Kari Kervinen

Publications (33)145.29 Total impact

• Article: Long-term Results after Simple versus Complex Stenting of Coronary Artery Bifurcation Lesions: Nordic Bifurcation Study 5-year Follow-up Results.

  Michael Maeng, Niels R Holm, Andrejs Erglis, Indulis Kumsars, Matti Niemelä, Kari Kervinen, Jan S Jensen, Anders Galløe, Terje K Steigen, Rune Wiseth, [......], Antti Ylitalo, Steffen Helqvist, Iwar Sjögren, Per Thayssen, Kari Virtanen, Mikko Puhakka, Juhani Airaksinen, Evald H Christiansen, Jens F Lassen, Leif Thuesen
  [show abstract] [hide abstract]
  ABSTRACT: OBJECTIVE: Randomized clinical trials with short-term follow-up have indicated that coronary bifurcation lesions may be optimally treated using the optional side branch stenting strategy. Here, we report the 5-year follow-up results of the Nordic Bifurcation Study. METHODS: A total of 413 patients with a coronary bifurcation lesion were randomized to a simple (stenting of main vessel (MV) and optional stenting of side branch (SB)) versus a complex stenting strategy (stenting of both MV and SB). RESULTS: Five-year clinical follow-up were available in 404 (98%) patients. The combined safety and efficacy endpoint of cardiac death, non-procedure related myocardial infarction, and target vessel revascularization were seen in 15.8% in the optional SB stenting group as compared to 21.8% in the MV and SB stenting group (p=0.15). All-cause death was seen in 5.9% versus 10.4% (p=0.16) and non-procedure related myocardial infarction in 4.0% versus 7.9% (p=0.09) in the optional SB stenting group versus the MV and SB stenting group, respectively. The rates of target vessel revascularization were 13.4 % versus 18.3 % (p=0.14) and the rates of definite stent thrombosis 3.0% versus 1.5% (p=0.31) in the optional SB stenting group versus the MV and SB stenting group, respectively. CONCLUSIONS: At 5-year follow-up in the Nordic Bifurcation Study, the clinical outcomes after simple optional side branch stenting remained at least equal to the more complex strategy of planned stenting of both the main vessel and the side branch.
  Journal of the American College of Cardiology 05/2013; · 14.16 Impact Factor
• Article: Five-year clinical outcome of titanium-nitride-oxide-coated bioactive stents versus paclitaxel-eluting stents in patients with acute myocardial infarction: Long-term follow-up from the TITAX AMI trial.

  Petri O Tuomainen, Antti Ylitalo, Matti Niemelä, Kari Kervinen, Mikko Pietilä, Jussi Sia, Kai Nyman, Wail Nammas, K E Juhani Airaksinen, Pasi P Karjalainen
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  ABSTRACT: BACKGROUND: The TITAX-AMI randomized controlled trial demonstrated a better clinical outcome with titanium-nitride-oxide-coated bioactive stents (BAS) as compared with paclitaxel-eluting stents (PES) at 2-year follow-up, in patients with acute myocardial infarction (MI) undergoing early percutaneous coronary intervention (PCI). We sought to present the 5-year clinical outcome of the TITAX-AMI trial. METHODS: A total of 425 patients with acute MI were randomly assigned to receive either BAS (214), or PES (211). The primary endpoint was major adverse cardiac events (MACE): a composite of cardiac death, recurrent MI or ischemia-driven target lesion revascularization (TLR). Clinical follow-up was performed to 5years. RESULTS: The 5-year cumulative incidence of MACE was significantly lower in patients assigned to BAS as compared with those assigned to PES (16.4% versus 25.1%, respectively, p=0.03). Similarly, the 5-year rates of cardiac death and recurrent MI were significantly lower in patients assigned to BAS (1.9% versus 5.7%, and 8.4% versus 18.0%, p=0.04 and p=0.004, respectively). Yet, the rates of ischemia-driven TLR were similar between the two study groups (11.2% versus 10.9%, respectively, p=0.92). The rate of definite stent thrombosis (ST) was again significantly lower in patients assigned to BAS (0.9% versus 7.1%, respectively, p=0.001). CONCLUSIONS: In the current prospective randomized TITAX-AMI trial, among patients presenting with acute MI who underwent early PCI, BAS achieved a better clinical outcome as compared with PES at 5-year follow-up, as reflected by lower cumulative rates of overall MACE, cardiac death, recurrent MI, and definite ST; yet, with statistically similar rates of ischemia-driven TLR.
  International journal of cardiology 12/2012; · 7.08 Impact Factor
• Article: Intravascular ultrasound assessed incomplete stent apposition and stent fracture in stent thrombosis after bare metal versus drug-eluting stent treatment the Nordic Intravascular Ultrasound Study (NIVUS).

  Petteri Kosonen, Saila Vikman, Lisette Okkels Jensen, Jens Flensted Lassen, Jan Harnek, Göran K Olivecrona, Andrejs Erglis, Eigil Fossum, Matti Niemelä, Kari Kervinen, Antti Ylitalo, Mikko Pietilä, Jens Aaroe, Thomas Kellerth, Kari Saunamäki, Per Thayssen, Lars Hellsten, Leif Thuesen, Kari Niemelä
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  ABSTRACT: BACKGROUND: This prospective multicenter registry used intravascular ultrasound (IVUS) in patients with definite stent thrombosis (ST) to compare rates of incomplete stent apposition (ISA), stent fracture and stent expansion in patients treated with drug-eluting (DES) versus bare metal (BMS) stents. ST is a rare, but potential life threatening event after coronary stent implantation. The etiology seems to be multifactorial. METHODS: 124 patients with definite ST were assessed by IVUS during the acute ST event. The study was conducted in 15 high-volume percutaneous coronary intervention -centers in the Nordic-Baltic countries. RESULTS: In early or late ST there were no differences in ISA between DES and BMS. In very late ST, ISA was a more frequent finding in DES than in BMS (52% vs.16%; p=0.005) and the maximum ISA area was larger in DES compared to BMS (1.1±2.3mm(2) vs. 0.1±0.5mm(2); p=0.004). Further, ISA was more prevalent in sirolimus-eluting than in paclitaxel-eluting stents (58% vs. 37%; p=0.02). Stent fractures were found both in DES (16%) and BMS (24%); p=0.28, and not related to time of stent thrombosis occurrence. For stents with nominal diameters ≥2.75mm, 38% of the DES and 22% of the BMS had a minimum stent area of less than 5mm(2); p=0.14. CONCLUSIONS: Very late stent thrombosis was more prevalent and associated with more extensive ISA in DES than in BMS treated patients. Stent fracture was a common finding in ST after DES and BMS implantation.
  International journal of cardiology 11/2012; · 7.08 Impact Factor
• Source

  Available from: Matti Niemelä

  Article: The effect of bone marrow microenvironment on the functional properties of the therapeutic bone marrow-derived cells in patients with acute myocardial infarction.

  Johanna A Miettinen, Riikka J Salonen, Kari Ylitalo, Matti Niemelä, Kari Kervinen, Marjaana Säily, Pirjo Koistinen, Eeva-Riitta Savolainen, Timo H Mäkikallio, Heikki V Huikuri, Petri Lehenkari
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  ABSTRACT: Treatment of acute myocardial infarction with stem cell transplantation has achieved beneficial effects in many clinical trials. The bone marrow microenvironment of ST-elevation myocardial infarction (STEMI) patients has never been studied even though myocardial infarction is known to cause an imbalance in the acid-base status of these patients. The aim of this study was to assess if the blood gas levels in the bone marrow of STEMI patients affect the characteristics of the bone marrow cells (BMCs) and, furthermore, do they influence the change in cardiac function after autologous BMC transplantation. The arterial, venous and bone marrow blood gas concentrations were also compared. Blood gas analysis of the bone marrow aspirate and peripheral blood was performed for 27 STEMI patients receiving autologous stem cell therapy after percutaneous coronary intervention. Cells from the bone marrow aspirate were further cultured and the bone marrow mesenchymal stem cell (MSC) proliferation rate was determined by MTT assay and the MSC osteogenic differentiation capacity by alkaline phosphatase (ALP) activity assay. All the patients underwent a 2D-echocardiography at baseline and 4 months after STEMI. As expected, the levels of pO(2), pCO(2), base excess and HCO(3) were similar in venous blood and bone marrow. Surprisingly, bone marrow showed significantly lower pH and Na(+) and elevated K(+) levels compared to arterial and venous blood. There was a positive correlation between the bone marrow pCO(2) and HCO(3) levels and MSC osteogenic differentiation capacity. In contrast, bone marrow pCO(2) and HCO(3) levels displayed a negative correlation with the proliferation rate of MSCs. Patients with the HCO(3) level below the median value exhibited a more marked change in LVEF after BMC treatment than patients with HCO(3) level above the median (11.13 ± 8.07% vs. 2.67 ± 11.89%, P = 0.014). Low bone marrow pCO(2) and HCO(3) levels may represent the optimal environment for BMCs in terms of their efficacy in autologous stem cell therapy in STEMI patients.
  Journal of Translational Medicine 04/2012; 10:66. · 3.41 Impact Factor
• Article: Gender-based analysis of the 3-year outcome of bioactive stents versus paclitaxel-eluting stents in patients with acute myocardial infarction: an insight from the TITAX-AMI trial.

  Petri O Tuomainen, Antti Ylitalo, Matti Niemelä, Kari Kervinen, Mikko Pietilä, Jussi Sia, Kai Nyman, Wail Nammas, K E Juhani Airaksinen, Pasi P Karjalainen
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  ABSTRACT: The TITAX-AMI trial demonstrated a better clinical outcome of titanium-nitride-oxide-coated bioactive stents (BAS) as compared with paclitaxel-eluting stents (PES) in patients with acute myocardial infarction (MI) undergoing early percutaneous coronary intervention (PCI). We explored the gender-based 3-year outcome of BAS as compared with PES in a subgroup analysis of the TITAX-AMI trial. A total of 214 patients (52 women) with acute MI were randomly assigned to BAS, and 211 patients (54 women) to PES. The primary endpoint was major adverse cardiac events (MACE) including cardiac death, recurrent MI, and target lesion revascularization (TLR). Secondary endpoints were all-cause death, a composite of cardiac death or recurrent MI, and stent thrombosis (ST). Women were older and had smaller reference vessel diameter (P<.001 for both) as compared with men. At 3-year follow-up, both MACE and TLR showed a trend to be higher in women as compared with men (24.5% versus 16.3% [P=.059] and 15.1% versus 8.8% [P=.065], respectively). The rate of all-cause death was significantly higher in women as compared with men (13.2% versus 6.0%, respectively; P=.02). Among female patients, MACE, cardiac death, recurrent MI, TLR, and ST were all statistically similar between the two stent groups (P>.05 for all). In the current post hoc gender-based analysis of the TITAX-AMI trial, the 3-year outcome of patients undergoing PCI for acute MI was slightly worse in female patients as compared with their male counterparts, as reflected by a trend toward a higher primary composite endpoint of MACE and TLR.
  The Journal of invasive cardiology 03/2012; 24(3):104-8. · 1.84 Impact Factor
• Article: Side branch fractional flow reserve measurements after main vessel stenting: a Nordic-Baltic Bifurcation Study III substudy.

  Indulis Kumsars, Inga Narbute, Leif Thuesen, Matti Niemelä, Terje K Steigen, Kari Kervinen, Dace Sondore, Niels R Holm, Jens F Lassen, Evald H Christiansen, Michael Maeng, Sanda Jegere, Dace Juhnevica, Andrejs Erglis
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  ABSTRACT: The substudy was performed to evaluate the acute and eight-month follow-up effect of final kissing balloon dilatation (FKBD) on fractional flow reserve (FFR) in the side branch (SB) after main vessel (MV) stenting. We included 75 patients in the Nordic-Baltic Bifurcation Study III FFR substudy: 42 in the FKBD group and 33 in the no-FKBD group. Complete angiographic and FFR eight-month follow-up was obtained in 25 (60%) patients in the FKBD group and 21 (63%) patients in the no-FKBD group. In the FKBD group the post-PCI mean SB FFR was significantly higher compared to the no-FKBD group (0.92 vs. 0.85, respectively; p=0.011). No significant difference in FFR value between treatments was detected at eight-month follow-up (0.91 vs. 0.87; p=0.19). There were no significant changes in mean SB FFR during the follow-up period (0.92 vs. 0.91; p=0.80) in the FKBD group and (0.87 vs. 0.87; p=0.91) in the no-FKBD group. FKBD in simple stenting of bifurcation lesions improved acute functional outcome in SB compared to leaving the SB jailed. No significant difference was detected at follow-up. In both groups there was no significant functional late loss during follow-up. Thus, both strategies were equally effective in ensuring that side branch jailing would not cause ischaemia in the long term.
  EuroIntervention: journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology 02/2012; 7(10):1155-61. · 3.29 Impact Factor
• Source

  Available from: Juha W Koskenvuo

  Article: Cardiac Function, Perfusion, Metabolism, and Innervation following Autologous Stem Cell Therapy for Acute ST-Elevation Myocardial Infarction. A FINCELL-INSIGHT Sub-Study with PET and MRI.

  Maija T Mäki, Juha W Koskenvuo, Heikki Ukkonen, Antti Saraste, Helena Tuunanen, Mikko Pietilä, Sergey V Nesterov, Ville Aalto, K E Juhani Airaksinen, Jussi P Pärkkä, [......], Kari Kervinen, Johanna A Miettinen, Timo H Mäkikallio, Matti Niemelä, Marjaana Säily, Pirjo Koistinen, Eeva-Riitta Savolainen, Kari Ylitalo, Heikki V Huikuri, Juhani Knuuti
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  ABSTRACT: Purpose: Beneficial mechanisms of bone marrow cell (BMC) therapy for acute ST-segment elevation myocardial infarct (STEMI) are largely unknown in humans. Therefore, we evaluated the feasibility of serial positron emission tomography (PET) and MRI studies to provide insight into the effects of BMCs on the healing process of ischemic myocardial damage. Methods: Nineteen patients with successful primary reteplase thrombolysis (mean 2.4 h after symptoms) for STEMI were randomized for BMC therapy (2.9 × 10(6) CD34+ cells) or placebo after bone marrow aspiration in a double-blind, multi-center study. Three days post-MI, coronary angioplasty, and paclitaxel eluting stent implantation preceded either BMC or placebo therapy. Cardiac PET and MRI studies were performed 7-12 days after therapies and repeated after 6 months, and images were analyzed at a central core laboratory. Results: In BMC-treated patients, there was a decrease in [(11)C]-HED defect size (-4.9 ± 4.0 vs. -1.6 ± 2.2%, p = 0.08) and an increase in [(18)F]-FDG uptake in the infarct area at risk (0.06 ± 0.09 vs. -0.05 ± 0.16, p = 0.07) compared to controls, as well as less left ventricular dilatation (-4.4 ± 13.3 vs. 8.0 ± 16.7 mL/m(2), p = 0.12) at 6 months follow-up. However, BMC treatment was inferior to placebo in terms of changes in rest perfusion in the area at risk (-0.09 ± 0.17 vs. 0.10 ± 0.17, p = 0.03) and infarct size (0.4 ± 4.2 vs. -5.1 ± 5.9 g, p = 0.047), and no effect was observed on ejection fraction (p = 0.37). Conclusion: After the acute phase of STEMI, BMC therapy showed only minor trends of long-term benefit in patients with rapid successful thrombolysis. There was a trend of more decrease in innervation defect size and enhanced glucose metabolism in the infarct-related myocardium and also a trend of less ventricular dilatation in the BMC-treated group compared to placebo. However, no consistently better outcome was observed in the BMC-treated group compared to placebo.
  Frontiers in physiology. 01/2012; 3:6.
• Article: Left ventricular functional recovery after intracoronary injection of autologous bone marrow-derived stem cells in patients with acute myocardial infarction: a dose-response pilot study.

  Johanna A Miettinen, Kari V Ylitalo, Matti Niemelä, Kari Kervinen, Marjaana Säily, Pirjo Koistinen, Eeva-Riitta Savolainen, Timo H Mäkikallio, Heikki V Huikuri
  International journal of cardiology 11/2011; 154(3):354-6. · 7.08 Impact Factor
• Article: Randomized comparison of final kissing balloon dilatation versus no final kissing balloon dilatation in patients with coronary bifurcation lesions treated with main vessel stenting: the Nordic-Baltic Bifurcation Study III.

  Matti Niemelä, Kari Kervinen, Andrejs Erglis, Niels R Holm, Michael Maeng, Evald H Christiansen, Indulis Kumsars, Sanda Jegere, Andis Dombrovskis, Pål Gunnes, [......], Thomas Kellerth, Jan Ravkilde, Jens Aarøe, Jan S Jensen, Steffen Helqvist, Iwar Sjögren, Stefan James, Heikki Miettinen, Jens F Lassen, Leif Thuesen
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  ABSTRACT: It is unknown whether the preferred 1-stent bifurcation stenting approach with stenting of the main vessel (MV) and optional side branch stenting using drug-eluting stents should be finalized by a kissing balloon dilatation (FKBD). Therefore, we compared strategies of MV stenting with and without FKBD. We randomized 477 patients with a bifurcation lesion to FKBD (n=238) or no FKBD (n=239) after MV stenting. The primary end point was major adverse cardiac events: cardiac death, non-procedure-related index lesion myocardial infarction, target lesion revascularization, or stent thrombosis within 6 months. The 6-month major adverse cardiac event rates were 2.1% and 2.5% (P=1.00) in the FKBD and no-FKBD groups, respectively. Procedure and fluoroscopy times were longer and more contrast media was needed in the FKBD group than in the no-FKBD group. Three hundred twenty-six patients had a quantitative coronary assessment. At 8 months, the rate of binary (re)stenosis in the entire bifurcation lesion (MV and side branch) was 11.0% versus 17.3% (P=0.11), in the MV was 3.1% versus 2.5% (P=0.68), and in the side branch was 7.9% versus 15.4% (P=0.039) in the FKBD versus no-FKBD groups, respectively. In patients with true bifurcation lesions, the side branch restenosis rate was 7.6% versus 20.0% (P=0.024) in the FKBD and no-FKBD groups, respectively. MV stenting strategies with and without FKBD were associated with similar clinical outcomes. FKBD reduced angiographic side branch (re)stenosis, especially in patients with true bifurcation lesions. The simple no-FKBD procedures resulted in reduced use of contrast media and shorter procedure and fluoroscopy times. Long-term data on stent thrombosis are needed. Clinical Trial Registration- URL: http://clinicaltrials.gov. Unique identifier: NCT00914199.
  Circulation 01/2011; 123(1):79-86. · 14.74 Impact Factor
• Article: Effects of intracoronary injection of autologous bone marrow-derived stem cells on natriuretic peptides and inflammatory markers in patients with acute ST-elevation myocardial infarction.

  Johanna A Miettinen, Kari Ylitalo, Pirjo Hedberg, Kari Kervinen, Matti Niemelä, Marjaana Säily, Pirjo Koistinen, Eeva-Riitta Savolainen, Heikki Ukkonen, Mikko Pietilä, K E Juhani Airaksinen, Juhani Knuuti, Olli Vuolteenaho, Timo H Mäkikallio, Heikki V Huikuri
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  ABSTRACT: Intracoronary administration of autologous bone marrow stem cells (BMC) has been shown to result in a subtle improvement of global left ventricular ejection fraction after ST-elevation myocardial infarction (STEMI), but the overall benefits of BMC therapy are still unclear. We studied the influence of intracoronary injections of BMC on levels of natriuretic peptides and inflammatory mediators, which are well established prognostic biomarkers, in patients with STEMI. In this randomized, double-blind study, consecutive patients with an acute STEMI treated with thrombolysis followed by PCI 2-6 days after STEMI, were randomly assigned to receive either intracoronary BMC or placebo medium into the infarct-related artery. Blood samples were drawn for biochemical determinations. From baseline to 6 months, there was a significant decrease in the levels of N-terminal probrain natriuretic peptide (NT-proBNP), interleukin-6 (IL-6) and high-sensitivity C-reactive protein (hsCRP) in the whole patient population (P < 0.001 for all). However, no difference was observed between the BMC group (n = 39) and the placebo group (n = 39) in the change of the levels of NT-proANP (median -54 vs. +112 pmol/L), NT-proBNP (-88 vs. -115 pmol/L) or inflammatory markers IL-6 (-3.86 vs. -5.61 pg/mL), hsCRP (-20.29 vs. -22.36 mg/L) and tumor necrosis factor α (-0.12 vs. -0.80 pg/mL) between baseline and 6 months. Intracoronary BMC therapy does not appear to exert any significant effects on the secretion of natriuretic peptides or inflammatory biomarkers in STEMI patients.
  Clinical Research in Cardiology 10/2010; 100(4):317-25. · 2.95 Impact Factor
• Article: Effects of intracoronary infusion of bone marrow-derived stem cells on pulmonary artery pressure and diastolic function after myocardial infarction.

  Johanna A Miettinen, Riikka J Salonen, Matti Niemelä, Kari Kervinen, Marjaana Säily, Pirjo Koistinen, Eeva-Riitta Savolainen, Heikki Ukkonen, Mikko Pietilä, K E Juhani Airaksinen, Juhani Knuuti, Timo H Mäkikallio, Heikki V Huikuri, Kari V Ylitalo
  International journal of cardiology 10/2010; 145(3):631-3. · 7.08 Impact Factor
• Article: Are glycoprotein inhibitors safe during percutaneous coronary intervention in patients on chronic warfarin treatment?

  Heli Lahtela, Pasi P Karjalainen, Matti Niemelä, Saila Vikman, Kari Kervinen, Antti Ylitalo, Marja Puurunen, Pekka Porela, Kai Nyman, Susanna Hinkka-Yli-Salomäki, K E Juhani Airaksinen
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  ABSTRACT: The aim of this study was to evaluate the safety of glycoprotein IIb/IIIa inhibitors (GPIs) during percutaneous coronary intervention (PCI) in patients on chronic warfarin therapy due to atrial fibrillation (AF). We analysed all consecutive AF patients (N = 377, mean age 70 years, male 71%) on warfarin therapy referred for PCI in seven centres. Major bleeding, access site complications and major adverse cardiovascular events were recorded during hospitalisation. A total of 111 patients (29%) received periprocedural GPIs with a wide inter-hospital variation in their use (range 3-68%). The use of GPIs increased with the severity of the disease presentation and 49% of patients with ST-elevation myocardial infarction received GPIs. Mean periprocedural international normalised ratio (INR) of patients who received GPIs was 1.89 (range 1.1-3.3). Major bleeding was more common in the patients treated with GPIs (9.0% vs. 1.5%, p = 0.001) than in those without GPIs, but there was no difference in major adverse cardiovascular events between the groups. In multivariable analysis, use of GPIs (odds ratio [OR] 5.1, 95% confidence interval [CI] 1.3-20.6, p = 0.02) and old age (OR 1.2, 95% CI 1.0-1.3, p= 0.02) remained as the only independent predictors of major bleeding. Also after adjusting for propensity score, GPIs remained as a significant predictor of major bleeding (OR 3.8, 95% CI 1.03-14.1, p = 0.045). In the GPI group, major bleeding was not predicted by INR level or warfarin pause. GPIs increase the risk of major bleeding events irrespective of periprocedural INR levels and should be used with caution in this fragile patient group.
  Thrombosis and Haemostasis 12/2009; 102(6):1227-33. · 5.04 Impact Factor
• Source

  Available from: Jari Jokelainen

  Article: Determinants of functional recovery after myocardial infarction of patients treated with bone marrow-derived stem cells after thrombolytic therapy.

  Johanna A Miettinen, Kari Ylitalo, Pirjo Hedberg, Jari Jokelainen, Kari Kervinen, Matti Niemelä, Marjaana Säily, Pirjo Koistinen, Eeva-Riitta Savolainen, Heikki Ukkonen, Mikko Pietilä, K E Juhani Airaksinen, Juhani Knuuti, Olli Vuolteenaho, Timo H Mäkikallio, Heikki V Huikuri
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  ABSTRACT: To assess the determinants of functional recovery in patients with ST-elevation myocardial infarction (STEMI) treated initially with thrombolysis, followed by percutaneous coronary intervention and intracoronary injection of bone marrow-derived stem cells (BMC). A randomised, placebo-controlled, double-blind study (substudy of FINCELL). Two tertiary cardiac centres. 78 patients with STEMI randomly assigned to receive either intracoronary BMC (n=39) or placebo (n=39) into the infarct-related artery. Thrombolysis a few hours after symptom onset, percutaneous coronary intervention and intracoronary injection of BMC 2-6 days later. Efficacy of the BMC treatment was assessed by measurement of the change of global left ventricular ejection fraction (LVEF) from baseline to 6 months after STEMI. Various predefined variables (eg, the levels of certain natriuretic peptides and inflammatory cytokines) were analysed as determinants of improvement of LVEF. In the BMC group, the most powerful determinant of the change in LVEF was the baseline LVEF (r=-0.58, p<0.001). Patients with baseline LVEF at or below the median (< or = 62.5%) experienced a more marked improvement in LVEF (+12.7 + or - 12.5 %units, p<0.001) than those above the median (-0.8 + or - 6.3 %units, p=0.10). Elevated N-terminal probrain natriuretic peptide (p<0.001) and N-terminal proatrial natriuretic peptide (p=0.052) levels were also associated with improvement in LVEF in the BMC group but not in the placebo group. The global LVEF recovers most significantly after intracoronary infusion of BMC in patients with the most severe impairment of LVEF on admission. The baseline levels of natriuretic peptides seem also to be associated with LVEF recovery after BMC treatment. Trial registration ClinicalTrials.gov number, NCT00363324.
  Heart (British Cardiac Society) 11/2009; 96(5):362-7. · 4.22 Impact Factor
• Article: Two-year follow-up after percutaneous coronary intervention with titanium-nitride-oxide-coated stents versus paclitaxel-eluting stents in acute myocardial infarction.

  Pasi P Karjalainen, Antti Ylitalo, Matti Niemelä, Kari Kervinen, Timo Mäkikallio, Mikko Pietilä, Jussi Sia, Petri Tuomainen, Kai Nyman, K E Juhani Airaksinen
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  ABSTRACT: The aim of this study was to evaluate the long-term effects of the titanium-nitride-oxide-coated (TITANOX) stent and the paclitaxel-eluting stent (PES) in patients who had undergone a percutaneous coronary intervention for acute myocardial infarction (MI). The TITAX-AMI trial randomly assigned 425 patients with MI to receive either a TITANOX stent or a PES. The primary end-point was a composite of MI, target lesion revascularization, or death from cardiac causes. At 12 months, there was no significant difference between patients receiving TITANOX stent or PES in the rate of primary end-point (10.3% versus 12.8%, P=0.5). After 2 years of follow-up, a significantly lower rate of primary end-point was observed in the TITANOX stent group compared with the PES group (11.2% versus 21.8%, HR 2.2, 95% confidence interval (CI) 1.3-3.8, P=0.004). This difference was driven by a reduced rate of MI (5.1% versus 15.6%, P<0.001) and cardiac death (0.9% versus 4.7%, P=0.02) in favour of the TITANOX stent. Definite stent thrombosis occurred in 0.5% and 6.2% of the patients (P=0.001), respectively. The implantation of a TITANOX stent resulted in better clinical outcome compared with a PES during 2 years of follow-up among patients treated for acute MI.
  Annals of medicine 08/2009; 41(8):599-607. · 3.52 Impact Factor
• Article: Interleukin-6 promoter polymorphism and late-onset Alzheimer's disease in the Finnish population.

  Anne M Koivisto, Seppo Helisalmi, Jussi Pihlajamäki, Leena Moilanen, Johanna Kuusisto, Markku Laakso, Mikko Hiltunen, Koivisto Keijo, Tuomo Hänninen, Eeva-Liisa Helkala, Kari Kervinen, Y Antero Kesäniemi, Hilkka Soininen
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  ABSTRACT: Recently, the involvement of the inflammatory response in Alzheimer's disease (AD) has received considerable attention. The gene encoding for interleukin-6 (IL-6) is interesting since IL-6 has been reported not only to be involved in immune functions but also in AD. We investigated whether the IL-6-174 G/C polymorphism is associated with late onset AD (LOAD) in the Finnish subjects. The G allele was over-represented in ApoE4-LOAD patients but remained unimportant in all and in the ApoE E4 carriers. Interestingly, the G allele frequency was lower in our population in both AD patients and in controls compared to Southern European populations.
  Journal of Neurogenetics 07/2009; 19(3-4):155-61. · 2.42 Impact Factor
• Article: [Coronary artery disease in women].

  Matti Niemelä, Kari Kervinen, Hannu Romppanen, Saila Vikman
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  ABSTRACT: Although the rate of coronary artery disease mortality has decreased over the last decades, it is still the leading cause of death in Finland. Coronary artery disease appears in women with a delay of ten years as compared with men. For women, diabetes and smoking increase the risk of developing the disease more than for men. Women's coronary arteries are smaller in size, which previously impaired the results of invasive treatment. Treatment outcome with current techniques is equal independently of gender. In spite of this, women in an acute attack of coronary artery disease are less frequently directed to coronary angiography.
  Duodecim; lääketieteellinen aikakauskirja 02/2009; 125(7):739-46.
• Article: Randomized comparison of coronary bifurcation stenting with the crush versus the culotte technique using sirolimus eluting stents: the Nordic stent technique study.

  Andrejs Erglis, Indulis Kumsars, Matti Niemelä, Kari Kervinen, Michael Maeng, Jens F Lassen, Pål Gunnes, Sindre Stavnes, Jan S Jensen, Anders Galløe, [......], Jan Mannsverk, Per Thayssen, Knud Nørregaard Hansen, Mikko Syvänne, Steffen Helqvist, Nikus Kjell, Rune Wiseth, Jens Aarøe, Mikko Puhakka, Leif Thuesen
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  ABSTRACT: In a number of coronary bifurcation lesions, both the main vessel and the side branch need stent coverage. Using sirolimus eluting stents, we compared 2 dedicated bifurcation stent techniques, the crush and the culotte techniques in a randomized trial with separate clinical and angiographic end-points. A total of 424 patients with a bifurcation lesion were randomized to crush (n=209) and culotte (n=215) stenting. The primary end point was major adverse cardiac events; cardiac death, myocardial infarction, target vessel revascularization, or stent thrombosis after 6 months. At 6 months there were no significant differences in major adverse cardiac event rates between the groups; crush 4.3%, culotte 3.7% (P=0.87). Procedure and fluoroscopy times and contrast volumes were similar in the 2 groups. The rates of procedure-related increase in biomarkers of myocardial injury were 15.5% in crush versus 8.8% in culotte group (P=0.08). A total of 324 patients had a quantitative coronary assessment at the index procedure and after 8 months. The angiographic end-points of in-segment and in-stent restenosis of main vessel and/or side branch after 8 months were found in 12.1% versus 6.6% (P=0.10) and in 10.5% versus 4.5% (P=0.046) in the crush and culotte groups, respectively. Both the crush and the culotte bifurcation stenting techniques were associated with similar and excellent clinical and angiographic results. Angiographically, there was a trend toward less in-segment restenosis and significantly reduced in-stent restenosis following culotte stenting.
  Circulation Cardiovascular Interventions 02/2009; 2(1):27-34. · 6.06 Impact Factor
• Article: [Myocardial infarction in a young patient--with underlying vasculitis].

  Hannu Romppanen, Matti Niemelä, Kari Kervinen, Kari Ylitalo, Heikki Huikuri
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  ABSTRACT: Myocardial infarction in a young patient is rare, and its diagnosis and treatment may be delayed. Vasculitis can cause inflammation in the coronary artery and cause a myocardial infarction even in a young person. We describe a sudden myocardial infarction caused by vasculitis in two young adults having chest pain symptoms.
  Duodecim; lääketieteellinen aikakauskirja 01/2009; 125(18):1973-7.
• Article: Effects of intracoronary injection of mononuclear bone marrow cells on left ventricular function, arrhythmia risk profile, and restenosis after thrombolytic therapy of acute myocardial infarction.

  Heikki V Huikuri, Kari Kervinen, Matti Niemelä, Kari Ylitalo, Marjaana Säily, Pirjo Koistinen, Eeva-Riitta Savolainen, Heikki Ukkonen, Mikko Pietilä, Juhani K E Airaksinen, Juhani Knuuti, Timo H Mäkikallio
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  ABSTRACT: To assess the efficacy and safety of bone marrow cell (BMC) therapy after thrombolytic therapy of an acute ST-elevation myocardial infarction (STEMI). Patients with STEMI treated with thrombolysis followed by percutaneous coronary intervention (PCI) 2-6 days after STEMI were randomly assigned to receive intracoronary BMCs (n = 40) or placebo medium (n = 40), collected and prepared 3-6 h prior PCI and injected into the infarct artery immediately after stenting. Efficacy was assessed by the measurement of global left ventricular ejection fraction (LVEF) by left ventricular angiography and 2-D echocardiography, and safety by measuring arrhythmia risk variables and restenosis of the stented vessel by intravascular ultrasound. At 6 months, BMC group had a greater absolute increase of global LVEF than placebo group, measured either by angiography (mean +/- SD increase 7.1 +/- 12.3 vs. 1.2 +/- 11.5%, P = 0.05) or by 2-D echocardiography (mean +/- SD increase 4.0 +/- 11.2 vs. -1.4 +/- 10.2%, P = 0.03). No differences were observed between the groups in the adverse clinical events, arrhythmia risk variables, or the minimal lumen diameter of the stented coronary lesion. Intracoronary BMC therapy is associated with an improvement of global LVEF and neutral effects on arrhythmia risk profile and restenosis of the stented coronary lesions in patients after thrombolytic therapy of STEMI.
  European Heart Journal 11/2008; 29(22):2723-32. · 10.48 Impact Factor
• Article: Safety in simple versus complex stenting of coronary artery bifurcation lesions. The nordic bifurcation study 14-month follow-up results.

  Jan S Jensen, Anders Galløe, Jens F Lassen, Andrejs Erglis, Indulis Kumsars, Terje K Steigen, Rune Wiseth, Inga Narbute, Pål Gunnes, Jan Mannsverk, [......], Stefan James, Jens Aarøe, Antti Ylitalo, Steffen Helqvist, Iwar Sjögren, Per Thayssen, Kari Virtanen, Mikko Puhakka, Juhani Airaksinen, Leif Thuesen
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  ABSTRACT: The risk of stent thrombosis has been reported to increase with percutaneous coronary intervention (PCI) complexity. The present study reports the pre-specified secondary endpoint of a 14-month stent thrombosis and major adverse cardiac events in patients stented with a simple versus a complex bifurcation technique using sirolimus eluting stents (SES). A total of 413 patients with a coronary bifurcation lesion were randomised to a simple treatment strategy; stenting of main vessel and optional stenting of side branch (MV group), or to a complex stenting strategy; stenting of both main vessel and side branch (MV+SB group). Mortality data were available in all patients and 14-month clinical follow-up data in 395 (96%) of the patients. After 14 months, the rates of definite, probable and possible stent thrombosis (ARC criteria) were 1.0% vs. 0.5%, 1.0% vs. 0% and 0.5% vs. 0% (ns) in the MV and in the MV+SB groups, respectively. Rates of MACE were 9.5% in the MV group and 8.2% in the MV+SB group (ns). Total death was seen in 2.4% vs. 1.0% and non-PCI related myocardial infarction in 2.0% vs. 1.0% in the MV and the MV+SB groups, respectively. After 14 months, two months after recommended cessation of dual antiplatelet therapy, the rates of stent thrombosis and major adverse cardiac events were low and independent of treatment complexity in patients treated with SES for coronary artery bifurcation lesions.
  EuroIntervention: journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology 09/2008; 4(2):229-33. · 3.29 Impact Factor