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Leupold F, Karimzadeh A, Breitkreuz T, Draht F, Klidis K, Grobe T, Weltermann B. Digital redesign of hypertension management with practice and patient apps for blood pressure control (PIA study): A cluster-randomised controlled trial in general practices. EClinicalMedicine 2023; 55:101712. [PMID: 36386033 PMCID: PMC9646864 DOI: 10.1016/j.eclinm.2022.101712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 09/30/2022] [Accepted: 10/05/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Long-term hypertension control prevents heart attacks and other cardiovascular diseases, yet implementation is insufficient worldwide. The redesign of hypertension management by information and communication technology (ICT) improved hypertension control, e.g., by transmission of blood pressure (BP) measurements to a central webspace. However, an easy-to-use secure patient app connected with a practice management centre is lacking. This study evaluates the effectiveness of the newly developed PIA (PC-supported case management of hypertensive patients to implement guideline-based hypertension therapy using a physician-defined and -supervised, patient-specific therapeutic algorithm) intervention with PIA-ICT and eLearning for general practices. METHODS The effectiveness of the PIA intervention was evaluated in a cluster-randomised study. Practices were randomly allocated (1:1) to the intervention or the control group (usual care). Group allocation was unmasked for participants and researchers. The primary outcome was the BP control rate (BP < 140/90 mmHg) after 6-12 months. Secondary outcomes included BP changes and satisfaction with PIA-ICT. The trial is registered in the German Clinical Trials Register (DRKS00012680). FINDINGS Starting from December 1, 2019, 64 general practices were recruited over 1 year during the COVID-19 pandemic. Overall, 848 patients were enrolled between April 15, 2020 and March 31, 2021. The study was completed Sept 30, 2021. At baseline, 636 patients (intervention: 331; control: 305) of 50 general practices met the inclusion criteria. The final dataset for analyses comprised 47 practices and 525 patients (intervention 265; control 260). In the adjusted hierarchical model, the PIA intervention increased the BP control rate significantly by 23.1% points (95% CI: 5.4-40.8%): intervention 59.8% (95% CI: 47.4-71.0%) compared to 36.7% (95% CI: 24.9-50.3%) in the control group. Systolic BP decreased by 21.1 mmHg in the intervention and 15.5 mmHg in the control group. INTERPRETATION The PIA redesign of care processes improved BP in an outcome-relevant way. Prospectively, it may constitute an important model for hypertension care in Germany. FUNDING This study is funded by the German Innovation Fund (Grant number: 01NVF17002).
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Affiliation(s)
- Frauke Leupold
- Institute of Family Medicine and General Practice, University Hospital Bonn, Venusberg-Campus 1, Bonn 53127, Germany
| | - Arian Karimzadeh
- Institute of Family Medicine and General Practice, University Hospital Bonn, Venusberg-Campus 1, Bonn 53127, Germany
| | - Thorben Breitkreuz
- aQua – Institute for Applied Quality Improvement and Research in Health Care, Maschmühlenweg 8-10, Göttingen 37073, Germany
| | - Fabian Draht
- Institute of Family Medicine and General Practice, University Hospital Bonn, Venusberg-Campus 1, Bonn 53127, Germany
| | - Kerstin Klidis
- Institute of Family Medicine and General Practice, University Hospital Bonn, Venusberg-Campus 1, Bonn 53127, Germany
| | - Thomas Grobe
- aQua – Institute for Applied Quality Improvement and Research in Health Care, Maschmühlenweg 8-10, Göttingen 37073, Germany
| | - Birgitta Weltermann
- Institute of Family Medicine and General Practice, University Hospital Bonn, Venusberg-Campus 1, Bonn 53127, Germany
- Corresponding author. Institute of Family Medicine and General Practice, University Hospital Bonn, Venusberg-Campus 1, Bonn 53127, Germany.
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Wicke FS, Ditscheid B, Breitkreuz T, Glushan A, Lehmann T, Karimova K, Sawicki OA, Vogel M, Freytag A, Beyer M. Clinical and economic outcomes of a collaborative cardiology care program. Am J Manag Care 2021; 27:e114-e122. [PMID: 33877778 DOI: 10.37765/ajmc.2021.88620] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES We evaluated a collaborative care program aimed at improving cooperation among general practitioners (GPs) and cardiologists in Baden-Wuerttemberg, Germany. The program focused on improving care for patients with chronic cardiac conditions. STUDY DESIGN We conducted a retrospective cohort study. The observation period was 2 years. METHODS The study was based on claims data and compared groups of patients who participated in the collaborative care program (GP-centered care and the cardiology contract) with patients receiving usual care. The evaluation focused on care coordination, quality, health service utilization, and costs in patients with heart failure, coronary heart disease, heart rhythm disorders, and/or valvular heart disease (disease cohorts). Multivariable regression models were used to adjust for differences in patient characteristics between the groups. RESULTS Across all disease cohorts, participation in the collaborative care program was associated with better care coordination and improved quality in a broad range of indicators (pharmacotherapy and vaccination). Results showed lower emergency service utilization and hospitalizations, lower consultation frequencies with GPs and specialists, and a shift from inpatient to outpatient procedures. Program participation resulted in higher costs for outpatient cardiologist treatment, but disease-specific costs were lower overall. CONCLUSIONS The results underline evidence that health care service programs that strengthen collaboration between GPs and cardiologists can substantially improve the care of patients with chronic cardiac conditions while simultaneously reducing costs.
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Affiliation(s)
| | | | | | | | | | | | - Olga Anastasia Sawicki
- Institute of General Practice, Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany.
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Sawicki OA, Mueller A, Glushan A, Breitkreuz T, Wicke FS, Karimova K, Gerlach FM, Wensing M, Smetak N, Bosch RF, Beyer M. Intensified ambulatory cardiology care: effects on mortality and hospitalisation-a comparative observational study. Sci Rep 2020; 10:14695. [PMID: 32895445 PMCID: PMC7477232 DOI: 10.1038/s41598-020-71770-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 08/03/2020] [Indexed: 11/24/2022] Open
Abstract
Since 2010, an intensified ambulatory cardiology care programme has been implemented in southern Germany. To improve patient management, the structure of cardiac disease management was improved, guideline-recommended care was supported, new ambulatory medical services and a morbidity-adapted reimbursement system were set up. Our aim was to determine the effects of this programme on the mortality and hospitalisation of enrolled patients with cardiac disorders. We conducted a comparative observational study in 2015 and 2016, based on insurance claims data. Overall, 13,404 enrolled patients with chronic heart failure (CHF) and 19,537 with coronary artery disease (CAD) were compared, respectively, to 8,776 and 16,696 patients that were receiving usual ambulatory cardiology care. Compared to the control group, patients enrolled in the programme had lower mortality (Hazard Ratio: 0.84; 95% CI: 0.77-0.91) and fewer all-cause hospitalisations (Rate Ratio: 0.94; 95% CI: 0.90-0.97). CHF-related hospitalisations in patients with CHF were also reduced (Rate Ratio: 0.76; 95% CI: 0.69-0.84). CAD patients showed a similar reduction in mortality rates (Hazard Ratio: 0.81; 95% CI: 0.76-0.88) and all-cause hospitalisation (Rate Ratio: 0.94; 95% CI: 0.91-0.97), but there was no effect on CAD-related hospitalisation. We conclude that intensified ambulatory care reduced mortality and hospitalisation in cardiology patients.
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Affiliation(s)
- Olga A Sawicki
- Institute of General Practice, Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany.
| | - Angelina Mueller
- Institute of General Practice, Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Anastasiya Glushan
- Institute of General Practice, Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Thorben Breitkreuz
- aQua, Institute for Applied Quality Improvement and Research in Health Care, 37073, Goettingen, Germany
| | - Felix S Wicke
- Institute of General Practice, Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Kateryna Karimova
- Institute of General Practice, Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Ferdinand M Gerlach
- Institute of General Practice, Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Michel Wensing
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | | | - Ralph F Bosch
- Cardio Centre Ludwigsburg-Bietigheim, 71634, Ludwigsburg, Germany
| | - Martin Beyer
- Institute of General Practice, Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
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Tsantilas P, Knappich C, Schmid S, Kallmayer M, Breitkreuz T, Zimmermann A, Eckstein HH, Kuehnl A. Last neurologic event is associated with risk of in-hospital stroke or death after carotid endarterectomy or carotid artery stenting: Secondary data analysis of the German statutory quality assurance database. J Vasc Surg 2019; 70:1488-1498. [DOI: 10.1016/j.jvs.2019.02.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 02/16/2019] [Indexed: 10/26/2022]
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Zimmermann A, Knappich C, Tsantilas P, Kallmayer M, Schmid S, Breitkreuz T, Storck M, Kuehnl A, Eckstein HH. Different perioperative antiplatelet therapies for patients treated with carotid endarterectomy in routine practice. J Vasc Surg 2018; 68:1753-1763. [DOI: 10.1016/j.jvs.2018.01.063] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 01/27/2018] [Indexed: 11/17/2022]
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Eckstein HH, Tsantilas P, Kühnl A, Haller B, Breitkreuz T, Zimmermann A, Kallmayer M. Surgical and Endovascular Treatment of Extracranial Carotid Stenosis. Dtsch Arztebl Int 2018; 114:729-736. [PMID: 29143732 DOI: 10.3238/arztebl.2017.0729] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 03/16/2017] [Accepted: 07/19/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND Carotid endarterectomy (CEA) and carotid artery stenting (CAS) can be used to prevent stroke due to arteriosclerotic lesions of the carotid artery. In Germany, legally mandated quality assurance (QA) enables the evaluation of outcome quality after CEA and CAS performed under routine conditions. METHODS We analyzed data on all elective CEA and CAS procedures performed over the periods 2009-2014 and 2012-2014, respectively. The endpoints of the study were the combined in-hospital stroke and death rate, stroke rate and mortality separately, local complications, and other complications. We analyzed the raw data with descriptive statistics and carried out a risk-adjusted analysis of the association of clinically unalterable variables with the risk of stroke and death. All analyses were performed separately for CEA and CAS. RESULTS Data were analyzed from 142 074 CEA procedures (67.8% of them in men) and 13 086 CAS procedures (69.7% in men). The median age was 72 years (CEA) and 71 years (CAS). The periprocedural rate of stroke and death after CEA was 1.4% for asymptomatic and 2.5% for symptomatic stenoses; the corresponding rates for CAS were 1.7% and 3.7%. Variables associated with increased risk included older age, higher ASA class (ASA = American Society of Anesthesiologists), symptomatic vs. asymptomatic stenosis, 50-69% stenosis, and contralateral carotid occlusion (for CEA only). CONCLUSION These data reveal a low periprocedural rate of stroke or death for both CEA and CAS. This study does however not permit any conclusions as to the superiority or inferiority of CEA and CAS.
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Affiliation(s)
- Hans-Henning Eckstein
- Department of Vascular and Endovascular Surgery/Vascular Center, Klinikum rechts der Isar der Technischen Universität München; Institut für Medizinische Statistik und Epidemiologie, Klinikum rechts der Isar, Technische Universität München; AQUA-Institute for Applied Quality Improvement and Research in Health Care GmbH, Göttingen
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Wetzka S, Gallwas J, Hasbargen U, Breitkreuz T, Rottmann M, Mahner S, Dannecker C. Einfluss von Konisation auf die Frühgeburtenrate und das perinatale Outcome: Eine retrospektive Analyse der Daten zur externen stationären Qualitätssicherung für die Erfassungsjahre 2009 – 2014. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671476] [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: 10/28/2022] Open
Affiliation(s)
- S Wetzka
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Klinikum der Universität München, Ludwig-Maximilians-Universität München, München, Deutschland
| | - J Gallwas
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Klinikum der Universität München, Ludwig-Maximilians-Universität München, München, Deutschland
| | - U Hasbargen
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Klinikum der Universität München, Ludwig-Maximilians-Universität München, München, Deutschland
| | - T Breitkreuz
- Institut für angewandte Qualitätsförderung und Forschung im Gesundheitswesen (AQUA), Göttingen, Deutschland
| | - M Rottmann
- Tumorregister München (TRM), Bayerisches Krebsregister – Regionalzentrum München, München, Deutschland
| | - S Mahner
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Klinikum der Universität München, Ludwig-Maximilians-Universität München, München, Deutschland
| | - C Dannecker
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Klinikum der Universität München, Ludwig-Maximilians-Universität München, München, Deutschland
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Andres E, Bleek J, Stock J, Bader E, Günter A, Wambach V, Lindenthal J, Breitkreuz T, Klingenberg A, Schillinger G, Szecsenyi J. [Measuring, assessing, acting: A practice test of quality indicators for coronary heart disease]. Z Evid Fortbild Qual Gesundhwes 2018; 137-138:9-19. [PMID: 30262390 DOI: 10.1016/j.zefq.2018.08.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 07/31/2018] [Accepted: 08/21/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND There are only limited possibilities for doctors in outpatient services to establish quality management that is based on data-driven feedback regarding the quality of health care. However, transparency about one's own activities is a prerequisite for refining this quality. The aim of this project was to make the quality of care for patients with coronary heart disease (CHD) more transparent, use this as a basis to initiate improvement processes, and explore the framework conditions and factors promoting or inhibiting the intended improvement of health care quality. METHOD 48 general practitioners (GPs) in 32 GP practices from a Bavarian doctors' network (Qualität und Effizienz, QuE) participated in the project. On the basis of claims data from the AOK-Bayern (a statutory health insurance in Bavaria), data from disease management programs (DMP) and medically documented data, 11 quality indicators for patients with CHD were calculated. The indicator scores were individually presented in feedback reports for each doctor's practice. These were the basis for two quality circles. The indicators were measured again after 12 months, and changes against the baseline measurement were registered. GPs from Bavaria formed the control group. Focus groups with the quality circle moderators and two participant surveys were used to identify promoting and inhibiting factors. RESULTS The baseline values showed a good level of care. Potential for improvement became apparent for pharmacotherapy with beta blockers and statins. After conducting the quality circles four of the eleven indicators showed an increase as intended ("beta blockers for CHD and cardiac insufficiency", "beta blockers after myocardial infarction", "statins", "successful blood pressure control"). For three of these indicators the increase rates were higher than those in the Bavarian control group. One indicator ("statins") was striking because of the wide variation of practice values suggesting differences in care within the network. The majority of participating doctors regarded the database as valid. Quality circles were highly appreciated as an opportunity for professional exchange among colleagues. The data-based feedback reports helped to make deficits in health care transparent and to identify actions that need to be taken. Barriers to implementing quality improvement measures in clinical practice became apparent. DISCUSSION Reflecting quality indicators in quality circles can effectively trigger quality improvement processes. Barriers would appear to exist, in particular, to the implementation of measures into daily practice routine. Additional organizational support offered by higher-level quality management structures, IT solutions for patient-related data processing as well as a system of financial compensation, which rewards professional concern for quality, may help to overcome the existing barriers.
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Affiliation(s)
| | | | | | | | | | - Veit Wambach
- Gesundheitsnetz Qualität und Effizienz eG (QuE), Nürnberg, Deutschland
| | - Jörg Lindenthal
- Gesundheitsnetz Qualität und Effizienz eG (QuE), Nürnberg, Deutschland
| | | | | | | | - Joachim Szecsenyi
- aQua-Institut, Göttingen, Deutschland; Abteilung Allgemeinmedizin und Versorgungsforschung, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
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Knappich C, Kuehnl A, Tsantilas P, Schmid S, Breitkreuz T, Kallmayer M, Zimmermann A, Eckstein HH. Patient characteristics and in-hospital outcomes of emergency carotid endarterectomy and carotid stenting after stroke in evolution. J Vasc Surg 2018; 68:436-444.e6. [DOI: 10.1016/j.jvs.2017.10.085] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Accepted: 10/26/2017] [Indexed: 11/30/2022]
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Tsantilas P, Knappich C, Schmid S, Kallmayer M, Breitkreuz T, Zimmermann A, Kuehnl A, Eckstein HH. Abstract 347: Significant Association Between the Qualifying Neurologic Event and the In-hospital Risk of Stroke or Death Following Carotid Endarterectomy and Carotid Artery Stenting. Arterioscler Thromb Vasc Biol 2018. [DOI: 10.1161/atvb.38.suppl_1.347] [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: 11/16/2022]
Abstract
Objectives:
The purpose of this observational study was to analyze the association between the initial neurological status and the risk of any in-hospital stroke or death in patients treated with carotid endarterectomy (CEA) or carotid artery stenting (CAS) under routine conditions in Germany.
Methods:
Secondary data analysis based on the German statutory quality assurance database for carotid procedures between 2009-2014. The primary outcome was any periprocedural stroke or all-cause death until discharge. To analyze the association between initial neurological status and outcome, a multilevel multivariable regression analyses adjusting for confounders was performed.
Results:
From a total of 182,033 patients documented between 2009 and 2014, 144,347 patients treated with CEA and 14,794 patients treated with CAS were included in the analysis. In total, there 68% were men and the mean age of the cohort was 70.5±9.1 years. The risk of any in-hospital stroke or death in patients treated with CEA was 2.0% (n=2923/144,347). The raw risk of any in-hospital stroke or death was 1.4% in asymptomatic patients and 3.0% in symptomatic patients treated with CEA. Within the group of symptomatic patients, risk of any in-hospital stroke or death after CEA increased from 1.2% (amaurosis fugax, AFX), 2.3% (TIA), 2.8% (minor stroke), 4.4% (major stroke), 4.8% (crescendo TIA, cTIA) to 9.0% (stroke in evolution, SIE). The risk of any in-hospital stroke or death in patients treated with CAS was 3.6% (n=538/14,794). The raw risk of any in-hospital stroke or death was 1.7% in asymptomatic patients and 6.1% in symptomatic patients treated with CAS. Within the group of symptomatic patients, risk of any in-hospital stroke or death increased from 1.0% (AFX), 4.1% (TIA), 4.1% (minor stroke), 5.4% (major stroke), 5.2% (cTIA) to 11.7% (SIE). Regression analysis revealed that the severity of initial neurologic symptoms was associated with an increased risk of any in-hospital stroke or death in both patients treated for CEA and CAS.
Conclusion:
Periprocedural risk for any stroke or death did not significantly differ between asymptomatic patients and patients with AFX but between asymptomatic patients and patients with TIA, stroke, cTIA or SIE.
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Affiliation(s)
- Pavlos Tsantilas
- Div of Vascular Surgery, Stanford Univ Sch of Medicine, Stanford, CA
| | - Christoph Knappich
- Dept of Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical Univ of Munich, Munich, Germany
| | - Sofie Schmid
- Dept of Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical Univ of Munich, Munich, Germany
| | - Michael Kallmayer
- Dept of Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical Univ of Munich, Munich, Germany
| | - Thorben Breitkreuz
- aQua – Institute for Applied Quality Improvement and Rsch in Health GmbH, Göttingen, Germany
| | - Alexander Zimmermann
- Dept of Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical Univ of Munich, Munich, Germany
| | - Andreas Kuehnl
- Dept of Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical Univ of Munich, Munich, Germany
| | - Hans-Henning Eckstein
- Dept of Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical Univ of Munich, Munich, Germany
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Tsantilas P, Kuehnl A, Kallmayer M, Knappich C, Schmid S, Breitkreuz T, Zimmermann A, Eckstein HH. Risk of Stroke or Death Is Associated With the Timing of Carotid Artery Stenting for Symptomatic Carotid Stenosis: A Secondary Data Analysis of the German Statutory Quality Assurance Database. J Am Heart Assoc 2018; 7:e007983. [PMID: 29588311 PMCID: PMC5907586 DOI: 10.1161/jaha.117.007983] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 02/06/2018] [Indexed: 01/22/2023]
Abstract
BACKGROUND Subgroup analyses from randomized trials indicate that the time interval between the neurologic index event and carotid artery stenting is associated with periprocedural stroke and death rates in patients with symptomatic carotid stenosis. The aim of this article is to analyze whether this observation holds true under routine conditions in Germany. METHODS AND RESULTS Secondary data analysis was done on 4717 elective carotid artery stenting procedures that were performed for symptomatic carotid stenosis. The patient cohort was divided into 4 groups according to the time interval between the index event and intervention (group I 0-2, II 3-7, III 8-14, and IV 15-180 days). Primary outcome was any in-hospital stroke or death. For risk-adjusted analyses, a multilevel multivariable regression model was used. The in-hospital stroke or death rate was 3.7% in total and 6.0%, 4.4%, 2.4%, and 3.0% in groups I, II, III, and IV, respectively. Adjusted analysis showed a decreased risk for any stroke or death in group III, a decreased risk for any major stroke or death in groups III and IV, and a decreased risk for any death in groups II and III compared to the reference group I. CONCLUSIONS A short time interval between the neurologic index event and carotid artery stenting of up to 7 days is associated with an increased risk for stroke or death under routine conditions in Germany. Although results cannot prove causal relationships, carotid artery stenting may be accompanied by an increased risk of stroke or death during the early period after the index event.
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Affiliation(s)
- Pavlos Tsantilas
- Department of Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University Munich, Germany
| | - Andreas Kuehnl
- Department of Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University Munich, Germany
| | - Michael Kallmayer
- Department of Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University Munich, Germany
| | - Christoph Knappich
- Department of Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University Munich, Germany
| | - Sofie Schmid
- Department of Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University Munich, Germany
| | - Thorben Breitkreuz
- aQua-Institute for Applied Quality Improvement and Research in Health GmbH, Göttingen, Germany
| | - Alexander Zimmermann
- Department of Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University Munich, Germany
| | - Hans-Henning Eckstein
- Department of Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University Munich, Germany
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Tsantilas P, Kühnl A, Maegdefessel L, König T, Breitkreuz T, Knappich C, Schmid S, Kallmayer M, Zimmermann A, Eckstein HH. Abstract 124: Safety of Carotid Endarterectomy and Carotid Stenting in the Early Period After the Neurologic Index Event - Results From the German Quality Assurance Registry on > 50,000 Patients. Arterioscler Thromb Vasc Biol 2017. [DOI: 10.1161/atvb.37.suppl_1.124] [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: 11/16/2022]
Abstract
Objectives:
Current guidelines recommend that carotid endarterectomy (CEA) should be performed within two weeks after the neurologic index event in patients with a 50-99% symptomatic carotid artery stenosis (sCS). Safety of early CEA and early carotid artery stenting (CAS) within those two weeks remains unclair. This study aims to analyze the safety of CEA and CAS in sCS in Germany.
Methods:
By German law all extracranial carotid procedures have to be documented prospectively in a nationwide quality assurance registry. We analysed data on 56,336 CEAs (68% male, mean age 71 years (SD ± 9.6) and 4,726 CAS (68% male, median age 70 years (SD ± 9.8) treated between 2009-2014 for sCS. The patient cohort was divided into four time interval groups (I: 0-2 days, II: 3-7 days, III: 8-14 days and IV: 14-180 days respectively). Primary endpoint was the combined in-hospital stroke and mortality rate. We excluded all emergency CEAs (stroke-in-evolution, acute occlusion) and all procedures for recurrent carotid stenosis from this analysis. We performed chi-squared tests and a multivariable multilevel Poisson-regression analysis to estimate adjusted risk ratios (RR).
Results:
The procedural combined stroke and mortality rate was 3.0% (157 of 5198)/6.0% (33 of 550) in group I, 2.5% (480 of 19,117)/4.4% (70 of 1579) in group II, 2.6% (427 of 16,205)/2.4% (30 of 1244) in group III and 2.3% (370 of 15,759)/3.0% (40 of 1344) in group IV respectively. In the multivariable regression analysis the time interval was no independent risk factor for patients treated by CEA. However, CAS was associated with a decreased periprocedural risk when performed 8-14 days (group III) after the index event vs. group I (0-2 days) (RR 0.47, 95% CI 0.28-0.79). No significance was found comparing time group II vs. I (RR 0.80, 95% CI0.52-1.24) and IV vs. I (RR 0.64, 95% CI 0.39-1.05).
Conclusion:
Time interval between neurologic event and CEA has no significant influence on the perioperative stroke and mortality rate. CAS was associated with a higher risk when performed early. In accordance with the guidelines, CEA remains to be the treatment of choice in the early period after cerebral ischemia.
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Affiliation(s)
- Pavlos Tsantilas
- Klinikum Rechts der Isar, Technical Univ of Munich, Munich, Germany
| | - Andreas Kühnl
- Klinikum Rechts der Isar, Technical Univ of Munich, Munich, Germany
| | | | - Thomas König
- AQUA - Institute for Applied Quality Improvement and Rsch in Health GmbH, Göttingen, Germany
| | - Thorben Breitkreuz
- AQUA - Institute for Applied Quality Improvement and Rsch in Health GmbH, Göttingen, Germany
| | | | - Sofie Schmid
- Klinikum Rechts der Isar, Technical Univ of Munich, Munich, Germany
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Knappich C, Kuehnl A, Tsantilas P, Schmid S, Breitkreuz T, Kallmayer M, Zimmermann A, Eckstein HH. Intraoperative Completion Studies, Local Anesthesia, and Antiplatelet Medication Are Associated With Lower Risk in Carotid Endarterectomy. Stroke 2017; 48:955-962. [DOI: 10.1161/strokeaha.116.014869] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 01/21/2017] [Accepted: 01/27/2017] [Indexed: 01/05/2023]
Abstract
Background and Purpose—
In Germany, all surgical and endovascular procedures on the carotid bifurcation must be documented in a statutory nationwide quality assurance database. We aimed to analyze the association between procedural and perioperative variables and in-hospital stroke or death rates after carotid endarterectomy.
Methods—
Between 2009 and 2014, overall 142 074 elective carotid endarterectomy procedures for asymptomatic or symptomatic carotid artery stenosis were documented in the database. The primary outcome of this secondary data analysis was in-hospital stroke or death. Major stroke or death, stroke, and death, each until discharge were secondary outcomes. Adjusted relative risks (RRs) were assessed by multivariable multilevel regression analyses.
Results—
The primary outcome occurred in 1.8% of patients, with a rate of 1.4% in asymptomatic and 2.5% in symptomatic patients, respectively. In the multivariable analysis, lower risks of stroke or death were independently associated with local anesthesia (versus general anesthesia: RR, 0.85; 95% confidence interval [CI], 0.75–0.95), carotid endarterectomy with patch plasty compared with primary closure (RR, 0.71; 95% CI, 0.52–0.97), intraoperative completion studies by duplex ultrasound (RR, 0.74; 95% CI, 0.63–0.88) or angiography (RR, 0.80; 95% CI, 0.71–0.90), and perioperative antiplatelet medication (RR, 0.83; 95% CI, 0.71–0.97). No shunting and a short cross-clamp time were also associated with lower risks; however, these are suspected to be confounded.
Conclusions—
Local anesthesia, patch plasty compared with primary closure, intraoperative completion studies by duplex ultrasound or angiography, and perioperative antiplatelet medication were independently associated with lower in-hospital stroke or death rates after carotid endarterectomy.
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Affiliation(s)
- Christoph Knappich
- From the Department of Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany (C.K., A.K., P.T., S.S., M.K., A.Z., H.-H.E.); and AQUA-Institut für angewandte Qualitätsförderung und Forschung im Gesundheitswesen GmbH, Göttingen, Germany (T.B.)
| | - Andreas Kuehnl
- From the Department of Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany (C.K., A.K., P.T., S.S., M.K., A.Z., H.-H.E.); and AQUA-Institut für angewandte Qualitätsförderung und Forschung im Gesundheitswesen GmbH, Göttingen, Germany (T.B.)
| | - Pavlos Tsantilas
- From the Department of Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany (C.K., A.K., P.T., S.S., M.K., A.Z., H.-H.E.); and AQUA-Institut für angewandte Qualitätsförderung und Forschung im Gesundheitswesen GmbH, Göttingen, Germany (T.B.)
| | - Sofie Schmid
- From the Department of Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany (C.K., A.K., P.T., S.S., M.K., A.Z., H.-H.E.); and AQUA-Institut für angewandte Qualitätsförderung und Forschung im Gesundheitswesen GmbH, Göttingen, Germany (T.B.)
| | - Thorben Breitkreuz
- From the Department of Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany (C.K., A.K., P.T., S.S., M.K., A.Z., H.-H.E.); and AQUA-Institut für angewandte Qualitätsförderung und Forschung im Gesundheitswesen GmbH, Göttingen, Germany (T.B.)
| | - Michael Kallmayer
- From the Department of Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany (C.K., A.K., P.T., S.S., M.K., A.Z., H.-H.E.); and AQUA-Institut für angewandte Qualitätsförderung und Forschung im Gesundheitswesen GmbH, Göttingen, Germany (T.B.)
| | - Alexander Zimmermann
- From the Department of Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany (C.K., A.K., P.T., S.S., M.K., A.Z., H.-H.E.); and AQUA-Institut für angewandte Qualitätsförderung und Forschung im Gesundheitswesen GmbH, Göttingen, Germany (T.B.)
| | - Hans-Henning Eckstein
- From the Department of Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany (C.K., A.K., P.T., S.S., M.K., A.Z., H.-H.E.); and AQUA-Institut für angewandte Qualitätsförderung und Forschung im Gesundheitswesen GmbH, Göttingen, Germany (T.B.)
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Schmid S, Tsantilas P, Knappich C, Kallmayer M, König T, Breitkreuz T, Zimmermann A, Kuehnl A, Eckstein HH. Risk of Inhospital Stroke or Death Is Associated With Age But Not Sex in Patients Treated With Carotid Endarterectomy for Asymptomatic or Symptomatic Stenosis in Routine Practice: Secondary Data Analysis of the Nationwide German Statutory Quality Assurance Database From 2009 to 2014. J Am Heart Assoc 2017; 6:JAHA.116.004764. [PMID: 28288976 PMCID: PMC5524011 DOI: 10.1161/jaha.116.004764] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Background Guideline recommendations on carotid endarterectomy are based predominantly on randomized, controlled trials, in which women or elderly patients are often under‐represented. This study analyzed the association of age and sex with the risk of in‐hospital stroke or death following carotid endarterectomy under routine conditions in Germany. Methods and Results Secondary data analysis using the Statutory German Quality Assurance Database on all carotid endarterectomy procedures (n=142 074) performed between 2009 and 2014. Primary outcome was any stroke or death until discharge; secondary outcomes were any in‐hospital stroke (alone), and death (alone). Descriptive statistics and multilevel multivariable regression analyses were applied. Patients were predominately male (68%), with mean age 71 years. Carotid stenosis was symptomatic in 40%. Primary outcome occurred in 1.8% of women and 1.9% of men. Multivariable regression analysis revealed that more‐advanced age was associated with a higher primary outcome rate (relative risk [RR] per 10‐year increase: 1.19; 95% CI, 1.14–1.24). Risk of death (alone) was associated with age (RR, 1.68; 95% CI, 1.54–1.84). Age was associated with the risk of stroke (alone; RR, 1.05; 95% CI, 1.00–1.11). Sex was not associated with primary outcome rate (1.01; 95% CI, 0.93–1.10), nor did it significantly modify the age effect. Conclusions This study shows that increasing age, but not sex, is associated with a higher risk of in‐hospital stroke or death following carotid endarterectomy under everyday conditions in Germany. Whereas the risk of death (alone) is significantly associated with age, the association between age and the risk of stroke (alone) can be considered of minor importance.
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Affiliation(s)
- Sofie Schmid
- Department of Vascular and Endovascular Surgery, Klinikum rechts der Isar Technical University of Munich, Germany
| | - Pavlos Tsantilas
- Department of Vascular and Endovascular Surgery, Klinikum rechts der Isar Technical University of Munich, Germany
| | - Christoph Knappich
- Department of Vascular and Endovascular Surgery, Klinikum rechts der Isar Technical University of Munich, Germany
| | - Michael Kallmayer
- Department of Vascular and Endovascular Surgery, Klinikum rechts der Isar Technical University of Munich, Germany
| | - Thomas König
- AQUA-Institut für angewandte Qualitätsförderung und Forschung im Gesundheitswesen GmbH, Göttingen, Germany
| | - Thorben Breitkreuz
- AQUA-Institut für angewandte Qualitätsförderung und Forschung im Gesundheitswesen GmbH, Göttingen, Germany
| | - Alexander Zimmermann
- Department of Vascular and Endovascular Surgery, Klinikum rechts der Isar Technical University of Munich, Germany
| | - Andreas Kuehnl
- Department of Vascular and Endovascular Surgery, Klinikum rechts der Isar Technical University of Munich, Germany
| | - Hans-Henning Eckstein
- Department of Vascular and Endovascular Surgery, Klinikum rechts der Isar Technical University of Munich, Germany
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15
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Tsantilas P, Kuehnl A, König T, Breitkreuz T, Kallmayer M, Knappich C, Schmid S, Storck M, Zimmermann A, Eckstein HH. Short Time Interval Between Neurologic Event and Carotid Surgery Is Not Associated With an Increased Procedural Risk. Stroke 2016; 47:2783-2790. [DOI: 10.1161/strokeaha.116.014058] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Accepted: 09/15/2016] [Indexed: 12/31/2022]
Abstract
Background and Purpose—
Guidelines recommend that carotid endarterectomy should be performed within 2 weeks in patients with a symptomatic carotid stenosis. Because a Swedish register study indicated that patients treated within the first days after a stroke or transient ischemic attack might have an increased perioperative stroke and mortality risk, this study aimed to find out whether these findings are also true under everyday conditions in Germany.
Methods—
Secondary data analysis including 56 336 elective carotid endarterectomy procedures performed for symptomatic carotid stenosis under everyday conditions between 2009 and 2014. The patient cohort was divided into 4 groups according to time interval between index event and surgery (I: 0–2, II: 3–7, III: 8–14, and IV: 14–180 days). Primary outcome was any in-hospital stroke or death. For risk-adjusted analyses, a multilevel multivariable regression model was used.
Results—
Mean patients’ age was 71.1±9.6 years; 67.5% were men. Overall rate of any stroke or death was 2.5% (n=1434). Risk of any in-hospital stroke or death was 3.0% in group I, 2.5% in group II, 2.6% in group III, and 2.3% in group IV. Multivariable regression analysis revealed that the time interval was not significantly associated with the primary outcome.
Conclusions—
The time interval between the index event and carotid endarterectomy was not associated with the risk of any in-hospital stroke or death in patients with symptomatic carotid stenosis in Germany. In clinically stable patients, carotid endarterectomy might, therefore, be performed safely as soon as possible after the neurological index event.
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Affiliation(s)
- Pavlos Tsantilas
- From the Department of Vascular and Endovascular Surgery, Klinikum Rechts der Isar, Technical University of Munich, Germany (P.T., A.K., M.K., C.K., S.S., A.Z., H.-H.E.); AQUA - Institute for Applied Quality Improvement and Research in Health GmbH, Göttingen, Germany (T.K., T.B.); and Department for Vascular and Thoracic Surgery, Klinikum Karlsruhe, Academic Teaching Hospital University of Freiburg, Karlsruhe, Germany (M.S.)
| | - Andreas Kuehnl
- From the Department of Vascular and Endovascular Surgery, Klinikum Rechts der Isar, Technical University of Munich, Germany (P.T., A.K., M.K., C.K., S.S., A.Z., H.-H.E.); AQUA - Institute for Applied Quality Improvement and Research in Health GmbH, Göttingen, Germany (T.K., T.B.); and Department for Vascular and Thoracic Surgery, Klinikum Karlsruhe, Academic Teaching Hospital University of Freiburg, Karlsruhe, Germany (M.S.)
| | - Thomas König
- From the Department of Vascular and Endovascular Surgery, Klinikum Rechts der Isar, Technical University of Munich, Germany (P.T., A.K., M.K., C.K., S.S., A.Z., H.-H.E.); AQUA - Institute for Applied Quality Improvement and Research in Health GmbH, Göttingen, Germany (T.K., T.B.); and Department for Vascular and Thoracic Surgery, Klinikum Karlsruhe, Academic Teaching Hospital University of Freiburg, Karlsruhe, Germany (M.S.)
| | - Thorben Breitkreuz
- From the Department of Vascular and Endovascular Surgery, Klinikum Rechts der Isar, Technical University of Munich, Germany (P.T., A.K., M.K., C.K., S.S., A.Z., H.-H.E.); AQUA - Institute for Applied Quality Improvement and Research in Health GmbH, Göttingen, Germany (T.K., T.B.); and Department for Vascular and Thoracic Surgery, Klinikum Karlsruhe, Academic Teaching Hospital University of Freiburg, Karlsruhe, Germany (M.S.)
| | - Michael Kallmayer
- From the Department of Vascular and Endovascular Surgery, Klinikum Rechts der Isar, Technical University of Munich, Germany (P.T., A.K., M.K., C.K., S.S., A.Z., H.-H.E.); AQUA - Institute for Applied Quality Improvement and Research in Health GmbH, Göttingen, Germany (T.K., T.B.); and Department for Vascular and Thoracic Surgery, Klinikum Karlsruhe, Academic Teaching Hospital University of Freiburg, Karlsruhe, Germany (M.S.)
| | - Christoph Knappich
- From the Department of Vascular and Endovascular Surgery, Klinikum Rechts der Isar, Technical University of Munich, Germany (P.T., A.K., M.K., C.K., S.S., A.Z., H.-H.E.); AQUA - Institute for Applied Quality Improvement and Research in Health GmbH, Göttingen, Germany (T.K., T.B.); and Department for Vascular and Thoracic Surgery, Klinikum Karlsruhe, Academic Teaching Hospital University of Freiburg, Karlsruhe, Germany (M.S.)
| | - Sofie Schmid
- From the Department of Vascular and Endovascular Surgery, Klinikum Rechts der Isar, Technical University of Munich, Germany (P.T., A.K., M.K., C.K., S.S., A.Z., H.-H.E.); AQUA - Institute for Applied Quality Improvement and Research in Health GmbH, Göttingen, Germany (T.K., T.B.); and Department for Vascular and Thoracic Surgery, Klinikum Karlsruhe, Academic Teaching Hospital University of Freiburg, Karlsruhe, Germany (M.S.)
| | - Martin Storck
- From the Department of Vascular and Endovascular Surgery, Klinikum Rechts der Isar, Technical University of Munich, Germany (P.T., A.K., M.K., C.K., S.S., A.Z., H.-H.E.); AQUA - Institute for Applied Quality Improvement and Research in Health GmbH, Göttingen, Germany (T.K., T.B.); and Department for Vascular and Thoracic Surgery, Klinikum Karlsruhe, Academic Teaching Hospital University of Freiburg, Karlsruhe, Germany (M.S.)
| | - Alexander Zimmermann
- From the Department of Vascular and Endovascular Surgery, Klinikum Rechts der Isar, Technical University of Munich, Germany (P.T., A.K., M.K., C.K., S.S., A.Z., H.-H.E.); AQUA - Institute for Applied Quality Improvement and Research in Health GmbH, Göttingen, Germany (T.K., T.B.); and Department for Vascular and Thoracic Surgery, Klinikum Karlsruhe, Academic Teaching Hospital University of Freiburg, Karlsruhe, Germany (M.S.)
| | - Hans-Henning Eckstein
- From the Department of Vascular and Endovascular Surgery, Klinikum Rechts der Isar, Technical University of Munich, Germany (P.T., A.K., M.K., C.K., S.S., A.Z., H.-H.E.); AQUA - Institute for Applied Quality Improvement and Research in Health GmbH, Göttingen, Germany (T.K., T.B.); and Department for Vascular and Thoracic Surgery, Klinikum Karlsruhe, Academic Teaching Hospital University of Freiburg, Karlsruhe, Germany (M.S.)
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Schad F, Merkle A, Hoffmann V, Lenneweit G, Spahn G, Hesse M, Paxino C, Wellmann G, Matthes B, Baute R, Breitkreuz T, Matthes H. An integrative approach of cancer treatment with mistletoe therapy, surgery, irradiation and chemotherapy in CAM settings. Eur J Integr Med 2009. [DOI: 10.1016/j.eujim.2009.08.079] [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: 10/20/2022]
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Schad F, Teodoridis C, Albrecht U, Merkle A, Baute R, Breitkreuz T, Matthes H. Network Oncology (NO)—A European approach to health service research on cancer treatment with focus on concurrent use of complementary therapies. Eur J Integr Med 2008. [DOI: 10.1016/j.eujim.2008.08.019] [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] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Breitkreuz T, Romanakis K, Lutz S, Seitz G, Bonkhoff H, Unteregger G, Zwergel T, Zang KD, Wullich B. Genotypic characterization of prostatic carcinomas: a combined cytogenetic, flow cytometry, and in situ DNA hybridization study. Cancer Res 1993; 53:4035-40. [PMID: 8358732] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Cytogenetic studies were performed on 36 biopsies obtained from 26 primary prostatic adenocarcinomas. Following histopathological characterization of control sections, the biopsies were investigated using metaphase cytogenetics, DNA flow cytometry, and fluorescence in situ DNA hybridization. In 12 specimens, no carcinoma was found in control sections by histopathological means. In 24 carcinoma biopsies clonal aberrations were detected in 15 specimens. Tetraploidy as sole aberration was detected in five specimens. Loss of the Y chromosome was seen in eight samples. Only one tumor revealed structural abnormalities. Eight samples were found to be normal (46,XY). Remarkably, nonclonal chromosome aberrations, particularly marked chromosome loss, were frequently detected in prostatic carcinomas and premalignant lesions (prostatic intraepithelial neoplasia). In the series of biopsies investigated by means of cytogenetics and flow cytometry, biopsies with aneuploid DNA content were found to be cytogenetically normal. Conversely, the cytogenetically aberrant clones were found to be of diploid DNA content. Evidence of focal intratumoral heterogeneity was revealed by cytogenetics, flow cytometry, and in situ hybridization.
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Affiliation(s)
- T Breitkreuz
- Institute of Human Genetics, University of the Saar, Homburg/Saar, Germany
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Wullich B, Breitkreuz T, Zwergel T, Unteregger G, Seitz G, Zang KD. Cytogenetic evidence of intratumoral focal heterogeneity in prostatic carcinomas. Urol Int 1992; 48:372-7. [PMID: 1413297 DOI: 10.1159/000282358] [Citation(s) in RCA: 8] [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] [Indexed: 12/26/2022]
Abstract
Although prostatic cancer is the most common malignant disease in men in western countries, only limited data on chromosomal changes are available. We report on our cytogenetic findings in cell cultures from four primary prostatic carcinomas indicating the existence of intratumoral focal heterogeneity concerning chromosomal anomalies in prostatic cancer.
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Affiliation(s)
- B Wullich
- Institut für Humangenetik, Universität des Saarlandes, Homburg/Saar, Deutschland
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