Optimization of care for ST-elevation myocardial infarction

Velders, M.A. (2014)

Doctoral Thesis

978-94-6182-393-9 The first part of this thesis identified several high-risk sub-populations to improve the care and risk stratification of patients with ST-elevation myocardial infarction (STEMI). It was observed that common patient characteristics such as female gender, cancer and age have a strong impact on the delay to reperfusion therapy and the prognosis after STEMI. Furthermore, the historically devastating complication of out-of-hospital cardiac arrest continues to have an impact of the STEMI population. Angiographic determinants of the occurrence and prognosis of out-of-hospital cardiac arrest were identified, which may improve the care of these high-risk patients. The second part of this thesis investigated the use of second generation drug-eluting stents (DES) for the treatment of coronary heart disease. Among the second generation DES, everolimus-eluting stents showed superior results compared to Endeavor zotarolimus-eluting stents in a real world cohort of STEMI patients. A randomized acute MI trial subsequently established the non-inferiority of the everolimus-eluting stent to the first generation sirolimus-eluting stent, with results suggesting superiority. However, these stents performed similarly during long term follow-up, both in patients with and without STEMI. Low rates of stent thrombosis and similar efficacy confirmed the usefulness of both stents in the full range of coronary heart disease.

• Drug-eluting stents
• Risk factors
• Coronary heart disease
• Primary percutaneous coronary intervention
• ST-elevation myocardial infarction

• All authors: Velders, M.A.
• Supervisor: Schalij, M.J.
• Co-supervisor: Boven, A.J. van,; Umans, V.A.W.M.
• Qualification: Doctor (dr.)
• Awarding Institution: Leiden University Medical Center (LUMC), Leiden University
• Date: 2014-01-23
• ISBN (print): 9789461823939