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Terkelsen CJ, Thim T, Freeman P, Dahl JS, Nørgaard BL, Kim WY, Tang M, Sørensen HT, Christiansen EH, Nissen H. Randomized comparison of TAVI valves: The Compare-TAVI trial. Am Heart J 2024:S0002-8703(24)00118-2. [PMID: 38729550 DOI: 10.1016/j.ahj.2024.05.003] [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] [Received: 01/08/2024] [Revised: 05/01/2024] [Accepted: 05/03/2024] [Indexed: 05/12/2024]
Abstract
INTRODUCTION Based on technical advancements and clinical evidence, transcatheter aortic valve implantation (TAVI) has been widely adopted. New generation TAVI valve platforms are continually being developed. Ideally, new valves should be superior or at least non-inferior regarding efficacy and safety, when compared to best-in-practice contemporary TAVI valves. METHODS AND ANALYSIS The Compare-TAVI trial (ClinicalTrials.gov NCT04443023) was launched in 2020, to perform a 1:1 randomized comparison of new versus contemporary TAVI valves, preferably in all comers. Consecutive cohorts will be launched with sample sizes depending on the choice of interim analyses, expected event rates, and chosen superiority or non-inferiority margins. Enrollment has just been finalized in cohort B, comparing the Sapien 3/ Sapien 3 Ultra Transcatheter Heart Valve (THV) series (Edwards Lifesciences, Irvine, California, USA) and the Myval/Myval Octacor THV series (Meril Life Sciences Pvt. Ltd., Vapi, Gujarat, India) balloon expandable valves. This non-inferiority study was aimed to include 1062 patients. The 1-year composite safety and efficacy endpoint comprises death, stroke, moderate-severe aortic regurgitation, and moderate-severe valve deterioration. Patients will be followed until withdrawal of consent, death, or completion of 10-year follow-up, whichever comes first. Secondary endpoints will be monitored at 30 days, 1, 3, 5, and 10 years. SUMMARY The Compare-TAVI organization will launch consecutive cohorts wherein patients scheduled for TAVI are randomized to one of two valves. The aim is to ensure that the short- and long-term performance and safety of new valves being introduced is benchmarked against what achieved bybest-in-practice contemporary valves.
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Affiliation(s)
- Christian Juhl Terkelsen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University Hospital, Denmark.; The Danish Heart Foundation.
| | - Troels Thim
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Philip Freeman
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | | | - Bjarne Linde Nørgaard
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University Hospital, Denmark
| | - Won-Yong Kim
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University Hospital, Denmark
| | - Mariann Tang
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital and Aarhus University, Aarhus, Denmark
| | | | - Henrik Nissen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
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Strandkjær N, Jørgensen N, Hasselbalch RB, Kristensen J, Knudsen MSS, Kock TO, Lange T, Lindholm MG, Bruun NE, Holmvang L, Terkelsen CJ, Pedersen CK, Christensen MK, Lassen JF, Hilsted L, Ladefoged S, Nybo M, Bor MV, Dahl M, Hansen AB, Kamstrup PR, Bundgaard H, Torp-Pedersen C, Iversen KK. DANSPOT: A Multicenter Stepped-Wedge Cluster-Randomized Trial of the Reclassification of Acute Myocardial Infarction: Rationale and Study Design. J Am Heart Assoc 2024; 13:e033493. [PMID: 38639348 DOI: 10.1161/jaha.123.033493] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 03/13/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND Cardiac troponins are the preferred biomarkers for the diagnosis of acute myocardial infarction. Although sex-specific 99th percentile thresholds of troponins are recommended in international guidelines, the clinical effect of their use is poorly investigated. The DANSPOT Study (The Danish Study of Sex- and Population-Specific 99th percentile upper reference limits of Troponin) aims to evaluate the clinical effect of a prospective implementation of population- and sex-specific diagnostic thresholds of troponins into clinical practice. METHODS This study is a nationwide, multicenter, stepped-wedge cluster-randomized trial of the implementation of population- and sex-specific thresholds of troponins in 22 of 23 clinical centers in Denmark. We established sex-specific thresholds for 5 different troponin assays based on troponin levels in a healthy Danish reference population. Centers will sequentially cross over from current uniform manufacturer-derived thresholds to the new population- and sex-specific thresholds. The primary cohort is defined as patients with symptoms suggestive of acute coronary syndrome having at least 1 troponin measurement performed within 24 hours of arrival with a peak troponin value between the current uniform threshold and the new sex-specific female and male thresholds. The study will compare the occurrence of the primary outcome, defined as a composite of nonfatal myocardial infarction, unplanned revascularization, and all-cause mortality within 1 year, separately for men and women before and after the implementation of the new sex-specific thresholds. CONCLUSIONS The DANSPOT Study is expected to show the clinical effects on diagnostics, treatment, and clinical outcomes in patients with myocardial infarction of implementing sex-specific diagnostic thresholds for troponin based on a national Danish reference population. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT05336435.
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Affiliation(s)
- Nina Strandkjær
- Department of Emergency Medicine Copenhagen University Hospital-Herlev and Gentofte Herlev Denmark
- Department of Cardiology Copenhagen University Hospital-Herlev and Gentofte Herlev Denmark
- Department of Clinical Medicine University of Copenhagen Denmark
| | - Nicoline Jørgensen
- Department of Emergency Medicine Copenhagen University Hospital-Herlev and Gentofte Herlev Denmark
- Department of Cardiology Copenhagen University Hospital-Herlev and Gentofte Herlev Denmark
| | - Rasmus Bo Hasselbalch
- Department of Emergency Medicine Copenhagen University Hospital-Herlev and Gentofte Herlev Denmark
- Department of Cardiology Copenhagen University Hospital-Herlev and Gentofte Herlev Denmark
- Department of Clinical Medicine University of Copenhagen Denmark
| | - Jonas Kristensen
- Department of Emergency Medicine Copenhagen University Hospital-Herlev and Gentofte Herlev Denmark
- Department of Cardiology Copenhagen University Hospital-Herlev and Gentofte Herlev Denmark
- Department of Clinical Medicine University of Copenhagen Denmark
| | - Marie Sophie Sander Knudsen
- Department of Emergency Medicine Copenhagen University Hospital-Herlev and Gentofte Herlev Denmark
- Department of Cardiology Copenhagen University Hospital-Herlev and Gentofte Herlev Denmark
| | - Thilde Olivia Kock
- Department of Cardiology Copenhagen University Hospital-Herlev and Gentofte Herlev Denmark
| | - Theis Lange
- Department of Public Health University of Copenhagen Denmark
| | | | - Niels Eske Bruun
- Department of Clinical Medicine University of Copenhagen Denmark
- Department of Cardiology Zealand University Hospital Roskilde Denmark
| | - Lene Holmvang
- Department of Cardiology Copenhagen University Hospital-Rigshospitalet Copenhagen Denmark
| | | | | | | | | | - Linda Hilsted
- Department of Clinical Biochemistry Copenhagen University Hospital-Rigshospitalet Copenhagen Denmark
| | - Søren Ladefoged
- Department of Clinical Biochemistry Aarhus University Hospital Aarhus Denmark
| | - Mads Nybo
- Department of Clinical Biochemistry Odense University Hospital Odense Denmark
| | - Mustafa Vakur Bor
- Department of Clinical Biochemistry University of Hospital of South Denmark Esbjerg Denmark
| | - Morten Dahl
- Department of Clinical Medicine University of Copenhagen Denmark
- Department of Clinical Biochemistry Zealand University Hospital Køge Denmark
| | | | - Pia Rørbæk Kamstrup
- Department of Clinical Biochemistry Copenhagen University Hospital-Herlev and Gentofte Herlev Denmark
| | - Henning Bundgaard
- Department of Clinical Medicine University of Copenhagen Denmark
- Department of Cardiology Copenhagen University Hospital-Rigshospitalet Copenhagen Denmark
| | - Christian Torp-Pedersen
- Department of Public Health University of Copenhagen Denmark
- Department of Cardiology Copenhagen University Hospital-North Zealand Hillerød Denmark
| | - Kasper Karmark Iversen
- Department of Emergency Medicine Copenhagen University Hospital-Herlev and Gentofte Herlev Denmark
- Department of Cardiology Copenhagen University Hospital-Herlev and Gentofte Herlev Denmark
- Department of Clinical Medicine University of Copenhagen Denmark
- Department of Internal Medicine Copenhagen University Hospital-Herlev and Gentofte Herlev Denmark
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Thevathasan T, Gregers E, Rasalingam Mørk S, Degbeon S, Linde L, Bønding Andreasen J, Smerup M, Eifer Møller J, Hassager C, Laugesen H, Dreger H, Brand A, Balzer F, Landmesser U, Juhl Terkelsen C, Flensted Lassen J, Skurk C, Søholm H. Lactate and lactate clearance as predictors of one-year survival in extracorporeal cardiopulmonary resuscitation - An international, multicentre cohort study. Resuscitation 2024; 198:110149. [PMID: 38403182 DOI: 10.1016/j.resuscitation.2024.110149] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 02/09/2024] [Accepted: 02/18/2024] [Indexed: 02/27/2024]
Abstract
AIM Extracorporeal cardiopulmonary resuscitation (ECPR) can be considered in selected patients with refractory cardiac arrest. Given the risk of patient futility and high resource utilisation, identifying ECPR candidates, who would benefit from this therapy, is crucial. Previous ECPR studies investigating lactate as a potential prognostic marker have been small and inconclusive. In this study, it was hypothesised that the lactate level (immediately prior to initiation of ECPR) and lactate clearance (within 24 hours after ECPR initiation) are predictors of one-year survival in a large, multicentre study cohort of ECPR patients. METHODS Adult patients with refractory cardiac arrest at three German and four Danish tertiary cardiac care centres between 2011 and 2021 were included. Pre-ECPR lactate and 24-hour lactate clearance were divided into three equally sized tertiles. Multivariable logistic regression analyses and Kaplan-Meier analyses were used to analyse survival outcomes. RESULTS 297 adult patients with refractory cardiac arrest were included in this study, of which 65 (22%) survived within one year. The pre-ECPR lactate level and 24-hour lactate clearance were level-dependently associated with one-year survival: OR 5.40 [95% CI 2.30-13.60] for lowest versus highest pre-ECPR lactate level and OR 0.25 [95% CI 0.09-0.68] for lowest versus highest 24-hour lactate clearance. Results were confirmed in Kaplan-Meier analyses (each p log rank < 0.001) and subgroup analyses. CONCLUSION Pre-ECPR lactate levels and 24 hour-lactate clearance after ECPR initiation in patients with refractory cardiac arrest were level-dependently associated with one-year survival. Lactate is an easily accessible and quickly available point-of-care measurement which might be considered as an early prognostic marker when considering initiation or continuation of ECPR treatment.
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Affiliation(s)
- Tharusan Thevathasan
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany; Berlin Institute of Health, Anna-Louisa-Karsch-Straße 2, 10178 Berlin, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Potsdamer Str. 58, 10785 Berlin, Germany; Institute of Medical Informatics, Charité - Universitätsmedizin Berlin, Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany
| | - Emilie Gregers
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Sivagowry Rasalingam Mørk
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Blvd. 161, 8200 Aarhus, Denmark
| | - Sêhnou Degbeon
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Louise Linde
- Department of Cardiology, Odense University Hospital, J. B. Winsløws Vej 4, 5000 Odense, Denmark; Department of Clinical Research, University of Southern Denmark, J. B. Winsløws Vej 17, 5000 Odense, Denmark
| | - Jo Bønding Andreasen
- Department of Anesthesiology and Intensive Medicine, Aalborg University Hospital, Hobrovej 18-22, 9000 Aalborg, Denmark
| | - Morten Smerup
- Department of Cardiothoracic Surgery, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Jacob Eifer Møller
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark; Department of Cardiology, Odense University Hospital, J. B. Winsløws Vej 4, 5000 Odense, Denmark; Department of Clinical Research, University of Southern Denmark, J. B. Winsløws Vej 17, 5000 Odense, Denmark
| | - Christian Hassager
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
| | - Helle Laugesen
- Department of Anesthesiology and Intensive Medicine, Aalborg University Hospital, Hobrovej 18-22, 9000 Aalborg, Denmark
| | - Henryk Dreger
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Campus Virchow Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Anna Brand
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany
| | - Felix Balzer
- Institute of Medical Informatics, Charité - Universitätsmedizin Berlin, Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany
| | - Ulf Landmesser
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany; Berlin Institute of Health, Anna-Louisa-Karsch-Straße 2, 10178 Berlin, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Potsdamer Str. 58, 10785 Berlin, Germany
| | - Christian Juhl Terkelsen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Blvd. 161, 8200 Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; The Danish Heart Foundation, Vognmagergade 7, 3rd Floor, 1120 Copenhagen, Denmark
| | - Jens Flensted Lassen
- Department of Cardiology, Odense University Hospital, J. B. Winsløws Vej 4, 5000 Odense, Denmark; Department of Clinical Research, University of Southern Denmark, J. B. Winsløws Vej 17, 5000 Odense, Denmark
| | - Carsten Skurk
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Potsdamer Str. 58, 10785 Berlin, Germany.
| | - Helle Søholm
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark; Department of Cardiology, Zealand University Hospital Roskilde, Sygehusvej 10, 4000 Roskilde, Denmark
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4
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Gregers E, Kragholm K, Linde L, Mørk SR, Andreasen JB, Terkelsen CJ, Lassen JF, Møller JE, Laugesen H, Smerup M, Kjærgaard J, Møller-Sørensen PH, Holmvang L, Torp-Pedersen C, Hassager C, Søholm H. Return to Work After Refractory Out-of-Hospital Cardiac Arrest in Patients Managed With or Without Extracorporeal Cardiopulmonary Resuscitation: A Nationwide Register-Based Study. J Am Heart Assoc 2024; 13:e034024. [PMID: 38533974 DOI: 10.1161/jaha.123.034024] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Accepted: 02/19/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND Extracorporeal cardiopulmonary resuscitation (ECPR) is increasingly used for refractory out-of-hospital cardiac arrest (OHCA). However, survivors managed with ECPR are at risk of poor functional status. The purpose of this study was to investigate return to work (RTW) after refractory OHCA. METHODS AND RESULTS Of 44 360 patients with OHCA in the period of 2011 to 2020, this nationwide registry-based study included 805 patients with refractory OHCA in the working age (18-65 years) who were employed before OHCA (2% of the total OHCA cohort). Demographics, prehospital characteristics, status at hospital arrival, employment status, and survival were retrieved through the Danish national registries. Sustainable RTW was defined as RTW for ≥6 months without any long sick leave relapses. Median follow-up time was 4.1 years. ECPR and standard advanced cardiovascular life support were applied in 136 and 669 patients, respectively. RTW 1 year after OHCA was similar (39% versus 54%; P=0.2) and sustainable RTW was high in both survivors managed with ECPR and survivors managed with standard advanced cardiovascular life support (83% versus 85%; P>0.9). Younger age and shorter length of hospitalization were associated with RTW in multivariable Cox analysis, whereas ECPR was not. CONCLUSIONS In refractory OHCA-patients employed prior to OHCA, approximately 1 out of 2 patients were employed after 1 year with no difference between patients treated with ECPR or standard advanced cardiovascular life support. Younger age and shorter length of hospitalization were associated with RTW while ECPR was not.
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Affiliation(s)
- Emilie Gregers
- Department of Cardiology Rigshospitalet Copenhagen Denmark
| | - Kristian Kragholm
- Department of Cardiology Aalborg University Hospital Aalborg Denmark
- Department of Clinical Medicine Aalborg University Aalborg Denmark
| | - Louise Linde
- Department of Cardiology Odense University Hospital Odense Denmark
| | | | | | - Christian Juhl Terkelsen
- Department of Cardiology Aarhus University Hospital Aarhus Denmark
- Department of Clinical Medicine Aarhus University Aarhus Denmark
| | - Jens Flensted Lassen
- Department of Cardiology Odense University Hospital Odense Denmark
- Department of Clinical Medicine University of Southern Denmark Copenhagen Denmark
| | - Jacob Eifer Møller
- Department of Cardiology Rigshospitalet Copenhagen Denmark
- Department of Cardiology Odense University Hospital Odense Denmark
- Department of Clinical Medicine University of Southern Denmark Copenhagen Denmark
| | - Helle Laugesen
- Department of Anaesthesiology Aalborg University Hospital Aalborg Denmark
| | - Morten Smerup
- Department of Cardiothoracic Surgery Rigshospitalet Copenhagen Denmark
- Department of Clinical Medicine Copenhagen University Copenhagen Denmark
| | | | | | - Lene Holmvang
- Department of Cardiology Rigshospitalet Copenhagen Denmark
- Department of Clinical Medicine Copenhagen University Copenhagen Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology North Zealand Hospital Hillerød Denmark
- Department of Public Health Copenhagen University Copenhagen Denmark
| | - Christian Hassager
- Department of Cardiology Rigshospitalet Copenhagen Denmark
- Department of Clinical Medicine Copenhagen University Copenhagen Denmark
| | - Helle Søholm
- Department of Cardiology Rigshospitalet Copenhagen Denmark
- Department of Cardiology Zealand University Hospital Roskilde Roskilde Denmark
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5
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De Maria GL, Greenwood JP, Zaman AG, Carrié D, Coste P, Valgimigli M, Behan M, Berry C, Erglis A, Panoulas VF, Van Belle E, Juhl Terkelsen C, Hunziker Munsch L, Jain AK, Lassen JF, Palmer N, Stone GW, Banning AP. Pressure-Controlled Intermittent Coronary Sinus Occlusion (PiCSO) in Acute Myocardial Infarction: The PiCSO-AMI-I Trial. Circ Cardiovasc Interv 2024; 17:e013675. [PMID: 38626079 DOI: 10.1161/circinterventions.123.013675] [Citation(s) in RCA: 1] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 01/09/2024] [Indexed: 04/18/2024]
Abstract
BACKGROUND Primary percutaneous coronary intervention (pPCI) has improved clinical outcomes in patients with ST-segment-elevation myocardial infarction. However, as many as 50% of patients still have suboptimal myocardial reperfusion and experience extensive myocardial necrosis. The PiCSO-AMI-I trial (Pressure-Controlled Intermittent Coronary Sinus Occlusion-Acute Myocardial Infarction-I) evaluated whether PiCSO therapy can further reduce myocardial infarct size (IS) in patients undergoing pPCI. METHODS Patients with anterior ST-segment-elevation myocardial infarction and Thrombolysis in Myocardial Infarction flow 0-1 were randomized at 16 European centers to PiCSO-assisted pPCI or conventional pPCI. The PiCSO Impulse Catheter (8Fr balloon-tipped catheter) was inserted via femoral venous access after antegrade flow restoration of the culprit vessel and before proceeding with stenting. The primary end point was the difference in IS (expressed as a percentage of left ventricular mass) at 5 days by cardiac magnetic resonance. Secondary end points were the extent of microvascular obstruction and intramyocardial hemorrhage at 5 days and IS at 6 months. RESULTS Among 145 randomized patients, 72 received PiCSO-assisted pPCI and 73 conventional pPCI. No differences were observed in IS at 5 days (27.2%±12.4% versus 28.3%±11.45%; P=0.59) and 6 months (19.2%±10.1% versus 18.8%±7.7%; P=0.83), nor were differences between PiCSO-treated and control patients noted in terms of the occurrence of microvascular obstruction (67.2% versus 64.6%; P=0.85) or intramyocardial hemorrhage (55.7% versus 60%; P=0.72). The study was prematurely discontinued by the sponsor with no further clinical follow-up beyond 6 months. However, up to 6 months of PiCSO use appeared safe with no device-related adverse events. CONCLUSIONS In this prematurely discontinued randomized trial, PiCSO therapy as an adjunct to pPCI did not reduce IS when compared with conventional pPCI in patients with anterior ST-segment-elevation myocardial infarction. PiCSO use was associated with increased procedural time and contrast but no increase in adverse events up to 6 months. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT03625869.
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Affiliation(s)
- Giovanni Luigi De Maria
- Oxford Heart Centre, Oxford University Hospitals NHS Trust, United Kingdom (G.L.D.M., A.P.B.)
- National Institute for Health Research Oxford Biomedical Research Centre, United Kingdom (G.L.D.M., A.P.B.)
| | - John P Greenwood
- Leeds University and Leeds Teaching Hospitals NHS Trust, United Kingdom (J.P.G.)
| | - Azfar G Zaman
- Cardiothoracic Centre, Freeman Hospital and Newcastle University, Newcastle upon Tyne, United Kingdom (A.G.Z.)
| | | | - Pierre Coste
- Hôpital Cardiologique du Haut Lévéque, University of Bordeaux, France (P.C.)
| | - Marco Valgimigli
- Istituto Cardiocentro Ticino-Ente Ospedaliero Cantonale, Lugano, Switzerland (M.V.)
| | - Miles Behan
- Edinburgh Heart Centre, United Kingdom (M.B.)
| | - Colin Berry
- Golden Jubilee National Hospital, Glasgow, United Kingdom (C.B.)
| | - Andrejs Erglis
- Pauls Stradins Clinical University Hospital, University of Latvia, Riga, Latvia (A.E.)
| | - Vasileios F Panoulas
- Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom (V.F.P.)
| | - Eric Van Belle
- Institut Coeur-Poumon, Centre Hospitalier Regional, INSERM U1011, Lille Cedex, France (E.V.B.)
| | | | | | - Ajay K Jain
- Barts Heart Centre, London, United Kingdom (A.K.J.)
| | | | - Nick Palmer
- Liverpool Heart and Chest Hospital, United Kingdom (N.P.)
| | - Gregg W Stone
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (G.W.S.)
| | - Adrian P Banning
- Oxford Heart Centre, Oxford University Hospitals NHS Trust, United Kingdom (G.L.D.M., A.P.B.)
- National Institute for Health Research Oxford Biomedical Research Centre, United Kingdom (G.L.D.M., A.P.B.)
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6
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Noori M, Christiansen EH, Raungaard B, Junker A, Christensen MK, Kahlert J, Maeng M, Freeman P, Hansen KN, Terkelsen CJ, Ellert-Gregersen J, Kristensen SD, Veien KT, Jakobsen L, Jensen LO. Long-term outcomes after coronary intervention with biodegradable polymer stents in patients with acute coronary syndromes. Catheter Cardiovasc Interv 2024; 103:276-285. [PMID: 38091338 DOI: 10.1002/ccd.30937] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 11/27/2023] [Accepted: 12/06/2023] [Indexed: 12/22/2023]
Abstract
BACKGROUND Patients with acute coronary syndromes (ACS) may have worse outcomes after percutaneous coronary intervention compared to patients without ACS. AIMS To compare 5-year efficacy and safety outcomes in patients with and without ACS treated with biodegradable polymers, the ultrathin strut sirolimus-eluting Orsiro stent (O-SES) or the biolimus-eluting Nobori stent (N-BES). METHODS The Scandinavian Organisation for Randomized Trials with Clinical Outcome VII is a randomized trial comparing O-SES and N-BES in an all-comer setting. Of 2525 patients, 1329 (53%) patients had ACS and 1196 (47%) patients were without ACS. Endpoints were target lesion failure (TLF) (a composite of cardiac death, target lesion myocardial infarction, or target lesion revascularization) and definite stent thrombosis within 5 years. RESULTS At 5-year follow-up, TLF did not differ significantly between patients with and without ACS (12.3% vs. 13.2%; rate ratio (RR) 1.00; 95% confidence interval (CI): 0.70-1.44), whereas the risk of definite stent thrombosis was increased in patients with ACS (2.3% vs. 1.3; RR: 2.01 [95% CI: 1.01-3.98]). In patients with ACS, the rate of TLF was similar between O-SES and N-BES (12.4% vs. 12.3%; RR: 1.02; 95% CI: 0.74-1.40). The reduced risk of definite stent thrombosis in O-SES treated ACS patients within the first year (0.2% vs. 1.6%; RR: 0.12; 95% CI: 0.02-0.93) was not maintained after 5 years (1.8% vs. 2.7%; RR: 0.77; 95% CI: 0.37-1.63). CONCLUSION Patients with ACS had an increased risk of stent thrombosis regardless of the stent type used. Long-term outcomes were similar for ACS patients treated with O-SES or N-BES at 5 years.
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Affiliation(s)
- Manijeh Noori
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | | | - Bent Raungaard
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Anders Junker
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | | | - Johnny Kahlert
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Michael Maeng
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Phillip Freeman
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | | | | | | | | | | | - Lars Jakobsen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
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7
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Kim WK, Möllmann H, Montorfano M, Ellert-Gregersen J, Rudolph TK, Van Mieghem NM, Hilker M, Amat-Santos I, Terkelsen CJ, Petronio AS, Stella P, Götberg M, Rück A, Kasel AM, Trillo R, Appleby C, Barbanti M, Blanke P, Asch FM, Modolo R, Allocco DJ, Tamburino C. Outcomes and performance of the ACURATE neo2 transcatheter heart valve in clinical practice: one-yearresults of the ACURATE neo2 PMCF Study. EUROINTERVENTION 2024; 20:85-94. [PMID: 37982152 PMCID: PMC10756225 DOI: 10.4244/eij-d-23-00823] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 10/23/2023] [Indexed: 11/21/2023]
Abstract
BACKGROUND Transcatheter aortic valve implantation is an effective treatment for patients with aortic stenosis; however, complications related to paravalvular leakage (PVL) persist, including increased risk of mortality, cardiovascular mortality, and rehospitalisation. AIMS We sought to evaluate the clinical outcomes and valve performance at 1 year in patients with severe aortic stenosis treated with the ACURATE neo2 valve in a post-market clinical setting. METHODS Valve Academic Research Consortium-2 safety events were assessed up to 1 year. Independent core laboratories evaluated echocardiographic measures of valve performance and hypoattenuated leaflet thickening (HALT; as measured by four-dimensional computed tomography). RESULTS The study enrolled 250 patients (64% female; mean age: 81 years; baseline Society of Thoracic Surgeons risk score: 2.9±2.0%); 246 patients were implanted with ACURATE neo2. All-cause mortality was 0.8% at 30 days and 5.1% at 1 year. The 1-year rates for stroke and disabling stroke were 3.0% and 1.3%, respectively. Overall, HALT of >50% leaflet involvement of at least one leaflet was present in 9% of patients at 30 days and in 12% of patients at 1 year. No association was observed between the presence of HALT and 1-year clinical or haemodynamic outcomes. Early haemodynamic improvements were maintained up to 1 year (mean aortic valve gradient: 47.6±14.5 mmHg at baseline, 7.6±3.2 mmHg at 1 year; mean aortic valve area: 0.7±0.2 cm2 at baseline, 1.7±0.4 cm2 at 1 year). At 1 year, 99% of patients had mild or no/trace PVL (<1% had moderate PVL; no patient had severe PVL). CONCLUSIONS The study outcomes confirm favourable performance and safety up to 1 year in patients treated with ACURATE neo2 in routine clinical practice. (ClinicalTrials.gov: NCT04655248).
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Affiliation(s)
| | | | - Matteo Montorfano
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy and Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Tanja K Rudolph
- Heart and Diabetes Center North Rhine-Westphalia, Bad Oeynhausen, Germany
| | | | | | | | | | | | - Pieter Stella
- University Medical Center Utrecht, Utrecht, the Netherlands
| | - Matthias Götberg
- Department of Cardiology, Skåne University Hospital, Lund University, Lund, Sweden
| | - Andreas Rück
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | | | - Ramiro Trillo
- Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain and Centro de Investigación Biomedica en Red Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Clare Appleby
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | | | - Philipp Blanke
- Department of Radiology, St Paul's Hospital & University of British Columbia, Vancouver, BC, Canada
| | | | | | | | - Corrado Tamburino
- Division of Cardiology, Azienda Ospedaliero Universitaria Policlinico G. Rodoloco-San Marco, Catania, Italy
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8
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Krasniqi L, Schødt Riber LP, Nissen H, Terkelsen CJ, Andersen NH, Freeman P, Povlsen JA, Gerke O, Clavel MA, Dahl JS. Impact of mandatory preoperative dental screening on post-procedural risk of infective endocarditis in patients undergoing transcatheter aortic valve implantation: a nationwide retrospective observational study. Lancet Reg Health Eur 2024; 36:100789. [PMID: 38188272 PMCID: PMC10769890 DOI: 10.1016/j.lanepe.2023.100789] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 11/02/2023] [Accepted: 11/03/2023] [Indexed: 01/09/2024]
Abstract
Background Guidelines recommend preoperative dental screening (PDS) prior to cardiac valve surgery, to reduce the incidence of prosthetic valve infective endocarditis (IE). However, limited data support these recommendations, particular in patients undergoing transcatheter aortic valve implantation (TAVI). We aimed to investigate the effect of mandatory PDS on risk of IE in patients undergoing TAVI. Methods In this observational study, a total of 1133 patients undergoing TAVI in Western-Denmark from 2020 to 2022 were included. Patients were categorized based on two implemented PDS practices: mandatory PDS (MPDS group), and no referral for PDS (NPDS group). Outcome data were retrieved from Danish registries and confirmed using medical records. The primary outcome was incidence of IE. Secondary outcomes were all-cause mortality and composite outcome of all-cause mortality and IE. Findings Of 568 patients in the MPDS group 126 (22.2%) underwent subsequent oral dental surgery, compared to 8 (1.4%) among 565 patients in the NPDS group. During a median follow-up of 1.9 years (interquartile range 1.4-2.5 years), 31 (2.7%) developed IE. The yearly incidence IE rate was 1.4% (0.8-2.3) and 1.5% (0.8-2.4) in MPDS and NPDS, respectively, p = 0.86. All-cause mortality rates were similar between groups (estimated 2-year overall mortality of 6.7% (4.8-9.2) vs. 4.7% (3.2-6.9), MPDS and NPDS, respectively, p = 0.15). Consistent findings were found in 712 propensity score-matched patients. Interpretation Mandatory PDS did not demonstrate reduced risk of IE or all-cause mortality compared to targeted PDS in patients undergoing TAVI. Funding The funder had no role in the study design, data management, or writing.
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Affiliation(s)
- Lytfi Krasniqi
- Department of Cardiac, Thoracic and Vascular Surgery, Odense University Hospital, Denmark
- Department of Clinical Research, University of Southern Denmark, Denmark
| | - Lars Peter Schødt Riber
- Department of Cardiac, Thoracic and Vascular Surgery, Odense University Hospital, Denmark
- Department of Clinical Research, University of Southern Denmark, Denmark
| | - Henrik Nissen
- Department of Cardiology, Odense University Hospital, Denmark
| | | | | | - Phillip Freeman
- Department of Cardiology, Aalborg University Hospital, Denmark
| | | | - Oke Gerke
- Department of Nuclear Medicine, Odense University Hospital, Denmark
- Department of Clinical Research, University of Southern Denmark, Denmark
| | | | - Jordi Sanchez Dahl
- Department of Cardiology, Odense University Hospital, Denmark
- Department of Clinical Research, University of Southern Denmark, Denmark
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9
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Pedersen CK, Stengaard C, Bøtker MT, Søndergaard HM, Dodt KK, Terkelsen CJ. Accelerated -Rule-Out of acute Myocardial Infarction using prehospital copeptin and in-hospital troponin: The AROMI study. Eur Heart J 2023; 44:3875-3888. [PMID: 37477353 PMCID: PMC10568000 DOI: 10.1093/eurheartj/ehad447] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 05/07/2023] [Accepted: 06/29/2023] [Indexed: 07/22/2023] Open
Abstract
AIMS The present acute myocardial infarction (AMI) rule-out strategies are challenged by the late temporal release of cardiac troponin. Copeptin is a non-specific biomarker of endogenous stress and rises early in AMI, covering the early period where troponin is still normal. An accelerated dual-marker rule-out strategy combining prehospital copeptin and in-hospital high-sensitivity troponin T could reduce length of hospital stay and thus the burden on the health care systems worldwide. The AROMI trial aimed to evaluate if the accelerated dual-marker rule-out strategy could safely reduce length of stay in patients discharged after early rule-out of AMI. METHODS AND RESULTS Patients with suspected AMI transported to hospital by ambulance were randomized 1:1 to either accelerated rule-out using copeptin measured in a prehospital blood sample and high-sensitivity troponin T measured at arrival to hospital or to standard rule-out using a 0 h/3 h rule-out strategy. The AROMI study included 4351 patients with suspected AMI. The accelerated dual-marker rule-out strategy reduced mean length of stay by 0.9 h (95% confidence interval 0.7-1.1 h) in patients discharged after rule-out of AMI and was non-inferior regarding 30-day major adverse cardiac events when compared to standard rule-out (absolute risk difference -0.4%, 95% confidence interval -2.5 to 1.7; P-value for non-inferiority = 0.013). CONCLUSION Accelerated dual marker rule-out of AMI, using a combination of prehospital copeptin and first in-hospital high-sensitivity troponin T, reduces length of hospital stay without increasing the rate of 30-day major adverse cardiac events as compared to using a 0 h/3 h rule-out strategy.
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Affiliation(s)
- Claus Kjær Pedersen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Blvd. 99, Aarhus N 8200, Denmark
| | - Carsten Stengaard
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Blvd. 99, Aarhus N 8200, Denmark
| | - Morten Thingemann Bøtker
- Research & Development, Prehospital Emergency Medical Services, Central Denmark Region, Olof Palmes Allé 34, Aarhus N 8200, Denmark
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Blvd. 82, Aarhus N 8200, Denmark
- Department of Anaesthesiology, Randers Regional Hospital, Skovlyvej 15, Randers NØ 8930, Denmark
| | | | - Karen Kaae Dodt
- Department of Internal Medicine, Horsens Regional Hospital, Sundvej 30, Horsens 8700, Denmark
| | - Christian Juhl Terkelsen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Blvd. 99, Aarhus N 8200, Denmark
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Meilandt C, Fink Vallentin M, Blumensaadt Winther K, Bach A, Dissing TH, Christensen S, Juhl Terkelsen C, Lass Klitgaard T, Mikkelsen S, Folke F, Granfeldt A, Andersen LW. Intravenous vs. intraosseous vascular access during out-of-hospital cardiac arrest - protocol for a randomised clinical trial. Resusc Plus 2023; 15:100428. [PMID: 37502742 PMCID: PMC10368931 DOI: 10.1016/j.resplu.2023.100428] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 06/27/2023] [Indexed: 07/29/2023] Open
Abstract
Objective During cardiac arrest, current guidelines recommend attempting intravenous access first and to consider intraosseous access if intravenous access is unsuccessful or impossible. However, these recommendations are only based on very low-certainty evidence. Therefore, the "Intravenous vs Intraosseous Vascular Access During Out-of-Hospital Cardiac Arrest" (IVIO) trial aims to determine whether there is a difference in patient outcomes depending on the type of vascular access attempted during out-of-hospital cardiac arrest. This current article describes the clinical IVIO trial. Methods The IVIO trial is an investigator-initiated, randomised trial of intravenous vs. intraosseous vascular access during adult non-traumatic out-of-hospital cardiac arrest in Denmark. The intervention will consist of minimum two attempts (if unsuccessful on the first attempt) to successfully establish intravenous or intraosseous vascular access during cardiac arrest. The intraosseous group will be further randomised to the humeral or tibial site. The primary outcome is sustained return of spontaneous circulation and key secondary outcomes include survival and survival with a favourable neurological outcome at 30 days. A total of 1,470 patients will be included. Results The trial started in March 2022 and the last patient is anticipated to be included in the spring of 2024. The primary results will be reported after 90-day follow-up and are anticipated in mid-2024. Conclusion The current article describes the design of the Danish IVIO trial. The findings of this trial will help inform future guidelines for selecting the optimal vascular access route during out-of-hospital cardiac arrest.
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Affiliation(s)
- Carsten Meilandt
- Prehospital Emergency Medical Services, Central Denmark Region, Denmark
| | | | | | - Allan Bach
- Prehospital Emergency Medical Services, Central Denmark Region, Denmark
| | - Thomas H. Dissing
- Prehospital Emergency Medical Services, Central Denmark Region, Denmark
- Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Denmark
| | - Steffen Christensen
- Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Denmark
- Department of Clinical Medicine, Aarhus University, Denmark
| | | | | | - Søren Mikkelsen
- The Prehospital Research Unit, Region of Southern Denmark, Denmark
| | - Fredrik Folke
- Copenhagen Emergency Medical Services, Capital Region of Denmark, Denmark
- Department of Cardiology, Herlev Gentofte University Hospital, Denmark
- Department of Clinical Medicine, University of Copenhagen, Denmark
| | - Asger Granfeldt
- Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Denmark
- Department of Clinical Medicine, Aarhus University, Denmark
| | - Lars W. Andersen
- Prehospital Emergency Medical Services, Central Denmark Region, Denmark
- Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Denmark
- Department of Clinical Medicine, Aarhus University, Denmark
- Department of Anesthesiology and Intensive Care, Viborg Regional Hospital, Viborg, Denmark
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11
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Thim T, Jakobsen L, Jensen RV, Støttrup N, Eftekhari A, Grove EL, Larsen SB, Sørensen JT, Carstensen S, Amiri S, Veien KT, Christiansen EH, Terkelsen CJ, Maeng M, Kristensen SD. Real-World Experience with Cangrelor as Adjuvant to Percutaneous Coronary Intervention: A Single-Centre Observational Study. Cardiol Res Pract 2023; 2023:3197512. [PMID: 37361000 PMCID: PMC10289876 DOI: 10.1155/2023/3197512] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 01/03/2023] [Accepted: 05/26/2023] [Indexed: 06/28/2023] Open
Abstract
Background Reversible P2Y12 inhibition can be obtained with cangrelor administered intravenously. More experience with cangrelor use in acute PCI with unknown bleeding risk is needed. Objectives To describe real-world use of cangrelor including patient and procedure characteristics and patient outcomes. Methods We performed a single-centre, retrospective, and observational study including all patients treated with cangrelor in relation to percutaneous coronary intervention at Aarhus University Hospital during the years 2016, 2017, and 2018. We recorded procedure indication and priority, the indications for cangrelor use, and patient outcomes within the first 48 hours after initiation of cangrelor treatment. Results We treated 991 patients with cangrelor in the study period. Of these, 869 (87.7%) had an acute procedure priority. Among acute procedures, patients were mainly treated for STEMI (n = 723) and the remaining were treated for cardiac arrest and acute heart failure. Use of oral P2Y12 inhibitors prior to percutaneous coronary intervention was rare. Fatal bleeding events (n = 6) were only observed among patients undergoing acute procedures. Stent thrombosis was observed in two patients receiving acute treatment for STEMI. Thus, cangrelor can be used in relation to PCI under acute circumstances with advantages in terms of clinical management. The benefits and risks, in terms of patient outcomes, should ideally be assessed in randomized trials.
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Affiliation(s)
- Troels Thim
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Lars Jakobsen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Nicolaj Støttrup
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Ashkan Eftekhari
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Erik Lerkevang Grove
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | | | | | - Steen Carstensen
- Emergency Department, Bispebjerg University Hospital, Bispebjerg, Denmark
| | - Sahar Amiri
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Evald Høj Christiansen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Christian Juhl Terkelsen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Michael Maeng
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Steen Dalby Kristensen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
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12
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Rasalingam Mørk S, Qvist Kristensen L, Christensen S, Tang M, Juhl Terkelsen C, Eiskjær H. Long-term survival, functional capacity and quality of life after refractory out-of-hospital cardiac arrest treated with mechanical circulatory support. Resusc Plus 2023; 14:100387. [PMID: 37056957 PMCID: PMC10085776 DOI: 10.1016/j.resplu.2023.100387] [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] [Received: 01/20/2023] [Revised: 03/21/2023] [Accepted: 03/23/2023] [Indexed: 04/08/2023] Open
Abstract
Introduction Studies on long-term outcomes after refractory out-of-hospital cardiac arrest (OHCA) treated with mechanical circulatory support (MCS) are limited. This study aimed to evaluate long-term neurologically intact survival, functional capacity and quality of life after refractory OHCA treated with MCS. Methods This was a follow-up study of survivors after refractory OHCA treated with MCS. Follow-up examinations comprised clinical assessment with transthoracic echocardiography and cardiopulmonary exercise test (CPX). Neurological and cognitive screening was evaluated with the Cerebral Performance Category (CPC) and Montreal Cognitive Assessment (MoCA test). A good neurological outcome was defined as CPC 1 or CPC 2. Health-related quality of life was measured by questionnaires (Short Form-36 (SF-36)). Results A total of 101 patients with refractory OHCA were treated with MCS at Aarhus University Hospital between 2015 and 2019. The total low-flow time was median 105 min [IQR, 94-123] minutes. The hospital discharge rate was 27%. At a mean follow-up time of 4.8 years ± 1.6 (range 2.8-6.1 years), 21 patients remained alive of whom 15 consented to participate in the present study. Good neurological outcome with CPC 1-2 was found in 93% (14/15) patients. No severe cognitive function was discovered; mean MoCA score of 26.4 ± 3.1. Functional capacity examined by CPX showed acceptable VO2 max values (23.9 ± 6.3 mL/kg/min). Mean SF-36 scores revealed an overall high level of quality of life in long-term survivors. Conclusions Long-term survival with a good neurological outcome with functional recovery was high in patients with refractory OHCA treated with MCS. These patients may expect a reasonable quality of life after discharge despite prolonged resuscitation.
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Affiliation(s)
- Sivagowry Rasalingam Mørk
- Department of Cardiology, Aarhus University Hospital, Denmark
- Faculty of Health, Aarhus University, Denmark
- Corresponding author at: Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark.
| | - Lola Qvist Kristensen
- Faculty of Health, Aarhus University, Denmark
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Denmark
| | - Steffen Christensen
- Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Denmark
- Prehospital Emergency Medical Service, Central Denmark Region, Denmark
| | - Mariann Tang
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Denmark
| | - Christian Juhl Terkelsen
- Department of Cardiology, Aarhus University Hospital, Denmark
- Faculty of Health, Aarhus University, Denmark
- The Danish Heart Foundation, Denmark
| | - Hans Eiskjær
- Department of Cardiology, Aarhus University Hospital, Denmark
- Faculty of Health, Aarhus University, Denmark
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13
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Elkoumy A, Jose J, Terkelsen CJ, Nissen H, Gunasekaran S, Abdelshafy M, Seth A, Elzomor H, Kumar S, Bedogni F, Ielasi A, Arsang-Jang S, Dora SK, Chandra S, Parikh K, Unic D, Baumbach A, Serruys P, Soliman O. One-Year Outcomes after Myval Implantation in Patients with Bicuspid Aortic Valve Stenosis-A Multicentre Real-World Experience. J Clin Med 2023; 12:jcm12062398. [PMID: 36983397 PMCID: PMC10054138 DOI: 10.3390/jcm12062398] [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] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/08/2023] [Accepted: 03/09/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND Bicuspid aortic valve (BAV) affects approximately 1.5% of the general population and is seen in nearly 50% of candidates for aortic valve replacement (AVR). Despite increasingly utilised transcatheter aortic valve implantation (TAVI) in aortic stenosis (AS) patients, its use among patients with severe bicuspid AS is limited as BAV is a heterogeneous disease associated with multiple and complex anatomical challenges. AIM To investigate the one-year outcomes of TAVI using the balloon-expandable Myval transcatheter heart valve (THV) (Meril Life Sciences Pvt. Ltd., Vapi, India) in patients with severe bicuspid AS. METHODS AND RESULTS We collected data from consecutive patients with bicuspid AS who underwent TAVI with the Myval THV and had at least one-year follow-up. Baseline characteristics, procedural, and 30-day echocardiographic and clinical outcomes were collected. Sixty-two patients were included in the study. The median age was 72 [66.3, 77.0] years, 45 (72.6%) were males, and the mean STS PROM score was 3.2 ± 2.2%. All TAVI procedures were performed via the transfemoral route. The median follow-up duration was 13.5 [12.2, 18.3] months; all-cause mortality was reported in 7 (11.3%) patients and cardiovascular hospitalisation in 6 (10.6%) patients. All-stroke was reported in 2 (3.2%), permanent pacemaker implantation 5 (8.3%), and myocardial infarction 1 (1.6%) patients. The echocardiographic assessment revealed a mean pressure gradient of 10 [8, 16.5] mmHg, effective orifice area 1.7 [1.4, 1.9] cm2, moderate AR in 1 (2%), mild AR in 14 (27%), and none/trace AR in 37 (71%). In total, 1 patient was diagnosed with valve thrombosis (2.1%), Stage II (moderate) haemodynamic deterioration was seen in 3 (6.4%), and stage III (severe) haemodynamic deterioration in 1 (2.1%) patient. CONCLUSIONS TAVI with the Myval THV in selected BAV anatomy is associated with favourable one-year hemodynamic and clinical outcomes.
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Affiliation(s)
- Ahmed Elkoumy
- Health Service Executive and CORRIB Core Lab, Discipline of Cardiology, Saolta Group, Galway University Hospital, University of Galway, H91 V4AY Galway, Ireland
- Islamic Center of Cardiology, Al-Azhar University, Cairo 11651, Egypt
| | - John Jose
- Christian Medical College & Hospital, Vellore 632004, India
| | | | - Henrik Nissen
- Department of Cardiology, Odense University Hospital, 5000 Odense, Denmark
| | | | - Mahmoud Abdelshafy
- Health Service Executive and CORRIB Core Lab, Discipline of Cardiology, Saolta Group, Galway University Hospital, University of Galway, H91 V4AY Galway, Ireland
- Department of Cardiology, Al-Azhar University, Cairo 11311, Egypt
| | - Ashok Seth
- Fortis Escorts Heart Institute, New Delhi 110025, India
| | - Hesham Elzomor
- Health Service Executive and CORRIB Core Lab, Discipline of Cardiology, Saolta Group, Galway University Hospital, University of Galway, H91 V4AY Galway, Ireland
| | - Sreenivas Kumar
- Department of Cardiology, Apollo Hospitals, Apollo Health City, Jubilee Hills, Hyderabad 500050, India
| | - Francesco Bedogni
- Department of Cardiology, IRCCS Policlinico San Donato, 20097 Milan, Italy
| | - Alfonso Ielasi
- Clinical and Interventional Cardiology Unit, Istituto Clinico Sant'Ambrogio, 20149 Milan, Italy
| | - Shahram Arsang-Jang
- Health Service Executive and CORRIB Core Lab, Discipline of Cardiology, Saolta Group, Galway University Hospital, University of Galway, H91 V4AY Galway, Ireland
- CÚRAM-SFI Research Centre for Medical Devices, H91 TK33 Galway, Ireland
| | | | - Sharad Chandra
- Department of Cardiology, King George's Medical University, Lucknow 226003, India
| | - Keyur Parikh
- Care Institute of Medical Sciences, Ahmedabad 380060, India
| | - Daniel Unic
- Department of Cardiac and Transplant Surgery, University Hospital Dubrava, 10000 Zagreb, Croatia
| | - Andreas Baumbach
- Barts Heart Centre, William Harvey Research Institute, Queen Mary University of London, London EC1M 6BQ, UK
| | - Patrick Serruys
- Health Service Executive and CORRIB Core Lab, Discipline of Cardiology, Saolta Group, Galway University Hospital, University of Galway, H91 V4AY Galway, Ireland
- Clinical and Interventional Cardiology Unit, Istituto Clinico Sant'Ambrogio, 20149 Milan, Italy
- National Heart and Lung Institute (NHLI), Imperial College London, London SW7 2AZ, UK
| | - Osama Soliman
- Health Service Executive and CORRIB Core Lab, Discipline of Cardiology, Saolta Group, Galway University Hospital, University of Galway, H91 V4AY Galway, Ireland
- CÚRAM-SFI Research Centre for Medical Devices, H91 TK33 Galway, Ireland
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14
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Råmunddal T, Holck EN, Karim S, Eftekhari A, Escaned J, Ioanes D, Walsh S, Spratt J, Veien K, Jensen LO, Tilsted HH, Terkelsen CJ, Havndrup O, Olsen NT, Kajander OA, Faurie B, Lanematt P, Jakobsen L, Christiansen EH. International randomized trial on the effect of revascularization or optimal medical therapy of chronic total coronary occlusions with myocardial ischemia - ISCHEMIA-CTO trial - rationale and design. Am Heart J 2023; 257:41-50. [PMID: 36423733 DOI: 10.1016/j.ahj.2022.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 11/11/2022] [Accepted: 11/15/2022] [Indexed: 05/11/2023]
Abstract
BACKGROUND Chronic total occlusions (CTO) are frequent among patients with coronary artery disease. Revascularization with percutaneous coronary intervention (PCI) is safe and feasible in experienced hands. However, randomized data are needed to demonstrate symptomatic as well as prognostic effect of CTO-PCI compared to optimal medical therapy alone. METHODS This trial aims to evaluate the effect of CTO PCI in patients with a CTO lesion and target vessel diameter ≥ 2.5 mm, and myocardial ischemia in the relevant territory. First, all patients are subjected to optimal medical therapy (OMT) for at least for 3 months and non-CTO lesions are managed according to guidelines. Subsequently, prior to randomization myocardial ischemia and quality of life (Seattle Questionnaire (SAQ)) is assessed. Patients are divided into two cohorts based on their SAQ score and randomized to either OMT alone or OMT and CTO-PCI. Cohort A is defined as Low- or asymptomatic patients with a quality-of-life score > 60 and/or CCS class < 2, and more than 10 % ischemia in the left ventricle (LV). Cohort B is symptomatic patients with a quality-of-life score < 60 or CCS class angina > 1 and at least ischemia in 5% of the LV. The primary end-point in cohort A is a composite of major adverse cardiac and cerebral events, hospitalization for heart failure and malignant ventricular arrhythmias. The primary endpoint in cohort B is difference in quality of life 6 months after randomization. IMPLICATIONS This trial is designed to investigate if CTO-PCI improves QoL and MACCE. Both positive and negative outcome of the trial will affect future guidelines and recommendations on how to treat patients with CTO.
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Affiliation(s)
| | | | - Salma Karim
- Dept. Cardiology Aarhus University Hospital, Skejby, Denmark
| | - Ashkan Eftekhari
- Dept. of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Javier Escaned
- Hospital Universitario Clíníco San Carlos, Madrid, Spain
| | - Dan Ioanes
- Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Simon Walsh
- Cardiology Department, Belfast Health & Social Care Trust Belfast, Northern Ireland, United Kingdom
| | - James Spratt
- Edinburgh Royal Infirmary, Edinburgh, United Kingdom
| | | | | | | | | | | | - Niels Thue Olsen
- Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
| | - Olli A Kajander
- Tays Heart Hospital and Tampere University, Tampere, Finland
| | - Benjamin Faurie
- Cardiovascular Institute, Groupe Hospitalier Mutualiste, Grenoble, France
| | | | - Lars Jakobsen
- Dept. Cardiology Aarhus University Hospital, Skejby, Denmark
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15
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Linde L, Mørk SR, Gregers E, Andreasen JB, Lassen JF, Ravn HB, Schmidt H, Riber LP, Thomassen SA, Laugesen H, Eiskjær H, Terkelsen CJ, Christensen S, Tang M, Moeller-Soerensen H, Holmvang L, Kjaergaard J, Hassager C, Moller JE. Selection of patients for mechanical circulatory support for refractory out-of-hospital cardiac arrest. Heart 2023; 109:216-222. [PMID: 36371665 PMCID: PMC9872231 DOI: 10.1136/heartjnl-2022-321405] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 08/12/2022] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVE To describe characteristics of patients admitted with refractory cardiac arrest for possible extracorporeal cardiopulmonary resuscitation (ECPR) and gain insight into the reasons for refraining from treatment in some. METHODS Nationwide retrospective cohort study involving all tertiary centres providing ECPR in Denmark. Consecutive patients admitted with ongoing chest compression for evaluation for ECPR treatment were enrolled. Presenting characteristics, duration of no-flow and low-flow time, end-tidal carbon dioxide (ETCO2), lactate and pH, and recording of reasons for refraining from ECPR documented by the treating team were recorded. Outcomes were survival to intensive care unit admission and survival to hospital discharge. RESULTS Of 579 patients admitted with refractory cardiac arrest for possible ECPR, 221 patients (38%) proceeded to ECPR and 358 patients (62%) were not considered candidates. Median prehospital low-flow time was 70 min (IQR 56 to 85) in ECPR patients and 62 min (48 to 81) in no-ECPR patients, p<0.001. Intra-arrest transport was more than 50 km in 92 (42%) ECPR patients and 135 in no-ECPR patients (38%), p=0.25. The leading causes for not initiating ECPR stated by the treating team were duration of low-flow time in 39%, severe metabolic derangement in 35%, and in 31% low ETCO2. The prevailing combination of contributing factors were non-shockable rhythm, low ETCO2, and metabolic derangement or prehospital low-flow time combined with low ETCO2. Survival to discharge was only achieved in six patients (1.7%) in the no-ECPR group. CONCLUSIONS In this large nationwide study of patients admitted for possible ECPR, two-thirds of patients were not treated with ECPR. The most frequent reasons to abstain from ECPR were long duration of prehospital low-flow time, metabolic derangement and low ETCO2.
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Affiliation(s)
- Louise Linde
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | | | - Emilie Gregers
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Kobenhavn, Denmark
| | - Jo Bønding Andreasen
- Department of Anesthesiology and Intensive Care, Aalborg University Hospital, Aalborg, Denmark
| | | | - Hanne Berg Ravn
- Department of Anesthesiology and Intensive Care, Odense University Hospital, Odense, Denmark
| | - Henrik Schmidt
- Department of Anesthesiology and Intensive Care, Odense University Hospital, Odense, Denmark
| | - Lars Peter Riber
- Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, Odense, Denmark
| | - Sisse Anette Thomassen
- Department of Anesthesiology and Intensive Care, Aalborg University Hospital, Aalborg, Denmark
| | - Helle Laugesen
- Department of Anesthesiology and Intensive Care, Aalborg University Hospital, Aalborg, Denmark
| | - Hans Eiskjær
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Steffen Christensen
- Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Mariann Tang
- Department of Thoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
| | | | - Lene Holmvang
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Kobenhavn, Denmark
| | - Jesper Kjaergaard
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Kobenhavn, Denmark,Department Clinical Medicine, Copenhagen University, Kobenhavn, Denmark
| | - Christian Hassager
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Kobenhavn, Denmark,Department Clinical Medicine, Copenhagen University, Kobenhavn, Denmark
| | - Jacob Eifer Moller
- Department of Cardiology, Odense University Hospital, Odense, Denmark .,Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Kobenhavn, Denmark
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16
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Thuesen L, Terkelsen CJ, Jensen LO, Efekthari A, Christensen MK, Nørgaard BL, Maeng M, Jakobsen CJ. Differences in diagnostication, and revascularisation of ischaemic heart disease in Western Denmark. Dan Med J 2023; 70:A01220007. [PMID: 36892218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
Abstract
INTRODUCTION In Denmark, the incidence of and mortality from ischaemic heart disease (IHD) has been declining. In this context, it is of interest to assess any regional differences in diagnostication and invasive treatment of IHD. METHODS We intended to describe the diagnostication and invasive treatment of IHD in Western Denmark at the regional/municipal level using the Western Denmark Heart Registry. Coronary angiography (CAG), percutaneous coronary intervention (PCI) and coronary arterial bypass grafting were registered from 2000 through 2019; cardiac multislice computed tomography (CMCT), from 2015 through 2019. RESULTS Concerning the use of revascularisation for acute coronary syndrome (ACS), we found comparable regional activity levels but significant differences between individual municipalities. Furthermore, the use of CAG for chronic coronary syndrome (CCS) was significantly higher and the use of CMCT significantly lower in the North Denmark Region than in the Central and South Denmark Regions. CONCLUSION We found differences in the rates of PCI for ACS at the municipal level but not between the Western Denmark regions. Furthermore, at the regional level, evaluation of chronic IHD differed regarding use of elective CAG and CMCT, and use of CMCT was not paralleled by a reduction in the number of CAG procedures. This may possibly prompt discussions on the strategy for invasive and non-invasive diagnosis of CCS and on targeted preventive measures. FUNDING none TRIAL REGISTRATION. not relevant.
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Affiliation(s)
- Leif Thuesen
- Department of Cardiology, Aalborg University Hospital
| | | | | | | | | | | | - Michael Maeng
- Department of Cardiology, Aarhus University Hospital.,Department of Clinical Medicine, Aarhus University
| | - Carl-Johan Jakobsen
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Denmark
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17
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Pedersen ALD, Povlsen JA, Rasmussen VG, Frederiksen CA, Christiansen EH, Terkelsen CJ, Vase H, Poulsen SH. Prognostic implications of residual left ventricular hypertrophy and systolic dysfunction in aortic stenosis following transcatheter aortic valve replacement. Int J Cardiovasc Imaging 2023; 39:13-22. [PMID: 36598683 DOI: 10.1007/s10554-022-02688-8] [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: 05/25/2022] [Accepted: 07/01/2022] [Indexed: 01/07/2023]
Abstract
The impact of left ventricle (LV) hypertrophy (LVH) regression on contractility-associated measures, the extent of residual cardiac dysfunction and prognostic implications after the initial remodeling process after transcatheter aortic valve replacement (TAVR) has not been investigated. We aimed to assess whether greater LV mass regression from pre-TAVR to 12-months after TAVR was associated with increased systolic function; and assess the prognostic value of residual LVH, systolic function and contractility-associated measures 12-months after TAVR. A total of 439 symptomatic patients were included and examined by echocardiography. LVH regression was assessed as percentage change in LV mass index (LVMi) from baseline to 12-months after TAVR. Midwall fractional shortening (mFS) and stress-corrected (SC-mFS) were used as contractility-associated measures. Primary outcome was all-cause mortality. SC-mFS increased from 0.94 (0.7) at baseline (BS) to 1.22 (0.7) (p < 0.05) 12-months after TAVR for patients with the most LVH regression, compared to patients with no LV regression (BS 1.06 (0.7) to 1.04 (0.5), NS). At 12-months after TAVR, multivariate analysis showed independent prognostic value of LVEF < 50% or GLS < 15% (HR 1.59, p = 0.049) and mFS < 14% (HR 1.99, p = 0.002) for future all cause death. LVH regression in AS after TAVR is associated with significant improvements of LV systolic function in contrast to patients without LV regression. Residual LVH and subsequent LV systolic dysfunction is substantial 12 months after TAVR and are associated with reduced survival. Impaired mFS and the combination of abnormal LVEF or GLS independently predicted all-cause mortality beyond 12 months after TAVR.
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Affiliation(s)
| | - Jonas Agerlund Povlsen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Vibeke Guldbrand Rasmussen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | | | - Evald Høj Christiansen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Christian Juhl Terkelsen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Henrik Vase
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Steen Hvitfeldt Poulsen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
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18
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Sabbah M, Veien K, Niemela M, Freeman P, Linder R, Ioanes D, Terkelsen CJ, Kajander OA, Koul S, Savontaus M, Karjalainen P, Erglis A, Minkkinen M, Jørgensen T, Sondergaard L, De Backer O, Engstrøm T, Lønborg J. Routine revascularization with percutaneous coronary intervention in patients with coronary artery disease undergoing transcatheter aortic valve implantation - the third nordic aortic valve intervention trial - NOTION-3. Am Heart J 2023; 255:39-51. [PMID: 36220354 DOI: 10.1016/j.ahj.2022.10.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 08/24/2022] [Accepted: 10/05/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Coronary artery disease (CAD) frequently coexists with severe aortic valve stenosis (AS) in patients planned for transcatheter aortic valve implantation (TAVI). How to manage CAD in this patient population is still an unresolved question. In particular, it is still not known whether fractional flow reserve (FFR) guided revascularization with percutaneous coronary intervention (PCI) is superior to medical treatment for CAD in terms of clinical outcomes. STUDY DESIGN The third Nordic Aortic Valve Intervention (NOTION-3) Trial is an open-label investigator-initiated, multicenter multinational trial planned to randomize 452 patients with severe AS and significant CAD to either FFR-guided PCI or medical treatment, in addition to TAVI. Patients are eligible for the study in the presence of at least 1 significant PCI-eligible coronary stenosis. A significant stenosis is defined as either FFR ≤0.80 and/or diameter stenosis >90%. The primary end point is a composite of first occurring all-cause mortality, myocardial infarction, or urgent revascularization (PCI or coronary artery bypass graft performed during unplanned hospital admission) until the last included patient have been followed for 1 year after the TAVI. SUMMARY NOTION-3 is a multicenter, multinational randomized trial aiming at comparing FFR-guided revascularization vs medical treatment of CAD in patients with severe AS planned for TAVI.
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Affiliation(s)
- Muhammad Sabbah
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Denmark
| | - Karsten Veien
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Matti Niemela
- Department of Cardiology, Oulu University Hospital, University of Oulu, Finland
| | - Phillip Freeman
- Department of Cardiology, Aalborg University Hospital, Denmark
| | - Rickard Linder
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden; Division of Cardiovascular Medicine, Department of Clinical Sciences, Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden
| | - Dan Ioanes
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Christian Juhl Terkelsen
- The Danish Heart Foundation; Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Olli A Kajander
- Heart and Lung Center, Helsinki University Hospital and Helsinki University, Helsinki, Finland
| | - Sasha Koul
- Department of Cardiology, Clinical Sciences, Lund University, Skane University Hospital, Lund, Sweden
| | | | - Pasi Karjalainen
- Heart and Lung Center, Helsinki University Hospital and Helsinki University, Helsinki, Finland
| | | | - Mikko Minkkinen
- Heart and Lung Center, Helsinki University Hospital and Helsinki University, Helsinki, Finland
| | - Troels Jørgensen
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Denmark
| | - Lars Sondergaard
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Denmark; Department of Clinical Medicine, University of Copenhagen, Denmark
| | - Ole De Backer
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Denmark
| | - Thomas Engstrøm
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Denmark; Department of Clinical Medicine, University of Copenhagen, Denmark
| | - Jacob Lønborg
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Denmark.
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19
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Hansen KN, Jensen LO, Maeng M, Christensen MK, Noori M, Kahlert J, Jakobsen L, Junker A, Freeman P, Ellert-Gregersen J, Raungaard B, Terkelsen CJ, Veien KT, Christiansen EH. Five-Year Clinical Outcome of the Biodegradable Polymer Ultrathin Strut Sirolimus-Eluting Stent Compared to the Biodegradable Polymer Biolimus-Eluting Stent in Patients Treated With Percutaneous Coronary Intervention: From the SORT OUT VII Trial. Circ Cardiovasc Interv 2023; 16:e012332. [PMID: 36649389 DOI: 10.1161/circinterventions.122.012332] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Biodegradable polymer drug-eluting stents were developed to improve safety and efficacy outcomes for patients undergoing percutaneous coronary intervention. However, few long-term follow-up efficacy studies are available. The study sought to investigate 5-year results from the SORT OUT VII trial (Scandinavian Organization for Randomized Trials With Clinical Outcome) comparing the biodegradable polymer ultrathin-strut sirolimus-eluting Orsiro stent (O-SES) versus the biodegradable polymer biolimus-eluting Nobori stent (N-BES). METHODS This registry-based, randomized, multicenter, single-blinded, noninferiority trial compared O-SES and N-BES in an all-comer population. The composite primary end point, target lesion failure, consisted of cardiac death, myocardial infarction related to the target lesion, or target lesion revascularization within 1 year. Follow-up was extended to 5 years. RESULTS Five-year follow-up was completed for 2521 patients (99.8%). Five-year target lesion failure did not differ between O-SES (12.4%) and N-BES (13.1%; rate ratio [RR], 0.94 [95% CI, 0.75-1.18]). Cardiac death (RR, 0.95 [95% CI, 0.67-1.34]), target myocardial infarction (RR, 1.14 [95% CI, 0.76-1.71]), target lesion revascularization (RR, 0.90 [95% CI, 0.67-1.21]), and definite stent thrombosis rates (RR, 0.73 [95% CI, 0.41-1.33]) did not differ significantly between the 2 stents. Within the first year, definite ST was significantly lower for O-SES (0.4%) compared to N-BES (1.2%; RR, 0.33 [95% CI, 0.12-0.92]), but no difference was from 1 through 5 years: O-SES 1.2% and N-BES 0.9% (RR, 1.28 [95% CI, 0.58-2.82]). CONCLUSIONS Five years after treatment with biodegradable polymer stents, target lesion failure did not differ among O-SES and N-BES. Definite stent thrombosis was less often seen within the first year in the O-SES but the difference was not maintained after 5 years. REGISTRATION URL: https://clinicaltrials.gov; Unique identifier: NCT01879358.
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Affiliation(s)
- Kirstine Nørregaard Hansen
- Department of Cardiology, Odense University Hospital, Denmark (K.N.H., L.O.J., M.N., A.J., J.E.-G., K.T.V.)
| | - Lisette Okkels Jensen
- Department of Cardiology, Odense University Hospital, Denmark (K.N.H., L.O.J., M.N., A.J., J.E.-G., K.T.V.)
| | - Michael Maeng
- Department of Cardiology, Aarhus University Hospital, Denmark (M.M., L.J., C.J.T., E.H.C.)
| | | | - Manijeh Noori
- Department of Cardiology, Odense University Hospital, Denmark (K.N.H., L.O.J., M.N., A.J., J.E.-G., K.T.V.)
| | - Johnny Kahlert
- Department of Clinical Epidemiology, Aarhus University Hospital, Denmark (J.K.)
| | - Lars Jakobsen
- Department of Cardiology, Aarhus University Hospital, Denmark (M.M., L.J., C.J.T., E.H.C.)
| | - Anders Junker
- Department of Cardiology, Odense University Hospital, Denmark (K.N.H., L.O.J., M.N., A.J., J.E.-G., K.T.V.)
| | - Phillip Freeman
- Department of Cardiology, Aalborg University Hospital, Denmark (M.K.C., P.F., B.R.)
| | - Julia Ellert-Gregersen
- Department of Cardiology, Odense University Hospital, Denmark (K.N.H., L.O.J., M.N., A.J., J.E.-G., K.T.V.)
| | - Bent Raungaard
- Department of Cardiology, Aalborg University Hospital, Denmark (M.K.C., P.F., B.R.)
| | | | - Karsten Tange Veien
- Department of Cardiology, Odense University Hospital, Denmark (K.N.H., L.O.J., M.N., A.J., J.E.-G., K.T.V.)
| | - Evald Høj Christiansen
- Department of Cardiology, Aarhus University Hospital, Denmark (M.M., L.J., C.J.T., E.H.C.)
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20
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Kim WK, Tamburino C, Möllmann H, Montorfano M, Ellert-Gregersen J, Rudolph TK, Van Mieghem NM, Hilker M, Amat-Santos IJ, Terkelsen CJ, Petronio AS, Stella PR, Götberg M, Rück A, Kasel AM, Trillo R, Appleby C, Barbanti M, Blanke P, Modolo R, Allocco DJ, Sondergaard L. Clinical outcomes of the ACURATE neo2 transcatheter heart valve: a prospective, multicenter, observational, post-market surveillance study. EUROINTERVENTION 2022; 19:EIJ-D-22-00914. [PMID: 36440588 PMCID: PMC10173758 DOI: 10.4244/eij-d-22-00914] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 11/22/2022] [Indexed: 05/14/2023]
Abstract
BACKGROUND The next-generation ACURATE neo2 transcatheter aortic valve was designed for simplified implantation and to mitigate the risk of paravalvular leak (PVL) compared to the earlier device. AIMS To collect clinical outcomes and device performance data, including echocardiography and 4-dimensional computed tomography (4D-CT) data, with the ACURATE neo2 transcatheter heart valve in patients with severe aortic stenosis (AS). METHODS ACURATE neo2 PMCF is a single-arm, multicentre study of patients with severe AS treated in routine clinical practice. The primary safety endpoint was all-cause mortality at 30-days. The primary imaging endpoint was hypo-attenuated leaflet thickening (HALT), measured by core laboratory-adjudicated 4D-CT at 30 days. Secondary endpoints included VARC safety endpoints, procedural success, and evaluation of valve performance via core laboratory-adjudicated echocardiography. RESULTS The study enrolled 250 patients at 18 European centres (mean age: 80.8 years; 63.6% female; mean STS score: 2.9±2.0%); 246 (98.4%) were successfully treated with ACURATE neo2. The 30-day rates for mortality and disabling stroke were 0.8% and 0%, respectively. The new permanent pacemaker implantation rate was 6.5%. HALT >50% was present in 9.3% of patients at 30 days. Valve haemodynamics improved from baseline to 30 days (mean aortic valve gradient: from 47.6±14.5 mmHg to 8.6±3.9 mmHg; mean aortic valve area: from 0.7±0.2 cm2 to 1.6±0.4 cm2). At 30 days, PVL was evaluated as none/trace in 79.2% of patients, mild in 18.9%, moderate in 1.9%, and severe in 0%. CONCLUSIONS The study results support the safety and efficacy of TAVI with ACURATE neo2 in patients in routine clinical practice.
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Affiliation(s)
| | - Corrado Tamburino
- Division of Cardiology, Azienda Ospedaliero Universitaria Policlinico-San Marco, Catania, Italy
| | | | - Matteo Montorfano
- Interventional Cardiology Unit IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Tanja K Rudolph
- Heart and Diabetes Center Northrhine-Westphalia, Bad Oeynhausen, Germany
| | | | | | | | | | | | | | - Matthias Götberg
- Department of Cardiology, Skane University Hospital, Lund University, Lund, Sweden
| | - Andreas Rück
- Karolinska University Hospital, Stockholm, Sweden
| | | | - Ramiro Trillo
- Complejo Hospitalario Universitario de Santiago, Santiago de Compostela. Centro de Investigación Biomedica en Red Enfermedades Cardiovasculares - CIBERCV, Madrid, Spain
| | - Clare Appleby
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Marco Barbanti
- Division of Cardiology, Azienda Ospedaliero Universitaria Policlinico-San Marco, Catania, Italy
| | - Philipp Blanke
- Department of Radiology, St Paul's Hospital & University of British Columbia, Vancouver, British Columbia, Canada
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21
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Gregers E, Mørk SR, Linde L, Andreasen JB, Smerup M, Kjærgaard J, Møller-Sørensen PH, Holmvang L, Christensen S, Terkelsen CJ, Tang M, Møller JE, Lassen JF, Schmidt H, Riber LP, Winther-Jensen M, Thomassen S, Laugesen H, Hassager C, Søholm H. Extracorporeal cardiopulmonary resuscitation: a national study on the association between favourable neurological status and biomarkers of hypoperfusion, inflammation, and organ injury. European Heart Journal. Acute Cardiovascular Care 2022; 11:808-817. [DOI: 10.1093/ehjacc/zuac135] [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] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 09/06/2022] [Accepted: 10/12/2022] [Indexed: 11/09/2022]
Abstract
Abstract
Aims
In refractory out-of-hospital cardiac arrest (OHCA) with prolonged whole-body ischaemia, global tissue injury proceeds even after establishment of circulation with extracorporeal cardiopulmonary resuscitation (ECPR). We aimed to investigate the role of biomarkers reflecting hypoperfusion, inflammation, and organ injury in prognostication of patients with refractory OHCA managed with ECPR.
Methods and results
This nationwide retrospective study included 226 adults with refractory OHCA managed with ECPR in Denmark (2011–2020). Biomarkers the first days after ECPR-initiation were assessed. Odds ratio of favourable neurological status (Cerebral Performance Category 1–2) at hospital discharge was estimated by logistic regression analyses. Cut-off values were calculated using the Youden’s index. Fifty-six patients (25%) survived to hospital discharge, 51 (91%) with a favourable neurological status. Factors independently associated with favourable neurological status were low flow time <81 min, admission leukocytes ≥12.8 × 109/L, admission lactate <13.2 mmol/L, alkaline phosphatase (ALP) < 56 (day1) or <55 U/L (day2), and day 1 creatine kinase MB (CK-MB) < 500 ng/mL. Selected biomarkers (leukocytes, C-reactive protein, and lactate) were significantly better predictors of favourable neurological status than classic OHCA-variables (sex, age, low-flow time, witnessed arrest, shockable rhythm) alone (P = 0.001) after hospital admission.
Conclusion
Biomarkers of hypoperfusion (lactate), inflammation (leucocytes), and organ injury (ALP and CK-MB) were independently associated with neurological status at hospital discharge. Biomarkers of hypoperfusion and inflammation (at hospital admission) and organ injury (days 1 and 2 after ECPR) may aid in the clinical decision of when to prolong or terminate ECPR in cases of refractory OHCA.
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Affiliation(s)
- Emilie Gregers
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet , Blegdamsvej 9, 2100 Copenhagen OE , Denmark
- Department of Cardiothoracic Surgery, Copenhagen University Hospital Rigshospitalet , Blegdamsvej 9, 2100 Copenhagen OE , Denmark
| | - Sivagowry Rasalingam Mørk
- Department of Cardiology, Aarhus University Hospital , Palle Juul-Jensens Boulevard 99, 8200 Aarhus N , Denmark
| | - Louise Linde
- Department of Cardiology, Odense University Hospital , J. B. Winsløws Vej 4, 5000 Odense C , Denmark
| | - Jo Bønding Andreasen
- Department of Anesthesiology and Intensive Care, Aalborg University Hospital , Hobrovej 18-22, 9000 Aalborg , Denmark
| | - Morten Smerup
- Department of Cardiothoracic Surgery, Copenhagen University Hospital Rigshospitalet , Blegdamsvej 9, 2100 Copenhagen OE , Denmark
- Department of Clinical Medicine, University of Copenhagen , Blegdamsvej 3, 2200 Copenhagen N , Denmark
| | - Jesper Kjærgaard
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet , Blegdamsvej 9, 2100 Copenhagen OE , Denmark
| | - Peter Hasse Møller-Sørensen
- Department of Cardiothoracic Anesthesiology, Copenhagen University Hospital Rigshospitalet , Blegdamsvej 9, 2100 Copenhagen OE , Denmark
| | - Lene Holmvang
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet , Blegdamsvej 9, 2100 Copenhagen OE , Denmark
- Department of Clinical Medicine, University of Copenhagen , Blegdamsvej 3, 2200 Copenhagen N , Denmark
| | - Steffen Christensen
- Department of Cardiology, Aarhus University Hospital , Palle Juul-Jensens Boulevard 99, 8200 Aarhus N , Denmark
- Department of Clinical Medicine, Aarhus University , Palle Juul-Jensens Boulevard 11, 8200 Aarhus N , Denmark
| | - Christian Juhl Terkelsen
- Department of Cardiology, Aarhus University Hospital , Palle Juul-Jensens Boulevard 99, 8200 Aarhus N , Denmark
- Department of Clinical Medicine, Aarhus University , Palle Juul-Jensens Boulevard 11, 8200 Aarhus N , Denmark
- The Danish Heart Foundation , Vognmagergade 7, 3. sal, 1120 Copenhagen K , Denmark
| | - Mariann Tang
- Department of Clinical Medicine, Aarhus University , Palle Juul-Jensens Boulevard 11, 8200 Aarhus N , Denmark
- Department of Cardiothoracic Surgery, Aarhus University Hospital , Palle Juul-Jensens Boulevard 99, 8200 Aarhus N , Denmark
| | - Jacob Eifer Møller
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet , Blegdamsvej 9, 2100 Copenhagen OE , Denmark
- Department of Cardiology, Odense University Hospital , J. B. Winsløws Vej 4, 5000 Odense C , Denmark
- Department of Clinical Research, University of Southern Denmark , J. B. Winsløws Vej 19, 3, 5000 Odense C , Denmark
| | - Jens Flensted Lassen
- Department of Cardiology, Odense University Hospital , J. B. Winsløws Vej 4, 5000 Odense C , Denmark
- Department of Clinical Research, University of Southern Denmark , J. B. Winsløws Vej 19, 3, 5000 Odense C , Denmark
| | - Henrik Schmidt
- Department of Anesthesiology and Intensive Care, Odense University Hospital , J. B. Winsløws Vej 4, 5000 Odense C , Denmark
| | - Lars Peter Riber
- Department of Cardiothoracic Surgery, Odense University Hospital , J. B. Winsløws Vej 4, 5000 Odense C , Denmark
| | - Matilde Winther-Jensen
- Section for Data, Biostatistics and Pharmacoepidemiology, Center for Clinical Research and Prevention, Frederiksberg Hospital , Nordre Fasanvej 57, Indgang 5 (bygning 41), 2000 Frederiksberg , Denmark
| | - Sisse Thomassen
- Department of Anesthesiology and Intensive Care, Aalborg University Hospital , Hobrovej 18-22, 9000 Aalborg , Denmark
| | - Helle Laugesen
- Department of Anesthesiology and Intensive Care, Aalborg University Hospital , Hobrovej 18-22, 9000 Aalborg , Denmark
| | - Christian Hassager
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet , Blegdamsvej 9, 2100 Copenhagen OE , Denmark
- Department of Clinical Medicine, University of Copenhagen , Blegdamsvej 3, 2200 Copenhagen N , Denmark
| | - Helle Søholm
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet , Blegdamsvej 9, 2100 Copenhagen OE , Denmark
- Department of Cardiology, Zealand University Hospital Roskilde , Sygehusvej 10, 4000 Roskilde , Denmark
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22
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Rasalingam Moerk S, Kristensen LQ, Osterlund LG, Christensen S, Tang M, Terkelsen CJ, Eiskjaer H. Long-term neurological intact survival and quality of life after refractory out-of-hospital cardiac arrest treated with rescue mechanical circulatory support. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Mechanical circulatory support (MCS) with either veno-arterial extracorporeal membrane oxygenation (V-A ECMO) or Impella has emerged as a rescue therapy for refractory out-of-hospital cardiac arrest (OHCA). However, only short-term outcome is specified and most studies do not report follow-up beyond six months. Long-term survival and quality of life in this high-risk population remains unknown.
Purpose
To determine long-term neurological intact survival and quality of life in patients with refractory OHCA treated with MCS.
Methods
This was an observational, single-centre study of OHCA-patients from January 2015 to December 2019. Patients treated with MCS for OHCA were compared with patients receiving conventional cardiopulmonary resuscitation (CPR). A follow-up of long-term survivors in the MCS group was conducted (>1 year after arrest). This included health related quality of life questionaries (Short Form-36 [SF-36]) and assessment of neurological function with Cerebral Performance Category (CPC). Good neurological outcome was defined as CPC 1 and CPC 2.
Results
A total of 1015 with OHCA were included; 101 received MCS for refractory cardiac arrest. Among these V-A ECMO was deployed in 97 patients and Impella in 4 patients. The MCS group had significantly longer low-flow times compared to the conventional group (105 [IQR, 94–123] minutes versus 18 [IQR 10–39] minutes) and were more metabolically deranged upon arrival at hospital (Table 1). In patients receiving MCS, the hospital discharge rate was 27% and good neurological outcome was seen in 93% among patients discharged. At follow-up, 15 out of 21 long-term survivors participated. Median follow-up time was 4.8±1.6 (range 2.8–6.1 years). Mean age at follow-up was 61±7.3 years, 11 (73%) were men. Neurological outcome with CPC 1 was found in 12 patients (80%), with CPC 2 in 2 patients (13%), and with CPC 3 in 1 patient (7%). Two had improved neurological status from CPC 2 to CPC 1 since discharge. Mean scores of the SF-36 revealed an overall high level of psychical and mental health in long-term survivors (Figure 1).
Conclusion
Long-term survival with good neurological outcome was high in patients with refractory OHCA treated with MCS despite prolonged resuscitation and severe metabolic derangement. These patients may expect a reasonable quality of life after discharge.
Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): Department of Cardiology, Aarhus University HospitalSnedkermester Sophus Jacobsen og hustru Astrid Jacobsens Fond
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Affiliation(s)
| | - L Q Kristensen
- Aarhus University, Department of Public Health , Aarhus , Denmark
| | - L G Osterlund
- Aarhus University Hospital, Department of Physiotherapy and Occupational Therapy (DEFACTUM) , Aarhus , Denmark
| | - S Christensen
- Aarhus University Hospital, Department of Anaesthesiology and Intensive Care , Aarhus , Denmark
| | - M Tang
- Aarhus University Hospital, Department of Thoracic and Vascular Surgery , Aarhus , Denmark
| | - C J Terkelsen
- Aarhus University Hospital, Department of Cardiology , Aarhus , Denmark
| | - H Eiskjaer
- Aarhus University Hospital, Department of Cardiology , Aarhus , Denmark
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23
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Gregers E, Moerk SR, Linde L, Andreasen JB, Smerup M, Kjaergaard J, Moeller-Soerensen PH, Holmvang L, Christensen S, Terkelsen CJ, Moeller JE, Lassen JF, Rieber LP, Laugesen H, Soeholm H. Extracorporeal cardiopulmonary resuscitation: a national study on the association between survival and biomarkers of hypoperfusion, inflammation, and organ failure. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
In refractory out-of-hospital cardiac arrest (OHCA) with prolonged whole-body ischemia, global tissue injury proceeds even after establishment of circulation with extracorporeal cardiopulmonary resuscitation (ECPR).
Purpose
We aimed to investigate the role of biomarkers reflecting hypoperfusion, inflammation, and organ injury in prognostication of patients with refractory OHCA managed with ECPR.
Methods
This nationwide retrospective study included 226 adults with refractory OHCA managed with ECPR in Denmark (2011–2020). Biomarkers at admission and consecutively two days after ECPR initiation were retrieved. Odds ratio (OR) of 90-day survival were assessed by logistic regression analyses. Cut-off values were calculated from area under the curve (AUC) via the Youden index.
Results
Fifty-six patients (25%) survived to hospital discharge, all were still alive after 90-days and 91% had a favorable neurological status at discharge. Factors independently associated with 90-day survival were: male sex, shockable presenting rhythm, low flow time, platelets, pH, lactate, C-reactive protein, lactate dehydrogenase (LDH), alkaline phosphatase (ALP), and creatine kinase MB (CK-MB) level. Comparing the ability of standard predictive variables (age, sex, shockable presenting rhythm, witnessed arrest, and low flow time) and selected biomarkers (from multivariate analyses) in predicting 90-day survival, biomarkers day 2 after OHCA were significantly better than standard variables (AUC 0.79 vs. 0.56, p=0.01).
Conclusion
Biomarkers of hypoperfusion (low lactate and high pH), inflammation (high platelets and CRP), and organ failure (low LDH, ALP, and CK-MB) were independently associated with 90-day survival. Biomarkers on day 2 after OHCA (d-dimer, ALP, and CK-MB) were more predictive of 90-day survival than standard predictive variables.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Odense University Hospital's and Rigshospitalet's Common Research Foundation
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Affiliation(s)
- E Gregers
- Rigshospitalet - Copenhagen University Hospital , Copenhagen , Denmark
| | - S R Moerk
- Aarhus University Hospital , Aarhus , Denmark
| | - L Linde
- Odense University Hospital , Odense , Denmark
| | | | - M Smerup
- Rigshospitalet - Copenhagen University Hospital , Copenhagen , Denmark
| | - J Kjaergaard
- Rigshospitalet - Copenhagen University Hospital , Copenhagen , Denmark
| | | | - L Holmvang
- Rigshospitalet - Copenhagen University Hospital , Copenhagen , Denmark
| | | | | | - J E Moeller
- Odense University Hospital , Odense , Denmark
| | - J F Lassen
- Odense University Hospital , Odense , Denmark
| | - L P Rieber
- Odense University Hospital , Odense , Denmark
| | - H Laugesen
- Aalborg University Hospital , Aalborg , Denmark
| | - H Soeholm
- Rigshospitalet - Copenhagen University Hospital , Copenhagen , Denmark
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24
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Linde L, Moerk SR, Gregers E, Andreasen JB, Lassen JF, Ravn HB, Schmidt H, Riber LP, Laugesen H, Terkelsen CJ, Moeller-Soerensen PH, Holmvang L, Kjaergaard J, Hassager C, Moeller JE. Selection of patients for mechanical circulatory support for refractory out-of-hospital cardiac arrest: a Danish nationwide multicenter study. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1518] [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
Extracorporeal cardiopulmonary resuscitation (ECPR) is a potential salvage therapy for selected patients with refractory out-of-hospital cardiac arrest (OHCA).
Purpose
The objective of this study was to describe the characteristics of potential ECPR patients.
Methods
This retrospective, observational cohort study included 579 patients admitted with refractory OHCA for possible ECPR at all tertiary cardiac arrest centers in Denmark between 2015 and 2020. Presenting characteristics, reasons for refraining from ECPR, and survival to hospital discharge were recorded.
Results
After initial evaluation, 221 patients (38%) proceeded to ECPR, and 358 (62%) were considered futile. Median prehospital low-flow time was 70 minutes [interquartile range 56–85] in ECPR patients and 62 minutes [48–81] in no-ECPR patients, p<0.001. Intra arrest transport was more than 50 km in 92 (42%) ECPR patients and 135 in no-ECPR patients (38%), p=0.25. Treatment decision was taken by a team of three specialists in 513 cases (97%). The leading cause for not initiating ECPR was duration of low flow time (39%). Severe metabolic derangement and low end-tidal CO2 (ETCO2) were contributing factors in 35% and 31%, respectively, Figure 1. 83% of the patients had two or more contributing factors recorded as reasons for not initiating ECPR, Figure 2. The most prevailing combination of contributing factors were non-shockable rhythm, low ETCO2, and metabolic derangement or duration of prehospital low flow time combined with low ETCO2. Survival to discharge was achieved in six patients (1.7%) in the no-ECPR group and 50 (23%) in the ECPR group.
Conclusions
In this large nationwide study of patients admitted for possible ECPR, 62% were not treated with ECPR. The most frequent reasons to abstain from ECPR were duration of prehospital low flow time, metabolic derangement, and low ETCO2.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): The Danish Heart Foundation
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Affiliation(s)
- L Linde
- Odense University Hospital, Department of Cardiology , Odense , Denmark
| | - S R Moerk
- Aarhus University Hospital, Department of Cardiology , Aarhus , Denmark
| | - E Gregers
- Copenhagen University Hospital, Department of Cardiology , Copenhagen , Denmark
| | - J B Andreasen
- Aalborg University Hospital, Department of Anesthesiology and Intensive Care , Aalborg , Denmark
| | - J F Lassen
- Odense University Hospital, Department of Cardiology , Odense , Denmark
| | - H B Ravn
- Odense University Hospital, Department of Anaesthesiology and Intensive Care , Odense , Denmark
| | - H Schmidt
- Odense University Hospital, Department of Anaesthesiology and Intensive Care , Odense , Denmark
| | - L P Riber
- Odense University Hospital, Department of Thoracic and Vascular Surgery , Odense , Denmark
| | - H Laugesen
- Aalborg University Hospital, Department of Anesthesiology and Intensive Care , Aalborg , Denmark
| | - C J Terkelsen
- Aarhus University Hospital, Department of Cardiology , Aarhus , Denmark
| | - P H Moeller-Soerensen
- Copenhagen University Hospital, Cardiothoracic Anesthesiology , Copenhagen , Denmark
| | - L Holmvang
- Copenhagen University Hospital, Department of Cardiology , Copenhagen , Denmark
| | - J Kjaergaard
- Copenhagen University Hospital, Department of Cardiology , Copenhagen , Denmark
| | - C Hassager
- Copenhagen University Hospital, Department of Cardiology , Copenhagen , Denmark
| | - J E Moeller
- Odense University Hospital, Department of Cardiology , Odense , Denmark
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Pedersen CK, Stengaard C, Boetker MT, Dodt KK, Soendergaard HM, Terkelsen CJ. Direct comparison of very early AMI rule-out algorithms. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Early rule-out of AMI may have a considerable impact on healthcare spending.
Numerous algorithms for early rule-out of AMI has been suggested within the last year. However, most algorithms are limited by the need for consecutive, timely separated in-hospital blood samples, prolonging length of hospital stay. Very early rule-out algorithms, providing necessary biomarker results shortly after arrival to hospital or even before, could reduce the burden on EDs and cardiology departments.
Many algorithms have been evaluated, validated and compared in several studies; however, often in different subpopulations of larger studies. Reported differences in diagnostic performance of these algorithms may very likely have been caused by differences between the tested patient subgroups. Therefore, a direct comparison of very early rule-out algorithms in a single cohort with all necessary information available for all algorithms is needed.
Purpose
In this study we aimed to compare the ESC 0h/1h algorithm with ten rule-out algorithms, including the ESC 0h/3h algorithm, an in-hospital Dual-Marker strategy (DMS) (combining hs-cTnT with copeptin), and seven very early algorithms (potential rule-out at admission) for rule-out of AMI. Four algorithms are strictly prehospital and three combines prehospital and in-hospital blood samples, see table 1 for description of evaluated algorithms.
Methods
The diagnostic performance of the rule-out algorithms was compared in patients with suspected AMI from a randomized, controlled, multicenter trial. We only included patients who had all required information for each diagnostic algorithm available.
AMI was adjudicated by at least two cardiologists.
Results
We included 1.601 patients, see table 2. Of these 136 (8.5%) had type 1 AMI.
We found that 7 of 11 algorithms, including the present ECS-recommended 0h/1h algorithm, performed with acceptable sensitivities above 98% and specificities between 13.5 and 52.0%.
The ESC 0h/3h algorithm had a unacceptably low sensitivity of 87.5%.
Four of the very early rule-out algorithms (the HEART score, the Modified prehospital HEART score, the Modified prehospital DMS, and the Modified prehospital/in-hospital DMS) all performed with excellent sensitivity of 100% and thereby missing no AMIs. Of these, the HEART score derivates ruled out 13.5–16.2% of pts. without AMI, while the two DMS derivates ruled out 14.3–27.4% of pts without AMI.
Compared with the ESC 0h/1h algorithm the very early rule out algorithms provide the necessary biomarker results at least 1 hour earlier, and when well-performing POCT analyses becomes available for copeptin and troponin analysis, even before arrival to hospital.
Conclusions
Four very early rule out algorithms performed excellent in the rule out of AMI, with 100% sensitivities and specificities of up to 27.4%. This enables safe rule out of AMI shortly after arrival to hospital, and in future, potentially already in the ambulance.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National budget only - Danish Heart Foundation and Independent Research Fund Denmark
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Affiliation(s)
- C K Pedersen
- Aarhus University Hospital, Department of Cardiology , Aarhus , Denmark
| | - C Stengaard
- Aarhus University Hospital, Department of Cardiology , Aarhus , Denmark
| | - M T Boetker
- Aarhus University, Dept. for Research and Development, Prehospital Emergency Medical Services, Central Denmark Region , Aarhus , Denmark
| | - K K Dodt
- Regional Hospital Horsens, Department of Internal Medicine , Horsens , Denmark
| | - H M Soendergaard
- Regional Hospital Central Jutland, Department of Cardiology , Viborg , Denmark
| | - C J Terkelsen
- Aarhus University Hospital, Department of Cardiology , Aarhus , Denmark
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Madsen JM, Kelbæk H, Nepper-Christensen L, Jacobsen MR, Ahtarovski KA, Høfsten DE, Holmvang L, Pedersen F, Tilsted HH, Aarøe J, Jensen SE, Raungaard B, Terkelsen CJ, Køber L, Engstrøm T, Lønborg JT. Clinical outcomes of no stenting in patients with ST-segment elevation myocardial infarction undergoing deferred primary percutaneous coronary intervention. EUROINTERVENTION 2022; 18:482-491. [PMID: 35289303 PMCID: PMC10241275 DOI: 10.4244/eij-d-21-00950] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 01/29/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND ST-segment elevation myocardial infarction (STEMI) is treated with stenting, but the underlying stenosis is often not severe, and stenting may potentially be omitted. AIMS The aim of the study was to investigate outcomes of patients with STEMI treated with percutaneous coronary intervention (PCI) without stenting. METHODS Patients were identified through the DANAMI-3-DEFER study. Stenting was omitted in the patients with stable flow after initial PCI and no significant residual stenosis on the deferral procedure, who were randomised to deferred stenting. These patients were compared to patients randomised to conventional PCI treated with immediate stenting. The primary endpoint was a composite of all-cause mortality, recurrent myocardial infarction (MI), and target vessel revascularisation (TVR). RESULTS Of 603 patients randomised to deferred stenting, 84 were treated without stenting, and in patients randomised to conventional PCI (n=612), 590 were treated with immediate stenting. Patients treated with no stenting had a median stenosis of 40%, median vessel diameter of 2.9 mm, and median lesion length of 11.4 mm. During a median follow-up of 3.4 years, the composite endpoint occurred in 14% and 16% in the no and immediate stenting groups, respectively (unadjusted hazard ratio [HR] 0.87, 95% confidence interval [CI]: 0.48-1.60; p=0.66). The association remained non-significant after adjusting for confounders (adjusted HR 0.53, 95% CI: 0.22-1.24; p=0.14). The rates of TVR and recurrent MI were 2% vs 4% (p=0.70) and 4% vs 6% (p=0.43), respectively. CONCLUSIONS Patients with STEMI, with no significant residual stenosis and stable flow after initial PCI, treated without stenting, had comparable event rates to patients treated with immediate stenting.
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Affiliation(s)
- Jasmine Melissa Madsen
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Henning Kelbæk
- Department of Cardiology, Zealand University Hospital, Roskilde, Denmark
| | - Lars Nepper-Christensen
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Mia Ravn Jacobsen
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Dan Eik Høfsten
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Lene Holmvang
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Frants Pedersen
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Hans-Henrik Tilsted
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jens Aarøe
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | | | - Bent Raungaard
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | | | - Lars Køber
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Thomas Engstrøm
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Cardiology, Lund University, Lund, Sweden
| | - Jacob Thomsen Lønborg
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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Fink Vallentin M, Granfeldt A, Meilandt C, Ling Povlsen A, Sindberg B, Holmberg MJ, Nees Iversen B, Mærkedahl R, Riis Mortensen L, Nyboe R, Partridge Vandborg M, Tarpgaard M, Runge C, Fynbo Christiansen C, Dissing TH, Juhl Terkelsen C, Christensen S, Kirkegaard H, Andersen LW. Effect of Calcium vs. Placebo on Long-Term Outcomes in Patients with Out-of-hospital Cardiac Arrest A Randomized Clinical Trial. Resuscitation 2022; 179:21-24. [PMID: 35917866 DOI: 10.1016/j.resuscitation.2022.07.034] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 07/25/2022] [Accepted: 07/26/2022] [Indexed: 01/25/2023]
Abstract
OBJECTIVE The Calcium for Out-of-hospital Cardiac Arrest (COCA) trial was a randomized, placebo-controlled, double-blind trial of calcium for out-of-hospital cardiac arrest. The primary and secondary outcomes have been reported previously. This article describes the long-term outcomes of the trial. METHODS Patients aged ≥ 18 years were included if they had a non-traumatic out-of-hospital cardiac arrest during which they received adrenaline. The trial drug consisted of calcium chloride (5 mmol) or saline placebo given after the first dose of adrenaline and again after the second dose of adrenaline for a maximum of two doses. This article presents pre-specified analyses of 6-month and 1-year outcomes for survival, survival with a favorable neurological outcome (modified Rankin Scale of 3 or less), and health-related quality of life. RESULTS A total of 391 patients were analyzed. At 1 year, 9 patients (4.7%) were alive in the calcium group while 18 (9.1%) were alive in the placebo group (risk ratio 0.51; 95% confidence interval 0.24, 1.09). At 1 year, 7 patients (3.6%) were alive with a favorable neurological outcome in the calcium group while 17 (8.6%) were alive with a favorable neurological outcome in the placebo group (risk ratio 0.42; 95% confidence interval 0.18, 0.97). Outcomes for health-related quality of life likewise suggested harm of calcium but results were imprecise with wide confidence intervals. CONCLUSIONS Effect estimates remained constant over time suggesting harm of calcium but with wide confidence intervals. The results do not support calcium administration during out-of-hospital cardiac arrest. Trial registration ClinicalTrials.gov-number, NCT04153435.
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Affiliation(s)
| | - Asger Granfeldt
- Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Carsten Meilandt
- Prehospital Emergency Medical Services, Central Denmark Region, Aarhus, Denmark
| | - Amalie Ling Povlsen
- Prehospital Emergency Medical Services, Central Denmark Region, Aarhus, Denmark
| | - Birthe Sindberg
- Research Center for Emergency Medicine, Department of Clinical Medicine and Emergency Department, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Mathias J Holmberg
- Research Center for Emergency Medicine, Department of Clinical Medicine and Emergency Department, Aarhus University and Aarhus University Hospital, Aarhus, Denmark; Department of Anesthesiology and Intensive Care, Horsens Regional Hospital, Denmark
| | - Bo Nees Iversen
- Prehospital Emergency Medical Services, Central Denmark Region, Aarhus, Denmark; Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Rikke Mærkedahl
- Prehospital Emergency Medical Services, Central Denmark Region, Aarhus, Denmark; Department of Anesthesiology and Intensive Care, Gødstrup Regional Hospital, Denmark
| | - Lone Riis Mortensen
- Prehospital Emergency Medical Services, Central Denmark Region, Aarhus, Denmark; Department of Anesthesiology and Intensive Care, Randers Regional Hospital, Denmark
| | - Rasmus Nyboe
- Prehospital Emergency Medical Services, Central Denmark Region, Aarhus, Denmark; Department of Anesthesiology and Intensive Care, Horsens Regional Hospital, Denmark
| | - Mads Partridge Vandborg
- Prehospital Emergency Medical Services, Central Denmark Region, Aarhus, Denmark; Department of Anesthesiology and Intensive Care, Viborg Regional Hospital, Denmark
| | - Maren Tarpgaard
- Prehospital Emergency Medical Services, Central Denmark Region, Aarhus, Denmark; Department of Anesthesiology and Intensive Care, Gødstrup Regional Hospital, Denmark
| | - Charlotte Runge
- Prehospital Emergency Medical Services, Central Denmark Region, Aarhus, Denmark; Elective Surgery Centre, Silkeborg Regional Hospital, Denmark
| | | | - Thomas H Dissing
- Prehospital Emergency Medical Services, Central Denmark Region, Aarhus, Denmark; Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | | | - Steffen Christensen
- Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Hans Kirkegaard
- Prehospital Emergency Medical Services, Central Denmark Region, Aarhus, Denmark; Research Center for Emergency Medicine, Department of Clinical Medicine and Emergency Department, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Lars W Andersen
- Prehospital Emergency Medical Services, Central Denmark Region, Aarhus, Denmark; Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark; Research Center for Emergency Medicine, Department of Clinical Medicine and Emergency Department, Aarhus University and Aarhus University Hospital, Aarhus, Denmark.
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Mørk SR, Bøtker MT, Christensen S, Tang M, Terkelsen CJ. Survival and neurological outcome after out-of-hospital cardiac arrest treated with and without mechanical circulatory support. Resusc Plus 2022; 10:100230. [PMID: 35434669 PMCID: PMC9010695 DOI: 10.1016/j.resplu.2022.100230] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 03/09/2022] [Accepted: 03/18/2022] [Indexed: 11/18/2022] Open
Abstract
Aim The aim of this study was to describe the survival and neurological outcome in patients with OHCA treated with and without mechanical circulatory support (MCS). Methods This was a retrospective observational cohort study on patients with OHCA admitted to Aarhus University Hospital, Denmark, between January 2015 and December 2019. Kaplan-Meier estimates were used to evaluate 30-day and 30–180-day survival. Cox regression analysis was used to assess the association between covariates and one-year mortality. Results Among 1,015 patients admitted, 698 achieved return of spontaneous circulation (ROSC) before admission, 101 patients with refractory OHCA received mechanical circulatory support (MCS) and the remaining 216 patients with refractory OHCA did not receive MCS treatment. Survival to hospital discharge was 47% (478/1015). Good neurological outcome defined as Cerebral Performance Categories 1–2 were seen among 92% (438/478) of the patients discharged from hospital. Median low-flow was 15 [8–22] minutes in the ROSC group and 105 [94–123] minutes in the MCS group. Mortality rates were high within the first 30 days, however; 30–180-day survival in patients discharged remained constant over time in both patients with ROSC on admission and patients admitted with MCS. Advanced age > 70 years (hazard ratio (HR) 1.98, 95% confidence interval (CI) 1.11–3.49), pulseless electrical activity (HR 2.39, 95% CI 1.25–4.60) and asystole HR 2.70, 95% CI 1.25–5.95) as initial rhythms were associated with one-year mortality in patients with ROSC. Conclusions Short-term survival rates were high among patients with ROSC and patients receiving MCS. Among patients who survived to day 30, landmark analyses showed comparable 180-day survival in the two groups despite long low-flow times in the MCS group. Advanced age and initial non-shockable rhythms were independent predictors of one-year mortality in patients with ROSC on admission.
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Affiliation(s)
- Sivagowry Rasalingam Mørk
- Department of Cardiology, Aarhus University Hospital, Denmark
- Aarhus University, Aarhus, Denmark
- Corresponding author at: Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200 Aarhus N, Denmark.
| | - Morten Thingemann Bøtker
- Aarhus University, Aarhus, Denmark
- Research and Development, Prehospital Emergency Medical Services, Central Denmark Region, Denmark
| | - Steffen Christensen
- Aarhus University, Aarhus, Denmark
- Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Denmark
| | - Mariann Tang
- Aarhus University, Aarhus, Denmark
- Department of Thoracic and Vascular Surgery, Aarhus University Hospital, Denmark
| | - Christian Juhl Terkelsen
- Department of Cardiology, Aarhus University Hospital, Denmark
- Aarhus University, Aarhus, Denmark
- The Danish Heart Foundation, Denmark
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Mørk SR, Christensen S, Tang M, Terkelsen CJ, Eiskjær H. [Treated prolonged cardiac arrest without severe cognitive impairment]. Ugeskr Laeger 2022; 184:V11210882. [PMID: 35656600] [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: 06/15/2023]
Abstract
The cognitive function and quality of life after extracorporeal cardiopulmonary resuscitation (ECPR) remain uncertain. In this case report, a 61-year-old male underwent ECPR for refractory out-of-hospital cardiac arrest after 102 minutes of resuscitation. The cause of cardiac arrest was acute myocardial infarction, and occlusion of the left anterior descending artery was treated with balloon angioplasty. Five years later, the patient had preserved psychical and mental health, cognitive function, and good quality of life despite prolonged cardiopulmonary resuscitation.
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Affiliation(s)
| | | | - Mariann Tang
- Afdeling for Hjerte- Lunge- og Karkirugi, Aarhus Universitetshospital
| | | | - Hans Eiskjær
- Afdeling for Hjertesygdomme, Aarhus Universitetshospital
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Mørk SR, Bøtker MT, Hjort J, Jensen LO, Pedersen F, Jørgensen G, Christensen EF, Christensen MK, Aarø J, Lippert F, Knudsen L, Hansen TM, Steinmetz J, Terkelsen CJ. Use of Helicopters to Reduce Health Care System Delay in Patients With ST-Elevation Myocardial Infarction Admitted to an Invasive Center. Am J Cardiol 2022; 171:7-14. [PMID: 35282876 DOI: 10.1016/j.amjcard.2022.01.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 01/19/2022] [Accepted: 01/25/2022] [Indexed: 12/12/2022]
Abstract
Timely reperfusion in ST-elevation myocardial infarction (STEMI) is essential. This study aimed to evaluate the reduction in system delay (time from emergency medical service [EMS] call to primary percutaneous coronary intervention [PPCI]) in patients with STEMI when using helicopter EMS (HEMS) rather than ground-based EMS (GEMS). This was a retrospective, nationwide cohort study of consecutive patients with STEMI treated with PPCI at 5 PPCI centers in Denmark. Polynomial spline curves were constructed to describe the association between system delay and distance to the PPCI center stratified by transportation mode. A total of 26,433 patients with STEMI were treated with PPCI between January 1, 1999, and December 31, 2016. In 16,436 patients field triaged directly to the PPCI center, the proportion treated within 120 minutes of the EMS call was 75% for those living 0 to 25 km from the PPCI center compared with 65% for all patients transported by GEMS (median transport distance 50 km [interquartile range 23 to 90]) and 64% for all patients transported by HEMS (median transport distance 119 km [interquartile range 99 to 142]). The estimated reduction in system delay owed to using HEMS rather than GEMS was 14, 16, 20, and 29 minutes for patients living 75, 100, 125, and 170 km from a PPCI center. In conclusion, this study confirmed that using HEMS ensures that most patients with STEMI, living up to 170 km from a PPCI center, can be treated within 120 minutes of their EMS call provided they are field triaged directly to the PPCI center.
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Affiliation(s)
| | | | - Jakob Hjort
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Frants Pedersen
- Department of Cardiology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Gitte Jørgensen
- Prehospital Medical Services, Region of Southern Denmark, Denmark
| | - Erika Frischknect Christensen
- Prehospital Medical Services, North Denmark Region, Denmark; Department of Emergency and Trauma Care, Centre for Internal Medicine and Emergency Care; Centre for Prehospital and Emergency Research, Aalborg University Hospital and Institute for Clinical Medicine, Aalborg University, Aalborg, Denmark
| | | | - Jens Aarø
- Department of Cardiology, Aalborg University Hospital, Denmark
| | - Freddy Lippert
- Prehospital Medical Services, Capital Region of Denmark, Denmark
| | | | | | | | - Christian Juhl Terkelsen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; The Danish Heart Foundation, Denmark
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Møller JE, Kjaergaard J, Terkelsen CJ, Hassager C. Impella to Treat Acute Myocardial Infarct-Related Cardiogenic Shock. J Clin Med 2022; 11:2427. [PMID: 35566553 PMCID: PMC9101440 DOI: 10.3390/jcm11092427] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 04/08/2022] [Accepted: 04/21/2022] [Indexed: 12/15/2022] Open
Abstract
Acute myocardial infarction complicated by cardiogenic shock (AMICS), is characterized by critically low cardiac output and decreased myocardial contractility. In this situation, a treatment that unloads the myocardium and restores CO without increasing the myocardial oxygen demand is theoretically appealing. Axial flow pumps offer hemodynamic support without increasing myocardial oxygen consumption. Consequently, the use of axial flow pumps, especially the Impella devices, is increasing. It is likely that the SCAI C patient with predominantly left ventricular failure and without prolonged cardiac arrest is the best candidate for these devices. Registry data suggest that pre-PCI Impella may be advantageous to post-PCI placement. However, several gaps in knowledge exist regarding optimal patient selection, futility criteria, timing, weaning and escalation strategy, and until data from adequately sized randomized trials are available, immediate individual evaluation for mechanical circulatory support by a shock team is warranted when a patient is diagnosed with AMICS.
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Affiliation(s)
- Jacob Eifer Møller
- Department of Cardiology, Odense University Hospital, 5000 Odense, Denmark
- Heart Center, Copenhagen University Hospital Rigshospitalet, 2100 Copenhagen, Denmark; (J.K.); (C.H.)
| | - Jesper Kjaergaard
- Heart Center, Copenhagen University Hospital Rigshospitalet, 2100 Copenhagen, Denmark; (J.K.); (C.H.)
| | | | - Christian Hassager
- Heart Center, Copenhagen University Hospital Rigshospitalet, 2100 Copenhagen, Denmark; (J.K.); (C.H.)
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32
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Jensen RV, Jensen JK, Christiansen EH, Tang M, Nielsen JC, Terkelsen CJ. Two case reports of transcatheter valve-in-valve implantation of Sapien 3 and MyVal in degenerated biological tricuspid prosthesis valves. Eur Heart J Case Rep 2022; 6:ytac131. [PMID: 35434509 PMCID: PMC9007432 DOI: 10.1093/ehjcr/ytac131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 12/31/2021] [Accepted: 03/18/2022] [Indexed: 11/12/2022]
Abstract
Background Patients with severe tricuspid valve stenosis or dysfunction following degeneration of biological valve prosthesis in tricuspid position are complex, have substantial comorbidity, and very high surgical risk. Case summary We report two cases with transcatheter tricuspid valve-in-valve implantation in patients with degenerated tricuspid bioprosthesis with transfemoral and transjugular access with Sapien 3 valve and MyVal, respectively. Discussion In patients with high surgical risk, transcatheter tricuspid valve implantation is a good alternative. Careful consideration of optimal access site, device size, and delivery system is paramount. This case report demonstrates technically feasible and safe transcatheter valve-in-valve implantantion in tricuspid position and highlights the importance of meticulous procedure planning.
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Affiliation(s)
- Rebekka Vibjerg Jensen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - Jesper Khedri Jensen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - Evald Høj Christiansen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - Mariann Tang
- Department of Thoracic Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - Jens Cosedis Nielsen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - Christian Juhl Terkelsen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
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Madsen JM, Glinge C, Jabbari R, Nepper-Christensen L, Høfsten DE, Tilsted HH, Holmvang L, Pedersen F, Joshi FR, Sørensen R, Bang LE, Bøtker HE, Terkelsen CJ, Mæng M, Jensen LO, Aarøe J, Kelbæk H, Torp-Pedersen C, Køber L, Lønborg JT, Engstrøm T. Comparison of Effect of Ischemic Postconditioning on Cardiovascular Mortality in Patients With ST-Segment Elevation Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention With Versus Without Thrombectomy. Am J Cardiol 2022; 166:18-24. [PMID: 34930614 DOI: 10.1016/j.amjcard.2021.11.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 11/03/2021] [Accepted: 11/08/2021] [Indexed: 12/14/2022]
Abstract
In patients with ST-segment elevation myocardial infarction (STEMI), ischemic postconditioning (iPOST) have shown ambiguous results in minimizing reperfusion injury. Previous findings show beneficial effects of iPOST in patients with STEMI treated without thrombectomy. However, it remains unknown whether the cardioprotective effect of iPOST in these patients persist on long term. In the current study, all patients were identified through the DANAMI-3-iPOST database. Patients were randomized to conventional primary percutaneous coronary intervention (PCI) or iPOST in addition to PCI. Cumulative incidence rates were calculated, and multivariable analyses stratified according to thrombectomy use were performed. The primary end point was a combination of cardiovascular mortality and hospitalization for heart failure. From 2011 to 2014, 1,234 patients with STEMI were included with a median follow-up of 4.8 years. In patients treated without thrombectomy (n = 520), the primary end point occurred in 15% (48/326) in the iPOST group and in 22% (42/194) in the conventional group (unadjusted hazard ratio [HR] 0.62, 95% confidence interval [CI] 0.41 to 0.94, p = 0.023). In adjusted Cox analysis, iPOST remained associated with reduced long-term risk of cardiovascular mortality (HR 0.53, 95% CI 0.29 to 0.97, p = 0.039). In patients treated with thrombectomy (n = 714), there was no significant difference between iPOST (17%, 49/291) and conventional treatment (17%, 72/423) on the primary end point (unadjusted HR 1.01, 95% CI 0.70 to 1.45, p = 0.95). During a follow-up of nearly 5 years, iPOST reduced long-term occurrence of cardiovascular mortality and hospitalization for heart failure in patients with STEMI treated with PCI but without thrombectomy.
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Jørgensen TH, Hansson N, De Backer O, Bieliauskas G, Terkelsen CJ, Wang X, Jensen JM, Christiansen EH, Piazza N, Svendsen JH, Nørgaard BL, Sondergaard L. Membranous septum morphology and risk of conduction abnormalities after transcatheter aortic valve implantation. EUROINTERVENTION 2022; 17:1061-1069. [PMID: 34338638 PMCID: PMC9725046 DOI: 10.4244/eij-d-21-00363] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND There are limited data on the association of membranous septum (MS) morphology and transcatheter heart valve (THV) implantation depth, and the development of new conduction abnormalities (CA) after transcatheter aortic valve implantation (TAVI). AIMS The aim of this study was to describe the morphology of the MS and predict the risk of new CA after TAVI based on the MS morphology and THV implantation depth. METHODS Based on preprocedural CT scans, the MS depth was measured for every 25% of the entire MS width in 272 TAVI patients without preprocedural bundle branch block (BBB) or pacemaker. Post-procedural CT scans for THV implantation depth assessment were available in 130 of these patients. RESULTS The MS depth was a median of 2.5 mm (IQR 1.4-3.8) deeper at the posterior edge when compared to the anterior edge of the MS. New CA developed in 7.1% of patients in whom the THV did not cross the lower MS border at its anterior edge (3.6% with new BBB and high degree CA, respectively), in 18.8% of patients (15.6% with new BBB and 3.1% with new high-degree CA) where the THV overlapped the lower MS border by <2.5 mm and in 47.1% of patients (24.3% with new BBB and 22.9% with new high-degree CA) with THV overlap of the lower MS border by ≥2.5 mm. CONCLUSIONS The difference of the MS depth and THV implantation depth measured at the anterior edge of the MS predicted new CA after TAVI.
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Affiliation(s)
| | - Nicolaj Hansson
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Ole De Backer
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Gintautas Bieliauskas
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Xi Wang
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark,Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | | | | | - Nicolo Piazza
- Division of Cardiology, McGill University Health Center, Montreal, ON, Canada
| | - Jesper Hastrup Svendsen
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Lars Sondergaard
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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35
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Vallentin MF, Granfeldt A, Meilandt C, Povlsen AL, Sindberg B, Holmberg MJ, Iversen BN, Mærkedahl R, Mortensen LR, Nyboe R, Vandborg MP, Tarpgaard M, Runge C, Christiansen CF, Dissing TH, Terkelsen CJ, Christensen S, Kirkegaard H, Andersen LW. Effect of Intravenous or Intraosseous Calcium vs Saline on Return of Spontaneous Circulation in Adults With Out-of-Hospital Cardiac Arrest: A Randomized Clinical Trial. JAMA 2021; 326:2268-2276. [PMID: 34847226 PMCID: PMC8634154 DOI: 10.1001/jama.2021.20929] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
IMPORTANCE It is unclear whether administration of calcium has a beneficial effect in patients with cardiac arrest. OBJECTIVE To determine whether administration of calcium during out-of-hospital cardiac arrest improves return of spontaneous circulation in adults. DESIGN, SETTING, AND PARTICIPANTS This double-blind, placebo-controlled randomized clinical trial included 397 adult patients with out-of-hospital cardiac arrest and was conducted in the Central Denmark Region between January 20, 2020, and April 15, 2021. The last 90-day follow-up was on July 15, 2021. INTERVENTIONS The intervention consisted of up to 2 intravenous or intraosseous doses with 5 mmol of calcium chloride (n = 197) or saline (n = 200). The first dose was administered immediately after the first dose of epinephrine. MAIN OUTCOMES AND MEASURES The primary outcome was sustained return of spontaneous circulation. The secondary outcomes included survival and a favorable neurological outcome (modified Rankin Scale score of 0-3) at 30 days and 90 days. RESULTS Based on a planned interim analysis of 383 patients, the steering committee stopped the trial early due to concerns about harm in the calcium group. Of 397 adult patients randomized, 391 were included in the analyses (193 in the calcium group and 198 in the saline group; mean age, 68 [SD, 14] years; 114 [29%] were female). There was no loss to follow-up. There were 37 patients (19%) in the calcium group who had sustained return of spontaneous circulation compared with 53 patients (27%) in the saline group (risk ratio, 0.72 [95% CI, 0.49 to 1.03]; risk difference, -7.6% [95% CI, -16% to 0.8%]; P = .09). At 30 days, 10 patients (5.2%) in the calcium group and 18 patients (9.1%) in the saline group were alive (risk ratio, 0.57 [95% CI, 0.27 to 1.18]; risk difference, -3.9% [95% CI, -9.4% to 1.3%]; P = .17). A favorable neurological outcome at 30 days was observed in 7 patients (3.6%) in the calcium group and in 15 patients (7.6%) in the saline group (risk ratio, 0.48 [95% CI, 0.20 to 1.12]; risk difference, -4.0% [95% CI, -8.9% to 0.7%]; P = .12). Among the patients with calcium values measured who had return of spontaneous circulation, 26 (74%) in the calcium group and 1 (2%) in the saline group had hypercalcemia. CONCLUSIONS AND RELEVANCE Among adults with out-of-hospital cardiac arrest, treatment with intravenous or intraosseous calcium compared with saline did not significantly improve sustained return of spontaneous circulation. These results do not support the administration of calcium during out-of-hospital cardiac arrest in adults. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04153435.
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Affiliation(s)
| | - Asger Granfeldt
- Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Carsten Meilandt
- Prehospital Emergency Medical Services, Central Denmark Region, Aarhus
| | | | - Birthe Sindberg
- Research Center for Emergency Medicine, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Emergency Department, Aarhus University Hospital, Aarhus, Denmark
| | - Mathias J. Holmberg
- Research Center for Emergency Medicine, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Emergency Department, Aarhus University Hospital, Aarhus, Denmark
- Department of Cardiology, Viborg Regional Hospital, Viborg, Denmark
| | - Bo Nees Iversen
- Prehospital Emergency Medical Services, Central Denmark Region, Aarhus
- Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Rikke Mærkedahl
- Prehospital Emergency Medical Services, Central Denmark Region, Aarhus
- Department of Anesthesiology and Intensive Care, Herning Regional Hospital, Herning, Denmark
| | - Lone Riis Mortensen
- Prehospital Emergency Medical Services, Central Denmark Region, Aarhus
- Department of Anesthesiology and Intensive Care, Randers Regional Hospital, Randers, Denmark
| | - Rasmus Nyboe
- Prehospital Emergency Medical Services, Central Denmark Region, Aarhus
- Department of Anesthesiology and Intensive Care, Horsens Regional Hospital, Horsens, Denmark
| | - Mads Partridge Vandborg
- Prehospital Emergency Medical Services, Central Denmark Region, Aarhus
- Department of Anesthesiology and Intensive Care, Viborg Regional Hospital, Viborg, Denmark
| | - Maren Tarpgaard
- Prehospital Emergency Medical Services, Central Denmark Region, Aarhus
- Department of Anesthesiology and Intensive Care, Herning Regional Hospital, Herning, Denmark
| | - Charlotte Runge
- Prehospital Emergency Medical Services, Central Denmark Region, Aarhus
- Elective Surgery Centre, Silkeborg Regional Hospital, Silkeborg, Denmark
| | | | - Thomas H. Dissing
- Prehospital Emergency Medical Services, Central Denmark Region, Aarhus
- Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | | | - Steffen Christensen
- Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Hans Kirkegaard
- Prehospital Emergency Medical Services, Central Denmark Region, Aarhus
- Research Center for Emergency Medicine, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Emergency Department, Aarhus University Hospital, Aarhus, Denmark
| | - Lars W. Andersen
- Prehospital Emergency Medical Services, Central Denmark Region, Aarhus
- Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
- Research Center for Emergency Medicine, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Emergency Department, Aarhus University Hospital, Aarhus, Denmark
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36
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Pedersen TGB, Sundbøll J, Becker SW, Grove EL, Terkelsen CJ, Pryds K. [Chronic coronary syndrome]. Ugeskr Laeger 2021; 183:V01210028. [PMID: 34796858] [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: 06/13/2023]
Abstract
In the 2019 European Society of Cardiology guidelines, chronic coronary syndrome (CCS) was introduced as a new term for stable coronary artery disease. Diagnosis, treatment and prevention of CCS have undergone major changes. In the diagnostic management of CCS, there is increased focus on non-invasive imaging modalities, including coronary CT angiography. Based on the risk of thrombosis and bleeding, choice and duration of antithrombotic treatment should be individualised, especially following coronary revascularisation.
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Moerk SR, Stengaard C, Linde L, Moller JE, Andreasen JB, Laugesen H, Thomassen SA, Freeman PM, Christensen S, Tang M, Gregers E, Kjaergaard J, Hassager C, Eiskjaer H, Terkelsen CJ. Mechanical circulatory support for refractory out-of-hospital cardiac arrest: a nationwide multicentre study. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Extracorporeal cardiopulmonary resuscitation (ECPR) has shown potential as a salvage therapy for patients with refractory out-of-hospital cardiac arrest (OHCA). Despite growing interest in and a growing body of literature on ECPR for refractory OHCA, robust evidence on patient eligibility is still lacking.
Purpose
To describe the survival, neurological outcome, and adherence to the national consensus with respect to use of ECPR for OHCA, and to identify factors associated with outcome.
Methods
Retrospective, observational cohort study of patients who underwent ECPR for OHCA at four cardiac arrest centres. Binary logistic regression and Kaplan-Meier survival curves were performed to assess association with 30-day mortality.
Results
A total of 259 patients receiving ECPR for OHCA between July 2011 and December 2020 were included in the study. Thirty-day survival was 26% and a good neurological outcome Cerebral Performance Category (CPC) 1–2 was observed in 94% of patients at discharge. Strict adherence to the national consensus showed a 30-day survival rate of 30%. Adding one or more of the following criteria to the national consensus: signs of life during cardiopulmonary resuscitation (CPR), pre-hospital low-flow <100 minutes, pH >6.8 and lactate <15 mmol/L increased the survival rate to 48%, but would exclude 58% of the survivors from the current cohort. Logistic regression identified initial presenting rhythm with asystole (RR 1.36, 95% CI 1.18–1.57), pulseless electrical activity (PEA) (RR 1.20, 95% CI 1.03–1.41), initial pH <6.8 (RR 1.28, 95% CI 1.12–1.46) and lactate levels >15 mmol/L (RR 1.16, 95% CI 1.16–1.53) as factors associated with increased risk of 30-day mortality. Patients presenting signs of life during CPR had threefold higher survival rate than patients without signs of life (45% versus 13%, p<0.001)
Conclusion
A high survival rate with a good neurological outcome was observed in this population of patients treated with ECPR for OHCA. Signs of life during CPR may aid the decision-making in the selection of appropriate candidates. Stringent patient selection for ECPR may produce higher survival rates but potentially withholds life-saving treatment in a significant proportion of survivors, why optimization of the selection criteria is still necessary.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): This work was supported by the Danish Heart Foundation [20-R142-A9498-22178]; and Health Research Foundation of Central Denmark Region [R64-A3178-B1349] Survival and adherence to consensusSigns of life during CPR
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Affiliation(s)
- S R Moerk
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - C Stengaard
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - L Linde
- Odense University Hospital, Department of Cardiology, Odense, Denmark
| | - J E Moller
- Odense University Hospital, Department of Cardiology, Odense, Denmark
| | - J B Andreasen
- Aalborg University Hospital, Department of Anaestesiology and Intensive Care, Aalborg, Denmark
| | - H Laugesen
- Aalborg University Hospital, Department of Anaestesiology and Intensive Care, Aalborg, Denmark
| | - S A Thomassen
- Aalborg University Hospital, Department of Anaestesiology and Intensive Care, Aalborg, Denmark
| | - P M Freeman
- Aalborg University Hospital, Department of Cardiology, Aalborg, Denmark
| | - S Christensen
- Aarhus University Hospital, Department of Anaesthesiology and Intensive Care, Aarhus, Denmark
| | - M Tang
- Aarhus University Hospital, Department of Thoracic and Vascular Surgery, Aarhus, Denmark
| | - E Gregers
- Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - J Kjaergaard
- Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - C Hassager
- Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - H Eiskjaer
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - C J Terkelsen
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
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38
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Iversen BN, Meilandt C, Væggemose U, Terkelsen CJ, Kirkegaard H, Fjølner J. Pre-charging the defibrillator before rhythm analysis reduces hands-off time in patients with out-of-hospital cardiac arrest with shockable rhythm. Resuscitation 2021; 169:23-30. [PMID: 34627866 DOI: 10.1016/j.resuscitation.2021.09.037] [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] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 09/07/2021] [Accepted: 09/26/2021] [Indexed: 11/26/2022]
Abstract
AIM To evaluate the effect of pre-charging the defibrillator before rhythm analysis on hands-off time in patients suffering from out-of-hospital cardiac arrest with shockable rhythm. METHODS Pre-charging was implemented in the Emergency Medical Service in the Central Denmark Region in June 2018. Training consisted of hands-on simulation scenarios, e-learning material, and written instructions. Data were extracted from the Danish Cardiac Arrest Registry for a 14-month period spanning the implementation of pre-charging. Patients having received at least one shock were included. Transthoracic impedance data were analysed. We recorded hands-off time and peri-shock pauses for all defibrillation procedures and the total hands-off fraction for all cardiac arrests. RESULTS Impedance and outcome data were available for 178 patients. 523 defibrillation procedures were analysed. The pre-charge method was associated with shorter median hands-off time per defibrillation procedure (7.6 (IQR 5.8-9.9) vs. 12.6 (IQR 10-16.4) seconds, p < 0.001) but longer pre-shock pause (4 (IQR 2.7-6.1) vs 1.7 (IQR 1.2-3) seconds, p < 0.001) when compared to the current guideline-recommended defibrillation method. The total hands-off fraction per cardiac arrest was reduced after implementation of the pre-charge method (16.5% vs. 20.4%, p = 0.003). No increase in shocks to non-shockable rhythms or personnel was registered. Patients who received only pre-charge defibrillations had an increased odds ratio of return of spontaneous circulation (aOR 2.91; 95%CI 1.09-7.8, p = 0.03). CONCLUSION Pre-charging the defibrillator reduced hands-off time during defibrillation procedures, reduces the total hands-off fraction and may be associated with increased return of spontaneous circulation in out-of-hospital cardiac arrest with shockable rhythm.
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Affiliation(s)
- Bo Nees Iversen
- Prehospital Emergency Medical Services, Central Denmark Region, Oluf Palmes Allé 34, 8200 Aarhus N, Denmark; Department of Research and Development, Prehospital Emergency Medical Services, Oluf Palmes Allé 34, 8200 Aarhus N, Denmark; Department of Anaesthesia and Operation 1, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - Carsten Meilandt
- Prehospital Emergency Medical Services, Central Denmark Region, Oluf Palmes Allé 34, 8200 Aarhus N, Denmark; Department of Research and Development, Prehospital Emergency Medical Services, Oluf Palmes Allé 34, 8200 Aarhus N, Denmark
| | - Ulla Væggemose
- Prehospital Emergency Medical Services, Central Denmark Region, Oluf Palmes Allé 34, 8200 Aarhus N, Denmark; Department of Research and Development, Prehospital Emergency Medical Services, Oluf Palmes Allé 34, 8200 Aarhus N, Denmark; Department of Clinical Medicine, Aarhus University, Incuba Skejby, Palle Juul-Jensens Boulevard 82, 8200 Aarhus N, Denmark
| | - Christian Juhl Terkelsen
- Department of Clinical Medicine, Aarhus University, Incuba Skejby, Palle Juul-Jensens Boulevard 82, 8200 Aarhus N, Denmark; Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark; The Danish Heart Foundation, Vognmagergade 7, 3. Floor, 1120 Copenhagen K, Denmark
| | - Hans Kirkegaard
- Prehospital Emergency Medical Services, Central Denmark Region, Oluf Palmes Allé 34, 8200 Aarhus N, Denmark; Department of Research and Development, Prehospital Emergency Medical Services, Oluf Palmes Allé 34, 8200 Aarhus N, Denmark; Department of Clinical Medicine, Aarhus University, Incuba Skejby, Palle Juul-Jensens Boulevard 82, 8200 Aarhus N, Denmark; Research Centre for Emergency Medicine, Emergency Department, Palle Juul-Jensens Boulevard 99 Aarhus University Hospital, Aarhus, Denmark
| | - Jesper Fjølner
- Prehospital Emergency Medical Services, Central Denmark Region, Oluf Palmes Allé 34, 8200 Aarhus N, Denmark; Department of Research and Development, Prehospital Emergency Medical Services, Oluf Palmes Allé 34, 8200 Aarhus N, Denmark; Department of Clinical Medicine, Aarhus University, Incuba Skejby, Palle Juul-Jensens Boulevard 82, 8200 Aarhus N, Denmark; Department of Intensive Care, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark.
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Mørk SR, Stengaard C, Linde L, Møller JE, Jensen LO, Schmidt H, Riber LP, Andreasen JB, Thomassen SA, Laugesen H, Freeman PM, Christensen S, Greisen JR, Tang M, Møller-Sørensen PH, Holmvang L, Gregers E, Kjaergaard J, Hassager C, Eiskjær H, Terkelsen CJ. Mechanical circulatory support for refractory out-of-hospital cardiac arrest: a Danish nationwide multicenter study. Crit Care 2021; 25:174. [PMID: 34022934 PMCID: PMC8141159 DOI: 10.1186/s13054-021-03606-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 05/14/2021] [Indexed: 12/16/2022]
Abstract
Background Mechanical circulatory support (MCS) with either extracorporeal membrane oxygenation or Impella has shown potential as a salvage therapy for patients with refractory out-of-hospital cardiac arrest (OHCA). The objective of this study was to describe the gradual implementation, survival and adherence to the national consensus with respect to use of MCS for OHCA in Denmark, and to identify factors associated with outcome. Methods This retrospective, observational cohort study included patients receiving MCS for OHCA at all tertiary cardiac arrest centers (n = 4) in Denmark between July 2011 and December 2020. Logistic regression and Kaplan–Meier survival analysis were used to determine association with outcome. Outcome was presented as survival to hospital discharge with good neurological outcome, 30-day survival and predictors of 30-day mortality. Results A total of 259 patients were included in the study. Thirty-day survival was 26%. Sixty-five (25%) survived to hospital discharge and a good neurological outcome (Glasgow–Pittsburgh Cerebral Performance Categories 1–2) was observed in 94% of these patients. Strict adherence to the national consensus showed a 30-day survival rate of 30% compared with 22% in patients violating one or more criteria. Adding criteria to the national consensus such as signs of life during cardiopulmonary resuscitation (CPR), pre-hospital low-flow < 100 min, pH > 6.8 and lactate < 15 mmol/L increased the survival rate to 48%, but would exclude 58% of the survivors from the current cohort. Logistic regression identified asystole (RR 1.36, 95% CI 1.18–1.57), pulseless electrical activity (RR 1.20, 95% CI 1.03–1.41), initial pH < 6.8 (RR 1.28, 95% CI 1.12–1.46) and lactate levels > 15 mmol/L (RR 1.16, 95% CI 1.16–1.53) as factors associated with increased risk of 30-day mortality. Patients presenting signs of life during CPR had reduced risk of 30-day mortality (RR 0.63, 95% CI 0.52–0.76). Conclusions A high survival rate with a good neurological outcome was observed in this Danish population of patients treated with MCS for OHCA. Stringent patient selection for MCS may produce higher survival rates but potentially withholds life-saving treatment in a significant proportion of survivors. Supplementary Information The online version contains supplementary material available at 10.1186/s13054-021-03606-5.
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Affiliation(s)
- Sivagowry Rasalingam Mørk
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark.
| | - Carsten Stengaard
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Louise Linde
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | | | | | - Henrik Schmidt
- Department of Anaesthesiology and Intensive Care, Odense University Hospital, Odense, Denmark
| | - Lars Peter Riber
- Department of Thoracic and Vascular Surgery, Odense University Hospital, Odense, Denmark
| | - Jo Bønding Andreasen
- Department of Anaesthesiology and Intensive Care, Aalborg University Hospital, Aalborg, Denmark
| | - Sisse Anette Thomassen
- Department of Anaesthesiology and Intensive Care, Aalborg University Hospital, Aalborg, Denmark
| | - Helle Laugesen
- Department of Anaesthesiology and Intensive Care, Aalborg University Hospital, Aalborg, Denmark
| | | | - Steffen Christensen
- Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Jacob Raben Greisen
- Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Mariann Tang
- Department of Thoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
| | | | - Lene Holmvang
- Department of Cardiology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Emilie Gregers
- Department of Cardiology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jesper Kjaergaard
- Department of Cardiology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Christian Hassager
- Department of Cardiology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Hans Eiskjær
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Christian Juhl Terkelsen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark.,The Danish Heart Foundation, Copenhagen, Denmark
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40
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Sejr‐Hansen M, Christiansen EH, Ahmad Y, Vendrik J, Westra J, Holm NR, Thim T, Seligman H, Hall K, Sen S, Terkelsen CJ, Eftekhari A. Performance of quantitative flow ratio in patients with aortic stenosis undergoing transcatheter aortic valve implantation. Catheter Cardiovasc Interv 2021; 99:68-73. [DOI: 10.1002/ccd.29518] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 11/25/2020] [Accepted: 12/13/2020] [Indexed: 01/09/2023]
Affiliation(s)
| | | | - Yousif Ahmad
- Department of Cardiology National Heart and Lung institute, Imperial College London London UK
| | - Jeroen Vendrik
- Department of Cardiology, AMC Medical Research BV Amsterdam The Netherlands
| | - Jelmer Westra
- Department of Cardiology Aarhus University Hospital Aarhus Denmark
| | - Niels R. Holm
- Department of Cardiology Aarhus University Hospital Aarhus Denmark
| | - Troels Thim
- Department of Cardiology Aarhus University Hospital Aarhus Denmark
| | - Henry Seligman
- Department of Cardiology National Heart and Lung institute, Imperial College London London UK
| | - Kerry Hall
- Department of Cardiology National Heart and Lung institute, Imperial College London London UK
| | - Sayan Sen
- Department of Cardiology National Heart and Lung institute, Imperial College London London UK
| | | | - Ashkan Eftekhari
- Department of Cardiology Aarhus University Hospital Aarhus Denmark
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41
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Povlsen JA, Rasmussen VG, Vase H, Jensen KT, Terkelsen CJ, Christiansen EH, Tang M, Pedersen ALD, Poulsen SH. Distribution and prognostic value of left ventricular global longitudinal strain in elderly patients with symptomatic severe aortic stenosis undergoing transcatheter aortic valve replacement. BMC Cardiovasc Disord 2020; 20:506. [PMID: 33267772 PMCID: PMC7709407 DOI: 10.1186/s12872-020-01791-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 11/22/2020] [Indexed: 11/29/2022] Open
Abstract
Aims The aim of present study was to examine the preoperative prevalence and distribution of impaired left ventricular global longitudinal strain (LVGLS) in elderly patients with symptomatic aortic stenosis (AS) undergoing transcutaneous aortic valve replacement (TAVR) and to determine the predictive value of LVGLS on survival. Methods We included 411 patients with symptomatic severe AS treated with TAVR during a 5-year period, where a baseline echocardiography including LVGLS assessment was available. Results Mean age was 80.1 ± 7.1 years and aortic valve area (AVA) index 0.4 ± 0.1 cm2. 78 patients died during a median follow-up of 762 days. Mean left ventricular ejection fraction (LVEF) was 50 ± 13% and mean LVGLS was − 14.0%. LVEF was preserved in 60% of patients, while impaired LVGLS > − 18% was seen in 75% of the patients. Previous myocardial infarction, LVEF < 50%, LVGLS > − 14%, low gradient AS (< 4.0 m/s), tricuspid regurgitant gradient > 30 mmHg were identified as significant univariate predictors of all-cause mortality. On multivariate analysis LVGLS > − 14% (HR 1.79 [1.02–3.14], p = 0.04) was identified as the only independent variable associated with all-cause mortality. Reduced survival was observed with an impaired LVGLS > − 14% in the total population (p < 0.002) but also in patients with high AS gradient with preserved LVEF. LVGLS provided incremental prognostic value with respect to clinical characteristics, AVA and LVEF (χ2 19.9, p = 0.006). Conclusions In patients with symptomatic AS undergoing TAVR, impaired LVGLS was highly prevalent despite preserved LVEF. LVGLS > − 14% was an independent predictor of all-cause mortality, and survival was reduced if LVGLS > − 14%.
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Affiliation(s)
- Jonas Agerlund Povlsen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark.
| | - Vibeke Guldbrand Rasmussen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Henrik Vase
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Kaare Troels Jensen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Christian Juhl Terkelsen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Evald Høj Christiansen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Mariann Tang
- Department of Cardiothoracic Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | | | - Steen Hvitfeldt Poulsen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
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42
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Terkelsen CJ. [Telemedicinsk diagnostik af patienter med akut myokardieinfarkt - kan vi nøjes med færre telecentre?]. Ugeskr Laeger 2020; 182:V205039. [PMID: 33118492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
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Thim T, Götberg M, Fröbert O, Nijveldt R, van Royen N, Baptista SB, Koul S, Kellerth T, Bøtker HE, Terkelsen CJ, Christiansen EH, Jakobsen L, Kristensen SD, Maeng M. Agreement between nonculprit stenosis follow-up iFR and FFR after STEMI (iSTEMI substudy). BMC Res Notes 2020; 13:410. [PMID: 32873327 PMCID: PMC7466494 DOI: 10.1186/s13104-020-05252-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 08/21/2020] [Indexed: 11/20/2022] Open
Abstract
Objective To evaluate agreement between instantaneous wave free ratio (iFR) and fractional flow reserve (FFR) for the functional assessment of nonculprit coronary stenoses at staged follow-up after ST-segment elevation myocardial infarction (STEMI). Results We measured iFR and FFR at staged follow-up in 112 STEMI patients with 146 nonculprit stenoses. Median interval between STEMI and follow-up was 16 (interquartile range 5–32) days. Agreement between iFR and FFR was 77% < 5 days after STEMI and 86% after ≥ 5 days (p = 0.19). Among cases with disagreement, the proportion of cases with hemodynamically significant iFR and non-significant FFR were different when assessed < 5 days (5 in 8, 63%) versus ≥ 5 days (3 in 15, 20%) after STEMI (p = 0.04). Overall classification agreement between iFR and FFR was comparable to that observed in stable patients. Time interval between STEMI and follow-up evaluation may impact agreement between iFR and FFR.
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Affiliation(s)
- Troels Thim
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark.
| | - Matthias Götberg
- Department of Cardiology, Skåne University Hospital, Malmö, Sweden
| | - Ole Fröbert
- Department of Cardiology, Örebro University, Örebro, Sweden
| | - Robin Nijveldt
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Niels van Royen
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Sasha Koul
- Department of Cardiology, Skåne University Hospital, Malmö, Sweden
| | | | - Hans Erik Bøtker
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Christian Juhl Terkelsen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Evald Høj Christiansen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Lars Jakobsen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Steen Dalby Kristensen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Michael Maeng
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
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Jensen LO, Maeng M, Raungaard B, Kahlert J, Ellert J, Jakobsen L, Villadsen AB, Veien KT, Kristensen SD, Ahlehoff O, Carstensen S, Christensen MK, Terkelsen CJ, Engstroem T, Hansen KN, Bøtker HE, Aaroe J, Thim T, Thuesen L, Freeman P, Aziz A, Eftekhari A, Junker A, Jensen SE, Lassen JF, Hansen HS, Christiansen EH, Thygesen K, Sørensen JT, Andersen HR. Randomized Comparison of the Polymer-Free Biolimus-Coated BioFreedom Stent With the Ultrathin Strut Biodegradable Polymer Sirolimus-Eluting Orsiro Stent in an All-Comers Population Treated With Percutaneous Coronary Intervention. Circulation 2020; 141:2052-2063. [DOI: 10.1161/circulationaha.119.040241] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [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: 11/16/2022]
Abstract
Background:
In patients with increased bleeding risk, the biolimus A9-coated BioFreedom stent, a stainless steel drug-coated stent free from polymer, has shown superiority compared with a bare-metal stent. The aim of this study was to investigate whether the BioFreedom stent is noninferior to a modern ultrathin strut biodegradable polymer cobalt-chromium sirolimus-eluting Orsiro stent in an all-comers patient population treated with percutaneous coronary intervention.
Methods:
The SORT OUT IX trial (Scandinavian Organization for Randomized Trials With Clinical Outcome IX), was a large-scale, registry-based, randomized, multicenter, single-blind, 2-arm, noninferiority trial. The primary end point, major adverse cardiovascular events, was defined as the composite of cardiac death, myocardial infarction not related to any segment other than the target lesion, or target lesion revascularization within 1 year, analyzed by intention-to-treat. The trial was powered to assess noninferiority for major adverse cardiovascular events of the BioFreedom stent compared with the Orsiro stent with a predetermined noninferiority margin of 0.021.
Results:
Between December 14, 2015 and April 21, 2017, 3151 patients were assigned to treatment with the BioFreedom stent (1572 patients, 1966 lesions) or to the Orsiro stent (1579 patients, 1985 lesions). Five patients were lost to follow-up because of emigration (99.9% follow-up rate). Mean age was 66.3±10.9, diabetes mellitus was seen in 19.3% of patients, and 53% of the patients had acute coronary syndromes. At 1 year, intention-to-treat analysis showed that 79 (5.0%) patients, who were assigned the BioFreedom stent, and 59 (3.7%), who were assigned the Orsiro stent, met the primary end point (absolute risk difference 1.29% [upper limit of one-sided 95% CI 2.50%];
P
noni
nferiority
=0.14). Significantly more patients in the BioFreedom stent group had target lesion revascularization than those in the Orsiro stent group (55 [3.5%] vs 20 [1.3%], rate ratio 2.77 [95% CI, 1.66–4.62];
P
<0.0001).
Conclusions:
The biolimus A9-coated BioFreedom polymer-free stent did not meet criteria for noninferiority for major adverse cardiovascular events at 12 months when compared with the ultrathin strut biodegradable polymer sirolimus-eluting Orsiro stent in an all-comers population
Registration:
URL:
https://www.clinicaltrials.gov
; Unique identifier: NCT02623140.
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Affiliation(s)
- Lisette Okkels Jensen
- Department of Cardiology, Odense University Hospital, Denmark (L.O.J., J.E., K.T.V., O.A., K.N.H., A.A., A.J., J.F.L., H.S.H.)
| | - Michael Maeng
- Department of Cardiology, Aarhus University Hospital, Skejby Hospital, Denmark (M.M., L.J., S.D.K., S.C., C.J.T., H.E.B., T.T., A.E., E.H.C.)
| | - Bent Raungaard
- Department of Cardiology, Aalborg University Hospital, Denmark (B.R., A.B.V., M.K.C., J.A., L.T., P.F., S.E.J.)
| | - Johnny Kahlert
- Department of Clinical Epidemiology, Aarhus University, Denmark (J.K.)
| | - Julia Ellert
- Department of Cardiology, Odense University Hospital, Denmark (L.O.J., J.E., K.T.V., O.A., K.N.H., A.A., A.J., J.F.L., H.S.H.)
| | - Lars Jakobsen
- Department of Cardiology, Aarhus University Hospital, Skejby Hospital, Denmark (M.M., L.J., S.D.K., S.C., C.J.T., H.E.B., T.T., A.E., E.H.C.)
| | - Anton Boel Villadsen
- Department of Cardiology, Aalborg University Hospital, Denmark (B.R., A.B.V., M.K.C., J.A., L.T., P.F., S.E.J.)
| | - Karsten Tange Veien
- Department of Cardiology, Odense University Hospital, Denmark (L.O.J., J.E., K.T.V., O.A., K.N.H., A.A., A.J., J.F.L., H.S.H.)
| | - Steen Dalby Kristensen
- Department of Cardiology, Aarhus University Hospital, Skejby Hospital, Denmark (M.M., L.J., S.D.K., S.C., C.J.T., H.E.B., T.T., A.E., E.H.C.)
| | - Ole Ahlehoff
- Department of Cardiology, Odense University Hospital, Denmark (L.O.J., J.E., K.T.V., O.A., K.N.H., A.A., A.J., J.F.L., H.S.H.)
| | - Steen Carstensen
- Department of Cardiology, Aarhus University Hospital, Skejby Hospital, Denmark (M.M., L.J., S.D.K., S.C., C.J.T., H.E.B., T.T., A.E., E.H.C.)
| | - Martin Kirk Christensen
- Department of Cardiology, Aalborg University Hospital, Denmark (B.R., A.B.V., M.K.C., J.A., L.T., P.F., S.E.J.)
| | - Christian Juhl Terkelsen
- Department of Cardiology, Aarhus University Hospital, Skejby Hospital, Denmark (M.M., L.J., S.D.K., S.C., C.J.T., H.E.B., T.T., A.E., E.H.C.)
| | | | - Knud Nørregaard Hansen
- Department of Cardiology, Odense University Hospital, Denmark (L.O.J., J.E., K.T.V., O.A., K.N.H., A.A., A.J., J.F.L., H.S.H.)
| | - Hans Erik Bøtker
- Department of Cardiology, Aarhus University Hospital, Skejby Hospital, Denmark (M.M., L.J., S.D.K., S.C., C.J.T., H.E.B., T.T., A.E., E.H.C.)
| | - Jens Aaroe
- Department of Cardiology, Aalborg University Hospital, Denmark (B.R., A.B.V., M.K.C., J.A., L.T., P.F., S.E.J.)
| | - Troels Thim
- Department of Cardiology, Aarhus University Hospital, Skejby Hospital, Denmark (M.M., L.J., S.D.K., S.C., C.J.T., H.E.B., T.T., A.E., E.H.C.)
| | - Leif Thuesen
- Department of Cardiology, Aalborg University Hospital, Denmark (B.R., A.B.V., M.K.C., J.A., L.T., P.F., S.E.J.)
| | - Philip Freeman
- Department of Cardiology, Aalborg University Hospital, Denmark (B.R., A.B.V., M.K.C., J.A., L.T., P.F., S.E.J.)
| | - Ahmed Aziz
- Department of Cardiology, Odense University Hospital, Denmark (L.O.J., J.E., K.T.V., O.A., K.N.H., A.A., A.J., J.F.L., H.S.H.)
| | - Ashkan Eftekhari
- Department of Cardiology, Aarhus University Hospital, Skejby Hospital, Denmark (M.M., L.J., S.D.K., S.C., C.J.T., H.E.B., T.T., A.E., E.H.C.)
| | - Anders Junker
- Department of Cardiology, Odense University Hospital, Denmark (L.O.J., J.E., K.T.V., O.A., K.N.H., A.A., A.J., J.F.L., H.S.H.)
| | - Svend Eggert Jensen
- Department of Cardiology, Aalborg University Hospital, Denmark (B.R., A.B.V., M.K.C., J.A., L.T., P.F., S.E.J.)
| | - Jens Flensted Lassen
- Department of Cardiology, Odense University Hospital, Denmark (L.O.J., J.E., K.T.V., O.A., K.N.H., A.A., A.J., J.F.L., H.S.H.)
- Department of Cardiology, Copenhagen University Hospital, Denmark (J.F.L.)
| | - Henrik Steen Hansen
- Department of Cardiology, Odense University Hospital, Denmark (L.O.J., J.E., K.T.V., O.A., K.N.H., A.A., A.J., J.F.L., H.S.H.)
| | - Evald Høj Christiansen
- Department of Cardiology, Aarhus University Hospital, Skejby Hospital, Denmark (M.M., L.J., S.D.K., S.C., C.J.T., H.E.B., T.T., A.E., E.H.C.)
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Kumsars I, Holm NR, Niemelä M, Erglis A, Kervinen K, Christiansen EH, Maeng M, Dombrovskis A, Abraitis V, Kibarskis A, Trovik T, Latkovskis G, Sondore D, Narbute I, Terkelsen CJ, Eskola M, Romppanen H, Laine M, Jensen LO, Pietila M, Gunnes P, Hebsgaard L, Frobert O, Calais F, Hartikainen J, Aarøe J, Ravkilde J, Engstrøm T, Steigen TK, Thuesen L, Lassen JF. Randomised comparison of provisional side branch stenting versus a two-stent strategy for treatment of true coronary bifurcation lesions involving a large side branch: the Nordic-Baltic Bifurcation Study IV. Open Heart 2020; 7:e000947. [PMID: 32076558 PMCID: PMC6999681 DOI: 10.1136/openhrt-2018-000947] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 08/05/2019] [Accepted: 09/11/2019] [Indexed: 01/25/2023] Open
Abstract
Background It is still uncertain whether coronary bifurcations with lesions involving a large side branch (SB) should be treated by stenting the main vessel and provisional stenting of the SB (simple) or by routine two-stent techniques (complex). We aimed to compare clinical outcome after treatment of lesions in large bifurcations by simple or complex stent implantation. Methods The study was a randomised, superiority trial. Enrolment required a SB≥2.75 mm, ≥50% diameter stenosis in both vessels, and allowed SB lesion length up to 15 mm. The primary endpoint was a composite of cardiac death, non-procedural myocardial infarction and target lesion revascularisation at 6 months. Two-year clinical follow-up was included in this primary reporting due to lower than expected event rates. Results A total of 450 patients were assigned to simple stenting (n=221) or complex stenting (n=229) in 14 Nordic and Baltic centres. Two-year follow-up was available in 218 (98.6%) and 228 (99.5%) patients, respectively. The primary endpoint of major adverse cardiac events (MACE) at 6 months was 5.5% vs 2.2% (risk differences 3.2%, 95% CI −0.2 to 6.8, p=0.07) and at 2 years 12.9% vs 8.4% (HR 0.63, 95% CI 0.35 to 1.13, p=0.12) after simple versus complex treatment. In the subgroup treated by newer generation drug-eluting stents, MACE was 12.0% vs 5.6% (HR 0.45, 95% CI 0.17 to 1.17, p=0.10) after simple versus complex treatment. Conclusion In the treatment of bifurcation lesions involving a large SB with ostial stenosis, routine two-stent techniques did not improve outcome significantly compared with treatment by the simpler main vessel stenting technique after 2 years. Trial registration number NCT01496638.
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Affiliation(s)
- Indulis Kumsars
- Department of Cardiology, Latvia Center of Cardiology, Paul Stradins Clinical University Hospital, Riga, Latvia
| | | | - Matti Niemelä
- Department of Cardiology, Oulu University Hospital, Oulu, Finland
| | - Andrejs Erglis
- Research Institute of Cardiology and Regenerative Medicine, Latvia Centre of Cardiology, Riga, Latvia
| | - Kari Kervinen
- Department of Cardiology, Oulu University Hospital, Oulu, Finland
| | | | - Michael Maeng
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Andis Dombrovskis
- Department of Cardiology, Latvia Center of Cardiology, Paul Stradins Clinical University Hospital, Riga, Latvia
| | - Vytautas Abraitis
- Department of Cardiology, Vilnius University Hospital, Vilnius, Lithuania
| | | | - Thor Trovik
- Department of Cardiology, University of North Norway, Tromsoe, Norway
| | - Gustavs Latkovskis
- Research Institute of Cardiology and Regenerative Medicine, Latvia Centre of Cardiology, Riga, Latvia
| | - Dace Sondore
- Department of Cardiology, Latvia Center of Cardiology, Paul Stradins Clinical University Hospital, Riga, Latvia
| | - Inga Narbute
- Research Institute of Cardiology and Regenerative Medicine, Latvia Centre of Cardiology, Riga, Latvia
| | | | - Markku Eskola
- Department of Cardiology, Heart Center, Tampere University Hospital, Tampere, Finland
| | - Hannu Romppanen
- Department of cardiology, Heart Center, Kuopio University Hospital, Kuopio, Finland
| | - Mika Laine
- Department of Cardiology, Helsinki University Central Hospital, Helsinki, Finland
| | | | - Mikko Pietila
- Department of Cardiology, Turku University Hospital, Turku, Finland
| | - Pål Gunnes
- Heart Center, Sørlandet Hospital, Arendal, Norway
| | - Lasse Hebsgaard
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Ole Frobert
- Örebro University, Faculty of Health, Department of Cardiology, Örebro, Sweden
| | - Fredrik Calais
- Örebro University, Faculty of Health, Department of Cardiology, Örebro, Sweden
| | - Juha Hartikainen
- Department of cardiology, Heart Center, Kuopio University Hospital, Kuopio, Finland
| | - Jens Aarøe
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Jan Ravkilde
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Thomas Engstrøm
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | - Terje K Steigen
- Department of Cardiology, University Hospital of North Norway, Tromsoe and Cardiovascular Diseases Research Group, UiT The Arctic University of Norway, Tromsø, Norway
| | - Leif Thuesen
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Jens F Lassen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
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Ahmad Y, Vendrik J, Eftekhari A, Howard JP, Cook C, Rajkumar C, Malik I, Mikhail G, Ruparelia N, Hadjiloizou N, Nijjer S, Al-Lamee R, Petraco R, Warisawa T, Wijntjens GWM, Koch KT, van de Hoef T, de Waard G, Echavarria-Pinto M, Frame A, Sutaria N, Kanaganayagam G, Ariff B, Anderson J, Chukwuemeka A, Fertleman M, Koul S, Iglesias JF, Francis D, Mayet J, Serruys P, Davies J, Escaned J, van Royen N, Götberg M, Juhl Terkelsen C, Høj Christiansen E, Piek JJ, Baan J, Sen S. Determining the Predominant Lesion in Patients With Severe Aortic Stenosis and Coronary Stenoses: A Multicenter Study Using Intracoronary Pressure and Flow. Circ Cardiovasc Interv 2019; 12:e008263. [PMID: 31752515 PMCID: PMC6924937 DOI: 10.1161/circinterventions.119.008263] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Patients with severe aortic stenosis (AS) often have coronary artery disease. Both the aortic valve and the coronary disease influence the blood flow to the myocardium and its ability to respond to stress; leading to exertional symptoms. In this study, we aim to quantify the effect of severe AS on the coronary microcirculation and determine if this is influenced by any concomitant coronary disease. We then compare this to the effect of coronary stenoses on the coronary microcirculation.
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Affiliation(s)
- Yousif Ahmad
- National Heart and Lung Institute, Hammersmith Hospital, Imperial College London, United Kingdom (Y.A., J.P.H., C.C., C.R., R.A.-L., R.P., T.W., D.F., J.M., P.S., S.S.)
| | - Jeroen Vendrik
- Amsterdam UMC, University of Amsterdam, Heart Center, Department of Clinical and Experimental Cardiology, the Netherlands (J.V., K.T.K., T.v.d.H., J.J.P., J.B.)
| | - Ashkan Eftekhari
- Aarhus University Hospital Skejby, Denmark (A.E., C.J.T., E.H.C.)
| | - James P Howard
- National Heart and Lung Institute, Hammersmith Hospital, Imperial College London, United Kingdom (Y.A., J.P.H., C.C., C.R., R.A.-L., R.P., T.W., D.F., J.M., P.S., S.S.)
| | - Christopher Cook
- National Heart and Lung Institute, Hammersmith Hospital, Imperial College London, United Kingdom (Y.A., J.P.H., C.C., C.R., R.A.-L., R.P., T.W., D.F., J.M., P.S., S.S.)
| | - Christopher Rajkumar
- National Heart and Lung Institute, Hammersmith Hospital, Imperial College London, United Kingdom (Y.A., J.P.H., C.C., C.R., R.A.-L., R.P., T.W., D.F., J.M., P.S., S.S.)
| | - Iqbal Malik
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom (I.M., G.M., N.R., N.H., S.N., A.F., N.S., G.K., B.A., J.A., A.C., M.F., J.D.)
| | - Ghada Mikhail
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom (I.M., G.M., N.R., N.H., S.N., A.F., N.S., G.K., B.A., J.A., A.C., M.F., J.D.)
| | - Neil Ruparelia
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom (I.M., G.M., N.R., N.H., S.N., A.F., N.S., G.K., B.A., J.A., A.C., M.F., J.D.)
| | - Nearchos Hadjiloizou
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom (I.M., G.M., N.R., N.H., S.N., A.F., N.S., G.K., B.A., J.A., A.C., M.F., J.D.)
| | - Sukhjinder Nijjer
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom (I.M., G.M., N.R., N.H., S.N., A.F., N.S., G.K., B.A., J.A., A.C., M.F., J.D.)
| | - Rasha Al-Lamee
- National Heart and Lung Institute, Hammersmith Hospital, Imperial College London, United Kingdom (Y.A., J.P.H., C.C., C.R., R.A.-L., R.P., T.W., D.F., J.M., P.S., S.S.)
| | - Ricardo Petraco
- National Heart and Lung Institute, Hammersmith Hospital, Imperial College London, United Kingdom (Y.A., J.P.H., C.C., C.R., R.A.-L., R.P., T.W., D.F., J.M., P.S., S.S.)
| | - Takayuki Warisawa
- National Heart and Lung Institute, Hammersmith Hospital, Imperial College London, United Kingdom (Y.A., J.P.H., C.C., C.R., R.A.-L., R.P., T.W., D.F., J.M., P.S., S.S.)
| | | | - Karel T Koch
- Amsterdam UMC, University of Amsterdam, Heart Center, Department of Clinical and Experimental Cardiology, the Netherlands (J.V., K.T.K., T.v.d.H., J.J.P., J.B.)
| | - Tim van de Hoef
- Amsterdam UMC, University of Amsterdam, Heart Center, Department of Clinical and Experimental Cardiology, the Netherlands (J.V., K.T.K., T.v.d.H., J.J.P., J.B.)
| | - Guus de Waard
- Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands (G.d.W., N.v.R.)
| | | | - Angela Frame
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom (I.M., G.M., N.R., N.H., S.N., A.F., N.S., G.K., B.A., J.A., A.C., M.F., J.D.)
| | - Nilesh Sutaria
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom (I.M., G.M., N.R., N.H., S.N., A.F., N.S., G.K., B.A., J.A., A.C., M.F., J.D.)
| | - Gajen Kanaganayagam
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom (I.M., G.M., N.R., N.H., S.N., A.F., N.S., G.K., B.A., J.A., A.C., M.F., J.D.)
| | - Ben Ariff
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom (I.M., G.M., N.R., N.H., S.N., A.F., N.S., G.K., B.A., J.A., A.C., M.F., J.D.)
| | - Jon Anderson
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom (I.M., G.M., N.R., N.H., S.N., A.F., N.S., G.K., B.A., J.A., A.C., M.F., J.D.)
| | - Andrew Chukwuemeka
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom (I.M., G.M., N.R., N.H., S.N., A.F., N.S., G.K., B.A., J.A., A.C., M.F., J.D.)
| | - Michael Fertleman
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom (I.M., G.M., N.R., N.H., S.N., A.F., N.S., G.K., B.A., J.A., A.C., M.F., J.D.)
| | - Sasha Koul
- Department of Cardiology, Clinical Sciences, Lund University, Skåne University Hospital, Sweden (S.K., M.G.)
| | - Juan F Iglesias
- Cardiology Department, Lausanne University Hospital, Switzerland (J.F.I.)
| | - Darrel Francis
- National Heart and Lung Institute, Hammersmith Hospital, Imperial College London, United Kingdom (Y.A., J.P.H., C.C., C.R., R.A.-L., R.P., T.W., D.F., J.M., P.S., S.S.)
| | - Jamil Mayet
- National Heart and Lung Institute, Hammersmith Hospital, Imperial College London, United Kingdom (Y.A., J.P.H., C.C., C.R., R.A.-L., R.P., T.W., D.F., J.M., P.S., S.S.)
| | - Patrick Serruys
- National Heart and Lung Institute, Hammersmith Hospital, Imperial College London, United Kingdom (Y.A., J.P.H., C.C., C.R., R.A.-L., R.P., T.W., D.F., J.M., P.S., S.S.)
| | - Justin Davies
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom (I.M., G.M., N.R., N.H., S.N., A.F., N.S., G.K., B.A., J.A., A.C., M.F., J.D.)
| | - Javier Escaned
- Hospital Clínico San Carlos, Madrid, Spain (M.E.-P., J.E.)
| | - Niels van Royen
- Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands (G.d.W., N.v.R.)
| | - Matthias Götberg
- Department of Cardiology, Clinical Sciences, Lund University, Skåne University Hospital, Sweden (S.K., M.G.)
| | | | | | - Jan J Piek
- Amsterdam UMC, University of Amsterdam, Heart Center, Department of Clinical and Experimental Cardiology, the Netherlands (J.V., K.T.K., T.v.d.H., J.J.P., J.B.)
| | - Jan Baan
- Amsterdam UMC, University of Amsterdam, Heart Center, Department of Clinical and Experimental Cardiology, the Netherlands (J.V., K.T.K., T.v.d.H., J.J.P., J.B.)
| | - Sayan Sen
- National Heart and Lung Institute, Hammersmith Hospital, Imperial College London, United Kingdom (Y.A., J.P.H., C.C., C.R., R.A.-L., R.P., T.W., D.F., J.M., P.S., S.S.)
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47
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De Backer O, Butt JH, Wong YH, Torp-Pedersen C, Terkelsen CJ, Nissen H, Fosbøl EL, Køber L, Søndergaard L. Early and late risk of ischemic stroke after TAVR as compared to a nationwide background population. Clin Res Cardiol 2019; 109:791-801. [DOI: 10.1007/s00392-019-01565-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 10/18/2019] [Indexed: 11/29/2022]
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Hausenloy DJ, Kharbanda RK, Møller UK, Ramlall M, Aarøe J, Butler R, Bulluck H, Clayton T, Dana A, Dodd M, Engstrom T, Evans R, Lassen JF, Christensen EF, Garcia-Ruiz JM, Gorog DA, Hjort J, Houghton RF, Ibanez B, Knight R, Lippert FK, Lønborg JT, Maeng M, Milasinovic D, More R, Nicholas JM, Jensen LO, Perkins A, Radovanovic N, Rakhit RD, Ravkilde J, Ryding AD, Schmidt MR, Riddervold IS, Sørensen HT, Stankovic G, Varma M, Webb I, Terkelsen CJ, Greenwood JP, Yellon DM, Bøtker HE. Effect of remote ischaemic conditioning on clinical outcomes in patients with acute myocardial infarction (CONDI-2/ERIC-PPCI): a single-blind randomised controlled trial. Lancet 2019; 394:1415-1424. [PMID: 31500849 PMCID: PMC6891239 DOI: 10.1016/s0140-6736(19)32039-2] [Citation(s) in RCA: 202] [Impact Index Per Article: 40.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 08/09/2019] [Accepted: 08/22/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND Remote ischaemic conditioning with transient ischaemia and reperfusion applied to the arm has been shown to reduce myocardial infarct size in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). We investigated whether remote ischaemic conditioning could reduce the incidence of cardiac death and hospitalisation for heart failure at 12 months. METHODS We did an international investigator-initiated, prospective, single-blind, randomised controlled trial (CONDI-2/ERIC-PPCI) at 33 centres across the UK, Denmark, Spain, and Serbia. Patients (age >18 years) with suspected STEMI and who were eligible for PPCI were randomly allocated (1:1, stratified by centre with a permuted block method) to receive standard treatment (including a sham simulated remote ischaemic conditioning intervention at UK sites only) or remote ischaemic conditioning treatment (intermittent ischaemia and reperfusion applied to the arm through four cycles of 5-min inflation and 5-min deflation of an automated cuff device) before PPCI. Investigators responsible for data collection and outcome assessment were masked to treatment allocation. The primary combined endpoint was cardiac death or hospitalisation for heart failure at 12 months in the intention-to-treat population. This trial is registered with ClinicalTrials.gov (NCT02342522) and is completed. FINDINGS Between Nov 6, 2013, and March 31, 2018, 5401 patients were randomly allocated to either the control group (n=2701) or the remote ischaemic conditioning group (n=2700). After exclusion of patients upon hospital arrival or loss to follow-up, 2569 patients in the control group and 2546 in the intervention group were included in the intention-to-treat analysis. At 12 months post-PPCI, the Kaplan-Meier-estimated frequencies of cardiac death or hospitalisation for heart failure (the primary endpoint) were 220 (8·6%) patients in the control group and 239 (9·4%) in the remote ischaemic conditioning group (hazard ratio 1·10 [95% CI 0·91-1·32], p=0·32 for intervention versus control). No important unexpected adverse events or side effects of remote ischaemic conditioning were observed. INTERPRETATION Remote ischaemic conditioning does not improve clinical outcomes (cardiac death or hospitalisation for heart failure) at 12 months in patients with STEMI undergoing PPCI. FUNDING British Heart Foundation, University College London Hospitals/University College London Biomedical Research Centre, Danish Innovation Foundation, Novo Nordisk Foundation, TrygFonden.
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Affiliation(s)
- Derek J Hausenloy
- The Hatter Cardiovascular Institute, University College London, London, UK; National Institute of Health Research Biomedical Research Centre at University College London Hospitals, Research & Development, London, UK; Cardiovascular & Metabolic Disorders Program, Duke-National University of Singapore Medical School, Singapore; National Heart Research Institute Singapore, National Heart Centre, Singapore; Yong Loo Lin School of Medicine, National University Singapore, Singapore; Centro de Biotecnologia-FEMSA, Tecnologico de Monterrey, Monterrey, Mexico.
| | - Rajesh K Kharbanda
- Oxford Heart Centre, Oxford University Hospitals National Health Service Trust, Oxford, UK; Department of Cardiovascular Medicine, University of Oxford, Oxford, UK
| | | | - Manish Ramlall
- The Hatter Cardiovascular Institute, University College London, London, UK; University Hospital Southampton National Health Service Foundation Trust, Southampton, UK
| | - Jens Aarøe
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Robert Butler
- Department of Cardiology, University Hospitals of North Midlands, Royal Stoke University Hospital, Stoke-on-Trent, UK
| | | | - Tim Clayton
- Clinical Trials Unit and Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
| | - Ali Dana
- Portsmouth Hospitals National Health Service Trust, Portsmouth, UK
| | - Matthew Dodd
- Clinical Trials Unit and Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
| | - Thomas Engstrom
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Richard Evans
- Clinical Trials Unit and Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
| | | | | | - José Manuel Garcia-Ruiz
- Instituto de Investigación Sanitaria del Principado de Asturias, Hospital Universitario de Cabueñes, Oviedo, Spain; Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Madrid, Spain
| | - Diana A Gorog
- Department of Cardiology, Lister Hospital, East and North Hertfordshire National Health Service Trust, Stevenage, UK; National Heart and Lung Institute, Imperial College London, London, UK
| | - Jakob Hjort
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | | | - Borja Ibanez
- Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain; Centro de Investigacion Biomedica En Red Cardiovascular, Madrid, Spain; IIS-Fundación Jiménez Díaz University Hospital, Madrid, Spain
| | - Rosemary Knight
- Clinical Trials Unit and Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
| | - Freddy K Lippert
- Prehospital Emergency Medical Services, Capital Region of Denmark, Denmark
| | - Jacob T Lønborg
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Michael Maeng
- The Hatter Cardiovascular Institute, University College London, London, UK
| | - Dejan Milasinovic
- Department of Cardiology, Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ranjit More
- Lancashire Cardiac Centre, Blackpool Teaching Hospitals National Health Service Foundation Trust, Blackpool, UK
| | - Jennifer M Nicholas
- Clinical Trials Unit and Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Alexander Perkins
- Clinical Trials Unit and Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
| | - Nebojsa Radovanovic
- Cardiology Clinic, Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia; Emergency Centre, Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Roby D Rakhit
- Royal Free Hospital London and Institute of Cardiovascular Science, University College London, London, UK
| | - Jan Ravkilde
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Alisdair D Ryding
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, UK
| | - Michael R Schmidt
- The Hatter Cardiovascular Institute, University College London, London, UK
| | | | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Goran Stankovic
- Cardiology Clinic, Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia; Department for Diagnostic and Catheterization Laboratories, Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Madhusudhan Varma
- The Heart Centre, North Cumbria University Hospitals National Health Service Trust, Carlisle, UK
| | - Ian Webb
- King's College Hospital, King's Health Partnership, London, UK
| | | | - John P Greenwood
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK; Leeds Teaching Hospitals National Health Service Trust, Leeds, UK
| | - Derek M Yellon
- The Hatter Cardiovascular Institute, University College London, London, UK
| | - Hans Erik Bøtker
- The Hatter Cardiovascular Institute, University College London, London, UK.
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49
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Povlsen JA, Rasmussen VG, Vase H, Jensen KT, Terkelsen CJ, Christiansen EH, Mathiassen ON, Poulsen SH. 479Preoperative global longitudinal strain is the best predictor of mortality following transcatheter aortic valve replacement. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0129] [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
Prognosis after transcatheter aortic valve replacement (TAVR) is variable. This might depend on preoperative evaluation of myocardial performance by other measurements than ejection fraction (EF).
Purpose
The aim of this study was to investigate the predictive value of preoperative global longitudinal strain (GLS) and the guidelines specified subtypes of aortic stenosis (AS) on mortality following TAVR.
Methods
We included 511 patients with severe AS who underwent TAVR in the period July 2012–June 2017.
Patients were divided into guidelines-specified subgroups based on EF (EF: ≥50 (NEF) or <50% (LEF)), peak gradient (PG: ≥4 (HG) or <4 m/s (LG)) and flow status (stroke volume index (SVI): ≥35 (NF) or <35 ml/min/kg (LF)): (1) HG-NEF (n=228), (2) HG-LEF (n=91), (3) LG-LF-NEF (n=71) and (4) LG-LF-LEF (n=121). We also investigated the effect of replacing EF by GLS in the guideline specified subgroups (GLS ≤−14 (HGLS) and GLS >−14% (LGLS)).
Results
Mean follow up time was 1033 days. Mean age was 80.2±7.1 years. Median overall survival was 5.3±0.3 years. Comorbidity burden was higher in patients with LF – and LEF status in terms of a higher median plasma creatinine (103 [85; 135], p<0.001) and EurologII score (6.1 [3.4; 9.6], p<0.001).
LG-LF-LEF AS was associated with a significantly worse outcome compared with all other groups (p<0.005, Fig. 1A). High gradient status, irrespective of EF (p=0.88), was associated with the best prognosis with a median survival of 5.0±0.5 and 5.5±0.1 years for NEF and LEF, respectively.
Overall and in patients with HG-NEF, impaired GLS (>−14%) was associated with poor outcome (Fig. 1B–D). There was a trend towards a poorer prognosis with GLS >−14% in LG-LF-NEF AS (p=0.10).
In an univariate analysis impaired GLS >−14% (HR 2.04, p<0.005), LG-LF-LEF status (HR 1.82, p=0.001), PG <4m/s (HR 1.74, p=0.001) and tricuspid regurgitation gradient >30 mmHg (HR 1.63, p<0.001) were significant predictors of mortality in contrast to EF, SVI, age, gender and plasma creatinine.
GLS >−14% emerged as the only significant outcome predictor in a multivariate analysis (HR 1.93, p<0.05).
Figure 1
Conclusion
Impaired global longitudinal strain >−14% was the best individual echocardiographic predictor of overall survival in symptomatic severe AS and could identify a subgroup of patients with HG-NEF AS with a worse prognosis.
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Affiliation(s)
| | | | - H Vase
- Aarhus University Hospital, Aarhus, Denmark
| | - K T Jensen
- Aarhus University Hospital, Aarhus, Denmark
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Pedersen CK, Stengaard C, Friesgaard K, Dodt KK, Søndergaard HM, Terkelsen CJ, Bøtker MT. Chest pain in the ambulance; prevalence, causes and outcome - a retrospective cohort study. Scand J Trauma Resusc Emerg Med 2019; 27:84. [PMID: 31464622 PMCID: PMC6716930 DOI: 10.1186/s13049-019-0659-6] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 08/14/2019] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Chest pain is common in acute ambulance transports. This study aims to characterize and compare ambulance-transported chest pain patients to non-chest pain patients and evaluate if patient characteristics and accompanying symptoms accessible at the time of emergency call can predict cause and outcome in chest pain patients. METHODS Retrospective, observational population-based study, including acute ambulance transports. Patient characteristics and symptoms are included in a multivariable risk model to identify characteristics, associated with being discharged without an acute cardiac diagnosis and surviving 30 days after chest pain event. RESULTS In total, 10,033 of 61,088 (16.4%) acute ambulance transports were due to chest pain. In chest pain patients, 30-day mortality was 2.1% (95%CI 1.8-2.4) compared to 6.0% (95%CI 5.7-6.2) in non-chest pain patients. Of chest pain patients, 1054 (10.5%) were diagnosed with acute myocardial infarction, and 5068 (50.5%) were discharged without any diagnosis of disease. This no-diagnosis group had very low 30-day mortality, 0.4% (95%CI 0.2-0.9). Female gender, younger age, chronic pulmonary disease, absence of accompanying symptoms of dyspnoea, radiation, severe pain for > 5 min, clammy skin, uncomfortable, and nausea were associated with being discharged without an acute cardiac diagnosis and surviving 30 days after a chest pain event. CONCLUSION Chest pain is a common reason for ambulance transport, but the majority of patients are discharged without a diagnosis and with a high survival rate. Early risk prediction seems to hold a potential for resource downgrading and thus cost-saving in selected chest pain patients.
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Affiliation(s)
- Claus Kjær Pedersen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark.
| | - Carsten Stengaard
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Kristian Friesgaard
- Department of Anesthesiology, Aarhus University Hospital, Aarhus, Denmark.,Research and Development, Prehospital Emergency Medical Services, Central Denmark Region, Aarhus, Denmark
| | - Karen Kaae Dodt
- Department of Internal Medicine, Regional Hospital Horsens, Horsens, Denmark
| | | | - Christian Juhl Terkelsen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Morten Thingemann Bøtker
- Department of Anesthesiology, Aarhus University Hospital, Aarhus, Denmark.,Research and Development, Prehospital Emergency Medical Services, Central Denmark Region, Aarhus, Denmark
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