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Povlsen JA, Rasmussen VG, Vase H, Jensen KT, Terkelsen CJ, Christiansen EH, Mathiassen ON, Poulsen SH. 479Preoperative global longitudinal strain is the best predictor of mortality following transcatheter aortic valve replacement. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Prognosis after transcatheter aortic valve replacement (TAVR) is variable. This might depend on preoperative evaluation of myocardial performance by other measurements than ejection fraction (EF).
Purpose
The aim of this study was to investigate the predictive value of preoperative global longitudinal strain (GLS) and the guidelines specified subtypes of aortic stenosis (AS) on mortality following TAVR.
Methods
We included 511 patients with severe AS who underwent TAVR in the period July 2012–June 2017.
Patients were divided into guidelines-specified subgroups based on EF (EF: ≥50 (NEF) or <50% (LEF)), peak gradient (PG: ≥4 (HG) or <4 m/s (LG)) and flow status (stroke volume index (SVI): ≥35 (NF) or <35 ml/min/kg (LF)): (1) HG-NEF (n=228), (2) HG-LEF (n=91), (3) LG-LF-NEF (n=71) and (4) LG-LF-LEF (n=121). We also investigated the effect of replacing EF by GLS in the guideline specified subgroups (GLS ≤−14 (HGLS) and GLS >−14% (LGLS)).
Results
Mean follow up time was 1033 days. Mean age was 80.2±7.1 years. Median overall survival was 5.3±0.3 years. Comorbidity burden was higher in patients with LF – and LEF status in terms of a higher median plasma creatinine (103 [85; 135], p<0.001) and EurologII score (6.1 [3.4; 9.6], p<0.001).
LG-LF-LEF AS was associated with a significantly worse outcome compared with all other groups (p<0.005, Fig. 1A). High gradient status, irrespective of EF (p=0.88), was associated with the best prognosis with a median survival of 5.0±0.5 and 5.5±0.1 years for NEF and LEF, respectively.
Overall and in patients with HG-NEF, impaired GLS (>−14%) was associated with poor outcome (Fig. 1B–D). There was a trend towards a poorer prognosis with GLS >−14% in LG-LF-NEF AS (p=0.10).
In an univariate analysis impaired GLS >−14% (HR 2.04, p<0.005), LG-LF-LEF status (HR 1.82, p=0.001), PG <4m/s (HR 1.74, p=0.001) and tricuspid regurgitation gradient >30 mmHg (HR 1.63, p<0.001) were significant predictors of mortality in contrast to EF, SVI, age, gender and plasma creatinine.
GLS >−14% emerged as the only significant outcome predictor in a multivariate analysis (HR 1.93, p<0.05).
Figure 1
Conclusion
Impaired global longitudinal strain >−14% was the best individual echocardiographic predictor of overall survival in symptomatic severe AS and could identify a subgroup of patients with HG-NEF AS with a worse prognosis.
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Pedersen CK, Stengaard C, Friesgaard K, Dodt KK, Søndergaard HM, Terkelsen CJ, Bøtker MT. Chest pain in the ambulance; prevalence, causes and outcome - a retrospective cohort study. Scand J Trauma Resusc Emerg Med 2019; 27:84. [PMID: 31464622 PMCID: PMC6716930 DOI: 10.1186/s13049-019-0659-6] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 08/14/2019] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Chest pain is common in acute ambulance transports. This study aims to characterize and compare ambulance-transported chest pain patients to non-chest pain patients and evaluate if patient characteristics and accompanying symptoms accessible at the time of emergency call can predict cause and outcome in chest pain patients. METHODS Retrospective, observational population-based study, including acute ambulance transports. Patient characteristics and symptoms are included in a multivariable risk model to identify characteristics, associated with being discharged without an acute cardiac diagnosis and surviving 30 days after chest pain event. RESULTS In total, 10,033 of 61,088 (16.4%) acute ambulance transports were due to chest pain. In chest pain patients, 30-day mortality was 2.1% (95%CI 1.8-2.4) compared to 6.0% (95%CI 5.7-6.2) in non-chest pain patients. Of chest pain patients, 1054 (10.5%) were diagnosed with acute myocardial infarction, and 5068 (50.5%) were discharged without any diagnosis of disease. This no-diagnosis group had very low 30-day mortality, 0.4% (95%CI 0.2-0.9). Female gender, younger age, chronic pulmonary disease, absence of accompanying symptoms of dyspnoea, radiation, severe pain for > 5 min, clammy skin, uncomfortable, and nausea were associated with being discharged without an acute cardiac diagnosis and surviving 30 days after a chest pain event. CONCLUSION Chest pain is a common reason for ambulance transport, but the majority of patients are discharged without a diagnosis and with a high survival rate. Early risk prediction seems to hold a potential for resource downgrading and thus cost-saving in selected chest pain patients.
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Kaier TE, Stengaard C, Marjot J, Sørensen JT, Alaour B, Stavropoulou‐Tatla S, Terkelsen CJ, Williams L, Thygesen K, Weber E, Marber M, Bøtker HE. Cardiac Myosin-Binding Protein C to Diagnose Acute Myocardial Infarction in the Pre-Hospital Setting. J Am Heart Assoc 2019; 8:e013152. [PMID: 31345102 PMCID: PMC6761674 DOI: 10.1161/jaha.119.013152] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 07/08/2019] [Indexed: 11/16/2022]
Abstract
Background Early triage is essential to improve outcomes in patients with suspected acute myocardial infarction (AMI). This study investigated whether cMyC (cardiac myosin-binding protein), a novel biomarker of myocardial necrosis, can aid early diagnosis of AMI and risk stratification. Methods and Results cMyC and high-sensitivity cardiac troponin T were retrospectively quantified in blood samples obtained by ambulance-based paramedics in a prospective, diagnostic cohort study. Patients with ongoing or prolonged periods of chest discomfort, acute dyspnoea in the absence of known pulmonary disease, or clinical suspicion of AMI were recruited. Discrimination power was evaluated by calculating the area under the receiver operating characteristics curve; diagnostic performance was assessed at predefined thresholds. Diagnostic nomograms were derived and validated using bootstrap resampling in logistic regression models. Seven hundred seventy-six patients with median age 68 [58;78] were recruited. AMI was the final adjudicated diagnosis in 22%. Median symptom to sampling time was 70 minutes. cMyC concentration in patients with AMI was significantly higher than with other diagnoses: 98 [43;855] versus 17 [9;42] ng/L. Discrimination power for AMI was better with cMyC than with high-sensitivity cardiac troponin T (area under the curve, 0.839 versus 0.813; P=0.005). At a previously published rule-out threshold (10 ng/L), cMyC reaches 100% sensitivity and negative predictive value in patients after 2 hours of symptoms. In logistic regression analysis, cMyC is superior to high-sensitivity cardiac troponin T and was used to derive diagnostic and prognostic nomograms to evaluate risk of AMI and death. Conclusions In patients undergoing blood draws very early after symptom onset, cMyC demonstrates improved diagnostic discrimination of AMI and could significantly improve the early triage of patients with suspected AMI.
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Laursen PN, Holmvang L, Lønborg J, Køber L, Høfsten DE, Helqvist S, Clemmensen P, Kelbæk H, Jørgensen E, Lassen JF, Pedersen F, Høi-Hansen T, Raungaard B, Terkelsen CJ, Jensen LO, Sadjadieh G, Engstrøm T. Unreported exclusion and sampling bias in interpretation of randomized controlled trials in patients with STEMI. Int J Cardiol 2019; 289:1-5. [DOI: 10.1016/j.ijcard.2019.04.064] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 02/16/2019] [Accepted: 04/23/2019] [Indexed: 10/26/2022]
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Udesen NJ, Møller JE, Lindholm MG, Eiskjær H, Schäfer A, Werner N, Holmvang L, Terkelsen CJ, Jensen LO, Junker A, Schmidt H, Wachtell K, Thiele H, Engstrøm T, Hassager C. Rationale and design of DanGer shock: Danish-German cardiogenic shock trial. Am Heart J 2019; 214:60-68. [PMID: 31176289 DOI: 10.1016/j.ahj.2019.04.019] [Citation(s) in RCA: 155] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 04/26/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The DanGer Shock trial test the hypothesis that left ventricular (LV) mechanical circulatory support with Impella CP transvalvular microaxial flow pump improves survival in patients with ST segment elevation acute myocardial infarction complicated by cardiogenic shock (AMICS) compared to conventional guideline-driven treatment. This paper describes the rationale and design of the randomized trial, in addition to the baseline characteristics of the population screened and enrolled so far. METHODS The DanGer Shock study is a prospective, multicenter, open-label trial in patients with AMICS randomized 1:1 to Impella CP or current guideline-driven therapy with planned enrollment of 360 patients. Patients comatose after out of hospital cardiac arrest are excluded. Eligible patients are randomized immediately following shock diagnosis. Among patients randomized to receive Impella CP, the device is placed prior to angioplasty. The primary endpoint is all-cause mortality at 180 days. Baseline characteristics of patients screened and randomized in the DanGer Shock as of June 2018 are compared with 2 contemporary AMICS studies. RESULTS As of end of June 2018, 314 patients were screened and 100 patients were randomized. Patients had median arterial lactate of 5.5 mmol/L (interquartile range 3.7-8.8 mmol/L), median systolic blood pressure of 76 mmHg (interquartile range 70-88 mmHg), and median LV ejection fraction of 20% (interquartile range 10%-30%). CONCLUSION The DanGer Shock trial will be the first adequately powered randomized trial to address whether mechanical circulatory LV support with Impella CP can improve survival in AMICS. Baseline characteristics of the first 100 randomized patients indicate a population in profound cardiogenic shock.
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Nepper-Christensen L, Høfsten DE, Helqvist S, Lassen JF, Tilsted HH, Holmvang L, Pedersen F, Joshi F, Sørensen R, Bang L, Bøtker HE, Terkelsen CJ, Maeng M, Jensen LO, Aarøe J, Kelbæk H, Køber L, Engstrøm T, Lønborg J. Interaction of ischaemic postconditioning and thrombectomy in patients with ST-elevation myocardial infarction. Heart 2019; 106:24-32. [PMID: 31315939 DOI: 10.1136/heartjnl-2019-314952] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 05/24/2019] [Accepted: 06/21/2019] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVE The Third Danish Study of Optimal Acute Treatment of Patients with ST-segment Elevation Myocardial Infarction - Ischaemic Postconditioning (DANAMI-3-iPOST) did not show improved clinical outcome in patients with ST-segment elevation myocardial infarction (STEMI) treated with ischaemic postconditioning. However, the use of thrombectomy was frequent and thrombectomy may in itself diminish the effect of ischaemic postconditioning. We evaluated the effect of ischaemic postconditioning in patients included in DANAMI-3-iPOST stratified by the use of thrombectomy. METHODS Patients with STEMI were randomised to conventional primary percutaneous coronary intervention (PCI) or ischaemic postconditioning plus primary PCI. The primary endpoint was a combination of all-cause mortality and hospitalisation for heart failure. RESULTS From March 2011 until February 2014, 1234 patients were included with a median follow-up period of 35 (interquartile range 28 to 42) months. There was a significant interaction between ischaemic postconditioning and thrombectomy on the primary endpoint (p=0.004). In patients not treated with thrombectomy (n=520), the primary endpoint occurred in 33 patients (10%) who underwent ischaemic postconditioning (n=326) and in 35 patients (18%) who underwent conventional treatment (n=194) (adjusted hazard ratio (HR) 0.55 (95%confidence interval (CI) 0.34 to 0.89), p=0.016). In patients treated with thrombectomy (n=714), there was no significant difference between patients treated with ischaemic postconditioning (n=291) and conventional PCI (n=423) on the primary endpoint (adjusted HR 1.18 (95% CI 0.62 to 2.28), p=0.62). CONCLUSIONS In this post-hoc study of DANAMI-3-iPOST, ischaemic postconditioning, in addition to primary PCI, was associated with reduced risk of all-cause mortality and hospitalisation for heart failure in patients with STEMI not treated with thrombectomy. TRIAL REGISTRATION NUMBER NCT01435408.
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Maeng M, Christiansen EH, Raungaard B, Kahlert J, Terkelsen CJ, Kristensen SD, Carstensen S, Aarøe J, Jensen SE, Villadsen AB, Lassen JF, Thim T, Eftekhari A, Veien KT, Hansen KN, Junker A, Bøtker HE, Jensen LO, Maeng M, Bøtker HE, Christiansen EH, Raungaard B, Jensen SE, Hansen HS, Jensen LO, Bargsteen H, Pedersen H, Jørgensen LP, Ottosen P, Pedersen KM, Thygesen K, Sørensen JT, Andersen HR, Kahlert J. Everolimus-Eluting Versus Biolimus-Eluting Stents With Biodegradable Polymers in Unselected Patients Undergoing Percutaneous Coronary Intervention. JACC Cardiovasc Interv 2019; 12:624-633. [DOI: 10.1016/j.jcin.2018.12.036] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 12/26/2018] [Indexed: 11/24/2022]
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Jensen JM, Bøtker HE, Mathiassen ON, Grove EL, Øvrehus KA, Pedersen KB, Terkelsen CJ, Christiansen EH, Maeng M, Leipsic J, Kaltoft A, Jakobsen L, Sørensen JT, Thim T, Kristensen SD, Krusell LR, Nørgaard BL. Computed tomography derived fractional flow reserve testing in stable patients with typical angina pectoris: influence on downstream rate of invasive coronary angiography. Eur Heart J Cardiovasc Imaging 2019; 19:405-414. [PMID: 28444153 PMCID: PMC5915944 DOI: 10.1093/ehjci/jex068] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 03/18/2017] [Indexed: 12/11/2022] Open
Abstract
Aims To assess the use of downstream coronary angiography (ICA) and short-term safety of frontline coronary CT angiography (CTA) with selective CT-derived fractional flow reserve (FFRCT) testing in stable patients with typical angina pectoris. Methods and results Between 1 January 2016 and 30 June 2016 all patients (N = 774) referred to non-emergent ICA or coronary CTA at Aarhus University Hospital on a suspicion of CAD had frontline CTA performed. Downstream testing and treatment within 3 months and adverse events ≥90 days were registered. Patients were divided into two groups according to the presence of typical angina pectoris, which according to local practice would have resulted in referral to ICA, (low-intermediate-risk, n = 593 [76%]; high-risk, n = 181 [24%]) with mean pre-test probability of CAD of 31 ± 16% and 67 ± 16%, respectively. Coronary CTA was performed in 745 (96%) patients in whom FFRCT was prescribed in 212 (28%) patients. In the high- vs. low-intermediate-risk group, ICA was cancelled in 75% vs. 91%. Coronary revascularization was performed more frequently in high-risk than in low-intermediate-risk patients, 76% vs. 52% (P = 0.03). Mean follow-up time was 157 ± 50 days. Serious clinical events occurred in four patients, but not in any patients with cancelled ICA by coronary CTA with selective FFRCT testing. Conclusion Frontline coronary CTA with selective FFRCT testing in stable patients with typical angina pectoris in real-world practice is associated with a high rate of safe cancellation of planned ICAs.
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Tarantini G, Lefèvre T, Terkelsen CJ, Frerker C, Ohlmann P, Mojoli M, Eltchaninoff H, Pinaud F, Redwood S, Windecker S. One-Year Outcomes of a European Transcatheter Aortic Valve Implantation Cohort According to Surgical Risk. Circ Cardiovasc Interv 2019; 12:e006724. [DOI: 10.1161/circinterventions.118.006724] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Jørgensen TH, De Backer O, Nissen H, Terkelsen CJ, Mortensen PE, Klaaborg KE, Aarøe J, Christiansen EH, Søndergaard L. [Transcatheter aortic valve implantation in Denmark]. Ugeskr Laeger 2018; 180:V05180340. [PMID: 30274590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
During the latest decade, transcatheter aortic valve implantation (TAVI) has evolved from being indicated only in patients with severe aortic stenosis and prohibitive or high surgical risk, to be an alternative to surgical aortic valve replacement in patients with intermediate surgical risk. Improvements of the peri-procedural management have resulted in marked reduction of complications and an increasing number of patients treated with TAVI every year in Denmark. By a minimalist approach, TAVI can be performed in local anesthaesia, with same day mobilisation and discharge within few days, without affecting the safety.
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Hansen KN, Bendix K, Antonsen L, Veien KT, Mæng M, Junker A, Christiansen EH, Kahlert J, Terkelsen CJ, Christensen LB, Fallesen CO, Boetker HE, Jensen LO. One-year rehospitalisation after percutaneous coronary intervention: a retrospective analysis. EUROINTERVENTION 2018; 14:926-934. [DOI: 10.4244/eij-d-17-00800] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Ellert J, Christiansen EH, Maeng M, Raungaard B, Jensen SE, Kristensen SD, Veien KT, Junker AB, Jakobsen L, Aarøe J, Terkelsen CJ, Kahlert J, Villadsen AB, Bøtker HE, Jensen LO. Impact of diabetes on clinical outcomes after revascularization with sirolimus‐eluting and biolimus‐eluting stents with biodegradable polymer from the SORT OUT VII trial. Catheter Cardiovasc Interv 2018; 93:567-573. [DOI: 10.1002/ccd.27891] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 07/25/2018] [Accepted: 08/29/2018] [Indexed: 11/11/2022]
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Frederiksen CA, Nielsen R, Frederiksen AS, Christensen S, Greisen J, Vase H, Logstrup BB, Mellemkjaer S, Wiggers H, Molgaard H, Terkelsen CJ, Poulsen SH, Eiskjaer H. P5689Echocardiographic predictors for successful weaning from veno-arterial extracorporeal membrane oxygenation. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Tranberg T, Lippert FK, Christensen EF, Stengaard C, Hjort J, Lassen JF, Petersen F, Jensen JS, Bäck C, Jensen LO, Ravkilde J, Bøtker HE, Terkelsen CJ. Distance to invasive heart centre, performance of acute coronary angiography, and angioplasty and associated outcome in out-of-hospital cardiac arrest: a nationwide study. Eur Heart J 2018; 38:1645-1652. [PMID: 28369362 PMCID: PMC5451896 DOI: 10.1093/eurheartj/ehx104] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 02/19/2017] [Indexed: 01/03/2023] Open
Abstract
Aims To evaluate whether the distance from the site of event to an invasive heart centre, acute coronary angiography (CAG)/percutaneous coronary intervention (PCI) and hospital-level of care (invasive heart centre vs. local hospital) is associated with survival in out-of-hospital cardiac arrest (OHCA) patients. Methods and results Nationwide historical follow-up study of 41 186 unselected OHCA patients, in whom resuscitation was attempted between 2001 and 2013, identified through the Danish Cardiac Arrest Registry. We observed an increase in the proportion of patients receiving bystander CPR (18% in 2001, 60% in 2013, P < 0.001), achieving return of spontaneous circulation (ROSC) (10% in 2001, 29% in 2013, P < 0.001) and being admitted directly to an invasive centre (26% in 2001, 45% in 2013, P < 0.001). Simultaneously, 30-day survival rose from 5% in 2001 to 12% in 2013, P < 0.001. Among patients achieving ROSC, a larger proportion underwent acute CAG/PCI (5% in 2001, 27% in 2013, P < 0.001). The proportion of patients undergoing acute CAG/PCI annually in each region was defined as the CAG/PCI index. The following variables were associated with lower mortality in multivariable analyses: direct admission to invasive heart centre (HR 0.91, 95% CI: 0.89-0.93), CAG/PCI index (HR 0.33, 95% CI: 0.25-0.45), population density above 2000 per square kilometre (HR 0.94, 95% CI: 0.89-0.98), bystander CPR (HR 0.97, 95% CI: 0.95-0.99) and witnessed OHCA (HR 0.87, 95% CI: 0.85-0.89), whereas distance to the nearest invasive centre was not associated with survival. Conclusion Admission to an invasive heart centre and regional performance of acute CAG/PCI were associated with improved survival in OHCA patients, whereas distance to the invasive centre was not. These results support a centralized strategy for immediate post-resuscitation care in OHCA patients.
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Clemmensen TS, Holm NR, Eiskjær H, Jakobsen L, Berg K, Neghabat O, Løgstrup BB, Christiansen EH, Dijkstra J, Terkelsen CJ, Maeng M, Poulsen SH. Detection of early changes in the coronary artery microstructure after heart transplantation: A prospective optical coherence tomography study. J Heart Lung Transplant 2018; 37:486-495. [DOI: 10.1016/j.healun.2017.10.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 10/02/2017] [Accepted: 10/18/2017] [Indexed: 11/25/2022] Open
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Westra J, Tu S, Winther S, Nissen L, Vestergaard MB, Andersen BK, Holck EN, Fox Maule C, Johansen JK, Andreasen LN, Simonsen JK, Zhang Y, Kristensen SD, Maeng M, Kaltoft A, Terkelsen CJ, Krusell LR, Jakobsen L, Reiber JHC, Lassen JF, Bøttcher M, Bøtker HE, Christiansen EH, Holm NR. Evaluation of Coronary Artery Stenosis by Quantitative Flow Ratio During Invasive Coronary Angiography: The WIFI II Study (Wire-Free Functional Imaging II). Circ Cardiovasc Imaging 2018; 11:e007107. [PMID: 29555835 PMCID: PMC5895131 DOI: 10.1161/circimaging.117.007107] [Citation(s) in RCA: 156] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 01/11/2018] [Indexed: 01/10/2023]
Abstract
BACKGROUND Quantitative flow ratio (QFR) is a novel diagnostic modality for functional testing of coronary artery stenosis without the use of pressure wires and induction of hyperemia. QFR is based on computation of standard invasive coronary angiographic imaging. The purpose of WIFI II (Wire-Free Functional Imaging II) was to evaluate the feasibility and diagnostic performance of QFR in unselected consecutive patients. METHODS AND RESULTS WIFI II was a predefined substudy to the Dan-NICAD study (Danish Study of Non-Invasive Diagnostic Testing in Coronary Artery Disease), referring 362 consecutive patients with suspected coronary artery disease on coronary computed tomographic angiography for diagnostic invasive coronary angiography. Fractional flow reserve (FFR) was measured in all segments with 30% to 90% diameter stenosis. Blinded observers calculated QFR (Medis Medical Imaging bv, The Netherlands) for comparison with FFR. FFR was measured in 292 lesions from 191 patients. Ten (5%) and 9 patients (5%) were excluded because of FFR and angiographic core laboratory criteria, respectively. QFR was successfully computed in 240 out of 255 lesions (94%) with a mean diameter stenosis of 50±12%. Mean difference between FFR and QFR was 0.01±0.08. QFR correctly classified 83% of the lesions using FFR with cutoff at 0.80 as reference standard. The area under the receiver operating characteristic curve was 0.86 (95% confidence interval, 0.81-0.91) with a sensitivity, specificity, negative predictive value, and positive predictive value of 77%, 86%, 75%, and 87%, respectively. A QFR-FFR hybrid approach based on the present results enables wire-free and adenosine-free procedures in 68% of cases. CONCLUSIONS Functional lesion evaluation by QFR assessment showed good agreement and diagnostic accuracy compared with FFR. Studies comparing clinical outcome after QFR- and FFR-based diagnostic strategies are required. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov. Unique identifier: NCT02264717.
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Thim T, Götberg M, Fröbert O, Nijveldt R, van Royen N, Baptista SB, Koul S, Kellerth T, Bøtker HE, Terkelsen CJ, Christiansen EH, Jakobsen L, Kristensen SD, Maeng M. Nonculprit Stenosis Evaluation Using Instantaneous Wave-Free Ratio in Patients With ST-Segment Elevation Myocardial Infarction. JACC Cardiovasc Interv 2017; 10:2528-2535. [DOI: 10.1016/j.jcin.2017.07.021] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 05/24/2017] [Accepted: 05/24/2017] [Indexed: 01/10/2023]
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Ibáñez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H, Caforio AL, Crea F, Goudevenos JA, Halvorsen S, Hindricks G, Kastrati A, Lenzen MJ, Prescott E, Roffi M, Valgimigli M, Varenhorst C, Vranckx P, Widimsk P, Collet JP, Kristensen SD, Aboyans V, Baumbach A, Bugiardini R, Mircea Coman I, Delgado V, Fitzsimons D, Gaemperli O, Gershlick AH, Gielen S, Harjola VP, Katus HA, Knuuti J, Kolh P, Leclercq C, Lip GY, Morais J, Neskovic AN, Neumann FJ, Niessner A, Piepoli MF, Richter DJ, Shlyakhto E, Simpson IA, Steg G, Terkelsen CJ, Thygesen K, Windecker S, Zamorano JL, Zeymer U. Guía ESC 2017 sobre el tratamiento del infarto agudo de miocardio en pacientes con elevación del segmento ST. Rev Esp Cardiol 2017. [DOI: 10.1016/j.recesp.2017.10.048] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Jabbari R, Jabbari J, Glinge C, Risgaard B, Sattler S, Winkel BG, Terkelsen CJ, Tilsted HH, Jensen LO, Hougaard M, Haunsø S, Engstrøm T, Albert CM, Tfelt-Hansen J. Association of common genetic variants related to atrial fibrillation and the risk of ventricular fibrillation in the setting of first ST-elevation myocardial infarction. BMC MEDICAL GENETICS 2017; 18:138. [PMID: 29162046 PMCID: PMC5699191 DOI: 10.1186/s12881-017-0497-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 11/09/2017] [Indexed: 01/09/2023]
Abstract
Background Cohort studies have revealed an increased risk for ventricular fibrillation (VF) and sudden cardiac death (SCD) in patients with atrial fibrillation (AF). In this study, we hypothesized that single nucleotide polymorphisms (SNP) previously associated with AF may be associated with the risk of VF caused by first ST-segment elevation myocardial infarction (STEMI). Methods We investigated association of 24 AF-associated SNPs with VF in the prospectively assembled case–control study among first STEMI-patients of Danish ancestry. Results We included 257 cases (STEMI with VF) and 537 controls (STEMI without VF). The median age at index infarction was 60 years for the cases and 61 years for the controls (p = 0.100). Compared to the control group, the case group was more likely to be male (86% vs. 75%, p = 0.001), have a history of AF (7% vs. 2%, p = 0.006) or hypercholesterolemia (39% vs. 31%, p = 0.023), and a family history of sudden death (40% vs. 25%, p < 0.001). All 24 selected SNPs have previously been associated with AF. None of the 24 SNPs were associated with the risk of VF after adjustment for age and sex under additive genetic model of inheritance in the logistic regression model. Conclusion In this study, we found that the 24 AF-associated SNPs may not be involved in increasing the risk of VF. Larger VF cohorts and use of new next generation sequencing and epigenetic may in future identify additional AF and VF risk loci and improve our understanding of genetic pathways behind the two arrhythmias.
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Jensen LO, Thayssen P, Maeng M, Ravkilde J, Krusell LR, Raungaard B, Junker A, Terkelsen CJ, Veien KT, Villadsen AB, Kaltoft A, Tilsted HH, Hansen KN, Aaroe J, Kristensen SD, Hansen HS, Jensen SE, Madsen M, Bøtker HE, Berencsi K, Lassen JF, Christiansen EH. Randomized Comparison of a Biodegradable Polymer Ultrathin Strut Sirolimus-Eluting Stent With a Biodegradable Polymer Biolimus-Eluting Stent in Patients Treated With Percutaneous Coronary Intervention: The SORT OUT VII Trial. CIRCULATION. CARDIOVASCULAR INTERVENTIONS 2017. [PMID: 27412869 DOI: 10.1161/circinterventions.115.003610.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Coronary drug-eluting stents with biodegradable polymers have been designed to improve safety and efficacy. METHODS AND RESULTS The Scandinavian Organization for Randomized Trials With Clinical Outcome (SORT OUT) VII trial-a large-scale registry-based randomized, multicenter, single-blind, 2-arm, noninferiority trial-compared 2 biodegradable polymer drug-eluting stents: the thin-strut cobalt-chromium sirolimus-eluting Orsiro stent and the stainless steel biolimus-eluting Nobori stent in an all-comer patient population. The primary end point target lesion failure was a composite of cardiac death, myocardial infarction (not related to other than index lesion), or target lesion revascularization within 1 year, analyzed by intention to treat (noninferiority margin of 3.0%). Clinically driven event detection based on Danish registries was used. A total of 1261 patients were assigned to receive the sirolimus-eluting stent (1590 lesions) and 1264 patients to the biolimus-eluting stent (1588 lesions). At 1 year, the composite end point target lesion failure occurred in 48 patients (3.8%) in the sirolimus-eluting group and in 58 patients (4.6%) in the biolimus-eluting group (absolute risk difference, -0.78% [upper limit of 1-sided 95% confidence interval, 0.61%]; P<0.0001). Rates of definite stent thrombosis occurred in 5 (0.4%) of the sirolimus-eluting group compared with 15 (1.2%) biolimus-eluting stent-treated patients (rate ratio, 0.33; 95% confidence interval, 0.12-0.92; P=0.034), which largely was attributable to a lower risk of subacute definite stent thrombosis: 0.1% versus 0.6% (rate ratio, 0.12; 95% confidence interval, 0.02-1.00; P=0.05). CONCLUSIONS The thin-strut sirolimus-eluting Orsiro stent was noninferior to the biolimus-eluting Nobori stent in unselected patients for target lesion failure at 1 year. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01879358.
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Jensen LO, Thayssen P, Maeng M, Ravkilde J, Krusell LR, Raungaard B, Junker A, Terkelsen CJ, Veien KT, Villadsen AB, Kaltoft A, Tilsted HH, Hansen KN, Aaroe J, Kristensen SD, Hansen HS, Jensen SE, Madsen M, Bøtker HE, Berencsi K, Lassen JF, Christiansen EH. Randomized Comparison of a Biodegradable Polymer Ultrathin Strut Sirolimus-Eluting Stent With a Biodegradable Polymer Biolimus-Eluting Stent in Patients Treated With Percutaneous Coronary Intervention: The SORT OUT VII Trial. Circ Cardiovasc Interv 2017; 9:CIRCINTERVENTIONS.115.003610. [PMID: 27412869 DOI: 10.1161/circinterventions.115.003610] [Citation(s) in RCA: 100] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2015] [Accepted: 05/31/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND Coronary drug-eluting stents with biodegradable polymers have been designed to improve safety and efficacy. METHODS AND RESULTS The Scandinavian Organization for Randomized Trials With Clinical Outcome (SORT OUT) VII trial-a large-scale registry-based randomized, multicenter, single-blind, 2-arm, noninferiority trial-compared 2 biodegradable polymer drug-eluting stents: the thin-strut cobalt-chromium sirolimus-eluting Orsiro stent and the stainless steel biolimus-eluting Nobori stent in an all-comer patient population. The primary end point target lesion failure was a composite of cardiac death, myocardial infarction (not related to other than index lesion), or target lesion revascularization within 1 year, analyzed by intention to treat (noninferiority margin of 3.0%). Clinically driven event detection based on Danish registries was used. A total of 1261 patients were assigned to receive the sirolimus-eluting stent (1590 lesions) and 1264 patients to the biolimus-eluting stent (1588 lesions). At 1 year, the composite end point target lesion failure occurred in 48 patients (3.8%) in the sirolimus-eluting group and in 58 patients (4.6%) in the biolimus-eluting group (absolute risk difference, -0.78% [upper limit of 1-sided 95% confidence interval, 0.61%]; P<0.0001). Rates of definite stent thrombosis occurred in 5 (0.4%) of the sirolimus-eluting group compared with 15 (1.2%) biolimus-eluting stent-treated patients (rate ratio, 0.33; 95% confidence interval, 0.12-0.92; P=0.034), which largely was attributable to a lower risk of subacute definite stent thrombosis: 0.1% versus 0.6% (rate ratio, 0.12; 95% confidence interval, 0.02-1.00; P=0.05). CONCLUSIONS The thin-strut sirolimus-eluting Orsiro stent was noninferior to the biolimus-eluting Nobori stent in unselected patients for target lesion failure at 1 year. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01879358.
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Obling L, Wiberg S, Møller JE, Hassager C, Terkelsen CJ, Holmvang L, Aarøe J, Møller-Sørensen H, Fjølner J, Rudolph SS, Kjaergaard J. [Extracorporeal cardiopulmonary resuscitation for patients with out-of-hospital refractory cardiac arrest]. Ugeskr Laeger 2017; 179:V04170293. [PMID: 29084620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Out-of-hospital cardiac arrest is associated with high mortality and morbidity. Treatment options remain few in refractory cases, but extracorporeal cardiopulmonary resuscitation (eCPR) is increasingly applied to improve the outcome. This article summarizes the use, experience and outcome of eCPR focussing on current knowledge of criteria for selection of relevant patients for treatment.
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Barkholt TØ, Neghabat O, Terkelsen CJ, Christiansen EH, Holm NR. Restenosis in a Collapsed Magnesium Bioresorbable Scaffold. Circ Cardiovasc Interv 2017; 10:CIRCINTERVENTIONS.117.005677. [DOI: 10.1161/circinterventions.117.005677] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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74
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Clemmensen TS, Holm NR, Eiskjær H, Løgstrup BB, Christiansen EH, Dijkstra J, Barkholt TØ, Terkelsen CJ, Maeng M, Poulsen SH. Layered Fibrotic Plaques Are the Predominant Component in Cardiac Allograft Vasculopathy. JACC Cardiovasc Imaging 2017; 10:773-784. [DOI: 10.1016/j.jcmg.2016.10.021] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 09/22/2016] [Accepted: 10/20/2016] [Indexed: 10/20/2022]
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White A, Ng HX, Ng WY, Ng EKX, Fook-Chong S, Kua PHJ, Ong MEH, Steensberg AT, Andersen LB, Eriksen MM, Hendriksen OM, Thougaard T, Claesson A, Lennartsson J, Svensson L, Ringh M, Hollenberg J, Nordberg P, Rosenqvist M, Djarv T, Österberg S, Fredman D, Ban Y, Löwe AS, Nielsen J, Zimling M, Schmidt J, Lippert F, Ersbøll AK, Møller TP, Jørgensen MD, Lippert F, Hamilton A, Steinmetz J, Wissenberg M, Torp-Pedersen C, Lippert F, Hove L, Lohse N, Thorsager B, Bonde H, Rasmussen MB, Østergaard D, Hansen CS, Brabrand M, Lassen A, Hansen CS, Brabrand M, Lassen A, Kjer C, Holgersen M, Viggers S, Pedersen CK, Bøtker MT, Riddervold IS, Terkelsen CJ, Nystøyl DS, Hunskaar S, Zakariassen E, Fredman D, Svensson L, Ban Y, Jonsson M, Hollenberg J, Nordberg P, Ringh M, Rosenqvist M, Lundén M, Claesson A, Fredman D, Jonsson M, Haas J, Svensson L, Ban Y, Claesson A, Ribeiro F, Newton M, Freitas P, Rocha D, Leal E, Santos N, Cortez T, Allmark S, Marsden J, Linderoth G, Lippert F, Møller TP, Østergaard D, Thomas G, Nielsen AM, Øllgaard G, Inaba H, Yamashita A, Maeda T, Bakke HK, Steinvik T, Angell J, Wisborg T, Bakke HK, Steinvik T, Ruud H, Wisborg T, Haug IA, Birkenes TS, Myklebust H, Kramer-Johansen J, Funder KS, Rasmussen LS, Hesselfeldt R, Siersma V, Lohse N, Sonne A, Wulffeld S, Steinmetz J, Funde AS, Rasmussen LS, Lohse N, Hesselfeldt R, Siersma V, Pedersen F, Hendriksen OM, Lippert FK, Steinmetz J, Sol-A K, Shin SD, Lee K, Lee EJ, Ro YS, Hong KJ, Kim YJ, Jeong J, Ho PJ, Binderup LG, Mikkelsen S, de Muckadell CS, Lossius HM, Toft P, Lassen AT, Thompson L, Hill M, Hov MR, Lindner T, Franer E, Monstad A, Lund CG, Betzer M, Lyngby RM, Jousi M, Nurmi J, Kruse N, Barfod C, Raaber N, Bøtker MT, Seidenfaden SC, Riddervold IS, Simpson P, Thyer L, van Nugteren B, Seidenfaden SC, Riddervold IS, Kirkegaard H, Juul N, Bøtker MT, Zwisler T, Rønnov C, Mieritz HB, Mikkelsen S, Jørgensen G, Ångerman-Haasmaa S, Länkimäki S, Nurmi J, Mikkelsen S, Lossius HM, Toft P, Lassen AT, Viereck S, Møller TP, Rothman JP, Folke F, Lippert FK, Filipescu T, Gray A, Williams TA, Ho KM, Tohira H, Fatovich D, Brink D, Bailey P, Perkins GD, Finn J, Møller TP, Viereck S, Folke F, Lippert F, Møller TP, Ersbøll AK, Kjærulff TM, Østergaard D, Tolstrup JS, Andersen JT, Overton J, Rasmussen LS, Folke F, Lippert F, Jensen TW, Møller TP, Viereck S, Roland J, Folke F, Lassen JF, Østergaard D, Lippert F, Puolakka T, Länkimäki S, Puolakka J, Hallikainen J, Rantanen K, Kuisma M. Meeting abstracts from the first European Emergency Medical Services congress (EMS2016). Scand J Trauma Resusc Emerg Med 2017. [PMCID: PMC5356044 DOI: 10.1186/s13049-017-0358-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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