OBJECTIVES: This registry study assessed the safety and efficacy of the 2 types of drug-eluting stents (DES), sirolimus-eluting stents (SES) and paclitaxel-eluting stents (PES), compared with bare-metal stents (BMS). BACKGROUND: Drug-eluting stents may increase the risk of stent thrombosis (ST), myocardial infarction (MI), and death. METHODS: A total of 12,395 consecutive patients with coronary intervention and stent implantation recorded in the Western Denmark Heart Registry from January 2002 through June 2005 were followed up for 2 years. Data on death and MI were ascertained from national medical databases. We used Cox regression analysis to control for confounding. RESULTS: The 2-year incidence of definite ST was 0.64% in BMS patients, 0.79% in DES patients (adjusted relative risk [RR]: 1.09; 95% confidence interval [CI]: 0.72 to 1.65), 0.50% in SES patients (adjusted RR: 0.63, 95% CI: 0.35 to 1.15), and 1.30% in PES patients (adjusted RR: 1.82, 95% CI: 1.13 to 2.94). The incidence of MI was 3.8% in BMS-treated patients, 4.5% in DES-treated patients (adjusted RR: 1.24, 95% CI: 1.02 to 1.51), 4.1% in SES-treated patients (adjusted RR: 1.15, 95% CI: 0.91 to 1.47), and 5.3% in PES-treated patients (adjusted RR: 1.38, 95% CI: 1.06 to 1.81). Whereas overall 2-year adjusted mortality was similar in the BMS and the 2 DES stent groups, 12- to 24-month mortality was higher in patients treated with PES (RR 1.46, 95% CI: 1.02 to 2.09). Target lesion revascularization was reduced in both DES groups. CONCLUSIONS: During 2 years of follow-up, patients treated with PES had an increased risk of ST and MI compared with those treated with BMS and SES. Mortality after 12 months was also increased in PES patients.
Comment In: J Am Coll Cardiol. 2009 Feb 24;53(8):665-619232898
Secondary prevention is an important component of a structured rehabilitation programme following a cardiac event. Comprehensive programmes have been developed in many European countries, the vast majority of which are hospital based. In Sweden, all patients with cardiac disease are also given the opportunity to participate in secondary prevention activities arranged by the National Association for Heart and Lung Patients [The Heart & Lung School (HL)]. The aim of this 3-year longitudinal study was to compare persons who attended the HL after a cardiac event and those who declined participation, with regard to health aspects, life situation, social network and support, clinical data, rehospitalisation and mortality. Totally 220 patients were included in the study. The patients were asked to fill in a questionnaire on four occasions, in addition to visiting a health care center for physical examination. After 3 years, 160 persons were still participating, 35 of whom attended the HL. The results show that persons who participated in the HL exercised more regularly, smoked less and had a denser network as well as more social support from nonfamily members than the comparison groups. This study contributes to increased knowledge among healthcare professionals, politicians and decision makers about peer support groups as a support strategy after a cardiac event.
Previous studies comparing percutaneous coronary intervention (PCI) with thrombolysis for treatment of myocardial infarction with ST-elevation have in meta-analyses but not in randomized trials shown that PCI is more effective. Despite a large volume of primary PCI performed in Sweden no controlled trials have been carried out. The present study included 96 patients with myocardial infarction with ST-segment elevation treated with primary PCI 1995-1998. The main indications were shock (15 cases), contraindication to thrombolysis (24 cases), as an alternative to thrombolysis (57 cases), with a mortality in the respective groups of 67, 25 and 10 percent. Controls matched for age and infarct location and treated with thrombolysis could be identified for 55 of the patients treated with PCI. After four years 40 percent and 52 percent of the patients treated with PCI and thrombolysis respectively reached the combined endpoint of death/myocardial infarction/revascularization/angina pectoris (not significant). In conclusion, the study shows that primary PCI in patients with myocardial infarction with ST-segment elevation can be performed safely also in Sweden.
The aim of this study was to assess the impact of a mobile emergency care unit (MECU) staffed with an anaesthetist, in terms of increased survival among patients with acute myocardial infarction (MI). The setting was an urban area with 330 000 inhabitants. This was a quasi-experimental before-and-after-study including consecutive emergency calls during September to November 1996 (Period 1, without the MECU) and September to November 1997 (Period 2, including the MECU). Fifty-four ambulance patients had their MI diagnosis confirmed at hospital during Period 1, and another 54 in Period 2. The 28-day mortality was collected from relevant registers. Twenty-four (44%) of Period 2 patients were transported by the MECU. MECU patients had lower systolic blood pressure (SBP) than other patients, both before and after hospital admission. Nitroglycerine treatment was relatively frequent in MECU patients, and cardioversion, anaesthesia and intubation was applied exclusively in these patients. After arrival at hospital, MECU patients had thrombolysis relatively often (46% versus 23% in other Period 2 patients) but percutaneous transluminal coronary angioplasty (PTCA) relatively infrequently (21% vs 30%). The total mortality was significantly lower in Period 2 than in Period 1 patients (11% vs 21%,
OBJECTIVES: The objectives were to compare quality of life (QoL) after first myocardial infarction with an age- and sex-adjusted normative population and to test whether the 1-month QoL had predictive properties. DESIGN: QoL was assessed by self-administered questionnaires (SF-36 and Cardiac Health Profile) 1, 3 and 6 months after index-event. Participants were 60 consecutive patients (20% women) with a mean age of 58 +/- 7.4 years. RESULTS: Patients > or =59 years improved in Physical (PCS) and Mental Component Summary (MCS), scoring comparable to community norms at 6 months. However, patients
BACKGROUND: Percutaneous angioplasty is an alternative to thrombolysis to reestablish coronary blood flow in patients with transmural myocardial infarction. At present, this treatment option is not widely accepted in Norway. MATERIAL AND METHODS: From 1996 to 1998, one hundred consecutive patients were treated with angioplasty for acute transmural infarction. The angiography showed one-vessel disease in 55%, two-vessel in 25%, and multivessel in 20%. The infarct related artery was the LAD in 44%, the CX in 14%, the RCA in 41%, and bypass graft in one. 92% had TIMI 0 or 1 flow. Stent was placed in 73%, GPIIb/IIIa was used in 11% and temporary pacemaker placed in 5%. RESULTS: Successful angioplasty was performed in 95%, 3% was not done, and 2% failed. Peripheral stenoses were treated in 15% and stenoses in other arteries in 10%. Complications and events within 24 hours related to the angioplasty were seen in 9%. CONCLUSION: Primary angioplasty for acute myocardial infarction can be done with high primary success, good short-term results and few complications.
BACKGROUND: Primary or rescue angioplasty are reperfusion modalities in selected patients with acute myocardial infarction, after initial diagnosis in local hospitals. We sought to evaluate the feasibility and safety of transporting patients to a tertiary care hospital for interventional treatment. MATERIALS AND METHODS: Between January 1999 and April 2000, 50 consecutive patients were included in this prospective observational study. Comparisons were performed between patients admitted to primary angioplasty, either directly (n = 20; group A) or from other hospitals (n = 14; group B), and those transferred for rescue angioplasty (n = 16; group C). RESULTS: No severe complications occurred during interhospital transport. Median time interval from onset of symptoms to hospitalization was comparable between groups. Median time interval from onset of symptoms to balloon inflation in group C (340 minutes) was significantly longer than in groups A and B (181 and 130 minutes). All patients were alive at follow-up after median 230 days. Median echocardiographically determined left ventricular ejection fraction in group A was non-significantly higher (50%) than in groups B and C (43% and 46%). INTERPRETATION: Acute transfer for primary or rescue angioplasty is feasible and safe for selected patients with acute myocardial infarction.
OBJECTIVES: The purpose of the present study was to assess whether brief, repeated coronary artery occlusions during balloon angioplasty protect against ischemia-induced ventricular ectopy. BACKGROUND: Most sudden cardiac deaths are caused by fatal ventricular arrhythmias precipitated by early myocardial ischemia of acute coronary occlusion. In animals, a preceding 3- to 5-min coronary occlusion protects against malignant ventricular arrhythmias during a subsequent prolonged coronary occlusion. Whether such an antiarrhythmic effect caused by ischemic preconditioning occurs in humans is not known. METHODS: To assess the effects of a preceding, brief vessel occlusion-reperfusion cycle on the occurrence of ventricular ectopy, continuous electrocardiographic, heart rate and blood pressure recordings were performed in 156 patients before and during two identical balloon occlusions of a coronary artery (mean 111 s) separated by a 5-min equilibration period. RESULTS: The occluded vessel was the left anterior descending coronary artery in 94 patients, the left circumflex branch in 29 patients and the right coronary artery in 33 patients. Balloon occlusion of a coronary artery caused ventricular ectopy in 24 patients. The incidence of ventricular ectopy was higher during the first occlusion than during the second occlusion (21 patients [13.5%] vs. 11 patients [7%], p = 0.02). In 13 patients, ventricular ectopy was observed only during the first occlusion; in 8 patients during both occlusions; and in 3 patients only during the second occlusion. Bigeminal or repetitive ectopic beats were observed in eight patients during the first coronary occlusion and in four patients during the second occlusion. Atrial premature beats occurred during the first occlusion in three patients, but in none of the patients during the second occlusion. The 24 patients with ventricular ectopy during coronary occlusion had milder stenosis than the rest of the patients (mean [+/- SD] 74 +/- 12% vs. 81 +/- 12%, p = 0.01). The 13 patients with ventricular ectopy only during the first occlusion did not, however, differ significantly with respect to any clinical or angiographic features from the rest of the patients with ventricular ectopy. There were no significant differences in the signs of myocardial ischemia or hemodynamic variables between the sequential occlusions. CONCLUSIONS: A preceding, short vessel occlusion-reperfusion cycle seems to increase the electrical stability of ischemic myocardium.
Percutaneous transluminal coronary angioplasty is the most commonly used method for coronary revascularization in Norway. More than 3,500 procedures were performed in 1997. The presence of atherosclerotic endothelium is a strong stimulus to increased haemostasis. During balloon angioplasty, activation of the coagulation system is further increased by the trauma caused to the vessel wall. Major complications associated with coronary angioplasty include vessel occlusion, myocardial infarction, and periprocedural death. Most early complications occur as a result of the formation of a thrombus at the angioplasty site. Effective antithrombotic treatment is essential to reduce the risk of thromboembolic complications during and after percutaneous transluminal coronary angioplasty with or without stent implantation. All patients should be treated in advance with acetylsalicylic acid. Heparin must be given during the procedure. After stent implantation the patient should be treated with a combination of the two antiplatelet agents acetylsalicylic acid and ticlopidine. This article presents the current practice for using antithrombotic medication in percutaneous transluminal coronary angioplasty.