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Emilsson OL, Bergman S, Mohammad MA, Olivecrona GK, Götberg M, Erlinge D, Koul S. Pretreatment with heparin in patients with ST-segment elevation myocardial infarction: a report from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR). EUROINTERVENTION 2022; 18:709-718. [PMID: 36036797 PMCID: PMC10241276 DOI: 10.4244/eij-d-22-00432] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [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] [Received: 05/10/2022] [Accepted: 07/03/2022] [Indexed: 09/20/2023]
Abstract
BACKGROUND Unfractionated heparin (UFH) is frequently administered before percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI). AIMS The aim of the study was to investigate if pretreatment with UFH prior to arrival at the catheterisation laboratory affects coronary artery occlusion, mortality, and in-hospital major bleeding in patients with STEMI undergoing PCI. METHODS Patients with a first STEMI event undergoing PCI between 2008 and 2016 were extracted from the Swedish Coronary Angiography and Angioplasty Registry. Risk ratios for UFH pretreatment versus no pretreatment regarding coronary artery occlusion at presentation in the catheterisation laboratory, 30-day mortality, and bleeding were obtained using adjusted Poisson regression models with robust standard errors. Analyses of propensity score (PS)-matched groups were performed to obtain absolute risk differences. RESULTS In all, 41,631 patients were included, 16,026 (38%) with and 25,605 (62%) without UFH pretreatment. Adjusted risk ratios were 0.89 (95% confidence interval [CI]: 0.87 to 0.90) for coronary artery occlusion, 0.87 (0.77 to 0.99) for mortality, and 1.01 (0.86 to 1.18) for bleeding. In the PS-matched analyses, the absolute risk differences were -0.087 (-0.074 to -0.099) for coronary artery occlusion, -0.011 (-0.017 to -0.0041) for mortality, and 0 (-0.0052 to 0.0052) for bleeding. CONCLUSIONS Pretreatment with UFH was associated with a reduction in coronary artery occlusion among patients with STEMI, with a number needed to treat (NNT) of 12, without increasing the risk of major in-hospital bleeding. Regarding mortality, a reduction was found with UFH pretreatment, with an NNT of 94, but this effect was not robust over all sensitivity analyses and residual confounding cannot be excluded.
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Affiliation(s)
| | - Sofia Bergman
- Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden
- Department of Cardiology, Skåne University Hospital, Lund, Sweden
| | - Moman A Mohammad
- Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden
- Department of Cardiology, Skåne University Hospital, Lund, Sweden
| | - Göran K Olivecrona
- Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden
- Department of Cardiology, Skåne University Hospital, Lund, Sweden
| | - Matthias Götberg
- Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden
- Department of Cardiology, Skåne University Hospital, Lund, Sweden
| | - David Erlinge
- Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden
- Department of Cardiology, Skåne University Hospital, Lund, Sweden
| | - Sasha Koul
- Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden
- Department of Cardiology, Skåne University Hospital, Lund, Sweden
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2
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Mohammad MA, Persson J, Buccheri S, Odenstedt J, Sarno G, Angerås O, Völz S, Tödt T, Götberg M, Isma N, Yndigegn T, Tydén P, Venetsanos D, Birgander M, Olivecrona GK. Trends in Clinical Practice and Outcomes After Percutaneous Coronary Intervention of Unprotected Left Main Coronary Artery. J Am Heart Assoc 2022; 11:e024040. [PMID: 35350870 PMCID: PMC9075483 DOI: 10.1161/jaha.121.024040] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Background The use of percutaneous coronary intervention (PCI) to treat unprotected left main coronary artery disease has expanded rapidly in the past decade. We aimed to describe nationwide trends in clinical practice and outcomes after PCI for left main coronary artery disease. Methods and Results Patients (n=4085) enrolled in the SCAAR (Swedish Coronary Angiography and Angioplasty Registry) as undergoing PCI for left main coronary artery disease from 2005 to 2017 were included. A count regression model was used to analyze time‐related differences in procedural characteristics. The 3‐year major adverse cardiovascular and cerebrovascular event rate defined as death, myocardial infarction, stroke, and repeat revascularization was calculated with the Kaplan‐Meier estimator and Cox proportional hazard model. The number of annual PCI procedures grew from 121 in 2005 to 589 in 2017 (389%). The increase was greater for men (479%) and individuals with diabetes (500%). Periprocedural complications occurred in 7.9%, decreasing from 10% to 6% during the study period. A major adverse cardiovascular and cerebrovascular event occurred in 35.7% of patients, falling from 45.6% to 23.9% (hazard ratio, 0.56; 95% CI, 0.41–0.78; P=0.001). Radial artery access rose from 21.5% to 74.2% and intracoronary diagnostic procedures from 14.0% to 53.3%. Use of bare‐metal stents and first‐generation drug‐eluting stents fell from 19.0% and 71.9%, respectively, to 0, with use of new‐generation drug‐eluting stents increasing to 95.2%. Conclusions Recent changes in clinical practice relating to PCI for left main coronary artery disease are characterized by a 4‐fold rise in procedures conducted, increased use of evidence‐based adjunctive treatment strategies, intracoronary diagnostics, newer stents, and more favorable outcomes.
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Affiliation(s)
- Moman A Mohammad
- Department of Cardiology Clinical Sciences Lund UniversitySkane University Hospital Lund Sweden
| | - Jonas Persson
- Division of Cardiovascular Medicine Department of Clinical Sciences Karolinska InstitutetDanderyd University Hospital Stockholm Sweden
| | - Sergio Buccheri
- Division of Cardiology Uppsala UniversityUppsala University hospital Uppsala Sweden
| | - Jacob Odenstedt
- Department of Cardiology Gothenburg UniversitySahlgrenska University Hospital Gothenburg Sweden
| | - Giovanna Sarno
- Division of Cardiology Uppsala UniversityUppsala University hospital Uppsala Sweden
| | - Oskar Angerås
- Department of Cardiology Gothenburg UniversitySahlgrenska University Hospital Gothenburg Sweden
| | - Sebastian Völz
- Department of Cardiology Gothenburg UniversitySahlgrenska University Hospital Gothenburg Sweden
| | - Tim Tödt
- Department of Cardiology Clinical Sciences Lund UniversitySkane University Hospital Lund Sweden
| | - Matthias Götberg
- Department of Cardiology Clinical Sciences Lund UniversitySkane University Hospital Lund Sweden
| | - Nazim Isma
- Department of Cardiology Clinical Sciences Lund UniversitySkane University Hospital Lund Sweden
| | - Troels Yndigegn
- Department of Cardiology Clinical Sciences Lund UniversitySkane University Hospital Lund Sweden
| | - Patrik Tydén
- Department of Cardiology Clinical Sciences Lund UniversitySkane University Hospital Lund Sweden
| | - Dimitrios Venetsanos
- Department of Cardiology Karolinska Institutet Solna and Karolinska University Hospital Stockholm Sweden
| | - Mats Birgander
- Department of Cardiology Clinical Sciences Lund UniversitySkane University Hospital Lund Sweden
| | - Göran K Olivecrona
- Department of Cardiology Clinical Sciences Lund UniversitySkane University Hospital Lund Sweden
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3
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Desta L, Jurga J, Völz S, Omerovic E, Ulvenstam A, Zwackman S, Pagonis C, Calle F, Olivecrona GK, Persson J, Venetsanos D. Transradial versus trans-femoral access site in high-speed rotational atherectomy in Sweden. Int J Cardiol 2022; 352:45-51. [PMID: 35074496 DOI: 10.1016/j.ijcard.2022.01.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 01/17/2022] [Accepted: 01/19/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Radial artery is the preferred access site in contemporary percutaneous coronary intervention (PCI). However, limited data exist regarding utilization pattern, safety, and long-term efficacy of transradial artery access (TRA) PCI in heavily calcified lesions using high-speed rotational atherectomy (HSRA). METHODS All patients who underwent HSRA-PCI in Sweden between 2005 and 2016 were included. Outcomes were major adverse cardiac events (MACE, including death, myocardial infarction (MI) or target vessel revascularisation (TVR)), in-hospital bleeding and restenosis. Inverse probability of treatment weighting was used to adjust for the non-randomized access site selection. RESULTS We included 1479 patients of whom 649 had TRA and 782 transfemoral artery access (TFA) HSRA-PCI. The rate of TRA increased significantly by 18% per year but remained lower in HSRA-PCI (60%) than in the overall PCI population (85%) in 2016. TRA was associated with comparable angiographic success but significantly lower risk for major (adjusted OR 0.16; 95% CI 0.05-0.47) or any in-hospital bleeding (adjusted OR 0.32; 95% CI 0.13-0.78). At one year, the adjusted risk for MACE (HR 0.87; 95% CI 0.67-1.13) and its individual components did not differ between TRA and TFA patients. The risk for restenosis did not significantly differ between TRA and TFA HSRA-PCI treated lesions (adjusted HR 0.92; 95% CI 0.46-1.81). CONCLUSION HSRA-PCI by TRA was associated with significantly lower risk for in-hospital bleeding and equivalent long-term efficacy when compared with TFA. Our data support the feasibility and superior safety profile of TRA in HSRA-PCI.
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Affiliation(s)
- Liyew Desta
- Division of Cardiology, Department of Medicine, Karolinska Institute Huddinge and Karolinska University Hospital, Stockholm, Sweden
| | - Juliane Jurga
- Division of Cardiology, Department of Medicine, Karolinska Institute Solna and Karolinska University Hospital, Stockholm, Sweden
| | - Sebastian Völz
- Department of Cardiology, Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy at University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Elmir Omerovic
- Department of Cardiology, Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy at University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Anders Ulvenstam
- Department of Internal Medicine and Cardiology, Östersund Hospital, Östersund, Sweden
| | - Sammy Zwackman
- Department of Cardiology, and Department of Health, Medicine and Caring Sciences, Unit of Cardiovascular Sciences, Linköping University Linköping, Sweden
| | - Christos Pagonis
- Department of Cardiology, and Department of Health, Medicine and Caring Sciences, Unit of Cardiovascular Sciences, Linköping University Linköping, Sweden
| | - Fredrik Calle
- Örebro University, Faculty of Health, Department of Cardiology, Örebro, Sweden
| | - Göran K Olivecrona
- Department of Cardiology, Lund University and HSkåne University Hospital, Lund, Sweden
| | - Jonas Persson
- Department of Clinical sciences, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden
| | - Dimitrios Venetsanos
- Division of Cardiology, Department of Medicine, Karolinska Institute Solna and Karolinska University Hospital, Stockholm, Sweden.
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4
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Birkemeyer R, Olivecrona GK, Hellig F, Wöhrle J, Rottbauer W, Witkowski A, Kuliczkowski W, Bernhardt P, Bettels N, Schrage B, von Zur Mühlen C, Cook S, Miljak T, Eggbrecht H, Eeckhout E, Westermann D, Monsegu J, Dumonteil N. Sealing of Coronary Perforations With a Second-Generation Covered Stent Graft - Results From the PAST-PERF Registry. Cardiovasc Revasc Med 2020; 25:20-26. [PMID: 33132086 DOI: 10.1016/j.carrev.2020.10.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 09/29/2020] [Accepted: 10/21/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND The PAST-PERF registry was initiated to collect data on the PK Papyrus covered stent, a second-generation device for the treatment of coronary artery perforations with enhanced mechanical properties, but with limited available data. METHODS Patients treated for coronary artery perforations with the PK Papyrus stent at 14 international centers were retrospectively identified. The primary effectiveness outcome was successful sealing of the perforation. The primary safety outcome was a composite of all-cause mortality, definite or probable stent thrombosis, myocardial infarction and target lesion revascularization. RESULTS Among the 94 included patients, 72.3% (68/94) had Ellis type III and cavity spilling perforations. Complete sealing was achieved in 93.6% (n = 88), and no sealing could be achieved in 3.2% (n = 3, including one patient with a geographical miss and one patient in whom the device could not be implanted). Pericardiocentesis was required in 25.0% (n = 23), emergency cardiac surgery was needed in 7.6% (n = 7), acute stent thrombosis was observed in 1.1% (n = 1), and in-hospital mortality occurred in 11.7% (n = 11). The median follow-up duration was 283 (IQR:40;670) days. At 6 and 12 months, the incidence of the primary safety endpoint was 26.6% [95%CI:18.6;37.1] and 32.0% [95%CI:22.8;43.4], mortality 15.0% [95%CI:9.0;24.6] and 19.0% [95%CI:11.3;30.0], and target lesion revascularization 5.5% [95%CI:2.0;14.6] and 7.7% [95%CI:3.1;18.2]. Two definite stent thrombosis occurred, one during the procedure and one on post-procedure day 233. CONCLUSIONS The registry demonstrates favorably high rates of successful stent delivery and sealing of coronary perforations using a second-generation covered stent with low target lesion revascularization and stent thrombosis rates. ANNOTATED TABLE OF CONTENT The PAST-PERF registry demonstrates favorably high rates of successful stent delivery and sealing of coronary perforations using a second-generation covered stent with low target lesion revascularization and stent thrombosis rates. Specifically, complete sealing was achieved in 93.6% of patients (n = 88/94), and no sealing could be achieved in 3.2% (n = 3, including one patient with a geographical miss and one patient in whom the device could not be implanted). The 12-month mortality was 19.0% [95%CI:11.3;30.0], the rate of target lesion revascularization was 7.7% [95%CI:3.1;18.2], and two definite stent thromboses occurred (one during procedure and one on post-procedure day 233).
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Affiliation(s)
| | | | | | - Jochen Wöhrle
- University Hospital Ulm, Ulm, Germany; Medical Campus Lake Constance, Friedrichshafen, Germany
| | | | | | | | | | | | | | | | | | | | | | - Eric Eeckhout
- CHUV (Centre Hospitalier Universitaire Vaudoise), Lausanne, Switzerland
| | | | - Jaques Monsegu
- Groupe Hospitalier Mutualiste de Grenoble, Grenoble, France
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5
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Mohammad MA, Koul S, Olivecrona GK, Gӧtberg M, Tydén P, Rydberg E, Scherstén F, Alfredsson J, Vasko P, Omerovic E, Angerås O, Fröbert O, Calais F, Völz S, Ulvenstam A, Venetsanos D, Yndigegn T, Oldgren J, Sarno G, Grimfjärd P, Persson J, Witt N, Ostenfeld E, Lindahl B, James SK, Erlinge D. Incidence and outcome of myocardial infarction treated with percutaneous coronary intervention during COVID-19 pandemic. Heart 2020; 106:1812-1818. [PMID: 33023905 PMCID: PMC7677488 DOI: 10.1136/heartjnl-2020-317685] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [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: 07/11/2020] [Revised: 09/03/2020] [Accepted: 09/10/2020] [Indexed: 12/15/2022] Open
Abstract
Objective Most reports on the declining incidence of myocardial infarction (MI) during the COVID-19 have either been anecdotal, survey results or geographically limited to areas with lockdowns. We examined the incidence of MI during the COVID-19 pandemic in Sweden, which has remained an open society with a different public health approach fighting COVID-19. Methods We assessed the incidence rate (IR) as well as the incidence rate ratios (IRRs) of all MI referred for coronary angiography in Sweden using the nationwide Swedish Coronary Angiography and Angioplasty Registry (SCAAR), during the COVID-19 pandemic in Sweden (1 March 2020–7 May 2020) in relation to the same days 2015–2019. Results A total of 2443 MIs were referred for coronary angiography during the COVID-19 pandemic resulting in an IR 36 MIs/day (204 MIs/100 000 per year) compared with 15 213 MIs during the reference period with an IR of 45 MIs/day (254 MIs/100 000 per year) resulting in IRR of 0.80, 95% CI (0.74 to 0.86), p<0.001. Results were consistent in all investigated patient subgroups, indicating no change in patient category seeking cardiac care. Kaplan-Meier event rates for 7-day case fatality were 439 (2.3%) compared with 37 (2.9%) (HR: 0.81, 95% CI (0.58 to 1.13), p=0.21). Time to percutaneous coronary intervention (PCI) was shorter during the pandemic and PCI was equally performed, indicating no change in quality of care during the pandemic. Conclusion The COVID-19 pandemic has significantly reduced the incidence of MI referred for invasive treatment strategy. No differences in overall short-term case fatality or quality of care indicators were observed.
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Affiliation(s)
- Moman A Mohammad
- Department of Cardiology, Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden
| | - Sasha Koul
- Department of Cardiology, Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden
| | - Göran K Olivecrona
- Department of Cardiology, Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden
| | - Matthias Gӧtberg
- Department of Cardiology, Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden
| | - Patrik Tydén
- Department of Cardiology, Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden
| | - Erik Rydberg
- Department of Cardiology, Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden
| | - Fredrik Scherstén
- Department of Cardiology, Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden
| | | | - Peter Vasko
- Department of Medicine, Växjö Hospital, Växjö, Sweden
| | - Elmir Omerovic
- Department of Cardiology, Department of Molecular and Clinical Medicine, Department of Cardiology, Sahlgrenska University Hospital, Institute of Medicine, Department of Molecular and Clinical Medicine,Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Oskar Angerås
- Department of Cardiology, Department of Molecular and Clinical Medicine, Department of Cardiology, Sahlgrenska University Hospital, Institute of Medicine, Department of Molecular and Clinical Medicine,Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Ole Fröbert
- Department of Cardiology, Faculty of Health, Örebro University, Örebro, Sweden
| | - Fredrik Calais
- Department of Cardiology, Faculty of Health, Örebro University, Örebro, Sweden
| | - Sebastian Völz
- Department of Cardiology, Department of Molecular and Clinical Medicine, Department of Cardiology, Sahlgrenska University Hospital, Institute of Medicine, Department of Molecular and Clinical Medicine,Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | | | | | - Troels Yndigegn
- Department of Cardiology, Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden
| | - Jonas Oldgren
- Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Giovanna Sarno
- Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Per Grimfjärd
- Department of Internal Medicine, Västmanlands Sjuk, Lund, Sweden
| | - Jonas Persson
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Karolinska Institutet, Danderyd University Hospital, Stockolm, Sweden
| | - Nils Witt
- Dvision of Cardiology, Department of Clinical Science and Education, Karolinska Institute, Södersjukhuset, Stockholm, Sweden
| | - Ellen Ostenfeld
- Department of Clinical Physiology, Clinical Sciences, Lund University, Skane University Hospital, Lund, Sweden
| | - Bertil Lindahl
- Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Stefan K James
- Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - David Erlinge
- Department of Cardiology, Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden
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6
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Brilakis ES, Mashayekhi K, Tsuchikane E, Abi Rafeh N, Alaswad K, Araya M, Avran A, Azzalini L, Babunashvili AM, Bayani B, Bhindi R, Boudou N, Boukhris M, Božinović NŽ, Bryniarski L, Bufe A, Buller CE, Burke MN, Büttner HJ, Cardoso P, Carlino M, Christiansen EH, Colombo A, Croce K, Damas de Los Santos F, De Martini T, Dens J, Di Mario C, Dou K, Egred M, ElGuindy AM, Escaned J, Furkalo S, Gagnor A, Galassi AR, Garbo R, Ge J, Goel PK, Goktekin O, Grancini L, Grantham JA, Hanratty C, Harb S, Harding SA, Henriques JPS, Hill JM, Jaffer FA, Jang Y, Jussila R, Kalnins A, Kalyanasundaram A, Kandzari DE, Kao HL, Karmpaliotis D, Kassem HH, Knaapen P, Kornowski R, Krestyaninov O, Kumar AVG, Laanmets P, Lamelas P, Lee SW, Lefevre T, Li Y, Lim ST, Lo S, Lombardi W, McEntegart M, Munawar M, Navarro Lecaro JA, Ngo HM, Nicholson W, Olivecrona GK, Padilla L, Postu M, Quadros A, Quesada FH, Prakasa Rao VS, Reifart N, Saghatelyan M, Santiago R, Sianos G, Smith E, C Spratt J, Stone GW, Strange JW, Tammam K, Ungi I, Vo M, Vu VH, Walsh S, Werner GS, Wollmuth JR, Wu EB, Wyman RM, Xu B, Yamane M, Ybarra LF, Yeh RW, Zhang Q, Rinfret S. Guiding Principles for Chronic Total Occlusion Percutaneous Coronary Intervention. Circulation 2019; 140:420-433. [PMID: 31356129 DOI: 10.1161/circulationaha.119.039797] [Citation(s) in RCA: 223] [Impact Index Per Article: 44.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) have improved because of advancements in equipment and techniques. With global collaboration and knowledge sharing, we have identified 7 common principles that are widely accepted as best practices for CTO-PCI. 1. Ischemic symptom improvement is the primary indication for CTO-PCI. 2. Dual coronary angiography and in-depth and structured review of the angiogram (and, if available, coronary computed tomography angiography) are key for planning and safely performing CTO-PCI. 3. Use of a microcatheter is essential for optimal guidewire manipulation and exchanges. 4. Antegrade wiring, antegrade dissection and reentry, and the retrograde approach are all complementary and necessary crossing strategies. Antegrade wiring is the most common initial technique, whereas retrograde and antegrade dissection and reentry are often required for more complex CTOs. 5. If the initially selected crossing strategy fails, efficient change to an alternative crossing technique increases the likelihood of eventual PCI success, shortens procedure time, and lowers radiation and contrast use. 6. Specific CTO-PCI expertise and volume and the availability of specialized equipment will increase the likelihood of crossing success and facilitate prevention and management of complications, such as perforation. 7. Meticulous attention to lesion preparation and stenting technique, often requiring intracoronary imaging, is required to ensure optimum stent expansion and minimize the risk of short- and long-term adverse events. These principles have been widely adopted by experienced CTO-PCI operators and centers currently achieving high success and acceptable complication rates. Outcomes are less optimal at less experienced centers, highlighting the need for broader adoption of the aforementioned 7 guiding principles along with the development of additional simple and safe CTO crossing and revascularization strategies through ongoing research, education, and training.
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Affiliation(s)
- Emmanouil S Brilakis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, MN (E.S.B., M.N.B.)
| | - Kambis Mashayekhi
- Department of Cardiology and Angiology II University Heart Center Freiburg Bad Krozingen, Germany (K.M., H.J.B.)
| | | | - Nidal Abi Rafeh
- St. George Hospital University Medical Center, Beirut, Lebanon (N.A.R.)
| | | | - Mario Araya
- Clínica Alemana and Instituto Nacional del Tórax, Santiago, Chile (M.A.)
| | - Alexandre Avran
- Arnault Tzank Institut St. Laurent Du Var Nice, France (A.A.)
| | - Lorenzo Azzalini
- Interventional Cardiology Division, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy (L.A., M.C.)
| | - Avtandil M Babunashvili
- Department of Cardiovascular Surgery, Center for Endosurgery and Lithotripsy, Moscow, Russian Federation (A.M.B.)
| | - Baktash Bayani
- Cardiology Department, Mehr Hospital, Mashhad, Iran (B.B.)
| | - Ravinay Bhindi
- Department of Cardiology, Royal North Shore Hospital and Kolling Institute, University of Sydney, Australia (R.B.)
| | | | - Marouane Boukhris
- Cardiology department, Abderrahment Mami Hospital, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunisia (M.B.)
| | - Nenad Ž Božinović
- Department of Interventional Cardiology Clinic for Cardiovascular Diseases University Clinical Center Nis, Serbia (N.Z.B.)
| | - Leszek Bryniarski
- II Department of Cardiology and Cardiovascular Interventions Institute of Cardiology, Jagiellonian University Medical College, Cracow, Poland (L.B.)
| | - Alexander Bufe
- Department of Cardiology, Heartcentre Niederrhein, Helios Clinic Krefeld, Krefeld, Germany, Institute for Heart and Circulation Research, University of Cologne, Germany, and University of Witten/Herdecke, Witten, Germany (A.B.)
| | | | - M Nicholas Burke
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, MN (E.S.B., M.N.B.)
| | - Heinz Joachim Büttner
- Department of Cardiology and Angiology II University Heart Center Freiburg Bad Krozingen, Germany (K.M., H.J.B.)
| | - Pedro Cardoso
- Cardiology Department, Santa Maria University Hospital (CHULN), Lisbon Academic Medical Centre (CAML) and Centro Cardiovascular da Universidade de Lisboa (CCUL), Portugal (P.C.)
| | - Mauro Carlino
- Interventional Cardiology Division, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy (L.A., M.C.)
| | | | - Antonio Colombo
- San Raffaele Hospital and Columbus Hospital, Milan, Italy (A.C.)
| | - Kevin Croce
- Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (K.C.)
| | - Felix Damas de Los Santos
- Interventional Cardiology Department, Instituto Nacional de Cardiología Ignacio Chávez Mexico City, Mexico (F.D.d.l.S.)
| | - Tony De Martini
- SIU School of Medicine, Memorial Medical Center, Springfield, IL (T.D.M.)
| | - Joseph Dens
- Department of Cardiology, Hospital Oost-Limburg, Genk, Belgium (J.D.)
| | - Carlo Di Mario
- Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy (C.D.M.)
| | - Kefei Dou
- Center for Coronary Heart Disease, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (K.D.)
| | - Mohaned Egred
- Freeman Hospital and Newcastle University, Newcastle upon Tyne, United Kingdom (M.E.)
| | - Ahmed M ElGuindy
- Department of Cardiology, Aswan Heart Center, Egypt (A.M.E.).,National Heart and Lung Institute, Imperial College London, United Kingdom (A.M.E.)
| | - Javier Escaned
- Hospital Clinico San Carlos IDISSC and Universidad Complutense de Madrid, Spain (J.E.)
| | - Sergey Furkalo
- Department of Endovascular Surgery and Angiography, National Institute of Surgery and Transplantology of AMS of Ukraine, Kiev (S.F.)
| | - Andrea Gagnor
- Department of Invasive Cardiology, Maria Vittoria Hospital, Turin, Italy (A.G.)
| | - Alfredo R Galassi
- Chair of Cardiology, Department of PROMISE, University of Palermo, Italy (A.R.G.)
| | - Roberto Garbo
- Director of Interventional Cardiology, San Giovanni Bosco Hospital, Turin, Italy (R.G.)
| | - Junbo Ge
- Zhongshan Hospital, Fudan University, Shanghai, China (J.G.)
| | - Pravin Kumar Goel
- Sanjay Gandhi Post Graduate Institute of Medical Sciences Lucknow, India (P.K.G.)
| | | | - Luca Grancini
- Centro Cardiologico Monzino, IRCCS, Milan, Italy (L.G.)
| | - J Aaron Grantham
- Saint Luke's Mid America Heart Institute, Kansas City, MO (J.A.G.)
| | - Colm Hanratty
- Belfast Health and Social Care Trust, United Kingdom (C.H., S.W.)
| | - Stefan Harb
- LKH Graz II, Standort West, Kardiologie, Teaching Hospital of the University of Graz, Austria (S.H.)
| | - Scott A Harding
- Wellington Hospital, Capital and Coast District Health Board, New Zealand (S.A.H.)
| | - Jose P S Henriques
- Academic Medical Centre of the University of Amsterdam, The Netherlands (J.P.S.H.)
| | | | - Farouc A Jaffer
- Cardiology Division, Massachusetts General Hospital, Boston (F.A.J.)
| | - Yangsoo Jang
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, South Korea (Y.J.)
| | | | - Artis Kalnins
- Department of Cardiology, Eastern Clinical University Hospital, Riga, Latvia (A. Kalnins)
| | | | | | - Hsien-Li Kao
- Department of Internal Medicine, National Taiwan University Hospital, Taipei(H.-L.K.)
| | | | - Hussien Heshmat Kassem
- Cardiology Department, Kasr Al-Ainy Faculty of Medicine, Cairo University, Egypt(H.H.K.).,Fujairah Hospital, United Arab Emirates (H.H.K.)
| | - Paul Knaapen
- Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands (P.K.)
| | - Ran Kornowski
- Department of Cardiology, Rabin Medical Center, Petach Tikva, "Sackler" School of Medicine, Tel Aviv University, Petach Tikva, Israel (R.K.)
| | | | - A V Ganesh Kumar
- Department of Cardiology, Dr LH Hiranandani Hospital, Mumbai, India (A.V.G.K.)
| | - Peep Laanmets
- North Estonia Medical Center Foundation, Tallinn, Estonia(P. Laanmets)
| | - Pablo Lamelas
- Department of Interventional Cardiology and Endovascular Therapeutics, Instituto Cardiovascular de Buenos Aires, Argentina (P. Lamelas).,Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada (P. Lamelas)
| | - Seung-Whan Lee
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea (S.-W.L.)
| | - Thierry Lefevre
- Institut Cardiovasculaire Paris Sud Hopital prive Jacques Cartier, Massy, France (T.L.)
| | - Yue Li
- Department of Cardiology, the First Affiliated Hospital of Harbin Medical University, China (Y.L.)
| | - Soo-Teik Lim
- Department of Cardiology, National Heart Centre Singapore (S.-T.L.)
| | - Sidney Lo
- Department of Cardiology, Liverpool Hospital and The University of New South Wales, Sydney, Australia (S.L.)
| | | | | | | | - José Andrés Navarro Lecaro
- Médico Cardiólogo Universitario - Hemodinamista en Hospital de Especialidades Eugenio Espejo y Hospital de los Valles, Ecuador (J.A.N.L.)
| | | | | | | | - Lucio Padilla
- Department of Interventional Cardiology and Endovascular Therapeutics, ICBA, Instituto Cardiovascular, Buenos Aires, Argentina (L.P.)
| | - Marin Postu
- Cardiology Department, University of Medicine and Pharmacy "Carol Davila," Institute of Cardiovascular Diseases "Prof. Dr. C.C. Iliescu," Bucharest, Romania (M.P.)
| | - Alexandre Quadros
- Instituto de Cardiologia / Fundação Universitária de Cardiologia - IC/FUC, Porto Alegre, RS - Brazil (A.Q.)
| | - Franklin Hanna Quesada
- Interventional Cardiology Department, Clinica Comfamiliar Pereira City, Colombia (F.H.Q.)
| | | | - Nicolaus Reifart
- Department of Cardiology, Main Taunus Heart Institute, Bad Soden, Germany (N.R.)
| | | | - Ricardo Santiago
- Hospital Pavia Santurce, PCI Cardiology Group, San Juan, Puerto Rico (R.S.T.)
| | - George Sianos
- AHEPA University Hospital, Thessaloniki, Greece (G.S.)
| | - Elliot Smith
- Department of Cardiology, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom (E.S.)
| | - James C Spratt
- St George's University Hospital NHS Trust, London, United Kingdom (J.S.)
| | - Gregg W Stone
- Center for Interventional Vascular Therapy, Division of Cardiology, New York-Presbyterian Hospital/Columbia University Medical Center (G.W.S.)
| | - Julian W Strange
- Department of Cardiology, Bristol Royal Infirmary, United Kingdom (J.W.S.)
| | - Khalid Tammam
- Cardiac Center of Excellence, International Medical Center, Jeddah, Saudi Arabia (K.T.)
| | - Imre Ungi
- 2nd Department of Internal Medicine and Cardiology Center, University of Szeged, Hungary (I.U.)
| | - Minh Vo
- Mazankowski Alberta Heart Institute, Edmonton, AB, Canada (M.V.)
| | - Vu Hoang Vu
- Interventional Cardiology Department, Heart Center, University Medical Center at Ho Chi Minh City, and University of Medicine and Pharmacy, Vietnam (H.V.)
| | - Simon Walsh
- Belfast Health and Social Care Trust, United Kingdom (C.H., S.W.)
| | - Gerald S Werner
- Medizinische Klinik I Klinikum Darmstadt GmbH, Germany (G.W.)
| | | | | | | | - Bo Xu
- Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing (B.X.)
| | - Masahisa Yamane
- Saitima St. Luke's International Hospital, Tokyo, Japan (M.Y.)
| | - Luiz F Ybarra
- London Health Sciences Centre, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada (L.F.Y.)
| | - Robert W Yeh
- Beth Israel Deaconess Medical Center, Boston, MA (R.W.Y.)
| | - Qi Zhang
- Shanghai East Hospital, Tongji University, China (Q.Z.)
| | - Stephane Rinfret
- McGill University Health Centre, McGill University, Montreal, QC, Canada (S.R.)
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7
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Buccheri S, James S, Lindholm D, Fröbert O, Olivecrona GK, Persson J, Hambraeus K, Witt N, Erlinge D, Angerås O, Lagerqvist B, Sarno G. Clinical and angiographic outcomes of bioabsorbable vs. permanent polymer drug-eluting stents in Sweden: a report from the Swedish Coronary and Angioplasty Registry (SCAAR). Eur Heart J 2019; 40:2607-2615. [DOI: 10.1093/eurheartj/ehz244] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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] [Received: 06/22/2018] [Revised: 10/31/2018] [Accepted: 04/05/2019] [Indexed: 11/14/2022] Open
Abstract
Abstract
Aims
Randomized clinical trials have consistently demonstrated the non-inferiority of bioabsorbable polymer drug-eluting stents (BP-DES) with respect to DES having permanent polymers (PP-DES). To date, the comparative performance of BP- and PP-DES in the real world has not been extensively investigated.
Methods and results
From October 2011 to June 2016, we analysed the outcomes associated with newer generation DES use in Sweden. After stratification according to the type of DES received at the index procedure, a total of 16 504 and 79 106 stents were included in the BP- and PP-DES groups, respectively. The Kaplan–Meier estimates for restenosis at 2 years were 1.2% and 1.4% in BP- and PP-DES groups, respectively. Definite stent thrombosis (ST) was low in both groups (0.5% and 0.7% in BP- and PP-DES groups, respectively). The adjusted hazard ratio (HR) for either restenosis or definite ST did not differ between BP- and PP-DES [adjusted HR 0.95, 95% confidence interval (CI) 0.74–1.21; P = 0.670 and adjusted HR 0.79, 95% CI 0.57–1.09; P = 0.151, respectively]. Similarly, there were no differences in the adjusted risk of all-cause death and myocardial infarction (MI) between the two groups (adjusted HR for all-cause death 1.01, 95% CI 0.82–1.25; P = 0.918 and adjusted HR for MI 1.05, 95% CI 0.93–1.19; P = 0.404).
Conclusion
In a large, nationwide, and unselected cohort of patients, percutaneous coronary intervention with BP-DES implantation was not associated with an incremental clinical benefit over PP-DES use at 2 years follow-up.
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Affiliation(s)
- Sergio Buccheri
- Department of Medical Sciences, Cardiology and Uppsala Clinical Research Center, Uppsala University, Dag Hammarskjölds Väg 38, Uppsala, Sweden
| | - Stefan James
- Department of Medical Sciences, Cardiology and Uppsala Clinical Research Center, Uppsala University, Dag Hammarskjölds Väg 38, Uppsala, Sweden
| | - Daniel Lindholm
- Department of Medical Sciences, Cardiology and Uppsala Clinical Research Center, Uppsala University, Dag Hammarskjölds Väg 38, Uppsala, Sweden
| | - Ole Fröbert
- Department of Cardiology, Faculty of Health, Örebro University, Södra Grev Rosengatan, Örebro, Sweden
| | - Göran K Olivecrona
- Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden
| | - Jonas Persson
- Department of Cardiology, Danderyd University Hospital, Stockholm, Sweden
| | | | - Nils Witt
- Unit of Cardiology, Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Sjukhusbacken 10, Stockholm, Sweden
| | - David Erlinge
- Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden
| | - Oskar Angerås
- Department of Cardiology, Sahlgrenska University Hospital, Bruna stråket 16, Göteborg, Sweden
| | - Bo Lagerqvist
- Department of Medical Sciences, Cardiology and Uppsala Clinical Research Center, Uppsala University, Dag Hammarskjölds Väg 38, Uppsala, Sweden
| | - Giovanna Sarno
- Department of Medical Sciences, Cardiology and Uppsala Clinical Research Center, Uppsala University, Dag Hammarskjölds Väg 38, Uppsala, Sweden
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8
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Karlsson S, Andell P, Mohammad MA, Koul S, Olivecrona GK, James SK, Fröbert O, Erlinge D. Editor’s Choice- Heparin pre-treatment in patients with ST-segment elevation myocardial infarction and the risk of intracoronary thrombus and total vessel occlusion. Insights from the TASTE trial. European Heart Journal: Acute Cardiovascular Care 2017; 8:15-23. [DOI: 10.1177/2048872617727723] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Pre-treatment with unfractionated heparin is common in ST-segment elevation myocardial infarction (STEMI) protocols, but the effect on intracoronary thrombus burden is unknown. We studied the effect of heparin pre-treatment on intracoronary thrombus burden and Thrombolysis in Myocardial Infarction (TIMI) flow prior to percutaneous coronary intervention in patients with STEMI. Methods: The Thrombus Aspiration in ST-Elevation Myocardial Infarction in Scandinavia (TASTE) trial angiographically assessed intracoronary thrombus burden and TIMI flow, prior to percutaneous coronary intervention, in patients with STEMI. In this observational sub-study, patients pre-treated with heparin were compared with patients not pre-treated with heparin. Primary end points were a visible intracoronary thrombus and total vessel occlusion prior to percutaneous coronary intervention. Secondary end points were in-hospital bleeding, in-hospital stroke and 30-day all-cause mortality. Results: Heparin pre-treatment was administered in 2898 out of 7144 patients (41.0%). Patients pre-treated with heparin less often presented with an intracoronary thrombus (61.3% vs. 66.0%, p<0.001) and total vessel occlusion (62.9% vs. 71.6%, p<0.001). After adjustments, heparin pre-treatment was independently associated with a reduced risk of intracoronary thrombus (odds ratio (OR) 0.73, 95% confidence interval (CI)=0.65–0.83) and total vessel occlusion (OR 0.64, 95% CI=0.56–0.73), prior to percutaneous coronary intervention. There were no significant differences in secondary end points of in-hospital bleeding (OR 0.84, 95% CI=0.55–1.27), in-hospital stroke (OR 1.17, 95% CI=0.48–2.82) or 30-day all-cause mortality (hazard ratio 0.88, 95% CI=0.60–1.30). Conclusions: Heparin pre-treatment was independently associated with a lower risk of intracoronary thrombus and total vessel occlusion before percutaneous coronary intervention in patients with STEMI, without evident safety concerns, in this large multi-centre observational study.
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Affiliation(s)
- Sofia Karlsson
- Department of Cardiology, Clinical Sciences, Lund University, Skane University Hospital, Lund, Sweden
| | - Pontus Andell
- Department of Cardiology, Clinical Sciences, Lund University, Skane University Hospital, Lund, Sweden
| | - Moman A Mohammad
- Department of Cardiology, Clinical Sciences, Lund University, Skane University Hospital, Lund, Sweden
| | - Sasha Koul
- Department of Cardiology, Clinical Sciences, Lund University, Skane University Hospital, Lund, Sweden
| | - Göran K Olivecrona
- Department of Cardiology, Clinical Sciences, Lund University, Skane University Hospital, Lund, Sweden
| | - Stefan K James
- Department of Medical Sciences, Uppsala University, Sweden
| | - Ole Fröbert
- Department of Cardiology, Faculty of Health, Örebro University, Sweden
| | - David Erlinge
- Department of Cardiology, Clinical Sciences, Lund University, Skane University Hospital, Lund, Sweden
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9
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Biasco L, Götberg M, Harnek J, Lundin A, Kandzari DE, De Backer O, Olivecrona GK. First-in-Man Experience With the ClearLumen Thrombectomy System as an Adjunctive Therapy in Primary Percutaneous Coronary Interventions. J Interv Cardiol 2016; 29:155-61. [DOI: 10.1111/joic.12285] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Luigi Biasco
- The Heart Centre; Rigshospitalet; Copenhagen Denmark
- Fondazione Cardiocentro Ticino; University of Zurich; Lugano Switzerland
| | - Matthias Götberg
- Department of Cardiology; Skåne University Hospital-Lund University; Lund Sweden
| | - Jan Harnek
- Department of Cardiology; Skåne University Hospital-Lund University; Lund Sweden
| | - Anders Lundin
- Department of Cardiology; Skåne University Hospital-Lund University; Lund Sweden
| | | | - Ole De Backer
- The Heart Centre; Rigshospitalet; Copenhagen Denmark
| | - Göran K. Olivecrona
- The Heart Centre; Rigshospitalet; Copenhagen Denmark
- Department of Cardiology; Skåne University Hospital-Lund University; Lund Sweden
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10
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Wagner H, Hardig BM, Rundgren M, Zughaft D, Harnek J, Götberg M, Olivecrona GK. Mechanical chest compressions in the coronary catheterization laboratory to facilitate coronary intervention and survival in patients requiring prolonged resuscitation efforts. Scand J Trauma Resusc Emerg Med 2016; 24:4. [PMID: 26795941 PMCID: PMC4721004 DOI: 10.1186/s13049-016-0198-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 01/08/2016] [Indexed: 11/21/2022] Open
Abstract
Background Resuscitation after cardiac arrest (CA) in the catheterization laboratory (cath-lab) using mechanical chest compressions (CC) during simultaneous percutaneous coronary intervention (PCI) is a strong recommendation in the 2015 European Resuscitation Council (ERC) guidelines. This study aimed at re-evaluating survival to hospital discharge and assess long term outcome in this patient population. Methods Patients presenting at the cath lab with spontaneous circulation, suffering CA and requiring prolonged mechanical CC during cath lab procedures between 2009 and 2013 were included. Circumstances leading to CA, resuscitation parameters and outcomes were evaluated within this cohort. For comparison, patients needing prolonged manual CC in the cath lab in the pre-mechanical CC era were evaluated. Six-month and one year survival with a mechanical CC treatment strategy from 2004 to 2013 was also evaluated. Results Thirty-two patients were included between 2009 and 2013 (24 ST-elevation myocardial infarction (STEMI), 4 non-STEMI, 2 planned PCI, 1 angiogram and 1 intra-aortic counter pulsation balloon pump insertion). Twenty were in cardiogenic shock prior to inclusion. Twenty-five were successfully treated with PCI. Median mechanical CC duration for the total cohort (n = 32) was 34 min (range 5–90), for the 15 patients with circulation discharged from the cath-lab, 15 min (range 5–90), and for the eight discharged alive from hospital, 10 min (range 5–52). Twenty-five percent survived with good neurological outcome at hospital discharge. Ten patients treated with manual CC were included with one survivor. Discussion Eighty-seven percent of the patients included in the mechanical CC cohort had their coronary or cardiac intervention performed during mechanical CC with an 80 % success rate. This shows that the use of mechanical CC during an intervention does not seem to impair the interventional result substantially. The survival rate after one year was 87 %. Conclusions Among patients suffering CA treated with mechanical CC in the cath-lab, 25 % had a good neurological outcome at hospital discharge compared to 10 % treated with manual CC. Long term survival in patients discharged from hospital is good.
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Affiliation(s)
- Henrik Wagner
- Department of Cardiology, Lund University, Lund, Sweden.
| | | | - Malin Rundgren
- Department of Anaesthesiology and Intensive Care, Lund University, Lund, Sweden.
| | - David Zughaft
- Department of Cardiology, Lund University, Lund, Sweden.
| | - Jan Harnek
- Department of Cardiology, Lund University, Lund, Sweden.
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11
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Biasco L, Pedersen F, Lønborg J, Holmvang L, Helqvist S, Saunamäki K, Kelbaek H, Clemmensen P, Olivecrona GK, Jørgensen E, Engstrøm T, De Backer O. Angiographic characteristics of intermediate stenosis of the left anterior descending artery for determination of lesion significance as identified by fractional flow reserve. Am J Cardiol 2015; 115:1475-80. [PMID: 25857401 DOI: 10.1016/j.amjcard.2015.02.047] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 02/26/2015] [Accepted: 02/26/2015] [Indexed: 10/23/2022]
Abstract
Previous studies have shown a poor correlation between angiographic assessment of stenosis grade (%) and its functional assessment by fractional flow reserve (FFR). This study aimed to investigate whether a more comprehensive evaluation of the coronary angiogram may contribute to a better identification of flow-limiting stenoses. Coronary angiograms of 1,350 patients (1,883 lesions) were retrospectively analyzed for stenosis grade (eyeballing, %) and matched with FFR values. Angiography-derived optimal cut-off values and intervals delineating the [90% sensitivity-90% specificity] range were 50.8% [42.5-65.0%] for the left main (LM), 62.2% [50.0-72.5%] for the proximal (prox)/mid left anterior descending (LAD) artery, 66.3% [57.5-77.5%] for the prox/mid right coronary artery (RCA), 70.5% [60.0-80.0%] for the prox left circumflex/first obtuse marginal (LCX/OM1), and 71.4% [62.5-82.5%] for the more distal segments. In patients with intermediate LAD lesions, 5 angiographic parameters were identified as independent predictors of flow limitation: (1) a 30-50% lesion prox to the lesion of interest, (2) lesion length >20 mm, (3) distal take-off of all diagonal branches ≥2 mm diameter, (4) "apical wrap" of LAD, and (5) collaterals to an occluded LCX/RCA. Based on these results, a risk score (P20-DAC2) for prediction of flow limitation in intermediate LAD lesions was derived. In conclusion, a comprehensive evaluation of the coronary angiogram-in which besides stenosis grade also other lesion/vessel characteristics are evaluated-can lead to a more accurate identification of functionally significant coronary stenoses.
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12
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Erlinge D, Götberg M, Noc M, Lang I, Holzer M, Clemmensen P, Jensen U, Metzler B, James S, Bøtker HE, Omerovic E, Koul S, Engblom H, Carlsson M, Arheden H, Östlund O, Wallentin L, Klos B, Harnek J, Olivecrona GK. Therapeutic hypothermia for the treatment of acute myocardial infarction-combined analysis of the RAPID MI-ICE and the CHILL-MI trials. Ther Hypothermia Temp Manag 2015; 5:77-84. [PMID: 25985169 DOI: 10.1089/ther.2015.0009] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
In the randomized rapid intravascular cooling in myocardial infarction as adjunctive to percutaneous coronary intervention (RAPID MI-ICE) and rapid endovascular catheter core cooling combined with cold saline as an adjunct to percutaneous coronary intervention for the treatment of acute myocardial infarction CHILL-MI studies, hypothermia was rapidly induced in conscious patients with ST-elevation myocardial infarction (STEMI) by a combination of cold saline and endovascular cooling. Twenty patients in RAPID MI-ICE and 120 in CHILL-MI with large STEMIs, scheduled for primary percutaneous coronary intervention (PCI) within <6 hours after symptom onset were randomized to hypothermia induced by rapid infusion of 600-2000 mL cold saline combined with endovascular cooling or standard of care. Hypothermia was initiated before PCI and continued for 1-3 hours after reperfusion aiming at a target temperature of 33°C. The primary endpoint was myocardial infarct size (IS) as a percentage of myocardium at risk (IS/MaR) assessed by cardiac magnetic resonance imaging at 4±2 days. Patients randomized to hypothermia treatment achieved a mean core body temperature of 34.7°C before reperfusion. Although significance was not achieved in CHILL-MI, in the pooled analysis IS/MaR was reduced in the hypothermia group, relative reduction (RR) 15% (40.5, 28.0-57.6 vs. 46.6, 36.8-63.8, p=0.046, median, interquartile range [IQR]). IS/MaR was predominantly reduced in early anterior STEMI (0-4h) in the hypothermia group, RR=31% (40.5, 28.8-51.9 vs. 59.0, 45.0-67.8, p=0.01, median, IQR). There was no mortality in either group. The incidence of heart failure was reduced in the hypothermia group (2 vs. 11, p=0.009). Patients with large MaR (>30% of the left ventricle) exhibited significantly reduced IS/MaR in the hypothermia group (40.5, 27.0-57.6 vs. 55.1, 41.1-64.4, median, IQR; hypothermia n=42 vs. control n=37, p=0.03), while patients with MaR<30% did not show effect of hypothermia (35.8, 28.3-57.5 vs. 38.4, 27.4-59.7, median, IQR; hypothermia n=15 vs. control n=19, p=0.50). The prespecified pooled analysis of RAPID MI-ICE and CHILL-MI indicates a reduction of myocardial IS and reduction in heart failure by 1-3 hours with endovascular cooling in association with primary PCI of acute STEMI predominantly in patients with large area of myocardium at risk. (ClinicalTrials.gov id NCT00417638 and NCT01379261).
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Affiliation(s)
- David Erlinge
- 1 Department of Cardiology, Clinical Sciences, Lund University , Lund, Sweden
| | - Matthias Götberg
- 1 Department of Cardiology, Clinical Sciences, Lund University , Lund, Sweden
| | - Marko Noc
- 2 Center for Intensive Internal Medicine , Ljubljana, Slovenia
| | - Irene Lang
- 3 Department of Cardiology, Medical University of Vienna , Vienna, Austria .,4 Department of Emergency Medicine, Medical University of Vienna , Vienna, Austria
| | - Michael Holzer
- 3 Department of Cardiology, Medical University of Vienna , Vienna, Austria .,4 Department of Emergency Medicine, Medical University of Vienna , Vienna, Austria
| | - Peter Clemmensen
- 5 Department of Cardiology, Nykoebing F Hospital , Nykoebing F, Denmark
| | - Ulf Jensen
- 6 Cardiology Unit, Department of Medicine, Karolinska University Hospital , Stockholm, Sweden
| | - Bernhard Metzler
- 7 Department of Cardiology, University Hospital for Internal Medicine, Innsbruck , Austria
| | - Stefan James
- 8 Department of Medical Sciences, Cardiology and Uppsala Clinical Research Center, Uppsala University , Uppsala, Sweden
| | - Hans Erik Bøtker
- 9 Department of Cardiology, Aarhus University Hospital Skejby , Aarhus, Denmark
| | - Elmir Omerovic
- 10 Department of Cardiology, Sahlgrenska University , Gothenburg, Sweden
| | - Sasha Koul
- 1 Department of Cardiology, Clinical Sciences, Lund University , Lund, Sweden
| | - Henrik Engblom
- 11 Department of Clinical Physiology, Lund University , Lund, Sweden
| | - Marcus Carlsson
- 11 Department of Clinical Physiology, Lund University , Lund, Sweden
| | - Håkan Arheden
- 11 Department of Clinical Physiology, Lund University , Lund, Sweden
| | - Ollie Östlund
- 12 Uppsala Clinical Research Center, Uppsala University , Uppsala, Sweden
| | - Lars Wallentin
- 8 Department of Medical Sciences, Cardiology and Uppsala Clinical Research Center, Uppsala University , Uppsala, Sweden
| | | | - Jan Harnek
- 1 Department of Cardiology, Clinical Sciences, Lund University , Lund, Sweden
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13
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Lagerqvist B, Fröbert O, Olivecrona GK, Gudnason T, Maeng M, Alström P, Andersson J, Calais F, Carlsson J, Collste O, Götberg M, Hårdhammar P, Ioanes D, Kallryd A, Linder R, Lundin A, Odenstedt J, Omerovic E, Puskar V, Tödt T, Zelleroth E, Östlund O, James SK. Outcomes 1 year after thrombus aspiration for myocardial infarction. N Engl J Med 2014; 371:1111-20. [PMID: 25176395 DOI: 10.1056/nejmoa1405707] [Citation(s) in RCA: 260] [Impact Index Per Article: 26.0] [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: 12/30/2022]
Abstract
BACKGROUND Routine intracoronary thrombus aspiration before primary percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI) has not been proved to reduce short-term mortality. We evaluated clinical outcomes at 1 year after thrombus aspiration. METHODS We randomly assigned 7244 patients with STEMI to undergo manual thrombus aspiration followed by PCI or to undergo PCI alone, in a registry-based, randomized clinical trial. The primary end point of all-cause mortality at 30 days has been reported previously. Death from any cause at 1 year was a prespecified secondary end point of the trial. RESULTS No patients were lost to follow-up. Death from any cause occurred in 5.3% of the patients (191 of 3621 patients) in the thrombus-aspiration group, as compared with 5.6% (202 of 3623) in the PCI-only group (hazard ratio, 0.94; 95% confidence interval [CI], 0.78 to 1.15; P=0.57). Rehospitalization for myocardial infarction at 1 year occurred in 2.7% and 2.7% of the patients, respectively (hazard ratio, 0.97; 95% CI, 0.73 to 1.28; P=0.81), and stent thrombosis in 0.7% and 0.9%, respectively (hazard ratio, 0.84; 95% CI, 0.50 to 1.40; P=0.51). The composite of death from any cause, rehospitalization for myocardial infarction, or stent thrombosis occurred in 8.0% and 8.5% of the patients, respectively (hazard ratio, 0.94; 95% CI, 0.80 to 1.11; P=0.48). The results were consistent across all the major subgroups, including grade of thrombus burden and coronary flow before PCI. CONCLUSIONS Routine thrombus aspiration before PCI in patients with STEMI did not reduce the rate of death from any cause or the composite of death from any cause, rehospitalization for myocardial infarction, or stent thrombosis at 1 year. (Funded by the Swedish Research Council and others; TASTE ClinicalTrials.gov number, NCT01093404.).
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Affiliation(s)
- Bo Lagerqvist
- From the Department of Medical Sciences, Cardiology Section, and Uppsala Clinical Research Center, Uppsala University, Uppsala (B.L., O.O., S.K.J.), Department of Cardiology, Örebro University Hospital, Örebro (O.F., F.C.), Department of Coronary Heart Disease, Skane University Hospital, Clinical Sciences Section, Lund University, Lund (G.K.O., M.G., A.L.), Department of Cardiology, Karolinska Institutet, Södersjukhuset (P.A., O.C.), and Department of Cardiology, Karolinska Institutet, Danderyd (R.L.), Stockholm, Department of Cardiology, Umeå University Hospital, Umeå (J.A.), Section of Cardiology, Kalmar County Hospital and Linnaeus University, Kalmar (J.C.), Department of Cardiology, Halmstad Hospital, Halmstad (P.H.), Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (D.I., J.O., E.O.), Department of Cardiology, Skaraborgs Hospital, Skövde (A.K.), Department of Radiology, Ryhov Hospital, Jönköping (V.P.), Department of Cardiology, Linköping University Hospital, Linköping (T.T.), and Department of Radiology, Mälarsjukhuset, Eskilstuna (E.Z.) - all in Sweden; Department of Cardiology and Cardiovascular Research Center, Landspitali University Hospital, Reykjavik, Iceland (T.G.); and the Department of Cardiology, Aarhus University Hospital, Skejby, Aarhus, Denmark (M.M.)
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Erlinge D, Götberg M, Lang I, Holzer M, Noc M, Clemmensen P, Jensen U, Metzler B, James S, Bötker HE, Omerovic E, Engblom H, Carlsson M, Arheden H, Ostlund O, Wallentin L, Harnek J, Olivecrona GK. Rapid endovascular catheter core cooling combined with cold saline as an adjunct to percutaneous coronary intervention for the treatment of acute myocardial infarction. The CHILL-MI trial: a randomized controlled study of the use of central venous catheter core cooling combined with cold saline as an adjunct to percutaneous coronary intervention for the treatment of acute myocardial infarction. J Am Coll Cardiol 2014; 63:1857-65. [PMID: 24509284 DOI: 10.1016/j.jacc.2013.12.027] [Citation(s) in RCA: 176] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Revised: 12/09/2013] [Accepted: 12/23/2013] [Indexed: 10/25/2022]
Abstract
OBJECTIVES The aim of this study was to confirm the cardioprotective effects of hypothermia using a combination of cold saline and endovascular cooling. BACKGROUND Hypothermia has been reported to reduce infarct size (IS) in patients with ST-segment elevation myocardial infarctions. METHODS In a multicenter study, 120 patients with ST-segment elevation myocardial infarctions (<6 h) scheduled to undergo percutaneous coronary intervention were randomized to hypothermia induced by the rapid infusion of 600 to 2,000 ml cold saline and endovascular cooling or standard of care. Hypothermia was initiated before percutaneous coronary intervention and continued for 1 h after reperfusion. The primary end point was IS as a percent of myocardium at risk (MaR), assessed by cardiac magnetic resonance imaging at 4 ± 2 days. RESULTS Mean times from symptom onset to randomization were 129 ± 56 min in patients receiving hypothermia and 132 ± 64 min in controls. Patients randomized to hypothermia achieved a core body temperature of 34.7°C before reperfusion, with a 9-min longer door-to-balloon time. Median IS/MaR was not significantly reduced (hypothermia: 40.5% [interquartile range: 29.3% to 57.8%; control: 46.6% [interquartile range: 37.8% to 63.4%]; relative reduction 13%; p = 0.15). The incidence of heart failure was lower with hypothermia at 45 ± 15 days (3% vs. 14%, p < 0.05), with no mortality. Exploratory analysis of early anterior infarctions (0 to 4 h) found a reduction in IS/MaR of 33% (p < 0.05) and an absolute reduction of IS/left ventricular volume of 6.2% (p = 0.15). CONCLUSIONS Hypothermia induced by cold saline and endovascular cooling was feasible and safe, and it rapidly reduced core temperature with minor reperfusion delay. The primary end point of IS/MaR was not significantly reduced. Lower incidence of heart failure and a possible effect in patients with early anterior ST-segment elevation myocardial infarctions need confirmation. (Efficacy of Endovascular Catheter Cooling Combined With Cold Saline for the Treatment of Acute Myocardial Infarction [CHILL-MI]; NCT01379261).
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Affiliation(s)
- David Erlinge
- Department of Cardiology, Lund University, Lund, Sweden.
| | | | - Irene Lang
- Department of Cardiology and the Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Michael Holzer
- Department of Cardiology and the Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Marko Noc
- Center for Intensive Internal Medicine, Ljubljana, Slovenia
| | | | - Ulf Jensen
- Cardiology Unit, Department of Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Bernhard Metzler
- Department of Cardiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Stefan James
- Uppsala Clinical Research Center, Uppsala, Sweden; Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Hans Erik Bötker
- Department of Cardiology, Sahlgrenska University, Gothenburg, Sweden
| | - Elmir Omerovic
- Department of Cardiology, Sahlgrenska University, Gothenburg, Sweden
| | - Henrik Engblom
- Department of Clinical Physiology, Lund University, Lund, Sweden
| | - Marcus Carlsson
- Department of Clinical Physiology, Lund University, Lund, Sweden
| | - Håkan Arheden
- Department of Clinical Physiology, Lund University, Lund, Sweden
| | | | - Lars Wallentin
- Uppsala Clinical Research Center, Uppsala, Sweden; Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Jan Harnek
- Department of Cardiology, Lund University, Lund, Sweden
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Erlinge D, Götberg M, Grines C, Dixon S, Baran K, Kandzari D, Olivecrona GK. A pooled analysis of the effect of endovascular cooling on infarct size in patients with ST-elevation myocardial infarction. EUROINTERVENTION 2013; 8:1435-40. [PMID: 23164721 DOI: 10.4244/eijv8i12a217] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [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: 12/29/2022]
Abstract
AIMS Prior evaluations of endovascular cooling during primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) have suggested variability in treatment effect related to core temperature at the time of reperfusion, to infarct location and time from symptom onset to reperfusion. Recent results from a randomised feasibility study suggest rapid induction of hypothermia in primary PCI results in a significant reduction in infarct size (IS). METHODS AND RESULTS Outcomes from two randomised trials of hypothermia in primary PCI were pooled to examine IS as a percentage of left ventricular myocardium assessed by SPECT or magnetic resonance imaging. Compared with controls (n=103), hypothermia (n=94) was associated with a significant 24% relative reduction (RR) in IS (10.7±1.3% vs. 14.1±1.6%, mean±SEM, p=0.049). Among hypothermia-treated patients for whom core temperature <35C° was achieved before reperfusion, IS was reduced by 37% (8.8±1.7% vs. 14.1±1.6%, p=0.01), a benefit observed for both anterior (14.9±2.9% vs. 22.2±2.7%, RR 33%; p=0.03) and inferior infarcts (4.5±1.4% vs. 7.7±1.3%, RR 42%; p=0.04). CONCLUSIONS In a pooled analysis of randomised trials evaluating adjunctive hypothermia in primary PCI, achievement of core body temperature <35°C before reperfusion may reduce infarct size with a similar efficacy for both anterior and inferior MI.
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Affiliation(s)
- David Erlinge
- Department of Cardiology, Lund University, Skane University Hospital, Lund, Sweden.
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Fröbert O, Lagerqvist B, Olivecrona GK, Omerovic E, Gudnason T, Maeng M, Aasa M, Angerås O, Calais F, Danielewicz M, Erlinge D, Hellsten L, Jensen U, Johansson AC, Kåregren A, Nilsson J, Robertson L, Sandhall L, Sjögren I, Ostlund O, Harnek J, James SK. Thrombus aspiration during ST-segment elevation myocardial infarction. N Engl J Med 2013; 369:1587-97. [PMID: 23991656 DOI: 10.1056/nejmoa1308789] [Citation(s) in RCA: 774] [Impact Index Per Article: 70.4] [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: 12/16/2022]
Abstract
BACKGROUND The clinical effect of routine intracoronary thrombus aspiration before primary percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI) is uncertain. We aimed to evaluate whether thrombus aspiration reduces mortality. METHODS We conducted a multicenter, prospective, randomized, controlled, open-label clinical trial, with enrollment of patients from the national comprehensive Swedish Coronary Angiography and Angioplasty Registry (SCAAR) and end points evaluated through national registries. A total of 7244 patients with STEMI undergoing PCI were randomly assigned to manual thrombus aspiration followed by PCI or to PCI only. The primary end point was all-cause mortality at 30 days. RESULTS No patients were lost to follow-up. Death from any cause occurred in 2.8% of the patients in the thrombus-aspiration group (103 of 3621), as compared with 3.0% in the PCI-only group (110 of 3623) (hazard ratio, 0.94; 95% confidence interval [CI], 0.72 to 1.22; P=0.63). The rates of hospitalization for recurrent myocardial infarction at 30 days were 0.5% and 0.9% in the two groups, respectively (hazard ratio, 0.61; 95% CI, 0.34 to 1.07; P=0.09), and the rates of stent thrombosis were 0.2% and 0.5%, respectively (hazard ratio, 0.47; 95% CI, 0.20 to 1.02; P=0.06). There were no significant differences between the groups with respect to the rate of stroke or neurologic complications at the time of discharge (P=0.87). The results were consistent across all major prespecified subgroups, including subgroups defined according to thrombus burden and coronary flow before PCI. CONCLUSIONS Routine thrombus aspiration before PCI as compared with PCI alone did not reduce 30-day mortality among patients with STEMI. (Funded by the Swedish Research Council and others; ClinicalTrials.gov number, NCT01093404.).
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Affiliation(s)
- Ole Fröbert
- From the Department of Cardiology, Örebro University Hospital, Örebro (O.F., F.C.), Department of Medical Sciences, Cardiology, and Uppsala Clinical Research Center, Uppsala University, Uppsala (B.L., O.O., S.K.J.), Department of Cardiology, Lund University Hospital, Lund (G.K.O., D.E., J.H.), Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (E.O., O.A.), Department of Cardiology, Karolinska Institutet, Sodersjukhuset (M.A.), and Cardiology Unit, Department of Medicine, Karolinska University Hospital (U.J.), Stockholm, Department of Cardiology, Karlstad Hospital, Karlstad (M.D.), Department of Cardiology, Gävle Hospital, Gävle (L.H.), PCI Unit, Sunderby Hospital, Sunderby (A.C.J.), Department of Cardiology, Västerås Hospital, Västerås (A.K.), Department of Cardiology, Heart Center, Umea University, Umea (J.N.), Department of Cardiology, Borås Hospital, Borås (L.R.), Department of Radiology, Helsingborg Hospital, Helsingborg (L.S.), and Department of Cardiology, Falun Hospital, Falun (I.S.) - all in Sweden; Department of Cardiology and Cardiovascular Research Center, Landspitali University Hospital of Iceland, Reykjavik, Iceland (T.G.); and Department of Cardiology, Aarhus University Hospital, Skejby, Aarhus, Denmark (M.M.)
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Harnek J, Hochbergs P, Thilen U, Holm J, Bjursten H, Gustafsson R, Olivecrona GK. Early valve failure in a first-in-man implant with an Edwards SAPIEN XT valve using the split sheath NovaFlex system in the treatment of a pulmonary conduit stenosis. EUROINTERVENTION 2013; 9:768, 2 p following p768. [DOI: 10.4244/eijv9i6a124] [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: 11/23/2022]
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Kosonen P, Vikman S, Jensen LO, Lassen JF, Harnek J, Olivecrona GK, Erglis A, Fossum E, Niemelä M, Kervinen K, Ylitalo A, Pietilä M, Aaroe J, Kellerth T, Saunamäki K, Thayssen P, Hellsten L, Thuesen L, Niemelä K. Intravascular ultrasound assessed incomplete stent apposition and stent fracture in stent thrombosis after bare metal versus drug-eluting stent treatment the Nordic Intravascular Ultrasound Study (NIVUS). Int J Cardiol 2013; 168:1010-6. [DOI: 10.1016/j.ijcard.2012.10.033] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2012] [Revised: 10/02/2012] [Accepted: 10/28/2012] [Indexed: 12/13/2022]
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Bondesson P, Lagerqvist B, James SK, Olivecrona GK, Venetsanos D, Harnek J. Comparison of two drug-eluting balloons: a report from the SCAAR registry. EUROINTERVENTION 2012; 8:444-9. [DOI: 10.4244/eijv8i4a70] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Götberg M, Pals J, Götberg M, Olivecrona GK, Kanski M, Koul S, Otto A, Engblom H, Ugander M, Arheden H, Erlinge D. Optimal timing of hypothermia in relation to myocardial reperfusion. Basic Res Cardiol 2011; 106:697-708. [DOI: 10.1007/s00395-011-0195-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2010] [Revised: 05/10/2011] [Accepted: 06/07/2011] [Indexed: 01/18/2023]
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Harnek J, Olivecrona GK, Rück A. [Transcatheter aortic valve implantation a new alternative to surgery]. Lakartidningen 2011; 108:1113-1116. [PMID: 21815344] [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] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- Jan Harnek
- Kliniken för kranskärlssjukdom, Skånes universitetssjukhus, Lund
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Abstract
Prolonged cardiac arrest in the cath lab is associated with very high mortality rates. Use of manual chest compressions have, until recently, been the only rapid response available to circulate the patient in such scenarios. The recent introduction of mechanical chest compression devices offers a new alternative that may perform better than manual chest compressions, especially during a continued interventional procedure.
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Johansson M, Nozohoor S, Kimblad PO, Harnek J, Olivecrona GK, Sjögren J. Transapical Versus Transfemoral Aortic Valve Implantation: A Comparison of Survival and Safety. Ann Thorac Surg 2011; 91:57-63. [DOI: 10.1016/j.athoracsur.2010.07.072] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2010] [Revised: 07/17/2010] [Accepted: 07/21/2010] [Indexed: 11/28/2022]
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Krarup NH, Terkelsen CJ, Johnsen SP, Clemmensen P, Olivecrona GK, Hansen TM, Trautner S, Lassen JF. Quality of cardiopulmonary resuscitation in out-of-hospital cardiac arrest is hampered by interruptions in chest compressions--a nationwide prospective feasibility study. Resuscitation 2010; 82:263-9. [PMID: 21146913 DOI: 10.1016/j.resuscitation.2010.11.003] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2010] [Revised: 11/01/2010] [Accepted: 11/07/2010] [Indexed: 11/25/2022]
Abstract
AIM OF THE STUDY Quality of cardiopulmonary resuscitation (CPR) is a critical determinant of outcome following out-of-hospital cardiac arrest. The aim of our study was to evaluate the quality of CPR provided by emergency medical service providers (Basic Life Support (BLS) capability) and emergency medical service providers assisted by paramedics, nurse anesthetists or physician-manned ambulances (Advanced Life Support (ALS) capability) in a nationwide, unselected cohort of out-of-hospital cardiac arrest cases. METHODS We conducted a prospective, observational study of out-of-hospital cardiac arrest with non-traumatic etiology (>18 years of age) occurring from the 1st to the 31st of January 2009 and treated by the primary Danish emergency medical service operator, covering approximately 85% of the population. One hundred and ninety-one cases were eligible for analysis. Follow-up was up to one year or death. Quality of CPR was evaluated using measurements of transthoracic impedance. RESULTS The majority of patients were treated by ambulances with ALS capability (54%). Interruptions in CPR related to loading of the patient into the emergency medical service vehicle were substantial, but independent of whether patients were managed by ALS or BLS capable units (222s versus 224s, P = 0.76) as were duration of interruptions during rhythm analysis alone (20s versus 22s, P = 0.33) and defibrillation (24s versus 26s, P = 0.07). CONCLUSIONS Nationwide, routine monitoring of transthoracic impedance is feasible. CPR is hampered by extended interruptions, particularly during loading of the patient into the emergency medical service vehicle, rhythm analysis and defibrillation.
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Affiliation(s)
- Niels Henrik Krarup
- Department of Cardiology B, Aarhus University Hospital, Skejby, Brendstrupgaardsvej 100, DK-8200 Aarhus N, Denmark.
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Fröbert O, Lagerqvist B, Gudnason T, Thuesen L, Svensson R, Olivecrona GK, James SK. Thrombus Aspiration in ST-Elevation myocardial infarction in Scandinavia (TASTE trial). A multicenter, prospective, randomized, controlled clinical registry trial based on the Swedish angiography and angioplasty registry (SCAAR) platform. Study design and rationale. Am Heart J 2010; 160:1042-8. [PMID: 21146656 DOI: 10.1016/j.ahj.2010.08.040] [Citation(s) in RCA: 129] [Impact Index Per Article: 9.2] [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] [Received: 06/25/2010] [Accepted: 08/21/2010] [Indexed: 11/28/2022]
Abstract
BACKGROUND In ST-elevation myocardial infarction (STEMI), distal embolization of thrombus material often precludes restoration of normal coronary artery flow. Small-scaled studies have demonstrated that intracoronary thrombus aspiration improves flow and myocardial perfusion, but only one larger randomized single-center study has suggested a survival benefit. Thrombus aspiration is widely used in clinical practice and is recommended by international guidelines despite limited evidence. METHODS/DESIGN The Thrombus Aspiration in ST-Elevation myocardial infarction in Scandinavia is a multicenter, prospective, randomized, controlled, clinical open-label trial based on the Swedish angiography and angioplasty registry (SCAAR) platform with blinded evaluation of end points. A total of 5,000 patients with STEMI undergoing primary percutaneous coronary intervention (PCI) will randomly be assigned either to conventional PCI or to thrombus aspiration followed by PCI. SCAAR will be used as the platform for randomization, allowing a broad population of all-comers in the registry network to be enrolled. All follow-up will also be done in SCAAR and other national registries. The primary end point is time to all-cause death at 30 days. DISCUSSION The Thrombus Aspiration in ST-Elevation myocardial infarction in Scandinavia trial is the largest trial to date to evaluate the effect of thrombus aspiration on death following PCI in patients with STEMI. We propose the term randomized clinical registry trial to describe the novel entity of using an online national registry as platform for case records, randomization, and follow-up.
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Affiliation(s)
- Ole Fröbert
- Department of Cardiology, Örebro University Hospital, Örebro, Sweden.
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Fröbert O, Lagerqvist B, Kreutzer M, Olivecrona GK, James SK. Thrombus aspiration in ST-elevation myocardial infarction in Sweden. Int J Cardiol 2010; 145:572-3. [DOI: 10.1016/j.ijcard.2010.05.044] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2010] [Accepted: 05/18/2010] [Indexed: 10/19/2022]
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van der Pals J, Koul S, Andersson P, Götberg M, Ubachs JFA, Kanski M, Arheden H, Olivecrona GK, Larsson B, Erlinge D. Treatment with the C5a receptor antagonist ADC-1004 reduces myocardial infarction in a porcine ischemia-reperfusion model. BMC Cardiovasc Disord 2010; 10:45. [PMID: 20875134 PMCID: PMC2955599 DOI: 10.1186/1471-2261-10-45] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2010] [Accepted: 09/27/2010] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Polymorphonuclear neutrophils, stimulated by the activated complement factor C5a, have been implicated in cardiac ischemia/reperfusion injury. ADC-1004 is a competitive C5a receptor antagonist that has been shown to inhibit complement related neutrophil activation. ADC-1004 shields the neutrophils from C5a activation before they enter the reperfused area, which could be a mechanistic advantage compared to previous C5a directed reperfusion therapies. We investigated if treatment with ADC-1004, according to a clinically applicable protocol, would reduce infarct size and microvascular obstruction in a large animal myocardial infarct model. METHODS In anesthetized pigs (42-53 kg), a percutaneous coronary intervention balloon was inflated in the left anterior descending artery for 40 minutes, followed by 4 hours of reperfusion. Twenty minutes after balloon inflation the pigs were randomized to an intravenous bolus administration of ADC-1004 (175 mg, n = 8) or saline (9 mg/ml, n = 8). Area at risk (AAR) was evaluated by ex vivo SPECT. Infarct size and microvascular obstruction were evaluated by ex vivo MRI. The observers were blinded to the treatment at randomization and analysis. RESULTS ADC-1004 treatment reduced infarct size by 21% (ADC-1004: 58.3 ± 3.4 vs control: 74.1 ± 2.9%AAR, p = 0.007). Microvascular obstruction was similar between the groups (ADC-1004: 2.2 ± 1.2 vs control: 5.3 ± 2.5%AAR, p = 0.23). The mean plasma concentration of ADC-1004 was 83 ± 8 nM at sacrifice. There were no significant differences between the groups with respect to heart rate, mean arterial pressure, cardiac output and blood-gas data. CONCLUSIONS ADC-1004 treatment reduces myocardial ischemia-reperfusion injury and represents a novel treatment strategy of myocardial infarct with potential clinical applicability.
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van der Schaaf RJ, Claessen BE, Hoebers LP, Verouden NJ, Koolen JJ, Suttorp MJ, Barbato E, Bax M, Strauss BH, Olivecrona GK, Tuseth V, Glogar D, Råmunddal T, Tijssen JG, Piek JJ, Henriques JPS. Rationale and design of EXPLORE: a randomized, prospective, multicenter trial investigating the impact of recanalization of a chronic total occlusion on left ventricular function in patients after primary percutaneous coronary intervention for acute ST-elevation myocardial infarction. Trials 2010; 11:89. [PMID: 20858263 PMCID: PMC2949852 DOI: 10.1186/1745-6215-11-89] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2010] [Accepted: 09/21/2010] [Indexed: 01/28/2023] Open
Abstract
Background In the setting of primary percutaneous coronary intervention, patients with a chronic total occlusion in a non-infarct related artery were recently identified as a high-risk subgroup. It is unclear whether ST-elevation myocardial infarction patients with a chronic total occlusion in a non-infarct related artery should undergo additional percutaneous coronary intervention of the chronic total occlusion on top of optimal medical therapy shortly after primary percutaneous coronary intervention. Possible beneficial effects include reduction in adverse left ventricular remodeling and preservation of global left ventricular function and improved clinical outcome during future coronary events. Methods/Design The Evaluating Xience V and left ventricular function in Percutaneous coronary intervention on occLusiOns afteR ST-Elevation myocardial infarction (EXPLORE) trial is a randomized, prospective, multicenter, two-arm trial with blinded evaluation of endpoints. Three hundred patients after primary percutaneous coronary intervention for ST-elevation myocardial infarction with a chronic total occlusion in a non-infarct related artery are randomized to either elective percutaneous coronary intervention of the chronic total occlusion within seven days or standard medical treatment. When assigned to the invasive arm, an everolimus-eluting coronary stent is used. Primary endpoints are left ventricular ejection fraction and left ventricular end-diastolic volume assessed by cardiac Magnetic Resonance Imaging at four months. Clinical follow-up will continue until five years. Discussion The ongoing EXPLORE trial is the first randomized clinical trial powered to investigate whether recanalization of a chronic total occlusion in a non-infarct related artery after primary percutaneous coronary intervention for ST-elevation myocardial infarction results in a better preserved residual left ventricular ejection fraction, reduced end-diastolic volume and enhanced clinical outcome. Trial registration trialregister.nl NTR1108.
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Affiliation(s)
- René J van der Schaaf
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
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Götberg M, van der Pals J, Olivecrona GK, Götberg M, Koul S, Erlinge D. Mild hypothermia reduces acute mortality and improves hemodynamic outcome in a cardiogenic shock pig model. Resuscitation 2010; 81:1190-6. [DOI: 10.1016/j.resuscitation.2010.04.033] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2010] [Revised: 03/25/2010] [Accepted: 04/25/2010] [Indexed: 11/12/2022]
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Götberg M, Olivecrona GK, Koul S, Carlsson M, Engblom H, Ugander M, van der Pals J, Algotsson L, Arheden H, Erlinge D. A pilot study of rapid cooling by cold saline and endovascular cooling before reperfusion in patients with ST-elevation myocardial infarction. Circ Cardiovasc Interv 2010; 3:400-7. [PMID: 20736446 DOI: 10.1161/circinterventions.110.957902] [Citation(s) in RCA: 172] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Experimental studies have shown that induction of hypothermia before reperfusion of acute coronary occlusion reduces infarct size. Previous clinical studies, however, have not been able to show this effect, which is believed to be mainly because therapeutic temperature was not reached before reperfusion in the majority of the patients. We aimed to evaluate the safety and feasibility of rapidly induced hypothermia by infusion of cold saline and endovascular cooling catheter before reperfusion in patients with acute myocardial infarction. METHODS AND RESULTS Twenty patients with acute myocardial infarction scheduled to undergo primary percutaneous coronary intervention were enrolled in this prospective, randomized study. After 4 ± 2 days, myocardium at risk and infarct size were assessed by cardiac magnetic resonance using T2-weighted imaging and late gadolinium enhancement imaging, respectively. A core body temperature of <35°C (34.7 ± 0.3°C) was achieved before reperfusion without significant delay in door-to-balloon time (43 ± 7 minutes versus 40 ± 6 minutes, hypothermia versus control, P=0.12). Despite similar duration of ischemia (174 ± 51 minutes versus 174 ± 62 minutes, hypothermia versus control, P=1.00), infarct size normalized to myocardium at risk was reduced by 38% in the hypothermia group compared with the control group (29.8 ± 12.6% versus 48.0 ± 21.6%, P=0.041). This was supported by a significant decrease in both peak and cumulative release of Troponin T in the hypothermia group (P=0.01 and P=0.03, respectively). CONCLUSIONS The protocol demonstrates the ability to reach a core body temperature of <35°C before reperfusion in all patients without delaying primary percutaneous coronary intervention and that combination hypothermia as an adjunct therapy in acute myocardial infarction may reduce infarct size at 3 days as measured by MRI. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00417638.
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Affiliation(s)
- Matthias Götberg
- Department of Coronary Heart Disease, Skane University Hospital, Lund University, Lund, Sweden
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Ugander M, Kanski M, Engblom H, Götberg M, Olivecrona GK, Erlinge D, Heiberg E, Arheden H. Pulmonary Blood Volume Variation Decreases after Myocardial Infarction in Pigs: A Quantitative and Noninvasive MR Imaging Measure of Heart Failure. Radiology 2010; 256:415-23. [DOI: 10.1148/radiol.10090292] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Torbrand C, Ugander M, Engblom H, Olivecrona GK, Gålne O, Arheden H, Ingemansson R, Malmsjö M. Changes in cardiac pumping efficiency and intra-thoracic organ volume during negative pressure wound therapy of sternotomy wounds, assessment using magnetic resonance imaging. Int Wound J 2010; 7:305-11. [PMID: 20633058 PMCID: PMC7951601 DOI: 10.1111/j.1742-481x.2010.00712.x] [Citation(s) in RCA: 5] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Knowledge on the effects of negative pressure wound therapy (NPWT) on the intra-thoracic organs is limited. The present study was performed to investigate the effects of NPWT on the volume of the intra-thoracic organs, using magnetic resonance imaging (MRI), in a porcine sternotomy wound model. Six pigs underwent median sternotomy followed by NPWT at -75, -125 and -175 mmHg. Six pigs were not sternotomised. MR images covering the thorax and heart were acquired. The volumes of the thoracic cavity, lungs, wound fluid and heart were then determined. The volumes of the thoracic cavity and intra-thoracic organs increased after sternotomy and decreased upon NPWT application. The total heart volume variation, which is inversely related to cardiac pumping efficiency, was higher after sternotomy and decreased during NPWT. NPWT did not result in the evacuation of wound fluid from the bottom of the wound. NPWT largely closes and restores the thoracic cavity. Cardiac pumping efficiency returns to pre-sternotomy levels during NPWT. This may contribute to the clinical benefits of NPWT over open-chest care, including the stabilizing effects and the reduced need for mechanical ventilation.
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Torbrand C, Ugander M, Engblom H, Olivecrona GK, Gålne O, Arheden H, Ingemansson R, Malmsjö M. Changes in cardiac pumping efficiency and intra-thoracic organ volume during negative pressure wound therapy of sternotomy wounds, assessment using magnetic resonance imaging. Int Wound J 2010; 7:115-21. [PMID: 20529152 PMCID: PMC7951507 DOI: 10.1111/j.1742-481x.2010.00664.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Knowledge on the effects of negative pressure wound therapy (NPWT) on the intra-thoracic organs is limited. The present study was performed to investigate the effects of NPWT on the volume of the intra-thoracic organs, using magnetic resonance imaging (MRI), in a porcine sternotomy wound model. Six pigs underwent median sternotomy followed by NPWT at -75, -125 and -175 mmHg. Six pigs were not sternotomised. MR images covering the thorax and heart were acquired. The volumes of the thoracic cavity, lungs, wound fluid and heart were then determined. The volumes of the thoracic cavity and intra-thoracic organs increased after sternotomy and decreased upon NPWT application. The total heart volume variation, which is a measure of cardiac pumping efficiency, was higher after sternotomy and decreased during NPWT. NPWT did not result in the evacuation of wound fluid from the bottom of the wound. NPWT largely closes and restores the thoracic cavity. Cardiac pumping efficiency returns to pre-sternotomy levels during NPWT. This may contribute to the clinical benefits of NPWT over open-chest care, including the stabilizing effects and the reduced need for mechanical ventilation.
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van der Pals J, Koul S, Götberg MI, Olivecrona GK, Ugander M, Kanski M, Otto A, Götberg M, Arheden H, Erlinge D. Apyrase treatment of myocardial infarction according to a clinically applicable protocol fails to reduce myocardial injury in a porcine model. BMC Cardiovasc Disord 2010; 10:1. [PMID: 20047685 PMCID: PMC2820435 DOI: 10.1186/1471-2261-10-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2009] [Accepted: 01/04/2010] [Indexed: 11/10/2022] Open
Abstract
Background Ectonucleotidase dependent adenosine generation has been implicated in preconditioning related cardioprotection against ischemia-reperfusion injury, and treatment with a soluble ectonucleotidase has been shown to reduce myocardial infarct size (IS) when applied prior to induction of ischemia. However, ectonucleotidase treatment according to a clinically applicable protocol, with administration only after induction of ischemia, has not previously been evaluated. We therefore investigated if treatment with the ectonucleotidase apyrase, according to a clinically applicable protocol, would reduce IS and microvascular obstruction (MO) in a large animal model. Methods A percutaneous coronary intervention balloon was inflated in the left anterior descending artery for 40 min, in 16 anesthetized pigs (40-50 kg). The pigs were randomized to 40 min of 1 ml/min intracoronary infusion of apyrase (10 U/ml, n = 8) or saline (0.9 mg/ml, n = 8), twenty minutes after balloon inflation. Area at risk (AAR) was evaluated by ex vivo SPECT. IS and MO were evaluated by ex vivo MRI. Results No differences were observed between the apyrase group and saline group with respect to IS/AAR (75.7 ± 4.2% vs 69.4 ± 5.0%, p = NS) or MO (10.7 ± 4.8% vs 11.4 ± 4.8%, p = NS), but apyrase prolonged the post-ischemic reactive hyperemia. Conclusion Apyrase treatment according to a clinically applicable protocol, with administration of apyrase after induction of ischemia, does not reduce myocardial infarct size or microvascular obstruction.
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Morén H, Undrén P, Gesslein B, Olivecrona GK, Andreasson S, Malmsjö M. The porcine retinal vasculature accessed using an endovascular approach: a new experimental model for retinal ischemia. Invest Ophthalmol Vis Sci 2009; 50:5504-10. [PMID: 19516013 DOI: 10.1167/iovs.09-3529] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE The aim of this study was to examine whether the retinal circulation in the pig can be accessed using interventional neuroradiology and to explore the possibility of creating occlusions that result in experimental retinal ischemia. METHODS Six experiments were performed using 100-kg pigs. The external carotid system was catheterized using a fluoroscopy-monitored, transfemoral, endovascular approach. Transient and permanent vascular occlusions were performed using an angioplasty balloon catheter or a liquid embolic agent that was administered via an injection-catheter. RESULTS A technique for transfemoral catheterization of arteries supplying the retina was established. The ophthalmic artery was demonstrated to give rise to the main ciliary artery from which the retinal artery branched as a single artery or as several arteries. A balloon-catheter could be introduced into the ophthalmic artery but not into the main ciliary artery. An injection-catheter could, in all experiments, be introduced into the main ciliary artery and, in some experiments, into the retinal artery. Occlusion of the ophthalmic artery, over the branching of the main ciliary artery, caused incomplete ischemia, presumably because of collaterals feeding the distal parts of the vasculature. Multifocal ERG (mfERG) recordings showed decreased amplitudes and increased implicit times, indicating retinal ischemia. Occlusion of the ciliary and retinal arteries caused complete ischemia, as shown by complete flattening of the mfERG recordings and, by indirect ophthalmoscopy, blanching of the retinal arteries and a pale retina, CONCLUSIONS The authors show for the first time that the ophthalmic and retinal artery can be catheterized using a transfemoral endovascular approach. This technique may be useful to produce clear-cut experimental retinal ischemia.
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Affiliation(s)
- Håkan Morén
- Department of Ophthalmology, Lund University, Lund, Sweden
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Otto-student A, Engblom H, Heiberg E, Ugander M, Götberg M, Olivecrona GK, Erlinge D, Arheden H. 1028 The hyperenhanced region assessed by ex vivo DE-MRI is consistently larger than infarct size determined by TTC staining in the acute phase of reperfused ischemic myocardial injury. J Cardiovasc Magn Reson 2008. [DOI: 10.1186/1532-429x-10-s1-a153] [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: 11/10/2022] Open
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Heiberg E, Ugander M, Engblom H, Götberg M, Olivecrona GK, Erlinge D, Arheden H. Automated Quantification of Myocardial Infarction from MR Images by Accounting for Partial Volume Effects: Animal, Phantom, and Human Study. Radiology 2008; 246:581-8. [DOI: 10.1148/radiol.2461062164] [Citation(s) in RCA: 163] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Olivecrona GK, Härdig BM, Roijer A, Block M, Grins E, Persson HW, Johansson L, Olsson B. Can pulsed ultrasound increase tissue damage during ischemia? A study of the effects of ultrasound on infarcted and non-infarcted myocardium in anesthetized pigs. BMC Cardiovasc Disord 2005; 5:8. [PMID: 15831106 PMCID: PMC1090565 DOI: 10.1186/1471-2261-5-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2004] [Accepted: 04/15/2005] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The same mechanisms by which ultrasound enhances thrombolysis are described in connection with non-beneficial effects of ultrasound. The present safety study was therefore designed to explore effects of beneficial ultrasound characteristics on the infarcted and non-infarcted myocardium. METHODS In an open chest porcine model (n = 17), myocardial infarction was induced by ligating a coronary diagonal branch. Pulsed ultrasound of frequency 1 MHz and intensity 0.1 W/cm2 (ISATA) was applied during one hour to both infarcted and non-infarcted myocardial tissue. These ultrasound characteristics are similar to those used in studies of ultrasound enhanced thrombolysis. Using blinded assessment technique, myocardial damage was rated according to histopathological criteria. RESULTS Infarcted myocardium exhibited a significant increase in damage score compared to non-infarcted myocardium: 6.2 +/- 2.0 vs. 4.3 +/- 1.5 (mean +/- standard deviation), (p = 0.004). In the infarcted myocardium, ultrasound exposure yielded a further significant increase of damage scores: 8.1 +/- 1.7 vs. 6.2 +/- 2.0 (p = 0.027). CONCLUSION Our results suggest an instantaneous additive effect on the ischemic damage in myocardial tissue when exposed to ultrasound of stated characteristics. The ultimate damage degree remains to be clarified.
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Affiliation(s)
| | | | - Anders Roijer
- Department of Cardiology, Lund University, SE-22185 Lund, Sweden
| | - Mattias Block
- Department of Pathology, Lund University, SE-22100 Lund, Sweden
| | - Edgars Grins
- Departement of Anaesthesiology, Lund University, SE-22100 Lund, Sweden
| | - Hans W Persson
- Electrical Measurements, Lund Institute of Technology, SE-22100 Lund, Sweden
| | - Leif Johansson
- Department of Pathology, Lund University, SE-22100 Lund, Sweden
| | - Bertil Olsson
- Department of Cardiology, Lund University, SE-22185 Lund, Sweden
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Abstract
PURPOSE The aim of this study was to investigate the outcome of aortic valve replacement (AVR) and the effect on quality of life in patients aged over 85 who had symptomatic aortic stenosis. METHODS We performed a retrospective analysis of 21 patients, aged 85-91 years (mean age 86.5), who underwent AVR, 10 of whom underwent concomitant coronary artery bypass grafting (CABG) between 1989 and 1995. All patients were categorized as New York Heart Association (NYHA) functional class III and IV. A questionnaire was used to evaluate heart symptoms and quality of life among the 13 patients who were alive at follow-up (9-83 months). RESULTS Eighteen patients were categorized as NYHA functional class I and II for 1 year (9 months for one patient) after AVR. Three patients, all undergoing concomitant CABG, died early. The overall 1-, 2- and 3-year actuarial survival rate was 85%, 64% and 53% (among the patients undergoing only AVR the figures were 100%, 100% and 85%). Follow-up questionnaire results showed an improvement in the patients' symptoms of heart disease, dyspnea (P = 0.017) and angina (P = 0.03). An improvement in the patients' physical functioning (P = 0.025), satisfaction with physical ability (P = 0.005), sleep (P = 0.025), health status (P = 0.025) and perception of general health (P = 0.005) was also observed. CONCLUSIONS Our results show that AVR can be performed on patients > or = 85 years of age or older, with an improvement in heart symptoms and quality of life.
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Affiliation(s)
- I L Levin
- Department of Cardiology, University Hospital of Lund, Sweden
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