1
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Zeymer U, Hochadel M, Schaechinger V, Zahn R. Comparative efficacy and safety of ticagrelor vs. prasugrel in patients undergoing PCI for NSTE-ACS. Results of the prospective ALKK-Registry. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Dual antiplatelet therapy with aspirin and a P2Y12 inhibitor has become standard of care for patients with NSTE-ACS. Guidelines recommend prasugrel and ticagrelor over clopidogrel. In the ISAR-5 trial prasugrel was superior to ticagrelor in NSTE-ACS patients. We evaluated the outcome of patients undergoing PCI for NSTE-ACS in a large number of patients in real life and compared patients treated with prasugrel and ticagrelor.
Methods
We used the data of the prospective German ALKK-PCI registry and included patients treated with prasugrel or ticagrelor and undergoing PCI for NSTE-ACS treated in 42 centers. Baseline variables, procedural features, antithrombotic therapies and in-hospital outcomes were centrally collected and analysed. Patients with cardiogenic shock were excluded.
Results
Between 2011 and 2020 a total of 7888 patients <75 years without prior stroke undergoing PCI for NSTE-ACS were included. Of these 4905 (62.2%) patients were treated with ticagrelor and 2983 (37.8%) were treated with prasugrel. Baseline characteristics, procedural features and in-hospital outcomes are given in the table.
Conclusion
In clinical practice in patients with NSTE-ACS undergoing PCI ticagrelor was used more often than prasugrel. Ticagrelor treated patients were older and had more comorbidities. Despite this higher risk profile in ticagrelor patients the in-hospital mortality and the short-term safety profile were comparable in both groups.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Institut für Herzinfarktforschung Ludwigshafen
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Affiliation(s)
- U Zeymer
- Klinikum Ludwigshafen , Ludwigshafen , Germany
| | - M Hochadel
- Stiftung Institut fuer Herzinfarktforschung , Ludwigshafen , Germany
| | | | - R Zahn
- Klinikum Ludwigshafen , Ludwigshafen , Germany
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2
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Kaiser L, Hochadel M, Senges J, Kleemann T, Szendey I, Voss F, Steinbeck G, Leschke M, Butter C, Becker R, Willems S, Hakmi S. Procedure related complications following implantation of cardiac resynchronization therapy (CRT) and implantable cardioverter-defibrillator (ICD) devices - Insights from the German DEVICE registry. Europace 2022. [DOI: 10.1093/europace/euac053.465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): Stiftung Institut für Herzinfarktforschung
Background
The number of patients receiving cardiac resynchronization therapy (CRT) and implantable cardioverter-defibrillator (ICD) devices has been increasing in the last decades. Both CRT and ICD play an essential role in modern heart failure therapy. However, the implantation procedure might be ensued by serious complications. Therefore, knowledge about the prevalence of complications and identification of risk factors are key to improve patient care.
Methods
Between 2007-2014 the German DEVICE registry enrolled patients from 50 German centers undergoing ICD or CRT implantation. Patient characteristics, data on procedural outcome, adverse events and mortality during index hospitalization and follow-up at 1 year from discharge, were recorded. Patients who suffered from perioperative complications during or shortly after device implantation were identified for comparative analysis with patients without complications.
Results
Out of 4170 patients enrolled, 119 (2.9%) suffered from procedure related complications. The proportion of female patients suffering from perioperative complications was higher with 29.4%, compared to 18.5% of female patients without complications (p=0.003). There were neither any differences in age (66.3±13.6 vs. 65.4±12.5 years; p=0.13), nor in cardiac or non-cardiac comorbidities and in the indications for device implantation between groups. There was a trend towards a higher rate of complications with procedures on pre-existing devices (24,8 vs. 18.1%; p=0.064), than observed with de-novo implantations (75.2 vs. 81.9%; p=0.064). CRT implantations were more frequent among patients who suffered from complications (46.2 vs. 28.9%; p<0.001), compared to the group without complications, in which the proportion of ICD implantations was much more frequent (53.8 vs. 71.1%; p<0.001). The most frequent complication overall was pocket hematoma (55.1%), followed by pneumothorax (30.3%), pericardial effusion/tamponade (12.7%) and haemothorax (4.2%). The median hospital stay was significantly longer for patients with complications (7 [5; 11] vs. 3 [2; 5] days; p<0.001)). There was no difference in all-cause in-hospital mortality between respective groups. Median follow-up was 455 [398; 551] vs. 462 [391; 569] days (p=0.82) with no differences in all-cause mortality (6.5 vs. 6.9%; p=0.88), device-associated complications (12.6 vs. 8.5%; p=0.18) or rehospitalizations (37.9 vs. 32.2%; p=0.26) after 1-year follow-up.
Conclusion
The overall procedure-related complication rate following CRT or ICD implantation is low (2.9%). Among patients with complications female gender and patients receiving CRT devices were more prevalent. Perioperative device complications neither seem to translate into increased in-hospital mortality, nor in increased rates of further device-associated complications, rehospitalizations or death after 1-year follow-up.
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Affiliation(s)
- L Kaiser
- Asklepios Clinic St. Georg, Cardiology, Hamburg, Germany
| | - M Hochadel
- Stiftung Institut fuer Herzinfarktforschung, Ludwigshafen, Germany
| | - J Senges
- Stiftung Institut fuer Herzinfarktforschung, Ludwigshafen, Germany
| | - T Kleemann
- Klinikum Ludwigshafen, Ludwigshafen, Germany
| | - I Szendey
- Krankenhaus St. Franziskus, Kliniken Maria Hilf GmbH, Mönchengladbach, Germany
| | - F Voss
- Hospital Barmherzigen Bruder Trier, Trier, Germany
| | - G Steinbeck
- Klinikum Starnberg, Zentrum fuer Kardiologie, Starnberg, Germany
| | - M Leschke
- Clinic Esslingen, Esslingen, Germany
| | - C Butter
- Brandenburg Heart Center, Bernau bei Berlin, Germany
| | - R Becker
- Clinic Wolfsburg, Wolfsburg, Germany
| | - S Willems
- Asklepios Clinic St. Georg, Cardiology, Hamburg, Germany
| | - S Hakmi
- Asklepios Clinic St. Georg, Cardiology, Hamburg, Germany
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3
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Chung D, Hochadel M, Senges J, Kleemann T, Eckhardt L, Brachmann J, Steinbeck G, Larbig R, Butter C, Schulz E, Willems S, Hakmi S. Implantable cardioverter-defibrillator therapy in the very young - Patient characteristics procedural outcome and one-year follow-up - A subgroup analysis of the german DEVICE registry. Europace 2022. [DOI: 10.1093/europace/euac053.456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
The implantable cardioverter-defibrillator (ICD) and cardiac resynchronization therapy defibrillator (CRT-D) are well-established and essential therapeutic pillars for patients with heart failure and survivors of sudden cardiac death. The number of young patients receiving ICD or CRT-D has been increasing in the last decades. Understanding the key differences between the typically older ICD population and younger patients is paramount to optimized patient care.
Methods
The DEVICE registry prospectively enrolled patients undergoing ICD/CRT implantation or revision from 50 German centers between 2007–2014. Data on patient characteristics, procedural outcome, adverse events and mortality during the initial stay and follow-up was collected. All patients under the age of 45 years were identified and included into a comparative analysis with the remaining population.
Results
A total number of 4181 patients were enrolled into the registry, of which 236 patients (5.6%) were under the age of 45 years. Median age was 38.0 [31.0; 42.0] vs. 69.0 [60.0; 75.0] years, p<0.001), compared to older patients. Young patients were more likely to receive an ICD (91.5 vs. 69.4%, p<0.001), than CRT device and were less likely to suffer from non-cardiac comorbidities (20.3 vs. 67.4%, p<0.001). Coronary artery disease was less common in young patients (15.7 vs. 63.6%, p<0.001), whereas hypertrophic cardiomyopathy (11.0 vs. 2.5%, p<0.001) and primary cardiac electrical diseases (14.0 vs. 1.6%, p< 0.001) were encountered more often. Mean left-ventricular ejection fractions were 42.4±18.5 vs. 31.5±11.8%, respectively (p<0.001) with less young patients in NYHA functional class III/IV (19.5 vs. 45.3%, p<0.001). Primary symptom at presentation was chronic heart failure for older patients (19.5 vs. 34.8%, p<0.001) and survived sudden cardiac death (30.9 vs. 15.6%, p<0.001) for young patients. Thus, ICD for secondary prevention was more common in young patients (53.8 vs. 43.2%, p<0.001). There were no detectable differences in postoperative complications (3.0 vs. 4.1%, p=0.500) or in-hospital mortality (0.0 vs. 0.3%, p=1.000). Median follow-up time was 514 [398; 669] vs. 458 [391; 563] days (p=0.006). Device-associated complications requiring revision were more common in young patients (16.3 vs. 8.2%, p<0.001) and all-cause 1-year-mortality after implantation was lower (3.1 vs. 7.3%, p=0.029; HR 0.42, 95%CI: 0.19-0.94). Even though there was no difference in rates of rehospitalization between groups (32.1 vs. 32.4%, p=0.93), young patients were re-admitted more often for "cardiac" reasons (82.7 vs. 58.9%, p<0.001).
Conclusion
Rates for procedural complications and in-hospital mortality were very low and without differences between both age groups. However younger patients experienced a higher rate of postoperative complications requiring revision and had higher readmission rates for cardiac reasons, potentially due to a more active lifestyle.
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Affiliation(s)
- D Chung
- Asklepios St. Georg Clinic, Cardiology & Critical Care Medicine, Hamburg, Germany
| | - M Hochadel
- IHF GmbH Institute for Heart Attack Research, Ludwigshafen, Germany
| | - J Senges
- IHF GmbH Institute for Heart Attack Research, Ludwigshafen, Germany
| | - T Kleemann
- Klinikum Ludwigshafen, Cardiology, Ludwigshafen, Germany
| | - L Eckhardt
- Muenster University Hospital, Cardiac Electrophysiology, Muenster, Germany
| | - J Brachmann
- Cardiac Center of Coburg, RegioMed Medical School, Coburg, Germany
| | | | - R Larbig
- Kliniken Maria Hilf Moenchengladbach, Cardiology, Moenchengladbach, Germany
| | - C Butter
- Brandenburg Heart Center, Cardiology, Bernau bei Berlin, Germany
| | - E Schulz
- General Hospital of Celle, Cardiology, Celle, Germany
| | - S Willems
- Asklepios St. Georg Clinic, Cardiology & Critical Care Medicine, Hamburg, Germany
| | - S Hakmi
- Asklepios St. Georg Clinic, Cardiology & Critical Care Medicine, Hamburg, Germany
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4
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Schleberger R, Metzner A, Kuck KH, Andresen D, Willems S, Hoffmann E, Deneke T, Eckardt L, Brachmann J, Hochadel M, Senges J, Rillig A. Antiarrhythmic drug therapy after catheter ablation for atrial fibrillation has no impact on recurrences, cardiovascular events and mortality – insights from the German Ablation Registry. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Data on the optimal treatment strategy for antiarrhythmic drug therapy (AAD) after atrial fibrillation (AF) catheter ablation are inconsistent. While AAD potentially stabilizes sinus rhythm, it also increases the patients' treatment burden.
Methods
Patients from the prospective German Ablation Registry (n=3275) discharged with or without AAD after AF catheter ablation were compared regarding long-term success, cardiovascular events and patient reported outcome.
Results
In patients with paroxysmal AF (n=2138) recurrence and rehospitalization rates did not differ when discharged with (n=1051) or without (n=1087) AAD (recurrence: adjusted odds ratio (OR) 1.13, 95% confidence interval (CI) [0.95–1.35]; rehospitalization: OR 1.08, 95% CI [0.90–1.30]). The reablation rate was higher and reduced treatment satisfaction was reported more often in those discharged with AAD (reablation: OR 1.30, 95% CI [1.05–1.61]; reduced treatment satisfaction: OR 1.76, 95% CI [1.20–2.58]).
Similar rates of recurrences, rehospitalisations, reablations and treatment satisfaction were found in patients with persistent AF (n=1137) discharged with (n=641) or without (n=496) AAD (recurrence: OR 1.22, 95% CI [0.95–1.56]; rehospitalization: OR 1.16, 95% CI [0.90–1.50]; reablation: OR 1.21, 95% CI [0.91–1.61]; treatment satisfaction: OR 1.24, 95% CI [0.74–2.08]).
The incidence of cardiovascular events and mortality did not differ at follow-up in paroxysmal and persistent AF patients discharged with or without AAD.
Conclusion
The rates of recurrences, cardiovascular events and mortality did not differ between patients discharged with or without AAD after AF catheter ablation. However, AAD should be considered carefully in patients with paroxysmal AF, in whom it was associated with a higher reablation rate and reduced treatment satisfaction.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- R Schleberger
- University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - A Metzner
- University Heart & Vascular Center Hamburg, Hamburg, Germany
| | | | | | - S Willems
- Asklepios Clinic St. Georg, Hamburg, Germany
| | | | - T Deneke
- Heart Center Bad Neustadt, Bad Neustadt a. d. Saale, Germany
| | - L Eckardt
- Muenster University Hospital, Muenster, Germany
| | | | - M Hochadel
- Stiftung Institut fuer Herzinfarktforschung, Ludwigshafen, Germany
| | - J Senges
- Stiftung Institut fuer Herzinfarktforschung, Ludwigshafen, Germany
| | - A Rillig
- University Heart & Vascular Center Hamburg, Hamburg, Germany
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5
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Kany S, Brachmann J, Lewalter T, Akin I, Sievert H, Zeymer U, Ledwoch J, Ince H, Thomas D, Hochadel M, Senges J, Kirchhof P, Rillig A. Impact of atrial fibrillation pattern on left atrial appendage closure: insights from the prospective LAARGE registry. Europace 2021. [DOI: 10.1093/europace/euab116.123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): Stiftung für Herzinfarkforschung
Background
Non-paroxysmal (NPAF) forms of atrial fibrillation (AF) have been reported to be associated with an increased risk for systemic embolism or death compared with paroxysmal AF (PAF). This study investigates the procedural safety and long-term outcomes of left atrial appendage closure (LAAC) in patients with different forms of AF.
Methods
Comparison of procedural details and long-term outcomes in patients (pts) with PAF against controls with NPAF in the prospective, multicentre observational registry of patients undergoing LAAC in Germany (LAARGE).
Results
A total of 638 pts (PAF 274 pts, NPAF 364 pts) were enrolled. NPAF consisted of 31.6% patients with persistent AF and 68.4% with longstanding persistent AF or permanent AF. In both groups, a history of PVI was rare (4.0% vs 1.6%, p = 0.066). The PAF group had significantly less history of heart failure (19.0% vs 33.0%, p < 0.001) while the current median LVEF was similar (60% vs 60%, p = 0.26). The total CHA2DS2-VASc score was lower in the PAF group (4.4 ± 1.5 vs 4.6 ± 1.5, p = 0.033), but no difference in the HAS-BLED score (3.8 ± 1.1 vs 3.9 ± 1.1, p = 0.40) was observed. The rate of successful implantation was equally high (97.4% vs 97.8%, p = 0.77) in both groups. In the three-month echo follow-up, device-related thrombi (2.1% vs 7.3%, p = 0.12) and peridevice leak >5 mm (0.0% vs 7.1%, p= 0.53) were numerically higher in the NPAF group. Overall, in-hospital complications occurred in 15.0% of the PAF cohort and 10.7% of the NPAF cohort (p = 0.12). In the one-year follow-up, unadjusted mortality (8.4% vs 14.0%, p = 0.039) and combined outcome of death, stroke and systemic embolism (8.8% vs 15.1%, p = 0.022) were significantly higher in the NPAF cohort. After adjusting for CHA2DS2-VASc and previous bleeding, NPAF was associated with increased death/stroke/systemic embolism (HR 1.67, 95%-CI: 1.02-2.72).
Conclusion
Atrial fibrillation type did not impair periprocedural safety or in-hospital MACE of patients undergoing LAAC. However, after one year, NPAF was associated with higher mortality and combined outcome of death, stroke and systemic embolism.
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Affiliation(s)
- S Kany
- University Heart Centre Hamburg, Hamburg, Germany
| | - J Brachmann
- Hospital Coburg, Cardiology, Coburg, Germany
| | - T Lewalter
- Clinic Thalkirchner Straße, Cardiology, Munich, Germany
| | - I Akin
- University Medical Centre of Mannheim, Cardiology, Mannheim, Germany
| | - H Sievert
- CardioVascular Center Frankfurt, Cardiology, Frankfurt, Germany
| | - U Zeymer
- Klinikum Ludwigshafen, Cardiology, Ludwigshafen, Germany
| | - J Ledwoch
- Clinic Neuperlach, Cardiology, Munich, Germany
| | - H Ince
- University Hospital Rostock, Cardiology, Rostock, Germany
| | - D Thomas
- University Hospital of Heidelberg, Cardiology, Heidelberg, Germany
| | - M Hochadel
- Stiftung Institut fuer Herzinfarktforschung, Ludwigshafen, Germany
| | - J Senges
- Stiftung Institut fuer Herzinfarktforschung, Ludwigshafen, Germany
| | - P Kirchhof
- University Heart Centre Hamburg, Hamburg, Germany
| | - A Rillig
- University Heart Centre Hamburg, Hamburg, Germany
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6
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Zahn R, Hochadel M, Schumacher B, Pauschinger M, Stellbrink C, Schaechinger V, Behrens S, Mudra H, Elsaesser A, Zeymer U. Cardiogenic shock and radial access in patients with an acute ST elevation myocardial infarction. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1791] [Citation(s) in RCA: 1] [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: 11/13/2022] Open
Abstract
Abstract
Background
Cardiogenic shock (CS) in patients (pts) with acute ST elevation myocardial infarction (STEMI) is the strongest predictor of hospital mortality. Radial in contrast to femoral access in STEMI pts might be associated with a lower mortality. However, little is known on radial access in CS pts.
Methods
We retrospectively analysed all STEMI pts between 2009 and 2015 who sufferend from CS and who were included into the ALKK PCI registry. Pts treated via a radial access were compared to those treated via a femoral access.
Results
Between 2009 and 2015 23796 STEMI pts were included in the registry. 1763 (7.4%) of pts were in CS. The proportion of radial access was 6.6%: in 2009 4.0% and in 2015 19.6%, p for trend <0.0001 with a strong variation between the participating centres (0% to 37%).
Conclusions
Radial access was only used in 6.6% of STEMI pts presenting in CS. However, a significant increase in the use of radial access was observed over time (2009: 4%, 2015 19.6%, p<0.001), with a great variance in its use between the participating hospitals. Despite similar pt characteristics the difference in hospital mortality according to access site has to be interpretated with caution.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- R Zahn
- Klinikum Ludwigshafen, Ludwigshafen, Germany
| | - M Hochadel
- Stiftung Institut, Ludwigshafen, Germany
| | | | - M Pauschinger
- klinikum Nuernberg - Sued-Nuernberg, Nuremberg, Germany
| | | | - V Schaechinger
- Klinikum Fulda Heart-Thorax-Center Cardiology, Fulda, Germany
| | - S Behrens
- Vivantes Humboldt Klinikum, Berlin, Germany
| | - H Mudra
- Clinic Neuperlach, Munich, Germany
| | | | - U Zeymer
- Klinikum Ludwigshafen, Ludwigshafen, Germany
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7
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Ledwoch J, Franke J, Akin I, Geist V, Weiss C, Zeymer U, Pleger S, Hochadel M, Mudra H, Senges J, Lewalter T, Brachmann J, Sievert H. WATCHMAN versus ACP or amulet for left atrial appendage closure. Results from the LAARGE registry. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Several left atrial appendage (LAA) closure systems are available and due to differences in device design safety and efficacy of specific occluders derived from trials cannot be simply generalized to all devices.
Purpose
The present analysis sought to assess two contemporary LAA closure devices in clinical practice.
Methods
The present work represents a non-randomized sub-analysis of the prospective, multicenter, Left-Atrium-Appendage Occluder Register - GErmany (LAARGE) registry. The WATCHMAN (group 1) and the Amplatzer Cardiac Plug (ACP) or Amulet occluder (group 2) were assessed regarding technical success and procedural safety.
Results
A total of 641 patients at 38 centers were enrolled. Of them, 278 (43%) and 340 (53%) patients received the WATCHMAN and ACP/Amulet occluder, respectively. High technical success was achieved with a slight difference between the groups (96% in group 1 vs. 99% in group 2; p=0.007). Procedural safety did not differ (98% in group 1 vs. 97% in group 2; p=0.55). Chicken wing morphology of the LAA seemed to trigger the use of the ACP/Amulet (chicken wing in 36% of the cases in group 1 vs. 55% in group 2; p<0.001). The Kaplan Meier estimated 1-year composite of death or stroke was 12.0% and 12.9%, respectively (Figure 1A). The respective rates for the composite endpoint of death, stroke or systemic embolism were 12.0% and 13.2% (Figure 1B).
Conclusions
Both the WATCHMAN and the ACP/Amulet occluder provide excellent procedural results with comparable implantation success and no differences regarding procedural safety and long-term effectiveness.
Figure 1. Composite endpoints at 1-year
Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): Stiftung Institut für Herzinfarktforschung (IHF)
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Affiliation(s)
- J Ledwoch
- Klinikum Neuperlach, Klinik für Kardiologie, Pneumologie und Internistische Intensivmedizin, Munich, Germany
| | - J Franke
- CardioVascular Center Frankfurt, Frankfurt, Germany
| | - I Akin
- University Medical Centre of Mannheim, Mannheim, Germany
| | - V Geist
- Heart Center Bad Segeberg, Bad Segeberg, Germany
| | - C Weiss
- Hospital Lueneburg, Lueneburg, Germany
| | - U Zeymer
- Klinikum Ludwigshafen, Ludwigshafen, Germany
| | - S Pleger
- University Hospital of Heidelberg, Heidelberg, Germany
| | - M Hochadel
- Stiftung Institut fuer Herzinfarktforschung, Ludwigshafen, Germany
| | - H Mudra
- Klinikum Neuperlach, Klinik für Kardiologie, Pneumologie und Internistische Intensivmedizin, Munich, Germany
| | - J Senges
- Stiftung Institut fuer Herzinfarktforschung, Ludwigshafen, Germany
| | - T Lewalter
- Peter Osypka Heart Center, Munich, Germany
| | | | - H Sievert
- CardioVascular Center Frankfurt, Frankfurt, Germany
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8
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Frommeyer G, Reinke F, Andresen D, Klemann T, Spitzer SG, Jehle J, Brachmann J, Stellbrink C, Hochadel M, Senges J, Eckardt L. P988Implantable cardioverter defibrillators in patients with electrical heart disease and hypertrophic cardiomyopathy - data from the German device Registry. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Implantable cardioverter- defibrillator (ICD) therapy is established for prevention of sudden cardiac death (SCD) in different entities. However, data from large patient cohorts on patients with electrical heart disease of hypertrophic cardiomyopathy (HCM) is rare. Therefore, we investigated these patients by analysing registry data from a multi-center “real-life” registry.
Methods
The German Device Registry (DEVICE) is a nationwide, prospective registry with one-year follow-up investigating 5450 patients receiving device implantations in 50 German centres. The present analysis of DEVICE focussed on patients with electrical heart disease or HCM who received an ICD for primary or secondary prevention.
Results
174 patients with HCM and 112 patients with electrical heart disease were compared with 5164 other ICD patients. Median follow-up was 17.0 months. Patients in the control group were significantly older. Of note, overall mortality after one year was 1.8% in HCM patients, 6.6% in patients with electrical heart disease and 7.3% in the control group. Patients in the control group presented significantly more severe comorbidities. In contrast to HCM patients and the control group where primary prevention was the major indication for ICD implantation 77.5% of patients with electrical heart disease received an ICD for secondary prevention. The number of surgical revisions was higher in patients with electrical heart disease.
Conclusion
Data from the present registry display a surprisingly high mortality in patients with electrical heart disease equivalent to the control group. A high proportion of patients who received an ICD for secondary prevention may be regarded as a major determinant for these results while severe comorbidities such as diabetes, hypertension and renal failure are major determinants for mortality in the control cohort.
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Affiliation(s)
- G Frommeyer
- University Medical Center, Clinic for Cardiology II - Electrophysiology, Münster, Germany
| | - F Reinke
- University Medical Center, Clinic for Cardiology II - Electrophysiology, Münster, Germany
| | - D Andresen
- Department of Cardiology, Kardiologie am Hubertus-Krankenhaus, Berlin, Germany
| | - T Klemann
- Hear Center Ludwigshafen, Ludwigshafen, Germany
| | - S G Spitzer
- Praxisklinik Herz und Gefaesse, Dresden, Germany
| | - J Jehle
- Department of Cardiology, Klinikum Straubing, Straubing, Germany, Straubing, Germany
| | | | | | - M Hochadel
- Stiftung Institut für Herzinfarktforschung, Ludwigshafen, Germany
| | - J Senges
- Stiftung Institut für Herzinfarktforschung, Ludwigshafen, Germany
| | - L Eckardt
- University Medical Center, Clinic for Cardiology II - Electrophysiology, Münster, Germany
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9
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Fastner C, Brachmann J, Lewalter T, Zeymer U, Sievert H, Borggrefe M, Weiss C, Geist V, Krapivsky A, Kaeunicke M, Mudra H, Hochadel M, Schneider S, Senges J, Akin I. P3727Left atrial appendage closure in patients with a reduced left ventricular ejection fraction: results from the prospective multicenter German LAARGE registry. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background and purpose
Atrial fibrillation (AF) patients with increased thromboembolic risk and contraindications for standard oral anticoagulation (OAC) can profit from an interventional left atrial appendage closure (LAAC). While impaired left ventricular ejection fraction (LVEF) is associated with an increased thromboembolic risk in AF patients, cardiac interventions are often associated with an increase in complications in this patient population, and, therefore, the LAAC procedure's success and benefit has yet to be investigated in this subgroup.
Methods
This prospective, observational LAAC registry included 622 patients with documented LVEF from 37 German centers between April 2014 and January 2016. Patients were categorized into one of three groups: LVEF >55% (preserved; p), LVEF 35–55% (mid-range; mr) and LVEF <35% (reduced; r). Procedure was conducted in a standard fashion, and baseline characteristics, imaging as well as procedural data, intra-hospital and one-year follow-up outcome were registered for each group.
Results
55.3% of patients had a pLVEF, 38.7% a mrLVEF and 5.9% a rLVEF. Patients with rLVEF were more often affected by coronary artery disease (p<0.001 for trend), and had an elevated CHA2DS2-VASc (4.3±1.5 vs. 4.8±1.5 vs. 5.3±1.6; p<0.001) and HAS-BLED score (3.7±1.1 vs. 4.1±1.2 vs. 4.3±0.9; p<0.001). Percentage of prior cerebrovascular events and major bleedings was comparable at baseline (each p=n.s.). Procedural success was high (97.9%), while rates of intra-hospital MACCE (0.5%) and other major complications (4.2%) were low, with no significant difference between the groups (each p=n.s.). MACCE during follow-up was more frequent in rLVEF patients (11.0 vs. 11.3 vs. 27.8%; p=0.013), which was mainly driven by myocardial infarctions and all-cause deaths in this high risk collective. Likewise, Kaplan-Meier estimation showed a lower overall survival in this group (89.7 vs. 89.3 vs. 74.6%; p<0.01). On the contrary, rates of stroke were extremely low across all groups and statistically similar (0.3 vs. 1.0 vs. 0%; p=n.s.). This was 93.4, 82.7 and 100.0% less in comparison to the estimated risk calculated from the CHA2DS2-VASc score
Conclusions
The LVEF had no influence on the procedural success as well as the intra-hospital complications after LAAC. Annual rate of stroke was low across all groups, and risk reduction was substantial especially in this high risk collective, as compared to the estimated risk.
Acknowledgement/Funding
Stiftung Institut für Herzinfarktforschung, Ludwigshafen, Germany
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Affiliation(s)
- C Fastner
- University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, First Department of Medicine, and DZHK partner site Heidelberg/Mannheim, Mannheim, Germany
| | - J Brachmann
- Hospital Coburg, Department of Cardiology, Angiology and Pneumology, Second Medical Clinic, Coburg, Germany
| | - T Lewalter
- Hospital Munich-Thalkirchen, Department of Medicine - Cardiology and Intensive Care, Munich, Germany
| | - U Zeymer
- Heart Center Ludwigshafen, Department of Cardiology, Ludwigshafen, Germany
| | - H Sievert
- CardioVascular Center Frankfurt, Frankfurt am Main, Germany
| | - M Borggrefe
- University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, First Department of Medicine, and DZHK partner site Heidelberg/Mannheim, Mannheim, Germany
| | - C Weiss
- Hospital Lueneburg, Department of Cardiology, Lueneburg, Germany
| | - V Geist
- Heart Center Bad Segeberg, Department of Cardiology, Bad Segeberg, Germany
| | - A Krapivsky
- Evangelisches Krankenhaus, Department of Cardiology, Muelheim (Ruhr), Germany
| | - M Kaeunicke
- University of Witten/Herdecke, Katholisches Klinikum Essen, Department of Cardiology, Essen, Germany
| | - H Mudra
- Klinikum Neuperlach, Department of Cardiology, Munich, Germany
| | - M Hochadel
- Stiftung Institut für Herzinfarktforschung, Ludwigshafen, Germany
| | - S Schneider
- Stiftung Institut für Herzinfarktforschung, Ludwigshafen, Germany
| | - J Senges
- Stiftung Institut für Herzinfarktforschung, Ludwigshafen, Germany
| | - I Akin
- University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, First Department of Medicine, and DZHK partner site Heidelberg/Mannheim, Mannheim, Germany
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Fastner C, Brachmann J, Lewalter T, Zeymer U, Sievert H, Nienaber CA, Weiss C, Ince H, Maier J, Achenbach S, Sigusch HH, Hochadel M, Schneider S, Senges J, Akin I. P3724Impact of chronic kidney disease on efficacy and safety of interventional left atrial appendage closure – results from the prospective multicenter LAARGE registry. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The interventional left atrial appendage closure (LAAC) is an effective and safe alternative to standard oral anticoagulation (OAC) for stroke prevention in atrial fibrillation (AF) patients with contraindications for long-term OAC. Chronic kidney disease (CKD) has a high prevalence among AF patients, and was shown to increase the number of peri-procedural complications in cardiac interventions.
Purpose
This subanalysis of the LAARGE registry aimed to investigate CKD's impact on outcomes after LAAC.
Methods
This prospective, real-world LAAC registry included 625 patients with documented renal function from 37 German centers between April 2014 and January 2016. CKD was defined by an eGFR <60 mL/min/1.73 m2. Procedure was conducted with different LAAC devices considering the relevant recommendations. Baseline characteristics, procedural data, intra-hospital and one-year follow-up outcome were registered for CKD and non-CKD patients stratified by the different CKD stages.
Results
CKD patients (n=300; 48.0%) had a more pronounced cardiovascular risk profile, a higher stroke (CHA2DS2-VASc score 4.9±1.5 vs. 4.2±1.5; p<0.001) and bleeding risk (HAS-BLED score 4.3±1.0 vs. 3.5±1.0; p<0.001), and had experienced more prior bleedings (83.7 vs. 76.3%; p=0.022). Implantation success was similarly high between both groups (97.9%; p=n.s.). In CKD patients, MACCE during one-year follow-up was more frequent (18.1 vs. 6.8%; p<0.001) mainly being triggered by all-cause deaths, but in-hospital MACCE was not (0.3 vs. 0.3%; p=n.s.). Kaplan-Meier estimation showed a lower one-year survival among CKD patients (82.4 vs. 94.4%; p<0.001) without significant accentuation in patients with advanced CKD (i.e., <30 mL/min/1.73 m2; p=n.s. to other CKD patients). While annual rate of device associated complications (2.6 vs. 2.8%; p=n.s.) and strokes (0 vs. 1.0%; p=n.s.) was comparable during follow-up, annual severe bleeding rate was higher in CKD patients (2.6 vs. 0.3%; p=0.027) which was 71.4 and 94.4% less than expected from the HAS-BLED score (p<0.01 for the comparison to the estimated risks, but no significant interaction between groups).
Conclusions
Despite an increased cardiovascular risk profile of CKD patients, device implantation was safe, and annual stroke rate was statistically indifferent to non-CKD patients across all CKD stages after LAAC. Moreover, a substantial reduction of annual stroke and major bleeding risk was observed, as compared to the estimated annual risk.
Acknowledgement/Funding
Stiftung Institut für Herzinfarktforschung, Ludwigshafen, Germany
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Affiliation(s)
- C Fastner
- University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, First Department of Medicine, and DZHK partner site Heidelberg/Mannheim, Mannheim, Germany
| | - J Brachmann
- Hospital Coburg, Department of Cardiology, Angiology and Pneumology, Second Medical Clinic, Coburg, Germany
| | - T Lewalter
- Hospital Munich-Thalkirchen, Department of Medicine - Cardiology and Intensive Care, Munich, Germany
| | - U Zeymer
- Heart Center Ludwigshafen, Department of Cardiology, Ludwigshafen, Germany
| | - H Sievert
- CardioVascular Center Frankfurt, Frankfurt am Main, Germany
| | - C A Nienaber
- Royal Brompton Hospital, Cardiology and Aortic Center, London, United Kingdom
| | - C Weiss
- Lueneburg Hospital, Department of Cardiology, Lueneburg, Germany
| | - H Ince
- University Hospital Rostock, Clinic for Internal Medicine, Rostock, Germany
| | - J Maier
- SLK-Kliniken Heilbronn GmbH, Klinikum Am Gesundbrunnen, Medical Department I, Heilbronn, Germany
| | - S Achenbach
- University Hospital Erlangen, Department of Medicine, Erlangen, Germany
| | - H H Sigusch
- Heinrich-Braun-Klinikum Zwickau gGmbH, Clinic for Internal Medicine I, Zwickau, Germany
| | - M Hochadel
- Stiftung Institut für Herzinfarktforschung, Ludwigshafen, Germany
| | - S Schneider
- Stiftung Institut für Herzinfarktforschung, Ludwigshafen, Germany
| | - J Senges
- Stiftung Institut für Herzinfarktforschung, Ludwigshafen, Germany
| | - I Akin
- University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, First Department of Medicine, and DZHK partner site Heidelberg/Mannheim, Mannheim, Germany
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Wienbergen H, Pfister O, Hochadel M, Fach A, Backhaus T, Bruder O, Remppis BA, Maeder MT, Von Scheidt W, Pauschinger M, Senges J, Hambrecht R. 5217Long-term effects of iron deficiency in patients with heart failure with or without anemia - the RAID-HF follow-up study. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.5217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- H Wienbergen
- Klinikum Links der Weser, Bremer Institut für Herz- und Kreislaufforschung, Bremen, Germany
| | - O Pfister
- University Hospital Basel, Basel, Switzerland
| | - M Hochadel
- Heart Attack Research Center, Ludwigshafen am Rhein, Germany
| | - A Fach
- Klinikum Links der Weser, Bremer Institut für Herz- und Kreislaufforschung, Bremen, Germany
| | - T Backhaus
- Klinikum Links der Weser, Bremer Institut für Herz- und Kreislaufforschung, Bremen, Germany
| | - O Bruder
- Elisabeth Hospital, Essen, Germany
| | - B A Remppis
- Herz- und Gefäßzentrum, Bad Bevensen, Germany
| | - M T Maeder
- Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | | | - M Pauschinger
- Klinikum Nürnberg - Süd, Nürnberg, Nurnberg, Germany
| | - J Senges
- Heart Attack Research Center, Ludwigshafen am Rhein, Germany
| | - R Hambrecht
- Klinikum Links der Weser, Bremer Institut für Herz- und Kreislaufforschung, Bremen, Germany
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Zeymer U, Brachmann J, Lewalter T, Akin I, Sievert H, Mudra H, Geist V, Ekapic D, Pfleger S, Hochadel M, Senges J. P2897Impact of age >75 years on one-year events in patients with atrial fibrillation and left atrial appendage occluder implantation. Results of the prospective LAARGE Registry. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- U Zeymer
- Institut für Herzinfarktforschung, Ludwigshafen Am Rhein, Germany
| | | | - T Lewalter
- Peter Osypka Herzzentrum, Munich, Germany
| | - I Akin
- University Medical Centre of Mannheim, Mannheim, Germany
| | - H Sievert
- CardioVascular Center Frankfurt, Frankfurt am Main, Germany
| | - H Mudra
- Klinikum Neuperlach, Munich, Germany
| | - V Geist
- Heart Center Bad Segeberg, Bad Segeberg, Germany
| | - D Ekapic
- Justus-Liebig University of Giessen, Giessen, Germany
| | - S Pfleger
- University Hospital of Heidelberg, Heidelberg, Germany
| | - M Hochadel
- Institut für Herzinfarktforschung, Ludwigshafen Am Rhein, Germany
| | - J Senges
- Institut für Herzinfarktforschung, Ludwigshafen Am Rhein, Germany
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Riedmaier P, Hochadel M, Hoffmeister H, Schumacher B, Darius H, Kerber S, Zahn R, Zeymer U. P6402In-hospital outcome in very elderly patients with NSTEMI undergoing early angiography. Results of the prospective ALKK-registry. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- P Riedmaier
- Klinikum Ludwigshafen, Ludwigshafen Am Rhein, Germany
| | - M Hochadel
- Heart Attack Research Center, Ludwigshafen am Rhein, Germany
| | | | | | - H Darius
- Vivantes Clinics for Health, Berlin, Germany
| | - S Kerber
- Heart Center Bad Neustadt, Bad Neustadt a.d. Saale, Germany
| | - R Zahn
- Klinikum Ludwigshafen, Ludwigshafen Am Rhein, Germany
| | - U Zeymer
- Klinikum Ludwigshafen, Ludwigshafen Am Rhein, Germany
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Jilek C, Brachmann J, Lewalter TH, Kuck KH, Andresen D, Willems SG, Spitzer SG, Straube F, Schumacher B, Eckardt L, Danilovic D, Thomas D, Hochadel M, Senges J. 366No support for additional left atrial substrate modification among patients with persistent atrial fibrillation at first PVI procedure - results from German Ablation registry. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- C Jilek
- Peter-Osypka-Heart Centre, Hospital for Internal Medicine Munich South, Munich, Germany
| | - J Brachmann
- Coburg Hospital, Department of Cardiology, Angiology, and Pneumology, Second Medical Clinic, Coburg, Germany
| | - T H Lewalter
- Peter-Osypka-Heart Centre, Hospital for Internal Medicine Munich South, Munich, Germany
| | - K H Kuck
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - D Andresen
- Vivantes Klinik Am Urban, Department of Cardiology and Internal Medicine, Berlin, Germany
| | - S G Willems
- University Heart Center Hamburg, Department of Electrophysiology, Hamburg, Germany
| | - S G Spitzer
- Praxisklinik Herz und Gefäße, Dresden, Germany
| | - F Straube
- Municipal Hospital of Munich, Heart Center Munich-Bogenhausen, Munich, Germany
| | - B Schumacher
- Westpfalz Hospital, Department of Cardiology, Pneumology, Angiology and Intensive Care, Kaiserslautern, Germany
| | - L Eckardt
- University Medical Center, Division of Electrophysiology, Department of Cardiology and Angiology, Münster, Germany
| | - D Danilovic
- Stiftung Institut für Herzinfarktforschung, Ludwigshafen, Germany
| | - D Thomas
- University of Heidelberg, Department of Cardiology, Heidelberg, Germany
| | - M Hochadel
- Stiftung Institut für Herzinfarktforschung, Ludwigshafen, Germany
| | - J Senges
- Stiftung Institut für Herzinfarktforschung, Ludwigshafen, Germany
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Zeymer U, Hochadel M, Hoffmeister HM, Ince H, Kerber S, Zahn R. P2727Success rate and clinical outcome of left main PCI in patients with AMI complicated by cardiogenic shock. Results of the ALKK-registry. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- U Zeymer
- Institut für Herzinfarktforschung, Ludwigshafen Am Rhein, Germany
| | - M Hochadel
- Institut für Herzinfarktforschung, Ludwigshafen Am Rhein, Germany
| | | | - H Ince
- Vivantes Klinikum im Friedrichshain, Berlin, Germany
| | - S Kerber
- Heart Center Bad Neustadt, Bad Neustadt a.d. Saale, Germany
| | - R Zahn
- Klinikum Ludwigshafen, Ludwigshafen Am Rhein, Germany
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Bock D, Senges J, Pohlmann C, Hochadel M, Münzel T, Giannitsis E, Schmitt C, Heusch G, Voigtländer T, Mudra H, Schumacher B, Darius H, Maier LS, Hailer B, Haude M, Gohlke H, Hink U. The German CPU registry: Comparison of smokers and nonsmokers. Herz 2018; 45:293-298. [PMID: 30054712 DOI: 10.1007/s00059-018-4733-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 06/22/2018] [Accepted: 06/28/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Chest pain is a major reason for admission to an internal emergency department, and smoking is a well-known risk factor for coronary artery disease (CAD) and acute coronary syndrome (ACS). The aim of this analysis is to illustrate the differences between smokers and nonsmokers presenting to German chest pain units (CPU) in regard to patient characteristics, CAD manifestation, treatment strategy, and prognosis. METHODS From December 2008 to March 2014, 13,902 patients who had a complete 3‑month follow-up were enrolled in the German CPU registry. The analysis comprised 5796 patients with ACS and documented smoking status. RESULTS Of all the patients in the CPU registry, 35.2% were smokers. Compared with nonsmokers, they were 13.5 years younger (58.2 vs. 71.7 years, p < 0.001), predominantly men (77.1% vs. 65.2%, p < 0.001), and were more frequently diagnosed with single-vessel disease (32.1% vs. 25.2%) as well as ST-elevation myocardial infarction (STEMI; 23.8% vs. 15.5%, p < 0.001). Although the Global Registry of Acute Coronary Events (GRACE) Risk Score for hospital mortality was lower in the group of smokers (106.1 vs. 123.3, p < 0.001), we did not observe any differences in CPU death (0.4% vs. 0.4%, p = 0.69) and CPU major adverse cardiac event (MACE) rates (3.8% vs 2.9%, p = 0.073) between the groups. In the 3‑month follow-up, we documented higher mortality rates in the nonsmoker group (1.9% vs. 2.9%, p = 0.035) in correlation with the GRACE Risk Score (80.3 vs. 105.2, p < 0.001). MACE rates were similar during the follow-up (3.1% vs. 4.1%, p = 0.065). CONCLUSION Observations from the German CPU registry demonstrate that smoking is a strong predictor of acute CAD manifestation early in life, especially STEMI. In spite of a lower GRACE Risk Score and fewer comorbidities, smokers had a rate of hospital mortality similar to the older group of nonsmokers.
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Affiliation(s)
- D Bock
- Department of Cardiology, Klinikum Höchst, Gotenstraße 6-8, 65929, Frankfurt am Main, Germany.
| | - J Senges
- Institut für Herzinfarktforschung, Ludwigshafen, Germany
| | - C Pohlmann
- Department of Cardiology, Klinikum Höchst, Gotenstraße 6-8, 65929, Frankfurt am Main, Germany
| | - M Hochadel
- Institut für Herzinfarktforschung, Ludwigshafen, Germany
| | - T Münzel
- Department of Cardiology, Universitätsklinik Mainz, Mainz, Germany
| | - E Giannitsis
- Department of Cardiology, Universitätsklinik Heidelberg, Heidelberg, Germany
| | - C Schmitt
- Department of Cardiology, Klinikum Karlsruhe, Karlsruhe, Germany
| | - G Heusch
- Institute for Pathophysiology, Universitätsklinik Essen, Essen, Germany
| | - T Voigtländer
- Cardiovascular Center Bethanien, Frankfurt/Main, Germany
| | - H Mudra
- Department of Cardiology, Städtisches Klinikum München, Munich, Germany
| | - B Schumacher
- 2nd Department of Medicine, Westpfalzklinikum Kaiserslautern, Kaiserslautern, Germany
| | - H Darius
- Department of Cardiology, Vivantes Hospital Neukölln, Berlin, Germany
| | - L S Maier
- Department of Cardiology, University of Regensburg, Regensburg, Germany
| | - B Hailer
- Department of Cardiology, Katholisches Klinikum Essen, Essen, Germany
| | - M Haude
- Lukaskrankenhaus, Städtische Kliniken Neuss, Neuss, Germany
| | - H Gohlke
- Universitäts-Herz-Zentrum Bad Krozingen, Bad Krozingen, Germany
| | - U Hink
- Department of Cardiology, Klinikum Höchst, Gotenstraße 6-8, 65929, Frankfurt am Main, Germany
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Bogossian H, Hochadel M, Ince H, Spitzer SG, Eckardt L, Maier S, Kleemann T, Brachmann J, Stellbrink C, Gonska BD, Kaab S, Senges J, Lemke B. 1075Single chamber implantable cardioverter defibrillator compared to dual chamber implantable cardioverter defibrillator. Less is more. Data from the German Device Registry. Europace 2018. [DOI: 10.1093/europace/euy015.579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- H Bogossian
- Maerkische Klinken GmbH / Witten-Herdecke University, Cardiology and Angiology, Lüdenscheid/ Witten-Herdecke, Germany
| | - M Hochadel
- Stiftung Institut für Herzinfarktforschung, Ludwigshafen, Germany
| | - H Ince
- Vivantes Klinikum am Urban, Cardiology, Berlin, Germany
| | - S G Spitzer
- Praxisklinik Herz und Gefäße, Dresden, Germany
| | - L Eckardt
- University Medical Center, Münster, Germany
| | - S Maier
- Krankenhaus St. Elisabeth, Straubing, Germany
| | - T Kleemann
- Klinikum Ludwigshafen, Ludwigshafen, Germany
| | | | | | - B D Gonska
- St. Vincentius-Kliniken, Karlsruhe, Germany
| | - S Kaab
- University Hospital of Munich, Munich, Germany
| | - J Senges
- Stiftung Institut für Herzinfarktforschung, Ludwigshafen, Germany
| | - B Lemke
- Märkische Kliniken GmbH, Klinikum Lüdenscheid, Luedenscheid, Germany
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18
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Jilek C, Brachmann J, Lewalter T, Kuck KH, Andresen D, Willems S, Spitzer SG, Straube F, Schumacher B, Eckardt L, Danilovic D, Thomas D, Hochadel M, Senges J. 1012No support for additional left atrial substrate modification among patients with persistent atrial fibrillation at first PVI procedure- Results from German Ablation registry. Europace 2018. [DOI: 10.1093/europace/euy015.561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- C Jilek
- Peter-Osypka-Heart Centre, Hospital for Internal Medicine Munich South, Munich, Germany
| | - J Brachmann
- Coburg Hospital, Department of Cardiology, Angiology, and Pneumology, Second Medical Clinic, Coburg, Germany
| | - T Lewalter
- Peter-Osypka-Heart Centre, Hospital for Internal Medicine Munich South, Munich, Germany
| | - K H Kuck
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - D Andresen
- Vivantes Klinikum Am Urban, Department of Cardiology and Internal Medicine, Berlin, Germany
| | - S Willems
- University Heart Center Hamburg, Department of Electrophysiology, Hamburg, Germany
| | - S G Spitzer
- Praxisklinik Herz und Gefäße, Dresden, Germany
| | - F Straube
- Munich Municipal Hospital Group, Heart Center Munich- Bogenhausen, Munich, Germany
| | - B Schumacher
- Westpfalz Hospital, Department of Cardiology, Pneumology, Angiology and Intensive Care, Kaiserslautern, Germany
| | - L Eckardt
- University Medical Center, Division of Electrophysiology, Department of Cardiology and Angiology, Münster, Germany
| | - D Danilovic
- Stiftung Institut für Herzinfarktforschung (IHF), Ludwigshafen, Germany
| | - D Thomas
- University of Heidelberg, Department of Cardiology, Heidelberg, Germany
| | - M Hochadel
- Stiftung Institut für Herzinfarktforschung (IHF), Ludwigshafen, Germany
| | - J Senges
- Stiftung Institut für Herzinfarktforschung (IHF), Ludwigshafen, Germany
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19
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Sultan A, Lüker J, Andresen D, Kuck KH, Hoffmann E, Brachmann J, Hochadel M, Willems S, Eckardt L, Lewalter T, Senges J, Steven D. Predictors of Atrial Fibrillation Recurrence after Catheter Ablation: Data from the German Ablation Registry. Sci Rep 2017; 7:16678. [PMID: 29192223 PMCID: PMC5709464 DOI: 10.1038/s41598-017-16938-6] [Citation(s) in RCA: 96] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 11/20/2017] [Indexed: 11/09/2022] Open
Abstract
Catheter ablation (CA) for atrial fibrillation (AF) has emerged as a widespread first or second line treatment option. However, up to 45% of patients (pts) show recurrence of AF within 12 month after CA. We present prospective multicenter registry data comparing characteristics of pts with and without recurrence of AF within the first year after CA. This study comprises all pts with complete follow-up one year after CA (1-y-FU; n = 3679). During 1y-FU in 1687 (45.9%) pts recurrence of AF occurred. The multivariate analysis revealed female sex and AF type prior to the procedure as predictors for AF recurrence. Furthermore, comorbidities such as valvular heart disease and renal failure as well as an early AF relapse were also predictors of AF recurrence during 1-y-FU. However, despite an AF recurrence rate of 45.9%, the majority of these pts (72.4%) reported a significant alleviation of clinical symptoms. In conclusion in pts with initially successful CA for AF female sex, AF type, in-hospital AF relapse and comorbidities such as renal failure and valvular heart disease are independent predictors for AF recurrence during 1-y-FU. However, the majority of pts deemed their interventions as successful with significant reduction of symptoms irrespective of AF.
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Affiliation(s)
- A Sultan
- University Heart Center Cologne, Dept. of Electrophysiology, Cologne, Germany.
| | - J Lüker
- University Heart Center Cologne, Dept. of Electrophysiology, Cologne, Germany
| | | | - K H Kuck
- Asklepios Hosp. St. Georg Hamburg, Hamburg, Germany
| | | | | | | | - S Willems
- University Heart Center Hamburg, Dept. of Electrophysiology, Hamburg, Germany
| | - L Eckardt
- University Hosp. Münster, Dept. of Electrophysiology, Münster, Germany
| | - T Lewalter
- Dept. of Medicine-Cardiology, P. Osypka Heart Center Munich, Munich, Germany
| | - J Senges
- IHF Ludwigshafen, Ludwigshafen, Germany
| | - D Steven
- University Heart Center Cologne, Dept. of Electrophysiology, Cologne, Germany
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Moser J, Hoffmann B, Andresen D, Kuck KH, Brachmann J, Eckardt L, Hoffmann E, Lewalter T, Schumacher B, Spitzer S, Hochadel M, Senges J, Willems S. P786Factors associated with acute pacemaker implantation after carvo- tricuspidal isthmus ablation - results from the German ablation registry. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx501.p786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Moser J, Hoffmann B, Andresen D, Brachmann J, Eckardt L, Hoffmann E, Kuck KH, Lewalter T, Schumacher B, Spitzer S, Hochadel M, Senges J, Willems S. P2672Which factors are associated with acute pacemaker implantation after ablation of atrial fibrillation? Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p2672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Zeymer U, Hochadel M, Karcher A, Kerber S, Elsaesser A, Brachmann J, Budde T, Hoffmeister H, Zahn R. P2724Inhospital mortality in patients with infarct-relaled cardiogenic shock undergoing coronary angiography treated with and without acute revascularization therapy. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p2724] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Jilek C, Pauschinger M, von Scheidt W, Frankenstein L, Pfister O, Hambrecht R, Bruder O, Brachmann J, Hartmann A, Strasser R, Lewalter T, Hochadel M, Senges J. P4938Cardioverter-defibrillator does not improve survival among patients with dilative cardiomyopathy and reduced LV ejection fraction: Data from real-world registry EVITA-HF - The answer to DANISH. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p4938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Moser J, Hoffmann B, Andresen D, Brachmann J, Eckardt L, Hoffmann E, Kuck K, Lewalter T, Schumacher B, Spitzer S, Hochadel M, Senges J, Willems S. P783Influencing factors of in-hospital pacemaker implantation after ablation of AV-nodal reentry- and AV-reentry tachycardia: results from the German ablation registry. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx501.p783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Perne A, Schmidt FP, Hochadel M, Giannitsis E, Darius H, Maier LS, Schmitt C, Heusch G, Voigtländer T, Mudra H, Gori T, Senges J, Münzel T. Admission heart rate in relation to presentation and prognosis in patients with acute myocardial infarction. Treatment regimens in German chest pain units. Herz 2015; 41:233-40. [PMID: 26411426 DOI: 10.1007/s00059-015-4355-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 08/12/2015] [Accepted: 08/21/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Higher heart rates on admission have been associated with poor outcomes in patients with an acute coronary syndrome in previous cohorts. Whether such a linear relationship still exists in contemporary high-level care is unclear. METHODS Prospectively collected data from patients presenting with myocardial infarction (MI) in centers participating in the Chest Pain Unit (CPU) Registry between December 2008 and July 2014 were analyzed. Patients were classified according to their initial heart rate (I: < 50; II: 50-69; III: 70-89; IV: ≥ 90 bpm). A total of 6,168 patients out of 30,339 patients presenting to 38 centers were included in the study. RESULTS Patients in group IV had more comorbidities, while patients in group I more often had a history of MI. Patients in the lowest heart rate group presented significantly earlier to the hospital (4 h 31 min vs. 7 h 37 min; p < 0.05) and had the highest rate of interventions. The overall survival after 3 months was significantly worse in group IV after adjusting for baseline variables. In the subgroup analysis, heart rate was a prognostic factor in the non-ST-segment elevation MI group but not in the ST-segment elevation MI group. The correlation between heart rate and major adverse cardiac events followed a J-shaped curve with worst outcomes in the lowest and highest heart rate groups. CONCLUSION Patients admitted to a dedicated CPU with the diagnosis of MI and a heart rate > 90 bpm experience reduced survival at 3 months despite optimal treatment. Patients with bradycardia also seem to be at increased risk for cardiovascular events despite much earlier presentation and treatment.
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Affiliation(s)
- A Perne
- 2nd Department of Medicine, Johannes Gutenberg University of Mainz, Mainz, Germany
| | - F P Schmidt
- 2nd Department of Medicine, Johannes Gutenberg University of Mainz, Mainz, Germany
| | - M Hochadel
- Institute for Myocardial Infarction Research Foundation Ludwigshafen, University of Heidelberg, Heidelberg, Germany
| | - E Giannitsis
- 3rd Department of Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - H Darius
- Department of Cardiology, Angiology and Intensive Care Medicine, Vivantes-Klinikum Neukölln, Berlin, Germany
| | - L S Maier
- 2nd Department of Medicine, University Hospital of Regensburg, Regensburg, Germany
| | - C Schmitt
- Clinic for Cardiology and Angiology, Municipal Hospital Karlsruhe, Karlsruhe, Germany
| | - G Heusch
- Institute for Pathophysiology, West German Heart and Vascular Center University Duisburg-Essen, Essen, Germany
| | - T Voigtländer
- CCB, Cardioangiologisches Centrum Bethanien, Frankfurt am Main, Germany
| | - H Mudra
- Department of Cardiology, Pneumology and Internal Intensive Care Medicine, Klinikum Neuperlach, Städtisches Klinikum München GmbH, Munich, Germany
| | - T Gori
- 2nd Department of Medicine, Johannes Gutenberg University of Mainz, Mainz, Germany
| | - J Senges
- Institute for Myocardial Infarction Research Foundation Ludwigshafen, University of Heidelberg, Heidelberg, Germany
| | - T Münzel
- 2nd Department of Medicine, Johannes Gutenberg University of Mainz, Mainz, Germany.
- 2. Medical Clinic for Cardiology, Angiology and Intensive Care, Langenbeckstrasse 1, 55131, Mainz, Germany.
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Moser J, Kuck KH, Andresen D, Spitzer SG, Hoffmann E, Schumacher B, Eckardt L, Brachmann J, Lewalter T, Hochadel M, Senges J, Willems S, Hoffmann BA. [Anticoagulation in high thromboembolic risk after catheter ablation for atrial fibrillation: results from the German Ablation Registry]. Dtsch Med Wochenschr 2014; 139:1923-8. [PMID: 25225860 DOI: 10.1055/s-0034-1387316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Catheter ablation (CA) for atrial fibrillation (AF) is an effective therapeutic option for the treatment of symptomatic drug-refractory AF. According to current guidelines, the prevention of stroke and embolism is the most important therapeutic goal in AF and the recommendations for anticoagulation (OAC) after successful CA are based upon the CHA2DS2-VASc-Score 3. The aim of this study was to evaluate the use of OAC in patients with a high risk for thromboembolic events 1 year after CA and to identify predictor variables for discontinuation of OAC. METHODS Between January 2007 and January 2010 13092 patients were enrolled in the study. A total of 52 German electrophysiological centers agreed to participate in this prospective multicenter registry. 41 centers included patients undergoing CA for AF. Analysis included patients who were discharged with OAC after CA and had a CHA2DS2-VASc-Score ≥ 2. A centralized 1 year follow-up (FU) was conducted via telephone. RESULTS 1300 patients fulfilled the inclusion criteria. One year after CA 51.8 % of these patients were on OAC. Factors significantly associated with discontinuation of OAC included no AF recurrence in FU (adjusted odds ratio (OR): 2.14, [95 % confidence interval (CI): 1.73-2.66], P < 0.001) and paroxysmal AF (OR: 1.53 [95 % CI: 1.29-1.81], P < 0.001). Factors associated with continuation of OAK were patient age (OR per 10 years: 0.79 [95 % CI: 0.68-0.91], P = 0.002), valvular heart disease (OR: 0.67 [95 % CI: 0.48-0.92], P = 0.013), an implanted pacemaker, defibrillator or a cardiac resynchronization therapy system (OR: 0.55 [95 % CI: 0.41-0.74], P < 0.001) and neurological events in hospital or during FU (OR: 0.40 [95 % CI: 0.18-0.88], P < 0.022). CONCLUSION Almost half of the patients with an indication for OAC are not adequately anticoagulated one year after CA for AF. Paroxysmal AF or freedom from AF is significantly associated with discontinuation of OAC.
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Affiliation(s)
- J Moser
- Klinik für Kardiologie mit Schwerpunkt Elektrophysiologie, Universitäres Herzzentrum Hamburg, Universitätsklinikum Hamburg-Eppendorf
| | - K H Kuck
- Abteilung für Kardiologie, Asklepios Klinik St. Georg, Hamburg
| | - D Andresen
- Klinik für Innere Medizin - Kardiologie, Vivantes Klinikum Am Urban, Berlin
| | | | - E Hoffmann
- Klinik für Kardiologie und Intensivmedizin , Städtische Kliniken München, Klinikum Bogenhausen, München
| | - B Schumacher
- Medizinische Klinik II, Westpfalz-Klinikum, Kaiserslautern
| | - L Eckardt
- Abteilung Rhythmologie, Department für Kardiologie und Angiologie, Universitätsklinikum Münster, Münster
| | - J Brachmann
- II. Medizinische Klinik, Regiomed Klinik, Coburg
| | - T Lewalter
- Klinik für Kardiologie und internistische Intensivmedizin, Isar Herz Zentrum, Isar Kliniken GmbH, München
| | - M Hochadel
- Institut für Herzinfarktforschung, Ludwigshafen
| | - J Senges
- Institut für Herzinfarktforschung, Ludwigshafen
| | - S Willems
- Klinik für Kardiologie mit Schwerpunkt Elektrophysiologie, Universitäres Herzzentrum Hamburg, Universitätsklinikum Hamburg-Eppendorf
| | - B A Hoffmann
- Klinik für Kardiologie mit Schwerpunkt Elektrophysiologie, Universitäres Herzzentrum Hamburg, Universitätsklinikum Hamburg-Eppendorf
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Gitt AK, Hochadel M, Zahn R, Zeymer U, Wojakowski W, Tendera M, Schiele F, Bassand JP. Atrial fibrillation is an independent predictor of hospital mortality in STEMI but not in NSTE-ACS in clinical practice - results of the Euro heart survey ACS-registry. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht307.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Zeymer U, Gitt A, Hochadel M, Lauer B, Kaul N, Andresen D, Zahn R. Pretreatment with prasugrel is safe and associated with an improvement outcome in patients with NSTE-ACS. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht310.p4866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Werner N, Mudra H, Blacha U, Von Flotow P, Janicke I, Leschke M, Geist V, Hochadel M, Langhoff R, Zahn R. Carotid artery stenting in clinical practice: first results of the multidisciplinary GECAS registry. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht307.p377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Gitt AK, Hochadel M, Wojakowski W, Zeymer U, Tendera M, Schiele F, Zahn R, Bassand JP. Renal failure but not diabetes determines hospital mortality in patients with NSTE-ACS - results of the Euro heart survey ACS-registry. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht307.p413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Bauer T, Hochadel M, Brachmann J, Schaechinger V, Boekstegers P, Zrenner B, Zahn R, Zeymer U. Use and outcome of radial versus femoral approach in patients with primary PCI for acute ST elevation myocardial infarction without cardiogenic shock: results of the ALKK PCI registry. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht307.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Wienbergen H, Hochadel M, Michel S, Boehm M, Neumann T, Strasser RH, Von Scheidt W, Senges J, Pauschinger M, Hambrecht R. Iron deficiency in chronic heart failure: diagnostics and therapy are rarely performed in clinical practice. Results of the RAID-HF registry. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.p3337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Liosis S, Hochadel M, Darius H, Behrens S, Mudra H, Lauer B, Gitt AK, Zeymer U. The high event rate in patients with diabetes mellitus treated with PCI for acute coronary syndromes is observed in the subgroup of patients with impaired renal function. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.p3136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Zeymer U, Hochadel M, Gitt A, Brachmann J, Schuehlen H, Zahn R. GP IIb/IIIa inhibitors improve outcome in patients with primary PCI for STEMI. Results of the prospective ALKK-Registry. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht307.p445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Gitt AK, Hochadel M, Zeymer U, Wojakowski W, Zahn R, Tendera M, Schiele F, Bassand JP. Independent impact of diabetes and renal failure on hospital outcome of STEMI - results of the Euro Heart Survey ACS registry. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht308.p2224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Schmidt K, Zahn R, Hochadel M, Hauptmann K, Elsaesser A, Darius H, Zeymer U. Impact of immediate multivessel intervention on outcome of patients with multivessel disease undergoing primary PCI for STEMI without cardiogenic shock for cardiogenic shock. Results of the prospective. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.2592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Rittger H, Hochadel M, Behrens S, Hauptmann KE, Zahn R, Mudra H, Brachmann J, Zeymer U. Interventional treatment and outcome in elderly patients with stable coronary artery disease. Results from the German ALKK registry. Herz 2013; 39:212-8. [PMID: 23712825 DOI: 10.1007/s00059-013-3822-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2012] [Revised: 03/07/2013] [Accepted: 03/24/2013] [Indexed: 12/13/2022]
Abstract
BACKGROUND The number of elderly and very elderly patients undergoing percutaneous coronary interventions (PCI) is increasing. We therefore analyzed data from the German ALKK registry (Arbeitsgemeinschaft Leitende Krankenhausärzte; Working Group of Hospital Cardiologists) to determine differences in procedural features, antithrombotic treatment, and in-hospital outcome in patients with coronary artery disease (CAD) according to age in a large series of patients. METHODS AND RESULTS The present analysis was based on the data of 35,534 consecutive patients undergoing elective PCI who were enrolled in the ALKK registry. Of these 27,145 (76.4 %) were younger than 75 years, 7,645 (21.5 %) were aged between 75 and 84 years, and 744 (2.1 %) patients were older than 85 years. Mean age was 68.5 years (60.9-74.5 years), and 25,784 patients (72.6 %) were male. Overall intraprocedural events were very low (1.1 %) and there was no significant difference between the three age groups [< 75 years (1.1 %); 75-< 85 years (1.2 %); ≥ 85 years (0.5 %) (p = not significant)]. Rates of in-hospital death, stroke and transient ischemic attack (TIA), as well as the combined endpoint in-hospital major adverse cardiac and cerebrovascular events (MACCE) were also very low (0.6 % vs. 0.9 % vs. 0.9 %; p < 0.001) but significantly higher in elderly patients with no further increase in the very elderly patient group. CONCLUSION We found no differences in this registry in intraprocedural complications during elective PCI between younger and elderly patients. Although in-hospital MACCE were somewhat higher in the elderly, the overall event rate was low and thus elderly patients should not be deprived from this therapy because of age alone.
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Affiliation(s)
- H Rittger
- Medizinische Klinik 2, Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany,
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Wojakowski W, Tendera M, Tubaro M, Gierlotka M, Bueno H, Hochadel M, Hasin Y, Bassand J, Gitt A. Are Elderly Patients with Acute Coronary Syndromes Undertreated? Data from Euro Heart Survey on ACS III Registry. Am J Cardiol 2013. [DOI: 10.1016/j.amjcard.2013.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Höllriegel R, Linke A, Hochadel M, Schuler G, Kerber S, Hambrecht R, Grube E, Hauptmann K, Zahn R, Zeymer U, Senges J. Impact of coronary artery disease on in-hospital mortality in patients with aortic valve disease. Herz 2013; 38:387-90. [DOI: 10.1007/s00059-012-3712-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2012] [Revised: 09/27/2012] [Accepted: 10/03/2012] [Indexed: 11/24/2022]
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Totzeck M, Hendgen-Cotta U, Rammos C, Petrescu A, Stock P, Goedecke A, Shiva S, Kelm M, Rassaf T, Duerr GD, Heuft T, Klaas T, Suchan G, Roell W, Zimmer A, Welz A, Fleischmann BK, Dewald O, Luedde M, Carter N, Lutz M, Sosna J, Jacoby C, Floegel U, Hippe HJ, Adam D, Heikenwaelder M, Frey N, Sobierajski J, Luedicke P, Hendgen-Cotta U, Lue H, Totzeck M, Dewor M, Kelm M, Bernhagen J, Rassaf T, Cortez-Dias N, Costa M, Carrilho-Ferreira P, Silva D, Jorge C, Robalo Martins S, Fiuza M, Pinto FJ, Nunes Diogo A, Enguita FJ, Tsiachris D, Tsioufis C, Kasiakogias A, Flessas D, Antonakis V, Kintis K, Giakoumis M, Hatzigiannis P, Katsimichas T, Stefanadis C, Andrikou E, Tsioufis C, Thomopoulos C, Kasiakogias A, Tzamou V, Andrikou I, Bafakis I, Lioni L, Kintis K, Stefanadis C, Lazaros G, Tsiachris D, Tsioufis C, Vlachopoulos C, Brili S, Chrysohoou C, Tousoulis D, Stefanadis C, Santos De Sousa CI, Pires S, Nunes A, Cortez Dias N, Belo A, Cabrita I, Pinto FJ, Benova T, Radosinska J, Viczenczova C, Bacova B, Knezl V, Dosenko V, Navarova J, Zeman M, Tribulova N, Maceira Gonzalez AM, Cosin Sales J, Igual B, Ruvira J, Diago JL, Aguilar J, Lopez Lereu MP, Monmeneu JV, Estornell J, Choi JC, Cha KS, Lee HW, Yun EY, Ahn JH, Oh JH, Choi JH, Lee HC, Hong TJ, Manzano Fernandez S, Lopez-Cuenca A, Januzzi JL, Mateo-Martinez A, Sanchez-Martinez M, Parra-Pallares S, Orenes-Pinero E, Romero-Aniorte AI, Valdes-Chavarri M, Marin F, Bouzas Mosquera A, Peteiro J, Broullon FJ, Alvarez Garcia N, Couto Mallon D, Bouzas Zubeldia B, Martinez Ruiz D, Yanez Wonenburger JC, Fabregas Casal R, Castro Beiras A, Backus BE, Six AJ, Cullen L, Greenslade J, Than M, Kameyama T, Sato T, Noto T, Nakadate T, Ueno H, Yamada K, Inoue H, Albrecht-Kuepper B, Kretschmer A, Kast R, Baerfacker L, Schaefer S, Kolkhof P, Andersson C, Kober L, Christensen SB, Nguyen CD, Nielsen MB, Olsen AMS, Gislason GH, Torp-Pedersen C, Shigekiyo M, Harada K, Lieu H, Neutel J, Maddock S, Goldsmith S, Koren M, Antwerp BV, Burnett J, Christensen SB, Charlot MG, Madsen M, Andersson C, Kober L, Gustafsson F, Torp-Pedersen C, Gislason GH, Cavusoglu Y, Mert KU, Nadir A, Mutlu F, Gencer E, Ulus T, Birdane A, Lim HS, Tahk SJ, Yang HM, Kim JW, Seo KW, Choi BJ, Choi SY, Yoon MH, Hwang GS, Shin JH, Russ MA, Wackerl C, Hochadel M, Brachmann J, Mudra H, Zeymer U, Weber MA, Menozzi A, Saia F, Valgimigli M, Belotti LM, Casella G, Manari A, Cremonesi A, Piovaccari G, Guastaroba P, Marzocchi A, Kuramitsu S, Iwabuchi M, Haraguchi T, Domei T, Nagae A, Hyodo M, Takabatake Y, Yokoi H, Toyota F, Nobuyoshi M, Kaitani K, Hanazawa K, Izumi C, Nakagawa Y, Ando K, Arita T, Nobuyoshi M, Shizuta S, Kimura T, Isshiuki T, Trucco ME, Tolosana JM, Castel MA, Borras R, Sitges M, Khatib M, Arbelo E, Berruezo A, Brugada J, Mont L, Romanov A, Pokushalov E, Prokhorova D, Chernyavskiy A, Shabanov V, Goscinska-Bis K, Bis J, Bochenek A, Gersak B, Karaskov A, Linde C, Daubert C, Bergemann TL, Abraham WT, Gold MR, Van Boven N, Bogaard K, Ruiter JH, Kimman GP, Kardys I, Umans VA, Cipriani M, Lunati M, Landolina M, Vittori C, Vargiu S, Ghio S, Petracci B, Campo C, Bisetti S, Frigerio M, Bongiorni MG, Soldati E, Segreti L, Zucchelli G, Di Cori A, De Lucia R, Viani S, Paperini L, Boem A, Levorato D, Kutarski A, Malecka B, Zabek A, Czajkowski M, Chudzik M, Kutarski A, Mitkowski P, Maciag A, Kempa M, Golzio PG, Fanelli A, Vinci M, Pelissero E, Morello M, Grosso Marra W, Gaita F, Kutarski A, Czajkowski M, Pietura R, Golzio PG, Vinci M, Pelissero E, Fanelli A, Ferraris F, Gaita F, Cuypers JAAE, Menting ME, Opic P, Utens EMWJ, Van Domburg RT, Helbing WA, Witsenburg M, Van Den Bosch AE, Bogers AJJC, Roos-Hesselink JW, Van Der Linde D, Takkenberg JJM, Rizopoulos D, Heuvelman HJ, Witsenburg M, Budts W, Van Dijk APJ, Bogers AJJC, Oechslin EN, Roos-Hesselink JW, Diller GP, Kempny A, Liodakis E, Alonso-Gonzalez R, Orwat S, Dimopoulos K, Swan L, Li W, Gatzoulis MA, Baumgartner H, Andrade AC, Voges I, Jerosch-Herold M, Pham M, Hart C, Hansen T, Kramer HH, Rickers C, Kempny A, Wustmann K, Borgia F, Dimopoulos K, Uebing A, Piorkowski A, Yacoub MH, Gatzoulis MA, Swan L, Diller GP, Mueller J, Weber R, Pringsheim M, Hoerer J, Hess J, Hager A, Hu K, Liu D, Niemann M, Herrmann S, Cikes M, Stoerk S, Knob S, Ertl G, Bijnens B, Weidemann F, Mornos C, Cozma D, Dragulescu D, Ionac A, Mornos A, Petrescu L, Mingo S, Ruiz Bautista L, Monivas Palomero V, Prados C, Maiz L, Giron R, Martinez M, Cavero Gibanel MA, Segovia J, Pulpon L, Kato H, Kubota S, Takasawa Y, Kumamoto T, Iacoviello M, Puzzovivo A, Forleo C, Lattarulo MS, Monitillo F, Antoncecchi V, Malerba G, Marangelli V, Favale S, Ruiz Bautista L, Mingo S, Monivas V, Segovia J, Prados C, Maiz L, Giron R, Martinez MT, Gonzalez Estecha M, Alonso Pulpon LA, Ren B, De Groot-De Laat L, Mcghie J, Vletter W, Ten Cate F, Geleijnse M, Looi JL, Lam YY, Yu CM, Lee PW, Apor A, Sax B, Huttl T, Nagy A, Kovacs A, Merkely B, Vecera J, Bartunek J, Vanderheyden M, Mertens P, Bodea O, Penicka M, Biaggi P, Gaemperli O, Corti R, Gruenenfelder J, Felix C, Bettex D, Datta S, Jenni R, Tanner F, Herzog B, Fattouch K, Murana G, Castrovinci S, Sampognaro R, Bertolino EC, Caccamo G, Ruvolo G, Speziale G, Lancellotti P. Saturday, 25 August 2012. Eur Heart J 2012. [DOI: 10.1093/eurheartj/ehs280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Biffi M, Exner D, Crossley G, Ramza B, Coutu B, Tomassoni GF, Kranig W, Voss F, Teo KM, Stuart AG, Tomassoni G, Baker J, Corbisiero R, Love C, Martin D, Niazi I, Sheppard R, Worley S, Jurkuvenas P, Sedlacek K, Malek I, Hoskova L, Kautzner J, Landolina M, Lunati M, Gasparini M, Santini M, Giannola G, Ammirati F, Ricci R, Valsecchi S, Folino AF, Vaccari D, Zanotto G, Marras E, Bertaglia M, Chiusso F, Buja G, Veneto Region HMSG, Strunk-Mueller C, Meyer Zu Vilsendorf D, Stellbrink C, Senges J, Schwab JO, Gordon BJ, Fazal IA, Plummer CJ, Mccomb JM, Kleemann T, Strauss M, Hochadel M, Seidl K, Zahn R. Hot topics: CRT and ICD therapy. Europace 2011. [DOI: 10.1093/europace/eur219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Komajda M, Hanon O, Hochadel M, Lopez-Sendon JL, Follath F, Ponikowski P, Harjola VP, Drexler H, Dickstein K, Tavazzi L, Nieminen M. Contemporary management of octogenarians hospitalized for heart failure in Europe: Euro Heart Failure Survey II. Eur Heart J 2008; 30:478-86. [DOI: 10.1093/eurheartj/ehn539] [Citation(s) in RCA: 222] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
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Zahn R, Gottwik M, Hochadel M, Senges J, Zeymer U, Vogt A, Meinertz T, Dietz R, Hauptmann KE, Grube E, Kerber S, Sechtem U. Volume-outcome relation for contemporary percutaneous coronary interventions (PCI) in daily clinical practice: is it limited to high-risk patients? Results from the Registry of Percutaneous Coronary Interventions of the Arbeitsgemeinschaft Leitende Kardiologische Krankenhausarzte (ALKK). Heart 2007; 94:329-35. [PMID: 17664190 DOI: 10.1136/hrt.2007.118737] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE The formerly observed volume-outcome relation for percutaneous coronary interventions (PCIs) has recently been questioned. DESIGN We analysed data of the PCI registry of the Arbeitsgemeinschaft Leitende Kardiologische Krankenhausärzte. PATIENTS In 2003 a total of 27 965 patients at 67 hospitals were included. RESULTS The median PCI volume per hospital was 327. In-hospital mortality was 1.85% in hospitals belonging to the lowest PCI volume quartile and 1.21% in the highest quartile (p for trend <0.001). Two groups of patients were then compared according to their treatment at hospitals with either <325 PCIs (n = 5754) or >325 PCIs (n = 22 211) per year. Logistic regression analysis showed that a PCI performed at hospitals with a volume of >325 PCI/year was independently associated with a lower hospital mortality (OR = 0.67, 95% CI: 0.52 to 0.87; p = 0.002). If PCI was performed in patients with acute myocardial infarction there was a significant decline in mortality with increasing volume (p for trend = 0.004); however, there was no association in patients without a myocardial infarction. CONCLUSIONS This analysis of contemporary PCI in clinical practice shows a small but significant volume-outcome relation for in-hospital mortality. However, this relation was only apparent in high-risk subgroups, such as patients presenting with acute myocardial infarction.
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Affiliation(s)
- R Zahn
- Kardiologie/Angiologie/Internistische Intensivmedizin, Klinikum Nürnberg Süd, Nürnberg.
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Zahn R, Ischinger T, Hochadel M, Mark B, Zeymer U, Jung J, Schramm A, Hauptmann KE, Seggewiss H, Janicke I, Mudra H, Senges J. Glycoprotein IIb/IIIa antagonists during carotid artery stenting:. Clin Res Cardiol 2007; 96:730-7. [PMID: 17593309 DOI: 10.1007/s00392-007-0551-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [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: 12/17/2006] [Accepted: 05/07/2007] [Indexed: 11/28/2022]
Abstract
BACKGROUND Glycoprotein II b/IIIa antagonists (GPII b/IIIa-A) lower the periprocedural rate of ischemic events during high risk percutaneous coronary interventions. Their clinical impact on carotid artery stenting (CAS) remains to be determined. METHODS We analyzed data from the Carotid Artery Stent (CAS) Registry. RESULTS From 01/ 2000 to 06/2005 1322 CAS interventions were registered. In 94 (7.1%) procedures a GPII b/IIIa-A was used: abciximab in 8 cases (8.6%), tirofiban in 53 cases (57%) and eptifibatide in 32 cases (34.4%). The use of a GPII b/IIIa-A during CAS decreased significantly over time: from 17.6% in 2000 to 3% in 2005, p for trend <0.0001. The mean use of a GPII b/IIIa-A at the hospitals was 5.2%. More than 50% of the hospitals never used a GPII b/IIIa-A. There were no significant differences in baseline characteristics and concomitant diseases in CAS patients treated with GPII b/IIIa-A compared to those without GPII b/IIIa-A. A bilateral intervention was performed more often in patients treated with GPII b/IIIa-A (2.1 vs 0.2%, p = 0.04), a thrombus was more often visible (27 vs 12.4%, p <0.001) and an ulcer more frequently diagnosed (50 vs 37.5%, p = 0.03). There was no significant difference in the combined death or stroke rate between the two groups (5.3 vs 3.0%, p = 0.22, OR = 1.81, 95% CI: 0.69-4.72), which was confirmed by logistic regression analysis after adjusting for possible confounders (OR = 1.67, 95% CI: 0.62-4.46, p = 0.31). CONCLUSIONS Our data neither demonstrate a significant benefit nor a significant risk with the use of GPIIb/IIIa-A during CAS. However, only an adequately sized randomized controlled clinical trial could establish the real value of GPII b/IIIa-A during CAS. Until then, considering the potential increase in cerebral hemorrhage, we should not use GPII b/ IIIa-A routinely during CAS.
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Affiliation(s)
- R Zahn
- Kardiologie/Angiologie/Internistische Intensivmedizin, Klinikum Nürnberg, Breslauer Strasse 201, 90471 Nürnberg, Germany.
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Zahn R, Hochadel M, Zeymer U, Senges J, Mudra H. Concerns on carotid stenting in octogenarians: reply. Eur Heart J 2007. [DOI: 10.1093/eurheartj/ehm252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Hanon O, Hochadel M, Follath F, Swedberg K, Cleland J, Komajda M. Déterminants de la prescription des médicaments recommandés pour le traitement de l'insuffisance cardiaque, chez les sujets très âgés: les leçons de l'étude Euro Heart Failure Survey I. Rev Med Interne 2006. [DOI: 10.1016/j.revmed.2006.10.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Hanon O, Hochadel M, Follath F, Swedberg K, Cleland J, Komajda M. Déterminants de la mortalité chez les insuffisants cardiaques âgés de plus de 80 ans: résultats de l'étude Euro Heart Failure Survey I. Rev Med Interne 2006. [DOI: 10.1016/j.revmed.2006.10.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Friedrich J, Tebbe U, Weber M, Gottwik M, Bonzel T, Hochadel M, Zahn R, Senges J, Zeymer U. Prädiktiver Wert eines Ischämietests bei Männern und Frauen mit stabiler Angina pectoris im Klinikalltag. Dtsch Med Wochenschr 2006; 131:1078-84. [PMID: 16685628 DOI: 10.1055/s-2006-941723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND AND OBJECTIVE Symptoms of coronary artery disease (CAD) and the accuracy of non-invasive tests differ between men and women. This study sought to evaluate the difference between the predictive value of a stress test in clinical practice for the diagnosis of significant coronary heart disease (CHD: stenosis > 50%) between women and men with stable angina. PATIENTS AND METHODS 143,848 consecutive patients undergoing diagnostic coronary angiography at 99 hospitals during 2002 were included in the prospective cardiac catheter registry of the Working Party of Senior Hospital Cardiologists (Arbeitsgemeinschaft Leitende Kardiologische Krankenhausärzte [ALKK]). All patients with stress test and stable angina CCS class I-III (n=27387; 20.4%) were included, 10,911 (39.8%) of them female. 70.6% of women and 73.2% of men had a positive stress test. RESULTS In 46.1% of women and 71.5% of men with positive test and stable angina had relevant CHD (p<0,001). Diabetes increased the prevalence of CHD in patients with a positive test both in women (65.5%) and men (80.5%), with CCS class III angina to 63.3% and 85.8%, respectively. CONCLUSIONS In clinical practice a positive stress test in women with stable angina is associated significantly less often with clinically relevant CHD than in men. The low positive predictive value of 46.1% underlines the need for additional clinical features like diabetes or cardiac symptoms (CCS class) before invasive diagnosis is performed.
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Affiliation(s)
- J Friedrich
- Herzzentrum Ludwigshafen, Medizinische Klinik B
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Zahn R, Hochadel M, Grau A, Senges J. Stent-supported angioplasty versus endarterectomy for carotid artery stenosis: evidence from current randomized trials. ACTA ACUST UNITED AC 2006; 94:836-43. [PMID: 16382386 DOI: 10.1007/s00392-005-0311-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2005] [Accepted: 08/17/2005] [Indexed: 11/25/2022]
Abstract
BACKGROUND Carotid artery stenting (CAS) for carotid artery stenoses is evolving as an alternative to carotid endarterectomy (CEA). However, the value of CAS is still a matter of debate. Therefore, we performed a metaanalysis of the randomized controlled clinical trials (RCT) on this issue. METHODS RCTs were identified through searching MEDLINE, textbooks and by personal communication. RESULTS Six finished RCTs on this issue could be identified, including 1263 patients, 628 randomized to CAS and 635 to CEA. The 30-day death or stroke rate was 8.0% (50/628) in patients treated with CAS compared to 6.1% (39/635) in CEA patients (OR=1.36, 95% CI: 0.88-2.11; p=0.17; p for heterogeneity=0.009). The rate of cranial nerve palsy was 7.1% in the CEA compared to 0% in the CAS group (p<0.0001). The rate of myocardial infarctions was reduced from 3.1 to 1% (OR=0.32, 95% CI: 0.12- 0.81; p=0.02; p for heterogeneity=0.49). The death or stroke rate during follow-up was 12.1% in patients treated with CAS compared to 12.2% in CEA patients (OR=0.99, 95% CI: 0.70-1.42; p=0.98; p for heterogeneity=0.02). CONCLUSION The available RCT data on CAS vs. CEA suggest that both methods seem to be equally effective concerning short- and medium-term results, while CAS is associated with lower minor complications than CEA. However, because of the significant heterogeneity between the study outcomes, the results of the large RCTs underway should be awaited before it can be advised to use CAS in a broader perspective.
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Affiliation(s)
- R Zahn
- Herzzentrum Ludwigshafen, Kardiologie, Bremserstr. 79, 67063, Ludwigshafen, Germany.
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Zeymer U, Zahn R, Hochadel M, Bonzel T, Weber M, Gottwik M, Tebbe U, Senges J. Incications and complications of invasive diagnostic procedures and percutaneous coronary interventions in the year 2003. Results of the quality control registry of the Arbeitsgemeinschaft Leitende Kardiologische Krankenhausarzte (ALKK). ACTA ACUST UNITED AC 2005; 94:392-8. [PMID: 15940439 DOI: 10.1007/s00392-005-0233-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2004] [Accepted: 01/14/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND The ALKK registry contains about 20% of the invasive and interventional cardiological procedures performed in Germany. METHODS In 2003 a total of 82,282 consecutive diagnostic invasive and 30,689 interventional procedures from 75 hospitals were centrally collected and analyzed. RESULTS The main indication for an invasive diagnostic procedure was coronary artery disease in 92.5% of cases, myocardial disease in 1.6%, impaired left ventricular function in 4.0%, valve disease in 4% and other indications in 1.9%. An acute coronary syndrome was present in 25% of the patients. The rate of severe complications in patients with a lone diagnostic invasive procedure was low (<0.5%). The indication for percutaneous coronary intervention (n=30,689) was stable angina in 44.1%, ST elevation myocardial infarction in 22.3%, non ST elevation myocardial infarction in 14.8%, unstable angina in 10.0%, silent ischemia in 2.2%, prognostic in 5.2% of patients. The majority of interventions were performed directly after the diagnostic procedure (n=23,887=78.6%). The intervention was successful in 94.6% of cases. Stent implantation was performed in 77.2%, with 1 stent in 88.4%, two stents in 7.6% and 3 or more stents in 3.3%. A drug-eluting stent was implanted in 3.6% of the cases. The complication rate after PCI was influenced by the indication for the intervention. The in-hospital mortality in patients with cardiogenic shock was 33%, while in patients with stable angina, silent ischemia and prognostic indication only 0.2% died. CONCLUSION There is an increase of invasive diagnostic and interventional procedures in patients with acute coronary syndromes, with 47% of PCIs performed in these patient. PCIs were performed in 75% of the cases directly after the diagnostic procedure. The rate of stent implantation seems to have reached a plateau at around 80%, while drug-eluting stents were implanted only in a minority of cases. The complication rate is mainly dependent on the clinical presentation of the patients and the indication for PCI.
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Affiliation(s)
- U Zeymer
- Herzzentrum Ludwigshafen, Bremserstrasse 79, 67063 Ludwigshafen, Germany.
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