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2-year patient-related versus stent-related outcomes: the SORT OUT IV (Scandinavian Organization for Randomized Trials With Clinical Outcome IV) Trial.

https://arctichealth.org/en/permalink/ahliterature120892
Source
J Am Coll Cardiol. 2012 Sep 25;60(13):1140-7
Publication Type
Article
Date
Sep-25-2012
Author
Lisette Okkels Jensen
Per Thayssen
Evald Høj Christiansen
Hans Henrik Tilsted
Michael Maeng
Knud Nørregaard Hansen
Anne Kaltoft
Henrik Steen Hansen
Hans Erik Bøtker
Lars Romer Krusell
Jan Ravkilde
Morten Madsen
Leif Thuesen
Jens Flensted Lassen
Author Affiliation
Department of Cardiology, Odense University Hospital, Odense, Denmark. okkels@dadlnet.dk
Source
J Am Coll Cardiol. 2012 Sep 25;60(13):1140-7
Date
Sep-25-2012
Language
English
Publication Type
Article
Keywords
Aged
Angioplasty, Balloon, Coronary
Coronary Artery Disease - mortality - therapy
Death
Denmark
Drug-Eluting Stents
Female
Follow-Up Studies
Humans
Immunosuppressive Agents - therapeutic use
Male
Middle Aged
Myocardial Infarction - etiology
Myocardial Revascularization - statistics & numerical data
Single-Blind Method
Sirolimus - adverse effects - analogs & derivatives - therapeutic use
Thrombosis - etiology
Treatment Outcome
Abstract
There are limited head-to-head randomized data on patient-related versus stent-related outcomes for everolimus-eluting stents (EES) and sirolimus-eluting stents (SES).
In the SORT OUT IV (Scandinavian Organization for Randomized Trials With Clinical Outcome IV) trial, comparing the EES with the SES in patients with coronary artery disease, the EES was noninferior to the SES at 9 months.
The primary endpoint was a composite: cardiac death, myocardial infarction (MI), definite stent thrombosis, or target vessel revascularization. Safety and efficacy outcomes at 2 years were further assessed with specific focus on patient-related composite (all death, all MI, or any revascularization) and stent-related composite outcomes (cardiac death, target vessel MI, or symptom-driven target lesion revascularization). A total of 1,390 patients were assigned to receive the EES, and 1,384 patients were assigned to receive the SES.
At 2 years, the composite primary endpoint occurred in 8.3% in the EES group and in 8.7% in the SES group (hazard ratio [HR]: 0.94, 95% confidence interval [CI]: 0.73 to 1.22). The patient-related outcome: 15.0% in the EES group versus 15.6% in the SES group, (HR: 0.95, 95% CI: 0.78 to 1.15), and the stent-related outcome: 5.2% in the EES group versus 5.3% in the SES group (HR: 0.97, 95% CI: 0.70 to 1.35) did not differ between groups. Rate of definite stent thrombosis was lower in the EES group (0.2% vs. 0.9%, (HR: 0.23, 95% CI: 0.07 to 0.80).
At 2-year follow-up, the EES was found to be noninferior to the SES with regard to both patient-related and stent-related clinical outcomes.
PubMed ID
22958957 View in PubMed
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A 10-month angiographic and 4-year clinical outcome of everolimus-eluting versus sirolimus-eluting coronary stents in patients with diabetes mellitus (the DiabeDES IV randomized angiography trial).

https://arctichealth.org/en/permalink/ahliterature275976
Source
Catheter Cardiovasc Interv. 2015 Dec 1;86(7):1161-7
Publication Type
Article
Date
Dec-1-2015
Author
Michael Maeng
Arvydas Baranauskas
Evald Høj Christiansen
Anne Kaltoft
Niels Ramsing Holm
Lars Romer Krusell
Jan Ravkilde
Hans-Henrik Tilsted
Per Thayssen
Lisette Okkels Jensen
Source
Catheter Cardiovasc Interv. 2015 Dec 1;86(7):1161-7
Date
Dec-1-2015
Language
English
Publication Type
Article
Keywords
Aged
Cardiovascular Agents - administration & dosage
Coronary Angiography
Coronary Artery Disease - mortality - radiography - therapy
Coronary Restenosis - mortality - radiography
Coronary Stenosis - mortality - radiography - therapy
Coronary Thrombosis - mortality - radiography
Denmark
Diabetic Angiopathies - mortality - radiography - therapy
Drug-Eluting Stents
Everolimus - administration & dosage
Female
Humans
Male
Middle Aged
Myocardial Infarction - mortality - radiography
Percutaneous Coronary Intervention - adverse effects - instrumentation - mortality
Predictive value of tests
Prospective Studies
Prosthesis Design
Risk factors
Sirolimus - administration & dosage
Time Factors
Treatment Outcome
Abstract
We aimed to compare angiographic and clinical outcomes after the implantation of everolimus-eluting (EES) and sirolimus-eluting (SES) stents in patients with diabetes.
There are limited data on long-term outcome after EES vs SES implantation in diabetic patients.
We randomized 213 patients with diabetes and coronary artery disease to EES (n?=?108) or SES (n?=?105) implantation. Angiographic follow-up was performed 10 months after the index procedure and all patients were followed clinically for 4 years. The primary endpoint was angiographic in-stent late luminal loss at 10-month follow-up. Secondary endpoints included angiographic restenosis rate, the need for target lesion revascularization (TLR) and major adverse cardiac events (MACE; defined as cardiac death, myocardial infarction, definite stent thrombosis, or TLR) at 4-year follow-up.
At 10-month angiographic follow-up, in-stent late lumen loss was 0.20?±?0.53 mm and 0.11?±?0.49 mm (P?=?0.28), and angiographic restenosis rate was 3.8% and 5.2% (P?=?0.72) in the EES and SES groups, respectively. At 4-year clinical follow-up, MACE had occurred in 22 (20.4%) patients in the EES group and 25 (23.8%) patients in SES group (HR 0.84, 95% CI 0.47-1.49; P?=?0.55), with TLR performed in 6 (5.6%) and 10 (9.5%) patients in the two groups (HR 0.57, 95% CI 0.21-1-58; P?=?0.28).
EES and SES had comparable 10-month angiographic and 4-year clinical outcomes in patients with diabetes mellitus and coronary artery disease.
PubMed ID
25640050 View in PubMed
Less detail

Clinical outcome after primary percutaneous coronary intervention with drug-eluting and bare metal stents in patients with ST-segment elevation myocardial infarction.

https://arctichealth.org/en/permalink/ahliterature98528
Source
Circ Cardiovasc Interv. 2008 Dec;1(3):176-84
Publication Type
Article
Date
Dec-2008
Author
Lisette Okkels Jensen
Michael Maeng
Per Thayssen
Anne Kaltoft
Hans Henrik Tilsted
Morten Bøttcher
Jens Flensted Lassen
Knud Nørregaard Hansen
Lars Romer Krusell
Klaus Rasmussen
Knud Erik Pedersen
Lars Pedersen
Søren Paaske Johnsen
Henrik Toft Sørensen
Leif Thuesen
Author Affiliation
Department of Cardiology, Odense University Hospital, Sdr. Boulevard 29, Odense, Denmark. okkels@dadlnet.dk
Source
Circ Cardiovasc Interv. 2008 Dec;1(3):176-84
Date
Dec-2008
Language
English
Publication Type
Article
Keywords
Aged
Angioplasty, Transluminal, Percutaneous Coronary
Cohort Studies
Coronary Thrombosis - epidemiology
Diabetes Mellitus - epidemiology
Female
Follow-Up Studies
Humans
Incidence
Male
Middle Aged
Myocardial Infarction - mortality - therapy
Prosthesis Design
Registries
Retreatment - statistics & numerical data
Stents - adverse effects
Abstract
BACKGROUND: The use of drug-eluting stents (DESs) versus bare metal stents (BMSs) in primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction is a matter of debate. Therefore, we examined the risk of target lesion revascularization (TLR), stent thrombosis, myocardial infarction, and death after the implantation of DES or BMS in primary PCI patients in Western Denmark. METHODS AND RESULTS: A total of 3756 consecutive patients with ST-segment elevation myocardial infarction treated with primary PCI and stent implantation, recorded in the Western Denmark Heart Registry from January 2002 through June 2005, were followed up for 2 years. We used Cox regression analysis to control for confounding. The 2-year incidence of definite stent thrombosis was 1.9% in the DES group and 1.1% in the BMS group (adjusted relative risk [RR]=1.53; 95% CI=0.84 to 2.78; P=0.17). Very late definite stent thrombosis (> or =12 months) was seen in 0.4% in the DES group and 0.06% in the BMS group (adjusted RR=6.74; 95% CI=1.23 to 37.00; P=0.03). The 2-year incidence of myocardial infarction was similar in the 2 groups, 5.2% in the DES group versus 6.3% in the BMS group (P=0.28; adjusted RR=1.13; 95% CI=0.81 to 1.59; P=0.47). All-cause 2-year mortality was 7.8% in the DES group and 11.4% in BMS group (P
Notes
RefSource: Circ Cardiovasc Interv. 2008 Dec;1(3):161-3
PubMed ID
20031676 View in PubMed
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Clopidogrel discontinuation within the first year after coronary drug-eluting stent implantation: an observational study.

https://arctichealth.org/en/permalink/ahliterature259840
Source
BMC Cardiovasc Disord. 2014;14:100
Publication Type
Article
Date
2014
Author
Troels Thim
Martin Berg Johansen
Gro Egholm Chisholm
Morten Schmidt
Anne Kaltoft
Henrik Toft Sørensen
Leif Thuesen
Steen Dalby Kristensen
Hans Erik Bøtker
Lars Romer Krusell
Jens Flensted Lassen
Per Thayssen
Lisette Okkels Jensen
Hans-Henrik Tilsted
Michael Maeng
Source
BMC Cardiovasc Disord. 2014;14:100
Date
2014
Language
English
Publication Type
Article
Keywords
Aged
Coronary Thrombosis - etiology - mortality - prevention & control
Denmark
Drug Administration Schedule
Drug Prescriptions
Drug-Eluting Stents
Female
Humans
Male
Medication Adherence
Middle Aged
Myocardial Infarction - etiology - mortality - prevention & control
Percutaneous Coronary Intervention - adverse effects - instrumentation - mortality
Platelet Aggregation Inhibitors - administration & dosage
Registries
Retrospective Studies
Risk assessment
Risk factors
Ticlopidine - administration & dosage - analogs & derivatives
Time Factors
Treatment Outcome
Abstract
The impact of adherence to the recommended duration of dual antiplatelet therapy after first generation drug-eluting stent implantation is difficult to assess in real-world settings and limited data are available.
We followed 4,154 patients treated with coronary drug-eluting stents in Western Denmark for 1 year and obtained data on redeemed clopidogrel prescriptions and major adverse cardiovascular events (MACE, i.e., cardiac death, myocardial infarction, or stent thrombosis) from medical databases.
Discontinuation of clopidogrel within the first 3 months after stent implantation was associated with a significantly increased rate of MACE at 1-year follow-up (hazard ratio (HR) 2.06; 95% confidence interval (CI): 1.08-3.93). Discontinuation 3-6 months (HR 1.29; 95% CI: 0.70-2.41) and 6-12 months (HR 1.29; 95% CI: 0.54-3.07) after stent implantation were associated with smaller, not statistically significant, increases in MACE rates. Among patients who discontinued clopidogrel, MACE rates were highest within the first 2 months after discontinuation.
Discontinuation of clopidogrel was associated with an increased rate of MACE among patients treated with drug-eluting stents. The increase was statistically significant within the first 3 months after drug-eluting stent implantation but not after 3 to 12 months.
Notes
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PubMed ID
25125079 View in PubMed
Less detail

Comparison of outcomes in patients with versus without diabetes mellitus after revascularization with everolimus- and sirolimus-eluting stents (from the SORT OUT IV trial).

https://arctichealth.org/en/permalink/ahliterature120882
Source
Am J Cardiol. 2012 Dec 1;110(11):1585-91
Publication Type
Article
Date
Dec-1-2012
Author
Lisette Okkels Jensen
Per Thayssen
Anders Junker
Michael Maeng
Hans-Henrik Tilsted
Anne Kaltoft
Knud Nørregaard Hansen
Evald Høj Christiansen
Steen Dalby Kristensen
Jan Ravkilde
Morten Madsen
Henrik Toft Sørensen
Leif Thuesen
Jens Flensted Lassen
Author Affiliation
Department of Cardiology, Odense University Hospital, Odense, Denmark. okkels@dadlnet.dk
Source
Am J Cardiol. 2012 Dec 1;110(11):1585-91
Date
Dec-1-2012
Language
English
Publication Type
Article
Keywords
Angioplasty, Balloon, Coronary - methods
Coronary Artery Disease - complications - mortality - surgery
Denmark - epidemiology
Diabetes Mellitus - mortality
Drug-Eluting Stents
Female
Follow-Up Studies
Humans
Immunosuppressive Agents - pharmacology
Male
Middle Aged
Retrospective Studies
Sirolimus - analogs & derivatives - pharmacology
Survival Rate - trends
Treatment Outcome
Abstract
Diabetes is associated with increased risk of major adverse cardiac events (MACEs) after percutaneous coronary intervention. The purpose of this substudy of the SORT OUT IV trial was to compare clinical outcomes in patients with and without diabetes mellitus treated with everolimus-eluting stents (EESs) or sirolimus-eluting stents (SESs). In total 2,774 patients (390 with diabetes, 14.1%) were randomized to stent implantation with EESs (n = 1,390, diabetes in 14.0%) or SESs (n = 1,384, diabetes in 14.2%). Randomization was stratified by presence/absence of diabetes. The primary end point was MACEs, a composite of cardiac death, myocardial infarction, definite stent thrombosis, or target vessel revascularization within 18 months. MACEs were higher in diabetic than in nondiabetic patients (13.1% vs 6.4%, hazard ratio [HR] 2.08, 95% confidence interval [CI] 1.51 to 2.86). In diabetic patients, MACEs were seen in 10.3% of those treated with EESs and in 15.8% of those treated with SESs (HR 0.63, 95% CI 0.36 to 1.11). In nondiabetic patients, MACEs occurred in 6.6% of EES-treated and in 6.3% SES-treated patients (HR 1.06, 95% CI 0.77 to 1.46). In diabetics, cardiac death occurred in 3.1% of EES-treated and in 4.6% of SES-treated patients (HR 0.67, 95% CI 0.24 to 1.89), myocardial infarction occurred in 0.5% of EES-treated and in 3.6% of SES-treated patients (HR 0.14, 95% CI 0.02 to 1.16), and clinically driven target lesion revascularization was needed in 3.1% of EES-treated and in 7.7% of SES-treated patients (HR 0.40, 95% CI 0.15 to 1.02). No interaction between diabetes status and type of drug-eluting stent was found for the end points. In conclusion, patients with diabetes have higher MACE rates than nondiabetics. No significant differences in safety or efficacy outcomes after EES or SES implantation were present in nondiabetic or diabetic patients.
Notes
Comment In: Expert Rev Cardiovasc Ther. 2013 Feb;11(2):151-423405836
PubMed ID
22959714 View in PubMed
Less detail

Comparison of outcomes of patients = 80 years of age having percutaneous coronary intervention according to presentation (stable vs unstable angina pectoris/non-ST-segment elevation myocardial infarction vs ST-segment elevation myocardial infarction).

https://arctichealth.org/en/permalink/ahliterature131661
Source
Am J Cardiol. 2011 Nov 15;108(10):1395-400
Publication Type
Article
Date
Nov-15-2011
Author
Lisbeth Antonsen
Lisette Okkels Jensen
Per Thayssen
Evald Høj Christiansen
Anders Junker
Hans-Henrik Tilsted
Christian Juhl Terkelsen
Anne Kaltoft
Michael Maeng
Knud Noerregaard Hansen
Jan Ravkilde
Jens Flensted Lassen
Morten Madsen
Henrik Toft Sørensen
Leif Thuesen
Author Affiliation
Department of Cardiology, Odense University Hospital, Odense, Denmark. dr_lissie@hotmail.com
Source
Am J Cardiol. 2011 Nov 15;108(10):1395-400
Date
Nov-15-2011
Language
English
Publication Type
Article
Keywords
Aged, 80 and over
Angina, Stable - mortality - therapy
Angina, Unstable - mortality - therapy
Angioplasty, Balloon, Coronary - statistics & numerical data - trends
Arrhythmias, Cardiac - mortality
Cohort Studies
Comorbidity
Coronary Artery Disease - mortality - therapy
Denmark - epidemiology
Female
Follow-Up Studies
Heart Failure - mortality
Humans
Male
Myocardial Infarction - mortality - therapy
Registries
Regression Analysis
Abstract
Patients = 80 years old with coronary artery disease constitute a particular risk group in relation to percutaneous coronary intervention (PCI). From 2002 through 2008 we examined the annual proportion of patients = 80 years old undergoing PCI in western Denmark, their indications for PCI, and prognosis. From 2002 through 2009 all elderly patients treated with PCI were identified in a population of 3.0 million based on the Western Denmark Heart Registry. Cox regression analysis was used to compare mortality rates according to clinical indications controlling for potential confounding. In total 3,792 elderly patients (= 80 years old) were treated with PCI and the annual proportion increased from 224 (5.4%) in 2002 to 588 (10.2%) in 2009. The clinical indication was stable angina pectoris (SAP) in 30.2%, ST-segment elevation myocardial infarction (STEMI) in 35.0%, UAP/non-STEMI in 29.7%, and "ventricular arrhythmia or congestive heart failure" in 5.1%. Overall 30-day and 1-year mortality rates were 9.2% and 18.1%, respectively. Compared to patients with SAP the adjusted 1-year mortality risk was significantly higher for patients presenting with STEMI (hazard ratio 3.86, 95% confidence interval 3.08 to 4.85), UAP/non-STEMI (hazard ratio 1.95, 95% confidence interval 1.53 to 2.50), and ventricular arrhythmia or congestive heart failure (hazard ratio 2.75, 95% confidence interval 1.92 to 3.92). In patients with SAP target vessel revascularization decreased from 7.1% in 2002 to 2.5% in 2008. In conclusion, the proportion of patients = 80 years old treated with PCI increased significantly over an 8-year period. Patients with SAP had the lowest mortality rates and rates of clinically driven target vessel revascularization decreased over time.
PubMed ID
21890087 View in PubMed
Less detail

Comparison of zotarolimus-eluting and sirolimus-eluting coronary stents: a study from the Western Denmark Heart Registry.

https://arctichealth.org/en/permalink/ahliterature120203
Source
BMC Cardiovasc Disord. 2012;12:84
Publication Type
Article
Date
2012
Author
Michael Maeng
Lisette Okkels Jensen
Anne Kaltoft
Hans-Henrik Tilsted
Evald Høj Christiansen
Per Thayssen
Morten Madsen
Henrik Toft Sørensen
Jens Flensted Lassen
Leif Thuesen
Author Affiliation
Department of Cardiology, Aarhus University Hospital, Skejby, Brendstrupgaardsvej 100, 8200 Aarhus N, Denmark. michael.maeng@ki.au.dk
Source
BMC Cardiovasc Disord. 2012;12:84
Date
2012
Language
English
Publication Type
Article
Keywords
Aged
Angioplasty, Balloon, Coronary
Cohort Studies
Denmark - epidemiology
Drug-Eluting Stents - adverse effects
Female
Humans
Male
Middle Aged
Registries
Sirolimus - administration & dosage - analogs & derivatives
Abstract
We evaluated the effectiveness and safety of a zotarolimus-eluting (ZES) versus a sirolimus-eluting (SES) coronary stent in a large cohort of patients treated with one of these stents in Western Denmark.
A total of 6,122 patients treated with ZES (n=2,282) or SES (n=3,840) were followed for up to 27 months. We ascertained clinical outcomes based on national medical databases.
Incidence of target lesion revascularization (no. per 100 person-years) was 5.3 in the ZES group compared to 1.9 in the SES group (adjusted hazard ratio (HR)=2.19, 95% confidence intervals (CI): 1.39-3.47; p=0.001). All-cause mortality was also higher in the ZES group (ZES: 6.3; SES: 3.3; adjusted HR=1.34, 95% CI: 1.05-1.72; p=0.02), while stent thrombosis (ZES: 1.2; SES: 0.5; adjusted HR=1.98, 95% CI: 0.75-5.23; p=0.14) did not differ significantly.
In agreement with previously published randomised data, this observational study indicated that the ZES was associated with an increased risk of death and TLR in a large cohort of consecutive patients.
Notes
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PubMed ID
23031197 View in PubMed
Less detail

Concomitant use of clopidogrel and statins and risk of major adverse cardiovascular events following coronary stent implantation.

https://arctichealth.org/en/permalink/ahliterature128016
Source
Br J Clin Pharmacol. 2012 Jul;74(1):161-70
Publication Type
Article
Date
Jul-2012
Author
Morten Schmidt
Martin B Johansen
Michael Maeng
Anne Kaltoft
Lisette O Jensen
Hans-Henrik Tilsted
Hans E Bøtker
John A Baron
Henrik Toft Sørensen
Author Affiliation
Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus Department of Cardiology, Aarhus, Denmark. morten.schmidt@dce.au.dk
Source
Br J Clin Pharmacol. 2012 Jul;74(1):161-70
Date
Jul-2012
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Cardiovascular Diseases - epidemiology - prevention & control
Cohort Studies
Cytochrome P-450 CYP3A - antagonists & inhibitors
Denmark
Drug Interactions
Female
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors - adverse effects - therapeutic use
Male
Middle Aged
Platelet Aggregation Inhibitors - adverse effects - therapeutic use
Regression Analysis
Risk factors
Stents
Ticlopidine - adverse effects - analogs & derivatives - therapeutic use
Time Factors
Abstract
• The CYP3A4 inhibition by lipophilic statins may attenuate the effectiveness of clopidogrel. • No studies have measured drug exposure in a time-varying manner that detects discontinuation and restart of clopidogrel and statin therapy, allowing clinical quantification of the interaction effect.
• Clopidogrel and CYP3A4-metabolizing statin use were each associated with a substantially reduced rate of major adverse cardiovascular events within 12 months after coronary stent implantation. • Although we observed an interaction between use of clopidogrel and statins, statin use vs. non-use was not associated with an increased rate of major adverse cardiovascular events in patients using clopidogrel after coronary stent implantation.
To examine whether CYP3A4-metabolizing statin use modified the association between clopidogrel use and major adverse cardiovascular events (MACE) after coronary stent implantation, using time-varying drug exposure ascertainment.
We conducted this population-based cohort study in Western Denmark (population: 3 million) using medical databases. We identified all 13 001 patients with coronary stent implantation between 2002 and 2005 and their comorbidities. During 12 months of follow-up, we tracked the use of clopidogrel and CYP3A4-metabolizing statins and the rate of MACE. We used Cox regression to compute hazard ratios (HRs) controlling for potential confounders.
The rate of MACE per 1000 person years was 104 for concomitant clopidogrel and statin use, 130 for clopidogrel without statin use, 108 for statin without clopidogrel use and 446 for no use of either drug. The adjusted HR comparing clopidogrel use with non-use was 0.68 (95% confidence interval (CI) 0.58, 0.79) among statin users and 0.34 (95% CI 0.29, 0.40) among statin non-users, yielding an interaction effect (i.e. relative rate increase) of 1.97 (95% CI 1.59, 2.44). The adjusted HR for MACE comparing statin use with non-use was 0.97 (95% CI 0.83, 1.13) among clopidogrel users and 0.49 (95% CI 0.42, 0.57) among clopidogrel non-users.
Clopidogrel and CYP3A4-metabolizing statin use were each associated with a substantially reduced rate of MACE within 12 months after coronary stent implantation. Although we observed an interaction between use of clopidogrel and statins, statin use vs. non-use was not associated with an increased rate of MACE in patients using clopidogrel after coronary stent implantation.
Notes
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PubMed ID
22243420 View in PubMed
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Establishing primary angioplasty as the preferred treatment for acute myocardial infarction.

https://arctichealth.org/en/permalink/ahliterature53674
Source
Scand Cardiovasc J. 2002 Aug;36(4):215-20
Publication Type
Article
Date
Aug-2002
Author
Anne Kaltoft
Morten Bøttcher
Lars Krusell
Leif Thuesen
Steen Dalby Kristensen
Henning Rud Andersen
Torsten Toftegaard Nielsen
Author Affiliation
Department of Cardiology, Skejby Hospital, Aarhus University Hospital, Denmark. akk@nucmed.auh.dk
Source
Scand Cardiovasc J. 2002 Aug;36(4):215-20
Date
Aug-2002
Language
English
Publication Type
Article
Keywords
Acute Disease - mortality - therapy
Aged
Aged, 80 and over
Angioplasty, Transluminal, Percutaneous Coronary - statistics & numerical data - utilization
Arrhythmia - complications
Cause of Death
Coronary Angiography
Coronary Stenosis - complications - mortality - therapy
Denmark - epidemiology
Female
Hospital Mortality
Humans
Male
Middle Aged
Myocardial Infarction - complications - mortality - therapy
Patient Transfer - statistics & numerical data
Thrombolytic Therapy
Time Factors
Treatment Outcome
Abstract
OBJECTIVE: To report procedural results and mortality rates from the first 4 years after establishing primary angioplasty as the preferred treatment for acute myocardial infarction in a single Scandinavian centre. DESIGN AND RESULTS: From August 1995 to October 1999 all patients with the diagnosis of suspected acute myocardial infarction (n = 529, mean age 62 +/- 13 years, 72% men), either transferred (73%) or directly admitted to our institution for coronary angiography with the intention of performing primary percutaneous coronary intervention (primary PCI), were prospectively registered. Procedural success in terms of residual stenosis
PubMed ID
12201968 View in PubMed
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The impact of distal embolization and distal protection on long-term outcome in patients with ST elevation myocardial infarction randomized to primary percutaneous coronary intervention--results from a randomized study.

https://arctichealth.org/en/permalink/ahliterature270068
Source
Eur Heart J Acute Cardiovasc Care. 2015 Apr;4(2):180-8
Publication Type
Article
Date
Apr-2015
Author
Jacob Lønborg
Henning Kelbæk
Steffen Helqvist
Lene Holmvang
Erik Jørgensen
Kari Saunamäki
Lene Kløvgaard
Anne Kaltoft
Hans Erik Bøtker
Jens F Lassen
Leif Thuesen
Christian Juhl Terkelsen
Klaus Fuglsang Kofoed
Peter Clemmensen
Lars Køber
Thomas Engstrøm
Source
Eur Heart J Acute Cardiovasc Care. 2015 Apr;4(2):180-8
Date
Apr-2015
Language
English
Publication Type
Article
Keywords
Aged
Angioplasty, Balloon, Coronary - methods
Denmark
Embolization, Therapeutic
Female
Follow-Up Studies
Hospitals, University
Humans
Male
Middle Aged
Myocardial Infarction - diagnosis - mortality - physiopathology - therapy
Percutaneous Coronary Intervention - adverse effects
Platelet Aggregation Inhibitors - therapeutic use
Prognosis
Prospective Studies
Recurrence
Reproducibility of Results
Risk assessment
Risk factors
Stents
Time Factors
Treatment Outcome
Abstract
The impact of angiographically visible distal embolization (DE) and distal protection occurring during primary percutaneous coronary intervention (PCI) on long-term outcome has not been studied in a contemporary ST-segment elevation myocardial infarction (STEMI) cohort. To evaluate the association between DE and long-term outcome in STEMI patients treated with primary PCI with or without distal protection.
In this post-hoc analysis of a randomized study, 591 STEMI patients were randomized to conventional primary PCI or primary PCI with distal protection and followed for 5 years. There was no statistically significant difference in MACE rate between patients treated with or wthout distal protection (19% versus 25%; p=0.10). There seemed to be interaction between distal protection and DE in major adverse cardiac events (MACE) (p=0.08), mortality (p=0.02) and reinfarction (p=0.06), but not admission for heart failure (p=0.40). DE was related to increased risk of admission for heart failure independently of distal protection (12.0% versus 5.0; p=0.015). The MACE rate for patients treated with standard PCI with DE was 31.3% compared to 24.8% for patients without DE (p=0.30), and 44.4% for patients treated with distal protection with DE compared to 17.9% for patients without DE (p=0.005). DE was not related to mortality (p=0.52) or reinfarction (p=0.52) among patients treated with standard PCI, but was related to higher rates of mortality (p=0.012) and reinfarction (p=0.008) when distal protection was used.
DE occurred in 11% of STEMI patients treated with conventional primary PCI, and was associated with increased risk of development of heart failure. Distal protection did not improve the 5-years MACE rate, and might even aggravate the prognosis following DE, but this should only be considered hypothesis-generating.
PubMed ID
25013089 View in PubMed
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