P W Radke

RWTH Aachen University, Aachen, North Rhine-Westphalia, Germany

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Publications (31)177.95 Total impact

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    ABSTRACT: Recent studies emphasized the non-lipid-lowering effects of hydroxymethylglutaryl coenzyme A reductase inhibitors on endothelial function, inflammation, and platelet activation in patients with stable atherosclerosis. This study sought to evaluate the impact of statin pretreatment in patients with acute myocardial infarction (AMI) on level of systemic inflammation and myocardial perfusion. A total of 253 consecutive patients undergoing primary angioplasty on a native vessel within 12 hours of AMI were divided into a group with statin pretreatment (n = 86) and control patients (n = 167). Angiographic myocardial blush grade (MBG) after revascularization of the infarct-related artery was determined to evaluate myocardial perfusion. Statin pretreatment was associated with a lower frequency of increased C-reactive protein (>or=5 mg/L) on admission compared with the control group (48% vs 64%; p = 0.019). The frequency of normal perfusion (MBG 3) was higher in the statin-pretreatment group than the control group (45% vs 26%, respectively; p <0.001). Statin pretreatment was an independent predictor of normal myocardial perfusion (MBG 3; odds ratio 2.53, 95% confidence interval 1.15 to 9.53, p = 0.022) in addition to age <or=70 years and C-reactive protein <5 mg/L. In conclusion, statin pretreatment in patients with AMI was associated with decreased systemic inflammation and better perfusion after primary angioplasty of the infarct-related artery.
    The American Journal of Cardiology 01/2008; 101(2):139-43. DOI:10.1016/j.amjcard.2007.07.059 · 3.43 Impact Factor
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    ABSTRACT: Most studies that proved intracoronary radiation therapy (IRT) to be highly effective to reduce recurrent restenosis after treatment of in-stent restenosis (ISR) have looked at time periods up to 12 months. Whether the beneficial effect from radiation is sustained during long-term follow-up remains a concern. This study sought to evaluate the effectiveness of IRT using a beta-emitter during a 3-year follow-up period. One hundred twenty-eight consecutive symptomatic patients (mean age, 63 +/- 11 years) with 134 in-stent restenotic lesions were treated for ISR with IRT (noncentred beta-emitter, Novoste; radiation dosis 21.1 +/- 3.1 Gy). Six-month angiographic follow-up was obtained in 104 patients (81%) with 105 lesions (78%). All patients underwent 36-month clinical follow-up. Six-month angiographic restenosis rate was 22% in stent (29% in lesion) with an in-stent late loss of 0.49 +/- 0.62 mm. Target lesion resvascularization (TLR) at 6-month follow-up was performed in 23 cases (18%). MACE (death, myocardial infarction, and target vessel revascularisation) was observed in 24 patients (19%). At 36-month follow-up, TLR increased to 36 cases (28%) and MACE was observed in 47 patients (37%). In a multivariate analysis, minimal lumen diameter before treatment of ISR using IRT was the only predictor of recurrent TLR at 36 months (OR = 0.131; 95% CI, 0.068-0.254; p = 0.002). In a subgroup of patients (N = 15) without restenosis at 6-month angiography but with clinically driven recurrent late angiography (mean, 18 +/- 7 months); in-lesion late loss increased from 0.47 +/- 0.54 mm at 6 months to 1.27 +/- 0.76 mm at repeated angiography (p = 0.005). There is a considerable number of delayed recurrent restenosis post IRT for ISR. This is due to ongoing late loss more than 6-month post IRT. The minimal lumen diameter before IRT predicts the need for recurrent TLR at 36 months.
    Catheterization and Cardiovascular Interventions 04/2006; 67(4):600-6. DOI:10.1002/ccd.20667 · 2.40 Impact Factor
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    ABSTRACT: To compare acute and follow up clinical and angiographic results after treatment of in-stent restenosis (ISR) by sirolimus eluting stents (SES) with results obtained after intracoronary radiation therapy (IRT). Matched pair analysis. 62 consecutive ISR lesions (< 30 mm lesion length, reference diameter < 3.5 mm) in 62 patients were treated with SES. From a database of 174 lesions (n = 141 patients) treated for ISR by intracoronary beta radiation, 62 lesions (62 patients) were pair matched with the SES group for diabetes mellitus, lesion length, vessel size, and pattern of ISR. Six month angiographic and 12 month clinical follow up results were obtained. Baseline clinical and angiographic characteristics were similar between the groups (not significant). SES implantation resulted in significantly lower postprocedural in-lesion diameter stenosis than did IRT (mean (SD) 14.2 (9.5)% v 21.1 (10.6)%, p = 0.001), significantly higher minimum lumen diameter at follow up (1.91 (0.58) v 1.55 (0.72) mm, p = 0.005), and a higher net gain (1.16 (0.55) v 0.77 (0.70) mm, p = 0.002). Angiographic binary in-lesion restenosis rate at six months was 11% in the SES group and 29% in the IRT group (p = 0.046). In 16 ISR lesions SES were used after failed IRT and in 46 lesions for first time ISR. In-lesion late loss was higher after use of SES for failed IRT than after use of SES for first time ISR (0.61 (0.67) mm v 0.24 (0.41) mm, p = 0.018). In a multivariate analysis prior failed IRT was the only independent predictor for recurrent restenosis after SES for ISR (p = 0.052, odds ratio 5.8). Six patients (10%) in the SES group and 17 patients (27%) in the IRT group underwent target lesion revascularisation during the 12 months of follow up (p = 0.022). In this non-randomised matched cohort SES achieved acute and follow up results superior to IRT for treatment of ISR even if cases of failed IRT are included. Failed IRT is a predictor of impaired SES effectiveness.
    Heart (British Cardiac Society) 12/2005; 91(12):1584-9. DOI:10.1136/hrt.2004.047704 · 6.02 Impact Factor
  • P.W. Radke · P. Hanrath
    Intensiv- und Notfallbehandlung 01/2005; 30(01):11-18. DOI:10.5414/IBP30011
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    ABSTRACT: This study evaluated the safety and efficacy of a dexamethasone-eluting stent with a special high dexamethasone-loading dose for treatment of de novo coronary lesions in 30 patients. Eight patients had in-stent restenosis (restenosis rate 31%) at 6-month follow-up, and the in-stent late lumen loss was 0.96 +/- 0.63 mm due to an average intimal hyperplasia area obstruction of 32 +/- 21%, indicating that high-dose dexamethasone-loaded stents do not significantly reduce neointimal proliferation. (C) 2004 by Excerpta Medica, Inc.
    The American Journal of Cardiology 08/2004; 94(2):193-5. DOI:10.1016/j.amjcard.2004.03.061 · 3.43 Impact Factor
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    ABSTRACT: Treatment of in-stent restenosis remains a therapeutic challenge. Twenty-seven lesions with in-stent restenosis were treated with non-polymer-based paclitaxel-eluting stents. At 6-month follow-up, in-stent late loss was 0.44 +/- 0.54 mm and the restenosis rate was 20%, indicating effective treatment for reduction of recurrent restenosis.
    The American Journal of Cardiology 04/2004; 93(6):760-2. DOI:10.1016/j.amjcard.2003.12.006 · 3.43 Impact Factor
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    ABSTRACT: This study sought to analyze the evolution of myocardial perfusion during follow-up after primary angioplasty for acute myocardial infarction (AMI) and relate it to final left ventricular (LV) function. In 101 patients with a first AMI, angiographic myocardial blush grade (MBG) was analyzed immediately after intervention and at follow-up 7.5 +/- 5.6 months later. Cine ventriculography was performed at follow-up angiography to define LV function. Five patients had occluded stents or flow-limiting restenosis. In the remaining patients, myocardial perfusion at follow-up, as defined by MBG, was persistently abnormal in 19 patients (20%), had become normalized from previously abnormal MBG in 30 patients (31%), remained normal in 40 patients (42%), and deteriorated from normal to abnormal in 7 patients (7%). Patients with improvement of abnormal blush determined immediately after intervention to normal blush at follow-up (n = 30) compared with patients with persistently abnormal blush (n = 19) had a better LV ejection fraction at follow-up (53.7 +/- 11.1 vs. 37.4 +/- 9.7%, p <0.001). Evolution of MBG had a better predictive value for LV ejection fraction at follow-up than acute MBG only. Multivariate analysis proved evolution of MBG from AMI to follow-up to be an independent predictor of LV function (R(2) = 0.177, p <0.001) in addition to the initial size of jeopardized myocardium as defined by the sum of ST-segment elevation (R(2) = 0.138, p = 0.001) and infarct location (R(2) = 0.044, p = 0.033). In conclusion, tissue reperfusion after angioplasty for AMI is characterized by frequent improvement over time, as indicated by repeated MBG analysis. Patients with recovery of perfusion have better, final LV function.
    The American Journal of Cardiology 11/2003; 92(9):1015-9. DOI:10.1016/j.amjcard.2003.07.001 · 3.43 Impact Factor
  • P W Radke · A Kaiser · C Frost · U Sigwart
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    ABSTRACT: To evaluate the clinical outcome after treatment of coronary in-stent restenosis. For identification of the relevant literature a specific search strategy was conducted and explicit inclusion criteria were defined to avoid selection bias. Based on the selected literature, a systematic review using descriptive statistics and meta-analysis methods regarding the outcome after treatment of coronary in-stent restenosis was performed. The proportion of patients experiencing a major adverse cardiac event (MACE) as defined by death, myocardial infarction, and target lesion revascularization was the main outcome measure. A total of 1304 citations were identified. Among these, 28 studies (six different treatment modalities) including a total of 3012 patients met the inclusion criteria and were incorporated into this analysis. The estimated average probability of experiencing a major cardiac adverse event after treatment for in-stent restenosis with a follow-up period of 9+/-4 months was 30.0% (25.0-34.9%, 95% confidence interval) with strong evidence for heterogeneity between study specific results (P=0.0001). The clinical outcome was not significantly different between treatment modalities. After adjustment for confounding factors (i.e. lesion length), however, patients undergoing intracoronary radiation showed an estimated advantage of 16.9% (-37.7+/-4.0%, 95% confidence interval) in MACE free survival, as compared to balloon angioplasty. The post-interventional diameter stenosis was the only independent predictor for the long-term outcome after treatment of in-stent restenosis. Treatment of in-stent restenosis is associated with an overall 30% rate of major adverse cardiac events. Currently, repeat angioplasty is the treatment option of choice, especially when a sufficient acute procedural result can be achieved. Intracoronary radiation should be considered in cases with therapy refractory forms of diffuse in-stent restenosis.
    European Heart Journal 03/2003; 24(3):266-73. DOI:10.1016/S0195-668X(02)00202-6 · 14.72 Impact Factor
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    P W Radke · R Blindt · P K Haager · J Vom Dahl
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    ABSTRACT: Restenosis after coronary stent implantation remains the major limitation of this treatment modality. At present, re-dilatation is considered the therapeutic option of choice for focal lesions, however, long restenotic lesions (>10 mm) do not respond favourably. Despite the emerging concept of intracoronary radiation, encouraging acute procedural results are also reported for different debulking techniques (Excimer laser angioplasty, directional coronary atherectomy, and rotational atherectomy, or rotablation). Rotablation has been studied most extensively with acute and long- term results published in a total of more than 850 patients. Experimental and first clinical data indicate favourable results for the rotablator as compared to balloon angioplasty alone for the treatment of in-stent restenosis. Data from the first 2 randomized clinical trials (ROSTER-, and ARTIST-trial) have now been published with conflicting results: The european multicenter ARTIST-trial including 300 patients could not prove a benefit for the rotablator as compared to re-dilatation in patients with diffuse stent restenosis. On the contrary, the monocenter ROSTER-trial, which has been presented as an abstract until today, suggests a clinical benefit of patients treated by the rotablator if they were studied with intracoronary ultrasound prior to randomization. Currently, rotablation for the treatment of restenosis cannot be considered as the first line treatment modality in patients with in-stent restenosis. As a result of unsatisfying angiographic and clinical long-term results by the use of a variety of treatment modalities in diffuse stent restenosis, prevention of this iatrogenic entity has become mandatory.
    Minerva cardioangiologica 10/2002; 50(5):555-63. · 0.48 Impact Factor
  • U Janssens · H Groesdonk · J Graf · P W Radke · W Lepper · P Hanrath
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    ABSTRACT: Gastric PCO2 measured by balloon tonometry can estimate the adequacy of splanchnic perfusion. However, enteral feeding and gastric content can interfere with gastric PCO2 assessment. Tonometry in other sites of the body could avoid these problems. We therefore tested the hypothesis that oesophageal air tonometry would give results similar to gastric tonometry. We studied 20 consecutive patients (mean age 68 (SD 9) [range 49-81] yr, 18 males, SAPS II score 55 (SD 18), ICU mortality 55%) with circulatory disorders during mechanical ventilation in the intensive care unit. Tonometer probes were placed via the nose, one into the stomach and the other in the oesophagus. PCO2 was measured with two automated gas analysers, at admission and 30 min, 1, 2, 3, 32, 40, and 48 h thereafter. One hundred and forty-eight paired measurements were obtained. Gastric PCO2 was greater than oesophageal PCO2 on admission (7.19 (1.43) vs 5.89 (0.73) kPa, P < 0.01) and subsequently. Differences between the measures correlated (r = 0.67) with the mean absolute value, indicating that overestimation increased as gastric PCO2 increased. Oesophageal PCO2 is less than gastric PCO2, and the difference is greater when gastric PCO2 levels are greater. Air tonometry may not measure regional PCO2 levels in the oesophagus satisfactorily. Other methods and sites for carbon dioxide tonometry should be examined.
    BJA British Journal of Anaesthesia 08/2002; 89(2):237-41. DOI:10.1093/bja/aef174 · 4.35 Impact Factor
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    Peter W Radke · Ulrich Sigwart
    The Lancet 10/2001; 358(9283):757; author reply 758-9. DOI:10.1016/S0140-6736(01)05906-2 · 45.22 Impact Factor
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    ABSTRACT: Restenosis remains the major limitation of coronary stent implantation, especially in diffuse forms of in-stent restenosis. In this study, rotablation (RA) with adjunct angioplasty of in-stent restenosis was performed in 84 patients. Clinical follow-up and control angiography were obtained 6-month postprocedure. The rate of recurrent restenosis after rotablation for in-stent restenosis at 6-month angiographic follow-up was 45%, resulting in a rate of major adverse cardiac events of 35%. At 3-year follow-up, the cumulative event-free survival rate was 57% for the entire population. The only predictor of MACE at 3-year clinical follow-up by multivariate logistic regression analysis was in-stent lesion length. RA for the treatment of diffuse in-stent restenosis is thereby characterized by high procedural success rates and recurrent angiographic restenosis in 45% of patients with diffuse lesions. Major adverse cardiac events occur most likely within the first 6 months postprocedure. Three years after rotablation of in-stent restenosis, 43% of patients had experienced at least one major adverse cardiac event. Cathet Cardiovasc Intervent 2001;53:334-340.
    Catheterization and Cardiovascular Interventions 07/2001; 53(3):334-40. DOI:10.1002/ccd.1177 · 2.40 Impact Factor
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    ABSTRACT: Experimental and clinical data support an infectious cause of atherosclerosis and thereby coronary artery disease. This study was intended to assess the prevalence and possible clinical associations of the presence of cytomegalovirus DNA within coronary samples from patients undergoing coronary artery bypass grafting. A coronary thrombendatherectomy was performed in 53 patients with advanced coronary artery disease. Two samples of each atheroma were used for further analysis and pathogen detection. In 30% of patients with advanced coronary artery disease cytomegalovirus DNA was detected in coronary samples as assessed by highly sensitive PCR methods. The occurrence of the virus within the vessels was characterized by an inhomogeneous distribution pattern. Due to an increased proportion of restenotic lesions and a higher degree of calcification in cytomegalovirus-positive lesions, a causative association between the virus presence and mechanisms of restenosis post angioplasty is further supported. Antiviral pharmacological interventions to prevent restenosis in high-risk patients, however, seem not to be justified by the data currently available.
    Medizinische Klinik 04/2001; 96(3):129-34. · 0.27 Impact Factor
  • P W Radke · P Hanrath · J vom Dahl
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    ABSTRACT: Restenosis after coronary stent implantation remains one of the major limitations of this treatment modality. At present, redilatation is considered the therapeutic option of choice for focal lesions; however, long restenotic lesions (> 10 mm) do not respond favourably. Despite the emerging concept of intracoronary radiation, encouraging acute procedural results are also reported for different debulking techniques (excimer laser angioplasty, directional coronary atherectomy, and rotational atherectomy, or rotablation). Rotablation has been studied most extensively with acute and long-term results published in a total of 500 patients. Experimental and first clinical data indicate favourable results for the rotablator as compared to balloon angioplasty alone for the treatment of in-stent restenosis. Data from the first two randomised clinical trials (ROSTER and A.R.T.I.S.T. trials) have now been published in abstract form, with conflicting results: whereas the monocenter ROSTER trial suggests a clinical benefit to patients treated by the rotablator, the multicenter A.R.T.I.S.T. trial including nearly 300 patients could not prove a benefit for the rotablator as compared to re-dilatation in patients with diffuse stent restenosis. Currently, rotablation for the treatment of restenosis can not be considered as the first line treatment modality in patients with stent restenosis. As a result of unsatisfying angiographic and clinical long-term results by the use of a variety of treatment modalities in diffuse stent restenosis, prevention of this iatrogenic entity will become mandatory.
    Zeitschrift für Kardiologie 03/2001; 90(3):161-9. · 0.97 Impact Factor
  • U Sigwart · S Prasad · P Radke · I Nadra
    The Journal of invasive cardiology 03/2001; 13(2):141-2; discussion 158-70. · 0.82 Impact Factor
  • P. W. Radke · P. Hanrath · J. vom Dahl
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    ABSTRACT: Die Restenosierung nach koronarer Stentimplantation stellt weiterhin ein bedeutendes Problem in der interventionellen Kardiologie dar. Derzeit gilt die erneute Dilatation (Re-Dilatation) bei fokaler und kurzstreckiger Stent-Restenose als Verfahren der Wahl, die Behandlung langstreckiger Formen der Stent-Restenose (>10mm) bleibt jedoch trotz Verwendung unterschiedlicher Techniken aufgrund unbefriedigender Langzeit-Ergebnisse problematisch. Neben der intrakoronaren Strahlentherapie (Brachytherapie), bei der die potentiell limitierenden Phänomene der Randstenosierung („Candy-Wrapper”) und der „späten” Thrombose noch nicht abschließend geklärt sind, sind derzeit vor allem Gewebe-ablative Verfahren (Excimer Laser-Angioplastie, direktionale koronare Atherektomie, Rotations-Atherektomie) Gegenstand zahlreicher klinischer Studien.    Für die Rotations-Atherektomie (Rotablation) liegt mit fast 500 behandelten Patienten das umfangreichste Datenmaterial vor. Tierexperimentelle Untersuchungen und erste vergleichende klinische Studien konnten Vorteile dieses Therapieverfahrens gegenüber der alleinigen Re-Dilatation aufzeigen. Die einzigen bisher in Abstractform veröffentlichten randomisierten Untersuchungen, die ROSTER- und die A.R.T.I.S.T.-Studie, erbrachten jedoch konträre Ergebnisse. Während der monozentrische ROSTER-Trial einen klinischen Vorteil der Patienten aufzeigen konnte, die mit Rotablation therapiert wurden, ergab die multizentrische A.R.T.I.S.T.-Studie bei fast 300 Patienten in den angiographischen und klinischen Endpunkten keinen Vorteil für die Rotablation.    Das Verfahren der Rotablation mit adjuvanter Angioplastie kann daher noch nicht als etabliertes Verfahren in der Therapie der Stent-Restenose angesehen werden. Aufgrund der weitgehend unbefriedigenden Ergebnisse in der Therapie der diffusen Stent-Restenose unter Verwendung verschiedener Verfahren und den noch nicht gänzlich verstandenen Nebeneffekten der Brachytherapie kommt der Prävention der Stent-Restenose in Zukunft besondere Bedeutung zu. Restenosis after coronary stent implantation remains one of the major limitations of this treatment modality. At present, re-dilatation is considered the therapeutic option of choice for focal lesions; however, long restenotic lesions (>10mm) do not respond favourably. Despite the emerging concept of intracoronary radiation, encouraging acute procedural results are also reported for different debulking techniques (excimer laser angioplasty, directional coronary atherectomy, and rotational atherectomy, or rotablation).     Rotablation has been studied most extensively with acute and long-term results published in a total of 500 patients. Experimental and first clinical data indicate favourable results for the rotablator as compared to balloon angioplasty alone for the treatment of in-stent restenosis. Data from the first two randomised clinical trials (ROSTER and A.R.T.I.S.T. trials) have now been published in abstract form, with conflicting results: whereas the monocenter ROSTER trial suggests a clinical benefit to patients treated by the rotablator, the multicenter A.R.T.I.S.T. trial including nearly 300 patients could not prove a benefit for the rotablator as compared to re-dilatation in patients with diffuse stent restenosis.    Currently, rotablation for the treatment of restenosis can not be considered as the first line treatment modality in patients with stent restenosis. As a result of unsatisfying angiographic and clinical long-term results by the use of a variety of treatment modalities in diffuse stent restenosis, prevention of this iatrogenic entity will become mandatory. Schlüsselwörter–Stent-Restenose–Therapie–Rotations-AtherektomieKey words Stent restenosis–treatment–rotational atherectomy
    Zeitschrift für Kardiologie 03/2001; 90(3):161-169. DOI:10.1007/s003920170179 · 0.97 Impact Factor
  • S Reith · P W Radke · O Volk · J vom Dahl · H G Klues
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    ABSTRACT: In-stent restenosis (ISR) is still a growing problem in interventional cardiology due to the increasing number of stent implantations. Various treatment modalities are available at present. As a non ablative strategy balloon angioplasty is the strategy of choice for focal ISR, while ablative techniques such as directional coronary atherectomy, Excimer laser coronary angioplasty and rotational atherectomy are used preferentially in diffuse restenosis processes. These debulking techniques are optimized by peri-interventional use of intravascular ultrasound and adjunctive balloon angioplasty. Study data comparing different interventional approaches, usually with adjunct balloon angioplasty, have not proven an optimal treatment modality for ISR yet.
    Seminars in interventional cardiology: SIIC 01/2001; 5(4):199-208. DOI:10.1053/siic.2000.0140
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    ABSTRACT: To evaluate the use of the Sequential Organ Failure Assessment (SOFA) score, the total maximum SOFA (TMS) score, and a derived variable, the deltaSOFA (TMS score minus total SOFA score on day 1) in medical, cardiovascular patients as a means for describing the incidence and severity of organ dysfunction and the prognostic value regarding outcome. Prospective, clinical study. Medical intensive care unit in a university hospital. A total of 303 consecutive patients were included (216 men, 87 women; mean age 62 +/- 12.6 years; SAPS II 26.2 +/- 12.7). They were evaluated 24 h after admission and thereafter every 24 h until ICU discharge or death between November 1997 and March 1998. Readmissions and patients with an ICU stay shorter than 12 h were excluded. Survival status at hospital discharge, incidence of organ dysfunction/failure. Collection of clinical and demographic data and raw data for the computation of the SOFA score every 24 h until ICU discharge. Length of ICU stay was 3.7 +/- 4.7 days. ICU mortality was 8.3% and hospital mortality 14.5%. Nonsurvivors had a higher total SOFA score on day 1 (5.9 +/- 3.7 vs. 1.9 +/- 2.3, p < 0.001) and thereafter until day 8. High SOFA scores for any organ system and increasing number of organ failures (SOFA score > or = 3) were associated with increased mortality. Cardiovascular and neurological systems (day 1) were related to outcome and cardiovascular and respiratory systems, and admission from another ICU to length of ICU stay. TMS score was higher in nonsurvivors (1.76 +/- 2.55 vs. 0.58 +/- 1.39, p < 0.01), and deltaSOFA/total SOFA on day 1 was independently related to outcome. The area under the receiver-operating characteristic curve was 0.86 for TMS, 0.82 for SOFA on day 1, and 0.77 for SAPS II. The SOFA, TMS, and deltaSOFA scores provide the clinician with important information on degree and progression of organ dysfunction in medical, cardiovascular patients. On day 1 both SOFA score and TMS score had a better prognostic value than SAPS II score. The model is closely related to outcome and identifies patients who are at increased risk for prolonged ICU stay.
    Intensive Care Medicine 09/2000; 26(8):1037-45. · 5.54 Impact Factor
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    ABSTRACT: Objective: To evaluate the use of the Sequential Organ Failure Assessment (SOFA) score, the total maximum SOFA (TMS) score, and a derived variable, the ΔSOFA (TMS score minus total SOFA score on day 1) in medical, cardiovascular patients as a means for describing the incidence and severity of organ dysfunction and the prognostic value regarding outcome. Design: Prospective, clinical study. Setting: Medical intensive care unit in a university hospital. Patients: A total of 303 consecutive patients were included (216 men, 87 women; mean age 62 12.6 years; SAPS II 26.2 12.7). They were evaluated 24 h after admission and thereafter every 24 h until ICU discharge or death between November 1997 and March 1998. Readmissions and patients with an ICU stay shorter than 12 h were excluded. Main outcome measure: Survival status at hospital discharge, incidence of organ dysfunction/failure. Interventions: Collection of clinical and demographic data and raw data for the computation of the SOFA score every 24 h until ICU discharge. Measurements and main results: Length of ICU stay was 3.7 4.7 days. ICU mortality was 8.3 % and hospital mortality 14.5 %. Nonsurvivors had a higher total SOFA score on day 1 (5.9 3.7 vs. 1.9 2.3, p < 0.001) and thereafter until day 8. High SOFA scores for any organ system and increasing number of organ failures (SOFA score ≥ 3) were associated with increased mortality. Cardiovascular and neurological systems (day 1) were related to outcome and cardiovascular and respiratory systems, and admission from another ICU to length of ICU stay. TMS score was higher in nonsurvivors (1.76 2.55 vs. 0.58 1.39, p < 0.01), and ΔSOFA/total SOFA on day 1 was independently related to outcome. The area under the receiver-operating characteristic curve was 0.86 for TMS, 0.82 for SOFA on day 1, and 0.77 for SAPS II. Conclusions: The SOFA, TMS, and ΔSOFA scores provide the clinician with important information on degree and progression of organ dysfunction in medical, cardiovascular patients. On day 1 both SOFA score and TMS score had a better prognostic value than SAPS II score. The model is closely related to outcome and identifies patients who are at increased risk for prolonged ICU stay.
    Intensive Care Medicine 08/2000; 26(8):1037-1045. DOI:10.1007/s001340051316 · 5.54 Impact Factor
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    ABSTRACT: New Zealand obese (NZO) mice exhibit a polygenic obesity associated with hyperinsulinaemia and hyperglycaemia. Here we show that the strain presents additional features of a metabolic syndrome, i.e. elevated blood pressure, serum cholesterol and serum triglyceride levels. A back-cross model of NZO mice with the lean Swiss Jackson Laboratory (SJL) strain was established in order to investigate further the correlation between hypertension, obesity, serum insulin and hyperglycaemia. Systolic blood pressure was significantly elevated at 6 weeks of age and appeared to parallel the weight gain of the animals. Serum insulin levels, presumably reflecting insulin resistance, and systolic blood pressure values were significantly correlated with the body mass index (r2 = 0.707 and 0.486, respectively) in the back-cross mice. In contrast, blood pressure was only weakly correlated with serum insulin (r2 = 0.288) in non-diabetic mice, and was independent of serum insulin levels in diabetic animals. The data are consistent with the concept that hypertension and insulin resistance are a characteristic consequence of the genetic constellation leading to obesity in the NZO strain, and that these traits reflect related mechanisms. It appears unlikely, however, that hypertension is a direct consequence of hyperinsulinaemia.
    European Journal of Clinical Investigation 04/2000; 30(3):195-202. DOI:10.1046/j.1365-2362.2000.00611.x · 2.83 Impact Factor

Publication Stats

534 Citations
177.95 Total Impact Points

Institutions

  • 1997–2006
    • RWTH Aachen University
      • • Institute of Medical Statistics
      • • Institute of Pharmacology and Toxicology
      Aachen, North Rhine-Westphalia, Germany
  • 1999–2003
    • University Hospital RWTH Aachen
      • Department of Neurology
      Aachen, North Rhine-Westphalia, Germany
  • 2001
    • The Heart Lung Center
      Londinium, England, United Kingdom