5 results on '"Helqvist, Steffen"'
Search Results
2. Sub-acute cardiac magnetic resonance to predict irreversible reduction in left ventricular ejection fraction after ST-segment elevation myocardial infarction: A DANAMI-3 sub-study.
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Alzuhairi, Karam Sadoon, Lønborg, Jacob, Ahtarovski, Kiril Aleksov, Nepper-Christensen, Lars, Kyhl, Kasper, Lassen, Jens F., Sørensen, Rikke, Joshi, Francis, Ghotbi, Adam Ali, Schoos, Mikkel, Goransson, Christoffer, Bertelsen, Litten, Helqvist, Steffen, Holmvang, Lene, Jørgensen, Erik, Pedersen, Frants, Tilsted, Hans-Henrik, Høfsten, Dan, Køber, Lars, and Kelbæk, Henning
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VENTRICULAR ejection fraction , *MYOCARDIAL infarction , *MAGNETIC resonance , *PATIENT selection , *IMPLANTABLE cardioverter-defibrillators - Abstract
To predict irreversible reduction in left ventricular ejection fraction (LVEF) during admission for ST-segment elevation myocardial infarction (STEMI) using cardiac magnetic resonance (CMR) in addition to classical clinical parameters. Irreversible reduction in LVEF is an important prognostic factor after STEMI which necessitates medical therapy and implantation of prophylactic implantable cardioverter defibrillator (ICD). A post-hoc analysis of DANAMI-3 trial program (Third DANish Study of Optimal Acute Treatment of Patients With ST-elevation Myocardial Infarction) which recruited 649 patients who had CMR performed during index hospitalization and after 3 months. Patients were divided into two groups according to CMR-LVEF at 3 months: Group 1 with LVEF≤35% and Group 2 with LVEF>35%. Group 1 included 15 patients (2.3%) while Group 2 included 634 patients (97.7%). A multivariate analysis showed that: Killip class >1 (OR 7.39; CI:1.47–36.21, P = 0.01), symptom onset-to-wire ≥6 h (OR 7.19; CI 1.07–50.91, P = 0.04), LVEF≤35% using index echocardiography (OR 7.11; CI: 1.27–47.43, P = 0.03), and infarct size ≥40% of LV on index CMR (OR 42.62; CI:7.83–328.29, P < 0.001) independently correlated with a final LVEF≤35%. Clinical models consisted of these parameters could identify 7 out of 15 patients in Group 1 with 100% positive predictive value. Together with other clinical measurements, the assessment of infarct size using late Gadolinium enhancement by CMR during hospitalization is a strong predictor of irreversible reduction in CMR_LVEF ≤35. That could potentially, after validation with future research, aids the selection and treatment of high-risk patients after STEMI, including implantation of prophylactic ICD during index hospitalization. • Irreversible damage to the myocardium after STEMI can be predicted in 47% of the patients. • ICD implantation can be considered in these patients with irreversible damage to the myocardium. • Cardiac MRI during admission for STEMI can help directing the future treatment in selected patients. • 77% of STEMI patients with LVEF <35% will experience increase in their LVEF to >35% within three months. [ABSTRACT FROM AUTHOR]
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- 2020
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3. Unreported exclusion and sampling bias in interpretation of randomized controlled trials in patients with STEMI.
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Laursen, Peter Nørkjær, Holmvang, Lene, Lønborg, Jacob, Køber, Lars, Høfsten, Dan E., Helqvist, Steffen, Clemmensen, Peter, Kelbæk, Henning, Jørgensen, Erik, Lassen, Jens Flensted, Pedersen, Frants, Høi-Hansen, Thomas, Raungaard, Bent, Terkelsen, Christian Juhl, Jensen, Lisette Okkels, Sadjadieh, Golnaz, and Engstrøm, Thomas
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RANDOMIZED controlled trials , *MYOCARDIAL infarction - Abstract
To assess the impact of sampling bias due to reported as well as unreported exclusion of the target population in a multi-center randomized controlled trial (RCT) of ST-elevation myocardial infarction (STEMI). We compared clinical characteristics and mortality between participants in the DANAMI-3 trial to contemporary non-participants with STEMI using unselected registries. A total of 179 DANAMI-3 participants (8%) and 617 contemporary non-participants (22%) had died (Log-Rank: P < 0.001) after a median follow-up of 1333 days (range: 1–2021 days). In an unadjusted Cox regression model all groups of non-participants had a higher hazard ratio to predict mortality compared to participants: eligible excluded (n = 144) (hazard ratio: 3.41 (95% CI: (2.69–4.32)), ineligible excluded (n = 472) (hazard ratio: 3.42 (95% CI: (2.44–4.80), eligible non-screened (n = 154) (hazard ratio: 3.37 (95% CI: (2.36–4.82)), ineligible non-screened (n = 154) (hazard ratio: 6.48 (95% CI: (4.77–8.80). Sampling bias had occurred due to both reported and unreported exclusion of eligible patients and the difference in mortality between participants and non-participants could not be explained only by the trial exclusion criteria. Thus, screening logs may not be suited to address the risks of sampling bias. • Participants in the DANAMI-3 trial were not representative to the background population with STEMI. • Participants in the DANAMI-3 trial were not representative to the per protocol target population. • Sampling bias and unreported screening had occurred. • Screening logs may not be suitable for addressing issues of external validity. [ABSTRACT FROM AUTHOR]
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- 2019
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4. Instent neointimal hyperplasia after percutaneous intervention for ST-elevation myocardial infarction and treatment with granulocyte-colony stimulating factor. Results from the stem cells in myocardial infarction (STEMMI) trial
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Jørgensen, Erik, Baldazzi, Federica, Ripa, Rasmus S., Friis, Tina, Wang, Yongzong, Helqvist, Steffen, and Kastrup, Jens
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HYPERPLASIA , *GRANULOCYTE-macrophage colony-stimulating factor , *MYOCARDIAL infarction , *GRANULOCYTE-colony stimulating factor , *STEM cells , *CORONARY restenosis , *FIBROBLAST growth factors , *VASCULAR endothelial growth factors , *SURGICAL stents - Abstract
Abstract: Background: Recombinant granulocyte-colony stimulating factor (G-CSF) mobilized pluripotent cells from the bone marrow are proposed to have a regenerative potential. Though, a report of excessive instent restenosis, in patients treated with G-CSF before percutaneous coronary intervention (PCI) warrants caution. Methods: Patients (n =59) enrolled in the STEMMI trial, a randomized and double blind study, comparing G-CSF and placebo after large ST-elevation myocardial infarctions, had an intracoronary ultrasound imaging at 6 months follow-up with a quantitative analysis of instent neointimal hyperplasia. Results: During G-CSF treatment leukocyte counts, and CD34+ and CD45−/CD34− cell fractions in peripheral blood increased markedly ( p <0.0001 vs. placebo). At follow-up, there were no differences in intracoronary late lumen loss, expressed as neointima volume per mm of stent (1.6 mm3 ±1.2 [G-CSF group] vs. 1.9 mm3 ±1.3 [placebo group]; p =0.38), and in minimal instent lumen area (5.4 mm2 ±2.4 vs. 5.3 mm2 ±2.6, p =0.90). In the placebo group, plasma concentration of stromal cell-derived factor-1 (SDF-1) increased significantly after STEMI. This SDF-1 response was completely suppressed during G-CSF treatment. A rebound increase of SDF-1 was observed after withdrawal of G-CSF ( p =0.001). Plasma concentration of SDF-1 at the time of stent implantation correlated positively to neointimal hyperplasia ( p =0.025). Conclusions: G-CSF treatment, initiated after PCI, does not lead to excessive instent neointimal hyperplasia or restenosis in patients with STEMI. The timing of G-CSF, in relation to the PCI, might be important, as G-CSF influences SDF-1. [Copyright &y& Elsevier]
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- 2010
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5. Sirolimus-eluting versus bare-metal stent implantation in patients with ostial lesions
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Jørgensen, Erik, Kelbæk, Henning, Kløvgaard, Lene, Thuesen, Leif, Krusell, Lars R., Bøtker, Hans E., Saunamäki, Kari, Lassen, Jens F., and Helqvist, Steffen
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RAPAMYCIN , *SURGICAL stents , *CARDIA , *CORONARY heart disease treatment , *FOLLOW-up studies (Medicine) , *MYOCARDIAL revascularization , *HEALTH outcome assessment , *DRUG administration - Abstract
Abstract: Introduction: To investigate the efficacy of implantation of sirolimus-eluting stents (SES) in the ostium of coronary arteries. Methods: We assigned 96 patients with lesions located in ostias of the coronary circulation to receive a SES or a bare-metal stent (BMS). Results: At follow-up the late lumen loss was 0.07mm in the SES versus 1.06mm in the BMS group (p <0.001); −0.04mm versus 0.11mm (p =0.12) in the neighbour ostium. The rate of target lesion revascularisation was 2% with SES and 39% with BMS (p <0.001), and major adverse cardiac events (MACE) 6% versus 41% (p =0.001). Conclusions: In patients with ostial coronary lesions the angiographic outcome is improved and the long-term MACE rate is low after SES compared with BMS implantation. [ABSTRACT FROM AUTHOR]
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- 2010
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