Aim of this thesis was to evaluate contemporary care and prognosis for patients with acute coronary syndrome and identify pitfalls in its treatment. Complications after coronary stent implantation... Show moreAim of this thesis was to evaluate contemporary care and prognosis for patients with acute coronary syndrome and identify pitfalls in its treatment. Complications after coronary stent implantation were explored and demonstrated that in sirolimus-eluting stents, the benefit of reduced repeat revascularization during one year after primary PCI was not sustained during long-term follow-up. Additionally, an increased risk of very late stent thrombosis was suggested. Late stent malapposition, more commonly observed after this stent type and suspected to be involved in the multifactorial etiology of stent thrombosis, is shown to persist in the greater portion of STEMI patients during long-term follow-up, depending on the degree of vessel wall remodelling and change in plaque burden. Women were identified as a sub-population with poorer prognosis early after STEMI. Identification of high-risk patients, and estimation of infarct size and prognosis, which a single measurement of troponin already may indicate, facilitates individualized treatment and likely results in better outcomes. Although numerous novel treatment modalities emerged in recent years, certain pitfalls become increasingly important. Major bleeding is one of them, responsible for an excess mortality amongst STEMI patients after primary PCI, and should be incorporated in risk stratification models for the choice of treatment strategy. Show less
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).... Show more978-94-6182-393-9 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. Show less
Cardiovascular disease remains the leading cause of mortality in the western World, but significant improvements have been made in its treatment and prevention. This thesis shows that consistent... Show moreCardiovascular disease remains the leading cause of mortality in the western World, but significant improvements have been made in its treatment and prevention. This thesis shows that consistent implementation of a structured regional treatment and prevention program for acute myocardial infarction patients is feasible when health professionals of various disciplines collaborate.The aim of the main part of this thesis was to evaluate the implementation of the MISSION! AMI protocol in clinical practice at various stages of the program (from pre-hospital care to secondary prevention), to evaluate efficacy and safety of sirolimus-eluting stents at 3-year follow-up, and to study differences in stent edge characteristics in a subgroup of patients by the use of virtual histology-intravascular ultrasound imaging. Show less
Restenosis is the main drawback of percutaneous coronary interventions (PCI). Recently, drug-eluting stents (DES) were introduced successfully in clinical practice leading to a drop in the post... Show moreRestenosis is the main drawback of percutaneous coronary interventions (PCI). Recently, drug-eluting stents (DES) were introduced successfully in clinical practice leading to a drop in the post-angioplasty restenosis rate. Nevertheless, safety and efficacy concerns related to the active compounds of such stents still exist. This thesis aimed at the development of a local delivery system, in combination with the cuff-induced mouse model of neointima formation, in order to closely mimic the DES mode-of-action and to further answer to such remaining questions related to this novel technology. Altogether, these comprehensive studies on efficacy and safety of anti-restenotic compounds using a novel developed mouse model of neointimal hyperplasia have resulted in a thorough understanding of the mode-of-action of these anti-restenotic drugs on neointimal hyperplasia inhibition as well as to further assess the potential adverse effects on vessel wall biology and on the (treated) pre-existing underlying atherosclerotic lesions. Especially the discovery of novel anti-restenotic strategies to be used in combination with the DES technology is of specially importance for further preclinical studies in more advance animal models of restenosis (e.g. porcine coronary artery model) as well as directly in the field of interventional cardiology per se. Show less
