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Unterkrozingen, Germany

Scheinert D.,Park Krankenhaus Leipzig Sudost GmbH | Katsanos K.,University of Patras | Zeller T.,Herz Zentrum Bad Krozingen | Koppensteiner R.,Medical University of Vienna | And 9 more authors.
Journal of the American College of Cardiology

Objectives: The study investigated the efficacy and safety of a balloon expandable, sirolimus-eluting stent (SES) in patients with symptomatic infrapopliteal arterial disease. Background: Results of infrapopliteal interventions using balloon angioplasty and/or bare stents are limited by a relatively high restenosis rate, which could be potentially improved by stabilizing the lesion with a SES. Methods: Two hundred patients (total lesion length 27 ± 21 mm) were randomized to infrapopliteal SES stenting or percutaneous transluminal balloon angioplasty (PTA). The primary endpoint was 1-year in-segment binary restenosis by quantitative angiography. Results: Ninety-nine and 101 patients (mean age 73.4 years; 64% diabetics) were randomized to SES and PTA, respectively (8 crossover bailout cases to SES). At 1 year, there were lower angiographic restenosis rates (22.4% vs. 41.9%, p = 0.019), greater vessel patency (75.0% vs. 57.1%, p =0.025), and similar death, repeat revascularization, index-limb amputation rates, and proportions of patients with improved Rutherford class for SES versus PTA. Conclusions: SES implantation may offer a promising therapeutic alternative to PTA for treatment of infrapopliteal peripheral arterial disease. © 2012 American College of Cardiology Foundation. Source

Bahlmann E.,Asklepios Clinic St Georg | Gerdts E.,University of Bergen | Cramariuc D.,University of Bergen | Gohlke-Baerwolf C.,Herz Zentrum Bad Krozingen | And 6 more authors.

Background-: Aortic valve area index adjusted for pressure recovery (energy loss index [ELI]) has been suggested as a more accurate measure of aortic stenosis (AS) severity, but its prognostic value has not been determined in a prospective study. Methods and Results-: The relation between baseline ELI and rate of aortic valve events and combined total mortality and hospitalization for heart failure resulting from the progression of AS was assessed by multivariate Cox regression and reclassification analysis in 1563 patients with initial asymptomatic AS in the Simvastatin and Ezetimibe in Aortic Stenosis (SEAS) study. During 4.3 years follow-up, a total of 498 aortic valve events and 181 combined total mortalities and hospitalizations for heart failure caused by the progression of AS occurred. In Cox regression analyses, 1-cm2/m 2 lower baseline ELI predicted a 2-fold higher risk both for aortic valve events and for combined total mortality and hospitalization for heart failure independently of baseline peak aortic jet velocity or mean aortic gradient and independently of aortic root size (all P<0.05). In reclassification analysis, ELI improved the prediction of aortic valve events by 13% (95% confidence interval, 5-19), whereas the prediction of combined total mortality and hospitalization for heart failure resulting from the progression of AS did not improve significantly. Conclusions-: In asymptomatic AS patients without known atherosclerotic disease or diabetes mellitus, ELI provides independent and additional prognostic information to that derived from conventional measures of AS severity, suggesting that ELI should be measured in such patients. Clinical Trial Registration Information-: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00092677. © 2013 American Heart Association, Inc. Source

Kristensen S.D.,Aarhus University Hospital | Wurtz M.,Aarhus University Hospital | Grove E.L.,Aarhus University Hospital | de Caterina R.,University of Chieti Pescara | And 3 more authors.
Thrombosis and Haemostasis

Platelet glycoprotein IIb/IIIa inhibitors (GPI) are antithrombotic agents preventing the binding of fibrinogen to GP IIb/IIIa receptors. Thus, GPI interfere with interplatelet bridging mediated by fibrinogen. Currently, three generic GPI with different antithrombotic properties are available for intravenous administration: abciximab, eptifibatide, and tirofiban. The development of oral GPI was abandoned, whereas intravenous GPI were introduced in various clinical settings during the 1990s, yielding substantial benefit in the treatment of acute coronary syndromes, particularly during percutaneous coronary interventions. Results of the many randomised trials evidenced the efficacy of this drug class, though these trials were conducted prior to the emergence of modern oral antiplatelet therapy with efficient P2Y 12 inhibitors. Subsequent trials failed to consolidate the strongly favourable impression of GPI, and indications for their use have been more restricted in recent years. Nonetheless, GPI may still be beneficial during coronary interventions among high-risk patients including acute ST-elevation and non-ST-elevation myocardial infarctions, particularly in the absence of adequate pretreatment with oral antiplatelet drugs or when direct thrombin inhibitors are not utilised. Intracoronary GPI administration has been suggested as adjunctive therapy during primary percutaneous coronary intervention, and the results of larger ongoing trials are expected to elucidate its clinical potential. The present review outlines the key milestones of GPI development and provides an up-to-date overview of the clinical applicability of these drugs in the era of refined coronary stenting, potent antithrombotic drugs, and novel thrombin inhibiting agents. © Schattauer 2012. Source

Zeller T.,Herz Zentrum Bad Krozingen | Macharzina R.,Herz Zentrum Bad Krozingen
Vasa - Journal of Vascular Diseases

Chronic mesenteric ischemia (CMI) is most likely caused by atherosclerosis and less frequently by external compression, fi bromuscular dysplasia and vasculitis. Symptomatic CMI is an uncommon, potentially under-diagnosed condition caused by fi xed stenoses or occlusion of in most conditions at least two visceral arteries. If only one of the three major bowel providing arteries - the celiac trunk, the superior and inferior mesenteric arteries - is affected, the patient is usually asymptomatic due to a tight collateral network. Symptoms and clinical signs of CMI may vary from the classical triad of postprandial pain, weight loss and upper abdominal bruit to nonspecifi c symptoms thus frequently resulting in delayed diagnosis. Established non-invasive diagnostic means are duplex ultrasound or CTand MR-angiography offering excellent three dimensional reconstruction of the vessel pathology facilitating the decision for the appropriate revascularisation strategy. During the last decade, despite higher restenosis rates endovascular revascularization has replaced surgical revascularization as therapy of choice in most centers. If untreated CMI of atherosclerotic origin is associated with a high morbidity and mortality. This manuscript reviews the most relevant clinical aspects of the disease and the current practice of diagnosis and treatment of CMI. Source

Rogge B.P.,University of Bergen | Cramariuc D.,University of Bergen | Lonnebakken M.T.,University of Bergen | Gohlke-Barwolf C.,Herz Zentrum Bad Krozingen | And 3 more authors.
Journal of the American College of Cardiology

Objectives This study investigated whether overweight and obesity impacted outcome in patients with aortic valve stenosis (AS). Background Increased body mass index (BMI) is a strong predictor of higher cardiovascular (CV) morbidity and mortality in the general population but not among patients undergoing heart surgery. Methods Cardiovascular events in 1,664 patients with initially asymptomatic AS were recorded during a mean of 4.3 years of follow-up in the SEAS (Simvastatin Ezetimibe in Aortic Stenosis) study. Patients were grouped according to baseline BMI class. Results Overweight (n = 737) and obese patients (n = 334) had higher prevalence of hypertension, more abnormal left ventricular geometry, and lower stress-corrected midwall shortening throughout the study compared with normal weight patients (all p < 0.01). The AS progression rate did not differ between BMI classes. In univariate Cox regression, overweight was associated with a 17% to 22% lower rate of AS-related (p = 0.04) and ischemic CV events (p = 0.05). In multivariate analyses, adjusting for AS severity and differences in baseline characteristics, overweight had no significant influence on the rate of ischemic CV or AS-related events, whereas overweight and obesity had 46% and 67% higher rate of total mortality and 42% and 69% higher rate of combined hospital stay for heart failure and death from any cause, respectively, compared with normal weight patients (all p < 0.05). Conclusions In patients with initially asymptomatic AS participating in the SEAS study, overweight and obesity did not influence AS progression or rate of AS-related or ischemic CV events but were both associated with increased mortality. © 2013 by the American College of Cardiology Foundation Published by Elsevier Inc. Source

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