Coronary Artery Disease: Gitt A

Daemen J, Simoons ML, Wijns W, Bagust A, Bos G, Bowen JM, Braunwald E, Camenzind E, Chevaliers B, DiMario C, Fajadeto J, Gitt A, Guagliumi G, Hillege HL, James S, Jüni P, Kastrati A, Kloth S, Kristensen SD, Krucoff M, Legrand V, Pfisterer M, Rothman M, Serruys PW, Silber S, Steg PG, Tariah I, Wallentin L, Windecker SW, Aimonetti A, Allocco D, Berenger M, Boam A, Calle JP, Campo G, Carlier S, de Schepper J, Di Bisceglie G, Dobbels H, Farb A, Ghislain JC, Hellbardt S, ten Hoedt R, Isaia C, de Jong P, Lekehal M, LeNarz L, Mhullain FN, Nagai H, Patteet A, Paunovic D, Potgieter A, Purdy I, Raveau-Landon C, Ternstrom S, Van Wuytswinkel J, Waliszewski M, Anonymous00071. · Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands. · EuroIntervention. · Pubmed #19284063 No free full text.

This publication has no abstract.

Onuma Y, Kukreja N, Ramcharitar S, Hochadel M, Gitt A, Serruys P. · Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands. · EuroIntervention. · Pubmed #19378677 No free full text.

Abstract: AIMS: The objective of the study is to determine the demographics and the in-hospital outcome of diabetic and non-diabetic patients treated with percutaneous coronary interventions (PCI) in Europe, to report the type of equipment and technology used for PCI procedures in diabetics and to clarify whether the treatment of diabetic patients complies with current European Society of Cardiology (ESC) guidelines. METHODS AND RESULTS: A total of 14,458 patients treated with PCI were enrolled from 29 member countries of the ESC between June 2005 and January 2006. Data were collected on patient characteristics and treatment, using new Cardiology Audit and Registration Data standards. In total, 3603 patients (24.9%) were diabetic. Diabetics were older, more often female and had a higher body mass index than non-diabetics. Diabetics had higher rates of hypercholesterolaemia and hypertension, while current smokers were more frequent in the non-diabetics. Diabetics also had significantly higher rates of previous cardiovascular events. Clopidogrel was administered only in 48.1% of diabetic patients before PCI, while IIb/IIIa inhibitors were 22.9% during PCI. At discharge, there was a major adjustment of treatment with increases in the use of Beta-blocker (80.4%), angiotensin converting enzyme inhibitor (ACEI, 71.3%) and statins (89.8%) compared with on admission (Beta-blocker 60.9%, ACEI 55.0%, statin 63.1%). In-hospital mortality was higher in diabetics (1.8% vs 1.2%) although the in-hospital MACCE rate was not significantly different (3.6% vs. 3.0%, p = 0.09). CONCLUSIONS: Diabetic patients treated with PCI were older with more comorbidity. According to ESC guideline, the under-usage of clopidogrel, GP IIb/IIIa inhibitors should be improved. PCI is now taken as a good opportunity to adjust the use of appropriate medication.

Bauer T, Böhm M, Zahn R, Jünger C, Koeth O, Gitt A, Bestehorn K, Senges J, Zeymer U, Anonymous00059. · Department of Cardiology, Herzzentrum Ludwigshafen, Ludwigshafen, Germany. · J Cardiovasc Pharmacol. · Pubmed #19188836 No free full text.

Abstract: PURPOSE: We sought to investigate the impact of prior statin therapy on in-hospital outcome in patients presenting with acute non-ST-elevation myocardial infarction. METHODS AND RESULTS: We analyzed the data of consecutive patients with non-ST-elevation myocardial infarction who were prospectively enrolled in the German Acute Coronary Syndrome Registry between July 2000 and November 2002. Overall, 6358 patients were included, and we compared the patients who received statins before hospital admission (n = 1247, 19.6%) with those who did not (n = 5111, 80.4%). There was no age difference between the two groups; however, pretreated patients had a higher incidence of prior atherothrombotic events diabetes mellitus and renal insufficiency. The percentage of patients undergoing percutaneous coronary intervention and coronary artery bypass grafting was similar. Infarct size measured by peak creatine kinase level was lower in statin users (238 vs. 283 U/L, P < 0.0001). After adjustment for confounding variables, a significant reduction of in-hospital death could be observed in patients on statins (odds ratio 0.65, 95% confidence interval 0.46-0.90). CONCLUSIONS: In clinical practice, pretreatment with statins was associated with smaller myocardial infarction size (peak creatine kinase level) and a significant reduction of hospital mortality. However, the data were obtained from an observational study, and the results need further prospective confirmation.

Zeymer U, Gitt A, Jünger C, Koeth O, Zahn R, Wienbergen H, Gottwik M, Senges J, Anonymous00101. · Herzzentrum Ludwigshafen, Medizinische Klinik B, Ludwigshafen, Germany. · Am J Cardiol. · Pubmed #16784913 No free full text.

Abstract: In randomized clinical trials, low-molecular-weight heparin enoxaparin has been shown to decrease ischemic complications in patients with acute coronary syndromes (ACSs) without ST elevations who are treated conservatively. Enoxaparin has been shown to be equally effective as unfractionated heparin in high-risk patients with an early invasive approach. Little is known about the use and efficacy of enoxaparin in unselected patients with non-ST-elevation ACSs in clinical practice. In a retrospective analysis of the prospective ACOS registry, we compared the outcome of patients who were >60 years of age with non-ST-elevation myocardial infarction or unstable angina with ST-segment changes who were treated with enoxaparin or unfractionated heparin. In total, 4,806 patients (55%) with non-ST-elevation ACS fulfilled our inclusion criteria for this analysis; 1,178 (25%) were treated with enoxaparin and 3,628 (75%) with unfractionated heparin. There were no differences between groups in baseline characteristics. We observed a significant decrease in the combined end point of death or nonfatal reinfarction with enoxaparin in the entire study group (odds ratio 0.51, 95% confidence interval 0.37 to 0.70) and in subgroups treated with early percutaneous coronary intervention (n = 1,333, odds ratio 0.36, 95% confidence interval 0.17 to 0.80), coronary artery bypass grafting during the index hospitalization (n = 270, odds ratio 0.31, 95% confidence interval 0.04 to 2.42), or conservatively (n = 3,203, odds ratio 0.57, 95% confidence interval 0.40 to 0.81). There was no significant increase in severe bleeding complications with enoxaparin (5.2% vs 4.5%). In conclusion, in clinical practice, in unselected high-risk patients with non-ST-elevation ACSs who are treated conservatively or with early percutaneous coronary intervention, early treatment with enoxaparin is associated with a significant decrease in the combined end point of in-hospital death and reinfarction, without a significant increase in severe bleeding complications.