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916 results on '"Berg J. M."'

406. ChemInform Abstract: STRUCTURAL COMPARISON OF OCTAHEDRAL DIOXOMOLYBDENUM(2+) COMPLEXES OF BIDENTATE AND LINEAR TETRADENTATE NITROGEN, SULFUR‐DONOR LIGANDS

Author

BERG, J. M., primary, SPIRA, D., additional, WO, K., additional, MCCORD, B., additional, LYE, R., additional, CO, M. S., additional, BELMONT, J., additional, BARNES, C., additional, KOSYDAR, K., additional, RAYBUCK, S., additional, HODGSON, K. O., additional, BRUCE, A. E., additional, CORBIN, J. L., additional, and STIEFEL, E. I., additional

Published
1985
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425. Lionel Sharples Penrose.

Author

Berg, J. M.

Subjects
PENROSE, Lionel Sharples
Abstract

The article presents an obituary for Lionel Sharples Penrose, scientist, physician, and teacher from different institutions in England.

Published
1972

426. Book Reviews.

Author

Stevenson, A. C., Kirman, B. H., and Berg, J. M.

Subjects
NONFICTION
Abstract

Reviews several books about mental deficiency. "Down's Anomaly," by L. S. Penrose and G. F. Smith; "Mongolism," edited by G. E. W. Wolstenholme and Ruth Porter; "The Care and Training of the Mentally Subnormal," 3rd ed., by Charles H. Hallas.

Published
1967
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427. High-dose tirofiban pretreatment reduces the need for bail-out study medication in patients with ST-segment elevation myocardial infarction: results of a subgroup analysis of the On-TIME 2 trial.

Author

Hermanides, R. S., Heestermans, A. A. C. M., ten Berg, J. M., Gosselink, A. T. M., Ottervanger, J. P., van Houwelingen, K. G., Kolkman, J. J. E., Stella, P. R., Dill, T., Hamm, C., and van 't Hof, A. W. J.

Subjects
TIROFIBAN, DRUG dosage, MYOCARDIAL infarction, HEART diseases, THERAPEUTICS
Abstract

Objective This study investigated the outcome of patients who received bail-out study medication and evaluated whether high-dose tirofiban (HDT) pretreatment may reduce the need for bail-out study medication. Design A prespecified analysis of the multicentre, double-blind, placebo controlled, randomised On-TIME 2 trial. Bail-out use of study medication was predefined and part of the combined clinical end point. Patients 984 patients excluded from many coronary intervention hospitals in different countries were randomly assigned to HDT or placebo. In the subgroup who received blinded bail-out treatment, patients pretreated with placebo who received bail-out HDT were compared with those pretreated with HDT who received bail-out placebo. Interventions Routine prehospital initiation of HDT versus bail-out use of HDT. Main Outcome Measures Electrocardiographic and clinical outcome. Results Blinded bail-out study medication was used in 24% (237/980) of patients, with a higher rate in patients pretreated with placebo: 29% (140/492) versus 20% (97/488), p=0.002. Bail-out versus no bail-out use of study medication was associated with more residual ST deviation (5.5±7.2 vs 3.7±4.8⇔…mm, p=0.005), and worse clinical outcome (major adverse cardiac events (MACE) at 30⇔…days 12.2% vs 5.6%, p<0.001), mainly due to poor outcome in patients who received HDT bail-out. In patients pretreated with HDT who received placebo bail-out study medication, residual ST deviation and clinical outcome did not differ significantly compared with patients who did not receive bail-out medication (4.0±4.6 vs 3.7± 4.8⇔…mm, p=0.703, MACE 7.2% vs 5.6%, p=0.535). Conclusions Routine prehospital treatment with HDT significantly reduced the use of blinded bail-out study medication. The need for bail-out therapy was associated with a less favourable outcome. This analysis suggests that routine pretreatment is superior to provisional use of HDT in patients with ST-segment elevation myocardial infarction. [ABSTRACT FROM AUTHOR]

Published
2011
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430. Sex Chromatin Survey of Women in a Special Psychiatric Hospital

Author

BERG, J. M., RIDLER, M. A. C., and MCQUAID, A.

Abstract

AN increasing interest in a possible association of abnormal behaviour with sex chromosome aberrations has led to a series of studies1on special populations. There tends to be little or no intellectual impairment in females with single or triple X-chromosomes. These aberrant chromosomal states, however, may be associated with social incompetence, emotional instability and even psychosis2–5.

Published
1969
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431. Sensitivity to gravitational changes.

Author

Berg, Janet M. and Berg, J M

Subjects
LETTERS to the editor, ANXIETY, AGORAPHOBIA, FEAR, GRAVITATION, PHOBIAS, TRANSPORTATION, ANXIETY disorders
Abstract

A letter to the editor is presented in response to the article "Anxeity in a patient during an unconsciously experienced earth tremor," by Daniel Traub-Werner in the previous issue.

Published
1989
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435. Mongolism and Duration of Marriage

Author

PENROSE, L. S. and BERG, J. M.

Abstract

GERMAN1suggested that the cause of mongolism is connected with delayed fertilization and that this depends on factors related to the duration of marriage.

Published
1968
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436. Therapeutic drug monitoring of anti-TNF drugs: an overview of applicability in daily clinical practice in the era of treatment with biologics in juvenile idiopathic arthritis (JIA).

Author

Nassar-Sheikh Rashid, A., Schonenberg-Meinema, D., Bergkamp, S. C., Bakhlakh, S., de Vries, A., Rispens, T., Kuijpers, T. W., Wolbink, G., and van den Berg, J. M.

Subjects
*JUVENILE idiopathic arthritis, *DRUG monitoring, *BIOLOGICALS
Abstract

Background: Anti-tumor necrosis factor (TNF) drugs have improved the prognosis for juvenile idiopathic arthritis (JIA) significantly. However, evidence for individual treatment decisions based on serum anti-TNF drug levels and the presence of anti-drug antibodies (ADAbs) in children is scarce. We aimed to assess if anti-TNF drug levels and/or ADAbs influenced physician's treatment decisions in children with JIA. Methods: Patients' records in our center were retrospectively screened for measurements of anti-TNF drug levels and ADAbs in children with JIA using etanercept, adalimumab or infliximab. Clinical characteristics and disease activity were retrieved from patient charts. Results: We analyzed 142 measurements of anti-TNF drug levels in 65 children with JIA. Of these, ninety-seven (68.3%) were trough concentrations. N = 14/97 (14.4%) of these showed trough concentrations within the therapeutic drug range known for adults with RA and IBD. ADAbs against adalimumab were detected in seven patients and against infliximab in one patient. Seven (87,5%) of these ADAb-positive patients had non-detectable drug levels. A flowchart was made on decisions including rational dose escalation, stopping treatment in the presence of ADAbs and undetectable drug levels, showing that 45% of measurements influenced treatment decisions, which concerned 65% of patients (n = 42/65). Conclusions: In the majority of patients, measurement of anti-TNF drug levels led to changes in treatment. A wide variation of anti-TNF drug levels was found possibly due to differences in drug clearance in different age groups. There is need for determination of therapeutic drug ranges and pharmacokinetic curves for anti-TNF and other biologics in children with JIA. [ABSTRACT FROM AUTHOR]

Published
2021
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437. Percutaneous Atrial Septal Defect Closure Using the Occlutech Figulla Device in Adults: More than 800 Patient-Years of Follow-Up.

Author

Snijder, R. J. R., Renes, L. E., Bosshardt, D., Suttorp, M. J., ten Berg, J. M., and Post, M. C.

Subjects
*ATRIAL septal defects, *ATRIAL fibrillation, *ADULTS
Abstract

Purpose: The Occlutech Figulla occluder has been proven safe and effective at midterm follow-up after percutaneous atrial septal defect (ASD) closure. We describe the safety and efficacy at long-term follow-up in adults.Methods: All consecutive adult patients that underwent ASD closure between 2008 and 2015 were included. All complications were registered. Residual left-to-right shunt (LRS) was diagnosed using color-Doppler transthoracic echocardiography (TTE). Right-to-left shunting was diagnosed using contrast TTE. Successful closure was defined as no LRS at follow-up.Results: In total, 166 patients (mean age 56.7 ± 16.1 years; 62% female) underwent percutaneous ASD closure using the Occlutech Flex I (70%) or Flex II (30%) device (diameter 24 mm; range 10-40 mm) under general anaesthesia and transoesophageal echocardiographic guidance. Long-term follow-up data were available for 144 patients (87%) with a mean follow-up of 5.9 ± 2.6 years, a total of 814 patient-years. During hospitalization, device embolization occurred in three patients (1.8%) with successful extraction in all. During the long-term follow-up, 15 patients (9.8%) suffered new-onset atrial fibrillation and stroke occurred in 2.1%. There was no residual LRS at 12-month follow-up. No device embolization occurred during the long-term follow-up.Conclusion: Percutaneous ASD closure using the Occlutech device appears to be safe at long-term follow-up with a high successful closure rate at one year. [ABSTRACT FROM AUTHOR]

Published
2020
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438. Book Reviews.

Author

Sacks, B. I. and Berg, J. M.

Subjects
NONFICTION
Abstract

Reviews several books. "Selective Neuronal Death: Ciba Foundation Symposium 126," edited by Gregory Bock and Maeve O'Connor; "Dementia," edited by Bruce Pitt; "International Review of Research in Mental Retardation," vol. 14, edited by Norman R. Ellis and Norman W. Bray.

Published
1988
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440. Current Approaches to Down's Syndrome.

Author

Berg, J. M.

Subjects
DOWN syndrome, NONFICTION
Abstract

Reviews the book "Current Approaches to Down's Syndrome," edited by D. Lane and B. Stratford.

Published
1986

441. Biomedical Concerns In Persons With Down Syndrome.

Author

Glidden, Larainc Masters and Berg, J. M.

Subjects
DOWN syndrome, NONFICTION
Abstract

Reviews the book "Biomedical Concerns in Persons With Down Syndrome," by Siegfried M. Pueschel and Jeanette K. Pueschel.

Published
1994

442. Pre-Hospital Antiplatelet Therapy for STEMI Patients Undergoing Primary Percutaneous Coronary Intervention

Author

Serge Korjian, Christopher B. Granger, Arnoud W J van 't Hof, Jurriën M. ten Berg, C. Michael Gibson, Enrico Fabris, Barry S. Coller, Fabris, E., Korjian, S., Coller, B. S., Ten Berg, J. M., Granger, C. B., Gibson, C. M., and Van 'T Hof, A. W. J.

Subjects
Emergency Medical Services, Percutaneous, Time Factors, medicine.medical_treatment, PRIMARY PCI, PRIMARY ANGIOPLASTY, glycoprotein IIb/IIIa, 030204 cardiovascular system & hematology, antiplatelet therapy, DOUBLE-BLIND, 0302 clinical medicine, P2Y12, Risk Factors, inhibitors, ST-SEGMENT ELEVATION, 030212 general & internal medicine, Myocardial infarction, coronary reperfusion, Hematology, P2Y, inhibitor, Treatment Outcome, myocardial infarction, Human, medicine.medical_specialty, Time Factor, Ischemia, 12, pre-hospital, RUC-4, selatogrel, STEMI, Hemorrhage, Humans, Platelet Aggregation Inhibitors, ST Elevation Myocardial Infarction, Percutaneous Coronary Intervention, Article, 03 medical and health sciences, IIB-IIIA INHIBITORS, IIIa, medicine, In patient, cardiovascular diseases, Intensive care medicine, Emergency Medical Service, business.industry, Platelet Aggregation Inhibitor, Risk Factor, ELEVATION MYOCARDIAL-INFARCTION, Percutaneous coronary intervention, medicine.disease, (12), EMERGENCY-DEPARTMENT, Review article, Pharmacodynamics, PLATELET-AGGREGATION, glycoprotein IIb, CLOPIDOGREL PRETREATMENT, business, TASK-FORCE
Abstract

Early recanalization of the infarct-related artery to achieve myocardial reperfusion is the primary therapeutic goal in patients with ST-elevation myocardial infarction (STEMI). To decrease the duration of ischaemia, continuous efforts have been made to improve pre-hospital treatment and to target the early period after symptom onset. In this period the platelet content of the fresh coronary thrombus is maximal and the thrombi are dynamic, and thus more susceptible to powerful antiplatelet agents. There have been substantial advances in antiplatelet therapy in the last three decades with several classes of oral and intravenous antiplatelet agents with different therapeutic targets, pharmacokinetics, and pharmacodynamic properties. New parenteral drugs achieve immediate inhibition of platelet aggregation, and fast and easy methods of administration may create the opportunity to bridge the initial gap in platelet inhibition observed with oral P2Y12 inhibitors. Moreover, potential future management of STEMI could directly involve patients in the process of care with self-administered antiplatelet agents designed to achieve rapid reperfusion. However, the potential anti-ischaemic benefits of potent antiplatelet agents will need to be balanced against their risk of increased bleeding. This study presents a comprehensive and updated review of pre-hospital antiplatelet therapy among STEMI patients undergoing primary percutaneous intervention and explores new therapies under development.

Published
2021
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443. Initial presenting manifestations in 16,486 patients with inborn errors of immunity include infections and noninfectious manifestations

Author

Tim Niehues, Catherine Waruiru, Conleth Feighery, Uwe Schauer, Virginie Courteille, Kai Lehmberg, Ingo Müller, I. Esteves, Henner Morbach, Michael Borte, Patrick Hundsdoerfer, Klaus Schwarz, Ewelina Gowin, Alessandro Aiuti, Andreas Holbro, Federica Barzaghi, João Farela Neves, Dagmar Graf, Hannah Tamary, Veneta Milenova, Benedikt Boetticher, Eleonora Gambineri, Vera Goda, Alia Eldash, Jan-Christian Wasmuth, Fabio Candotti, Svetlana O. Sharapova, Markus Metzler, Juergen Brunner, Anna Hilfanova, Brindusa Ruxandra Capilna, Pere Soler-Palacín, Arnau Antolí, Horst von Bernuth, Vassilios Lougaris, Maria Carrabba, Bernd H. Belohradsky, Julian Thalhammer, Nathalie de Vergnes, Peter Olbrich, Peter Kopač, Leif G. Hanitsch, Alexandra Nieters, Filomeen Haerynck, Juliana Gabzdilova, Sezin Aydemir, Rabab El Hawary, Patrick F.K. Yong, Maria Giovanna Danieli, Alberto Tommasini, Sandra Steinmann, Ulrich Baumann, Figen Dogu, Elisabeth Förster-Waldl, Carolina Marasco, Donato Amodio, Lorenzo Lodi, Xavier Solanich, Caterina Cancrini, Brigita Sitkauskiene, Torsten Witte, Clementina Vanessa, Nima Rezaei, Jean-Christophe Goffard, Kirsten Wittke, Emmanouil Liatsis, Helen Baxendale, Susana L. Silva, Bodo Grimbacher, Henrike Ritterbusch, Evangelia Farmaki, Safa Meshaal, Sujal Ghosh, Larysa Kostyuchenko, David Edgar, Simone Cesaro, R Zeuner, Nerea Salmón Rodríguez, Isabella Quinti, Stephan Ehl, Pauline Brosselin, Joerg C. Henes, Pilar Llobet Agulló, Rosa Maria Dellepiane, Andrea Meinhardt, Marina Kojić, Georgios Sogkas, Stephan Borte, Catharina Schuetz, Suheyla Ocak, Karin Marschall, Lukas M. Gasteiger, Stefan Raffac, Sofia Tantou, Sadia Noorani, Matthaios Speletas, Philippe Randrianomenjanahary, Ursula Holzer, Ayca Kiykim, Johannes G. Liese, Angelo Vacca, Gisela Fecker, Ekrem Unal, Koen J. van Aerde, Alba Parra-Martínez, Kaan Boztug, Sophie Stiehler, Sybille Landwehr-Kenzel, Claudio Pignata, Jennifer Neubert, Janine Reichenbach, Shahnaz Parvin, Sarah Goddard, Andrea Schroll, Dirk Holzinger, Asghar Aghamohammadi, Hassan Abolhassani, Johannes Trück, Estela Paz-Artal, Shereen M. Reda, Anna Shcherbina, Maria Raptaki, Jaroslava Orosova, Beata Wolska-Kuśnierz, Tessa Kerre, Gerrit Ahrenstorf, Ben Zion Garty, Dirk Foell, Benjamin Becker, Ulrike F. Demel, Androniki Kapousouzi, Abraham Rutgers, Klaus Warnatz, Gemma Rocamora Blanch, Stephan Rusch, Luis M. Allende, Dalia Abd Elaziz, Safa Baris, Jorisvan Montfrans, Dominik T. Schneider, Raphael Scheible, Juana Gil-Herrera, Gerhard Kindle, Annarosa Soresina, Giovanna Fabio, Uwe Wintergerst, Emilia Faria, Maria Fasshauer, Silvia Ricci, Aisha Elmarsafy, Barbara Pietrucha, Carsten Speckmann, Nizar Mahlaoui, Ulrich Heininger, Isabelle Meyts, Matthew Buckland, Efimia Papadopoulou-Alataki, Robin Kobbe, A Herwadkar, Sebastian F. N. Bode, Ali Sobh, László Maródi, Baldassarre Martire, Chiara Azzari, Maximilian Heeg, Katja Masjosthusmann, Michael H. Albert, Matteo Chinello, Juan Luis Santos-Pérez, Aarnoud Huissoon, Tanya I. Coulter, Hendrik Schulze-Koops, Norbert Graf, Radwa Alkady, Jolanta Bernatoniene, Seraina Prader, Alenka Gagro, Joachim Roesler, Taco W. Kuijpers, Ewa Więsik-Szewczyk, Maria Elena Maccari, Conrad Ferdinand Lippert, Miriam González-Amores, Johannes Dirks, Daniel E Pleguezuelo, Christof M. Kramm, Anders Fasth, Volker Schuster, Olov Ekwall, Nikolaus Rieber, Javier Carbone, Petra Kaiser-Labusch, Diana Ernst, Lucia Augusta Baselli, Luis Ignacio Gonzalez-Granado, Maria Kanariou, Stefanie S. V. Henriet, Sigune Goldacker, Kerstin Felgentreff, Oana Joean, Fine Roosens, Fabian Hauck, Eva C. Schwaneck, Milos Jesenak, Manfred Hoenig, Lenka Kapustova, Christoph Boesecke, Alain Fischer, Sara Pereira da Silva, Julia Körholz, Ansgar Schulz, Carolynne Schwarze-Zander, Mikko Seppänen, Nermeen Galal, Nora Naumann-Bartsch, Tomaz Garcez, Peter Ciznar, Klara M. Posfay-Barbe, Zelimir Pavle Eric, Reinhold E. Schmidt, Hermann J. Girschick, Sabine Heine, Anika-Kerstin Biegner, Annick A. J. M. van de Ven, Stefan Schreiber, J. Merlijn van den Berg, Nurit Assia Batzir, Alexandra Jablonka, Kim Stol, Gregor Dückers, Antonios G.A. Kolios, Ioannis Kakkas, Christian Klemann, Marina N. Guseva, Sofia Grigoriadou, Elif Karakoc-Aydiner, Antonio Marzollo, Peter D. Arkwright, Urs C. Steiner, Sara Sebnem Kilic, Romina Dieli-Crimi, Gergely Kriván, Monika Sparber-Sauer, Marco Cazzaniga, Fulvio Porta, Paraskevi Maggina, Tomas Milota, Robbert G. M. Bredius, Martine Pergent, Klaus Tenbrock, Jana Pachlopnik Schmid, Florentia Dimitriou, Cathal Laurence Steele, Helen Bourne, Anna Bobcakova, Gerd Horneff, Judith Potjewijd, Marc Schmalzing, Tobias Ankermann, Paul Ryan, Oksana Boyarchuk, Necil Kutukculer, Carl Friedrich Classen, Zita Chovancová, Moira Thomas, Cinzia Milito, Michaela Bitzenhofer-Grüber, Faranaz Atschekzei, Eva Hlaváčková, Viviana Moschese, Julie Smet, Hans-Hartmut Peter, Carla Teixeira, Sabine M El-Helou, Suzanne de Kruijf Bazen, Helmut Wittkowski, Donate Jakoby, Marina Garcia-Prat, Esther de Vries, Richard Herriot, Sven Kracker, Alessandro Plebani, Lisa Göschl, Laura Hora Marques, Anna Sediva, Jiri Litzman, Mark M. Gompels, Renate Krüger, Şefika İlknur Kökçü Karadağ, Nadine Binder, Anna Szaflarska, Peter Jandus, Lisa Ibberson, Johann Greil, Ulf Schulze-Sturm, Mehtap Sirin, Aydan Ikinciogullari, Edyta Heropolitańska-Pliszka, Michael E. Weiss, Alla Skapenko, Lukas Wisgrill, Hana Alachkar, Uta Behrends, Silvia Sánchez-Ramón, Maria N. Hatzistilianou, Otilia Petrovicova, Darko Richter, Zoreh Nademi, Jürgen K. Rockstroh, Sohilla Lotfy, Markus G. Seidel, Timothy Ronan Leahy, Audra Blažienė, Translational Immunology Groningen (TRIGR), Paediatric Infectious Diseases / Rheumatology / Immunology, AII - Inflammatory diseases, ARD - Amsterdam Reproduction and Development, University of Zurich, Ehl, Stephan, Thalhammer, J., Kindle, G., Nieters, A., Rusch, S., Seppanen, M. R. J., Fischer, A., Grimbacher, B., Edgar, D., Buckland, M., Mahlaoui, N., Ehl, S., Boztug, K., Brunner, J., Demel, U. F., Forster-Waldl, E., Gasteiger, L. M., Goschl, L., Kojic, M., Schroll, A., Seidel, M. G., Wintergerst, U., Wisgrill, L., Sharapova, S. O., Goffard, J. -C., Kerre, T., Meyts, I., Roosens, F., Smet, J., Haerynck, F., Eric, Z. P., Milenova, V., Gagro, A., Richter, D., Chovancova, Z., Hlavackova, E., Litzman, J., Milota, T., Sediva, A., Elaziz, D. A., Alkady, R. S., El Sayed El Hawary, R., Eldash, A. S., Galal, N., Lotfy, S., Meshaal, S. S., Reda, S. M., Sobh, A., Elmarsafy, A., Brosselin, P., Courteille, V., De Vergnes, N., Kracker, S., Pergent, M., Randrianomenjanahary, P., Ahrenstorf, G., Albert, M. H., Ankermann, T., Atschekzei, F., Baumann, U., Becker, B. C., Behrends, U., Belohradsky, B. H., Biegner, A. -K., Binder, N., Bode, S. F. N., Boesecke, C., Boetticher, B., Borte, M., Borte, S., Classen, C. F., Dirks, J., Duckers, G., El-Helou, S., Ernst, D., Fasshauer, M., Fecker, G., Felgentreff, K., Foell, D., Ghosh, S., Girschick, H. J., Goldacker, S., Graf, N., Graf, D., Greil, J., Hanitsch, L. G., Hauck, F., Heeg, M., Heine, S. I., Henes, J. C., Hoenig, M., Holzer, U., Holzinger, D., Horneff, G., Hundsdoerfer, P., Jablonka, A., Jakoby, D., Joean, O., Kaiser-Labusch, P., Klemann, C., Kobbe, R., Korholz, J., Kramm, C. M., Kruger, R., Landwehr-Kenzel, S., Lehmberg, K., Liese, J. G., Lippert, C. F., Maccari, M. E., Masjosthusmann, K., Meinhardt, A., Metzler, M., Morbach, H., Muller, I., Naumann-Bartsch, N., Neubert, J., Niehues, T., Peter, H. -H., Rieber, N., Ritterbusch, H., Rockstroh, J. K., Roesler, J., Schauer, U., Scheible, R., Schmalzing, M., Schmidt, R. E., Schneider, D. T., Schreiber, S., Schuetz, C., Schulz, A., Schulze-Koops, H., Schulze-Sturm, U., Schuster, V., Schwaneck, E. C., Schwarz, K., Schwarze-Zander, C., Sirin, M., Skapenko, A., Sogkas, G., Sparber-Sauer, M., Speckmann, C., Steinmann, S., Stiehler, S., Tenbrock, K., von Bernuth, H., Warnatz, K., Wasmuth, J. -C., Weiss, M., Witte, T., Wittke, K., Wittkowski, H., Zeuner, R. A., Farmaki, E., Hatzistilianou, M. N., Kakkas, I., Kanariou, M. G., Kapousouzi, A., Liatsis, E., Maggina, P., Papadopoulou-Alataki, E., Raptaki, M., Speletas, M., Tantou, S., Goda, V., Krivan, G., Marodi, L., Abolhassani, H., Aghamohammadi, A., Rezaei, N., Feighery, C., Leahy, T. R., Ryan, P., Batzir, N. A., Garty, B. Z., Tamary, H., Aiuti, A., Amodio, D., Azzari, C., Barzaghi, F., Baselli, L. A., Cancrini, C., Carrabba, M., Cazzaniga, M., Cesaro, S., Chinello, M., Danieli, M. G., Dellepiane, R. M., Fabio, G., Gambineri, E., Lodi, L., Lougaris, V., Marasco, C., Martire, B., Marzollo, A., Milito, C., Moschese, V., Pignata, C., Plebani, A., Porta, F., Quinti, I., Ricci, S., Soresina, A., Tommasini, A., Vacca, A., Vanessa, C., Blaziene, A., Sitkauskiene, B., Gowin, E., Heropolitanska-Pliszka, E., Pietrucha, B., Szaflarska, A., Wiesik-Szewczyk, E., Wolska-Kusnierz, B., Esteves, I., Faria, E., Marques, L. H., Neves, J. F., Silva, S. L., Teixeira, C., Pereira da Silva, S., Capilna, B. R., Guseva, M. N., Shcherbina, A., Bobcakova, A., Ciznar, P., Gabzdilova, J., Jesenak, M., Kapustova, L., Orosova, J., Petrovicova, O., Raffac, S., Kopac, P., Allende, L. M., Antoli, A., Blanch, G. R., Carbone, J., Dieli-Crimi, R., Garcia-Prat, M., Gil-Herrera, J., Gonzalez-Granado, L. I., Agullo, P. L., Olbrich, P., Parra-Martinez, A., Paz-Artal, E., Pleguezuelo, D. E., Rodriguez, N. S., Sanchez-Ramon, S., Santos-Perez, J. L., Solanich, X., Soler-Palacin, P., Gonzalez-Amores, M., Ekwall, O., Fasth, A., Bitzenhofer-Gruber, M., Candotti, F., Dimitriou, F., Heininger, U., Holbro, A., Jandus, P., Kolios, A. G. A., Marschall, K., Schmid, J. P., Posfay-Barbe, K. M., Prader, S., Reichenbach, J., Steiner, U. C., Truck, J., Bredius, R. G., de Kruijf- Bazen, S., de Vries, E., Henriet, S. S. V., Kuijpers, T. W., Potjewijd, J., Rutgers, A., Stol, K., van Aerde, K. J., Van den Berg, J. M., van de Ven, A. A. J. M., Montfrans, J., Aydemir, S., Baris, S., Dogu, F., Ikinciogullari, A., Karakoc-Aydiner, E., Kilic, S. S., Kiykim, A., Kokcu Karadag, S. I., Kutukculer, N., Ocak, S., Unal, E., Boyarchuk, O., Hilfanova, A., Kostyuchenko, L. V., Alachkar, H., Arkwright, P. D., Baxendale, H. E., Bernatoniene, J., Coulter, T. I., Garcez, T., Goddard, S., Gompels, M. M., Grigoriadou, S., Herriot, R., Herwadkar, A., Huissoon, A., Ibberson, L., Nademi, Z., Noorani, S., Parvin, S., Steele, C. L., Thomas, M., Waruiru, C., Yong, P. F. K., and Bourne, H.

Subjects
0301 basic medicine, Male, Pediatrics, syndromic, Sex Factor, Disease, registry, medicine.disease_cause, Cohort Studies, 0302 clinical medicine, Primary Immunodeficiency Disease, inborn error of immunity, Immunology and Allergy, warning signs, Age Factor, Registries, Family history, presenting symptom, Child, Primary immunodeficiency, Granuloma, autoimmune, immune dysregulation, inflammatory, Adult, Autoimmune Diseases, Female, Humans, Infections, Lymphoproliferative Disorders, Middle Aged, Primary Immunodeficiency Diseases, Sex Factors, Age Factors, 10177 Dermatology Clinic, Infections/epidemiology, 3. Good health, Settore MED/02, Warning signs, Lymphoproliferative Disorder, 2723 Immunology and Allergy, Infection, Human, medicine.medical_specialty, Immunology, 610 Medicine & health, Malignancy, primary immunodeficiency, Autoimmune Disease, 03 medical and health sciences, Immunity, Autoimmune Diseases/epidemiology, medicine, 2403 Immunology, business.industry, warning sign, Common variable immunodeficiency, Granuloma/epidemiology, Immune dysregulation, medicine.disease, Primary Immunodeficiency Diseases/epidemiology, 030104 developmental biology, Lymphoproliferative Disorders/epidemiology, Cohort Studie, business, 030215 immunology
Abstract

BACKGROUND: Inborn errors of immunity (IEI) are rare diseases, which makes diagnosis a challenge. A better description of the initial presenting manifestations should improve awareness and avoid diagnostic delay. Although increased infection susceptibility is a well-known initial IEI manifestation, less is known about the frequency of other presenting manifestations.OBJECTIVE: We sought to analyze age-related initial presenting manifestations of IEI including different IEI disease cohorts.METHODS: We analyzed data on 16,486 patients of the European Society for Immunodeficiencies Registry. Patients with autoinflammatory diseases were excluded because of the limited number registered.RESULTS: Overall, 68% of patients initially presented with infections only, 9% with immune dysregulation only, and 9% with a combination of both. Syndromic features were the presenting feature in 12%, 4% had laboratory abnormalities only, 1.5% were diagnosed because of family history only, and 0.8% presented with malignancy. Two-third of patients with IEI presented before the age of 6 years, but a quarter of patients developed initial symptoms only as adults. Immune dysregulation was most frequently recognized as an initial IEI manifestation between age 6 and 25 years, with male predominance until age 10 years, shifting to female predominance after age 40 years. Infections were most prevalent as a first manifestation in patients presenting after age 30 years.CONCLUSIONS: An exclusive focus on infection-centered warning signs would have missed around 25% of patients with IEI who initially present with other manifestations.

Published
2021

445. Cost Effectiveness of a CYP2C19 Genotype-Guided Strategy in Patients with Acute Myocardial Infarction: Results from the POPular Genetics Trial

Author

Richard M. Tjon Joe Gin, Emanuele Barbato, Thomas O. Bergmeijer, Arnoud W J van 't Hof, Pim W. M. van Dorst, Daniel M.F. Claassens, Arend Mosterd, Vera H.M. Deneer, Renicus S Hermanides, Carmine Morisco, Folkert W. Asselbergs, Willem Dewilde, Gerrit J.A. Vos, C. Boersma, Pim van der Harst, Jean-Paul R. Herrman, Jurriën M. ten Berg, Maarten J. Postma, Claassens, D. M. F., van Dorst, P. W. M., Vos, G. J. A., Bergmeijer, T. O., Hermanides, R. S., van 't Hof, A. W. J., van der Harst, P., Barbato, E., Morisco, C., Tjon Joe Gin, R. M., Asselbergs, F. W., Mosterd, A., Herrman, J. -P. R., Dewilde, W. J. M., Postma, M. J., Deneer, V. H. M., ten Berg, J. M., Boersma, C., RS: Carim - H01 Clinical atrial fibrillation, Cardiologie, MUMC+: MA Med Staf Spec Cardiologie (9), RS: Carim - B04 Clinical thrombosis and Haemostasis, Cardiovascular Centre (CVC), Value, Affordability and Sustainability (VALUE), Real World Studies in PharmacoEpidemiology, -Genetics, -Economics and -Therapy (PEGET), and Microbes in Health and Disease (MHD)

Subjects
SELECTION, Acute coronary syndrome, Prasugrel, Cost effectiveness, AMERICAN-COLLEGE, GUIDELINES, ACUTE CORONARY SYNDROME, PRASUGREL, Medicine, Pharmacology (medical), ST-SEGMENT ELEVATION, TICAGRELOR, health care economics and organizations, Genetics, ANTIPLATELET THERAPY, business.industry, Standard treatment, General Medicine, Clopidogrel, medicine.disease, CLOPIDOGREL, Conventional PCI, Cohort, Cardiology and Cardiovascular Medicine, business, Ticagrelor, medicine.drug, TASK-FORCE
Abstract

INTRODUCTION: The POPular Genetics trial demonstrated that a CYP2C19 genotype-guided P2Y12 inhibitor strategy reduced bleeding rates compared with standard treatment with ticagrelor or prasugrel without increasing thrombotic event rates after primary percutaneous coronary intervention (PCI).OBJECTIVE: In this analysis, we aimed to evaluate the cost effectiveness of a genotype-guided strategy compared with standard treatment with ticagrelor or prasugrel.METHODS: A 1-year decision tree based on the POPular Genetics trial in combination with a lifelong Markov model was developed to compare costs and quality-adjusted life-years (QALYs) between a genotype-guided and a standard P2Y12 inhibitor strategy in patients with myocardial infarction undergoing primary PCI. The cost-effectiveness analysis was conducted from a Dutch healthcare system perspective. Within-trial survival and utility data were combined with lifetime projections to evaluate lifetime cost effectiveness for a cohort of 1000 patients. Costs and utilities were discounted at 4 and 1.5%, respectively, according to Dutch guidelines for health economic studies. Besides deterministic and probabilistic sensitivity analyses, several scenario analyses were also conducted (different time horizons, different discount rates, equal prices for P2Y12 inhibitors, and equal distribution of thrombotic events between the two strategies).RESULTS: Base-case analysis with a hypothetical cohort of 1000 subjects demonstrated 8.98 QALYs gained and €725,550.69 in cost savings for the genotype-guided strategy (dominant). The deterministic and probabilistic sensitivity analysis confirmed the robustness of the model and the cost-effectiveness results. In scenario analyses, the genotype-guided strategy remained dominant.CONCLUSION: In patients undergoing primary PCI, a CYP2C19 genotype-guided strategy compared with standard treatment with ticagrelor or prasugrel resulted in QALYs gained and cost savings.TRIAL REGISTRATION: Clinicaltrials.gov number: NCT01761786, Netherlands trial register number: NL2872.

Published
2022

446. Clopidogrel Versus Ticagrelor or Prasugrel After Primary Percutaneous Coronary Intervention According to CYP2C19 Genotype A POPular Genetics Subanalysis

Author

Vera H.M. Deneer, Renicus S Hermanides, Carmine Morisco, Richard M. Tjon Joe Gin, Gerrit J.A. Vos, Arend Mosterd, Pim van der Harst, Daniel M.F. Claassens, Jean-Paul R. Herrman, Johannes C. Kelder, Willem Dewilde, Paul W.A. Janssen, Bakhtawar K. Mahmoodi, Arnoud W J van 't Hof, Jurriën M. ten Berg, Folkert W. Asselbergs, Thomas O. Bergmeijer, Emanuele Barbato, Cardiovascular Centre (CVC), Cardiology, Claassens, D. M. F., Bergmeijer, T. O., Vos, G. J. A., Hermanides, R. S., Van 'T Hof, A. W. J., Van Der Harst, P., Barbato, E., Morisco, C., Tjon Joe Gin, R. M., Asselbergs, F. W., Mosterd, A., Herrman, J. -P. R., Dewilde, W. J. M., Janssen, P. W. A., Kelder, J. C., Mahmoodi, B. K., Deneer, V. H. M., Ten Berg, J. M., Afd Pharmacoepi & Clinical Pharmacology, Pharmacoepidemiology and Clinical Pharmacology, RS: Carim - H01 Clinical atrial fibrillation, Cardiologie, MUMC+: MA Med Staf Spec Cardiologie (9), and RS: Carim - B04 Clinical thrombosis and Haemostasis

Subjects
Prasugrel, IMPACT, medicine.medical_treatment, VARIANT, 030204 cardiovascular system & hematology, GUIDELINES, THERAPY, Clopidogrel/adverse effects, 0302 clinical medicine, ARTERY-DISEASE, Medicine, 030212 general & internal medicine, Percutaneous Coronary Intervention/adverse effects, pharmacogenetics, Genetics, Hazard ratio, ASSOCIATION, Prasugrel Hydrochloride/adverse effects, Clopidogrel, Ticagrelor/adverse effects, Treatment Outcome, myocardial infarction, pharmacogenetic, Cardiology and Cardiovascular Medicine, Ticagrelor, medicine.drug, Platelet Aggregation Inhibitors/adverse effects, Acute coronary syndrome, Genotype, CYP2C19, CARDIOVASCULAR OUTCOMES, acute coronary syndrome, genetic testing, ticagrelor, 03 medical and health sciences, Acute Coronary Syndrome/drug therapy, ANTIPLATELET TREATMENT, Humans, POLYMORPHISMS, clopidogrel, business.industry, percutaneous coronary intervention, Percutaneous coronary intervention, CYP2C19-ASTERISK-17, medicine.disease, Cytochrome P-450 CYP2C19, THROMBOSIS, MYOCARDIAL-INFARCTION, Conventional PCI, Cytochrome P-450 CYP2C19/genetics, business, Prasugrel Hydrochloride, Platelet Aggregation Inhibitors, TASK-FORCE
Abstract

Background: Guidelines favor ticagrelor or prasugrel over clopidogrel in patients with myocardial infarction. However, the POPular Genetics trial (Patient Outcome After Primary Percutaneous Coronary Intervention [PCI]) showed that in patients with primary PCI, a CYP2C19 genotype–guided strategy was associated with a lower bleeding risk without increasing thrombotic risk, compared with routine ticagrelor/prasugrel treatment. Nevertheless, optimal P2Y 12 inhibitor treatment in specific CYP2C19 genetic subgroups is still a subject of debate. Methods: A prespecified subanalysis of the POPular Genetics trial was performed, using patients in whom CYP2C19 *2, *3, and *17 genotypes was determined. Two different analyses were planned. The first assessed the effect of the CYP2C19 *17 allele in clopidogrel-treated patients. The second compared the effect of clopidogrel in noncarriers of a loss-of-function allele with ticagrelor/prasugrel–treated patients, irrespective of CYP2C19 genotype. Main outcomes were a thrombotic outcome (cardiovascular death, myocardial infarction, stent thrombosis, and stroke) and a bleeding outcome (PLATO [Platelet Inhibition and Patient Outcomes] major and minor bleeding) after 12 months. Results: A total of 2429 patients were used for analyses. In the first analysis, the CYP2C19 *17 polymorphism was not found to have a significant influence on thrombotic (adjusted hazard ratio, 0.95 [95% CI, 0.45–2.02]) or bleeding outcomes (adjusted hazard ratio, 0.74 [95% CI, 0.48–1.18]). In the second analysis, clopidogrel was associated with a lower number of bleeding events compared with ticagrelor/prasugrel (9.9% versus 11.7%, adjusted hazard ratio, 0.74 [95% CI, 0.56–0.96]), without a significant increase in thrombotic events (3.4% versus 2.5%, adjusted hazard ratio, 1.14 [95% CI, 0.68–1.90]). Conclusions: In patients with primary PCI not carrying a CYP2C19 loss-of-function allele, the use of clopidogrel compared with ticagrelor or prasugrel was associated with lower bleeding rates, without an increase in thrombotic events. No effect on clinical outcomes was found for the CYP2C19 *17 polymorphism. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT01761786. URL: https://www.trialregister.nl/ ; Unique identifier: NL2872.

Published
2021

447. Working with juvenile idiopathic arthritis

Author

van Gulik, Charlotte C., Maas, Mario, Kuijpers, Taco W., van den Berg, J. M., Hemke, Robert, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam Movement Sciences, AII - Inflammatory diseases, and Graduate School

Published
2021

448. Efficacy and Safety of Glycoprotein IIb/IIIa Inhibitors on Top of Ticagrelor in STEMI: A Subanalysis of the ATLANTIC Trial

Author

Robert F. Storey, Angel Cequier, Shaun G. Goodman, Uwe Zeymer, Atlantic Investigators, Jean P. Collet, Anne H. Tavenier, Eric Vicaut, Abdourahmane Diallo, Jurriën M. ten Berg, Renicus S Hermanides, Enrico Fabris, Frank F. Willems, Arnoud W J van 't Hof, Jens Flensted Lassen, Patrick Ecollan, Béla Merkely, Christian W. Hamm, Mohamed Chettibi, Christopher J. Hammett, Warren J. Cantor, Magnus Janzon, Leonardo Bolognese, Johanne Silvain, Kurt Huber, Frédéric Lapostolle, Gilles Montalescot, University of Trieste, SAMU 93 [Bobigny], Hôpital Avicenne [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Institute of cardiometabolism and nutrition (ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), St. Antonius Hospital [Nieuwegein], University of Toronto, Institut d'Investigació Biomèdica de Bellvitge [Barcelone] (IDIBELL), Linköpings universitet, Semmelweis University of Medicine [Budapest], University of Sheffield [Sheffield], Hôpital Lariboisière-Fernand-Widal [APHP], Maastricht University Medical Centre (MUMC), Maastricht University [Maastricht], Tavenier, A. H., Hermanides, R. S., Fabris, E., Lapostolle, F., Silvain, J., Ten Berg, J. M., Lassen, J. F., Bolognese, L., Cantor, W. J., Cequier, A., Chettibi, M., Goodman, S. G., Hammett, C. J., Huber, K., Janzon, M., Merkely, B., Storey, R. F., Zeymer, U., Ecollan, P., Collet, J. -P., Willems, F. F., Diallo, A., Vicaut, E., Hamm, C. W., Montalescot, G., Van 'T Hof, A. W. J., Cardiologie, MUMC+: MA Med Staf Spec Cardiologie (9), and RS: Carim - H01 Clinical atrial fibrillation

Subjects
0301 basic medicine, Male, st-segment elevation, tirofiban, medicine.medical_treatment, [SDV]Life Sciences [q-bio], high-dose tirofiban, PRIMARY ANGIOPLASTY, 030204 cardiovascular system & hematology, glycoprotein IIb/IIIa inhibitors, 0302 clinical medicine, Postoperative Complications, Myocardial infarction, iiia inhibitors, eptifibatide, Hematology, Middle Aged, Clopidogrel, primary percutaneous coronary intervention, 3. Good health, Treatment Outcome, Cardiology, Drug Therapy, Combination, Female, lipids (amino acids, peptides, and proteins), Ticagrelor, medicine.drug, medicine.medical_specialty, ACUTE MYOCARDIAL-INFARCTION, glycoprotein IIb/IIIa inhibitor, PERCUTANEOUS CORONARY INTERVENTION, Hemorrhage, Platelet Glycoprotein GPIIb-IIIa Complex, Revascularization, ticagrelor, STEMI, 03 medical and health sciences, abciximab, bailout, Double-Blind Method, IIB-IIIA INHIBITORS, Internal medicine, STENT THROMBOSIS, medicine, PREHOSPITAL INITIATION, Humans, cardiovascular diseases, Aged, INDIVIDUAL PATIENTS DATA, business.industry, Percutaneous coronary intervention, Thrombosis, Odds ratio, medicine.disease, Survival Analysis, platelet inhibition, 030104 developmental biology, Glycoprotein IIb/IIIa inhibitors, Conventional PCI, ST Elevation Myocardial Infarction, glycoprotein IIb, business, Platelet Aggregation Inhibitors
Abstract

Background Glycoprotein IIb/IIIa inhibitors (GPIs) in combination with clopidogrel improve clinical outcome in ST-elevation myocardial infarction (STEMI); however, finding a balance that minimizes both thrombotic and bleeding risk remains fundamental. The efficacy and safety of GPI in addition to ticagrelor, a more potent P2Y12-inhibitor, have not been fully investigated. Methods 1,630 STEMI patients who underwent primary percutaneous coronary intervention (PCI) were analyzed in this subanalysis of the ATLANTIC trial. Patients were divided in three groups: no GPI, GPI administration routinely before primary PCI, and GPI administration in bailout situations. The primary efficacy outcome was a composite of death, myocardial infarction, urgent target revascularization, and definite stent thrombosis at 30 days. The safety outcome was non-coronary artery bypass graft (CABG)-related PLATO major bleeding at 30 days. Results Compared with no GPI (n = 930), routine GPI (n = 525) or bailout GPI (n = 175) was not associated with an improved primary efficacy outcome (4.2% no GPI vs. 4.0% routine GPI vs. 6.9% bailout GPI; p = 0.58). After multivariate analysis, the use of GPI in bailout situations was associated with a higher incidence of non-CABG-related bleeding compared with no GPI (odds ratio [OR] 2.96, 95% confidence interval [CI] 1.32–6.64; p = 0.03). However, routine GPI use compared with no GPI was not associated with a significant increase in bleeding (OR 1.78, 95% CI 0.88–3.61; p = 0.92). Conclusion Use of GPIs in addition to ticagrelor in STEMI patients was not associated with an improvement in 30-day ischemic outcome. A significant increase in 30-day non-CABG-related PLATO major bleeding was seen in patients who received GPIs in a bailout situation.

Published
2020
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449. Clopidogrel in noncarriers of CYP2C19 loss-of-function alleles versus ticagrelor in elderly patients with acute coronary syndrome: A pre-specified sub analysis from the POPular Genetics and POPular Age trials CYP2C19 alleles in elderly patients

Author

Michiel Voskuil, J. Wouter Jukema, Arnoud W J van 't Hof, Ton Heestermans, Gerrit J.A. Vos, Pim van der Harst, Richard M. Tjon Joe Gin, Marieke E. Gimbel, Sjoerd H. Hofma, A. Mosterd, Clemens von Birgelen, Jurriën M. ten Berg, Evelyn A. de Vrey, Folkert W. Asselbergs, Emanuele Barbato, Vera H.M. Deneer, Renicus S Hermanides, Thomas O. Bergmeijer, Willem Dewilde, Jean-Paul R. Herrman, Carmine Morisco, Frank R. den Hartog, Daniel M.F. Claassens, Bakhtawar K. Mahmoodi, Reinier A. Waalewijn, Claassens, D. M. F., Gimbel, M. E., Bergmeijer, T. O., Vos, G. J. A., Hermanides, R. S., van der Harst, P., Barbato, E., Morisco, C., Tjon Joe Gin, R. M., de Vrey, E. A., Heestermans, T. A. C. M., Jukema, J. W., von Birgelen, C., Waalewijn, R. A., Hofma, S. H., den Hartog, F. R., Voskuil, M., van't Hof, A. W. J., Asselbergs, F. W., Mosterd, A., Herrman, J. -P. R., Dewilde, W., Mahmoodi, B. K., Deneer, V. H. M., ten Berg, J. M., Cardiologie, MUMC+: MA Med Staf Spec Cardiologie (9), RS: Carim - H01 Clinical atrial fibrillation, RS: Carim - B04 Clinical thrombosis and Haemostasis, Cardiology, Cardiovascular Centre (CVC), Afd Pharmacoepi & Clinical Pharmacology, and Pharmacoepidemiology and Clinical Pharmacology

Subjects
Ticagrelor, P2Y12, 030204 cardiovascular system & hematology, 0302 clinical medicine, 80 and over, PRASUGREL, 030212 general & internal medicine, Myocardial infarction, Stroke, Genetics, Aged, 80 and over, Allele, OUTCOMES, Pharmacogenetic, Hazard ratio, DUAL ANTIPLATELET THERAPY, ABCB1, Clopidogrel, Treatment Outcome, Cardiology and Cardiovascular Medicine, medicine.drug, Human, Acute coronary syndrome, Genotyping, Genotype, Clopidogrel/therapeutic use, CYP2C19, 03 medical and health sciences, medicine, Humans, cardiovascular diseases, Acute Coronary Syndrome, Alleles, Aged, business.industry, Platelet Aggregation Inhibitor, cyp2c19, genotyping, myocardial infarction, older, p2y12, pharmacogenetics, aged, alleles, clopidogrel, cytochrome p-450 cyp2c19, genotype, humans, platelet aggregation inhibitors, ticagrelor, treatment outcome, acute coronary syndrome, medicine.disease, Acute Coronary Syndrome/diagnosis, Cytochrome P-450 CYP2C19, Older, Pharmacogenetics, Cytochrome P-450 CYP2C19/genetics, business, Platelet Aggregation Inhibitors
Abstract

Background: Patients with acute coronary syndrome (ACS) who are carrying CYP2C19 loss-of-function alleles derive less benefit from clopidogrel treatment. Despite this, in elderly patients, clopidogrel might be preferred over more potent P2Y12 inhibitors due to a lower bleeding risk. Whether CYP2C19 genotype-guided antiplatelet treatment in the elderly could be of benefit has not been studied specifically.Methods: Patients aged 70 years and older with known CYP2C19*2 and *3 genotype were identified from the POPular Genetics and POPular Age trials. Noncarriers of loss-of-function alleles treated with clopidogrel were compared to patients, irrespective of CYP2C19 genotype, treated with ticagrelor and to clopidogrel treated carriers of loss-of-function alleles. We assessed net clinical benefit (all-cause death, myocardial infarction, stroke and Platelet Inhibition and Patient Outcomes (PLATO) major bleeding), atherothrombotic outcomes (cardiovascular & nbsp;death, myocardial infarction, stroke) and bleeding outcomes (PLATO major and minor bleeding).Results: A total of 991 patients were assessed. There was no significant difference in net clinical benefit (17.2% vs. 15.1%, adjusted hazard ratio (adjHR) 1.05, 95% confidence interval (CI) 0.77 & ndash;1.44), atherothrombotic outcomes (9.7% vs. 9.2%, adjHR 1.00, 95%CI 0.66 & ndash;1.50), and bleeding outcomes (17.7% vs. 19.8%, adjHR 0.80, 95%CI 0.62 & ndash;1.12) between clopidogrel in noncarriers of loss-of-function alleles and ticagrelor respectively.Conclusion: In ACS patients aged 70 years and older, there was no significant difference in net clinical benefit and atherothrombotic outcomes between noncarriers of a loss-of-function allele treated with clopidogrel and pa-tients treated with ticagrelor. The bleeding rate was numerically; though not statistically significant, lower in pa-tients using clopidogrel.(c) 2021 Published by Elsevier B.V.

Published
2021

450. Pre-hospital administration of ticagrelor in diabetic patients with ST-elevation myocardial infarction undergoing primary angioplasty: A sub-analysis of the ATLANTIC trial

Author

Shaun G. Goodman, Magnus Janzon, Robert F. Storey, Jurriën M. ten Berg, Christopher J. Hammett, Jens Flensted Lassen, Arnoud W J van 't Hof, Mathieu Kerneis, Christian W. Hamm, Béla Merkely, Warren J. Cantor, Abdourahmane Diallo, Leonardo Bolognese, Kurt Huber, Mohamed Chettibi, Eric Vicaut, Uwe Zeymer, Frédéric Lapostolle, Angel Cequier, Enrico Fabris, Gilles Montalescot, RS: Carim - H01 Clinical atrial fibrillation, Cardiologie, MUMC+: MA Med Staf Spec Cardiologie (9), RS: CARIM - R2.01 - Clinical atrial fibrillation, Fabris, E., van't Hof, A., Hamm, C. W., Lapostolle, F., Lassen, J. F., Goodman, S. G., ten Berg, J. M., Bolognese, L., Cequier, A., Chettibi, M., Hammett, C. J., Huber, K., Janzon, M., Merkely, B., Storey, R. F., Zeymer, U., Cantor, W. J., Kerneis, M., Diallo, A., Vicaut, E., and Montalescot, G.

Subjects
Male, Time Factors, antithrombotic drug, medicine.medical_treatment, 030204 cardiovascular system & hematology, MELLITUS, 0302 clinical medicine, Risk Factors, Antithrombotic, 030212 general & internal medicine, Myocardial infarction, Prospective Studies, education.field_of_study, OUTCOMES, diabetes mellitu, General Medicine, Thrombolysis, Middle Aged, Treatment Outcome, CLOPIDOGREL, diabetes mellitus, Cardiology, PLATELET INHIBITION, Female, Cardiology and Cardiovascular Medicine, Ticagrelor, medicine.drug, medicine.medical_specialty, Population, Revascularization, Risk Assessment, Drug Administration Schedule, ticagrelor, STEMI, 03 medical and health sciences, Percutaneous Coronary Intervention, Double-Blind Method, Internal medicine, medicine, Humans, Radiology, Nuclear Medicine and imaging, education, Aged, business.industry, ACUTE CORONARY SYNDROMES, Percutaneous coronary intervention, medicine.disease, REACTIVITY, Conventional PCI, ST Elevation Myocardial Infarction, business, Platelet Aggregation Inhibitors
Abstract

Objective: We investigated, in the contemporary era of ST-elevation myocardial infarction (STEMI) treatment, the influence of diabetes mellitus (DM) on cardiovascular outcomes, and whether pre-hospital administration of ticagrelor may affect these outcomes in a subgroup of STEMI patients with DM. Background: DM patients have high platelet reactivity and a prothrombotic condition which highlight the importance of an effective antithrombotic regimen in this high-risk population. Methods: In toal 1,630 STEMI patients enrolled in the ATLANTIC trial who underwent primary percutaneous coronary intervention (PCI) were included. Multivariate analysis was used to explore the association of DM with outcomes and potential treatment-by-diabetes interaction was tested. Results: A total of 214/1,630 (13.1%) patients had DM. DM was an independent predictor of poor myocardial reperfusion as reflected by less frequent ST-segment elevation resolution (≥70%) after PCI (OR 0.59, 95% CI 0.43–0.82, P < 0.01) and was an independent predictor of the composite 30-day outcomes of death/new myocardial infarction (MI)/urgent revascularization/definite stent thrombosis (ST) (OR 2.80, 95% CI 1.62–4.85, P < 0.01), new MI or definite acute ST (OR 2.46, 95% CI 1.08–5.61, P = 0.03), and definite ST (OR 10.00, 95% CI 3.54–28.22, P < 0.01). No significant interaction between pre-hospital ticagrelor vs in-hospital ticagrelor administration and DM was present for the clinical, electrocardiographic and angiographic outcomes as well as for thrombolysis in myocardial infarction major bleeding. Conclusions: DM remains independently associated with poor myocardial reperfusion and worse 30-day clinical outcomes. No significant interaction was found between pre-hospital vs in-hospital ticagrelor administration and DM status. Further approaches for the treatment of DM patients are needed. CLINICAL TRIAL REGISTRATION: clinicaltrials.gov identifier: NCT01347580.

Published
2019
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