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Gajulapalli RD, Kanmanthareddy A, Balakumaran K, Hong H, Bolen S, Kondapaneni M, Pasala TKR. Aspiration thrombectomy in ST-Elevation myocardial infarction: Further insights from a network meta-analysis of randomized trials. Indian Heart J 2021; 73:161-168. [PMID: 33865512 PMCID: PMC8065356 DOI: 10.1016/j.ihj.2021.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 10/11/2020] [Accepted: 01/02/2021] [Indexed: 11/28/2022] Open
Abstract
Background The initial enthusiasm for thrombectomy during percutaneous coronary intervention (PCI) of ST-elevation myocardial infarction (STEMI) patients has given way to restraint. There has been some limited interest whether it is beneficial in a few selected subgroups. Hence, we performed a network meta-analysis to compare conventional PCI (cPCI), Aspiration or manual thrombectomy (AT) and Mechanical thrombectomy (McT) for clarification. Methods Electronic databases were searched for randomized studies that compared AT, McT, or cPCI. A network meta-analysis was performed and odd’s ratio (OR) with 95% confidence intervals was generated for major adverse cardiac events (MACE), mortality, myocardial infarction (MI), target vessel revascularization (TVR), stent thrombosis (ST), stroke, left ventricular ejection fraction (LVEF), myocardial blush grade (MBG) and ST segment resolution (STR). Results A total of 43 randomized trials (n = 26,682) were included. The risk of MACE (OR 0.86 95% CI 0.73–1.00), Mortality (OR 0.85 95% CI 0.73–0.99), MI (OR 0.65, 95% CI: 0.44–0.95) and TVR (OR 0.86, 95% CI: 0.74–1.00) were lower with AT compared to cPCI. The risk of ST and stroke was no different with the use of adjunctive AT. MBG, STR, and LVEF improved with the use of AT while the infarct size was no different in the two groups. Conclusions Our comprehensive network meta-analysis suggests conflicting outcomes with AT. While Mortality, MACE, MI seem better, there is a suggestion that, Stroke and ST might be worse. Whether AT can still be pursued in any select cases should be further scrutinized.
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Affiliation(s)
| | - Arun Kanmanthareddy
- Division of Cardiology, Creighton University School of Medicine, Omaha, NE, USA
| | - Kathir Balakumaran
- The Heart and Vascular Center, Case Western Reserve University/MetroHealth, Cleveland, OH, USA
| | - Hwanhee Hong
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Shari Bolen
- Center for Health Care Research and Policy, MetroHealth/Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Meera Kondapaneni
- The Heart and Vascular Center, Case Western Reserve University/MetroHealth, Cleveland, OH, USA
| | - Tilak K R Pasala
- Heart and Vascular Center, Hackensack University Medical Center, Hackensack, NJ, USA
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Hemingway H, Asselbergs FW, Danesh J, Dobson R, Maniadakis N, Maggioni A, van Thiel GJM, Cronin M, Brobert G, Vardas P, Anker SD, Grobbee DE, Denaxas S. Big data from electronic health records for early and late translational cardiovascular research: challenges and potential. Eur Heart J 2018; 39:1481-1495. [PMID: 29370377 PMCID: PMC6019015 DOI: 10.1093/eurheartj/ehx487] [Citation(s) in RCA: 129] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 07/19/2017] [Accepted: 08/08/2017] [Indexed: 12/13/2022] Open
Abstract
Aims Cohorts of millions of people's health records, whole genome sequencing, imaging, sensor, societal and publicly available data present a rapidly expanding digital trace of health. We aimed to critically review, for the first time, the challenges and potential of big data across early and late stages of translational cardiovascular disease research. Methods and results We sought exemplars based on literature reviews and expertise across the BigData@Heart Consortium. We identified formidable challenges including: data quality, knowing what data exist, the legal and ethical framework for their use, data sharing, building and maintaining public trust, developing standards for defining disease, developing tools for scalable, replicable science and equipping the clinical and scientific work force with new inter-disciplinary skills. Opportunities claimed for big health record data include: richer profiles of health and disease from birth to death and from the molecular to the societal scale; accelerated understanding of disease causation and progression, discovery of new mechanisms and treatment-relevant disease sub-phenotypes, understanding health and diseases in whole populations and whole health systems and returning actionable feedback loops to improve (and potentially disrupt) existing models of research and care, with greater efficiency. In early translational research we identified exemplars including: discovery of fundamental biological processes e.g. linking exome sequences to lifelong electronic health records (EHR) (e.g. human knockout experiments); drug development: genomic approaches to drug target validation; precision medicine: e.g. DNA integrated into hospital EHR for pre-emptive pharmacogenomics. In late translational research we identified exemplars including: learning health systems with outcome trials integrated into clinical care; citizen driven health with 24/7 multi-parameter patient monitoring to improve outcomes and population-based linkages of multiple EHR sources for higher resolution clinical epidemiology and public health. Conclusion High volumes of inherently diverse ('big') EHR data are beginning to disrupt the nature of cardiovascular research and care. Such big data have the potential to improve our understanding of disease causation and classification relevant for early translation and to contribute actionable analytics to improve health and healthcare.
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Affiliation(s)
- Harry Hemingway
- Research Department of Clinical Epidemiology, The Farr Institute of Health Informatics Research, University College London, 222 Euston Road, London NW1 2DA, UK
- The National Institute for Health Research, Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, University College London, 222 Euston Road, London NW1 2DA, UK
| | - Folkert W Asselbergs
- Research Department of Clinical Epidemiology, The Farr Institute of Health Informatics Research, University College London, 222 Euston Road, London NW1 2DA, UK
- The National Institute for Health Research, Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, University College London, 222 Euston Road, London NW1 2DA, UK
- Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, Utrecht 3584 CX, The Netherlands
| | - John Danesh
- MRC/BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Worts Causeway, Cambridge CB1 8RN, UK
| | - Richard Dobson
- Research Department of Clinical Epidemiology, The Farr Institute of Health Informatics Research, University College London, 222 Euston Road, London NW1 2DA, UK
- The National Institute for Health Research, Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, University College London, 222 Euston Road, London NW1 2DA, UK
- NIHR Biomedical Research Centre for Mental Health (IOP), King‘s College London, De Crespigny Park, London SE5 8AF, UK
| | - Nikolaos Maniadakis
- European Society of Cardiology (ESC), 2035 Route des Colles, Les Templiers - CS 80179 Biot, 06903 Sophia Antipolis, France
| | - Aldo Maggioni
- European Society of Cardiology (ESC), 2035 Route des Colles, Les Templiers - CS 80179 Biot, 06903 Sophia Antipolis, France
| | - Ghislaine J M van Thiel
- Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, Utrecht 3584 CX, The Netherlands
| | - Maureen Cronin
- Vifor Pharma Ltd, lughofstrasse 61, 8152 Glattbrugg, Zurich, Switzerland
| | - Gunnar Brobert
- Department of Epidemiology, Bayer Pharma AG, Müllerstrasse 178, 13353 Berlin, Germany
| | - Panos Vardas
- European Society of Cardiology (ESC), 2035 Route des Colles, Les Templiers - CS 80179 Biot, 06903 Sophia Antipolis, France
| | - Stefan D Anker
- Division of Cardiology and Metabolism—Heart Failure, Cachexia & Sarcopenia; Department of Cardiology (CVK), Berlin-Brandenburg Center for Regenerative Therapies (BCRT), Charité University Medicine, Charitépl. 1, 10117 Berlin, Germany
- Department of Cardiology and Pneumology, University Medicine Göttingen (UMG), Robert-Koch-Strasse 40, 37099, Göttingen, Germany
| | - Diederick E Grobbee
- Julius Centre for Health Sciences and Primary Care, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Spiros Denaxas
- Research Department of Clinical Epidemiology, The Farr Institute of Health Informatics Research, University College London, 222 Euston Road, London NW1 2DA, UK
- The National Institute for Health Research, Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, University College London, 222 Euston Road, London NW1 2DA, UK
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Hoedemaker NPG, Ten Haaf ME, Maas JC, Damman P, Appelman Y, Tijssen JGP, de Winter RJ, van 't Hof AWJ. Practice of ST-segment elevation myocardial infarction care in the Netherlands during four snapshot weeks with the National Cardiovascular Database Registry for Acute Coronary Syndrome. Neth Heart J 2017; 25:264-270. [PMID: 28144818 PMCID: PMC5355385 DOI: 10.1007/s12471-017-0947-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Clinical registries provide information on the process of care and patient outcomes, with the potential to improve the quality of patient care. A large Dutch national acute coronary syndrome (ACS) registry is currently lacking. Recently, we initiated the National Cardiovascular Database Registry (NCDR) for ACS in the Netherlands. The purpose of this study was to assess the NCDR ACS registry on feasibility and data completeness during a pilot phase of four snapshot weeks. METHODS Between 2013 and 2015, we invited all hospitals in the Netherlands to record a predefined dataset for every patient that was admitted to their hospital with ST-segment elevation myocardial infarction (STEMI). Data were entered in an online case report form. All patient-specific data were encrypted to ensure privacy. RESULTS A total of 392 patients were registered in 35 centres. The mean age of the patients was 64 years (SD 13); 8% of patients presented with signs of cardiogenic shock and 11% with an out-of-hospital cardiac arrest. The median time from first medical contact to percutaneous coronary intervention (PCI) was 75 min (IQR 51-108) and this was significantly longer for patients who presented at a non-PCI centre or to a primary care physician. In-hospital and 30-day mortality rates were 5.2% and 7.8%, respectively. The amount of completeness varied, with improved completeness over time. CONCLUSION This report shows that a Dutch ACS registry is feasible with respect to STEMI patients. Data completeness, however, was suboptimal. Improved data completeness is warranted for the future.
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Affiliation(s)
- N P G Hoedemaker
- Department of Cardiology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - M E Ten Haaf
- Department of Cardiology, VU Medical Centre, VU University Amsterdam, Amsterdam, The Netherlands
| | - J C Maas
- National Cardiovascular Data Registry, Utrecht, The Netherlands
| | - P Damman
- Department of Cardiology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Y Appelman
- Department of Cardiology, VU Medical Centre, VU University Amsterdam, Amsterdam, The Netherlands
| | - J G P Tijssen
- Department of Cardiology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - R J de Winter
- Department of Cardiology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - A W J van 't Hof
- National Cardiovascular Data Registry, Utrecht, The Netherlands. .,Isala Klinieken Hospital, Zwolle, The Netherlands.
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Giglioli C, Cecchi E, Sciagrá R, Baldereschi GJ, Meucci F, Valente S, Chiostri M, Gensini GF, Spini V, Landi D, Romano SM, Calabretta R. COmparison between COronary THrombus aspiration with Angiojet® or Export® catheter in patients with ST-elevation myocardial infarction submitted to primary angioplasty: The COCOTH Study. Int J Cardiol 2016; 203:757-62. [DOI: 10.1016/j.ijcard.2015.03.158] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Revised: 02/05/2015] [Accepted: 03/15/2015] [Indexed: 10/23/2022]
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