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Background: ST-segment elevation myocardial infarction (STEMI) is associated with high early mortality. However, it remains unclear if patients surviving the early phase have long-term excess mortality., Objectives: This study aims to assess excess mortality in STEMI patients treated with primary percutaneous coronary intervention (PCI) compared with an age- and- sex-matched general population at landmark periods 0 to 30 days, 31 to 90 days, and 91 days to 10 years., Methods: Using the Western Denmark Heart Registry, we identified first-time PCI-treated patients who had primary PCI for STEMI from January 2003 to October 2018. Each patient was matched by age and sex to 5 individuals from the general population., Results: We included 18,818 patients with first-time STEMI and 94,090 individuals from the general population. Baseline comorbidity burden was similar in STEMI patients and matched individuals. Compared with the matched individuals, STEMI was associated with a 5.9% excess mortality from 0 to 30 days (6.0% vs 0.2%; HR: 36.44; 95% CI: 30.86-43.04). An excess mortality remained present from 31 to 90 days (0.9% vs 0.4%; HR: 2.43; 95% CI: 2.02-2.93). However, in 90-day STEMI survivors, the absolute excess mortality was only 2.1 percentage points at 10-year follow-up (26.5% vs 24.5%; HR: 1.04; 95% CI: 1.01-1.08). Use of secondary preventive medications such as statins, antiplatelet therapy, and beta-blockers was very high in STEMI patients throughout 10-year follow-up., Conclusions: In primary PCI-treated STEMI patients with high use of guideline-recommended therapy, patients surviving the first 90 days had 10-year mortality that was only 2% higher than that of a matched general population., Competing Interests: Funding Support and Author Disclosures The study was supported by a grant from Aase and Ejnar Danielsen’s Foundation. Dr Olesen has received grants from the Danish Cardiovascular Academy funded by the Danish Heart Association and Novo Nordisk. Dr Mortensen has received lecture fees from Novo Nordisk, Amgen, Sanofi, AstraZeneca, and Amarin. Dr Kristensen is national coordinating investigator in the SOS-AMI (Suspected Acute Myocardial Infarction) trial (Idorsia). Dr Maeng has received grants from the Novo Nordisk Foundation (grant number NNF22OC0074083); has received lecture and/or advisory board fees from AstraZeneca, Bayer, Boehringer Ingelheim, Bristol Myers Squibb, and Novo Nordisk; has received a travel grant from Novo Nordisk; has received institutional research grants from Philips, Bayer, and Novo Nordisk; has ongoing research contracts with Janssen, Novo Nordisk, and Philips; and is a minor shareholder in Novo Nordisk, Eli Lilly and Company, and Verve Therapeutics. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2024 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)

Aims: In 2010, the European Society of Cardiology Guidelines on atrial fibrillation (AF) introduced the CHA 2 DS 2 -VASc score to guide initiation of oral anticoagulation. In patients with AF undergoing percutaneous coronary intervention (PCI), triple therapy with oral anticoagulation and dual antiplatelet therapy was recommended to reduce ischaemic risk. We examined how the CHA 2 DS 2 -VASc score impacted oral anticoagulation use and risks of ischaemic and hospitalized bleeding events in patients with AF undergoing PCI., Methods: We included 6,014 patients with AF undergoing first-time PCI in Western Denmark between 2003 and 2017. We divided patients into four groups based on year of PCI and estimated 1-year risks of major adverse cardiac events (MACE) and hospitalization for bleeding., Results: The proportion of oral anticoagulation users was 48% in 2003-2006 and 49% in 2006-2010. Following the CHA 2 DS 2 -VASc score implementation, the proportion increased to 59% in 2011-2014 and 77% in 2015-2017. Using 2003-2006 as reference, risks of MACE were similar in 2007-2010 (adjusted relative risk [RR adj ] 0.99, 95% confidence interval [CI] 0.83-1.18) and 2011-2014 (RR adj 0.92, 95% CI 0.78-1.09), but declined by 23% in 2015-2017 (RR adj 0.77, 95% CI 0.65-0.92). Hospitalizations for bleeding did not increase despite wider use of triple therapy., Conclusion: Implementation of the CHA 2 DS 2 -VASc score in the 2010 European guidelines on AF was associated with an increased utilization of oral anticoagulation and triple therapy among AF patients undergoing PCI. These changes were associated with a gradual decline in the risk of MACE, while the risk of hospitalized bleeding remained unchanged., (© 2021 Stichting European Society for Clinical Investigation Journal Foundation. Published by John Wiley & Sons Ltd.)

Inflammation is an important mediator in the pathogenesis of atherosclerosis. Neutrophil gelatinase-associated lipocalin (NGAL) is a small glycoprotein secreted by neutrophils. NGAL regulates the activity of matrix metalloproteinase-9, which plays a role in plaque instability. It has therefore been hypothesised that NGAL may modulate inflammation and promote the development and progression of atherosclerosis. Our aim was to assess the predictive value of plasma NGAL in a prospective cohort study of 876 high-risk patients with stable coronary artery disease (CAD). NGAL levels were measured using the NGAL Test TM from BioPorto Diagnostics. Clinical follow-up was performed after a median of 3.1 years. The endpoint was a combination of non-fatal acute myocardial infarction (MI), cardiovascular death (CVD), or ischaemic stroke. The NGAL concentration was (median [25;75%]: 64.3 µg/L [51.3;81.4]). The area under the receiver operating characteristic curve (AUC) was 0.56 (95% confidence interval (CI): 0.49;0.64) for the diagnosis of the composite endpoint and 0.66 (95% CI: 0.56;0.75) after adding NGAL to high-sensitive C-reactive protein (hs-CRP), leucocyte count, interleukin-6 (IL-6), calprotectin, age, sex, body mass index (BMI), diabetes mellitus, smoking and creatinine. However, the AUC for hs-CRP, leucocyte count, IL-6, calprotectin, age, sex, BMI, diabetes mellitus, smoking and creatinine without NGAL was similar at 0.66 (95% CI: 0.56;0.76). NGAL alone had no predictive value with respect to the composite endpoint of non-fatal AMI, ischaemic stroke, or CVD in stable CAD patients. NGAL did not add any predictive value to the endpoint compared with existing inflammatory biomarkers and cardiovascular risk factors.

Objective: To evaluate the safety of heparin neutralisation by protamine immediately after PCI., Design: Retrospective analysis of prospectively registered data., Setting: A Danish mono-centre study., Patients: All angina pectoris patients treated with PCI between January 1999 and December 2002. The cohort was divided into two groups. Group I (n=1.129 procedures) were patients admitted January 1999 to December 1999, and group II n=4.193 procedures) were admitted January 1, 2000 to December 31, 2002., Interventions: In group I, the femoral sheath was removed 4 hours after the PCI procedure. In group II, circulating heparin was neutralised by protamine sulphate, and the femoral sheath removed immediately after the procedure., Main Outcome Measures: Rates of puncture site complications, stent thrombosis, non-fatal myocardial infarction and death during admission., Results: The rates of stent thrombosis, non-fatal myocardial infarction and in-hospital mortality were similar in the two groups. The rate of puncture site complications were 4,7% in group 1 and 2,6% in group 2 (p<0,001)., Conclusions: Circulating heparin can be safely neutralised by protamine sulphate immediately after PCI.

Transesophageal echocardiography (TEE) provides a rapid and accurate diagnosis in patients with dissection of the thoracic aorta. The procedure is considered to be safe. We report a case where rupture of a dissecting thoracic aneurysm occurred during attempted TEE in a patient, who had been clinically stable for 1 week. TEE was performed because aortic valve endocarditis was suspected, and the procedure did not include close surveillance of the blood pressure. Careful manipulation of the probe, adequate sedation, monitoring, and treatment of acute rises in blood pressure was recommended in patients with even a slight suspicion of dissection undergoing TEE. (ECHOCARDIOGRAPHY, Volume 13, July 1996)

The relation between the bleeding time and the megakaryocyte nuclear DNA content and size was evaluated in eleven consecutive patients with normal steady state thrombopoiesis undergoing thoracotomy. A statistically significant inverse correlation was found between the bleeding time and both megakaryocyte DNA content (r = -0.71, p less than 0.05), megakaryocyte total size (r = -0.58, p less than 0.05), megakaryocyte cytoplasmic size (r = -0.64, p less than 0.05) and megakaryocyte nuclear size (r = -0.58, p less than 0.05). The megakaryocyte total size and the megakaryocyte cytoplasmic size were statistically significantly larger in men than women (p less than 0.02 and p less than 0.03 respectively). Changes in the megakaryocytes in the bone marrow are associated with changes in primary haemostasis in normal individuals.

The bleeding time is shortened and the mean platelet volume is increased in the acute phase of myocardial infarction. In this follow-up study we repeated the measurement of the bleeding time, the platelet count and the platelet volume distribution in 18 patients who had suffered from a definite acute myocardial infarction two years before and in 16 control patients who had been admitted with chest pain but no definite myocardial infarction at that time. At the time of follow-up the bleeding time was significantly lengthened in the myocardial infarction group (median values = 169 s and 209 s respectively), whereas it had shortened in the control group (median values = 258 s and 228 s respectively). Comparison of the platelet volume distribution curves of the myocardial infarction patients at time of infarction and 2 years later revealed a significantly higher percentage of small platelets and significantly lower percentages of both medium-sized and large platelets at the time of infarction. These changes in the platelet volume distribution could indicate consumption of medium-sized and large platelets at the time of myocardial infarction. None of the measured variables predicted which of the patients with acute myocardial infarction would subsequently re-infarct or die. In the patients studied with definite ischaemic heart disease (n = 26) a significant negative correlation between bleeding time and mean platelet volume was found. The shortened bleeding time in myocardial infarction is related to the acute event itself or proceeds it, but is reversed two years later.