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Kumsars I, Holm NR, Niemelä M, Erglis A, Kervinen K, Christiansen EH, Maeng M, Dombrovskis A, Abraitis V, Kibarskis A, Trovik T, Latkovskis G, Sondore D, Narbute I, Terkelsen CJ, Eskola M, Romppanen H, Laine M, Jensen LO, Pietila M, Gunnes P, Hebsgaard L, Frobert O, Calais F, Hartikainen J, Aarøe J, Ravkilde J, Engstrøm T, Steigen TK, Thuesen L, Lassen JF. Randomised comparison of provisional side branch stenting versus a two-stent strategy for treatment of true coronary bifurcation lesions involving a large side branch: the Nordic-Baltic Bifurcation Study IV. Open Heart 2020; 7:e000947. [PMID: 32076558 PMCID: PMC6999681 DOI: 10.1136/openhrt-2018-000947] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 08/05/2019] [Accepted: 09/11/2019] [Indexed: 01/25/2023] Open
Abstract
Background It is still uncertain whether coronary bifurcations with lesions involving a large side branch (SB) should be treated by stenting the main vessel and provisional stenting of the SB (simple) or by routine two-stent techniques (complex). We aimed to compare clinical outcome after treatment of lesions in large bifurcations by simple or complex stent implantation. Methods The study was a randomised, superiority trial. Enrolment required a SB≥2.75 mm, ≥50% diameter stenosis in both vessels, and allowed SB lesion length up to 15 mm. The primary endpoint was a composite of cardiac death, non-procedural myocardial infarction and target lesion revascularisation at 6 months. Two-year clinical follow-up was included in this primary reporting due to lower than expected event rates. Results A total of 450 patients were assigned to simple stenting (n=221) or complex stenting (n=229) in 14 Nordic and Baltic centres. Two-year follow-up was available in 218 (98.6%) and 228 (99.5%) patients, respectively. The primary endpoint of major adverse cardiac events (MACE) at 6 months was 5.5% vs 2.2% (risk differences 3.2%, 95% CI −0.2 to 6.8, p=0.07) and at 2 years 12.9% vs 8.4% (HR 0.63, 95% CI 0.35 to 1.13, p=0.12) after simple versus complex treatment. In the subgroup treated by newer generation drug-eluting stents, MACE was 12.0% vs 5.6% (HR 0.45, 95% CI 0.17 to 1.17, p=0.10) after simple versus complex treatment. Conclusion In the treatment of bifurcation lesions involving a large SB with ostial stenosis, routine two-stent techniques did not improve outcome significantly compared with treatment by the simpler main vessel stenting technique after 2 years. Trial registration number NCT01496638.
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Affiliation(s)
- Indulis Kumsars
- Department of Cardiology, Latvia Center of Cardiology, Paul Stradins Clinical University Hospital, Riga, Latvia
| | | | - Matti Niemelä
- Department of Cardiology, Oulu University Hospital, Oulu, Finland
| | - Andrejs Erglis
- Research Institute of Cardiology and Regenerative Medicine, Latvia Centre of Cardiology, Riga, Latvia
| | - Kari Kervinen
- Department of Cardiology, Oulu University Hospital, Oulu, Finland
| | | | - Michael Maeng
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Andis Dombrovskis
- Department of Cardiology, Latvia Center of Cardiology, Paul Stradins Clinical University Hospital, Riga, Latvia
| | - Vytautas Abraitis
- Department of Cardiology, Vilnius University Hospital, Vilnius, Lithuania
| | | | - Thor Trovik
- Department of Cardiology, University of North Norway, Tromsoe, Norway
| | - Gustavs Latkovskis
- Research Institute of Cardiology and Regenerative Medicine, Latvia Centre of Cardiology, Riga, Latvia
| | - Dace Sondore
- Department of Cardiology, Latvia Center of Cardiology, Paul Stradins Clinical University Hospital, Riga, Latvia
| | - Inga Narbute
- Research Institute of Cardiology and Regenerative Medicine, Latvia Centre of Cardiology, Riga, Latvia
| | | | - Markku Eskola
- Department of Cardiology, Heart Center, Tampere University Hospital, Tampere, Finland
| | - Hannu Romppanen
- Department of cardiology, Heart Center, Kuopio University Hospital, Kuopio, Finland
| | - Mika Laine
- Department of Cardiology, Helsinki University Central Hospital, Helsinki, Finland
| | | | - Mikko Pietila
- Department of Cardiology, Turku University Hospital, Turku, Finland
| | - Pål Gunnes
- Heart Center, Sørlandet Hospital, Arendal, Norway
| | - Lasse Hebsgaard
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Ole Frobert
- Örebro University, Faculty of Health, Department of Cardiology, Örebro, Sweden
| | - Fredrik Calais
- Örebro University, Faculty of Health, Department of Cardiology, Örebro, Sweden
| | - Juha Hartikainen
- Department of cardiology, Heart Center, Kuopio University Hospital, Kuopio, Finland
| | - Jens Aarøe
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Jan Ravkilde
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Thomas Engstrøm
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | - Terje K Steigen
- Department of Cardiology, University Hospital of North Norway, Tromsoe and Cardiovascular Diseases Research Group, UiT The Arctic University of Norway, Tromsø, Norway
| | - Leif Thuesen
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Jens F Lassen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
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Kaaja R, Kujala S, Manhem K, Katzman P, Kibarskis A, Antikainen R, Ylihärsilä H, Erkkola R, Tuomilehto J. Effects of sympatholytic therapy on insulin sensitivity indices in hypertensive postmenopausal women. Int J Clin Pharmacol Ther 2007; 45:394-401. [PMID: 17725246 DOI: 10.5414/cpp45394] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [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: 11/18/2022] Open
Abstract
Cardiovascular risk factors are often ineffectively controlled in hypertensive postmenopausal women, and moreover, some antihypertensive drugs may increase particular risk factors such as insulin resistance. In a multicenter, multinational (Finland, Sweden, Lithuania), double-blind, prospectively randomized study hypertensive obese postmenopausal women without hormone therapy (n = 98) were randomly assigned to receive treatment with either the centrally acting agent moxonidine, 0.6 mg/day, or with the peripherally acting atenolol, 50 mg/day, for 8 weeks. In addition to blood pressure measurements, insulin sensitivity was estimated by the quantitative insulin sensitivity check index (QUICKI) and by the insulin sensitivity index (ISI-Matsuda). Subgroup analysis in insulin-resistant women (fasting P-insulin > or = 10 mU/l) and blood pressure responders (diastolic blood pressure < or = 90 mmHg and/or reduction of blood pressure > or = 10 mmHg) were also carried out. Both atenolol and moxonidine led to a significant reduction in diastolic blood pressure of 9.5 mmHg and 6.2 mmHg, respectively. Among insulin-resistant women, an increase in the insulin sensitivity assessed by ISI was improved with moxonidine treatment (p = 0.025). A decrease in insulin sensitivity assessed by QUICKI was observed with atenolol treatment in women with fasting insulin level < 10 mU/l. In patients, in whom blood pressure was reduced, an improvement in insulin sensitivity (ISI) was associated with moxonidine treatment (p = 0.019), but not with atenolol treatment. The centrally acting sympatholytic agent moxonidine did reduce blood pressure somewhat less than atenolol, but it was associated with an improved metabolic profile in terms of decreased insulin resistance both in insulin-resistant postmenopausal women and in women with a significant blood pressure response.
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Affiliation(s)
- R Kaaja
- Department of Obstetrics and Gynecology, Helsinki University Central Hospital, Helsinki, Finland.
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Rugienius J, Zvironaite V, Kibarskis A, Sakalas A. [A new method of recording spike potentials of the atria from the body surface]. Z Gesamte Inn Med 1981; 36:480-5. [PMID: 7281822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
A new method of recording spike potentials (rapid deflections) of the heart conductive system (sinus node, atrial conductive tracts, His' bundle)from the body surface was developed using differential magnifying 50 to 250 times and yielding frequencies 30-110 Hz with special filters. The curves with differentially amplified spike potentials (DASP) of the heart conductive system were recorded in 249 patients with various cardiac arrhythmias; the control group consisted of 60 healthy persons. By means of synchronous recording of intracardiac ECG and DASP curves on the latter well recognizable points for the determination of the excitation spreading rate in certain areas of the conductive system were distinguished. The recording of DASP-curves allowed the determination of intraatrial conduction disturbances, atrial overloading and distinguishing of retrograde conduction in atria, sinoventricular conduction, ectopic prefibrillatory activity and differentiation of paroxysmal tachycardias. The new method of recording of spike potentials of the atria from the body surface allows the diagnosis of the conduction disturbances and cardiac arrhythmias, including life threatening ones, which were previously determined using exclusively intracardiac ECG. The application of our method enables to increase the possibilities of the investigation of cardiac arrhythmias and conductive disturbances and allows a multiple examination and evaluation of the influence of drugs on the heart conductive system.
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