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3. Clinical case of transitional high degree mitral insufficiency

Author

Gatzov, P., Velchev, V., Finkov, B., and Stoyanov, N.

Subjects
myocardial ischemia, eclipsed mitral regurgitation, mitral regurgitation
Abstract

We’re presenting a case of an 80-year-old woman with ischemic heart disease, who for several weeks transitioned between a state of high-grade mitral regurgitation and a state of virtually no mitral regurgitation and vice versa, with no clear link to her clinical presentation. Possible differential diagnoses and the chosen approach to the patient will be discussed.

Published
2022

4. 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes

Author

Knuuti, Juhani, Wijns, William, Saraste, Antti, Capodanno, Davide, Barbato, Emanuele, Funck-Brentano, Christian, Prescott, Eva, Storey, Robert F, Deaton, Christi, Cuisset, Thomas, Agewall, Stefan, Dickstein, Kenneth, Edvardsen, Thor, Escaned, Javier, Gersh, Bernard J, Svitil, Pavel, Gilard, Martine, Hasdai, David, Hatala, Robert, Mahfoud, Felix, Masip, Josep, Muneretto, Claudio, Valgimigli, Marco, Achenbach, Stephan, Bax, Jeroen J, Neumann FJ, Sechtem U, Banning AP, Bonaros N, Bueno H, Bugiardini R, Chieffo A, Crea F, Czerny M, Delgado V, Dendale P, Flachskampf FA, Gohlke H, Grove EL, James S, Katritsis D, Landmesser U, Lettino M, Matter CM, Nathoe H, Niessner A, Patrono C, Petronio AS, Pettersen SE, Piccolo R, Piepoli MF, Popescu BA, Räber L, Richter DJ, Roffi M, Roithinger FX, Shlyakhto E, Sibbing D, Silber S, Simpson IA, Sousa-Uva M, Vardas P, Witkowski A, Zamorano JL, Achenbach S, Agewall S, Barbato E, Bax JJ, Capodanno D, Cuisset T, Deaton C, Dickstein K, Edvardsen T, Escaned J, Funck-Brentano C, Gersh BJ, Gilard M, Hasdai D, Hatala R, Mahfoud F, Masip J, Muneretto C, Prescott E, Saraste A, Storey RF, Svitil P, Valgimigli M, Windecker S, Aboyans V, Baigent C, Collet JP, Dean V, Fitzsimons D, Gale CP, Grobbee D, Halvorsen S, Hindricks G, Iung B, Jüni P, Katus HA, Leclercq C, Lewis BS, Merkely B, Mueller C, Petersen S, Touyz RM, Benkhedda S, Metzler B, Sujayeva V, Cosyns B, Kusljugic Z, Velchev V, Panayi G, Kala P, Haahr-Pedersen SA, Kabil H, Ainla T, Kaukonen T, Cayla G, Pagava Z, Woehrle J, Kanakakis J, Tóth K, Gudnason T, Peace A, Aronson D, Riccio C, Elezi S, Mirrakhimov E, Hansone S, Sarkis A, Babarskiene R, Beissel J, Maempel AJC, Revenco V, de Grooth GJ, Pejkov H, Juliebø V, Lipiec P, Santos J, Chioncel O, Duplyakov D, Bertelli L, Dikic AD, Studenčan M, Bunc M, Alfonso F, Bäck M, Zellweger M, Addad F, Yildirir A, Sirenko Y, Clapp B, Sorbonne Université (SU), 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), Service de pharmacologie médicale [CHU Pitié-Salpêtrière], CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre recherche en CardioVasculaire et Nutrition = Center for CardioVascular and Nutrition research (C2VN), Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Département de Cardiologie [Hôpital de la Timone - APHM], Hôpital de la Timone [CHU - APHM] (TIMONE)-Assistance Publique - Hôpitaux de Marseille (APHM), Knuuti, Juhani, Wijns, William, Saraste, Antti, Capodanno, Davide, Barbato, Emanuele, Funck-Brentano, Christian, Prescott, Eva, Storey, Robert F, Deaton, Christi, Cuisset, Thoma, Agewall, Stefan, Dickstein, Kenneth, Edvardsen, Thor, Escaned, Javier, Gersh, Bernard J, Svitil, Pavel, Gilard, Martine, Hasdai, David, Hatala, Robert, Mahfoud, Felix, Masip, Josep, Muneretto, Claudio, Valgimigli, Marco, Achenbach, Stephan, Bax, Jeroen J, Neumann FJ, Sechtem U, Banning AP, Bonaros N, Bueno H, Bugiardini R, Chieffo A, Crea F, Czerny M, Delgado V, Dendale P, Flachskampf FA, Gohlke H, Grove EL, James S, Katritsis D, Landmesser U, Lettino M, Matter CM, Nathoe H, Niessner A, Patrono C, Petronio AS, Pettersen SE, Piccolo R, Piepoli MF, Popescu BA, Räber L, Richter DJ, Roffi M, Roithinger FX, Shlyakhto E, Sibbing D, Silber S, Simpson IA, Sousa-Uva M, Vardas P, Witkowski A, Zamorano JL, Achenbach S, Agewall S, Barbato E, Bax JJ, Capodanno D, Cuisset T, Deaton C, Dickstein K, Edvardsen T, Escaned J, Funck-Brentano C, Gersh BJ, Gilard M, Hasdai D, Hatala R, Mahfoud F, Masip J, Muneretto C, Prescott E, Saraste A, Storey RF, Svitil P, Valgimigli M, Windecker S, Aboyans V, Baigent C, Collet JP, Dean V, Delgado V, Fitzsimons D, Gale CP, Grobbee D, Halvorsen S, Hindricks G, Iung B, Jüni P, Katus HA, Landmesser U, Leclercq C, Lettino M, Lewis BS, Merkely B, Mueller C, Petersen S, Petronio AS, Richter DJ, Roffi M, Shlyakhto E, Simpson IA, Sousa-Uva M, Touyz RM, Benkhedda S, Metzler B, Sujayeva V, Cosyns B, Kusljugic Z, Velchev V, Panayi G, Kala P, Haahr-Pedersen SA, Kabil H, Ainla T, Kaukonen T, Cayla G, Pagava Z, Woehrle J, Kanakakis J, Tóth K, Gudnason T, Peace A, Aronson D, Riccio C, Elezi S, Mirrakhimov E, Hansone S, Sarkis A, Babarskiene R, Beissel J, Maempel AJC, Revenco V, de Grooth GJ, Pejkov H, Juliebø V, Lipiec P, Santos J, Chioncel O, Duplyakov D, Bertelli L, Dikic AD, Studenčan M, Bunc M, Alfonso F, Bäck M, Zellweger M, Addad F, Yildirir A, Sirenko Y, Clapp B, Clinical sciences, Cardio-vascular diseases, Cardiology, Knuuti, Juhani [0000-0003-3156-9593], Apollo - University of Cambridge Repository, Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Research Unit on Cardiovascular and Metabolic Diseases (ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Institut de Cardiométabolisme et Nutrition = Institute of Cardiometabolism and Nutrition [CHU Pitié Salpêtrière] (IHU ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Assistance Publique - Hôpitaux de Marseille (APHM)- Hôpital de la Timone [CHU - APHM] (TIMONE), University of Zurich, Knuuti, J., Wijns, W., Achenbach, S., Agewall, S., Barbato, E., Bax, J. J., Capodanno, D., Cuisset, T., Deaton, C., Dickstein, K., Edvardsen, T., Escaned, J., Funck-Brentano, C., Gersh, B. J., Gilard, M., Hasdai, D., Hatala, R., Mahfoud, F., Masip, J., Muneretto, C., Prescott, E., Saraste, A., Storey, R. F., Svitil, P., Valgimigli, M., Windecker, S., Aboyans, V., Baigent, C., Collet, J. -P., Dean, V., Delgado, V., Fitzsimons, D., Gale, C. P., Grobbee, D. E., Halvorsen, S., Hindricks, G., Iung, B., Juni, P., Katus, H. A., Landmesser, U., Leclercq, C., Lettino, M., Lewis, B. S., Merkely, B., Mueller, C., Petersen, S., Petronio, A. S., Richter, D. J., Roffi, M., Shlyakhto, E., Simpson, I. A., Sousa-Uva, M., Touyz, R. M., Benkhedda, S., Metzler, B., Sujayeva, V., Cosyns, B., Kusljugic, Z., Velchev, V., Panayi, G., Kala, P., Haahr-Pedersen, S. A., Kabil, H., Ainla, T., Kaukonen, T., Cayla, G., Pagava, Z., Woehrle, J., Kanakakis, J., Toth, K., Gudnason, T., Peace, A., Aronson, D., Riccio, C., Elezi, S., Mirrakhimov, E., Hansone, S., Sarkis, A., Babarskiene, R., Beissel, J., Cassar Maempel, A. J., Revenco, V., de Grooth, G. J., Pejkov, H., Juliebo, V., Lipiec, P., Santos, J., Chioncel, O., Duplyakov, D., Bertelli, L., Dikic, A. D., Studencan, M., Bunc, M., Alfonso, F., Back, M., Zellweger, M., Addad, F., Yildirir, A., Sirenko, Y., and Clapp, B.

Subjects
anti-ischaemic drug, chronic coronary syndromes, medicine.medical_treatment, [SDV]Life Sciences [q-bio], lipid-lowering drugs, Diagnostic Techniques, Cardiovascular, antithrombotic therapy, Disease, 030204 cardiovascular system & hematology, Guideline, Coronary artery disease, 0302 clinical medicine, Disease management (health), Societies, Medical, ComputingMilieux_MISCELLANEOUS, chronic coronary syndrome, angina pectori, Disease Management, food and beverages, imaging, risk assessment, Syndrome, 3. Good health, Natural history, Europe, Cardiology, Cardiology and Cardiovascular Medicine, coronary artery disease, medicine.medical_specialty, lifestyle modifications, anti-ischaemic drugs, Ischemia, 610 Medicine & health, vasospastic angina, Guidelines, Revascularization, diagnostic testing, 11171 Cardiocentro Ticino, 2705 Cardiology and Cardiovascular Medicine, 03 medical and health sciences, angina pectoris, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Internal medicine, medicine, Journal Article, Humans, business.industry, screening, fungi, 030229 sport sciences, medicine.disease, lipid-lowering drug, Angina pectoris, Anti-ischaemic drugs, Antithrombotic therapy, Chronic coronary syndromes, Diagnostic testing, Imaging, Lifestyle modifications, Lipid-lowering drugs, Microvascular angina, Myocardial ischaemia, Myocardial revascularization, Risk assessment, Screening, Vasospastic angina, myocardial ischaemia, myocardial revascularization, Heart failure, microvascular angina, Chronic Disease, Settore MED/11 - MALATTIE DELL'APPARATO CARDIOVASCOLARE, lifestyle modification, Coronary Artery Disease/diagnosis, business, Fibrinolytic agent
Abstract

Coronary artery disease (CAD) is a pathological process characterized by atherosclerotic plaque accumulation in the epicardial arteries, whether obstructive or non-obstructive. This process can be modified by lifestyle adjustments, pharmacological therapies, and invasive interventions designed to achieve disease stabilization or regression. The disease can have long, stable periods but can also become unstable at any time, typically due to an acute atherothrombotic event caused by plaque rupture or erosion. However, the disease is chronic, most often progressive, and hence serious, even in clinically apparently silent periods. The dynamic nature of the CAD process results in various clinical presentations, which can be conveniently categorized as either acute coronary syndromes (ACS) or chronic coronary syndromes (CCS). The Guidelines presented here refer to the management of patients with CCS. The natural history of CCS is illustrated in Figure 1.

Published
2019

8. Present criteria for prophylactic ICD implantation:insights from the EU-CERT-ICD (Comparative Effectiveness Research to Assess the Use of Primary ProphylacTic Implantable Cardioverter Defibrillators in EUrope) project

Author

Zabel, M. (Markus), Schloegl, S. (Simon), Lubinski, A. (Andrzej), Svendsen, J. H. (Jesper Hastrup), Bauer, A. (Axel), Arbelo, E. (Elena), Brusich, S. (Sandro), Conen, D. (David), Cygankiewicz, I. (Iwona), Dommasch, M. (Michael), Flevari, P. (Panagiota), Galuszka, J. (Jan), Hansen, J. (Jim), Hasenfuss, G. (Gerd), Hatala, R. (Robert), Huikuri, H. V. (Heikki V.), Kentta, T. (Tuomas), Kucejko, T. (Tomasz), Haarmann, H. (Helge), Harden, M. (Markus), Iovev, S. (Svetoslav), Kaab, S. (Stefan), Kaliska, G. (Gabriela), Katsimardos, A. (Andreas), Kasprzak, J. D. (Jaroslaw D.), Qavoq, D. (Dariusz), Luethje, L. (Lars), Malik, M. (Marek), Novotny, T. (Tomas), Pavlovic, N. (Nikola), Perge, P. (Peter), Roever, C. (Christian), Schmidt, G. (Georg), Shalganov, T. (Tchavdar), Sritharan, R. (Rajeeva), Svetlosak, M. (Martin), Sallo, Z. (Zoltan), Szavits-Nossan, J. (Janko), Traykov, V. (Vassil), Vandenberk, B. (Bert), Velchev, V. (Vasil), Vos, M. A. (Marc A.), Willich, S. N. (Stefan N.), Friede, T. (Tim), Willems, R. (Rik), Merkely, B. (Bela), and Sticherling, C. (Christian)

Subjects
Sudden cardiac death, Risk factors, Implantable cardioverter defibrillator, Mortality
Abstract

Background: The clinical effectiveness of primary prevention implantable cardioverter defibrillator (ICD) therapy is under debate. It is urgently needed to better identify patients who benefit from prophylactic ICD therapy. The EUropean Comparative Effectiveness Research to Assess the Use of Primary ProphylacTic Implantable Cardioverter Defibrillators (EU-CERT-ICD) completed in 2019 will assess this issue. Summary: The EU-CERT-ICD is a prospective investigator-initiated non-randomized, controlled, multicenter observational cohort study done in 44 centers across 15 European countries. A total of 2327 patients with heart failure due to ischemic heart disease or dilated cardiomyopathy indicated for primary prophylactic ICD implantation were recruited between 2014 and 2018 (>1500 patients at first ICD implantation, >750 patients non-randomized non-ICD control group). The primary endpoint was all-cause mortality, and first appropriate shock was co-primary endpoint. At baseline, all patients underwent 12‑lead ECG and Holter-ECG analysis using multiple advanced methods for risk stratification as well as documentation of clinical characteristics and laboratory values. The EU-CERT-ICD data will provide much needed information on the survival benefit of preventive ICD therapy and expand on previous prospective risk stratification studies which showed very good applicability of clinical parameters and advanced risk stratifiers in order to define patient subgroups with above or below average ICD benefit. Conclusion: The EU-CERT-ICD study will provide new and current data about effectiveness of primary prophylactic ICD implantation. The study also aims for improved risk stratification and patient selection using clinical risk markers in general, and advanced ECG risk markers in particular.

Published
2019

9. Benefit and Risks of Aspirin in Addition to Ticagrelor in Acute Coronary Syndromes: A Post Hoc Analysis of the Randomized GLOBAL LEADERS Trial

Author

Tomaniak, M, Chichareon, P, Onuma, Y, Deliargyris, EN, Takahashi, K, Kogame, N, Modolo, R, Chang, CC, Rademaker-Havinga, T, Storey, RF, Dangas, GD, Bhatt, DL, Angiolillo, DJ, Hamm, C, Valgimigli, M, Windecker, S, Steg, PG, Vranckx, P, Serruys, PW, Bertrand, OF, Plante, S, Van Geuns, RJ, Hofma, SH, Royaards, KJ, Slagboom, T, Suryapranata, H, Umans, VAWM, Rensing, B, van der Harst, P, Magro, M, Barbato, E, Aminian, A, Benit, E, Janssens, L, Vrolix, M, Buysschaert, I, Carrie, D, Barraud, P, Teiger, E, Koning, R, Farzin, B, Morelle, JF, Isaaz, K, Maillard, L, Abdellaoui, M, Brunel, P, Angioi, M, Lantelme, P, Sabate, M, Gonzalez-Trevilla, AA, Cequier, A, Iiguez, A, Penaranda, AS, Miguel, CM, Diaz, JF, Antolin, RAH, Goicolea, J, Ribeiro, VG, da Silva, PC, Ferreira, RC, Almeida, M, Ungi, I, Merkely, B, Fontos, G, Horvath, I, Koszegi, Z, Jambrik, Z, Edes, I, Jozsef, F, Colombo, A, Bolognese, L, Ferrario, M, Tumscitz, C, Dominici, M, Curello, S, Roffi, M, Eeckhout, E, Moccetti, T, Moschovitis, A, Leibundgut, G, Huber, K, Frey, B, Delle Karth, G, Friedrich, G, Steinwender, C, Zweiker, R, Stables, R, Anderson, R, Chowdhary, S, Garg, S, Hildick-Smith, D, Fath-Ordoubadi, F, Oldroyd, KG, Galasko, G, Kukreja, N, Zaman, A, Subkovas, E, Curzen, N, Hoole, S, Talwar, S, Walsh, S, Adlam, D, Cotton, J, Holmvang, L, Ottesen, MM, Buszman, P, Zurakowski, A, Galuszka, G, Prokopczuk, J, Zmudka, K, Jasionowicz, P, Mlodziankowski, A, Liebetrau, C, Naber, CK, Neumann, FJ, Schchinger, V, Seidler, T, Ibrahim, K, Zrenner, B, Gori, T, Werner, N, Akin, I, Geisler, T, vom Dahl, J, Haude, M, Eitel, I, Krackhardt, F, Jung, W, Neto, PAL, Sousa, A, Quintella, EF, Leandro, S, Botelho, R, Raffel, C, Barlis, P, Hai, KT, Ong, P, Petrov, I, Konteva, M, Velchev, V, Gelev, V, Tonev, G, Valkov, V, Vassilev, D, and Trendafilova-Lazarova, D

Abstract

Key PointsQuestionWhat are the benefits and risks of continuing aspirin in addition to P2Y12 receptor inhibition with ticagrelor among patients with acute coronary syndrome between 1 month and 12 months after percutaneous coronary intervention? FindingsIn this nonprespecified, post hoc analysis of the GLOBAL LEADERS randomized clinical trial, beyond 1 month after percutaneous coronary intervention in acute coronary syndrome, aspirin was associated with increased bleeding risk and appeared not to add to the benefit of ticagrelor on ischemic events. MeaningThe findings of this hypothesis-generating analysis pave the way for further trials evaluating aspirin-free antiplatelet strategies after percutaneous coronary intervention. ImportanceThe role of aspirin as part of antiplatelet regimens in acute coronary syndromes (ACS) needs to be clarified in the context of newer potent P2Y12 antagonists. ObjectiveTo evaluate the benefit and risks of aspirin in addition to ticagrelor among patients with ACS beyond 1 month after percutaneous coronary intervention (PCI). Design, Setting, and ParticipantsThis is a nonprespecified, post hoc analysis of GLOBAL LEADERS, a randomized, open-label superiority trial comparing 2 antiplatelet treatment strategies after PCI. The trial included 130 secondary/tertiary care hospitals in different countries, with 15991 unselected patients with stable coronary artery disease or ACS undergoing PCI. Patients had outpatient visits at 1, 3, 6, 12, 18, and 24 months after index procedure. InterventionsThe experimental group received aspirin plus ticagrelor for 1 month followed by 23-month ticagrelor monotherapy; the reference group received aspirin plus either clopidogrel (stable coronary artery disease) or ticagrelor (ACS) for 12 months, followed by 12-month aspirin monotherapy. In this analysis, we examined the clinical outcomes occurring between 31 days and 365 days after randomization, specifically in patients with ACS who, within this time frame, were assigned to receive either ticagrelor alone or ticagrelor and aspirin. Main Outcomes and MeasuresThe primary outcome was the composite of all-cause death or new Q-wave myocardial infarction. ResultsOf 15968 participants, there were 7487 patients with ACS enrolled; 3750 patients were assigned to the experimental group and 3737 patients to the reference group. Between 31 and 365 days after randomization, the primary outcome occurred in 55 patients (1.5%) in the experimental group and in 75 patients (2.0%) in the reference group (hazard ratio [HR], 0.73; 95% CI, 0.51-1.03; P=.07); investigator-reported Bleeding Academic Research Consortium-defined bleeding type 3 or 5 occurred in 28 patients (0.8%) in the experimental group and in 54 patients (1.5%) in the reference arm (HR, 0.52; 95% CI, 0.33-0.81; P=.004). Conclusions and RelevanceBetween 1 month and 12 months after PCI in ACS, aspirin was associated with increased bleeding risk and appeared not to add to the benefit of ticagrelor on ischemic events. These findings should be interpreted as exploratory and hypothesis generating; however, they pave the way for further trials evaluating aspirin-free antiplatelet strategies after PCI. Trial RegistrationClinicalTrials.gov identifier: NCT01813435. This secondary analysis of the GLOBAL LEADERS randomized clinical trial evaluates the benefit and risks of aspirin in addition to ticagrelor among patients with acute coronary syndrome beyond 1 month after percutaneous coronary intervention.

Published
2019

10. Evolocumab and clinical outcomes in patients with cardiovascular disease

Author

Sabatine, Marc S., Giugliano, Robert P., Keech, Anthony C., Honarpour, Narimon, Wiviott, Stephen D., Murphy, Sabina A., Kuder, Julia F., Wang, Huei, Liu, Thomas, Wasserman, Scott M., Sever, Peter S., Pedersen, Fish MP, Terje R., Abrahamsen, Te, Im, K, Kanevsky, E, Bonaca, Mp, Lira Pineda, A, Hanlon, K, Knusel, B, Somaratne, R, Kurtz, C, Scott, R, Accini Mendoza JL, Amerena, J, Badariene, J, Burgess, L, Ceska, R, Charng, Mj, Choi, D, Cobos, Jl, Dan, Ga, De Ferrari GM, Deedwania, Pc, Chopra, Vk, Erglis, A, Ezhov, Mv, Ferreira, J, Filipová, S, Gaciong, Za, Pasierski, T, Georgiev, Bg, Gonzalez-Galvez, G, Gouni-Berthold, I, Schäufele, T, Hirayama, A, Huber, K, Rammer, M, Kjaerulf Jensen, H, Wermuth, S, Jiang, L, Jukema, Jw, Kraydashenko, O, Leiter, La, Lewis, Bs, López-Miranda, J, Lorenzatti, Aj, Mach, F, Mcadam, B, Nilsson, L, Olsson, Å, Rallidis, L, Rogelio, Gg, Kerr Saraiva JF, Scheen, A, Schiele, F, Scott, Rs, Connolly, D, Siu, Cw, Tay, L, Thorgeirsson, G, Tikkanen, Mj, Tokgozoglu, Sl, Toth, K, Viigimaa, M, Wan Ahmad WA, Hennekens, Ch, Andreotti, F, Baigent, C, Brown, Wv, Davis, Br, Newcomer, Jw, Wood, Sk, Larosa, J, Ansell, B, Olsson, A, Lowe, C, Zahn, L, Awtry, E, Berger, C, Croce, K, Desai, A, Gelfand, E, Ho, C, Leeman, D, Link, M, Norden, A, Pande, A, Rost, N, Ruberg, F, Silverman, S, Singhal, A, Vita, J, Mackinnon, I, Vogel, Dr, Leon de la Fuente, R, Perna, E, Amuchastegui, M, Pacora, F, Hershson, A, Blumberg, E, Glenny, Ja, Colombo, H, Cuadrado, Ja, Nicolosi, L, Rojas, Cg, Ulla, Mr, Hasbani, Eg, Cuneo, C, Lopez Santi RG, Sanabria, Hd, Hrabar, A, Lozada, A, Begg, A, Lehman, S, Wittert, G, Juergens, C, Kostner, K, Beltrame, J, Simpson, R, Sinhal, A, Adams, M, Kritharides, L, Roberts Thomson, P, Cross, D, Thompson, P, Van Gaal, W, Cox, N, Farshid, A, Hammett, C, Garrahy, P, Prasan, A, Horrigan, M, Ebenbichler, C, Hanusch, U, Prager, R, Schernthaner, G, Luger, A, Siostrzonek, P, Toplak, H, Bergler-Klein, J, Paulweber, B, Sinzinger, H, Buysschaert, I, Thoeng, J, Vandekerckhove, H, Catez, E, Verheye, S, Descamps, O, Hoffer, E, Wollaert, B, Chenu, P, van de Borne, P, De Meulemeester, M, Friart, A, Charlier, F, De Raedt, H, Rietzschel, E, Roelandt, R, Lalmand, J, Tavares Russo LA, Reis, G, Duarte Barbosa EC, Vidotti, Mh, Fernandes Manenti ER, Dutra, O, Leaes, Pe, Rech, Rl, Bertolim Precoma, D, Nicolau, Jc, Amoedo, R, Eliaschewitz, Fg, Pereira, A, Kurtz Lisboa HR, Soares Piegas, L, Cunha Borges JL, Ferreira Rossi PR, Pimentel Filho, P, Bodanese, Lc, de Sa Cunha, R, Moura Jorge JC, Ardito, Wr, Barroso de Souza WK, Hissa, M, Izar, Mc, Manolova, A, Kitova, L, Kinova, E, Tzekova, M, Velchev, V, Tarnovska-Kadreva, R, Gotchev, D, Petrov, I, Raev, D, Trendafilova-Lazarova, D, Yotov, Y, Lazov, P, Rahimi, S, St Amour, E, Constance, C, Pesant, Y, Hess, A, Anderson, T, Sussex, B, Henein, S, Tsoukas, G, Pandey, As, Bergeron, J, Hart, R, Gosselin, G, Chehayeb, R, Hamet, P, Hartleib, M, Mukherjee, A, Halperin, F, Petrella, R, Bhargava, R, Lonn, E, Sabbah, E, Bata, I, Cha, J, Gaudet, D, Chapman, K, Murthy, D, Nigro, F, Rupka, D, Gossard, D, Gupta, M, Dowell, A, Mansour, S, Baass, A, Geadah, C, Huynh, T, Peterson, S, Poirier, P, Sabe-Affaki, G, Vertes, G, Crowley, D, Duchesne, L, Pincetti Jofre CP, Potthoff Cardenas, S, Conejeros Kindel, C, Saavedra Gajardo VA, Lanas Zanetti, F, Sepulveda Varela PA, Stockins Fernandez BA, Li, W, Li, D, Zhao, S, Li, Z, Wang, J, Yang, Y, Zhang, L, Yang, P, Zhang, X, Huang, H, Xue, L, Zheng, Z, Huang, W, Dai, H, Su, H, Zeng, X, Zheng, Y, Tang, Y, Yao, Z, Sun, Y, Du, Y, Ge, Z, Yan, J, Chen, X, Liu, F, Pei, H, Yang, X, Cui, H, Gu, Y, Yang, Z, Li, J, Lian, Y, Cui, Y, Wang, D, Jiang, J, Li, X, Chen, J, Mo, Z, Xu, P, He, Y, Zhou, C, Qu, P, Zhu, Y, Liu, Y, Shen, X, Gao, X, Terront Lozano MA, Moncada Corredor MA, Hernandez Triana, E, Botero Lopez, R, Coronel Arroyo JA, Quintero Baiz AE, Sanchez Vallejo, G, Arana Londoño, C, Molina de Salazar DI, Castellanos Bueno, R, Manzur Jattin, F, Cure Cure CA, Sotomayor Herazo, 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Beer, H, Eberli, F, Krahenbuhl, S, Linka, A, Ackermann, D, Michel, P, Yeh, H, Tsai, C, Wu, C, Hsia, C, Juang, J, Hsieh, I, Lai, W, Huang, C, Hsieh, Y, Sahin, T, Duzenli, M, Yigit, Z, Demir, M, Yilmaz, M, Muderrisoglu, I, Kirma, C, Ercan, E, Kayikcioglu, L, Balbay, Y, Lymar, I, Kulynych, O, Prokhorov, O, Karpenko, O, Kraіz, I, Vakaliuk, I, Stanislavchuk, M, Korzh, O, Rudyk, I, Zhurba, S, Svishchenko, Y, Tseluyko, V, Gyrina, O, Reshotko, D, Kopytsya, M, Volkov, V, Myshanych, G, Rebrov, B, Rishko, M, Rudenko, L, Shatylo, V, Parkhomenko, O, Yena, L, Golovchenko, O, Sorokina, I, Malynovsky, Y, Ivan, P, Blagden, M, Dear, H, Mathew, A, Lagocki, S, Kondagunta, V, Ahsan, A, Mckinnon, C, Douglas, F, Thom, S, Fiore, G, Caulfield, M, Lynch, M, Thomas, H, Bain, S, Hall, A, Mcnally, D, Fisher, M, Keeling, P, Al-Bahrani, A, Lip, G, Ellery, A, Purohit, J, Travill, C, Cappuccio, F, Davis, G, Gaunt, R, Adlam, D, Asamoah, N, Jaafar, F, Mccormack, T, Jupp, B, Pye, M, Ainsworth, P, Chauhan, A, Paul, N, 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Wiseman, A, Doyle, T, Henderson, D, Herzog, W, Schnitzler, R, Carr, K, Davis, M, Nagajothi, N, Olsen, S, Rogers, W, Rubino, J, Singh, I, Tarleton, G, Bhagwat, R, Clardy, D, Jardula, M, Robinson, J, Torres, M, Vijay, N, Farris, N, Lillo, J, Moriarty, P, Recknor, C, Berlacher, P, Christensen, T, Gabra, N, Issa, M, Janik, M, Lawless, A, Molter, D, Stout, E, Brezina, B, Claxton, E, Linsky, R, Poock, J, Remler, R, Roseman, H, Schramm, E, Al-Joundi, T, Amin, J, Hitchcock, J, Isserman, S, Kirstein, J, Rider, J, Shalek, M, Sherman, H, Bernstein, M, Chandra, L, Hatharasinghe, R, Ibrahim, H, Iteld, B, Linzmeyer, K, Seaton, B, Zeig, S, Christofides, E, Dunbar, R, Griffin, S, Kohli, N, Koren, M, Pharr, W, Purdy, D, Spencer, R, Yeoman, G, Banerjee, S, Cheek, H, Engel, E, Hamroff, G, Huling, R, Kozlowski, L, Levin, P, Makam, S, Meengs, M, Bhushan, R, Erickson, B, Herman, L, Lo, E, Mcdowell, E, Mcgrew, F, Miller, M, Ord, J, Webel, R, Wilhoit, G, Wise, J, Yang, E, Budoff, M, Collins, J, Dauber, I, 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Subjects
Male, STATIN THERAPY, 2700 General Medicine, Disease, Cardiovascular, PLACEBO-CONTROLLED TRIAL, Gastroenterology, 0302 clinical medicine, Anticholesteremic Agent, Medicine, Myocardial infarction, 11 Medical and Health Sciences, ddc:616, Incidence, Antibodies, Monoclonal, General Medicine, Cholesterol, Cardiovascular Diseases, Monoclonal, Drug Therapy, Combination, Proprotein Convertase 9, Antibody, Aged, Anticholesteremic Agents, Atherosclerosis, Cholesterol, LDL, Double-Blind Method, Female, Follow-Up Studies, Humans, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Hypercholesterolemia, Least-Squares Analysis, Middle Aged, Medicine (all), REDUCING LIPIDS, Human, medicine.medical_specialty, Evinacumab, Clinical Trials and Supportive Activities, PCSK9 INHIBITION, Follow-Up Studie, LDL, 03 medical and health sciences, Drug Therapy, Clinical Research, LDL-C, Least-Squares Analysi, Science & Technology, Unstable angina, PCSK9, medicine.disease, chemistry, Clinical Biochemistry, 030204 cardiovascular system & hematology, Bococizumab, FOURIER Steering Committee and Investigators, Medical and Health Sciences, chemistry.chemical_compound, Antibodies monoclonal, Cardiovascular Disease, 030212 general & internal medicine, Stroke, Humanized, RISK, biology, PCSK9 Inhibitors, 10051 Rheumatology Clinic and Institute of Physical Medicine, Heart Disease, Atherosclerosi, 6.1 Pharmaceuticals, Combination, Cardiology, Life Sciences & Biomedicine, Antibodies, Monoclonal, Humanized, EZETIMIBE, 610 Medicine & health, Antibodies, Medicine, General & Internal, General & Internal Medicine, Internal medicine, CORONARY-HEART-DISEASE, In patient, Heart Disease - Coronary Heart Disease, Alirocumab, Ldl cholesterol, business.industry, Evaluation of treatments and therapeutic interventions, Evolocumab, Good Health and Well Being, Settore MED/11 - MALATTIE DELL'APPARATO CARDIOVASCOLARE, biology.protein, MODERATE, Hydroxymethylglutaryl-CoA Reductase Inhibitor, business
Abstract

Background Evolocumab is a monoclonal antibody that inhibits proprotein convertase subtilisin–kexin type 9 (PCSK9) and lowers low-density lipoprotein (LDL) cholesterol levels by approximately 60%. Whether it prevents cardiovascular events is uncertain. Methods We conducted a randomized, double-blind, placebo-controlled trial involving 27,564 patients with atherosclerotic cardiovascular disease and LDL cholesterol levels of 70 mg per deciliter (1.8 mmol per liter) or higher who were receiving statin therapy. Patients were randomly assigned to receive evolocumab (either 140 mg every 2 weeks or 420 mg monthly) or matching placebo as subcutaneous injections. The primary efficacy end point was the composite of cardiovascular death, myocardial infarction, stroke, hospitalization for unstable angina, or coronary revascularization. The key secondary efficacy end point was the composite of cardiovascular death, myocardial infarction, or stroke. The median duration of follow-up was 2.2 years. Results At 48 weeks, the least-squares mean percentage reduction in LDL cholesterol levels with evolocumab, as compared with placebo, was 59%, from a median baseline value of 92 mg per deciliter (2.4 mmol per liter) to 30 mg per deciliter (0.78 mmol per liter) (P

Published
2017

11. 2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension

Author

Galie N., Humbert M., Vachiery J. -L., Gibbs S., Lang I., Torbicki A., Simonneau G., Peacock A., Vonk Noordegraaf A., Beghetti M., Ghofrani A., Gomez Sanchez M. A., Hansmann G., Klepetko W., Lancellotti P., Matucci M., McDonagh T., Pierard L. A., Trindade P. T., Zompatori M., Hoeper M., Aboyans V., Vaz Carneiro A., Achenbach S., Agewall S., Allanore Y., Asteggiano R., Badano L., Albert Barbera J., Bouvaist H., Bueno H., Byrne R. A., Carerj S., Castro G., Erol C., Falk V., Funck-Brentano C., Gorenflo M., Granton J., Iung B., Kiely D. G., Kirchhof P., Kjellstrom B., Landmesser U., Lekakis J., Lionis C., Lip G. Y. H., Orfanos S. E., Park M. H., Piepoli M. F., Ponikowski P., Revel M. -P., Rigau D., Rosenkranz S., Voller H., Luis Zamorano J., Myftiu S., Bonderman D., Firdovsi I., Lazareva I., De Pauw M., Sokolovic S., Velchev V., Cikes M., Moutiris J. A., Jansa P., Nielsen-Kudsk J. E., Anton L., Jaaskelainen P., Bauer F., Chukhrukidze A., Opitz C., Giannakoulas G., Karlocai K., Oddsson O., Gaine S., Menachemi D., Emdin M., Sooronbaev T., Rudzitis A., Gumbiene L., Lebrun F., Micallef J., Botnaru V., Oukerraj L., Andreassen A. K., Kurzyna M., Leite Baptista M. J. R., Coman I. M., Moiseeva O., Stefanovic B. S., Simkova I., Wikstrom G., Schwerzmann M., Srbinovska-Kostovska E., van Dijk A. P. J., Mahdhaoui A., Kaymaz C., Coghlan G., Sirenko Y., Galie, N, Humbert, M, Vachiery, J, Gibbs, S, Lang, I, Torbicki, A, Simonneau, G, Peacock, A, Vonk Noordegraaf, A, Beghetti, M, Ghofrani, A, Gomez Sanchez, M, Hansmann, G, Klepetko, W, Lancellotti, P, Matucci, M, Mcdonagh, T, Pierard, L, Trindade, P, Zompatori, M, Hoeper, M, Aboyans, V, Vaz Carneiro, A, Achenbach, S, Agewall, S, Allanore, Y, Asteggiano, R, Badano, L, Albert Barbera, J, Bouvaist, H, Bueno, H, Byrne, R, Carerj, S, Castro, G, Erol, C, Falk, V, Funck-Brentano, C, Gorenflo, M, Granton, J, Iung, B, Kiely, D, Kirchhof, P, Kjellstrom, B, Landmesser, U, Lekakis, J, Lionis, C, Lip, G, Orfanos, S, Park, M, Piepoli, M, Ponikowski, P, Revel, M, Rigau, D, Rosenkranz, S, Voller, H, Luis Zamorano, J, Myftiu, S, Bonderman, D, Firdovsi, I, Lazareva, I, De Pauw, M, Sokolovic, S, Velchev, V, Cikes, M, Moutiris, J, Jansa, P, Nielsen-Kudsk, J, Anton, L, Jaaskelainen, P, Bauer, F, Chukhrukidze, A, Opitz, C, Giannakoulas, G, Karlocai, K, Oddsson, O, Gaine, S, Menachemi, D, Emdin, M, Sooronbaev, T, Rudzitis, A, Gumbiene, L, Lebrun, F, Micallef, J, Botnaru, V, Oukerraj, L, Andreassen, A, Kurzyna, M, Leite Baptista, M, Coman, I, Moiseeva, O, Stefanovic, B, Simkova, I, Wikstrom, G, Schwerzmann, M, Srbinovska-Kostovska, E, van Dijk, A, Mahdhaoui, A, Kaymaz, C, Coghlan, G, and Sirenko, Y

Subjects
Endothelin receptor antagonist, Chronic thromboembolic pulmonary hypertension, Heart failure, Guideline, Prostacyclin analogue, Respiratory failure, Pulmonary arterial hypertension, Chronic thromboembolic pulmonary hypertension, Congenital heart disease, Connective tissue disease, Endothelin receptor antagonists, Guidelines, Heart failure, Left heart disease, Lung disease, Phosphodiesterase type 5 inhibitors, Prostacyclin analogues, Pulmonary arterial hypertension, Pulmonary hypertension, Respiratory failure, Pulmonary hypertension, Phosphodiesterase type 5 inhibitor, Left heart disease, Lung disease, Connective tissue disease, Congenital heart disease
Abstract

Document Reviewers: Victor Aboyans (CPG Review Coordinator) (France), Antonio Vaz Carneiro (CPG Review Coordinator) (Portugal), Stephan Achenbach (Germany), Stefan Agewall (Norway), Yannick Allanore (France), Riccardo Asteggiano (Italy), Luigi Paolo Badano (Italy), Joan Albert Barbera (Spain), Helene Bouvaist (France), Hector Bueno (Spain), Robert A. Byrne (Germany), Scipione Carerj (Italy), Graca Castro (Portugal), Cetin Erol (Turkey), Volkmar Falk (Germany), Christian Funck-Brentano (France), Matthias Gorenflo (Germany), John Granton (Canada), Bernard Iung (France), David G. Kiely (UK), Paulus Kirchhof (Germany/UK), Barbro Kjellstrom (Sweden), Ulf Landmesser (Switzerland), John Lekakis (Greece), Christos Lionis (Greece), Gregory Y. H. Lip (UK), Stylianos E. Orfanos (Greece), Myung H. Park (USA), Massimo F. Piepoli (Italy), Piotr Ponikowski (Poland), Marie-Pierre Revel (France), David Rigau (ERS methodologist) (Switzerland), Stephan Rosenkranz (Germany), Heinz Voller (Germany), and Jose Luis Zamorano (Spain)

Published
2016

15. Abstracts

Author

Barthelemy, O., primary, Silvain, J., additional, Brieger, D., additional, Bellemain-Appaix, A., additional, Cayla, G., additional, Beygui, F., additional, Lancar, R., additional, Collet, J. P., additional, Mercadier, A., additional, Montalescot, G., additional, Cha, K. S., additional, Nam, Y. H., additional, Kim, J. H., additional, Park, S. Y., additional, Park, T. H., additional, Kim, M. H., additional, Kim, Y. D., additional, Lee, H. C., additional, Ahn, M. S., additional, Hong, T. J., additional, Blanco, R., additional, Blanco, F., additional, Szarfer, J., additional, Garcia Escudero, A., additional, Gigena, G., additional, Gagliardi, J., additional, Rodriguez, A., additional, Sarmiento, R., additional, Affatatto, S., additional, Riccitelli, M., additional, Petris, A., additional, Datcu, M. D., additional, Pop, C., additional, Radoi, M., additional, Arsenescu-Georgescu, C., additional, Petrescu, I., additional, Petrescu, L., additional, Serban, L., additional, Nechita, E., additional, Tatu-Chitoiu, G., additional, Dorobantu, M., additional, Benedek, I., additional, Craiu, E., additional, Sinescu, C., additional, Ionescu, D. D., additional, Ginghina, C., additional, Minescu, B., additional, Izzo, A., additional, Mantovani, P., additional, Tomasi, L., additional, Dall'oglio, L., additional, Bonatti, S., additional, Rosiello, R., additional, Romano, M., additional, Agostini, F., additional, Zanini, R., additional, Zhao, Z. Y., additional, Wu, Y. J., additional, Li, J. J., additional, Yany, Y. J., additional, Qian, H. Y., additional, Tang, Y. D., additional, Timoteo, A. T., additional, Toste, A., additional, Lousinha, A., additional, Ramos, R., additional, Oliveira, J. A., additional, Ferreira, M. L., additional, Ferreira, R. C., additional, Cabades, C., additional, Diez Gil, J. L., additional, Aguar, P., additional, Sanmiguel, D., additional, Lopez-March, A., additional, Marmol, R., additional, Guerra, L., additional, Girbes, V., additional, Ferrando, J., additional, Rincon De Arellano, A., additional, Patricio, L., additional, Blondal, M., additional, Ainla, T., additional, Marandi, T., additional, Eha, J., additional, Oliveira, M. M., additional, Silva, M. N., additional, Cunha, P. S., additional, Feliciano, J., additional, Silva, S., additional, Kanovsky, J., additional, Kala, P., additional, Parenica, J., additional, Poloczek, M., additional, Prymusova, K., additional, Kubkova, L., additional, Spinar, J., additional, Olinic, D., additional, Homorodean, C., additional, Ober, M., additional, Olinic, M., additional, Andrioaia, C., additional, Condac, A., additional, Masmoudi, M., additional, Berdaoui, B., additional, Labidi, S., additional, Tapia Ballesteros, C., additional, Hernandez Luis, C., additional, Sandin, M. G., additional, Vegas, J. M., additional, Andion, R., additional, Martinez, N., additional, Gonzalez, I. A., additional, Alvarado, M., additional, Amat, I. J., additional, San Roman, J. A., additional, Garcia Gonzalez, M. J., additional, Arroyo Ucar, E., additional, Hernandez Garcia, C., additional, Dorta Martin, M., additional, Marrero Rodriguez, F., additional, Dragu, R., additional, Kapeliovich, M., additional, Hammerman, H., additional, Silva, D., additional, Cortez-Dias, N., additional, Jorge, C., additional, Silva Marques, J., additional, Carilho Ferreira, P., additional, Robalo Martins, S., additional, Almeida Ribeiro, M., additional, Calisto, C., additional, Fiuza, M., additional, Lopes, M. G., additional, Milicevic, P., additional, Panic, M., additional, Stankovic, I., additional, Milicevic, D., additional, Kalezic, T., additional, Kafedzic, S., additional, Ilic, I., additional, Cerovic, M., additional, Putnikovic, B., additional, Neskovic, A., additional, Rott, D., additional, Leibowitz, D., additional, Monhart, Z., additional, Reissigova, J., additional, Grunfeldova, H., additional, Jansky, P., additional, Valente, B., additional, Villanueva Benito, I., additional, Solla, I., additional, Paredes, E., additional, Diaz Castro, O., additional, Calvo, F., additional, Baz, J. A., additional, Iniguez, A., additional, Aleksova, A., additional, Gerloni, R., additional, Belfiore, R., additional, Carriere, C., additional, Barbati, G., additional, Fabris, E., additional, Possa, F., additional, Nait, D., additional, Milo, M., additional, Sinagra, G., additional, Marques, N., additional, Mimoso, J., additional, Gomes, V., additional, Agra Bermejo, R. M., additional, Emad Abu Assi, E. A. A., additional, Sergio Raposeiras Roubin, S. R. R., additional, Pilar Cabanas Grandio, P. C. G., additional, Carlos Pena Gil, C. P. G., additional, Jose Maria Garcia Acuna, J. M. G. A., additional, Jose Ramon Gonzalez Juanatey, J. R. G. J., additional, Daly, M. J., additional, Scott, P., additional, Owens, C. G., additional, Tomlin, A., additional, Smith, B., additional, Adgey, A. A. J., additional, Alvarez-Contreras, L. R., additional, Juarez, U., additional, Altamirano, A., additional, Arias, A., additional, Alvarez-San Gabriel, A., additional, Gonzalez-Pacheco, H., additional, Martinez-Sanchez, C., additional, Rahnavardi, M., additional, Keshtkar-Jahromi, M., additional, Vakili, H., additional, Gholamin, S., additional, Razavi, S. M., additional, Gilis-Januszewski, T., additional, Mellwig, K.- P., additional, Wiemer, M., additional, Gilis-Januszewski, J., additional, Peterschroeder, A., additional, Koerfer, J., additional, Horstkotte, D., additional, Vrsalovic, M., additional, Getaldic, B., additional, Vrkic, N., additional, Pintaric, H., additional, Khan, S., additional, Wasan, B., additional, Moretti, L., additional, Grossi, P., additional, Silenzi, S., additional, Testa, M., additional, Candelori, L., additional, Clementi, L. N., additional, Forlini, M., additional, Lando, L., additional, Pezzuoli, M. L., additional, Corradetti, P., additional, Leurent, G., additional, Pennec, P. Y., additional, Filippi, E., additional, Moquet, B., additional, Hacot, J. P., additional, Druelles, P., additional, Rialan, A., additional, Rouault, G., additional, Coudert, I., additional, Le Breton, H., additional, Gevaert, S., additional, Tromp, F., additional, Vandecasteele, E., additional, De Somer, F., additional, Van Belleghem, Y., additional, Bouchez, S., additional, Martens, F., additional, Herck, I., additional, De Pauw, M., additional, Ludka, O., additional, Sepsi, M., additional, Miklik, R., additional, Dusek, L., additional, Tomcikova, D., additional, Garcia-Acuna, J. M., additional, Aguiar-Souto, P., additional, Raposeiras Roubin, S., additional, Agra-Bermejo, R., additional, Jacquet, M., additional, Abu-Assi, E., additional, Gonzalez-Juanatey, J. R., additional, Ibatov, A., additional, Labrova, R., additional, Karlik, R., additional, Lokaj, P., additional, She, Q., additional, Deng, S. B., additional, Huang, S. H., additional, Gu, L. J., additional, Rong, J. I. A. N., additional, Wu, Z. K., additional, Li, Y., additional, Zhang, J., additional, Parascan, L., additional, Campanile, A., additional, Spinelli, L., additional, Santulli, G., additional, Ciccarelli, M., additional, De Gennaro, S., additional, Assante Di Panzillo, E., additional, Trimarco, B., additional, Iaccarino, G., additional, Bobescu, E., additional, Datcu, G., additional, Dobreanu, D., additional, Doka, B., additional, Charniot, J.- C., additional, Cosson, C., additional, Albertini, J. P., additional, Bittar, R., additional, Giral, P., additional, Cherfils, C., additional, Guillerm, E., additional, Bonnefont-Rousselot, D., additional, Rusali, A., additional, Cojocaru, L., additional, Parepa, I., additional, Koizumi, T., additional, Iida, S., additional, Sato, J., additional, Kikutani, T., additional, Muramatsu, T., additional, Nishimura, S., additional, Komiyama, N., additional, Lee, W. P., additional, Ong, B. B., additional, Haralambos, K., additional, Townsend, D., additional, Rees, J. A. E., additional, Williams, E. J., additional, Halcox, J. P., additional, Mcdowell, I., additional, Damjanovic, M., additional, Koracevic, G., additional, Djordjevic-Radojkovic, D., additional, Pavlovic, M., additional, Krstic, N., additional, Ciric-Zdravkovic, S., additional, Stojkovic, A., additional, Perisic, Z., additional, Apostolovic, S., additional, Faustino, A., additional, Seca, L., additional, Barra, S., additional, Caetano, F., additional, Providencia, R., additional, Silva, J., additional, Gomes, P., additional, Costa, G., additional, Costa, M., additional, Leitao-Marques, A., additional, Volkova, A. L., additional, Arutyunov, G. P., additional, Bylova, N. A., additional, Dayter, I. I., additional, Jao, Y. T. F. N., additional, Fang, C. C., additional, Chen, Y., additional, Yu, C. L., additional, Wang, S. P., additional, Valencia, J., additional, Perez-Berbel, P., additional, Ruiz-Nodar, J. M., additional, Pineda, J., additional, Bordes, P., additional, Quintanilla, M., additional, Mainar, V., additional, Sogorb, F., additional, Santos, N., additional, Serrao, M., additional, Cafe, H., additional, Silva, B., additional, Oliveira, R., additional, Caires, G., additional, Drumond, A., additional, Araujo, J., additional, Providencia, R. A., additional, Gomes, P. L., additional, Pais, J. R., additional, Mota, P., additional, Leitao-Marques, A. M., additional, Farhan, S., additional, Jarai, R., additional, Tentzeris, I., additional, Vogel, B., additional, Freynhofer, M. K., additional, Wojta, J., additional, Huber, K., additional, Poli, M., additional, Trambaiolo, P., additional, Corsi, F., additional, De Luca, M., additional, Mustilli, M., additional, Lukic, V., additional, Simonetti, M., additional, Ferraiuolo, G., additional, Lettino, M., additional, Casella, G., additional, Conte, M. R., additional, De Luca, L., additional, Geraci, G., additional, Ceravolo, R., additional, Pani, A., additional, Fradella, G., additional, Schratter, A., additional, Thiele, H., additional, Klemm, T., additional, Demmin, K., additional, Lehmann, D., additional, Mende, M., additional, Schuler, G., additional, Pittl, U., additional, Chernova, A., additional, Nikulina, S. U., additional, Naruke, T., additional, Inomata, T., additional, Yanagisawa, T., additional, Maekawa, E., additional, Mizutani, T., additional, Shinagawa, H., additional, Nishii, M., additional, Takeuchi, I., additional, Takehana, H., additional, Izumi, T., additional, Paulo, C., additional, Mascarenhas, J., additional, Patacho, M., additional, Pimenta, J., additional, Bettencourt, P., additional, Nardai, S., additional, Szabo, G. Y., additional, Berta, B., additional, Edes, I., additional, Merkely, B., additional, Delgado Silva, J., additional, Baptista, R., additional, Faria, R., additional, Trigo, J., additional, Gago, P., additional, Gheorghe, G., additional, Nanea, I. T., additional, Cristea, A., additional, Almarichi, S., additional, Martins, H., additional, Saraiva, F., additional, Jorge, E., additional, Mendes, P. L., additional, Monteiro, P., additional, Costa, S., additional, Franco, F., additional, Providencia, L. A., additional, Nanea, T., additional, Gheorghe, G. S., additional, Visan, S., additional, Paun, N., additional, Gaber, R., additional, Delewi, R., additional, Nijveldt, R., additional, De Bruin, H. A., additional, Hirsch, A., additional, Van Der Laan, A., additional, Bouma, B. J., additional, Tijssen, J. P. G., additional, Van Rossum, A. C., additional, Zijlstra, F., additional, Piek, J. J., additional, Rus, H., additional, Donea, M., additional, Ciurea, C., additional, Ifteni, G., additional, Casolo, G., additional, Chioccioli, M., additional, Magnacca, M., additional, Del Meglio, J., additional, Comella, A., additional, Baratto, M., additional, Lera, J., additional, Salvadori, L., additional, Tessa, C., additional, Vignali, C., additional, Keca, Z., additional, Momcilov Popin, T., additional, Panic, G., additional, White, R., additional, Mateen, F., additional, Weaver, A., additional, Agmon, Y., additional, Okisheva, E., additional, Tsaregorodtsev, D., additional, Sulimov, V., additional, Amat Santos, I. J., additional, Hernandez, C., additional, Tapia, C., additional, Campo, A., additional, Fredman, D., additional, Svensson, L., additional, Rosenqvist, M., additional, Tadel-Kocjancic, S., additional, Radsel, P., additional, Knafelj, R., additional, Gorjup, V., additional, Noc, M., additional, Zima, E., additional, Jenei, Z. S., additional, Kovacs, E., additional, Osztheimer, I., additional, Molnar, L., additional, Horvath, A., additional, Becker, D., additional, Geller, L., additional, Maggi, R., additional, Furukawa, T., additional, Viscardi, V., additional, Brignole, M., additional, Leal, S. R. N., additional, Dores, H., additional, Rosario, I., additional, Monge, J., additional, Carvalho, M. J., additional, Arroja, I., additional, Leitao, A., additional, Fonseca, C., additional, Aleixo, A., additional, Silva, A., additional, Keuleers, S., additional, Herijgers, P., additional, Herregods, M. C., additional, Budts, W., additional, Dubois, C., additional, Meuris, B., additional, Verhamme, P., additional, Flameng, W., additional, Van De Werf, F., additional, Adriaenssens, T., additional, Badran, H., additional, Elnoamany, M., additional, Lolah, T., additional, Olariu, C., additional, Macarie, C., additional, Mollik, M. A. H., additional, Hassan, A. I., additional, Paul, T. K., additional, Haque, M. Z., additional, Jahan, R., additional, Rahmatullah, M., additional, Khatun, M. A., additional, Rahman, M. T., additional, Chowdhury, M. H., additional, Bustamante Munguira, J., additional, Tamayo, E., additional, Garcia-Cuenca, I., additional, Bustamante, E., additional, Gualis, J., additional, Gomez-Martinez, M. L., additional, Florez, S., additional, Gomez-Herreras, J. I., additional, Ramirez Rodriguez, R., additional, Ramirez Rodriguez, A. M., additional, Garcia-Bello, M. A., additional, Hernadez Ortega, E., additional, Caballero Dorta, E., additional, Garcia Quintana, A., additional, Piro Mastraccio, V., additional, Medina Fernandez Aceytuno, A., additional, Assanelli, E., additional, De Metrio, M., additional, Rubino, M., additional, Lauri, G., additional, Cabiati, A., additional, Campodonico, J., additional, Grazi, M., additional, Moltrasio, M., additional, Marana, I., additional, Marenzi, G., additional, Lovlien, M., additional, Schei, B., additional, Picon-Heras, R., additional, Acebal, C., additional, Garcia Rubira, J. C., additional, Vivas Balcones, D., additional, Nunez-Gil, I., additional, Ruiz-Mateos, B., additional, Ibanez, B., additional, Fernandez-Ortiz, A., additional, Vintila, V. D., additional, Enescu, O. A., additional, Stoicescu, C. I., additional, Udroiu, C., additional, Cinteza, M., additional, Tatu - Chitoiu, G., additional, Vinereanu, D., additional, Fresco, C., additional, De Biasio, M., additional, Muser, D., additional, Sappa, R., additional, Morocutti, G., additional, Bernardi, G., additional, Proclemer, A., additional, Fontanella, B., additional, Affatato, A., additional, Ciccarese, C., additional, Sacchini, M., additional, Volpini, M., additional, Bianchetti, F., additional, Verzura, G., additional, Dei Cas, L., additional, Pudil, R., additional, Blaha, V., additional, Vojacek, J., additional, Paraskevaidis, I., additional, Ikonomidis, I., additional, Parissis, J., additional, Papadopoulos, C., additional, Stasinos, V., additional, Bistola, V., additional, Anastasiou-Nana, M., additional, Shochat, M., additional, Shotan, A., additional, Kazatsker, M., additional, Gurovich, V., additional, Asif, A., additional, Noiman, E., additional, Levy, Y., additional, Blondhaim, D., additional, Rabinovich, P., additional, Meisel, S., additional, Petrovic, S., additional, Glasnovic, J., additional, Tomasevic, M., additional, Sakac, D., additional, Obradovic, S., additional, Londono Sanchez, O., additional, Pacreu, S., additional, Torres, L., additional, Mihaylov, G., additional, Shaban, G. M., additional, Trendafilova, E., additional, Krasteva, V., additional, Mudrov, T. S., additional, Didon, J. P., additional, Panageas, V., additional, Vlachos, N., additional, Pernat, A., additional, Radan, I., additional, Mozina, H., additional, Pepi, P., additional, Cionini, F., additional, Baccaglioni, N., additional, Viertel, A., additional, Havers, J., additional, Ballard, G., additional, Groenefeld, G., additional, Branco, L. M., additional, Ferreira, L., additional, Fiarresga, A., additional, Lettieri, L., additional, Reggiani, A., additional, Juarez Prera, R., additional, Blanco Palacios, G., additional, Martin, A.- C., additional, Manzo Silberman, S., additional, Chaib, A., additional, Varenne, O., additional, Allouch, P., additional, Salengro, E., additional, Jegou, A., additional, Margot, O., additional, Spaulding, C., additional, Diego, A., additional, De Miguel, A., additional, Cuellas, C., additional, Fraile, E., additional, Martin, J., additional, Vega, B., additional, Bangueses, R., additional, Fernandez-Vazquez, F., additional, Perez De Prado, A., additional, Leal, S., additional, Correia, M. J., additional, Monge, J. C., additional, Abecasis, J., additional, Garcia-Garcia, C., additional, Subirana, I., additional, Sala, J., additional, Bruguera, J., additional, Valle, V., additional, Sanz, G., additional, Fiol, M., additional, Aros, F., additional, Marrugat, J., additional, Elosua, R., additional, Barra, S. N. C., additional, Leitao Marques, A., additional, Yang, Y. J., additional, Xu, B., additional, Song, G. Y., additional, G, R. L., additional, Aleksic, A., additional, Serpytis, P., additional, Rucinskas, K., additional, Kalinauskas, A., additional, Karvelyte, N., additional, Santos De Sousa, C. I., additional, Ferreira, S., additional, Calaca, J., additional, Lousada, N., additional, Palma Reis, R., additional, Gualandro, D. M., additional, Seguro, L. F. B. C., additional, Braga, F. G. M., additional, Silvestre, O. M., additional, Lage, R. L., additional, Fabri, J., additional, Oliveira, M. T., additional, Urbano Moral, J. A., additional, Torres Llergo, J., additional, Solanilla Rodriguez, R., additional, Sanchez Gonzalez, A., additional, Martinez Martinez, A., additional, Den Uil, C. A., additional, Lagrand, W. K., additional, Van Der Ent, M., additional, Jewbali, L. S. D., additional, Cheng, J. M., additional, Spronk, P. E., additional, Simoons, M. L., additional, Mornos, C., additional, Dragulescu, D., additional, Ionac, A., additional, Guardado, J., additional, Azevedo, O., additional, Fernandes, M., additional, Canario-Almeida, F., additional, Sanfins, V., additional, Pereira, A., additional, Almeida, J., additional, Kaplunova, V. U., additional, Belenkov, Y. N., additional, Privalova, E. V., additional, Fomin, A. A., additional, Suvorov, A. Y., additional, Goodkova, A., additional, Rubakova, M. G., additional, Kuznetsova, I. A., additional, Semernin, E. N., additional, Keshavarzi, F., additional, Kojuri, J., additional, Mikhailov, V. M., additional, Vezhenkova, I. V., additional, Goodkova, A. Y. A., additional, Pavlovic, I., additional, Schwarz, M., additional, Jakl, G., additional, Smetana, P., additional, Perkmann, T., additional, Mayr, A., additional, Mair, J., additional, Klug, G., additional, Schocke, M., additional, Trieb, T., additional, Jaschke, W., additional, Pachinger, O., additional, Metzler, B., additional, Bronze Carvalho, L., additional, Azevedo, J., additional, Andrade, M. L., additional, Relvas, M. J., additional, Coucello, J., additional, Morais, G., additional, Seabra, M., additional, Afamefule, F., additional, Luaces Mendez, M., additional, Teijeiro-Mestre, R., additional, Nunez-Gil, I. J., additional, Leco-Gil, N., additional, Madronal-Cerezo, E., additional, Zannin, I., additional, Ruiz, J., additional, Orynchak, M. A., additional, Vakalyuk, I. I., additional, Vakalyuk, I. 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A., additional, Adgey, J. A. A., additional, Caeiro Pereira, D., additional, Braga, P., additional, Fontes Carvalho, R., additional, Rodrigues, A., additional, Goncalves, M., additional, Simoes, L., additional, and Borisov, K. V., additional

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2010
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17. Reperfusion therapy for ST elevation acute myocardial infarction 2010/2011: current status in 37 ESC countries

Author

Kristensen, S. D., Laut, K. G., Fajadet, J., Kaifoszova, Z., Kala, P., Di Mario, C., Wijns, W., Clemmensen, P., Agladze, V., Antoniades, L., Alhabib, K. F., Boer, M. -J, Claeys, M. J., Deleanu, D., Dudek, D., Erglis, A., Gilard, M., Goktekin, O., Guagliumi, G., Gudnason, T., Hansen, K. W., Huber, K., James, S., Janota, T., Jennings, S., Kajander, O., Kanakakis, J., Karamfiloff, K. K., Kedev, S., Kornowski, R., Ludman, P. F., Merkely, B., Milicic, D., Najafov, R., Nicolini, F. A., No, M., Ostojic, M., Pereira, H., Radovanovic, D., Sabate, M., Sobhy, M., Sokolov, M., Studencan, M., Terzic, I., Steffen Wahler, Widimsky, P., Muhlberger, V., Legrand, V., Spuzic, M., Hajric, R., Markota, D., Srdic, S., Jorgova, J., Velchev, V., Petrov, I., Nikolic Heitzler, V., Babic, Z., Nicolaides, E., Christodulides, T., Georgiou, P., Jansky, P., Stasek, J., Terkelsen, C. J., Galatius, S., Sorensen, R., Shal, A. E., Romppanen, H., Muller, A., Rustige, J., Alexopoulos, D., Kallikazaros, I., Papaioannou, G., Becker, D., Ungi, I., Kiss, R. G., Skuladottir, F. B., Bjornsdottir, T. K., Cavanagh, B., Twomey, K., Daly, K., Matetzky, S., Luca, L., Cremonesi, A., Bovenzi, F., Zakke, I., Maca, A., Narbute, I., Antov, S., Koch, K. T., Mimoso, J., Almeida, M., Pereira, E., Tatu, G., Vinereanu, D., D Angeli, C., Nedeljkovic, M., Vukcevic, V., Dobric, M., Hricak, V., Kova, F., Kurray, P., Peral, V., Tresserras, R., Regueiro, A., Erne, P., Rickli, H., Windecker, S., Kozan, O., Ertas, G., Kervan, U., Birkhead, J., and Sokolov, Y.

Abstract

Aims Primary percutaneous coronary intervention (PPCI) is the preferred reperfusion therapy in ST-elevation myocardial infarction (STEMI). We conducted this study to evaluate the contemporary status on the use and type of reperfusion therapy in patients admitted with STEMI in the European Society of Cardiology (ESC) member countries. Methods and results A cross-sectional descriptive study based on aggregated country-level data on the use of reperfusion therapy in patients admitted with STEMI during 2010 or 2011. Thirty-seven ESC countries were able to provide data from existing national or regional registries. In countries where no such registries exist, data were based on best expert estimates. Data were collected on the use of STEMI reperfusion treatment and mortality, the numbers of cardiologists, and the availability of PPCI facilities in each country. Our survey provides a brief data summary of the degree of variation in reperfusion therapy across Europe. The number of PPCI procedures varied between countries, ranging from 23 to 884 per million inhabitants. Primary percutaneous coronary intervention and thrombolysis were the dominant reperfusion strategy in 33 and 4 countries, respectively. The mean population served by a single PPCI centre with a 24-h service 7 days a week ranged from 31 300 inhabitants per centre to 6 533 000 inhabitants per centre. Twenty-seven of the total 37 countries participated in a former survey from 2007, and major increases in PPCI utilization were observed in 13 of these countries. Conclusion Large variations in reperfusion treatment are still present across Europe. Countries in Eastern and Southern Europe reported that a substantial number of STEMI patients are not receiving any reperfusion therapy. Implementation of the best reperfusion therapy as recommended in the guidelines should be encouraged

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18. Ticagrelor plus aspirin for 1 month, followed by ticagrelor monotherapy for 23 months vs aspirin plus clopidogrel or ticagrelor for 12 months, followed by aspirin monotherapy for 12 months after implantation of a drug-eluting stent: a multicentre, open-label, randomised superiority trial

Author

Pascal Vranckx, Marco Valgimigli, Peter Jüni, Christian Hamm, Philippe Gabriel Steg, Dik Heg, Gerrit Anne van Es, Eugene P McFadden, Yoshinobu Onuma, Cokky van Meijeren, Ply Chichareon, Edouard Benit, Helge Möllmann, Luc Janssens, Maurizio Ferrario, Aris Moschovitis, Aleksander Zurakowski, Marcello Dominici, Robert Jan Van Geuns, Kurt Huber, Ton Slagboom, Patrick W Serruys, Stephan Windecker, Mohamed Abdellaoui, David Adlam, Ibrahim Akin, Agustin Albarran Gonzalez-Trevilla, Manuel Almeida, Pedro Alves Lemos Neto, Adel Aminian, Richard Anderson, Rick Andreae, Michael Angioi, Taku Asano, Emanuele Barbato, Peter Barlis, Pascal Barraud, Olivier Bertrand, Farzin Beygui, Leonardo Bolognese, Roberto Botelho, Coby Bouwman, Marco Bressers, Philippe Brunel, Pawel Buszman, Ian Buysschaert, Pedro Canas da Silva, Didier Carrie, Angel Cequier, Chun Chin Chang, Saqib Chowdhary, Carlos Collet, Antonio Colombo, James Cotton, Rui Cruz Ferreira, Salvatore Curello, Nick Curzen, Judith de Bot, Tone de Vreede, Georg Delle Karth, Lynn Dijksma, István Édes, Eric Eeckhout, Ingo Eitel, József Faluközy, Farzin Fath-Ordoubadi, Geza Fontos, Jose Francisco Diaz, Edgard Freitas Quintella, Bernhard Frey, Guy Friedrich, Gavin Galasko, Grzegorz Galuszka, Vasco Gama Ribeiro, Scot Garg, Giuseppe Gargiulo, Tobias Geisler, Valeri Gelev, Art Ghandilyan, Javier Goicolea, Tommaso Gori, Felice Gragnano, Ana Guimarães, Michael Haude, Pieter Heijke, Rosa Ana Hernández Antolin, David Hildick-Smith, Dorien Hillen, Ina Hoekman, Sjoerd Hofma, Lene Holmvang, Stephen Hoole, Iván Horváth, Annemarie Hugense, Karim Ibrahim, Andres Iñiguez, Karl Isaaz, Zoltán Jambrik, Pawel Jasionowicz, Judith Jonk, Werner Jung, Yuki Katagiri, Norihiro Kogame, Tian Hai Koh, René Koning, Mariana Konteva, Zsolt Kőszegi, Florian Krackhardt, Yvonne Kreuger, Neville Kukreja, Boudijn Ladan, Pierre Lantelme, Sergio Leandro, Gregor Leibundgut, Christoph Liebetrau, Wietze Lindeboom, Carlos Macaya Miguel, François Mach, Michael Magro, Luc Maillard, Negar Manavifar, Laura Mauri, Eugene McFadden, Bela Merkely, Yosuke Miyazaki, Adam Młodziankowski, Tiziano Moccetti, Rodrigo Modolo, Helge Möllman, Jean-François Morelle, Michael Munndt Ottesen, Martin Muurling, Christoph Kurt Naber, Franz-Josef Neumann, Keith Oldroyd, Paul Ong, Sanne Palsrok, Ivo Petrov, Sylvain Plante, Janusz Prokopczuk, Tessa Rademaker-Havinga, Christopher Raffel, Benno Rensing, Marco Roffi, Kees-Jan Royaards, Manel Sabate, Volker Schächinger, Tim Seidler, Antonio Serra Peñaranda, Patrick Serruys, Lali Sikarulidze, Osama I Soliman, Amanda Sousa, Ernest Spitzer, Rod Stables, Gabriel Steg, Clemens Steinwender, Eduardas Subkovas, Harry Suryapranata, Kuniaki Takahashi, Suneel Talwar, Emmanuel Teiger, Addy ter Weele, Eva Teurlings, Attila Thury, Jan Tijssen, Gincho Tonev, Diana Trendafilova-Lazarova, Carlo Tumscitz, Victor Umans, Imre Ungi, Veselin Valkov, Pim van der Harst, Robert Jan van Geuns, Dobrin Vassilev, Vasil Velchev, Esther Velthuizen, Freek Verheugt, Natalia Vlcek, Jürgen vom Dahl, Mathias Vrolix, Simon Walsh, Nikos Werner, Maarten Witsenburg, Azfar Zaman, Krzysztof Żmudka, Bernhard Zrenner, Robert Zweiker, University of Zurich, Serruys, Patrick W, Cardiology, Vranckx, P., Valgimigli, M., Juni, P., Hamm, C., Steg, P. G., Heg, D., van Es, G. A., Mcfadden, E. P., Onuma, Y., van Meijeren, C., Chichareon, P., Benit, E., Mollmann, H., Janssens, L., Ferrario, M., Moschovitis, A., Zurakowski, A., Dominici, M., Van Geuns, R. J., Huber, K., Slagboom, T., Serruys, P. W., Windecker, S., Abdellaoui, M., Adlam, D., Akin, I., Albarran Gonzalez-Trevilla, A., Almeida, M., Alves Lemos Neto, P., Aminian, A., Anderson, R., Andreae, R., Angioi, M., Asano, T., Barbato, E., Barlis, P., Barraud, P., Bertrand, O., Beygui, F., Bolognese, L., Botelho, R., Bouwman, C., Bressers, M., Brunel, P., Buszman, P., Buysschaert, I., Canas da Silva, P., Carrie, D., Cequier, A., Chin Chang, C., Chowdhary, S., Collet, C., Colombo, A., Cotton, J., Cruz Ferreira, R., Curello, S., Curzen, N., de Bot, J., de Vreede, T., Delle Karth, G., Dijksma, L., Edes, I., Eeckhout, E., Eitel, I., Falukozy, J., Fath-Ordoubadi, F., Fontos, G., Francisco Diaz, J., Freitas Quintella, E., Frey, B., Friedrich, G., Galasko, G., Galuszka, G., Gama Ribeiro, V., Garg, S., Gargiulo, G., Geisler, T., Gelev, V., Ghandilyan, A., Goicolea, J., Gori, T., Gragnano, F., Guimaraes, A., Haude, M., Heijke, P., Hernandez Antolin, R. A., Hildick-Smith, D., Hillen, D., Hoekman, I., Hofma, S., Holmvang, L., Hoole, S., Horvath, I., Hugense, A., Ibrahim, K., Iniguez, A., Isaaz, K., Jambrik, Z., Jasionowicz, P., Jonk, J., Jung, W., Katagiri, Y., Kogame, N., Koh, T. H., Koning, R., Konteva, M., Koszegi, Z., Krackhardt, F., Kreuger, Y., Kukreja, N., Ladan, B., Lantelme, P., Leandro, S., Leibundgut, G., Liebetrau, C., Lindeboom, W., Macaya Miguel, C., Mach, F., Magro, M., Maillard, L., Manavifar, N., Mauri, L., Mcfadden, E., Merkely, B., Miyazaki, Y., Mlodziankowski, A., Moccetti, T., Modolo, R., Mollman, H., Morelle, J. -F., Munndt Ottesen, M., Muurling, M., Naber, C. K., Neumann, F. -J., Oldroyd, K., Ong, P., Palsrok, S., Petrov, I., Plante, S., Prokopczuk, J., Rademaker-Havinga, T., Raffel, C., Rensing, B., Roffi, M., Royaards, K. -J., Sabate, M., Schachinger, V., Seidler, T., Serra Penaranda, A., Serruys, P., Sikarulidze, L., Soliman, O. I., Sousa, A., Spitzer, E., Stables, R., Steg, G., Steinwender, C., Subkovas, E., Suryapranata, H., Takahashi, K., Talwar, S., Teiger, E., ter Weele, A., Teurlings, E., Thury, A., Tijssen, J., Tonev, G., Trendafilova-Lazarova, D., Tumscitz, C., Umans, V., Ungi, I., Valkov, V., van der Harst, P., van Geuns, R. J., Vassilev, D., Velchev, V., Velthuizen, E., Verheugt, F., Vlcek, N., vom Dahl, J., Vrolix, M., Walsh, S., Werner, N., Witsenburg, M., Zaman, A., Zmudka, K., Zrenner, B., Zweiker, R., ACS - Atherosclerosis & ischemic syndromes, ACS - Microcirculation, Graduate School, ACS - Heart failure & arrhythmias, and ACS - Amsterdam Cardiovascular Sciences

Subjects
medicine.medical_specialty, Aspirin, Acute coronary syndrome, business.industry, medicine.medical_treatment, Vascular damage Radboud Institute for Health Sciences [Radboudumc 16], Percutaneous coronary intervention, 610 Medicine & health, General Medicine, 2700 General Medicine, 030204 cardiovascular system & hematology, medicine.disease, Clopidogrel, 11171 Cardiocentro Ticino, Coronary artery disease, 03 medical and health sciences, 0302 clinical medicine, Drug-eluting stent, Internal medicine, medicine, 030212 general & internal medicine, Myocardial infarction, business, Ticagrelor, medicine.drug
Abstract

Background We hypothesised that ticagrelor, in combination with aspirin for 1 month, followed by ticagrelor alone, improves outcomes after percutaneous coronary intervention compared with standard antiplatelet regimens. Methods GLOBAL LEADERS was a randomised, open-label superiority trial at 130 sites in 18 countries. Patients undergoing percutaneous coronary intervention with a biolimus A9-eluting stent for stable coronary artery disease or acute coronary syndromes were randomly assigned (1:1) to 75-100 mg aspirin daily plus 90 mg ticagrelor twice daily for 1 month, followed by 23 months of ticagrelor monotherapy, or standard dual antiplatelet therapy with 75-100 mg aspirin daily plus either 75 mg clopidogrel daily (for patients with stable coronary artery disease) or 90 mg ticagrelor twice daily (for patients with acute coronary syndromes) for 12 months, followed by aspirin monotherapy for 12 months. Randomisation was concealed, stratified by centre and clinical presentation (stable coronary artery disease vs acute coronary syndrome), and blocked, with randomly varied block sizes of two and four. The primary endpoint at 2 years was a composite of all-cause mortality or non-fatal centrally adjudicated new Q-wave myocardial infarction as assessed by a core lab in a blinded manner. The key secondary safety endpoint was site-reported bleeding assessed according to the Bleeding Academic Research Consortium criteria (grade 3 or 5). Analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT01813435, and is closed to new participants, with followup completed. Findings Between July 1, 2013, and Nov 9, 2015, 15 968 participants were randomly assigned, 7980 to the experimental group and 7988 to the control group. At 2 years, 304 (3.81%) participants in the experimental group had died or had a non-fatal centrally adjudicated new Q-wave myocardial infarction, compared with 349 (4.37%) participants in the control group (rate ratio 0.87 [95% CI 0. 75-1. 01]; p=0.073]). There was no evidence for a difference in treatment effects for the primary endpoint across prespecified subgroups of acute coronary syndromes and stable coronary artery disease (p=0.93). Grade 3 or 5 bleeding occurred in 163 participants in the experimental group and 169 in the control group (2.04% vs 2.12%; rate ratio 0.97 [95% CI 0. 78-1. 20]; p=0.77). Interpretation Ticagrelor in combination with aspirin for 1 month followed by ticagrelor alone for 23 months was not superior to 12 months of standard dual antiplatelet therapy followed by 12 months of aspirin alone in the prevention of all-cause mortality or new Q-wave myocardial infarction 2 years after percutaneous coronary intervention. Copright (C) 2018 Elsevier Ltd. All rights reserved. European Clinical Research Institute; Biosensors International; AstraZeneca; Medicines Company; Canada Research Chairs Programme

Published
2018

19. Use of the "Two-Three Click" Protocol in Screw Stabilization of a Patient With Loosened Nuts and Dislocation of Rods - A Case Report.

Author

Penchev P, Petrov PP, Ivanov K, Ilyov I, Hyusein RR, Velchev V, and Iliev B

Abstract

Vertebral fixation, utilizing titanium screws, is a highly prevalent technique employed to address spinal instability. Screw stabilization malfunction due to pedicle screw nuts loosening is rare. Under tightening the internal nut in the pedicle screw head may increase the likelihood of rod movement within the system resulting in severe pain when moving. Our goal is to raise the attention of surgeons when tightening the screws nuts of the screw stabilization because the consequences for the patient can be subsequent additional operations and complications.  This report describes a clinical case of a 40-year-old man who underwent three surgeries at different clinics several years ago for disc herniation at the L4-L5 level and screw stabilization at the same level. The patient presents to the neurosurgery clinic of Saint Marina University Hospital with a clinical manifestation of low back pain escalating with movement, with a pain intensity rating of six on the Visual Analogue Scale (VAS). From the CT scan, it was revealed a malfunction in the screw stabilization with loosening of the screw nuts and dislodgement of the rods. Screw stabilization was restored using intraoperative X-ray guidance and following the "two-three click" protocol. The patient was mobilized on the first day after surgery and discharged on the fifth day with neurological improvement (VAS=1). The patient was followed up for a period of six months, and no further complications were observed. Surgeons must use caution while tightening the screw nuts, as not doing so may result in additional surgeries and complications for the patient in the future. The "two-three click" protocol for screw stabilization is an effective method for minimizing the issues associated with inner loosening and rod migration., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. University Hospital Saint Marina issued approval 266/20.04.2024. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Penchev et al.)

Published
2024
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20. Chronic Cerebellar Meningoencephalitis in Adulthood: A Report of a Rare Case.

Author

Velchev V, Burev S, Yankov D, Petrova S, Petrov PP, Hyusein RR, and Penchev P

Abstract

The development of meningoencephalitis is a result of an inflammation of the meninges and the brain, which can cause neurological sequelae. Cerebellar meningoencephalitis in adult patients is extremely rare and requires special diagnostic approaches. The aim of this report is to present a rare case of meningoencephalitis and evaluate the diagnostic and therapeutic techniques. We present a 45-year-old male patient who has entered the neurosurgery clinic with a severe headache lasting for a month. Neurological status determines intracranial hypertension. Magnetic resonance tomography (MRT) showed evidence of hyperintense lesions with homogenous enhancement in the right hemisphere of the cerebellum. The patient underwent a suboccipital paramedian craniotomy to excise the lesions and for the pathohistological examination of the biopsy material. Biopsy examination found sections expressing an infection process causing chronic meningoencephalitis in the right hemisphere of the cerebellum. The patient was treated postoperatively with cephalothin 2 g every 12 hours for 14 days. Follow-up examinations proved a relief of the symptoms. Meningoencephalitis of the cerebellum and the meninges is a complication that may occur in adulthood, and surgical excision, biopsy examination, and antibiotic therapy are promising methods for managing the disease., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Velchev et al.)

Published
2024
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21. Awake Craniotomy for a Frontal Astrocytoma: A Case Report.

Author

Velchev V, Burev S, Ferdinandov D, Popov D, Vasileva P, Petrova S, Petrov PP, Hyusein RR, and Penchev P

Abstract

Awake craniotomy is a surgical procedure that has been gaining significance over the past decades. Neuronavigation is an intraoperative technology that locates tumors and monitors the brain cortex during awake craniotomy. The presence of cerebral low-grade gliomas in the frontal lobe creates a risk of affecting vital centers of the brain cortex during surgery. We present a clinical case of a 42-year-old male patient who entered the neurosurgery clinic with a clinical manifestation of headache for two months. MRI showed evidence of the recurrence of a left frontal glioma. Differential diagnoses of frontal gliomas include metastases, abscesses, and cysts. The pathophysiologic background of the disease is the mutation of neuroglial cells, which leads to an abnormal and uncontrollable proliferation. Under sleep-awake anesthesia, operative treatment was performed through left frontal awake craniotomy under neuronavigation. As a result, a total excision was achieved. Motor functions of the right limbs and speech have been preserved. The patient was mobilized on the day after the intervention. Surgery-related complications were not observed. The patient had relief from the symptoms and was discharged on the fifth day. Awake craniotomy combined with neuronavigation was the most efficient and the least harmful method for the excision of the tumor. For low-grade gliomas localized in the frontal area of the encephalon, awake craniotomy is the only secure option for surgery., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Velchev et al.)

Published
2024
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22. Symptomatic Cavum Vergae Cyst in a Geriatric Patient: A Report of a Rare Case and Conservative Management Approach.

Author

Penchev P, Petrov PP, Velchev V, and Velev A

Abstract

Cavum vergae (CV) cysts constitute a small proportion of intracranial cysts, and although generally asymptomatic, there are occasional cases where they might exhibit clinical manifestations. We present a clinical case of a 79-year-old female patient who had a clinical manifestation of headache on the occipital side of the head with irradiation to the shoulder girdle as well as numbness, dizziness, visual impairment, sleep disturbances, and tingling in the hands for three months. Vertigo and rightward staggering had been experienced for two weeks. On physical examination, it was discovered that there was smoothed physiological lordosis, restricted and painful movements, and paravertebral muscle rigidity in the cervical region. The patient had bilaterally reduced biceps and triceps reflexes, painful Erb's points, and hypesthesia over the C5 and C6 dermatomes on the right side. The patient had decreased coordination and displayed staggered movement to the right. A CT scan discovered dilated subarachnoid spaces of the convexity and a CV cyst. The patient was prescribed conservative therapy consisting of etoricoxib oral at a dosage of 2 × 60 mg for seven days, tolperisone hydrochloride orally at a dosage of 2 × 150 mg for seven days, pregabalin 75 mg, one pill in the evening for seven days, ozoid (a gel containing ozone) for external application, and vinpocetine 2 × 10 mg orally for two months. Following the conservative treatment, the patient exhibited improvement in her symptoms and no longer had challenges carrying out her daily tasks. Furthermore, six months after the therapy, the patient did not experience any symptoms. Long-term follow-up will be conducted in cases of symptom recurrence or cyst enlargement., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Penchev et al.)

Published
2024
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23. Cerebral Calcifications as a Result of Primary Hyperparathyroidism: A Report of a Rare Case.

Author

Hyusein RR, Atsev S, Boyukliev A, Petrov PP, Velchev V, and Penchev P

Abstract

Primary hyperparathyroidism (PHPT) is an extremely uncommon cause of cerebral calcification. A male patient, aged 45, was admitted to the neurosurgery clinic with a closed traumatic brain injury, namely a concussion, resulting in symptoms of headache and loss of balance. A CT scan was conducted, which detected bilateral calcifications on the basal ganglia and the tentorium. The blood tests revealed increased levels of serum calcium, phosphate, and parathyroid hormone (PTH), while vitamin D levels were within the normal range. The patient received symptomatic therapy for the cerebral concussion and was referred for further diagnostic procedures. Based on these exams, it was determined that the patient had a parathyroid adenoma, which was responsible for PHPT characterised by increased levels of calcium, phosphate, and PTH. The patient subsequently underwent a successful parathyroidectomy. Half a year following the surgical procedure, the patient remained free of any indications of neurological conditions, and the levels of PTH and calcium in their body were within the expected range. Whenever trying to identify the cause of cerebral calcification, it is important to explore several possible diagnoses. A possible cause that should be taken into account is PHTP., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Hyusein et al.)

Published
2024
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24. Botulinum Toxin Type A in the Treatment of Raynaud's Syndrome: A Case Report.

Author

Penchev P, Dobrev V, Petrov PP, Hyusein R, Velchev V, and Georgiev K

Abstract

Raynaud's syndrome is characterized by paroxysmal vasospasm in the digital arterioles, following exposure to cold or stress. Pain, swelling, stiffness, and hypoesthesia are observed as manifestations. The presence of a trophic ulcer is accompanied by a range of severe manifestations. The assaults occur in three distinct phases, namely vasospastic, plethoric, and erythema. Various approaches improve the overall well-being of a patient. It is possible to differentiate between primary and secondary Raynaud's syndrome, the latter being linked to systemic diseases. The application of botulin toxin is commonly indicated in several medical conditions including focal dystonia, spasticity with or without contractures, paraparesis in children with cerebral palsy, multiple sclerosis, brain injuries, involuntary muscle hyperactivity of a non-dystonic nature, pain management, strabismus, nystagmus, sialorrhea, and esthetic medicine. When treating Raynaud's a technique is used with injection at the base of each finger, from the palmar side, which helps with cooling and minimizing discomfort for patients. We present a clinical case of a 70-year-old female patient with Raynaud's syndrome in which we have placed 70E distributed to both hands botulin toxin type A. Improvement in the patient's symptomatology was noticed on day 3, with warming of the hands, lack of swelling, and pain with duration of the effect little over three months. The patient underwent a six-month follow-up following the therapy with botulinum toxin type A, and no indications of recurrence or advancement of Raynaud's syndrome (RS) were seen., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Penchev et al.)

Published
2024
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25. Anticoagulation with edoxaban in patients with long atrial high-rate episodes ≥24 h.

Author

Becher N, Toennis T, Bertaglia E, Blomström-Lundqvist C, Brandes A, Cabanelas N, Calvert M, Camm AJ, Chlouverakis G, Dan GA, Dichtl W, Diener HC, Fierenz A, Goette A, de Groot JR, Hermans ANL, Lip GYH, Lubinski A, Marijon E, Merkely B, Mont L, Ozga AK, Rajappan K, Sarkozy A, Scherr D, Schnabel RB, Schotten U, Sehner S, Simantirakis E, Vardas P, Velchev V, Wichterle D, Zapf A, and Kirchhof P

Subjects
Humans, Female, Aged, Aged, 80 and over, Male, Heart Atria, Risk Factors, Anticoagulants therapeutic use, Atrial Fibrillation complications, Atrial Fibrillation drug therapy, Atrial Fibrillation diagnosis, Stroke etiology, Stroke prevention & control, Stroke diagnosis, Pyridines, Thiazoles
Abstract

Background and Aims: Patients with long atrial high-rate episodes (AHREs) ≥24 h and stroke risk factors are often treated with anticoagulation for stroke prevention. Anticoagulation has never been compared with no anticoagulation in these patients., Methods: This secondary pre-specified analysis of the Non-vitamin K antagonist Oral anticoagulants in patients with Atrial High-rate episodes (NOAH-AFNET 6) trial examined interactions between AHRE duration at baseline and anticoagulation with edoxaban compared with placebo in patients with AHRE and stroke risk factors. The primary efficacy outcome was a composite of stroke, systemic embolism, or cardiovascular death. The safety outcome was a composite of major bleeding and death. Key secondary outcomes were components of these outcomes and electrocardiogram (ECG)-diagnosed atrial fibrillation., Results: Median follow-up of 2389 patients with core lab-verified AHRE was 1.8 years. AHRE ≥24 h were present at baseline in 259/2389 patients (11%, 78 ± 7 years old, 28% women, CHA2DS2-VASc 4). Clinical characteristics were not different from patients with shorter AHRE. The primary outcome occurred in 9/132 patients with AHRE ≥24 h (4.3%/patient-year, 2 strokes) treated with anticoagulation and in 14/127 patients treated with placebo (6.9%/patient-year, 2 strokes). Atrial high-rate episode duration did not interact with the efficacy (P-interaction = .65) or safety (P-interaction = .98) of anticoagulation. Analyses including AHRE as a continuous parameter confirmed this. Patients with AHRE ≥24 h developed more ECG-diagnosed atrial fibrillation (17.0%/patient-year) than patients with shorter AHRE (8.2%/patient-year; P < .001)., Conclusions: This hypothesis-generating analysis does not find an interaction between AHRE duration and anticoagulation therapy in patients with device-detected AHRE and stroke risk factors. Further research is needed to identify patients with long AHRE at high stroke risk., (© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.)

Published
2024
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26. A Rare Case of Lumbar Region Diastematomyelia in a 25-year-old Woman With Lower Back Pain.

Author

Velchev V, Iliev B, Petrov PP, Ilyov I, and Penchev P

Abstract

Diastematomyelia is an infrequent congenital anomaly that anatomically presents with a longitudinal division of the spinal cord at the level of one or several sections. It is generally diagnosed and treated in children. We present a 25-year-old female patient who has entered the Neurosurgery clinic after a traumatic experience with severe low back pain evaluated with 7 points on the visual analog scale (VAS). Magnetic resonance imaging (MRI) of the lumbar area discovered evidence for diastematomyelia type 1 at levels L3-L5 with deformations in L4 and L5 vertebrae and mild scoliosis. Because of the lack of neurological deficiency, the patient's treatment was conservative and included a 10-day intake of nonsteroid anti-inflammatory drugs (NSAIDs) in combination with myorelaxant and physiotherapy. On the 15 th day, the patient was evaluated with 2 points on VAS. Neurological follow-up examinations were conducted on the third and the sixth month and the patient was evaluated with VAS 1, which proves that conservative treatment is successful for diastematomyelia in adults without neurological deficiency., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Velchev et al.)

Published
2024
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27. Navigating the Landscape of Herniated Discs: A Rare Case of Herniated Disc Regression.

Author

Ilyov I, Vasvi E, Petrov PP, Velchev V, and Penchev P

Abstract

A herniated disc is a condition in which the nucleus pulposus is displaced from the intervertebral space. It usually leads to back pain, thus being the most common reason for it. Patients often describe the first symptoms of a herniated disc as extreme and decisive pain. Unlike the usual mechanical back pain, a herniated disc is often related to a stinging or burning sensation that often spreads to the lower extremities and proves to be continuous at lower temperatures. We present a case of a 58-year-old male patient who visited the Acibadem City Clinic with complaints of pain initially starting from his hip, which in time extended to his left leg (L5 radiculopathy) and a few days later to his right leg (L5 radiculopathy). Before visiting the clinic, he had been treated in Germany with physiotherapy and supplements, which had proved ineffective. After an MRI, which revealed an L4-L5 herniated disc, he underwent conservative treatment with nonsteroidal anti-inflammatory drugs (NSAIDs) and proton pump inhibitors (PPIs) for 14 days in addition to Medrol 4mg tablets (3x1 per day for 10 days). On the third day of the treatment, 60% of the symptoms had subsided. Seven months later, he came in for a scheduled checkup, and 95% of the symptoms were gone. A controlled MRI was done, and the herniated disc had completely vanished. We hope that this type of research will benefit medical professionals, patients, researchers, doctors, and students, among others. Such cases also contribute to the quality of care for such patients and help set regulated factual guidelines regarding their treatment as a whole., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Ilyov et al.)

Published
2024
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28. Аn Unusual Case of an Epidural Lesion of the Lumbar Spine: Tumor or Hematoma?

Author

Penchev P, Petrov PP, Velchev V, Ilyov I, and Vasvi E

Abstract

Spinal epidural hematoma is a rare clinical entity with an incidence of approximately one per 1,000,000 patients per year. Spinal epidural hematoma is a lesion that can cause spinal cord compression or cauda equina syndrome. We report a clinical case of а 69-year-old male patient who presented to the Neurosurgery Clinic of the General Hospital for Active Treatment "Dobrich" with pain and weakness in both legs for two months after falling in the bathroom. MRI revealed an L2-L3 fracture and a formation in the L2-L3 epidural space, which was compressing the nerve roots. An operative treatment was performed under general anesthesia and, intraoperatively, it was discovered that the formation was a hematoma. Aspiration of the hematoma and decompression of the spinal canal were performed. An L2-L3 stabilization with pedicle screws was done due to total laminectomy and potential instability. Postoperatively, the patient was mobilized on the day after intervention, and no surgery-related complications were observed. The patient experienced relief from his symptoms and was discharged on the fifth day. Six months post-surgery, the patient started to experience pain in his left leg. Radiography showed coxarthrosis on the left hip joint and the patient was referred to the orthopedics for further treatment., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Penchev et al.)

Published
2023
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29. AWAreness during REsuscitation - II: A multi-center study of consciousness and awareness in cardiac arrest.

Author

Parnia S, Keshavarz Shirazi T, Patel J, Tran L, Sinha N, O'Neill C, Roellke E, Mengotto A, Findlay S, McBrine M, Spiegel R, Tarpey T, Huppert E, Jaffe I, Gonzales AM, Xu J, Koopman E, Perkins GD, Vuylsteke A, Bloom BM, Jarman H, Nam Tong H, Chan L, Lyaker M, Thomas M, Velchev V, Cairns CB, Sharma R, Kulstad E, Scherer E, O'Keeffe T, Foroozesh M, Abe O, Ogedegbe C, Girgis A, Pradhan D, and Deakin CD

Subjects
Humans, Consciousness, Prospective Studies, Cross-Sectional Studies, Death, Biomarkers, Cardiopulmonary Resuscitation methods, Heart Arrest, Out-of-Hospital Cardiac Arrest
Abstract

Introduction: Cognitive activity and awareness during cardiac arrest (CA) are reported but ill understood. This first of a kind study examined consciousness and its underlying electrocortical biomarkers during cardiopulmonary resuscitation (CPR)., Methods: In a prospective 25-site in-hospital study, we incorporated a) independent audiovisual testing of awareness, including explicit and implicit learning using a computer and headphones, with b) continuous real-time electroencephalography(EEG) and cerebral oxygenation(rSO 2 ) monitoring into CPR during in-hospital CA (IHCA). Survivors underwent interviews to examine for recall of awareness and cognitive experiences. A complementary cross-sectional community CA study provided added insights regarding survivors' experiences., Results: Of 567 IHCA, 53(9.3%) survived, 28 of these (52.8%) completed interviews, and 11(39.3%) reported CA memories/perceptions suggestive of consciousness. Four categories of experiences emerged: 1) emergence from coma during CPR (CPR-induced consciousness [CPRIC]) 2/28(7.1%), or 2) in the post-resuscitation period 2/28(7.1%), 3) dream-like experiences 3/28(10.7%), 4) transcendent recalled experience of death (RED) 6/28(21.4%). In the cross-sectional arm, 126 community CA survivors' experiences reinforced these categories and identified another: delusions (misattribution of medical events). Low survival limited the ability to examine for implicit learning. Nobody identified the visual image, 1/28(3.5%) identified the auditory stimulus. Despite marked cerebral ischemia (Mean rSO 2  = 43%) normal EEG activity (delta, theta and alpha) consistent with consciousness emerged as long as 35-60 minutes into CPR., Conclusions: Consciousness. awareness and cognitive processes may occur during CA. The emergence of normal EEG may reflect a resumption of a network-level of cognitive activity, and a biomarker of consciousness, lucidity and RED (authentic "near-death" experiences)., Competing Interests: Declaration of Competing Interest 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., (Copyright © 2023. Published by Elsevier B.V.)

Published
2023
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30. Anticoagulation with Edoxaban in Patients with Atrial High-Rate Episodes.

Author

Kirchhof P, Toennis T, Goette A, Camm AJ, Diener HC, Becher N, Bertaglia E, Blomstrom Lundqvist C, Borlich M, Brandes A, Cabanelas N, Calvert M, Chlouverakis G, Dan GA, de Groot JR, Dichtl W, Kravchuk B, Lubiński A, Marijon E, Merkely B, Mont L, Ozga AK, Rajappan K, Sarkozy A, Scherr D, Sznajder R, Velchev V, Wichterle D, Sehner S, Simantirakis E, Lip GYH, Vardas P, Schotten U, and Zapf A

Subjects
Aged, Female, Humans, Male, Atrial Fibrillation complications, Atrial Fibrillation diagnosis, Hemorrhage chemically induced, Stroke etiology, Stroke prevention & control, Electrodes, Implanted, Double-Blind Method, Risk Factors, Anticoagulants adverse effects, Anticoagulants therapeutic use, Embolism drug therapy, Embolism etiology, Factor Xa Inhibitors adverse effects, Factor Xa Inhibitors therapeutic use, Arrhythmias, Cardiac complications, Arrhythmias, Cardiac diagnosis
Abstract

Background: Device-detected atrial high-rate episodes (AHREs) are atrial arrhythmias detected by implanted cardiac devices. AHREs resemble atrial fibrillation but are rare and brief. Whether the occurrence of AHREs in patients without atrial fibrillation (as documented on a conventional electrocardiogram [ECG]) justifies the initiation of anticoagulants is not known., Methods: We conducted an event-driven, double-blind, double-dummy, randomized trial involving patients 65 years of age or older who had AHREs lasting for at least 6 minutes and who had at least one additional risk factor for stroke. Patients were randomly assigned in a 1:1 ratio to receive edoxaban or placebo. The primary efficacy outcome was a composite of cardiovascular death, stroke, or systemic embolism, evaluated in a time-to-event analysis. The safety outcome was a composite of death from any cause or major bleeding., Results: The analysis population consisted of 2536 patients (1270 in the edoxaban group and 1266 in the placebo group). The mean age was 78 years, 37.4% were women, and the median duration of AHREs was 2.8 hours. The trial was terminated early, at a median follow-up of 21 months, on the basis of safety concerns and the results of an independent, informal assessment of futility for the efficacy of edoxaban; at termination, the planned enrollment had been completed. A primary efficacy outcome event occurred in 83 patients (3.2% per patient-year) in the edoxaban group and in 101 patients (4.0% per patient-year) in the placebo group (hazard ratio, 0.81; 95% confidence interval [CI], 0.60 to 1.08; P = 0.15). The incidence of stroke was approximately 1% per patient-year in both groups. A safety outcome event occurred in 149 patients (5.9% per patient-year) in the edoxaban group and in 114 patients (4.5% per patient-year) in the placebo group (hazard ratio, 1.31; 95% CI, 1.02 to 1.67; P = 0.03). ECG-diagnosed atrial fibrillation developed in 462 of 2536 patients (18.2% total, 8.7% per patient-year)., Conclusions: Among patients with AHREs detected by implantable devices, anticoagulation with edoxaban did not significantly reduce the incidence of a composite of cardiovascular death, stroke, or systemic embolism as compared with placebo, but it led to a higher incidence of a composite of death or major bleeding. The incidence of stroke was low in both groups. (Funded by the German Center for Cardiovascular Research and others; NOAH-AFNET 6 ClinicalTrials.gov number, NCT02618577; ISRCTN number, ISRCTN17309850.)., (Copyright © 2023 Massachusetts Medical Society.)

Published
2023
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31. The influence of atrial high-rate episodes on stroke and cardiovascular death: an update.

Author

Toennis T, Bertaglia E, Brandes A, Dichtl W, Fluschnik N, de Groot JR, Marijon E, Mont L, Lundqvist CB, Cabanelas N, Dan GA, Lubinski A, Merkely B, Rajappan K, Sarkozy A, Velchev V, Wichterle D, and Kirchhof P

Subjects
Humans, Aged, Risk Factors, Anticoagulants therapeutic use, Heart Atria, Atrial Fibrillation complications, Atrial Fibrillation diagnosis, Atrial Fibrillation drug therapy, Stroke diagnosis, Stroke etiology, Stroke prevention & control
Abstract

Atrial high-rate episodes (AHRE) are atrial tachyarrhythmias detected by continuous rhythm monitoring by pacemakers, defibrillators, or implantable cardiac monitors. Atrial high-rate episodes occur in 10-30% of elderly patients without atrial fibrillation. However, it remains unclear whether the presence of these arrhythmias has therapeutic consequences. The presence of AHRE increases the risk of stroke compared with patients without AHRE. Oral anticoagulation would have the potential to reduce the risk of stroke in patients with AHRE but is also associated with a rate of major bleeding of ∼2%/year. The stroke rate in patients with AHRE appears to be lower than the stroke rate in patients with atrial fibrillation. Wearables like smart-watches will increase the absolute number of patients in whom atrial arrhythmias are detected. It remains unclear whether anticoagulation is effective and, equally important, safe in patients with AHRE. Two randomized clinical trials, NOAH-AFNET6 and ARTESiA, are expected to report soon. They will provide much-needed information on the efficacy and safety of oral anticoagulation in patients with AHRE., Competing Interests: Conflict of interest: T.T. received speaker fees from Medtronic and honoraria from Boston Scientific. A.B. received honorarium from Boehringer-Ingelheim, Bristol-Myers Squibb and received research grants from Theravance, Zealand Region, Canadian Institutes of Health Research and the Danish Heart Foundation. N.F. received a grant from Biotronik, speaker fees from Abbott, Medtronic, all outside the submitted work. J.R.G. receives consultant or speaker fees from Atricure, Daiichi Sakyo, Bayer, and Novartis. He received research funding through institution from Abbott, Boston Scientific, Medtronic, Atricure, and Owner RhythmCare. E.M. receives consultant fees from Abbott, Bayer, Boston Scientific, Medtronic, and Zoll Carina Blomström Lundqvist received honorarium from Medtronic, Boston Scientific, Abbott, Bayer, Sanofi, Organon, Milestone, Philips, Cathprint outside this work. G.-A.D. receives speaker and consultation fees from Boehringer Ingelheim, Bayer, Novartis, Berlin Chemie, Amgen, Sanofi; nothing linked to the submitted work. B.M. received speaker fees from Abbott, Astra Zeneca, Biotronik, Boehringer Ingelheim, Novartis. Paulus Kirchhof receives research support for basic, translational, and clinical research projects from European Union, British Heart Foundation, Leducq Foundation, Medical Research Council (UK), and German Centre for Cardiovascular Research, from several drug and device companies active in atrial fibrillation and has received honoraria from several such companies in the past, but not in the last 3 years (unrelated to the submitted work). P.K. is listed as inventor on two patents held by University of Birmingham (Atrial Fibrillation Therapy WO 2015140571, Markers for Atrial Fibrillation WO 2016012783). All remaining authors have declared no conflicts of interest., (© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.)

Published
2023
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32. Novel insights on GTPBP3-associated hypertrophic cardiomyopathy.

Author

Angelova P, Velchev V, Stoyanov N, Atemin S, Todorov T, Tourtourikov I, Mitev V, and Todorova A

Subjects
Male, Humans, Pedigree, Genetic Testing, Exome Sequencing, Mutation, GTP-Binding Proteins genetics, Cardiomyopathy, Hypertrophic diagnosis, Cardiomyopathy, Hypertrophic genetics, Cardiomyopathies genetics
Abstract

About 100 genes have been associated with cardiomyopathies with genotype-phenotype correlations often hard to establish. Genetic testing may help to confirm the genetic diagnosis and assess the risk of inheritance in the family. A 25-year old male with hypertrophic cardiomyopathy and fasciculoventricular accessory pathway was referred for genetic testing by his cardiologist. Targeted PRKAG2 screening and whole-exome sequencing were performed, followed by Sanger sequencing segregation analysis in the family. The PRKAG2 gene screening was negative. Whole-exome sequencing revealed the following four variants in the patient: c.181G>C (p.Ala61Pro) and c.1199C>T (p.Thr400Met) in the GTPBP3 gene, as well as c.752C>T (p.Thr251Ile) and c.1760C>T (p.Pro587Leu) in the POLG gene. Family segregation analysis showed that the patient's mother is a carrier of variant c.181G>C and the patient's paternal grandmother is a carrier of variant c.1199C>T in the GTPBP3 gene, which is in accordance with an autosomal recessive model of inheritance of the disease. Both variants in the POLG are found paternally inherited in the patient's healthy half-brother, thus are not considered disease-causing. GTPBP3 variants have been reported in patients with hypertrophic cardiomyopathy, associated with combined oxidative phosphorylation deficiency 23. These novel variants represent the probable cause of the observed clinical symptoms in the patient., (© 2023 Wiley Periodicals LLC.)

Published
2023
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33. And don't forget your anti in-stent stenosis pill! Commentary on 'Factors associated with in-stent stenosis after cerebral aneurysm embolization using a Pipeline embolization device' by Flores-Milan et al.

Author

Sirakov A, Stoyanov N, Velchev V, and Sirakov S

Subjects
Humans, Treatment Outcome, Retrospective Studies, Constriction, Pathologic complications, Constriction, Pathologic therapy, Stents, Cerebral Angiography, Intracranial Aneurysm diagnostic imaging, Intracranial Aneurysm therapy, Intracranial Aneurysm complications, Embolization, Therapeutic methods
Abstract

In their INR study, Flores-Milan et al. present a retrospective single-centre study that aimed to investigate and determine some of the factors associated with in-stent stenosis (ISS) after intracranial aneurysm (IA) embolization using a commercially available flow diverter stent (FD). The retrospective analyses included ruptured and unruptured intracranial aneurysms treated with standalone flow diverter stent implantation or initial coil obliteration with the FD device placed subsequently two weeks after initial treatment. The article's methodology was carefully tailored to demystify the unknown pathophysiological mechanism behind the entity of interest called in-stent stenosis. Study outcomes also included angiographic evaluation of aneurysm occlusion thrombotic and hemorrhagic events. The authors reported excellent technical and clinical results altogether. The achieved angiographic occlusion rates resonate with the current obliteration results reported in the literature. Mortality and morbidity are congruent with previously published results and were 5.3% and 1.1%, respectively.

Published
2023
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34. Early experience with pulmonary endarterectomy in Bulgaria-case series.

Author

Ignatov G, Ng CY, Tan Z, Velchev V, Kurkchieva T, Whitbread JC, and Valchanov KP

Abstract

Background: Pulmonary arterial hypertension (PAH) is a condition that limits the quality of life and life expectancy. The predicted mortality at 1 year is estimated at 30-40% without treatment. Of the types of PAH, chronic thromboembolic pulmonary hypertension (CTEPH) is most amenable to treatment and guidelines recommend pulmonary endarterectomy (PEA) surgery for 'operable' patients (where disease is found in the proximal pulmonary vessels). Traditionally these patients were referred to a European centre with the complexities of international travel, pre- and post-operative care, and funding. We sought to establish a national PEA programme to serve the Bulgarian population and avoid some of the problems of international healthcare., Case Description: A total of 11 patients underwent PEA in 2 cardiac centres in Bulgaria (Acibadem Hospital and Government Hospital Lozenetz Sofia). The age of patients ranged from 22 to 80. The preoperative pulmonary vascular resistance (PVR) ranged from 309 to 1,906 dynes/sec/cm -5 . For the surviving patients the average PVR reduction was 615 dynes/sec/cm -5 at 6 months, the average intensive care unit (ICU) stay 6.7 days, and hospitalisation 15.2 days. Nine out of 11 patients survived to hospital discharge and 6 months follow, all with normalised PVR and exercise tolerance., Conclusions: We present our results of initial experience with PEA in Bulgaria with encouraging results. Our work shows that inter-European relationship for healthcare can be productive and offer safe treatment on local level., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://atm.amegroups.com/article/view/10.21037/atm-22-4370/coif). The authors have no conflicts of interest to declare., (2023 Annals of Translational Medicine. All rights reserved.)

Published
2023
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35. Impact of Medication Nonadherence in a Clinical Trial of Dual Antiplatelet Therapy.

Author

Valgimigli M, Frigoli E, Vranckx P, Ozaki Y, Morice MC, Chevalier B, Onuma Y, Windecker S, Delorme L, Kala P, Kedev S, Abhaichand RK, Velchev V, Dewilde W, Podolec J, Leibundgut G, Topic D, Schultz C, Stankovic G, Lee A, Johnson T, Tonino PAL, Klotzka A, Lesiak M, Lopes RD, Smits PC, and Heg D

Subjects
Drug Therapy, Combination, Hemorrhage chemically induced, Hemorrhage drug therapy, Hemorrhage epidemiology, Humans, Medication Adherence, Platelet Aggregation Inhibitors therapeutic use, Polymers, Treatment Outcome, Drug-Eluting Stents adverse effects, Percutaneous Coronary Intervention methods
Abstract

Background: Nonadherence to antiplatelet therapy after percutaneous coronary intervention (PCI) is common, even in clinical trials., Objectives: The purpose of this study was to investigate the impact of nonadherence to study protocol regimens in the MASTER DAPT (Management of High Bleeding Risk Patients Post Bioresorbable Polymer Coated Stent Implantation With an Abbreviated Versus Prolonged DAPT Regimen) trial., Methods: At 1-month after PCI, 4,579 high bleeding risk patients were randomized to single antiplatelet therapy (SAPT) for 11 months (or 5 months in patients on oral anticoagulation [OAC]) or dual antiplatelet therapy (DAPT) for ≥2 months followed by SAPT. Coprimary outcomes included net adverse clinical events (NACE), major adverse cardiac and cerebral events (MACE), and major or clinically relevant nonmajor bleeding (MCB) at 335 days. Inverse probability-of-censoring weights were used to correct for nonadherence Academic Research Consortium type 2 or 3., Results: In total, 464 (20.2%) patients in the abbreviated-treatment and 214 (9.4%) in the standard-treatment groups incurred nonadherence Academic Research Consortium type 2 or 3. At inverse probability-of-censoring weights analyses, NACE (HR: 1.01; 95% CI: 0.88-1.27) or MACE (HR: 1.07; 95% CI: 0.83-1.40) did not differ, and MCB was lower with abbreviated compared with standard treatment (HR: 0.51; 95% CI: 0.60-0.73) consistently across OAC subgroups; among OAC patients, SAPT discontinuation 6 months after PCI was associated with similar MACE and lower MCB (HR: 0.47; 95% CI: 0.22-0.99) compared with SAPT continuation., Conclusions: In the MASTER DAPT adherent population, 1-month compared with ≥3-month DAPT was associated with similar NACE or MACE and lower MCB. Among OAC patients, SAPT discontinuation after 6 months was associated with similar MACE and lower MCB than SAPT continuation (Management of High Bleeding Risk Patients Post Bioresorbable Polymer Coated Stent Implantation With an Abbreviated Versus Prolonged DAPT Regimen [MASTER DAPT]; NCT03023020)., Competing Interests: Funding Support and Author Disclosures The MASTER DAPT trial is conducted with support from Terumo. The study sponsor, European Cardiovascular Research Institute (ECRI), Rotterdam, the Netherlands, a nonprofit organization, received grant support from Terumo for the conduct of the MASTER DAPT trial. ECRI outsourced to Clinical trial Unit, Bern, Switzerland all statistical analyses of the present paper under a research contract agreement between the 2 institutions. None of the authors received personal or institutional payment for the present paper. Dr Valgimigli has received grants and personal fees from Terumo; and has received personal fees from AstraZeneca, Alvimedica/CID, Abbott Vascular, Daiichi-Sankyo, Bayer, CoreFLOW, Idorsia Pharmaceuticals Ltd, Universität Basel, Department Klinische Forschung, Vifor, Bristol Myers Squibb SA, Biotronik, Boston Scientific, Medtronic, Vesalio, Novartis, Chiesi, and PhaseBio. Dr Heg’s institution, CTU Bern, University of Bern, has a staff policy of not accepting honoraria or consultancy fees; however, CTU Bern is involved in design, conduct, or analysis of clinical studies funded by not-for-profit and for-profit organizations, and in particular, pharmaceutical and medical device companies provide direct funding to some of these studies. Dr Vranckx has received personal fees from Daiichi-Sankyo, Bayer AG, BLS Bering, and AstraZeneca. Dr Ozaki has received grants from Takeda Pharmaceutical Company Ltd, Daiichi-Sankyo Company Ltd, Otsuka Pharmaceutical Company Ltd, and Sanofi. Dr Morice is a shareholder and CEO of CERC and a minor shareholder of Electroducer (a start-up not involved in the MASTER DAPT trial). Dr Chevalier has received personal fees from Terumo and CERC; and holds stock options in Colibri. Dr Windecker has received grants from Abbott, Amgen, AstraZeneca, Bristol Myers Squibb, Bayer, Biotronik, Boston Scientific, Cardinal Health, CadioValve, CSL Behring, Daiichi-Sankyo, Edwards Lifesciences, Guerbet, InfraRedx, Johnson and Johnson, Medicure, Medtronic, Novartis, Polares, OrPha Suisse, Pfizer, Regeneron Pharmaceuticals, Sanofi, Sinomed, Terumo, and V-Wave; serves as unpaid advisory board member and/or unpaid member of the steering/executive group of trials funded by Abbott, Abiomed, Amgen, AstraZeneca, Bristol Myers Squibb, Boston Scientific, Biotronik, Cardiovalve, Edwards Lifesciences, MedAlliance, Medtronic, Novartis, Polares, Sinomed, V-Wave, and Xeltis, but has not received personal payments by pharmaceutical companies or device manufacturers; is a member of the steering/executive committee group of several investigator-initiated trials that receive funding by industry without impact on his personal remuneration; is an unpaid member of the Pfizer Research Award selection committee in Switzerland and of the Women as One Awards Committee; is a member of the Clinical Study Group of the Deutsches Zentrum für Herz Kreislauf-Forschung and of the Advisory Board of the Australian Victorian Heart Institute; and is chairperson of the ESC Congress Program Committee, former chairperson of the ESC Clinical Practice Guidelines Committee, and Deputy Editor of JACC: Cardiovascular Interventions. Dr Kala has served as a consultant for Boston Scientific; has received research support from Novartis; and has received honoraria from Bayer, Servier, AstraZeneca, Chiesi, and Boehringer Ingelheim. Dr Schultz has received grants and personal fees from Abbott Vascular. Dr Lopes has received institutional research grants and consulting fees from Bristol Myers Squibb, Pfizer, GlaxoSmithKline, Medtronic PLC, and Sanofi; and has received consulting fees from Amgen, Bayer, and Boehringer Ingelheim. Dr Podolec has received grants and personal fees from Amgen, Terumo, The Medicines Company, AstraZeneca, and Meril. Dr Smits has received personal fees from Terumo and Opsense; has received grants and personal fees from Abbott Vascular, Microport, and Daiichi-Sankyo; and has received grants from SMT and Microport. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2022 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)

Published
2022
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36. Endovascular iliac vein recanalization for permanent pacemaker implantation in a patient who has long-term haemodialysis: a case report.

Author

Stoyanov N, Goranovska V, Gegouskov V, and Velchev V

Abstract

Background: In chronic haemodialysis patients central veins occlusion occur very often. In such patients, permanent pacemaker placement implantation can be challenging and alternative approaches should be used., Case Summary: This is a case of 66-year-old male patient with complete atrioventricular block after a mitral valve (MV) surgery for endocarditis. The patient has a permanent surgically inserted haemodialysis catheter in right heart atrium after several unsuccessful attempts of endovascular recanalization of superior vena cava. A lead was implanted in the right ventricle after successful endovascular revascularization of the right iliac vein. The pacemaker was placed in a pouch on the right lower abdominal wall., Discussion: To our knowledge, this is the first reported case where a permanent single-chamber pacemaker was implanted through the right iliac vein after successful endovascular recanalization in chronic haemodialysis patient post-MV replacement., (© The Author(s) 2020. Published by Oxford University Press on behalf of the European Society of Cardiology.)

Published
2020
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37. Present criteria for prophylactic ICD implantation: Insights from the EU-CERT-ICD (Comparative Effectiveness Research to Assess the Use of Primary ProphylacTic Implantable Cardioverter Defibrillators in EUrope) project.

Author

Zabel M, Schlögl S, Lubinski A, Svendsen JH, Bauer A, Arbelo E, Brusich S, Conen D, Cygankiewicz I, Dommasch M, Flevari P, Galuszka J, Hansen J, Hasenfuß G, Hatala R, Huikuri HV, Kenttä T, Kucejko T, Haarmann H, Harden M, Iovev S, Kääb S, Kaliska G, Katsimardos A, Kasprzak JD, Qavoq D, Lüthje L, Malik M, Novotný T, Pavlović N, Perge P, Röver C, Schmidt G, Shalganov T, Sritharan R, Svetlosak M, Sallo Z, Szavits-Nossan J, Traykov V, Vandenberk B, Velchev V, Vos MA, Willich SN, Friede T, Willems R, Merkely B, and Sticherling C

Subjects
Electrocardiography, Europe, Humans, Multicenter Studies as Topic, Observational Studies as Topic, Prospective Studies, Treatment Outcome, Comparative Effectiveness Research, Death, Sudden, Cardiac prevention & control, Defibrillators, Implantable
Abstract

Background: The clinical effectiveness of primary prevention implantable cardioverter defibrillator (ICD) therapy is under debate. It is urgently needed to better identify patients who benefit from prophylactic ICD therapy. The EUropean Comparative Effectiveness Research to Assess the Use of Primary ProphylacTic Implantable Cardioverter Defibrillators (EU-CERT-ICD) completed in 2019 will assess this issue., Summary: The EU-CERT-ICD is a prospective investigator-initiated non-randomized, controlled, multicenter observational cohort study done in 44 centers across 15 European countries. A total of 2327 patients with heart failure due to ischemic heart disease or dilated cardiomyopathy indicated for primary prophylactic ICD implantation were recruited between 2014 and 2018 (>1500 patients at first ICD implantation, >750 patients non-randomized non-ICD control group). The primary endpoint was all-cause mortality, and first appropriate shock was co-primary endpoint. At baseline, all patients underwent 12‑lead ECG and Holter-ECG analysis using multiple advanced methods for risk stratification as well as documentation of clinical characteristics and laboratory values. The EU-CERT-ICD data will provide much needed information on the survival benefit of preventive ICD therapy and expand on previous prospective risk stratification studies which showed very good applicability of clinical parameters and advanced risk stratifiers in order to define patient subgroups with above or below average ICD benefit., Conclusion: The EU-CERT-ICD study will provide new and current data about effectiveness of primary prophylactic ICD implantation. The study also aims for improved risk stratification and patient selection using clinical risk markers in general, and advanced ECG risk markers in particular., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Published
2019
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38. Atrial high-rate episodes: prevalence, stroke risk, implications for management, and clinical gaps in evidence.

Author

Bertaglia E, Blank B, Blomström-Lundqvist C, Brandes A, Cabanelas N, Dan GA, Dichtl W, Goette A, de Groot JR, Lubinski A, Marijon E, Merkely B, Mont L, Piorkowski C, Sarkozy A, Sulke N, Vardas P, Velchev V, Wichterle D, and Kirchhof P

Subjects
Atrial Fibrillation complications, Atrial Fibrillation drug therapy, Global Health, Humans, Prevalence, Risk Factors, Stroke etiology, Stroke prevention & control, Anticoagulants therapeutic use, Atrial Fibrillation epidemiology, Heart Atria physiopathology, Heart Rate physiology, Risk Assessment methods, Stroke epidemiology
Abstract

Self-terminating atrial arrhythmias are commonly detected on continuous rhythm monitoring, e.g. by pacemakers or defibrillators. It is unclear whether the presence of these arrhythmias has therapeutic consequences. We sought to summarize evidence on the prevalence of atrial high-rate episodes (AHREs) and their impact on risk of stroke. We performed a comprehensive, tabulated review of published literature on the prevalence of AHRE. In patients with AHRE, but without atrial fibrillation (AF), we reviewed the stroke risk and the potential risk/benefit of oral anticoagulation. Atrial high-rate episodes are found in 10-30% of AF-free patients. Presence of AHRE slightly increases stroke risk (0.8% to 1%/year) compared with patients without AHRE. Atrial high-rate episode of longer duration (e.g. those >24 h) could be associated with a higher stroke risk. Oral anticoagulation has the potential to reduce stroke risk in patients with AHRE but is associated with a rate of major bleeding of 2%/year. Oral anticoagulation is not effective in patients with heart failure or survivors of a stroke without AF. It remains unclear whether anticoagulation is effective and safe in patients with AHRE. Atrial high-rate episodes are common and confer a slight increase in stroke risk. There is true equipoise on the best way to reduce stroke risk in patients with AHRE. Two ongoing trials (NOAH-AFNET 6 and ARTESiA) will provide much-needed information on the effectiveness and safety of oral anticoagulation using non-vitamin K antagonist oral anticoagulants in patients with AHRE., (© The Author(s) 2019. Published by Oxford University Press on behalf of the European Society of Cardiology.)

Published
2019
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39. Rationale and design of the EU-CERT-ICD prospective study: comparative effectiveness of prophylactic ICD implantation.

Author

Zabel M, Sticherling C, Willems R, Lubinski A, Bauer A, Bergau L, Braunschweig F, Brugada J, Brusich S, Conen D, Cygankiewicz I, Flevari P, Taborsky M, Hansen J, Hasenfuß G, Hatala R, Huikuri HV, Iovev S, Kääb S, Kaliska G, Kasprzak JD, Lüthje L, Malik M, Novotny T, Pavlović N, Schmidt G, Shalganov T, Sritharan R, Schlögl S, Szavits Nossan J, Traykov V, Tuinenburg AE, Velchev V, Vos MA, Willich SN, Friede T, Svendsen JH, and Merkely B

Subjects
Cardiomyopathy, Dilated complications, Cardiomyopathy, Dilated mortality, Death, Sudden, Cardiac epidemiology, Death, Sudden, Cardiac etiology, Electrocardiography, Europe epidemiology, Follow-Up Studies, Humans, Patient Selection, Prospective Studies, Quality of Life, Survival Rate trends, Treatment Outcome, Cardiomyopathy, Dilated therapy, Death, Sudden, Cardiac prevention & control, Defibrillators, Implantable, Primary Prevention methods, Risk Assessment
Abstract

Aims: The clinical effectiveness of primary prevention implantable cardioverter defibrillator (ICD) therapy is under debate. The EUropean Comparative Effectiveness Research to Assess the Use of Primary ProphylacTic Implantable Cardioverter Defibrillators (EU-CERT-ICD) aims to assess its current clinical value., Methods and Results: The EU-CERT-ICD is a prospective investigator-initiated non-randomized, controlled, multicentre observational cohort study performed in 44 centres across 15 European Union countries. We will recruit 2250 patients with ischaemic or dilated cardiomyopathy and a guideline indication for primary prophylactic ICD implantation. This sample will include 1500 patients at their first ICD implantation and 750 patients who did not receive a primary prevention ICD despite having an indication for it (non-randomized control group). The primary endpoint is all-cause mortality; the co-primary endpoint in ICD patients is time to first appropriate shock. Secondary endpoints include sudden cardiac death, first inappropriate shock, any ICD shock, arrhythmogenic syncope, revision procedures, quality of life, and cost-effectiveness. At baseline (and prior to ICD implantation if applicable), all patients undergo 12-lead electrocardiogram (ECG) and Holter ECG analysis using multiple advanced methods for risk stratification as well as detailed documentation of clinical characteristics and laboratory values. Genetic biobanking is also organized. As of August 2018, baseline data of 2265 patients are complete. All subjects will be followed for up to 4.5 years., Conclusions: The EU-CERT-ICD study will provide a necessary update about clinical effectiveness of primary prophylactic ICD implantation. This study also aims for improved risk stratification and patient selection using clinical and ECG risk markers., (© 2018 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of the European Society of Cardiology.)

Published
2019
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40. Tailoring clopidogrel dose according to multiple electrode aggregometry decreases the rate of ischemic complications after percutaneous coronary intervention.

Author

Hazarbasanov D, Velchev V, Finkov B, Postadjian A, Kostov E, Rifai N, and Aradi D

Subjects
Acute Coronary Syndrome mortality, Aged, Angina Pectoris mortality, Clopidogrel, Disease-Free Survival, Female, Humans, Male, Middle Aged, Platelet Function Tests, Prospective Studies, Purinergic P2Y Receptor Antagonists adverse effects, Ticlopidine administration & dosage, Ticlopidine adverse effects, Time Factors, Acute Coronary Syndrome therapy, Angina Pectoris therapy, Angioplasty, Balloon, Coronary, Purinergic P2Y Receptor Antagonists administration & dosage, Ticlopidine analogs & derivatives
Abstract

Multiple studies have shown a correlation between high on-treatment platelet reactivity (HPR) and ischemic complications after percutaneous coronary interventions (PCI); however, the role of platelet reactivity testing in order to adjust clopidogrel dose is debated. We sought to determine whether a strategy incorporating platelet reactivity testing with the Multiplate analyzer to tailor the dose of clopidogrel is superior to standard clopidogrel treatment after PCI. Between May 2008 and June 2009, 192 consecutive patients undergoing PCI were randomized to a tailored treatment strategy using the Multiplate analyzer or to uniform administration of 75 mg clopidogrel. In the tailored group, platelet function was assessed 24 h after clopidogrel loading, and patients with HPR (>46 U) received an additional 600 mg loading dose and 150 mg clopidogrel thereafter for one month. The primary endpoint was the composite of cardiac death, myocardial infarction, ischemic stroke or definite/probable stent thrombosis during six months. In the tailored group, a repeated loading dose of 600 mg clopidogrel significantly decreased platelet reactivity in patients with HPR (61.0 U [IQR: 52.5-71.5] vs. 21.5 U [15.8-30.5]; P < 0.0001) that remained unchanged during the maintenance phase on 150 mg clopidogrel (25.0 U [IQR: 19.8-27.0]; P = 0.20). The incidence of the primary endpoint was significantly higher in the standard clopidogrel group as compared to the Multiplate-tailored arm (5.3% vs. 0%, P = 0.03). In parallel, MACCE-free survival significantly improved in patients with Multiplate-tailored therapy (Kaplan-Meier log-rank: P = 0.02). Increasing the dose of clopidogrel according to the Multiplate assay may reduce ischemic complications in patients on clopidogrel after PCI.

Published
2012
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41. Permanent pacing in patients with recurrence of symptoms and relapse of left ventricular obstruction at midcavity level after alcohol septal ablation.

Author

Velchev V, Postadzhiyan A, Hazarbasanov D, and Finkov B

Abstract

Treatment of symptom recurrence after initially successful alcohol septal ablation (ASA) in hypertrophic obstructive cardiomyopathy (HOCM) when accompanied by relapse of intracavitary left ventricular pressure gradient (LVG) is guided by the underlying mechanism. We describe our experience with permanent pacing in three patients with relapse of both LVG and symptoms 7 to 12 months after successful ASA. Even though pressure gradient recurrence was observed at midventricular level, we were able to achieve symptomatic improvement and LVG reduction after right ventricular apex pacing in all three cases. The effect on symptoms was long lasting-the 6-month followup echo-stress tests confirmed good exercise capacity and lack of provocable LVG. We found pacing to be a safe and effective treatment option in this clinical scenario. Based on our overall observations, we propose pacing as a niche treatment for patients with recurrence of LVG at midventricular level after ASA.

Published
2012
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42. Case report: Percutaneous balloon pericardiotomy using Inoue balloon for patients with massive pericardial effusion.

Author

Velchev V and Finkov B

Subjects
Catheterization instrumentation, Female, Humans, Male, Middle Aged, Pericardiectomy instrumentation, Severity of Illness Index, Catheterization methods, Pericardial Effusion surgery, Pericardial Effusion therapy, Pericardiectomy methods
Abstract

Two patients presenting with huge pericardial effusion were treated with pericardiotomy, using an Inoue balloon dilating catheter, to prevent recurrences and achieve symptoms relief. The procedure is a modification of an original technique reported by Palacios et al. gaining advantage of the Inoue balloon self positioning abilities and low profile. No early recurrence was observed. In both cases the effect was excellent and lead to quick ambulation sparing the patients the risk of more aggressive surgical procedure and general anesthesia. It is concluded that percutaneous balloon pericardiotomy supported by the Inoue balloon unique versatility is a simple and safe way to drain massive pericardial effusions., (Copyright 2008 Elsevier Ireland Ltd. All rights reserved.)

Published
2010
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43. [The analgesic efficacy of transversus abdominis plane (TAP) block].

Author

Velchev V and Malamov K

Subjects
Adult, Aged, Aged, 80 and over, Analgesia methods, Anesthetics, Local therapeutic use, Bupivacaine analogs & derivatives, Bupivacaine therapeutic use, Female, Humans, Levobupivacaine, Male, Middle Aged, Pain Measurement, Postoperative Period, Young Adult, Abdominal Wall surgery, Pain, Postoperative prevention & control, Pain, Postoperative surgery
Abstract

The transversus abdominis plane (TAP) block is a novel approach for blocking the abdominal wall neural afferents via the bilateral lumbar triangles of Petit. It was described for the first time in 2007 by McDonnell et al. We applied the technique after the original methodology of the authors. We evaluated its analgesic efficacy first 24 postoperative hours of patients, undergoing to surgical and urological interventions. After induction of anesthesia, 20 ml of 0.375% levobupivacaine was deposited into the transversus abdominis neuro-fascial plane via the bilateral lumbar triangles of Petit. Each patient was evaluated by VAS in the postanesthesia care unit at the 2, 4, 6, 12 and 24 h postoperatively. Despite the results were more unsatisfactory than those of McDonnel, they were good. Our first impression is that the TAP block provided highly effective postoperative analgesia in the first 24 postoperative hours after major abdominal surgery.

Published
2010

44. [Extensive resections of the small intestine].

Author

Velchev V

Subjects
Adaptation, Physiological, Adolescent, Adult, Aged, Female, Humans, Intestine, Small physiopathology, Male, Middle Aged, Postoperative Complications physiopathology, Intestine, Small surgery
Published
1981

48. [Casuistics of the urachus].

Author

Velchev V

Subjects
Adult, Cysts etiology, Cysts pathology, Humans, Male, Urachus surgery, Urachus pathology
Published
1980

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