Publications (106) View all
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Article: Hypercoagulation Assessed by Thromboelastography is Neither Related to Infarct Size nor to Clinical Outcome After Primary Percutaneous Coronary Intervention.
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ABSTRACT: Objectives: We investigated the relationship between coagulation assessed by thromboelastography (TEG) and myocardial damage in ST-segment elevation myocardial infarction (STEMI). Methods: We measured platelet activity with TEG-maximum amplitude (TEG-MA) in 233 patients undergoing urgent percutaneous coronary intervention (PCI). Infarct size and myocardial salvage index were evaluated using cardiac magnetic resonance, and the relation of these parameters to posttreatment coagulation was examined retrospectively. Adverse events were adjudicated and related to the coagulation status during the index event. Results: Hypercoagulation was found in 82 (35.2%) patients and was neither correlated to infarct size nor correlated to myocardial salvage index (P = .28 and .65, respectively) or clinical adverse events. Patients who experienced an adverse event during follow-up had a slightly higher TEG-MA value than patients with an event-free follow-up, but this was not statistically significant (68.1 vs 67.3, P = .44). Conclusions: The TEG-MA does not appear to be a sensitive predictor of reperfusion success and prognosis in urgent PCI for STEMI.Clinical and Applied Thrombosis/Hemostasis 04/2013; · 1.33 Impact Factor -
Article: Deferred stent implantation in patients with ST-segment elevation myocardial infarction: a pilot study.
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ABSTRACT: Aims: Disturbance in the flow of an infarct-related artery due to embolisation of thrombus and plaque material occurs frequently during primary percutaneous coronary intervention (PCI) and is associated with impaired prognosis. The aim of the present study was to minimise the risk of embolisation during PCI in patients with ST-segment elevation myocardial infarction (STEMI). Methods and results: Of 124 consecutive patients with STEMI, thrombectomy and/or balloon dilatation was performed in 110 (89%). Stent implantation was deferred in 113 (91%) patients who then comprised the study group. In 38% of the patients stent implantation was deemed unnecessary at the second examination because of <30% residual stenosis and no visible thrombus, and all lesions re-examined three months later were patent. Major adverse cardiac events occurred in two patients during eight months of follow-up (one cardiac death, one case of reinfarction with target lesion revascularisation). In five patients no PCI was performed at all. Myocardial salvage determined by cardiac magnetic resonance in a subset of patients was relatively high. Conclusions: Deferred stent implantation is safe in the majority of patients with STEMI. Although the concept has to be evaluated in a randomised trial, the strategy may prove beneficial for many patients referred for primary PCI.EuroIntervention: journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology 02/2013; 8(10):1126-33. · 3.29 Impact Factor -
Article: Association between lectin complement pathway initiators, C-reactive protein and left ventricular remodeling in myocardial infarction-A magnetic resonance study.
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ABSTRACT: BACKGROUND: Lectin complement pathway (LP) activation is an important mechanism in myocardial ischemia reperfusion injury (IRI). LP is activated via the recognition molecules mannose-binding lectin (MBL), ficolins-2 and-3 and is regulated by MBL/Ficolin-associated Protein-1 (MAP-1). Also, C-reactive protein (CRP) and ficolin-2 interact in vitro, but the role of the ficolins in IRI is unknown. METHODS AND RESULTS: In 55 patients with ST segment elevation myocardial infarction, we investigated the association of LP components and CRP in plasma samples with left ventricular (LV) end systolic and diastolic volumes (ESV and EDV) and infarct size, assessed by cardiac magnetic resonance early at 1-3 days after primary percutaneous coronary intervention and at 6 months follow-up. Opposed to MBL, ficolin-3 and MAP-1, ficolin-2 levels were low at baseline. At baseline, ficolin-2>median was associated with ESV and EDV increases by 7.83ml/m(2) (p=0.004) and 14.04ml/m(2) (p<0.001). MBL and MAP-1 were not associated with LV dilatation, yet ficolin-2 and MBL worked synergistically and the combination of their levels>median was associated with ESV (11.21ml/m(2); p=0.017) and EDV increases (14.72ml/m(2); p=0.006). MAP-1<median+ficolin-2>median had the greatest LV dilatation (17.61ml/m(2)). The ficolin-2×CRP interaction variable was positively associated with infarct size and inversely associated with EDV change over 6 months (p=0.006). There was no interaction between CRP and the other LP molecules. CONCLUSION: The LP initiator molecule ficolin-2 and combinations of ficolin-2, MBL and MAP-1 are associated with LV dilatation after myocardial infarction. Interaction of ficolin-2 and CRP was associated with infarct size and LV remodeling, indicating a potential role for LP and LP-pentraxin cross-activation in IRI and LV remodeling.Molecular Immunology 02/2013; 54(3-4):408-414. · 2.90 Impact Factor -
Article: [Early invasive examination of coronary arteries are indicated by non-ST elevation myocardial infarction.]
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ABSTRACT: Today there is solid evidence that high-risk patients with acute myocardial infarction without ST-elevation should undergo routine invasive treatment, preferably with a very short delay. Evidence suggests that acute coronary occlusions are present in many of these patients. Nevertheless, so far no studies have been powered to evaluate the impact of primary percutaneous coronary intervention on outcome in this patient population. With the advanced, prehospital, diagnostic possibilities available today it would be possible to investigate this issue further.Ugeskrift for laeger 01/2013; 175(4):198-201. -
Article: Final infarct size measured by cardiovascular magnetic resonance in patients with ST elevation myocardial infarction predicts long-term clinical outcome: an observational study.
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ABSTRACT: AIMS: Tailored heart failure treatment and risk assessment in patients following ST-segment elevation myocardial infarction (STEMI) is mainly based on the assessment of the left ventricular (LV) ejection fraction (EF). Assessment of the final infarct size in addition to the LVEF may improve the prognostic evaluation. To evaluate the prognostic importance of the final infarct size measured by cardiovascular magnetic resonance (CMR) in patients with STEMI. METHODS AND RESULTS: In an observational study the final infarct size was measured by late gadolinium enhancement CMR 3 months after initial admission in 309 patients with STEMI. The clinical endpoint was a composite of all-cause mortality and admission for heart failure. During the follow-up period of median 807 days (IQR: 669-1117) 35 events (5 non-cardiac deaths, 3 cardiac deaths, and 27 admissions for heart failure) were recorded. Patients with a final infarct size ≥median had significantly higher event rates than patients with a final infarct size <median (17 vs. 6%; Log rank P = 0.002). In a multivariable Cox regression analysis, including age, peak troponin T, LVEF, LV volume index, and heart rate, the final infarct size remained significantly associated with the occurrence of subsequent events (adjusted hazard ratio 1.13 per 1% increase (95% CI: 1.05-1.21; P = 0.001). The overall Wald χ(2) value of a model including known risk factors was 47.3, which increased to 57.9 when the final infarct size was added (P = 0.001 for the difference). CONCLUSION: Assessment of the final infarct size by CMR 3 months after a STEMI provides strong independent prognostic information incremental to known risk factors including the LVEF, and may help to improve the risk stratification of STEMI patients.European heart journal cardiovascular Imaging. 11/2012;
