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2. Complete Revascularization Versus Culprit Lesion Only in Patients With ST-Segment Elevation Myocardial Infarction and Multivessel Disease: A DANAMI-3–PRIMULTI Cardiac Magnetic Resonance Substudy

Author

Kyhl, Kasper, Ahtarovski, Kiril Aleksov, Nepper-Christensen, Lars, Ekström, Kathrine, Ghotbi, Adam Ali, Schoos, Mikkel, Göransson, Christoffer, Bertelsen, Litten, Helqvist, Steffen, Holmvang, Lene, Jørgensen, Erik, Pedersen, Frants, Saunamäki, Kari, Clemmensen, Peter, De Backer, Ole, Høfsten, Dan Eik, Køber, Lars, Kelbæk, Henning, Vejlstrup, Niels, Lønborg, Jacob, and Engstrøm, Thomas

Published
2019
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4. Polypill Strategy in Secondary Cardiovascular Prevention

Author

Castellano, Jose M, Pocock, Stuart J, Bhatt, Deepak L, Quesada, Antonio J, Owen, Ruth, Fernandez-Ortiz, Antonio, Sanchez, Pedro L, Marin Ortuño, Francisco, Vazquez Rodriguez, Jose M, Domingo-Fernández, Alexandra, Lozano, Iñigo, Roncaglioni, Maria C, Baviera, Marta, Foresta, Andreana, Ojeda-Fernandez, Luisa, Colivicchi, Furio, Di Fusco, Stefania A, Doehner, Wolfram, Meyer, Antje, Schiele, François, Ecarnot, Fiona, Linhart, Aleš, Lubanda, Jean-Claude, Barczi, Gyorgy, Merkely, Bela, Ponikowski, Piotr, Kasprzak, Marta, Fernandez Alvira, Juan M, Andres, Vicente, Bueno, Hector, Collier, Timothy, Van de Werf, Frans, Perel, Pablo, Rodriguez-Manero, Moises, Alonso Garcia, Angeles, Proietti, Marco, Schoos, Mikkel M, Simon, Tabassome, Fernandez Ferro, Jose, Lopez, Nicolas, Beghi, Ettore, Bejot, Yannick, Vivas, David, Cordero, Alberto, Ibañez, Borja, Fuster, Valentin, and SECURE Investigators

Subjects
Aspirin, Ramipril, Cardiovascular Diseases, Atorvastatin, Myocardial Infarction, Secondary Prevention, Humans, Angiotensin-Converting Enzyme Inhibitors, General Medicine, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Platelet Aggregation Inhibitors, Ischemic Stroke
Abstract

BACKGROUND: A polypill that includes key medications associated with improved outcomes (aspirin, angiotensin-converting-enzyme [ACE] inhibitor, and statin) has been proposed as a simple approach to the secondary prevention of cardiovascular death and complications after myocardial infarction. METHODS: In this phase 3, randomized, controlled clinical trial, we assigned patients with myocardial infarction within the previous 6 months to a polypill-based strategy or usual care. The polypill treatment consisted of aspirin (100 mg), ramipril (2.5, 5, or 10 mg), and atorvastatin (20 or 40 mg). The primary composite outcome was cardiovascular death, nonfatal type 1 myocardial infarction, nonfatal ischemic stroke, or urgent revascularization. The key secondary end point was a composite of cardiovascular death, nonfatal type 1 myocardial infarction, or nonfatal ischemic stroke. RESULTS: A total of 2499 patients underwent randomization and were followed for a median of 36 months. A primary-outcome event occurred in 118 of 1237 patients (9.5%) in the polypill group and in 156 of 1229 (12.7%) in the usual-care group (hazard ratio, 0.76; 95% confidence interval [CI], 0.60 to 0.96; P = 0.02). A key secondary-outcome event occurred in 101 patients (8.2%) in the polypill group and in 144 (11.7%) in the usual-care group (hazard ratio, 0.70; 95% CI, 0.54 to 0.90; P = 0.005). The results were consistent across prespecified subgroups. Medication adherence as reported by the patients was higher in the polypill group than in the usual-care group. Adverse events were similar between groups. CONCLUSIONS: Treatment with a polypill containing aspirin, ramipril, and atorvastatin within 6 months after myocardial infarction resulted in a significantly lower risk of major adverse cardiovascular events than usual care. (Funded by the European Union Horizon 2020; SECURE ClinicalTrials.gov number, NCT02596126; EudraCT number, 2015-002868-17.).

Published
2022

7. Association Between Early Q Waves and Reperfusion Success in Patients With ST-Segment–Elevation Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention: A Cardiac Magnetic Resonance Imaging Study

Author

Topal, Divan Gabriel, Lønborg, Jacob, Ahtarovski, Kiril Aleksov, Nepper-Christensen, Lars, Helqvist, Steffen, Holmvang, Lene, Pedersen, Frants, Clemmensen, Peter, Saünamaki, Kari, Jørgensen, Erik, Kyhl, Kasper, Ghotbi, Ali, Schoos, Mikkel Malby, Göransson, Christoffer, Bertelsen, Litten, Høfsten, Dan, Køber, Lars, Kelbæk, Henning, Vejlstrup, Niels, and Engstrøm, Thomas

Published
2017
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8. Ischemia From Nonculprit Stenoses Is Not Associated With Reduced Culprit Infarct Size in Patients with ST-Segment–Elevation Myocardial Infarction

Author

Ekström, Kathrine, primary, Nielsen, Julie V.W., additional, Nepper-Christensen, Lars, additional, Ahtarovski, Kiril A., additional, Kyhl, Kasper, additional, Göransson, Christoffer, additional, Bertelsen, Litten, additional, Ghotbi, Adam A., additional, Kelbæk, Henning, additional, Høfsten, Dan E., additional, Køber, Lars, additional, Schoos, Mikkel M., additional, Vejlstrup, Niels, additional, Lønborg, Jacob, additional, and Engstrøm, Thomas, additional

Published
2021
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9. Impact of age on reperfusion success and long-term prognosis in ST-segment elevation myocardial infarction – A cardiac magnetic resonance imaging study

Author

Gabriel Topal, Divan, primary, Aleksov Ahtarovski, Kiril, additional, Lønborg, Jacob, additional, Høfsten, Dan, additional, Nepper-Christensen, Lars, additional, Kyhl, Kasper, additional, Schoos, Mikkel, additional, Ghotbi, Adam Ali, additional, Göransson, Christoffer, additional, Bertelsen, Litten, additional, Holmvang, Lene, additional, Helqvist, Steffen, additional, Pedersen, Frants, additional, Schnabel, Renate, additional, Køber, Lars, additional, Kelbæk, Henning, additional, Vejlstrup, Niels, additional, Engstrøm, Thomas, additional, and Clemmensen, Peter, additional

Published
2021
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11. Impact of Multiple Myocardial Scars Detected by CMR in Patients Following STEMI

Author

Ekström, Kathrine, primary, Nepper-Christensen, Lars, additional, Ahtarovski, Kiril A., additional, Kyhl, Kasper, additional, Göransson, Christoffer, additional, Bertelsen, Litten, additional, Ghotbi, Adam A., additional, Kelbæk, Henning, additional, Helqvist, Steffen, additional, Høfsten, Dan E., additional, Køber, Lars, additional, Schoos, Mikkel M., additional, Vejlstrup, Niels, additional, Lønborg, Jacob, additional, and Engstrøm, Thomas, additional

Published
2019
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12. Assessment of the myocardial area at risk: comparing T2-weighted cardiovascular magnetic resonance imaging with contrast-enhanced cine (CE-SSFP) imaging—a DANAMI3 substudy

Author

Göransson, Christoffer, primary, Ahtarovski, Kiril Aleksov, additional, Kyhl, Kasper, additional, Lønborg, Jacob, additional, Nepper-Christensen, Lars, additional, Bertelsen, Litten, additional, Ghotbi, Adam Ali, additional, Schoos, Mikkel Malby, additional, Køber, Lars, additional, Høfsten, Dan, additional, Helqvist, Steffen, additional, Kelbæk, Henning, additional, Engstrøm, Thomas, additional, and Vejlstrup, Niels, additional

Published
2018
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13. MR‐proADM as a Prognostic Marker in Patients With ST‐Segment–Elevation Myocardial Infarction—DANAMI‐3 (a Danish Study of Optimal Acute Treatment of Patients With STEMI) Substudy

Author

Falkentoft, Alexander C., primary, Rørth, Rasmus, additional, Iversen, Kasper, additional, Høfsten, Dan E., additional, Kelbæk, Henning, additional, Holmvang, Lene, additional, Frydland, Martin, additional, Schoos, Mikkel M., additional, Helqvist, Steffen, additional, Axelsson, Anna, additional, Clemmensen, Peter, additional, Jørgensen, Erik, additional, Saunamäki, Kari, additional, Tilsted, Hans‐Henrik, additional, Pedersen, Frants, additional, Torp‐Pedersen, Christian, additional, Kofoed, Klaus F., additional, Goetze, Jens P., additional, Engstrøm, Thomas, additional, and Køber, Lars, additional

Published
2018
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14. Myocardial Damage in Patients With Deferred Stenting After STEMI

Author

Lønborg, Jacob, primary, Engstrøm, Thomas, additional, Ahtarovski, Kiril Aleksov, additional, Nepper-Christensen, Lars, additional, Helqvist, Steffen, additional, Vejlstrup, Niels, additional, Kyhl, Kasper, additional, Schoos, Mikkel Malby, additional, Ghotbi, Ali, additional, Göransson, Christoffer, additional, Bertelsen, Litten, additional, Holmvang, Lene, additional, Pedersen, Frants, additional, Jørgensen, Erik, additional, Saunamäki, Kari, additional, Clemmensen, Peter, additional, De Backer, Ole, additional, Kløvgaard, Lene, additional, Høfsten, Dan Eik, additional, Køber, Lars, additional, and Kelbæk, Henning, additional

Published
2017
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15. Left Ventricular Hypertrophy Is Associated With Increased Infarct Size and Decreased Myocardial Salvage in Patients With ST‐Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

Author

Nepper‐Christensen, Lars, primary, Lønborg, Jacob, additional, Ahtarovski, Kiril Aleksov, additional, Høfsten, Dan Eik, additional, Kyhl, Kasper, additional, Ghotbi, Adam Ali, additional, Schoos, Mikkel Malby, additional, Göransson, Christoffer, additional, Bertelsen, Litten, additional, Køber, Lars, additional, Helqvist, Steffen, additional, Pedersen, Frants, additional, Saünamaki, Kari, additional, Jørgensen, Erik, additional, Kelbæk, Henning, additional, Holmvang, Lene, additional, Vejlstrup, Niels, additional, and Engstrøm, Thomas, additional

Published
2017
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16. Prevalence, Impact, and Predictive Value of Detecting Subclinical Coronary and Carotid Atherosclerosis in Asymptomatic Adults:The BioImage Study

Author

Baber, Usman, Mehran, Roxana, Sartori, Samantha, Schoos, Mikkel Malby, Sillesen, Henrik, Muntendam, Pieter, Garcia, Mario J., Gregson, John, Pocock, Stuart, Falk, Erling, and Fuster, Valentin

Subjects
carotid ultrasound, risk prediction, cardiovascular diseases, atherosclerosis, coronary artery calcification
Abstract

BACKGROUND: Although recent studies suggest that measuring coronary artery calcification (CAC) may be superior to indirect atherosclerotic markers in predicting cardiac risk, there are limited data evaluating imaging-based biomarkers that directly quantify atherosclerosis in different vascular beds performed in a single cohort.OBJECTIVES: The BioImage Study (A Clinical Study of Burden of Atherosclerotic Disease in an At-Risk Population) sought to identify imaging biomarkers that predict near-term (3-year) atherothrombotic events.METHODS: The BioImage Study enrolled 5,808 asymptomatic U.S. adults (mean age: 69 years, 56.5% female) in a prospective cohort evaluating the role of vascular imaging on cardiovascular risk prediction. All patients were evaluated by CAC and novel 3-dimensional carotid ultrasound. Plaque areas from both carotid arteries were summed as the carotid plaque burden (cPB). The primary endpoint was the composite of major adverse cardiac events (MACE) (cardiovascular death, myocardial infarction, and ischemic stroke). A broader secondary MACE endpoint also included all-cause death, unstable angina, and coronary revascularization.RESULTS: Over a median follow-up of 2.7 years, MACE occurred in 216 patients (4.2%), of which 82 (1.5%) were primary events. After adjustment for risk factors, and compared with individuals without any cPB, hazard ratios for MACE were 0.78 (95% confidence interval [CI]: 0.31 to 1.91), 1.45 (95% CI: 0.67 to 3.14), and 2.36 (95% CI: 1.13 to 4.92) with increasing cPB tertile, with similar results for CAC. Net reclassification significantly improved with either cPB (0.23) or CAC (0.25). MACE rates increased simultaneously with higher levels of both cPB and CAC.CONCLUSIONS: Detection of subclinical carotid or coronary atherosclerosis improves risk predictions and reclassification compared with conventional risk factors, with comparable results for either modality. Cost-effective analyses are warranted to define the optimal roles of these complementary techniques. (BioImage Study: A Clinical Study of Burden of Atherosclerotic Disease in an At-Risk Population; NCT00738725).

Published
2015

17. Stroke After Transcatheter Aortic Valve Replacement: Incidence, Risk Factors, Prognosis, and Preventive Strategies

Author

Mastoris, Ioannis, Schoos, Mikkel M., Dangas, George D., and Mehran, Roxana

Subjects
Stroke, Diffusion Magnetic Resonance Imaging, Postoperative Complications, Time Factors, Risk Factors, Aortic Valve, Reviews, Humans, Prognosis, Magnetic Resonance Imaging
Abstract

The first transcatheter aortisc valve replacement (TAVR) was performed in 2002, and has been proven beneficial in inoperable and high-risk patients for open heart surgery. Stroke occurrence after TAVR, both periprocedure and at follow-up, has not been well described. We sought to review incidence, pathophysiology, predictors, prognosis, and current preventive strategies of cerebrovascular accidents (CVAs) after TAVR. Studies were selected from a Medline search if they contained clinical outcomes data after TAVR. Acute and subacute CVAs after TAVR have been reported in 3% to 6% of patients. Approximately 45% of CVAs occur within 2 days after TAVR; 28% between 3 and 10 days; 4% between 10 and 30 days; and 10.5% occur from 1 month to 2 years. Clinically silent cerebral embolisms have been reported, with an incidence greatly exceeding that of overt CVAs. Underlying pathophysiologic mechanisms for CVAs can be broadly categorized into embolic and nonembolic causes, as well as procedural and postprocedural (early and late). Important predictors of early CVAs are small aortic valve area, atrial fibrillation, and balloon postdilation, whereas late CVAs are mostly influenced by chronic atrial fibrillation, prior cerebrovascular disease, and transapical approach. Following stroke, patients exhibit increased morbidity and mortality. A multilevel approach for the prevention of CVAs includes improved interventional techniques, embolic protection devices, antithrombotic treatment, close monitoring, and aggressive management of modifiable risk factors. Technology advances notwithstanding stroke morbidity and mortality remains steady. The significance of silent cerebral embolism on prognosis remains uncertain, and optimal medical treatment during and after TAVR should be further investigated.

Published
2014

18. Assessment of the myocardial area at risk: comparing T2-weighted cardiovascular magnetic resonance imaging with contrast-enhanced cine (CE-SSFP) imaging—a DANAMI3 substudy.

Author

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

Subjects
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]

Published
2019
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19. Early Stent Thrombosis and Mortality After Primary Percutaneous Coronary Intervention in ST-Segment–Elevation Myocardial Infarction

Author

Dangas, George D., primary, Schoos, Mikkel M., additional, Steg, Philippe Gabriel, additional, Mehran, Roxana, additional, Clemmensen, Peter, additional, van ‘t Hof, Arnoud, additional, Prats, Jayne, additional, Bernstein, Debra, additional, Deliargyris, Efthymios N., additional, and Stone, Gregg W., additional

Published
2016
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22. TCT-87 Frequency And Impact Of Intraprocedural Thrombotic Events During Percutaneous Coronary Intervention In Women Compared To Men: Pooled Analysis From The ACUITY And HORIZONS-AMI Trials

Author

Schoos, Mikkel, primary, Mehran, Roxana, additional, Baber, Usman, additional, Xu, Ke, additional, Feit, Frederick, additional, Gersh, Bernard j, additional, Ohman, E. Magnus, additional, Witzenbichler, Bernhard, additional, and Stone, Gregg W., additional

Published
2014
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24. TCT-501 Dual Antiplatelet Therapy Interruption For Surgery: Insights From The PARIS (Patterns Of Non-adherence To Anti-Platelet Regiments In Stented Patients) Registry

Author

Schoos, Mikkel, primary, Bhasin, Aarti, additional, Sartori, Samantha, additional, Aquino, Melissa, additional, Yu, Jennifer, additional, Henry, Timothy D., additional, Cohen, David, additional, Moliterno, David J., additional, Ariti, Cono, additional, and Mehran, Roxana, additional

Published
2014
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25. TCT-483 Impact of HbA1c Levels on Residual Platelet Reactivity and Outcomes after Coronary Drug-Eluting Stents: The ADAPT-DES study

Author

Schoos, Mikkel, primary, Mehran, Roxana, additional, Kirtane, Ajay J., additional, Yu, Jennifer, additional, Xu, Ke, additional, Witzenbichler, Bernhard, additional, Rinaldi, Michael, additional, Neumann, Franz-Josef, additional, Metzger, D. Christopher, additional, Henry, Timothy D., additional, Cox, David, additional, Mazzaferri, Ernest L., additional, Maehara, Akiko, additional, and Stone, Gregg W., additional

Published
2014
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27. ASSOCIATIONS BETWEEN DUAL ANTIPLATELET THERAPY CESSATION AND MACE DUE TO STOPPING ONE OR BOTH DRUGS: INSIGHTS FROM THE PARIS REGISTRY

Author

Baber, Usman, primary, Schoos, Mikkel, additional, Sartori, Samantha, additional, Steg, Philippe, additional, Ariti, Cono, additional, Weisz, Giora, additional, Witzenbichler, Bernhard, additional, Henry, Timothy, additional, Kini, Annapoorna, additional, Stuckey, Thomas, additional, Cohen, David, additional, Berger, Peter B., additional, Iakovou, Ioannis, additional, Dangas, George, additional, Waksman, Ron, additional, Krucoff, Mitchell, additional, Hermiller, James, additional, Shawl, Fayaz, additional, Gibson, C Michael, additional, Chieffo, Alaide, additional, Alu, Maria, additional, Moliterno, David, additional, Colombo, Antonio, additional, Pocock, Stuart, additional, and Mehran, Roxana, additional

Published
2014
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28. DETECTION AND IMPACT OF SUBCLINICAL CORONARY AND CAROTID ATHEROSCLEROSIS ON CARDIOVASCULAR RISK PREDICTION AND RECLASSIFICATION IN ASYMPTOMATIC US ADULTS: INSIGHTS FROM THE HIGH RISK PLAQUE BIOIMAGE STUDY

Author

Baber, Usman, primary, Mehran, Roxana, additional, Sartori, Samantha, additional, Schoos, Mikkel, additional, Falk, Erling, additional, Sillesen, Henrik, additional, Muntendam, Pieter, additional, Garcia, Mario, additional, Gregson, John, additional, Pocock, Stuart, additional, and Fuster, Valentin, additional

Published
2014
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29. ASSOCIATIONS BETWEEN DIFFERENT MODES OF DAPT CESSATION AND MAJOR ADVERSE EVENTS AT 6 MONTHS AND BEYOND: INSIGHTS FROM THE PARIS REGISTRY

Author

Schoos, Mikkel M., primary, Sartori, Samantha, additional, Baber, Usman, additional, Steg, Philippe, additional, Ariti, Cono, additional, Weisz, Giora, additional, Witzenbichler, Bernhard, additional, Henry, Timothy, additional, Kini, Annapoorna, additional, Stuckney, Thomas, additional, Cohen, David, additional, Berger, Peter, additional, Dangas, George, additional, Waksman, Ron, additional, Krucoff, Mitchell, additional, Antoniucci, David, additional, Hermiller, James, additional, Shawl, Fayaz, additional, Gibson, C. Michael, additional, Chieffo, Alaide, additional, Moliterno, David, additional, Colombo, Antonio, additional, Pocock, Stuart, additional, Mehran, Roxana, additional, and Alu, Maria, additional

Published
2014
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31. TEMPORAL ASSOCIATIONS BETWEEN TIME AFTER PERCUTANEOUS CORONARY INTERVENTION, DUAL ANTIPLATELET THERAPY CESSATION AND STENT THROMBOSIS IN THE CONTEMPORARY PCI ERA: INSIGHTS FROM THE PARIS REGISTRY

Author

Baber, Usman, primary, Schoos, Mikkel, additional, Sartori, Samantha, additional, Steg, Philippe, additional, Ariti, Cono, additional, Weisz, Giora, additional, Witzenbichler, Bernhard, additional, Henry, Timothy, additional, Kini, Annapoorna, additional, Stuckey, Thomas, additional, Cohen, David J., additional, Berger, Peter B., additional, Dangas, George, additional, Waksman, Ron, additional, Antoniucci, David, additional, Krucoff, Mitchell, additional, Hermiller, James, additional, Shawl, Fayaz, additional, Gibson, C Michael, additional, Chieffo, Alaide, additional, Alu, Maria, additional, Moliterno, David, additional, Colombo, Antonio, additional, Pocock, Stuart, additional, and Mehran, Roxana, additional

Published
2014
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37. Exenatide Reduces Final Infarct Size in Patients With ST-Segment–Elevation Myocardial Infarction and Short-Duration of Ischemia

Author

Lønborg, Jacob, primary, Kelbæk, Henning, additional, Vejlstrup, Niels, additional, Bøtker, Hans Erik, additional, Kim, Won Yong, additional, Holmvang, Lene, additional, Jørgensen, Erik, additional, Helqvist, Steffen, additional, Saunamäki, Kari, additional, Terkelsen, Christian Juhl, additional, Schoos, Mikkel Malby, additional, Køber, Lars, additional, Clemmensen, Peter, additional, Treiman, Marek, additional, and Engstrøm, Thomas, additional

Published
2012
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38. PRE-PROCEDURAL HIGH-SENSITIVITY C-REACTIVE PROTEIN PREDICTS DEATH, RECURRENT MYOCARDIAL INFARCTION AND STENT THROMBOSIS ACCORDING TO STENT TYPE IN PATIENTS WITH ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION TREATED WITH PRIMARY PERCUTANEOUS CORONARY INTERVENTION

Author

Schoos, Mikkel M., primary, Kelbæk, Henning, additional, Kofoed, Klaus F., additional, Køber, Lars, additional, Kløvgaard, Lene, additional, Helqvist, Steffen, additional, Engstrøm, Thomas, additional, Saunamäki, Kari, additional, Jørgensen, Erik, additional, Holmvang, Lene, additional, and Clemmensen, Peter, additional

Published
2011
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39. Echocardiographic predictors of exercise capacity and mortality in chronic bstructive pulmonary disease.

Author

Schoos, Mikkel Malby, Dalsgaard, Morten, Kjærgaard, Jesper, Moesby, Dorte, Jensen, Sidse Graff, Steffensen, Ida, and Iversen, Kasper Karmark

Subjects
ECHOCARDIOGRAPHY, EXERCISE, OBSTRUCTIVE lung diseases, MORTALITY, CARDIOLOGY
Abstract

Background Chronic obstructive pulmonary disease (COPD) reduces exercise capacity, but lung function parameters do not fully explain functional class and lung-heart interaction could be the explanation. We evaluated echocardiographic predictors of mortality and six minutes walking distance (6MWD), a marker for quality of life and mortality in COPD. Methods Ninety COPD patients (GOLD criteria) were evaluated by body plethysmography, 6MWD and advanced echocardiography parameters (pulsed wave tissue Doppler and speckle tracking). Results Mean 6MWD was 403 (± 113) meters. All 90 subjects had preserved left ventricular (LV) ejection fraction 64.3% ± 8.6%. Stroke volume decreased while heart rate increased with COPD severity and hyperinflation. In 66% of patients, some degree of diastolic dysfunction was present. Mitral tissue Doppler data in COPD could be interpreted as a sign of low LV preload and not necessarily an intrinsic impairment in LV relaxation/compliance. Tricuspid regurgitation (TR) increased with COPD severity and hyperinflation. Age (p < 0.001), BMI (p <0.001), DLCO SB (p <0.001) and TR (p 0.005) were independent predictors of 6MWD and a multivariable model incorporating heart function parameters (adjusted r2 = .511) was superior to a model with lung function parameters alone (adjusted r2 = .475). LV global longitudinal strain (p = 0.034) was the only independent predictor of mortality among all baseline, body plethysmographic and echocardiographic variables. Conclusions Among subjects with moderate to severe COPD and normal LVEF, GLS independently predicted all-cause mortality. Exercise tolerance correlated with standard lung function parameters only in univariate models; in subsequent models including echocardiographic parameters, longer 6MWD correlated independently with milder TR, better DLCO SB, younger age and lower BMI. We extended the evidence on COPD affecting cardiac chamber volumes, LV preload, heart rate, as well as systolic and diastolic function. Our results highlight lung-heart interaction and the necessity of cardiac evaluation in COPD. [ABSTRACT FROM AUTHOR]

Published
2013
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41. Long-Term Outcome of PCI Versus CABG in Insulin and Non–Insulin-Treated Diabetic Patients Results From the FREEDOM Trial

Author

Dangas, George D., Farkouh, Michael E., Sleeper, Lynn A., Yang, May, Schoos, Mikkel M., Macaya, Carlos, Abizaid, Alexandre, Buller, Christopher E., Devlin, Gerard, Rodriguez, Alfredo E., Lansky, Alexandra J., Siami, F. Sandra, Domanski, Michael, and Fuster, Valentin

Subjects
surgical procedures, operative, diabetes, angioplasty, revascularization, cardiovascular diseases, coronary bypass surgery
Abstract

BackgroundThe prospective, randomized FREEDOM (Comparison of Two Treatments for Multivessel Coronary Artery Disease in Individuals With Diabetes) trial found coronary artery bypass graft surgery (CABG) was associated with better clinical outcomes than percutaneous coronary intervention (PCI) in patients with diabetes and multivessel disease, managed with or without insulin.ObjectivesIn this subgroup analysis of the FREEDOM trial, we examined the association of long-term clinical outcomes after revascularization in patients with insulin-treated diabetes mellitus (ITDM) compared with patients not treated with insulin.MethodsA total of 1,850 FREEDOM subjects had an index revascularization procedure performed: 956 underwent PCI with drug-eluting stents (DES), and 894 underwent CABG. A total of 602 patients (32.5%) had ITDM (PCI/DES n = 325, 34%; CABG n = 277, 31%). Subjects were classified according to ITDM versus non-ITDM, with comparison of PCI/DES versus CABG for each group. Interaction analyses were performed for treatment by diabetes mellitus (DM) status alone and for treatment by DM status by coronary lesion complexity. Analyses were performed for the primary outcome composite of death/stroke/myocardial infarction (MI) using all available follow-up data.ResultsThe overall 5-year event rate of death/stroke/MI was significantly higher in ITDM versus non-ITDM patients (28.7% vs. 19.5%, p < 0.001), which persisted even after adjustment for multiple baseline factors, angiographic complexity, and revascularization treatment group (death/stroke/MI hazard ratio [HR]: 1.35, 95% confidence interval [CI]: 1.06 to 1.73, p = 0.014). With respect to the primary composite endpoint, CABG was superior to PCI/DES in both DM types and the magnitude of treatment effect was similar (interaction p = 0.40) for ITDM (PCI vs. CABG HR: 1.21; 95% CI: 0.87 to 1.69) and non-ITDM patients (PCI vs. CABG HR: 1.46; 95% CI 1.10 to 1.94), even after adjusting for the angiographic SYNTAX score level. Based on 5-year event rates, the number needed to treat with CABG versus PCI to prevent 1 event is 12.7 in ITDM and 13.2 in non-ITDM.ConclusionsIn patients with diabetes and multivessel coronary artery disease, the rate of major adverse cardiovascular events (death, MI, or stroke) is higher in patients treated with insulin than in those not treated with insulin. Furthermore, we did not detect a significant difference in the magnitude of PCI versus CABG treatment effect for patients treated with insulin and those not treated with insulin. (Comparison of Two Treatments for Multivessel Coronary Artery Disease in Individuals With Diabetes [FREEDOM]; NCT00086450).

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43. Causes, Timing, and Impact of Dual Antiplatelet Therapy Interruption for Surgery (from the Patterns of Non-adherence to Anti-platelet Regimens In Stented Patients Registry)

Author

Roxana Mehran, Aarti Bhasin, Annapoorna Kini, Sabato Sorrentino, Bernhard Witzenbichler, Alaide Chieffo, Mitchell Kruckoff, George Dangas, Samantha Sartori, C. Michael Gibson, Antonio Colombo, Timothy D. Henry, David J. Moliterno, Stuart J. Pocock, Birgit Vogel, Cono Ariti, Mikkel Malby Schoos, Ioannis Iakovou, David J. Cohen, P. Gabriel Steg, Melissa Aquino, Serdar Farhan, Jaya Chandrasekhar, Thomas Stuckey, Usman Baber, Giora Weisz, Schoos, Mikkel, Chandrasekhar, Jaya, Baber, Usman, Bhasin, Aarti, Sartori, Samantha, Aquino, Melissa, Vogel, Birgit, Farhan, Serdar, Sorrentino, Sabato, Kini, Annapoorna, Kruckoff, Mitchell, Moliterno, David, Henry, Timothy D., Weisz, Giora, Gibson, C. Michael, Iakovou, Ioanni, Colombo, Antonio, Steg, P. Gabriel, Witzenbichler, Bernhard, Chieffo, Alaide, Cohen, David, Stuckey, Thoma, Ariti, Cono, Dangas, George, Pocock, Stuart, and Mehran, Roxana

Subjects
Male, Registrie, Time Factors, medicine.medical_treatment, Coronary Artery Disease, 030204 cardiovascular system & hematology, 0302 clinical medicine, Retrospective Studie, Prospective Studies, Registries, 030212 general & internal medicine, Aspirin, Middle Aged, Clopidogrel, Minor surgery, Cohort, Drug Therapy, Combination, Female, Cardiology and Cardiovascular Medicine, medicine.drug, Human, medicine.medical_specialty, animal structures, Ticlopidine, Time Factor, Follow-Up Studie, Medication Adherence, 03 medical and health sciences, Percutaneous Coronary Intervention, Preoperative Care, medicine, Humans, In patient, cardiovascular diseases, Retrospective Studies, Aged, business.industry, Platelet Aggregation Inhibitor, Percutaneous coronary intervention, Anti platelet, Non adherence, Surgery, Prospective Studie, Withholding Treatment, Conventional PCI, business, Platelet Aggregation Inhibitors, Follow-Up Studies
Abstract

Temporary interruption of dual antiplatelet therapy (DAPT) is not infrequently required in patients undergoing percutaneous coronary intervention (PCI). We sought to describe the procedures and outcomes associated with DAPT interruption in patients treated with DAPT following successful PCI from the Patterns of non-adherence to anti-platelet regimens in stented patients registry (n = 5018). DAPT interruption was prespecified as physician recommended cessation for

Published
2017

44. Impact of age on reperfusion success and long-term prognosis in ST-segment elevation myocardial infarction - A cardiac magnetic resonance imaging study.

Author

Topal DG, Aleksov Ahtarovski K, Lønborg J, Høfsten D, Nepper-Christensen L, Kyhl K, Schoos M, Ghotbi AA, Göransson C, Bertelsen L, Holmvang L, Helqvist S, Pedersen F, Schnabel R, Køber L, Kelbæk H, Vejlstrup N, Engstrøm T, and Clemmensen P

Abstract

Background: Coronary collateral circulation and conditioning from remote ischemic coronary territories may protect culprit myocardium in the elderly, and younger STEMI patients could suffer from larger infarcts. We evaluated the impact of age on myocardial salvage and long-term prognosis in a contemporary STEMI cohort., Methods: Of 1603 included STEMI patients 807 underwent cardiac magnetic resonance. To assess the impact of age on infarct size and left ventricular ejection fraction (LVEF) as well as the composite endpoint of death and re-hospitalization for heart failure we stratified the patients by an age cut-off of 60 years., Results: Younger STEMI patients had smaller final infarcts (10% vs. 12%, P = 0.012) and higher final LVEF (60% vs. 58%, P = 0.042). After adjusting for multiple potential confounders age did not remain significantly associated with infarct size and LVEF. During 4-year follow-up, the composite endpoint occurred less often in the young (3.2% vs. 17.2%; P < 0.001) with a univariate hazard ratio of 5.77 (95% CI, 3.75-8.89; p < 0.001). Event estimates of 4 subgroups (young vs. elderly and infarct size beyond vs. below median) showed a gradual increase in the occurrence of the composite endpoint depending on both age and acute infarct size (log-rank p < 0.001)., Conclusion: Having a STEMI after entering the seventh decade of life more than quadrupled the risk of future death or re-hospitalization for heart failure. Risk of death and re-hospitalization depended on both advanced age and infarct size, albeit no substantial difference was found in infarct size, LVEF and salvage potential between younger and elderly patients with STEMI., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2021 The Authors.)

Published
2021
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45. Assessment of the myocardial area at risk: comparing T2-weighted cardiovascular magnetic resonance imaging with contrast-enhanced cine (CE-SSFP) imaging-a DANAMI3 substudy.

Author

Göransson C, Ahtarovski KA, Kyhl K, Lønborg J, Nepper-Christensen L, Bertelsen L, Ghotbi AA, Schoos MM, Køber L, Høfsten D, Helqvist S, Kelbæk H, Engstrøm T, and Vejlstrup N

Subjects
Aged, Contrast Media, Edema, Cardiac diagnostic imaging, Edema, Cardiac physiopathology, Female, Humans, Magnetic Resonance Imaging methods, Male, Middle Aged, Observer Variation, Prognosis, Risk Assessment, ST Elevation Myocardial Infarction mortality, Severity of Illness Index, Survival Rate, Treatment Outcome, Angioplasty, Balloon, Coronary methods, Image Interpretation, Computer-Assisted, Magnetic Resonance Imaging, Cine methods, ST Elevation Myocardial Infarction diagnostic imaging, ST Elevation Myocardial Infarction therapy
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., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2018. For permissions, please email: journals.permissions@oup.com.)

Published
2019
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