The first part of this thesis identified patients at low risk for recurrent events or death after STEMI. It was observed that asymptomatic patients with a LVEF>45% after one year can safely be... Show moreThe first part of this thesis identified patients at low risk for recurrent events or death after STEMI. It was observed that asymptomatic patients with a LVEF>45% after one year can safely be referred to the GP with mortality rates after STEMI that come close to the rate in the general population.The second part focused to identify high-risk subpopulations to improve risk stratification. Despite current standards of care aimed at achieving targets for LDLc and other traditional risk factors, STEMI patients remain at high risk of new cardiovascular events. Valuable effort should therefore be made to further reduce residual cardiovascular risk by using additional more discriminating and more refined treatments targets like apoB and apoB/apoA1 ratio. Furthermore, novel biomarkers were identified to improve risk stratification and select high risk sub-populations. GDF-15, a more general marker for disease severity in STEMI patient demonstrated to have an additional prognostic value beyond identified risk factors and other cardiac biomarkers such as cTn and NT-proBNP.Lastly, the third part of this thesis showed that a dedicated pre-hospital triage protocol is an effective tool to select patients for admission at the cardiac emergency department. Overcrowding is a major public health problem and this thesis shows that the introduction of dedicated cardiac emergency departments can potentially reduce the caseload of the general emergency department. Show less
Objective Consistent with the aging population in the Western world, there is agrowing number of elderly patients with ST-segment elevation myocardial infarction (STEMI). Primary percutaneous... Show moreObjective Consistent with the aging population in the Western world, there is agrowing number of elderly patients with ST-segment elevation myocardial infarction (STEMI). Primary percutaneous coronary intervention (PCI) is the recommended reperfusion strategy in elderly patients; risk models to determine which of these patients are prone to have poor clinical outcomes are, however, essential. The purpose of this study was to assess the association between frailty and short-term mortality and PCI-related serious adverse events (SAE) in elderly patients.Methods All STEMI patients (aged >= 70 years) treated with primary PCI in 2013-2015 at the Leiden University Medical Centre were assessed. The Safety Management Programme (VMS) score was used to identify frail elderly patients. The primary endpoint was 30-day all-cause mortality; the secondary endpoint included 30-day clinical death, target vessel failure, major bleeding, contrast induced kidney insufficiency and stroke.Results A total of 206 patients were included (796.4 years, 119 [58%] male). The VMS score was 1 in 28% of all cases. Primary and secondary endpoint rates were 5 and 23% respectively. VMS score 1 was an independent predictor for both 30-day mortality (odds ratio [OR] 9.6 [95% confidence interval, CI 1.6-56.9] p-value = 0.013) and 30-day SAE (OR 2.9 [95% CI 1.1-7.9] p-value = 0.038).Conclusions VMS score for frailty is independently associated with short-term mortality and PCI-related SAE in elderly patients with STEMI treated with primary PCI. These results suggest that frailty in elderly patients is an important feature to measure and to be taken into account when developing risk models. 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
Velders, M.A.; N. van boven; Boden, H.; Hoeven, B.L. van der; Heestermans, A.A.C.M.; Jukema, J.W.; ... ; Umans, V.A.W.M. 2013
