16 results on '"Rakowski T"'
Search Results
2. Impact of advanced age on myocardial perfusion, distal embolization, and mortality patients with ST-segment elevation myocardial infarction treated by primary angioplasty and glycoprotein IIb-IIIa inhibitors.
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De Luca G, van't Hof AW, Huber K, Gibson CM, Bellandi F, Arntz HR, Maioli M, Noc M, Zorman S, Secco GG, Zeymer U, Gabriel HM, Emre A, Cutlip D, Rakowski T, Gyongyosi M, and Dudek D
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- Age Factors, Aged, Comorbidity, Coronary Angiography, Female, Humans, Male, Myocardial Infarction diagnosis, Myocardial Infarction mortality, Myocardial Infarction physiopathology, Myocardial Perfusion Imaging, Platelet Aggregation Inhibitors adverse effects, Randomized Controlled Trials as Topic, Risk Factors, Smoking adverse effects, Smoking epidemiology, Time Factors, Treatment Outcome, Angioplasty, Balloon, Coronary adverse effects, Angioplasty, Balloon, Coronary mortality, Coronary Circulation, Myocardial Infarction therapy, Platelet Aggregation Inhibitors therapeutic use, Platelet Glycoprotein GPIIb-IIIa Complex antagonists & inhibitors
- Abstract
Despite mechanical reperfusion, the outcome is still unsatisfactory in elderly patients with ST-segment elevation myocardial infarction (STEMI). The vast majority of studies have been conducted without extensive use of glycoprotein (Gp) IIb-IIIa inhibitors, which have been associated with improved perfusion and survival. Thus the aim of the current study was to evaluate the impact of age on the angiographic and clinical outcome patients with STEMI undergoing primary angioplasty with Gp IIb-IIIa inhibitors. Our population is represented by a total of 1,662 patients undergoing primary angioplasty for STEMI included in 11 randomized trials comparing early versus late administration of Gp IIb-IIIa inhibitors. Myocardial perfusion was evaluated by myocardial blush grade and ST-segment resolution. Follow-up data were collected between 30 days and 1 year after primary angioplasty. A total of 231 (13.9 %) patients were older than 75 years. Elderly patients showed a larger prevalence of female gender, hypertension, and diabetes, more advanced Killip class at presentation and longer time to treatment, but a smaller prevalence of smoking. All patients were treated with GP IIb-IIIa inhibitors. Elderly patients showed a significantly impaired postprocedural thrombolysis in myocardial infarction (TIMI) flow (TIMI 0-2: 17.7 vs 10.3 %, P = 0.002) and myocardial perfusion (myocardial blush grade 0-1: 38.3 vs 26.5 %, P = 0.001), and higher prevalence of distal embolization (19.2 vs 9.8 %, P < 0.001), whereas no difference was observed in terms of ST-segment resolution. At follow-up, elderly patients showed a significantly higher mortality (3.2 vs 11.0 %, hazard ratio (HR) (95 % confidence interval (CI)) = 3.78 (2.31-6.16), P < 0.001), which was confirmed after adjustment for baseline confounding factors (HR (95 % CI) = 5.01 (2.63-9.55), P < 0.0001). This study showed that among patients with STEMI undergoing primary angioplasty, advanced age is an independent predictor of mortality after primary angioplasty. Higher rates of distal embolization and poor myocardial perfusion, in addition to the worse risk profile, contribute toward explaining the impact of aging on mortality.
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- 2014
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3. Early administration of abciximab reduces mortality in female patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention (from the EUROTRANSFER Registry).
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Dziewierz A, Siudak Z, Rakowski T, Kleczyński P, Dubiel JS, and Dudek D
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- Abciximab, Aged, Europe epidemiology, Female, Humans, Male, Middle Aged, Sex Characteristics, Time Factors, Antibodies, Monoclonal administration & dosage, Immunoglobulin Fab Fragments administration & dosage, Myocardial Infarction mortality, Myocardial Infarction therapy, Percutaneous Coronary Intervention, Platelet Aggregation Inhibitors administration & dosage
- Abstract
The present study assessed the impact of early administration of abciximab in female and male patients with ST-segment elevation myocardial infarction (STEMI) transferred for primary angioplasty (PPCI). Data were gathered for 1,650 consecutive patients with STEMI transferred for PPCI from hospital networks in seven countries in Europe from November 2005 to January 2007 (the EUROTRANSFER Registry population). Among 1,086 patients who received abciximab, there were 186 women and 541 men who received abciximab early (>30 min before PPCI), and 86 women and 273 men treated with late abciximab. Female patients were high-risk individuals, with advanced age and increased rate of ischemic events. Early abciximab administration was associated with enhanced patency of the infarct-related artery before PPCI, and improved epicardial flow after PPCI in both women and men. Early abciximab in women led to the decrease in ischemic events, including 30 day (adjusted OR 0.26, 95 % CI 0.10-0.69, p = 0.007) and 1 year (adjusted OR 0.37, 95 % CI 0.16-0.84, p = 0.017) mortality reduction. In contrast, the reduction in 30 day (adjusted OR 0.69, 95 % CI 0.35-1.39, p = 0.27) and 1 year (adjusted OR 0.68, 95 % CI 0.38-1.22, p = 0.19) mortality was not significant in men. The frequency of bleeding events was similar in the early abciximab group compared to the late abciximab group in both women and men. Early administration of abciximab improved patency of the infarct-related artery before and after PPCI, and led to improved survival in female patients with STEMI.
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- 2013
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4. Impact of multivessel disease on myocardial perfusion and survival among patients undergoing primary percutaneous coronary intervention with glycoprotein IIb/IIIa inhibitors.
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De Luca G, Gibson M, Cutlip D, Huber K, Dudek D, Bellandi F, Noc M, Maioli M, Zorman S, Zeymer U, Secco GG, Mesquita Gabriel H, Emre A, Arntz HR, Rakowski T, Gyongyosi M, and Hof AW
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- Aged, Biomarkers blood, Chi-Square Distribution, Coronary Angiography, Coronary Artery Disease blood, Coronary Artery Disease mortality, Coronary Artery Disease physiopathology, Creatine Kinase, MB Form blood, Europe, Female, Humans, Kaplan-Meier Estimate, Logistic Models, Male, Middle Aged, Myocardial Infarction blood, Myocardial Infarction mortality, Myocardial Infarction physiopathology, Myocardial Perfusion Imaging methods, Odds Ratio, Predictive Value of Tests, Proportional Hazards Models, Registries, Risk Assessment, Risk Factors, Severity of Illness Index, Time Factors, Treatment Outcome, Coronary Artery Disease therapy, Coronary Circulation, Myocardial Infarction therapy, Percutaneous Coronary Intervention adverse effects, Percutaneous Coronary Intervention mortality, Platelet Aggregation Inhibitors therapeutic use, Platelet Glycoprotein GPIIb-IIIa Complex antagonists & inhibitors
- Abstract
Background: Although primary angioplasty achieves thrombolysis in myocardial infarction (TIMI) 3 flow in most patients with ST-elevation myocardial infarction, epicardial recanalization does not guarantee optimal perfusion in a large proportion of patients. The influence of multivessel disease on myocardial reperfusion and survival after primary angioplasty has not been extensively investigated., Aim: To evaluate the impact of multivessel disease on myocardial perfusion and survival in a large cohort of patients with ST-elevation myocardial infarction treated with angioplasty and glycoprotein (GP) IIb/IIIa inhibitors., Methods: This analysis is based on 1494 patients undergoing primary angioplasty included in the EGYPT database. Myocardial perfusion was evaluated by angiography or ST-segment resolution, whereas infarct size was estimated by using peak creatine kinase-MB (CK-MB). Follow-up data were collected between 30 days and 1 year after primary angioplasty., Results: Multivessel disease was observed in 870 patients (58.2%). The extent of coronary artery disease was associated with age, diabetes, hypertension, previous myocardial infarction, previous revascularization, abciximab treatment and longer ischaemic time, and was independently associated with impaired angiographic myocardial perfusion (adjusted odds ratio 1.18, 95% confidence interval [CI] 1.01-1.40, P=0.049). At 208±160 days, the extent of coronary artery disease was independently associated with higher mortality (adjusted hazard ratio 1.54, 95% CI 1.06-2.24, P=0.022)., Conclusions: Among patients with ST-elevation myocardial infarction undergoing primary angioplasty with GP IIb/IIIa inhibitor treatment, the extent of coronary artery disease was independently associated with impaired myocardial perfusion and survival., (Copyright © 2013 Elsevier Masson SAS. All rights reserved.)
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- 2013
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5. Inverted takotsubo cardiomyopathy in a patient with essential thrombocythemia exposed to anagrelide and phentermine.
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Dziewierz A, Olszanecka A, Wiliński J, Rakowski T, Kleczyński P, Dubiel JS, and Dudek D
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- Adult, Female, Humans, Platelet Aggregation Inhibitors therapeutic use, Quinazolines therapeutic use, Thrombocythemia, Essential drug therapy, Appetite Depressants adverse effects, Phentermine adverse effects, Platelet Aggregation Inhibitors adverse effects, Quinazolines adverse effects, Takotsubo Cardiomyopathy chemically induced
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- 2012
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6. Early abciximab administration before primary percutaneous coronary intervention improves clinical outcome in diabetic patients with ST-segment elevation myocardial infarction (EUROTRANSFER Registry).
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Dziewierz A, Mielecki W, Siudak Z, Rakowski T, Janzon M, Birkemeyer R, Zasada W, Dubiel JS, and Dudek D
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- Abciximab, Aged, Chi-Square Distribution, Coronary Circulation drug effects, Diabetes Mellitus mortality, Drug Administration Schedule, Europe epidemiology, Female, Humans, Kaplan-Meier Estimate, Logistic Models, Male, Middle Aged, Myocardial Infarction drug therapy, Myocardial Infarction mortality, Odds Ratio, Propensity Score, Registries, Risk Assessment, Risk Factors, Time Factors, Treatment Outcome, Vascular Patency drug effects, Angioplasty, Balloon, Coronary adverse effects, Angioplasty, Balloon, Coronary mortality, Antibodies, Monoclonal administration & dosage, Diabetes Mellitus epidemiology, Immunoglobulin Fab Fragments administration & dosage, Myocardial Infarction therapy, Platelet Aggregation Inhibitors administration & dosage
- Abstract
Background: Diabetes is an important determinant of prognosis in patients with ST-segment elevation myocardial infarction (STEMI). Limited data are available concerning benefits and risks of upstream abciximab administration in diabetic patients. Thus, the objective of the study was to assess the impact of early abciximab administration before primary angioplasty (PCI) for STEMI in diabetic patients., Methods: Data were gathered for 1650 consecutive STEMI patients transferred for primary PCI from hospital networks in seven countries in Europe from November 2005 to January 2007 (the EUROTRANSFER Registry population). Patients were stratified by diabetes mellitus presence and then by abciximab administration strategy (early - more than 30 min before PCI vs. late)., Results: Diabetes mellitus was diagnosed in 262 (15.9%) patients. Patients with diabetes mellitus were high-risk individuals, with advanced age, higher prevalence of comorbidities and increased risk of ischemic events during follow-up in comparison to non-diabetic patients. A total of 1086 patients who received abciximab were identified. Strategy of early abciximab administration was associated with enhanced infarct-related artery patency before PCI, and improved epicardial flow after PCI in both diabetic and non-diabetic patients. Importantly, early abciximab in diabetic patients led to the decrease in ischemic events, including 30-day (OR 0.260, 95% CI 0.089-0.759, p = 0.012) and 1-year (OR 0.273, 95% CI 0.099-0.749, p = 0.012) mortality reduction. However, only a trend toward improved survival was confirmed after adjustment for potential confounders. On the contrary, the reduction of 30-day (OR 0.620, 95% CI 0.334-1.189, p = 0.16) and 1-year (OR 0.643, 95% CI 0.379-1.089, p = 0.10) mortality rates was not significant among non-diabetic patients., Conclusions: Early administration of abciximab improves infarct-related artery patency before and after primary PCI, and leads to improved survival in diabetic STEMI patients., (Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.)
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- 2012
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7. Early glycoprotein IIb-IIIa inhibitors in primary angioplasty-abciximab long-term results (EGYPT-ALT) cooperation: individual patient's data meta-analysis.
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DE Luca G, Bellandi F, Huber K, Noc M, Petronio AS, Arntz HR, Maioli M, Gabriel HM, Zorman S, DE Carlo M, Rakowski T, Gyongyosi M, and Dudek D
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- Abciximab, Antibodies, Monoclonal pharmacology, Humans, Immunoglobulin Fab Fragments pharmacology, Platelet Aggregation Inhibitors pharmacology, Randomized Controlled Trials as Topic, Angioplasty, Antibodies, Monoclonal therapeutic use, Immunoglobulin Fab Fragments therapeutic use, Integrin beta3 drug effects, Platelet Aggregation Inhibitors therapeutic use
- Abstract
Background: Even although time to treatment has been shown to be a determinant of mortality in primary angioplasty, the potential benefits are still unclear from early pharmacological reperfusion by glycoprotein (Gp) IIb-IIIa inhibitors. Therefore, the aim of this meta-analysis was to combine individual data from all randomized trials conducted on upstream as compared with late peri-procedural abciximab administration in primary angioplasty., Methods: The literature was scanned using formal searches of electronic databases (MEDLINE and EMBASE) from January 1990 to December 2010. All randomized trials on upstream abciximab administration in primary angioplasty were examined. No language restrictions were enforced., Results: We included a total of seven randomized trials enrolling 722 patients, who were randomized to early (n = 357, 49.4%) or late (n = 365, 50.6%) peri-procedural abciximab administration. No difference in baseline characteristics was observed between the two groups. Follow-up data were collected at a median (25th-75th percentiles) of 1095 days (720-1967). Early abciximab was associated with a significant reduction in mortality (primary endpoint) [20% vs. 24.6%; hazard ratio (HR) 95% confidence interval (CI) = 0.65 (0.42-0.98) P = 0.02, P(het) = 0.6]. Furthermore, early abciximab administration was associated with a significant improvement in pre-procedural thrombolysis in myocardial infarction (TIMI) 3 flow (21.6% vs. 10.1%, P < 0.0001), post-procedural TIMI 3 flow (90% vs. 84.8%, P = 0.04), an improvement in myocardial perfusion as evaluated by post-procedural myocardial blush grade (MBG) 3 (52.0% vs. 43.2%, P = 0.03) and ST-segment resolution (58.4% vs. 43.5%, P < 0.0001) and significantly less distal embolization (10.1% vs. 16.2%, P = 0.02). No difference was observed in terms of major bleeding complications between early and late abciximab administration (3.3% vs. 2.3%, P = 0.4)., Conclusions: This meta-analysis shows that early upstream administration of abciximab in patients undergoing primary angioplasty for ST-segment elevation myocardial infarction (STEMI) is associated with significant benefits in terms of pre-procedural epicardial re-canalization and ST-segment resolution, which translates in to significant mortality benefits at long-term follow-up., (© 2011 International Society on Thrombosis and Haemostasis.)
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- 2011
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8. Early abciximab administration before primary percutaneous coronary intervention improves clinical outcome in elderly patients transferred with ST-elevation myocardial infarction: data from the EUROTRANSFER registry.
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Dziewierz A, Siudak Z, Rakowski T, Chyrchel M, Mielecki W, Janzon M, Birkemeyer R, Tierala I, Wojdyła RM, Dubiel JS, and Dudek D
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- Abciximab, Age Distribution, Aged, Angioplasty, Balloon, Coronary adverse effects, Coronary Thrombosis mortality, Coronary Thrombosis prevention & control, Drug Administration Schedule, Electrocardiography, Female, Humans, Kaplan-Meier Estimate, Male, Middle Aged, Myocardial Infarction diagnosis, Registries, Risk Factors, Angioplasty, Balloon, Coronary mortality, Antibodies, Monoclonal administration & dosage, Immunoglobulin Fab Fragments administration & dosage, Myocardial Infarction mortality, Myocardial Infarction therapy, Platelet Aggregation Inhibitors administration & dosage
- Abstract
Background: Limited data are available concerning benefits and risks of early abciximab (EA) administration before primary percutaneous coronary intervention (PPCI) in elderly ST-segment elevation myocardial infarction (STEMI) patients. The objective of the study was to assess the impact of EA before PPCI in elderly (>or=65 years) patients., Methods and Results: We identified 545 patients <65 years (354 with EA administration (>30 min before PPCI), 191 late abciximab (LA)), and 541 patients >or=65 years of age (373 EA, 168 LA) in the EUROTRANSFER Registry database. Elderly patients were more likely to have comorbidities, angiographic PCI complications, and bleeding events. EA promotes infarct-related artery patency before PPCI and improves myocardial reperfusion after PPCI in both age groups, but the risk of 30-day death (EA vs. LA: <65 years, 2.0% vs. 1.6%; p=0.999; >or=65 years, 5.9% vs. 14.3%; p=0.001) and 30-day death+reinfarction (EA vs. LA: <65 years, 2.5% vs. 2.1%; p=0.999; >or=65 years, 7.5% vs. 17.3%; p=0.001) was reduced in elderly patients only. There was no difference in bleedings, especially major bleedings requiring transfusion (EA vs. LA: patients <65 years, 2.3% vs. 0%, p=0.055; >or=65 years, 2.4% vs. 3%; p=0.448) between groups., Conclusions: Patients >or=65 years of age have a substantially increased risk of angiographic PCI complications, death and bleeding events compared with their younger counterparts. Strategy of EA before PPCI improves reperfusion parameters and clinical outcome in elderly patients and is not associated with elevated risk of major bleeding., (Copyright (c) 2009 Elsevier Ireland Ltd. All rights reserved.)
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- 2010
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9. Transradial approach in patients with ST-elevation myocardial infarction treated with abciximab results in fewer bleeding complications: data from EUROTRANSFER registry.
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Siudak Z, Zawislak B, Dziewierz A, Rakowski T, Jakala J, Bartus S, Noworolnik B, Zasada W, Dubiel JS, and Dudek D
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- Abciximab, Aged, Angioplasty, Balloon, Coronary adverse effects, Antibodies, Monoclonal adverse effects, Blood Transfusion, Chi-Square Distribution, Europe, Female, Hematoma etiology, Hematoma prevention & control, Hemorrhage etiology, Humans, Immunoglobulin Fab Fragments adverse effects, Male, Middle Aged, Myocardial Infarction drug therapy, Odds Ratio, Platelet Aggregation Inhibitors adverse effects, Punctures, Registries, Risk Assessment, Risk Factors, Treatment Outcome, Angioplasty, Balloon, Coronary methods, Antibodies, Monoclonal therapeutic use, Femoral Artery, Hemorrhage prevention & control, Immunoglobulin Fab Fragments therapeutic use, Myocardial Infarction therapy, Platelet Aggregation Inhibitors therapeutic use, Radial Artery
- Abstract
Objectives: Our aim was to investigate the safety and efficacy of transradial approach, predictors of bleeding complications, and choice of radial access site in a real-life setting using a contemporary European registry of percutaneous coronary intervention (PCI) in ST-elevation myocardial infarction (STEMI)., Background: There is an increasing amount of data suggesting that transradial approach is associated with less bleeding at access site and other vascular complications when compared with procedures carried out through the femoral artery., Methods: Consecutive data on STEMI patients transferred for primary PCI in hospital STEMI networks between November 2005 and January 2007 from seven countries in Europe were gathered. Patients were divided into the following two groups: radial approach - with radial access site for primary PCI, and transfemoral approach (FEM) - with femoral access site., Results: Data from a total of 1650 patients were collected in the EUROTRANSFER Registry. Abciximab was administered in 1086 patients (66%), 169 patients were assigned to radial approach group, whereas 917 to FEM group. Puncture site hematomas were more frequent in the FEM group (1.2 vs. 9.4%, P<0.001). Major bleedings requiring blood transfusion occurred similarly in both the studied groups. Independent predictors of bleeding (puncture site hematoma and major bleeding requiring transfusion) included female sex, lower weight, chronic renal failure, past stroke, and femoral access site (odds ratio=3.54)., Conclusion: The choice of radial access site in patients with STEMI treated with primary PCI is associated with lower local bleeding complications like puncture site hematomas and is an independent predictor of fewer bleedings.
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- 2010
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10. Early abciximab use in ST-elevation myocardial infarction treated with primary percutaneous coronary intervention improves long-term outcome. Data from EUROTRANSFER Registry.
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Siudak Z, Rakowski T, Dziewierz A, Janzon M, Birkemeyer R, Stefaniak J, Partyka Ł, Zmudka K, and Dudek D
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- Abciximab, Adult, Aged, Aged, 80 and over, Combined Modality Therapy, Drug Administration Schedule, Electrocardiography, Europe epidemiology, Female, Follow-Up Studies, Humans, Male, Middle Aged, Myocardial Infarction diagnosis, Myocardial Infarction mortality, Survival Analysis, Treatment Outcome, Angioplasty, Balloon, Coronary, Antibodies, Monoclonal administration & dosage, Immunoglobulin Fab Fragments administration & dosage, Myocardial Infarction therapy, Platelet Aggregation Inhibitors administration & dosage, Registries statistics & numerical data
- Abstract
Background: Primary percutaneous coronary intervention (PCI) is the preferred method of reperfusion in patients with ST elevation myocardial infarction (STEMI). Abciximab is a well established adjunct to primary PCI. The proper timing of abciximab administration in STEMI patients has been investigated in randomised trials, registries and metanalysis, providing conflicting results., Methods: Consecutive data on STEMI patients, transferred for primary PCI in hospital/ambulance STEMI networks between November 2005 and January 2007, from 15 PCI centres in seven European countries was gathered together for a one-year long-term clinical observation (93% rate of completeness)., Results: Data from 1,650 patients was collected in the EUROTRANSFER Registry. Abciximab was administered to 1,086 patients (66%), 727 patients received early (at least 30 minutes prior to first balloon inflation) abciximab (EA), and another 359 patients received late abciximab (LA). One year mortality was 5.8% in the EA group vs 10.3% with LA (p = 0.007). Adjustment for propensity score methods for EA administration did not change the results, still providing a favourable outcome for the EA group (p = 0.004). It was also revealed that only a minority of patients (36%) were treated within the 90-minute recommended time window from first medical contact to PCI (and 60% for the 120-min time delay)., Conclusions: Patients transferred for primary PCI in STEMI hospital networks showed lower rates of death in long-term one-year clinical follow-up when treatment with abciximab was started early.
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- 2010
11. Diabetes mellitus is associated with distal embolization, impaired myocardial perfusion, and higher mortality in patients with ST-segment elevation myocardial infarction treated with primary angioplasty and glycoprotein IIb-IIIa inhibitors.
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De Luca G, Gibson CM, Bellandi F, Noc M, Dudek D, Zeymer U, Arntz HR, Cutlip D, Maioli M, Zorman S, Mesquita Gabriel H, Emre A, Rakowski T, Gyongyosi M, Huber K, and Van't Hof AW
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- Aged, Coronary Angiography, Diabetes Complications drug therapy, Diabetes Complications mortality, Diabetes Complications physiopathology, Electrocardiography, Embolism mortality, Embolism prevention & control, Female, Humans, Kaplan-Meier Estimate, Male, Middle Aged, Myocardial Infarction complications, Myocardial Infarction drug therapy, Myocardial Infarction mortality, Myocardial Infarction physiopathology, Proportional Hazards Models, Randomized Controlled Trials as Topic, Retrospective Studies, Risk Assessment, Risk Factors, Time Factors, Treatment Outcome, Angioplasty, Balloon, Coronary adverse effects, Coronary Circulation drug effects, Diabetes Complications therapy, Embolism etiology, Myocardial Infarction therapy, Platelet Aggregation Inhibitors therapeutic use, Platelet Glycoprotein GPIIb-IIIa Complex antagonists & inhibitors
- Abstract
Background: It has been shown that, among patients with ST-segment elevation myocardial infarction (STEMI), diabetes is associated with a significantly higher mortality. The aim of the current study was to investigate the impact of diabetes on myocardial perfusion and mortality among STEMI patients treated with primary angioplasty and glycoprotein IIb-IIIa inhibitors., Methods: Our population is represented by a total of 1662 patients undergoing primary angioplasty for STEMI included in 11 randomized trials. Myocardial perfusion was evaluated by angiography (n=1324) or postprocedural ECG (n=1371). Distal embolization was defined as an abrupt "cutoff" in the main vessel or one of the coronary branches of the infarct-related artery, distal to the angioplasty site (data available in 1181 patients)., Results: Diabetes was observed in a total of 281 patients (16.9%). Diabetic patients were older, with a larger prevalence of female gender, hypertension, hypercholesterolemia, advanced killip class at presentation and multivessel disease. Diabetes was associated with impaired postprocedural TIMI 3 flow (82% vs 90%, p<0.001), MBG 2-3 (60.1% vs 74.2%, p<0.001), complete ST-segment resolution (43.2% vs 60%, p<0.001) and more distal embolization (16.4% vs 10.1%, p<0.0001). The association with impaired MBG and distal embolization was confirmed after correction for baseline confounding factors. Diabetes was associated with significantly impaired mortality (12.6% vs 3.9%, HR=3.0 [1.84-4.89], p<0.001), that persisted even after correction for baseline confounding factors (HR=2.6 [1.52-4.45], p=0.001)., Conclusion: This study showed that, among patients with STEMI undergoing primary angioplasty on the top of glycoprotein IIb-IIIa inhibitors, diabetes mellitus is independently associated with impaired perfusion and distal embolization, that contribute to explain the higher mortality observed in these patients.
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- 2009
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12. Early abciximab administration before transfer for primary percutaneous coronary interventions for ST-elevation myocardial infarction reduces 1-year mortality in patients with high-risk profile. Results from EUROTRANSFER registry.
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Rakowski T, Siudak Z, Dziewierz A, Birkemeyer R, Legutko J, Mielecki W, Depukat R, Janzon M, Stefaniak J, Zmudka K, Dubiel JS, Partyka L, and Dudek D
- Subjects
- Abciximab, Aged, Europe epidemiology, Female, Follow-Up Studies, Humans, Male, Middle Aged, Myocardial Infarction diagnosis, Myocardial Infarction therapy, Platelet Glycoprotein GPIIb-IIIa Complex antagonists & inhibitors, Prospective Studies, Risk Factors, Survival Rate trends, Time Factors, Angioplasty, Balloon, Coronary methods, Antibodies, Monoclonal administration & dosage, Electrocardiography, Immunoglobulin Fab Fragments administration & dosage, Myocardial Infarction mortality, Patient Transfer statistics & numerical data, Platelet Aggregation Inhibitors administration & dosage, Registries
- Abstract
Background: There are conflicting data on the clinical benefit from early administration of abciximab from a large randomized trial and a registry. However, both sources suggest that a benefit may depend on the baseline risk profile of the patients. We evaluated the role of early abciximab administration in patients with ST-segment-elevation myocardial infarction (STEMI) referred for primary percutaneous coronary intervention stratified by the STEMI Thrombolysis In Myocardial Infarction (TIMI) risk score., Methods: A total of 1,650 patients were enrolled into the EUROTRANSFER Registry. One thousand eighty-six patients received abciximab (66%). Abciximab was administered early in 727 patients (EA) and late in 359 patients (LA). We used the TIMI risk score for risk stratification. Patients with scores >or=3 constituted the high-risk group of 616 patients (56.7%), whereas 470 patients formed the low-risk cohort. Factoring in the timing of the abciximab administration resulted in 4 groups of patients who were compared for mortality at 1 year: EA/high-risk (n = 413); LA/high-risk (n = 203); EA/low-risk (n = 314); LA/low-risk (n = 156). Baseline difference was accounted for by means of propensity score., Results: In high-risk patients, 1-year mortality was significantly lower with early abcximab compared to late administration (8.7% vs 15.8%; odds ratio 0.51, CI 0.31-0.85, P = .01). In multivariable Cox regression analysis, both early abciximab administration and patients' risk profile (TIMI score >or=3) were identified as independent predictors of 1-year mortality., Conclusions: Early abciximab administration before transfer for percutaneous coronary intervention in STEMI shows lower mortality at 1-year follow-up. This effect is confined to patients with higher risk profile as defined by TIMI risk score >or=3.
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- 2009
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13. Benefits of pharmacological facilitation with glycoprotein IIb-IIIa inhibitors in diabetic patients undergoing primary angioplasty for STEMI. A subanalysis of the EGYPT cooperation.
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De Luca G, Michael Gibson C, Bellandi F, Murphy S, Maioli M, Noc M, Zeymer U, Dudek D, Arntz HR, Zorman S, Gabriel HM, Emre A, Cutlip D, Rakowski T, Gyongyosi M, Huber K, and Van't Hof AW
- Subjects
- Angioplasty, Diabetic Angiopathies surgery, Humans, Myocardial Infarction surgery, Randomized Controlled Trials as Topic statistics & numerical data, Treatment Outcome, Diabetes Mellitus drug therapy, Diabetic Angiopathies prevention & control, Platelet Aggregation Inhibitors therapeutic use, Platelet Glycoprotein GPIIb-IIIa Complex antagonists & inhibitors
- Abstract
The Early Glycoprotein IIb-IIIa inhibitors in Primary angioplasty (EGYPT) cooperation aimed at evaluating, by pooling individual patient's data of randomized trials, the benefits of pharmacological facilitation with Gp IIb-IIIa inhibitors among STEMI patients undergoing primary angioplasty. In the current study we analyze the benefits of early Gp IIb-IIIa inhibitors in diabetic patients. The literature was scanned by formal searches of electronic databases (MEDLINE, EMBASE) from January 1990 to October 2007. We examined all randomized trials on facilitation by early administration of Gp IIb-IIIa inhibitors in STEMI. No language restrictions were enforced. Individual patients' data were obtained from 11 out of 13 trials, including 1,662 patients. Diabetes was present in 281 (16.9%). Early Gp IIb-IIIa inhibitors were associated with improved preprocedural TIMI 3 flow (26.0% vs. 13.1%, P = 0.006), postprocedural TIMI 3 flow (90.1% vs. 75.0%, P = 0.18), MBG 3 (40.8% vs. 30.4%, P = 0.004), and less distal embolization (11.6% vs. 20.8%, P = 0.05). However, early Gp IIb-IIIa inhibitors did not significantly reduce mortality (8.3% vs. 9.5%, P = 0.64). This meta-analysis shows that pharmacological facilitation with early administration of Gp IIb-IIIa inhibitors in STEMI patients with diabetes undergoing primary angioplasty, is associated with significant benefits in terms of preprocedural and postprocedural TIMI flow, improved myocardial perfusion, without significant benefits in mortality.
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- 2009
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14. European registry on patients with ST-elevation myocardial infarction transferred for mechanical reperfusion with a special focus on early administration of abciximab -- EUROTRANSFER Registry.
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Dudek D, Siudak Z, Janzon M, Birkemeyer R, Aldama-Lopez G, Lettieri C, Janus B, Wisniewski A, Berti S, Olivari Z, Rakowski T, Partyka L, Goedicke J, and Zmudka K
- Subjects
- Abciximab, Aged, Antibodies, Monoclonal adverse effects, Cardiac Catheterization, Comorbidity, Drug Administration Schedule, Female, Follow-Up Studies, Hospital Mortality, Humans, Immunoglobulin Fab Fragments adverse effects, Male, Middle Aged, Myocardial Infarction mortality, Platelet Aggregation Inhibitors adverse effects, Premedication, Prospective Studies, Survival Analysis, Time and Motion Studies, Angioplasty, Balloon, Coronary, Antibodies, Monoclonal administration & dosage, Electrocardiography, Immunoglobulin Fab Fragments administration & dosage, Myocardial Infarction therapy, Platelet Aggregation Inhibitors administration & dosage, Registries
- Abstract
Background: Abciximab is established as adjunct to primary percutaneous coronary intervention (PCI). Based on some smaller studies, ST-segment elevation myocardial infarction (STEMI) networks in various European countries have adopted the start of abciximab before transfer to the catheterization laboratory (cathlab) hospital as part of their routine treatment options. Although a recently published study did not reveal improved clinical outcome when starting abciximab before the cathlab, a potential benefit from such early administration, in particular in the setting of transfer networks, remains unclear and has been the subject of debate., Methods: Data of consecutive patients with STEMI transferred for primary PCI in hospital/ambulance-feeded STEMI networks treated between November 2005 and January 2007 at 15 PCI centers from 7 European countries were collected in the web-based EUROTRANSFER Registry., Results: Data from a total of 1,650 patients were collected. Abciximab was administered to 1086 patients (66%), of whom 727 received early abciximab (EA group: abciximab started before admission to cathlab, at least 30 minutes before balloon). Another 359 patients received late abciximab (LA group: periprocedural administration of abciximab in the cathlab). Preprocedural TIMI 3 flow was observed in 17.7% of patients with EA and in 8.9% in the LA group (P < .0001). Thirty-day mortality was 3.9% in the EA group versus 7.5% with LA (OR 0.49, 95% CI 0.29-0.85, P = .011), and composite 30-day outcome including death, repeated myocardial infarction, and urgent revascularization was present in 5.5% and 10.3%, respectively (OR 0.51, 95% CI 0.32-0.81, P = .004). These differences remain statistically significant in favor of early abciximab after accounting and adjustment for differences between the groups by means of a multivariate regression model and propensity score., Conclusions: Patients in STEMI networks transferred for primary PCI who have received abciximab before transfer rather than in the cathlab had more patent arteries before PCI and showed lower rates for death and the composite clinical outcome at 30-day follow-up.
- Published
- 2008
- Full Text
- View/download PDF
15. In-hospital management and mortality in elderly patients with non-ST-segment elevation acute coronary syndromes treated in centers without on-site invasive facilities.
- Author
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Dziewierz A, Siudak Z, Rakowski T, Zdzienicka J, Dykla D, Mielecki W, Dubiel JS, and Dudek D
- Subjects
- Acute Coronary Syndrome diagnosis, Age Distribution, Aged, Aged, 80 and over, Aging, Angiotensin-Converting Enzyme Inhibitors therapeutic use, Electrocardiography, Female, Humans, Hydroxymethylglutaryl-CoA Reductase Inhibitors therapeutic use, Inpatients statistics & numerical data, Male, Multivariate Analysis, Poland epidemiology, Proportional Hazards Models, Prospective Studies, Registries statistics & numerical data, Risk Factors, Treatment Outcome, Acute Coronary Syndrome drug therapy, Acute Coronary Syndrome mortality, Adrenergic beta-Antagonists therapeutic use, Hospital Mortality, Platelet Aggregation Inhibitors therapeutic use
- Abstract
Background: The purpose was to assess age-related differences in hospital management and mortality in non-ST-elevation acute coronary syndrome (NSTE ACS) patients treated conservatively, with a focus on the influence of aggressive pharmacological treatment on in-hospital clinical outcome., Methods: We identified 807 NSTE ACS patients treated conservatively in the 29 hospitals participating in the Krakow Registry of Acute Coronary Syndromes from February to March 2005 and from December 2005 to January 2006. Out of 807 patients' 32.1% were less than 65 years of age, 33% from 65 to 74, 30.5% from 75 to 84, and 5.3% >or= 85. For all patients, pharmacotherapy index based on the use of pharmacological treatment regimen during hospital stay was assessed. Each patient received 1 point for each of the following guideline-recommended drugs used: aspirin, clopidogrel, glycoprotein IIb/IIIa inhibitor, LMWH, beta-blocker, ACE inhibitor/angiotensin II receptor blocker and statin - the range of points being from 0 to 7., Results: Significant age-related differences in baseline characteristics and pharmacotherapy index values were found. In-hospital mortality was higher in elderly patients (2.4% vs. 3.4% vs. 8.9% vs. 14.0%, respectively for age groups, p < 0.0001). Similarly, in non-shock patients and in patients with elevated cardiac markers, age-dependent differences in mortality were observed. Independent predictors of in-hospital death were: age, cardiogenic shock, elevated cardiac markers and pharmacotherapy index., Conclusions: Advanced age is associated with less aggressive pharmacological treatment and higher in-hospital mortality in NSTE ACS patients remaining in community hospitals for conservative treatment. Broader implementation of current guidelines and more frequent invasive treatment might improve the outcomes of NSTE ACS patients regardless of age.
- Published
- 2008
16. Early abciximab administration before primary percutaneous coronary intervention improves infarct-related artery patency and left ventricular function in high-risk patients with anterior wall myocardial infarction: a randomized study.
- Author
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Rakowski T, Zalewski J, Legutko J, Bartus S, Rzeszutko L, Dziewierz A, Sorysz D, Bryniarski L, Zmudka K, Kaluza GL, Dubiel JS, and Dudek D
- Subjects
- Abciximab, Aged, Coronary Angiography, Female, Humans, Infusions, Intravenous, Male, Middle Aged, Myocardial Infarction diagnostic imaging, Stroke Volume, Time Factors, Vascular Patency drug effects, Ventricular Function, Left drug effects, Angioplasty, Balloon, Coronary, Antibodies, Monoclonal administration & dosage, Immunoglobulin Fab Fragments administration & dosage, Myocardial Infarction physiopathology, Myocardial Infarction therapy, Platelet Aggregation Inhibitors administration & dosage
- Abstract
Background: Early abciximab administration before primary percutaneous coronary intervention (PPCI) for ST-segment elevation myocardial infarction (STEMI) is recommended in practice guidelines. However, the evidence supporting abciximab use before and during transfer for PPCI is limited. We investigated the effect of early abciximab administration on early reperfusion, ST-segment resolution, enzymatic infarct size, and left ventricular function in patients with first anterior wall STEMI., Methods: A total of 59 nonshock patients with STEMI admitted <12 hours to remote hospitals with anticipated delay to PPCI of <90 minutes were randomly assigned to 2 study groups: 27 patients received abciximab before transfer to catheterization laboratory (Early group), and 32 patients received abciximab immediately before PPCI (Late group)., Results: Angiography revealed more frequent infarct-related artery patency in the Early group than in the Late group (TIMI 2 + 3: 48% vs 20%, P = .04). Better ST-segment resolution of >50% 60 minutes after PPCI was found in Early group than in the Late group (84% vs 56.7%, P = .04). The area under the curve for creatine kinase-MB indicated a significantly greater extent of myocardial injury in the Late group versus the Early group (8324 +/- 4185 vs 5938 +/- 3949 U/L . h, P = .04). There was a significant difference in the 30-day left ventricular end-systolic volume index (P = .02) and end-diastolic volume index (P = .05) in the echocardiography favoring the Early group., Conclusions: Early abciximab administration before transfer for PPCI in patients with first anterior wall STEMI results in more frequent infarct-related artery patency before PPCI, better myocardial tissue perfusion after PPCI, with lower enzymatic infarct size and lower degree of left ventricular remodeling during 30-day follow-up.
- Published
- 2007
- Full Text
- View/download PDF
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