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Introduction
Current institution
Publications
Publications (511)
Background
Conduction disturbances are common after transcatheter aortic valve implantation (TAVI) and frequently require permanent pacemaker implantation (PPI). Data regarding its impact on mortality and morbidity are conflicting. This study aims to assess the impact of PPI before or within 30 days after TAVI on mortality and health‐related Qualit...
Objectives
To perform a systematic review and meta-analysis on diagnostic accuracy and other outcomes of coronary computed tomography angiography (CCTA) and CT-derived fractional flow reserve (CT-FFR) in candidates for trans-catheter aortic valve implantation (TAVI).
Background
Screening for obstructive coronary artery disease (CAD) with CCTA duri...
Background
Patients with acute coronary syndrome (ACS) and extreme body weights exhibit varying risks of bleeding and thrombotic outcomes. Furthermore, extreme body weights can influence the pharmacodynamic response to potent P2Y12 inhibitors (ticagrelor/prasugrel) and clopidogrel.
Purpose
This study aims to assess the impact of extreme body weigh...
Background
CYP2C19 genotype-guided de-escalation from ticagrelor or prasugrel to clopidogrel, may optimize the balance between ischemic and bleeding risk in ACS patients.
Purpose
Compare bleeding and ischemic event rates in genotyped patients versus standard care.
Methods
Since 2015, ACS patients in the FORCE-ACS registry received standard dual a...
Background Despite advancements in secondary cardiovascular prevention, individuals with chronic coronary syndrome (CCS) still experience a lingering risk of adverse ischemic events. To minimize this residual risk by stabilizing and regressing the chronic disease process, there is consensus that antithrombotic therapy is crucial role for secondary...
Background
Due to the increasing life expectancy, more older people will be affected by coronary artery disease (CAD). The evaluation of frailty and comorbidity is crucial when elderly patients with non–ST-segment elevation myocardial infarction (NSTEMI) are treated, as frailty can increase the risk of adverse clinical outcomes.
Purpose
The aim of...
Background
Current guidelines recommend prasugrel and ticagrelor in patients undergoing percutaneous coronary intervention (PCI), however these potent P2Y12-inhibitors are associated with a higher bleeding risk when compared to clopidogrel. The CYP2C19 gene influences the efficacy of clopidogrel, with carriers of loss-of-function alleles having a h...
Background
Two subcutaneously injected antiplatelet drugs, zalunfiban and selatogrel, are under development for prehospital administration for STEMI and (N)STEMI, respectively. Zalunfiban is a glycoprotein IIb/IIIa inhibitor that produces high-grade inhibition of platelet aggregation induced by ADP or a thrombin receptor activating peptide (TRAP) w...
Background Dabigatran is a direct oral anticoagulant (DOAC) used for thromboembolic prevention in patients with atrial fibrillation (AF). Several studies, including the landmark trial RE-LY, suggest an increased incidence of myocardial infarction (MI) among AF patients using Dabigatran as compared to vitamin-k-antagonists (VKAs).
Objective The aim...
Background:
Early and complete restoration of target vessel patency in ST-elevation myocardial infarction (STEMI) is associated with improved outcomes. Oral P2Y12 inhibitors have failed to demonstrate either improved patency or reduced mortality when administered in the pre-hospital setting. Thus, there is a need for antiplatelet agents that achie...
Background/rationale
Newly diagnosed atrial fibrillation(AF) during acute coronary syndrome(ACS) is associated with worse outcomes. In this study we evaluated the associated stroke risk of newly diagnosed AF in ACS patients according to the onset and duration of the episode.
Results
Amongst 4433 patients presenting with ACS, 439(9.9%) had newly di...
Background
The importance of time to reperfusion after ST-elevation myocardial infarction (STEMI) is well established. Pre-hospital use of glycoprotein IIb/IIIa (GPIIb/IIIa) inhibitors improves pre-percutaneous coronary intervention (PCI) perfusion rates, but they require intravenous administration and continuous infusions and so are difficult for...
Background/Introduction
Newly diagnosed atrial fibrillation (AF) frequently occurs during acute coronary syndrome (ACS). In contrast to known AF, little is known about the prognostic and therapeutic implications of new AF.
Purpose
To evaluate the prognostic impact of newly diagnosed and known AF in patients with ACS. Furthermore, we evaluated the...
Background
Contemporary real-world data on conservatively managed patients with acute coronary syndrome (ACS) is scarce.
Objective
To evaluate conservative management compared with revascularization therapy in ACS patients, focused on ischemic and bleeding outcomes at one year follow-up, and to provide insight in physician's rationale of choice fo...
Background
Myocardial injury is frequently observed in patients undergoing transcatheter aortic valve implantation (TAVI) and has been linked to worse prognosis [1,2]. Yet, knowledge concerning the underlying mechanisms and preventive strategies is scarce.
Purpose
To identify clinical determinants and the effect of periprocedural antithrombotic st...
Objectives
To assess the diagnostic performance of CT-FFR for the diagnosis of CAD in the work-up for TAVI.
Background
Work-up for transcatheter aortic valve implantation (TAVI) currently utilizes computed tomography (CT) to evaluate annulus diameter and peripheral vascular access, plus invasive coronary angiography (ICA) to assess significant cor...
Background/Introduction
Elderly constitute a large though specific group of patients presenting with non-ST elevation myocardial infarction (NSTEMI), as they are at higher risk of adverse cardiovascular events, as well as treatment-related complications. However as they underrepresented in clinical trials, the optimal management strategy for older...
Background/Introduction
In older patients with non-ST-elevation acute coronary syndrome (NSTEMI) the POPular AGE trial clopidogrel showed superiority to ticagrelor in reducing bleeding risk and non-inferiority in net clinical benefit (all-cause death, myocardial infarction, stroke, and PLATelet inhibition and patient Outcomes; major or minor bleedi...
Background
Radial crossover and unsuccessful radial access during coronary angiography or percutaneous coronary intervention (PCI) are associated with worse outcomes compared to successful radial access. The MATRIX score estimates the risk of radial crossover, but the predictive value of this novel risk score has not been evaluated in real-world ac...
Background
Current guidelines recommend using ticagrelor in patients with acute coronary syndrome. Ticagrelor is predominantly metabolized by CYP3A4 and to a lesser extent by CYP3A5. CYP3A4*22 allele and the CYP3A5 expressor status influence the metabolization of ticagrelor, increasing plasma concentration and platelet inhibition. Nevertheless, lit...
Background
Postoperative myocardial injury (PMI) after major vascular surgery, detected by elevated cardiac troponin (cTn), has been associated with morbidity and mortality. It is unclear whether the pathophysiology of PMI is determined by increased platelet activity.
Objective
To examine the relationship between platelet activation (P-selectin ex...
This commentary refers to ‘Towards personalized antithrombotic management with drugs and devices across the cardiovascular spectrum’, by T. Lüscher et al., https://doi.org/10.1093/eurheartj/ehab642.
In this state-of-the-art review, Lüscher et al. portray a well-appreciated oversight of the treatment of different thromboembolic diseases across the c...
Background:
For patients with oral anticoagulants (OAC) undergoing percutaneous coronary intervention (PCI), European guidelines have recently changed their recommendations to dual antithrombotic therapy (DAT; P2Y12 inhibitor and OAC) without aspirin.
Aims:
The prospective WOEST 2 registry was designed to obtain contemporary real-world data on a...
Background
Age and comorbidities increase COVID-19 related in-hospital mortality risk, but the extent by which comorbidities mediate the impact of age remains unknown.
Methods
In this multicenter retrospective cohort study with data from 45 Dutch hospitals, 4806 proven COVID-19 patients hospitalized in Dutch hospitals (between February and July 20...
Background
Patients on oral anticoagulants (OACs) undergoing percutaneous coronary intervention (PCI) also require aspirin and a P2Y12 inhibitor (triple therapy). However, triple therapy increases bleeding. The use of non-vitamin K antagonist oral anticoagulants (NOACs) and stronger P2Y12 inhibitors has increased. The aim of our study was to gain i...
Aims
Patients with cardiac disease are considered high risk for poor outcomes following hospitalization with COVID-19. The primary aim of this study was to evaluate heterogeneity in associations between various heart disease subtypes and in-hospital mortality.
Methods and results
We used data from the CAPACITY-COVID registry and LEOSS study. Multi...
Introduction
Despite considerable advances in the last decade, major adverse events remain a concern after transcatheter aortic valve implantation (TAVI). The aim of this study was to provide a detailed overview of their underlying causes and contributing factors in order to identify key domains for quality improvement.
Methods
This observational,...
Background
Acute coronary syndrome (ACS) patients are a heterogeneous group with a varying risk of in-hospital and long-term mortality. Clinical risk scores play an important role in estimating these risks. Among the available risk scores, the Global Registry of Acute Coronary Events (GRACE) risk score is most used in routine clinical practice. Giv...
Introduction
Paravalvular leakage (PVL) is a relatively common complication of heart valve replacement, associated with heart failure and increased mortality. Transcatheter PVL closure may be a promising alternative to surgical repair, especially in high-risk patients.
Purpose
Assessment of safety and efficacy of transcatheter PVL closure compared...
Background
Acute coronary syndrome (ACS) patients at high risk might benefit most from guideline-recommended interventions. However, it is well recognized that the delivery of guideline-directed care is inversely related to the estimated mortality risk, the so called risk-treatment paradox.
Purpose
To assess the existence of the risk-treatment par...
Background
Patients with multiple clinical risk factors are a complex group in whom both bleeding and recurrent ischaemic events often occur during treatment with dual/triple antithrombotic therapy after percutaneous coronary intervention. Decisions on optimal antithrombotic treatment in these patients are challenging and not supported by clear gui...
The residual risk of patients surviving until 1 year after acute coronary syndromes (ACS) is still high, despite secondary prevention. The cornerstone of treatment of patients with ACS is dual antiplatelet therapy (DAPT) consisting of low-dose aspirin and a P2Y12 inhibitor (clopidogrel, prasugrel or ticagrelor) for 12 months, or less in those patie...
Recently, the European Society of Cardiology (ESC) has updated its guidelines for the management of patients with acute coronary syndrome (ACS) without ST-segment elevation. The current consensus document of the Dutch ACS working group and the Working Group of Interventional Cardiology of the Netherlands Society of Cardiology aims to put the 2020 E...
Background
Despite the advances of potent oral P2Y 12 inhibitors, their onset of action is delayed, which might have a negative impact on clinical outcome in patients undergoing percutaneous coronary intervention (PCI). Trials conducted in the United States of America have identified cangrelor as a potent and rapid-acting intravenous P2Y 12 inhibit...
Introduction
Dual antiplatelet therapy (DAPT) is the standard of treatment for patients with acute coronary syndrome (ACS). This includes lifelong aspirin combined with a P2Y12 inhibitor for one year. The indication for one of the P2Y12 inhibitors (clopidogrel, prasugrel, ticagrelor) is dependent on the treatment strategy; whether the patients unde...
Background:
Pre-hospital platelet inhibition in patients with ST-segment elevation myocardial infarction (STEMI) may improve outcomes. RUC-4 is a novel, second-generation glycoprotein IIb/IIIa inhibitor designed for first-point-of-medical-contact treatment for STEMI by subcutaneous injection.
Aims:
The open-label, phase 2A, CEL-02 trial aimed to...
A Correction to this paper has been published: 10.1007/s12471-019-01331-x
Dual antiplatelet therapy (DAPT, aspirin, and a P2Y12 inhibitor) reduces thrombotic events in patients with coronary artery disease (CAD). The T-TAS PL assay uses arterial shear flow over collagen surface, better mimicking in vivo conditions compared to conventional agonist-based platelet function assays, to evaluate platelet function. Here, the pl...
Background
In patients with acute coronary syndrome (ACS) shortened duration of dual antiplatelet therapy (DAPT) should be considered in those at high risk of bleeding. Risk scores may be used to assess the bleeding risk, but their predictive value remains unclear.
Purpose
To externally validate and compare the PRECISE-DAPT and the PARIS bleeding...
Introduction
Patients requiring concomittant use of oral anticoagulants for atrial fibrillation and dual antiplatelet therapy after percutaneous coronary intervention (PCI) are at increased risk of bleeding and mortality. Omittance of aspirin (dual antithrombotic therapy, DAT) reduces bleeding as compared to triple antithrombotic therapy (TAT), but...
Introduction
VA-ECMO is an upcoming technique in the treatment of cardiogenic shock in patients with STEMI however it increases afterload. IABP in addition to VA-ECMO has been suggested to reduce afterload and increase survival.
Methods
A multi-center in-hospital registry was kept on all patients undergoing VA-ECMO or VA-ECMO and additional IABP t...
Background
Fractional flow reserve (FFR) adoption persists low mainly due to procedural and operator related factors as well as costs. An alternative for FFR, quantitative flow ratio (QFR) achieves a high accuracy mainly outside the intermediate zone without the need for hyperemia and wire-use. Currently, no outcome trials assess the role of QFR in...
Background
Elderly patients form a large and growing part of the patients presenting with non-ST-elevation myocardial infarction (NSTEMI). Choosing the optimal antithrombotic treatment in these elderly patients is more complicated because they frequently have characteristics indicating both a high ischaemic and high bleeding risk.
Purpose
We descr...
Background
Antithrombotic treatment choices are complicated when patients have both atrial fibrillation (AF) and acute coronary syndrome and/or undergo percutaneous coronary intervention (PCI). In this study, we aimed to gain insight into antithrombotic management strategies in daily clinical practice.
Methods
We invited interventional cardiologis...
Background
Transcatheter aortic valve replacement (TAVR) is increasingly being used as an alternative to conventional surgical valve replacement. Prosthetic valve endocarditis (PVE) is a rare but feared complication after TAVR, with reported first-year incidences varying from 0.57 to 3.1%. This study was performed to gain insight into the incidence...
Background
We sought to compare long-term follow-up of coronary artery bypass grafting (CABG) with percutaneous coronary intervention (PCI) in elderly patients with left main or multivessel disease, hypothesising that completeness of revascularisation and severity of coronary artery disease are predictors of adverse outcomes.Methods
Patients aged ≥...
Purpose:
The Occlutech Figulla occluder has been proven safe and effective at midterm follow-up after percutaneous atrial septal defect (ASD) closure. We describe the safety and efficacy at long-term follow-up in adults.
Methods:
All consecutive adult patients that underwent ASD closure between 2008 and 2015 were included. All complications were...
Funding Acknowledgements
Boehringer Ingelheim International GmbH
On Behalf
The Re-DUAL PCI Investigators
Background
The RE-DUAL PCI study (NCT02164864) compared dabigatran dual antithrombotic therapy (D-DAT) with warfarin triple antithrombotic therapy (W-TAT) in patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention...
Correction to:
Neth Heart J 2019
10.1007/s12471-019-01344-6
The reference to the term acute coronary syndrome with normal or near-normal (non-obstructive) coronary arteries (ACSNNOCA) from Manolis et al. (2018) was inadvertently omitted to the original published article. Therefore, …
Background:
Current guidelines recommend non-vitamin‑K oral anticoagulants (NOACs) as the first-choice therapy for stroke prevention in patients with atrial fibrillation (AF). The use of drugs in a clinical trial setting differs from that in real-world populations. Real-world data are important to accrue more heterogeneous patient populations with...
Patients with myocardial infarction and non-obstructive coronary arteries (MINOCA), defined as angiographic stenosis <50%, represent a conundrum given the many potential underlying aetiologies. Possible causes of MINOCA can be subdivided into coronary, myocardial and non-cardiac disorders. MINOCA is found in up to 14% of patients presenting with an...
Background
Non-vitamin‑K oral anticoagulants (NOACs) are recommended as the first-choice therapy for stroke prevention in patients with non-valvular atrial fibrillation (AF). However, the lack of monitoring may impact patients’ adherence, and non-adherence to medication is a potential hazard to safe and efficacious use. This is the first report wit...
An early invasive strategy in patients who have acute coronary syndrome without ST-elevation (NSTE-ACS) can improve clinical outcome in high-risk subgroups. According to the current guidelines of the European Society of Cardiology (ESC), the majority of NSTE-ACS patients are classified as “high-risk”. We propose to prioritise patients with a global...
Background
In the setting of AMI, rapid platelet inhibition is desirable but the onset of pharmacodynamic (PD) effect of oral platelet P2Y12 inhibitors is delayed, sometimes for hours. Subcutaneous (s.c) administration of a rapidly-acting P2Y12 inhibitor would overcome many of the limitations of available therapies. Patients with stable CAD were in...
Objectives
This study aimed to investigate the onset and the associated predictors of new conduction disturbances (CDs) requiring permanent pacemaker implantation (PPI) after transcatheter aortic valve implantation (TAVI).
Background
The onset and associated predictors of onset of new CDs leading to PPI are still unknown. However, these are essent...
BACKGROUND
It is unknown whether patients undergoing primary percutaneous coronary intervention (PCI) benefit from genotype-guided selection of oral P2Y12 inhibitors.
METHODS
We conducted a randomized, open-label, assessor-blinded trial in which patients undergoing primary PCI with stent implantation were assigned in a 1:1 ratio to receive either a...
Early recognition of myocardial infarction (MI) remains a challenge, especially in patients presenting with non-ST-segment elevation MI. Heart-type fatty acid binding protein (hFABP) has shown to be a more sensitive marker for myocardial necrosis as compared to non-high sensitive troponins (4th generation and older). However, since high sensitive t...
Introduction
Surgery for infective endocarditis imposes great challenges in post-operative circulatory and pulmonary support but the role of veno-arterial extra-corporal membrane oxygenation in this respect is unclear.
Methods
All patients undergoing veno-arterial extra-corporal membrane oxygenation after infective endocarditis surgery were analys...
Background
Sex differences in acute coronary syndrome (ACS) have been reported, but little is known about the situation in the Netherlands.
Methods
This registry is a merge of available data on ACS patients in the electronic data capture systems of 11 centres with 24/7 interventional cardiology services. We included patients >18 years undergoing a...
Background
Percutaneous recanalization of coronary chronic total occlusions (CTOs) traditionally relies on the use of dual‐access and large bore catheters, with trans‐femoral approach adoption in most cases.
Objectives
Aim of this manuscript is to describe the outcomes of an alternative hybrid algorithm, called “Minimalistic Hybrid Algorithm,” whi...
This review provides a comprehensive overview of the available data on antithrombotic therapy after transcatheter aortic valve implantation (TAVI). In the absence of large randomised clinical trials, clinical practice is leaning towards evidence reported in other populations. Due to the greater risk of major bleeding associated with oral anticoagul...
P2Y 12 -inhibitor initiation with clopidogrel using a loading dose (LD) versus no LD (NLD) provides more rapid inhibition of platelet activation and reduced risk of ischemic events after coronary stenting. Whether a similar beneficial effect is achieved in the setting of transcatheter aortic valve implantation (TAVI) is unknown. We evaluate the eff...
Percutaneous recanalization of coronary chronic total occlusions (CTOs) traditionally relies on the use of dual access and large bore catheters, with trans-femoral approach adoption in most of the cases. Aim of this manuscript is to describe an alternative algorithm, that we called “Minimalistic Hybrid Algorithm” in order to minimize the use of dou...
Objectives
Available data indicate mixed outcomes after using retrograde techniques for chronic total occlusion(CTO) recanalization, with generally higher need for repeat revascularization. Aim of this study is to analyze the angiographic and clinical outcome of patients treated with retrograde techniques in the PRISON‐IV trial.
Methods and Result...
Background
Emerging evidence indicates combination therapy with anticoagulants and antiplatelet agents for atrial fibrillation (AF) will be increasingly required. Numerous studies compare the efficacy and cost-effectiveness of anticoagulation alone in AF, i. e., non-vitamin K oral anticoagulants (NOACs) vs. warfarin. However, the addition of antipl...
Objectives:
The purpose of this study was to assess neoatherosclerosis in a registry of prospectively enrolled patients presenting with stent thrombosis using optical coherence tomography.
Background:
In-stent neoatherosclerosis was recently identified as a novel disease manifestation of atherosclerosis after coronary stent implantation.
Method...
Aims:
Non-vitamin K oral anticoagulants (NOACs) have consistently demonstrated superior efficacy in terms of stroke prevention and safety in terms of bleeding over vitamin K antagonist (VKA) in patients with non-valvular atrial fibrillation (AF). The potential use of NOACs in AF patients requiring anti-platelet therapy has only been assessed in sm...
On behalf of the Dutch ACS working group, we discuss the most important changes in recommendations in the 2017 ESC guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation relevant for both the general and interventional cardiologist.
Bleeding is a feared complication in patients who are treated with antithrombotic therapy (oral anticoagulation or antiplatelet therapy). Management of antithrombotic therapy after bleeding poses a dilemma where restarting the crucial medication could lead to recurrent bleeding, while interrupting or even discontinuing treatment could increase the...
In the current daily practice of acute coronary syndromes, patients experiencing non-ST-elevation acute coronary syndrome (NSTE-ACS) represent the majority of this population. In these patients it is of utmost importance to estimate both ischaemic and bleeding risk, with subsequent, and preferably tailored pharmacological and, if indicated, invasiv...
Aim:
A tailored antiplatelet strategy based on CYP2C19 genotype may reduce atherothrombotic and bleeding events. We describe our experience with CYP2C19 genotyping, using on-site TaqMan or Spartan genotyping or shipment to a central laboratory.
Methodology:
Data from two ongoing projects were used: Popular Risk Score project (non-urgent percutan...
Aims:
Of patients with atrial fibrillation (AF), approximately 10% undergo percutaneous coronary intervention (PCI). We studied the safety and efficacy of dual vs. triple antithrombotic therapy (DAT vs. TAT) in this population.
Methods and results:
A systematic review and meta-analysis was conducted using PubMed, Embase, EBSCO, Cochrane database...
Objectives:
The aim of this study was to determine predictors of very late stent thrombosis (VLST; >1 year after stenting), and to evaluate whether addition of these predictors to the dual antiplatelet therapy (DAPT) score would improve the ability to identify patients at high risk of VLST who might benefit from DAPT.
Background:
VLST is a sever...
