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3 results on '"George J. Vlachojannis"'

1. Cost Analysis From a Randomized Comparison of Immediate Versus Delayed Angiography After Cardiac Arrest

Author

Cyril Camaro, Judith L. Bonnes, Eddy M. Adang, Eva M. Spoormans, Gladys N. Janssens, Nina W. van der Hoeven, Lucia S. Jewbali, Eric A. Dubois, Martijn Meuwissen, Tom A. Rijpstra, Hans A. Bosker, Michiel J. Blans, Gabe B. Bleeker, Rémon Baak, George J. Vlachojannis, Bob J. Eikemans, Pim van der Harst, Iwan C. van der Horst, Michiel Voskuil, Joris J. van der Heijden, Bert Beishuizen, Martin Stoel, Hans van der Hoeven, José P. Henriques, Alexander P. Vlaar, Maarten A. Vink, Bas van den Bogaard, Ton A. Heestermans, Wouter de Ruijter, Thijs S. Delnoij, Harry J. Crijns, Gillian A. Jessurun, Pranobe V. Oemrawsingh, Marcel T. Gosselink, Koos Plomp, Michael Magro, Paul W. Elbers, Peter M. van de Ven, Jorrit S. Lemkes, and Niels van Royen

Subjects
coronary angiography, health care costs, non–ST‐segment–elevation myocardial infarction, out‐of‐hospital cardiac arrest, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Background In patients with out‐of‐hospital cardiac arrest without ST‐segment elevation, immediate coronary angiography did not improve clinical outcomes when compared with delayed angiography in the COACT (Coronary Angiography After Cardiac Arrest) trial. Whether 1 of the 2 strategies has benefits in terms of health care resource use and costs is currently unknown. We assess the health care resource use and costs in patients with out‐of‐hospital cardiac arrest. Methods and Results A total of 538 patients were randomly assigned to a strategy of either immediate or delayed coronary angiography. Detailed health care resource use and cost‐prices were collected from the initial hospital episode. A generalized linear model and a gamma distribution were performed. Generic quality of life was measured with the RAND‐36 and collected at 12‐month follow‐up. Overall total mean costs were similar between both groups (EUR 33 575±19 612 versus EUR 33 880±21 044; P=0.86). Generalized linear model: (β, 0.991; 95% CI, 0.894–1.099; P=0.86). Mean procedural costs (coronary angiography and percutaneous coronary intervention, coronary artery bypass graft) were higher in the immediate angiography group (EUR 4384±3447 versus EUR 3028±4220; P

Published
2022
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2. Coronary Angiography after Cardiac Arrest without ST Segment Elevation: One-Year Outcomes of the COACT Randomized Clinical Trial

Author

Michiel Voskuil, José P.S. Henriques, Bob J.W. Eikemans, Eric A. Dubois, Thijs Delnoij, Wouter de Ruijter, Michiel J. Blans, Eva M. Spoormans, Niels van Royen, Joris J. van der Heijden, Remon Baak, Alexander P.J. Vlaar, Topm A. Rijpstra, Paul W. G. Elbers, Heleen M. Oudemans-van Straaten, Marcel Gosselink, Michael Magro, Bas van den Bogaard, Pim van der Harst, Maarten A. Vink, Lucia S.D. Jewbali, Harry J.G.M. Crijns, Martijn Meuwissen, Gillian A.J. Jessurun, Hans van der Hoeven, Jorrit S. Lemkes, Gladys N. Janssens, Cyril Camaro, Martin G. Stoel, Gabe B. Bleeker, George J. Vlachojannis, Koos Plomp, Pranobe V. Oemrawsingh, Nina W. van der Hoeven, Ton Heestermans, Albertus Beishuizen, Hans A. Bosker, Iwan C. C. van der Horst, Peter M. van de Ven, Cardiology, MUMC+: MA Intensive Care (3), Intensive Care, MUMC+: MA Medische Staf IC (9), RS: Carim - V04 Surgical intervention, MUMC+: MA Med Staf Spec Cardiologie (9), MUMC+: MA Cardiologie (9), Cardiologie, RS: Carim - H01 Clinical atrial fibrillation, Cardiovascular Centre (CVC), ACS - Atherosclerosis & ischemic syndromes, Intensive Care Medicine, ACS - Microcirculation, ACS - Pulmonary hypertension & thrombosis, Intensive care medicine, ACS - Diabetes & metabolism, Epidemiology and Data Science, ACS - Heart failure & arrhythmias, and APH - Methodology

Subjects
Male, medicine.medical_specialty, Time Factors, Resuscitation, medicine.medical_treatment, Coronary Angiography, Revascularization, law.invention, Randomized controlled trial, law, Internal medicine, Humans, Medicine, Myocardial infarction, Aged, Original Investigation, medicine.diagnostic_test, SECONDARY, business.industry, Percutaneous coronary intervention, Odds ratio, Middle Aged, medicine.disease, Treatment Outcome, MYOCARDIAL-INFARCTION, Heart failure, Angiography, Conventional PCI, Cardiology, ST Elevation Myocardial Infarction, IMMEDIATE, Female, Cardiology and Cardiovascular Medicine, business, INTERVENTION, Out-of-Hospital Cardiac Arrest
Abstract

IMPORTANCE: Ischemic heart disease is a common cause of cardiac arrest. However, randomized data on long-term clinical outcomes of immediate coronary angiography and percutaneous coronary intervention (PCI) in patients successfully resuscitated from cardiac arrest in the absence of ST segment elevation myocardial infarction (STEMI) are lacking. OBJECTIVE: To determine whether immediate coronary angiography improves clinical outcomes at 1 year in patients after cardiac arrest without signs of STEMI, compared with a delayed coronary angiography strategy. DESIGN, SETTING, AND PARTICIPANTS: A prespecified analysis of a multicenter, open-label, randomized clinical trial evaluated 552 patients who were enrolled in 19 Dutch centers between January 8, 2015, and July 17, 2018. The study included patients who experienced out-of-hospital cardiac arrest with a shockable rhythm who were successfully resuscitated without signs of STEMI. Follow-up was performed at 1 year. Data were analyzed, using the intention-to-treat principle, between August 29 and October 10, 2019. INTERVENTIONS: Immediate coronary angiography and PCI if indicated or coronary angiography and PCI if indicated, delayed until after neurologic recovery. MAIN OUTCOMES AND MEASURES: Survival, myocardial infarction, revascularization, implantable cardiac defibrillator shock, quality of life, hospitalization for heart failure, and the composite of death or myocardial infarction or revascularization after 1 year. RESULTS: At 1 year, data on 522 of 552 patients (94.6%) were available for analysis. Of these patients, 413 were men (79.1%); mean (SD) age was 65.4 (12.3) years. A total of 162 of 264 patients (61.4%) in the immediate angiography group and 165 of 258 patients (64.0%) in the delayed angiography group were alive (odds ratio, 0.90; 95% CI, 0.63-1.28). The composite end point of death, myocardial infarction, or repeated revascularization since the index hospitalization was met in 112 patients (42.9%) in the immediate group and 104 patients (40.6%) in the delayed group (odds ratio, 1.10; 95% CI, 0.77-1.56). No significant differences between the groups were observed for the other outcomes at 1-year follow-up. For example, the rate of ICD shocks was 20.4% in the immediate group and 16.2% in the delayed group (odds ratio, 1.32; 95% CI, 0.66-2.64). CONCLUSIONS AND RELEVANCE: In this trial of patients successfully resuscitated after out-of-hospital cardiac arrest and without signs of STEMI, a strategy of immediate angiography was not found to be superior to a strategy of delayed angiography with respect to clinical outcomes at 1 year. Coronary angiography in this patient group can therefore be delayed until after neurologic recovery without affecting outcomes. TRIAL REGISTRATION: trialregister.nl Identifier: NTR4973

Published
2020
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3. Provisional Stenting for the Treatment of Bifurcation Lesions: In Vitro Insights

Author

C K Jaryl, Ng, Valeria, Paradies, George J, Vlachojannis, Han Wei, Toh, Hwa Liang, Leo, E H Philip, Wong, Nicolas, Foin, and Hui Ying, Ang

Subjects
Models, Anatomic, Coronary Thrombosis, Hemodynamics, Models, Cardiovascular, Drug-Eluting Stents, Coronary Artery Disease, Coronary Vessels, Coronary Circulation, Hydrodynamics, Humans, Computer Simulation, Stress, Mechanical, Angioplasty, Balloon, Coronary, Tomography, Optical Coherence
Abstract

Provisional stenting is considered the gold standard approach for most bifurcation lesions, but the benefit of routine side branch (SB) strut dilatation has not been fully elucidated. A benchtop model was used to determine the benefits of routine side branch (SB) dilatation techniques on strut apposition, acute thrombogenicity, and flow disruption. Three different provisional bifurcation techniques were compared: no SB dilatation "keep it open" method (KIO), sequential balloon dilatation (SBD), and kissing balloon inflation (KBI). Stents were deployed in a silicon bifurcation model and perfused with blood at a flow rate of 200 ml/min for 60 min. Optical coherence tomography (OCT) pullbacks were obtained before and after flow perfusion to conduct strut analysis and acute thrombus measurement respectively. Computational fluid dynamics (CFD) models were created using OCT pullbacks and simulated based on experimental conditions to analyze flow disruption. The strut analysis showed that KBI had the lowest percentage of floating (10.6 ± 2.3%) (p = 0.0004) and malapposed (41.2 ± 8.5%) struts (p = 0.59), followed by SBD and then KIO. This correlated to KBI having the lowest amount of thrombus formed at the SB, followed by SBD, with KIO being the most thrombogenic (KBI: 0.84 ± 0.22mm

Published
2020

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