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Gencer B, Gale CP, Aktaa S, Halvorsen S, Beska B, Abdelhamid M, Mueller C, Tutarel O, McGreavy P, Schirmer H, Geissler T, Sillesen H, Niessner A, Zacharowski K, Mehilli J, Potpara T. European Society of Cardiology Quality Indicators for the Cardiovascular Preoperative Assessment and Management of patients considered for non-cardiac surgery. Developed in collaboration with the European Society of Anaesthesiology & Intensive Care. Eur Heart J Qual Care Clin Outcomes 2022:qcac057. [PMID: 36069905 DOI: 10.1093/ehjqcco/qcac057] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
AIMS To establish a set of quality indicators (QIs) for the cardiovascular (CV) assessment and management of patients undergoing non-cardiac surgery. METHODS AND RESULTS The Quality Indicator Committee of the European Society of Cardiology (ESC) and European Society of Anaesthesiology & Intensive Care (ESAIC) in collaboration with Task Force members of the 2022 ESC Guidelines on CV assessment and management of patients undergoing non-cardiac surgery followed the ESC methodology for QI development. This included 1) identification, by constructing a conceptual framework of care, of domains of the CV assessment and management of patients with risk factors or established cardiovascular disease (CVD) who are considered for or undergoing non-cardiac surgery, 2) development of candidate QIs following a systematic literature review, 3) selection of the final set of QIs using a modified Delphi method, 4) evaluation of the feasibility of the developed QIs. In total, eight main and nine secondary QIs were selected across six domains: 1) Structural framework (written policy), 2) Patient education and quality of life (CV risk discussion), 3) Peri-operative risk assessment (indication for diagnostic tests), 4) Peri-operative risk mitigation (use of hospital therapies), 5) Follow-up (post-discharge assessment) and 6) Outcomes (major CV events). CONCLUSION We present the 2022 ESC/ESAIC QIs for the CV assessment and management of patients with risk factors or established CVD who are considered for or are undergoing non-cardiac surgery. These indicators are supported by evidence from the literature, underpinned by expert consensus and align with 2022 ESC Guidelines on CV assessment and management of patients undergoing non-cardiac surgery.
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Affiliation(s)
- Baris Gencer
- Cardiology Division, Geneva University Hospitals, Geneva, Switzerland
- Institute of Primary Health Care (BIHAM), Bern University, Bern, Switzerland
| | - Chris P Gale
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, UK
- Leeds Institute for Data Analytics and Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Suleman Aktaa
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, UK
- Leeds Institute for Data Analytics and Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Sigrun Halvorsen
- Department of Cardiology, Oslo University Hospital Ulleval, Oslo, Norway
| | - Ben Beska
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, UK
- Leeds Institute for Data Analytics and Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Magdy Abdelhamid
- Cardiology Department, Faculty of Medicine, Kase Al Ainy, Cairo University, Cairo, Egypt
| | - Christian Mueller
- Cardiovascular Research Institute Basel, University Heart Center, University Hospital Basel, Basel, Switzerland, University of Basel, Basel, Switzerland
| | - Oktay Tutarel
- Department of Congenital Heart Disease and Paediatric Cardiology, German Heart Centre Munich, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Paul McGreavy
- Patient representatives, European Society of Cardiology (ESC)
| | - Henrik Schirmer
- Department of Cardiology, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, Campus Ahus, University of Oslo, Lørenskog, Norway
| | - Tobias Geissler
- Department of Cardiology and Angiology, University Hospital Tübingen, Tübingen, Germany
| | - Henrik Sillesen
- Vascular Surgery, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark, Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Alexander Niessner
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Kai Zacharowski
- Department Anaesthesiology, Intensive Care Medicine & Pain Therapy, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Julinda Mehilli
- Department of Cardiology, LMU University Hospital and German Centre for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Munich, Germany
- Department of Cardiology, Medizinische Klinik I, Landshut-Achdorf Hospital, Landshut, Germany
| | - Tatjana Potpara
- Cardiology Clinic, University Clinical Centre of Serbia, Belgrade, Serbia
- School of Medicine, University of Belgrade, Serbia
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Kleeberger JA, Ouarrak T, Freund A, Fuernau G, Geissler T, Huber K, Noc M, Montalescot G, Clemmensen P, Zeymer U, Desch S, Schneider S, Hausleiter J, Thiele H, Orban M. ADP-receptor antagonists in patients with acute myocardial infarction complicated by cardiogenic shock: a pooled IABP-SHOCK II and CULPRIT-SHOCK trial sub-analysis. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1513] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Purpose
The purpose of this pooled analysis is to compare the clinical outcome of patients with acute myocardial infarction complicated by cardiogenic shock treated with either clopidogrel or the newer, more potent ADP-receptor antagonists prasugrel or ticagrelor. Patients from the Intraaortic Balloon Pump in Cardiogenic Shock II (IABP-SHOCK II) and Culprit Lesion Only PCI versus Multivessel PCI in Cardiogenic Shock (CULPRIT-SHOCK) trial were included.
Methods and results
For the current analysis, the primary endpoint was 1-year mortality and the secondary safety endpoint was moderate or severe bleedings until hospital discharge with respect to three different ADP-receptor antagonists. Eight hundred fifty-six patients were eligible for analysis. Of these, five hundred seven patients (59.2%) received clopidogrel, one hundred seventy-eight patients (20.8%) prasugrel and one hundred seventy-one patients (20.0%) ticagrelor as acute antiplatelet therapy. The adjusted rate of mortality after 1-year did not differ between prasugrel and clopidogrel (hazard ratio [HR]: 0.81, 95% confidence interval [CI] 0.60–1.09, padj=0.17) or between ticagrelor and clopidogrel treated patients (HR: 0.86, 95% CI 0.65–1.15, padj=0.31). In-hospital bleeding events were significantly less frequent in patients treated with ticagrelor vs. clopidogrel (HR: 0.37, 95% CI 0.20–0.69, padj=0.002) and not different in patients treated with prasugrel vs. clopidogrel (HR: 0.73, 95% CI 0.43–1.24, padj=0.24), see Table 1.
Conclusion
This pooled sub-analysis is the largest analysis on safety and efficacy of three oral ADP-receptor antagonists and shows that an acute therapy with either clopidogrel, prasugrel or ticagrelor is no predictor of 1-year mortality. Treatment with ticagrelor seems to be associated with less in-hospital moderate and severe bleeding events in comparison to clopidogrel.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): German Heart FoundationEuropean Union 7th Framework Program
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Affiliation(s)
| | - T Ouarrak
- Stiftung Institut fuer Herzinfarktforschung, Ludwigshafen, Germany
| | - A Freund
- Heart Center at University of Leipzig, Leipzig, Germany
| | - G Fuernau
- University Heart Center, Luebeck, Germany
| | - T Geissler
- University Hospital of Tuebingen, Tuebingen, Germany
| | - K Huber
- Wilhelminen Hospital, Vienna, Austria
| | - M Noc
- University Medical Centre of Ljubljana, Ljubljana, Slovenia
| | - G Montalescot
- Pitié-Salpêtrière APHP University Hospital, Paris, France
| | - P Clemmensen
- University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - U Zeymer
- Stiftung Institut fuer Herzinfarktforschung, Ludwigshafen, Germany
| | - S Desch
- Heart Center at University of Leipzig, Leipzig, Germany
| | - S Schneider
- Stiftung Institut fuer Herzinfarktforschung, Ludwigshafen, Germany
| | | | - H Thiele
- Heart Center at University of Leipzig, Leipzig, Germany
| | - M Orban
- University Hospital of Munich, Munich, Germany
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Kreuter M, Geissler T, Molinari F, Eichinger M, Ley S, Bonomo L, Heußel CP, Kauczor HU, Herth FJF, Puderbach M. Reproduzierbarkeit der Navigator-getriggerten Sauerstoff-verstärkten MRT der Lunge. Pneumologie 2010. [DOI: 10.1055/s-0030-1251424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Jung F, Matschke K, Mrowietz C, Tugtekin SM, Geissler T, Keller S, Spitzer SG. Influence of radiographic contrast media on myocardial tissue oxygen tension: NaCl-controlled, randomised, comparative study of iohexol versus iopromide in an animal model. Clin Hemorheol Microcirc 2003; 29:53-61. [PMID: 14561904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
It was tested whether a bolus injection of 10 ml radiographic contrast medium (iopromide vs. iohexol), compared to a 10 ml NaCl bolus and administered into the left anterior descending artery (LAD) of farm pigs, influenced the tissue pO2 in the territory of this artery. The radiographic contrast media and the NaCl bolus were given in randomised order. The mean pO2 LAD fell from initially 40.3+/-10.9 mmHg to a minimal value of 22.5+/-8.9 mmHg 241+/-44 sec after injecting the iopromide bolus, with this result representing a mean decrease of 44.2% (p=0.0003). The initial pO2 (baseline) was reached again after approximately 10 minutes. The mean pO2 LAD fell from the initial value of 34.5+/-14.6 mmHg to a minimal value of 29.4+/-13.9 mmHg 171.7+/-11.9 sec after injection of the iohexol bolus, with this result representing a mean decrease of 14.8% (p=0.0003). The baseline pO2 was reached again after approx. 5 minutes. The drop in the pO2 after iopromide administration was significantly larger than that after iohexol (p=0.0001), and also the time after which the baseline pO2 is reached again was considerably shorter for iohexol (p=0.001). The two radiographic contrast media did not influence the tissue pO2 in either the territory of the right coronary artery or in skeletal muscle. Injection of a NaCl bolus into the LAD influenced neither the tissue pO2 of the territory of the LAD nor that of the RCA or of the skeletal muscle. The tissue temperature, heart rate and the systolic and diastolic blood pressure were not affected during the three injections. Injection of radiographic contrast media into a coronary artery can lead to a distinct, local microcirculatory impairment in the myocardial territory supplied by this artery. In this case, the extent of the microcirculation impairment seems to depend not only on the viscosity of the contrast media but rather also on its chemotoxicity.
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Affiliation(s)
- F Jung
- Dresdner Institut für Herz- und Kreislaufforschung, Forststrasse 5, 01099 Dresden, Germany
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Abstract
A nonclinical sample of 102 women students were given the BULIT-R to measure bulimic symptomatology and the Multidimensional Body-Self Relations Questionnaire, a multidimensional measure of body-image parameters. Statistically significant relationships between Appearance Evaluation, Appearance Orientation, and Illness Orientation subscales of the two inventories were identified. These findings indicate that women university students reporting higher scores on bulimic symptoms are more likely to report a general unhappiness with their physical appearance.
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Affiliation(s)
- T Geissler
- Department of Educational Psychology, College of Education, University of Saskatchewan, Saskatoon, Canada
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Abstract
Analysis of 102 undergraduate women's responses replicated the 1993 findings of Janzen, Saklofske, and Kelly considering the relationship between personality characteristics based on the Eysenck Personality Questionnaire--Revised and bulimic symptomatology as measured by the BULIT--R. Consistent with Janzen, et al., the strongest relationship with bulimic symptomatology was for Neuroticism. Also consistent was the lack of relationship with Extraversion scores. At variance with the earlier findings was a weak positive association between reports of bulimic symptoms and scores on Psychoticism.
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Affiliation(s)
- T Geissler
- Department of Educational Psychology, College of Education, University of Saskatchewan, Saskatoon, Canada
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