138 results on '"Engstrøm, Thomas"'
Search Results
2. Discovery of plasma proteins associated with ventricular fibrillation during first ST-elevation myocardial infarction via proteomics.
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Stampe, Niels Kjær, Ottenheijm, Maud Eline, Drici, Lylia, Wewer Albrechtsen, Nicolai J, Nielsen, Annelaura Bach, Christoffersen, Christina, Warming, Peder Emil, Engstrøm, Thomas, Winkel, Bo Gregers, Jabbari, Reza, Tfelt-Hansen, Jacob, and Glinge, Charlotte
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- 2024
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3. Organized thrombus is a frequent underlying feature in culprit lesion morphology in non-ST-elevation myocardial infarction. A study using optical coherence tomography and magnetic resonance imaging.
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Ekström, Kathrine, Jensen, Maria Radu Juul, Holmvang, Lene, Joshi, Francis Richard, Iversen, Allan Zeeberg, Madsen, Per Lav, Olsen, Niels Thue, Pedersen, Frants, Sørensen, Rikke, Tilsted, Hans-Henrik, Engstrøm, Thomas, and Lønborg, Jacob
- Abstract
The concept that the culprit lesion in non-ST segment elevation myocardial infarction (NSTEMI) is caused by sudden plaque rupture with acute thrombus formation has recently been challenged. While angiography is an old gold-standard for culprit identification it merely visualizes the lumen contour. Optical coherence tomography (OCT) provides a detailed view of culprit features. Combined with myocardial edema on cardiac magnetic resonance (CMR), indicating acute ischemia and thus culprit location, we aimed to characterize culprit lesions using OCT. Patients with NSTEMI referred for angiography were prospectively enrolled. OCT was performed on angiographic stenoses ≥50% and on operator-suspected culprit lesions. Hierarchical OCT-culprit identifiers were defined in case of multiple unstable lesions, including OCT-defined thrombus age. An OCT-based definition of an organizing thrombus as corresponding to histological early healing stage was introduced. Lesions were classified as OCT-culprit or non-culprit, and characteristics compared. CMR was performed in a subset of patients. We included 65 patients with 97 lesions, of which 49 patients (75%) had 53 (54%) OCT-culprit lesions. The most common OCT-culprit identifiers were the presence of acute (66%) and organizing thrombus (19%). Plaque rupture was visible in 45% of OCT-culprit lesions. CMR performed in 38 patients revealed myocardial oedema in the corresponding territories of 67% of acute thrombi and 50% of organizing thrombi. A culprit lesion was identified by OCT in 75% patients with NSTEMI. Acute thrombus was the most frequent feature followed by organizing thrombus. Applying specific OCT-criteria to identify the culprit could prove valuable in ambiguous cases. [ABSTRACT FROM AUTHOR]
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- 2024
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4. Prevalence and Impact of Frailty in Patients ≥70 Years Old with Acute Coronary Syndrome Referred for Coronary Angiography.
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Ratcovich, Hanna, Joshi, Francis R., Palm, Pernille, Færch, Jane, Bang, Lia E., Tilsted, Hans-Henrik, Sadjadieh, Golnaz, Engstrøm, Thomas, and Holmvang, Lene
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ACUTE coronary syndrome ,CORONARY angiography ,DISEASE risk factors ,FRAILTY ,OLDER patients - Abstract
Introduction: Elderly patients with acute coronary syndrome (ACS) have a higher risk of adverse cardiovascular events and may be frail but are underrepresented in clinical trials. Previous studies have proposed that frailty assessment is a better tool than chronological age, in assessing older patients' biological age, and may exceed conventional risk scores in predicting the prognosis. Therefore, we wanted to investigate the prevalence and impact on 12-month outcomes of frailty in patients ≥70 years with ACS referred for coronary angiography (CAG). Methods: Patients ≥70 years with ACS referred for CAG underwent frailty scoring with the clinical frailty scale (CFS). Patients were divided into three groups depending on their CFS: robust (1–3), vulnerable (4), and frail (5–9) and followed for 12 months. Results: Of 455 patients, 69 (15%) patients were frail, 79 (17%) were vulnerable, and 307 (68%) were robust. Frail patients were older (frail: 80.9 ± 5.7 years, vulnerable: 78.5 ± 5.5 years, and robust: 76.6 ± 4.9 years, p < 0.001) and less often treated with percutaneous coronary intervention (frail: 56.5%, vulnerable: 53.2%, and robust: 68.6%, p = 0.014). 12-month mortality was higher among frail patients (frail: 24.6%, vulnerable: 21.8%, and robust: 6.2%, p < 0.001). Frailty was associated with a higher mortality after adjustment for age, sex, comorbidities, the Global Registry of Acute Coronary Events (GRACE) score, and revascularisation (HR 2.67, 95% CI 1.30–5.50, p = 0.008). There was no difference between GRACE and CFS in predicting 12-month mortality (p = 0.893). Conclusions: Fifteen percent of patients ≥70 years old with ACS referred for CAG are frail. Frail patients have significantly higher 12-month mortality. GRACE and CFS are similar in predicting 12-month mortality. [ABSTRACT FROM AUTHOR]
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- 2024
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5. Pre-hospital pulse glucocorticoid therapy in patients with ST-segment elevation myocardial infarction transferred for primary percutaneous coronary intervention: a randomized controlled trial (PULSE-MI).
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Madsen, Jasmine Melissa, Obling, Laust Emil Roelsgaard, Rytoft, Laura, Folke, Fredrik, Hassager, Christian, Andersen, Lars Bredevang, Vejlstrup, Niels, Bang, Lia Evi, Engstrøm, Thomas, and Lønborg, Jacob Thomsen
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ST elevation myocardial infarction ,REPERFUSION ,PERCUTANEOUS coronary intervention ,REPERFUSION injury ,MYOCARDIAL infarction ,RANDOMIZED controlled trials ,CORONARY vasospasm - Abstract
Background: Inflammation in ST-segment elevation myocardial infarction (STEMI) is an important contributor to both acute myocardial ischemia and reperfusion injury after primary percutaneous coronary intervention (PCI). Methylprednisolone is a glucocorticoid with potent anti-inflammatory properties with an acute effect and is used as an effective and safe treatment of a wide range of acute diseases. The trial aims to investigate the cardioprotective effects of pulse-dose methylprednisolone administered in the pre-hospital setting in patients with STEMI transferred for primary PCI. Methods: This trial is a randomized, blinded, placebo-controlled prospective clinical phase II trial. Inclusion will continue until 378 patients with STEMI have been evaluated for the primary endpoint. Patients will be randomized 1:1 to a bolus of 250 mg methylprednisolone intravenous or matching placebo over a period of 5 min in the pre-hospital setting. All patients with STEMI transferred for primary PCI at Rigshospitalet, Copenhagen University Hospital, Denmark, will be screened for eligibility. The main eligibility criteria are age ≥ 18 years, acute onset of chest pain with < 12 h duration, STEMI on electrocardiogram, no known allergy to glucocorticoids or no previous coronary artery bypass grafting, previous acute myocardial infarction in assumed culprit, or a history with previous maniac/psychotic episodes. Primary outcome is final infarct size measured by late gadolinium enhancement on cardiac magnetic resonance (CMR) 3 months after STEMI. Secondary outcomes comprise key CMR efficacy parameters, clinical endpoints at 3 months, the peak of cardiac biomarkers, and safety. Discussion: We hypothesize that pulse-dose methylprednisolone administrated in the pre-hospital setting decreases inflammation and thus reduces final infarct size in patients with STEMI treated with primary PCI. Trial registration: EU-CT number: 2022–500762-10–00; Submitted May 5, 2022. ClinicalTrials.gov Identifier: NCT05462730; Submitted July 7, 2022, first posted July 18, 2022. [ABSTRACT FROM AUTHOR]
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- 2023
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6. Instantaneous wave free ratio vs. fractional flow reserve and 5-year mortality: iFR SWEDEHEART and DEFINE FLAIR.
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Eftekhari, Ashkan, Holck, Emil Nielsen, Westra, Jelmer, Olsen, Niels Thue, Bruun, Niels Henrik, Jensen, Lisette Okkels, Engstrøm, Thomas, and Christiansen, Evald Høj
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MAJOR adverse cardiovascular events ,ARTERIAL stenosis ,MORTALITY - Abstract
Background and Aims Guidelines recommend revascularization of intermediate epicardial artery stenosis to be guided by evidence of ischaemia. Fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR) are equally recommended. Individual 5-year results of two major randomized trials comparing FFR with iFR-guided revascularization suggested increased all-cause mortality following iFR-guided revascularization. The aim of this study was a study-level meta-analysis of the 5-year outcome data in iFR-SWEDEHEART (NCT02166736) and DEFINE-FLAIR (NCT02053038). Methods Composite of major adverse cardiovascular events (MACE) and its individual components [all-cause death, myocardial infarction (MI), and unplanned revascularisation] were analysed. Raw Kaplan–Meier estimates, numbers at risk, and number of events were extracted at 5-year follow-up and analysed using the ipdfc package (Stata version 18, StataCorp, College Station, TX, USA). Results In total, iFR and FFR-guided revascularization was performed in 2254 and 2257 patients, respectively. Revascularization was more often deferred in the iFR group [ n = 1128 (50.0%)] vs. the FFR group [ n = 1021 (45.2%); P =.001]. In the iFR-guided group, the number of deaths, MACE, unplanned revascularization, and MI was 188 (8.3%), 484 (21.5%), 235 (10.4%), and 123 (5.5%) vs. 143 (6.3%), 420 (18.6%), 241 (10.7%), and 123 (5.4%) in the FFR group. Hazard ratio [95% confidence interval (CI)] estimates for MACE were 1.18 [1.04; 1.34], all-cause mortality 1.34 [1.08; 1.67], unplanned revascularization 0.99 [0.83; 1.19], and MI 1.02 [0.80; 1.32]. Conclusions Five-year all-cause mortality and MACE rates were increased with revascularization guided by iFR compared to FFR. Rates of unplanned revascularization and MI were equal in the two groups. [ABSTRACT FROM AUTHOR]
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- 2023
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7. Myocardial scarring and recurrence of ventricular arrhythmia in patients surviving an out‐of‐hospital cardiac arrest.
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Thomsen, Anna F., Winkel, Bo G., Golvano, Leticia Camino Castrillo, Porta‐Sánchez, Andreu, Jøns, Christian, Ferro, Elisenda, Bertelsen, Litten, Vazquez, Sara, Bhardwaj, Priya, Stampe, Niels Kjær, Ortiz‐Perez, José T., Andrea, Rut, Engstrøm, Thomas, Køber, Lars, Vejlstrup, Niels, Mont, Lluís, Roca‐Luque, Ivo, and Jacobsen, Peter K.
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DIGITAL image processing ,MYOCARDIUM ,HUMAN research subjects ,ANALYSIS of variance ,CONFIDENCE intervals ,MAGNETIC resonance imaging ,RETROSPECTIVE studies ,MANN Whitney U Test ,FISHER exact test ,DISEASE relapse ,RISK assessment ,INFORMED consent (Medical law) ,DIAGNOSTIC imaging ,T-test (Statistics) ,CARDIAC arrest ,VENTRICULAR arrhythmia ,DESCRIPTIVE statistics ,SENSITIVITY & specificity (Statistics) ,RECEIVER operating characteristic curves ,DATA analysis software ,DISEASE risk factors - Abstract
Introduction: Prediction of recurrent ventricular arrhythmia (VA) in survivors of an out‐of‐hospital cardiac arrest (OHCA) is important, but currently difficult. Risk of recurrence may be related to presence of myocardial scarring assessed with late gadolinium enhancement cardiac magnetic resonance (LGE‐CMR). Our study aims to characterize myocardial scarring as defined by LGE‐CMR in survivors of a VA‐OHCA and investigate its potential role in the risk of new VA events. Methods: Between 2015 and 2022, a total of 230 VA‐OHCA patients without ST‐segment elevation myocardial infarction had CMR before implantable cardioverter‐defibrillator implantation for secondary prevention at Copenhagen University Hospital, Rigshospitalet, and Hospital Clínic, University of Barcelona, of which n = 170 patients had a conventional (no LGE protocol) CMR and n = 60 patients had LGE‐CMR (including LGE protocol). Scar tissue including core, border zone (BZ) and BZ channels were automatically detected by specialized investigational software in patients with LGE‐CMR. The primary endpoint was recurrent VA. Results: After exclusion, n = 52 VA‐OHCA patients with LGE‐CMR and a mean left ventricular ejection fraction of 49 ± 16% were included, of which 18 (32%) patients reached the primary endpoint of VA. Patients with recurrent VA in exhibited greater scar mass, core mass, BZ mass, and presence of BZ channels compared with patients without recurrent VA. The presence of BZ channels identified patients with recurrent VA with 67% sensitivity and 85% specificity (area under the ROC curve (AUC) 0.76; 95% CI: 0.63–0.89; p <.001) and was the strongest predictor of the primary endpoint. Conclusions: The presence of BZ channels was the strongest predictor of recurrent VA in patients with an out of‐hospital cardiac arrest and LGE‐CMR. [ABSTRACT FROM AUTHOR]
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- 2023
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8. Employment status at time of acute myocardial infarction and risk of death and recurrent acute myocardial infarction.
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Petersen, Jeppe K, Shams-Eldin, Abdulrahman N, Fosbøl, Emil L, Rørth, Rasmus, Sørensen, Rikke, Jabbari, Reza, Engstrøm, Thomas, Holmvang, Lene, Pedersen, Frants, Alhakak, Amna, Krøll, Johanna, Torp-Pedersen, Christian, Køber, Lars, and Butt, Jawad H
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- 2023
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9. Coronary CT and timing of invasive coronary angiography in patients ≥75 years old with non-ST segment elevation acute coronary syndromes.
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Ratcovich, Hanna, Sadjadieh, Golnaz, Linde, Jesper J., Joshi, Francis R., Kelbæk, Henning, Kofoed, Klaus F., Køber, Lars, Hansen, Peter Riis, Torp-Pedersen, Christian, Elming, Hanne, Gislason, Gunnar Hilmar, Høfsten, Dan Eik, Engstrøm, Thomas, and Holmvang, Lene
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HEART failure ,ACUTE coronary syndrome ,CORONARY angiography ,MYOCARDIAL perfusion imaging - Abstract
Background: The ability of coronary CT angiography (cCTA) to rule out significant coronary artery disease (CAD) in older patients with non-ST segment elevation acute coronary syndromes (NSTEACS) is unclear since valid cCTA analysis may be limited by extensive coronary artery calcification. In addition, the effect of very early invasive coronary angiography (ICA) with possible revascularisation is debated.Methods: This is a posthoc analysis of patients ≥75 years included in the Very Early vs Standard Care Invasive Examination and Treatment of Patients with Non-ST-Segment Elevation Acute Coronary Syndrome Trial. cCTA was performed prior to the ICA. The diagnostic accuracy of cCTA was investigated. Presence of a coronary artery stenosis ≥50% by subsequent ICA was used as reference. Patients were randomised to a very early (within 12 hours of diagnosis) or a standard ICA (within 48-72 hours of diagnosis). The primary composite endpoint was 5-year all-cause mortality, non-fatal recurrent myocardial infarction or hospital admission for refractory myocardial ischaemia or heart failure.Results: Of 452 (21%) patients ≥75 years, 161 (35.6%) underwent cCTA. 19% of cCTAs excluded significant CAD. The negative predictive value (NPV) of cCTA was 94% (95% CI 79 to 99) and the sensitivity 98% (95% CI 94 to 100). No significant differences in the frequency of primary endpoints were seen in patients randomised to very early ICA (at 5-year follow-up, n=100 (46.9%) vs 122 (51.0%), log-rank p=0.357).Conclusion: In patients ≥75 years with NSTEACS, cCTA before ICA showed a high NPV. A very early ICA <12 hours of diagnosis did not significantly improve long-term clinical outcomes. [ABSTRACT FROM AUTHOR]- Published
- 2023
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10. Scar border zone mass and presence of border zone channels assessed with cardiac magnetic resonance imaging are associated with ventricular arrhythmia in patients with ST-segment elevation myocardial infarction.
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Thomsen, Anna F, Bertelsen, Litten, Jøns, Christian, Jabbari, Reza, Lønborg, Jacob, Kyhl, Kasper, Göransson, Christoffer, Nepper-Christensen, Lars, Atharovski, Kiril, Ekström, Kathrine, Tilsted, Hans-Henrik, Pedersen, Frants, Køber, Lars, Engstrøm, Thomas, Vejlstrup, Niels, and Jacobsen, Peter Karl
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Aims Late gadolinium enhancement cardiac magnetic resonance (CMR) permits characterization of left ventricular ischaemic scars. We aimed to evaluate if scar core mass, border zone (BZ) mass, and BZ channels are risk markers for subsequent ventricular arrhythmia (VA) in ST-segment elevation myocardial infarction (STEMI). Methods and results A sub-study of the DANish Acute Myocardial Infarction-3 multi-centre trial and Danegaptide phase II proof-of-concept clinical trial in which a total of 843 STEMI patients had a 3-month follow-up CMR. Of these, 21 patients subsequently experienced VA during 100 months of follow-up and were randomly matched 1:5 with 105 controls. A VA event was defined as: ventricular tachycardia, ventricular fibrillation, or sudden cardiac death. Ischaemic scar characteristics were automatically detected by specialized software. We included 126 patients with a median left ventricular ejection fraction of 51.0 ± 11.6% in cases with VA vs. 55.5 ± 8.5% in controls (P = 0.10). Cases had a larger mean BZ mass and more often BZ channels compared to controls [BZ mass: 17.2 ± 10.3 g vs. 10.3 ± 6.0 g; P = 0.0002; BZ channels: 17 (80%) vs. 44 (42%); P = 0.001]. A combination of ≥17.2 g BZ mass and the presence of BZ channels was five times more prevalent in cases vs. controls (P ≤ 0.00001) with an odds ratio of 9.40 (95% confidence interval 3.26–27.13; P ≤ 0.0001) for VA. This identified cases with 52% sensitivity and 90% specificity. Conclusion(s) Scar characterization with CMR indicates that a combination of ≥17.2 g BZ mass and the presence of BZ channels had the strongest association with subsequent VA in STEMI patients. ClinicalTrials.gov Unique identifier: NCT01435408 (DANAMI 3-iPOST and DANAMI 3-DEFER), NCT01960933 (DANAMI 3-PRIMULTI), and NCT01977755 (Danegaptide). [ABSTRACT FROM AUTHOR]
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- 2023
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11. Long-term risk of new-onset arrhythmia in ST-segment elevation myocardial infarction according to revascularization status.
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Thomsen, Anna F, Jøns, Christian, Jabbari, Reza, Jacobsen, Mia R, Stampe, Niels Kjær, Butt, Jawad H, Olsen, Niels Thue, Kelbæk, Henning, Torp-Pedersen, Christian, Fosbøl, Emil L, Pedersen, Frants, Køber, Lars, Engstrøm, Thomas, and Jacobsen, Peter Karl
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Aims Emerging data show that complete revascularization (CR) reduces cardiovascular death and recurrent myocardial infarction in ST-segment elevation myocardial infarction (STEMI). However, the influence of revascularization status on development of arrhythmia in the long-term post-STEMI phase is poorly described. We hypothesized that incomplete revascularization (ICR) compared with CR in STEMI is associated with an increased long-term risk of new-onset arrhythmia. Methods and results Patients with STEMI treated with primary percutaneous coronary intervention (PPCI) at Copenhagen University Hospital, Rigshospitalet, Denmark, with CR or ICR were identified via the Eastern Danish Heart registry from 2009 to 2016. Using unique Danish administrative registries, the outcomes were assessed. The primary outcome was new-onset arrhythmia defined as a composite of atrial fibrillation/flutter (AF), sinoatrial block, advanced second- or third-degree atrioventricular block, ventricular tachycardia/fibrillation (VT), or cardiac arrest (CA), with presentation >7 days post-PPCI. Secondary outcomes were the components of the primary outcome and all-cause mortality. A total of 5103 patients (median age: 62.0 years; 76% men) were included, of whom 4009 (79%) and 1094 (21%) patients underwent CR and ICR, respectively. Compared with CR, ICR was associated with a higher risk of new-onset arrhythmia [hazard ratio (HR), 1.33; 95% confidence interval (CI), 1.07–1.66; P = 0.01], AF (HR, 1.29; 95% CI, 1.00–1.66; P = 0.05), a combined outcome of VT and CA (HR, 1.77; 95% CI, 1.10–2.84; P = 0.02) and all-cause mortality (HR, 1.27; 95% CI, 1.05–1.53; P = 0.01). All HRs adjusted. Conclusion Among patients with STEMI, ICR was associated with an increased long-term risk of new-onset arrhythmia and all-cause mortality compared with CR. [ABSTRACT FROM AUTHOR]
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- 2023
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12. Coronary Artery Lesion Lipid Content and Plaque Burden in Diabetic and Nondiabetic Patients: PROSPECT II.
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Gyldenkerne, Christine, Maeng, Michael, Kjøller-Hansen, Lars, Maehara, Akiko, Zhou, Zhipeng, Ben-Yehuda, Ori, Erik Bøtker, Hans, Engstrøm, Thomas, Matsumura, Mitsuaki, Mintz, Gary S., Fröbert, Ole, Persson, Jonas, Wiseth, Rune, Larsen, Alf I., Jensen, Lisette O., Nordrehaug, Jan E., Bleie, Øyvind, Omerovic, Elmir, Held, Claes, and James, Stefan K.
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- 2023
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13. Soluble ST2 in plasma is associated with post-procedural no-or-slow reflow after primary percutaneous coronary intervention in ST-elevation myocardial infarction.
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Søndergaard, Frederik T, Beske, Rasmus P, Frydland, Martin, Møller, Jacob Eifer, Helgestad, Ole K L, Jensen, Lisette Okkels, Holmvang, Lene, Goetze, Jens P, Engstrøm, Thomas, and Hassager, Christian
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- 2023
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14. On the Natural History of Coronary Artery Disease: A Longitudinal Nationwide Serial Angiography Study.
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Mohammad, Moman A., Stone, Gregg W., Koul, Sasha, Olivecrona, Göran K., Bergman, Sofia, Persson, Jonas, Engstrøm, Thomas, Fröbert, Ole, Jernberg, Tomas, Omerovic, Elmir, James, Stefan, Bergström, Göran, and Erlinge, David
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- 2022
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15. Angiographic outcome in patients treated with deferred stenting after ST-segment elevation myocardial infarction—results from DANAMI-3-DEFER .
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Nepper-Christensen, Lars, Kelbæk, Henning, Ahtarovski, Kiril A, Høfsten, Dan E, Holmvang, Lene, Pedersen, Frants, Tilsted, Hans-Henrik, Aarøe, Jens, Jensen, Svend E, Raungaard, Bent, Terkelsen, Christian J, Køber, Lars, Engstrøm, Thomas, and Lønborg, Jacob
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- 2022
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16. Is It Safe to Mobilize Patients Very Early After Transfemoral Coronary Procedures? (SAMOVAR): A Randomized Clinical Trial.
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Nørgaard, Marianne Wetendorff, Færch, Jane, Joshi, Francis R., Høfsten, Dan E., Engstrøm, Thomas, and Kelbæk, Henning
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- 2022
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17. Classification of Left and Right Coronary Arteries in Coronary Angiographies Using Deep Learning.
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Eschen, Christian Kim, Banasik, Karina, Christensen, Alex Hørby, Chmura, Piotr Jaroslaw, Pedersen, Frants, Køber, Lars, Engstrøm, Thomas, Dahl, Anders Bjorholm, Brunak, Søren, and Bundgaard, Henning
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DEEP learning ,CORONARY arteries ,CORONARY circulation ,MYOCARDIAL ischemia ,CORONARY disease ,CORONARY artery disease - Abstract
Multi-frame X-ray images (videos) of the coronary arteries obtained using coronary angiography (CAG) provide detailed information about the anatomy and blood flow in the coronary arteries and play a pivotal role in diagnosing and treating ischemic heart disease. Deep learning has the potential to quickly and accurately quantify narrowings and blockages of the arteries from CAG videos. A CAG consists of videos acquired separately for the left coronary artery and the right coronary artery (LCA and RCA, respectively). The pathology for LCA and RCA is typically only reported for the entire CAG, and not for the individual videos. However, training of stenosis quantification models is difficult when the RCA and LCA information of the videos are unknown. Here, we present a deep learning-based approach for classifying LCA and RCA in CAG videos. Our approach enables linkage of videos with the reported pathological findings. We manually labeled 3545 and 520 videos (approximately seven videos per CAG) to enable training and testing of the models, respectively. We obtained F1 scores of 0.99 on the test set for LCA and RCA classification LCA and RCA classification on the test set. The classification performance was further investigated with extensive experiments across different model architectures (R(2+1)D, X3D, and MVIT), model input sizes, data augmentations, and the number of videos used for training. Our results showed that CAG videos could be accurately curated using deep learning, which is an essential preprocessing step for a downstream application in diagnostics of coronary artery disease. [ABSTRACT FROM AUTHOR]
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- 2022
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18. Microcirculatory Function in Nonhypertrophic and Hypertrophic Myocardium in Patients With Aortic Valve Stenosis.
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Sabbah, Muhammad, Olsen, Niels Thue, Mikko Minkkinen, Lene Holmvang, Tilsted, Hans-Henrik, Pedersen, Frants, Joshi, Francis R., Ahtarovski, Kiril, Sørensen, Rikke, Linde, Jesper James, Søndergaard, Lars, Pijls, Nico, Lønborg, Jacob, Engstrøm, Thomas, Minkkinen, Mikko, and Holmvang, Lene
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- 2022
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19. Complete invasive diagnosis of patients with ischemia with nonobstructive coronary arteries: why it matters.
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Madsen, Jasmine Melissa, Lønborg, Jacob Thomsen, and Engstrøm, Thomas
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- 2022
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20. Impact of diabetes on 1‐year clinical outcome in patients undergoing revascularization with the BioFreedom stents or the Orsiro stents from the SORT OUT IX trial.
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Hansen, Kirstine Nørregaard, Maeng, Michael, Raungaard, Bent, Engstrøm, Thomas, Veien, Karsten Tange, Kristensen, Steen Dalby, Ellert‐Gregersen, Julia, Jensen, Svend Eggert, Junker, Anders, Kahlert, Johnny, Jakobsen, Lars, Christiansen, Evald Høj, and Jensen, Lisette Okkels
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- 2022
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21. Efect of remote ischaemic conditioning on infarct size and remodelling in ST‑segment elevation myocardial infarction patients: the CONDI‑2/ERIC‑PPCI CMR substudy.
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Francis, Rohin, Chong, Jun, Ramlall, Manish, Bucciarelli‑Ducci, Chiara, Clayton, Tim, Dodd, Matthew, Engstrøm, Thomas, Evans, Richard, Ferreira, Vanessa M., Fontana, Marianna, Greenwood, John P., Kharbanda, Rajesh K., Won Yong Kim, Kotecha, Tushar, Lønborg, Jacob T., Mathur, Anthony, Møller, Ulla Kristine, Moon, James, Perkins, Alexander, and Rakhit, Roby D.
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The effect of limb remote ischaemic conditioning (RIC) on myocardial infarct (MI) size and left ventricular ejection fraction (LVEF) was investigated in a pre-planned cardiovascular magnetic resonance (CMR) substudy of the CONDI-2/ERIC-PPCI trial. This single-blind multi-centre trial (7 sites in UK and Denmark) included 169 ST-segment elevation myocardial infarction (STEMI) patients who were already randomised to either control (n = 89) or limb RIC (n = 80) (4 × 5 min cycles of arm cuff inflations/deflations) prior to primary percutaneous coronary intervention. CMR was performed acutely and at 6 months. The primary endpoint was MI size on the 6 month CMR scan, expressed as median and interquartile range. In 110 patients with 6-month CMR data, limb RIC did not reduce MI size [RIC: 13.0 (5.1-17.1)% of LV mass; control: 11.1 (7.0-17.8)% of LV mass, P = 0.39], or LVEF, when compared to control. In 162 patients with acute CMR data, limb RIC had no effect on acute MI size, microvascular obstruction and LVEF when compared to control. In a subgroup of anterior STEMI patients, RIC was associated with lower incidence of microvascular obstruction and higher LVEF on the acute scan when compared with control, but this was not associated with an improvement in LVEF at 6 months. In summary, in this pre-planned CMR substudy of the CONDI-2/ERIC-PPCI trial, there was no evidence that limb RIC reduced MI size or improved LVEF at 6 months by CMR, findings which are consistent with the neutral effects of limb RIC on clinical outcomes reported in the main CONDI-2/ERIC-PPCI trial. [ABSTRACT FROM AUTHOR]
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- 2021
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22. Combined In-silico and Machine Learning Approaches Toward Predicting Arrhythmic Risk in Post-infarction Patients.
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Maleckar, Mary M., Myklebust, Lena, Uv, Julie, Florvaag, Per Magne, Strøm, Vilde, Glinge, Charlotte, Jabbari, Reza, Vejlstrup, Niels, Engstrøm, Thomas, Ahtarovski, Kiril, Jespersen, Thomas, Tfelt-Hansen, Jacob, Naumova, Valeriya, and Arevalo, Hermenegild
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MACHINE learning ,DATA augmentation ,MYOCARDIAL ischemia ,SUPPORT vector machines ,DECISION trees - Abstract
Background: Remodeling due to myocardial infarction (MI) significantly increases patient arrhythmic risk. Simulations using patient-specific models have shown promise in predicting personalized risk for arrhythmia. However, these are computationally- and time- intensive, hindering translation to clinical practice. Classical machine learning (ML) algorithms (such as K-nearest neighbors, Gaussian support vector machines, and decision trees) as well as neural network techniques, shown to increase prediction accuracy, can be used to predict occurrence of arrhythmia as predicted by simulations based solely on infarct and ventricular geometry. We present an initial combined image-based patient-specific in silico and machine learning methodology to assess risk for dangerous arrhythmia in post-infarct patients. Furthermore, we aim to demonstrate that simulation-supported data augmentation improves prediction models, combining patient data, computational simulation, and advanced statistical modeling, improving overall accuracy for arrhythmia risk assessment. Methods: MRI-based computational models were constructed from 30 patients 5 days post-MI (the "baseline" population). In order to assess the utility biophysical model-supported data augmentation for improving arrhythmia prediction, we augmented the virtual baseline patient population. Each patient ventricular and ischemic geometry in the baseline population was used to create a subfamily of geometric models, resulting in an expanded set of patient models (the "augmented" population). Arrhythmia induction was attempted via programmed stimulation at 17 sites for each virtual patient corresponding to AHA LV segments and simulation outcome, "arrhythmia," or "no-arrhythmia," were used as ground truth for subsequent statistical prediction (machine learning, ML) models. For each patient geometric model, we measured and used choice data features: the myocardial volume and ischemic volume, as well as the segment-specific myocardial volume and ischemia percentage, as input to ML algorithms. For classical ML techniques (ML), we trained k-nearest neighbors, support vector machine, logistic regression, xgboost, and decision tree models to predict the simulation outcome from these geometric features alone. To explore neural network ML techniques, we trained both a three - and a four-hidden layer multilayer perceptron feed forward neural networks (NN), again predicting simulation outcomes from these geometric features alone. ML and NN models were trained on 70% of randomly selected segments and the remaining 30% was used for validation for both baseline and augmented populations. Results: Stimulation in the baseline population (30 patient models) resulted in reentry in 21.8% of sites tested; in the augmented population (129 total patient models) reentry occurred in 13.0% of sites tested. ML and NN models ranged in mean accuracy from 0.83 to 0.86 for the baseline population, improving to 0.88 to 0.89 in all cases. Conclusion: Machine learning techniques, combined with patient-specific, image-based computational simulations, can provide key clinical insights with high accuracy rapidly and efficiently. In the case of sparse or missing patient data, simulation-supported data augmentation can be employed to further improve predictive results for patient benefit. This work paves the way for using data-driven simulations for prediction of dangerous arrhythmia in MI patients. [ABSTRACT FROM AUTHOR]
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- 2021
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23. Importance of Risk Assessment in Timing of Invasive Coronary Evaluation and Treatment of Patients With Non-ST-Segment-Elevation Acute Coronary Syndrome: Insights From the VERDICT Trial.
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Butt, Jawad H., Kofoed, Klaus F., Kelbæk, Henning, Hansen, Peter R., Torp-Pedersen, Christian, Høfsten, Dan, Holmvang, Lene, Pedersen, Frants, Bang, Lia E., Sigvardsen, Per E., Clemmensen, Peter, Linde, Jesper J., Heitmann, Merete, Hove, Jens Dahlgaard, Abdulla, Jawdat, Gislason, Gunnar, Engstrøm, Thomas, and Køber, Lars
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- 2021
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24. Initiation of and persistence with P2Y12 inhibitors in patients with myocardial infarction according to revascularization strategy: a nationwide study.
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Tajchman, Daniel H., Nabi, Hafsah, Aslam, Mohsin, Butt, Jawad H., Grove, Erik L., Engstrøm, Thomas, Holmvang, Lene, Fosbøl, Emil L., Køber, Lars, and Sørensen, Rikke
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- 2021
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25. Conductance artery stiffness impairs atrio-ventriculo-arterial coupling before manifestation of arterial hypertension or left ventricular hypertrophic remodelling.
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Kyhl, Kasper, von Huth, Sebastian, Bojer, Annemie, Thomsen, Carsten, Engstrøm, Thomas, Vejlstrup, Niels, and Madsen, Per Lav
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ARTERIAL diseases ,HYPERTENSION ,LEFT ventricular hypertrophy ,MAGNETIC resonance imaging ,BLOOD pressure - Abstract
As part of normal ageing, conductance arteries lose their cushion function, left ventricle (LV) filling and also left atrial emptying are impaired. The relation between conductance artery stiffness and LV diastolic function is normally explained by arterial hypertension and LV hypertrophy as needed intermediaries. We examined whether age-related aortic stiffening may influence LV diastolic function in normal healthy subjects. Aortic distensibility and pulse wave velocity (PWV) were related to LV emptying and filling parameters and left atrial emptying parameters as determined by magnetic resonance imaging in 36 healthy young (< 35 years) and 16 healthy middle-aged and elderly (> 35 years) with normal arterial blood pressure and myocardial mass. In the overall cohort, total aorta PWV correlated to a decrease in LV peak-emptying volume (r = 0.43), LV peak-filling (r = 0.47), passive atrial emptying volume (r = 0.66), and an increase in active atrial emptying volume (r = 0.47) (all p < 0.001). PWV was correlated to passive atrial emptying volume even if only the > 35-year-old were considered (r = 0.53; p < 0.001). Total peripheral resistance demonstrated similar correlations as PWV, but in a regression analysis only the total aorta PWV was related to left atrial (LA) passive emptying volume. Via impaired ventriculo-arterial coupling, the increased aortic PWV seen with normal ageing hence affects atrio-ventricular coupling, before increased aortic PWV is associated with significantly increased arterial blood pressure or LV hypertrophic remodelling. Our findings reinforce the existence of atrio-ventriculo-arterial coupling and suggest aortic distensibility should be considered an early therapeutic target to avoid diastolic dysfunction of the LV. [ABSTRACT FROM AUTHOR]
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- 2021
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26. Insulin resistance genetic risk score and burden of coronary artery disease in patients referred for coronary angiography.
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Skals, Regitze, Krogager, Maria Lukács, Appel, Emil Vincent R., Schnurr, Theresia M., Have, Christian Theil, Gislason, Gunnar, Poulsen, Henrik Enghusen, Køber, Lars, Engstrøm, Thomas, Stender, Steen, Hansen, Torben, Grarup, Niels, Lee, Christina Ji-Young, Andersson, Charlotte, Torp-Pedersen, Christian, and Weeke, Peter E.
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CORONARY artery disease ,CORONARY angiography ,INSULIN resistance ,CARDIOVASCULAR diseases ,METABOLIC syndrome ,CORONARY arteries - Abstract
Aims: Insulin resistance associates with development of metabolic syndrome and risk of cardiovascular disease. The link between insulin resistance and cardiovascular disease is complex and multifactorial. Confirming the genetic link between insulin resistance, type 2 diabetes, and coronary artery disease, as well as the extent of coronary artery disease, is important and may provide better risk stratification for patients at risk. We investigated whether a genetic risk score of 53 single nucleotide polymorphisms known to be associated with insulin resistance phenotypes was associated with diabetes and burden of coronary artery disease. Methods and results: We genotyped patients with a coronary angiography performed in the capital region of Denmark from 2010–2014 and constructed a genetic risk score of the 53 single nucleotide polymorphisms. Logistic regression using quartiles of the genetic risk score was performed to determine associations with diabetes and coronary artery disease. Associations with the extent of coronary artery disease, defined as one-, two- or three-vessel coronary artery disease, was determined by multinomial logistic regression. We identified 4,963 patients, of which 17% had diabetes and 55% had significant coronary artery disease. Of the latter, 27%, 14% and 14% had one, two or three-vessel coronary artery disease, respectively. No significant increased risk of diabetes was identified comparing the highest genetic risk score quartile with the lowest. An increased risk of coronary artery disease was found for patients with the highest genetic risk score quartile in both unadjusted and adjusted analyses, OR 1.21 (95% CI: 1.03, 1.42, p = 0.02) and 1.25 (95% CI 1.06, 1.48, p<0.01), respectively. In the adjusted multinomial logistic regression, patients in the highest genetic risk score quartile were more likely to develop three-vessel coronary artery disease compared with patients in the lowest genetic risk score quartile, OR 1.41 (95% CI: 1.10, 1.82, p<0.01). Conclusions: Among patients referred for coronary angiography, only a strong genetic predisposition to insulin resistance was associated with risk of coronary artery disease and with a greater disease burden. [ABSTRACT FROM AUTHOR]
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- 2021
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27. Predictors of 10-Year Stent-Related Adverse Outcomes after Coronary Drug-Eluting Stent Implantation: The Importance of Stent Size.
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Kjøller-Hansen, Lars, Kelbæk, Henning, Christiansen, Evald Høj, Hansen, Peter Riis, Engstrøm, Thomas, Junker, Anders, Bligaard, Niels, Jeppesen, Jørgen Lykke, and Galløe, Anders Michael
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TREATMENT failure ,DRUG-eluting stents ,CORONARY artery disease ,MYOCARDIAL infarction ,REGRESSION analysis - Abstract
Introduction: The predictors of stent treatment failure and their importance 10 years after treatment with drug-eluting stents (DESs) have not been reported in detail. Methods: Data were retrieved from the SORT-OUT II database encompassing 2,849 non-left main coronary lesions in 2,073 unselected all-comer patients treated with first-generation DES and followed clinically for 10 years. Stent treatment failure (STF) was defined as definite or probable stent thrombosis, target lesion revascularization (TLR), or >70% restenosis left untreated. Target lesion failure (TLF) was defined as cardiac death, target vessel myocardial infarction, or TLR. Characteristics predicting higher hazard ratios (HRs) were identified by the multivariate Cox regression analysis. Results: A stent diameter ≤2.5 versus ≥3.5 mm had STF 23.3 versus 11.8% and TLF 27.9 versus 18.8%. Stent length <20 versus >40 mm had STF 13.0 versus 29.0% and TLF 18.7 versus 34.6%. In multivariate analysis, decreasing stent diameter (HR: 1.24 [3.0 mm] to 2.12 [2.25 mm], reference ≥3.5 mm) and increasing stent length (HR: 1.15 [20–30 mm] to 2.07 [>40 mm], reference <20 mm) predicted STF together with diabetes (HR: 1.31), previous revascularization (HR: 1.31), restenotic (HR: 2.25), bifurcation (HR: 1.45), and chronically occluded lesions (HR: 1.54). A predictive score (PS) was calculated for each lesion from the HRs for the predictors present. The 10-year rates of STF were 10% in lesions with a PS ≤ 1.5 and 37% in those with PS ≥ 3.5. Conclusions: Ten-year outcomes show large variations depending on the stent size and a few patient and lesion characteristics. The calculation of a PS from these unambiguous variables may be used to improve the risk estimate in individual lesions and patients. [ABSTRACT FROM AUTHOR]
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- 2021
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28. Quantitative Flow Ratio to Predict Nontarget Vessel-Related Events at 5 Years in Patients With ST-Segment-Elevation Myocardial Infarction Undergoing Angiography-Guided Revascularization.
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Bär, Sarah, Kavaliauskaite, Raminta, Yasushi Ueki, Tatsuhiko Otsuka, Kelbæk, Henning, Engstrøm, Thomas, Baumbach, Andreas, Roffi, Marco, von Birgelen, Clemens, Ostojic, Miodrag, Pedrazzini, Giovanni, Kornowski, Ran, Tüller, David, Vukcevic, Vladan, Magro, Michael, Losdat, Sylvain, Windecker, Stephan, Räber, Lorenz, Ueki, Yasushi, and Otsuka, Tatsuhiko
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- 2021
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29. Clinical outcome following late reperfusion with percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction.
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Nepper-Christensen, Lars, Lønborg, Jacob, Høfsten, Dan Eik, Sadjadieh, Golnaz, Schoos, Mikkel Malby, Pedersen, Frants, Jørgensen, Erik, Kelbæk, Henning, Haahr-Pedersen, Sune, Lassen, Jens Flensted, Køber, Lars, Holmvang, Lene, and Engstrøm, Thomas
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- 2021
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30. The benefit of complete revascularization after primary PCI for STEMI is attenuated by increasing age: Results from the DANAMI‐3‐PRIMULTI randomized study.
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Joshi, Francis R., Lønborg, Jacob, Sadjadieh, Golnaz, Helqvist, Steffen, Holmvang, Lene, Sørensen, Rikke, Jørgensen, Erik, Pedersen, Frants, Tilsted, Hans Henrik, Høfsten, Dan, Køber, Lars, Kelbæk, Henning, and Engstrøm, Thomas
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- 2021
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31. Intravascular ultrasound–guided selection for early noninvasive cardiac allograft vasculopathy screening in heart transplant recipients.
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Nelson, Lærke Marie, Rossing, Kasper, Ihlemann, Nikolaj, Boesgaard, Søren, Engstrøm, Thomas, and Gustafsson, Finn
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HEART transplant recipients ,KIDNEY transplantation ,INTRAVASCULAR ultrasonography ,CORONARY angiography ,HEART transplantation ,STRESS echocardiography ,CARDIAC patients - Abstract
Background: Noninvasive screening for cardiac allograft vasculopathy (CAV) instead of invasive coronary angiography (ICA) within the first 3 to 5 years after heart transplantation (HTx) is controversial. We evaluated a strategy of intravascular ultrasound (IVUS)–guided conversion to early noninvasive screening post‐HTx. Methods: A single‐center study of 103 consecutive HTx recipients from 2008 to 2018 undergoing ICA at 1 year post‐HTx. Of 88 patients with normal 1‐year ICA, sixty‐six patients underwent IVUS examination for risk stratification by maximal intimal thickness (MIT) into (i) low‐risk group (MIT < 0.5 mm) (n = 41, 62%) followed noninvasively versus (ii) high‐risk group (MIT ≥ 0.5 mm) (n = 25, 38%) followed with yearly ICA. Both groups underwent ICA at year 5 post‐HTx. We evaluated a combined endpoint of angiographic CAV and death at 5‐year follow‐up post‐HTx. Results: Median (IQR) age was 51 (33–60) years, and 62% were male. Follow‐up was 1443 (1125–1456) days. Survival free from angiographic CAV (Kaplan‐Meier) differed significantly between groups (log‐rank p <.0001). A subgroup of 27 patients completed ICA at year 5, and the proportion of angiographic CAV was significantly lower in low‐risk patients (p <.0001). Conclusion: IVUS‐guided selection for early noninvasive CAV screening appears to be safe and holds promise as a novel strategy for early risk stratification and CAV surveillance post‐HTx. [ABSTRACT FROM AUTHOR]
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- 2020
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32. Coronary risk of patients with valvular heart disease: prospective validation of CT-Valve Score.
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Hasselbalch, Rasmus Bo, Pries-Heje, Mia Marie, Holle, Sarah Louise Kjølhede, Engstrøm, Thomas, Heitmann, Merete, Pedersen, Frants, Schou, Morten, Mickley, Hans, Elming, Hanne, Steffensen, Rolf, Koeber, Lars, and Iversen, Kasper
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- 2020
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33. Complete vs Culprit-Lesion-Only Revascularization for ST-Segment Elevation Myocardial Infarction: A Systematic Review and Meta-analysis.
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Bainey, Kevin R., Engstrøm, Thomas, Smits, Pieter C., Gershlick, Anthony H., James, Stefan K., Storey, Robert F., Wood, David A., Mehran, Roxana, Cairns, John A., and Mehta, Shamir R.
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- 2020
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34. Health-related qualify of life, angina type and coronary artery disease in patients with stable chest pain.
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Rieckmann, Nina, Neumann, Konrad, Feger, Sarah, Ibes, Paolo, Napp, Adriane, Preuß, Daniel, Dreger, Henryk, Feuchtner, Gudrun, Plank, Fabian, Suchánek, Vojtěch, Veselka, Josef, Engstrøm, Thomas, Kofoed, Klaus F., Schröder, Stephen, Zelesny, Thomas, Gutberlet, Matthias, Woinke, Michael, Maurovich-Horvat, Pál, Merkely, Béla, and Donnelly, Patrick
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CORONARY disease ,CHEST pain ,ANGINA pectoris ,QUALITY of life ,CORONARY angiography - Abstract
Background: Health-related quality of life (HRQoL) is impaired in patients with stable angina but patients often present with other forms of chest pain. The aim of this study was to compare the pre-diagnostic HRQoL in patients with suspected coronary artery disease (CAD) according to angina type, gender, and presence of obstructive CAD.Methods: From the pilot study for the European DISCHARGE trial, we analysed data from 24 sites including 1263 patients (45.9% women, 61.1 ± 11.3 years) who were clinically referred for invasive coronary angiography (ICA; 617 patients) or coronary computed tomography angiography (CTA; 646 patients). Prior to the procedures, patients completed HRQoL questionnaires: the Short Form (SF)-12v2, the EuroQoL (EQ-5D-3 L) and the Hospital Anxiety and Depression Scale.Results: Fifty-five percent of ICA and 35% of CTA patients had typical angina, 23 and 33% had atypical angina, 18 and 28% had non-anginal chest discomfort and 5 and 5% had other chest discomfort, respectively. Patients with typical angina had the poorest physical functioning compared to the other angina groups (SF-12 physical component score; 41.2 ± 8.8, 43.3 ± 9.1, 46.2 ± 9.0, 46.4 ± 11.4, respectively, all age and gender-adjusted p < 0.01), and highest anxiety levels (8.3 ± 4.1, 7.5 ± 4.1, 6.5 ± 4.0, 4.7 ± 4.5, respectively, all adjusted p < 0.01). On all other measures, patients with typical or atypical angina had lower HRQoL compared to the two other groups (all adjusted p < 0.05). HRQoL did not differ between patients with and without obstructive CAD while women had worse HRQoL compared with men, irrespective of age and angina type.Conclusions: Prior to a diagnostic procedure for stable chest pain, HRQoL is associated with chest pain characteristics, but not with obstructive CAD, and is significantly lower in women.Trial Registration: Clinicaltrials.gov, NCT02400229. [ABSTRACT FROM AUTHOR]- Published
- 2020
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35. Pilot study of the multicentre DISCHARGE Trial: image quality and protocol adherence results of computed tomography and invasive coronary angiography.
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De Rubeis, Gianluca, Napp, Adriane E., Schlattmann, Peter, Geleijns, Jacob, Laule, Michael, Dreger, Henryk, Kofoed, Klaus, Sørgaard, Mathias, Engstrøm, Thomas, Tilsted, Hans Henrik, Boi, Alberto, Porcu, Michele, Cossa, Stefano, Rodríguez-Palomares, José F., Xavier Valente, Filipa, Roque, Albert, Feuchtner, Gudrun, Plank, Fabian, Štěchovský, Cyril, and Adla, Theodor
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CORONARY angiography ,COMPUTED tomography ,PILOT projects ,SIGNAL-to-noise ratio ,RESEARCH ,RESEARCH evaluation ,CLINICAL trials ,RESEARCH methodology ,EVALUATION research ,MEDICAL cooperation ,COMPARATIVE studies ,CORONARY artery disease ,RESEARCH funding ,CORONARY arteries - Abstract
Objective: To implement detailed EU cardiac computed tomography angiography (CCTA) quality criteria in the multicentre DISCHARGE trial (FP72007-2013, EC-GA 603266), we reviewed image quality and adherence to CCTA protocol and to the recommendations of invasive coronary angiography (ICA) in a pilot study.Materials and Methods: From every clinical centre, imaging datasets of three patients per arm were assessed for adherence to the inclusion/exclusion criteria of the pilot study, predefined standards for the CCTA protocol and ICA recommendations, image quality and non-diagnostic (NDX) rate. These parameters were compared via multinomial regression and ANOVA. If a site did not reach the minimum quality level, additional datasets had to be sent before entering into the final accepted database (FADB).Results: We analysed 226 cases (150 CCTA/76 ICA). The inclusion/exclusion criteria were not met by 6 of the 226 (2.7%) datasets. The predefined standard was not met by 13 of 76 ICA datasets (17.1%). This percentage decreased between the initial CCTA database and the FADB (multinomial regression, 53 of 70 vs 17 of 75 [76%] vs [23%]). The signal-to-noise ratio and contrast-to-noise ratio of the FADB did not improve significantly (ANOVA, p = 0.20; p = 0.09). The CTA NDX rate was reduced, but not significantly (initial CCTA database 15 of 70 [21.4%]) and FADB 9 of 75 [12%]; p = 0.13).Conclusion: We were able to increase conformity to the inclusion/exclusion criteria and CCTA protocol, improve image quality and decrease the CCTA NDX rate by implementing EU CCTA quality criteria and ICA recommendations.Key Points: • Failure to meet protocol adherence in cardiac CTA was high in the pilot study (77.6%). • Image quality varies between sites and can be improved by feedback given by the core lab. • Conformance with new EU cardiac CT quality criteria might render cardiac CTA findings more consistent and comparable. [ABSTRACT FROM AUTHOR]- Published
- 2020
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36. Sibling history is associated with heart failure after a first myocardial infarction.
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Glinge, Charlotte, Oestergaard, Louise, Jabbari, Reza, Rossetti, Sara, Skals, Regitze, Køber, Lars, Engstrøm, Thomas, Bezzina, Connie R., Torp-Pedersen, Christian, Gislason, Gunnar, and Tfelt-Hansen, Jacob
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- 2020
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37. Seasonality of ventricular fibrillation at first myocardial infarction and association with viral exposure.
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Glinge, Charlotte, Engstrøm, Thomas, Midgley, Sofie E., Tanck, Michael W. T., Madsen, Jeppe Ekstrand Halkjær, Pedersen, Frants, Ravn Jacobsen, Mia, Lodder, Elisabeth M., Al-Hussainy, Nour R., Kjær Stampe, Niels, Trebbien, Ramona, Køber, Lars, Gerds, Thomas, Torp-Pedersen, Christian, Kølsen Fischer, Thea, Bezzina, Connie R., Tfelt-Hansen, Jacob, and Jabbari, Reza
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DRUG-eluting stents ,MYOCARDIAL infarction ,VENTRICULAR fibrillation ,ENTEROVIRUS diseases ,DIAGNOSTIC microbiology ,PERCUTANEOUS coronary intervention - Abstract
Aims: To investigate seasonality and association of increased enterovirus and influenza activity in the community with ventricular fibrillation (VF) risk during first ST-elevation myocardial infarction (STEMI). Methods: This study comprised all consecutive patients with first STEMI (n = 4,659; aged 18–80 years) admitted to the invasive catheterization laboratory between 2010–2016, at Copenhagen University Hospital, Rigshospitalet, covering eastern Denmark (2.6 million inhabitants, 45% of the Danish population). Hospital admission, prescription, and vital status data were assessed using Danish nationwide registries. We utilized monthly/weekly surveillance data for enterovirus and influenza from the Danish National Microbiology Database (2010–2016) that receives copies of laboratory tests from all Danish departments of clinical microbiology. Results: Of the 4,659 consecutively enrolled STEMI patients, 581 (12%) had VF before primary percutaneous coronary intervention. In a subset (n = 807), we found that VF patients experienced more generalized fatigue and flu-like symptoms within 7 days before STEMI compared with the patients without VF (OR 3.39, 95% CI 1.76–6.54). During the study period, 2,704 individuals were diagnosed with enterovirus and 19,742 with influenza. No significant association between enterovirus and VF (OR 1.00, 95% CI 0.99–1.02), influenza and VF (OR 1.00, 95% CI 1.00–1.00), or week number and VF (p-value 0.94 for enterovirus and 0.89 for influenza) was found. Conclusion: We found no clear seasonality of VF during first STEMI. Even though VF patients had experienced more generalized fatigue and flu-like symptoms within 7 days before STEMI compared with patients without VF, no relationship was found between enterovirus or influenza exposure and occurrence of VF. [ABSTRACT FROM AUTHOR]
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- 2020
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38. Potassium Disturbances and Risk of Ventricular Fibrillation Among Patients With ST-Segment-Elevation Myocardial Infarction.
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Jacobsen, Mia Ravn, Jabbari, Reza, Glinge, Charlotte, Stampe, Niels Kjær, Butt, Jawad Haider, Blanche, Paul, Lønborg, Jacob, Nielsen, Olav Wendelboe, Køber, Lars, Torp-Pedersen, Christian, Pedersen, Frants, Tfelt-Hansen, Jacob, Engstrøm, Thomas, Ravn Jacobsen, Mia, Kjær Stampe, Niels, and Wendelboe Nielsen, Olav
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- 2020
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39. 16-year follow-up of the Danish Acute Myocardial Infarction 2 (DANAMI-2) trial: primary percutaneous coronary intervention vs. fibrinolysis in ST-segment elevation myocardial infarction.
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Thrane, Pernille G, Kristensen, Steen D, Olesen, Kevin K W, Mortensen, Leif S, Bøtker, Hans Erik, Thuesen, Leif, Hansen, Henrik S, Abildgaard, Ulrik, Engstrøm, Thomas, Andersen, Henning R, and Maeng, Michael
- Abstract
Aims The DANish Acute Myocardial Infarction 2 (DANAMI-2) trial found that interhospital transport to primary percutaneous coronary intervention (pPCI) was superior to fibrinolysis at the local hospital in patients with ST-segment elevation myocardial infarction (STEMI) at 30 days. The present study investigates the 16-year cardiovascular outcomes. Methods and results We randomized 1572 STEMI patients to pPCI or fibrinolysis at 24 referral hospitals and 5 invasive centres in Denmark. Patients randomized to pPCI at referral hospitals were immediately transported to the nearest invasive centre. The main endpoint of the current study was a composite of death or rehospitalization for myocardial infarction (MI). Outcome information beyond 3 years was obtained through Danish health registries. After 16 years, pPCI-treated patients had a sustained lower rate of composite endpoint compared to patients treated with fibrinolysis in the overall cohort [58.7% vs. 62.3%; hazard ratio (HR) 0.86, 95% confidence interval (CI) 0.76–0.98], and among patients transported for pPCI (58.7% vs. 64.1%; HR 0.82, 95% CI 0.71–0.96). No difference in all-cause mortality was found, but cardiac mortality was reduced by an absolute of 4.4% in favour of pPCI (18.3% vs. 22.7%; HR 0.78, 95% CI 0.63–0.98). pPCI postponed a main event with 12.3 months in average compared to fibrinolysis (95% CI 5.0–19.5). Conclusion The benefit of pPCI over fibrinolysis was maintained at 16-year follow-up. pPCI reduced the composite endpoint of death or rehospitalization for MI, reduced cardiac mortality, and delayed average time to a main event by approximately 1 year. Open in new tab Download slide Open in new tab Download slide [ABSTRACT FROM AUTHOR]
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- 2020
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40. Antithrombotic Therapy in Patients With Atrial Fibrillation and Acute Coronary Syndrome Treated Medically or With Percutaneous Coronary Intervention or Undergoing Elective Percutaneous Coronary Intervention: Insights From the AUGUSTUS Trial.
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Windecker, Stephan, Lopes, Renato D., Massaro, Tyler, Jones-Burton, Charlotte, Granger, Christopher B., Aronson, Ronald, Heizer, Gretchen, Goodman, Shaun G., Darius, Harald, Jones, W. Schuyler, Aschermann, Michael, Brieger, David, Cura, Fernando, Engstrøm, Thomas, Fridrich, Viliam, Halvorsen, Sigrun, Huber, Kurt, Kang, Hyun-Jae, Leiva-Pons, Jose L., and Lewis, Basil S.
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- 2019
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41. Comparison of a Complete Percutaneous Versus Surgical Approach to Aortic Valve Replacement and Revascularization in Patients at Intermediate Surgical Risk: Results From the Randomized SURTAVI Trial.
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Søndergaard, Lars, Popma, Jeffrey J., Reardon, Michael J., Van Mieghem, Nicolas M., Deeb, G. Michael, Kodali, Susheel, George, Isaac, Williams, Mathew R., Yakubov, Steven J., Kappetein, Arie P., Serruys, Patrick W., Grube, Eberhard, Schiltgen, Molly B., Chang, Yanping, and Engstrøm, Thomas
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- 2019
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42. Coronary risk stratification of patients with newly diagnosed heart failure.
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Hasselbalch, Rasmus Bo, Pries-Heje, Mia, Engstrøm, Thomas, Sandø, Andreas, Heitmann, Merete, Pedersen, Frants, Schou, Morten, Mickley, Hans, Elming, Hanne, Steffensen, Rolf, Koeber, Lars, and Iversen, Kasper Karmark
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- 2019
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43. Differences in clinical characteristics in patients with first ST-segment elevation myocardial infarction and ventricular fibrillation according to sex.
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Jabbari, Reza, Glinge, Charlotte, Risgaard, Bjarke, Lynge, Thomas, Winkel, Bo, Haunsø, Stig, Albert, Christine, Engstrøm, Thomas, Tfelt-Hansen, Jacob, Lynge, Thomas Hadberg, Winkel, Bo Gregers, Haunsø, Stig, Albert, Christine M, and Engstrøm, Thomas
- Abstract
Purpose: We aimed to assess sex differences in clinical characteristics, circumstances of arrest, and procedural characteristics in ST-elevation myocardial infarction (STEMI) patients with ventricular fibrillation (VF) prior to angioplasty.Methods: Cases of VF with first STEMI (n = 329; 276 men and 53 women) were identified from the GEVAMI study, which is prospectively assembled case-control study among first STEMI patients in Denmark.Results: Compared to men, women experienced symptoms for a longer time interval prior to angioplasty (140 vs. 166 min, p = 0.020), and were more likely to present with VF later during transport to the hospital rather than prior to emergency medical services arrival (36 vs. 52%, p = 0.040). Prior to VF, women had a significantly lower income (p = 0.002) and education level (p = 0.008), were less likely to consume alcohol (3 vs. 6 units, p = 0.040), more likely to smoke (71 vs. 52%, p = 0.007), and more likely to have depression (25 vs. 10%, p = 0.002) or a history of angina (59 vs. 42%, p = 0.030). Even though women had more angina within a year prior to VF, no difference was observed in self-reported contact with the healthcare system (p = 0.200). In multivariable logistic regression models, history of angina (OR = 2.70; p = 0.006), low educational level (OR = 2.80, p = 0.012) and low income (OR = 6.00, p = 0.005) remained significantly associated with female sex. There were no differences in procedural characteristics between men and women.Conclusions: We found several sex differences in clinical characteristics and circumstances of arrest. The importance of seeking acute medical attention when experiencing angina should be emphasized in women, especially in women with low socioeconomic status. [ABSTRACT FROM AUTHOR]- Published
- 2017
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44. Correction: Hypertension genetic risk score is associated with burden of coronary heart disease among patients referred for coronary angiography.
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Krogager, Maria Lukács, Skals, Regitze Kuhr, Appel, Emil Vincent R., Schnurr, Theresia M., Engelbrechtsen, Line, Have, Christian Theil, Pedersen, Oluf, Engstrøm, Thomas, Roden, Dan M., Gislason, Gunnar, Poulsen, Henrik Enghusen, Køber, Lars, Stender, Steen, Hansen, Torben, Grarup, Niels, Andersson, Charlotte, Torp-Pedersen, Christian, and Weeke, Peter E.
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CARDIAC patients ,CORONARY disease ,CORONARY angiography ,HYPERTENSION ,GENETIC risk score - Abstract
In the Ethics subsection of the Methods, there is an error in the paragraph. Reference 1 Lukács Krogager M, Skals RK, Appel EVR, Schnurr TM, Engelbrechtsen L, Have CT, et al. (2018) Hypertension genetic risk score is associated with burden of coronary heart disease among patients referred for coronary angiography. [Extracted from the article]
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- 2023
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45. Five-year clinical outcomes and intracoronary imaging findings of the COMFORTABLE AMI trial: randomized comparison of biodegradable polymer-based biolimus-eluting stents with bare-metal stents in patients with acute ST-segment elevation myocardial infarction
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Räber, Lorenz, Yamaji, Kyohei, Kelbæk, Henning, Engstrøm, Thomas, Baumbach, Andreas, Roffi, Marco, Birgelen, Clemens von, Taniwaki, Masanori, Moschovitis, Aris, Zaugg, Serge, Ostojic, Miodrag, Pedrazzini, Giovanni, Karagiannis-Voules, Dimitrios-Alexios, Lüscher, Thomas F, Kornowski, Ran, Tüller, David, Vukcevic, Vladan, Heg, Dik, and Windecker, Stephan
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Aims The long-term outcomes of biolimus-eluting stents (BESs) with biodegradable polymer as compared with bare-metal stent (BMS) in patients with ST-segment elevation myocardial infarction (STEMI) remain unknown. Methods and results We performed a 5-year clinical follow-up of 1157 patients (BES: N = 575 and BMS: N = 582) included in the randomized COMFORTABLE AMI trial. Serial intracoronary imaging of stented segments using both intravascular ultrasound (IVUS) and optical coherence tomography performed at baseline and 13 months follow-up were analysed in 103 patients. At 5 years, BES reduced the risk of major adverse cardiac events [MACE; hazard ratio (HR) 0.56, 95% confidence interval (CI): 0.39–0.79, P = 0.001], driven by lower risks for target vessel-related reinfarction (HR 0.44, 95% CI: 0.22–0.87, P = 0.02) and ischaemia-driven target lesion revascularization (HR 0.41, 95% CI: 0.25–0.66, P < 0.001). Definite stent thrombosis (ST) was recorded in 2.2% and 3.9% (HR 0.57, 95% CI: 0.28–1.16, P = 0.12) with no differences in rates of very late definite ST (1.3% vs. 1.6%, P = 0.77). Optical coherence tomography showed no difference in the frequency of malapposed stent struts at follow-up (BES 0.08% vs. BMS 0.02%, P = 0.10). Uncovered stent struts were rarely observed but more frequent in BES (2.1% vs. 0.15%, P < 0.001). In the IVUS analysis, there was no positive remodelling in either group (external elastic membrane area change BES: −0.63 mm
2 , 95% CI: −1.44 to 0.39 vs. BMS −1.11 mm2 , 95% CI: −2.27 to 0.04, P = 0.07). Conclusion Compared with BMS, the implantation of biodegradable polymer-coated BES resulted in a lower 5-year rate of MACE in patients with STEMI undergoing primary percutaneous coronary intervention. At 13 months, vascular healing in treated culprit lesions was almost complete irrespective of stent type. Clinical Trial Registration http://www.clinicaltrials.gov. Unique identifier: NCT00962416. [ABSTRACT FROM AUTHOR]- Published
- 2019
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46. Five-Year Clinical and Echocardiographic Outcomes from the Nordic Aortic Valve Intervention (NOTION) Randomized Clinical Trial in Lower Surgical Risk Patients.
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Thyregod, Hans Gustav Hørsted, Ihlemann, Nikolaj, Jørgensen, Troels Højsgaard, Nissen, Henrik, Kjeldsen, Bo Juel, Petursson, Petur, Chang, Yanping, Franzen, Olaf Walter, Engstrøm, Thomas, Clemmensen, Peter, Hansen, Peter Bo, Andersen, Lars Willy, Steinbruüchel, Daniel Andreas, Olsen, Peter Skov, Søndergaard, Lars, and Steinbrüchel, Daniel Andreas
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- 2019
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47. Rubidium-82 PET imaging is feasible in a rat myocardial infarction model.
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Ghotbi, Adam Ali, Clemmensen, Andreas, Kyhl, Kasper, Follin, Bjarke, Hasbak, Philip, Engstrøm, Thomas, Ripa, Rasmus Sejersten, and Kjaer, Andreas
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Background: Small-animal myocardial infarct models are frequently used in the assessment of new cardioprotective strategies. A validated quantification of perfusion using a non-cyclotron-dependent PET tracer would be of importance in monitoring response to therapy. We tested whether myocardial PET perfusion imaging is feasible with Rubidium-82 (82Rb) in a small-animal scanner using a rat myocardial infarct model.Methods: 18 Sprague-Dawley rats underwent permanent coronary artery ligation (infarct group), and 11 rats underwent ischemia-reperfusion (reperfusion group) procedure. 82Rb-PET and magnetic resonance imaging (MRI) were conducted before and after the intervention. Perfusion was compared to both left ventricle ejection fraction (LVEF) and infarct size assessed by MRI.Results: Follow-up global 82Rb-uptake correlated significantly with infarct size (infarct group: r = -0.81, P < 0.001 and reperfusion group: r = -0.61, P = 0.04). Only 82Rb-uptake in the infarct group correlated with LVEF. At follow-up, a higher segmental 82Rb-uptake in the infarct group was associated with better wall motion (β = 0.034, CI [0.028;0.039], P < 0.001, R2 = 0.30), and inversely associated with scar transmurality (β = -2.4 [-2.6; -2.2], P < 0.001, R2 = 0.59). The associations were similar for the reperfusion group.Conclusion: 82Rb-PET is feasible in small animal scanners despite the long positron range and enables fast and time-efficient myocardial perfusion imaging in rat models. [ABSTRACT FROM AUTHOR]- Published
- 2019
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48. Early risk stratification using Rubidium-82 positron emission tomography in STEMI patients.
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Ghotbi, Adam Ali, Hasbak, Philip, Nepper-Christensen, Lars, Lønborg, Jacob, Atharovski, Kiril, Christensen, Thomas, Holmvang, Lene, Engstrøm, Thomas, Ripa, Rasmus Sejersten, and Kjær, Andreas
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Background: Assessment of infarct size after myocardial infarction is predictive of subsequent morphological changes and clinical outcome. This study aimed to assess subacute post-intervention Rubidium-82 (82Rb)-PET imaging in predicting left ventricle ejection fraction, regional wall motion, and final infarct size by CMR at 3-months after STEMI.Methods: STEMI patients undergoing percutaneous coronary intervention were included prospectively. Rest-only 82Rb-PET perfusion imaging was performed at median 36 hours [IQR: 22 to 50] after the treatment. The extent of hypoperfusion and absolute blood flow (mL·min·g) were estimated on a global and a 17-segment model with dedicated software. At 3-months follow-up patients completed the CMR functional and late gadolinium enhancement imaging.Results: 42 patients were included, but only 35 had follow-up CMR and constituted the study population. Absolute blood flow was significantly lower in the infarct-related territory compared to remote myocardium, P < .005. Extent of hypoperfusion correlated with final infarct size, r = 0.58, P < .001, while blood flow correlated with ejection fraction, r = 0.41, P < .05. In linear mixed models, higher subacute absolute blood flow (β = 4.6, confidence interval [3.5; 5.2], P < .001, R2 = 0.67) was associated with greater wall motion. Segmental extent of subacute hypoperfusion (β = 0.43 [0.38; 0.49], P < .001, R2 = 0.58) was associated with the degree of late gadolinium enhancement at 3-months.Conclusions: Subacute rest-only 82Rb-PET is feasible following STEMI and seems predictive of myocardial function and infarct size at 3-months. [ABSTRACT FROM AUTHOR]- Published
- 2019
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49. Assessment of the myocardial area at risk: comparing T2-weighted cardiovascular magnetic resonance imaging with contrast-enhanced cine (CE-SSFP) imaging—a DANAMI3 substudy.
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Göransson, Christoffer, Ahtarovski, Kiril Aleksov, Kyhl, Kasper, Lønborg, Jacob, Nepper-Christensen, Lars, Bertelsen, Litten, Ghotbi, Adam Ali, Schoos, Mikkel Malby, Køber, Lars, Høfsten, Dan, Helqvist, Steffen, Kelbæk, Henning, Engstrøm, Thomas, and Vejlstrup, Niels
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CARDIOMYOPATHIES ,CARDIOVASCULAR disease diagnosis ,CONFIDENCE intervals ,LEFT heart ventricle ,MAGNETIC resonance imaging ,RESEARCH evaluation ,RISK assessment ,INTER-observer reliability ,DESCRIPTIVE statistics ,DIAGNOSIS ,CARDIOVASCULAR diseases risk factors - Abstract
Aims Myocardial salvage following treatment for ST-segment elevation myocardial infarction is prognostic for morbidity and mortality. Studies with myocardial salvage as endpoint rely on valid assessment of the myocardial area at risk (AAR). T2-weighted cardiovascular magnetic resonance (CMR) imaging is the preferred method to assess the AAR. However, T2-weighted imaging can be of poor image quality and uninterpretable. Contrast-enhanced (CE) cine imaging can also show AAR and our aim was to investigate if CE-cine can replace T2-weighted imaging. Cine imaging is part of a standard CMR-protocol and implementing CE-cine imaging for assessment of the AAR would mean shorter investigation time. Methods and results As a DANAMI-3 substudy, we performed successful dual imaging of the AAR in 166 participants using both T2-weighted short tau inversion recovery (T2-STIR) and CE-cine imaging. T2-STIR imaging was non-diagnostic in nine and CE-cine in one scan during the period. CE-cine measured 4.7% of left ventricle (LV) [95% confidence interval 3.2–6.2%] smaller AAR compared with T2-STIR images (P < 0.001). Visual analysis of a plot of infarct size vs. AAR showed an overestimation of the AAR when measured with T2-STIR images. There was no difference in AAR with CE-cine in an interobserver analysis of 46 scans [1.2 g (standard deviation 9.5), P = 0.42]. Conclusions CE-cine imaging shows good internal consistency in assessment of the AAR. A visual inspection reveals possible overestimation of AAR with T2-STIR images. There is good interobserver agreement in the analysis of CE-cine imaging. CE-cine can replace T2-STIR imaging resulting in a more valid assessment of the myocardial AAR. [ABSTRACT FROM AUTHOR]
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- 2019
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50. Association of genetic variants previously implicated in coronary artery disease with age at onset of coronary artery disease requiring revascularizations.
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Andersson, Charlotte, Lukács Krogager, Maria, Kuhr Skals, Regitze, Rosenbaum Appel, Emil Vincent, Theil Have, Christian, Grarup, Niels, Pedersen, Oluf, Jeppesen, Jørgen L., Pedersen, Ole Dyg, Dominguez, Helena, Dixen, Ulrik, Engstrøm, Thomas, Tønder, Niels, Roden, Dan M., Stender, Steen, Gislason, Gunnar H., Enghusen-Poulsen, Henrik, Hansen, Torben, Køber, Lars, and Torp-Pedersen, Christian
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CORONARY heart disease risk factors ,MYOCARDIAL revascularization ,LOW density lipoproteins ,SINGLE nucleotide polymorphisms ,CORONARY angiography - Abstract
Background: The relation between burden of risk factors, familial coronary artery disease (CAD), and known genetic variants underlying CAD and low-density lipoprotein cholesterol (LDL-C) levels is not well-explored in clinical samples. We aimed to investigate the association of these measures with age at onset of CAD requiring revascularizations in a clinical sample of patients undergoing first-time coronary angiography. Methods: 1599 individuals (mean age 64 years [min-max 29–96 years], 28% women) were genotyped (from blood drawn as part of usual clinical care) in the Copenhagen area (2010–2014). The burden of common genetic variants was measured as aggregated genetic risk scores (GRS) of single nucleotide polymorphisms (SNPs) discovered in genome-wide association studies. Results: Self-reported familial CAD (prevalent in 41% of the sample) was associated with -3.2 years (95% confidence interval -4.5, -2.2, p<0.0001) earlier need of revascularization in sex-adjusted models. Patients with and without familial CAD had similar mean values of CAD-GRS (unweighted scores 68.4 vs. 68.0, p = 0.10, weighted scores 67.7 vs. 67.5, p = 0.49) and LDL-C-GRS (unweighted scores 58.5 vs. 58.3, p = 0.34, weighted scores 63.3 vs. 61.1, p = 0.41). The correlation between the CAD-GRS and LDL-C-GRS was low (r = 0.14, p<0.001). In multivariable adjusted regression models, each 1 standard deviation higher values of LDL-C-GRS and CAD-GRS were associated with -0.70 years (95% confidence interval -1.25, -0.14, p = 0.014) and -0.51 years (-1.07, 0.04, p = 0.07) earlier need for revascularization, respectively. Conclusions: Young individuals presenting with CAD requiring surgical interventions had a higher genetic burden of SNPs relating to LDL-C and CAD (although the latter was statistically non-significant), compared with older individuals. However, the absolute difference was modest, suggesting that genetic screening can currently not be used as an effective prediction tool of when in life a person will develop CAD. Whether undiscovered genetic variants can still explain a “missing heritability” in early-onset CAD warrants more research. [ABSTRACT FROM AUTHOR]
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- 2019
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