TY - JOUR AU - With, R.R. De AU - Erküner, Ö. AU - Rienstra, M. AU - Nguyen, B.O. AU - Körver, F.W.J. AU - Linz, D. AU - Ten, H. Cate AU - Spronk, H. AU - Kroon, A.A. AU - Maass, A.H. AU - Blaauw, Y. AU - Tieleman, R.G. AU - Hemels, M.E.W. AU - Groot, J.R. de AU - Elvan, A. AU - Melis, M. AU - Scheerder, C.O.S. AU - Al-Jazairi, M.I.H. AU - Schotten, U. AU - Luermans, J. AU - Crijns, H. AU - Gelder, I.C van PY - 2020 UR - https://hdl.handle.net/2066/225394 AB - Aims: Atrial fibrillation (AF) often starts as a paroxysmal self-terminating arrhythmia. Limited information is available on AF patterns and episode duration of paroxysmal AF. In paroxysmal AF patients, we longitudinally studied the temporal AF patterns, the association with clinical characteristics, and prevalence of AF progression. Methods and results: In this interim analysis of the Reappraisal of AF: Interaction Between HyperCoagulability, Electrical Remodelling, and Vascular Destabilisation in the Progression of AF (RACE V) registry, 202 patients with paroxysmal AF were followed with continuous rhythm monitoring (implantable loop recorder or pacemaker) for 6 months. Mean age was 64 ± 9 years, 42% were women. Atrial fibrillation history was 2.1 (0.5–4.4) years, CHA2DS2-VASc 1.9 ± 1.3, 101 (50%) had hypertension, 69 (34%) heart failure. One-third had no AF during follow-up. Patients with long episodes (>12 hours) were often men with more comorbidities (heart failure, coronary artery disease, higher left ventricular mass). Patients with higher AF burden (>2.5%) were older with more comorbidities (worse renal function, higher calcium score, thicker intima media thickness). In 179 (89%) patients, 1-year rhythm follow-up was available. On a quarterly basis, average daily AF burden increased from 3.2% to 3.8%, 5.2%, and 6.1%. Compared to the first 6 months, 111 (62%) patients remained stable during the second 6 months, 39 (22%) showed progression to longer AF episodes, 8 (3%) developed persistent AF, and 29 (16%) patients showed AF regression. Conclusions: In paroxysmal AF, temporal patterns differ suggesting that paroxysmal AF is not one entity. Atrial fibrillation burden is low and determined by number of comorbidities. Atrial fibrillation progression occurred in a substantial number. Trial registration number: Clinicaltrials.gov identifier NCT02726698. TI - Temporal patterns and short-term progression of paroxysmal atrial fibrillation: data from RACE V EP - 1172 SN - 1099-5129 IS - iss. 8 SP - 1162 JF - Europace VL - vol. 22 DO - https://doi.org/10.1093/europace/euaa123 ER - TY - JOUR AU - Gommans, D.H.F. AU - Nas, J. AU - Pinto-Sietsma, S.J. AU - Koop, Y. AU - Konst, R.E. AU - Mensink, F.B. AU - Aarts, G.W.A. AU - Konijnenberg, L.S.F. AU - Cortenbach, K.R. AU - Verhaert, D.V.M. AU - Thannhauser, J. AU - Mol, J.H.Q. AU - Rooijakkers, M.J.P. AU - Vos, J.L. AU - Rumund, A. van AU - Vart, P. AU - Hassing, R.J. AU - Cornel, J.H. AU - Jager, C.P.C. de AU - Heuvel, M. van den AU - Hoeven, J.G. van der AU - Royen, N. van AU - Kimmenade, R.R.J. van PY - 2020 UR - https://hdl.handle.net/2066/224636 TI - Rationale and design of the PRAETORIAN-COVID trial: A double-blind, placebo-controlled randomized clinical trial with valsartan for PRevention of Acute rEspiraTORy dIstress syndrome in hospitAlized patieNts with SARS-COV-2 Infection Disease EP - 68 SN - 0002-8703 SP - 60 JF - American Heart Journal VL - vol. 226 DO - https://doi.org/10.1016/j.ahj.2020.05.010 ER - TY - JOUR AU - Pustjens, T.F.S. AU - Appelman, Y. AU - Damman, P. AU - Berg, J.M. ten AU - Jukema, J.W. AU - Winter, R.J. de AU - Agema, W.R.P. AU - Wielen, M.L. van der AU - Arslan, F. AU - Rasoul, S. AU - Hof, A.W.J. van ’t PY - 2020 UR - https://hdl.handle.net/2066/220920 AB - Patients with myocardial infarction and non-obstructive coronary arteries (MINOCA), defined as angiographic stenosis <50%, represent a conundrum given the many potential underlying aetiologies. Possible causes of MINOCA can be subdivided into coronary, myocardial and non-cardiac disorders. MINOCA is found in up to 14% of patients presenting with an acute coronary syndrome. Clinical outcomes including mortality, and functional and psychosocial status, are comparable to those of patients with myocardial infarction and obstructive coronary arteries. However, many uncertainties remain regarding the definition, clinical features and management of these patients. This position paper of the Dutch ACS working group of the Netherlands Society of Cardiology aims to stress the importance of considering MINOCA as a dynamic working diagnosis and to guide the clinician in the management of patients with MINOCA by proposing a clinical diagnostic algorithm. TI - Guidelines for the management of myocardial infarction/injury with non-obstructive coronary arteries (MINOCA): a position paper from the Dutch ACS working group EP - 130 SN - 1568-5888 IS - iss. 3 SP - 116 JF - Netherlands Heart Journal VL - vol. 28 DO - https://doi.org/10.1007/s12471-019-01344-6 ER - TY - JOUR AU - Zwart, B. de AU - Berg, J.M. ten AU - Hof, A.W.J. van ’t AU - Tonino, P.A.L. AU - Appelman, Y. AU - Liem, A.H. AU - Arslan, F. AU - Waltenberger, J. AU - Jukema, J.W. AU - Winter, R.J. de AU - Damman, P. PY - 2020 UR - https://hdl.handle.net/2066/220929 AB - An early invasive strategy in patients who have acute coronary syndrome without ST-elevation (NSTE-ACS) can improve clinical outcome in high-risk subgroups. According to the current guidelines of the European Society of Cardiology (ESC), the majority of NSTE-ACS patients are classified as "high-risk". We propose to prioritise patients with a global registry of acute coronary events (GRACE) risk score >140 over patients with isolated troponin rise or electrocardiographic changes and a GRACE risk score <140. We also acknowledge that same-day transfer for all patients at a high risk is not necessary in the Netherlands since the majority of Dutch cardiology departments are equipped with a catheterisation laboratory where diagnostic coronary angiography is routinely performed in NSTE-ACS patients. Therefore, same-day transfer should be restricted to true high-risk patients (in addition to those NSTE-ACS patients with very high-risk (VHR) criteria) in centres without coronary angiography capabilities. TI - Indications for an early invasive strategy in NSTE-ACS patients EP - 135 SN - 1568-5888 IS - iss. 3 SP - 131 JF - Netherlands Heart Journal VL - vol. 28 DO - https://doi.org/10.1007/s12471-019-01337-5 ER - TY - JOUR AU - Cate, D. Ten AU - Ettema, R.G.A. AU - Huisman-de Waal, G.J. AU - Bell, J.J. AU - Verbrugge, R. AU - Vermeulen, H. AU - Heinen, M.M. AU - Belle, E. van AU - Schoonhoven, L. AU - Schuurmans, M.J. PY - 2020 UR - https://hdl.handle.net/2066/220931 AB - AIMS AND OBJECTIVES: To identify interventions to prevent and treat malnutrition in older adults, which can be integrated in nursing care, and to evaluate the effects of these interventions on outcomes related to malnutrition. BACKGROUND: Older adults are at great risk for malnutrition, which can lead to a number of serious health problems. Nurses have an essential role in nutritional care for older adults. Due to a lack of evidence for nursing interventions, adequate nursing nutritional care still lags behind. DESIGN: Systematic review. METHOD: We searched for and included randomised controlled trials on interventions, which can be integrated in nursing care for older adults, to prevent and treat malnutrition. We assessed the risk of bias with the Cochrane tool and evidence for outcomes with the GRADE. The PRISMA statement was followed for reporting. RESULTS: We included 21 studies of which 14 studies had a high risk of bias. Identified interventions were oral nutritional supplements, food/fluid fortification or enrichment, dietary counselling and educational interventions. In evaluating the effects of these interventions on 11 outcomes related to malnutrition, significant and nonsignificant effects were found. We graded the certainty of evidence as very low to moderate. CONCLUSION: Although slight effects were found in protein intake and body mass index, there is no convincing evidence about the effectiveness of the four identified interventions. There seems no harm in using these interventions, although it should be kept in mind that the evidence is sparse. Therefore, there is a need for high-quality research in building evidence for interventions in nursing nutritional care. RELEVANCE TO CLINICAL PRACTICE: Nurses can safely provide oral nutritional supplements and food/fluid fortification or enrichment, and give dietary counselling and education to older adults, as they are well placed to lead the essential processes of nutritional care to older adults. TI - Interventions to prevent and treat malnutrition in older adults to be carried out by nurses: A systematic review EP - 1902 SN - 0962-1067 IS - iss. 11-12 SP - 1883 JF - Journal of Clinical Nursing VL - vol. 29 DO - https://doi.org/10.1111/jocn.15153 ER - TY - JOUR AU - Prescott, E. AU - Mikkelsen, Nicolai AU - Holdgaard, Annette AU - Eser, Prisca AU - Marcin, Thimo AU - Wilhelm, M. AU - Meindersma, E.P. AU - Hof, A.W.J. van ’t AU - Kluiver, Ed P. de PY - 2019 UR - https://hdl.handle.net/2066/204798 TI - Cardiac rehabilitation in the elderly patient in eight rehabilitation units in Western Europe: Baseline data from the EU-CaRE multicentre observational study EP - 1063 SN - 2047-4873 IS - iss. 10 SP - 1052 JF - European Journal of Preventive Cardiology VL - vol. 26 DO - https://doi.org/10.1177/2047487319839819 ER - TY - JOUR AU - Lemkes, J.S. AU - Janssens, G.N. AU - Hoeven, N.W. Van Der AU - Ven, P.M. van de AU - Marques, K.M. AU - Nap, A. AU - Leeuwen, M.A.H. van AU - Appelman, Y.E.A. AU - Knaapen, P. AU - Verouden, N.J.W. AU - Allaart, C.P. AU - Brinckman, S.L. AU - Saraber, C.E. AU - Plomp, K.J. AU - Timmer, J.R. AU - Kedhi, E. AU - Hermanides, R.S. AU - Meuwissen, M. AU - Schaap, J. AU - Weerdt, A.P. van der AU - Rossum, A.C. van AU - Nijveldt, R. AU - Royen, N. van PY - 2019 UR - https://hdl.handle.net/2066/202703 AB - Aims: Patients with acute coronary syndrome who present initially with ST-elevation on the electrocardiogram but, subsequently, show complete normalization of the ST-segment and relief of symptoms before reperfusion therapy are referred to as transient ST-segment elevation myocardial infarction (STEMI) and pose a therapeutic challenge. It is unclear what the optimal timing of revascularization is for these patients and whether they should be treated with a STEMI-like or a non-ST-segment elevation myocardial infarction (NSTEMI)-like invasive approach. The aim of the study is to determine the effect of an immediate vs. a delayed invasive strategy on infarct size measured by cardiac magnetic resonance imaging (CMR). Methods and results: In a randomized clinical trial, 142 patients with transient STEMI with symptoms of any duration were randomized to an immediate (STEMI-like) [0.3 h; interquartile range (IQR) 0.2-0.7 h] or a delayed (NSTEMI-like) invasive strategy (22.7 h; IQR 18.2-27.3 h). Infarct size as percentage of the left ventricular myocardial mass measured by CMR at day four was generally small and not different between the immediate and the delayed invasive group (1.3%; IQR 0.0-3.5% vs. 1.5% IQR 0.0-4.1%, P = 0.48). By intention to treat, there was no difference in major adverse cardiac events (MACE), defined as death, reinfarction, or target vessel revascularization at 30 days (2.9% vs. 2.8%, P = 1.00). However, four additional patients (5.6%) in the delayed invasive strategy required urgent intervention due to signs and symptoms of reinfarction while awaiting angiography. Conclusion: Overall, infarct size in transient STEMI is small and is not influenced by an immediate or delayed invasive strategy. In addition, short-term MACE was low and not different between the treatment groups. TI - Timing of revascularization in patients with transient ST-segment elevation myocardial infarction: a randomized clinical trial EP - 291 SN - 0195-668X IS - iss. 3 SP - 283 JF - European Heart Journal VL - vol. 40 DO - https://doi.org/10.1093/eurheartj/ehy651 ER - TY - JOUR AU - Hoedemaker, N.P.G. AU - Damman, P. AU - Ottervanger, J.P. AU - Dambrink, J.H. AU - Gosselink, A. T. Marcel AU - Kedhi, Elvin AU - Winter, R.J. de AU - Hof, A.W.J. van ’t PY - 2019 UR - https://hdl.handle.net/2066/208146 TI - Trends in cardiovascular and bleeding outcomes in acute coronary syndrome patients treated with or without proton-pump inhibitors during the introduction of novel P2Y12 inhibitors: a five-year experience from a single-centre observational registry EP - 138 SN - 2055-6837 IS - iss. 3 SP - 127 JF - European Heart Journal - Cardiovascular Pharmacotherapy VL - vol. 5 DO - https://doi.org/10.1093/ehjcvp/pvy030 ER - TY - JOUR AU - Janssens, G.N. AU - Hoeven, N.W. Van Der AU - Lemkes, J.S. AU - Everaars, H. AU - Ven, P.M. van de AU - Marques, K.M. AU - Nap, A. AU - Leeuwen, Marc van AU - Appelman, Y. AU - Knaapen, P. AU - Verouden, N.J.W. AU - Allaart, C.P. AU - Brinckman, S.L. AU - Saraber, C.E. AU - Plomp, K.J. AU - Timmer, J.R. AU - Kedhi, E. AU - Hermanides, R.S. AU - Meuwissen, M. AU - Schaap, J. AU - Weerdt, A.P. van der AU - Rossum, A.C. van AU - Nijveldt, R. AU - Royen, N. van PY - 2019 UR - https://hdl.handle.net/2066/215251 AB - OBJECTIVES: The aim of the present study was to determine the effect of a delayed versus an immediate invasive approach on final infarct size and clinical outcome up to 1 year. BACKGROUND: Up to 24% of patients with acute coronary syndromes present with ST-segment elevation myocardial infarction (STEMI) but show complete resolution of ST-segment elevation and symptoms before revascularization. Current guidelines do not clearly state whether these patients with transient STEMI should be treated with a STEMI-like or non-ST-segment elevation acute coronary syndrome-like intervention strategy. METHODS: In this multicenter trial, 142 patients with transient STEMI were randomized 1:1 to either delayed or immediate coronary intervention. Cardiac magnetic resonance imaging was performed at 4 days and at 4-month follow-up to assess infarct size and myocardial function. Clinical follow-up was performed at 4 and 12 months. RESULTS: In the delayed (22.7 h) and the immediate (0.4 h) invasive groups, final infarct size as a percentage of the left ventricle was very small (0.4% [interquartile range: 0.0% to 2.5%] vs. 0.4% [interquartile range: 0.0% to 3.5%]; p = 0.79), and left ventricular function was good (mean ejection fraction 59.3 +/- 6.5% vs. 59.9 +/- 5.4%; p = 0.63). In addition, the overall occurrence of major adverse cardiac events, consisting of death, recurrent infarction, and target lesion revascularization, up to 1 year was low and not different between both groups (5.7% vs. 4.4%, respectively; p = 1.00). CONCLUSIONS: At follow-up, patients with transient STEMI have limited infarction and well-preserved myocardial function in general, and delayed or immediate revascularization has no effect on functional outcome and clinical events up to 1 year. TI - 1-Year Outcomes of Delayed Versus Immediate Intervention in Patients With Transient ST-Segment Elevation Myocardial Infarction EP - 2282 SN - 1936-8798 IS - iss. 22 SP - 2272 JF - Jacc. Cardiovascular Interventions VL - vol. 12 DO - https://doi.org/10.1016/j.jcin.2019.07.018 ER - TY - JOUR AU - Vroomen, M. AU - Maesen, B. AU - Meir, M. La AU - Luermans, J.G.L.M. AU - Vernooy, K. AU - Maessen, J.G. AU - Crijns, H.J.G.M. AU - Pison, L. PY - 2019 UR - https://hdl.handle.net/2066/209448 AB - Background: The long-term results of endocardial and percutaneous epicardial catheter ablation of ventricular tachycardia (VT) in patients with structural heart disease are disappointing. Arrhythmia recurrence after ablation and VTs with an epicardial substrate remain a clinical challenge. The purpose of this manuscript is to elaborate on feasibility and potential advantages of a surgical hybrid ablation (i.e., combined endocardial and surgical epicardial ablation) based on our initial experience consisting of five cases. Methods: Endocardial electro-anatomical voltage and activation maps were created (Carto, Biosense Webster, California, USA), and endocardial radiofrequency (RF) applications were applied at exit sites, low voltage areas and isthmi. Next, after surgical access, epicardial voltage and activation maps were produced in combination with visual assessment of the epicardial substrate. Epicardial low voltage areas, isthmi and exit sites were identified and ablated using RF energy. Results: After the procedure, VT was non-inducible in 80% of the cases (4/5, in one case no induction was performed). No peri-procedural complications occurred. After a mean follow-up of 18 months, one patient remained in sinus rhythm without, and 2 with use of antiarrhythmic drugs. One patient needed a redo procedure after 21 months, and in one patient the amiodarone dose was raised because of 2 sustained VTs. After this additional treatment, both kept sinus rhythm. Conclusions: Hybrid VT ablation is a safe and effective patient tailored procedure that comprises the major advantage of combining direct anatomical visualization and enhanced catheter stability with high-density 3D mapping. As a consequence, this procedure should be considered as a valid treatment option in complex VT management. TI - Hybrid Ablation of Ventricular Tachycardia: a Single-Centre Experience SN - 1941-6911 IS - iss. 5 SP - 2118 JF - Journal of atrial fibrillation VL - vol. 11 DO - https://doi.org/10.4022/jafib.2118 L1 - https://repository.ubn.ru.nl/bitstream/handle/2066/209448/209448.pdf?sequence=1 ER - TY - JOUR AU - Vroomen, M. AU - Meir, M. La AU - Maesen, B. AU - Luermans, J.G.L.M. AU - Vernooy, K. AU - Essers, B. AU - Greef, B.T.A. de AU - Maessen, J.G. AU - Crijns, H.J.G.M. AU - Pison, L. PY - 2019 UR - https://hdl.handle.net/2066/209449 AB - BACKGROUND: Success rates with conventional transvenous endocardial pulmonary vein isolation in patients with persistent and longstanding persistent atrial fibrillation (AF) are variable due to advanced electrical and structural remodeling of the atria. As a consequence, more extensive endocardial lesions, minimally invasive thoracoscopic surgical techniques, and hybrid ablation (combining thoracoscopic epicardial surgical and endocardial catheter ablation) have been developed. HYPOTHESIS: The HARTCAP-AF trial hypothesizes that hybrid AF ablation is more effective than (repeated) transvenous endocardial catheter ablation in (longstanding) persistent AF, without increasing the number of associated major adverse events. METHODS: This randomized controlled trial will include 40 patients with persistent or longstanding persistent AF who will be 1:1 randomized to either hybrid ablation or (repeated) catheter ablation. The procedures and follow-up are conducted according to the guidelines. The primary effectiveness endpoint is freedom from any supraventricular arrhythmia lasting longer than 5 min without the use of Vaughan-Williams class I or III antiarrhythmic drugs through 12 months of follow-up after the last procedure. In the catheter ablation arm, a second procedure planned within 6 months after the index procedure is allowed for obtaining the primary endpoint. Additionally, adverse events, cost-effectiveness, and quality of life data will be recorded. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02441738 . Registered on 12 May 2015. TI - Hybrid thoracoscopic surgical and transvenous catheter ablation versus transvenous catheter ablation in persistent and longstanding persistent atrial fibrillation (HARTCAP-AF): study protocol for a randomized trial SN - 1745-6215 JF - Trials VL - vol. 20 DO - https://doi.org/10.1186/s13063-019-3365-9 L1 - https://repository.ubn.ru.nl/bitstream/handle/2066/209449/209449.pdf?sequence=1 ER - TY - JOUR AU - Badings, E.A. AU - Hermanides, R.S. AU - Sluis, A. van der AU - Dambrink, J.H. AU - Gosselink, A.T.M. AU - Kedhi, E. AU - Ottervanger, J.P. AU - Roolvink, V. AU - Remkes, W.S. AU - Riet, E. van 't AU - Suryapranata, H. AU - Hof, A.W.J. van ’t PY - 2019 UR - https://hdl.handle.net/2066/202710 AB - BACKGROUND: An early invasive strategy (EIS) is recommended in high-risk patients with non-ST-elevation acute coronary syndrome (NSTE-ACS), defined as coronary angiography (CAG), within 24h of admission. The aim of the present study is to investigate guideline adherence, patient characteristics associated with timing of the intervention and clinical outcome. METHODS: In a prospective registry, the use and timing of CAG and the characteristics and clinical outcome associated with timing were evaluated in high-risk ACS patients. The outcome of early versus delayed invasive strategy (DIS) was compared. RESULTS: Between 2006 and 2014, 2,299 high-risk NSTE-ACS patients were included. The use of CAG increased from 77% in 2006 to 90% in 2014 (p trend <0.001) together with a decrease of median time to CAG from 23.3 to 14.5h (p trend <0.001) and an increase of patients undergoing EIS from 50 to 60% (p trend= 0.002). Patient factors independently related to DIS were higher GRACE risk score, higher age and the presence of comorbidities. No difference was found in incidence of mortality, reinfarction or bleeding at 30-day follow-up. All-cause mortality at 1year follow-up was 4.1% vs 7.0% in EIS and DIS respectively (hazard ratio 1.67, 95% confidence interval 1.12-2.49) but was comparable after adjustment for confounding factors. CONCLUSION: The percentage of high-risk NSTE-ACS patients undergoing CAG and EIS has increased in the last decade. In contrast to the guidelines, patients with a higher risk profile are less likely to undergo EIS. However, no difference in outcome after 30 days and 1 year was found after multivariate adjustment for this higher risk. TI - Use, timing and outcome of coronary angiography in patients with high-risk non-ST-segment elevation acute coronary syndrome in daily clinical practice: insights from a 'real world' prospective registry EP - 80 SN - 1568-5888 IS - iss. 2 SP - 73 JF - Netherlands Heart Journal VL - vol. 27 DO - https://doi.org/10.1007/s12471-018-1212-3 L1 - https://repository.ubn.ru.nl/bitstream/handle/2066/202710/202710.pdf?sequence=1 ER - TY - JOUR AU - Pisters, R. AU - Elvan, A. AU - Crijns, H.J.G.M. AU - Hemels, M.E.W. PY - 2018 UR - https://hdl.handle.net/2066/191924 TI - Optimal long-term antithrombotic management of atrial fibrillation: life cycle management EP - 320 SN - 1568-5888 IS - iss. 6 SP - 311 JF - Netherlands Heart Journal VL - vol. 26 DO - https://doi.org/10.1007/s12471-018-1118-0 L1 - https://repository.ubn.ru.nl/bitstream/handle/2066/191924/191924.pdf?sequence=1 ER - TY - JOUR AU - Pluymaekers, N.A. AU - Dudink, E.A. AU - Boersma, L. AU - Erkuner, O. AU - Gelissen, M. AU - Dijk, V. van AU - Wijffels, M. AU - Dinh, T. AU - Vernooy, K. AU - Crijns, H.J.G.M. AU - Balt, J. AU - Luermans, J.G.L.M. PY - 2018 UR - https://hdl.handle.net/2066/200100 AB - BACKGROUND: Atrial tachyarrhythmias are common in patients with cardiac implantable electronic devices (CIEDs). Restoration of sinus rhythm by external electrical cardioversion (eECV) is frequently used to alleviate symptoms and to ensure optimal device function. OBJECTIVES: To evaluate the safety of eECV in patients with contemporary CIEDs and to assess the need for immediate device interrogation after eECV. METHODS: We conducted a retrospective observational study of 229 patients (27.9% female, age 69 +/- 10 years) with a CIED (104 pacemakers, 69 implantable cardioverter defibrillators, and 56 biventricular devices) who underwent eECV between 2008 and 2016 in two centers. Data from device interrogation before eECV, immediately afterwards, and at first follow-up (FU) after eECV were collected. CIED-related complications and adverse events during and after eECV were recorded. RESULTS: No significant differences between right atrial (RA) and right ventricular (RV) sensing or threshold values before eECV, immediately afterwards, or at FU were observed. A small yet significant decrease was observed in RA and RV impedance immediately after eECV (484 Omega vs 462 Omega, P < 0.001 and 536 Omega vs 514 Omega, P < 0.001, respectively). The RV impedance did not recover to the baseline value (538 Omega vs 527 Omega, P = 0.02). The impedance changes were without clinical consequences. No changes in left ventricular lead threshold or impedance values were measured. No CIED-related complications or adverse events were documented following eECV. CONCLUSION: eECV in patients with contemporary CIEDs is safe. There seems to be no need for immediate device interrogation after eECV. TI - External electrical cardioversion in patients with cardiac implantable electronic devices: Is it safe and is immediate device interrogation necessary? EP - 1340 SN - 0147-8389 IS - iss. 10 SP - 1336 JF - Pace-Pacing and Clinical Electrophysiology VL - vol. 41 DO - https://doi.org/10.1111/pace.13467 ER - TY - JOUR AU - Arslan, F. AU - Bongartz, L.G. AU - Berg, J.M. ten AU - Jukema, J.W. AU - Appelman, Y. AU - Liem, A.H. AU - Hof, A.W.J. van ’t AU - Damman, P. PY - 2018 UR - https://hdl.handle.net/2066/195247 TI - 2017 ESC guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: comments from the Dutch ACS working group EP - 421 SN - 1568-5888 IS - iss. 9 SP - 417 JF - Netherlands Heart Journal VL - vol. 26 DO - https://doi.org/10.1007/s12471-018-1134-0 L1 - https://repository.ubn.ru.nl/bitstream/handle/2066/195247/195247.pdf?sequence=1 ER - TY - JOUR AU - Stipdonk, A.M.W. van AU - Horst, I.A.H. Ter AU - Kloosterman, M. AU - Engels, E.B. AU - Rienstra, M. AU - Crijns, H.J.G.M. AU - Maass, Alexander H. AU - Vernooy, K. PY - 2018 UR - https://hdl.handle.net/2066/199516 TI - QRS Area Is a Strong Determinant of Outcome in Cardiac Resynchronization Therapy SN - 1941-3149 IS - iss. 12 JF - Circulation-Arrhythmia and Electrophysiology VL - vol. 11 DO - https://doi.org/10.1161/CIRCEP.118.006497 ER - TY - JOUR AU - Smit, J.M. AU - Hermans, M.P. AU - Dimitriu-Leen, A.C. AU - Rosendael, A.R. van AU - Dibbets-Schneider, P. AU - Geus-Oei, L.F. de AU - Mertens, B.J. AU - Schalij, M.J. AU - Bax, J.J. AU - Scholte, A.J. PY - 2018 UR - https://hdl.handle.net/2066/200233 AB - Aims: The aim of this study was to determine the long-term prognostic value of infarct size and myocardial ischaemia on single-photon emission computed tomography myocardial perfusion imaging (SPECT MPI) after primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI). Methods and results: In total, 1092 STEMI patients who underwent primary PCI and SPECT MPI within 1-6 months were included (median follow-up time of 6.9 years). In the entire cohort, SPECT infarct size was independently associated with the composite of cardiac death or reinfarction [hazard ratio (HR) per 10% increase in summed rest score 1.33; 95% confidence interval (95% CI) 1.12-1.58; P = 0.001], whereas myocardial ischaemia was not (HR per 5% increase in summed difference score 1.18; 95% CI 0.94-1.48; P = 0.16). Addition of SPECT infarct size to a model including the clinical variables provided significant incremental prognostic value for the prediction of cardiac death or reinfarction (global chi2 13.8 vs. 24.2; P = 0.002), whereas addition of SPECT ischaemia did not add significantly (global chi2 24.2 vs. 25.6; P = 0.24). In the subgroup of patients with left ventricular ejection fraction (LVEF) 45%, only SPECT ischaemia was independently associated with cardiac death or reinfarction (HR 1.28; 95% CI 1.00-1.63; P = 0.050). Conclusion: In patients with first STEMI and primary PCI, SPECT infarct size was independently associated with cardiac death and/or reinfarction, whereas myocardial ischaemia was not. In patients with LVEF 45%, only SPECT ischaemia was independently associated with cardiac death or reinfarction. TI - Long-term prognostic value of single-photon emission computed tomography myocardial perfusion imaging after primary PCI for STEMI EP - 1293 SN - 2047-2404 IS - iss. 11 SP - 1287 JF - European Heart Journal Cardiovascular Imaging VL - vol. 19 DO - https://doi.org/10.1093/ehjci/jex332 ER - TY - JOUR AU - Adiyaman, A. AU - Buist, T.J. AU - Beukema, R.J. AU - Smit, J.J. AU - Delnoy, P. AU - Hemels, M.E. AU - Sie, H.T. AU - Misier, A.R.R. AU - Elvan, A. PY - 2018 UR - https://hdl.handle.net/2066/200354 AB - BACKGROUND: Current guidelines recommend both percutaneous catheter ablation (CA) and surgical ablation in the treatment of atrial fibrillation, with different levels of evidence. No direct comparison has been made between minimally invasive thoracoscopic pulmonary vein isolation with left atrial appendage ligation (surgical MIPI) versus percutaneous CA comprising of pulmonary vein isolation as primary treatment of atrial fibrillation. We, therefore, conducted a randomized controlled trial comparing the safety and efficacy of these 2 treatment modalities. METHODS: Eighty patients were enrolled in the study and underwent implantable loop recorder implantation. Twenty-eight patients did not reach randomization criteria. A total of 52 patients with symptomatic paroxysmal or early persistent atrial fibrillation were randomized, 26 to CA and 26 to surgical MIPI. The primary end point was defined as freedom of atrial tachyarrhythmias, without the use of antiarrhythmic drugs. The safety end point was freedom of complications. RESULTS: Median age was 57 years (range, 37-75), and 78% were men. Paroxysmal atrial fibrillation was present in 74%. Follow-up duration was >/=2 years in all patients. CA was noninferior to MIPI in terms of single-procedure arrhythmia-free survival after 2 years of follow-up (56.0% versus 29.2%; HR, 0.56; 95% CI, 0.26-1.20; log-rank P=0.059). Procedure-related major adverse events occurred significantly more often in MIPI than CA (20.8% versus 0%; P=0.029). CONCLUSIONS: Percutaneous pulmonary vein isolation was noninferior to MIPI in terms of efficacy and resulted in less complications. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov . Unique identifier: NCT00703157. TI - Randomized Controlled Trial of Surgical Versus Catheter Ablation for Paroxysmal and Early Persistent Atrial Fibrillation SN - 1941-3149 IS - iss. 10 SP - e006182 JF - Circulation-Arrhythmia and Electrophysiology VL - vol. 11 DO - https://doi.org/10.1161/CIRCEP.118.006182 ER - TY - JOUR AU - Maesen, B. AU - Pison, L. AU - Vroomen, M. AU - Luermans, J.G. AU - Vernooy, K. AU - Maessen, J.G. AU - Crijns, H.J.G.M. AU - Meir, M. La PY - 2018 UR - https://hdl.handle.net/2066/193279 AB - OBJECTIVES: The single-step hybrid atrial fibrillation (AF) ablation procedure combines a transvenous endocardial and thoracoscopic epicardial approach in 1 procedure. Short-term results are encouraging, but long-term outcome data are not available. METHODS: Hybrid AF ablation was successfully performed in 64 consecutive patients (53% with persistent AF). The mean follow-up period was 1732 +/- 353 days. Perprocedural endocardial touch-up of incomplete epicardial lesions was performed in 17 (26%) patients. RESULTS: In paroxysmal AF patients, arrhythmia-free cumulative survival rates after 1 hybrid AF ablation without Class I or III antiarrhythmic drugs procedure and without redo catheter ablation were 83%, 80% and 80% after 1, 2 and 3 years, respectively. In (long-standing) persistent AF patients, these were 82%, 79% and 79% after 1, 2 and 3 years. Thirteen (20%) patients had at least 1 recurrent episode of supraventricular arrhythmia lasting longer than 30 s: the most frequent recurrent arrhythmias were left atrial flutter and AF. No mortality or conversion to cardiopulmonary bypass, no phrenic nerve palsy and no pacemaker implantation were reported. CONCLUSIONS: Hybrid AF ablation, combining a transvenous endocardial and thoracoscopic epicardial approach in a single procedure, results in a cumulative 3-year freedom from arrhythmia without Class I or III antiarrhythmic drugs and without redo catheter ablation of 80% in paroxysmal AF (24 of 30 patients) and 79% in non-paroxysmal AF (26 of 33 patients). TI - Three-year follow-up of hybrid ablation for atrial fibrillation EP - i32 SN - 1010-7940 IS - iss. suppl_1 SP - i26 JF - European Journal of Cardio-Thoracic Surgery VL - vol. 53 DO - https://doi.org/10.1093/ejcts/ezy117 ER - TY - JOUR AU - Badings, E.A. AU - Hermanides, R.S. AU - The, S.H. AU - Dambrink, J.E. AU - Rasoul, S. AU - Wijngaarden, J. van AU - Suryapranata, H. AU - Hof, A.W.J. van ’t PY - 2018 UR - https://hdl.handle.net/2066/192090 TI - Comparison of Outcomes and Intervention Among Patients With Non-ST-Segment Elevation Acute Myocardial Infarction of Those With a Left Circumflex Versus Those With a Non-Left Circumflex-Related Coronary Artery (From the ELISA-3 Trial) EP - 1128 SN - 0002-9149 IS - iss. 10 SP - 1123 JF - American Journal of Cardiology VL - vol. 121 DO - https://doi.org/10.1016/j.amjcard.2018.01.031 ER - TY - JOUR AU - Yokota, S. AU - Ottervanger, J.P. AU - Mouden, M. AU - Boer, M.J. de AU - Jager, P.L. De AU - Timmer, J.R. PY - 2018 UR - https://hdl.handle.net/2066/190527 AB - PURPOSE: Normal myocardial perfusion imaging (MPI) is associated with excellent prognosis. However, in patients with persisting symptoms, it may be difficult to determine the patients in whom invasive angiography is justified to rule out false negative MPI. We evaluated predictors for severe stenosis at invasive angiography in patients with persisting symptoms after normal MPI. METHODS: 229 consecutive patients with normal MPI, without previous bypass surgery, underwent invasive angiography within 6 months. Older age was defined as >65 years. Multivariable analyses were performed to adjust for differences in baseline variables. RESULTS: Mean age was 62+/- 11 years, 48% were women. Severe stenosis was observed in 34%, and of these patients 60% had single-vessel disease (not left main coronary artery disease). After adjusting for several variables, including diabetes, smoking status, hypertension and hypercholesterolaemia, predictors of severe stenosis were male gender, odds ratio (OR) 2.7 (95% confidence interval (CI) 1.5-4.9), older age, OR 1.9 (95% CI 1.02-3.54) previous PCI, OR 2.0 (95% CI 1.0-4.3) and typical angina, OR 2.5 (95% CI 1.4-4.6). CONCLUSIONS: Increasing age, male gender, previous PCI and typical symptoms are predictors of severe stenosis at invasive coronary angiography in patients with normal MPI. The majority of these patients have single-vessel disease. TI - Predictors of severe stenosis at invasive coronary angiography in patients with normal myocardial perfusion imaging EP - 202 SN - 1568-5888 IS - iss. 4 SP - 192 JF - Netherlands Heart Journal VL - vol. 26 DO - https://doi.org/10.1007/s12471-018-1091-7 L1 - https://repository.ubn.ru.nl/bitstream/handle/2066/190527/190527.pdf?sequence=1 ER - TY - JOUR AU - Badings, E.A. AU - Remkes, W.S. AU - The, S.H. AU - Dambrink, J.E. AU - Tjeerdsma, G. AU - Rasoul, S. AU - Timmer, J.R. AU - Wielen, M.L. van der AU - Lok, D.J. AU - Hermanides, R.S. AU - Wijngaarden, J. van AU - Suryapranata, H. AU - Hof, A.W. van 't PY - 2017 UR - https://hdl.handle.net/2066/182932 AB - OBJECTIVE: To compare long-term outcome of an early to a delayed invasive strategy in high-risk patients with non-ST elevation acute coronary syndrome (NSTE-ACS). METHODS: This prospective, multicentre trial included patients with NSTE-ACS and at least two out of three of the following high-risk criteria: (1) evidence of extensive myocardial ischaemia on ECG, (2) elevated biomarkers for myocardial necrosis and (3) age above 65 years. Patients were randomised to either an early (angiography and revascularisation if appropriate <12 hours) or a delayed invasive strategy (>48 hours after randomisation). Endpoint for this prespecified long-term follow-up was the composite incidence of death or reinfarction after 2 years. Data collection was performed by telephone contact with the patients, their relatives or general practitioner and by review of hospital records. RESULTS: Endpoint status after 2-year follow-up was collected in 521 of 542 initially enrolled patients. Incidence of death or reinfarction was 11.8% in the early and 13.1% in the delayed treatment group (relative risk (RR)=0.90, 95% CI 0.57 to 1.42). No significant differences were found in occurrence of the individual components of the primary endpoint: death 6.1% vs 8.9%, RR 0.69 (95% CI 0.37 to 1.27), reinfarction 6.5% vs 5.4%, RR 1.20 (95% CI 0.60 to 2.38). Post-hoc subgroup analysis showed statistical significant interaction between age and treatment strategy on outcome (p=0.02). CONCLUSIONS: After 2 years follow-up, no difference in incidence of death or reinfarction was seen between early to late invasive strategy. These findings are in line with results of other studies with longer follow-up. Older patients seem to benefit more from early invasive treatment. TI - Two-year outcome after early or late Intervention in non-ST elevation acute coronary syndrome SN - 2053-3624 IS - iss. 1 JF - Open Heart VL - vol. 4 DO - https://doi.org/10.1136/openhrt-2016-000538 L1 - https://repository.ubn.ru.nl/bitstream/handle/2066/182932/182932.pdf?sequence=1 ER - TY - JOUR AU - Pisters, R. AU - Vugt, S.P.G. van AU - Brouwer, M.A. AU - Elvan, A. AU - Holt, W.L. ten AU - Zwart, P.A.G. AU - Crijns, H.J.G.M. AU - Hemels, M.E.W. PY - 2017 UR - https://hdl.handle.net/2066/179607 TI - Real-life use of Rivaroxaban in the Netherlands: data from the Xarelto for Prevention of Stroke in Patients with Atrial Fibrillation (XANTUS) registry EP - 558 SN - 1568-5888 IS - iss. 10 SP - 551 JF - Netherlands Heart Journal VL - vol. 25 DO - https://doi.org/10.1007/s12471-017-1009-9 L1 - https://repository.ubn.ru.nl/bitstream/handle/2066/179607/179607.pdf?sequence=1 ER - TY - JOUR AU - Schellings, D.A.A.M. AU - Hof, A.W. van 't AU - Berg, J.M. van den AU - Elvan, A. AU - Giannitsis, E. AU - Hamm, C. AU - Suryapranata, H. AU - Adiyaman, A. PY - 2017 UR - https://hdl.handle.net/2066/169760 AB - BACKGROUND: The Zwolle Risk Score (ZRS) identifies primary percutaneous coronary intervention (PPCI) patients at low mortality risk, eligible for early discharge. Recently, this score was improved by adding baseline NT-proBNP. However, the optimal timepoint for NT-proBNP measurement is unknown. METHODS: PPCI patients in the On-Time 2 study were candidates. The ZRS and NT-proBNP levels on admission, at 18-24 h, at 72-96 h, and the change in NT-proBNP from baseline to 18-24 h (delta NT-proBNP) were determined. We investigated whether addition of the different NT-proBNP measurements to the ZRS improves the prediction of 30-day mortality. Based on cut-off values reflecting zero mortality at 30 d, patients who potentially could be discharged early were identified and occurrence of major adverse cardiac events (MACE) and major bleeding until 10 d was registered. RESULTS: 845 patients were included. On multivariate analyses, NT-proBNP at baseline (HR 2.09, 95% CI 1.59-2.74, p < 0.001), at 18-24 h (HR 6.83, 95% CI 2.94-15.84), and at 72-96 h (HR 3.32, 95% CI 1.22-9.06) independently predicted death at 30 d. Addition of NT-proBNP to the ZRS improved prediction of mortality, particularly at 18-24 h (net reclassification index 29%, p < 0.0001, integrated discrimination improvement 17%, p < 0.0001). Based on ZRS (<2) or NT-proBNP at 18-24 h (<2500 pg/ml) 75% of patients could be targeted for early discharge at 48 h, with expected re-admission rates of 1.2% due to MACE and/or major bleeding. CONCLUSIONS: NT-proBNP at different timepoints improves prognostication of the ZRS. Particularly at 18-24 h post PPCI, the largest group of patients that potentially could be discharged early was identified. TI - NT-proBNP during and after primary PCI for improved scheduling of early hospital discharge EP - 249 SN - 1568-5888 IS - iss. 4 SP - 243 JF - Netherlands Heart Journal VL - vol. 25 DO - https://doi.org/10.1007/s12471-016-0935-2 L1 - https://repository.ubn.ru.nl/bitstream/handle/2066/169760/169760.pdf?sequence=1 ER - TY - JOUR AU - Takanari, H. AU - Bourgonje, V.J. AU - Fontes, M.S. AU - Raaijmakers, A.J. AU - Driessen, H. AU - Jansen, JA AU - Nagel, R. van der AU - Kok, B AU - Stuijvenberg, L. van AU - Boulaksil, M. AU - Takemoto, Y. AU - Yamazaki, M. AU - Tsuji, Y. AU - Honjo, H. AU - Kamiya, K. AU - Kodama, I. AU - Anderson, M.E. AU - Heyden, M.A. van der AU - Rijen, H.V. van AU - Veen, T.A. van AU - Vos, M.A. PY - 2016 UR - https://hdl.handle.net/2066/172068 AB - AIM: In healthy hearts, ventricular gap junctions are mainly composed by connexin43 (Cx43) and localize in the intercalated disc, enabling appropriate electrical coupling. In diseased hearts, Cx43 is heterogeneously down-regulated, whereas activity of calmodulin/calcium-calmodulin protein kinase II (CaM/CaMKII) signalling increases. It is unclear if CaM/CaMKII affects Cx43 expression/localization or impulse propagation. We analysed different models to assess this. METHODS AND RESULTS: AC3-I mice with CaMKII genetically inhibited were subjected to pressure overload (16 weeks, TAC vs. sham). Optical and epicardial mapping was performed on Langendorff-perfused rabbit and AC3-I hearts, respectively. Cx43 subcellular distribution from rabbit/mouse ventricles was evaluated by immunoblot after Triton X-100-based fractionation. In mice with constitutively reduced CaMKII activity (AC3-I), conduction velocity (CV) was augmented (n = 11, P < 0.01 vs. WT); in AC3-I, CV was preserved after TAC, in contrast to a reduction seen in TAC-WT mice (-20%). Cx43 expression was preserved after TAC in AC3-I mice, though arrhythmias and fibrosis were still present. In rabbits, W7 (CaM inhibitor, 10 microM) increased CV (6-13%, n= 6, P< 0.05), while susceptibility to arrhythmias decreased. Immunoconfocal microscopy revealed enlarged Cx43 cluster sizes at intercalated discs of those hearts. Total Cx43 did not change by W7 (n= 4), whereas Triton X-100 insoluble Cx43 increased (+21%, n= 4, P< 0.01). Similar findings were obtained in AC3-I mouse hearts when compared with control, and in cultured dog cardiomyocytes. Functional implication was shown through increased intercellular coupling in cultured neonatal rat cardiomyocytes. CONCLUSION: Both acute and chronic CaM/CaMKII inhibition improves conduction characteristics and enhances localization of Cx43 in the intercalated disc. In the absence of fibrosis, this reduced the susceptibility for arrhythmias. TI - Calmodulin/CaMKII inhibition improves intercellular communication and impulse propagation in the heart and is antiarrhythmic under conditions when fibrosis is absent EP - 421 SN - 0008-6363 IS - iss. 4 SP - 410 JF - Cardiovascular Research VL - vol. 111 DO - https://doi.org/10.1093/cvr/cvw173 ER - TY - JOUR AU - Beukema, R.J. AU - Adiyaman, A. AU - Smit, J.J. AU - Delnoy, P.P. AU - Ramdat Misier, A.R. AU - Elvan, A. PY - 2016 UR - https://hdl.handle.net/2066/172093 AB - OBJECTIVES: Minimally invasive thoracoscopic epicardial pulmonary vein isolation (MIPI) has an important role in the surgical treatment of atrial fibrillation (AF). However, the management of recurrent atrial arrhythmias after MIPI and long-term success rate of catheter ablation have not been well studied. METHODS: Electrophysiological study was performed in 23 patients, 378 +/- 282 days after MIPI surgery, because of recurrent symptomatic atrial arrhythmias. RESULTS: A total of 20 patients presented with paroxysmal and persistent AF, 2 patients had a combination of AF and atrial tachycardia (AT) and 1 patient had a combination of AF and atrial flutter. All patients showed pulmonary vein (PV) reconnection. ATs were micro-re-entry PV-related ATs and atrial flutter was cavotricuspid isthmus dependent. Eighteen of 23 patients (78.3%) were free of atrial arrhythmias after one catheter ablation procedure at a mean follow-up of 50 +/- 16 months. Three patients underwent a second ablation procedure for recurrent AF and macro-re-entry left atrial flutter. Eventually 20 of 23 patients (87%) remained free of atrial arrhythmias after a mean of 1.1 +/- 0.3 ablation procedures. CONCLUSIONS: Catheter ablation of recurrent atrial arrhythmias following MIPI for paroxysmal and persistent AF is a feasible and effective treatment with a good long-term success rate. Reconnection of PVs accounts for most recurrences. TI - Catheter ablation of symptomatic postoperative atrial arrhythmias after epicardial surgical disconnection of the pulmonary veins and left atrial appendage ligation in patients with atrial fibrillation EP - 271 SN - 1010-7940 IS - iss. 1 SP - 265 JF - European Journal of Cardio-Thoracic Surgery VL - vol. 49 DO - https://doi.org/10.1093/ejcts/ezv047 ER - TY - JOUR AU - Badings, E.A. AU - Remkes, W.S. AU - The, S.H. AU - Dambrink, J.E. AU - Tjeerdsma, G. AU - Rasoul, S. AU - Timmer, J.R. AU - Wielen, M.L. van der AU - Lok, D.J. AU - Hermanides, R. AU - Wijngaarden, J. van AU - Suryapranata, H. AU - Hof, A.W. van 't PY - 2016 UR - https://hdl.handle.net/2066/172391 AB - OBJECTIVES: To investigate incidence and patient characteristics of transient ST-segment elevation (TSTE) ACS and to compare outcome of early versus late invasive treatment. BACKGROUND: Optimal timing of treatment in TSTE-ACS patients is not outlined in current guidelines and no prospective randomized trials have been done so far. METHODS: Post hoc subgroup analysis of patients with TSTE randomized in the ELISA 3 trial. This study compared early (<12 h) versus late (>48 h) angiography and revascularization in 542 patients with high-risk NSTE-ACS. Primary endpoint was incidence of death, reinfarction, or recurrent ischemia at 30 days follow-up. RESULTS: TSTE was present in 129 patients (24.2%) and associated with male gender, smoking and younger age. The primary endpoint occurred in 8.9% of patients with and 13.0% of patients without TSTE (RR = 0.681, P = 0.214). Incidence of death or MI after 2 year follow-up was 5.7 and 14.6% respectively (RR = 0.384, P = 0.008). Within the group of patients with TSTE, incidence of the primary endpoint was 5.8% in the early and 12.7% in the late treatment group (RR = 0.455, P = 0.213), driven by reduction in recurrent ischemia. Enzymatic infarct size, bleeding and incidence of death or recurrent MI at 2 years follow-up was comparable between the treatment groups. CONCLUSIONS: In high-risk patients with NSTE-ACS, TSTE is frequently seen. Similar to findings in patients with high-risk NSTE-ACS, immediate angiography and revascularization in these patients is feasible but not superior to later treatment. Prospective randomized trials are needed to provide more evidence in the optimal timing of treatment in patients with TSTE-ACS. (c) 2016 Wiley Periodicals, Inc. TI - Early or late intervention in patients with transient ST-segment elevation acute coronary syndrome: Subgroup analysis of the ELISA-3 trial EP - 764 SN - 1522-1946 IS - iss. 5 SP - 755 JF - Catheterization and Cardiovascular Interventions VL - vol. 88 DO - https://doi.org/10.1002/ccd.26719 ER - TY - JOUR AU - Gal, P. AU - Parlak, E. AU - Schellings, D.A.A.M. AU - Beukema, R.J. AU - Berg, J ten AU - Adiyaman, A. AU - Hof, A.W. van 't AU - Elvan, A. PY - 2016 UR - https://hdl.handle.net/2066/167179 AB - AIMS: Previous reports claimed that high sensitivity troponin T (HsTnT) is not associated with atrial fibrillation (AF) in the setting of acute ST-elevation myocardial infarction (STEMI) and primary percutaneous coronary intervention. However, the association of serial HsTnT levels and new-onset AF is unknown. We therefore assessed the temporal association between HsTnT levels and post-infarction AF. METHODS AND RESULTS: 830 patients enrolled in On-TIME II were included. HsTnT was assessed at baseline, and 24h and 72h after admission for STEMI. New-onset AF episodes were divided into three subgroups: AF during the first 24h of admission, AF 24-72h after admission and AF >72h after admission. ROC analysis and binary logistic regression were performed. Mean age was 62+/-12 years and 76% were male. Seventy-three patients developed new-onset AF: 41 patients developed AF during the first 24h of admission, 14 patients developed AF 24-72h after admission and 18 patients developed AF >72h after admission. HsTnT at baseline was associated with new-onset AF (area under curve (AUC) 0.596, p=0.008), but not with AF during the first 24h of admission (AUC: 0.539, p=0.414). HsTnT after 24h (AUC 0.792, p=0.001) and after 72h (AUC: 0.884, p<0.001) were associated with AF 24-72h and >72h after admission. HsTnT after 24h and 72h were stronger predictors of AF compared with HsTnT at baseline. In regression analysis, age (odds ratio 1.056, p<0.001), Killip Class >1 (odds ratio: 2.694, p=0.010) and HsTnT after 24h (odds ratio: 1.012, p=0.017) and after 72h (odds ratio: 1.035, p<0.001) showed the strongest association with post-infarction AF. CONCLUSION: Serial HsTnT plasma levels are associated with post-infarction, new-onset AF. TI - Association of serial high sensitivity troponin T with onset of atrial fibrillation in ST elevation myocardial infarction patients undergoing primary percutaneous coronary intervention EP - 42 SN - 2048-8726 IS - iss. 1 SP - 33 JF - European Heart Journal Acute Cardiovascular Care VL - vol. 5 DO - https://doi.org/10.1177/2048872615570220 ER - TY - JOUR AU - Sanders, M.F. AU - Blankestijn, P.J. AU - Voskuil, M. AU - Spiering, W. AU - Vonken, E.J. AU - Rotmans, J.I. AU - Hoeven, B.L. van der AU - Daemen, J. AU - Meiracker, A.H. van den AU - Kroon, A.A. AU - Haan, M.W. de AU - Das, M. AU - Bax, M. AU - Meer, I.M. van der AU - Overhagen, H. van AU - Born, B.J. van den AU - Brussel, P.M. van AU - Valk, P.H. van der AU - Gregoor, P.J. Smak AU - Meuwissen, M. AU - Gomes, M.E.R. AU - Ophuis, T. Oude AU - Troe, E. AU - Tonino, W.A. AU - Konings, C.J. AU - Vries, P.A. de AU - Balen, A. van AU - Heeg, J.E. AU - Smit, J.J. AU - Elvan, A. AU - Steggerda, R. AU - Niamut, S.M. AU - Peels, J.O. AU - Swart, J.B. de AU - Wardeh, A.J. AU - Groeneveld, J.H. AU - Linden, E. van der AU - Hemmelder, M.H. AU - Folkeringa, R. AU - Stoel, M.G. AU - Kant, G.D. AU - Herrman, J.P. AU - Wissen, S. van AU - Deinum, J. AU - Westra, S.W. AU - Aengevaeren, W.R.M. AU - Parlevliet, K.J. AU - Schramm, A. AU - Jessurun, G.A. AU - Rensing, B.J. AU - Winkens, M.H. AU - Wierema, T.K. AU - Santegoets, E. AU - Lipsic, E. AU - Houwerzijl, E. AU - Kater, M. AU - Allaart, C.P. AU - Nap, A. AU - Bots, M.L. PY - 2016 UR - https://hdl.handle.net/2066/171454 AB - BACKGROUND: Percutaneous renal denervation (RDN) has recently been introduced as a treatment for therapyresistant hypertension. Also, it has been suggested that RDN may be beneficial for other conditions characterised by increased sympathetic nerve activity. There are still many uncertainties with regard to efficacy, safety, predictors for success and long-term effects. To answer these important questions, we initiated a Dutch RDN registry aiming to collect data from all RDN procedures performed in the Netherlands. METHODS: The Dutch RDN registry is an ongoing investigator-initiated, prospective, multicentre cohort study. Twenty-six Dutch hospitals agreed to participate in this registry. All patients who undergo RDN, regardless of the clinical indication or device that is used, will be included. Data are currently being collected on eligibility and screening, treatment and follow-up. RESULTS: Procedures have been performed since August 2010. At present, data from 306 patients have been entered into the database. The main indication for RDN was hypertension (n = 302, 99%). Patients had a mean office blood pressure of 177/100 (±29/16) mmHg with a median use of three (range 0-8) blood pressure lowering drugs. Mean 24-hour blood pressure before RDN was 157/93 (±18/13) mmHg. RDN was performed with different devices, with the Simplicity™ catheter currently used most frequently. CONCLUSION: Here we report on the rationale and design of the Dutch RDN registry. Enrolment in this investigator-initiated study is ongoing. We present baseline characteristics of the first 306 participants. TI - Safety and long-term effects of renal denervation: Rationale and design of the Dutch registry EP - 15 SN - 0300-2977 IS - iss. 1 SP - 5 JF - Netherlands Journal of Medicine VL - vol. 74 ER - TY - JOUR AU - Postma, S. AU - Dambrink, J.H. AU - Gosselink, A.T.M. AU - Ottervanger, J.P. AU - Kolkman, E. AU - Berg, J.M. van den AU - Suryapranata, H. AU - Hof, A.W.J. van ’t PY - 2015 UR - https://hdl.handle.net/2066/154209 AB - AIM: To evaluate the relationship between system delay and 30-day and long-term mortality in patients with anterior versus non-anterior ST-elevation myocardial infarction (STEMI). METHODS: We conducted a prospective observational cohort study. Patients with STEMI who were transported to the Isala Hospital, Zwolle, and underwent primary percutaneous coronary intervention (pPCI) from 2005 until 2010 were included. These patients were divided into quartiles of system delay (time from first medical contact until reperfusion therapy): Q1-Q4. RESULTS: In total, 3041 patients were included in our study. 41% (n=1253) of the patients had an anterior myocardial infarction (MI) and 59% of the patients (n=1788) had a non-anterior MI. Only in patients with an anterior MI, prolonged system delay was associated with a higher mortality (30-day Q1: 2.6%, Q2: 3.1%, Q3: 6.8%, Q4: 7.4%, p=0.001; long-term Q1: 12.8%, Q2: 13.7%, Q3: 24.1%, Q4: 22.6%, p<0.001). After multivariable adjustment, prolonged system delay was associated with a higher 30-day and long-term mortality in patients with an anterior MI (30 day Q2: HR 1.18, 95% CI (0.46 to 3.00), Q3: HR 2.45, 95% CI (1.07 to 5.63), Q4: HR 2.25, 95% CI (0.97 to 5.25)); long-term Q2: HR 1.09, 95% CI (0.71 to 1.68), Q3: HR 1.68, 95% CI (1.13 to 2.49), Q4: HR 1.55, 95% CI (1.03 to 2.33)), but not in patients with a non-anterior MI. CONCLUSIONS: Prolonged system delay significantly increased short-term as well as long-term mortality in patients with an anterior MI. This effect was not demonstrated in patients with a non-anterior MI. Therefore, it is of the greatest importance to minimise system delay in patients who present with an anterior MI. TI - The influence of system delay on 30-day and on long-term mortality in patients with anterior versus non-anterior ST-segment elevation myocardial infarction: a cohort study SN - 2053-3624 IS - iss. 1 SP - e000201 JF - Open Heart VL - vol. 2 DO - https://doi.org/10.1136/openhrt-2014-000201 L1 - https://repository.ubn.ru.nl/bitstream/handle/2066/154209/154209.pdf?sequence=1 ER - TY - JOUR AU - Luca, G. De AU - Savonitto, S. AU - Hof, A.W.J. van ’t AU - Suryapranata, H. PY - 2015 UR - https://hdl.handle.net/2066/153661 AB - Coronary artery disease and acute myocardial infarction still represent the leading cause of mortality in developed countries. Therefore, great efforts have been made in the last decades to improve reperfusion strategies and adjunctive antithrombotic therapies. In fact, despite optimal epicardial recanalisation, a large proportion of patients still experience impaired reperfusion and in-stent thrombosis. The adjunctive use of glycoprotein (GP) IIb-IIIa inhibitors may certainly contribute in the reduction of such complications, especially when administered in the early phase of infarction. In fact, in this phase a larger platelet composition of the thrombus and the presence of a larger amount of viable myocardium, as compared to a delayed phase, may increase the benefits from this therapy and counterbalance the potential higher risk of bleeding. A large body of evidence has been accumulated on the benefits from GP IIb-IIIa inhibitors in terms of prevention of stent thrombosis, and benefits in mortality, especially among high-risk patients and as upstream strategy. Therefore, based on current available data, GP IIb-IIIa inhibitors can be recommended as early as possible (upstream strategy) among high-risk patients, such as those with advanced Killip class or anterior myocardial infarction (MI), and those presenting within the first three hours. Even though it is not universally accepted, in our opinion this strategy should be implemented in a pre-hospital setting (in ambulance) or at first hospital admission (Emergency Room or Coronary Care Unit, irrespective of whether they are in the spoke or hub hospitals). Peri-procedural intracoronary administration of GP IIb-IIIa inhibitors has not provided additional benefits as compared to intravenous administration and therefore cannot be recommended. Even though the vast majority of trials have been conducted with abciximab, several meta-analyses comparing small molecules (mainly high-dose tirofiban rather than eptifibatide) versus abciximab showed similar angiographic and clinical results between the molecules. Several recent investigations and meta-analyses have documented the higher risk of stent thrombosis associated with bivalirudin as compared to unfractionated heparin (UFH). Being that these results are independent from the use of GP IIb-IIIa inhibitors, UFH should still remain the anticoagulation therapy of choice in ST-segment elevation myocardial infarction (STEMI) patients. Minimisation of bleeding complications by extensive use of the radial approach, in the setting of STEMI, may further contribute to the adoption of a more aggressive antithrombotic and antiplatelet therapy incorporating the use of GP IIb-IIIa inhibitors. The establishment of dedicated networks for STEMI, and the large STEMI campaign, will certainly contribute to increase the proportion of patients presenting at first medical contact within the early phase (3 h) of infarction and therefore highly suitable for a more aggressive pharmacoinvasive approach with upstream administration of GP IIb-IIIa inhibitors. In fact, although the current therapeutic targets of increased rates of timely reperfusion, mainly by primary percutaneous coronary intervention (PCI), has been achieved, a deep look into the future in the fight against MI will certainly put aborting infarction as the major desirable target to be achieved. TI - Platelet GP IIb-IIIa Receptor Antagonists in Primary Angioplasty: Back to the Future EP - 1253 SN - 0012-6667 IS - iss. 11 SP - 1229 JF - Drugs VL - vol. 75 DO - https://doi.org/10.1007/s40265-015-0425-7 ER - TY - JOUR AU - Boren, N. AU - Maas, A.H.E.M. AU - Ottervanger, J.P. PY - 2015 UR - https://hdl.handle.net/2066/152746 TI - Stop invasive coronary angiography as the gold standard for the diagnosis of stable angina! EP - 418 SN - 1755-5302 IS - iss. 5 SP - 415 JF - Interventional Cardiology VL - vol. 7 DO - https://doi.org/10.2217/ica.15.35 ER - TY - JOUR AU - Qaderdan, K. AU - Ishak, M. AU - Heestermans, A.A. AU - Vrey, E. de AU - Jukema, J.W. AU - Voskuil, M. AU - Boer, M.J. de AU - Hof, A.W.J. van ’t AU - Groenemeijer, B.E. AU - Vos, G.J. AU - Janssen, P.W. AU - Bergmeijer, T.O. AU - Kelder, J.C. AU - Deneer, V.H. AU - Berg, J.M. van den PY - 2015 UR - https://hdl.handle.net/2066/152866 AB - RATIONALE: Dual antiplatelet therapy with acetylsalicylic acid in combination with a more potent P2Y12- inhibitor (ticagrelor or prasugrel) is recommended in patients with acute coronary syndrome without ST-segment elevation (NSTE-ACS) to prevent atherothrombotic complications. The evidence on which this recommendation is based shows that ticagrelor and prasugrel reduce atherothrombotic events at the expense of an increase in bleeding events when compared with clopidogrel. However, it remains unclear whether ticagrelor or prasugrel has a better net clinical benefit in elderly patients with NSTE-ACS when compared with clopidogrel. The POPular AGE trial is designed to address the optimal antiplatelet strategy in elderly NSTE-ACS patients. STUDY DESIGN: POPular AGE is a multicenter, open-label, randomized controlled trial that aims to include 1000 patients >/=70years of age with NSTE-ACS. Patients are randomly assigned to receive either clopidogrel or a more potent P2Y12 inhibitor (ticagrelor or prasugrel). The first primary end point is any bleeding event requiring medical intervention. The second primary end point is the net clinical benefit, a composite of all-cause mortality, nonfatal myocardial infarction, nonfatal stroke, "PLATelet inhibition and patient Outcomes" major bleeding, or "PLATelet inhibition and patient Outcomes" minor bleeding. Patients will be followed for 1 year after randomization, and analyses will be performed on the basis of intention to treat. CONCLUSION: The POPular AGE is the first randomized controlled trial that will assess whether the treatment strategy with clopidogrel will result in fewer bleeding events without compromising the net clinical benefit in patients >/=70years of age with NSTE-ACS when compared with a treatment strategy with ticagrelor or prasugrel. TI - Ticagrelor or prasugrel versus clopidogrel in elderly patients with an acute coronary syndrome: Optimization of antiplatelet treatment in patients 70years and older-rationale and design of the POPular AGE study EP - 985.e1 SN - 0002-8703 IS - iss. 5 SP - 981 JF - American Heart Journal VL - vol. 170 DO - https://doi.org/10.1016/j.ahj.2015.07.030 ER - TY - JOUR AU - Beukema, R.J. AU - Smit, J.J. AU - Adiyaman, A. AU - Casteren, L. Van AU - Delnoy, P.P. AU - Ramdat Misier, A.R. AU - Elvan, A. PY - 2015 UR - https://hdl.handle.net/2066/153244 AB - AIMS: Focal atrial tachycardia successfully ablated from the non-coronary cusp (NCC) is rare. Our aim was to describe the characteristics of mapping and ablation therapy of NCC focal atrial tachycardias and to provide a comprehensive review of the literature. METHODS AND RESULTS: Seven patients (age 40 +/- 9 years) with symptomatic, drug-refractory atrial tachycardia were referred for electrophysiological study. Extensive right and left atrial mapping revealed atrial tachycardia near His in all patients but either failed to identify a successful ablation site or radiofrequency applications only resulted in temporary termination of the tachycardia. Mapping and ablation of the NCC were performed retrogradely via the right femoral artery. Mapping of the NCC demonstrated earliest atrial activation during atrial tachycardia 38 +/- 14 ms (ranging 17-56 ms) before the onset of the P-wave. Earliest atrial activation in the NCC was earlier than earliest activation in the right atrium and left atrium in all patients. The P-wave morphology was predominantly negative in the inferior leads and biphasic in leads V1 and V2. The tachycardia was successfully terminated by radiofrequency application in 10 +/- 6 s (2-16 s), without complications. All patients were free of symptoms during a follow-up of 19 +/- 9 months. Literature search revealed 18 reports (91 patients) describing NCC focal atrial tachycardia, with 99% long-term ablation success with a 1% complication rate. CONCLUSION: Symptomatic focal atrial tachycardia near His may originate from the NCC and can be treated safely and effectively with radiofrequency ablation. TI - Ablation of focal atrial tachycardia from the non-coronary aortic cusp: case series and review of the literature EP - 961 SN - 1099-5129 IS - iss. 6 SP - 953 JF - Europace VL - vol. 17 DO - https://doi.org/10.1093/europace/euu227 ER - TY - JOUR AU - Bulten, B.F. AU - Verberne, H.J. AU - Bellersen, L. AU - Oyen, W.J.G. AU - Sabate-Llobera, A. AU - Mavinkurve-Groothuis, A.M. AU - Kapusta, L. AU - Laarhoven, H.W.M. van AU - Geus-Oei, L.F. de PY - 2015 UR - https://hdl.handle.net/2066/152663 AB - PURPOSE: It remains challenging to identify patients at risk of anthracycline-induced cardiotoxicity. To better understand the different risk-stratifying approaches, we evaluated (123)I-metaiodobenzylguanidine ((123)I-mIBG) scintigraphy and its interrelationship with conventional echocardiography, 2D strain imaging and several biomarkers. METHODS: We performed (123)I-mIBG scintigraphy, conventional and strain echocardiography and biomarker (NT-proBNP, TNF-alpha, galectin-3, IL-6, troponin I, ST-2 and sFlt-1) assessment in 59 breast cancer survivors 1 year after anthracycline treatment. Interobserver and intermethod variability was calculated on planar and SPECT (123)I-mIBG scintigraphy, using the heart/mediastinum (H/M) ratio and washout (WO). Pearson's r and multivariate analyses were performed to identify correlations and independent predictors of (123)I-mIBG scintigraphy results. RESULTS: Delayed planar anterior whole-heart ROI (WH) H/M ratios and WO were the most robust (123)I-mIBG parameters. Significant correlations were observed between (123)I-mIBG parameters and several conventional echo parameters, global longitudinal and radial strain (GLS and GRS) and galectin-3. The highest Pearson's r was observed between delayed H/M ratio and GRS (Pearson's r 0.36, p = 0.01). Multivariate analysis showed that GRS was the only independent predictor of the delayed WH H/M ratio (p = 0.023). CONCLUSION: The delayed planar H/M ratio is the most robust (123)I-mIBG parameter. It correlates with several conventional echocardiographic parameters, GLS, GRS and galectin-3. Of these, only GRS predicts the H/M ratio. TI - Relationship of promising methods in the detection of anthracycline-induced cardiotoxicity in breast cancer patients EP - 967 SN - 0344-5704 IS - iss. 5 SP - 957 JF - Cancer Chemotherapy and Pharmacology VL - vol. 76 PS - 11 p. DO - https://doi.org/10.1007/s00280-015-2874-9 L1 - https://repository.ubn.ru.nl/bitstream/handle/2066/152663/152663.pdf?sequence=1 ER - TY - JOUR AU - Kilic, S. AU - Ottervanger, J.P. AU - Dambrink, J.H. AU - Hoorntje, J.C.A. AU - Koopmans, P.C. AU - Gosselink, A.T.M. AU - Suryapranata, H. AU - Hof, A.W. van 't AU - et al. PY - 2014 UR - https://hdl.handle.net/2066/133900 AB - It was the purpose of this study to assess the effect of thrombus aspiration (TA) during primary percutaneous coronary intervention (PPCI) on reperfusion and clinical outcome in a real-world STEMI population. The decision to use TA (Export catheter, Medtronic) was at the discretion of the treating cardiologist. The primary endpoint was mortality at short (in-hospital) and long term (one year) follow-up. Secondary end points were post-PCI TIMI flow, residual ST deviation and enzymatic infarct size. Cox proportional hazard models (propensity-weighted) and logistic regression analysis were used to adjust for known covariates, associated with mortality. We performed a retrospective analysis of prospectively collected data on 2,552 consecutive PPCI-treated STEMI patients between 2007 and 2010. Use of TA increased from 6.9% in 2007 to 62.2% in 2010 (p<0.001). TA was performed in 899 patients (35.2%). In-hospital and one-year mortality rates were 3.0% and 6.0%, respectively, in the TA group and 3.5% and 7.6% in the no-TA group. After multivariate analysis, TA was not significantly associated with in-hospital mortality (adjusted odds ratio [OR]: 0.70; 95% confidence interval [CI]: 0.33-1.49, p=0.36) nor one year mortality (adjusted hazard ratio [HR]: 0.75, 95%CI: 0.47-1.20, p=0.23) or cardiac mortality (HR: 0.81; 95%CI: 0.45-1.46, p=0.49). After matching on the propensity score, the HR in the TA group for one year mortality was 0.70 (95%CI: 0.41-1.20, p=0.19) and for one-year cardiac mortality 0.70 (95%CI: 0.36-1.34, p=0.28). In conclusion, no significant relationship of TA with one of the secondary end points was found. The use of TA increased over the last years but clinical outcome was similar in both groups (TA vs no-TA) in this large cohort of real-world, unselected STEMI patients. TI - The effect of thrombus aspiration during primary percutaneous coronary intervention on clinical outcome in daily clinical practice EP - 171 SN - 0340-6245 IS - iss. 1 SP - 165 JF - Thrombosis and Haemostasis VL - vol. 111 DO - https://doi.org/10.1160/TH13-05-0433 ER - TY - JOUR AU - Postma, S. AU - Dambrink, J.H. AU - Ottervanger, J.P. AU - Gosselink, A.T.M. AU - Koopmans, P.C. AU - Berg, J.M. van den AU - Suryapranata, H. AU - Hof, A.W. van 't PY - 2014 UR - https://hdl.handle.net/2066/134034 AB - Pre-hospital infarct diagnosis gives the opportunity to start anti-platelet and anti-thrombotic agents before arrival at the PCI centre. However, more evidence is necessary to demonstrate whether high dose (HD) clopidogrel (600 mg) administered in the ambulance is associated with improved initial patency of the infarct related vessel (IRV) and/or clinical outcome compared to in-hospital initiation of HD clopidogrel. From 2001 until 2009 all consecutive ST-Segment Elevation Myocardial Infarction (STEMI) patients who underwent pre-hospital diagnosis and therapy in the ambulance were prospectively included in our single-centre cohort study. We compared initial patency of the IRV and clinical outcome in patients treated from 2001 until June 2006 (in-hospital HD clopidogrel) with patients treated from July 2006 until 2009 (ambulance HD clopidogrel). A total of 2,475 patients with STEMI were registered; of these 1,110 (44.8%) received in-hospital HD clopidogrel and 1,365 (55.2%) received ambulance HD clopidogrel. Ambulance HD clopidogrel was not independently associated with initial patency (TIMI-2/3-flow pre-PCI (odds ratio: 1.18, 95% confidence interval [CI] 0.96-1.44); however, it was associated with fewer recurrent myocardial infarctions at 30 days (hazard ratio [HR]: 0.45, 95% CI 0.22-0.93) and at one year (HR: 0.45, 95% CI 0.25-0.80). No difference in TIMI 2/3 flow post-PCI, major bleeding, mortality, MACE - and the combination of mortality and recurrent myocardial infarction at 30-days and at one year was present between the two groups. In conclusion, early in-ambulance as compared to in-hospital initiation of HD clopidogrel in STEMI patients did not improve initial patency of the IRV or clinical outcome, except for a reduction of recurrent myocardial infarction. Therefore, early administration of HD clopidogrel seems to have net clinical benefit for these patients. TI - Early ambulance initiation versus in-hospital initiation of high dose clopidogrel in ST-segment elevation myocardial infarction EP - 613 SN - 0340-6245 IS - iss. 3 SP - 606 JF - Thrombosis and Haemostasis VL - vol. 112 DO - https://doi.org/10.1160/TH13-11-0951 ER - TY - JOUR AU - Mouden, M. AU - Ottervanger, J.P. AU - Knollema, S. AU - Timmer, J.R. AU - Reiffers, S. AU - Oostdijk, A.H. AU - Boer, M.J. de AU - Jager, P.L. De PY - 2014 UR - https://hdl.handle.net/2066/133837 AB - PURPOSE: Recently introduced ultrafast cardiac SPECT cameras with cadmium zinc telluride-based (CZT) detectors may provide superior image quality allowing faster acquisition with reduced radiation doses. Although the level of concordance between conventional SPECT and invasive fractional flow reserve (FFR) measurement has been studied, that between FFR and CZT-based SPECT is not yet known. Therefore, we aimed to assess the level of concordance between CZT SPECT and FFR in a large patient group with stable coronary artery disease. METHODS: Both invasive FFR and myocardial perfusion imaging with a CZT-based SPECT camera, using Tc-tetrofosmin as tracer, were performed in 100 patients with stable angina and intermediate grade stenosis on invasive coronary angiography. A cut-off value of <0.75 was used to define abnormal FFR. RESULTS: The mean age of the patients was 64 +/- 11 years, and 64 % were men. SPECT demonstrated ischaemia in 31 % of the patients, and 20 % had FFR <0.75. The concordance between CZT SPECT and FFR was 73 % on a per-patient basis and 79 % on a per-vessel basis. Discordant findings were more often seen in older patients and were mainly (19 %) the result of ischaemic SPECT findings in patients with FFR >/= 0.75, whereas only 8 % had an abnormal FFR without ischaemia as demonstrated by CZT SPECT. CONCLUSION: Only 20 - 30 % of patients with intermediate coronary stenoses had significant ischaemia as assessed by CZT SPECT or invasive FFR. CZT SPECT showed a modest degree of concordance with FFR, which is comparable with previous results with conventional SPECT. Further investigations are particularly necessary in patients with normal SPECT and abnormal FFR, especially to determine whether these patients should undergo revascularization. TI - Myocardial perfusion imaging with a cadmium zinc telluride-based gamma camera versus invasive fractional flow reserve EP - 962 SN - 1619-7070 IS - iss. 5 SP - 956 JF - European Journal of Nuclear Medicine and Molecular Imaging VL - vol. 41 DO - https://doi.org/10.1007/s00259-013-2630-5 ER - TY - JOUR AU - Postma, S. AU - Dambrink, J.H. AU - Boer, M.J. de AU - Gosselink, A.T.M. AU - Ottervanger, J.P. AU - Koopmans, P.C. AU - Berg, J.M. van den AU - Suryapranata, H. AU - Hof, A.W. van 't PY - 2014 UR - https://hdl.handle.net/2066/136116 AB - AIMS: To evaluate the relation between residential distance and total ischaemic time in patients with acute ST-elevation myocardial infarction (STEMI). METHODS: STEMI patients were transported to the Isala Hospital Zwolle with the intention to perform primary percutaneous coronary intervention PCI (pPCI) from 2004 until 2010 (n = 4149). Of these, 1424 patients (34 %) were referred via a non-PCI 'spoke' centre ('spoke' patients) and 2725 patients (66 %) were referred via field triage in the ambulance (ambulance patients). RESULTS: A longer residential distance increased median total ischaemic time in 'spoke' patients (0-30 km: 228 min, >30-60 km: 235 min, >60-90 km: 264 min, p < 0.001), however not in ambulance patients (0-30 km: 179 min, >30-60 km: 175 min, >60-90 km: 186 min, p = 0.225). After multivariable linear regression analysis, in 'spoke' patients residential distance of >30-60 km compared with 0-30 km was not independently associated with ischaemic time; however, a residential distance of >60-90 km (exp (B) = 1.11, 95 % CI 1.01-1.12) compared with 0-30 km was independently related with ischaemic time. In ambulance patients, residential distance of >30-60 and >60-90 km compared with 0-30 km was not independently associated with ischaemic time. CONCLUSION: A longer distance from the patient's residence to a PCI centre was associated with a small but significant increase in time to treatment in 'spoke' patients, however not in ambulance patients. Therefore, referral via field triage in the ambulance did not lead to a significant increase in time to treatment, especially at long distances (up to 90 km). TI - The influence of residential distance on time to treatment in ST-elevation myocardial infarction patients EP - 519 SN - 1568-5888 IS - iss. 11 SP - 513 JF - Netherlands Heart Journal VL - vol. 22 DO - https://doi.org/10.1007/s12471-014-0599-8 L1 - https://repository.ubn.ru.nl/bitstream/handle/2066/136116/136116.pdf?sequence=1 ER - TY - JOUR AU - Remkes, W.S. AU - Somi, S. AU - Roolvink, V. AU - Rasoul, S. AU - Ottervanger, J.P. AU - Gosselink, A.T.M. AU - Hoorntje, J.C.A. AU - Dambrink, J.H. AU - Boer, M.J. de AU - Suryapranata, H. AU - Hof, A.W. van 't PY - 2014 UR - https://hdl.handle.net/2066/134030 AB - OBJECTIVES: The aim was to investigate whether a strategy of direct drug-eluting stent (DES) implantation without pre-dilation is associated with a reduced incidence of restenosis compared with CS with pre-dilation or provisional stenting (PS). BACKGROUND: Previous studies were performed comparing direct stenting (DS) with conventional stenting (CS) after pre-dilation; however, none of these in the DES era. Therefore, the STRESSED (direct Stenting To reduce REStenosis in Stent Era with Drug elution) study was designed and carried out. METHODS: A total of 600 patients with angina pectoris or recent myocardial infarction were randomized to a DS, CS, or PS strategy. The primary endpoint was the mean minimal lumen diameter at 9-month follow-up angiography. Secondary endpoints were clinical procedural success defined as angiographic success without in-hospital major adverse cardiac events (MACE), and MACE at 9-month and 2-year follow-up. RESULTS: Stent implantation in the DS group was 98%, 99% in the CS group, and 77% in the PS group. Percutaneous coronary intervention success was 99% in all groups. The minimal lumen diameter at 9-month follow-up was 2.12 +/- 0.58 mm (DS), 2.17 +/- 0.67 mm (CS), and 1.99 +/- 0.69 mm (PS), p = 0.556 for comparison of DS with CS, p = 0.073 for comparison of DS with PS. The absolute difference was -0.05 (DS to CS), 95% confidence interval: -0.19 to -0.09, p = 0.48 and 0.13 (DS to PS), confidence interval: -0.02 to -0.27, p = 0.087. Restenosis was found in 3.4% (DS), 6.7% (CS), and 11.5% (PS), p = 0.025. At 9-month and 2-year follow-up, MACE occurred in 6.8% and 11.5% (DS), 4.6% and 10.3% (CS), and 7.6% and 13.8% (PS) (p = 0.439 and 0.536), respectively. CONCLUSIONS: Direct DES implantation compared with conventional DES implantation did not reduce restenosis. Provisional stenting, however, was associated with a higher rate of restenosis. This did not translate into a difference in the rate of MACE. (STRESSED study: direct Stenting To reduce REStenosis in Stent Era with Drug elution; ISRCTN41213536). TI - Direct drug-eluting stenting to reduce stent restenosis: a randomized comparison of direct stent implantation to conventional stenting with pre-dilation or provisional stenting in elective PCI patients EP - 758 SN - 1936-8798 IS - iss. 7 SP - 751 JF - Jacc. Cardiovascular Interventions VL - vol. 7 DO - https://doi.org/10.1016/j.jcin.2014.02.012 ER - TY - JOUR AU - Schellings, D.A.A.M. AU - Adiyaman, A. AU - Giannitsis, E. AU - Hamm, C. AU - Suryapranata, H. AU - Berg, J.M. van den AU - Hoorntje, J.C. AU - Hof, A.W. van 't PY - 2014 UR - https://hdl.handle.net/2066/136268 AB - BACKGROUND: The Zwolle Risk Score (ZRS) identifies ST-elevation myocardial infarction (STEMI) patients treated with primary percutaneous coronary intervention (PPCI) eligible for early discharge. We aimed to investigate whether baseline N-terminal pro-brain natriuretic peptide (NT-proBNP) is also able to identify these patients and could improve future risk strategies. METHODS AND RESULTS: PPCI patients included in the Ongoing Tirofiban in Myocardial Infarction Evaluation (On-TIME) II study were candidates (N=861). We analyzed whether ZRS and baseline NT-proBNP predicted 30-day mortality and assessed the occurrence of major adverse cardiac events (MACEs) and major bleeding. Receiver operating characteristic curve analysis was used to assess discriminative accuracy for ZRS, NT-pro-BNP, and their combination. After multiple imputation, 845 patients were included. Both ZRS >3 (hazard ratio [HR]=9.42; P<0.001) and log NT-pro-BNP (HR=2.61; P<0.001) values were associated with 30-day mortality. On multivariate analysis, both the ZRS (HR=1.41; 95% confidence interval [CI]=1.27 to 1.56; P<0.001) and log NT-proBNP (HR=2.09; 95% CI=1.59 to 2.74; P<0.001) independently predicted death at 30 days. The area under the curve for 30-day mortality for combined ZRS/NT-proBNP was 0.94 (95% CI=0.90 to 0.99), with optimal predictive values of a ZRS >/=2 and a NT-proBNP value of >/=200 pg/mL. Using these cut-off values, 64% of the study population could be identified as very low risk with zero mortality at 30 days follow-up and low occurrence of MACEs and major bleeding between 48 hours and 10 days (1.3% and 0.6%, respectively). CONCLUSION: Baseline NT-proBNP identifies a large group of low-risk patients who may be eligible for early (48- to 72-hour) discharge, whereas optimal predictive accuracy is reached by the combination of both baseline NT-proBNP and ZRS. TI - Early discharge after primary percutaneous coronary intervention: the added value of N-terminal pro-brain natriuretic Peptide to the zwolle risk score SN - 2047-9980 IS - iss. 6 SP - e001089 JF - Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease VL - vol. 3 DO - https://doi.org/10.1161/JAHA.114.001089 L1 - https://repository.ubn.ru.nl/bitstream/handle/2066/136268/136268.pdf?sequence=1 ER - TY - JOUR AU - Schoormans, D. AU - Mulder, B.J. AU - Melle, J.P. van AU - Pieper, P.G. AU - Dijk, A.P.J. van AU - Sieswerda, G.T. AU - Hulsbergen-Zwarts, M.S. AU - Plokker, T.H. AU - Brunninkhuis, L.G. AU - Vliegen, H.W. AU - Sprangers, M.A.G. PY - 2014 UR - https://hdl.handle.net/2066/134066 AB - BACKGROUND: To improve patients' quality of life (QoL) we need to identify modifiable determinants, such as illness perceptions. Patients' illness perceptions are known to regulate emotional responses and health-behaviour. Illness perceptions comprise several components: consequences, control, coherence, changeability and emotional representations. AIMS: To examine (a) the relation between patient characteristics and illness perceptions, and (b) the independent predictive value of illness perceptions for future QoL. METHODS: A longitudinal study in 845 patients with congenital heart disease was conducted. Patients completed three questionnaires: the IPQ-R (illness perceptions) and two years later the SF-36 and TAAQOL-CHD (QoL). Linear regression analyses were performed relating illness perceptions to patient characteristics (sex, age, disease complexity and functional status) and QoL. RESULTS: Patients with a complex defect or poor functional status reported poor illness perceptions. Independent of patient characteristics, poor illness perceptions (i.e. a strong belief that the illness has severe consequences; a weak belief that you have a coherent illness understanding and that the illness can be controlled by treatment; and a strong belief that the illness is changeable and causes negative emotions) were predictive of future QoL. CONCLUSION: Illness perceptions independently predict QoL, suggesting that QoL may be improved by altering patients' beliefs about their illness. For example, increasing patients' knowledge regarding their disease and informing them about treatment opportunities may enhance their QoL. TI - Illness perceptions of adults with congenital heart disease and their predictive value for quality of life two years later EP - 94 SN - 1474-5151 IS - iss. 1 SP - 86 JF - European Journal of Cardiovascular Nursing VL - vol. 13 DO - https://doi.org/10.1177/1474515113481908 ER - TY - JOUR AU - Otten, A.M. AU - Ottervanger, J.P. AU - Kloosterman, A. AU - Hof, A.W. van 't AU - Gosselink, A.T.M. AU - Dambrink, J.H. AU - Hoorntje, J.C. AU - Suryapranata, H. AU - Maas, A.H.E.M. PY - 2014 UR - https://hdl.handle.net/2066/136141 TI - Treatment assignment in young women with spontaneous coronary artery dissection EP - 1224 SN - 0167-5273 IS - iss. 3 SP - 1223 JF - International Journal of Cardiology VL - vol. 176 DO - https://doi.org/10.1016/j.ijcard.2014.07.218 ER - TY - JOUR AU - Otten, A.M. AU - Ottervanger, J.P. AU - Timmer, J.R. AU - Hof, A.W. van 't AU - Dambrink, J.H. AU - Gosselink, A.M. AU - Hoorntje, J.C.A. AU - Suryapranata, H. AU - Maas, A.H.E.M. PY - 2013 UR - https://hdl.handle.net/2066/119180 AB - BACKGROUND: Both acute hyperglycemia as diabetes results in an impaired prognosis in ST-elevation myocardial infarction (STEMI) patients. It is unknown whether there is a different prevalence of diabetes and acute hyperglycemia in men and women within age-groups. METHODS: Between 2004 and 2010, 4640 consecutive patients (28% women) with STEMI, were referred for primary PCI. Patients were stratified into two age groups, < 65 years (2447 patients) and >/=65 years (2193 patients). Separate analyses were performed in 3901 patients without diabetes. Diabetes was defined as known diabetes or HbA1c >/=6.5 mmol/l at admission. RESULTS: The prevalence of diabetes was comparable between women and men in the younger age group (14% vs 12%, p = 0.52), whereas in the older age group diabetes was more prevalent in women (25% vs 17% p < 0.001). In patients without diabetes, admission glucose was comparable between both genders in younger patients (8.1 +/- 2.0 mmol/l vs 8.0 +/- 2.2 mmol/l p = 0.36), but in older patients admission glucose was higher in women than in men (8.7 +/- 2.1 mmol/l vs 8.4 +/- 2.1 mmol/l p = 0.028). After multivariable analyses, the occurrence of increased admission glucose was comparable between men and women in the younger age group (OR 1.1, 95%CI 0.9-1.5), but increased in women in the older age group (OR 1.3, 95% CI 1.1-1.7). Both diabetes and hyperglycemia were associated with a higher one-year mortality in both men and women. CONCLUSIONS: The differences between men and women in hyperglycemia and diabetes in patients with STEMI are age dependent and can only be observed in older patients. This may have implications for medical treatment and should be investigated further. TI - Age-dependent differences in diabetes and acute hyperglycemia between men and women with ST-elevation myocardial infarction: a cohort study SN - 1758-5996 IS - iss. 1 SP - 34 JF - Diabetology & Metabolic Syndrome VL - vol. 5 L1 - https://repository.ubn.ru.nl/bitstream/handle/2066/119180/119180.pdf?sequence=1 ER - TY - JOUR AU - Roolvink, V. AU - Rasoul, S. AU - Ottervanger, J.P. AU - Dambrink, J.H. AU - Gosselink, M. AU - Hoorntje, J.C.A. AU - Hermanides, R. AU - Suryapranata, H. AU - Hof, A.W. van 't PY - 2013 UR - https://hdl.handle.net/2066/119242 TI - Circumflex artery related myocardial infarction: Less reperfusion therapy and large infarct size EP - 1626 SN - 0167-5273 IS - iss. 2 SP - 1624 JF - International Journal of Cardiology VL - vol. 168 DO - https://doi.org/10.1016/j.ijcard.2013.01.014 ER - TY - JOUR AU - Ng, S. AU - Ottervanger, J.P. AU - Hof, A.W. van 't AU - Boer, M.J. de AU - Reiffers, S. AU - Dambrink, J.H. AU - Hoorntje, J.C.A. AU - Gosselink, A.T.M. AU - Suryapranata, H. PY - 2013 UR - https://hdl.handle.net/2066/119307 AB - BACKGROUND: Myocardial necrosis is a time-dependent event. Nevertheless, clinical studies on association between ischemic time and left ventricle function showed inconsistent findings. Aim of current study is to evaluate the association between ischemic time and the post-infarction left ventricular function in ST-elevation myocardial infarction treated with primary PCI. METHODS: In 2529 patients treated with primary PCI, left ventricular ejection fraction (LVEF) was measured before discharge (median day 4) by radionuclide ventriculography or by echocardiography if patients had atrial fibrillation. Ischemic time was calculated from symptom onset to first balloon inflation. RESULTS: The correlation between ischemic time as continuous variable and LVEF was significant but weak (P=0.002, r=-0.062). The LVEF of patients in ischemic time intervals of >6, >3-6, and 1. Also patients with occlusion of the right coronary artery or TIMI flow 0 before primary PCI more commonly had AF after the procedure. Not successful reperfusion was also associated with a higher incidence of AF after primary PCI. Although both atrial fibrillation before and after primary PCI were associated with increased mortality, multivariable analyses, adjusting for differences in age, gender and Killip class on admission, revealed that atrial fibrillation after PCI (OR 3.69, 95% CI 1.87-7.29) but not before PCI (OR 1.86, 95% CI 0.89-3.90) was independent and statistically significantly associated with long-term mortality. CONCLUSION: In patients with STEMI, atrial fibrillation after but not before primary PCI has independent prognostic implications. Possibly, atrial fibrillation after the PCI is a symptom of failed reperfusion and a sign of heart failure. TI - Atrial fibrillation after but not before primary angioplasty for ST-segment elevation myocardial infarction of prognostic importance. EP - 160 SN - 1568-5888 IS - iss. 4 SP - 155 JF - Netherlands Heart Journal VL - vol. 20 N1 - 1 april 2012 DO - https://doi.org/10.1007/s12471-012-0242-5 ER - TY - JOUR AU - Schellings, D.A.A.M. AU - Symersky, T. AU - Ottervanger, J.P. AU - Ramdat Misier, A.R. AU - Boer, M.J. de PY - 2012 UR - https://hdl.handle.net/2066/110562 AB - BACKGROUND: Although patient care in cardiology departments may be of high quality, patients with cardiac disease in other departments tend to receive less attention from cardiologists. Driven by the shorter duration of admission nowadays and the fact that consultations are often performed in between the daily work schedules, the amount of cardiac disease as well as the impact on the daily workload can be underestimated. We determined characteristics, prevalence of cardiac disease and in-hospital mortality of patients in whom cardiology consultation was requested. METHOD: In this prospective, observational study, individual data of all consecutive patients admitted to non-cardiology departments in whom cardiology consultation was requested were registered. RESULTS: During the study period, 264 patients were included. Mean age was 70 years. Most patients were admitted to the internal medicine ward (37 %), followed by the surgical ward (30 %). The most common reasons for cardiology consultation were: suspected heart failure (20 %), suspected infective endocarditis (15 %), suspected rhythm abnormalities (14 %) and suspected acute coronary syndrome (13 %). In 29 % of all consultations a cardiac diagnosis was found. Hospital mortality was 9.0 %. CONCLUSION: Patients who are admitted to a non-cardiology department and who need cardiology consultation are particularly elderly people with a high prevalence of cardiac disease and high in-hospital mortality. For these reasons cardiology consultation is an important part of clinical cardiology deserving a structured approach. TI - Clinical cardiology consultation at non-cardiology departments: stepchild of patient care? EP - 263 SN - 1568-5888 IS - iss. 6 SP - 260 JF - Netherlands Heart Journal VL - vol. 20 N1 - 1 juni 2012 DO - https://doi.org/10.1007/s12471-012-0273-y ER - TY - JOUR AU - Drost, J.T. AU - Arpaci, G. AU - Ottervanger, J.P. AU - Boer, M.J. de AU - Eyck, J. van AU - Schouw, Y.T. van der AU - Maas, A.H.E.M. PY - 2012 UR - https://hdl.handle.net/2066/110490 AB - Introduction: Preeclampsia is a complication of pregnancy and a known risk factor for cardiovascular disease (CVD) later in a women's life. The best approach for prevention of CVD in affected young women is yet unclear. We sought to investigate the prevalence of cardiovascular risk factors in women at 10 years post preeclampsia in comparison with a reference group. Methods: Women with a history of early preeclampsia (exposed), DBP >/=90 mmHg with proteinuria >/=0.3gram/24 h before 32 weeks of gestation, and an equal number of women after uncomplicated pregnancy (non-exposed) from the obstetric database of 1991-2007, were sent a questionnaire and invited for a cardiovascular screening programme. Results: The current study included 339 exposed women and 332 non-exposed women, 10 years post index-pregnancy. Systolic and diastolic blood pressures (SBP/DBP) were 127/86 mmHg versus 119/79 mmHg in the exposed and reference group respectively (p < 0.001). Exposure to early preeclampsia was associated with a threefold increased prevalence of hypertension (adjusted odds ratio (OR) 3.59, 95%CI 2.48-5.20). BMI and waist circumference were 26.9 kg/m(2) and 86.5 cm in the exposed group and 26.2 kg/m(2) (p = 0.07) and 83 cm (p = 0.001) in the non-exposed group. We found no differences in levels of glucose, lipids and CRP. Adjusted OR for the metabolic syndrome in women post preeclampsia was 2.18 (95% CI 1.34-3.52) compared with women in the reference group. Conclusion: We found a high prevalence of hypertension in young women at 10 years post early preeclampsia. More research on the timing of cardiovascular screening in these high-risk women is needed. TI - Cardiovascular risk factors in women 10 years post early preeclampsia: the Preeclampsia Risk EValuation in FEMales study (PREVFEM). EP - 1144 SN - 2047-4873 IS - iss. 5 SP - 1138 JF - European Journal of Preventive Cardiology VL - vol. 19 N1 - 1 oktober 2012 PS - 7 p. DO - https://doi.org/10.1177/1741826711421079 ER - TY - JOUR AU - Drost, J.T. AU - Schouw, Y.T. van der AU - Ottervanger, J.P. AU - Eyck, J. van AU - Boer, M.J. de AU - Maas, A.H.E.M. PY - 2012 UR - https://hdl.handle.net/2066/107731 AB - OBJECTIVE: Women with a history of preeclampsia are at increased risk to develop cardiovascular disease (CVD) later in life, especially hypertension is common. In this study we aimed to evaluate electrocardiographic parameters as a proxy for detrimental hypertensive effects and later CVD. METHODS: The Preeclampsia Risk EValuation study in FEMales (PREVFEM) study is a prospective cohort study consisting of 339 women with a history of early onset preeclampsia (EOP) and 332 age-matched women without a history if EOP as reference. At ten years post index pregnancy a 12-lead electrocardiogram recording was made. RESULTS: There were no significant differences in ECG parameters between both groups at 3 9years of age. In our cohort of young women SBP (OR(mmHg): 1.04; 95% CI: 1.2-1.06) as well as DBP (OR(mmHg): 1.04; 95% CI: 1.01-1.07) and stage 2 hypertension (OR: 3.35; 95% CI: 1.16-9.63) were significantly associated with ECG criteria for LVH, but not for other ECG abnormalities. EOP gives no significant adjusted risk on ECG abnormalities compared to women without EOP. CONCLUSION: EOP is no significant predictor of non-specific ECG abnormalities. Routine ECG screening in young women after preeclampsia is not recommended in non-hypertensive women, but may be useful when hypertension is present. TI - Electrocardiographic parameters in women ten years post-early preeclampsia EP - 151 SN - 0378-5122 IS - iss. 2 SP - 148 JF - Maturitas VL - vol. 73 DO - https://doi.org/10.1016/j.maturitas.2012.06.006 ER - TY - JOUR AU - Schoormans, D. AU - Mulder, B.J. AU - Melle, J.P. van AU - Pieper, E.G. AU - Dijk, A.P.J. van AU - Sieswerda, G.J. AU - Hulsbergen-Zwarts, M.S. AU - Plokker, T.H. AU - Brunninkhuis, L.G. AU - Vliegen, H.W. AU - Sprangers, M.A.G. PY - 2012 UR - https://hdl.handle.net/2066/108996 AB - Background: Type D personality, characterized by high levels of negative affectivity and social inhibition, is related to mortality, morbidity, poor health status, quality of life (QoL) and less healthcare utilization in various cardiovascular patient groups. To date, studies in patients with congenital heart disease (CHD) are lacking. Aims: (1) To examine the prevalence of Type D personality in CHD patients; (2) to compare Type D to non-Type D patients with regard to disease severity, functional status, health status and QoL; and (3) to examine the extent to which Type D personality is independently related to healthcare utilization. Methods: A total of 1109 adult CHD patients were included in a questionnaire survey. Due to missing data, 302 patients were excluded. Results: The prevalence of Type D personality was 20.4%. Type D patients reported a poorer functional status, health status and QoL than non-Type D patients (p<0.05). Type D patients reported less healthcare use than non-Type D patients (primary and cardiac outpatient healthcare: adjusted OR=0.56, 95% CI=0.35-0.90; inpatient healthcare: adjusted OR=0.38, 95% CI=0.17-0.83). Results of a post-hoc analysis showed a high prevalence of Type D personality in patients with a poor functional status who did not consult their cardiologist. Conclusion: Type D patients report a poorer functional status, health status and QoL, but less healthcare utilization. In clinical practice, patients should be screened for Type D personality, since social inhibition may prevent them from contacting a healthcare provider in the event of symptom aggravation. TI - Patients with a congenital heart defect and Type D personality feel functionally more impaired, report a poorer health status and quality of life, but use less healthcare. EP - 355 SN - 1474-5151 IS - iss. 3 SP - 349 JF - European Journal of Cardiovascular Nursing VL - vol. 11 N1 - 1 september 2012 DO - https://doi.org/10.1177/1474515112437828 ER - TY - JOUR AU - Hueskes, B.A. AU - Willems, F.F. AU - Leen, A.C. AU - Ninaber, P.A. AU - Westra, R. AU - Mantel-Teeuwisse, A.K. AU - Janssens, H. AU - Lisdonk, E.H. van de AU - Roovers, E.A. AU - Janssen, M. PY - 2012 UR - https://hdl.handle.net/2066/110408 AB - AIMS: Gouty arthritis is a frequent and disabling complication in heart failure patients. This study aimed to investigate which factors are associated with the occurrence of gouty arthritis in these patients. METHODS AND RESULTS: A case-control study was performed in heart failure patients (February 2007 to October 2009). Cases were defined as patients with gouty arthritis. Factors that are possibly associated with gouty arthritis and/or heart failure were evaluated. Echocardiographic dimensions and laboratory values including glomerular filtration rate (GFR) and fractional excretion of uric acid (FEUA) were measured. Logistic regression analysis was used to determine crude and adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for possibly associated factors. In total, 188 patients (59 with gouty arthritis) were included. Spironolactone use was associated with a decreased occurrence of gouty arthritis (OR 0.32, 95% CI 0.13-0.77). Independently associated with an increased occurrence of gouty arthritis were hypertensive heart failure (OR 3.6, 95% CI 1.6-8.2), New York Heart Association (NYHA) class III/IV (OR 4.5, 95% CI 1.8-11.0), lower GFR (P < 0.001), and FEUA <4% (OR 3.3, 95% CI 1.4-7.9). Among the four age/gender groups, the strongest association with gouty arthritis was found in men <65 years. CONCLUSION: Our identification of factors that are associated with the occurrence of gouty arthritis makes it possible to develop strategies to improve further the quality of life in heart failure patients. The possible decreased occurrence of gouty arthritis in spironolactone users has to be confirmed in prospective studies. TI - A case-control study of determinants for the occurrence of gouty arthritis in heart failure patients EP - 921 SN - 1388-9842 IS - iss. 8 SP - 916 JF - European Journal of Heart Failure VL - vol. 14 PS - 6 p. DO - https://doi.org/10.1093/eurjhf/hfs086 ER - TY - JOUR AU - Hermanides, R.S. AU - Ottervanger, J.P. AU - Dambrink, J.H. AU - Boer, M.J. de AU - Hoorntje, J.C.A. AU - Gosselink, A.T.M. AU - Suryapranata, H. AU - Zijlstra, F. AU - Hof, A.W. van 't PY - 2011 UR - https://hdl.handle.net/2066/97380 AB - This is a prospective, observational study performed in all consecutive ST-elevation myocardial infarction (STEMI) patients who had activated clotting time (ACT) measurement on arrival in the cathlab before coronary angiography. We studied the therapeutic effects of a pre-hospital fixed heparin bolus dose in consecutive patients with STEMI. A total of 1,533 patients received pre-hospital administration of aspirin, high dose clopidogrel (600 mg) and a fixed bolus dose of 5,000 IU unfractionated heparin (UFH), according to the national ambulance protocols. Some patients were also treated with glycoprotein IIb/IIIa inhibitors (GPI) in the ambulance. A therapeutic ACT range was defined according to the ESC guidelines as 200-250 seconds when patients had GPI pre-treatment and 250-350 seconds when no GPI pre-treatment. Of the 1,533 patients, 216 patients (14.1%) had an ACT within the therapeutic range, 82.3% of the patients had a too low ACT, whereas 3.5% of the patients had a too high ACT. After multivariable analysis, the only independent predictor of a too low ACT was increasing weight (odds ratio 1.02/kg, 95% confidence interval 1.01-1.03, p=0.001). Patients with a too low ACT had less often an open infarct related vessel (initial TIMI flow 2,3) as compared to patients with an ACT in range (36.5% vs. 45.9%, p=0.013). In only a minority of patients with STEMI, pre-hospital treatment with a fixed bolus dose UFH is within the therapeutic ACT range. Increased weight is an independent determinant of a too low ACT. We strongly recommend weight adjusted administration of UFH in the ambulance. TI - Suboptimal anticoagulation with pre-hospital heparin in ST-elevation myocardial infarction EP - 640 SN - 0340-6245 IS - iss. 4 SP - 636 JF - Thrombosis and Haemostasis VL - vol. 106 DO - https://doi.org/10.1160/TH11-04-0257 ER - TY - JOUR AU - Hermanides, R.S. AU - Houwelingen, G. van AU - Ottervanger, J.P. AU - Boer, M.J. de AU - Dill, T. AU - Hamm, C. AU - Stella, P.R. AU - Boersma, E. AU - Berg, J.M. ten AU - Hof, A.W. van 't PY - 2011 UR - https://hdl.handle.net/2066/97433 AB - PURPOSE: Glycoprotein IIb/IIIa inhibitors are favourable in ST-elevation myocardial infarction (STEMI) patients, and the additional value of early pre-hospital high bolus dose tirofiban has recently been established. The aim of this study was to determine the impact of age on myocardial reperfusion and clinical outcomes of pre-hospital administration of high bolus dose tirofiban. METHODS: This is a pre-specified sub-analysis of the multicentre, double-blind, placebo-controlled, randomised On-TIME 2 trial and it's open label phase. The primary endpoint was mean residual ST segment deviation 1 h after primary PCI and was evaluated in three age groups. RESULTS: Of the 466 patients in the highest tertile (>/=68 years), median age was 74.4 years (IQR 71.3-78.6 years) and 231 (50%) were randomised to tirofiban. Mean residual ST segment deviation 1 h after PCI was significantly lower in elderly patients pre-treated with tirofiban compared to elderly patients without tirofiban pre-treatment (4.2 +/- 5.2 mm vs 6.4 +/- 7.5 mm, p = 0.001). Furthermore, elderly patients pre-treated with tirofiban had a non-significantly higher rate of 30-day major or minor bleeding compared to elderly patients without tirofiban pre-treatment (14.2% vs 9.0%, p = 0.088). 30-day net adverse clinical events in elderly patients with- or without tirofiban was not significantly different (11.9% vs 15.2%, p = 0.300). CONCLUSION: The effect of pre-hospital initiation of high bolus dose tirofiban on myocardial reperfusion, as determined by ST-segment resolution is highest in the elderly patients. However, this was associated with a trend towards more bleeding complications, resulting in a balanced clinical effect after 30-day follow-up. Future studies should evaluate whether the elderly STEMI patient may benefit from highly effective and safer antiplatelet therapy. TI - The impact of age on effects of pre-hospital initiation of high bolus dose of tirofiban before primary angioplasty for ST-elevation myocardial infarction EP - 330 SN - 0920-3206 IS - iss. 4 SP - 323 JF - Cardiovascular Drugs and Therapy VL - vol. 25 DO - https://doi.org/10.1007/s10557-011-6314-8 ER - TY - JOUR AU - Rasoul, S. AU - Ottervanger, J.P. AU - Boer, M.J. de AU - Dambrink, J.H. AU - Hoorntje, J.C.A. AU - Gosselink, A.T.M. AU - Suryapranata, H. AU - Hof, A.W. van 't PY - 2011 UR - https://hdl.handle.net/2066/98221 TI - Poor outcome after recurrent acute myocardial infarction: a plea for optimal secondary prevention EP - 300 SN - 0167-5273 IS - iss. 2 SP - 298 JF - International Journal of Cardiology VL - vol. 147 DO - https://doi.org/10.1016/j.ijcard.2010.12.046 ER - TY - JOUR AU - Postma, S. AU - Dambrink, J.H. AU - Boer, M.J. de AU - Gosselink, A.T.M. AU - Eggink, G.J. AU - Wetering, H. van de AU - Hollak, F. AU - Ottervanger, J.P. AU - Hoorntje, J.C.A. AU - Kolkman, E. AU - Suryapranata, H. AU - Hof, A.W. van 't PY - 2011 UR - https://hdl.handle.net/2066/98235 AB - BACKGROUND: We evaluated the effect of prehospital triage (PHT) in the ambulance on infarct size and clinical outcome and studied its relationship to the distance of patient's residence to the nearest percutaneous coronary intervention (PCI) center. METHODS: All consecutive ST-segment elevation myocardial infarction patients who were transported to the Isala klinieken from 1998 to 2008 were registered in a dedicated database. Of these, 2,288 (45%) were referred via a spoke center and 2.840 (55%) via PHT. RESULTS: PHT patients were more often treated within 3 hours after symptom onset (46.2% vs 26.8%, P < .001), more often had a post-procedural thrombolysis in myocardial infarction (TIMI) 3 flow (93.0% vs 89.7%, P < .001) had a smaller infarct size (peak creatine kinase 2,188 +/- 2,187 vs 2,575 +/- 2,259 IU/L, P < .001) and had a lower 1-year mortality (4.9% vs 7.0%, P = .002). After multivariate analysis, PHT was independently associated with ischemic time less than 3 hours (OR 2.45, 95% CI 2.13-2.83), a peak creatine kinase less than the median value (OR 1.19, 95% CI 1.04-1.36) and a lower 1-year mortality (OR 0.67, 95% CI 0.50-0.91). The observed differences between PHT patients and the spoke group were more pronounced in the subgroup of patients living >38 km from the PCI center. CONCLUSION: PHT in the ambulance is associated with a shorter time to treatment, a smaller infarct size and a more favorable clinical outcome, especially with longer distance from the patient's residence to the nearest PCI center. Therefore, PHT in the ambulance may reduce the negative effect of living at a longer distance from the PCI center. TI - Prehospital triage in the ambulance reduces infarct size and improves clinical outcome EP - 282 SN - 0002-8703 IS - iss. 2 SP - 276 JF - American Heart Journal VL - vol. 161 DO - https://doi.org/10.1016/j.ahj.2010.10.028 ER - TY - JOUR AU - Rasoul, S. AU - Ottervanger, J.P. AU - Timmer, J.R. AU - Yokota, S. AU - Boer, M.J. de AU - Hof, A.W. van 't PY - 2011 UR - https://hdl.handle.net/2066/95994 AB - BACKGROUND: Diabetes mellitus contributes to the increase of cardiovascular deaths worldwide. Despite continuous treatment evolution, patients with diabetes suffering from an acute coronary syndrome still have a high morbidity and mortality. We aimed to analyze the impact of diabetes on one-year outcome in an unselected patient population with non-ST-elevation myocardial infarction (non-STEMI). METHODS: Retrospective analysis of 847 unselected patients with non-STEMI. We compared the baseline characteristics, treatment and outcome of patients versus those without diabetes. RESULTS: A total of 138 patients had diabetes (16%) and 709 (84%) had no diabetes. Patients with diabetes were older, often had hypertension, hyperlipidemia, previous myocardial infarction and Killip class >/=2 on admission. Approximately 80% of both patients, with and without diabetes, underwent diagnostic coronary angiography. Multivessel disease was more present among patients with diabetes, but patients with diabetes were treated more often conservatively. At one-year follow up rates of death and major adverse cardiac events were significantly higher in patients with diabetes compared to those without diabetes (8% vs. 3%; P=0.001 and 23% vs. 14%; P=0.008, respectively). Even after adjustment for differences in baseline characteristics, diabetes remained an independent predictor of mortality (OR: 2.25; CI95%: 1.05-3.91). CONCLUSIONS: In an unselected patient population with non-STEMI, patients with diabetes have higher risk factors on admission, less often undergo coronary revascularisation and have worse outcome at one-year follow-up. Diabetes is an independent predictor of one-year mortality in patients with non-STEMI. TI - Impact of diabetes on outcome in patients with non-ST-elevation myocardial infarction EP - 92 SN - 0953-6205 IS - iss. 1 SP - 89 JF - European Journal of Internal Medicine VL - vol. 22 DO - https://doi.org/10.1016/j.ejim.2010.09.014 ER - TY - JOUR AU - Schellings, D.A.A.M. AU - Ottervanger, J.P. AU - Hof, A.W. van 't AU - Boer, M.J. de AU - Dambrink, J.H. AU - Hoorntje, J.C.A. AU - Gosselink, A.T.M. AU - Suryapranata, H. PY - 2011 UR - https://hdl.handle.net/2066/97240 AB - OBJECTIVE: Although most patients with ST-elevation myocardial infarction treated by primary percutaneous coronary intervention (PCI) have a good prognosis and can be discharged from hospital very soon, some patients must be admitted longer. We performed the current analysis to assess predictors and the prognostic significance of prolonged hospital stay. PATIENTS AND METHODS: In this prospective observational study, individual data from 2323 patients who survived at least 2 days after primary PCI in our hospital were recorded. Patients in the highest tertile of hospital stay were compared with the other patients. Both predictors and prognostic importance of prolonged hospital stay were evaluated. RESULTS: Mean admission duration was 6.7 days (standard deviation=6.6). A total of 797 patients had a hospital stay for more than 6 days (highest tertile). Patients with a longer hospital stay were older, more often female, had more often a history of previous myocardial infarction and signs of heart failure on admission, and had more frequently Thrombolysis in Myocardial Infarction flow 0 before PCI. In addition, a low left ventricular ejection fraction was independently associated with prolonged hospital stay [odds ratio: 2.06 (95% confidence interval: 1.54-2.76)], but with a comparable risk of 1-year mortality [odds ratio: 1.3 (95% confidence interval: 0.8-2.0)]. CONSLUSION: According to this study, a low left ventricular ejection fraction is associated with prolonged hospital stay in patients after primary PCI. Predictors of prolonged hospital stay are age, female sex, previous myocardial infarction, heart failure on admission, and Thrombolysis in Myocardial Infarction flow 0 before PCI. TI - Predictors and importance of prolonged hospital stay after primary PCI for ST elevation myocardial infarction EP - 462 SN - 0954-6928 IS - iss. 7 SP - 458 JF - Coronary Artery Disease VL - vol. 22 DO - https://doi.org/10.1097/MCA.0b013e3283495d5f ER - TY - JOUR AU - Schoormans, D. AU - Sprangers, M.A.G. AU - Pieper, P.G. AU - Melle, J.P. van AU - Dijk, A.P. van AU - Sieswerda, G.T. AU - Hulsbergen-Zwarts, M.S. AU - Plokker, T.H. AU - Brunninkhuis, L.G. AU - Vliegen, H.W. AU - Mulder, B.J. PY - 2011 UR - https://hdl.handle.net/2066/97445 AB - OBJECTIVE: A first step in the delivery of tailored care is answering the following question: does health care meet the needs of patients? Therefore patients' perspective on health care use and their needs was examined. The design used was cross-sectional questionnaire study. PATIENTS: A total of 1109 adult congenital heart defect (CHD) patients attending one of eight Dutch hospitals were randomly selected from a national database (10% of all registered patients). MAIN OUTCOME MEASURES: Patient reported questionnaires on in- and outpatient health care use during the past year and need for additional care. RESULTS: A total of 66% and 40% of patients had contact with their cardiologist and general practitioner, respectively. Six to 10 percent were hospitalized, operated upon, or visited the emergency room. For the majority, the amount of contact was sufficient. Most patients indicated that the communication skills and expertise of the cardiologist and general practitioner were sufficient, and health care improvements were not necessary. Frequent health care users had a poor functional status and frequent contact with their cardiologist and general practitioner. Patients who want more contact with their cardiologist rated the communication skills of the cardiologist as insufficient. CONCLUSIONS: For most patients, the amount and quality of care are both sufficient. Patients who rate the communication skills of the cardiologist as insufficient have need more contact. In addition to the recommended training program as described in the American College of Cardiology/American Heart Association (ACC/AHA) and European Society of Cardiology (ESC) guidelines, we recommend the incorporation of communication training. This is the first study to provide insight into health care use and needs of CHD patients in countries with a compulsory health insurance system from the patient perspective. TI - The perspective of patients with congenital heart disease: does health care meet their needs? EP - 227 SN - 1747-079X IS - iss. 3 SP - 219 JF - Congenital Heart Disease VL - vol. 6 DO - https://doi.org/10.1111/j.1747-0803.2011.00521.x ER - TY - JOUR AU - Juwana, Y.B. AU - Rasoul, S. AU - Ottervanger, J.P. AU - Suryapranata, H. PY - 2010 UR - https://hdl.handle.net/2066/88709 AB - OBJECTIVE: To compare the efficacy of rapamycin-eluting stents (RES) and paclitaxel-eluting stents (PES) in patients undergo percutaneous coronary intervention. BACKGROUND: RES and PES differ significantly with respect to polymer coating and antiproliferative drugs. It is not yet clear whether there are any differences between RES and PES with regard to clinical outcomes. METHODS: Systematic searches were conducted of randomized, controlled trials (RCTs) comparing RES with PES in Medline and the Cochrane Database of systematic reviews. A meta-analysis was done of all available randomized studies comparing PES with RES. Information on study design, inclusion and exclusion criteria, number of patients and clinical outcomes was extracted by two investigators. Disagreements were resolved by consensus. The primary outcome was reintervention, target lesion revascularization (TLR) and target vessel revascularization (TVR). Stent restenosis, myocardial infarction (MI) and all-cause mortality were secondary endpoints. RESULTS: Twenty-one RCTs of RES versus PES with a total number of 10,147 patients were included in this meta-analysis. Indication for angioplasty was either acute coronary syndrome or stable angina. The mean follow-up period ranged from 6 to 24 months. The rates of TLR were 4.9% vs. 7.0%; p = 0.0009 and the rates of TVR were 5.1 vs. 8.3%; p < 0.001 for RES vs. PES, respectively. The incidence of stent restenosis was 3.9% for RES vs. 5.3% for PES; p = 0.004. Rates of MI and all-cause mortality were comparable. CONCLUSIONS: This meta-analysis demonstrates that, as compared to PES, RES seems to be associated with a lower risk of reintervention and stent restenosis. The risk of MI and all-cause death was similar between the two stents. TI - Efficacy and safety of rapamycin as compared to paclitaxel-eluting stents: a meta-analysis. EP - 316 SN - 1042-3931 IS - iss. 7 SP - 312 JF - Journal of Invasive Cardiology VL - vol. 22 N1 - 1 juli 2010 ER - TY - JOUR AU - Timmer, J.R. AU - Berg, J. AU - Heestermans, A.A. AU - Dill, T. AU - Werkum, J.W. van AU - Dambrink, J.H. AU - Suryapranata, H. AU - Ottervanger, J.P. AU - Hamm, C. AU - Hof, A.W. van 't PY - 2010 UR - https://hdl.handle.net/2066/89688 AB - AIMS: Glycoprotein IIb/IIIa blocking agents seem to improve percutaneous coronary intervention (PCI) results in patients with ST-elevation myocardial infarction (STEMI). We aimed to compare the effect of pre-hospital administration of tirofiban in STEMI patients with and without diabetes mellitus (DM) treated with primary PCI. METHODS AND RESULTS: We performed a pre-specified sub-analysis of the randomised On-Time II trial (n=984) and it's open label run-in phase (n=414), which investigated pre-hospital administration of high dose tirofiban in STEMI patients treated with primary PCI. Two-hundred and twenty (16%) diabetic patients (known DM or Hba1C >/=6.2%) were included, 101 in the placebo group and 119 in the tirofiban group. In patients with DM, randomisation to tirofiban resulted in a lower residual ST deviation (5.1+/-8.5 mm vs. 6.2+/-5.6 mm, p=0.003), a reduced infarct size (CK 1694+/-1925 U/L vs. CK 2040+/-1829 U/L, p=0.02) and a trend towards lower one-year mortality (4.6% vs. 11.6%, p=0.07). The beneficial effects of tirofiban were more pronounced in diabetic patients compared to patients without diabetes. CONCLUSIONS: Pre-hospital administration of tirofiban in diabetic STEMI patients treated with primary PCI improves ST resolution and reduces myocardial infarct size. Tirofiban seems particularly beneficial in patients with diabetes. TI - Pre-hospital administration of tirofiban in diabetic patients with ST-elevation myocardial infarction undergoing primary angioplasty: a sub-analysis of the On-Time 2 trial. EP - 342 SN - 1774-024X IS - iss. 3 SP - 336 JF - Eurointervention VL - vol. 6 N1 - 1 augustus 2010 DO - https://doi.org/10.4244/EIJV6I3A56 ER - TY - JOUR AU - Hermanides, R.S. AU - Ottervanger, J.P. AU - Dambrink, J.H. AU - Boer, M.J. de AU - Hoorntje, J.C.A. AU - Gosselink, A.T.M. AU - Suryapranata, H. AU - Hof, A.W. van 't PY - 2010 UR - https://hdl.handle.net/2066/89051 AB - AIMS: Although closure devices may be comfortable for patients, the clinical benefits in patients with moderate-to-high risk of bleeding are not yet clear. We compared a closure device with manual compression in moderate- to high-risk bleeding patients undergoing percutaneous coronary intervention (PCI). METHODS AND RESULTS: A randomized study was performed to compare a closure device (Angio-Seal, St. Jude Medical, Inc.) with manual compression in 627 patients treated with aspirin, clopidogrel, a glycoprotein IIb/IIIa inhibitor and heparin during PCI. The primary endpoint was the inhospital combined incidence of: 1) severe hematoma > 5 cm at the puncture site or groin bleeding resulting in prolonged hospital stay, transfusion and/or surgical intervention at the puncture site; 2) arteriovenous fistula formation and/or surgical intervention at the puncture site. A total of 313 patients (49.9%) were randomized to the closure device and 314 patients (50.1%) to manual compression. The combined primary endpoint was 2.6% in the closure device group compared to 4.5% in the manual compression group (p = 0.195). In the predefined subgroup of patients with a history of hypertension, however, the combined primary endpoint (0.8% vs. 7.2%; p = 0.008) was significantly reduced after use of the closure device. CONCLUSION: This trial did not show the superiority of using a closure device over manual compression in patients treated with triple antiplatelet therapy who underwent PCI. The fact that patients with a history of hypertension had a benefit from a closure device merits further investigation. TI - Closure device or manual compression in patients undergoing percutaneous coronary intervention: a randomized comparison. EP - 566 SN - 1042-3931 IS - iss. 12 SP - 562 JF - Journal of Invasive Cardiology VL - vol. 22 N1 - 1 december 2010 ER - TY - JOUR AU - Dambrink, J.H. AU - Debrauwere, J.P. AU - Hof, A.W. van 't AU - Ottervanger, J.P. AU - Gosselink, A.T.M. AU - Hoorntje, J.C.A. AU - Boer, M.J. de AU - Suryapranata, H. PY - 2010 UR - https://hdl.handle.net/2066/89784 AB - AIMS: Evidence regarding the optimal treatment of non-culprit lesions detected during primary PCI is lacking. Our aim was to investigate whether early invasive treatment improves left ventricular ejection fraction (EF) and prevents major adverse cardiac events (MACE). METHODS AND RESULTS: Of 121 patients with at least one non-culprit lesion, 80 were randomised to early FFRguided PCI (invasive group), and 41 to medical treatment (conservative group). Primary endpoint was EF at six months, secondary endpoints included MACE. In the invasive group, early angiography was performed 7.5 days (5-20) after primary PCI. Forty percent of the non-culprit lesions did not show haemodynamic significance (FFR > 0.75). Subsequent PCI of at least one non-culprit lesion was performed in 52%, PCI without preceding FFR was performed in 8% and elective CABG was done in 4%. No in-hospital events occurred in the conservative group. After six months, EF was comparable (59+/-9% vs. 57+/-9%, p=0.362), and there was no difference in MACE between invasively and conservatively treated patients (21 vs. 22%, p=0.929). CONCLUSIONS: An invasive strategy towards non-culprit lesions does not lead to an increase in EF or a reduction in MACE. The functional stenosis severity of non-culprit lesions is frequently overestimated. TI - Non-culprit lesions detected during primary PCI: treat invasively or follow the guidelines? EP - 975 SN - 1774-024X IS - iss. 8 SP - 968 JF - Eurointervention VL - vol. 5 N1 - 1 april 2010 DO - https://doi.org/10.4244/EIJV5I8A162 ER - TY - JOUR AU - Heestermans, A.A. AU - Hermanides, R.S. AU - Gosselink, A.T.M. AU - Boer, M.J. de AU - Hoorntje, J.C.A. AU - Suryapranata, H. AU - Ottervanger, J.P. AU - Dambrink, J.H. AU - Kolkman, E.G.W. AU - Berg, J.M. ten AU - Zijlstra, F. AU - Hof, A.W. van 't PY - 2010 UR - https://hdl.handle.net/2066/89388 TI - A comparison between upfront high-dose tirofiban versus provisional use in the real-world of the non-selected STEMI patients undergoing primary PCI. EP - 597 SN - 1568-5888 IS - iss. 12 SP - 592 JF - Netherlands Heart Journal VL - vol. 18 DO - https://doi.org/10.1007/s12471-010-0840-z ER - TY - JOUR AU - Boer, M.J. de AU - Ottervanger, J.P. PY - 2010 UR - https://hdl.handle.net/2066/89411 TI - Response to dr. Gutierrez and collegues. EP - 2237 SN - 0002-8614 IS - iss. 11 SP - 2237 JF - Journal of the American Geriatrics Society VL - vol. 58 ER - TY - JOUR AU - Boer, M.J. de AU - Ottervanger, J.P. AU - Suryapranata, H. AU - Hoorntje, J.C.A. AU - Dambrink, J.H. AU - Gosselink, A.T.M. AU - Hof, A.W. van 't AU - Zijlstra, F. PY - 2010 UR - https://hdl.handle.net/2066/87221 AB - OBJECTIVES: To assess the influence of age as an independent factor determining the prognosis and outcome of patients with acute myocardial infarction (AMI) treated using primary percutaneous coronary intervention (PCI). DESIGN: A retrospective analysis from a dedicated database. SETTING: A high-volume interventional cardiology center in the Netherlands. PARTICIPANTS: Four thousand nine hundred thirty-three consecutive patients with AMI. MEASUREMENTS: Baseline characteristics and clinical outcomes after 30 days and 1 year were compared according to age categorized in three groups: younger than 65, 65 to 74, and 75 and older. A more-detailed analysis was performed with six age groups, from younger than 40 to 80 and older. RESULTS: Of the 4,933 consecutive patients with AMI treated with PCI between 1992 and 2004, 643 were aged 75 and older. Multivariate analysis revealed that patients aged 65 to 75 had a greater risk of 1-year mortality than those younger than 65 (adjusted odds ratio (AOR)=1.57, 95% confidence interval (CI)=1.15-2.16) and that those aged 75 and older had a greater risk of 1-year mortality than those younger than 65 (AOR=3.03, 95% CI=2.14-4.29). CONCLUSION: In this retrospective analysis, older age was independently associated with greater mortality after PCI for AMI. Patients aged 65 and older had a higher risk of mortality than younger patients, and those aged 75 and older had the highest risk of mortality. TI - Old age and outcome after primary angioplasty for acute myocardial infarction. EP - 872 SN - 0002-8614 IS - iss. 5 SP - 867 JF - Journal of the American Geriatrics Society VL - vol. 58 N1 - 1 mei 2010 DO - https://doi.org/10.1111/j.1532-5415.2010.02821.x ER - TY - JOUR AU - Hermanides, R.S. AU - Ottervanger, J.P. AU - Dambrink, J.H. AU - Boer, M.J. de AU - Hoorntje, J.C.A. AU - Gosselink, A.T.M. AU - Suryapranata, H. AU - Hof, A.W. van 't PY - 2010 UR - https://hdl.handle.net/2066/88076 AB - AIMS: To investigate incidence, predictors and prognosis of bleeding in ST elevation myocardial infarction (STEMI) patients who underwent primary percutaneous coronary intervention (PCI). METHODS AND RESULTS: A large scale, prospective, observational study was performed between 1991 and 2004 in a single teaching hospital in The Netherlands including all consecutive STEMI patients who underwent primary PCI. The independent association between both major and minor bleeding and one year mortality was evaluated using Cox proportional hazard models. A total of 5,030 patients were included, of whom 109 patients (2%) had cardiac surgery within 48 hours. Data on bleeding <48 hours were available in 4,717 patients (96%). Of these, 80 (1.6%) had major bleeding, whereas minor bleeding was observed in 266 patients (5.6%). Independent predictors of minor bleeding were advanced age, multivessel disease, Killip class > or = 2 on admission, anterior MI location and TIMI 0 flow before PCI. Killip class > or = 2 on admission was an independent predictor of major bleeding. Major bleeding (HR 3.5 [95% CI 2.3-5.4]) was associated with an increased risk of death at one year. CONCLUSIONS: After primary PCI, the incidence of major bleeding is less than 2%. Although relatively infrequent, major bleeding complications are strongly and independently related to short- and midterm mortality. TI - Incidence, predictors and prognostic importance of bleeding after primary PCI for ST-elevation myocardial infarction. EP - 111 SN - 1774-024X IS - iss. 1 SP - 106 JF - Eurointervention VL - vol. 6 N1 - 1 mei 2010 DO - https://doi.org/10.4244/EIJV6I1A16 ER - TY - JOUR AU - Schellings, D.A.A.M. AU - Dambrink, J.H. AU - Hoorntje, J.C.A. AU - Boer, M.J. de AU - Hof, A.W. van 't AU - Suryapranata, H. PY - 2010 UR - https://hdl.handle.net/2066/87279 AB - Background. In patients with unstable angina or non-ST-elevation acute coronary syndrome (NSTE-ACS) who are eligible for PCI, routine stenting is the recommended treatment strategy, based on the opinion of experts. Provisional stenting may provide a viable alternative by retaining the early benefits of stenting without its potential late hazards.Method. Patients with NSTE-ACS were randomised to provisional or routine stenting after coronary angiography. Patients were followed for up to ten years. The occurrence of major adverse cardiac events (MACE) was recorded.Results. 237 consecutive patients with NSTE-ACS were randomly assigned to routine stenting (n=116) or provisional stenting (n=121). No difference in the incidence of MACE at 30 days was observed. At six months, angiographic restenosis was lower in the routine stenting group (41 vs. 20%, p=0.02), paralleled by more MACE in the provisional stenting group at one year (40.5 vs. 27.6%, p=0.036). At complete follow-up the difference in MACE was not significant (61.2 vs. 50%, p=0.084) because of relatively more target lesion revascularisations in the routine stent group. There was no difference in the incidence of very late stent thrombosis (1.7 vs. 3.4%, p=0.439). The only independent predictor of MACE was beta-blocker use (RR 0.62 [0.431; 0.892] p=0.010).Conclusion. In selective patients with NSTE-ACS, routine stenting was more beneficial than provisional stenting for a period of up to five years, driven by a reduction in repeat revascularisation procedures. After this period, the benefit was no longer significant. Beta-blocker use was the only independent predictor of MACE throughout the complete follow-up period. (Neth Heart J 2010;18:307-13.). TI - Long-term comparison of balloon angioplasty with provisional stenting versus routine stenting in patients with non-ST-elevation acute coronary syndrome. EP - 313 SN - 1568-5888 IS - iss. 6 SP - 307 JF - Netherlands Heart Journal VL - vol. 18 N1 - 1 juni 2010 ER - TY - JOUR AU - Elsman, P. AU - Hof, A.W. van 't AU - Hoorntje, J.C.A. AU - Boer, M.J. de AU - Borm, G.F. AU - Suryapranata, H. AU - Ottervanger, J.P. AU - Gosselink, A.T.M. AU - Dambrink, J.H. AU - Zijlstra, F. PY - 2006 UR - https://hdl.handle.net/2066/49373 AB - In acute myocardial infarction that is treated with thrombolysis, proximal coronary artery occlusion is associated with worse prognosis, irrespective of the infarcted artery. Primary percutaneous coronary intervention (PCI) is currently the treatment of choice for ST-segment elevation acute myocardial infarction. Therefore, we evaluated the prognostic significance of proximal versus distal coronary artery occlusion in patients with acute myocardial infarction that was treated with primary PCI. Between 1994 and 2001, patients with a first acute myocardial infarction that was treated with primary PCI were analyzed. A lesion was considered proximal if it was located proximal to the first diagonal branch in the left anterior descending coronary artery (LAD), the first marginal obtuse branch in the left circumflex coronary artery, and the first right acute marginal branch in the right coronary artery. Lesions distal of these side branches were considered distal. In total, 1,468 patients were analyzed. Left ventricular ejection fraction (LVEF) for proximal LAD lesions was lower than that for distal ones (37 +/- 11% vs 42 +/- 11%, p <0.0001). Adjusted relative risk of 3-year mortality for proximal versus distal LAD was 4.04 (95% confidence interval 1.95 to 8.38). In patients with infarcts related to the right or left circumflex coronary artery, no significant association between lesion location and LVEF or mortality was seen. No difference was seen in adjusted 3-year mortality between distal LAD and non-LAD-related infarcts (p = 0.145). In conclusion, our analysis shows that, even in patients with acute myocardial infarction that is treated with primary PCI, infarcts related to the proximal LAD have the worst 3-year survival and lowest residual LVEF compared with distal LAD or non-LAD-related infarcts. TI - Effect of coronary occlusion site on angiographic and clinical outcome in acute myocardial infarction patients treated with early coronary intervention. EP - 1141 SN - 0002-9149 IS - iss. 8 SP - 1137 JF - American Journal of Cardiology VL - vol. 97 DO - https://doi.org/10.1016/j.amjcard.2005.11.027 ER - TY - JOUR AU - Elsman, P. AU - Hof, A.W. van 't AU - Boer, M.J. de AU - Suryapranata, H. AU - Borm, G.F. AU - Hoorntje, J.C.A. AU - Ottervanger, J.P. AU - Gosselink, A.T.M. AU - Dambrink, J.H. AU - Zijlstra, F. PY - 2006 UR - https://hdl.handle.net/2066/51316 AB - BACKGROUND: Left ventricular function and infarct size are strong predictors for prognosis after acute myocardial infarction (MI). Anterior MI is associated with greater reduction of left ventricular ejection fraction (LVEF) and worse prognosis. Our objective was to study whether the impact of infarct size on global LVEF is dependent of infarct location. METHODS: We analyzed 888 patients treated with primary percutaneous coronary intervention for acute MI. Enzymatic infarct size and LVEF within 1 week were measured. In 490 patients (55%), LVEF was measured a second time at 6 months. RESULTS: Every 1000 U/L of cumulative lactate dehydrogense release corresponded to a decrease of 4.7% (95% CI 4.1-5.3) in LVEF measured within 1 week post MI for left anterior descending coronary artery (LAD)-related infarcts and to a decrease of 2.4% (95% CI 1.7-3.1) in LVEF measured within 1 week post MI for non-LAD-related infarcts (P < .0001). Left ventricular ejection fraction measured 6 months post MI showed a decrease for every 1000 U/L cumulative lactate dehydrogense release of 4.8% (95% CI 4.2-5.3) for LAD and 2.4% (95% CI 1.7-3.1) for non-LAD-related infarcts (P < .0001). Multivariate correction for relevant clinical and angiographic data did not change these results. CONCLUSION: In patients with a first acute MI treated with primary percutaneous coronary intervention, LAD-related infarcts show for a similar amount of myocardial necrosis as determined by enzymatic infarct size, a lower residual LVEF when compared with non-LAD-related infarcts. TI - Impact of infarct location on left ventricular ejection fraction after correction for enzymatic infarct size in acute myocardial infarction treated with primary coronary intervention. EP - 14 SN - 0002-8703 IS - iss. 6 SP - 1239.e9 JF - American Heart Journal VL - vol. 151 ER - TY - JOUR AU - Liem, A. AU - Zijlstra, F. AU - Ottervanger, J.P. AU - Hoorntje, J.C.A. AU - Suryapranata, H. AU - Boer, M.J. de AU - Verheugt, F.W.A. PY - 2000 UR - https://hdl.handle.net/2066/184503 TI - High dose bolus heparin as pretreatment of primary angioplasty in acute myocardial infarction: the Heparin in Early Patency (HEAP) randomized trial EP - 604 SN - 0735-1097 SP - 600 JF - Journal of the American College of Cardiology VL - vol. 35 PS - 5 p. DO - https://doi.org/10.1016/S0735-1097(99)00597-5 ER -