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Gitt A, Horack M, Lautsch D, Zahn R, Ferrieres J. How many CCS- and ACS-patients might reach the newly recommended LDL-C-target <55mg/dl in clinical practice if guidelines were applied – an estimate from the DYSIS II study population. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The 2019 ESC guidelines for the management of dyslipidemia even further lowered the LDL-C-target values for the very high-risk population from <70mg/dl to <55mg/dl. Population based studies already had shown that the previous target was difficult to reach. It is yet unclear how many patients in clinical practice might be treated to the new target.
Methods
The Dyslipidemia International Study (DYSIS II) prospectively collected data of patients with chronic coronary syndromes (CCS) and acute coronary syndromes (ACS) (all on statins) in 18 countries in Europe, the Middle East, South- and East Asia to document patient characteristics, medication and a current lipid profile from 2012 to 2014 under real life conditions in physicians' offices and hospitals. We took these real-life lipid profiles and data on the kind/dose of used statins to estimate how treatment escalation such as changing statin treatment to a high dose (atorvastatin ≥40mg / rosuvastatin≥20mg), adding ezetimibe and adding a PCSK9-inhibitor might help to bring LDL-C-levels to the recommended <55mg/dl target.
Results
A total of 7,865 patients were enrolled into DYSIS II, 6,794 had CCS and 1,071 ACS. Under the documented statin treatment in DYSIS only 12.7% of patients reached an LDL-C <55mg/dl. Putting all patients on high dose statins in combination with ezetimibe, 64.1% would reach the target. If PCSK9-inhibitors would be used in the remaining patients not at goal a total of 94.0% would match the goal.
Conclusion
Our analysis indicates that in real life practice the use available lipid-lowering medications would substantially increase the percentage of CCS- and ACS-patients reaching the newly recommended 2019 ESC guideline LDL-C-target of <55 mg/dl from less than 20% to more than 90% of the population.
Funding Acknowledgement
Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): MSD
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Affiliation(s)
- A.K Gitt
- Klinikum Ludwigshafen, Ludwigshafen, Germany
| | - M Horack
- Institut f. Herzinfarktforschung Ludwigshafen, Ludwigshafen am Rhein, Germany
| | - D Lautsch
- Merck & Co, Inc., Kenilworth, United States of America
| | - R Zahn
- Klinikum Ludwigshafen, Ludwigshafen, Germany
| | - J Ferrieres
- Toulouse Rangueil University Hospital (CHU), Toulouse, France
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Normand C, Dickstein K, Auricchio A, Bogale N, Cleland J, Gitt A, Stellbrink C, Anker S, Filippatos G, Gasparini M, Hindricks G, Blomstrom Lundqvist C, Ponikowski P, Ruschitzka F, Linde C. 537CRT in women- results from the ESC CRT Survey II with 11 088 patients. Europace 2018. [DOI: 10.1093/europace/euy015.303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- C Normand
- Stavanger University Hospital, Cardiology, Stavanger, Norway
| | - K Dickstein
- Stavanger University Hospital, Cardiology, Stavanger, Norway
| | | | - N Bogale
- Stavanger University Hospital, Cardiology, Stavanger, Norway
| | - J Cleland
- Imperial College London, London, United Kingdom
| | - A Gitt
- Stiftung Institut für Herzinfarktforschung, Ludwigshafen, Germany
| | | | - S Anker
- University Medical Center Gottingen (UMG), Gottingen, Germany
| | | | - M Gasparini
- Clinical Institute Humanitas IRCCS, Rozzano, Italy
| | | | | | | | | | - C Linde
- Karolinska University Hospital, Stockholm, Sweden
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Ferrieres J, Lautsch D, Velkovski-Rouyer M, Ambegaonkar B, De Ferrari G, Vyas A, Baxter C, Horack M, Bash L, Al Mahmeed W, Chiang F, Keong Poh K, Brudi P, Gitt A. Use of guideline-recommended treatments in 10,661 patients with coronary heart disease: Observational multinational DYSIS II study. Archives of Cardiovascular Diseases Supplements 2018. [DOI: 10.1016/j.acvdsp.2017.11.173] [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: 11/26/2022]
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Gitt A, Böse-Ribeiro H, Nieder C, Kup P, Hermani H, Bühler H, Ergönenç H, Drüppel D, Adamietz I, Fakhrian K. EP-1958: Treatment results of Mammosite catheter in combination with whole breastirradiation. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)33209-1] [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: 11/26/2022]
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Lee S, Jeong M, Cho J, Kang W, Hur S, Jeon D, Lee S, Jeong J, Cho B, Gwon H, Chun K, Kim W, Han K, Seung K, Kim Y, Gitt A, Ashton V, Balaji H, Song W, Jang Y. Prevalence of lipid abnormalities among treated patients with stable CHD: The Dyslipidemia International Study (DYSIS) II South Korea results. Atherosclerosis 2015. [DOI: 10.1016/j.atherosclerosis.2015.04.455] [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] [Indexed: 11/30/2022]
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Gitt A, Ashton V, Horack M, Jannowitz C, Brudi P, Lautsch D, Ambegaonkar B. Low LDL-C target achievement among treated acs patients in germany: the dyslipidemia international study (dysis) iiacs results. Atherosclerosis 2015. [DOI: 10.1016/j.atherosclerosis.2015.04.971] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Pitsavos C, Alexopoulos D, Goudevenos J, Xixi E, Gitt A, Horack M, Ashton V, Brudi P, Lautsch D, Ambegaonkar B. Prevalence of lipid abnormalities among treated ACS patients in Greece: The Dyslipidemia International Study (DYSIS) II ACS results. Atherosclerosis 2015. [DOI: 10.1016/j.atherosclerosis.2015.04.452] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Agnelli G, Bauersachs R, Gitt A, Mismetti P, Monreal M, Willich S, Laeis P, Cohen A. C0472: Trends in Medical Management of Patients with VTE in 7 European Countries: First Baseline Data of the Prefer in VTE Registry. Thromb Res 2014. [DOI: 10.1016/s0049-3848(14)50382-9] [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: 10/25/2022]
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Fakhrian K, Gitt A, Hermani H, Böse-Ribeiro H, Drüppel D, Ergönenç H, Adamietz I. EP-1189: Acute toxicity after boost with MammoSite technique. Radiother Oncol 2014. [DOI: 10.1016/s0167-8140(15)31307-4] [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: 11/29/2022]
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Zeymer U, Hambrecht R, Theres H, Birkemeyer R, Gitt A, Schneider S, Senges J, Zahn R. [Treatment of ST-segment elevation acute myocardial infarction in hospitals with and without cardiac catheterization laboratory]. Dtsch Med Wochenschr 2013; 138:1935-40. [PMID: 24046132 DOI: 10.1055/s-0033-1349561] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND AND OBJECTIVE The goal of treatment of patients with ST-segment elevation acute myocardial infarction (STEMI) is to restore perfusion as soon as possible, preferably by primary percutaneous coronary intervention (PCI). The aim of this study of the German Myocardial Infarction Registry (DHR) was to document acute care and in-hospital course of STEMI patients in Germany. METHODS Over three months patients with STEMI were consecutively included and their basic data, treatments and in-hospital complications were centrally recorded using an internet-based standardized questionnaire. RESULTS Included were 6,330 patients from 243 hospitals, in group 1 (primary admission in 136 hospitals with cath lab) 4,656 patients (74%) and in group 2 (primary admission in 107 hospitals without cath lab) 1,674 (26%). Reperfusion therapy was performed more frequently in patients of group 1 (91.1% PCI, 2.7% fibrinolysis) than in group 2 (80.7% PCI after transfer, 6.4% fibrinolysis). In-hospital mortality was 7.3% in all patients, 7.0% in group 1 and 8.3% in group 2. CONCLUSION The DHR data show that about three quarters of patients with STEMI are primarily admitted to hospitals with cath labs. Primary PCI is the preferred treatment option both in hospitals with and without cath labs (in the latter after transfer); it is performed in about 85% of STEMI patients. In-hospital mortality is with over 7% higher in real-life than in randomized studies.
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Affiliation(s)
- U Zeymer
- Herzzentrum Ludwigshafen, Medizinische Klinik B
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Karcher JC, Kouraki K, Limbourg T, Zeymer U, Zahn R, Gitt A. Impact of early reperfusion therapy in patients with NSTEMI - results of the OPTAMI registry. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht307.p415] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Zeymer U, Gitt A, Hochadel M, Lauer B, Kaul N, Andresen D, Zahn R. Pretreatment with prasugrel is safe and associated with an improvement outcome in patients with NSTE-ACS. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht310.p4866] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Karcher JC, Kouraki K, Limbourg T, Zeymer U, Zahn R, Gitt A. Equal hospital but impaired 1-year outcome of MI in diabetics versus non-diabetics in the era of stringent reperfusion therapy - results of the OPTAMI registry. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.p3130] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Zeymer U, Hochadel M, Gitt A, Brachmann J, Schuehlen H, Zahn R. GP IIb/IIIa inhibitors improve outcome in patients with primary PCI for STEMI. Results of the prospective ALKK-Registry. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht307.p445] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Tschöpe D, Bramlage P, Binz C, Krekler M, Deeg E, Gitt A. DPP-4 Hemmer im Vergleich zu Sulfonylharnstoffen zusätzlich zu Metformin im klinischen Alltag - Ergebnisse der Nachbeobachtung des prospektiven DiaRegis Registers über 1 Jahr. DIABETOL STOFFWECHS 2012. [DOI: 10.1055/s-0032-1314555] [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: 10/28/2022]
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Bogale N, Priori S, Gitt A, Alings M, Linde C, Dickstein K, Dickstein K, Priori S, Auricchio A, Bogale N, Brugada J, Cleland JG, Derumeaux G, Gitt A, Gras D, Komajda M, Linde C, Morgan J, van Veldhuisen DJ, Fruhwald F, Strohmer B, Goethals M, Vijgen J, Trochu JN, Gras D, Kindermann M, Stellbrink C, McDonnald K, Keane D, Ben Gal T, Glikson M, Metra M, Gasparini M, Maass A, Jordaens L, Alings M, Larsen AI, Faerestrand S, Delgado J, Mont L, Persson H, Gadler F, Rocca HPBL, Osswald S, Squire I, Morgan J, Brant J, Gadler F, Linde C, Andresen D, Butter C, Gonska B, Jung W, Kuck KH, Senges J, Stellbrink C. The European cardiac resynchronization therapy survey: patient selection and implantation practice vary according to centre volume. Europace 2011; 13:1445-53. [DOI: 10.1093/europace/eur173] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Tschöpe D, Bramlage P, Binz C, Krekler M, Plate T, Deeg E, Gitt A. Typ-2 Diabetes und Hypogylkämien bei älteren Patienten –6-Monats Follow-up Ergebnisse des prospektiven DiaRegis Registers. DIABETOL STOFFWECHS 2011. [DOI: 10.1055/s-0031-1277424] [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: 10/18/2022]
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Tschöpe D, Binz C, Bramlage P, Krekler M, Plate T, Deeg E, Gitt A. Komorbidität und inzidente Hypoglykämien bei Patienten mit Typ-2 Diabetes und Herzinsuffizienz –6-Monats Follow-up Ergebnisse des prospektiven DiaRegis Registers. DIABETOL STOFFWECHS 2011. [DOI: 10.1055/s-0031-1277423] [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: 10/18/2022]
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Tschöpe D, Bramlage P, Binz C, Krekler M, Plate T, Deeg E, Gitt A. Typ-2 Diabetes und Hypoglykämien –6-Monats Follow-up Ergebnisse des prospektiven DiaRegis Registers. DIABETOL STOFFWECHS 2011. [DOI: 10.1055/s-0031-1277425] [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: 10/18/2022]
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Zeymer U, Zahn R, Gitt A, Dech M, Senges J. Aktuelle Versorgungsstruktur der Therapie des akuten Herzinfarkts in Deutschland. Kardiologe 2010. [DOI: 10.1007/s12181-010-0273-3] [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] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Tschöpe D, Bramlage P, Binz C, Deeg E, Gitt A. Prädiktoren für das Auftreten von Hypoglykämien bei der Behandlung des Typ-2 Diabetes mit einer oralen Mono- oder dualen Kombinationstherapie – Ergebnisse des prospektiven Diabetes Registers (DiaRegis). DIABETOL STOFFWECHS 2010. [DOI: 10.1055/s-0030-1253753] [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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Tschöpe D, Bramlage P, Deeg E, Krekler M, Plate T, Gitt A. Unterschiede in der Behandlung des Typ-2 Diabetes bei Männern und Frauen nach Versagen einer oralen Mono- oder dualen Kombinationstherapie – Ergebnisse des prospektiven Diabetes Registers (DiaRegis). DIABETOL STOFFWECHS 2010. [DOI: 10.1055/s-0030-1253882] [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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Daly CA, Clemens F, Lopez Sendon JL, Tavazzi L, Boersma E, Danchin N, Delahaye F, Gitt A, Julian D, Mulcahy D, Ruzyllo W, Thygesen K, Verheugt F, Fox KM. Inadequate control of heart rate in patients with stable angina: results from the European Heart Survey. Postgrad Med J 2010; 86:212-7. [DOI: 10.1136/pgmj.2009.084384] [Citation(s) in RCA: 26] [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] [Indexed: 11/04/2022]
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Gitt A. [Not Available]. MMW Fortschr Med 2010; 152:22. [PMID: 27370811 DOI: 10.1007/bf03365965] [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: 06/06/2023]
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Leiter L, Feely J, Ferrieres J, Gitt A, Gonzalez-Juanatey J, Korsgaared Thomsen K, Lundman P, Marques da Silva P, Pedersen T, Wood D, Kastelein J, Drexel H. Characteristics of statin-treated patients with diabetes mellitus in Europe and canada: results of the Dyslipidemia International study. Can J Diabetes 2009. [DOI: 10.1016/s1499-2671(09)33151-2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Daemen J, Simoons ML, Wijns W, Bagust A, Bos G, Bowen JM, Braunwald E, Camenzind E, Chevalier B, DiMario C, Fajadet J, Gitt A, Guagliumi G, Hillege HL, James S, Juni P, Kastrati A, Kloth S, Kristensen SD, Krucoff M, Legrand V, Pfisterer M, Rothman M, Serruys PW, Silber S, Steg PG, Tariah I, Wallentin L, Windecker SW, Aimonetti A, Allocco D, Baczynska A, Bagust A, Berenger M, Bos G, Boam A, Bowen J, Braunwald E, Calle J, Camenzind E, Campo G, Carlier S, Chevalier B, Daemen J, de Schepper J, Di Bisceglie G, DiMario C, Dobbels H, Fajadet J, Farb A, Ghislain J, Gitt A, Guagliumi G, Hellbardt S, Hillege H, ten Hoedt R, Isaia C, James S, de Jong P, Juni P, Kastrati A, Klasen E, Kloth S, Kristensen S, Krucoff M, Legrand V, Lekehal M, LeNarz L, Ni Mhullain F, Nagai H, Patteet A, Paunovic D, Pfisterer M, Potgieter A, Purdy I, Raveau-Landon C, Rothman M, Serruys P, Silber S, Simoons M, Steg P, Tariah I, Ternstrom S, Van Wuytswinkel J, Waliszewski M, Wallentin L, Wijns W, Windecker S. Meeting Report: ESC Forum on Drug Eluting Stents European Heart House, Nice, 27-28 September 2007. Eur Heart J 2008; 30:152-61. [DOI: 10.1093/eurheartj/ehn510] [Citation(s) in RCA: 8] [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] [Indexed: 12/21/2022] Open
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Gitt A. Akutintervention des ST-Hebungs-Myokardinfarkt (STEMI): Therapie in Europa. Dtsch Med Wochenschr 2008; 133:585. [DOI: 10.1055/s-2008-1067289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Bauer T, Koeth O, Junger C, Heer T, Wienbergen H, Gitt A, Zahn R, Senges J, Zeymer U. Effect of an invasive strategy on in-hospital outcome in elderly patients with non-ST-elevation myocardial infarction. Eur Heart J 2007; 28:2873-8. [DOI: 10.1093/eurheartj/ehm464] [Citation(s) in RCA: 101] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
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Zeymer U, Gitt A, Winkler R, Zahn R, Jünger C, Schiele R, Gottwik M, Senges J. Sterblichkeit bei über 75-jährigen Patienten mit akutem ST-Hebungsmyokardinfarkt im klinischen Alltag. Dtsch Med Wochenschr 2005; 130:633-6. [PMID: 15776344 DOI: 10.1055/s-2005-865072] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Patients who are older than 75 years are often excluded in clinical trials evaluating therapies for ST elevation myocardial infarction. Therefore there is a lack of prospective data for this steadily increasing number of elderly patients. PATIENTS AND METHODS Between 07/2000 and 11/2002 a total of 16 823 patients with acute coronary syndromes in 154 hospitals were enrolled in the ACOS registry, with 8309 having a STEMI. Baseline characteristics, therapies during the hospital course and at discharge, hospital-mortality and 1-year mortality were prospectively collected. In this study we analysed the outcome of patients older than 75 years with STEMI of less than 24 duration. RESULTS A total of 2045 patients > 75 years (median age 80.1 years, 53.9 % women) were included. Of the latter 51 % were treated conservatively, 19 % with fibrinolysis and 30 % with primary PCI. In-hospital mortality in the three groups was 23.4 %, 25.4 % und 10.2 %, while total mortality after one year was 52.4 %, 41.3 % und 19.3 %, respectively. In the multivariate analysis both primary PCI (odds ratio 0.36, 95 % CI 0.25 - 0.52) and fibrinolysis (odds ratio 0.65, 95 % CI 0.44 - 0.97) where associated with a lower mortality after discharge. CONCLUSION Hospital- as well as 1-year mortality in patients with STEMI who are older than 75 years are high. Primary PCI is associated with a decrease of in-hospital and 1-year mortality, while fibrinolysis improves mortality after discharge. Therefore early reperfusion therapy, preferably with primary PCI should be considered in elderly patients, after taking in count biological age and major comorbidities.
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Affiliation(s)
- U Zeymer
- Herzzentrum Ludwigshafen, Medizinische Klinik B.
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Zeymer U, Zahn R, Gitt A, Gottwik M, Senges J. [Who benefits from late recanalization after acute myocardial infarction?]. Dtsch Med Wochenschr 2004; 129:759-63. [PMID: 15042495 DOI: 10.1055/s-2004-822866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- U Zeymer
- Herzzentrum Ludwigshafen, Medizinische Klinik B.
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Drögemüller A, Seidl K, Schiele R, Schneider S, Gitt A, Gottwik M, von Leitner ER, Poppe C, Rettig-Stürmer G, Senges J. Prognostic value of non-sustained ventricular tachycardias after acute myocardial infarction in the thrombolytic era: importance of combination with frequent ventricular premature beats. Z Kardiol 2003; 92:164-72. [PMID: 12596078 DOI: 10.1007/s00392-003-0890-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE of this study was to re-evaluate the association between ventricular arrhythmias and long-term mortality after acute myocardial infarction (AMI) in the thrombolytic era. METHODS MITRA (maximal individual therapy in patients with AMI) is a multicenter registry of 54 hospitals in Germany investigating patients with AMI. RESULTS 2420 patients received Holter ECG. Positive Holter ECG was defined: > or =10 ventricular premature beats (VPB)/h, or > or =4 couplets/d, or > or =1 non-sustained ventricular tachycardia (nsusVT)/d, or their combination. Mortality rates (median 17 months) were 6.5% without ventricular arrhythmias, with > or =10 VPB/h 15.2% and with the combination of > or =10 VPB/h plus either > or =4 couplets/d or > or =1 nsusVT/d 23.4%. In multivariate analysis, none of the ventricular arrhythmias alone correlated with mortality. There was a significant association between mortality and the combination of > or =10 VPB/h plus > or =4 couplets/d (OR 2.3) or > or =10 VPB/h plus > or =1 nsusVT/d (OR 2.8). CONCLUSION Non-sustained VTs are only associated with poor prognosis if combined with frequent VPBs.
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Affiliation(s)
- A Drögemüller
- Herzzentrum Ludwigshafen, Kardiologie, Bremserstr. 79 67063 Ludwigshafen, Germany.
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Dönges K, Schiele R, Gitt A, Wienbergen H, Schneider S, Zahn R, Grube R, Baumgärtel B, Glunz HG, Senges J. Incidence, determinants, and clinical course of reinfarction in-hospital after index acute myocardial infarction (results from the pooled data of the maximal individual therapy in acute myocardial infarction [mitra], and the myocardial infarction registry [MIR]). Am J Cardiol 2001; 87:1039-44. [PMID: 11348599 DOI: 10.1016/s0002-9149(01)01458-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [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: 11/28/2022]
Abstract
There are few data about the incidence, determinants, and clinical course of in-hospital repeat acute myocardial infarction (RE-AMI) after an index AMI. From June 1994 to June 1998, 22,613 patients with AMI as an index event were registered by the Maximal Individual Therapy in Acute Myocardial Infarction (MITRA) and Myocardial Infarction Registries (MIR). Of these, 1,071 (4.7%) had a RE-AMI. For the index event, 9,143 patients (40.5%) were treated with thrombolysis, 1,707 (7.5%) with primary angioplasty, and 443 (2.0%) with a combination of both. Multivariate analysis showed that previous AMI (odds ratio [OR] 1.59; 95% confidence intervals [CI] 1.35 to 1.86), age >70 years (OR 1.57; 95% CI 1.36 to 1.81), diagnostic first electrocardiogram (OR 1.37; 95% CI 1.19 to 1.59), and female gender (OR 1.14; 95% CI 1.05 to 1.32) were independently associated with a higher incidence of RE-AMI. The incidence of RE-AMI was higher when patients received thrombolysis (OR 1.36; 95% CI 1.15 to 1.61), and it was lower when they underwent primary angioplasty (OR 0.74; 95% CI 0.53 to 1.03) or received beta blockers (OR 0.84; 95% CI 0.72 to 0.97). Patients with RE-AMI had higher hospital mortality compared with those without RE-AMI (OR 4.35; 95% CI 3.83 to 4.95). Multivariate logistic regression analysis showed an independent association of RE-AMI with in-hospital death (OR 6.60; 95% CI 5.61 to 7.70), repeat revascularization (OR 2.91; 95% CI 2.42 to 3.50), low workload capacity on the bicycle ergometry test (OR 2.17; 95% CI 1.71 to 2.76), and ejection fraction <40% (OR 1.72; 95% CI 1.38 to 2.14) at discharge. Thus, RE-AMI occurs in 4.7% of patients after an AMI. Previous AMI, age >70 years, diagnostic first electrocardiogram, and female gender are independent determinants for RE-AMI. Thrombolysis is associated with a higher and beta blockers with a lower incidence of RE-AMI. Once a RE-AMI occurs, it is a strong predictor of in-hospital mortality and morbidity.
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Affiliation(s)
- K Dönges
- Herzzentrum Ludwigshafen, Kardiologie, Ludwigshafen, Germany.
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Abstract
BACKGROUND The ventilatory response to exercise in patients with chronic heart failure (HF) is greater than normal for a given metabolic rate. The objective of the present study was to determine the mechanism(s) for the high ventilatory output in patients with chronic HF. METHODS AND RESULTS Centers in Germany, Italy, Japan, and the United States participated in this study. Each center contributed studies on patients and normal subjects of similar age and sex. One hundred thirty patients with chronic HF and 52 healthy subjects participated. Spirometric and breath-by-breath gas exchange measurements were made during rest and increasing cycle exercise. Arterial blood was sampled for measurement of pH, PaCO2, PaO2, and lactate during exercise in 85 patients. Resting forced expiratory volume in 1 second (FEV1) and vital capacity (VC) were proportionately reduced at all levels of impairment. Patients with more severe HF had greater tachypnea and a smaller tidal volume (VT) at a given exercise expired volume per unit time (VE). This was associated with an expiratory flow pattern characteristic of lung restriction. VE and VCO2 as a function of VO2 were increased during exercise in HF patients. The increases were greater the lower the peak VO2 per kilogram of body weight. The ratio of VD (physiological dead space) to VT and the difference between arterial and end tidal PCO2 at peak VO2 also increased inversely with peak VO2/kg. In contrast, the difference between alveolar and arterial PO2 and PaCO2 were both normal, on average, at peak VO2 regardless of the level of impairment. The more severe the exercise limitation, the higher the lactate and the lower the HCO3- at a given VO2, although pH was tightly regulated. CONCLUSIONS The increase in VE in chronic HF patients is caused by an increase in VD/VT due to high ventilation/perfusion mismatching, an increase in VCO2 relative to VO2 resulting from HCO3- buffering of lactic acid, and a decrease in PaCO2 due to tight regulation of arterial pH. With regard to the excessive VE in HF patients, the increases in VD/VT and VCO2 relative to VO2 are more important as the patient becomes more exercise limited. Regional hypoperfusion but not hypoventilation typifies lung gas exchange in HF. This and other mechanisms might account for the restrictive changes leading to exercise tachypnea in HF patients.
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Affiliation(s)
- K Wasserman
- Harbor-UCLA Medical Center, UCLA School of Medicine, Torrance, Calif 90509, USA
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Wassermann K, Gitt A, Weyde J, Eckel HE. Lung function changes and exercise-induced ventilatory responses to external resistive loads in normal subjects. Respiration 1995; 62:177-84. [PMID: 8578012 DOI: 10.1159/000196444] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
AIM The aim of this study was (1) to assess the value of common lung function variables in the follow-up of patients with obstructive lesions of the larynx and trachea and (2) to study the respiratory response to progressive upper airway stenosis at rest and during exercise. METHODS Lung function tests, including vital capacity (VC), residual volume (RV), total body plethysmographic resistance (RT), specific body plethysmographic resistance (Rs), total body plethysmographic resistance at low inspiratory/expiratory flows (Rlo), forced expiratory volume in 1 s (FEV1), peak expiratory flow rate (PEF), peak inspiratory flow rate (PIF), maximum expiratory flow at 50% VC(MEF50) and maximum inspiratory flow at 50% VC(MIF50) were performed in 14 normal subjects with added external resistive loads (inner diameter of circular orifice: 15, 10, 8, 6 mm; equivalent to surface areas of 177, 79, 50 and 28 mm2, respectively), applied in random order. The relative sensitivity of each variable to detect a stepwise decrease in orifice size by evoking 'relevant' obstructive responses was calculated. In addition, ventilatory and gaz exchange responses to loaded breathing (10-, 8- and 6-mm orifices, randomly inserted) during steady-state bicycle exercise (80 and 160 W) were assessed in a subgroup of 10 subjects. RESULTS The gradual increase of external load did not influence static lung volumes (VC, RV). MEF50/MIF50 (1.63 +/- 1.03 at baseline) remained essentially unchanged, consistent with the rigid nature of the obstructive device. PEF was superior in reproducing the transition from unloaded over mild (15 mm) and moderate (10 mm) to high grade (8 mm) central obstruction. Except for mild loads, PIF was equal in sensitivity to PEF. At high grade (8 mm) and severe loads (6 mm), no difference in sensitivity could be established between RT, Rs, FEV1, PIF and PEF. However, they were all superior to Rlo. Compared to unloaded breathing, ventilation across the 10- and 8-mm orifices at both rest and exercise produced a continuous significant increase in oxygen uptake (VO2). Respiratory rate (RR) fell, and a simultaneous enlargement of tidal volume (VT) was observed to maintain or even enhance minute ventilation (VE). However, ventilation across the 6 mm orifice was associated with a substantial decline in VO2, VCO2 and VE relative to the preceding load (8 mm) CONCLUSIONS It is suggested that the experimental use of inspiratory and expiratory extrinsic loads can mimic rigid obstructive lesions of the larynx and trachea. Among all conventional lung function values, PEF and, to a certain degree, PIF, seem to be the best suitable follow-up parameters to assess airway mechanics before and after surgical/endoscopic procedures. Upper airway stenosis involving surface areas of no more than 50 mm2 can be overcome using adequate respiratory compensation. But any additional narrowing below this limit will result in hypoventilation, inappropriate oxygen uptake and retention of CO2. Thus, experimental evidence indicates that laryngotracheal obstruction within a critical range below 50 mm2 surface area (diameter of circular orifice < 8 mm) compromises respiratory efforts enough to be of clinical importance.
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Affiliation(s)
- K Wassermann
- Medical Department III, University of Cologne, Germany
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