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2.
Heart ; 96(10): 736-40, 2010 May.
Article in English | MEDLINE | ID: mdl-20448123

ABSTRACT

Periprocedural myocardial injury (PMI) is common after percutaneous coronary intervention (PCI). Periprocedural infarction (myocardial infarction type 4a) occurs after at least 10% of PCI procedures and has an impact on long-term prognosis. Measurement of biomarkers to allow assessment of PMI is an important tool for clinical and research purposes and should be routine after every PCI (troponin I or T and CK-MB). The importance of oral and intravenous antiplatelet agents and other drugs which have been proven to reduce PMI is discussed.


Subject(s)
Angioplasty, Balloon, Coronary/adverse effects , Heart Injuries/etiology , Biomarkers/blood , Cardiotonic Agents/therapeutic use , Heart Injuries/prevention & control , Humans , Myocardial Infarction/etiology , Myocardial Infarction/prevention & control , Platelet Aggregation Inhibitors/therapeutic use
5.
Cardiology ; 115(2): 91-7, 2010.
Article in English | MEDLINE | ID: mdl-19907171

ABSTRACT

OBJECTIVES: The role of beta-blockers in the treatment of hypertension is discussed controversially and the data showing a clear benefit in acute coronary syndromes (ACS) were obtained in the thrombolysis era. The goal of this study was to analyze the role of pretreatment with beta-blockers in patients with ACS. METHODS: Using data from the Acute Myocardial Infarction in Switzerland (AMIS Plus) registry, we analyzed outcomes of patients with beta-blocker pretreatment in whom they were continued during hospitalization (group A), those without beta-blocker pretreatment but with administration after admission (group B) and those who never received them (group C). Major adverse cardiac events defined as composed endpoint of re-infarction and stroke (during hospitalization) and/or in-hospital death were compared between the groups. RESULTS: A total of 24,709 patients were included in the study (6,234 in group A, 12,344 in group B, 6,131 in group C). Patients of group B were younger compared to patients of group A and C (62.5, 67.6 and 68.4, respectively). In the multivariate analysis, odds ratio for major adverse cardiac events was 0.59 (CI 0.47-0.74) for group A and 0.66 (CI 0.55-0.83) for group B, while group C was taken as a reference. CONCLUSIONS: beta-Blocker therapy is beneficial in ACS and they should be started in those who are not pretreated and continued in stable patients who had been on chronic beta-blocker therapy before.


Subject(s)
Acute Coronary Syndrome/drug therapy , Adrenergic beta-Antagonists/administration & dosage , Acute Coronary Syndrome/mortality , Aged , Female , Humans , Male , Middle Aged , Switzerland/epidemiology , Treatment Outcome
6.
Eur J Clin Microbiol Infect Dis ; 27(11): 1145-9, 2008 Nov.
Article in English | MEDLINE | ID: mdl-18521635

ABSTRACT

The role of procalcitonin (PCT) in the diagnosis of infective endocarditis (IE) remains unclear. The aim of our study was to test the accuracy of PCT in the early diagnosis of IE and analyse if the accuracy of PCT is dependent on the type of pathogen causing IE. We carried out a prospective analysis of hospitalised patients referred for transthoracic echocardiography to search for an IE. The plasma PCT value was measured at the time of echocardiography. The diagnosis of IE was made using the modified Duke criteria. A total of 77 patients were included. IE was confirmed in 15 patients. The mean PCT values were 6.9 (+/-21.6) ug/l in patients without IE and 6.4 (+/-11.7) ug/l in patients with confirmed IE (p=0.92). IE patients with Staphylococcus aureus bacteraemia (n=7) had significantly higher PCT values compared to IE patients with other types of bacteraemia (n=8) (13.1 vs. 0.435, p=0.0299). This study demonstrates that PCT levels markedly differ at the time when IE is diagnosed. While PCT values are very high in patients with S. aureus bacteraemia, they are surprisingly low in patients with Streptococcus viridans bacteraemia, which are common offenders of endocarditis. We conclude that serum PCT has the potential to be used in the early diagnosis of S. aureus endocarditis.


Subject(s)
Calcitonin/blood , Endocarditis, Bacterial/microbiology , Protein Precursors/blood , Serum/chemistry , Staphylococcal Infections/diagnosis , Staphylococcus aureus/isolation & purification , Adult , Aged , Aged, 80 and over , Bacteremia/microbiology , Calcitonin Gene-Related Peptide , Humans , Middle Aged , Prospective Studies , Streptococcal Infections/diagnosis , Viridans Streptococci/isolation & purification
8.
Scand Cardiovasc J ; 42(3): 222-5, 2008 Jun.
Article in English | MEDLINE | ID: mdl-18569955

ABSTRACT

OBJECTIVES: Current guidelines still recommend transesophageal echocardiography (TEE) as reference method to diagnose interatrial shunts. The aim was to test the accuracy of high-end transthoracal echocardiography (TTE) to exclude inter-atrial shunts. METHODS: Prospective TTE and TEE study with second harmonic imaging to determine left-to-right shunt (L/R) by both colour Doppler or R/L by contrast echocardiography in patients with unexplained cerebrovascular incidents or newly detected valvular or myocardial disease. RESULTS: An inter-atrial shunt was diagnosed in 200 of 438 analyzed patients (117 males). Colour Doppler echocardiography visualized a shunt in 67 patients (34%) on TTE vs. 84 (42%) patients on TEE (p <0.0001). However injection of agitated blood with a valsalva maneuver detected 190 (95%) interatrial shunts by both TTE and TEE, but 10 shunts (5%) only by TTE. CONCLUSIONS: Our study shows that patent foramen ovale can safely be demonstrated with high-end transthoracic contrast- echocardiography. If additional studies confirm our results, TTE has the potential to become the method of choice in the diagnosis of PFO.


Subject(s)
Cardiomyopathies/diagnostic imaging , Cerebrovascular Disorders/diagnostic imaging , Echocardiography, Doppler, Color , Echocardiography, Transesophageal , Foramen Ovale, Patent/diagnostic imaging , Heart Valve Diseases/diagnostic imaging , Adult , Aged , Cardiomyopathies/physiopathology , Cerebrovascular Disorders/etiology , Cerebrovascular Disorders/physiopathology , Coronary Circulation , Female , Foramen Ovale, Patent/complications , Foramen Ovale, Patent/physiopathology , Heart Valve Diseases/physiopathology , Humans , Male , Middle Aged , Predictive Value of Tests , Prospective Studies , Valsalva Maneuver
9.
Cardiology ; 109(3): 156-62, 2008.
Article in English | MEDLINE | ID: mdl-17726316

ABSTRACT

OBJECTIVES: The role of statin use in the treatment of acute coronary syndromes (ACS) is not clear. The aim of our study was to evaluate the role of statins in ACS. METHODS: Using data from the Acute Myocardial Infarction in Switzerland (AMIS Plus) Project, we compared the effects of chronic statin use, statin therapy after admission and no statin therapy on presentation mode and outcomes in ACS. RESULTS: Available data from the period 2001-2006 including 11,603 patients were analyzed. Major cardiac event rates and in-hospital mortality were more common in statin-naive patients compared to patients who received statins. CONCLUSIONS: Our results support the importance of statin treatment in ACS. Chronic statin therapy seems to alter the initial presentation of ACS but it is questionable whether it provides an additional effect on early outcomes compared to the establishment of statin therapy after admission in statin-naive patients.


Subject(s)
Acute Coronary Syndrome/prevention & control , Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use , Acute Coronary Syndrome/mortality , Aged , Chi-Square Distribution , Female , Hospital Mortality , Humans , Logistic Models , Male , Middle Aged , Prospective Studies , Registries , Risk Factors , Switzerland/epidemiology , Treatment Outcome
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