Tobias Koppara

Publications (3)24.86 Total impact

• Article: Choice of contrast medium in patients with impaired renal function undergoing percutaneous coronary intervention.

  Rainer Wessely, Tobias Koppara, Christian Bradaric, Marc Vorpahl, Siegmund Braun, Stefanie Schulz, Julinda Mehilli, Albert Schömig, Adnan Kastrati
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  ABSTRACT: No clinical trial has yet focused on contrast-mediated nephrotoxicity in patients with chronic renal failure exclusively undergoing percutaneous coronary intervention (PCI). Therefore, the aim of this study was to compare the effect of contemporary contrast media on nephrotoxicity in this high-risk patient population. This prospective, randomized, double-blind, comparative clinical trial randomly selected 939 patients with chronic renal failure undergoing coronary angiography with potential PCI to receive either the iso-osmolar contrast medium iodixanol or the low-osmolar contrast medium iomeprol. Of those 939 patients, 615 received diagnostic angiography only and were not included in the primary study analysis, but were followed up in a registry. Three hundred twenty-four patients underwent PCI, of which one-half received iodixanol or iomeprol, respectively, and were included in the primary study analysis. The primary end point was the peak increase in S-creatinine during hospitalization for PCI. Maximum increase in S-creatinine after PCI was lower than expected and thus impaired the power of the study. It was not significantly different between the 2 contrast groups (0.19+/-0.40 mg/dL for iodixanol and 0.21+/-0.34 mg/dL for iomeprol; P=0.53). Albeit contrast media-induced nephropathy rates were lower with iodixanol (22.2% compared with 27.8% for iomeprol), this difference was not statistically different (P=0.25). Subgroup analysis suggested a favorable outcome regarding nephrotoxicity in patients who received higher contrast volumes (>340 mL) in the iodixanol group (P(interaction)=0.016). Routine use of iso-osmolar contrast medium is not associated with a significant reduction of nephrotoxicity compared with low-osmolar contrast medium in patients with chronic renal failure undergoing PCI. However, a positive effect was seen in the iso-osmolar contrast group for patients receiving high amounts of contrast medium, which awaits confirmation of a specifically designed randomized clinical trial. Clinical Trial Registration- clinicaltrials.gov Identifier: NCT00390585.
  Circulation Cardiovascular Interventions 10/2009; 2(5):430-7. · 6.06 Impact Factor
• Source

  Available from: Jens Kastrup

  Article: Stem cell mobilization by granulocyte colony-stimulating factor for myocardial recovery after acute myocardial infarction: a meta-analysis.

  Dietlind Zohlnhöfer, Alban Dibra, Tobias Koppara, Antoinette de Waha, Rasmus Sejersten Ripa, Jens Kastrup, Marco Valgimigli, Albert Schömig, Adnan Kastrati
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  ABSTRACT: The objective of this meta-analysis was to evaluate the effect of stem cell mobilization by granulocyte colony-stimulating factor (G-CSF) on myocardial regeneration on the basis of a synthesis of the data generated by randomized, controlled clinical trials of G-CSF after acute myocardial infarction (AMI). Experimental studies and early-phase clinical trials suggest that stem cell mobilization by G-CSF may have a positive impact on cardiac regeneration after AMI. The role of G-CSF in patients with AMI remains unclear considering the inconsistent results of several clinical trials. For our analysis, PubMed, the Cochrane Central Register of Controlled Trials, conference proceedings from major cardiology meetings, and Internet-based sources of information on clinical trials in cardiology from January 2003 to August 2007 served as sources. Two reviewers independently identified studies and abstracted data on sample size, baseline characteristics, and outcomes of interest. Eligible studies were randomized trials with stem cell mobilization by G-CSF after reperfused AMI that reported data regarding the change in left ventricular ejection fraction (LVEF) at follow-up. Ten trials using stem cell mobilization by G-CSF, including 445 patients, met the inclusion criteria. Significant improvement in LVEF at follow-up was observed in both the G-CSF and placebo groups. Compared with placebo, stem cell mobilization by G-CSF did not enhance the improvement of LVEF at follow-up (mean difference 1.32% [95% confidence interval -1.52 to 4.16; p = 0.36]). Moreover, the mean difference of reduction of infarct size between the treatment and placebo groups was -0.15 (95% confidence interval -0.38 to 0.07, p = 0.17). Cumulatively, available evidence does not support a beneficial effect of G-CSF in patients with AMI after reperfusion.
  Journal of the American College of Cardiology 05/2008; 51(15):1429-37. · 14.16 Impact Factor
• Article: Prognostic value of plasma myeloperoxidase concentration in patients with stable coronary artery disease.

  Ada Stefanescu, Siegmund Braun, Gjin Ndrepepa, Tobias Koppara, Herribert Pavaci, Julinda Mehilli, Albert Schömig, Adnan Kastrati
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  ABSTRACT: There are no studies yet on the usefulness of myeloperoxidase (MPO) as a prognostic tool in patients with stable coronary artery disease (CAD). The study included 382 patients with clinical and angiographic confirmation of stable CAD. Blood samples for MPO measurement were taken before angiography. Myeloperoxidase was determined using an enzyme immunoassay. The primary end point of the study was all-cause mortality. Patients were categorized into 2 groups: the high-MPO group included patients in the third tertile of MPO levels (>75.0 microg/L; 127 patients), and the low-MPO group included patients in the first (<52.6 microg/L) and second tertiles (52.6-75.0 microg/L) of MPO levels (255 patients). The median follow-up was 3.5 [3.3-4.8] years. There were 35 deaths (9.2%) during the follow-up. The MPO concentration was 60.1 [47.0; 83.8] microg/L in survivors and 72.7 [54.8; 105.1] microg/L in nonsurvivors (P = .06). There were 17 deaths in the high-MPO level and 18 deaths in the low-MPO group: Kaplan-Meier estimates of mortality were 18.3% and 10.5% with an odds ratio of 1.96 (95% confidence interval [1.02-3.76], P = .04). The Cox proportional hazards model adjusting for correlates of mortality showed that plasma MPO was not an independent correlate of mortality (hazard ratio 1.06, 95% confidence interval [0.71-1.59], P = .77 for 1 SD increase in the log variable). Although elevated plasma MPO concentration is associated with a more advanced cardiovascular risk profile, plasma MPO does not predict mortality independent of other cardiovascular risk factors in patients with stable CAD.
  American heart journal 03/2008; 155(2):356-60. · 4.65 Impact Factor