ORCID Profile
0000-0002-1703-7921
Current Organisation
Amsterdam University Medical Center
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Publisher: Elsevier BV
Date: 12-2012
DOI: 10.1016/J.JCIN.2012.07.016
Abstract: This study sought to examine the relationship between the aspirin dose prescribed at hospital discharge and long-term outcomes after ST-segment elevation myocardial infarction in patients treated with primary percutaneous coronary intervention (PCI). Patients with ST-segment elevation myocardial infarction who undergo primary PCI are prescribed maintenance aspirin doses that vary between 75 and 325 mg daily. Whether the dose of aspirin affects long-term patient outcomes is unknown. We compared 3-year outcomes in patients who were prescribed high-dose (>200 mg daily) versus low-dose (≤200 mg daily) aspirin from the large-scale HORIZONS-AMI (Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction) trial. Among 2,851 patients, 2,289 patients (80.3%) were discharged on low-dose aspirin and 562 patients (19.7%) were discharged on high-dose aspirin. Patients discharged on high-dose rather than low-dose aspirin were more likely to have a history of hypertension, hyperlipidemia, family history of premature coronary disease, prior treatment with PCI or coronary artery bypass surgery, and to be enrolled in the United States. Patients discharged on high-dose aspirin had higher 3-year rates of major adverse cardiovascular events, reinfarction, ischemic target vessel revascularization, major bleeding, and stent thrombosis. After multivariable analysis, discharge on high-dose aspirin was an independent predictor of major bleeding (hazard ratio: 2.80 95% confidence interval: 1.31 to 5.99 p = 0.008), but not of adverse ischemic events. In patients with ST-segment elevation myocardial infarction undergoing primary PCI, discharge on high-dose rather than low-dose aspirin may increase the rate of major bleeding without providing additional ischemic benefit.
Publisher: Wiley
Date: 23-10-2018
DOI: 10.1002/CCD.27860
Abstract: To investigate the prevalence, predictors and associations between guideline-directed medical therapy (GDMT) and clinical outcomes in acute myocardial infarction (AMI) patients undergoing percutaneous coronary intervention (PCI) from eight academic centers in the United States. Evidence for GDMT in patients with AMI comes from randomized controlled trials. The use of GDMT in clinical practice is unknown in this setting. PROMETHEUS is a multicenter observational registry comprising 19,914 patients with acute coronary syndrome (ACS) undergoing PCI. Patients with AMI were ided into two groups based on the prescription of GDMT or not (non-GDMT) at discharge. GDMT was defined according to American College of Cardiology/American Heart Association (ACC/AHA) class I recommendations, specifically, dual antiplatelet therapy, statin and beta-blocker for all AMI patients, and additional ACEI/ARB in patients with left ventricular ejection fraction (LVEF) less than 40%, hypertension, diabetes mellitus (DM) or chronic kidney disease (CKD). The primary endpoint was major adverse cardiovascular events (MACE) defined as a composite of all-cause death, MI, stroke or unplanned target vessel revascularization (TVR) at 1 year. Out of 4,834 patients with AMI, 3,356 (69.4%) patients were discharged on GDMT. Patients receiving GDMT were more often younger and male. Compared with non-GDMT patients, GDMT patients had a significantly lower frequency of comorbidities. Predictors of greater GDMT prescription at discharge were ST-segment elevation myocardial infarction (STEMI), and increased body mass index (BMI), whereas hypertension, prior PCI, anemia and CKD were associated with less GDMT prescription. At 1 year, the use of GDMT was associated with a significantly lower incidence of MACE (13.7% vs. 22.5% adjusted HR 0.68 95%CI 0.58-0.80 P < 0.001), death (3.7% vs. 9.4% adjusted HR 0.61 95%CI 0.46-0.80 P < 0.001), and unplanned TVR (8.4% vs. 11.3% adjusted HR 0.76 95%CI 0.61-0.96 P = 0.020). However, there were no significant differences in the incidence of MI (4.3% vs. 7.0% adjusted HR 0.75 95%CI 0.56-1.01 P = 0.056), stroke (1.5% vs. 2.0% adjusted HR 0.79 95%CI 0.47-1.34 P = 0.384) between the two groups. In a contemporary practice setting in the United States, GDMT was utilized in just over two-thirds of AMI patients undergoing PCI. Predictors of GDMT prescription at discharge included STEMI, BMI and absence of hypertension, CKD, anemia or prior PCI. Use of GDMT was associated with significantly lower risk of 1-year MACE and mortality.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-2012
DOI: 10.1161/CIRCINTERVENTIONS.112.972356
Abstract: Contrast-induced acute kidney injury (CI-AKI) after percutaneous coronary intervention is associated with adverse short- and long-term outcomes. However, identification of patients at risk for CI-AKI is challenging. Using a large contemporary randomized trial database of patients with ST-segment–elevation myocardial infarction, we therefore sought to examine whether admission B-type natriuretic peptide (BNP) levels predict the development of CI-AKI. A total of 979 ST-segment–elevation myocardial infarction patients enrolled in the Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction (HORIZONS-AMI) trial had BNP levels measured in the emergency room prior to primary percutaneous coronary intervention as part of the study protocol. CI-AKI was defined as a relative increase in serum creatinine of ≥25%, or an absolute increase of ≥0.5 mg/dL, occurring within 48 hours after contrast administration. Logistic regression analysis was used to estimate the association of admission BNP with development of CI-AKI. CI-AKI occurred in 131 patients (13.3%). Baseline BNP was a significant univariable correlate of CI-AKI (odds ratio 1.31, 95% confidence interval, 1.14–1.51 P =0.0001). After multivariable adjustment for clinical, laboratory, and angiographic variables, BNP remained a significant independent predictor of CI-AKI (1.29 [1.10, 1.51] P .001). Significant net reclassification improvement was achieved by addition of BNP to the current clinical risk prediction model (net reclassification improvement=0.177 P .001) and to the Mehran Risk Score (net reclassification improvement=0.100 P =0.015). Measurement of serum BNP at hospital admission may help identify patients who are at risk for developing CI-AKI after primary percutaneous coronary intervention in ST-segment–elevation myocardial infarction. URL: www.clinicaltrials.gov . Unique identifier: NCT00433966.
Publisher: Springer Berlin Heidelberg
Date: 2015
Location: United States of America
No related grants have been discovered for Bimmer Claessen.