| 1. |
- Dziewierz, Artur, et al.
(författare)
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Early abciximab administration before primary percutaneous coronary intervention improves clinical outcome in diabetic patients with ST-segment elevation myocardial infarction (EUROTRANSFER Registry)
- 2012
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Ingår i: Atherosclerosis. - : Elsevier. - 0021-9150 .- 1879-1484. ; 223:1, s. 212-218
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Tidskriftsartikel (refereegranskat)abstract
- Background: Diabetes is an important determinant of prognosis in patients with ST-segment elevation myocardial infarction (STEMI). Limited data are available concerning benefits and risks of upstream abciximab administration in diabetic patients. Thus, the objective of the study was to assess the impact of early abciximab administration before primary angioplasty (PCI) for STEMI in diabetic patients. Methods: Data were gathered for 1650 consecutive STEMI patients transferred for primary PCI from hospital networks in seven countries in Europe from November 2005 to January 2007 (the EURO-TRANSFER Registry population). Patients were stratified by diabetes mellitus presence and then by abciximab administration strategy (early - more than 30 min before PCI vs. late). Results: Diabetes mellitus was diagnosed in 262 (15.9%) patients. Patients with diabetes mellitus were high-risk individuals, with advanced age, higher prevalence of comorbidities and increased risk of ischemic events during follow-up in comparison to non-diabetic patients. A total of 1086 patients who received abciximab were identified. Strategy of early abciximab administration was associated with enhanced infarct-related artery patency before PCI, and improved epicardial flow after PCI in both diabetic and non-diabetic patients. Importantly, early abciximab in diabetic patients led to the decrease in ischemic events, including 30-day (OR 0.260, 95% CI 0.089-0.759, p = 0.012) and 1-year (OR 0.273, 95% CI 0.099-0.749, p = 0.012) mortality reduction. However, only a trend toward improved survival was confirmed after adjustment for potential confounders. On the contrary, the reduction of 30-day (OR 0.620, 95% CI 0.334-1.189, p = 0.16) and 1-year (OR 0.643, 95% CI 0.379-1.089, p = 0.10) mortality rates was not significant among non-diabetic patients. Conclusions: Early administration of abciximab improves infarct-related artery patency before and after primary PCI, and leads to improved survival in diabetic STEMI patients.
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| 2. |
- Dziewierz, Artur, et al.
(författare)
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Early abciximab administration before primary percutaneous coronary intervention improves clinical outcome in elderly patients transferred with ST-elevation myocardial infarction Data from the EUROTRANSFER registry
- 2010
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Ingår i: INTERNATIONAL JOURNAL OF CARDIOLOGY. - : Elsevier Science B.V., Amsterdam.. - 0167-5273. ; 143:2, s. 147-153
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Tidskriftsartikel (refereegranskat)abstract
- Background: Limited data are available concerning benefits and risks of early abciximab (EA) administration before primary percutaneous coronary intervention (PPCI) in elderly ST-segment elevation myocardial infarction (STEMI) patients. The objective of the study was to assess the impact of EA before PPCI in elderly (andgt;= 65 years) patients. Methods and results: We identified 545 patients andlt;65 years (354 with EA administration (andgt;30 min before PPCI), 191 late abciximab (LA)), and 541 patients andgt;= 65 years of age (373 EA, 168 LA) in the EUROTRANSFER Registry database. Elderly patients were more likely to have comorbidities, angiographic PCI complications, and bleeding events. EA promotes infarct-related artery patency before PPCI and improves myocardial reperfusion after PPCI in both age groups, but the risk of 30-day death (EA vs. LA: andlt;65 years, 2.0% vs. 1.6%; p = 0.999; andgt;= 65 years, 5.9% vs. 14.3%; p = 0.001) and 30-day death + reinfarction (EA vs. LA: andlt;65 years, 2.5% vs. 2.1%; p = 0.999; andgt;= 65 years, 7.5% vs. 17.3%; p = 0.001) was reduced in elderly patients only. There was no difference in bleedings, especially major bleedings requiring transfusion (EA vs. LA: patients andlt;65 years, 2.3% vs. 0%, p = 0.055; andgt;= 65 years, 2.4% vs. 3%; p = 0.448) between groups. Conclusions: Patients andgt;= 65 years of age have a substantially increased risk of angiographic PCI complications, death and bleeding events compared with their younger counterparts. Strategy of EA before PPCI improves reperfusion parameters and clinical outcome in elderly patients and is not associated with elevated risk of major bleeding.
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| 3. |
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| 4. |
- Kristensen, Steen D., et al.
(författare)
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Reperfusion therapy for ST elevation acute myocardial infarction 2010/2011 : current status in 37 ESC countries
- 2014
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Ingår i: European Heart Journal. - : Oxford University Press (OUP). - 0195-668X .- 1522-9645. ; 35:29, s. 1957-1970
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Tidskriftsartikel (refereegranskat)abstract
- Aims Primary percutaneous coronary intervention (PPCI) is the preferred reperfusion therapy in ST-elevation myocardial infarction (STEMI). We conducted this study to evaluate the contemporary status on the use and type of reperfusion therapy in patients admitted with STEMI in the European Society of Cardiology (ESC) member countries. Methods and results A cross-sectional descriptive study based on aggregated country-level data on the use of reperfusion therapy in patients admitted with STEMI during 2010 or 2011. Thirty-seven ESC countries were able to provide data from existing national or regional registries. In countries where no such registries exist, data were based on best expert estimates. Data were collected on the use of STEMI reperfusion treatment and mortality, the numbers of cardiologists, and the availability of PPCI facilities in each country. Our survey provides a brief data summary of the degree of variation in reperfusion therapy across Europe. The number of PPCI procedures varied between countries, ranging from 23 to 884 per million inhabitants. Primary percutaneous coronary intervention and thrombolysis were the dominant reperfusion strategy in 33 and 4 countries, respectively. The mean population served by a single PPCI centre with a 24-h service 7 days a week ranged from 31 300 inhabitants per centre to 6 533 000 inhabitants per centre. Twenty-seven of the total 37 countries participated in a former survey from 2007, and major increases in PPCI utilization were observed in 13 of these countries. Conclusion Large variations in reperfusion treatment are still present across Europe. Countries in Eastern and Southern Europe reported that a substantial number of STEMI patients are not receiving any reperfusion therapy. Implementation of the best reperfusion therapy as recommended in the guidelines should be encouraged.
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| 5. |
- Legutko, Jacek, et al.
(författare)
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Similar outcome of ST-elevation myocardial infarction patients treated with primary percutaneous coronary intervention regardless of presence of cardiac surgery on-site.
- 2014
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Ingår i: Kardiologia polska. - : Polskie Towarzystwo Kardiologiczne. - 0022-9032 .- 1897-4279. ; 72:10, s. 949-53
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The growing penetration of mechanical reperfusion in ST-elevation myocardial infarction (STEMI) has been achieved by the creation of new percutaneous coronary intervention (PCI) centres which have helped to shorten delays but have compromised PCI volumes.AIM: To compare the outcomes in STEMI patients treated in PCI centres with or without surgical back-up.METHODS: Data concerning 1,650 registry patients was analysed. The analysis was based on cathlab classification with cardiac surgery on site (n = 996) and without (n = 654).RESULTS: There was a 0.3% rate of transfer (two patients out of 654) for urgent coronary artery bypass grafting from PCI centres without cardiac surgery on site. There were no differences in in-hospital and long-term mortality in patients in both studied groups.CONCLUSIONS: No differences in short and long-term outcomes were noticed for STEMI patients treated in centres with or without cardiac surgery on-site.
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| 6. |
- Rakowski, Tomasz, et al.
(författare)
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Impact of infarct related artery patency after early abciximab administration on one-year mortality in patients with ST-segment elevation myocardial infarction (data from the EUROTRANSFER Registry)
- 2012
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Ingår i: Kardiologia polska. - : Polskie Towarzystwo Kardiologiczne. - 0022-9032 .- 1897-4279. ; 70:3, s. 215-221
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Tidskriftsartikel (refereegranskat)abstract
- Background: Spontaneous early infarct related artery (IRA) recanalisation before primary percutaneous coronary intervention (pPCI) has a favourable impact on outcome. However, the role played by pharmacotherapy driven patency prior to pPCI is still a matter of debate. less thanbrgreater than less thanbrgreater thanAim: To assess the role of early IRA patency (TIMI flow 2 or 3) after early abciximab administration in patients with ST-segment elevation myocardial infarction (STEM!) transferred for pPCI. less thanbrgreater than less thanbrgreater thanMethods: Data was gathered for 1,650 consecutive sTEMI patients transferred for pPCI from hospital networks in seven countries in Europe between November 2005 and January 2007. We identified 691 patients who were pretreated with abciximab before transportation to a cathlab hospital and underwent PCI. less thanbrgreater than less thanbrgreater thanResults: Angiography showed early IRA patency (TIMI flow 2 or 3) in 233 (33.7%) patients, and occluded IRA (TIMI flow 0 or 1) in 458 (66.3%) patients. In patients with patent IRA, in baseline angiography the rate of TIMI 3 flow and ECG ST-segment resolution andgt; 50% after PCI was higher compared to patients with occluded IRA. One year mortality was significantly lower in patients with patent IRA, 1.3% vs 7% (OR 0.17; CI 0.05-0.6; p = 0.001). In multivariable Cox regression analysis, IRA patency at baseline was identified as an independent predictor of one-year mortality. less thanbrgreater than less thanbrgreater thanConclusions: Infarct related artery recanalisation after early pharmacological pretreatment in STEMI patients undergoing transportation for pPCI is associated with better post-procedural myocardial perfusion and lower one-year mortality.
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| 7. |
- Sarno, Giovanna, et al.
(författare)
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Morphological and functional evaluation of the bioresorption of the bioresorbable everolimus-eluting vascular scaffold using IVUS, echogenicity and vasomotion testing at two year follow-up : a patient level insight into the ABSORB A clinical trial
- 2012
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Ingår i: The international journal of cardiovascular imaging. - : Springer Science and Business Media LLC. - 1875-8312 .- 1569-5794 .- 1573-0743. ; 28:1, s. 51-58
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to describe vaso-reactivity (by Acetylcholine and Methergine tests) at 2 year follow-up in parallel with the individual changes in the echogenicity characteristics of the polymer struts of the everolimus eluting bioresorbable vascular scaffold (BVS), from post-treatment to 2 year follow-up, in patients enrolled in the ABSORB Cohort A study. Intravascular ultrasound assessment was performed with a phased array catheter (EagleEye, Volcano Corporation, Cordova, CA, USA) with automated pullback at 0.5 mm per second. The % ratio at 6 months and 2 years [(Scaffold Area post PCI- Lumen Area)/Scaffold Area post PCI] was calculated as a measure of scaffold shrinkage. The % change of hyperechogenicity was defined as: ([post-procedural hyperechogenicity] - [2 year follow up hyperechogenicity])/[post-procedural hyperechogenicity]) × 100. The vasomotion test with intracoronary acetylcholine (10(-6) M) or intravenous methergine (0.4 mg) was performed at 2 years. Overall nine patients received all these analyses and were enrolled in the present analysis. A 50-96% reduction in hyperechogenicity was observed between baseline and 2 years, which corresponded to a change in vasoreactivity between 2 and 22%. A vasoconstriction of the scaffolded segment was observed in the 5 patients, who underwent the methergine test, with a mean decrease in lumen diameter after methergine of 9 ± 7% (P = 0.06), while vasodilatation occurred in the 4 patients who underwent the acetylcholine test with a mean increase in lumen diameter after acetylcholine of 8 ± 5% (P = 0.125). Bioresorption of the BVS is accompanied by re-establishment of both endothelial and non-endothelial dependent vasomotion.
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| 8. |
- Shin, Eun-Seok, et al.
(författare)
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Reproducibility of Shin's method for necrotic core and calcium content in atherosclerotic coronary lesions treated with bioresorbable everolimus-eluting vascular scaffolds using volumetric intravascular ultrasound radiofrequency-based analysis
- 2012
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Ingår i: The international journal of cardiovascular imaging. - : Springer Science and Business Media LLC. - 1875-8312 .- 1569-5794 .- 1573-0743. ; 28:1, s. 43-49
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Tidskriftsartikel (refereegranskat)abstract
- Although Virtual Histology intravascular ultrasound (VH-IVUS) is increasingly used in clinical research, the reproducibility of plaque composition remains unexplored in significant coronary artery and stented lesions. The purpose of this study was to assess the reproducibility of necrotic core and calcium content in atherosclerotic coronary lesions that were treated with a bioresorbable everolimus-eluting vascular scaffold (BVS) using a new measurement method (Shin's method) by VH-IVUS. Eight patients treated with a BVS (Abbott Vascular, Santa Clara, CA, USA) were analyzed with serial VH-IVUS assessments, i.e., pre- and post-stenting, and at 6 months and 2 years follow-up. A total of 32 coronary segments were imaged to evaluate the reproducibility of volumetric VH-IVUS measurements. In Shin's method, contours are drawn around the IVUS catheter (instead of the lumen) and vessel. Overall, in the imaged coronary segment, for necrotic core and dense calcium volumes, the relative intra-observer differences were 0.30 ± 0.22, 0.19 ± 0.16% for observer 1 and 0.45 ± 0.41, 0.36 ± 0.47% for observer 2, respectively. The inter-observer relative differences of necrotic core and dense calcium volumes were 0.51 ± 0.79 and 0.56 ± 1.01%, respectively. The present study demonstrates a good reproducibility for both, intra-observer and inter-observer measurements using Shin's method. This method is suitable for the measurement of necrotic core and dense calcium using VH-IVUS in longitudinal studies, especially studies on bioresorbable scaffolds, because the degradation process will be fully captured independently of the location of the struts and their greyscale appearance.
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| 9. |
- Siudak, Zbigniew, et al.
(författare)
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Early abciximab use in ST-elevation myocardial infarction treated with primary percutaneous coronary intervention improves long-term outcome. Data from EUROTRANSFER Registry
- 2010
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Ingår i: KARDIOLOGIA POLSKA. - : Polish Cardiac Society / TERMEDIA. - 0022-9032. ; 68:5, s. 539-545
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Tidskriftsartikel (refereegranskat)abstract
- Background: Primary percutaneous coronary intervention (PCI) is the preferred method of reperfusion in patients with ST elevation myocardial infarction (STEMI). Abciximab is a well established adjunct to primary PCI. The proper timing of abciximab administration in STEMI patients has been investigated in randomised trials, registries and metanalysis, providing conflicting results. Methods: Consecutive data on STEMI patients, transferred for primary PCI in hospital/ambulance STEMI networks between November 2005 and January 2007, from 15 PCI centres in seven European countries was gathered together for a one-year long-term clinical observation (93% rate of completeness). Results: Data from 1,650 patients was collected in the EUROTRANSFER Registry. Abciximab was administered to 1,086 patients (66%), 727 patients received early (at least 30 minutes prior to first balloon inflation) abciximab (EA), and another 359 patients received late abcixirnab (LA). One year mortality was 5.8% in the EA group vs 10.3% with LA (p = 0.007). Adjustment for propensity score methods for EA administration did not change the results, still providing a favourable outcome for the EA group (p = 0.004). It was also revealed that only a minority of patients (36%) were treated within the 90-minute recommended time window from first medical contact to PCI (and 60% for the 120-min time delay). Conclusions: Patients transferred for primary PCI in STEMI hospital networks showed lower rates of death in long-term one-year clinical follow-up when treatment with abciximab was started early.
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