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138 results on '"Miguel, E"'

2. Routine Fractional Flow Reserve Measurement After Percutaneous Coronary Intervention The FFR-SEARCH Study

Author

Jeroen Wilschut, Laurens J.C. van Zandvoort, Felix Zijlstra, Rutger J. van Bommel, Joost Daemen, Peter de Jaegere, Roberto Diletti, Nicolas M. Van Mieghem, Kaneshka Masdjedi, Miguel E. Lemmert, and Cardiology

Subjects
medicine.medical_specialty, business.industry, medicine.medical_treatment, Gold standard, Percutaneous coronary intervention, Hemodynamics, Fractional flow reserve, medicine.disease, surgical procedures, operative, Internal medicine, medicine, Cardiology, cardiovascular diseases, Myocardial infarction, Cardiology and Cardiovascular Medicine, business
Abstract

Background: Fractional flow reserve (FFR) is the current gold standard to determine hemodynamic severity of angiographically intermediate coronary lesions. Much less is known about the prognostic effects of FFR measured directly after percutaneous coronary intervention (PCI). The aims of this study were to evaluate post-PCI FFR values, identify predictors for a low post-PCI FFR, and to investigate whether a relationship between postprocedural FFR and outcome during 30-day follow-up exists. Methods and Results: The FFR-SEARCH (Fractional Flow Reserve—Stent Evaluated at Rotterdam Cardiology Hospital) is a prospective registry in which FFR measurements were performed after PCI in 1000 consecutive patients. All FFR measurements were performed under maximum hyperemia with intravenous adenosine with the Navvus RXi system (ACIST Medical Systems, Eden Prairie, MN). The clinical end point was defined as a composite of death, target vessel revascularization, or nonfatal myocardial infarction at 30-day follow-up. Measurement of post-PCI FFR was successful in 959 patients (96%), and a total of 1165 lesions were assessed. There were no complications related to the microcatheter. A total of 322 ST-segment–elevation myocardial infarction patients with 371 measured lesions were excluded leaving 637 patients with 794 measured lesions for the final analysis. Overall post-PCI FFR was 0.90±0.07. In 396 lesions (50%), post-PCI FFR was >0.90. A total of 357 patients (56%) had ≥1 lesion(s) with a post-PCI FFR ≤0.90, and 73 patients (11%) had ≥1 lesion(s) with a post-PCI FFR ≤0.80 with post-PCI FFR ≤0.80 in 78 lesions (9.8%). Complex lesion characteristics, use of multiple stents and smaller reference vessel diameter was associated with post-PCI FFR ≤0.90. During follow-up, 11 patients (1.8%) reached the clinical end point. There was no significant relationship between post-PCI FFR and the clinical end point at 30-day follow-up ( P =0.636). Conclusions: Routine measurement of post-PCI FFR using a monorail microcatheter is safe and feasible. Several lesion and patient characteristics were associated with a low post-PCI FFR. Post-PCI FFR did not correlate with clinical events at 30 days.

Published
2019

3. Height and timing of growth spurt during puberty in young people living with vertically acquired HIV in Europe and Thailand

Author

Fundación Investigación y Educación en Sida, Instituto de Salud Carlos III, European Commission, Fundación Mutua Madrileña, Crichton, Siobhan, Belfrage, Eric, Collins, Intira Jeanne, Doerholt, Katja, Judd, Ali, Le Coeur, Sophie, Spoulou, Vana, Goodall, Ruth, Scherpbier, Henriette, Smit, Colette, Goetghebuer, Tessa, Muñoz, Maria José, Grande, Ana, Romero, Francisco Jose, Wensing, A. M. J., Scholvinck, E. H., Mazza, Antonio, Pérez, Carlos, Jiménez de Ory, Santiago, Henriet, S. S., V, Couceiro, José, Bakker, Y., Zaaijer, H. L., de Tejada, Begona Martinez, Wolfs, T. F. W., Lillo, Miguel, Marczynska, Magdalena, Bezemer, M., Santos, Mar, de Jong, A., Losada, Begoña, Cornelissen, M. T. E., van der Meer, R., Niesters, H. G. M., El Berkaoui, A., Gavilán, César, Gloria Andres, Ana, Rius, Neus, Zaheri, S., Marugan, Victor, Neth, Olaf, Piqueras, Ana I., Ochoa, Carlos, Munjishvili, L., Schnorr, P., Breton, Rafael, Strik-Albers, R., Martínez, Jorge, Grivell, S., Delforge, Marc, Wit, F. W. M. N., Bezemer, D. O., Tuijn, E., de Martino, Maurizio, Paling, E., de Groot-de Jonge, H., Koops, J., Lipreri, Rita, Muñoz-Fernández, María Ángeles, Noguera-Julián, Antoni, Tovo, Pier Angelo, van de Sande, L., Patrizia, Osimani, Saavedra-Lozano, Jesús, Di Biagio, Antonio, Montesinos, Elena, Soler-Palacín, Pere, Berkhout, B., Meijering, R., van der Vliet, S., van Aerde, K., Antoinette Frick, Maria, Salvini, Filippo, Verduyn-Lunel, F., Tagliabue, Claudia, Geerlinks, J., Garrote, Elisa, Rovira, Nuria, Tuk, B., Bergsma, D., Pineda, Valentí, Coupland, Urszula, Tomás Ramos, José, Cellini, Monica, Dueñas, Joaquin, Pellegatta, Antonio, Bustillo Alonso, Matilde, Navarro, Maria Luisa, Pajkrt, D., Badolato, Raffaele, Terol, Pedro, Scherpbier, H. J., Garcia Hortelano, Milagros, Beceiro, Jose, Bernardi, Stefania, Weijsenfeld, A. M., Pocheville, Itziar, López, Núria, Doroba, Malgorzata, Schinkel, C. J., Ruiz, Beatriz, Wolthers, K. C., Fraaij, P. L. A., Fernandez Mc Phee, Carolina, Sainz, Talia, Zawadka, Konrad, van Rossum, A. M. C., Romano, Amelia, Fortuny, Claudia, Peeck, B., Mur, Antonio, Gibb, Diana M., Santa Ansone, Vermont, C. L., Alfayate, Santiago, Apilanez, Miren, Kruijne, E., Okhonskaia, Liubov, van der Knaap, L. C., Méndez, María José, Rojo, Pablo, van Leer-Buter, C. C., Rahamat-Langendoen, J., Angulo, Raquel, Ruggeri, Maurizio, Álvarez, Susana, Knoester, M., Back, N. K. T., Lisi, Catiuscia, Bont, L. J., Guerrero, Carmelo, Larovere, Domenico, Mellado, Maria Jose, Herranz, Mercedes, Colino, Elena, Raethke, M., Badillo, Katie, Roa, Miguel Angel, Collado, Pilar, Rutkens, T., Gonzalez-Tome, Maria I., Lo Vecchio, Andrea, Pas, S. D., Falcón Neyra, Lola, Venturini, Elisabetta, de Groot, L., Jareno, Enrique, van den Akker, M., Olmeo, Paolina, Lucas, E., Decker, Luc, Segarra, Inmaculada, Gomez Sirvent, Jorge, Perez, Amparo, Thorne, Claire, Menasalvas, Ana Isabel, Ree, C., Hillebregt, M., Regtop, R., Nauta, N., Faldella, Giacomo, Jourdain, Gonzague, Moreno-Pérez, David, Taramasso, Lucia, Álvarez, Cristina, Reiss, Peter, Ruijs, Y., Baldi, Francesco, Voronin, Evgeny, Boucher, C. A. B., Galli, Luisa, Miguel, E. de, Wisse, A., Miloenko, Milana, Giacomet, Vania, Labutina, Svetlana, Witte, E. C., Consolini, Rita, Smit, C., Hainaut, Marc, Mayol, Lluis, Rampon, Osvalda, Vallmanya, Teresa, Giaquinto, Carlo, Dona, Daniele, Erba, Paola, Dapena, Marta, Calavia, Olga, Veenenberg, L., Montagnani, Carlotta, van de Flier, M., Schuurman, R., Bruzzese, Eugenia, García, Lourdes, Geelen, S. P. M., Coll, María T., Oldakowska, Agnieszka, de Boer, C. G., Genovese, Orazio, Van der Kelen, Evelyne, Blázquez-Gamero, Daniel, Escosa-García, Luis, Jurriaans, S., Dodi, Icilio, Santos, Juan Luis, Prieto, Luís, Perez-Hoyos, Santiago, Lodewijk, C., Guillén, Sara, Koopmans, M. P. G., Ene, Luminita, Visser, E. G., Gabiano, Clara, Garzon, Monica, Kuekou, Hyppolite Tchidjou, Maccabruni, Anna, van Kampen, J. J. A., Roman, Vicente, Esposito, Susanna, Schoorl, M., Gamell, Anna, Cristiano, Letizia, Montesdeoca, Abián, Stelma, F. F., Mateo, Mercedes, Pokorska-Spiewak, Maria, van Sighem, A., I, Woudstra, T., Popielska, Jolanta, Garazzino, Silvia, Lendinez, Francisco, Fundación Investigación y Educación en Sida, Instituto de Salud Carlos III, European Commission, Fundación Mutua Madrileña, Crichton, Siobhan, Belfrage, Eric, Collins, Intira Jeanne, Doerholt, Katja, Judd, Ali, Le Coeur, Sophie, Spoulou, Vana, Goodall, Ruth, Scherpbier, Henriette, Smit, Colette, Goetghebuer, Tessa, Muñoz, Maria José, Grande, Ana, Romero, Francisco Jose, Wensing, A. M. J., Scholvinck, E. H., Mazza, Antonio, Pérez, Carlos, Jiménez de Ory, Santiago, Henriet, S. S., V, Couceiro, José, Bakker, Y., Zaaijer, H. L., de Tejada, Begona Martinez, Wolfs, T. F. W., Lillo, Miguel, Marczynska, Magdalena, Bezemer, M., Santos, Mar, de Jong, A., Losada, Begoña, Cornelissen, M. T. E., van der Meer, R., Niesters, H. G. M., El Berkaoui, A., Gavilán, César, Gloria Andres, Ana, Rius, Neus, Zaheri, S., Marugan, Victor, Neth, Olaf, Piqueras, Ana I., Ochoa, Carlos, Munjishvili, L., Schnorr, P., Breton, Rafael, Strik-Albers, R., Martínez, Jorge, Grivell, S., Delforge, Marc, Wit, F. W. M. N., Bezemer, D. O., Tuijn, E., de Martino, Maurizio, Paling, E., de Groot-de Jonge, H., Koops, J., Lipreri, Rita, Muñoz-Fernández, María Ángeles, Noguera-Julián, Antoni, Tovo, Pier Angelo, van de Sande, L., Patrizia, Osimani, Saavedra-Lozano, Jesús, Di Biagio, Antonio, Montesinos, Elena, Soler-Palacín, Pere, Berkhout, B., Meijering, R., van der Vliet, S., van Aerde, K., Antoinette Frick, Maria, Salvini, Filippo, Verduyn-Lunel, F., Tagliabue, Claudia, Geerlinks, J., Garrote, Elisa, Rovira, Nuria, Tuk, B., Bergsma, D., Pineda, Valentí, Coupland, Urszula, Tomás Ramos, José, Cellini, Monica, Dueñas, Joaquin, Pellegatta, Antonio, Bustillo Alonso, Matilde, Navarro, Maria Luisa, Pajkrt, D., Badolato, Raffaele, Terol, Pedro, Scherpbier, H. J., Garcia Hortelano, Milagros, Beceiro, Jose, Bernardi, Stefania, Weijsenfeld, A. M., Pocheville, Itziar, López, Núria, Doroba, Malgorzata, Schinkel, C. J., Ruiz, Beatriz, Wolthers, K. C., Fraaij, P. L. A., Fernandez Mc Phee, Carolina, Sainz, Talia, Zawadka, Konrad, van Rossum, A. M. C., Romano, Amelia, Fortuny, Claudia, Peeck, B., Mur, Antonio, Gibb, Diana M., Santa Ansone, Vermont, C. L., Alfayate, Santiago, Apilanez, Miren, Kruijne, E., Okhonskaia, Liubov, van der Knaap, L. C., Méndez, María José, Rojo, Pablo, van Leer-Buter, C. C., Rahamat-Langendoen, J., Angulo, Raquel, Ruggeri, Maurizio, Álvarez, Susana, Knoester, M., Back, N. K. T., Lisi, Catiuscia, Bont, L. J., Guerrero, Carmelo, Larovere, Domenico, Mellado, Maria Jose, Herranz, Mercedes, Colino, Elena, Raethke, M., Badillo, Katie, Roa, Miguel Angel, Collado, Pilar, Rutkens, T., Gonzalez-Tome, Maria I., Lo Vecchio, Andrea, Pas, S. D., Falcón Neyra, Lola, Venturini, Elisabetta, de Groot, L., Jareno, Enrique, van den Akker, M., Olmeo, Paolina, Lucas, E., Decker, Luc, Segarra, Inmaculada, Gomez Sirvent, Jorge, Perez, Amparo, Thorne, Claire, Menasalvas, Ana Isabel, Ree, C., Hillebregt, M., Regtop, R., Nauta, N., Faldella, Giacomo, Jourdain, Gonzague, Moreno-Pérez, David, Taramasso, Lucia, Álvarez, Cristina, Reiss, Peter, Ruijs, Y., Baldi, Francesco, Voronin, Evgeny, Boucher, C. A. B., Galli, Luisa, Miguel, E. de, Wisse, A., Miloenko, Milana, Giacomet, Vania, Labutina, Svetlana, Witte, E. C., Consolini, Rita, Smit, C., Hainaut, Marc, Mayol, Lluis, Rampon, Osvalda, Vallmanya, Teresa, Giaquinto, Carlo, Dona, Daniele, Erba, Paola, Dapena, Marta, Calavia, Olga, Veenenberg, L., Montagnani, Carlotta, van de Flier, M., Schuurman, R., Bruzzese, Eugenia, García, Lourdes, Geelen, S. P. M., Coll, María T., Oldakowska, Agnieszka, de Boer, C. G., Genovese, Orazio, Van der Kelen, Evelyne, Blázquez-Gamero, Daniel, Escosa-García, Luis, Jurriaans, S., Dodi, Icilio, Santos, Juan Luis, Prieto, Luís, Perez-Hoyos, Santiago, Lodewijk, C., Guillén, Sara, Koopmans, M. P. G., Ene, Luminita, Visser, E. G., Gabiano, Clara, Garzon, Monica, Kuekou, Hyppolite Tchidjou, Maccabruni, Anna, van Kampen, J. J. A., Roman, Vicente, Esposito, Susanna, Schoorl, M., Gamell, Anna, Cristiano, Letizia, Montesdeoca, Abián, Stelma, F. F., Mateo, Mercedes, Pokorska-Spiewak, Maria, van Sighem, A., I, Woudstra, T., Popielska, Jolanta, Garazzino, Silvia, and Lendinez, Francisco

Abstract

[Objective]: The aim of this study was to describe growth during puberty in young people with vertically acquired HIV. [Design]: Pooled data from 12 paediatric HIV cohorts in Europe and Thailand. [Methods]: One thousand and ninety-four children initiating a nonnucleoside reverse transcriptase inhibitor or boosted protease inhibitor based regimen aged 1–10 years were included. Super Imposition by Translation And Rotation (SITAR) models described growth from age 8 years using three parameters (average height, timing and shape of the growth spurt), dependent on age and height-for-age z-score (HAZ) (WHO references) at antiretroviral therapy (ART) initiation. Multivariate regression explored characteristics associated with these three parameters. [Results]: At ART initiation, median age and HAZ was 6.4 [interquartile range (IQR): 2.8, 9.0] years and −1.2 (IQR: −2.3 to −0.2), respectively. Median follow-up was 9.1 (IQR: 6.9, 11.4) years. In girls, older age and lower HAZ at ART initiation were independently associated with a growth spurt which occurred 0.41 (95% confidence interval 0.20–0.62) years later in children starting ART age 6 to 10 years compared with 1 to 2 years and 1.50 (1.21–1.78) years later in those starting with HAZ less than −3 compared with HAZ at least −1. Later growth spurts in girls resulted in continued height growth into later adolescence. In boys starting ART with HAZ less than −1, growth spurts were later in children starting ART in the oldest age group, but for HAZ at least −1, there was no association with age. Girls and boys who initiated ART with HAZ at least −1 maintained a similar height to the WHO reference mean. [Conclusion]: Stunting at ART initiation was associated with later growth spurts in girls. Children with HAZ at least −1 at ART initiation grew in height at the level expected in HIV negative children of a comparable age.

Published
2019

5. Effect of Prehospital Crushed Prasugrel Tablets in Patients With ST-Segment-Elevation Myocardial Infarction Planned for Primary Percutaneous Coronary Intervention: The Randomized COMPARE CRUSH Trial.

Author

Vlachojannis, Georgios J., Wilschut, Jeroen M., Vogel, Rosanne F., Lemmert, Miguel E., Delewi, Ronak, Diletti, Roberto, van der Waarden, Nancy W.P.L., Nuis, Rutger-Jan, Paradies, Valeria, Alexopoulos, Dimitrios, Zijlstra, Felix, Montalescot, Gilles, Angiolillo, Dominick J., Krucoff, Mitchell W., Van Mieghem, Nicolas M., and Smits, Pieter C.

Published
2020
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9. Effect of atorvastatin in elderly patients with a recent stroke or transient ischemic attack

Author

Chaturvedi, S, Zivin, J, Breazna, A, Amarenco, P, Callahan, A, Goldstein, L, Hennerici, M, Sillesen, H, Rudolph, A, Welch, M, Sparcl, I, Crimmins, D, Davis, S, Dimmitt, S, Donnan, G, Frayne, J, Freilich, D, Zagami, A, Mikocki, J, Schmidauer, C, Schmidt, R, De Bleecker, J, Deceuninck, F, Tack, P, Thijs, V, Gomes Fernandes, J, Beaudry, M, Cote, R, Hoyte, K, Lebrun, L, Mackey, A, Sahlas, D, Selchen, D, Shuaib, A, Spence, J, Teal, P, Winger, M, Matamala, G, Cifkova, R, Kalita, Z, Rektor, I, Rosolova, H, Stipal, R, Vaclavik, D, Boysen, G, Klingenberg, H, Iversen, Hillbom, M, Kaste, M, Numminen, H, Pilke, A, Salmivaara, A, Sivenius, J, Alamowitch, S, Boulliat, J, De Broucker, T, Chollet, F, Mahagne, M, Milandre, L, Moulin, T, Bogdahn, U, Diener, H, Dichgans, M, Glahn, J, Haberl, R, Harms, L, Knecht, S, Kroczek, G, Lichy, C, Sander, D, Schneider, D, Kazis, A, Karageorgiou, C, Milonas, I, Stathis, P, Vogiatzoglou, D, Bornstein, N, Honigman, S, Lampl, Y, Streifler, J, Capurso, A, Comi, G, Ferrarese, C, Gandolfo, C, Poloni, M, Senin, U, Rangel Guerra, R, Boon, A, De Keyser, J, De Kort, P, Haas, J, Kamphuis, D, Koudstaal, P, Anderson, N, Scott, R, Singh, G, Czlonkowska, A, Drozdowski, W, Gralewski, Z, Kozubski, W, Kuczynska Zardzewialy, A, Podemski, R, Stelmasiak, Z, Szczudlik, A, Da Costa Correia, C, Ferro, J, Salgueiro e., C, Lietava, J, Raslova, K, Carr, J, Gardiner, J, Kruger, A, Alvarez Sabin, J, Chamorro, A, Diez Tejedor, E, Fernández, O, Trejo Gabriel y., G, González Marcos, J, Egido Herrero, J, Jiménez Martínez, M, Lago Martin, A, Mostacero Miguel, E, Vivancos Mora, J, Moltó, J, Viguera Romero, J, Cuartero Rodriguez, E, Rodriguez, F, Serena, J, Laska, A, Leijd, B, Strand, T, Terent, A, Waegner, A, Wallén, T, Baumgartner, R, Bogousslavsky, J, Hungerbühler, H, Lyrer, P, Mattle, H, Bath, P, Ekpo, E, Freeman, A, Lees, K, Macleod, M, Macwalter, R, Sharma, A, Shetty, H, Albers, G, Altafullah, I, Benavente, O, Book, D, Broderick, J, Callahan A., 3, Calder, C, Carlini, W, Chippendale, T, Clark, W, Coull, B, Davis, P, Devlin, T, Dick, A, Dooneief, G, Duff, R, Estronza, N, Forteza, A, Frankel, M, Frey, J, Friday, G, Graham, G, Goldstein, J, Hammer, M, Harris, J, Harper, W, Hendin, B, Hendin, D, Hinton, R, Hollander, J, Hughes, R, Kasner, S, Kent, T, Kim, L, Kirshner, H, Lamonte, M, Ledbetter, L, Lee Kwen, P, Levin, K, Libman, R, Matlock, J, Mcdowell, P, McGee F., J, Meyer, B, Minagar, A, Moussouttas, M, Munson, R, Nash, M, Nassief, A, Orr, S, Ratinov, G, Salanga, V, Silliman, S, Singer, R, Smith, D, Sullivan, H, Tietjen, G, Thaler, D, Tuchman, M, Uskavitch, D, Verro, P, Vicari, R, Weinstein, R, Wilterdink, J, Zweifler, R, De Bastos, M, Goldstein, LB, Welch, MA, SPARCL Investigators, Crimmins D, Davis S, Dimmitt S, Donnan G, Frayne J, Freilich D, Zagami A, Mikocki J, Schmidauer C, Schmidt R, De Bleecker J, Deceuninck F, Tack P, Thijs V, Gomes Fernandes J, Beaudry M, Cote R, Hoyte K, Lebrun LH, Mackey A, Sahlas D, Selchen D, Shuaib A, Spence JD, Teal P, Winger M, Matamala G, Cifkova R, Kalita Z, Rektor I, Rosolova H, Stipal R, Vaclavik D, Boysen G, Klingenberg H, Sillesen H, Hillbom M, Kaste M, Numminen H, Pilke A, Salmivaara A, Sivenius J, Alamowitch S, Amarenco P, Boulliat J, De Broucker T, Chollet F, Mahagne MH, Milandre L, Moulin T, Bogdahn U, Diener HC, Dichgans M, Glahn J, Haberl R, Harms L, Hennerici MG, Knecht S, Kroczek G, Lichy C, Sander D, Schneider D, Kazis A, Karageorgiou C, Milonas I, Stathis P, Vogiatzoglou D, Bornstein N, Honigman S, Lampl Y, Streifler J, Capurso A, Comi G, Gandolfo C, Poloni M, Senin U, Rangel Guerra R, Boon AM, De Keyser JH, De Kort PL, Haas JA, Kamphuis DJ, Koudstaal PJ, Anderson N, Scott R, Singh G, Czlonkowska A, Drozdowski W, Gralewski Z, Kozubski W, Kuczynska Zardzewialy A, Podemski R, Stelmasiak Z, Szczudlik A, Da Costa Correia C, Ferro J, Salgueiro e. Cunha L, Lietava J, Raslova K, Carr J, Gardiner J, Kruger A, Alvarez Sabin J, Chamorro A, Diez Tejedor E, Fernández O, Trejo Gabriel y. Galán J, González Marcos J, Egido Herrero J, Jiménez Martínez M, Lago Martin A, Mostacero Miguel E, Vivancos Mora J, Moltó J, Viguera Romero J, Cuartero Rodriguez E, Rodriguez F, Serena J, Laska AC, Leijd B, Strand T, Terent A, Waegner A, Wallén T, Baumgartner R, Bogousslavsky J, Hungerbühler H, Lyrer P, Mattle H, Bath PM, Ekpo EB, Freeman A, Lees KR, MacLeod MJ, MacWalter RS, Sharma AK, Shetty HG, Albers G, Altafullah I, Benavente O, Book D, Broderick J, Callahan A. 3rd, Calder C, Carlini W, Chaturvedi S, Chippendale T, Clark W, Coull B, Davis P, Devlin T, Dick A, Dooneief G, Duff R, Estronza N, Forteza A, Frankel M, Frey J, Friday G, Graham G, Goldstein J, Hammer M, Harris J, Harper W, Hendin B, Hendin D, Hinton R, Hollander J, Hughes R, Kasner S, Kent T, Kim L, Kirshner H, LaMonte M, Ledbetter L, Lee Kwen P, Levin K, Libman R, Matlock J, McDowell P, McGee F. Jr, Meyer B, Minagar A, Moussouttas M, Munson R, Nash M, Nassief A, Orr S, Ratinov G, Salanga V, Silliman S, Singer R, Smith D, Sullivan H, Tietjen G, Thaler D, Tuchman M, Uskavitch D, Verro P, Vicari R, Weinstein R, Wilterdink J, Zweifler R, De Bastos M., FERRARESE, CARLO, Chaturvedi, S, Zivin, J, Breazna, A, Amarenco, P, Callahan, A, Goldstein, L, Hennerici, M, Sillesen, H, Rudolph, A, Welch, M, Sparcl, I, Crimmins, D, Davis, S, Dimmitt, S, Donnan, G, Frayne, J, Freilich, D, Zagami, A, Mikocki, J, Schmidauer, C, Schmidt, R, De Bleecker, J, Deceuninck, F, Tack, P, Thijs, V, Gomes Fernandes, J, Beaudry, M, Cote, R, Hoyte, K, Lebrun, L, Mackey, A, Sahlas, D, Selchen, D, Shuaib, A, Spence, J, Teal, P, Winger, M, Matamala, G, Cifkova, R, Kalita, Z, Rektor, I, Rosolova, H, Stipal, R, Vaclavik, D, Boysen, G, Klingenberg, H, Iversen, Hillbom, M, Kaste, M, Numminen, H, Pilke, A, Salmivaara, A, Sivenius, J, Alamowitch, S, Boulliat, J, De Broucker, T, Chollet, F, Mahagne, M, Milandre, L, Moulin, T, Bogdahn, U, Diener, H, Dichgans, M, Glahn, J, Haberl, R, Harms, L, Knecht, S, Kroczek, G, Lichy, C, Sander, D, Schneider, D, Kazis, A, Karageorgiou, C, Milonas, I, Stathis, P, Vogiatzoglou, D, Bornstein, N, Honigman, S, Lampl, Y, Streifler, J, Capurso, A, Comi, G, Ferrarese, C, Gandolfo, C, Poloni, M, Senin, U, Rangel Guerra, R, Boon, A, De Keyser, J, De Kort, P, Haas, J, Kamphuis, D, Koudstaal, P, Anderson, N, Scott, R, Singh, G, Czlonkowska, A, Drozdowski, W, Gralewski, Z, Kozubski, W, Kuczynska Zardzewialy, A, Podemski, R, Stelmasiak, Z, Szczudlik, A, Da Costa Correia, C, Ferro, J, Salgueiro e., C, Lietava, J, Raslova, K, Carr, J, Gardiner, J, Kruger, A, Alvarez Sabin, J, Chamorro, A, Diez Tejedor, E, Fernández, O, Trejo Gabriel y., G, González Marcos, J, Egido Herrero, J, Jiménez Martínez, M, Lago Martin, A, Mostacero Miguel, E, Vivancos Mora, J, Moltó, J, Viguera Romero, J, Cuartero Rodriguez, E, Rodriguez, F, Serena, J, Laska, A, Leijd, B, Strand, T, Terent, A, Waegner, A, Wallén, T, Baumgartner, R, Bogousslavsky, J, Hungerbühler, H, Lyrer, P, Mattle, H, Bath, P, Ekpo, E, Freeman, A, Lees, K, Macleod, M, Macwalter, R, Sharma, A, Shetty, H, Albers, G, Altafullah, I, Benavente, O, Book, D, Broderick, J, Callahan A., 3, Calder, C, Carlini, W, Chippendale, T, Clark, W, Coull, B, Davis, P, Devlin, T, Dick, A, Dooneief, G, Duff, R, Estronza, N, Forteza, A, Frankel, M, Frey, J, Friday, G, Graham, G, Goldstein, J, Hammer, M, Harris, J, Harper, W, Hendin, B, Hendin, D, Hinton, R, Hollander, J, Hughes, R, Kasner, S, Kent, T, Kim, L, Kirshner, H, Lamonte, M, Ledbetter, L, Lee Kwen, P, Levin, K, Libman, R, Matlock, J, Mcdowell, P, McGee F., J, Meyer, B, Minagar, A, Moussouttas, M, Munson, R, Nash, M, Nassief, A, Orr, S, Ratinov, G, Salanga, V, Silliman, S, Singer, R, Smith, D, Sullivan, H, Tietjen, G, Thaler, D, Tuchman, M, Uskavitch, D, Verro, P, Vicari, R, Weinstein, R, Wilterdink, J, Zweifler, R, De Bastos, M, Goldstein, LB, Welch, MA, SPARCL Investigators, Crimmins D, Davis S, Dimmitt S, Donnan G, Frayne J, Freilich D, Zagami A, Mikocki J, Schmidauer C, Schmidt R, De Bleecker J, Deceuninck F, Tack P, Thijs V, Gomes Fernandes J, Beaudry M, Cote R, Hoyte K, Lebrun LH, Mackey A, Sahlas D, Selchen D, Shuaib A, Spence JD, Teal P, Winger M, Matamala G, Cifkova R, Kalita Z, Rektor I, Rosolova H, Stipal R, Vaclavik D, Boysen G, Klingenberg H, Sillesen H, Hillbom M, Kaste M, Numminen H, Pilke A, Salmivaara A, Sivenius J, Alamowitch S, Amarenco P, Boulliat J, De Broucker T, Chollet F, Mahagne MH, Milandre L, Moulin T, Bogdahn U, Diener HC, Dichgans M, Glahn J, Haberl R, Harms L, Hennerici MG, Knecht S, Kroczek G, Lichy C, Sander D, Schneider D, Kazis A, Karageorgiou C, Milonas I, Stathis P, Vogiatzoglou D, Bornstein N, Honigman S, Lampl Y, Streifler J, Capurso A, Comi G, Gandolfo C, Poloni M, Senin U, Rangel Guerra R, Boon AM, De Keyser JH, De Kort PL, Haas JA, Kamphuis DJ, Koudstaal PJ, Anderson N, Scott R, Singh G, Czlonkowska A, Drozdowski W, Gralewski Z, Kozubski W, Kuczynska Zardzewialy A, Podemski R, Stelmasiak Z, Szczudlik A, Da Costa Correia C, Ferro J, Salgueiro e. Cunha L, Lietava J, Raslova K, Carr J, Gardiner J, Kruger A, Alvarez Sabin J, Chamorro A, Diez Tejedor E, Fernández O, Trejo Gabriel y. Galán J, González Marcos J, Egido Herrero J, Jiménez Martínez M, Lago Martin A, Mostacero Miguel E, Vivancos Mora J, Moltó J, Viguera Romero J, Cuartero Rodriguez E, Rodriguez F, Serena J, Laska AC, Leijd B, Strand T, Terent A, Waegner A, Wallén T, Baumgartner R, Bogousslavsky J, Hungerbühler H, Lyrer P, Mattle H, Bath PM, Ekpo EB, Freeman A, Lees KR, MacLeod MJ, MacWalter RS, Sharma AK, Shetty HG, Albers G, Altafullah I, Benavente O, Book D, Broderick J, Callahan A. 3rd, Calder C, Carlini W, Chaturvedi S, Chippendale T, Clark W, Coull B, Davis P, Devlin T, Dick A, Dooneief G, Duff R, Estronza N, Forteza A, Frankel M, Frey J, Friday G, Graham G, Goldstein J, Hammer M, Harris J, Harper W, Hendin B, Hendin D, Hinton R, Hollander J, Hughes R, Kasner S, Kent T, Kim L, Kirshner H, LaMonte M, Ledbetter L, Lee Kwen P, Levin K, Libman R, Matlock J, McDowell P, McGee F. Jr, Meyer B, Minagar A, Moussouttas M, Munson R, Nash M, Nassief A, Orr S, Ratinov G, Salanga V, Silliman S, Singer R, Smith D, Sullivan H, Tietjen G, Thaler D, Tuchman M, Uskavitch D, Verro P, Vicari R, Weinstein R, Wilterdink J, Zweifler R, De Bastos M., and FERRARESE, CARLO

Abstract

BACKGROUND: It is unclear whether patients age 65 years and over with a recent stroke or TIA benefit from statin treatment to a similar degree as younger patients. METHODS: The 4,731 patient cohort in the SPARCL study was divided into an elderly group (65 and over) and a younger group. The primary endpoint (fatal or nonfatal stroke) and secondary endpoints were analyzed, with calculation of the hazard ratio (HR) and p values from a Cox regression model. RESULTS: There were 2,249 patients in the elderly group and 2,482 in the younger group. The baseline LDL (133 mg/dL) and total cholesterol were comparable in the two groups. The elderly and younger groups had a 61.4 mg/dL and 58.7 mg/dL decrease in mean LDL during the trial. The primary endpoint was reduced by 26% in younger patients (HR 0.74, 0.57-0.96, p = 0.02) and by 10% in elderly subjects (HR 0.90, 0.73-1.11, p = 0.33). A test of heterogeneity for a treatment-age interaction was not significant (p = 0.52). The risk of stroke or TIA (HR 0.79, p = 0.01), major coronary events (HR 0.68, p = 0.035), any coronary heart disease event (HR 0.61, p = 0.0006), and revascularization procedures (HR 0.55, p = 0.0005) was reduced in the elderly group. CONCLUSIONS: There was no heterogeneity in the stroke reduction seen with atorvastatin in the elderly and younger groups. Cardiac events and revascularization procedures were also lower in both the elderly and younger subgroups treated with atorvastatin. These results support the use of atorvastatin in elderly patients with recent stroke or TIA.

Published
2009

10. Relative effects of statin therapy on stroke and cardiovascular events in men and women: Secondary analysis of the stroke prevention by aggressive reduction in cholesterol levels (SPARCL) study

Author

Goldstein, L, Amarenco, P, Lamonte, M, Gilbert, S, Messig, M, Callahan, A, Hennerici, M, Sillesen, H, Welch, K, Sparcl, I, Bogousslavsky, J, Zivin, J, Clark, W, Dávalos, A, Kaste, M, Leiter, L, Altafullah, I, Graham, G, Glahn, J, Jiménez Hernández, D, Macwalter, R, Scott, R, Shuaib, A, Sivenius, J, Stipal, R, Hart, R, Marsh, J, Norrving, B, Pocock, S, Sacco, R, Easton, J, Brown, M, Nagy, Z, Whisnant, J, O'Neill, B, Kleber, F, Lablanche, J, Welty, F, Crimmins, D, Davis, S, Dimmitt, S, Donnan, G, Frayne, J, Freilich, D, Zagami, A, Mikocki, J, Schmidauer, C, Schmidt, R, De Bleecker, J, Deceuninck, F, Tack, P, Thijs, V, Gomes Fernandes, J, Beaudry, M, Cote, R, Hoyte, K, Lebrun, L, Mackey, A, Sahlas, D, Selchen, D, Spence, J, Teal, P, Winger, M, Matamala, G, Cifkova, R, Kalita, Z, Rektor, I, Rosolova, H, Vaclavik, D, Boysen, G, Klingenberg, H, Hillbom, M, Numminen, H, Pilke, A, Salmivaara, A, Alamowitch, S, Boulliat, J, De Broucker, T, Chollet, F, Mahagne, M, Milandre, L, Moulin, T, Milonas, I, Stathis, P, Vogiatzoglou, D, Bornstein, N, Honigman, S, Lampl, Y, Streifler, J, Capurso, A, Comi, G, Ferrarese, C, Gandolfo, C, Poloni, M, Senin, U, Rangel Guerra, R, Boon, A, De Keyser, J, De Kort, P, Haas, J, Kamphuis, D, Koudstaal, P, Anderson, N, Singh, G, Czlonkowska, A, Drozdowski, W, Gralewski, Z, Kozubski, W, Kuczynska Zardzewialy, A, Podemski, R, Stelmasiak, Z, Szczudlik, A, Da Costa Correia, C, Ferro, J, Salgueiro e., C, Lietava, J, Raslova, K, Carr, J, Gardiner, J, Kruger, A, Alvarez Sabin, J, Chamorro, A, Diez Tejedor, E, Fernández, O, Trejo Gabriel y., G, González Marcos, J, Egido Herrero, J, Jiménez Martínez, M, Lago Martin, A, Mostacero Miguel, E, Vivancos Mora, J, Moltó, J, Viguera Romero, J, Cuartero Rodriguez, E, Rubio, F, Serena, J, Laska, A, Leijd, B, Strand, T, Terent, A, Waegner, A, Wallén, T, Baumgartner, R, Hungerbühler, H, Lyrer, P, Mattle, H, Bath, P, Ekpo, E, Freeman, A, Lees, K, Macleod, M, Sharma, A, Shetty, H, Albers, G, Benavente, O, Book, D, Broderick, J, Calder, C, Carlini, W, Chaturvedi, S, Chippendale, T, Coull, B, Davis, P, Devlin, T, Dick, A, Dooneief, G, Duff, R, Estronza, N, Forteza, A, Frankel, M, Frey, J, Friday, G, Goldstein, J, Hammer, M, Harris, J, Harper, W, Hendin, B, Hess, D, Hinton, R, Hollander, J, Hughes, R, Kasner, S, Kent, T, Kim, L, Kirshner, H, Ledbetter, L, Lee Kwen, P, Levin, K, Libman, R, Matlock, J, Mcdowell, P, McGee F., J, Meyer, B, Minagar, A, Moussouttas, M, Munson, R, Nash, M, Nassief, A, Orr, S, Ratinov, G, Salanga, V, Silliman, S, Singer, R, Smith, D, Sullivan, H, Tietjen, G, Thaler, D, Tuchman, M, Uskavitch, D, Verro, P, Vicari, R, Weinstein, R, Wilterdink, J, Zweifler, R, De Bastos, M, Goldstein, LB, Welch, KMA, SPARCL investigators, Bogousslavsky J, Goldstein LB, Zivin J, Clark W, Dávalos A, Kaste M, Leiter L, Altafullah I, Graham G, Glahn J, Jiménez Hernández D, MacWalter R, Scott R, Shuaib A, Sivenius J, Stipal R, Hart R, Marsh J, Norrving B, Pocock S, Sacco R, Easton J, Brown M, Nagy Z, Whisnant J, O'Neill B, Kleber F, LaBlanche JM, Welty F, Crimmins D, Davis S, Dimmitt S, Donnan G, Frayne J, Freilich D, Zagami A, Mikocki J, Schmidauer C, Schmidt R, De Bleecker J, Deceuninck F, Tack P, Thijs V, Gomes Fernandes J, Beaudry M, Cote R, Hoyte K, Lebrun LH, Mackey A, Sahlas D, Selchen D, Spence JD, Teal P, Winger M, Matamala G, Cifkova R, Kalita Z, Rektor I, Rosolova H, Vaclavik D, Boysen G, Klingenberg H, Sillesen H, Hillbom M, Numminen H, Pilke A, Salmivaara A, Alamowitch S, Amarenco P, Boulliat J, De Broucker T, Chollet F, Mahagne MH, Milandre L, Moulin T, Milonas I, Stathis P, Vogiatzoglou D, Bornstein N, Honigman S, Lampl Y, Streifler J, Capurso A, Comi G, Gandolfo C, Poloni M, Senin U, Rangel Guerra R, Boon AM, De Keyser JH, De Kort PL, Haas JA, Kamphuis DJ, Koudstaal PJ, Anderson N, Singh G, Czlonkowska A, Drozdowski W, Gralewski Z, Kozubski W, Kuczynska Zardzewialy A, Podemski R, Stelmasiak Z, Szczudlik A, Da Costa Correia C, Ferro J, Salgueiro e. Cunha L, Lietava J, Raslova K, Carr J, Gardiner J, Kruger A, Alvarez Sabin J, Chamorro A, Diez Tejedor E, Fernández O, Trejo Gabriel y. Galán J, González Marcos J, Egido Herrero J, Jiménez Martínez M, Lago Martin A, Mostacero Miguel E, Vivancos Mora J, Moltó J, Viguera Romero J, Cuartero Rodriguez E, Rubio F, Serena J, Laska AC, Leijd B, Strand T, Terent A, Waegner A, Wallén T, Baumgartner R, Hungerbühler H, Lyrer P, Mattle H, Bath PM, Ekpo EB, Freeman A, Lees KR, MacLeod MJ, MacWalter RS, Sharma AK, Shetty HG, Albers G, Benavente O, Book D, Broderick J, Calder C, Carlini W, Chaturvedi S, Chippendale T, Coull B, Davis P, Devlin T, Dick A, Dooneief G, Duff R, Estronza N, Forteza A, Frankel M, Frey J, Friday G, Goldstein J, Hammer M, Harris J, Harper W, Hendin B, Hess D, Hinton R, Hollander J, Hughes R, Kasner S, Kent T, Kim L, Kirshner H, LaMonte M, Ledbetter L, Lee Kwen P, Levin K, Libman R, Matlock J, McDowell P, McGee F. Jr, Meyer B, Minagar A, Moussouttas M, Munson R, Nash M, Nassief A, Orr S, Ratinov G, Salanga V, Silliman S, Singer R, Smith D, Sullivan H, Tietjen G, Thaler D, Tuchman M, Uskavitch D, Verro P, Vicari R, Weinstein R, Wilterdink J, Zweifler R, De Bastos M., FERRARESE, CARLO, Goldstein, L, Amarenco, P, Lamonte, M, Gilbert, S, Messig, M, Callahan, A, Hennerici, M, Sillesen, H, Welch, K, Sparcl, I, Bogousslavsky, J, Zivin, J, Clark, W, Dávalos, A, Kaste, M, Leiter, L, Altafullah, I, Graham, G, Glahn, J, Jiménez Hernández, D, Macwalter, R, Scott, R, Shuaib, A, Sivenius, J, Stipal, R, Hart, R, Marsh, J, Norrving, B, Pocock, S, Sacco, R, Easton, J, Brown, M, Nagy, Z, Whisnant, J, O'Neill, B, Kleber, F, Lablanche, J, Welty, F, Crimmins, D, Davis, S, Dimmitt, S, Donnan, G, Frayne, J, Freilich, D, Zagami, A, Mikocki, J, Schmidauer, C, Schmidt, R, De Bleecker, J, Deceuninck, F, Tack, P, Thijs, V, Gomes Fernandes, J, Beaudry, M, Cote, R, Hoyte, K, Lebrun, L, Mackey, A, Sahlas, D, Selchen, D, Spence, J, Teal, P, Winger, M, Matamala, G, Cifkova, R, Kalita, Z, Rektor, I, Rosolova, H, Vaclavik, D, Boysen, G, Klingenberg, H, Hillbom, M, Numminen, H, Pilke, A, Salmivaara, A, Alamowitch, S, Boulliat, J, De Broucker, T, Chollet, F, Mahagne, M, Milandre, L, Moulin, T, Milonas, I, Stathis, P, Vogiatzoglou, D, Bornstein, N, Honigman, S, Lampl, Y, Streifler, J, Capurso, A, Comi, G, Ferrarese, C, Gandolfo, C, Poloni, M, Senin, U, Rangel Guerra, R, Boon, A, De Keyser, J, De Kort, P, Haas, J, Kamphuis, D, Koudstaal, P, Anderson, N, Singh, G, Czlonkowska, A, Drozdowski, W, Gralewski, Z, Kozubski, W, Kuczynska Zardzewialy, A, Podemski, R, Stelmasiak, Z, Szczudlik, A, Da Costa Correia, C, Ferro, J, Salgueiro e., C, Lietava, J, Raslova, K, Carr, J, Gardiner, J, Kruger, A, Alvarez Sabin, J, Chamorro, A, Diez Tejedor, E, Fernández, O, Trejo Gabriel y., G, González Marcos, J, Egido Herrero, J, Jiménez Martínez, M, Lago Martin, A, Mostacero Miguel, E, Vivancos Mora, J, Moltó, J, Viguera Romero, J, Cuartero Rodriguez, E, Rubio, F, Serena, J, Laska, A, Leijd, B, Strand, T, Terent, A, Waegner, A, Wallén, T, Baumgartner, R, Hungerbühler, H, Lyrer, P, Mattle, H, Bath, P, Ekpo, E, Freeman, A, Lees, K, Macleod, M, Sharma, A, Shetty, H, Albers, G, Benavente, O, Book, D, Broderick, J, Calder, C, Carlini, W, Chaturvedi, S, Chippendale, T, Coull, B, Davis, P, Devlin, T, Dick, A, Dooneief, G, Duff, R, Estronza, N, Forteza, A, Frankel, M, Frey, J, Friday, G, Goldstein, J, Hammer, M, Harris, J, Harper, W, Hendin, B, Hess, D, Hinton, R, Hollander, J, Hughes, R, Kasner, S, Kent, T, Kim, L, Kirshner, H, Ledbetter, L, Lee Kwen, P, Levin, K, Libman, R, Matlock, J, Mcdowell, P, McGee F., J, Meyer, B, Minagar, A, Moussouttas, M, Munson, R, Nash, M, Nassief, A, Orr, S, Ratinov, G, Salanga, V, Silliman, S, Singer, R, Smith, D, Sullivan, H, Tietjen, G, Thaler, D, Tuchman, M, Uskavitch, D, Verro, P, Vicari, R, Weinstein, R, Wilterdink, J, Zweifler, R, De Bastos, M, Goldstein, LB, Welch, KMA, SPARCL investigators, Bogousslavsky J, Goldstein LB, Zivin J, Clark W, Dávalos A, Kaste M, Leiter L, Altafullah I, Graham G, Glahn J, Jiménez Hernández D, MacWalter R, Scott R, Shuaib A, Sivenius J, Stipal R, Hart R, Marsh J, Norrving B, Pocock S, Sacco R, Easton J, Brown M, Nagy Z, Whisnant J, O'Neill B, Kleber F, LaBlanche JM, Welty F, Crimmins D, Davis S, Dimmitt S, Donnan G, Frayne J, Freilich D, Zagami A, Mikocki J, Schmidauer C, Schmidt R, De Bleecker J, Deceuninck F, Tack P, Thijs V, Gomes Fernandes J, Beaudry M, Cote R, Hoyte K, Lebrun LH, Mackey A, Sahlas D, Selchen D, Spence JD, Teal P, Winger M, Matamala G, Cifkova R, Kalita Z, Rektor I, Rosolova H, Vaclavik D, Boysen G, Klingenberg H, Sillesen H, Hillbom M, Numminen H, Pilke A, Salmivaara A, Alamowitch S, Amarenco P, Boulliat J, De Broucker T, Chollet F, Mahagne MH, Milandre L, Moulin T, Milonas I, Stathis P, Vogiatzoglou D, Bornstein N, Honigman S, Lampl Y, Streifler J, Capurso A, Comi G, Gandolfo C, Poloni M, Senin U, Rangel Guerra R, Boon AM, De Keyser JH, De Kort PL, Haas JA, Kamphuis DJ, Koudstaal PJ, Anderson N, Singh G, Czlonkowska A, Drozdowski W, Gralewski Z, Kozubski W, Kuczynska Zardzewialy A, Podemski R, Stelmasiak Z, Szczudlik A, Da Costa Correia C, Ferro J, Salgueiro e. Cunha L, Lietava J, Raslova K, Carr J, Gardiner J, Kruger A, Alvarez Sabin J, Chamorro A, Diez Tejedor E, Fernández O, Trejo Gabriel y. Galán J, González Marcos J, Egido Herrero J, Jiménez Martínez M, Lago Martin A, Mostacero Miguel E, Vivancos Mora J, Moltó J, Viguera Romero J, Cuartero Rodriguez E, Rubio F, Serena J, Laska AC, Leijd B, Strand T, Terent A, Waegner A, Wallén T, Baumgartner R, Hungerbühler H, Lyrer P, Mattle H, Bath PM, Ekpo EB, Freeman A, Lees KR, MacLeod MJ, MacWalter RS, Sharma AK, Shetty HG, Albers G, Benavente O, Book D, Broderick J, Calder C, Carlini W, Chaturvedi S, Chippendale T, Coull B, Davis P, Devlin T, Dick A, Dooneief G, Duff R, Estronza N, Forteza A, Frankel M, Frey J, Friday G, Goldstein J, Hammer M, Harris J, Harper W, Hendin B, Hess D, Hinton R, Hollander J, Hughes R, Kasner S, Kent T, Kim L, Kirshner H, LaMonte M, Ledbetter L, Lee Kwen P, Levin K, Libman R, Matlock J, McDowell P, McGee F. Jr, Meyer B, Minagar A, Moussouttas M, Munson R, Nash M, Nassief A, Orr S, Ratinov G, Salanga V, Silliman S, Singer R, Smith D, Sullivan H, Tietjen G, Thaler D, Tuchman M, Uskavitch D, Verro P, Vicari R, Weinstein R, Wilterdink J, Zweifler R, De Bastos M., and FERRARESE, CARLO

Abstract

BACKGROUND AND PURPOSE: In SPARCL, treatment with atorvastatin 80 mg daily reduced stroke risk in patients with recent stroke or TIA and no known coronary heart disease by 16% versus placebo over 4.9 years of follow-up. The purpose of this secondary analysis was to determine whether men and women similarly benefited from randomization to statin treatment. METHODS: The effect of sex on treatment-related reductions in stroke and other cardiovascular outcomes were analyzed with Cox regression modeling testing for sex by treatment interactions. RESULTS: Women (n=1908) constituted 40% of the SPARCL study population. At baseline, men (n=2823) were younger (62.0+/-0.21 versus 63.9+/-0.27 years), had lower systolic BPs (138.1+/-0.35 versus 139.5+/-0.47 mm Hg), higher diastolic BPs (82.2+/-0.20 versus 81.0+/-0.25 mm Hg), more frequently had a history of smoking (73% versus 38%), and had lower total cholesterol (207.0+/-0.54 versus 218.9+/-0.67 mg/dL) and LDL-C levels (132+/-0.45 versus 134+/-0.57 mg/dL) than women. Use of antithrombotics and antihypertensives were similar. After prespecified adjustment for region, entry event, time since event, and age, there were no sex by treatment interactions for the combined risk of nonfatal and fatal stroke (treatment Hazard Ratio, HR=0.84, 95% CI 0.68, 1.02 in men versus HR=0.84, 95% CI 0.63, 1.11 in women; treatment x sex interaction P=0.99), major cardiac events (HR=0.61, 95% CI 0.42, 0.87 in men versus HR=0.76, 95% CI 0.48, 1.21 in women; P=0.45), major cardiovascular events (HR=0.78, 95% CI 0.65, 0.93 in men versus HR=0.84, 95% CI 0.65, 1.07 in women; P=0.63), revascularization procedures (HR=0.50, 95% CI 0.37, 0.67 in men versus HR=0.76, 95% CI 0.46, 1.24 in women; P=0.17), or any CHD event (HR=0.54, 95% CI 0.41, 0.72 in men versus 0.67 95% CI 0.46, 0.98 in women; P=0.40). CONCLUSIONS: Stroke and other cardiovascular events are similarly reduced with atorvastatin 80 mg/d in men and women with recent stroke or TIA.

Published
2008

13. Uncemented acetabular components with femoral head autograft for acetabular reconstruction in developmental dysplasia of the hip: a concise follow-up report at a mean of twenty years.

Author

Abdel, Matthew P, Stryker, Louis S, Trousdale, Robert T, Berry, Daniel J, and Cabanela, Miguel E

Abstract

We previously reported the five to twelve-year results of total hip arthroplasty with an uncemented acetabular component and an autogenous femoral head graft in forty-four consecutive hips with developmental dysplasia. The goal of the present study was to report the implant survival rate, status of bone grafts, and clinical outcomes in thirty-five of these hips (in twenty-nine patients) followed for a mean of 21.3 years. Functional, radiographic, and survivorship results were examined. Radiographic analysis revealed an average cup inclination angle of 43° and a mean arc of cup coverage by the graft of 30°. The twenty-year survivorship free from acetabular revision was 66% (twelve acetabular revisions; eight since our previous report). Of the twelve revisions, nine were for liner wear and/or osteolysis, one was for a liner fracture, one was for aseptic loosening, and one was for instability. All bone grafts healed to the pelvis. The graft facilitated revision cup placement as no additional structural grafts or metal augments were required. We concluded that an uncemented porous-coated socket used in conjunction with a bulk femoral head autograft provides good long-term fixation and restores bone stock. [ABSTRACT FROM AUTHOR]

Published
2014
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17. Comparative Survivorship of Different Tibial Designs in Primary Total Knee Arthroplasty.

Author

Kremers, Hilal Maradit, Sierra, Rafael J., Schleck, Cathy D., Berry, Daniel J., Cabanela, Miguel E., Hanssen, Arlen D., Pagnano, Mark W., Trousdale, Robert T., and Lewallen, David G.

Subjects
TOTAL knee replacement, ARTHROPLASTY, BONE resorption, BODY mass index, TIBIA
Abstract

Background: Few registry-based studies in the United States have compared the survivorship of different knee implant designs in total knee arthroplasty. The purpose of this study was to compare differences in survivorship of commonly used tibial implant designs in primary total knee arthroplasty. Methods: A total of 16,584 primary total knee arthroplasties in 11,992 patients were performed at a single institution from 1985 to 2005. Patients were prospectively followed at regular intervals to ascertain details of subsequent revisions. Overall revision rates and revisions for aseptic loosening, wear, and osteolysis were compared across twenty-two tibial implant designs using Cox proportional hazards regression models adjusting for age, sex, calendar year, and body mass index. Results: In comparison with metal-backed modular implants, all-polyethylene tibial components had a significantly lower risk of revision (hazard ratio, 0.3; 95% confidence intervals: 0.2, 0.5 [p < 0.0001]). The risk reduction with all-polyethylene tibial components was not affected by age, sex, or body mass index. With metal-backed modular tibial designs, cruciate-retaining knees performed better than the posterior-stabilized knees (p = 0.002), but this finding was limited to one specific metal-backed modular tibial component, the Press Fit Condylar design. With all-polyethylene tibial components, there was no survivorship difference between cruciate-retaining and posterior-stabilized designs. Conclusions: All-polyethylene tibial components were associated with better outcomes than metal-backed modular components. Cruciate-retaining and posterior-stabilized designs performed equally well, except with the Press Fit Condylar design. Obese patients may have superior results with all-polyethylene and posterior-stabilized components. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

Published
2014
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19. Risk Stratification Algorithm for Management of Patients with Metal-on-Metal Hip Arthroplasty: Consensus Statement of the American Association of Hip and Knee Surgeons, the American Academy of Orthopaedic Surgeons, and The Hip Society.

Author

Young-Min Kwon, Lombardi, Adolph V., Jacobs, Joshua J., Fehring, Thomas K., Lewis, Courtland G., and Cabanela, Miguel E.

Subjects
TOTAL hip replacement, ARTHROPLASTY, HIP surgery, SURGICAL complications, BONE resorption, PATIENTS, DISEASE risk factors
Abstract

The article examines on the advantages and disadvantages in management of risk stratification algorithm of patients having metal-on-metal (MoM) hip arthroplasty. It states that MOM has the possibility to reduce wear-induced osteolysis but has a greater implant stability due to use of large-diameter femoral components and bone conservation for hip resurfacings. It also mentions that hip joints' adverse periprosthetic tissue reactions revealed a significant reason for failure in MoM patients

Published
2014
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20. Comparative Survival of Uncemented Acetabular Components Following Primary Total Hip Arthroplasty.

Author

Howard, James L., Kremers, Hilal Maradit, Loechier, Youlonda A., Schieck, Cathy D., Harmsen, William S., Berry, Daniel J., Cabanela, Miguel E., Hanssen, Arlen D., Pagnano, Mark W., Trousdale, Robert T., and Lewallen, David G.

Subjects
ACETABULUM surgery, TOTAL hip replacement, ORTHOPEDICS patients, REOPERATION, WIRE netting, BONE resorption
Abstract

Background: Since their initial introduction in the early 1980s, uncemented acetabular components have become the preferred implant type for the majority of hip arthroplasties performed in the United States. The purpose of the present study was to compare differences in the survival of uncemented acetabular components following primary total hip arthroplasty. Methods: The study population included 7989 patients who had undergone 9584 primary total hip arthroplasties with twenty different types of uncemented acetabular components at the Mayo Clinic from January 1984 to December 2004. The overall rate of survival as well as the rate of survival free of revision for specific reasons (aseptic loosening, wear, osteolysis) were compared among the different components using age and sex-adjusted Cox proportional hazards re- gression models. Results: The risk of acetabular cup revision was significantly higher for beaded and hydroxyapatite-coated designs as compared with titanium wire mesh designs. Cross-linked polyethylene performed better than conventional polyethylene, but this finding did not reach significance. Elevated liners were associated with a significantly higher risk of cup revision due to aseptic loosening. Conclusions: There are significant differences in the long-term survival of different types of uncemented acetabular components following total hip arthroplasty. The increased risk of revisions in the second decade after the initial total hip arthroplasty is a concern and is largely due to a steady increase in revisions because of polyethylene wear, osteolysis, and component loosening more than ten years after the time of the index arthroplasty. Level of Evidence: Prognostic Level III. See Instructions to Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

Published
2011
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21. Total Hip Arthroplasty with Shortening Subtrochanteric Osteotomy in Crowe Type-IV Developmental Dysplasia.

Author

Krych, Aaron J., Howard, James L., Trousdale, Robert T., Cabanela, Miguel E., and Berry, Daniel J.

Subjects
ARTHROPLASTY, HIP surgery, DYSPLASIA, FRACTURE fixation, JOINT surgery, THERAPEUTICS
Abstract

BACKGROUND: When surgeons perform total hip arthroplasty for hips with a high dislocation related to developmental dysplasia of the hip, obtaining long-term stable implant fixation and optimizing patient function remain challenges. The purpose of this paper was to evaluate the results of cementless arthroplasty with a simultaneous subtrochanteric shortening osteotomy in a group of patients with Crowe type-IV developmental dysplasia of the hip. METHODS: In a retrospective study, we evaluated the results and complications of twenty-eight consecutive primary cementless total hip arthroplasties in twenty-four patients (twenty women and four men), all of whom had Crowe type-IV developmental dysplasia of the hip. The arthroplasty was performed in combination with a subtrochanteric shortening osteotomy and with placement of the acetabular component at the level of the anatomic hip center. The patients were evaluated at a mean of 4.8 years postoperatively. RESULTS: The mean Harris hip score increased from 43 points preoperatively to 89 points at the time of final follow-up (p < 0.01). Twelve (43%) of the twenty-eight hips had an early or late complication or a reoperation. Two (7%) of the twenty-eight subtrochanteric osteotomies were followed by nonunion. There was one instance of isolated loosening of the femoral stem. One acetabular component loosened, and one acetabular liner disengaged. Four hips dislocated postoperatively. All remaining components were well-fixed at the time of the last radiographic follow-up. No sciatic neurapraxic injuries were identified. CONCLUSIONS: Cementless total hip arthroplasty combined with a subtrochanteric femoral shortening osteotomy in patients with a high hip dislocation secondary to developmental dysplasia was associated with high rates of successful fixation of the implants and healing of the osteotomy site and a mean postoperative Harris hip score of 89 points. The complication rate, however, was substantially higher than that associated with primary total hip arthroplasty in patients with degenerative arthritis. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

Published
2010
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22. Total hip arthroplasty with shortening subtrochanteric osteotomy in Crowe type-IV developmental dysplasia.

Author

Krych AJ, Howard JL, Trousdale RT, Cabanela ME, Berry DJ, Krych, Aaron J, Howard, James L, Trousdale, Robert T, Cabanela, Miguel E, and Berry, Daniel J

Abstract

Background: When surgeons perform total hip arthroplasty for hips with a high dislocation related to developmental dysplasia of the hip, obtaining long-term stable implant fixation and optimizing patient function remain challenges. The purpose of this paper was to evaluate the results of cementless arthroplasty with a simultaneous subtrochanteric shortening osteotomy in a group of patients with Crowe type-IV developmental dysplasia of the hip.Methods: In a retrospective study, we evaluated the results and complications of twenty-eight consecutive primary cementless total hip arthroplasties in twenty-four patients (twenty women and four men), all of whom had Crowe type-IV developmental dysplasia of the hip. The arthroplasty was performed in combination with a subtrochanteric shortening osteotomy and with placement of the acetabular component at the level of the anatomic hip center. The patients were evaluated at a mean of 4.8 years postoperatively.Results: The mean Harris hip score increased from 43 points preoperatively to 89 points at the time of final follow-up (p < 0.01). Twelve (43%) of the twenty-eight hips had an early or late complication or a reoperation. Two (7%) of the twenty-eight subtrochanteric osteotomies were followed by nonunion. There was one instance of isolated loosening of the femoral stem. One acetabular component loosened, and one acetabular liner disengaged. Four hips dislocated postoperatively. All remaining components were well-fixed at the time of the last radiographic follow-up. No sciatic neurapraxic injuries were identified.Conclusions: Cementless total hip arthroplasty combined with a subtrochanteric femoral shortening osteotomy in patients with a high hip dislocation secondary to developmental dysplasia was associated with high rates of successful fixation of the implants and healing of the osteotomy site and a mean postoperative Harris hip score of 89 points. The complication rate, however, was substantially higher than that associated with primary total hip arthroplasty in patients with degenerative arthritis. [ABSTRACT FROM AUTHOR]

Published
2009
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23. Total Hip Arthroplasty with Shortening Subtrochanteric Osteotomy in Crowe Type-TV Developmental Dysplasia.

Author

Krych, Aaron J., Howard, James L., Trousdale, Robert T., Cabanela, Miguel E., and Berry, Daniel J.

Subjects
TOTAL hip replacement, OSTEOTOMY, DYSPLASIA, JOINT surgery, RADIOGRAPHY
Abstract

Background: When surgeons perform total hip arthroplasty for hips with a high dislocation related to developmental dysplasia of the hip, obtaining long-term stable implant fixation and optimizing patient function remain challenges. The purpose of this paper was to evaluate the results of cementless arthroplasty with a simultaneous subtrochanteric shortening osteotomy in a group of patients with Crowe type-IV developmental dysplasia of the hip. Methods: In a retrospective study, we evaluated the results and complications of twenty-eight consecutive primary cementless total hip arthroplasties in twenty-four patients (twenty women and four men), all of whom had Crowe type-IV developmental dysplasia of the hip. The arthroplasty was performed in combination with a subtrochanteric shortening osteotomy and with placement of the acetabular component at the level of the anatomic hip center. The patients were evaluated at a mean of 4.8 years postoperatively. Results: The mean Harris hip score increased from 43 points preoperatively to 89 points at the time of final follow-up (p < 0.01). Twelve (43%) of the twenty-eight hips had an early or late complication or a reoperation. Two (7%) of the twenty-eight subtrochanteric osteotomies were followed by nonunion. There was one instance of isolated loosening of the femoral stem. One acetabular component loosened, and one acetabular liner disengaged. Four hips dislocated postoperatively. All remaining components were well-fixed at the time of the last radiographic follow-up. No sciatic neurapraxic injuries were identified. Conclusions: Cementless total hip arthroplasty combined with a subtrochanteric femoral shortening osteotomy in patients with a high hip dislocation secondary to developmental dysplasia was associated with high rates of successful fixation of the implants and healing of the osteotomy site and a mean postoperative Harris hip score of 89 points. The complication rate, however, was substantially higher than that associated with primary total hip arthroplasty in patients with degenerative arthritis. Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

Published
2009
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25. Modes of Failure of Osteonics Constrained Tripolar Implants: A Retrospective Analysis of Forty-three Failed Implants.

Author

Olivier Guyen, David G. Lewallen, and Miguel E. Cabanela

Subjects
ARTIFICIAL implants, ARTHROPLASTY, TOTAL hip replacement reoperation, JOINT surgery
Abstract

Background: The Osteonics constrained tripolar implant has been one of the most commonly used options to manage recurrent instability after total hip arthroplasty. Mechanical failures were expected and have been reported. The purpose of this retrospective review was to identify the observed modes of failure of this device. Methods: Forty-three failed Osteonics constrained tripolar implants were revised at our institution between September 1997 and April 2005. All revisions related to the constrained acetabular component only were considered as failures. All of the devices had been inserted for recurrent or intraoperative instability during revision procedures. Seven different methods of implantation were used. Operative reports and radiographs were reviewed to identify the modes of failure. Results: The average time to failure of the forty-three implants was 28.4 months. A total of five modes of failure were observed: failure at the bone-implant interface (type I), which occurred in eleven hips; failure at the mechanisms holding the constrained liner to the metal shell (type II), in six hips; failure of the retaining mechanism of the bipolar component (type III), in ten hips; dislocation of the prosthetic head at the inner bearing of the bipolar component (type IV), in three hips; and infection (type V), in twelve hips. The mode of failure remained unknown in one hip that had been revised at another institution. Conclusions: The Osteonics constrained tripolar total hip arthroplasty implant is a complex device involving many parts. We showed that failure of this device can occur at most of its interfaces. It would therefore appear logical to limit its application to salvage situations. [ABSTRACT FROM AUTHOR]

Published
2008
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29. Early postoperative transverse pelvic fracture: a new complication related to revision arthroplasty with an uncemented cup.

Author

Springer BD, Berry DJ, Cabanela ME, Hanssen AD, Lewallen DG, Springer, Bryan D, Berry, Daniel J, Cabanela, Miguel E, Hanssen, Arlen D, and Lewallen, David G

Abstract

Background: Uncemented hemispherical cups are commonly used to revise failed acetabular total hip components, even in the presence of marked acetabular bone loss. The purpose of the present study was to report a new complication of acetabular component revision with an uncemented hemispherical cup.Methods: We retrospectively reviewed the records of seven patients (seven hips) in whom an early postoperative transverse acetabular fracture had developed following the implantation of an uncemented trabecular metal cup for the revision of a failed acetabular component. All patients were female. The average age was 63.6 years. The reason for acetabular revision was aseptic loosening of the original cup in five patients and reimplantation after a previous resection arthroplasty in the remaining two. The average cup size used for revision was 58 mm. In two hips, additional modular acetabular metal augments were used to restore the acetabular rim.Results: The average postoperative time to diagnosis of a transverse acetabular fracture was eight months. Five of the seven patients presented with a marked acute increase in pain and a new displaced transverse acetabular fracture (pelvic discontinuity) that was visible on plain radiographs. Two patients were asymptomatic but had a nondisplaced transverse acetabular fracture. In all seven patients, the trabecular metal socket appeared radiographically to be well fixed to part of the pelvis. The five patients with a displaced fracture were managed with additional surgery to stabilize the fracture.Conclusions: To our knowledge, early postoperative transverse pelvic fractures following revision of the acetabular component have not been reported previously. The most likely causes of this complication are further weakening of the remaining pelvic bone stock as a result of the reaming required to obtain a secure fit of a large-diameter hemispherical socket and the cyclic stresses on the weakened bone with resumption of walking. It is unlikely that the fractures occurred intraoperatively because in each case the socket remained well fixed to one of the pelvic fragments. [ABSTRACT FROM AUTHOR]

Published
2005
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33. Role of Baseline pol Genotype in HIV-1 Fitness Evolution.

Author

Weber, Jan, Rangel, Hector R., Chakraborty, Bikram, Marotta, Michael L., Valdez, Hernan, Fransen, Katrien, Florence, Eric, Connick, Elizabeth, Smith, Kimberly Y., Colebunders, Robert L., Landay, Alan, Kurtizkes, Daniel R., Lederman, Michael M., Vanham, Guido, and Quiñones-Mateu, Miguel E.

Published
2003
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34. Total knee arthroplasty in young patients with juvenile rheumatoid arthritis.

Author

Parvizi J, Lajam CM, Trousdale RT, Shaughnessy WJ, Cabanela ME, Parvizi, Javad, Lajam, Claudette M, Trousdale, Robert T, Shaughnessy, William J, and Cabanela, Miguel E

Abstract

Background: Juvenile rheumatoid arthritis is a disabling and destructive condition that commonly affects the knee during childhood. Total knee arthroplasty occasionally may be necessary for the treatment of end-stage disabling arthritis of the knee in young patients. There is a paucity of available data on the results of total knee arthroplasty in adolescents. We report our experience with total knee arthroplasty in patients under the age of twenty years who had juvenile rheumatoid arthritis.Materials and Methods: We reviewed the results of twenty-five consecutive total knee arthroplasties that had been performed at our institution between 1982 to 1997 in thirteen patients (mean age, seventeen years) with juvenile rheumatoid arthritis. The average duration of clinical follow-up was 10.7 years, and the average duration of radiographic follow-up was 6.5 years.Results: The mean Knee Society pain score improved markedly from 27.6 to 88.3 points, and the mean Knee Society function score improved modestly from 14.8 to 39.2 points. There was a slight improvement in the range of motion. Symptomatic and progressive radiolucent lines were noted in two knees, one of which was revised. Two knees (one patient) required exchange of the polyethylene liner at thirteen years. There were four additional reoperations, including manipulation under general anesthesia (two knees in one patient), lysis of adhesions (one knee), and extensor mechanism realignment (one knee).Conclusions: Despite a substantial number of postoperative complications, total knee arthroplasty provided excellent relief of pain and improvement in function in this group of adolescent patients with juvenile rheumatoid arthritis. [ABSTRACT FROM AUTHOR]

Published
2003

36. Magnetic Resonance Imaging Pelvimetry Before and After a Periacetabular Osteotomy.

Author

Trousdale, Robert T., Cabanela, Miguel E., Berry, Daniel J., and Wenger, Doris E.

Subjects
*OSTEOTOMY, *PELVIC bones, *PELVIMETRY
Abstract

Examines the effect of periacetabular osteotomy on the dimensions of the pelvic inlet and outlet. Measurement of the osseous pelvis of patients with symptomatic hip dysplasia; Use of magnetic resonance imaging pelvimetry before and after periacetabular osteotomy; Application of radiographic correction following the documentation of the anteroposterior pelvic.

Published
2002
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37. TWENTY-FIVE-YEAR SURVIVORSHIP OF TWO THOUSAND CONSECUTIVE PRIMARY CHARNLEY TOTAL HIP REPLACEMENTS.

Author

Berry, Daniel J., Harmsen, W. Scott, Cabanela, Miguel E., Morrey, Bernard F., Böhm, Paul, and Brzuske, Annemarie

Subjects
TOTAL hip replacement, ARTIFICIAL implants
Abstract

Background: Charnley total hip arthroplasty has been demonstrated to provide good clinical results and a high rate of implant survivorship for twenty years and longer. Most long-term series are not large enough to stratify the many demographic factors that influence implant survivorship. The purpose of this study was to analyze the effects of demographic factors and diagnoses on the long-term survivorship of the acetabular and femoral com-ponents used in Charnley total hip arthroplasty. Methods: Two thousand primary Charnley total hip arthroplasties (1689 patients) were performed at one institu-tion from 1969 to 1971. Patients were contacted at five-year intervals after the arthroplasty. Twenty-five years af-ter the surgery, 1228 patients had died and 461 patients were living. Hips that had not had a reoperation, revision or removal of a component for any reason, or revision or removal for aseptic loosening were considered to have survived. Survivorship data were calculated with use of the method of Kaplan and Meier. Patients were strat-ified by age, gender, and underlying diagnosis to determine the influence of these factors on implant survivorship. Results: The twenty-five year rates of survivorship free of reoperation, free of revision or removal of the implant for any reason, and free of revision or removal for aseptic loosening were 77.5%, 80.9% and 86.5%, respec-tively. The twenty-five-year survivorship free of revision for aseptic loosening was poorer for each decade earlier in life at which the procedure was performed; this survivorship ranged from 68.7% for patients who were less than forty years of age to 100% for patients who were eighty years of age or older. Men had a twofold higher rate of revision for aseptic loosening than did women. Conclusions: Age, gender, and underlying diagnosis all affected the likelihood of long-term survivorship of the acetabular and femoral components used in Charnley total hip arthroplasty. [ABSTRACT FROM AUTHOR]

Published
2002
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39. Uncemented Acetabular Components with Bulk Femoral Head Autograft for Acetabular Reconstruction in Developmental Dysplasia of the Hip.

Author

Spangehi, Mark J., Berry, Daniel J., Trousdale, Robert T., and Cabanela, Miguel E.

Subjects
PELVIC bones, TOTAL hip replacement
Abstract

Background: Anterolateral acetabular bone deficiency is one of the technical problems associated with total hip arthroplasty in patients with developmental hip dysplasia. The purpose of this study was to evaluate the results of one method of acetabular reconstruction for hip dysplasia—placement of an uncemented socket in conjunction with a bulk femoral head autograft. Methods: Forty-four hips in thirty-five patients (twenty-nine female and six male; average age, thirty-nine years) with developmental hip dysplasia were treated with primary total hip arthroplasty with use of an uncemented porous-coated titanium cup fixed with screws and an autogenous bulk femoral head graft. The patients were followed clinically in a prospective fashion for five to 12.3 years (mean, 7.5 years), and radiographs were analyzed retrospectively. Results: Four acetabular components were revised: two, because of severe polyethylene wear and osteolysis; one, because of aseptic loosening; and one, because of fracture of the acetabular shell. The mean Harris hip score for the unrevised hips improved from 51 points preoperatively to 91 points postoperatively. No unrevised socket had definite radiographic evidence of loosening. Forty-three of the forty-four hips had no radiographic evidence of resorption of the graft or had radiographic evidence of resorption limited to the nonstressed area of the graft lateral to the edge of the cup. Conclusions: This method of reconstruction provided reliable acetabular fixation and appeared to restore acetabular bone stock in patients with developmental hip dysplasia. We use this technique for patients with moderate anterolateral acetabular bone deficiency requiring total hip arthroplasty. [ABSTRACT FROM AUTHOR]

Published
2001
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