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Rikken SAOF, van 't Hof AWJ, ten Berg JM, Kereiakes DJ, Coller BS. Critical Analysis of Thrombocytopenia Associated With Glycoprotein IIb/IIIa Inhibitors and Potential Role of Zalunfiban, a Novel Small Molecule Glycoprotein Inhibitor, in Understanding the Mechanism(s). J Am Heart Assoc 2023; 12:e031855. [PMID: 38063187 PMCID: PMC10863773 DOI: 10.1161/jaha.123.031855] [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] [Indexed: 12/20/2023]
Abstract
Thrombocytopenia is a rare but serious complication of the intravenous glycoprotein IIb/IIIa (GPIIb/IIIa; integrin αIIbβ3) receptor inhibitors (GPIs), abciximab, eptifibatide, and tirofiban. The thrombocytopenia ranges from mild (50 000-100 000 platelets/μL), to severe (20 000 to <50 000/μL), to profound (<20 000/μL). Profound thrombocytopenia appears to occur in <1% of patients receiving their first course of therapy. Thrombocytopenia can be either acute (<24 hours) or delayed (up to ~14 days). Both hemorrhagic and thrombotic complications have been reported in association with thrombocytopenia. Diagnosis requires exclusion of pseudothrombocytopenia and heparin-induced thrombocytopenia. Therapy based on the severity of thrombocytopenia and symptoms may include drug withdrawals and treatment with steroids, intravenous IgG, and platelet transfusions. Abciximab-associated thrombocytopenia is most common and due to either preformed antibodies or antibodies induced in response to abciximab (delayed). Readministration of abciximab is associated with increased risk of thrombocytopenia. Evidence also supports an immune basis for thrombocytopenia associated with the 2 small molecule GPIs. The latter bind αIIbβ3 like the natural ligands and thus induce the receptor to undergo major conformational changes that potentially create neoepitopes. Thrombocytopenia associated with these drugs is also immune-mediated, with antibodies recognizing the αIIbβ3 receptor only in the presence of the drug. It is unclear whether the antibody binding depends on the conformational change and whether the drug contributes directly to the epitope. Zalunfiban, a second-generation subcutaneous small molecule GPI, does not induce the conformational changes; therefore, data from studies of zalunfiban will provide information on the contribution of the conformational changes to the development of GPI-associated thrombocytopenia.
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Affiliation(s)
- Sem A. O. F. Rikken
- Department of CardiologySt. Antonius HospitalNieuwegeinThe Netherlands
- Cardiovascular Research Institute Maastricht (CARIM)MaastrichtThe Netherlands
| | - Arnoud W. J. van 't Hof
- Cardiovascular Research Institute Maastricht (CARIM)MaastrichtThe Netherlands
- Department of CardiologyMUMC+MaastrichtThe Netherlands
- Department of CardiologyZuyderland Medical CentreHeerlenThe Netherlands
| | - Jurriën M. ten Berg
- Department of CardiologySt. Antonius HospitalNieuwegeinThe Netherlands
- Cardiovascular Research Institute Maastricht (CARIM)MaastrichtThe Netherlands
- Department of CardiologyMUMC+MaastrichtThe Netherlands
| | - Dean J. Kereiakes
- The Christ Hospital Heart and Vascular Institute and Lindner Clinical Research CenterCincinnatiOHUSA
| | - Barry S. Coller
- Allen and Frances Adler Laboratory of Blood and Vascular BiologyRockefeller UniversityNew YorkNYUSA
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van den Broek WWA, Gimbel ME, Chan Pin Yin DRPP, Azzahhafi J, Hermanides RS, Runnett C, Storey RF, Austin D, Oemrawsingh R, Cooke J, Galasko G, Walhout RJ, Schellings DAAM, Brinckman SL, The HK, Stoel MG, Heestermans AACM, Nicastia D, Emans ME, van ’t Hof AWJ, Alber H, Gerber R, van Bergen PFMM, Aksoy I, Nasser A, Knaapen P, Botman CJ, Liem A, Kelder JC, ten Berg JM. Conservative versus Invasive Strategy in Elderly Patients with Non-ST-Elevation Myocardial Infarction: Insights from the International POPular Age Registry. J Clin Med 2023; 12:5450. [PMID: 37685517 PMCID: PMC10487667 DOI: 10.3390/jcm12175450] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 08/15/2023] [Accepted: 08/18/2023] [Indexed: 09/10/2023] Open
Abstract
This registry assessed the impact of conservative and invasive strategies on major adverse clinical events (MACE) in elderly patients with non-ST-elevation myocardial infarction (NSTEMI). Patients aged ≥75 years with NSTEMI were prospectively registered from European centers and followed up for one year. Outcomes were compared between conservative and invasive groups in the overall population and a propensity score-matched (PSM) cohort. MACE included cardiovascular death, acute coronary syndrome, and stroke. The study included 1190 patients (median age 80 years, 43% female). CAG was performed in 67% (N = 798), with two-thirds undergoing revascularization. Conservatively treated patients had higher baseline risk. After propensity score matching, 319 patient pairs were successfully matched. MACE occurred more frequently in the conservative group (total population 20% vs. 12%, adjHR 0.53, 95% CI 0.37-0.77, p = 0.001), remaining significant in the PSM cohort (18% vs. 12%, adjHR 0.50, 95% CI 0.31-0.81, p = 0.004). In conclusion, an early invasive strategy was associated with benefits over conservative management in elderly patients with NSTEMI. Risk factors associated with ischemia and bleeding should guide strategy selection rather than solely relying on age.
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Affiliation(s)
- Wout W. A. van den Broek
- Department of Cardiology, St. Antonius Hospital, Koekoekslaan 1, 3435 CM Nieuwegein, The Netherlands; (M.E.G.); (D.R.P.P.C.P.Y.); (J.A.); (J.C.K.); (J.M.t.B.)
| | - Marieke E. Gimbel
- Department of Cardiology, St. Antonius Hospital, Koekoekslaan 1, 3435 CM Nieuwegein, The Netherlands; (M.E.G.); (D.R.P.P.C.P.Y.); (J.A.); (J.C.K.); (J.M.t.B.)
| | - Dean R. P. P. Chan Pin Yin
- Department of Cardiology, St. Antonius Hospital, Koekoekslaan 1, 3435 CM Nieuwegein, The Netherlands; (M.E.G.); (D.R.P.P.C.P.Y.); (J.A.); (J.C.K.); (J.M.t.B.)
| | - Jaouad Azzahhafi
- Department of Cardiology, St. Antonius Hospital, Koekoekslaan 1, 3435 CM Nieuwegein, The Netherlands; (M.E.G.); (D.R.P.P.C.P.Y.); (J.A.); (J.C.K.); (J.M.t.B.)
| | - Renicus S. Hermanides
- Department of Cardiology, Isala Hospital, Dokter van Heesweg 2, 8025 AB Zwolle, The Netherlands;
| | - Craig Runnett
- Department of Cardiology, Northumbria Healthcare NHS Foundation Trust, 8 Silver Fox Way, Newcastle upon Tyne NE27 0QJ, UK;
| | - Robert F. Storey
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield S10 2TN, UK;
| | - David Austin
- Academic Cardiovascular Unit, The James Cook University Hospital, Marton Rd., Middlesbrough TS4 3BW, UK;
| | - Rohit Oemrawsingh
- Department of Cardiology, Albert Schweitzer Hospital, Albert Schweitzerplaats 25, 3318 AT Dordrecht, The Netherlands;
| | - Justin Cooke
- Department of Cardiology, Chesterfield Royal Hospital NHS Foundation Trust, Chesterfield Rd., Calow, Chesterfield S44 5BL, UK;
| | - Gavin Galasko
- Department of Cardiology, Blackpool Teaching Hospital NHS Foundation Trust, Whinney Heys Rd., Blackpool FY3 8NR, UK;
| | - Ronald J. Walhout
- Department of Cardiology, Gelderse Vallei Hospital, Willy Brandtlaan 10, 6716 RP Ede, The Netherlands;
| | - Dirk A. A. M. Schellings
- Department of Cardiology, Slingeland Hospital, Kruisbergseweg 25, 7009 BL Doetinchem, The Netherlands;
| | - Stijn L. Brinckman
- Department of Cardiology, Tergooi MC, Rijksstraatweg 1, 1261 AN Blaricum, The Netherlands;
| | - Hong Kie The
- Department of Cardiology, Treant Zorggroep, Boermarkeweg 60, 7824 AA Emmen, The Netherlands;
| | - Martin G. Stoel
- Department of Cardiology, Medisch Spectrum Twente, Koningstraat 1, 7512 KZ Enschede, The Netherlands;
| | | | - Debby Nicastia
- Department of Cardiology, Gelre Hospital, Albert Schweitzerlaan 31, 7334 DZ Apeldoorn, The Netherlands;
| | - Mireille E. Emans
- Department of Cardiology, Ikazia Hospital, Montessoriweg 1, 3083 AN Rotterdam, The Netherlands;
| | - Arnoud W. J. van ’t Hof
- Department of Cardiology, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands;
- Cardiovascular Research Institute Maastricht, Universiteitssingel 50, 6229 ER Maastricht, The Netherlands
- Department of Cardiology, Zuyderland Medical Centre, Henri Dunantstraat 5, 6419 PC Heerlen, The Netherlands
| | - Hannes Alber
- Department for Internal Medicine and Cardiology, KABEG Klinikum, Feschnigstraße 11, 9020 Klagenfurt am Wörthersee, Austria;
| | - Robert Gerber
- Department of Cardiology, East Sussex Healthcare NHS Foundation Trust, Dane Rd., Seaford BN25 1DH, UK;
| | | | - Ismail Aksoy
- Department of Cardiology, Admiraal de Ruyter Hospital, ‘s-Gravenpolderseweg 114, 4462 RA Goes, The Netherlands;
| | - Abdul Nasser
- Department of Cardiology, South Tyneside and Sunderland NHS Foundation Trust, Harton Ln., South Shields NE34 0PL, UK;
| | - Paul Knaapen
- Department of Cardiology, Amsterdam University Medical Centre, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands;
| | - Cees-Joost Botman
- Department of Cardiology, Sint Jans Gasthuis, Vogelsbleek 5, 6001 BE Weert, The Netherlands;
| | - Anho Liem
- Department of Cardiology, Franciscus Gasthuis, Kleiweg 500, 3045 PM Rotterdam, The Netherlands;
| | - Johannes C. Kelder
- Department of Cardiology, St. Antonius Hospital, Koekoekslaan 1, 3435 CM Nieuwegein, The Netherlands; (M.E.G.); (D.R.P.P.C.P.Y.); (J.A.); (J.C.K.); (J.M.t.B.)
| | - Jurriën M. ten Berg
- Department of Cardiology, St. Antonius Hospital, Koekoekslaan 1, 3435 CM Nieuwegein, The Netherlands; (M.E.G.); (D.R.P.P.C.P.Y.); (J.A.); (J.C.K.); (J.M.t.B.)
- Cardiovascular Research Institute Maastricht, Universiteitssingel 50, 6229 ER Maastricht, The Netherlands
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Azzahhafi J, Bergmeijer TO, van den Broek WWA, Chan Pin Yin DRPP, Rayhi S, Peper J, Bor WL, Claassens DMF, van Schaik RHN, ten Berg JM. Effects of CYP3A4*22 and CYP3A5 on clinical outcome in patients treated with ticagrelor for ST-segment elevation myocardial infarction: POPular Genetics sub-study. Front Pharmacol 2022; 13:1032995. [PMID: 36545312 PMCID: PMC9760790 DOI: 10.3389/fphar.2022.1032995] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 11/23/2022] [Indexed: 12/12/2022] Open
Abstract
Aims: To determine the clinical efficacy, adverse events and side-effect dyspnea of CYP3A4*22 and CYP3A5 expressor status in ticagrelor treated patients. Methods and results: Ticagrelor treated patients from the POPular Genetics randomized controlled trial were genotyped for CYP3A4*22 and CYP3A5*3 alleles. Patients were divided based on their genotype. In total 1,281 patients with ST-segment elevation myocardial infarction (STEMI) were included. CYP3A4*22 carriers (n = 152) versus CYP3A4*22 non-carrier status (n = 1,129) were not found to have a significant correlation with the primary thrombotic endpoint: cardiovascular death, myocardial infarction, definite stent thrombosis and stroke [1.3% vs. 2.5%, adjusted hazard ratio 1.81 (0.43-7.62) p = 0.42], or the primary bleeding endpoint: PLATO major and minor bleeding [13.2% vs. 11.3%, adjusted hazard ratio 0.93 (0.58-1.50) p = 0.77]. Among the CYP3A4*1/*1 patients, CYP3A5 expressors (n = 196) versus non-expressors (n = 926) did not show a significant difference for the primary thrombotic [2.6% vs. 2.5%, adjusted hazard ratio 1.03 (0.39-2.71) p = 0.95], or the primary bleeding endpoint [12.8% vs. 10.9%, adjusted hazard ratio 1.13 (0.73-1.76) p = 0.58]. With respect to dyspnea, no significant difference was observed between CYP3A4*22 carriers versus CYP3A4*22 non-carriers [44.0% vs. 45.0%, odds ratio 1.04 (0.45-2.42) p = 0.93], or in the CYP3A4*1/*1 group, CYP3A5 expressors versus CYP3A5 non-expressors [35.3% vs. 47.8%, odds ratio 0.60 (0.27-1.30) p = 0.20]. Conclusion: In STEMI patients treated with ticagrelor, neither the CYP3A4*22 carriers, nor the CYP3A5 expressor status had a statistical significant effect on thrombotic and bleeding event rates nor on dyspnea. Clinical Trial Registration: ClinicalTrials.gov, identifier NCT01761786.
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Affiliation(s)
- Jaouad Azzahhafi
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, Netherlands,*Correspondence: Jaouad Azzahhafi,
| | | | | | | | - Senna Rayhi
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, Netherlands
| | - Joyce Peper
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, Netherlands
| | - Willem L. Bor
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, Netherlands
| | - Daniel M. F. Claassens
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, Netherlands,Department of Cardiology, Isala, Zwolle, Netherlands
| | - Ron H. N. van Schaik
- Department of Clinical Chemistry, Erasmus Medical Centre, Rotterdam, Netherlands
| | - Jurriën M. ten Berg
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, Netherlands,Cardiovascular Research Institute Maastricht (CARIM), University Medical Center Maastricht, Maastricht, Netherlands
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van den Broek WWA, van Paassen JG, Gimbel ME, Deneer VHM, ten Berg JM, Vreman RA. Cost-effectiveness of clopidogrel vs. ticagrelor in patients of 70 years or older with non-ST-elevation acute coronary syndrome. Eur Heart J Cardiovasc Pharmacother 2022; 9:76-84. [PMID: 35723240 PMCID: PMC9753095 DOI: 10.1093/ehjcvp/pvac037] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 05/13/2022] [Accepted: 06/15/2022] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The POPular AGE trial showed that clopidogrel significantly reduced bleeding risk compared with ticagrelor without any signs of an increase in thrombotic events. The aim of this analysis was to estimate the long-term cost-effectiveness of clopidogrel compared with ticagrelor in these patients aged 70 years or older with non-ST-elevation acute coronary syndrome (NSTE-ACS). METHODS AND RESULTS A 1-year decision tree based on the POPular AGE trial in combination with a lifelong Markov model was developed to compare clopidogrel with ticagrelor in terms of clinical outcomes, costs, and quality-adjusted life years (QALYs) in elderly patients (above 70 year) with NSTE-ACS. Cost-effectiveness was assessed from a Dutch healthcare system perspective. Events rates and utility data observed in the POPular AGE trial were combined with lifetime projections to evaluate costs and effects for a fictional cohort of 1000 patients. Treatment with clopidogrel instead of ticagrelor led to a cost saving of €1484 575 (€1485 per patient) and a decrease of 10.96 QALYs (0.011 QALY per patient) in the fictional cohort. In an alternative base case with equal distribution over health states in the first year, treatment with clopidogrel led to an increase in QALYs. In all scenario analyses, treatment with clopidogrel was cost-saving. CONCLUSION Clopidogrel is a cost-saving alternative to ticagrelor in elderly patients after NSTE-ACS, though regarding overall cost-effectiveness clopidogrel was not superior to ticagrelor, as it resulted in a small negative effect on QALYs. However, based on the results of the alternative base case and clinical outcomes of the POPular AGE trial, clopidogrel could be a reasonable alternative to ticagrelor for elderly NSTE-ACS patients with a higher bleeding risk.
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Affiliation(s)
- Wout W A van den Broek
- Department of Cardiology, St. Antonius Hospital, Koekoekslaan 1, 3435 CM, Nieuwegein, The Netherlands
| | - Jacqueline G van Paassen
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Heidelberglaan 8, 3584 CS, Utrecht, The Netherlands
| | - Marieke E Gimbel
- Department of Cardiology, Onze Lieve Vrouwe Gasthuis, Oosterpark 9, 1091 AC, Amsterdam, The Netherlands
| | - Vera H M Deneer
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Heidelberglaan 8, 3584 CS, Utrecht, The Netherlands,Department of Clinical Pharmacy, Division Laboratories, Pharmacy and Biomedical Genetics, University Medical Centre Utrecht, Heidelberglaan 8, 3584 CS, Utrecht, The Netherlands
| | - Jurriën M ten Berg
- Department of Cardiology, St. Antonius Hospital, Koekoekslaan 1, 3435 CM, Nieuwegein, The Netherlands,Cardiovascular Research Institute Maastricht (CARIM), Universiteitssingel 50, 6229 ER, Maastricht, The Netherlands
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van der Sangen NMR, Rozemeijer R, Chan Pin Yin DRPP, Valgimigli M, Windecker S, James SK, Buccheri S, ten Berg JM, Henriques JPS, Voskuil M, Kikkert WJ. Patient-tailored antithrombotic therapy following percutaneous coronary intervention. Eur Heart J 2021; 42:1038-1046. [PMID: 33515031 PMCID: PMC8244639 DOI: 10.1093/eurheartj/ehaa1097] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [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: 06/11/2020] [Revised: 09/03/2020] [Accepted: 12/24/2020] [Indexed: 12/12/2022] Open
Abstract
Dual antiplatelet therapy has long been the standard of care in preventing coronary and cerebrovascular thrombotic events in patients with chronic coronary syndrome and acute coronary syndrome undergoing percutaneous coronary intervention, but choosing the optimal treatment duration and composition has become a major challenge. Numerous studies have shown that certain patients benefit from either shortened or extended treatment duration. Furthermore, trials evaluating novel antithrombotic strategies, such as P2Y12 inhibitor monotherapy, low-dose factor Xa inhibitors on top of antiplatelet therapy, and platelet function- or genotype-guided (de-)escalation of treatment, have shown promising results. Current guidelines recommend risk stratification for tailoring treatment duration and composition. Although several risk stratification methods evaluating ischaemic and bleeding risk are available to clinicians, such as the use of risk scores, platelet function testing , and genotyping, risk stratification has not been broadly adopted in clinical practice. Multiple risk scores have been developed to determine the optimal treatment duration, but external validation studies have yielded conflicting results in terms of calibration and discrimination and there is limited evidence that their adoption improves clinical outcomes. Likewise, platelet function testing and genotyping can provide useful prognostic insights, but trials evaluating treatment strategies guided by these stratification methods have produced mixed results. This review critically appraises the currently available antithrombotic strategies and provides a viewpoint on the use of different risk stratification methods alongside clinical judgement in current clinical practice.
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Affiliation(s)
- Niels M R van der Sangen
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - Rik Rozemeijer
- Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands
| | - Dean R P P Chan Pin Yin
- Department of Cardiology, St. Antonius Hospital, Koekoekslaan 1, 3435 CM Nieuwegein, the Netherlands
| | - Marco Valgimigli
- Department of Cardiology, Cardiocentro Ticino, Via Tesserete 48, 6900 Lugano, Switzerland
- Department of Cardiology, Bern University Hospital, Freiburgstrasse 18, 3010 Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Bern University Hospital, Freiburgstrasse 18, 3010 Bern, Switzerland
| | - Stefan K James
- Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Dag Hammarskjölds Väg 38, 751 85 Uppsala, Sweden
| | - Sergio Buccheri
- Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Dag Hammarskjölds Väg 38, 751 85 Uppsala, Sweden
| | - Jurriën M ten Berg
- Department of Cardiology, St. Antonius Hospital, Koekoekslaan 1, 3435 CM Nieuwegein, the Netherlands
- Department of Cardiology, University Medical Center Maastricht, P. Debyelaan 25, 6229 HX Maastricht, the Netherlands
| | - José P S Henriques
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - Michiel Voskuil
- Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands
| | - Wouter J Kikkert
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
- Department of Cardiology, Onze Lieve Vrouwe Gasthuis, Oosterparkstraat 9, 1091 AC Amsterdam, the Netherlands
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Chan Pin Yin DRPP, Vos GJA, van der Sangen NMR, Walhout R, Tjon Joe Gin RM, Nicastia DM, Langerveld J, Claassens DMF, Gimbel ME, Azzahhafi J, Bor WL, Oirbans T, Dekker J, Vlachojannis GJ, van Bommel RJ, Appelman Y, Henriques JPS, Kikkert WJ, ten Berg JM. Rationale and Design of the Future Optimal Research and Care Evaluation in Patients with Acute Coronary Syndrome (FORCE-ACS) Registry: Towards "Personalized Medicine" in Daily Clinical Practice. J Clin Med 2020; 9:jcm9103173. [PMID: 33007932 PMCID: PMC7601438 DOI: 10.3390/jcm9103173] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 09/15/2020] [Accepted: 09/22/2020] [Indexed: 11/22/2022] Open
Abstract
Diagnostic and treatment strategies for acute coronary syndrome have improved dramatically over the past few decades, but mortality and recurrent myocardial infarction rates remain high. An aging population with increasing co-morbidities heralds new clinical challenges. Therefore, in order to evaluate and improve current treatment strategies, detailed information on clinical presentation, treatment and follow-up in real-world patients is needed. The Future Optimal Research and Care Evaluation in patients with Acute Coronary Syndrome (FORCE-ACS) registry (ClinicalTrials.gov Identifier: NCT03823547) is a multi-center, prospective real-world registry of patients admitted with (suspected) acute coronary syndrome. Both non-interventional and interventional cardiac centers in different regions of the Netherlands are currently participating. Patients are treated according to local protocols, enabling the evaluation of different diagnostic and treatment strategies used in daily practice. Data collection is performed using electronic medical records and quality-of-life questionnaires, which are sent 1, 12, 24 and 36 months after initial admission. Major end points are all-cause mortality, myocardial infarction, stent thrombosis, stroke, revascularization and all bleeding requiring medical attention. Invasive therapy, antithrombotic therapy including patient-tailored strategies, such as the use of risk scores, pharmacogenetic guided antiplatelet therapy and patient reported outcome measures are monitored. The FORCE-ACS registry provides insight into numerous aspects of the (quality of) care for acute coronary syndrome patients.
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Affiliation(s)
- Dean R. P. P. Chan Pin Yin
- Department of Cardiology, St. Antonius Hospital, 3435 CM Nieuwegein, The Netherlands; (D.M.F.C.); (M.E.G.); (J.A.); (W.L.B.); (T.O.); (J.D.); (J.M.t.B.)
- Correspondence: (D.R.P.P.C.P.Y.); (G.-J.A.V.); Tel.: +31-(0)-88-320-1228 (D.R.P.P.C.P.Y.); +31-(0)-6-21177402 (G.-J.A.V.)
| | - Gert-Jan A. Vos
- Department of Cardiology, St. Antonius Hospital, 3435 CM Nieuwegein, The Netherlands; (D.M.F.C.); (M.E.G.); (J.A.); (W.L.B.); (T.O.); (J.D.); (J.M.t.B.)
- Correspondence: (D.R.P.P.C.P.Y.); (G.-J.A.V.); Tel.: +31-(0)-88-320-1228 (D.R.P.P.C.P.Y.); +31-(0)-6-21177402 (G.-J.A.V.)
| | - Niels M. R. van der Sangen
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, 1105 AZ Amsterdam, The Netherlands; (N.M.R.v.d.S.); (J.P.S.H.)
| | - Ronald Walhout
- Department of Cardiology, Hospital Gelderse Vallei, 6716 RP Ede, The Netherlands;
| | | | - Deborah M. Nicastia
- Department of Cardiology, Gelre Hospitals, 7334 DZ Apeldoorn, The Netherlands;
| | - Jorina Langerveld
- Department of Cardiology, Rivierenland Hospital, 4002 WP Tiel, The Netherlands;
| | - Daniël M. F. Claassens
- Department of Cardiology, St. Antonius Hospital, 3435 CM Nieuwegein, The Netherlands; (D.M.F.C.); (M.E.G.); (J.A.); (W.L.B.); (T.O.); (J.D.); (J.M.t.B.)
| | - Marieke E. Gimbel
- Department of Cardiology, St. Antonius Hospital, 3435 CM Nieuwegein, The Netherlands; (D.M.F.C.); (M.E.G.); (J.A.); (W.L.B.); (T.O.); (J.D.); (J.M.t.B.)
| | - Jaouad Azzahhafi
- Department of Cardiology, St. Antonius Hospital, 3435 CM Nieuwegein, The Netherlands; (D.M.F.C.); (M.E.G.); (J.A.); (W.L.B.); (T.O.); (J.D.); (J.M.t.B.)
| | - Willem L. Bor
- Department of Cardiology, St. Antonius Hospital, 3435 CM Nieuwegein, The Netherlands; (D.M.F.C.); (M.E.G.); (J.A.); (W.L.B.); (T.O.); (J.D.); (J.M.t.B.)
| | - Tom Oirbans
- Department of Cardiology, St. Antonius Hospital, 3435 CM Nieuwegein, The Netherlands; (D.M.F.C.); (M.E.G.); (J.A.); (W.L.B.); (T.O.); (J.D.); (J.M.t.B.)
| | - Johan Dekker
- Department of Cardiology, St. Antonius Hospital, 3435 CM Nieuwegein, The Netherlands; (D.M.F.C.); (M.E.G.); (J.A.); (W.L.B.); (T.O.); (J.D.); (J.M.t.B.)
| | | | | | - Yolande Appelman
- Department of Cardiology, Amsterdam UMC, VU University, Amsterdam Cardiovascular Sciences, 1081 HV Amsterdam, The Netherlands;
| | - José P. S. Henriques
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, 1105 AZ Amsterdam, The Netherlands; (N.M.R.v.d.S.); (J.P.S.H.)
| | - Wouter J. Kikkert
- Department of Cardiology, Onze Lieve Vrouwe Gasthuis, 1091 AC Amsterdam, The Netherlands;
| | - Jurriën M. ten Berg
- Department of Cardiology, St. Antonius Hospital, 3435 CM Nieuwegein, The Netherlands; (D.M.F.C.); (M.E.G.); (J.A.); (W.L.B.); (T.O.); (J.D.); (J.M.t.B.)
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Mahmoodi BK, Tragante V, Kleber ME, Holmes MV, Schmidt AF, McCubrey RO, Howe LJ, Direk K, Allayee H, Baranova EV, Braund PS, Delgado GE, Eriksson N, Gijsberts CM, Gong Y, Hartiala J, Heydarpour M, Pasterkamp G, Kotti S, Kuukasjärvi P, Lenzini PA, Levin D, Lyytikäinen LP, Muehlschlegel JD, Nelson CP, Nikus K, Pilbrow AP, Tang W, van der Laan SW, van Setten J, Vilmundarson RO, Deanfield J, Deloukas P, Dudbridge F, James S, Mordi IR, Teren A, Bergmeijer TO, Body SC, Bots M, Burkhardt R, Cooper-DeHoff RM, Cresci S, Danchin N, Doughty RN, Grobbee DE, Hagström E, Hazen SL, Held C, Hoefer IE, Hovingh GK, Johnson JA, Kaczor MP, Kähönen M, Klungel OH, Laurikka JO, Lehtimäki T, Maitland-van der Zee AH, McPherson R, Palmer CN, Kraaijeveld AO, Pepine CJ, Sanak M, Sattar N, Scholz M, Simon T, Spertus JA, Stewart AFR, Szczeklik W, Thiery J, Visseren FL, Waltenberger J, Richards AM, Lang CC, Cameron VA, Åkerblom A, Pare G, März W, Samani NJ, Hingorani AD, ten Berg JM, Wallentin L, Asselbergs FW, Patel R. Association of Factor V Leiden With Subsequent Atherothrombotic Events: A GENIUS-CHD Study of Individual Participant Data. Circulation 2020; 142:546-555. [PMID: 32654539 PMCID: PMC7493828 DOI: 10.1161/circulationaha.119.045526] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Studies examining the role of factor V Leiden among patients at higher risk of atherothrombotic events, such as those with established coronary heart disease (CHD), are lacking. Given that coagulation is involved in the thrombus formation stage on atherosclerotic plaque rupture, we hypothesized that factor V Leiden may be a stronger risk factor for atherothrombotic events in patients with established CHD. METHODS We performed an individual-level meta-analysis including 25 prospective studies (18 cohorts, 3 case-cohorts, 4 randomized trials) from the GENIUS-CHD (Genetics of Subsequent Coronary Heart Disease) consortium involving patients with established CHD at baseline. Participating studies genotyped factor V Leiden status and shared risk estimates for the outcomes of interest using a centrally developed statistical code with harmonized definitions across studies. Cox proportional hazards regression models were used to obtain age- and sex-adjusted estimates. The obtained estimates were pooled using fixed-effect meta-analysis. The primary outcome was composite of myocardial infarction and CHD death. Secondary outcomes included any stroke, ischemic stroke, coronary revascularization, cardiovascular mortality, and all-cause mortality. RESULTS The studies included 69 681 individuals of whom 3190 (4.6%) were either heterozygous or homozygous (n=47) carriers of factor V Leiden. Median follow-up per study ranged from 1.0 to 10.6 years. A total of 20 studies with 61 147 participants and 6849 events contributed to analyses of the primary outcome. Factor V Leiden was not associated with the combined outcome of myocardial infarction and CHD death (hazard ratio, 1.03 [95% CI, 0.92-1.16]; I2=28%; P-heterogeneity=0.12). Subgroup analysis according to baseline characteristics or strata of traditional cardiovascular risk factors did not show relevant differences. Similarly, risk estimates for the secondary outcomes including stroke, coronary revascularization, cardiovascular mortality, and all-cause mortality were also close to identity. CONCLUSIONS Factor V Leiden was not associated with increased risk of subsequent atherothrombotic events and mortality in high-risk participants with established and treated CHD. Routine assessment of factor V Leiden status is unlikely to improve atherothrombotic events risk stratification in this population.
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Affiliation(s)
- Bakhtawar K. Mahmoodi
- St. Antonius Hospital, department of Cardiology, Koekoekslaan 1, 3435CM, Nieuwegein, the Netherlands
- Division of Hemostasis and Thrombosis, Department of Hematology, UMC Groningen, University of Groningen, Groningen, the Netherlands
| | - Vinicius Tragante
- Department of Cardiology, Division Heart and Lungs, UMC Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Marcus E. Kleber
- Vth Department of Medicine, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Michael V. Holmes
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Medical Research Council Population Health Research Unit at the University of Oxford, Oxford, UK
- National Institute for Health Research Oxford Biomedical Research Centre, Oxford University Hospital, Oxford, UK
| | - Amand F. Schmidt
- Department of Cardiology, Division Heart and Lungs, UMC Utrecht, Utrecht University, Utrecht, the Netherlands
- Institute of Cardiovascular Science and UCL BHF Research Accelerator, Faculty of Population Health Science, University College London, London, UK
| | - Raymond O. McCubrey
- Intermountain Heart Institute, Intermountain Medical Center, Salt Lake City, UT, USA
| | - Laurence J. Howe
- Institute of Cardiovascular Science and UCL BHF Research Accelerator, Faculty of Population Health Science, University College London, London, UK
| | - Kenan Direk
- Institute of Cardiovascular Science and UCL BHF Research Accelerator, Faculty of Population Health Science, University College London, London, UK
| | - Hooman Allayee
- Departments of Preventive Medicine and Biochemistry and Molecular Medicine, Keck School of Medicine of USC, Los Angeles, CA 90033, USA
| | - Ekaterina V. Baranova
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Utrecht, the Netherlands
| | - Peter S. Braund
- Department of Cardiovascular Sciences, University of Leicester, BHF Cardiovascular Research Centre, Glenfield Hospital, Leicester, UK
- NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Groby Road, Leicester, LE3 9QP, UK
| | - Graciela E. Delgado
- Vth Department of Medicine, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | | | | | - Yan Gong
- University of Florida, Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics, 1333 Center Drive, Gainesville, FL 32608, USA
| | - Jaana Hartiala
- Departments of Preventive Medicine and Biochemistry and Molecular Medicine, Keck School of Medicine of USC, Los Angeles, CA 90033, USA
- Institute for Genetic Medicine, Keck School of Medicine of USC, Los Angeles, CA 90033, USA
| | - Mahyar Heydarpour
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Boston, MA 02115, USA
- Harvard Medical School, Harvard University, Boston, MA 02115, USA
| | - Gerard Pasterkamp
- Department of Clinical Chemistry, UMC Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Salma Kotti
- Assistance Publique-Hôpitaux de Paris (APHP), Department of Clinical Pharmacology, Platform of Clinical Research of East Paris (URCEST-CRCEST-CRB HUEP-UPMC), Paris, France
| | - Pekka Kuukasjärvi
- Department of Cardio-Thoracic Surgery, Finnish Cardiovascular Research Center - Tampere, Faculty of Medicine and Health Techonology, Tampere University, Arvo Ylpön katu 34, Tampere 33014, Finland
| | - Petra A. Lenzini
- Washington University School of Medicine, Department of Genetics, Statistical Genomics Division, Saint Louis, Missouri, USA
| | - Daniel Levin
- Division of Molecular and Clinical Medicine, School of Medicine, University of Dundee, Dundee DD1 9SY, Scotland, UK
| | - Leo-Pekka Lyytikäinen
- Department of Clinical Chemistry, Fimlab Laboratories, Arvo Ylpön katu 34, Tampere 33014, Finland
- Department of Clinical Chemistry, Finnish Cardiovascular Research Center - Tampere, Faculty of Medicine and Health Techonology, Tampere University, Tampere 33014, Finland
| | - Jochen D. Muehlschlegel
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Boston, MA 02115, USA
- Harvard Medical School, Harvard University, Boston, MA 02115, USA
| | - Christopher P. Nelson
- Department of Cardiovascular Sciences, University of Leicester, BHF Cardiovascular Research Centre, Glenfield Hospital, Leicester, UK
- NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Groby Road, Leicester, LE3 9QP, UK
| | - Kjell Nikus
- Department of Cardiology, Heart Center, Tampere University Hospital, Ensitie 4, 33520 Tampere, Finland
- Department of Cardiology, Finnish Cardiovascular Research Center - Tampere, Faculty of Medicine and Health Technology, Tampere University, Tampere 33014, Finland
| | - Anna P. Pilbrow
- The Christchurch Heart Institute, University of Otago Christchurch, PO Box 4345, Christchurch 8140, New Zealand
| | - W.H.Wilson Tang
- Department of Cardiovascular and Metabolic Sciences, Lerner Research Institue, Cleveland Clinic, Cleveland, OH 44106, USA
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH 44106, USA
| | - Sander W. van der Laan
- Central Diagnostics Laboratory, Division Laboratories, Pharmacy, and Biomedical Genetics, UMC Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Jessica van Setten
- Department of Cardiology, Division Heart and Lungs, UMC Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Ragnar O. Vilmundarson
- Ruddy Canadian Cardiovascular Genetics Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ontario, Canada
| | - John Deanfield
- Institute of Cardiovascular Science and UCL BHF Research Accelerator, Faculty of Population Health Science, University College London, London, UK
| | - Panos Deloukas
- William Harvey Research Institute, Barts and the London Medical School, Queen Mary University of London, London, UK
- Centre for Genomic Health, Queen Mary University of London, London, UK
| | - Frank Dudbridge
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Stefan James
- Uppsala Clinical Research Center, Uppsala, Sweden
- Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden
| | - Ify R Mordi
- Division of Molecular and Clinical Medicine, School of Medicine, University of Dundee, Dundee DD1 9SY, Scotland, UK
| | - Andrej Teren
- Heart Center Leipzig, Leipzig, Germany
- LIFE Research Center for Civilization Diseases, University of Leipzig, Leipzig, Germany
| | - Thomas O. Bergmeijer
- St. Antonius Hospital, department of Cardiology, Koekoekslaan 1, 3435CM, Nieuwegein, the Netherlands
| | - Simon C. Body
- Department of Anaesthesiology, Boston University School of Medicine, 750 Albany St, Boston, MA 02118, USA
| | - Michiel Bots
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands
| | - Ralph Burkhardt
- LIFE Research Center for Civilization Diseases, University of Leipzig, Leipzig, Germany
- Institute of Clinical Chemistry and Laboratory Medicine, University Hospital Regensburg, Regensburg, Germany
| | - Rhonda M. Cooper-DeHoff
- University of Florida, Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics, 1333 Center Drive, Gainesville, FL 32608, USA
- College of Medicine, Division of Cardiovascular Medicine, University of Florida, 1600 SW Archer Road/Box 100277, Gainesville, FL 32610, USA
| | - Sharon Cresci
- Washington University School of Medicine, Department of Genetics, Statistical Genomics Division, Saint Louis, Missouri, USA
- Washington University School of Medicine, Department of Medicine, Cardiovascular Division, Saint Louis, Missouri, USA
| | - Nicolas Danchin
- Assistance Publique-Hôpitaux de Paris (APHP), Department of Cardiology, Hôpital Européen Georges Pompidou, 75015 Paris, France; FACT (french Alliance for cardiovascular trials); Université Paris Descartes, Paris, France
- Université Paris-Descartes, Paris, France
| | - Robert N. Doughty
- Heart Health Research Group, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand
| | - Diederick E. Grobbee
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands
| | - Emil Hagström
- Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden
- Uppsala University, Dept of Cardiology, Uppsala, Sweden and Uppsala Clinical Research Center, Uppsala, Sweden
| | - Stanley L. Hazen
- Department of Cardiovascular and Metabolic Sciences, Lerner Research Institue, Cleveland Clinic, Cleveland, OH 44106, USA
- Department of Cardiovascular Medicine, Heart and Vascular Institute, and Center for Microbiome and Human Health, Cleveland Clinic, Cleveland, OH 44106, USA
| | - Claes Held
- Uppsala Clinical Research Center, Uppsala, Sweden
- Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden
| | - Imo E. Hoefer
- Department of Clinical Chemistry and Hematology, UMC Utrecht, Utrecht University, Utrecht, the Netherlands
| | - G. Kees Hovingh
- Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Julie A. Johnson
- University of Florida, Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics, 1333 Center Drive, Gainesville, FL 32608, USA
- College of Medicine, Division of Cardiovascular Medicine, University of Florida, 1600 SW Archer Road/Box 100277, Gainesville, FL 32610, USA
| | - Marcin P. Kaczor
- Department of Internal Medicine, Jagiellonian University Medical College, 8 Skawinska Str, 31-066 Kraków, Poland
| | - Mika Kähönen
- Department of Clinical Physiology, Tampere University Hospital, FM1 3rd floor, Tampere 33521, Finland
- Department of Clinical Physiology, Finnish Cardiovascular Research Center - Tampere, Faculty of Medicine and Health Techonology, Tampere University, Tampere 33014, Finland
| | - Olaf H. Klungel
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Utrecht, the Netherlands
| | - Jari O. Laurikka
- Department of Cardio-Thoracic Surgery, Heart Center, Tampere University Hospital, Arvo Ylpön katu 6, Tampere 33521, Finland
- Department of Cardio-Thoracic Surgery, Finnish Cardiovascular Research Center - Tampere, Faculty of Medicine and Health Techonology, Tampere University, Tampere 33014, Finland
| | - Terho Lehtimäki
- Department of Clinical Chemistry, Fimlab Laboratories, Arvo Ylpön katu 34, Tampere 33014, Finland
- Department of Clinical Chemistry, Finnish Cardiovascular Research Center - Tampere, Faculty of Medicine and Health Techonology, Tampere University, Tampere 33014, Finland
| | - Anke H. Maitland-van der Zee
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Utrecht, the Netherlands
- Department of Respiratory Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Ruth McPherson
- Ruddy Canadian Cardiovascular Genetics Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Departments of Medicine and Biochemistry, Microbiology and Immunology, University of Ottawa, Ontario, Canada
| | - Colin N. Palmer
- Pat Macpherson Centre for Pharmacogenetics and Pharmacogenomics, Division of Molecular and Clinical Medicine, Level 5, Mailbox 12, Ninewells Hospital and Medical School, Dundee, UK
| | - Adriaan O. Kraaijeveld
- Department of Cardiology, Division Heart and Lungs, UMC Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Carl J. Pepine
- College of Medicine, Division of Cardiovascular Medicine, University of Florida, 1600 SW Archer Road/Box 100277, Gainesville, FL 32610, USA
| | - Marek Sanak
- Department of Internal Medicine, Jagiellonian University Medical College, 8 Skawinska Str, 31-066 Kraków, Poland
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Markus Scholz
- LIFE Research Center for Civilization Diseases, University of Leipzig, Leipzig, Germany
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany
| | - Tabassome Simon
- Assistance Publique-Hôpitaux de Paris (APHP), Department of Clinical Pharmacology, Platform of Clinical Research of East Paris (URCEST-CRCEST-CRB HUEP-UPMC), FACT (French Alliance for Cardiovascular trials); Sorbonne Université, Paris-06, France
- Paris-Sorbonne University, UPMC-Site St Antoine, 27 Rue Chaligny, 75012, Paris, France
| | - John A. Spertus
- University of Missouri-Kansas City, Kansas City, Missouri, USA
- Saint Luke’s Mid America Heart Institute, 4401 Wornall Road, 9th Floor, Kansas City, MO 64111, USA
| | - Alexandre F. R. Stewart
- Ruddy Canadian Cardiovascular Genetics Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ontario, Canada
| | - Wojciech Szczeklik
- Department of Internal Medicine, Jagiellonian University Medical College, 8 Skawinska Str, 31-066 Kraków, Poland
| | - Joachim Thiery
- LIFE Research Center for Civilization Diseases, University of Leipzig, Leipzig, Germany
- Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University Hospital, Leipzig, Germany
| | - Frank L.J. Visseren
- Department of Vascular Medicine, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands
| | | | - A. Mark Richards
- The Christchurch Heart Institute, University of Otago Christchurch, PO Box 4345, Christchurch 8140, New Zealand
- Cardiovascular Research Institute, National University of Singapore, 1 E Kent Ridge Road, Singapore
| | - Chim C. Lang
- Division of Molecular and Clinical Medicine, School of Medicine, University of Dundee, Dundee DD1 9SY, Scotland, UK
| | - Vicky A. Cameron
- The Christchurch Heart Institute, University of Otago Christchurch, PO Box 4345, Christchurch 8140, New Zealand
| | - Axel Åkerblom
- Uppsala Clinical Research Center, Uppsala, Sweden
- Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden
| | - Guillaume Pare
- McMaster University, Department of Pathology and Molecular Medicine, Hamilton, Canada
- Population Health Research Institute, Hamilton, ON L8L 2X2, Canada
| | - Winfried März
- Vth Department of Medicine, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
- Synlab Academy, Synlab Holding Deutschland GmbH, Mannheim, Germany
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
| | - Nilesh J. Samani
- Department of Cardiovascular Sciences, University of Leicester, BHF Cardiovascular Research Centre, Glenfield Hospital, Leicester, UK
- NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Groby Road, Leicester, LE3 9QP, UK
| | - Aroon D. Hingorani
- Institute of Cardiovascular Science and UCL BHF Research Accelerator, Faculty of Population Health Science, University College London, London, UK
| | - Jurriën M. ten Berg
- St. Antonius Hospital, department of Cardiology, Koekoekslaan 1, 3435CM, Nieuwegein, the Netherlands
| | - Lars Wallentin
- Uppsala Clinical Research Center, Uppsala, Sweden
- Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden
| | - Folkert W. Asselbergs
- Department of Cardiology, Division Heart and Lungs, UMC Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Riyaz Patel
- Institute of Cardiovascular Science and UCL BHF Research Accelerator, Faculty of Population Health Science, University College London, London, UK
- Bart’s Heart Centre, St Bartholomew’s Hospital, London, EC1A2DA, UK
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Willemsen LM, Janssen PW, Hackeng CM, Kelder JC, Tijssen JG, van Straten AH, Soliman-Hamad MA, Deneer VH, Daeter EJ, Sonker U, Klein P, ten Berg JM. A randomized, double-blind, placebo-controlled trial investigating the effect of ticagrelor on saphenous vein graft patency in patients undergoing coronary artery bypass grafting surgery-Rationale and design of the POPular CABG trial. Am Heart J 2020; 220:237-245. [PMID: 31884246 DOI: 10.1016/j.ahj.2019.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 12/06/2019] [Indexed: 12/14/2022]
Abstract
RATIONALE An estimated 15% of saphenous vein grafts (SVGs) occlude in the first year after coronary artery bypass grafting (CABG) despite aspirin therapy. Graft occlusion can result in symptoms, myocardial infarction, and death. SVG occlusion is primarily caused by atherothrombosis, in which platelet activation plays a pivotal role. Evidence regarding the effect of stronger platelet inhibition on SVG patency after CABG is limited. The main objective of the POPular CABG trial is to determine whether dual antiplatelet therapy with aspirin plus ticagrelor improves SVG patency when compared to aspirin alone. STUDY The POPular CABG is a randomized, double-blind, placebo-controlled, multicenter trial investigating the effect of adding ticagrelor to standard aspirin therapy on the rate of SVG occlusion. A total of 500 patients undergoing CABG with ≥ 1 SVG are randomized to ticagrelor or placebo. The primary end point is SVG occlusion rate, assessed with coronary computed tomography angiography at 1 year. Secondary end points are stenoses and occlusions in both SVGs and arterial grafts and SVG failure at 1 year, defined as a composite of SVG occlusion on coronary computed tomography angiography or coronary angiography, SVG revascularization, myocardial infarction in the territory supplied by an SVG, or sudden death. Safety end points are bleeding events at 30 days and 1 year. CONCLUSION The POPular CABG trial investigates whether adding ticagrelor to standard aspirin after CABG reduces the rate of SVG occlusion at 1 year.
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Maeng M, Steg PG, Bhatt DL, Hohnloser SH, Nordaby M, Miede C, Kimura T, Lip GY, Oldgren J, ten Berg JM, Cannon CP. Dabigatran Dual Therapy Versus Warfarin Triple Therapy Post–PCI in Patients With Atrial Fibrillation and Diabetes. JACC Cardiovasc Interv 2019; 12:2346-2355. [DOI: 10.1016/j.jcin.2019.07.059] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 07/09/2019] [Accepted: 07/11/2019] [Indexed: 01/17/2023]
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Godschalk TC, Gimbel ME, Nolet WW, van Kessel DJ, Amoroso G, Dewilde WJ, Wykrzykowska JJ, Janssen PW, Bergmeijer TO, Kelder JC, Heestermans T, ten Berg JM. A clinical risk score to identify patients at high risk of very late stent thrombosis. J Interv Cardiol 2018; 31:159-169. [DOI: 10.1111/joic.12494] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 12/27/2017] [Accepted: 01/04/2018] [Indexed: 01/31/2023] Open
Affiliation(s)
- Thea C. Godschalk
- Department of Cardiology; St Antonius Hospital; Nieuwegein the Netherlands
| | - Marieke E. Gimbel
- Department of Cardiology; St Antonius Hospital; Nieuwegein the Netherlands
| | - Wouter W. Nolet
- Department of Cardiology; St Antonius Hospital; Nieuwegein the Netherlands
| | | | | | | | | | - Paul W. Janssen
- Department of Cardiology; St Antonius Hospital; Nieuwegein the Netherlands
| | | | - Johannes C. Kelder
- Department of Cardiology; St Antonius Hospital; Nieuwegein the Netherlands
| | - Ton Heestermans
- Department of Cardiology; Noordwest Hospital Group; Alkmaar the Netherlands
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Qaderdan K, Vos GJA, McAndrew T, Steg PG, Hamm CW, van‘t Hof A, Mehran R, Deliargyris EN, Bernstein D, Stone GW, ten Berg JM. Outcomes in elderly and young patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention with bivalirudin versus heparin: Pooled analysis from the EUROMAX and HORIZONS-AMI trials. Am Heart J 2017; 194:73-82. [PMID: 29223437 DOI: 10.1016/j.ahj.2017.08.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 08/07/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND Since older age is a strong predictor of not only bleeding but also of ischemic events, understanding the risk:benefit profile of bivalirudin in the elderly undergoing primary percutaneous coronary intervention (pPCI) for ST-segment elevation (STEMI) is important. For this, we aim to compare elderly with young patients, who all underwent pPCI for STEMI and randomly received either bivalirudin or heparin. METHODS We performed a patient-level pooled analysis (n=5800) of two large randomized trials. A total of 2149 (37.1%) elderly patients (>65 years of age) with STEMI were enrolled and randomly assigned to either bivalirudin or heparin with or without a GPI (control group) before pPCI. Clinical outcomes at 30 days were analyzed. RESULTS In elderly patients, bivalirudin significantly reduced non-CABG major bleeding (7.1% vs 10.4%; P<.01), subacute ST (0.4% vs 1.5%; P<.01), and net adverse clinical events (NACE; composite of all-cause mortality, reinfarction, IDR, stroke or protocol-defined non-CABG major bleeding [13.7% vs 17.2%; P=.03]) with comparable rates of stroke, MI, acute ST, or all-cause death, when compared with heparin with or without GPI. CONCLUSIONS In a large group of elderly patients enrolled in the EUROMAX and HORIZONS-AMI trials, bivalirudin was associated with lower 30-day rates of non-CABG major bleeding, subacute ST and NACE, with similar 30-day rates of acute ST and mortality.
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Nijenhuis VJ, Bennaghmouch N, Kuijk JPV, Capodanno D, ten Berg JM. Antithrombotic treatment in patients undergoing transcatheter aortic valve implantation (TAVI). Thromb Haemost 2017; 113:674-85. [DOI: 10.1160/th14-10-0821] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Accepted: 11/27/2014] [Indexed: 12/31/2022]
Abstract
SummaryTranscatheter aortic valve implantation (TAVI) is an established treatment option for symptomatic patients with severe aortic valvular disease who are not suitable for conventional surgical aortic valve replacement. Despite improving experience and techniques, ischaemic and bleeding complications after TAVI remain prevalent and impair survival in this generally old and comorbid-rich population. Due to changing aetiology of complications over time, antiplatelet and anticoagulant therapy after TAVI should be carefully balanced. Empirically, a dual antiplatelet strategy is generally used after TAVI for patients without an indication for oral anticoagulation (OAC; e. g. atrial fibrillation, mechanical mitral valve prosthesis), including aspirin and a thienopyridine. For patients on OAC, a combination of OAC and aspirin or thienopyridine is generally used. This review shows that current registries are unfit to directly compare antithrombotic regimens. Small exploring studies suggest that additional clopidogrel after TAVI only affects bleeding and not ischemic complications. However, these studies are lack in quality in terms of Cochrane criteria. Currently, three randomised controlled trials are recruiting to gather more knowledge about the effects of clopidogrel after TAVI.
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Fabris E, van ’t Hof A, Hamm CW, Lapostolle F, Lassen JF, Goodman SG, ten Berg JM, Bolognese L, Cequier A, Chettibi M, Hammett CJ, Huber K, Janzon M, Merkely B, Storey RF, Zeymer U, Cantor WJ, Tsatsaris A, Kerneis M, Diallo A, Vicaut E, Montalescot G. Clinical impact and predictors of complete ST segment resolution after primary percutaneous coronary intervention: A subanalysis of the ATLANTIC Trial. European Heart Journal: Acute Cardiovascular Care 2017; 8:208-217. [DOI: 10.1177/2048872617727722] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background: In the ATLANTIC (Administration of Ticagrelor in the catheterization laboratory or in the Ambulance for New ST elevation myocardial Infarction to open the Coronary artery) trial the early use of aspirin, anticoagulation, and ticagrelor coupled with very short medical contact-to-balloon times represent good indicators of optimal treatment of ST-elevation myocardial infarction and an ideal setting to explore which factors may influence coronary reperfusion beyond a well-established pre-hospital system. Methods: This study sought to evaluate predictors of complete ST-segment resolution after percutaneous coronary intervention in ST-elevation myocardial infarction patients enrolled in the ATLANTIC trial. ST-segment analysis was performed on electrocardiograms recorded at the time of inclusion (pre-hospital electrocardiogram), and one hour after percutaneous coronary intervention (post-percutaneous coronary intervention electrocardiogram) by an independent core laboratory. Complete ST-segment resolution was defined as ≥70% ST-segment resolution. Results: Complete ST-segment resolution occurred post-percutaneous coronary intervention in 54.9% ( n=800/1456) of patients and predicted lower 30-day composite major adverse cardiovascular and cerebrovascular events (odds ratio 0.35, 95% confidence interval 0.19–0.65; p<0.01), definite stent thrombosis (odds ratio 0.18, 95% confidence interval 0.02–0.88; p=0.03), and total mortality (odds ratio 0.43, 95% confidence interval 0.19–0.97; p=0.04). In multivariate analysis, independent negative predictors of complete ST-segment resolution were the time from symptoms to pre-hospital electrocardiogram (odds ratio 0.91, 95% confidence interval 0.85–0.98; p<0.01) and diabetes mellitus (odds ratio 0.6, 95% confidence interval 0.44–0.83; p<0.01); pre-hospital ticagrelor treatment showed a favorable trend for complete ST-segment resolution (odds ratio 1.22, 95% confidence interval 0.99–1.51; p=0.06). Conclusions: This study confirmed that post-percutaneous coronary intervention complete ST-segment resolution is a valid surrogate marker for cardiovascular clinical outcomes. In the current era of ST-elevation myocardial infarction reperfusion, patients’ delay and diabetes mellitus are independent predictors of poor reperfusion and need specific attention in the future.
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Affiliation(s)
- Enrico Fabris
- Cardiology Department, Isala Heart Center, the Netherlands
- Cardiovascular Department, University of Trieste, Italy
| | - Arnoud van ’t Hof
- Cardiology Department, Isala Heart Center, the Netherlands
- Department of Cardiology, Maastricht University Medical Center, the Netherlands
- Department of Cardiology, Zuyderland Hospital, the Netherlands
| | | | | | - Jens F Lassen
- Department of Cardiology B, Aarhus University Hospital, Denmark
| | - Shaun G Goodman
- Canadian Heart Research Centre, University of Toronto, Canada
| | - Jurriën M ten Berg
- Department of Cardiology, St Antonius Hospital Nieuwegein, the Netherlands
| | - Leonardo Bolognese
- Cardiovascular and Neurological Department, Azienda Ospedaliera Arezzo, Italy
| | - Angel Cequier
- Heart Disease Institute, University of Barcelona, Spain
| | | | | | - Kurt Huber
- Cardiology and Intensive Care Medicine, Wilhelminen Hospital, Austria
- Sigmund Freud Private University, Austria
| | - Magnus Janzon
- Department of Cardiology, Linköping University, Sweden
- Department of Medical and Health Sciences, Linköping University, Sweden
| | - Béla Merkely
- Heart and Vascular Center, Semmelweis University, Hungary
| | - Robert F Storey
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, UK
| | - Uwe Zeymer
- Klinikum Ludwigshafen and Institut für Herzinfarktforschung, Germany
| | - Warren J Cantor
- Southlake Regional Health Centre, University of Toronto, Canada
| | | | | | | | - Eric Vicaut
- ACTION Study Group, Hospital Lariboisiere, France
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Swinkels BM, de Mol BA, Kelder JC, Vermeulen FE, ten Berg JM. New-onset postoperative atrial fibrillation after aortic valve replacement: Effect on long-term survival. J Thorac Cardiovasc Surg 2017; 154:492-498. [DOI: 10.1016/j.jtcvs.2017.02.052] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 01/27/2017] [Accepted: 02/20/2017] [Indexed: 10/20/2022]
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Bergmeijer TO, Janssen PW, van Oevelen M, van Rooijen D, Godschalk TC, Kelder JC, Deneer VH, Serebruany VL, ten Berg JM. Incidence and Causes for Early Ticagrelor Discontinuation: A “Real-World” Dutch Registry Experience. Cardiology 2017; 138:164-168. [DOI: 10.1159/000475705] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 03/31/2017] [Indexed: 11/19/2022]
Abstract
Objectives: The PLATO trial revealed superiority of ticagrelor over clopidogrel for the prevention of atherothrombotic events in patients with acute coronary syndrome. However, adverse events such as bleeding, dyspnea, and bradycardia were frequently reported, potentially leading to excess early ticagrelor discontinuation (ETD), later confirmed in the PEGASUS trial. We here evaluated the incidence and causes for ETD in a real-world patient cohort in a high-volume nonacademic percutaneous coronary intervention center in the Netherlands. Methods: In a retrospective single-center registry, all patients discharged from the hospital with a new ticagrelor prescription were screened for ETD. Follow-up data were obtained using the hospital electronic patient file records and confirmed by telephone contact with the patient and/or general practitioner, if necessary, to complement the data. Results: Ticagrelor was prescribed in 354 patients between December 2011 and December 2012. The follow-up data were available in 301 patients with a mean follow-up duration of 330 days. ETD or switching to another antiplatelet agent occurred in 73 patients (24.3%), mostly due to dyspnea (11.6%), bleeding (3.7%), or planned major surgery (2.7%). Conclusions: Almost one quarter of ticagrelor patients were discontinued prematurely or switched to another antiplatelet agent within 1 year, mostly due to dyspnea or bleeding.
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Liebregts M, Faber L, Jensen MK, Vriesendorp PA, Januska J, Krejci J, Hansen PR, Seggewiss H, Horstkotte D, Adlova R, Bundgaard H, ten Berg JM, Veselka J. Outcomes of Alcohol Septal Ablation in Younger Patients With Obstructive Hypertrophic Cardiomyopathy. JACC Cardiovasc Interv 2017; 10:1134-1143. [DOI: 10.1016/j.jcin.2017.03.030] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 02/21/2017] [Accepted: 03/23/2017] [Indexed: 10/19/2022]
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Godschalk TC, Willemsen LM, Zwart B, Bergmeijer TO, Janssen PWA, Kelder JC, Hackeng CM, ten Berg JM. Effect of Tailored Antiplatelet Therapy to Reduce Recurrent Stent Thrombosis and Cardiac Death After a First Episode of Stent Thrombosis. Am J Cardiol 2017; 119:1500-1506. [PMID: 28318511 DOI: 10.1016/j.amjcard.2017.02.033] [Citation(s) in RCA: 2] [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: 11/10/2016] [Revised: 02/01/2017] [Accepted: 02/01/2017] [Indexed: 10/20/2022]
Abstract
The recurrence rate of coronary stent thrombosis (ST) is high. Patients with ST often demonstrate high on-treatment platelet reactivity (HPR). It is suggested that patients at high risk of atherothrombotic events, that is patients with ST, could benefit from tailored antiplatelet therapy (APT). This study evaluated whether tailored APT, based on platelet function testing, reduced the rate of cardiac death and/or recurrent ST at 1 year after ST, compared with a historical cohort of patients with ST without tailored APT. Patients with definite ST visited our ST outpatient clinic for platelet function testing and tailored APT. These patients were evenly matched to a historical cohort of patients with ST treated with aspirin and clopidogrel, which was the standard of care at that time. The primary end point was a composite of cardiac death and/or recurrent definite ST after 1 year. In total, 113 patients who visited the outpatient clinic were included. HPR was observed in 46%, 6.7%, and 0% of the patients on clopidogrel, prasugrel, and ticagrelor, respectively. After tailored APT, 93% of the patients with HPR demonstrated normal platelet reactivity. The primary end point was observed in 4 patients who had visited the outpatient clinic and in 23 patients of the historical cohort. The odds ratio of tailored APT on the primary end point was 0.26 (95% confidence interval 0.11 to 0.64, p = 0.003), independent from the possible confounders prior myocardial infarction and stent type. In conclusion, the outpatient ST clinic was associated with lower HPR rates in patients with ST after tailored APT. Patients who visited the ST outpatient clinic had a lower risk for cardiac death and/or recurrent ST compared with a historical cohort of patients with ST without tailored APT. Regarding the high HPR rate in patients with ST on clopidogrel, these patients might benefit in particular from the strategy of tailored APT.
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Swinkels BM, de Mol BA, Kelder JC, Vermeulen FE, ten Berg JM. Prosthesis–Patient Mismatch After Aortic Valve Replacement: Effect on Long-Term Survival. Ann Thorac Surg 2016; 101:1388-94. [DOI: 10.1016/j.athoracsur.2016.01.048] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 01/02/2016] [Accepted: 01/11/2016] [Indexed: 10/22/2022]
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Montalescot G, van ’t Hof AW, Bolognese L, Cantor WJ, Cequier A, Chettibi M, Collet JP, Goodman SG, Hammett CJ, Huber K, Janzon M, Lapostolle F, Lassen JF, Licour M, Merkely B, Salhi N, Silvain J, Storey RF, ten Berg JM, Tsatsaris A, Zeymer U, Vicaut E, Hamm CW, Bougherbal R, Bouafia MT, Chettibi M, Nibouche D, Moklati A, Benalia A, Kaid O, Krim M, Hammett C, Garrahy P, Jayasinghe R, Rashford S, Huber K, Neunteufl T, Brussee H, Alber H, Weidinger F, Brunner M, Sipoetz J, Prause G, Baubin M, Sebald D, Cantor W, Vijayaraghavan R, Bata I, Lavoie A, Lassen JF, Ravkilde J, Jensen LO, Christensen AM, Toftegaard M, Köhler D, Montalescot G, Ducrocq G, Danchin N, Henry P, Livarek B, Berthier R, Hovasse T, Garot P, Payot L, Benamer H, Esteve JB, Elhadad S, Teiger E, Bonnet JL, Paganelli F, Cottin Y, Schiele F, Thuaire C, Cayla G, Coste P, Ohlmann P, Cudraz EB, Lantelme P, Perret T, Tron C, De Labriolle A, Aptecar E, Beliard O, Varenne O, El Mahmoud R, Filippi-Codaccioni E, Angoulvant D, Peycher P, Poitrineau O, Tabone X, Ecollan P, Broche C, Lambert Y, Briole N, Beruben A, Porcher N, Auffray JP, Freysz M, Depardieu F, Poubel D, De La Cousaye JE, Bartier JC, Jardel B, Boulanger B, Labourel H, Soulat LC, Lapostolle F, Julie V, Thicoipe M, Capel O, Stibbe O, Carli P, Tazarourte K, Alcouffe F, Aboucaya D, Aubert G, Kierzek G, Cahun-Giraud S, Zeymer U, Hamm C, Dengler T, Prondzinsky R, Biever PM, Schäfer A, Seyfarth M, Lemke B, Werner G, Nef H, Steiger H, Leschke M, Münzel T, Dell Orto MC, Loges C, Schinke M, Koberne F, Reiffen HP, Tiroch K, Wierich D, Kneussel M, Little S, Sauer H, Laufenberg-Feldmann R, Merkely B, Ungi I, Horváth I, Édes I, Mártai I, Bolognese L, Berti S, Chiarella F, Calabria P, Fineschi M, Galvani M, Valgimigli M, Moretti L, Tespili M, Mandó M, Bermano F, Biagioni R, Fabbri A, Ricciardelli A, Petroni MR, Vatteroni UR, Palumbo F, Willems FF, Al Mafragi A, Heestermans TA, Van Eck MJ, Heutz WM, Meppelder H, Jong ARD, Van de Pas H, Fillat ÁC, Tenas MS, Ferrer JM, Peñaranda AS, Ferrer JÁ, Del Blanco BG, Guardiola FM, Ruiz Nodar JM, Romo AÍ, González NV, Nouche RT, De La Llera LD, Hernández García JM, Rivero-Crespo F, Hernández FH, Zamorano Gómez JL, Fárega XJ, Fernández GA, Toboso JL, Carrasco M, Barreiro V, Iglesias Vázquez JA, Montero MDMR, Ortiz FR, Escudero GG, Ingelmo VSB, García AL, Janzon M, Oldgren J, Calais F, Kastberg R, Bergsten PA, Blomberg H, Thörn K, Skoog G, Storey RF, Zaman A, Gerber R, Ryding A, Spence M, Swanson N, Been M, Grosser K, Schofield P, Mackin D, Fell P, Quinn T, Foster T, McManus D, Carson A. Effect of Pre-Hospital Ticagrelor During the First 24 h After Primary Percutaneous Coronary Intervention in Patients With ST-Segment Elevation Myocardial Infarction. JACC Cardiovasc Interv 2016; 9:646-56. [DOI: 10.1016/j.jcin.2015.12.024] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 11/30/2015] [Accepted: 12/15/2015] [Indexed: 01/20/2023]
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Liebregts M, Bol GM, Groen JW, Lieuw-a-Fa M, Heijmen RH, ten Berg JM. FOLFOX chemotherapy as a cause of ventricular septal rupture after alcohol septal ablation for obstructive hypertrophic cardiomyopathy? Int J Cardiol 2016; 207:208-10. [DOI: 10.1016/j.ijcard.2016.01.154] [Citation(s) in RCA: 4] [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] [Received: 01/05/2016] [Accepted: 01/06/2016] [Indexed: 11/26/2022]
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Leunissen TC, Janssen PW, ten Berg JM, Moll FL, Korporaal SJ, de Borst GJ, Pasterkamp G, Urbanus RT. The use of platelet reactivity testing in patients on antiplatelet therapy for prediction of bleeding events after cardiac surgery. Vascul Pharmacol 2016; 77:19-27. [DOI: 10.1016/j.vph.2015.12.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 12/07/2015] [Accepted: 12/21/2015] [Indexed: 02/07/2023]
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Qaderdan K, Ishak M, Heestermans AA, de Vrey E, Jukema JW, Voskuil M, de Boer MJ, van‘t Hof AW, Groenemeijer BE, Vos GJA, Janssen PW, Bergmeijer TO, Kelder JC, Deneer VH, ten Berg JM. Ticagrelor or prasugrel versus clopidogrel in elderly patients with an acute coronary syndrome: Optimization of antiplatelet treatment in patients 70 years and older--rationale and design of the POPular AGE study. Am Heart J 2015; 170:981-985.e1. [PMID: 26542508 DOI: 10.1016/j.ahj.2015.07.030] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 07/20/2015] [Indexed: 10/23/2022]
Abstract
RATIONALE Dual antiplatelet therapy with acetylsalicylic acid in combination with a more potent P2Y12- inhibitor (ticagrelor or prasugrel) is recommended in patients with acute coronary syndrome without ST-segment elevation (NSTE-ACS) to prevent atherothrombotic complications. The evidence on which this recommendation is based shows that ticagrelor and prasugrel reduce atherothrombotic events at the expense of an increase in bleeding events when compared with clopidogrel. However, it remains unclear whether ticagrelor or prasugrel has a better net clinical benefit in elderly patients with NSTE-ACS when compared with clopidogrel. The POPular AGE trial is designed to address the optimal antiplatelet strategy in elderly NSTE-ACS patients. STUDY DESIGN POPular AGE is a multicenter, open-label, randomized controlled trial that aims to include 1000 patients ≥70years of age with NSTE-ACS. Patients are randomly assigned to receive either clopidogrel or a more potent P2Y12 inhibitor (ticagrelor or prasugrel). The first primary end point is any bleeding event requiring medical intervention. The second primary end point is the net clinical benefit, a composite of all-cause mortality, nonfatal myocardial infarction, nonfatal stroke, "PLATelet inhibition and patient Outcomes" major bleeding, or "PLATelet inhibition and patient Outcomes" minor bleeding. Patients will be followed for 1 year after randomization, and analyses will be performed on the basis of intention to treat. CONCLUSION The POPular AGE is the first randomized controlled trial that will assess whether the treatment strategy with clopidogrel will result in fewer bleeding events without compromising the net clinical benefit in patients ≥70years of age with NSTE-ACS when compared with a treatment strategy with ticagrelor or prasugrel.
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Liebregts M, Vriesendorp PA, Mahmoodi BK, Schinkel AF, Michels M, ten Berg JM. A Systematic Review and Meta-Analysis of Long-Term Outcomes After Septal Reduction Therapy in Patients With Hypertrophic Cardiomyopathy. JACC: Heart Failure 2015; 3:896-905. [DOI: 10.1016/j.jchf.2015.06.011] [Citation(s) in RCA: 119] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Revised: 06/09/2015] [Accepted: 06/12/2015] [Indexed: 11/15/2022]
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Dewilde WJM, Janssen PW, Kelder JC, Verheugt FW, De Smet BJ, Adriaenssens T, Vrolix M, Brueren GB, Van Mieghem C, Cornelis K, Vos J, Breet NJ, ten Berg JM. Uninterrupted oral anticoagulation versus bridging in patients with long-term oral anticoagulation during percutaneous coronary intervention: subgroup analysis from the WOEST trial. EUROINTERVENTION 2015; 11:381-90. [DOI: 10.4244/eijy14m06_07] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Jolly SS, Cairns JA, Yusuf S, Meeks B, Pogue J, Rokoss MJ, Kedev S, Thabane L, Stankovic G, Moreno R, Gershlick A, Chowdhary S, Lavi S, Niemelä K, Steg PG, Bernat I, Xu Y, Cantor WJ, Overgaard CB, Naber CK, Cheema AN, Welsh RC, Bertrand OF, Avezum A, Bhindi R, Pancholy S, Rao SV, Natarajan MK, ten Berg JM, Shestakovska O, Gao P, Widimsky P, Džavík V. Randomized trial of primary PCI with or without routine manual thrombectomy. N Engl J Med 2015; 372:1389-98. [PMID: 25853743 PMCID: PMC4995102 DOI: 10.1056/nejmoa1415098] [Citation(s) in RCA: 417] [Impact Index Per Article: 46.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND During primary percutaneous coronary intervention (PCI), manual thrombectomy may reduce distal embolization and thus improve microvascular perfusion. Small trials have suggested that thrombectomy improves surrogate and clinical outcomes, but a larger trial has reported conflicting results. METHODS We randomly assigned 10,732 patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary PCI to a strategy of routine upfront manual thrombectomy versus PCI alone. The primary outcome was a composite of death from cardiovascular causes, recurrent myocardial infarction, cardiogenic shock, or New York Heart Association (NYHA) class IV heart failure within 180 days. The key safety outcome was stroke within 30 days. RESULTS The primary outcome occurred in 347 of 5033 patients (6.9%) in the thrombectomy group versus 351 of 5030 patients (7.0%) in the PCI-alone group (hazard ratio in the thrombectomy group, 0.99; 95% confidence interval [CI], 0.85 to 1.15; P=0.86). The rates of cardiovascular death (3.1% with thrombectomy vs. 3.5% with PCI alone; hazard ratio, 0.90; 95% CI, 0.73 to 1.12; P=0.34) and the primary outcome plus stent thrombosis or target-vessel revascularization (9.9% vs. 9.8%; hazard ratio, 1.00; 95% CI, 0.89 to 1.14; P=0.95) were also similar. Stroke within 30 days occurred in 33 patients (0.7%) in the thrombectomy group versus 16 patients (0.3%) in the PCI-alone group (hazard ratio, 2.06; 95% CI, 1.13 to 3.75; P=0.02). CONCLUSIONS In patients with STEMI who were undergoing primary PCI, routine manual thrombectomy, as compared with PCI alone, did not reduce the risk of cardiovascular death, recurrent myocardial infarction, cardiogenic shock, or NYHA class IV heart failure within 180 days but was associated with an increased rate of stroke within 30 days. (Funded by Medtronic and the Canadian Institutes of Health Research; TOTAL ClinicalTrials.gov number, NCT01149044.).
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Affiliation(s)
- Sanjit S Jolly
- From the Population Health Research Institute and Department of Medicine, McMaster University and Hamilton Health Sciences, Hamilton, ON (S.S.J., S.Y., B.M., J.P., M.J.R., L.T., M.K.N., O.S., P.G.), University of British Columbia, Vancouver (J.A.C.), London Health Sciences Centre, Department of Medicine, London, ON (S.L.), Southlake Regional Health Centre, Newmarket, ON (W.J.C.), Peter Munk Cardiac Centre, University Health Network (C.B.O., V.D.), and St. Michael's Hospital (A.N.C.), Toronto, Mazankowski Alberta Heart Institute, Department of Medicine, Edmonton (R.C.W.), and Quebec Heart-Lung Institute, Laval University, Quebec, QC (O.F.B.) - all in Canada; University Clinic of Cardiology, Sts. Cyril and Methodius University, Skopje, Macedonia (S.K.); Clinical Center of Serbia and Department of Cardiology, Medical Faculty, University of Belgrade, Belgrade, Serbia (G.S.); University Hospital La Paz, Madrid (R.M.); University Hospitals of Leicester, Department of Cardiovascular Sciences, Leicester (A.G.), and University Hospitals South Manchester, Manchester Academic Health Science Centre, Manchester (S.C.) - both in the United Kingdom; Heart Center, Tampere University Hospital, Tampere, Finland (K.N.); Université Paris-Diderot, Sorbonne Paris-Cité, INSERM Unité 1148, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris (P.G.S.); University Hospital and Faculty of Medicine Pilsen, Pilsen (I.B.), and the Third Faculty of Medicine, Charles University Prague, University Hospital Kralovske Vinohrady, Prague (P.W.) - both in the Czech Republic; the Tenth People's Hospital, Tongji University, Shanghai, China (Y.X.); Department of Cardiology and Angiology, Contilla Heart and Vascular Center, Elisabeth-Krankenhaus, Essen, Germany (C.K.N.); Dante Pazzanese Institute of Cardiology, São Paulo (A.A.); Royal North Shore Hospital, Sydney (R.B.); Northeast Clinical Trials Group, Scranton, PA (S.P.); Duke Clinical Research Institute, Durham, NC (S.V.R.); and Department
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Rettig TC, Rigter S, Nijenhuis VJ, van Kuijk JP, ten Berg JM, Heijmen RH, van de Garde EM, Noordzij PG. The Systemic Inflammatory Response Syndrome Predicts Short-Term Outcome After Transapical Transcatheter Aortic Valve Implantation. J Cardiothorac Vasc Anesth 2015; 29:283-7. [DOI: 10.1053/j.jvca.2014.10.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Indexed: 11/11/2022]
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Dewilde WJ, Janssen PW, Verheugt FW, Storey RF, Adriaenssens T, Hansen ML, Lamberts M, ten Berg JM. Reply. J Am Coll Cardiol 2015; 65:516-8. [DOI: 10.1016/j.jacc.2014.10.061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Accepted: 10/27/2014] [Indexed: 11/30/2022]
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Halvorsen S, Andreotti F, ten Berg JM, Cattaneo M, Coccheri S, Marchioli R, Morais J, Verheugt FWA, De Caterina R. Aspirin therapy in primary cardiovascular disease prevention: a position paper of the European Society of Cardiology working group on thrombosis. J Am Coll Cardiol 2014; 64:319-27. [PMID: 25034070 DOI: 10.1016/j.jacc.2014.03.049] [Citation(s) in RCA: 108] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Revised: 03/11/2014] [Accepted: 03/17/2014] [Indexed: 01/12/2023]
Abstract
Although the use of oral anticoagulants (vitamin K antagonists) has been abandoned in primary cardiovascular prevention due to lack of a favorable benefit-to-risk ratio, the indications for aspirin use in this setting continue to be a source of major debate, with major international guidelines providing conflicting recommendations. Here, we review the evidence in favor and against aspirin therapy in primary prevention based on the evidence accumulated so far, including recent data linking aspirin with cancer protection. While awaiting the results of several ongoing studies, we argue for a pragmatic approach to using low-dose aspirin in primary cardiovascular prevention and suggest its use in patients at high cardiovascular risk, defined as ≥2 major cardiovascular events (death, myocardial infarction, or stroke) projected per 100 person-years, who are not at increased risk of bleeding.
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Affiliation(s)
- Sigrun Halvorsen
- Department of Cardiology, Oslo University Hospital Ulleval, Oslo, Norway
| | | | - Jurriën M ten Berg
- Department of Cardiology, St Antonius Hospital, Nieuwegein, the Netherlands
| | - Marco Cattaneo
- Medicina 3, Ospedale San Paolo, Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan, Italy
| | - Sergio Coccheri
- Department of Cardiovascular Disease, University of Bologna, Italy
| | | | | | - Freek W A Verheugt
- Department of Cardiology, Heartcenter, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands
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Ishak M, Ali D, Fokkert MJ, Slingerland RJ, Dikkeschei B, Tolsma RT, Lichtveld RA, Bruins W, Boomars R, Bruheim K, van Eenennaam F, Timmers L, Voskuil M, Doevendans PA, Mosterd A, Hoes AW, ten Berg JM, van 't Hof AWJ. Fast assessment and management of chest pain without ST-elevation in the pre-hospital gateway: rationale and design. Eur Heart J Acute Cardiovasc Care 2014; 4:129-36. [PMID: 25202026 DOI: 10.1177/2048872614549738] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND For chest pain patients without ST-segment elevation in the pre-hospital setting, current clinical guidelines merely offer in-hospital risk stratification and management, as opposed to chest pain patients with ST-segment elevation for whom there is a straightforward pre-hospital strategy for diagnosis, medication regimen and logistics. The FAMOUS TRIAGE study will assess the effects of introducing a pre-hospital triage system that reliably stratifies chest pain patients without ST-segment elevation into 1) patients at high risk for NSTEMI requiring a direct transfer to a PCI-hospital; 2) patients at intermediate risk for a major adverse cardiac event (MACE) who could be evaluated at the nearest non-PCI hospital; and 3) patients at low risk for MACE (benign non-cardiac chest pain) who could have further evaluation at home or in a primary care setting. METHODS The FAMOUS TRIAGE study will be performed in three phases. In the first phase an appropriate pre-hospital risk stratification tool will be designed for chest pain patients without ST-segment elevation by means of a retrospective and a prospective study. The second phase of the project represents the external validation of the risk stratification models, and in the third and final phase an optimal risk stratification tool will be implemented into clinical practice. Clinical and economical endpoints before and after implementation of the pre-hospital risk stratification tool will be compared to assess clinical benefit and cost-effectiveness. CONCLUSION The FAMOUS TRIAGE project is a triple phase study that aims to optimize the pre-hospital management of chest pain patients without ST-segment elevation by providing tools for pre-hospital identification of NSTEMI or exclusion of acute coronary syndrome at home. TRIAL ID NTR4205. Dutch Trial Register [http://www.trialregister.nl]: trial number 4205.
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Affiliation(s)
- Maycel Ishak
- Department of Cardiology, St. Antonius Hospital Nieuwegein, The Netherlands Division Heart and Lungs, Department of Cardiology, University Medical Center Utrecht, The Netherlands
| | - Danish Ali
- Department of Cardiology, Isala Zwolle, The Netherlands
| | | | | | - Bert Dikkeschei
- Department of Clinical Chemistry, Isala Zwolle, The Netherlands
| | - Rudolf T Tolsma
- Regional Ambulance Service IJsselland (abbreviation in Dutch: RAV IJsselland) - Zwolle, The Netherlands
| | - Rob A Lichtveld
- Regional Ambulance Service Utrecht (abbreviation in Dutch: RAVU) - Bilthoven, The Netherlands
| | - Wendy Bruins
- Regional Ambulance Service Utrecht (abbreviation in Dutch: RAVU) - Bilthoven, The Netherlands
| | - René Boomars
- Regional Ambulance Service Utrecht (abbreviation in Dutch: RAVU) - Bilthoven, The Netherlands
| | - Kim Bruheim
- The Decision Group Amsterdam, The Netherlands
| | - Fred van Eenennaam
- The Decision Group Amsterdam, The Netherlands Erasmus School of Accounting and Assurance (ESAA), Erasmus University Rotterdam, The Netherlands
| | - Leo Timmers
- Division Heart and Lungs, Department of Cardiology, University Medical Center Utrecht, The Netherlands
| | - Michiel Voskuil
- Division Heart and Lungs, Department of Cardiology, University Medical Center Utrecht, The Netherlands
| | - Pieter A Doevendans
- Division Heart and Lungs, Department of Cardiology, University Medical Center Utrecht, The Netherlands
| | - Arend Mosterd
- Department of Cardiology, Meander Medical Center Amersfoort, The Netherlands
| | - Arno W Hoes
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands
| | - Jurriën M ten Berg
- Department of Cardiology, St. Antonius Hospital Nieuwegein, The Netherlands
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Balt JC, Wijffels MCEF, Boersma LVA, Wever EFD, ten Berg JM. Continuous rhythm monitoring for ventricular arrhythmias after alcohol septal ablation for hypertrophic cardiomyopathy. Heart 2014; 100:1865-70. [DOI: 10.1136/heartjnl-2014-305593] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Osnabrugge RL, Head SJ, Zijlstra F, ten Berg JM, Hunink MG, Kappetein AP, Janssens ACJ. A systematic review and critical assessment of 11 discordant meta-analyses on reduced-function CYP2C19 genotype and risk of adverse clinical outcomes in clopidogrel users. Genet Med 2014; 17:3-11. [DOI: 10.1038/gim.2014.76] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Accepted: 05/16/2014] [Indexed: 01/08/2023] Open
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Janssen PW, ten Berg JM, Hackeng CM. The use of platelet function testing in PCI and CABG patients. Blood Rev 2014; 28:109-21. [DOI: 10.1016/j.blre.2014.03.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Accepted: 03/11/2014] [Indexed: 11/27/2022]
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Fokkema ML, Kleijn L, van der Meer P, Belonje AM, Achterhof SK, Hillege HL, van 't Hof A, Jukema JW, Peels HO, Henriques JP, ten Berg JM, Vos J, van Gilst WH, van Veldhuisen DJ, Voors AA. Long term effects of epoetin alfa in patients with ST- elevation myocardial infarction. Cardiovasc Drugs Ther 2014; 27:433-9. [PMID: 23784615 DOI: 10.1007/s10557-013-6470-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [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: 11/29/2022]
Abstract
PURPOSE The HEBE III trial showed that epoetin alfa administration in patients with a first ST-elevation myocardial infarction (STEMI) did not improve left ventricular function at 6 weeks after primary percutaneous coronary intervention (PCI). The long term effects of erythropoiesis- stimulating agents on cardiovascular morbidity and mortality are unknown, therefore we evaluated clinical events at 1 year after PCI. METHODS A total of 529 patients with a first STEMI and successful primary PCI were randomized to standard optimal medical treatment (N = 266) or an additional bolus of 60,000 IU epoetin alfa administered intravenously (N = 263) within 3 h after PCI. Analyses were performed by intention to treat. RESULTS At 1 year after STEMI, 485 patients had complete follow-up. The rate of the composite end point of all-cause mortality, re-infarction, target vessel revascularization, stroke and/or heart failure was 6.4 % (N = 15) in the epoetin alfa group and 9.6 % (N = 24) in the control group (p = 0.18). Thromboembolic events were present in 1.3 % (N = 3) of patients in the epoetin alfa group and 2.4 % (N = 6) in the control group. There was no evidence of benefit from epoetin alfa administration in subgroups of patients. CONCLUSIONS Administration of a single bolus of epoetin alfa in patients with STEMI does not result in a reduction of cardiovascular events at 1 year after primary PCI. There was a comparable incidence of thromboembolic complications in both treatment groups, suggesting that epoetin alfa administration is safe at long term.
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Affiliation(s)
- Marieke L Fokkema
- Department of Cardiology, University Medical Center Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands
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Montalescot G, Lassen JF, Hamm CW, Lapostolle F, Silvain J, ten Berg JM, Cantor WJ, Goodman SG, Licour M, Tsatsaris A, van't Hof AW. Ambulance or in-catheterization laboratory administration of ticagrelor for primary percutaneous coronary intervention for ST-segment elevation myocardial infarction: rationale and design of the randomized, double-blind Administration of Ticagrelor in the cath Lab or in the Ambulance for New ST elevation myocardial Infarction to open the Coronary artery (ATLANTIC) study. Am Heart J 2013; 165:515-22. [PMID: 23537967 DOI: 10.1016/j.ahj.2012.12.015] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2012] [Accepted: 12/16/2012] [Indexed: 01/03/2023]
Abstract
Primary percutaneous coronary intervention (PCI) is the treatment of choice for patients presenting with acute ST-segment elevation myocardial infarction (STEMI). However, if catheterization facilities are not immediately available, the effectiveness of PCI can be affected by delays in transfer. Evidence suggests that antiplatelet therapy administered early, preferably in the ambulance during transfer, may provide better and earlier perfusion. Ticagrelor, a direct platelet P2Y12 receptor inhibitor, is indicated for the management of patients with acute coronary syndromes. The ATLANTIC study (NCT01347580; EudraCT 2011-000214-19) is a 30-day international, randomized, parallel-group, placebo-controlled study in male and female patients (aged ≥18 years) who are diagnosed as having STEMI, with intended primary PCI. In total, 1770 patients will be randomized immediately after diagnosis to prehospital administration of ticagrelor 180 mg followed by matching placebo administered in hospital, or prehospital administration of placebo followed by ticagrelor 180 mg administered in hospital. All patients will then receive ticagrelor 90 mg twice daily for 30 days. The coprimary end point is the percentage of patients reaching thrombolysis in myocardial infarction flow grade 3 in the infarct-related artery at initial angiography or achieving ≥70% ST-segment elevation resolution pre-PCI. The primary safety end point is major, life-threatening, or minor bleeding after ticagrelor administration. The results of this study may have an impact on future recommendations for treatment for patients with STEMI.
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Affiliation(s)
- Gilles Montalescot
- Institut de Cardiologie, Centre Hospitalier Universitaire Pitié-Salpêtrière, Paris, France.
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Dewilde WJM, Oirbans T, Verheugt FWA, Kelder JC, De Smet BJGL, Herrman JP, Adriaenssens T, Vrolix M, Heestermans AACM, Vis MM, Tijsen JGP, van 't Hof AW, ten Berg JM. Use of clopidogrel with or without aspirin in patients taking oral anticoagulant therapy and undergoing percutaneous coronary intervention: an open-label, randomised, controlled trial. Lancet 2013; 381:1107-15. [PMID: 23415013 DOI: 10.1016/s0140-6736(12)62177-1] [Citation(s) in RCA: 1195] [Impact Index Per Article: 108.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND If percutaneous coronary intervention (PCI) is required in patients taking oral anticoagulants, antiplatelet therapy with aspirin and clopidogrel is indicated, but such triple therapy increases the risk of serious bleeding. We investigated the safety and efficacy of clopidogrel alone compared with clopidogrel plus aspirin. METHODS We did an open-label, multicentre, randomised, controlled trial in 15 centres in Belgium and the Netherlands. From November, 2008, to November, 2011, adults receiving oral anticoagulants and undergoing PCI were assigned clopidogrel alone (double therapy) or clopidogrel plus aspirin (triple therapy). The primary outcome was any bleeding episode within 1 year of PCI, assessed by intention to treat. This study is registered with ClinicalTrials.gov, number NCT00769938. FINDINGS 573 patients were enrolled and 1-year data were available for 279 (98·2%) patients assigned double therapy and 284 (98·3%) assigned triple therapy. Mean ages were 70·3 (SD 7·0) years and 69·5 (8·0) years, respectively. Bleeding episodes were seen in 54 (19·4%) patients receiving double therapy and in 126 (44·4%) receiving triple therapy (hazard ratio [HR] 0·36, 95% CI 0·26-0·50, p<0·0001). In the double-therapy group, six (2·2%) patients had multiple bleeding events, compared with 34 (12·0%) in the triple-therapy group. 11 (3·9%) patients receiving double therapy required at least one blood transfusion, compared with 27 (9·5%) patients in the triple-therapy group (odds ratio from Kaplan-Meier curve 0·39, 95% CI 0·17-0·84, p=0·011). INTERPRETATION Use of clopiogrel without aspirin was associated with a significant reduction in bleeding complications and no increase in the rate of thrombotic events. FUNDING Antonius Ziekenhuis Foundation, Strect Foundation.
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Breet NJ, van Werkum JW, Bouman HJ, Kelder JC, Harmsze AM, Hackeng CM, ten Berg JM. The Authors' reply. Heart 2012. [DOI: 10.1136/heartjnl-2011-301435] [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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Bergmeijer TO, ten Berg JM. Value of CYP2C19 *2 and *17 genotyping in clinical practice. Promising but not ready yet. Rev Esp Cardiol 2012; 65:205-7. [PMID: 22284726 DOI: 10.1016/j.recesp.2011.09.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2011] [Accepted: 09/18/2011] [Indexed: 11/20/2022]
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Bouman HJ, van Werkum JW, Rudež G, Hackeng CM, Leebeek FWG, ten Cate H, ten Berg JM, de Maat MPM. The relevance of P2Y(12)-receptor gene variation for the outcome of clopidogrel-treated patients undergoing elective coronary stent implantation: a clinical follow-up. Thromb Haemost 2011; 107:189-91. [PMID: 22159428 DOI: 10.1160/th11-05-0306] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2011] [Accepted: 10/14/2011] [Indexed: 01/02/2023]
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Heestermans T, de Boer MJ, van Werkum JW, Mosterd A, Gosselink ATM, Dambrink JHE, van Houwelingen G, Koopmans P, Hamm C, Zijlstra F, ten Berg JM, van 't Hof AWJ. Higher efficacy of pre-hospital tirofiban with longer pre-treatment time to primary PCI: protection for the negative impact of time delay. EUROINTERVENTION 2011; 7:442-8. [PMID: 21764662 DOI: 10.4244/eijv7i4a73] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [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: 11/23/2022]
Abstract
AIMS To evaluate the impact of longer duration of pre-hospital initiated antiplatelet and antithrombotic therapy on outcome in patients with ST-segment elevation myocardial infarction (STEMI). METHODS AND RESULTS In this sub-analysis of the Ongoing Tirofiban in Myocardial Evaluation (On-TIME) 2 trial, we studied, in 1,370 patients, the effect of pre-treatment time (time from administering study medication to time of angiography) on complete ST-segment resolution (STR), initial patency and 30-day mortality. Study medication consisted of high dose tirofiban (HDT) or control (placebo or no HDT) on top of high dose clopidogrel, aspirin and unfractionated heparin. Median pre-treatment time was 55 min (44-70). Longer pre-treatment was associated with longer transportation times, longer in-hospital delay, longer total ischaemic time (all p<0.001) and higher 30-day mortality (3.6% vs. 1.8%, p=0.046). Longer HDT pre-treatment time was independently associated with increased complete STR both before (odds ratio [OR] 1.51, 95%; confidence interval [CI] 0.98-2.32; p=0.06) and after PCI (OR 1.43, 95%; CI 1.02-2.02; p=0.039) and with a significantly improved initial TIMI 2 or 3 flow (51.4% vs. 43.4%, p=0.042) and reduced 30-day mortality (2.1% vs. 5.0%, p=0.047) as compared to longer control pre-treatment. CONCLUSIONS Longer time delay before primary PCI is associated with increased mortality. Pre-treatment with high dose tirofiban, however, may compensate for this negative effect by improving ST-segment resolution and initial patency and by reducing mortality. Further studies should be performed to confirm that this is an attractive therapy for patients with longer delays to reperfusion.
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Affiliation(s)
- Ton Heestermans
- Department of Cardiology, Medisch Centrum Alkmaar, Alkmaar, The Netherlands
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Bouman HJ, Schömig E, van Werkum JW, Velder J, Hackeng CM, Hirschhäuser C, Waldmann C, Schmalz HG, ten Berg JM, Taubert D. Reply to: "Paraoxonase-1 and clopidogrel efficacy". Nat Med 2011. [DOI: 10.1038/nm.2469] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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van der Lienden BT, Swinkels BM, Heijmen RH, Mast EG, De Kroon TL, ten Berg JM. First Valve-in-Valve Direct Transaortic CoreValve Implantation in an Insufficient Sapien Valve. JACC Cardiovasc Interv 2011; 4:1049-50. [DOI: 10.1016/j.jcin.2011.06.014] [Citation(s) in RCA: 6] [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] [Received: 05/18/2011] [Accepted: 06/02/2011] [Indexed: 11/28/2022]
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Bauer T, Bouman HJ, van Werkum JW, Ford NF, ten Berg JM, Taubert D. Impact of CYP2C19 variant genotypes on clinical efficacy of antiplatelet treatment with clopidogrel: systematic review and meta-analysis. BMJ 2011; 343:d4588. [PMID: 21816733 PMCID: PMC3191560 DOI: 10.1136/bmj.d4588] [Citation(s) in RCA: 180] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To evaluate the accumulated information from genetic association studies investigating the impact of variants of the cytochrome P450 (CYP) 2C19 genotype on the clinical efficacy of clopidogrel. DESIGN Systematic review and meta-analysis with a structured search algorithm and prespecified eligibility criteria for retrieval of relevant studies; dominant genetic model assumptions and quantitative methods for calculating summary effect estimates from study level odds ratios; systematic assessment of bias within and between studies; and grading of the cumulative evidence by consensus criteria. DATA SOURCES Medline, Embase, the Cochrane Library, online databases, contents pages and bibliographies of general medical, cardiovascular, pharmacological, and genetic journals. Eligibility criteria for selecting studies Original full length reports assessing the cumulative incidence of major adverse cardiovascular events or stent thrombosis over a follow-up period of at least a month in association with carrier status for the loss of function or gain of function CYP2C19 allele in adult patients with coronary artery disease and a clinical presentation of acute coronary syndrome or stable angina pectoris who were taking clopidogrel. RESULTS 15 studies met the inclusion criteria. The random effects summary odds ratio for stent thrombosis in carriers of at least one CYP2C19 loss of function allele versus non-carriers combining nine studies was 1.77 (95% confidence interval 1.31 to 2.40; P < 0.001). This nominally significant odds ratio was subject to considerable bias across the studies (small study effect bias and replication diversity). The adjustment for these quality modifiers tended to abolish the association. The corresponding random effects summary odds ratio of major adverse cardiovascular events for 12 studies combined was 1.11 (0.89 to 1.39; P = 0.36). The random effects summary odds ratio of stent thrombosis in carriers versus non-carriers of at least one CYP2C19*17 gain of function allele for three studies combined was 0.99 (0.60 to 1.62; P = 0.96), and the corresponding odds ratio of major adverse cardiovascular events in five studies was 0.93 (0.75 to 1.14; P = 0.48). The overall quality of epidemiological evidence was graded as low, which excludes reliable clinical assessments. CONCLUSIONS Accumulated information from genetic association studies does not indicate a substantial or consistent influence of CYP2C19 gene polymorphisms on the clinical efficacy of clopidogrel. The current evidence does not support the use of individualised antiplatelet regimens guided by CYP2C19 genotype.
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Affiliation(s)
- Tim Bauer
- Department of Pharmacology, University Hospital of Cologne, D-50931 Cologne, Germany
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Breet NJ, van Werkum JW, Bouman HJ, Kelder JC, Hackeng CM, ten Berg JM. The relationship between platelet reactivity and infarct-related artery patency in patients presenting with a ST-elevation myocardial infarction. Thromb Haemost 2011; 106:331-6. [PMID: 21713320 DOI: 10.1160/th10-08-0528] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2010] [Accepted: 11/25/2010] [Indexed: 11/05/2022]
Abstract
Both heightened platelet reactivity and an occluded infarct related artery (IRA) on initial angiography and at the time of primary percutaneous coronary intervention (PCI) are associated with a worsened clinical outcome in patients with ST-elevation myocardial infarction (STEMI). However, the relationship between platelet reactivity and IRA patency has not yet been established. Consecutive STEMI-patients were enrolled in this study. Patients who had TIMI-flow (thrombolysis in myocardial infarction) 0 or 1 on initial angiography constituted the occluded IRA group and patients having TIMI-flow 2 or 3 comprised the IRA patent group. Platelet function measurements were performed using the PFA-100 COL/ADP cartridge and light transmittance aggregometry without agonist (spontaneous) and after stimulation with adenosine diphosphate (ADP) and arachidonic acid (AA). Ninety-nine patients were enrolled, of whom 49 presented with an occluded IRA. Multivariate analysis identified the following independent factors to be associated with an occluded IRA; short COL/ADP closure time (ORper quartile increase=0.60; 95% CI, 0.39-.93; p=0.02), the 20 μM ADP-induced light transmittance aggregometry (ORper quartile increase =1.77; 95% CI, 1.15-2.73; p=0.01) and leukocyte counts (odds ratio [OR]=1.21; 95% CI, 1.05-1.39; p = 0.008). In conclusion, heightened platelet reactivity and elevated leukocyte counts are associated with an occluded IRA upon presentation in STEMI-patients. These results emphasise the importance of potent antithrombotic therapy early after the onset of symptoms, to obtain early recanalisation of the IRA.
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Affiliation(s)
- Nicoline J Breet
- St. Antonius Center for Platelet Function Research, St. Antonius Hospital, Nieuwegein, the Netherlands
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ten Berg JM. Error in a study of the comparison of platelet function tests in predicting clinical outcome in patients undergoing coronary artery stent implantation. JAMA 2011; 305:2172-3. [PMID: 21562204 DOI: 10.1001/jama.2011.709] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Breet NJ, van Werkum JW, Bouman HJ, Kelder JC, Harmsze AM, Hackeng CM, ten Berg JM. High on-treatment platelet reactivity to both aspirin and clopidogrel is associated with the highest risk of adverse events following percutaneous coronary intervention. Heart 2011; 97:983-90. [PMID: 21478385 DOI: 10.1136/hrt.2010.220491] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [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: 11/03/2022] Open
Abstract
AIM High on-clopidogrel platelet reactivity (HCPR) and high on-aspirin platelet reactivity (HAPR) are associated with atherothrombotic events following coronary stenting. There are, however, few data concerning high on-treatment platelet reactivity to both aspirin and clopidogrel simultaneously. The aim of the present study was to determine the incidence of dual high on-treatment platelet reactivity (DAPR) and its impact on clinical outcome. METHODS On-treatment platelet reactivity was measured in parallel by ADP- and arachidonic acid-induced light transmittance aggregometry (LTA) (n=921) and the point-of-care VerifyNow system (P2Y12 and aspirin) (n=422) in patients on dual antiplatelet therapy undergoing elective stent implantation. HCPR and HAPR were established by receiver-operator characteristic curve analysis. The primary endpoint was a composite of all-cause death, non-fatal acute myocardial infarction, stent thrombosis and ischaemic stroke at 1-year follow-up. RESULTS The incidence of DAPR varied between 14.7% and 26.9% depending on the platelet function test used. DAPR, assessed by LTA and the VerifyNow system, was highly associated with an adverse clinical outcome. At 1-year follow-up the primary endpoint occurred more frequently in patients with isolated HCPR (11.7%), isolated HAPR (9.6%) or DAPR (10.7%) compared with patients without high on-treatment platelet reactivity (4.2%, all p<0.01) when platelet function was evaluated with LTA. Using the VerifyNow system, patients exhibiting DAPR had the highest risk for the primary endpoint (17.7% vs 4.1% in patients without high on-treatment platelet reactivity, p=0.001). CONCLUSIONS In patients undergoing elective percutaneous coronary intervention, DAPR to aspirin and clopidogrel is present in one in five patients and is associated with a high risk for atherothrombotic events. DAPR measured by the point-of-care VerifyNow system has a higher predictability for atherothrombotic events than LTA. CLINICAL TRIAL REGISTRATION INFORMATION www.clinicaltrials.gov: NCT00352014.
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Affiliation(s)
- Nicoline J Breet
- Department of Cardiology, St Antonius Hospital, Nieuwegein, The Netherlands
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Van den Branden BJ, Post MC, Plokker HW, ten Berg JM, Suttorp MJ. Patent foramen ovale closure using a bioabsorbable closure device: safety and efficacy at 6-month follow-up. JACC Cardiovasc Interv 2011; 3:968-73. [PMID: 20850098 DOI: 10.1016/j.jcin.2010.06.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [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] [Received: 02/04/2010] [Revised: 06/10/2010] [Accepted: 06/27/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVES The aim of this study was to assess the mid-term safety and efficacy of percutaneous patent foramen ovale (PFO) closure using a bioabsorbable device (BioSTAR, NMT Medical, Boston, Massachusetts). BACKGROUND Closure of PFO in patients with cryptogenic stroke has proven to be safe and effective using different types of permanent devices. METHODS All consecutive patients who underwent percutaneous PFO closure with the bioabsorbable closure device between November 2007 and January 2009 were included. Residual shunt was assessed using contrast transthoracic echocardiography. RESULTS Sixty-two patients (55% women, mean age 47.7 ± 11.8 years) underwent PFO closure. The in-hospital complications were a surgical device retrieval in 2 patients (3.2%), device reposition in 1 (1.6%), and a minimal groin hematoma in 6 patients (9.7%). The short-term complications at 1-month follow-up (n = 60) were a transient ischemic attack in the presence of a residual shunt in 1 patient and new supraventricular tachycardia in 7 patients (11.3%). At 6-month follow-up (n = 60), 1 patient without residual shunt developed a transient ischemic attack and 1 developed atrial fibrillation. A mild or moderate residual shunt was noted in 51.7%, 33.9%, and 23.7% after 1-day, 1-month, and 6-month follow-up, respectively. A large shunt was present in 8.3%, 3.4%, and 0% after 1-day, 1-month, and 6-month follow-up. CONCLUSIONS Closure of PFO using the bioabsorbable device is associated with a low complication rate and a low recurrence rate of embolic events. However, a relatively high percentage of mild or moderate residual shunting is still present at 6-month follow-up.
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Affiliation(s)
- Ben J Van den Branden
- Department of Interventional Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands. antoniusziekenhuis.nl
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Luermans JGLM, Post MC, ten Berg JM, Plokker HWT, Suttorp MJ. Long-term outcome of percutaneous closure of secundum-type atrial septal defects in adults. EUROINTERVENTION 2011; 6:604-10. [PMID: 21044914 DOI: 10.4244/eijv6i5a101] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [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: 12/28/2022]
Abstract
AIMS Transcatheter closure of the secundum-type atrial septal defect (ASD) is widely practised. We report complications and efficacy of percutaneous ASD closure in adults using the Amplatzer ASD occluder and the Cardioseal/Starflex device during long-term follow-up. METHODS AND RESULTS Between 1996 and 2008 percutaneous ASD closure was performed in 133 patients (mean age 46.8 ± 16.9 years; 36 men) by using the Amplatzer(r) device in 104 patients and the Cardioseal/Starflex device in 29. During a mean follow-up of 3.4 ± 2.8 years the occurrence of major complications was higher in patients with the Cardioseal/Starflex compared to patients with the Amplatzer(r) devices (17.2 vs. 2.9%, log rank, P=0.005), due to a higher embolisation rate (13.8 vs. 1.0%, log rank, P=0.002). In univariable analysis, the implantation of a Cardioseal/Starflex device (OR 6.0 (CI 1.4-25.2); P=0.01) and a larger device diameter (OR 1.1 (CI 1.0-1.2); P=0.04) were found to be predictors of the occurrence of major complications. Minor complications occurred in 10.5%, recurrent thrombo-embolism in 2.3% and residual shunting at six months was 13.9% without differences between devices. NYHA class improved from 1.8 ± 0.6 before to 1.2 ± 0.4 after closure (P<0.001) without differences between devices. CONCLUSIONS During long-term follow-up, percutaneous ASD closure in adults is safe and effective when using the Amplatzer(r) device. Larger Cardioseal/Starflex devices are related to a higher embolisation rate. Randomised trials are needed.
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Peters BJM, Harmsze AM, ten Berg JM, Maitland-van der Zee AH, Tjoeng MM, de Boer A, Deneer VHM. CYP2C19 and ABCB1 genes and individualized treatment with clopidogrel. Pharmacogenomics 2011; 12:141-4. [DOI: 10.2217/pgs.10.211] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Bas JM Peters
- Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, The Netherlands and Department of Clinical Pharmacy, St Antonius Hospital, Nieuwegein, The Netherlands
| | - Ankie M Harmsze
- UIPS, Utrecht University, The Netherlands and St Antonius Hospital, The Netherlands
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Bouman HJ, Schömig E, van Werkum JW, Velder J, Hackeng CM, Hirschhäuser C, Waldmann C, Schmalz HG, ten Berg JM, Taubert D. Paraoxonase-1 is a major determinant of clopidogrel efficacy. Nat Med 2010; 17:110-6. [PMID: 21170047 DOI: 10.1038/nm.2281] [Citation(s) in RCA: 361] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2010] [Accepted: 11/22/2010] [Indexed: 12/14/2022]
Abstract
Clinical efficacy of the antiplatelet drug clopidogrel is hampered by its variable biotransformation into the active metabolite. The variability in the clinical response to clopidogrel treatment has been attributed to genetic factors, but the specific genes and mechanisms underlying clopidogrel bioactivation remain unclear. Using in vitro metabolomic profiling techniques, we identified paraoxonase-1 (PON1) as the crucial enzyme for clopidogrel bioactivation, with its common Q192R polymorphism determining the rate of active metabolite formation. We tested the clinical relevance of the PON1 Q192R genotype in a population of individuals with coronary artery disease who underwent stent implantation and received clopidogrel therapy. PON1 QQ192 homozygous individuals showed a considerably higher risk than RR192 homozygous individuals of stent thrombosis, lower PON1 plasma activity, lower plasma concentrations of active metabolite and lower platelet inhibition. Thus, we identified PON1 as a key factor for the bioactivation and clinical activity of clopidogrel. These findings have therapeutic implications and may be exploited to prospectively assess the clinical efficacy of clopidogrel.
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Affiliation(s)
- Heleen J Bouman
- Department of Cardiology, St. Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands
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