Thrombus aspiration during ST-segment elevation myocardial infarction.

To access publisher's full text version of this article. Please click on the hyperlink in Additional Links field.The clinical effect of routine intracoronary thrombus aspiration before primary percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI) is uncertain. We aimed to evaluate whether thrombus aspiration reduces mortality.We conducted a multicenter, prospective, randomized, controlled, open-label clinical trial, with enrollment of patients from the national comprehensive Swedish Coronary Angiography and Angioplasty Registry (SCAAR) and end points evaluated through national registries. A total of 7244 patients with STEMI undergoing PCI were randomly assigned to manual thrombus aspiration followed by PCI or to PCI only. The primary end point was all-cause mortality at 30 days.No patients were lost to follow-up. Death from any cause occurred in 2.8% of the patients in the thrombus-aspiration group (103 of 3621), as compared with 3.0% in the PCI-only group (110 of 3623) (hazard ratio, 0.94; 95% confidence interval [CI], 0.72 to 1.22; P=0.63). The rates of hospitalization for recurrent myocardial infarction at 30 days were 0.5% and 0.9% in the two groups, respectively (hazard ratio, 0.61; 95% CI, 0.34 to 1.07; P=0.09), and the rates of stent thrombosis were 0.2% and 0.5%, respectively (hazard ratio, 0.47; 95% CI, 0.20 to 1.02; P=0.06). There were no significant differences between the groups with respect to the rate of stroke or neurologic complications at the time of discharge (P=0.87). The results were consistent across all major prespecified subgroups, including subgroups defined according to thrombus burden and coronary flow before PCI.Routine thrombus aspiration before PCI as compared with PCI alone did not reduce 30-day mortality among patients with STEMI. (Funded by the Swedish Research Council and others; ClinicalTrials.gov number, NCT01093404.).Swedish Research Council, Swedish Association of Local Authorities and Regions, Terumo Medical Corporation, Medtronic, Vascular Solutions, Swedish Heart-Lung Foundation/20100178/ B0010401 Biotronik, Stentys, Abbott Vascular, St. Jude Medical, Boston Scientific, EPS Vascular, Cardiac Dimensions, AstraZeneca, Edwards Lifesciences

Long-term results after simple versus complex stenting of coronary artery bifurcation lesions:nordic bifurcation study 5-year follow-up results

ObjectivesThis study sought to report the 5-year follow-up results of the Nordic Bifurcation Study.BackgroundRandomized clinical trials with short-term follow-up have indicated that coronary bifurcation lesions may be optimally treated using the optional side branch stenting strategy.MethodsA total of 413 patients with a coronary bifurcation lesion were randomly assigned to a simple stenting strategy of main vessel (MV) and optional stenting of side branch (SB) or to a complex stenting strategy, namely, stenting of both MV and SB.ResultsFive-year clinical follow-up data were available for 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% 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 were 3% versus 1.5% (p = 0.31) in the optional SB stenting group versus the MV and SB stenting group, respectively.ConclusionsAt 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

Screening for GJB2 and GJB6 mutations in the Slovak deaf population

Introduction: Mutations of connexin genes account for up to 50% of prelingual bilateral sensorineural hearing loss (SNHL). In Slovakia the deaf population is estimated to reach about 9000 individuals. However, reliable data on bilateral SNHL etiology in Slovakia are not available to date. The aim of presented study was to analyze the GJB2 and GJB6 genes and describe their mutation spectrum in patients with bilateral SNHL and thus to determine epidemiology of one of the most dominant causes of SNHL in Slovakia. Methods: Since 2010 we performed molecular-genetic testing for GJB2 and GJB6 mutations in >500 subjects suffering from bilateral SNHL, that included 375 unrelated individuals selected for epidemiology analyses. Patients were recruited at 2 ORL clinics in Bratislava and special schools for hearing impaired children throughout Slovakia. Inclusion criteria were bilateral SNHL and age below 60 years at the time of hearing loss diagnosis. Direct sequencing and MLPA was used for DNA analysis. Results: We identified 11 mutations and six polymorphisms in GJB2 gene. Homozygous mutations occurred in 22% and compound heterozygotes in 9% of subjects. Negative subjects, without any pathogenic allele found accounted for 61%. Mutations c.35delG and c.71G>A were recorded most frequently (60.4% and 15.8% respectively). The large GJB6 deletion (delD13S1830) was found in 1 family.Conclusions: DNA analysis of patients with SNHL revealed mutation spectrum of GJB2 and GJB6 genes in our cohort and also confirmed exact genetic cause of hearing loss in almost one third of investigated subjects. Our results represent fundamental data for genetic counseling, clinical prognosis, improvement of diagnostic tools for clinical practice and possible personalized treatment in future.Supported by: Grants APVV 0148-10 and VEGA 1/0465/11Der Erstautor gibt keinen Interessenkonflikt an

Outcome after percutaneous coronary intervention for different indications : Long-term results from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR)

Aims: The aim of this study was to evaluate clinical outcome for different indications for PCI in an unselected, nationwide PCI population at short-and long-term follow-up. Methods and results: We evaluated clinical outcome up to six years after PCI in all patients undergoing a PCI procedure for different indications in Sweden between 2006 and 2010. A total of 70,479 patients were treated for stable coronary artery disease (CAD) (21.0%), unstable angina (11.0%), non-ST-elevation myocardial infarction (NSTEMI) (36.6%) and ST-elevation myocardial infarction (STEMI) (31.4%). Mortality was higher in STEMI patients at one year after PCI (9.6%) compared to NSTEMI (4.7%), unstable angina (2.2%) and stable CAD (2.0%). At one year after PCI until the end of follow-up, the adjusted mortality risk (one to six years after PCI) and the risk of myocardial infarction were comparable between NSTEMI and STEMI patients and lower in patients with unstable angina and stable CAD. The adjusted risk of stent thrombosis and heart failure was highest in STEMI patients. Conclusions: The risk of short-term mortality, heart failure and stent thrombosis is highest for STEMI patients after PCI. Therapies to reduce stent thrombosis and heart failure appear to be most important in decreasing mortality in patients with STEMI or NSTEMI undergoing PCI

Population Trends in Percutaneous Coronary Intervention 20-Year Results From the SCAAR (Swedish Coronary Angiography and Angioplasty Registry)

<p>Objectives The aim of this study was to describe the characteristics and outcome of all consecutive patients treated with percutaneous coronary intervention (PCI) in an unselected nationwide cohort over the past 2 decades.</p><p>Background Over the last 20 years, treatment with PCI has evolved dramatically, but the change in patient characteristics has not been well described.</p><p>Methods We included all patients undergoing a PCI procedure for the first time between January 1990 and December 2010 from the SCAAR (Swedish Coronary Angiography and Angioplasty Registry). Patients were divided into different cohorts on the basis of the year of the first PCI procedure.</p><p>Results A total of 144,039 patients was included. The mean age increased from 60.1 +/- 9.9 years in 1990 to 1995 to 67.1 +/- 11.2 years in 2009 to 2010. The proportion of patients presenting with unstable coronary artery disease and ST-segment elevation myocardial infarction increased from 27.4% and 6.2% to 47.7% and 32.5%, respectively. Diabetes mellitus and multivessel disease were more often present in the later-year cohorts. The 1-year mortality increased from 2.2% in 1990 to 1995 to 5.9% in 2009 to 2010, but after adjustment for age and indication, a modest decrease was shown, mainly in ST-segment elevation myocardial infarction patients.</p><p>Conclusions Characteristics of PCI patients have changed substantially over time, reflecting the establishment of new evidence. The increasing age and proportion of patients undergoing PCI for acute coronary syndromes greatly influence outcome. Understanding the changing patient characteristics is important for the translation of evidence to real-world clinical practice. (J Am Coll Cardiol 2013; 61: 1222-30) (C) 2013 by the American College of Cardiology Foundation</p>