic
- Isala Heart Centre, Zwolle, The Netherlands
| | - A W J van 't Hof
- Department of Cardiology, Maastricht UMC, Maastricht, The Netherlands.
- Department of Cardiology, Zuyderland Medical Centre (Heerlen location), Heerlen, The Netherlands.
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15
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Schram HCF, Hemradj VV, Hermanides RS, Kedhi E, Ottervanger JP. Coronary artery ectasia, an independent predictor of no-reflow after primary PCI for ST-elevation myocardial infarction. Int J Cardiol 2018; 265:12-17. [PMID: 29731349 DOI: 10.1016/j.ijcard.2018.04.120] [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] [Received: 02/13/2018] [Revised: 04/20/2018] [Accepted: 04/24/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND The no-reflow phenomenon is a serious complication after primary percutaneous coronary intervention (PCI) for ST-elevation Myocardial Infarction (STEMI). Coronary artery ectasia (CAE) may increase the risk of no-reflow, however, only limited data is available on the potential impact of CAE. The aim of this study was to determine the potential association between CAE and no-reflow after primary PCI. METHODS A case control study was performed based on a prospective cohort of STEMI patients from January 2000 to December 2011. All patients with TIMI 0-1 flow post primary PCI, in the absence of dissection, thrombus, spasm or high-grade residual stenosis, were considered as no-reflow case. Control subjects were two consecutive STEMI patients after each case, with TIMI flow ≥2 after primary PCI. CAE was defined as dilatation of an arterial segment to a diameter at least 1.5 times that of the adjacent normal coronary artery. RESULTS In the no-reflow group, frequency of CAE was significantly higher (33.8% vs 3.9%, p < 0.001) compared to the control group. Baseline variables were comparable between patients with and without CAE. Patients with CAE had more often TIMI 0-1 flow pre-PCI (91% vs 71% p = 0.03), less often anterior STEMI (3% vs 37%, p < 0.001) and underwent significantly less often a PCI with stenting (47% vs 74%, p = 0.003). After multivariate analysis, CAE remained a strong and independent predictor of no-reflow (OR 13.9, CI 4.7-41.2, p < 0.001). CONCLUSION CAE is a strong and independent predictor of no-reflow after primary PCI for STEMI. Future studies should assess optimal treatment.
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Affiliation(s)
| | | | | | - E Kedhi
- Isala, Zwolle, The Netherlands
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- Isala, Zwolle, The Netherlands
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16
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Remkes WS, Hermanides RS, Kennedy MW, Fabris E, Kaplan E, Ottervanger JP, van 't Hof AWJ, Kedhi E. Everolimus-eluting bioresorbable vascular scaffold in daily clinical practice: A single-centre experience. Neth Heart J 2017; 25:611-617. [PMID: 28913627 PMCID: PMC5653537 DOI: 10.1007/s12471-017-1038-4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background Recent evidence has raised concerns regarding the safety of the everolimus-eluting bioresorbable vascular scaffold (E-BVS) (Absorb, Abbott Vascular, Santa Clara, CA, USA). Following these data, the use of this device has diminished in the Netherlands; however, daily practice data are limited. Therefore we studied the incidence of safety and efficacy outcomes with this device in daily clinical practice in a single large tertiary centre in the Netherlands. Methods All E‑BVS treated patients were included in this analysis. The primary endpoint was target lesion failure (TLF), a composite of cardiac death, target vessel non-fatal myocardial infarction (TV-MI) and clinically-driven target lesion revascularisation (TLR). The secondary endpoint was the incidence of definite scaffold thrombosis. Results Between October 2013 and January 2017, 105 patients were treated with 147 E‑BVS. This population contained 42 (40%) patients with diabetes mellitus and 43 (40.9%) undergoing treatment for acute coronary syndrome, and thus represents a high-risk patient cohort. Mean follow-up was 19.8 months. Intravascular imaging guidance during scaffold implantation was used in 64/105 (43.5%) patients. The primary endpoint (TLF) occurred in 3 (2.9%) patients. All-cause mortality and cardiac mortality occurred in 2 (2%) and 0 (0%) patients respectively. TV-MI occurred in 2 patients (1.9%): both were periprocedural and not related to the BVS implantation. TLR occurred in 1 patient (1.0%) during follow-up. No definite scaffold thrombosis occurred during follow-up. Conclusion This single-centre study examining the real-world experience of E‑BVS implantation in a high-risk population shows excellent procedural safety and long-term clinical outcomes.
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Affiliation(s)
- W S Remkes
- Isala Hartcentrum, Zwolle, The Netherlands
| | | | | | - E Fabris
- Isala Hartcentrum, Zwolle, The Netherlands
| | - E Kaplan
- Isala Hartcentrum, Zwolle, The Netherlands
| | | | | | - E Kedhi
- Isala Hartcentrum, Zwolle, The Netherlands.
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17
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Kilic S, Hermanides RS, Ottervanger JP, Kolkman E, Dambrink JHE, Roolvink V, Gosselink ATM, Kedhi E, van 't Hof AWJ. Effects of radial versus femoral artery access in patients with acute myocardial infarction: A large centre prospective registry. Neth Heart J 2016; 25:33-39. [PMID: 27561283 PMCID: PMC5179360 DOI: 10.1007/s12471-016-0887-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Aim This study sought to assess whether radial artery access improves clinical outcomes in patients presenting with acute myocardial infarction compared with femoral artery access. Methods This is a single-centre, prospective observational registry of all STEMI and NSTEMI patients who underwent coronary angiography and/or primary PCI in the period January 2010 to December 2013. Primary endpoint was 30-day all-cause mortality. Choice of access was left to the discretion of the cardiologist. Differences in the risk of death at 30 days between patients undergoing transradial intervention versus transfemoral intervention was assessed on an intention-to-treat comparison. Results Retrospective analysis of prospectively collected data was performed in 3580 patients with an acute coronary syndrome who underwent coronary angiography, of which 1310 had radial artery access. PCI was performed in 77 % of the patients. Before propensity score matching, patients who underwent transradial intervention and those intended to undergo transfemoral approach differed significantly in intra-aortic balloon pump use (1.7 % vs. 6.7 %, p < 0.001), and Killip class (Killip 1: 10.8 % vs. 17.3 %, p < 0.001). 30-day mortality rates were 1.7 % in the transradial group and 4.6 % in the transfemoral group (p < 0.001). After matching on the propensity score, the hazard ratio for 30-day mortality in the transradial group was 0.56 (95 % CI: 0.29–1.07, p = 0.08). Conclusion This registry-based study showed that radial access is associated with improved outcome in patients with an acute coronary syndrome. However, this difference was no longer significant after multivariate and propensity score adjustment for differences in baseline characteristics.
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Affiliation(s)
- S Kilic
- Department of Cardiology, Isala Klinieken Zwolle, Zwolle, The Netherlands
| | - R S Hermanides
- Department of Cardiology, Isala Klinieken Zwolle, Zwolle, The Netherlands
| | - J P Ottervanger
- Department of Cardiology, Isala Klinieken Zwolle, Zwolle, The Netherlands
| | - E Kolkman
- Department of Cardiology, Isala Klinieken Zwolle, Zwolle, The Netherlands
| | - J H E Dambrink
- Department of Cardiology, Isala Klinieken Zwolle, Zwolle, The Netherlands
| | - V Roolvink
- Department of Cardiology, Isala Klinieken Zwolle, Zwolle, The Netherlands
| | - A T M Gosselink
- Department of Cardiology, Isala Klinieken Zwolle, Zwolle, The Netherlands
| | - E Kedhi
- Department of Cardiology, Isala Klinieken Zwolle, Zwolle, The Netherlands
| | - A W J van 't Hof
- Department of Cardiology, Isala Klinieken Zwolle, Zwolle, The Netherlands.
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18
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Hermanides RS, Coenen JLLM, Groeneveld PHP. Acute left-sided abdominal pain. Neth J Med 2013; 71:84-87. [PMID: 23462057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- R S Hermanides
- Department of Internal Medicine, Isala Klinieken, Zwolle, The Netherlands.
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19
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Heestermans AACM, Hermanides RS, Gosselink ATM, de Boer MJ, Hoorntje JCA, Suryapranata H, Ottervanger JP, Dambrink JHE, Kolkman E, Ten Berg JM, Zijlstra F, van 't Hof AWJ. A comparison between upfront high-dose tirofiban versus provisional use in the real-world of non-selected STEMI patients undergoing primary PCI: Insights from the Zwolle acute myocardial infarction registry. Neth Heart J 2011; 18:592-7. [PMID: 21301621 DOI: 10.1007/s12471-010-0840-z] [Citation(s) in RCA: 9] [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: 10/18/2022] Open
Abstract
BACKGROUND Despite the proven benefit of glycoprotein IIb/IIIa blockers in patients with acute ST-segment elevation myocardial infarction (STEMI), there is still debate on the timing of administration of these drugs and whether all or only a selection of patients should be treated. We evaluated the effect of routine upfront versus provisional use of high-dose tirofiban (HDT) in a large real-world population of non-selected STEMI patients. METHODS Consecutive STEMI patients were registered in a single-centre dedicated database. Patients with upfront HDT therapy before first balloon inflation were compared with patients who received the drug on a provisional basis, after first balloon inflation. Initial TIMI flow of the infarct-related vessel and enzymatic infarct size and 30-day clinical outcome were assessed. RESULTS Out of 2679 primary PCI patients HDT was given upfront in 885 (33.0%) and provisionally in 812 (45.3%). Upfront as compared with provisional HDT showed higher initial patency (22.3 vs. 17.9%, p=0.006), smaller infarct size (1401 IU/l (IQR 609 to 2948) vs. 1620 (753 to 3132), p=0.03) and a lower incidence of death or recurrent MI at 30 days (3.3 vs. 5.1%, p=0.04) without an increase in TIMI bleeding (p=0.24). Upfront HDT independently predicted initial patency (odds ratio (OR) 1.47, 95% confidence interval (CI) 1.15 to 1.88, p=0.02), enzymatic infarct size (OR 0.70, 95% CI 0.56 to 0.86, p=0.001) and 30-day death or recurrent MI (OR 0.59, 95% CI 0.37 to 0.95, p=0.03). CONCLUSION Our findings support the use of upfront potent antiplatelet and antithrombotic therapy in STEMI patients and encourage further clinical investigations in this field. (Neth Heart J 2010;18:592-7.).
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Hermanides RS, van 't Hof AWJ. The Authors' reply. Heart 2011. [DOI: 10.1136/heartjnl-2011-300220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Hermanides RS, Heestermans AACM, ten Berg JM, Gosselink ATM, Ottervanger JP, van Houwelingen KG, Kolkman JJE, Stella PR, Dill T, Hamm C, van 't Hof AWJ. High-dose tirofiban pretreatment reduces the need for bail-out study medication in patients with ST-segment elevation myocardial infarction: results of a subgroup analysis of the On-TIME 2 trial. Heart 2010; 97:106-11. [DOI: 10.1136/hrt.2010.194951] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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