European Society of CardiologyThis is the author accepted manuscript. The final version is available from Oxford University Press via http://dx.doi.org/10.1093/eurheartj/ehw10

Aboyans, Victor

Agewall, Stefan

Albus, Christian

Bachl, Norbert

Binno, Simone

Brotons, Carlos

Carerj, Scipione

Catapano, Alberico L.

Cho, Leslie

Cooney, Marie-Therese

Corra, Ugo

Cosyns, Bernanrd

De Backer, Guy

Deaton, Christi

Graham, Ian

Hall, Michael Stephen

Hobbs, F. D. Richards

Hoes, Arno W.

Loechen, Maja-Lisa

Lollgen, Herbert

Marques-Vidal, Pedro

Perk, Joep

Piepoli, Massimo F.

Prescott, Eva

Redon, Josep

Richter, Dimitrios J.

Roffi, Marco

Sattar, Naveed

Smulders, Yvo

Tiberi, Monica

Van der Worp, Henk

van Dis, Ineke

Verschuren, W. M. Monique

European Heart Journal

English

PubMed

[Extract] A 69-year-old previously healthy woman presented in extremis with multiorgan failure after 7 days of diarrhoea, abdominal discomfort, fatigue, and increasing pain and discoloration of her distal limbs. Initial assessment demonstrated a drowsy, obese woman with marked distal acrocyanosis and early gangrene (Panels A–C). Doppler ultrasound of her limbs showed absent flow signal in the distal left ulnar artery and in both the left distal posterior and anterior tibial arteries but normal flow elsewhere

Buchholz, Stefan

Lutchmann, Dave

Keightley, Chloe

ResearchOnline@JCU

Phaeochromocytoma: delayed diagnosis with severe consequences

Piepoli, M.F.

Hoes, A.W.

Agewall, S.

Albus, C.

Brotons, C.

Catapano, A.L.

Cooney, M.T.

Corrà, U.

Cosyns, B.

Deaton, C.

Graham, I.

Hall, M.S.

Hobbs, F.D.

Løchen, M.L.

Löllgen, H.

Marques-Vidal, P.

Perk, J.

Prescott, E.

Redon, J.

Richter, D.J.

Sattar, N.

Smulders, Y.

Tiberi, M.

Bart van der Worp, H.

van Dis, I.

Verschuren, W.M.

Serveur académique lausannois

2016 European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts) Developed with the special contribution of the European Association for Cardiovascular Prevention &amp; Rehabilitation (EACPR).

Aims: This randomized controlled trial (RCT) evaluated whether a process with single combined testing of copeptin and troponin at admission in patients with low-to-intermediate risk and suspected acute coronary syndrome (ACS) does not lead to a higher proportion of major adverse cardiac events (MACE) than the current standard process (non-inferiority design).\ud
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Methods and results: A total of 902 patients were randomly assigned to either standard care or the copeptin group where patients with negative troponin and copeptin values at admission were eligible for discharge after final clinical assessment. The proportion of MACE (death, survived sudden cardiac death, acute myocardial infarction (AMI), re-hospitalization for ACS, acute unplanned percutaneous coronary intervention, coronary artery bypass grafting, or documented life threatening arrhythmias) was assessed after 30 days. Intention to treat analysis showed a MACE proportion of 5.17% [95% confidence intervals (CI) 3.30–7.65%; 23/445] in the standard group and 5.19% (95% CI 3.32–7.69%; 23/443) in the copeptin group. In the per protocol analysis, the MACE proportion was 5.34% (95% CI 3.38–7.97%) in the standard group, and 3.01% (95% CI 1.51–5.33%) in the copeptin group. These results were also corroborated by sensitivity analyses. In the copeptin group, discharged copeptin negative patients had an event rate of 0.6% (2/362).\ud
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Conclusion: After clinical work-up and single combined testing of troponin and copeptin to rule-out AMI, early discharge of low- to intermediate risk patients with suspected ACS seems to be safe and has the potential to shorten length of stay in the ED. However, our results need to be confirmed in larger clinical trials or registries, before a clinical directive can be propagated

Möckel, Martin

Searle, Julia

Hamm, Christian

Slagman, Anna

Blankenberg, Stefan

Huber, Kurt

Katus, Hugo

Liebetrau, Christoph

Müller, Christian

Muller, Reinhold

Peitsmeyer, Philipp

von Recum, Johannes

Tajsic, Milos

Vollert, Jörn O.

Giannitsis, Evangelos

Early discharge using single cardiac troponin and copeptin testing in patients with suspected acute coronary syndrome (ACS): a randomized, controlled clinical process study

AIMS: This study aims to evaluate temporal changes in stroke complications and their association with mortality and MACE outcomes in a national cohort of patients undergoing percutaneous coronary interventions (PCIs) in England and Wales. METHODS AND RESULTS: A total of 426 046 patients who underwent PCI in England and Wales between 2007 and 2012 in the British Cardiovascular Intervention Society (BCIS) database were analysed. Statistical analyses were performed evaluating the rates of stroke complications according to the year of PCI and multiple logistic regressions were used to evaluate the odds of 30-day mortality and in-hospital major adverse cardiovascular events (MACE; a composite of in-hospital mortality, myocardial infarction or re-infarction, and revascularization) with stroke complications. Four hundred and thirty-six patients (0.1%) sustained an ischaemic stroke/TIA complication and 107 patients (0.03%) sustained a haemorrhagic stroke complication. Ischaemic stroke/TIA complications increased non-linearly from 0.67 (95% CI 0.47-0.87) to 1.14 (0.94-1.34) per 1000 patients between 2007 and 2012 (P = 0.006), whilst haemorrhagic stroke rates decreased non-linearly from 0.29 (0.19-0.39) to 0.15 (0.05-0.25) per 1000 patients in 2012 (P = 0.009). Following adjustment for baseline clinical and procedural demographics, ischaemic stroke was independently associated with both 30-day mortality (OR 4.92, 3.06-7.92) and in-hospital MACE (OR 3.11, 1.83-5.27). An even greater impact on prognosis was observed with haemorrhagic complications (30-day mortality: OR 13.87, 6.37-30.21), in-hospital MACE (OR 13.50, 6.30-28.92). CONCLUSIONS: Incident ischaemic stroke complications have increased over time, whilst haemorrhagic stroke complications have decreased, driven through changes in clinical, procedural, drug-treatment, and demographic factors. Both ischaemic and haemorrhagic strokes are rare but devastating complications with high 30-day mortality and in-hospital MACE rates

Kwok, CS

Kontopantelis, E

Myint, PK

Zaman, A

Berry, C

Keavney, B

Nolan, J

Ludman, PF

de Belder, MA

Buchan, I

Mamas, MA

Name not available

Stroke following percutaneous coronary intervention: type-specific incidence, outcomes and determinants seen by the British Cardiovascular Intervention Society 2007-12

S. Biere-Rafi

B. A. Hutten

A. Squizzato

W. Ageno

P. C. Souverein

A. de Boer

V. E. A. Gerdes

H. R. Buller

P. W. Kamphuisen

Crossref

Statin treatment and the risk of recurrent pulmonary embolism

Aims: Diabetes increases the risk of atherothrombosis, but reduces the risk of abdominal aortic aneurysm (AAA). The reason for this difference is unknown. We examined the role of diabetes and glycation on AAA expansion and extracellular matrix–monocyte interactions.



Methods and results: We followed 198 patients (20 with diabetes) who had 30–45 mm AAAs with yearly aortic ultrasound for 3 years. Diabetes was independently associated with reduced AAA growth (β = –0.17, P = 0.01; OR for expansion above median 0.18, 95% confidence interval 0.06–0.57). In vitro incubation of resting human monocytes with glycated bovine serum albumin or monomeric type I collagen increased matrix metalloproteinase (MMP) secretion. In contrast, exposure of activated monocytes to glycated type I collagen lattices induced a marked reduction in MMP and interleukin-6 secretion. This de-activating effect was also demonstrated in cross-linked non-glycated collagen lattices, healthy decellularized aortic media, and decellularized aortic media from diabetes patients with atherosclerosis. In contrast, decellularized aortic media from patients with atherosclerosis, but no diabetes, induced increased MMP secretion.



Conclusion: These findings confirm that the progression of AAA is slower in patients with diabetes and suggest a mechanism by which the aortic media may be protected from degradation in these individuals

Golledge, Jonathan

Karan, Mirko

Moran, Corey S.

Muller, Juanita

Clancy, Paula

Dear, Anthony E.

Norman, Paul E.

Reduced expansion rate of abdominal aortic aneurysms in patients with diabetes may be related to aberrant monocyte–matrix interactions

Aims Patients with idiopathic venous thromboembolism (VTE) have a high recurrence risk during and after stopping anticoagulant treatment. Several studies suggest that treatment with statins reduces the incidence of a first episode of VTE, but data on the effects in patients with a previous episode are lacking. We examined the effect of statin therapy on the risk of recurrent pulmonary embolism (PE).Methods and results Using the PHARMO Record Linkage System, a Dutch population-based registry of pharmacy records linked with hospital discharge records, patients hospitalized with an acute episode of PE were identified between 1998 and 2008. Prescription-based use of statins and vitamin K antagonist (VKA) were identified starting at hospital discharge and during follow-up. The association between statin use (time-varying) and the incidence of recurrences, cardiovascular events, and death was assessed using Cox regression analysis. The mean (standard deviation) age was 61 (17) years. The median (range) duration of VKA treatment after acute PE was 199 (45-3793) days. Twenty-four per cent of the patients (n = 737) had at least one prescription of statins during the follow-up period and the median duration of statin therapy was 1557 (5-4055) days. During a median follow-up of 1529 (1-4155) days, 285 (9.2%) patients experienced a recurrence. Treatment with statins was associated with a reduced risk of recurrent PE [adjusted hazard ratio (HR) 0.50, 95% CI: 0.36-0.70], both during and after stopping VKA treatment. A dose-response relationship was shown for potency, with the largest reduction in those with the most potent statins. Finally, statin treatment also reduced the risk for cardiovascular events and all-cause mortality.Conclusion Statin treatment decreases the risk of recurrent PE, irrespective of VKA treatment. Treatment with statins may be an attractive alternative for anticoagulant treatment in the long-term treatment of PE.

Biere-Rafi, Sara

Hutten, Barbara A.

Squizzato, Alessandro

Ageno, Walter

Souverein, Patrick C.

de Boer, Anton

Gerdes, Victor E. A.

Buller, Harry R.

Kamphuisen, Pieter W.

University of Groningen Digital Archive

Piepoli, Massimo F

Hoes, Arno W

Catapano, Alberico L

Cooney, Marie Therese

Corrà, Ugo

Cosyns, Bernard

Hobbs, F D Richard

Løchen, Maja-Lisa

Löllgen, Herbert

Richter, Dimitrios J

Smulders, Yvo M

van der Worp, H Bart

Verschuren, W M Monique

Copenhagen University Research Information System

2016 European Guidelines on cardiovascular disease prevention in clinical practice:The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts)Developed with the special contribution of the European Association for Cardiovascular Prevention &amp; Rehabilitation (EACPR)

Richard Hobbs, F.D.

Monique Verschuren, W.M.

2016 European Guidelines on cardiovascular disease prevention in clinical practice

A bootstrap resampling procedure for model building: application to the Cox regression model. Stat Med

Adverse impact of bleeding on prognosis in patients with acute coronary syndromes.

American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents. ACCF/ACG/AHA

Automated variable selection methods for logistic regression produced unstable models for predicting acute myocardial infarction mortality.

Bleeding with Antithrombotic Therapy (BAT) Study Group. Dual antithrombotic therapy increases severe bleeding events in patients with stroke and cardiovascular disease: a prospective, multicenter, observational study.

Bootstrap methods for developing predictive models.

Clinical classiﬁcation schemes for predicting hemorrhage: results from the National Registry of Atrial Fibrillation (NRAF).

Development and validation of a prognostic risk score for major bleeding in patients undergoing percutaneous coronary intervention via the femoral approach.

Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive Summary of The Third Report

External validity of clinical trials in acute myocardial infarction.

External validity of randomised controlled trials: ‘to whom do the results of this trial apply?’.

Guideline Update for percutaneous coronary intervention: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines:

Guidelines for Percutaneous Coronary Intervention.

Investigators. An international randomized trial comparing four thrombolytic strategies for acute myocardial infarction.

Late clinical events after clopidogrel discontinuation may limit the beneﬁt of drug-eluting stents: an observational study of drug-eluting versus bare-metal stents.

REACH Registry Investigators. The REduction of Atherothrombosis for Continued Health (REACH) Registry: an international, prospective, observational investigation in subjects at risk for atherothrombotic events-study design. Am Heart J

Risk of adverse outcomes associated with concomitant use of clopidogrel and proton pump inhibitors following acute coronary syndrome.

The TIMI risk score for unstable angina/non-ST elevation MI: A method for prognostication and therapeutic decision making. JAMA 2000;284:835–842. Risk score to predict bleeding risk in outpatients with atherothrombosis 1265

Topol EJ, CHARISMA Investigators. Clopidogrel and aspirin versus aspirin alone for the prevention of atherothrombotic events.

Topol EJ. Aspirin to prevent cardiovascular disease: the association of aspirin dose and clopidogrel with thrombosis and bleeding. Ann Intern Med

Unanswered questions - drug-eluting stents and the risk of late thrombosis.

Update on aspirin in the treatment and prevention of cardiovascular disease.

Use and misuse of the receiver operating characteristic curve in risk prediction.

http://dx.doi.org/10.1093/eurheartj/ehl212

2016 European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts)Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR).

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ResearchOnline@JCU

Serveur académique lausannois

ResearchOnline@JCU

Name not available

Crossref

ResearchOnline@JCU

University of Groningen Digital Archive

Copenhagen University Research Information System

Serveur académique lausannois