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Macherey S, Meertens MM, Adler C, Braumann S, Heyne S, Tichelbäcker T, Nießen FS, Christ H, Ahrens I, Baer FM, Eberhardt F, Horlitz M, Meissner A, Sinning JM, Baldus S, Lee S. Impact of respiratory infectious epidemics on STEMI incidence and care. Sci Rep 2021; 11:23066. [PMID: 34845282 PMCID: PMC8630015 DOI: 10.1038/s41598-021-02480-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 11/15/2021] [Indexed: 01/12/2023] Open
Abstract
The effect of respiratory infectious diseases on STEMI incidence, but also STEMI care is not well understood. The Influenza 2017/2018 epidemic and the COVID-19 pandemic were chosen as observational periods to investigate the effect of respiratory virus diseases on these outcomes in a metropolitan area with an established STEMI network. We analyzed data on incidence and care during the COVID-19 pandemic, Influenza 2017/2018 epidemic and corresponding seasonal control periods. Three comparisons were performed: (1) COVID-19 pandemic group versus pandemic control group, (2) COVID-19 pandemic group versus Influenza 2017/2018 epidemic group and (3) Influenza 2017/2018 epidemic group versus epidemic control group. We used Student's t-test, Fisher's exact test and Chi square test for statistical analysis. 1455 patients were eligible. The daily STEMI incidence was 1.49 during the COVID-19 pandemic, 1.40 for the pandemic season control period, 1.22 during the Influenza 2017/2018 epidemic and 1.28 during the epidemic season control group. Median symptom-to-contact time was 180 min during the COVID-19 pandemic. In the pandemic season control group it was 90 min (p = 0.183), and in the Influenza 2017/2018 cohort it was 90 min, too (p = 0.216). Interval in the epidemic control group was 79 min (p = 0.733). The COVID-19 group had a door-to-balloon time of 49 min, corresponding intervals were 39 min for the pandemic season group (p = 0.038), 37 min for the Influenza 2017/2018 group (p = 0.421), and 38 min for the epidemic season control group (p = 0.429). In-hospital mortality was 6.1% for the COVID-19 group, 5.9% for the Influenza 2017/2018 group (p = 1.0), 11% and 11.2% for the season control groups. The respiratory virus diseases neither resulted in an overall treatment delay, nor did they cause an increase in STEMI mortality or incidence. The registry analysis demonstrated a prolonged door-to-balloon time during the COVID-19 pandemic.
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Affiliation(s)
- S. Macherey
- grid.6190.e0000 0000 8580 3777Clinic III for Internal Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - M. M. Meertens
- grid.6190.e0000 0000 8580 3777Clinic III for Internal Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - C. Adler
- grid.6190.e0000 0000 8580 3777Clinic III for Internal Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - S. Braumann
- grid.6190.e0000 0000 8580 3777Clinic III for Internal Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - S. Heyne
- grid.6190.e0000 0000 8580 3777Clinic III for Internal Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - T. Tichelbäcker
- grid.6190.e0000 0000 8580 3777Clinic III for Internal Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - F. S. Nießen
- grid.6190.e0000 0000 8580 3777Clinic III for Internal Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - H. Christ
- grid.6190.e0000 0000 8580 3777Institute of Medical Statistics and Computational Biology, University of Cologne, Cologne, Germany
| | - I. Ahrens
- Department of Cardiology, Augustinerinnen Hospital, Cologne, Germany
| | - F. M. Baer
- grid.459927.40000 0000 8785 9045Department of Cardiology, St. Antonius Hospital, Cologne, Germany
| | - F. Eberhardt
- grid.477199.50000 0004 0389 9672Department of Cardiology, Evangelisches Krankenhaus Kalk, Cologne, Germany
| | - M. Horlitz
- grid.477476.10000 0004 0559 3714Department of Cardiology, Krankenhaus Porz am Rhein, Cologne, Germany
| | - A. Meissner
- grid.491990.cDepartment of Cardiology, Krankenhaus Köln-Merheim, Cologne, Germany
| | - J. M. Sinning
- Department of Cardiology, St. Vinzenz Hospital, Cologne, Germany
| | - S. Baldus
- grid.6190.e0000 0000 8580 3777Clinic III for Internal Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - S. Lee
- grid.6190.e0000 0000 8580 3777Clinic III for Internal Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Str. 62, 50937 Cologne, Germany
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Macherey S, Meertens M, Eichel S, Schipper J, Mauri V, Frerker C, Adam M, Kuhn E, Wahlers T, Lee S, Baldus S, Schmidt T. Stroke and mortality rates after valve-in-valve TAVR and comparison with data from redo SAVR. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2611] [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 and purpose
Early registry data described a potentially increased risk for cerebrovascular events and mortality in patients undergoing transcatheter aortic valve replacement (TAVR) as valve-in-valve (viv) procedures. Further data of small patient cohorts described divergent results for cerebrovascular events and mortality in patients undergoing TAVR as viv procedures for failed surgical bioprotheses in comparison with patients on redo surgical aortic valve replacement (SAVR). We performed a meta-analysis of stroke rates and mortality for viv TAVR procedures basing on the current literature.
Methods
We included all case series (≥10 patients), case-control studies and randomized controlled trials comparing viv TAVR and redo SAVR procedures with respect to cerebrovascular events and mortality rates. Additionally, we included all case series and registries with patients undergoing viv TAVR. After a structured literature research, 17 studies were eligible. For statistical analysis risk ratios and confidence intervals using Mantel-Haenszel test and the I-statistic to quantify possible heterogeneity were calculated. A P-value <0.05 was defined as statistical significant difference.
Results
Eleven case series and registries reporting on stroke and mortality in 8,509 patients undergoing viv TAVR were eligible for analysis. The quantitative analysis of non-comparative studies showed a calculated 30-day stroke rate of 2.2% and 30-day mortality rate of 4.2% after viv TAVR. Data on the 1-year rates were sporadically reported, therefore meta analysis was not appropriately feasible.
Six studies reporting on 498 participants undergoing viv TAVR (N=254) and redo SAVR (N=244) were eligible. The median age ranged from 72.3 to 80.2 years for viv TAVR and from 66.2 to 78.8 years for redo SAVR patients. The STS score was 7.2–7.4% (viv TAVR) and 5.8–7.7% (redo SAVR), respectively. A total of 3/226 participants treated with viv TAVR and 4/214 patients undergoing redo SAVR experienced a stroke during the first 30 postoperative days (N=4 trials, RR 0.86, 95% CI 0.20 to 3.59, p=0.83, I2 = 0%). None of the studies reported sufficient data on the 1-year stroke incidence. The 30-day mortality was 4.3% for viv TAVR and 4.5% for redo SAVR patients. This difference was not significantly different (N=6 trials, RR 0.90, 95% CI 0.40 to 2.05, p=0.80, I2 = 0%). The 1-year mortality rates were 13.3% and 13.6%, respectively (N=2 trials, RR 0.98, 95% CI 0.49 to 1.94, p=0.94, I2 = 0%).
Conclusion
In the current literature favorable stroke and mortality rates at 30 days for patients undergoing viv TAVR are documented. Similar stroke and mortality rates comparing viv TAVR and redo SAVR patients at 30 days were found as well as similar 1-year mortality. A selection bias for the viv TAVR and redo SAVR patients may exist, but cannot be dissolved with this registry analysis, only showing a trend of younger and lower risk patients receiving a redo SAVR procedure.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- S Macherey
- Cologne University Hospital - Heart Center, Cologne, Germany
| | - M Meertens
- Cologne University Hospital - Heart Center, Cologne, Germany
| | - S Eichel
- Cologne University Hospital - Heart Center, Cologne, Germany
| | - J Schipper
- Cologne University Hospital - Heart Center, Cologne, Germany
| | - V Mauri
- Cologne University Hospital - Heart Center, Cologne, Germany
| | - C Frerker
- Cologne University Hospital - Heart Center, Cologne, Germany
| | - M Adam
- Cologne University Hospital - Heart Center, Cologne, Germany
| | - E Kuhn
- Cologne University Hospital - Heart Center, Department of Cardiothoracic Surgery, Cologne, Germany
| | - T Wahlers
- Cologne University Hospital - Heart Center, Department of Cardiothoracic Surgery, Cologne, Germany
| | - S Lee
- Cologne University Hospital - Heart Center, Cologne, Germany
| | - S Baldus
- Cologne University Hospital - Heart Center, Cologne, Germany
| | - T Schmidt
- Cologne University Hospital - Heart Center, Cologne, Germany
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Abstract
Objectives This review presents laser resection as treatment option in pulmonary metastasectomy and summarizes the current evidence. Moreover, it includes the comparison of laser resection and common techniques used in lung metastasectomy. Methods We performed a systematic literature research in Medline and the Cochrane library to detect case series and even randomized trials. All included studies underwent qualitative analysis. Results Laser metastasectomy is a safe procedure. Data regarding relevant clinical end points as hospitalization, duration of chest tube drainage and long-term survival are heterogeneous and still controversial. Laser enucleation decreases the resection volume. Therefore, it leads to a significant reduction of parenchymal loss. Survival rates after laser metastasectomy are equal to the outcome after resection using other techniques. Conclusions Laser resection is a parenchyma-sparing method. Hence, it offers radical metastasectomy even in case of multiple pulmonary lesions or impaired lung capacity.
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Affiliation(s)
- S Macherey
- Medizinische Fakultät, Universität zu Köln, Köln
| | - F Doerr
- Klinik und Poliklinik für Herz- und Thoraxchirurgie, Universität zu Köln, Köln
| | - T Wahlers
- Klinik und Poliklinik für Herz- und Thoraxchirurgie, Universität zu Köln, Köln
| | - K Hekmat
- Klinik und Poliklinik für Herz- und Thoraxchirurgie, Universität zu Köln, Köln
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Macherey S, Doerr F, Gassa A, Seo J, Heldwein M, Stange S, Wahlers T, Hekmat K. Lung Nodules in Cancer Patients: Chest CT Scan Misses Up to 66% of Malignant Nodules. Thorac Cardiovasc Surg 2017. [DOI: 10.1055/s-0037-1598679] [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: 10/20/2022]
Affiliation(s)
- S. Macherey
- Universität zu Köln, Medizinische Fakultät, Köln, Germany
| | - F. Doerr
- Klinik für Herz- und Thoraxchirurgie, Universität zu Köln, Köln, German
| | - A. Gassa
- Klinik für Herz- und Thoraxchirurgie, Universität zu Köln, Köln, German
| | - J.Y. Seo
- Klinik für Herz- und Thoraxchirurgie, Universität zu Köln, Köln, German
| | - M. Heldwein
- Klinik für Herz- und Thoraxchirurgie, Universität zu Köln, Köln, German
| | - S. Stange
- Klinik für Herz- und Thoraxchirurgie, Universität zu Köln, Köln, German
| | - T. Wahlers
- Klinik für Herz- und Thoraxchirurgie, Universität zu Köln, Köln, German
| | - K. Hekmat
- Klinik für Herz- und Thoraxchirurgie, Universität zu Köln, Köln, German
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Stange S, Doerr F, Seo J, Gassa A, Heldwein M, Macherey S, Wahlers T, Hekmat K. Operative Strategy in NSCLC: A Meta-Analysis of 16,943 Patients. Thorac Cardiovasc Surg 2017. [DOI: 10.1055/s-0037-1598889] [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: 10/20/2022]
Affiliation(s)
| | | | - J. Seo
- Uniklinik Köln, Köln, Germany
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Stange S, Doerr F, Gassa A, Seo J, Heldwein M, Macherey S, Wahlers T, Hekmat K. Best Evidence Topic: Avoidance and Treatment of a Bronchial Stump Insufficiency following Major Lung Surgery. Thorac Cardiovasc Surg 2017. [DOI: 10.1055/s-0037-1598682] [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: 10/20/2022]
Affiliation(s)
| | | | | | - J. Seo
- Uniklinik Köln, Köln, Germany
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Seo J, Doerr F, Heldwein M, Stange S, Gassa A, Macherey S, Wahlers T, Hekmat K. Is Video-Assisted Thoracoscopic Surgery (VATS) a Worthy Alternative to Median Sternotomy in Resecting Stage I and II Thymoma? Thorac Cardiovasc Surg 2017. [DOI: 10.1055/s-0037-1598677] [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: 10/20/2022]
Affiliation(s)
- J. Seo
- Department of Cardiothoracic Surgery, University of Cologne, Cologne, Germany
| | - F. Doerr
- Department of Cardiothoracic Surgery, University of Cologne, Cologne, Germany
| | - M. Heldwein
- Department of Cardiothoracic Surgery, University of Cologne, Cologne, Germany
| | - S. Stange
- Department of Cardiothoracic Surgery, University of Cologne, Cologne, Germany
| | - A. Gassa
- Department of Cardiothoracic Surgery, University of Cologne, Cologne, Germany
| | - S. Macherey
- University of Cologne, School of Medicine, Cologne, Germany
| | - T. Wahlers
- Department of Cardiothoracic Surgery, University of Cologne, Cologne, Germany
| | - K. Hekmat
- Department of Cardiothoracic Surgery, University of Cologne, Cologne, Germany
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Macherey S, Doerr F, Heldwein M, Stange S, Wahlers T, Hekmat K. Almost 50 Years of Nd:YAG Laser Resection in Pulmonary Metastasectomy - Lessons Learned from This Period. Thorac Cardiovasc Surg 2016. [DOI: 10.1055/s-0036-1571683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Dörr F, Macherey S, Heldwein M, Stange S, Wahlers T, Hekmat K. Postoperative Pain Reduction in Thoracic Surgery through Multifactorial Treatment Approach. Thorac Cardiovasc Surg 2016. [DOI: 10.1055/s-0036-1571682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Dörr F, Macherey S, Heldwein M, Wahlers T, Hekmat K. Is Surgical Therapy of Pulmonary Metastases from Malignant Melanoma Feasible? Thorac Cardiovasc Surg 2015. [DOI: 10.1055/s-0035-1544371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Macherey S, Dörr F, Heldwein M, Wahlers T, Hekmat K. Strategy to Manage Patients on Antiplatelet Therapy Undergoing Anatomical Lung Resection. Thorac Cardiovasc Surg 2015. [DOI: 10.1055/s-0035-1544368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Macherey S, Preuss SF, Doerr F, Grönke S, Heldwein M, Quaas A, Zander T, Hekmat K. [Surgical therapy of lung metastases from head and neck cancer]. HNO 2014; 62:893-901; quiz 902-3. [PMID: 25294229 DOI: 10.1007/s00106-014-2933-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Pulmonary metastasectomy is an established procedure in oncological therapeutic concepts. A systematic literature search and an analysis of all studies published since 01.01.2000 should evaluate the advantage of pulmonary metastasectomy for patients with primary head and neck cancer. Lung metastases develop in 1.9-13% of head and neck cancer patients. Following metastasectomy, patients reach a median survival of 9.5-78 months and 5-year survival rates of up to 58% are achieved. Intrathoracic recurrence occurs in 18.4-81.8% of patients, selected instances of which can be successfully treated by remetastasectomy. Patients with squamous cell carcinoma have the worst prognosis, but could also become long-term survivors (≥ 60 months). Pulmonary metastasectomy is frequently the only potentially curative therapeutic approach and offers a better long-term survival than nonsurgical therapies. Lung metastasectomy is thus the treatment of choice in selected patients with pulmonary metastases from primary head and neck cancer.
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Affiliation(s)
- S Macherey
- Medizinische Fakultät, Universität zu Köln, Köln, Deutschland
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