The impact of implementing an endocarditis team in comparison to the classic heart team in a tertiary referral centre.

BACKGROUND: Infective endocarditis (IE) is a complex disease for which the European Society of Cardiology guideline recommends a dedicated multidisciplinary endocarditis team (ET) approach since 2015. It is currently unknown whether this ET approach is beneficial compared to a classic heart team approach including bedside consultation by an infectious disease specialist in Western Europe. METHODS: This retrospective single centre, observational cohort study was conducted at the Radboudumc, a tertiary referral centre in the Netherlands. Consecutive patients treated for IE were included from September 2017 to September 2018 before implementation of a dedicated ET and from May 2019 to May 2020 afterwards. RESULTS: In total, 90 IE patients (45 patients before and 45 patients after the implementation of the ET) were included. No significant differences were found in diagnostic workup, surgical treatment (surgery performed 69% vs. 71%, p = 0.82), time to surgery because of an urgent indication (median 4 vs. 6 days, p = 0.82), in-hospital complications (53% vs. 67%, p = 0.20), and 6-month mortality (11% vs. 13%, p = 0.75) between IE patients treated before and after the implementation of the ET. CONCLUSION: Formalization of the recommended multidisciplinary endocarditis team might not significantly improve the complication rate nor the short term outcome.

Changes in electronic structure and chemical bonding upon crystallization of the phase change material GeSb2Te4.

High-resolution photoelectron spectroscopy of in situ prepared films of GeSb2Te4 reveals significant differences in electronic and chemical structure between the amorphous and the crystalline phase. Evidence for two different chemical environments of Ge and Sb in the amorphous structure is found. This observation can explain the pronounced property contrast between both phases and provides new insight into the formation of the amorphous state.

[Antithrombotic therapy during percutaneous coronary interventions]. / Antitrombotische therapie rondom percutane coronaire interventie.

Antithrombotic therapy is essential during percutaneous coronary interventions for the prevention of peri-procedural death and myocardial infarction. The most commonly used agents are aspirin, clopidogrel and heparin in patients treated by percutaneous angioplasty or receiving an arterial stent. Glycoprotein IIb/IIIa receptor antagonists such as abciximab are indicated during percutaneous interventions in high-risk-patients as well as, in principle, in all patients with an acute coronary syndrome with ST-segment elevation undergoing primary percutaneous angioplasty. In patients with so-called drug-eluting stents, clopidogrel should be continued for several months longer than the usual 30 days.

Fibrinolysis and primary PCI for ST-elevation myocardial infarction: call for a more refined perspective.

The latest meta-analysis comparing fibrinolysis with primary percutaneous intervention (PCI) has fuelled the discussion regarding the best reperfusion therapy for acute ST-elevation myocardial infarction. As far as patients presenting to centres with intervention facilities are concerned, the superiority of primary PCI has been unequivocally demonstrated. However, only a small proportion of patients with St-elevation myocardial infarction primarily present to an intervention centre, the majority go to a hospital without these facilities. The optimal reperfusion strategy for patients presenting to a nonintervention centre or for patients presenting in the prehospital setting has been studied less extensively and the question remains as to whether all these patients should be transferred to an intervention centre to undergo primary PCI. The available data to date on interhospital transport for primary PCI do show a mortality benefit for primary PCI. Yet, as far as inferences to clinical practice are concerned, it remains to be seen whether these studies are truly representative: almost half of patients in the transportation trials received streptokinase, they were treated relatively late, and the subsequent revascularisation strategy was rather conservative. The impact of primary PCI as compared with prehospital fibrinolysis in patients presenting in the prehospital setting has so far only been addressed in the randomised CAPTIM trial, without significant differences in outcome. Additional studies are warranted, with early treatment as primary focus. For patients presenting to non-intervention centres or prehospitally, the impact of triage, and of combined pharmaco-invasive reperfusion strategies are promising fields of further exploration.