1
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Jacobsen MR, Jabbari R, Engstroem T, Grove EL, Glinge C, Pedersen F, Holmvang L, Koeber L, Torp-Pedersen C, Maeng M, Veien K, Freeman P, Charlot MG, Kelbaek H, Soerensen R. High bleeding risk in all-comers with ST-segment elevation myocardial infarction and use of P2Y12-inhibitiors. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1270] [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
Bleeding has an important prognostic impact in patients with ST-segment elevation myocardial infarction (STEMI), yet stratification of bleeding risk to guide dual antiplatelet therapy (DAPT) is not routinely performed in clinical practice.
Purpose
To describe high bleeding risk (HBR) patients according to the PRECISE-DAPT (predicting bleeding complications in patients undergoing stent implantation and subsequent DAPT) score and use of P2Y12-inhibitors.
Methods
This single-centre observational study included consecutive patients with STEMI who were treated with percutaneous coronary intervention (PCI) from 2009–2016. Individual linkage to Danish nationwide registries was conducted to obtain information on diagnoses, claimed drugs, and vital status. Age, prior bleeding diagnosis, and blood samples before PCI (maximum 30 days before hospitalisation) were used to calculate the PRECISE-DAPT score. A score ≥25 was considered as HBR. Due to 26.7% missing on blood parameters (mainly leucocytes), the maximum and minimum values of the missing parameters and respective imputed PRECISE-DAPT scores were calculated. If both the maximum and minimum score were ≥25 or <25, patients were categorised accordingly, and a maximum score of ≥25 and minimum score of <25 as missing. Differences between continuous (median [interquartile range, IQR]) and categorical variables (frequency [percentage]) were assessed using Wilcoxon rank-sum and χ2-test for patients with vs. without HBR. Cumulative incidence of major bleeding (composite of bleedings leading to hospitalisation) and major adverse cardiovascular events (MACE) (composite of all-cause mortality, recurrent MI, and ischemic stroke) 1 year after PCI were plotted for patients with and without HBR. Number of HBR patients alive and collecting a P2Y12-inhibitor prescription within 30 days from discharge was reported.
Results
We identified 6179 PCI-treated patients with STEMI, of whom 5530 (89.5%) had imputed PRECISE-DAPT scores (Figure 1). A total of 1821 (32.9%) were at HBR, and these were more often female (38.3 vs. 18.2%, p-value<0.001), elderly (median age 75 [IQR 67, 81] vs. 57 years [IQR 51, 64], p-value<0.001), and had more comorbidities (diabetes [16.7 vs. 12.1%], heart failure [16.2 vs. 7.6%], cardiac arrhythmia [24.9 vs. 12.3%], cancer [17.5 vs. 5.7%], and ischemic stroke [8.1 vs. 2.6%], all p-values<0.001) compared with patients not at HBR. One-year cumulative incidence of major bleeding and MACE for patients with and without HBR were plotted (Figure 2). Of the 1431 (78.6%) HBR patients who were alive and claimed a P2Y12-inhibitior prescription 30 days from discharge, 459 (32.1%) were treated with clopidogrel, 672 (46.9%) with ticagrelor, and 300 (21.0%) with prasugrel (Figure 1).
Conclusion
Every third PCI-treated all-comer with STEMI was at HBR according to the PRECISE-DAPT score. HBR patients were more often treated with potent P2Y12-inhibitors (prasugrel or ticagrelor) instead of clopidogrel.
Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship.
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Affiliation(s)
- M R Jacobsen
- Rigshospitalet - Copenhagen University Hospital , Copenhagen , Denmark
| | - R Jabbari
- Rigshospitalet - Copenhagen University Hospital , Copenhagen , Denmark
| | - T Engstroem
- Rigshospitalet - Copenhagen University Hospital , Copenhagen , Denmark
| | - E L Grove
- Aarhus University Hospital , Aarhus , Denmark
| | - C Glinge
- Bispebjerg University Hospital , Copenhagen , Denmark
| | - F Pedersen
- Rigshospitalet - Copenhagen University Hospital , Copenhagen , Denmark
| | - L Holmvang
- Rigshospitalet - Copenhagen University Hospital , Copenhagen , Denmark
| | - L Koeber
- Rigshospitalet - Copenhagen University Hospital , Copenhagen , Denmark
| | | | - M Maeng
- Aarhus University Hospital , Aarhus , Denmark
| | - K Veien
- Odense University Hospital , Odense , Denmark
| | - P Freeman
- Aalborg University Hospital , Aalborg , Denmark
| | - M G Charlot
- Gentofte University Hospital , Gentofte , Denmark
| | - H Kelbaek
- Zealand University Hospital , Roskilde , Denmark
| | - R Soerensen
- Rigshospitalet - Copenhagen University Hospital , Copenhagen , Denmark
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2
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Warming PE, Aagesen FN, Lynge TH, Prescott E, Banner J, Jabbari R, Tfelt-Hansen J. Income and education are associated with incidence of sudden cardiac death in a general population cohort. Europace 2022. [DOI: 10.1093/europace/euac053.339] [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: Public grant(s) – EU funding. Main funding source(s): European Union’s Horizon 2020 research and innovation programme under acronym ESCAPE-NET, registered under grant agreement No 733381
Introduction
Socioeconomic status is associated to all-cause mortality and common cardiac risk factors. The association between socioeconomic status and sudden cardiac death (SCD) taking prevalence of other risk factors into account has not been fully established.
Objective
The aim of this study was to investigate the association between income and education level and incidence of SCD.
Methods
All participants in the third wave of the Copenhagen City Heart Study were followed from 1993 to 2016 and all deaths were adjudicated using high quality death certificates, autopsy reports, and national registry data. Medical history and social demographics were self-reported. Hazard ratios (HR) were calculated using Cox proportional hazards regression and adjusted cumulative incidences were predicted using cause specific cox models.
Results
The study enrolled 10099 participants who were alive at start of follow up (median age at entry (IQR): 61 (48-72) years, 56% female). During 24 years of follow up, there were 5575 deaths of which 834 were classified as SCD. Compared with lowest income group and adjusted for age, sex, job, and education, higher income was associated with lower HR of SCD: middle income HR 0.82 (95% CI: 0.69-0.98) and high income HR 0.62 (0.47-0.81). This effect was attenuated, but still present, when adjusting for common cardiac risk factors (smoking, alcohol, BMI, physical activity, AMI, diabetes, hypertension, hypercholesterolemia). Compared with no education, increasing length of education was associated with lower HR of SCD: apprenticeship HR 0.82 (0.68-0.98), short education HR 0.80 (0.67-0.96), bachelor’s degree HR 0.56 (0.41-0.76), master’s degree HR 0.41 (0.28-0.59). This effect was also attenuated when adjusting for risk factors, job, and income. Adjusted cumulative incidences of SCD during the first 10 years of follow up according to income and education are shown in the figures.
Conclusions
In this study we found an association between lower income and shorter education and increased risk of SCD, an association not fully explained by prevalence of common cardiac risk factors, calling for further research into competing causes of SCD.
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Affiliation(s)
- PE Warming
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - FN Aagesen
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - TH Lynge
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - E Prescott
- Bispebjerg University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - J Banner
- University of Copenhagen, Department of Forensic Medicine, Copenhagen, Denmark
| | - R Jabbari
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - J Tfelt-Hansen
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
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3
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Warming PE, Glinge C, Jabbari R, Stampe NK, Dusi V, Tan HL, Bezzina CR, Crotti L, De Ferrari GM, Engstrom T, Schwartz PJ, Wilde AAM, Tfelt-Hansen J. Clinical risk factors associated with ventricular fibrillation during first ST-elevation myocardial infarction. Europace 2022. [DOI: 10.1093/europace/euac053.336] [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: Public grant(s) – EU funding. Main funding source(s): European Union’s Horizon 2020 research and innovation programme under acronym ESCAPE-NET, registered under grant agreement No 733381
Introduction
Sudden cardiac death (SCD) remains a major public health issue. Most cases in the general population are caused by ischemic heart disease, and often occur in patients without known ischemic heart disease. The assessment of risk factors may point to novel causal pathways or new targets for intervention and risk prediction of SCD.
Objective
The aim of this study was to evaluate the effect of family history of sudden death, prior history of atrial fibrillation (AF), and anterior infarct location on ECG on the development of ventricular fibrillation (VF) during first ST-elevation myocardial infarction (STEMI).
Methods
We performed individual participant data meta-analyses of three European case-control studies including first STEMI patients (aged 18-80 years) with VF (cases) and without VF (controls) before revascularization (GEVAMI, AGNES, and PREDESTINATION). Analyses were done using fixed-effect, inverse variance weighted meta-analysis and multivariable logistic regression. Potential confounding variables were identified using causal diagrams and missing data were handled with multiple imputation for each cohort separately.
Results
We included 1664 cases and 2497 controls (median age (IQR) = 59 (51-67) years, 20% females) in the analyses. After adjusting for potential confounding, we found an independent and additive association between the three exposures and VF (see picture): for family history of sudden death odds ratio (OR) 1.59 (95% confidence interval: 1.37-1.85), for AF OR 2.41 (1.49-3.89), and for anterior myocardial infarction OR 1.50 (1.32-1.71). Further investigation indicated increased effect of family history with multiple sudden deaths in the family, a stronger effect of AF on VF developing within the first minutes of symptoms, and the effect of anterior infarctions being modified by enzymatically determined infarct size. The three risk factors showed an additive effect: with one factor present OR 1.59 (1.38-1.84), two factors OR 2.41 (1.95-2.99), and all three factors OR 5.49 (1.43-21.1). Complete case analysis gave similar results for all analyses.
Conclusions
Family history of sudden death, history of AF, and anterior infarct location with significant interaction with enzymatic infarct size were all independently and additively associated with an increased risk of VF in patients with a first STEMI.
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Affiliation(s)
- PE Warming
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - C Glinge
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - R Jabbari
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - NK Stampe
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - V Dusi
- I.R.C.C.S. San Matteo Polyclinic, Pavia, Italy
| | - HL Tan
- Amsterdam UMC, University of Amsterdam, Department of Clinical and Experimental Cardiology, Amsterdam, Netherlands (The)
| | - CR Bezzina
- Amsterdam UMC, University of Amsterdam, Department of Clinical and Experimental Cardiology, Amsterdam, Netherlands (The)
| | - L Crotti
- Italian Auxological Institute San Luca Hospital, Center for Cardiac Arrhythmias of Genetic Origin, Milan, Italy
| | - GM De Ferrari
- Hospital Citta Della Salute e della Scienza di Torino, Division of Cardiology, Turin, Italy
| | - T Engstrom
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - PJ Schwartz
- Italian Auxological Institute San Luca Hospital, Center for Cardiac Arrhythmias of Genetic Origin, Milan, Italy
| | - AAM Wilde
- Amsterdam UMC, University of Amsterdam, Department of Clinical and Experimental Cardiology, Amsterdam, Netherlands (The)
| | - J Tfelt-Hansen
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
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4
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Stampe NK, Glinge C, Rasmussen BS, Bhardwaj P, Linnet K, Jabbari R, Hassager C, Kjaergaard J, Tfelt-Hansen J, Winkel BG. Untargeted toxicology in sudden cardiac arrest victims. Europace 2022. [DOI: 10.1093/europace/euac053.126] [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: Public grant(s) – EU funding. Main funding source(s): European Union’s Horizon 2020 research and innovation programme to J.T.-H under acronym ESCAPE-NET
Background
Sudden cardiac arrest (SCA) is a major public health challenge and is associated with poor outcomes. Many drugs are known to increase risk of arrythmias and ultimately sudden cardiac death. To our knowledge an untargeted toxicological analysis has not previously been performed in an initially resuscitated SCA cohort.
Purpose
We aimed to determine the qualitative and quantitative drug composition present in SCA patients by using forensic toxicological analytical chemistry of all illicit, non-prescription and prescribed drugs, and further investigate whether these drugs are in therapeutic levels or overdosed and to correlate the clinical findings with the toxicology results.
Methods
We performed a prospective single-tertiary-center study and included all SCA victims (aged 18-90 years) admitted to our cardiac intensive care unit, between February 2019 to November 2019 (Figure 1). Traumatic and overt overdose related SCA were not included in the study. Drugs used during resuscitation and administered prior to sample collection were identified in each patient and excluded.
Results
We prospectively identified 85 all-cause SCA patients with a median age of 60 years (IQR: 53-71) and male predominance (80%). The majority had a shockable rhythm as first rhythm (95%). The major cause of cardiac arrest was acute and chronic ischemia (56/77, 66%), followed by cardiomyopathy (9/77, 12%), idiopathic ventricular fibrillation (8/77, 10%), bradycardia (2/77, 2.6%), primary arrhythmia (1/77, 1.3%), other (1/77, 1.3%). The remaining 8 patients (9.4%) died prior to diagnosis.
A positive toxicology was identified in 67 patients (79%) with a total of 218 detected drugs. The most frequent drugs were mild analgesics (32/85, 38%), beta-blockers (21/85, 25%) and ACE-inhibitors/ARB (20/85, 24%). A total of 9 (11%) patients had one or more potentially abusable drugs detected, with the most common being opioid agonists in 5 patients (Figure 2). Importantly, all drugs were found at sub-therapeutic or therapeutic concentrations. None had overdose concentrations. Moreover, polypharmacy was common and a median of 2 drugs (IQR: 1-4) were detected (excluding caffeine that was detected in 83 patients).
Conclusion
We found that the majority had drugs detected, and polypharmacy is displayed in a considerable proportion. Potentially abusive drugs were encountered in 11%. However, we did not identify any occult overdose related cardiac arrests among all resuscitated SCA patients. In our setting, toxicological screening in cardiac arrest patients who is not obviously overdosed is excessive.
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Affiliation(s)
- NK Stampe
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, The Heart Centre, Copenhagen, Denmark
| | - C Glinge
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, The Heart Centre, Copenhagen, Denmark
| | - BS Rasmussen
- University of Copenhagen, Department of Forensic Medicine, Faculty of Medical Sciences, Copenhagen, Denmark
| | - P Bhardwaj
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, The Heart Centre, Copenhagen, Denmark
| | - K Linnet
- University of Copenhagen, Department of Forensic Medicine, Faculty of Medical Sciences, Copenhagen, Denmark
| | - R Jabbari
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, The Heart Centre, Copenhagen, Denmark
| | - C Hassager
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, The Heart Centre, Copenhagen, Denmark
| | - J Kjaergaard
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, The Heart Centre, Copenhagen, Denmark
| | - J Tfelt-Hansen
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, The Heart Centre, Copenhagen, Denmark
| | - BG Winkel
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, The Heart Centre, Copenhagen, Denmark
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5
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Glinge C, Rossetti S, Bruun Oestergaard L, Stampe NK, Ravn Jacobsen M, Koeber L, Engstroem T, Torp-Pedersen C, Gislason G, Jabbari R, Tfelt-Hansen J. Familial clustering of unexplained heart failure - A Danish nationwide cohort study. Europace 2022. [DOI: 10.1093/europace/euac053.008] [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: Public grant(s) – EU funding. Main funding source(s): This project has received funding from the European Union’s Horizon 2020 research and innovation programme under acronym ESCAPE-NET, registered under grant agreement No 733381, and the European Union’s COST programme under acronym PARQ, registered under grant agreement No CA19137.
Background
Although family history of heart failure (HF) is associated with increased risk of HF, the extent to which a family history contributes to the risk of HF needs further investigation.
Purpose
To determine whether a family history of unexplained HF in first-degree relatives (children or sibling) increases the rate of unexplained HF.
Methods
Using Danish nationwide registry data (1978-2017), we identified patients (probands) diagnosed with first unexplained HF (HF without any known comorbidities) in Denmark, and their first-degree relatives. All first-degree relatives were followed from the HF date of the proband and until an event of unexplained HF, exclusion diagnosis, death, emigration, or study end, whichever occurred first. Using the general population as a reference, we calculated adjusted standardized incidence ratios (SIR) of unexplained HF in the three groups of relatives using Poisson regression models.
Results
We identified 57,845 first-degree relatives to individuals previously diagnosed with unexplained HF. Having a family history was associated with a significantly increased unexplained HF rate of 2.08 (95% CI 1.82-2.38) (Figure 1). The estimate was higher among siblings (SIR 4.82 [95% CI 3.17-7.32]). Noteworthy, the rate of HF increased for all first-degree relatives when the proband was diagnosed with HF in a young age (≤50 years, SIR of 3.60 [95% CI 2.37-5.47]) and having >1 proband (SIR of 2.73 [95% CI 1.14-6.56]). The highest estimate of HF was observed if the proband was ≤40 years at diagnosis (6.12 [95% CI 3.39-11.05]) (Figure 2).
Conclusion
A family history of unexplained HF was associated with a two-fold increased rate of unexplained HF among first-degree relatives. If the proband age was ≤40 years, the risk was six-folded. These findings suggest that screening families of unexplained HF with onset below 50 years is indicated.
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Affiliation(s)
- C Glinge
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, The Heart Centre, Copenhagen, Denmark
| | - S Rossetti
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, The Heart Centre, Copenhagen, Denmark
| | - L Bruun Oestergaard
- Aalborg University, Department of Health, Science and Technology, Aalborg, Denmark
| | - NK Stampe
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, The Heart Centre, Copenhagen, Denmark
| | - M Ravn Jacobsen
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, The Heart Centre, Copenhagen, Denmark
| | - L Koeber
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, The Heart Centre, Copenhagen, Denmark
| | - T Engstroem
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, The Heart Centre, Copenhagen, Denmark
| | - C Torp-Pedersen
- Aalborg University, Department of Health, Science and Technology, Aalborg, Denmark
| | - G Gislason
- Gentofte University Hospital, Cardiology, Gentofte, Denmark
| | - R Jabbari
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, The Heart Centre, Copenhagen, Denmark
| | - J Tfelt-Hansen
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, The Heart Centre, Copenhagen, Denmark
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Thomsen AF, Bertelsen L, Jons C, Jabbari R, Lonborg JT, Ekstrom K, Tilsted HH, Pedersen F, Kober L, Engstrom T, Vejlstrup N, Jacobsen PK. Scar related border zone channels assessed with cardiac MRI are associated with ventricular arrhythmia in patients with ST-segment elevation myocardial infarction. Europace 2022. [DOI: 10.1093/europace/euac053.343] [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: 11/15/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
Prediction of scar-related ventricular arrhythmia in ST-Segment Elevation Myocardial Infarction (STEMI) is important, but currently difficult. Late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) permits characterization of left ventricular (LV) ischemic scars, including differentiation between core, border zone (BZ) and BZ channels. The latter represents potential electrical circuits of slow conductivity responsible for ventricular arrhythmic events. We hypothesized that detailed BZ channel characterization potentially serves as a risk marker for ventricular arrhythmia, therefore contributing to risk stratification following STEMI.
Purpose
The aim of this study was to assess scar-related arrhythmic BZ channels with advanced CMR in STEMI patients developing subsequent ventricular arrhythmia compared with controls.
Methods
This is a CMR sub-study of the DANAMI-3 STEMI multicenter trial (year 2011, n=1234) and Danegaptide phase II proof-of-concept clinical trial (year 2013, n=591). All patients were admitted for primary PCI in all primary PCI centers in Denmark. A total of 779 patients had a 3-month follow-up CMR. Of these, 21 patients subsequently experienced ventricular arrhythmia during 68 months of follow-up and were randomly matched 1:2 with 42 controls, who constituted the study population. Matching were based on left ventricular ejection fraction (LVEF), infarct location, culprit vessel, and revascularization status in patients with multivessel disease. Ischemic scar tissue including core, BZ and BZ channels were automatically detected by a specialized investigational software (1). To differentiate BZ from healthy tissue and BZ from core, thresholds of 40% ± 5% and 60% ± 5% of the maximum signal intensity were applied. A BZ channel in the LGE-CMR reconstruction was defined as a continuous corridor of BZ between 2 core areas or between a core area and a valve annulus (Figure 1).
Results
We included 63 patients (median age: 58.0 years; 84% men; median LVEF: 45 ± 10%), of whom 30 (48%) patients had an anterior located infarction, and 45 (71%) patients were completely revascularized. The median time from STEMI to a ventricular arrhythmic event was 3 ± 2 years. A significantly higher number of patients with ventricular arrhythmia had BZ channels (n=16 (76%) vs. n=18 (43%), P=0.02) including an increased number of BZ channels (2 ± 2 vs. 1 ± 1, P=0.02) compared with controls. Patients with subsequent ventricular arrhythmia had a larger scar mass (core mass + BZ mass) (27 ± 17g vs. 19 ± 11g; P=0.03), core mass (9 ± 8g vs. 6 ± 5g; P=0.06) and BZ mass (18 ± 10g vs. 13 ± 7g; P=0.01).
Conclusion(s)
Border zone channels visualized by LGE-CMR were associated with subsequent development of ventricular arrhythmia in patients with STEMI and may serve as risk stratification following STEMI.
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Affiliation(s)
- AF Thomsen
- Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
| | - L Bertelsen
- Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
| | - C Jons
- Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
| | - R Jabbari
- Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
| | - JT Lonborg
- Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
| | - K Ekstrom
- Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
| | - HH Tilsted
- Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
| | - F Pedersen
- Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
| | - L Kober
- Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
| | - T Engstrom
- Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
| | - N Vejlstrup
- Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
| | - PK Jacobsen
- Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
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Garcia R, Rajan D, Barcella C, Svane J, Warming P, Jabbari R, Gislason G, Torp-Petersen C, Folke F, Tfelt-Hansen J. Racial disparities in out-of-hospital cardiac arrest in Denmark. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0647] [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
Introduction
American studies have pointed out racial disparities regarding sudden cardiac death occurrence and outcomes. Black individuals have higher sudden cardiac death rates and lower survival compared with white subjects (1). Although income and social status partly explain differences in outcomes (2), sudden cardiac death is 2-fold higher in black individuals after adjustment on these characteristics (3,4).
In Denmark, immigrants account for 9.1% of the population (5) but to date, no data exists regarding Out-of-Hospital Cardiac Arrest (OHCA) incidence.
Purpose
The main objective of this study was to compare the incidence of OHCA among native and immigrant individuals between 2001 and 2014 in Denmark.
Methods
This nationwide study included all patients identified from the Danish Cardiac Arrest Registry with OHCA of presumed cardiac cause between 18 and 80 years from 2001 to 2014 (6).
The primary outcome was OHCA occurrence defined as a clinical condition of cardiac arrest resulting in resuscitation efforts either by bystanders or by EMS personnel. The immigrant status was defined as native or immigrant according to the national database from Statistics Denmark. An immigrant was defined as a person born abroad whose both parents were either foreign citizens or born abroad.
The odds ratio of OHCA between immigrants and native Danes were adjusted according to age, sex, income, and education level.
Results
A total of 33,730 OHCA were recorded between 2001 and 2014. Among them, 1,684 occurred in immigrants and 32,046 in natives. Compared to natives, immigrant victims of OHCA were younger (62.0 [51.0, 71.0] vs. 66.0 [56.0, 74.0], p<0.001), and more often had a history of diabetes (20.5% vs. 14.0; p<0.001), myocardial infarction (11.9% vs. 8.7%; p<0.001) and chronic heart failure (17.0% vs. 14.7%; p<0.01). Female proportion was not statistically different between the two groups (30.2% vs. 31.3% of immigrants and natives respectively; p=0.32).
The incidence of OHCA was 61.0/100,000 person-years in natives and 35.0/100,000 person-years in immigrants (OR=0.57; 95% CI 0.54–0.60; p<0.001). Between 2001 and 2014, the OHCA incidence decreased from 71.4 [67.9–75.0] to 70.9 [68.2–73.6]/100 000 person-years in natives (p=0.99) and from 40.2 [30.8–51.5] to 36.5 [31.1–42.6] /100,000 person-years in immigrants (p=0.91) (Figure).
After logistic regression, compared to natives, the immigrant status was associated with 0.61-fold odds of OHCA when adjusting on age and sex (OR=0.61; 95% CI 0.59–0.65; p<0.001), and 0.65-fold odds of OHCA when adjusting on age, sex, income, and education level (OR=0.66; 95% CI 0.63–0.70; p<0.001).
Conclusion
This is the first study assessing the incidence of OHCA in immigrants versus natives in a European country. Despite higher cardiovascular burden, the incidence of OHCA was lower in immigrants even when adjusted on sex, age, income, and education reflecting a selection of individuals migrating to Denmark.
Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): Fédération Française de Cardiologie
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Affiliation(s)
- R Garcia
- Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
| | - D Rajan
- Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
| | - C.A Barcella
- Gentofte University Hospital, Copenhagen, Denmark
| | - J Svane
- Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
| | - P.E Warming
- Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
| | - R Jabbari
- Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
| | - G.H Gislason
- Gentofte University Hospital, Copenhagen, Denmark
| | | | - F Folke
- Gentofte University Hospital, Copenhagen, Denmark
| | - J Tfelt-Hansen
- Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
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Ravn Jacobsen M, Engstroem T, Torp-Pedersen C, Gislason G, Glinge C, Holmvang L, Pedersen F, Koeber L, Jabbari R, Soerensen R. Efficacy and safety of clopidogrel, ticagrelor, and prasugrel in an all-comers population of patients with ST-segment elevation myocardial infarction. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1768] [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
Until 2009, aspirin and clopidogrel were recommended for most patients with acute coronary syndrome (ACS). After 2009, this recommendation was changed to aspirin combined with prasugrel or ticagrelor since randomised trials had demonstrated reduced cardiovascular mortality and ischemic events, however with a slight increase in bleeding risk. Randomised clinical trials often include selected patients and the results may not be generalisable to an all-comers population of high-risk ACS patients.
Purpose
To compare efficacy and safety of clopidogrel, ticagrelor, and prasugrel in all-comers patients with ST-segment elevation myocardial infarction (STEMI).
Methods
The Eastern Danish Heart Registry was utilised to identify all consecutive STEMI patients admitted to the capital region from 2009–2016. By individual linkage to Danish nationwide registries, claimed drug prescriptions and end points were obtained. Patients alive a week after discharge were included and stratified according to clopidogrel, ticagrelor, or prasugrel treatment, and followed for 18 months. The risk of the primary efficacy end point (a composite of all-cause mortality, recurrent myocardial infarction, and ischemic stroke) and the safety end point (bleeding events leading to hospital admission) were assessed by multivariate Cox proportional-hazard models.
Results
In total, 4841 STEMI patients were included (clopidogrel [n=1222], ticagrelor [n=1820], prasugrel [n=1799]). The median age was 66 (IQR 57–76) for clopidogrel, 64 (IQR 54–73) for ticagrelor, and 59 (IQR 51–67) for prasugrel, and only 19% were women of the prasugrel treated patients (29% for clopidogrel, 25% for ticagrelor). Treatment with anticoagulant therapy was 21% for clopidogrel treated patients (4% for ticagrelor, 5% for prasugrel). Number of events and incidence rates/100 years (IR) for the primary efficacy end point were 165 (IR 9.7) for clopidogrel, 134 (IR 5.1) for ticagrelor, and 107 (IR 4.1) for prasugrel, and for bleeding events 57 (IR 3.3) for clopidogrel, 60 (IR 2.3) for ticagrelor, and 55 (IR 2.1) for prasugrel treatment. Compared with clopidogrel, a reduction in the primary efficacy end point was found in patients treated with both ticagrelor (HR 0.47, 95% CI 0.36–0.63, p<0.001) and prasugrel (HR 0.49, 95% CI 0.36–0.67, p<0.001) with no difference in bleeding events (HR 0.71, 95% CI 0.45–1.13, p=0.15 and HR 0.72, 95% CI 0.44–1.17, p=0.18, respectively). No differences were found between prasugrel and ticagrelor treated patients for the primary efficacy end point (HR 0.83, 95% CI 0.60–1.16, p=0.28) or safety end point (HR 0.97, 95% CI 0.61–1.54, p=0.90).
Conclusion
Ticagrelor and prasugrel treatment in all-comers STEMI patients were associated with reduced rates of all-cause mortality and ischemic events without an increase in bleeding events when compared with clopidogrel treatment. No differences in efficacy or safety were found between prasugrel and ticagrelor treated patients.
Efficacy+safety end points at 18 months
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- M Ravn Jacobsen
- Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
| | - T Engstroem
- Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
| | - C Torp-Pedersen
- Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
| | - G Gislason
- Gentofte University Hospital, Gentofte, Denmark
| | - C Glinge
- Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
| | - L Holmvang
- Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
| | - F Pedersen
- Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
| | - L Koeber
- Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
| | - R Jabbari
- Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
| | - R Soerensen
- Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
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Glinge C, Jabbari R, Hadberg Lynge T, Skals R, Winkel BG, Bezzina C, Banner J, Torp-Pedersen C, Behr E, Gislason G, Tfelt-Hansen J. 518Risk of sudden infant death syndrome (SIDS) among siblings of SIDS victims: a Danish nationwide cohort study. Europace 2018. [DOI: 10.1093/europace/euy015.285] [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 Glinge
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, The Heart Centre, Copenhagen, Denmark
| | - R Jabbari
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, The Heart Centre, Copenhagen, Denmark
| | - T Hadberg Lynge
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, The Heart Centre, Copenhagen, Denmark
| | - R Skals
- Aalborg University, Department of Health, Science and Technology, Aalborg, Denmark
| | - B G Winkel
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, The Heart Centre, Copenhagen, Denmark
| | - C Bezzina
- Academic Medical Center of Amsterdam, Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam, Netherlands
| | - J Banner
- Rigshospitalet - Copenhagen University Hospital, Department of Forensic Medicine, Copenhagen, Denmark
| | - C Torp-Pedersen
- Aalborg University, Department of Health, Science and Technology, Aalborg, Denmark
| | - E Behr
- St George's University of London, Cardiology Clinical Academic Group, London, United Kingdom
| | - G Gislason
- Gentofte Hospital - Copenhagen University Hospital, Department of Cardiology, Hellerup, Denmark
| | - J Tfelt-Hansen
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, The Heart Centre, Copenhagen, Denmark
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Sattler SM, Lubberding AL, Skibsbye L, Flethoj M, Jabbari R, Jespersen T, Tfelt-Hansen J. P509Amiodarone in the prevention of ventricular fibrillation during first acute myocardial infarction - results from a porcine model. Europace 2017. [DOI: 10.1093/ehjci/eux140.005] [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: 11/14/2022] Open
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Risgaard B, Winkel BG, Jabbari R, Ingemann-Hansen O, Thomsen JL, Ottesen GL, Bundgaard H, Hausoe S, Holst AG, Tfelt-Hansen J. Nationwide study on sudden cardiac death in Danes aged 1-49 years. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht308.1741] [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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Jabbari R, Risgaard B, Holst AG, Nielsen JB, Engstrom T, Bundgaard H, Svendsen JH, Haunso S, Winkel BG, Tfelt-Hansen J. Cardiac symptoms before sudden cardiac death caused by coronary artery disease: a nationwide study among young Danes. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht308.p1359] [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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Jabbari J, Jabbari R, Nielsen MW, Holst AG, Nielsen JB, Haunso S, Tfelt-Hansen J, Svendsen JH, Olesen MS. New exome data question the pathogenicity of genetic variants previously associated with catecholaminergic polymorphic ventricular tachycardia. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht308.p2292] [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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Golnaz G, Jabbari R, Risgaard B, Olesen MS, Haunsoe S, Tfelt-Hansen J, Winkel BG. First nationwide study of sudden cardiac death due to arrhythmogenic right ventricular cardiomyopathy in the young; fifty percent have symptoms prior to death. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.3771] [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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Risgaard B, Jabbari R, Refsgaard L, Holst AG, Haunsø S, Sadjadieh A, Winkel BG, Olesen MS, Tfelt-Hansen J. High prevalence of genetic variants previously associated with Brugada syndrome in new exome data. Clin Genet 2013; 84:489-95. [PMID: 23414114 DOI: 10.1111/cge.12126] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Revised: 02/13/2013] [Indexed: 01/08/2023]
Abstract
More than 300 variants in 12 genes have been associated with Brugada syndrome (BrS) which has a prevalence ranging between 1:2000 and 1:100,000. Until recently, there has been little knowledge regarding the distribution of genetic variations in the general population. This problem was partly solved, when exome data from the NHLI GO Exome Sequencing Project (ESP) was published. In this study, we aimed to report the prevalence of previously BrS-associated variants in the ESP population. We performed a search in ESP for variants previously associated with BrS. In addition, four variants in ESP were genotyped in a second Danish control population (n = 536) with available electrocardiograms. In ESP, we identified 38 of 355 (10%) variants, distributed on 272 heterozygote carriers and two homozygote carriers. The genes investigated were on average screened in 6258 individuals. This corresponds to a surprisingly high genotype prevalence of 1:23 (274:6258). Genotyping the four common ESP-derived variants CACNA2D1 S709N, SCN5A F2004L, CACNB2 S143F, and CACNB2 T450I in the Danish controls, we found a genotype prevalence comparable with that found in ESP. We suggest that exome data are used in research, as an additive tool to predict the pathogenicity of variants in patients suspected for BrS.
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Affiliation(s)
- B Risgaard
- Danish National Research Foundation Centre for Cardiac Arrhythmia (DARC), University of Copenhagen, Copenhagen, Denmark; Laboratory of Molecular Cardiology, Department of Cardiology, The Heart Centre; Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
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Barzegar-Jalali M, Maleki N, Garjani A, Khandar AA, Haji-Hosseinloo M, Jabbari R, Dastmalchi S. Enhancement of dissolution rate and anti-inflammatory effects of piroxicam using solvent deposition technique. Drug Dev Ind Pharm 2002; 28:681-6. [PMID: 12149960 DOI: 10.1081/ddc-120003859] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Piroxicam solid depositions were prepared by means of the solvent deposition technique using different concentrations of microcrystalline cellulose as carrier material. The solvent deposition system (SDS) with drug to carrier ratio of 1:9 had a rapid dissolution rate in vitro. When this SDS was administered perorally to rats with a previous experimentally induced inflammation in their paws, it exhibited a pronounced anti-inflammatory action. X-ray diffraction and infrared (IR) spectroscopy showed no differences in the crystal state of piroxicam in SDS formulation and physical mixture of piroxicam and carrier. The increase in the dissolution rate and consequent enhancement of anti-inflammatory effect of piroxicam in SDS were attributed to the reduced particle size of drug deposited on the carrier and enhanced wettability of the particles brought about by the carrier.
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Affiliation(s)
- M Barzegar-Jalali
- Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran
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