1
|
Kofoed KF, Engstrøm T, Sigvardsen PE, Linde JJ, Torp-Pedersen C, de Knegt M, Hansen PR, Fritz-Hansen T, Bech J, Heitmann M, Nielsen OW, Høfsten D, Kühl JT, Raymond IE, Kristiansen OP, Svendsen IH, Domínguez Vall-Lamora MH, Kragelund C, Hove JD, Jørgensen T, Fornitz GG, Steffensen R, Jurlander B, Abdulla J, Lyngbæk S, Elming H, Therkelsen SK, Jørgensen E, Kløvgaard L, Bang LE, Helqvist S, Galatius S, Pedersen F, Abildgaard U, Clemmensen P, Saunamäki K, Holmvang L, Gislason G, Kelbæk H, Køber LV. Prognostic Value of Coronary CT Angiography in Patients With Non-ST-Segment Elevation Acute Coronary Syndromes. J Am Coll Cardiol 2021; 77:1044-1052. [PMID: 33632478 DOI: 10.1016/j.jacc.2020.12.037] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 09/16/2020] [Revised: 12/17/2020] [Accepted: 12/21/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Severity and extent of coronary artery disease (CAD) assessed by invasive coronary angiography (ICA) guide treatment and may predict clinical outcome in patients with non-ST-segment elevation acute coronary syndrome (NSTEACS). OBJECTIVES This study tested the hypothesis that coronary computed tomography angiography (CTA) is equivalent to ICA for risk assessment in patients with NSTEACS. METHODS The VERDICT (Very Early Versus Deferred Invasive Evaluation Using Computerized Tomography in Patients With Acute Coronary Syndromes) trial evaluated timing of treatment in relation to outcome in patients with NSTEACS and included a clinically blinded coronary CTA conducted prior to ICA. Severity of CAD was defined as obstructive (coronary stenosis ≥50%) or nonobstructive. Extent of CAD was defined as high risk (obstructive left main or proximal left anterior descending artery stenosis and/or multivessel disease) or non-high risk. The primary endpoint was a composite of all-cause death, nonfatal recurrent myocardial infarction, hospital admission for refractory myocardial ischemia, or heart failure. RESULTS Coronary CTA and ICA were conducted in 978 patients. During a median follow-up time of 4.2 years (interquartile range: 2.7 to 5.5 years), the primary endpoint occurred in 208 patients (21.3%). The rate of the primary endpoint was up to 1.7-fold higher in patients with obstructive CAD compared with in patients with nonobstructive CAD as defined by coronary CTA (hazard ratio [HR]: 1.74; 95% confidence interval [CI]: 1.22 to 2.49; p = 0.002) or ICA (HR: 1.54; 95% CI: 1.13 to 2.11; p = 0.007). In patients with high-risk CAD, the rate of the primary endpoint was 1.5-fold higher compared with the rate in those with non-high-risk CAD as defined by coronary CTA (HR: 1.56; 95% CI: 1.18 to 2.07; p = 0.002). A similar trend was noted for ICA (HR: 1.28; 95% CI: 0.98 to 1.69; p = 0.07). CONCLUSIONS Coronary CTA is equivalent to ICA for the assessment of long-term risk in patients with NSTEACS. (Very Early Versus Deferred Invasive Evaluation Using Computerized Tomography in Patients With Acute Coronary Syndromes [VERDICT]; NCT02061891).
Collapse
Affiliation(s)
- Klaus F Kofoed
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Department of Radiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
| | - Thomas Engstrøm
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Per E Sigvardsen
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Jesper J Linde
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology, Herlev-Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Martina de Knegt
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Peter R Hansen
- Department of Cardiology, Herlev-Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Fritz-Hansen
- Department of Cardiology, Herlev-Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Jan Bech
- Department of Cardiology, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Merete Heitmann
- Department of Cardiology, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Olav W Nielsen
- Department of Cardiology, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Dan Høfsten
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Jørgen T Kühl
- Department of Cardiology, Zealand University Hospital, Roskilde, Slagelse & Holbæk, Denmark
| | - Ilan E Raymond
- Department of Cardiology, Zealand University Hospital, Roskilde, Slagelse & Holbæk, Denmark
| | - Ole P Kristiansen
- Department of Cardiology, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Ida H Svendsen
- Department of Cardiology, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - M H Domínguez Vall-Lamora
- Department of Cardiology, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Charlotte Kragelund
- Department of Cardiology, Herlev-Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Jens D Hove
- Department of Cardiology, Hvidovre and Amager Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Tem Jørgensen
- Department of Cardiology, Hvidovre and Amager Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Gitte G Fornitz
- Department of Cardiology, Hvidovre and Amager Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Rolf Steffensen
- Department of Cardiology, Hillerød Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Birgit Jurlander
- Department of Cardiology, Hillerød Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Jawdat Abdulla
- Department of Cardiology, Hvidovre and Amager Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Stig Lyngbæk
- Department of Cardiology, Glostrup Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Hanne Elming
- Department of Cardiology, Zealand University Hospital, Roskilde, Slagelse & Holbæk, Denmark
| | - Susette K Therkelsen
- Department of Cardiology, Zealand University Hospital, Roskilde, Slagelse & Holbæk, Denmark
| | - Erik Jørgensen
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Lene Kløvgaard
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Lia E Bang
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Steffen Helqvist
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Søren Galatius
- Department of Cardiology, Herlev-Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Frants Pedersen
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Ulrik Abildgaard
- Department of Cardiology, Herlev-Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Peter Clemmensen
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Clinic Hamburg-Eppendorf, Hamburg, Germany; Department of Medicine, Nykoebing F Hospital, Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Kari Saunamäki
- Department of Cardiology, Herlev-Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Lene Holmvang
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Gunnar Gislason
- Department of Cardiology, Herlev-Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Henning Kelbæk
- Department of Cardiology, Zealand University Hospital, Roskilde, Slagelse & Holbæk, Denmark
| | - Lars V Køber
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
2
|
Linde JJ, Kelbæk H, Hansen TF, Sigvardsen PE, Torp-Pedersen C, Bech J, Heitmann M, Nielsen OW, Høfsten D, Kühl JT, Raymond IE, Kristiansen OP, Svendsen IH, Vall-Lamora MHD, Kragelund C, de Knegt M, Hove JD, Jørgensen T, Fornitz GG, Steffensen R, Jurlander B, Abdulla J, Lyngbæk S, Elming H, Therkelsen SK, Jørgensen E, Kløvgaard L, Bang LE, Hansen PR, Helqvist S, Galatius S, Pedersen F, Abildgaard U, Clemmensen P, Saunamäki K, Holmvang L, Engstrøm T, Gislason G, Køber LV, Kofoed KF. Coronary CT Angiography in Patients With Non-ST-Segment Elevation Acute Coronary Syndrome. J Am Coll Cardiol 2020; 75:453-463. [PMID: 32029126 DOI: 10.1016/j.jacc.2019.12.012] [Citation(s) in RCA: 99] [Impact Index Per Article: 24.8] [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: 06/17/2019] [Revised: 12/02/2019] [Accepted: 12/03/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND In patients with non-ST-segment elevation acute coronary syndrome (NSTEACS), coronary pathology may range from structurally normal vessels to severe coronary artery disease. OBJECTIVES The purpose of this study was to test if coronary computed tomography angiography (CTA) may be used to exclude coronary artery stenosis ≥50% in patients with NSTEACS. METHODS The VERDICT (Very Early Versus Deferred Invasive Evaluation Using Computerized Tomography in Patients With Acute Coronary Syndromes) trial (NCT02061891) evaluated the outcome of patients with confirmed NSTEACS randomized 1:1 to very early (within 12 h) or standard (48 to 72 h) invasive coronary angiography (ICA). As an observational component of the trial, a clinically blinded coronary CTA was conducted prior to ICA in both groups. The primary endpoint was the ability of coronary CTA to rule out coronary artery stenosis (≥50% stenosis) in the entire population, expressed as the negative predictive value (NPV), using ICA as the reference standard. RESULTS Coronary CTA was conducted in 1,023 patients-very early, 2.5 h (interquartile range [IQR]: 1.8 to 4.2 h), n = 583; and standard, 59.9 h (IQR: 38.9 to 86.7 h); n = 440 after the diagnosis of NSTEACS was made. A coronary stenosis ≥50% was found by coronary CTA in 68.9% and by ICA in 67.4% of the patients. Per-patient NPV of coronary CTA was 90.9% (95% confidence interval [CI]: 86.8% to 94.1%) and the positive predictive value, sensitivity, and specificity were 87.9% (95% CI: 85.3% to 90.1%), 96.5% (95% CI: 94.9% to 97.8%) and 72.4% (95% CI: 67.2% to 77.1%), respectively. NPV was not influenced by patient characteristics or clinical risk profile and was similar in the very early and the standard strategy group. CONCLUSIONS Coronary CTA has a high diagnostic accuracy to rule out clinically significant coronary artery disease in patients with NSTEACS.
Collapse
Affiliation(s)
- Jesper J Linde
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Henning Kelbæk
- Department of Cardiology, Zealand University Hospital, Roskilde, Slagelse & Holbæk, Roskilde, Denmark
| | - Thomas F Hansen
- Department of Cardiology, Herlev-Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Per E Sigvardsen
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology, Herlev-Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Jan Bech
- Department of Cardiology, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Merete Heitmann
- Department of Cardiology, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Olav W Nielsen
- Department of Cardiology, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Dan Høfsten
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Jørgen T Kühl
- Department of Cardiology, Zealand University Hospital, Roskilde, Slagelse & Holbæk, Roskilde, Denmark
| | - Ilan E Raymond
- Department of Cardiology, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Ole P Kristiansen
- Department of Cardiology, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Ida H Svendsen
- Department of Cardiology, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Maria H D Vall-Lamora
- Department of Cardiology, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Charlotte Kragelund
- Department of Cardiology, Herlev-Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Martina de Knegt
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Jens D Hove
- Department of Cardiology, Hvidovre and Amager Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Tem Jørgensen
- Department of Cardiology, Hvidovre and Amager Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Gitte G Fornitz
- Department of Cardiology, Hvidovre and Amager Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Rolf Steffensen
- Department of Cardiology, Hillerød Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Birgit Jurlander
- Department of Cardiology, Hillerød Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Jawdat Abdulla
- Department of Cardiology, Glostrup Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Stig Lyngbæk
- Department of Cardiology, Glostrup Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Hanne Elming
- Department of Cardiology, Zealand University Hospital, Roskilde, Slagelse & Holbæk, Roskilde, Denmark
| | - Susette K Therkelsen
- Department of Cardiology, Zealand University Hospital, Roskilde, Slagelse & Holbæk, Roskilde, Denmark
| | - Erik Jørgensen
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Lene Kløvgaard
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Lia Evi Bang
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Peter Riis Hansen
- Department of Cardiology, Herlev-Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Steffen Helqvist
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Søren Galatius
- Department of Cardiology, Herlev-Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Frants Pedersen
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Ulrik Abildgaard
- Department of Cardiology, Herlev-Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Peter Clemmensen
- Department of General and Interventional Cardiology, University Heart Center Hamburg, University Clinic Hamburg-Eppendorf, Hamburg, Germany
| | - Kari Saunamäki
- Department of Cardiology, Herlev-Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Lene Holmvang
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Engstrøm
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Gunnar Gislason
- Department of Cardiology, Herlev-Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Lars V Køber
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Klaus F Kofoed
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
| |
Collapse
|
3
|
De Backer O, Lønborg J, Helqvist S, Warnøe J, Kløvgaard L, Holmvang L, Pedersen F, Tilsted HH, Raungaard B, Jørgensen E, Køber L, Høfsten DE, Kelbæk H, Engstrøm T. Characterisation of lesions undergoing ischaemia-driven revascularisation after complete revascularisation versus culprit lesion only in patients with STEMI and multivessel disease: a DANAMI-3-PRIMULTI substudy. EUROINTERVENTION 2019; 15:172-179. [PMID: 30666962 DOI: 10.4244/eij-d-18-00766] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS Treatment of the infarct-related artery only (IRA only) in ST-segment elevation myocardial infarction (STEMI) is associated with a significantly higher rate of ischaemia-driven revascularisation (ID-RV) during follow-up than fractional flow reserve-guided complete revascularisation (FFR-CRV). This study aimed to characterise all lesions which underwent ID-RV in the DANAMI-3-PRIMULTI trial with respect to location, stenosis grade and functional significance. METHODS AND RESULTS The study included 627 patients with STEMI and multivessel disease; 313 patients were randomised to treatment of the IRA only versus 314 undergoing staged FFR-CRV during the index admission. Rates of admission for suspected cardiac ischaemia (17%) were similar in both groups; however, ID-RV was significantly less frequent in the FFR-CRV group than in the IRA-only group (5% vs. 17%; p<0.001). In both groups, the primary reason for ID-RV was related to non-culprit, non-treated lesions (N=71/82 lesions in IRA-only; N=13/26 in FFR-CRV). De novo lesions or revascularisation of previously treated lesions were rarely causes of ID-RV. In the IRA-only group, there was a trend towards a higher ID-RV rate for lesions with a higher stenosis grade and located in more proximal segments - in particular, ≥80% stenosis of the left anterior descending and right coronary artery also led to angina class IV/unstable angina. In the FFR-CRV group, an FFR value ≤0.80 was shown to be an appropriate threshold for revascularisation. CONCLUSIONS FFR-CRV in STEMI is associated with a significantly lower rate of ID-RV at follow-up than treatment of the IRA only. This is due to a difference in non-culprit, non-treated lesions between both groups and not in de novo lesions or repeat revascularisation of previously treated lesions. Further considerations are warranted in case of high-grade non-culprit stenosis at proximal coronary segments, borderline FFR values and/or anticipated complex PCI.
Collapse
Affiliation(s)
- Ole De Backer
- The Heart Center, Rigshospitalet, University of Copenhagen, Denmark
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
4
|
Engstrøm T, Kelbæk H, Helqvist S, Høfsten DE, Kløvgaard L, Clemmensen P, Holmvang L, Jørgensen E, Pedersen F, Saunamaki K, Ravkilde J, Tilsted HH, Villadsen A, Aarøe J, Jensen SE, Raungaard B, Bøtker HE, Terkelsen CJ, Maeng M, Kaltoft A, Krusell LR, Jensen LO, Veien KT, Kofoed KF, Torp-Pedersen C, Kyhl K, Nepper-Christensen L, Treiman M, Vejlstrup N, Ahtarovski K, Lønborg J, Køber L. Effect of Ischemic Postconditioning During Primary Percutaneous Coronary Intervention for Patients With ST-Segment Elevation Myocardial Infarction: A Randomized Clinical Trial. JAMA Cardiol 2019; 2:490-497. [PMID: 28249094 DOI: 10.1001/jamacardio.2017.0022] [Citation(s) in RCA: 94] [Impact Index Per Article: 18.8] [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] [Indexed: 12/15/2022]
Abstract
Importance Ischemic postconditioning of the heart during primary percutaneous coronary intervention (PCI) induced by repetitive interruptions of blood flow to the ischemic myocardial region immediately after reopening of the infarct-related artery may limit myocardial damage. Objective To determine whether ischemic postconditioning can improve the clinical outcomes in patients with ST-segment elevation myocardial infarction (STEMI). Design, Setting, And Participants In this multicenter, randomized clinical trial, patients with onset of symptoms within 12 hours, STEMI, and thrombolysis in myocardial infarction (TIMI) grade 0-1 flow in the infarct-related artery at arrival were randomized to conventional PCI or postconditioning. Inclusion began on March 21, 2011, through February 2, 2014, and follow-up was completed on February 2, 2016. Analysis was based on intention to treat. Interventions Patients were randomly allocated 1:1 to conventional primary PCI, including stent implantation, or postconditioning performed as 4 repeated 30-second balloon occlusions followed by 30 seconds of reperfusion immediately after opening of the infarct-related artery and before stent implantation. Main Outcome and Measures A combination of all-cause death and hospitalization for heart failure. Results During the inclusion period, 1234 patients (975 men [79.0%] and 259 women [21.0%]; mean [SD] age, 62 [11] years) underwent randomization in the trial. Median follow-up was 38 months (interquartile range, 24-58 months). The primary outcome occurred in 69 patients (11.2%) who underwent conventional primary PCI and in 65 (10.5%) who underwent postconditioning (hazard ratio, 0.93; 95% CI, 0.66-1.30; P = .66). The hazard ratios were 0.75 (95% CI, 0.49-1.14; P = .18) for all-cause death and 0.99 (95% CI, 0.60-1.64; P = .96) for heart failure. Conclusions and Relevance Routine ischemic postconditioning during primary PCI failed to reduce the composite outcome of death from any cause and hospitalization for heart failure in patients with STEMI and TIMI grade 0-1 flow at arrival. Trial Registration clinicaltrials.gov Identifier: NCT01435408.
Collapse
Affiliation(s)
- Thomas Engstrøm
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Henning Kelbæk
- Department of Cardiology, Roskilde Hospital, Roskilde, Denmark
| | - Steffen Helqvist
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Dan Eik Høfsten
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Lene Kløvgaard
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Peter Clemmensen
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Lene Holmvang
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Erik Jørgensen
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Frants Pedersen
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Kari Saunamaki
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Jan Ravkilde
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Hans-Henrik Tilsted
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Anton Villadsen
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Jens Aarøe
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | | | - Bent Raungaard
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Hans E Bøtker
- Department of Cardiology, Skejby University Hospital, Skejby, Denmark
| | | | - Michael Maeng
- Department of Cardiology, Skejby University Hospital, Skejby, Denmark
| | - Anne Kaltoft
- Department of Cardiology, Skejby University Hospital, Skejby, Denmark
| | - Lars R Krusell
- Department of Cardiology, Skejby University Hospital, Skejby, Denmark
| | - Lisette O Jensen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Karsten T Veien
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Klaus Fuglsang Kofoed
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | - Kasper Kyhl
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | - Marek Treiman
- Department of Biomedical Sciences, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Niels Vejlstrup
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Kiril Ahtarovski
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Jacob Lønborg
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Lars Køber
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | |
Collapse
|
5
|
Kofoed KF, Kelbæk H, Hansen PR, Torp-Pedersen C, Høfsten D, Kløvgaard L, Holmvang L, Helqvist S, Jørgensen E, Galatius S, Pedersen F, Bang L, Saunamaki K, Clemmensen P, Linde JJ, Heitmann M, Wendelboe Nielsen O, Raymond IE, Kristiansen OP, Svendsen IH, Bech J, Dominguez Vall-Lamora MH, Kragelund C, Hansen TF, Dahlgaard Hove J, Jørgensen T, Fornitz GG, Steffensen R, Jurlander B, Abdulla J, Lyngbæk S, Elming H, Therkelsen SK, Abildgaard U, Jensen JS, Gislason G, Køber LV, Engstrøm T. Early Versus Standard Care Invasive Examination and Treatment of Patients With Non-ST-Segment Elevation Acute Coronary Syndrome. Circulation 2018; 138:2741-2750. [DOI: 10.1161/circulationaha.118.037152] [Citation(s) in RCA: 118] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Klaus F. Kofoed
- Department of Cardiology, The Heart Centre, Rigshospitalet (K.F.K., D.H., L.K., L.H., S.H., E.J., F.P., L.B., K.S., P.C., J.J.L., L.V.K., T.E.), University of Copenhagen, Denmark
| | - Henning Kelbæk
- Department of Cardiology, Zealand University Hospital, Roskilde, Denmark (H.K., H.E., S.K.T.)
| | - Peter Riis Hansen
- Department of Cardiology, Herlev and Gentofte Hospitals (P.R.H., C.T.-P., S.G., J.B., C.K., T.F.H., U.A., J.S.J., G.G.), University of Copenhagen, Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology, Herlev and Gentofte Hospitals (P.R.H., C.T.-P., S.G., J.B., C.K., T.F.H., U.A., J.S.J., G.G.), University of Copenhagen, Denmark
| | - Dan Høfsten
- Department of Cardiology, The Heart Centre, Rigshospitalet (K.F.K., D.H., L.K., L.H., S.H., E.J., F.P., L.B., K.S., P.C., J.J.L., L.V.K., T.E.), University of Copenhagen, Denmark
| | - Lene Kløvgaard
- Department of Cardiology, The Heart Centre, Rigshospitalet (K.F.K., D.H., L.K., L.H., S.H., E.J., F.P., L.B., K.S., P.C., J.J.L., L.V.K., T.E.), University of Copenhagen, Denmark
| | - Lene Holmvang
- Department of Cardiology, The Heart Centre, Rigshospitalet (K.F.K., D.H., L.K., L.H., S.H., E.J., F.P., L.B., K.S., P.C., J.J.L., L.V.K., T.E.), University of Copenhagen, Denmark
| | - Steffen Helqvist
- Department of Cardiology, The Heart Centre, Rigshospitalet (K.F.K., D.H., L.K., L.H., S.H., E.J., F.P., L.B., K.S., P.C., J.J.L., L.V.K., T.E.), University of Copenhagen, Denmark
| | - Erik Jørgensen
- Department of Cardiology, The Heart Centre, Rigshospitalet (K.F.K., D.H., L.K., L.H., S.H., E.J., F.P., L.B., K.S., P.C., J.J.L., L.V.K., T.E.), University of Copenhagen, Denmark
| | - Søren Galatius
- Department of Cardiology, Herlev and Gentofte Hospitals (P.R.H., C.T.-P., S.G., J.B., C.K., T.F.H., U.A., J.S.J., G.G.), University of Copenhagen, Denmark
| | - Frants Pedersen
- Department of Cardiology, The Heart Centre, Rigshospitalet (K.F.K., D.H., L.K., L.H., S.H., E.J., F.P., L.B., K.S., P.C., J.J.L., L.V.K., T.E.), University of Copenhagen, Denmark
| | - Lia Bang
- Department of Cardiology, The Heart Centre, Rigshospitalet (K.F.K., D.H., L.K., L.H., S.H., E.J., F.P., L.B., K.S., P.C., J.J.L., L.V.K., T.E.), University of Copenhagen, Denmark
| | - Kari Saunamaki
- Department of Cardiology, The Heart Centre, Rigshospitalet (K.F.K., D.H., L.K., L.H., S.H., E.J., F.P., L.B., K.S., P.C., J.J.L., L.V.K., T.E.), University of Copenhagen, Denmark
| | - Peter Clemmensen
- Department of Cardiology, The Heart Centre, Rigshospitalet (K.F.K., D.H., L.K., L.H., S.H., E.J., F.P., L.B., K.S., P.C., J.J.L., L.V.K., T.E.), University of Copenhagen, Denmark
| | - Jesper J. Linde
- Department of Cardiology, The Heart Centre, Rigshospitalet (K.F.K., D.H., L.K., L.H., S.H., E.J., F.P., L.B., K.S., P.C., J.J.L., L.V.K., T.E.), University of Copenhagen, Denmark
| | - Merete Heitmann
- Department of Cardiology, Bispebjerg and Frederiksberg Hospitals (M.H., O.W.N., I.E.R., O.P.K., I.H.S., M.H.D.V.-L.), University of Copenhagen, Denmark
| | - Olav Wendelboe Nielsen
- Department of Cardiology, Bispebjerg and Frederiksberg Hospitals (M.H., O.W.N., I.E.R., O.P.K., I.H.S., M.H.D.V.-L.), University of Copenhagen, Denmark
| | - Ilan E. Raymond
- Department of Cardiology, Bispebjerg and Frederiksberg Hospitals (M.H., O.W.N., I.E.R., O.P.K., I.H.S., M.H.D.V.-L.), University of Copenhagen, Denmark
| | - Ole Peter Kristiansen
- Department of Cardiology, Bispebjerg and Frederiksberg Hospitals (M.H., O.W.N., I.E.R., O.P.K., I.H.S., M.H.D.V.-L.), University of Copenhagen, Denmark
| | - Ida Hastrup Svendsen
- Department of Cardiology, Bispebjerg and Frederiksberg Hospitals (M.H., O.W.N., I.E.R., O.P.K., I.H.S., M.H.D.V.-L.), University of Copenhagen, Denmark
| | - Jan Bech
- Department of Cardiology, Herlev and Gentofte Hospitals (P.R.H., C.T.-P., S.G., J.B., C.K., T.F.H., U.A., J.S.J., G.G.), University of Copenhagen, Denmark
| | - Maria Helena Dominguez Vall-Lamora
- Department of Cardiology, Bispebjerg and Frederiksberg Hospitals (M.H., O.W.N., I.E.R., O.P.K., I.H.S., M.H.D.V.-L.), University of Copenhagen, Denmark
| | - Charlotte Kragelund
- Department of Cardiology, Herlev and Gentofte Hospitals (P.R.H., C.T.-P., S.G., J.B., C.K., T.F.H., U.A., J.S.J., G.G.), University of Copenhagen, Denmark
| | - Thomas Fritz Hansen
- Department of Cardiology, Herlev and Gentofte Hospitals (P.R.H., C.T.-P., S.G., J.B., C.K., T.F.H., U.A., J.S.J., G.G.), University of Copenhagen, Denmark
| | - Jens Dahlgaard Hove
- Department of Cardiology, Hvidovre and Amager Hospitals (J.D.H., T.J., G.G.F.), University of Copenhagen, Denmark
| | - Tem Jørgensen
- Department of Cardiology, Hvidovre and Amager Hospitals (J.D.H., T.J., G.G.F.), University of Copenhagen, Denmark
| | - Gitte G. Fornitz
- Department of Cardiology, Hvidovre and Amager Hospitals (J.D.H., T.J., G.G.F.), University of Copenhagen, Denmark
| | - Rolf Steffensen
- Department of Cardiology, Hillerød Hospital (R.S., B.J.), University of Copenhagen, Denmark
| | - Birgit Jurlander
- Department of Cardiology, Hillerød Hospital (R.S., B.J.), University of Copenhagen, Denmark
| | - Jawdat Abdulla
- Department of Cardiology, Glostrup Hospital (J.A., S.L.), University of Copenhagen, Denmark
| | - Stig Lyngbæk
- Department of Cardiology, Glostrup Hospital (J.A., S.L.), University of Copenhagen, Denmark
| | - Hanne Elming
- Department of Cardiology, Zealand University Hospital, Roskilde, Denmark (H.K., H.E., S.K.T.)
| | | | - Ulrik Abildgaard
- Department of Cardiology, Herlev and Gentofte Hospitals (P.R.H., C.T.-P., S.G., J.B., C.K., T.F.H., U.A., J.S.J., G.G.), University of Copenhagen, Denmark
| | - Jan Skov Jensen
- Department of Cardiology, Herlev and Gentofte Hospitals (P.R.H., C.T.-P., S.G., J.B., C.K., T.F.H., U.A., J.S.J., G.G.), University of Copenhagen, Denmark
| | - Gunnar Gislason
- Department of Cardiology, Herlev and Gentofte Hospitals (P.R.H., C.T.-P., S.G., J.B., C.K., T.F.H., U.A., J.S.J., G.G.), University of Copenhagen, Denmark
| | - Lars V. Køber
- Department of Cardiology, The Heart Centre, Rigshospitalet (K.F.K., D.H., L.K., L.H., S.H., E.J., F.P., L.B., K.S., P.C., J.J.L., L.V.K., T.E.), University of Copenhagen, Denmark
| | - Thomas Engstrøm
- Department of Cardiology, The Heart Centre, Rigshospitalet (K.F.K., D.H., L.K., L.H., S.H., E.J., F.P., L.B., K.S., P.C., J.J.L., L.V.K., T.E.), University of Copenhagen, Denmark
| |
Collapse
|
6
|
de Knegt MC, Linde JJ, Fuchs A, Pham MHC, Jensen AK, Nordestgaard BG, Kelbæk H, Køber LV, Heitmann M, Fornitz G, Hove JD, Kofoed KF, Kofoed KF, Nordestgaard B, Køber LV, Kühl JT, Fuchs A, Sigvardsen P, Sørgaard M, de Knegt MC, Norsk J, Frestad D, Mejdahl M, Elming M, Sørensen SK, Hindsøe L, Thomsen AF, Udholm PM, Pihl C, Nilsson J, Byrne C, Knudsen AD, Haugen M, Windfeld-Mathiasen J, Wiegandt YTL, Pham MHC, Ballegaard C, Arnaa K, Møller C, Thrysøe K, Linde JJ, Kofoed KF, Hove JD, Jensen GB, Sørgaard M, Kelbæk H, Kühl JT, Nielsen W, Køber LV, Trysøe K, Møller C, Bock-Pedersen T, Hansen B, Udholm PM, de Knegt MC, Kofoed KF, Køber LV, Kløvgaard L, Linde JJ, Kühl JT, Holmvang L, Engstrøm T, Helquist S, Jørgensen E, Petersen F, Saunamaki K, Clemmensen P, de Knegt MC, Sadjadieh G, Laursen PN, Hansen PR, Gislason G, Abildgaard U, Jensen JS, Galatius S, Fritz-Hansen T, Bech J, Wachtell C, Madsen JK, Smedegaard L, Özcan C, Svendsen IH, Nielsen OW, Kristiansen O, Bjerre AF, Hove JD, Nielsen W, Dixen U, Madsen JK, Fornitz GG, Raymond I, Abdulla J, Lyngbæk; S, Steffensen R, Jurlander B, Kragelund C, Dominguez H, Schou M, Kelbæk H, Elming H, Therkelsen S. Relationship between patient presentation and morphology of coronary atherosclerosis by quantitative multidetector computed tomography. Eur Heart J Cardiovasc Imaging 2018; 20:1221-1230. [DOI: 10.1093/ehjci/jey146] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 09/11/2018] [Indexed: 12/13/2022] Open
Abstract
Abstract
Aims
Quantitative computed tomography (QCT) allows assessment of morphological features of coronary atherosclerosis. We aimed to test the hypothesis that clinical patient presentation is associated with distinct morphological features of coronary atherosclerosis.
Methods and results
A total of 1652 participants, representing a spectrum of clinical risk profiles [787 asymptomatic individuals from the general population, 468 patients with acute chest pain without acute coronary syndrome (ACS), and 397 patients with acute chest pain and ACS], underwent multidetector computed tomography. Of these, 274 asymptomatic individuals, 254 patients with acute chest pain without ACS, and 327 patients with acute chest pain and ACS underwent QCT to assess coronary plaque volumes and proportions of dense calcium (DC), fibrous, fibro fatty (FF), and necrotic core (NC) tissue. Furthermore, the presence of vulnerable plaques, defined by plaque volume and tissue composition, was examined. Coronary plaque volume increased significantly with worsening clinical risk profile [geometric mean (95% confidence interval): 148 (129–166) mm3, 257 (224–295) mm3, and 407 (363–457) mm3, respectively, P < 0.001]. Plaque composition differed significantly across cohorts, P < 0.0001. The proportion of DC decreased, whereas FF and NC increased with worsening clinical risk profile (mean proportions DC: 33%, 23%, 23%; FF: 50%, 61%, 57%; and NC: 17%, 17%, 20%, respectively). Significant differences in plaque composition persisted after multivariable adjustment for age, gender, body surface area, hypertension, statin use at baseline, diabetes, smoking, family history of ischaemic heart disease, total plaque volume, and tube voltage, P < 0.01.
Conclusion
Coronary atherosclerotic plaque volume and composition are strongly associated to clinical presentation.
Collapse
Affiliation(s)
- Martina C de Knegt
- Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, Copenhagen, Denmark
- Department of Cardiology, Amager-Hvidovre Hospital, University of Copenhagen, Kettegård Allé 30, Hvidovre, Copenhagen, Denmark
| | - Jesper J Linde
- Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, Copenhagen, Denmark
| | - Andreas Fuchs
- Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, Copenhagen, Denmark
| | - Michael H C Pham
- Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, Copenhagen, Denmark
| | - Andreas K Jensen
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, Copenhagen, Denmark
| | - Børge G Nordestgaard
- Department of Clinical Biochemistry and the Copenhagen General Population Study, Herlev Hospital, University of Copenhagen, Herlev Ringvej 75, Herlev, Copenhagen, Denmark
| | - Henning Kelbæk
- Department of Cardiology, Zealand University Hospital, Sygehusvej 10, Roskilde, Denmark
| | - Lars V Køber
- Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, Copenhagen, Denmark
| | - Merete Heitmann
- Department of Cardiology, Bispebjerg Hospital, University of Copenhagen, Bispebjerg Bakke 23, Copenhagen, Denmark
| | - Gitte Fornitz
- Department of Cardiology, Amager-Hvidovre Hospital, University of Copenhagen, Kettegård Allé 30, Hvidovre, Copenhagen, Denmark
| | - Jens D Hove
- Department of Cardiology, Amager-Hvidovre Hospital, University of Copenhagen, Kettegård Allé 30, Hvidovre, Copenhagen, Denmark
| | - Klaus F Kofoed
- Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, Copenhagen, Denmark
- Department of Radiology, The Diagnostic Centre, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, Copenhagen, Denmark
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
7
|
Engstrøm T, Nepper-Christensen L, Helqvist S, Kløvgaard L, Holmvang L, Jørgensen E, Pedersen F, Saunamaki K, Tilsted HH, Steensberg A, Fabricius S, Mouritzen U, Vejlstrup N, Ahtarovski KA, Göransson C, Bertelsen L, Kyhl K, Olivecrona G, Kelbæk H, Lassen JF, Køber L, Lønborg J. Danegaptide for primary percutaneous coronary intervention in acute myocardial infarction patients: a phase 2 randomised clinical trial. Heart 2018; 104:1593-1599. [PMID: 29602883 DOI: 10.1136/heartjnl-2017-312774] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [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: 11/27/2017] [Revised: 02/28/2018] [Accepted: 02/28/2018] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Reperfusion immediately after reopening of the infarct-related artery in ST-segment elevation myocardial infarction (STEMI) may cause myocardial damage in addition to the ischaemic insult (reperfusion injury). The gap junction modulating peptide danegaptide has in animal models reduced this injury. We evaluated the effect of danegaptide on myocardial salvage in patients with STEMI. METHODS In addition to primary percutaneous coronary intervention in STEMI patients with thrombolysis in myocardial infarction flow 0-1, single vessel disease and ischaemia time less than 6 hours, we tested, in a clinical proof-of-concept study, the therapeutic potential of danegaptide at two-dose levels. Primary outcome was myocardial salvage evaluated by cardiac MRI after 3 months. RESULTS From November 2013 to August 2015, a total of 585 patients were randomly enrolled in the trial. Imaging criteria were fulfilled for 79 (high dose), 80 (low dose) and 84 (placebo) patients eligible for the per-protocol analysis. Danegaptide did not affect the myocardial salvage index (danegaptide high (63.9±14.9), danegaptide low (65.6±15.6) and control (66.7±11.7), P=0.40), final infarct size (danegaptide high (19.6±11.4 g), danegaptide low (18.6±9.6 g) and control (21.4±15.0 g), P=0.88) or left ventricular ejection fraction (danegaptide high (53.9%±9.5%), danegaptide low (52.7%±10.3%) and control (52.1%±10.9%), P=0.64). There was no difference between groups with regard to clinical outcome. CONCLUSIONS Administration of danegaptide to patients with STEMI did not improve myocardial salvage. TRIAL REGISTRATION NUMBER NCT01977755; Pre-results.
Collapse
Affiliation(s)
- Thomas Engstrøm
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,Department of Cardiology, University of Lund, Lund, Sweden
| | | | - Steffen Helqvist
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Lene Kløvgaard
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Lene Holmvang
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Erik Jørgensen
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Frants Pedersen
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Kari Saunamaki
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Hans-Henrik Tilsted
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | | | | | - Niels Vejlstrup
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Kiril A Ahtarovski
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Christoffer Göransson
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Litten Bertelsen
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Kasper Kyhl
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | - Henning Kelbæk
- Department of Cardiology, Zealand University Hospital, Roskilde, Denmark
| | - Jens Flensted Lassen
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Lars Køber
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Jacob Lønborg
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
8
|
Lønborg J, Engstrøm T, Kelbæk H, Helqvist S, Kløvgaard L, Holmvang L, Pedersen F, Jørgensen E, Saunamäki K, Clemmensen P, De Backer O, Ravkilde J, Tilsted HH, Villadsen AB, Aarøe J, Jensen SE, Raungaard B, Køber L, Høfsten DE. Fractional Flow Reserve-Guided Complete Revascularization Improves the Prognosis in Patients With ST-Segment-Elevation Myocardial Infarction and Severe Nonculprit Disease: A DANAMI 3-PRIMULTI Substudy (Primary PCI in Patients With ST-Elevation Myocardial Infarction and Multivessel Disease: Treatment of Culprit Lesion Only or Complete Revascularization). Circ Cardiovasc Interv 2017; 10:CIRCINTERVENTIONS.116.004460. [PMID: 28404623 DOI: 10.1161/circinterventions.116.004460] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [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: 08/27/2016] [Accepted: 03/06/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND The impact of disease severity on the outcome after complete revascularization in patients with ST-segment-elevation myocardial infarction and multivessel disease is uncertain. The objective of this post hoc study was to evaluate the impact of number of diseased vessel, lesion location, and severity of the noninfarct-related stenosis on the effect of fractional flow reserve-guided complete revascularization. METHODS AND RESULTS In the DANAMI-3-PRIMULTI study (Primary PCI in Patients With ST-Elevation Myocardial Infarction and Multivessel Disease: Treatment of Culprit Lesion Only or Complete Revascularization), we randomized 627 ST-segment-elevation myocardial infarction patients to fractional flow reserve-guided complete revascularization or infarct-related percutaneous coronary intervention only. In patients with 3-vessel disease, fractional flow reserve-guided complete revascularization reduced the primary end point (all-cause mortality, reinfarction, and ischemia-driven revascularization; hazard ratio [HR], 0.33; 95% confidence interval [CI], 0.17-0.64; P=0.001), with no significant effect in patients with 2-vessel disease (HR, 0.77; 95% CI, 0.47-1.26; P=0.29; P for interaction =0.046). A similar effect was observed in patients with diameter stenosis ≥90% of noninfarct-related arteries (HR, 0.32; 95% CI, 0.18-0.62; P=0.001), but not in patients with less severe lesions (HR, 0.72; 95% CI, 0.44-1.19; P=0.21; P for interaction =0.06). The effect was most pronounced in patients with 3-vessel disease and noninfarct-related stenoses ≥90%, and in this subgroup, there was a nonsignificant reduction in the end point of mortality and reinfarction (HR, 0.32; 95% CI, 0.08-1.32; P=0.09). Proximal versus distal location did not influence the benefit from complete revascularization. CONCLUSIONS The benefit from fractional flow reserve-guided complete revascularization in ST-segment-elevation myocardial infarction patients with multivessel disease was dependent on the presence of 3-vessel disease and noninfarct diameter stenosis ≥90% and was particularly pronounced in patients with both of these angiographic characteristics. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01960933.
Collapse
Affiliation(s)
- Jacob Lønborg
- From the Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (J.L., T.E., S.H., L. Kløvgaard, L.H., F.P., E.J., K.S., O.D.B., H.-H.T., L. Køber, D.E.H.); Department of Cardiology, Roskilde Hospital, Denmark (H.K.); Department of Cardiology, Nykoebing Falster Hospital, Denmark (P.C.); and Department of Cardiology, Aalborg University Hospital, Denmark (J.R., A.B.V., J.A., S.E.J., B.R.).
| | - Thomas Engstrøm
- From the Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (J.L., T.E., S.H., L. Kløvgaard, L.H., F.P., E.J., K.S., O.D.B., H.-H.T., L. Køber, D.E.H.); Department of Cardiology, Roskilde Hospital, Denmark (H.K.); Department of Cardiology, Nykoebing Falster Hospital, Denmark (P.C.); and Department of Cardiology, Aalborg University Hospital, Denmark (J.R., A.B.V., J.A., S.E.J., B.R.)
| | - Henning Kelbæk
- From the Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (J.L., T.E., S.H., L. Kløvgaard, L.H., F.P., E.J., K.S., O.D.B., H.-H.T., L. Køber, D.E.H.); Department of Cardiology, Roskilde Hospital, Denmark (H.K.); Department of Cardiology, Nykoebing Falster Hospital, Denmark (P.C.); and Department of Cardiology, Aalborg University Hospital, Denmark (J.R., A.B.V., J.A., S.E.J., B.R.)
| | - Steffen Helqvist
- From the Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (J.L., T.E., S.H., L. Kløvgaard, L.H., F.P., E.J., K.S., O.D.B., H.-H.T., L. Køber, D.E.H.); Department of Cardiology, Roskilde Hospital, Denmark (H.K.); Department of Cardiology, Nykoebing Falster Hospital, Denmark (P.C.); and Department of Cardiology, Aalborg University Hospital, Denmark (J.R., A.B.V., J.A., S.E.J., B.R.)
| | - Lene Kløvgaard
- From the Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (J.L., T.E., S.H., L. Kløvgaard, L.H., F.P., E.J., K.S., O.D.B., H.-H.T., L. Køber, D.E.H.); Department of Cardiology, Roskilde Hospital, Denmark (H.K.); Department of Cardiology, Nykoebing Falster Hospital, Denmark (P.C.); and Department of Cardiology, Aalborg University Hospital, Denmark (J.R., A.B.V., J.A., S.E.J., B.R.)
| | - Lene Holmvang
- From the Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (J.L., T.E., S.H., L. Kløvgaard, L.H., F.P., E.J., K.S., O.D.B., H.-H.T., L. Køber, D.E.H.); Department of Cardiology, Roskilde Hospital, Denmark (H.K.); Department of Cardiology, Nykoebing Falster Hospital, Denmark (P.C.); and Department of Cardiology, Aalborg University Hospital, Denmark (J.R., A.B.V., J.A., S.E.J., B.R.)
| | - Frants Pedersen
- From the Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (J.L., T.E., S.H., L. Kløvgaard, L.H., F.P., E.J., K.S., O.D.B., H.-H.T., L. Køber, D.E.H.); Department of Cardiology, Roskilde Hospital, Denmark (H.K.); Department of Cardiology, Nykoebing Falster Hospital, Denmark (P.C.); and Department of Cardiology, Aalborg University Hospital, Denmark (J.R., A.B.V., J.A., S.E.J., B.R.)
| | - Erik Jørgensen
- From the Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (J.L., T.E., S.H., L. Kløvgaard, L.H., F.P., E.J., K.S., O.D.B., H.-H.T., L. Køber, D.E.H.); Department of Cardiology, Roskilde Hospital, Denmark (H.K.); Department of Cardiology, Nykoebing Falster Hospital, Denmark (P.C.); and Department of Cardiology, Aalborg University Hospital, Denmark (J.R., A.B.V., J.A., S.E.J., B.R.)
| | - Kari Saunamäki
- From the Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (J.L., T.E., S.H., L. Kløvgaard, L.H., F.P., E.J., K.S., O.D.B., H.-H.T., L. Køber, D.E.H.); Department of Cardiology, Roskilde Hospital, Denmark (H.K.); Department of Cardiology, Nykoebing Falster Hospital, Denmark (P.C.); and Department of Cardiology, Aalborg University Hospital, Denmark (J.R., A.B.V., J.A., S.E.J., B.R.)
| | - Peter Clemmensen
- From the Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (J.L., T.E., S.H., L. Kløvgaard, L.H., F.P., E.J., K.S., O.D.B., H.-H.T., L. Køber, D.E.H.); Department of Cardiology, Roskilde Hospital, Denmark (H.K.); Department of Cardiology, Nykoebing Falster Hospital, Denmark (P.C.); and Department of Cardiology, Aalborg University Hospital, Denmark (J.R., A.B.V., J.A., S.E.J., B.R.)
| | - Ole De Backer
- From the Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (J.L., T.E., S.H., L. Kløvgaard, L.H., F.P., E.J., K.S., O.D.B., H.-H.T., L. Køber, D.E.H.); Department of Cardiology, Roskilde Hospital, Denmark (H.K.); Department of Cardiology, Nykoebing Falster Hospital, Denmark (P.C.); and Department of Cardiology, Aalborg University Hospital, Denmark (J.R., A.B.V., J.A., S.E.J., B.R.)
| | - Jan Ravkilde
- From the Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (J.L., T.E., S.H., L. Kløvgaard, L.H., F.P., E.J., K.S., O.D.B., H.-H.T., L. Køber, D.E.H.); Department of Cardiology, Roskilde Hospital, Denmark (H.K.); Department of Cardiology, Nykoebing Falster Hospital, Denmark (P.C.); and Department of Cardiology, Aalborg University Hospital, Denmark (J.R., A.B.V., J.A., S.E.J., B.R.)
| | - Hans-Henrik Tilsted
- From the Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (J.L., T.E., S.H., L. Kløvgaard, L.H., F.P., E.J., K.S., O.D.B., H.-H.T., L. Køber, D.E.H.); Department of Cardiology, Roskilde Hospital, Denmark (H.K.); Department of Cardiology, Nykoebing Falster Hospital, Denmark (P.C.); and Department of Cardiology, Aalborg University Hospital, Denmark (J.R., A.B.V., J.A., S.E.J., B.R.)
| | - Anton Boel Villadsen
- From the Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (J.L., T.E., S.H., L. Kløvgaard, L.H., F.P., E.J., K.S., O.D.B., H.-H.T., L. Køber, D.E.H.); Department of Cardiology, Roskilde Hospital, Denmark (H.K.); Department of Cardiology, Nykoebing Falster Hospital, Denmark (P.C.); and Department of Cardiology, Aalborg University Hospital, Denmark (J.R., A.B.V., J.A., S.E.J., B.R.)
| | - Jens Aarøe
- From the Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (J.L., T.E., S.H., L. Kløvgaard, L.H., F.P., E.J., K.S., O.D.B., H.-H.T., L. Køber, D.E.H.); Department of Cardiology, Roskilde Hospital, Denmark (H.K.); Department of Cardiology, Nykoebing Falster Hospital, Denmark (P.C.); and Department of Cardiology, Aalborg University Hospital, Denmark (J.R., A.B.V., J.A., S.E.J., B.R.)
| | - Svend Eggert Jensen
- From the Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (J.L., T.E., S.H., L. Kløvgaard, L.H., F.P., E.J., K.S., O.D.B., H.-H.T., L. Køber, D.E.H.); Department of Cardiology, Roskilde Hospital, Denmark (H.K.); Department of Cardiology, Nykoebing Falster Hospital, Denmark (P.C.); and Department of Cardiology, Aalborg University Hospital, Denmark (J.R., A.B.V., J.A., S.E.J., B.R.)
| | - Bent Raungaard
- From the Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (J.L., T.E., S.H., L. Kløvgaard, L.H., F.P., E.J., K.S., O.D.B., H.-H.T., L. Køber, D.E.H.); Department of Cardiology, Roskilde Hospital, Denmark (H.K.); Department of Cardiology, Nykoebing Falster Hospital, Denmark (P.C.); and Department of Cardiology, Aalborg University Hospital, Denmark (J.R., A.B.V., J.A., S.E.J., B.R.)
| | - Lars Køber
- From the Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (J.L., T.E., S.H., L. Kløvgaard, L.H., F.P., E.J., K.S., O.D.B., H.-H.T., L. Køber, D.E.H.); Department of Cardiology, Roskilde Hospital, Denmark (H.K.); Department of Cardiology, Nykoebing Falster Hospital, Denmark (P.C.); and Department of Cardiology, Aalborg University Hospital, Denmark (J.R., A.B.V., J.A., S.E.J., B.R.)
| | - Dan Eik Høfsten
- From the Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (J.L., T.E., S.H., L. Kløvgaard, L.H., F.P., E.J., K.S., O.D.B., H.-H.T., L. Køber, D.E.H.); Department of Cardiology, Roskilde Hospital, Denmark (H.K.); Department of Cardiology, Nykoebing Falster Hospital, Denmark (P.C.); and Department of Cardiology, Aalborg University Hospital, Denmark (J.R., A.B.V., J.A., S.E.J., B.R.)
| | | |
Collapse
|
9
|
Lønborg J, Engstrøm T, Ahtarovski KA, Nepper-Christensen L, Helqvist S, Vejlstrup N, Kyhl K, Schoos MM, Ghotbi A, Göransson C, Bertelsen L, Holmvang L, Pedersen F, Jørgensen E, Saunamäki K, Clemmensen P, De Backer O, Kløvgaard L, Høfsten DE, Køber L, Kelbæk H. Myocardial Damage in Patients With Deferred Stenting After STEMI. J Am Coll Cardiol 2017; 69:2794-2804. [DOI: 10.1016/j.jacc.2017.03.601] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 03/14/2017] [Accepted: 03/29/2017] [Indexed: 11/16/2022]
|
10
|
Hinterbuchner L, Coelho S, Esteves R, Carson S, Kløvgaard L, Gonçalves L, Windecker S, Zughaft D. A cardiac catheterisation laboratory core curriculum for the continuing professional development of nurses and allied health professions: developed by the Education working group of the Nurses and Allied Professions Committee for the European Association of Percutaneous Cardiovascular Interventions (EAPCI) 2016. EUROINTERVENTION 2017; 12:2028-2030. [PMID: 27821376 DOI: 10.4244/eij-d-16-00374] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS The aim of this report is to provide a standard educational structure for nurses and allied professionals (NAP) specialising in interventional cardiology. The curriculum can also be used as a basis for training on a certificate-based level in interventional cardiology. METHODS AND RESULTS The curriculum was developed by a panel of experts from various allied health professions. The syllabus focuses on nine core areas of themes essential for NAP working in interventional cardiology. The highly technical knowledge required for working in interventional cardiology as well as the various roles of the different professional groups have been taken into consideration. CONCLUSIONS This core curriculum will ensure that essential content is covered during education and a basic level of quality is achieved across specialty cardiovascular educational programmes throughout Europe.
Collapse
Affiliation(s)
- Lynne Hinterbuchner
- Department of Cardiology, Paracelsus Medical University, Salzburger Landeskliniken, Salzburg, Austria
| | | | | | | | | | | | | | | |
Collapse
|
11
|
Lønborg J, Kelbæk H, Holmvang L, Helqvist S, Vejlstrup N, Jørgensen E, Saunamäki K, Dridi NP, Kløvgaard L, Kaltoft A, Bøtker HE, Lassen JF, Clemmensen P, Terkelsen CJ, Engstrøm T. Comparison of Outcome of Patients With ST-Segment Elevation Myocardial Infarction and Complete Versus Incomplete ST-Resolution Before Primary Percutaneous Coronary Intervention. Am J Cardiol 2016; 117:1735-40. [PMID: 27062938 DOI: 10.1016/j.amjcard.2016.03.009] [Citation(s) in RCA: 105] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 03/10/2016] [Accepted: 03/10/2016] [Indexed: 01/04/2023]
Abstract
Some patients presenting with ST-segment elevation myocardial infarction (STEMI) have complete ST resolution in the electrocardiogram, which may be clinical useful in the triage of patients with STEMI. However, the importance of complete ST resolution in these patients remains uncertain. Thus, the purpose was to describe the prognosis of patients with complete ST resolution before primary percutaneous coronary intervention (PCI). Continuous ST monitoring from arrival until 90 minutes after PCI was performed in 933 patients with STEMI. Complete ST resolution was defined as no residual significant ST elevations before intervention. The patients were followed clinically for 5.5 years (range 0 to 6.8 years). Infarct size and myocardial salvage were assessed in a subgroup of patients (n = 221) by cardiovascular magnetic resonance. Complete ST resolution was observed in 24% of the patients, who had a higher incidence of Thrombolysis In Myocardial Infarction grade 2/3 flow before intervention (64% vs 24%), smaller infarct size (6% vs 11%), and higher myocardial salvage index (0.82 vs 0.69; all p <0.001) compared with patients with continuous ST elevations. Complete ST resolution was associated with a significantly lower rate of the composite end point of all-cause death and admission for heart failure (14% vs 22%; p = 0.006) although it only tended to be an independent predictor in a multivariate analysis (hazard ratio 0.69, 95% CI 0.49 to 1.06; p = 0.09). In conclusion, compared to patients without incomplete ST resolution, patients with STEMI and complete ST resolution before primary PCI have a higher incidence of normalized epicardial flow before PCI, a larger myocardial salvage and smaller infarct size after the procedure and presumably improved long-term outcome compared with incomplete ST resolution.
Collapse
|
12
|
Kelbæk H, Høfsten DE, Køber L, Helqvist S, Kløvgaard L, Holmvang L, Jørgensen E, Pedersen F, Saunamäki K, De Backer O, Bang LE, Kofoed KF, Lønborg J, Ahtarovski K, Vejlstrup N, Bøtker HE, Terkelsen CJ, Christiansen EH, Ravkilde J, Tilsted HH, Villadsen AB, Aarøe J, Jensen SE, Raungaard B, Jensen LO, Clemmensen P, Grande P, Madsen JK, Torp-Pedersen C, Engstrøm T. Deferred versus conventional stent implantation in patients with ST-segment elevation myocardial infarction (DANAMI 3-DEFER): an open-label, randomised controlled trial. Lancet 2016; 387:2199-206. [PMID: 27053444 DOI: 10.1016/s0140-6736(16)30072-1] [Citation(s) in RCA: 221] [Impact Index Per Article: 27.6] [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: 01/09/2023]
Abstract
BACKGROUND Despite successful treatment of the culprit artery lesion by primary percutaneous coronary intervention (PCI) with stent implantation, thrombotic embolisation occurs in some cases, which impairs the prognosis of patients with ST-segment elevation myocardial infarction (STEMI). We aimed to assess the clinical outcomes of deferred stent implantation versus standard PCI in patients with STEMI. METHODS We did this open-label, randomised controlled trial at four primary PCI centres in Denmark. Eligible patients (aged >18 years) had acute onset symptoms lasting 12 h or less, and ST-segment elevation of 0·1 mV or more in at least two or more contiguous electrocardiographic leads or newly developed left bundle branch block. Patients were randomly assigned (1:1), via an electronic web-based system with permuted block sizes of two to six, to receive either standard primary PCI with immediate stent implantation or deferred stent implantation 48 h after the index procedure if a stabilised flow could be obtained in the infarct-related artery. The primary endpoint was a composite of all-cause mortality, hospital admission for heart failure, recurrent infarction, and any unplanned revascularisation of the target vessel within 2 years' follow-up. Patients, investigators, and treating clinicians were not masked to treatment allocation. We did analysis by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT01435408. FINDINGS Between March 1, 2011, and Feb 28, 2014, we randomly assigned 1215 patients to receive either standard PCI (n=612) or deferred stent implantation (n=603). Median follow-up time was 42 months (IQR 33-49). Events comprising the primary endpoint occurred in 109 (18%) patients who had standard PCI and in 105 (17%) patients who had deferred stent implantation (hazard ratio 0·99, 95% CI 0·76-1·29; p=0·92). Procedure-related myocardial infarction, bleeding requiring transfusion or surgery, contrast-induced nephopathy, or stroke occurred in 28 (5%) patients in the conventional PCI group versus 27 (4%) patients in the deferred stent implantation group, with no significant differences between groups. INTERPRETATION In patients with STEMI, routine deferred stent implantation did not reduce the occurrence of death, heart failure, myocardial infarction, or repeat revascularisation compared with conventional PCI. Results from ongoing randomised trials might shed further light on the concept of deferred stenting in this patient population. FUNDING Danish Agency for Science, Technology and Innovation, and Danish Council for Strategic Research.
Collapse
Affiliation(s)
- Henning Kelbæk
- Department of Cardiology, Roskilde Hospital, Roskilde, Denmark.
| | - Dan Eik Høfsten
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Lars Køber
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Steffen Helqvist
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Lene Kløvgaard
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Lene Holmvang
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Erik Jørgensen
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Frants Pedersen
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Kari Saunamäki
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Ole De Backer
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Lia E Bang
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Klaus F Kofoed
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Jacob Lønborg
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Kiril Ahtarovski
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Niels Vejlstrup
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Hans E Bøtker
- Department of Cardiology, Skejby Hospital, University of Aarhus, Aarhus, Denmark
| | | | - Evald H Christiansen
- Department of Cardiology, Skejby Hospital, University of Aarhus, Aarhus, Denmark
| | - Jan Ravkilde
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | | | - Anton B Villadsen
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Jens Aarøe
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Svend E Jensen
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Bent Raungaard
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Lisette O Jensen
- Department of Cardiology, Odense Hospital, University of Odense, Odense, Denmark
| | | | - Peer Grande
- Department of Cardiology, Nykøbing Falster Hospital, Denmark
| | - Jan K Madsen
- Department of Cardiology, Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | | | - Thomas Engstrøm
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
13
|
Engstrøm T, Kelbæk H, Helqvist S, Høfsten DE, Kløvgaard L, Holmvang L, Jørgensen E, Pedersen F, Saunamäki K, Clemmensen P, De Backer O, Ravkilde J, Tilsted HH, Villadsen AB, Aarøe J, Jensen SE, Raungaard B, Køber L. Complete revascularisation versus treatment of the culprit lesion only in patients with ST-segment elevation myocardial infarction and multivessel disease (DANAMI-3—PRIMULTI): an open-label, randomised controlled trial. Lancet 2015; 386:665-71. [PMID: 26347918 DOI: 10.1016/s0140-6736(15)60648-1] [Citation(s) in RCA: 652] [Impact Index Per Article: 72.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Patients with acute ST-segment elevation myocardial infarction (STEMI) and multivessel coronary disease have a worse prognosis compared with individuals with single-vessel disease. We aimed to study the clinical outcome of patients with STEMI treated with fractional flow reserve (FFR)-guided complete revascularisation versus treatment of the infarct-related artery only. METHODS We undertook an open-label, randomised controlled trial at two university hospitals in Denmark. Patients presenting with STEMI who had one or more clinically significant coronary stenosis in addition to the lesion in the infarct-related artery were included. After successful percutaneous coronary intervention (PCI) of the infarct-related artery, patients were randomly allocated (in a 1:1 ratio) either no further invasive treatment or complete FFR-guided revascularisation before discharge. Randomisation was done electronically via a web-based system in permuted blocks of varying size by the clinician who did the primary PCI. All patients received best medical treatment. The primary endpoint was a composite of all-cause mortality, non-fatal reinfarction, and ischaemia-driven revascularization of lesions in non-infarct-related arteries and was assessed when the last enrolled patient had been followed up for 1 year. Analysis was on an intention-to-treat basis. This trial is registered with ClinicalTrials.gov, number NCT01960933. FINDINGS From March, 2011, to February, 2014, we enrolled 627 patients to the trial; 313 were allocated no further invasive treatment after primary PCI of the infarct-related artery only and 314 were assigned complete revascularization guided by FFR values. Median follow-up was 27 months (range 12–44 months). Events comprising the primary endpoint were recorded in 68 (22%) patients who had PCI of the infarct-related artery only and in 40 (13%) patients who had complete revascularisation (hazard ratio 0∙56, 95% CI 0∙38–0∙83; p=0∙004). INTERPRETATION In patients with STEMI and multivessel disease, complete revascularisation guided by FFR measurements significantly reduces the risk of future events compared with no further invasive intervention after primary PCI. This effect is driven by significantly fewer repeat revascularisations, because all-cause mortality and non-fatal reinfarction did not differ between groups. Thus, to avoid repeat revascularisation, patients can safely have all their lesions treated during the index admission. Future studies should clarify whether complete revascularization should be done acutely during the index procedure or at later time and whether it has an effect on hard endpoints. FUNDING Danish Agency for Science, Technology and Innovation and Danish Council for Strategic Research.
Collapse
|
14
|
Lønborg J, Kelbæk H, Engstrøm T, Helqvist S, Kløvgaard L, Holmvang L, Vejlstrup N, Jørgensen E, Saunamäki K, Dridi NP, Kaltoft A, Bøtker HE, Clemmensen P, Terkelsen CJ. ST peak during percutaneous coronary intervention serves as an early prognostic predictor in patients with ST-segment elevation myocardial. EUROINTERVENTION 2015; 10:466-74. [PMID: 25138184 DOI: 10.4244/eijv10i4a80] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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: 11/23/2022]
Abstract
AIMS To evaluate the clinical importance of the ST peak phenomenon during primary percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI). METHODS AND RESULTS Continuous ST monitoring was performed in 942 STEMI patients from arrival until 90 minutes after revascularisation. ST peak was defined as ≥1 mm increase in the ST-segment during PCI compared with the ST elevation before intervention. ST peak was observed in 26.9% of patients. During median follow-up of 4.1 years, 20.7% of patients experienced a major adverse cardiac event (MACE). ST peak was associated with higher rates of mortality (13.4% versus 9.3%; p=0.044), admission for heart failure (10.6% versus 5.2%; p=0.002) and MACE (26.9% versus 18.2%; p=0.002), but not reinfarction (7.1% versus 5.2%; p=0.14). In two different Cox regression analyses, adjusting for predictors of MACE and ST peak including ST resolution and epicardial flow, ST peak remained significantly associated with MACE: adjusted hazard ratio (HR) 1.40 (95% confidence interval [CI] 1.01-1.95) and 1.41 (95% CI: 1.02-1.96). CONCLUSIONS In the largest study hitherto evaluating the ST peak phenomenon during primary PCI, we demonstrated that ST peak is a strong predictor of adverse long-term outcome and provides independent prognostic information beyond that provided by ST resolution and epicardial flow.
Collapse
Affiliation(s)
- Jacob Lønborg
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Lønborg J, Kelbæk H, Helqvist S, Holmvang L, Jørgensen E, Saunamäki K, Kløvgaard L, Kaltoft A, Bøtker HE, Lassen JF, Thuesen L, Terkelsen CJ, Kofoed KF, Clemmensen P, Køber L, Engstrøm T. The impact of distal embolization and distal protection on long-term outcome in patients with ST elevation myocardial infarction randomized to primary percutaneous coronary intervention – results from a randomized study. European Heart Journal: Acute Cardiovascular Care 2014; 4:180-8. [DOI: 10.1177/2048872614543780] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Jacob Lønborg
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark
| | - Henning Kelbæk
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark
| | - Steffen Helqvist
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark
| | - Lene Holmvang
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark
| | - Erik Jørgensen
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark
| | - Kari Saunamäki
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark
| | - Lene Kløvgaard
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark
| | - Anne Kaltoft
- Department of Cardiology, Skejby, University of Aarhus, Denmark
| | | | - Jens F Lassen
- Department of Cardiology, Skejby, University of Aarhus, Denmark
| | - Leif Thuesen
- Department of Cardiology, Skejby, University of Aarhus, Denmark
| | | | | | - Peter Clemmensen
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark
| | - Lars Køber
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark
| | - Thomas Engstrøm
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark
| |
Collapse
|
16
|
Lønborg JT, Kelbaek H, Helqvist S, Holmvang L, Jorgensen E, Kløvgaard L, Saunamäki K, Kofoed KF, Thuesen L, Kaltoft A, Terkelsen CJ, Boetker HE, Lassen JF, Køber L, Clemmensen P, Engstrøm T. TCT-214 Five-year prognostic impact of distal embolization during primary percutaneous coronary intervention in ST elevation myocardial infarction patients treated with or without distal protection. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.08.949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
17
|
Holmvang L, Kelbæk H, Kaltoft A, Thuesen L, Lassen JF, Clemmensen P, Kløvgaard L, Engstrøm T, Bøtker HE, Saunamäki K, Krusell LR, Jørgensen E, Tilsted HH, Christiansen EH, Ravkilde J, Køber L, Kofoed KF, Terkelsen CJ, Helqvist S. Long-Term Outcome After Drug-Eluting Versus Bare-Metal Stent Implantation in Patients With ST-Segment Elevation Myocardial Infarction. JACC Cardiovasc Interv 2013; 6:548-53. [PMID: 23683734 DOI: 10.1016/j.jcin.2012.12.129] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Revised: 11/11/2012] [Accepted: 12/21/2012] [Indexed: 10/26/2022]
|
18
|
Kelbæk H, Engstrøm T, Ahtarovski KA, Lønborg J, Vejlstrup N, Pedersen F, Holmvang L, Helqvist S, Saunamäki K, Jørgensen E, Clemmensen P, Kløvgaard L, Tilsted HH, Raungaard B, Ravkilde J, Aaroe J, Eggert S, Køber L. Deferred stent implantation in patients with ST-segment elevation myocardial infarction: a pilot study. EUROINTERVENTION 2013; 8:1126-33. [DOI: 10.4244/eijv8i10a175] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [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]
|
19
|
Helqvist S, Kelbæk H, Thuesen L, Kløvgaard L, Krusell LR, Jørgensen E, Bøtker HE, Jensen GVH, Lassen JF, Thayssen P, Galløe A, Saunamäki K. Efficiency and safety of the sirolimus eluting stent in complex coronary artery lesions after cessation of dual antiplatelet therapy: fifteen months clinical outcome of the randomised Stenting Coronary Arteries in Non-stress/benestent Disease (SCANDSTENT) trial. EUROINTERVENTION 2012; 3:309-14. [PMID: 19737710 DOI: 10.4244/eijv3i3a57] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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: 11/23/2022]
Abstract
BACKGROUND The randomised Stenting Coronary Arteries in Non-stress/benestent Disease (SCANDSTENT) trial reported considerably less angiographic restenosis after implantation of sirolimus-eluting stents (SES) vs bare metal stents (BMS) in patients with complex coronary lesions. The purpose of this study was to evaluate the clinical outcome after a majority of the SCANDSTENT patients had stopped the dual antiplatelet therapy. METHODS AND RESULTS The SCANDSTENT trial randomly assigned 322 patients with symptomatic complex coronary artery disease (occlusions, bifurcations, ostial or angulated lesions) to receive SES or BMS. At 15 months after stent implantation, when 80% of the patients had stopped taking clopidogrel, six patients in the SES group and 10 in the BMS group had died or suffered a myocardial infarction (non significant [NS]). Compared with BMS, SES reduced the rate of target vessel revascularisation (TVR) from 33.1% to 5.6% (P<0.001) and the frequency of major adverse cardiac events from 35.7% to 8.6% (p<0.001). Definite stent thrombosis was observed in five patients in the BMS group, and two cases of probable and possible stent thrombosis were observed in the SES group (NS). One case of possible SES thrombosis occurred more than one year after stent implantation. CONCLUSIONS Compared with BMS, SES markedly reduced the frequency of TVR and MACE within 15 months in SCANDSTENT patients with complex coronary artery lesions without development of delayed restenosis.
Collapse
|
20
|
Schoos MM, Kelbæk H, Kofoed KF, Køber L, Kløvgaard L, Helqvist S, Engstrøm T, Saunamäki K, Jørgensen E, Holmvang L, Clemmensen P. Usefulness of preprocedure high-sensitivity C-reactive protein to predict death, recurrent myocardial infarction, and stent thrombosis according to stent type in patients with ST-segment elevation myocardial infarction randomized to bare metal or drug-eluting stenting during primary percutaneous coronary intervention. Am J Cardiol 2011; 107:1597-603. [PMID: 21439539 DOI: 10.1016/j.amjcard.2011.01.042] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2010] [Revised: 01/20/2011] [Accepted: 01/20/2011] [Indexed: 10/18/2022]
Abstract
It is unknown whether high-sensitivity C-reactive protein (hs-CRP) predicts outcome depending on implanted stent type. We investigated the prognostic value of hs-CRP in relation to type of stent implanted in patients with ST-segment elevation myocardial infarction (STEMI). Immediately before primary percutaneous coronary intervention (pPCI), 301 patients had blood drawn. Patients were categorized according to hs-CRP levels and combination of hs-CRP (≤2 vs >2 mg/L) and stent type (bare metal stent [BMS] vs drug-eluting stent [DES]). Hs-CRP >2 mg/L (median, hazard ratio 2.7, 95% confidence interval 1.3 to 5.6, p = 0.007) and the combined variable of hs-CRP >2 mg/L and BMS (hazard ratio 2.4, 95% confidence interval 1.2 to 4.5, p = 0.006) independently predicted the composite end point of death and MI at 36-month follow-up. There was a significant interaction (p = 0.006) for hs-CRP and stent type. Survival analysis demonstrated significant differences for occurrence of death and MI: 4.8% in BMS + CRP ≤2 mg/L, 11.9% in DES + CRP ≤2 mg/L, 17.6% in DES + CRP >2 mg/L, and 27.9% in BMS + CRP >2 mg/L. None of the 14 stent thromboses occurred in patients with BMS + CRP ≤2 mg/L. In conclusion, preprocedure hs-CRP predicts outcome after pPCI in patients with STEMI. Our hypothesis-generating data indicate that BMS implantation should be preferred when hs-CRP is ≤2 mg/L and DES when hs-CRP is >2 mg/L to decrease long-term adverse outcomes including stent thrombosis in patients with STEMI treated with pPCI. These findings need confirmation in larger randomized clinical trials.
Collapse
|
21
|
Schoos MM, Kelbæk H, Kofoed KF, Køber L, Kløvgaard L, Helqvist S, Engstrøm T, Saunamäki K, Jørgensen E, Holmvang L, Clemmensen P. PRE-PROCEDURAL HIGH-SENSITIVITY C-REACTIVE PROTEIN PREDICTS DEATH, RECURRENT MYOCARDIAL INFARCTION AND STENT THROMBOSIS ACCORDING TO STENT TYPE IN PATIENTS WITH ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION TREATED WITH PRIMARY PERCUTANEOUS CORONARY INTERVENTION. J Am Coll Cardiol 2011. [DOI: 10.1016/s0735-1097(11)61787-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
22
|
Jørgensen E, Kelbæk H, Kløvgaard L, Thuesen L, Krusell LR, Bøtker HE, Saunamäki K, Lassen JF, Helqvist S. Sirolimus-eluting versus bare-metal stent implantation in patients with ostial lesions. Int J Cardiol 2010; 145:162-3. [PMID: 19716192 DOI: 10.1016/j.ijcard.2009.07.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2009] [Accepted: 07/25/2009] [Indexed: 11/27/2022]
Abstract
INTRODUCTION To investigate the efficacy of implantation of sirolimus-eluting stents (SES) in the ostium of coronary arteries. METHODS We assigned 96 patients with lesions located in ostias of the coronary circulation to receive a SES or a bare-metal stent (BMS). RESULTS At follow-up the late lumen loss was 0.07 mm in the SES versus 1.06 mm in the BMS group (p<0.001); -0.04 mm versus 0.11 mm (p = 0.12) in the neighbour ostium. The rate of target lesion revascularisation was 2% with SES and 39% with BMS (p<0.001), and major adverse cardiac events (MACE) 6% versus 41% (p = 0.001). CONCLUSIONS In patients with ostial coronary lesions the angiographic outcome is improved and the long-term MACE rate is low after SES compared with BMS implantation.
Collapse
|
23
|
Kaltoft A, Kelbæk H, Kløvgaard L, Terkelsen CJ, Clemmensen P, Helqvist S, Lassen JF, Thuesen L. Increased Rate of Stent Thrombosis and Target Lesion Revascularization After Filter Protection in Primary Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction. J Am Coll Cardiol 2010; 55:867-71. [DOI: 10.1016/j.jacc.2009.09.052] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2009] [Revised: 09/04/2009] [Accepted: 09/14/2009] [Indexed: 11/25/2022]
|
24
|
Jørgensen E, Helqvist S, Kløvgaard L, Kastrup J, Clemmensen P, Holmvang L, Engstrøm T, Saunamaki K, Kelbaek H. Restenosis in coronary bare metal stents. Importance of time to follow-up: a comparison of coronary angiograms 6 months and 4 years after implantation. SCAND CARDIOVASC J 2008; 43:87-93. [PMID: 19031301 DOI: 10.1080/14017430802582602] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Angiographic late lumen loss measured 6 to 9 month after bare metal stent implantation in the coronary arteries is a validated restenosis parameter. DESIGN We performed a second angiographic follow-up after 4 years in event free survivors from the DANSTENT trial cohort. RESULTS Quantitative comparison of paired coronary angiograms at 6 months and 4 years showed a reduction of late loss from 0.68+/-0.52 mm to 0.42 (+/-0.52) (mean difference 0.26 (0.17 to 0.36), p<0.0001). Minimal instent lumen diameter had increased from 2.39+/-0.62 mm to 2.64+/-0.56 mm (mean difference: -0.24 mm, 95% confidence interval: -0.34 mm to -0.14 mm, p<0.0001). Instent diameter stenosis decreased from 24.8+/-14.2% to 18.6+/-9.3% (mean difference 6.16%, 95% confidence interval: 2.82 to 9.48%, p=0.0006). This observed spontaneous decrease of instent restenosis corresponds to a 19% increase of minimal cross-sectional vessel area and a 39% reduction of the binary restenosis rate over time. CONCLUSIONS Instent late lumen loss in bare metal stents decreases spontaneously over time. Maturation of early hyperplastic tissue reaction after stent implantation with subsequent thinning of fibrotic tissue might explain this phenomenon.
Collapse
Affiliation(s)
- Erik Jørgensen
- Cardiac Catheterisation Laboratory, Department of Cardiology, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark.
| | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Thuesen L, Kelbaek H, Kløvgaard L, Helqvist S, Jørgensen E, Aljabbari S, Krusell LR, Jensen GVH, Bøtker HE, Saunamäki K, Lassen JF, van Weert A. Comparison of sirolimus-eluting and bare metal stents in coronary bifurcation lesions: subgroup analysis of the Stenting Coronary Arteries in Non-Stress/Benestent Disease Trial (SCANDSTENT). Am Heart J 2006; 152:1140-5. [PMID: 17161067 DOI: 10.1016/j.ahj.2006.06.035] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.6] [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: 02/14/2006] [Accepted: 06/26/2006] [Indexed: 10/23/2022]
Abstract
BACKGROUND Sirolimus-eluting stent implantation improves the outcome in simple coronary artery lesions compared with bare metal stents, but there is limited evidence of their safety and efficacy when implanted in complex lesions like coronary bifurcations. METHODS SCANDSTENT was a randomized controlled study comparing implantation of sirolimus-eluting stents with bare-metal stents in patients with complex coronary artery disease. This substudy evaluates the angiographic and clinical outcome of 126 patients with lesions located in a coronary bifurcation. RESULTS The baseline characteristics of the patients were comparable: 15% had diabetes, and 1.7 stents were implanted per lesion. At follow-up, the minimum lumen diameter of the main branch was 2.35 mm in patients who received sirolimus-eluting stents compared with 1.68 mm in those who received bare-metal stents, and that of the side branch was 1.70 versus 1.19 mm (both P < .001). The late lumen loss in the main branch was 0.12 mm in the sirolimus-eluting stent group versus 0.99 mm in the bare-metal stent group and 0.03 versus 0.56 mm in the side branch (both P < .001). Thus, sirolimus-eluting stents reduced the restenosis rate from 28.3% to 4.9% in the main branch and from 43.4% to 14.8% in the side branches (both P < .001). Major adverse cardiac events occurred in 9% with sirolimus-eluting stents versus 28% with bare-metal stents (P = .01), and stent thrombosis was observed in 0% versus 9% (P = .02). CONCLUSION Sirolimus-eluting stent implantation improves both the angiographic and clinical outcomes considerably compared with that of bare-metal stents in patients with stenoses located in coronary bifurcations.
Collapse
|
26
|
Kelbaek H, Helqvist S, Thuesen L, Kløvgaard L, Jørgensen E, Saunamäki K, Krusell LR, Bøtker HE, Engstrøm T, Jensen GVH. Sirolimus versus bare metal stent implantation in patients with total coronary occlusions: subgroup analysis of the Stenting Coronary Arteries in Non-Stress/Benestent Disease (SCANDSTENT) trial. Am Heart J 2006; 152:882-6. [PMID: 17070149 DOI: 10.1016/j.ahj.2006.03.028] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [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: 11/15/2005] [Accepted: 03/20/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND Coronary restenosis is more common in a total coronary occlusion (TCO) than other lesion types after implantation of bare metal stents (BMS). But whereas sirolimus-eluting stents (SES) have been shown to improve the outcomes in simple coronary artery lesions, data on their efficacy in complex coronary lesions are scarce. METHODS We enrolled 127 patients with coronary artery disease and a TCO > or = 15 mm in length to have either SES or BMS implanted after successful recanalization. Outcome measures included the minimal lumen diameter, the late lumen loss, and angiographic restenosis (> 50% diameter stenosis) at 6 months follow-up and the occurrence of target vessel failure during a 7-month period. RESULTS The patients were well matched in demographic and angiographic baseline characteristics, and 20% had diabetes. The reference vessel was 2.92 mm in mean, and the lesion length was 25.2 mm. At follow-up, patients who received SES had a minimal lumen diameter of 2.49 mm compared with 1.46 mm in those who received BMS (P = .015), 0% versus 38% developed restenosis (P < .001), lumen loss was -0.05 versus 0.99 mm (P < .001), and the target vessel failure rate 5% with SES versus 35% with BMS (P < .001). Stent thrombosis occurred in 1 patient in the BMS group. CONCLUSIONS Implantation of SES is safe, and it markedly reduces angiographic restenosis and the occurrence of adverse events in patients with a TCO.
Collapse
|
27
|
Kelbaek H, Thuesen L, Helqvist S, Kløvgaard L, Jørgensen E, Aljabbari S, Saunamäki K, Krusell LR, Jensen GVH, Bøtker HE, Lassen JF, Andersen HR, Thayssen P, Galløe A, van Weert A. The Stenting Coronary Arteries in Non-stress/benestent Disease (SCANDSTENT) Trial. J Am Coll Cardiol 2006; 47:449-55. [PMID: 16412876 DOI: 10.1016/j.jacc.2005.10.045] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.8] [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: 09/06/2005] [Revised: 09/27/2005] [Accepted: 10/11/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVES The purpose of the SCANDSTENT study was to evaluate the use of sirolimus-eluting stents (SES) in complex coronary lesions. BACKGROUND The use of SES improves angiographic and clinical outcomes compared with bare-metal stents (BMS) in simple coronary artery lesions, but there is limited evidence of their safety and efficacy when implanted in complex lesions. METHODS We randomly assigned 322 patients with symptomatic complex coronary artery disease to receive either SES or BMS. The lesions were occluded (36%), bifurcational (34%), ostial (22%), or angulated (8%) in morphology. The primary end point was the difference in minimal lumen diameter six months after stent implantation. RESULTS The patients were well matched in terms of demographic and angiographic baseline characteristics; 18% had diabetes. The reference vessel diameter was 2.86 mm in mean, and the lesion length 18.0 mm. At follow-up, patients who received SES had a minimal lumen diameter of 2.48 mm compared with 1.65 mm in those who received BMS (p < 0.001), a diameter stenosis of 19.3% versus 43.8% (p < 0.001), and 2.0% versus 31.9% developed restenosis (p < 0.001). The rate of major adverse cardiac events was 4.3% with SES versus 29.3% with BMS (p < 0.001), and stent thrombosis was observed in 0.6% in the SES group versus 3.1% in the BMS group (p = 0.15). CONCLUSIONS The use of SES markedly reduced restenosis and the occurrence of major adverse cardiac events in patients with complex coronary artery lesions without increasing the risk of stent thrombosis.
Collapse
Affiliation(s)
- Henning Kelbaek
- Cardiac Catheterization Laboratory, Rigshospitalet, Copenhagen, Denmark.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Jørgensen E, Kelbaek H, Helqvist S, Jensen GVH, Saunamäki K, Kastrup J, Madsen JK, Kløvgaard L, Thuesen L, Villadsen A, van Weert AWM, Reiber JHC. Low restenosis rate of the NIR coronary stent: results of the Danish multicenter stent study (DANSTENT)--a randomized trial comparing a first-generation stent with a second-generation stent. Am Heart J 2003; 145:e5. [PMID: 12595860 DOI: 10.1067/mhj.2003.32] [Citation(s) in RCA: 3] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Larger studies evaluating the angiographic results of second-generation stents are scarce. The objectives of this study were to assess current standards of angiographic and clinical outcomes after implantation of the second-generation stainless steel stent, NIR (Medinol Ltd, Tel Aviv, Israel), and to compare the outcomes with those of the first-generation Palmaz-Schatz (PS) stent (Johnson & Johnson, Warren, NJ). METHODS Patients having coronary artery lesions that could be covered by a stent of 15 mm in length were randomly assigned to receive the NIR or the PS. Procedural success, 6-month angiographic findings, and 1-year clinical outcomes were determined. RESULTS In 424 patients included in the study, the overall procedural success rate was high (NIR 98%, PS 99%, P =.90). Follow-up angiography was conducted in 91% of the patients. The overall rate of angiographic restenosis was low in both groups (NIR 9.9%, PS 12.6%, P =.35). We found a low restenosis rate in vessels with a minimal lumen diameter >3.1 mm after the procedure, particularly in the NIR group (<6%). The rate of target lesion revascularization after 1 year did not differ (NIR 12%, PS 10%, P =.47). CONCLUSIONS The angiographic and clinical outcomes after implantation of the second-generation stainless steel stent were not significantly better than those of the first-generation stent. The low restenosis rates, particularly in patients with the largest minimal lumen diameters after stent implantation, warrants circumspection when planning the evaluation of newer stent technologies that aim to further reduce coronary restenosis.
Collapse
Affiliation(s)
- Erik Jørgensen
- Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen, Denmark.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|