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1. Reperfusion therapies and in-hospital outcomes for ST-elevation myocardial infarction in europe. the ACVC-EAPCI EORP STEMI registry of the european society of cardiology

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Zeymer, U., Ludman, P., Danchin, N., Kala, P., Laroche, C., Sadeghi, M., Caporale, R., Shaheen, S. M., Legutko, J., Iakobsishvili, Z., Alhabib, K. F., Motovska, Z., Studencan, M., Mimoso, J., Becker, D., Alexopoulos, D., Kereseselidze, Z., Stojkovic, S., Zelveian, P., Goda, A., Mirrakhimov, E., Bajraktari, G., Al-Farhan, H., Serpytis, P., Raungaard, B., Marandi, T., Moore, A. M., Quinn, M., Karjalainen, P. P., Tatu-Chitolu, G., Gale, C. P., Maggioni, A. P., Weidinger, F., Sinnaeve, P., Ferrari, R., Karamfilov, K., Lidon, R. -M., Kereselidze, Z., Iakobishvili, Z., Erglis, A., Kedev, S., Dudek, D., Tatu-Chitoiu, G., Shlyakhto, E., Bunc, M., Mourali, M. S., Konte, M., Larras, F., Lefrancq, E. F., Mekhaldi, S., Shuka, N., Pavli, E., Tafaj, E., Gishto, T., Dibra, A., Duka, A., Gjana, A., Kristo, A., Knuti, G., Demiraj, A., Dado, E., Hasimi, E., Simoni, L., Siqeca, M., Sisakian, H., Hayrapetyan, H., Markosyan, S., Galustyan, L., Arustamyan, N., Kzhdryan, H., Pepoyan, S., Zirkik, A., Von Lewinski, D., Paetzold, S., Kienzl, I., Matyas, K., Neunteufl, T., Nikfardjam, M., Neuhold, U., Mihalcz, A., Glaser, F., Steinwender, C., Reiter, C., Grund, M., Hrncic, D., Hoppe, U., Hammerer, M., Hinterbuchner, L., Hengstenberg, C., Delle Karth, G., Lang, I., Winkler, W., Hasun, M., Kastner, J., Havel, C., Derntl, M., Oberegger, G., Hajos, J., Adlbrecht, C., Publig, T., Leitgeb, M. -C., Wilfing, R., Jirak, P., C. -Y., Ho, Puskas, L., Schrutka, L., Spinar, J., Parenica, J., Hlinomaz, O., Fendrychova, V., Semenka, J., Sikora, J., Sitar, J., Groch, L., Rezek, M., Novak, M., Kramarikova, P., Stasek, J., Dusek, J., Zdrahal, P., Polasek, R., Karasek, J., Seiner, J., Sukova, N., Varvarovsky, I., Lazarak, T., Novotny, V., Matejka, J., Rokyta, R., Volovar, S., Belohlavek, J., Siranec, M., Kamenik, M., Kralik, R., Ravkilde, J., Jensen, S. E., Villadsen, A., Villefrance, K., Schmidt Skov, C., Maeng, M., Moeller, K., Hasan-Ali, H., Ahmed, T. A., Hassan, M., Elguindy, A., Farouk Ismail, M., Ibrahim Abd El-Aal, A., El-Sayed Gaafar, A., Magdy Hassan, H., Ahmed Shafie, M., Nabil El-Khouly, M., Bendary, A., Darwish, M., Ahmed, Y., Amin, O. A., Abdelhakim, A., Abosaif, K., Kandil, H., Galal, M. A. G., El Hefny, E. E., El Sayed, M., Aly, K., Mokarrab, M., Osman, M., Abdelhamid, M., Mantawy, S., Ali, M. R., Kaky, S. D., Khalil, V. A., Saraya, M. E. A., Talaat, A., Nabil, M., Mounir, W. M., Mahmoud, K., Aransa, A., Kazamel, G., Anwar, S., Al-Habbaa, A., Abd El Monem, M., Ismael, A., Amin Abu-Sheaishaa, M., Abd Rabou, M. M., Hammouda, T. M. A., Moaaz, M., Elkhashab, K., Ragab, T., Rashwan, A., Rmdan, A., Abdelrazek, G., Ebeid, H., Soliman Ghareeb, H., Farag, N., Zaki, M., Seleem, M., Torki, A., Youssef, M., Allah Nasser, N. A., Rafaat, A., Selim, H., Makram, M. M., Khayyal, M., Malasi, K., Madkour, A., Kolib, M., Alkady, H., Nagah, H., Yossef, M., Wafa, A., Mahfouz, E., Faheem, G., Magdy Moris, M., Ragab, A., Ghazal, M., Mabrouk, A., El-Masry, M., Naseem, M., Samir, S., Reinmets, J., Allvee, M., Saar, A., Ainla, T., Vaide, A., Kisseljova, M., Pakosta, U., Eha, J., Lotamois, K., Sia, J., Myllymaki, J., Pinola, T., Paana, T., Mikkelsson, J., Ampio, M., Tsivilasvili, J., Zurab, P., Agladze, R., Melia, A., Gogoberidze, D., Khubua, N., Totladze, L., Metreveli, I., Chikovani, A., Eitel, I., Poss, J., Werner, M., Constantz, A., Ahrens, C., Tolksdorf, H., Klinger, S., Sack, S., Heer, T., Lekakis, J., Kanakakis, I., Xenogiannis, I., Ermidou, K., Makris, N., Ntalianis, A., Katsaros, F., Revi, E., Kafkala, K., Mihelakis, E., Diakakis, G., Grammatikopoulos, K., Voutsinos, D., Xanthopoulou, I., Mplani, V., Foussas, S., Papakonstantinou, N., Patsourakos, N., Dimopoulos, A., Derventzis, A., Athanasiou, K., Vassilikos, V. P., Papadopoulos, C., Tzikas, S., Vogiatzis, I., Datsios, A., Galitsianos, I., Koutsampasopoulos, K., Grigoriadis, S., Douras, A., Baka, N., Spathis, S., Kyrlidis, T., Hatzinikolaou, H., Kiss, R. G., Nowotta, F., Toth, K., Szabo, S., Lakatos, C., Jambrik, Z., Ruzsa, J., Ruzsa, Z., Rona, S., Toth, J., Vargane Kosik, A., Toth, K. S. B., Nagy, G. G., Ondrejko, Z., Koromi, Z., Botos, B., Pourmoghadas, M., Salehi, A., Massoumi, G., Soleimani, A., Sarrafzadegan, N., Roohafza, H., Azarm, M., Mirmohammadsadeghi, A., Rajabi, D., Rahmani, Y., Siabani, S., Najafi, F., Hamzeh, B., Karim, H., Siabani, H., Saleh, N., Charehjoo, H., Zamzam, L., Al-Temimi, G., Al-Yassin, A., Mohammad, A., Ridha, A., Al-Saedi, G., Atabi, N., Sabbar, O., Mahmood, S., Dakhil, Z., Yaseen, I. F., Almyahi, M., Alkenzawi, H., Alkinani, T., Alyacopy, A., Kearney, P., Twomey, K., Shlomo, N., Beigel, R., Caldarola, P., Rutigliano, D., Sublimi Saponetti, L., Locuratolo, N., Palumbo, V., Scherillo, M., Formigli, D., Canova, P., Musumeci, G., Roncali, F., Metra, M., Lombardi, C., Visco, E., Rossi, L., Meloni, L., Montisci, R., Pippia, V., Marchetti, M. F., Congia, M., Cacace, C., Luca, G., Boscarelli, G., Indolfi, C., Ambrosio, G., Mongiardo, A., Spaccarotella, C., De Rosa, S., Canino, G., Critelli, C., Chiappetta, D., Battista, F., Gabrielli, D., Marziali, A., Bernabo, P., Navazio, A., Guerri, E., Manca, F., Gobbi, M., Oreto, Giuseppe, Andò, Giuseppe, Carerj, Scipione, Saporito, Francesco, Cimmino, Michele, Rigo, F., Zuin, G., Tuccillo, B., Scotto DI Uccio, F., Irace, L., Lorenzoni, G., Meloni, I., Merella, P., Polizzi, G. M., Pino, R., Marzilli, M., Morrone, D., Caravelli, P., Orsini, E., Mosa, S., Piovaccari, G., Santarelli, A., Cavazza, C., Romeo, F., Fedele, F., Mancone, M., Straito, M., Salvi, N., Scarparo, P., Severino, P., Razzini, C., Massaro, G., Cinque, A., Gaudio, C., Barilla, F., Torromeo, C., Porco, L., Mei, M., Iorio, R., Nassiacos, D., Barco, B., Sinagra, G., Falco, L., Priolo, L., Perkan, A., Strana, M., Percuku, L., Berisha, G., Mziu, B., Beishenkulov, M., Abdurashidova, T., Toktosunova, A., Kaliev, K., Serpytis, R., Butkute, E., Lizaitis, M., Broslavskyte, M., Xuereb, R. G., Mercieca Balbi, M., Paris, E., Buttigieg, L., Musial, W., Dobrzycki, S., Dubicki, A., Kazimierczyk, E., Tycinska, A., Wojakowski, W., Kalanska-Lukasik, B., Ochala, A., Wanha, W., Dworowy, S., Sielski, J., Janion, M., Janion-Sadowska, A., Wojtasik-Bakalarz, J., Bryniarski, L., Peruga, J. Z., Jonczyk, M., Jankowski, L., Klecha, A., Michalowska, J., Brzezinski, M., Kozmik, T., Kowalczyk, T., Adamczuk, J., Maliszewski, M., Kuziemka, P., Plaza, P., Jaros, A., Pawelec, A., Sledz, J., Bartus, S., Zmuda, W., Bogusz, M., Wisnicki, M., Szastak, G., Adamczyk, M., Suska, M., Czunko, P., Opolski, G., Kochman, J., Tomaniak, M., Miernik, S., Paczwa, K., Witkowski, A., Opolski, M. P., Staruch, A. D., Kalarus, Z., Honisz, G., Mencel, G., Swierad, M., Podolecki, T., Marques, J., Azevedo, P., Pereira, M. A., Gaspar, A., Monteiro, S., Goncalves, F., Leite, L., Manuel Lopes Dos Santos, W., Amado, J., Pereira, D., Silva, B., Caires, G., Neto, M., Rodrigues, R., Correia, A., Freitas, D., Lourenco, A., Ferreira, F., Sousa, F., Portugues, J., Calvo, L., Almeida, F., Alves, M., Silva, A., Caria, R., Seixo, F., Militaru, C., Ionica, E., Istratoaie, O., Florescu, M., Lipnitckaia, E., Osipova, O., Konstantinov, S., Bukatov, V., Vinokur, T., Egorova, E., Nefedova, E., Levashov, S., Gorbunova, A., Redkina, M., Karaulovskaya, N., Bijieva, F., Babich, N., Smirnova, O., Filyanin, R., Eseva, S., Kutluev, A., Chlopenova, A., Shtanko, A., Kuppar, E., Shaekhmurzina, E., Ibragimova, M., Mullahmetova, M., Chepisova, M., Kuzminykh, M., Betkaraeva, M., Namitokov, A., Khasanov, N., Baleeva, L., Galeeva, Z., Magamedkerimova, F., Ivantsov, E., Tavlueva, E., Kochergina, A., Sedykh, D., Kosmachova, E., Skibitskiy, V., Porodenko, N., Litovka, K., Ulbasheva, E., Niculina, S., Petrova, M., Harkov, E., Tsybulskaya, N., Lobanova, A., Chernova, A., Kuskaeva, A., Kuskaev, A., Ruda, M., Zateyshchikov, D., Gilarov, M., Konstantinova, E., Koroleva, O., Averkova, A., Zhukova, N., Kalimullin, D., Borovkova, N., Tokareva, A., Buyanova, M., Khaisheva, L., Pirozhenko, A., Novikova, T., Yakovlev, A., Tyurina, T., Lapshin, K., Moroshkina, N., Kiseleva, M., Fedorova, S., Krylova, L., Duplyakov, D., Semenova, Y., Rusina, A., Ryabov, V., Syrkina, A., Demianov, S., Reitblat, O., Artemchuk, A., Efremova, E., Makeeva, E., Menzorov, M., Shutov, A., Klimova, N., Shevchenko, I., Elistratova, O., Kostyuckova, O., Islamov, R., Budyak, V., Ponomareva, E., Ullah Jan, U., Alshehri, A. M., Sedky, E., Alsihati, Z., Mimish, L., Selem, A., Malik, A., Majeed, O., Altnji, I., Alshehri, M., Aref, A., Alhabib, K., Aldosary, M., Tayel, S., Abd Alrahman, M., Asfina, K. N., Abdin Hussein, G., Butt, M., Markovic Nikolic, N., Obradovic, S., Djenic, N., Brajovic, M., Davidovic, A., Romanovic, R., Novakovic, V., Dekleva, M., Spasic, M., Dzudovic, B., Jovic, Z., Cvijanovic, D., Veljkovic, S., Ivanov, I., Cankovic, M., Jarakovic, M., Kovacevic, M., Trajkovic, M., Mitov, V., Jovic, A., Hudec, M., Gombasky, M., Sumbal, J., Bohm, A., Baranova, E., Kovar, F., Samos, M., Podoba, J., Kurray, P., Obona, T., Remenarikova, A., Kollarik, B., Verebova, D., Kardosova, G., Alusik, D., Macakova, J., Kozlej, M., Bayes-Genis, A., Sionis, A., Garcia Garcia, C., Duran Cambra, A., Labata Salvador, C., Rueda Sobella, F., Sans Rosello, J., Vila Perales, M., Oliveras Vila, T., Ferrer Massot, M., Baneras, J., Lekuona, I., Zugazabeitia, G., Fernandez-Ortiz, A., Viana Tejedor, A., Ferrera, C., Alvarez, V., DIaz-Castro, O., Agra-Bermejo, R. M., Gonzalez-Cambeiro, C., Gonzalez-Babarro, E., Domingo-Del Valle, J., Royuela, N., Burgos, V., Canteli, A., Castrillo, C., Cobo, M., Ruiz, M., Abu-Assi, E., Garcia Acuna, J., Zeymer, U., Ludman, P., Danchin, N., Kala, P., Laroche, C., Sadeghi, M., Caporale, R., Shaheen, S. M., Legutko, J., Iakobsishvili, Z., Alhabib, K. F., Motovska, Z., Studencan, M., Mimoso, J., Becker, D., Alexopoulos, D., Kereseselidze, Z., Stojkovic, S., Zelveian, P., Goda, A., Mirrakhimov, E., Bajraktari, G., Al-Farhan, H., Serpytis, P., Raungaard, B., Marandi, T., Moore, A. M., Quinn, M., Karjalainen, P. P., Tatu-Chitolu, G., Gale, C. P., Maggioni, A. P., Weidinger, F., Sinnaeve, P., Ferrari, R., Karamfilov, K., Lidon, R. -M., Kereselidze, Z., Iakobishvili, Z., Erglis, A., Kedev, S., Dudek, D., Tatu-Chitoiu, G., Shlyakhto, E., Bunc, M., Mourali, M. S., Konte, M., Larras, F., Lefrancq, E. F., Mekhaldi, S., Shuka, N., Pavli, E., Tafaj, E., Gishto, T., Dibra, A., Duka, A., Gjana, A., Kristo, A., Knuti, G., Demiraj, A., Dado, E., Hasimi, E., Simoni, L., Siqeca, M., Sisakian, H., Hayrapetyan, H., Markosyan, S., Galustyan, L., Arustamyan, N., Kzhdryan, H., Pepoyan, S., Zirkik, A., Von Lewinski, D., Paetzold, S., Kienzl, I., Matyas, K., Neunteufl, T., Nikfardjam, M., Neuhold, U., Mihalcz, A., Glaser, F., Steinwender, C., Reiter, C., Grund, M., Hrncic, D., Hoppe, U., Hammerer, M., Hinterbuchner, L., Hengstenberg, C., Delle Karth, G., Lang, I., Winkler, W., Hasun, M., Kastner, J., Havel, C., Derntl, M., Oberegger, G., Hajos, J., Adlbrecht, C., Publig, T., Leitgeb, M. -C., Wilfing, R., Jirak, P., Ho, C. -Y., Puskas, L., Schrutka, L., Spinar, J., Parenica, J., Hlinomaz, O., Fendrychova, V., Semenka, J., Sikora, J., Sitar, J., Groch, L., Rezek, M., Novak, M., Kramarikova, P., Stasek, J., Dusek, J., Zdrahal, P., Polasek, R., Karasek, J., Seiner, J., Sukova, N., Varvarovsky, I., Lazarak, T., Novotny, V., Matejka, J., Rokyta, R., Volovar, S., Belohlavek, J., Siranec, M., Kamenik, M., Kralik, R., Ravkilde, J., Jensen, S. E., Villadsen, A., Villefrance, K., Schmidt Skov, C., Maeng, M., Moeller, K., Hasan-Ali, H., Ahmed, T. A., Hassan, M., Elguindy, A., Farouk Ismail, M., Ibrahim Abd El-Aal, A., El-Sayed Gaafar, A., Magdy Hassan, H., Ahmed Shafie, M., Nabil El-Khouly, M., Bendary, A., Darwish, M., Ahmed, Y., Amin, O. A., Abdelhakim, A., Abosaif, K., Kandil, H., Galal, M. A. G., El Hefny, E. E., El Sayed, M., Aly, K., Mokarrab, M., Osman, M., Abdelhamid, M., Mantawy, S., Ali, M. R., Kaky, S. D., Khalil, V. A., Saraya, M. E. A., Talaat, A., Nabil, M., Mounir, W. M., Mahmoud, K., Aransa, A., Kazamel, G., Anwar, S., Al-Habbaa, A., Abd El Monem, M., Ismael, A., Amin Abu-Sheaishaa, M., Abd Rabou, M. M., Hammouda, T. M. A., Moaaz, M., Elkhashab, K., Ragab, T., Rashwan, A., Rmdan, A., Abdelrazek, G., Ebeid, H., Soliman Ghareeb, H., Farag, N., Zaki, M., Seleem, M., Torki, A., Youssef, M., Allah Nasser, N. A., Rafaat, A., Selim, H., Makram, M. M., Khayyal, M., Malasi, K., Madkour, A., Kolib, M., Alkady, H., Nagah, H., Yossef, M., Wafa, A., Mahfouz, E., Faheem, G., Magdy Moris, M., Ragab, A., Ghazal, M., Mabrouk, A., El-Masry, M., Naseem, M., Samir, S., Reinmets, J., Allvee, M., Saar, A., Ainla, T., Vaide, A., Kisseljova, M., Pakosta, U., Eha, J., Lotamois, K., Sia, J., Myllymaki, J., Pinola, T., Paana, T., Mikkelsson, J., Ampio, M., Tsivilasvili, J., Zurab, P., Agladze, R., Melia, A., Gogoberidze, D., Khubua, N., Totladze, L., Metreveli, I., Chikovani, A., Eitel, I., Poss, J., Werner, M., Constantz, A., Ahrens, C., Tolksdorf, H., Klinger, S., Sack, S., Heer, T., Lekakis, J., Kanakakis, I., Xenogiannis, I., Ermidou, K., Makris, N., Ntalianis, A., Katsaros, F., Revi, E., Kafkala, K., Mihelakis, E., Diakakis, G., Grammatikopoulos, K., Voutsinos, D., Xanthopoulou, I., Mplani, V., Foussas, S., Papakonstantinou, N., Patsourakos, N., Dimopoulos, A., Derventzis, A., Athanasiou, K., Vassilikos, V. P., Papadopoulos, C., Tzikas, S., Vogiatzis, I., Datsios, A., Galitsianos, I., Koutsampasopoulos, K., Grigoriadis, S., Douras, A., Baka, N., Spathis, S., Kyrlidis, T., Hatzinikolaou, H., Kiss, R. G., Nowotta, F., Toth, K., Szabo, S., Lakatos, C., Jambrik, Z., Ruzsa, J., Ruzsa, Z., Rona, S., Toth, J., Vargane Kosik, A., Toth, K. S. B., Nagy, G. G., Ondrejko, Z., Koromi, Z., Botos, B., Pourmoghadas, M., Salehi, A., Massoumi, G., Soleimani, A., Sarrafzadegan, N., Roohafza, H., Azarm, M., Mirmohammadsadeghi, A., Rajabi, D., Rahmani, Y., Siabani, S., Najafi, F., Hamzeh, B., Karim, H., Siabani, H., Saleh, N., Charehjoo, H., Zamzam, L., Al-Temimi, G., Al-Yassin, A., Mohammad, A., Ridha, A., Al-Saedi, G., Atabi, N., Sabbar, O., Mahmood, S., Dakhil, Z., Yaseen, I. F., Almyahi, M., Alkenzawi, H., Alkinani, T., Alyacopy, A., Kearney, P., Twomey, K., Shlomo, N., Beigel, R., Caldarola, P., Rutigliano, D., Sublimi Saponetti, L., Locuratolo, N., Palumbo, V., Scherillo, M., Formigli, D., Canova, P., Musumeci, G., Roncali, F., Metra, M., Lombardi, C., Visco, E., Rossi, L., Meloni, L., Montisci, R., Pippia, V., Marchetti, M. F., Congia, M., Cacace, C., Luca, G., Boscarelli, G., Indolfi, C., Ambrosio, G., Mongiardo, A., Spaccarotella, C., De Rosa, S., Canino, G., Critelli, C., Chiappetta, D., Battista, F., Gabrielli, D., Marziali, A., Bernabo, P., Navazio, A., Guerri, E., Manca, F., Gobbi, M., Oreto, G., Ando, G., Carerj, S., Saporito, F., Cimmino, M., Rigo, F., Zuin, G., Tuccillo, B., Scotto DI Uccio, F., Irace, L., Lorenzoni, G., Meloni, I., Merella, P., Polizzi, G. M., Pino, R., Marzilli, M., Morrone, D., Caravelli, P., Orsini, E., Mosa, S., Piovaccari, G., Santarelli, A., Cavazza, C., Romeo, F., Fedele, F., Mancone, M., Straito, M., Salvi, N., Scarparo, P., Severino, P., Razzini, C., Massaro, G., Cinque, A., Gaudio, C., Barilla, F., Torromeo, C., Porco, L., Mei, M., Iorio, R., Nassiacos, D., Barco, B., Sinagra, G., Falco, L., Priolo, L., Perkan, A., Strana, M., Percuku, L., Berisha, G., Mziu, B., Beishenkulov, M., Abdurashidova, T., Toktosunova, A., Kaliev, K., Serpytis, R., Butkute, E., Lizaitis, M., Broslavskyte, M., Xuereb, R. G., Mercieca Balbi, M., Paris, E., Buttigieg, L., Musial, W., Dobrzycki, S., Dubicki, A., Kazimierczyk, E., Tycinska, A., Wojakowski, W., Kalanska-Lukasik, B., Ochala, A., Wanha, W., Dworowy, S., Sielski, J., Janion, M., Janion-Sadowska, A., Wojtasik-Bakalarz, J., Bryniarski, L., Peruga, J. Z., Jonczyk, M., Jankowski, L., Klecha, A., Michalowska, J., Brzezinski, M., Kozmik, T., Kowalczyk, T., Adamczuk, J., Maliszewski, M., Kuziemka, P., Plaza, P., Jaros, A., Pawelec, A., Sledz, J., Bartus, S., Zmuda, W., Bogusz, M., Wisnicki, M., Szastak, G., Adamczyk, M., Suska, M., Czunko, P., Opolski, G., Kochman, J., Tomaniak, M., Miernik, S., Paczwa, K., Witkowski, A., Opolski, M. P., Staruch, A. D., Kalarus, Z., Honisz, G., Mencel, G., Swierad, M., Podolecki, T., Marques, J., Azevedo, P., Pereira, M. A., Gaspar, A., Monteiro, S., Goncalves, F., Leite, L., Manuel Lopes Dos Santos, W., Amado, J., Pereira, D., Silva, B., Caires, G., Neto, M., Rodrigues, R., Correia, A., Freitas, D., Lourenco, A., Ferreira, F., Sousa, F., Portugues, J., Calvo, L., Almeida, F., Alves, M., Silva, A., Caria, R., Seixo, F., Militaru, C., Ionica, E., Istratoaie, O., Florescu, M., Lipnitckaia, E., Osipova, O., Konstantinov, S., Bukatov, V., Vinokur, T., Egorova, E., Nefedova, E., Levashov, S., Gorbunova, A., Redkina, M., Karaulovskaya, N., Bijieva, F., Babich, N., Smirnova, O., Filyanin, R., Eseva, S., Kutluev, A., Chlopenova, A., Shtanko, A., Kuppar, E., Shaekhmurzina, E., Ibragimova, M., Mullahmetova, M., Chepisova, M., Kuzminykh, M., Betkaraeva, M., Namitokov, A., Khasanov, N., Baleeva, L., Galeeva, Z., Magamedkerimova, F., Ivantsov, E., Tavlueva, E., Kochergina, A., Sedykh, D., Kosmachova, E., Skibitskiy, V., Porodenko, N., Litovka, K., Ulbasheva, E., Niculina, S., Petrova, M., Harkov, E., Tsybulskaya, N., Lobanova, A., Chernova, A., Kuskaeva, A., Kuskaev, A., Ruda, M., Zateyshchikov, D., Gilarov, M., Konstantinova, E., Koroleva, O., Averkova, A., Zhukova, N., Kalimullin, D., Borovkova, N., Tokareva, A., Buyanova, M., Khaisheva, L., Pirozhenko, A., Novikova, T., Yakovlev, A., Tyurina, T., Lapshin, K., Moroshkina, N., Kiseleva, M., Fedorova, S., Krylova, L., Duplyakov, D., Semenova, Y., Rusina, A., Ryabov, V., Syrkina, A., Demianov, S., Reitblat, O., Artemchuk, A., Efremova, E., Makeeva, E., Menzorov, M., Shutov, A., Klimova, N., Shevchenko, I., Elistratova, O., Kostyuckova, O., Islamov, R., Budyak, V., Ponomareva, E., Ullah Jan, U., Alshehri, A. M., Sedky, E., Alsihati, Z., Mimish, L., Selem, A., Malik, A., Majeed, O., Altnji, I., Alshehri, M., Aref, A., Alhabib, K., Aldosary, M., Tayel, S., Abd Alrahman, M., Asfina, K. N., Abdin Hussein, G., Butt, M., Markovic Nikolic, N., Obradovic, S., Djenic, N., Brajovic, M., Davidovic, A., Romanovic, R., Novakovic, V., Dekleva, M., Spasic, M., Dzudovic, B., Jovic, Z., Cvijanovic, D., Veljkovic, S., Ivanov, I., Cankovic, M., Jarakovic, M., Kovacevic, M., Trajkovic, M., Mitov, V., Jovic, A., Hudec, M., Gombasky, M., Sumbal, J., Bohm, A., Baranova, E., Kovar, F., Samos, M., Podoba, J., Kurray, P., Obona, T., Remenarikova, A., Kollarik, B., Verebova, D., Kardosova, G., Alusik, D., Macakova, J., Kozlej, M., Bayes-Genis, A., Sionis, A., Garcia Garcia, C., Duran Cambra, A., Labata Salvador, C., Rueda Sobella, F., Sans Rosello, J., Vila Perales, M., Oliveras Vila, T., Ferrer Massot, M., Baneras, J., Lekuona, I., Zugazabeitia, G., Fernandez-Ortiz, A., Viana Tejedor, A., Ferrera, C., Alvarez, V., DIaz-Castro, O., Agra-Bermejo, R. M., Gonzalez-Cambeiro, C., Gonzalez-Babarro, E., Domingo-Del Valle, J., Royuela, N., Burgos, V., Canteli, A., Castrillo, C., Cobo, M., Ruiz, M., Abu-Assi, E., and Garcia Acuna, J.

Subjects
Registrie, medicine.medical_specialty, medicine.medical_treatment, Cardiology, Myocardial Reperfusion, 030204 cardiovascular system & hematology, 03 medical and health sciences, Hospital, 0302 clinical medicine, Reperfusion therapy, Percutaneous Coronary Intervention, Internal medicine, Fibrinolysis, medicine, Humans, 030212 general & internal medicine, Myocardial infarction, Registries, Prospective Studies, Prospective cohort study, Observational studies, observational studies, reperfusion therapy, business.industry, Mortality rate, Primary percutaneous coronary intervention, ST-elevation myocardial infarction, Europe, Hospitals, Treatment Outcome, ST Elevation Myocardial Infarction, Percutaneous coronary intervention, medicine.disease, primary percutaneous coronary intervention, Observational studie, 3. Good health, Prospective Studie, Cohort, Conventional PCI, Cardiology and Cardiovascular Medicine, business, Human
Abstract

Aims The aim of this study was to determine the contemporary use of reperfusion therapy in the European Society of Cardiology (ESC) member and affiliated countries and adherence to ESC clinical practice guidelines in patients with ST-elevation myocardial infarction (STEMI). Methods and results Prospective cohort (EURObservational Research Programme STEMI Registry) of hospitalized STEMI patients with symptom onset Conclusions The use of reperfusion therapy for STEMI in the ESC member and affiliated countries was high. Primary PCI was the most frequently used treatment and associated total in-hospital mortality was below 5%. However, there was geographic variation in the use of primary PCI, which was associated with differences in in-hospital mortality.

Published
2021

4. Supplementary Material for: Neointimal Healing Evaluated by Optical Coherence Tomography after Drug-Eluting Absorbable Metal Scaffold Implantation in de novo Native Coronary Lesions: Rationale and Design of the Magmaris-OCT Study

Author

Karjalainen, P., Paana, T., Sia, J., and Nammas, W.

Abstract

Objectives: We sought to explore neointimal healing assessed by optical coherence tomography (OCT) following implantation of the Magmaris sirolimus-eluting absorbable metal scaffold. Methods: The Magmaris-OCT is a prospective, multicenter, single-arm observational clinical study, intended to enrol 60 consecutive patients with up to 2 de novo native coronary lesions, each located in different major epicardial vessels, with a reference vessel diameter of 2.5-3.5 mm, and a maximum lesion length of 20 mm. Patients will undergo Magmaris scaffold implantation in the target lesion, according to the standard practice. Clinical follow-up will take place at 30 days, and at 3, 6, 9, and 12 months. For invasive-imaging follow-up, patients will be classified into 3 groups: cohort A will be scheduled for follow-up at 3 months, cohort B at 6 months, and cohort C at 12 months. Invasive imaging will include quantitative coronary angiography, OCT evaluation, and coronary flow reserve measurement. The primary end point will be the percentage of uncovered scaffold struts assessed by OCT at the prespecified follow-up. Conclusions: This study will provide insight into the short- and mid-term healing properties following Magmaris scaffold implantation, with special emphasis on the neointimal coverage of scaffold struts.

Published
2017
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6. Impact of Intraprocedural Pressure Changes on Hemodynamic Outcome During Self-Expanding TAVR.

Author

Pykäri J, Vasankari T, Ylitalo A, Porela P, Paana T, Malmberg M, Laurila S, Koskinen J, Koivisto T, and Savontaus M

Abstract

Introduction: During the transcatheter aortic valve replacement (TAVR) procedure, hemodynamic measurements can be used to evaluate transcatheter heart valve (THV) performance. We hypothesized that the occurrence of a significant decrease in invasive aortic pressure immediately after annular contact by a self-expanding THV indicates effective annular sealing. This phenomenon could thus be used as a marker for the occurrence of paravalvular leak (PVL)., Methods: Thirty-eight patients undergoing TAVR procedure with a self-expandable Evolut R or Evolut Pro (Medtronic) valve prosthesis were included in the study. Drop in aortic pressure during valve expansion was defined as a decrease in systolic pressure of 30 mmHg immediately after annular contact. The primary endpoint was the occurrence of more than mild PVL immediately after valve implantation., Results: A pressure drop was seen in 60.5% (23/38) of patients. More than mild PVL requiring balloon post-dilatation (BPD) was significantly more frequent in patients who did not have a systolic pressure decrease > 30 mmHg during valve implantation (46.7% [7/15] vs. 13.0% [3/23], respectively; p = 0.03). Patients without a systolic pressure decrease > 30 mmHg also had a lower mean cover index on computed tomography analysis (16.2% vs. 13.3%; p = 0.016). The 30-day outcomes were similar between the two groups, and echocardiography at 30 days demonstrated more than none/trace PVL in 21.1% (8/38) of patients, with no difference between the two groups., Conclusion: A decrease in aortic pressure after annular contact is associated with an increased probability of good hemodynamic outcome after self-expanding TAVR implantation. In addition to other methods, this parameter could be used as an additional marker for optimal valve positioning and hemodynamic outcome during the implantation procedure., (© 2023. The Author(s).)

Published
2023
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7. Coronary subclavian steal syndrome due to thrombosis of the left subclavian artery aneurysm: a case report.

Author

Kiugel M, Dabravolskaite V, Paana T, and Helmiö P

Abstract

Background: Coronary subclavian steal syndrome (CSSS) is an often easily overlooked cause of angina that may occur after a coronary artery bypass graft (CABG) procedure. The onset of CSSS several years after coronary revascularization has been described in case reports, and in the few retrospective reviews that compare the endovascular approach with surgical treatment. Subclavian stenosis can naturally coincide with coronary artery disease and may already be present during the initial CABG., Case Summary: A 59-year-old male with a history of three-vessel disease who had a left internal mammary artery (LIMA) bypass graft, exhibited a gradual worsening of angina that coincided with numbness and impaired function of the left fingers, hand, and arm. Myocardial perfusion imaging showed reversible ischaemia, and coronary angiography suggested a thrombotic lesion proximal to the LIMA ostium. Calcified and partially thrombosed proximal left subclavian artery (LSA) aneurysm was visualized using computed tomography imaging, whereas Doppler ultrasound revealed a partially reversed vertebral flow. The lowest risk treatment was a bypass between the left common carotid artery and the LSA. The procedure was immediately successful, with cessation of symptoms and a favourable medium-term outcome., Discussion: As no guidelines exist for such cases, the importance of multidisciplinary co-operation in diagnostics and devising a treatment plan is underlined. Moreover, screening for subclavian artery stenosis in CABG candidates should be warranted as part of the initial preoperative assessment., Competing Interests: Conflict of interest: None declared., (© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.)

Published
2023
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8. Association of CHA2DS2-VASc Score with Long-Term Incidence of New-Onset Atrial Fibrillation and Ischemic Stroke after Myocardial Infarction.

Author

Jaakkola S, Paana T, Airaksinen J, Sipilä J, and Kytö V

Abstract

The CHA2DS2-VASc score is a reliable tool used to estimate the risk of ischemic stroke (IS) in patients with atrial fibrillation (AF). Few tools exist for the prediction of new-onset AF (NOAF) after myocardial infarction (MI) and its relation to IS. We studied the usefulness of CHA2DS2-VASc in predicting NOAF and IS in a long-term follow-up after MI. Consecutive MI patients without baseline AF (n = 70,922; mean age: 68.2 years), discharged from 20 hospitals in Finland during 2005−2018, were retrospectively studied using national registries. The outcomes of interest after discharge were NOAF- and IS-assessed with competing risk analyses at one and ten years. The median follow-up was 4.2 years. The median baseline CHA2DS2-VASc score was 3 (IQR 2−5). The likelihood of both NOAF and NOAF-related IS increased stepwise with this score at one and ten years (all p < 0.0001). The one-year-adjusted subdistribution hazard ratio (sHR) was 4.03 (CI 3.68−4.42) for NOAF in patients with CHA2DS2-VASc scores ≥6 points. The cumulative incidence of IS was 15.2% in patients with NOAF vs. 6.2% in patients without AF at 10 years after MI (adj. sHR 2.12; CI 1.98−2.28; p < 0.0001). Coronary artery bypass surgery was associated with a higher NOAF incidence compared to percutaneous coronary intervention (adj. sHR 1.87; CI 1.65−2.13; p < 0.0001 one year after MI). The CHA2DS2-VASc score is a simple tool used to estimate the long-term risk of NOAF and IS after MI in patients without baseline AF. Coronary bypass surgery is associated with an increased NOAF incidence after MI.

Published
2022
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9. Minor troponin T elevation and mortality in patients with atrial fibrillation presenting to the emergency department.

Author

Paana T, Jaakkola S, Biancari F, Nuotio I, Vasankari T, Kiviniemi TO, and Airaksinen KEJ

Subjects
Aged, Aged, 80 and over, Cause of Death, Emergency Service, Hospital, Female, Humans, Male, Proportional Hazards Models, Risk Factors, Atrial Fibrillation blood, Mortality, Troponin T blood
Abstract

Background: There are limited data on the association of minor troponin elevation in unselected patients with atrial fibrillation (AF) presenting to the emergency department (ED) with adverse events. In this study, we sought to assess the early and mid-term mortality of these patients., Methods: In this observational study, 2911 patients with AF were admitted to the ED. They were divided into 3 groups based on peak high-sensitivity troponin (TnT) levels: normal (<15 ng/L), 15-50 ng/L and 51-100 ng/L. The primary outcomes of this study were all-cause mortality at 30 days and 1 year., Results: All-cause mortality was 6.7% (n = 196) at 30 days and 22.2% (n = 646) at 1 year. Mortality rate increased along with increasing levels of TnT irrespective of baseline covariates, primary discharge diagnosis and type of AF. A significant association between TnT levels and all-cause mortality was observed. The adjusted hazard ratio (HR) at 30 days was 6.02 (95% CI 2.62-13.83) for TnT 15-50 ng/L and 11.28 (95% CI 4.87-26.12) for TnT 51-100 ng/L (P<.001 for both) compared to TnT <15 ng/L. At 1 year, the adjusted HRs were 3.08 (95% CI 2.15-4.40) and 5.07 (95% CI 3.49-7.35), respectively (P < .001). When patients with TnT <15 ng/L were divided into two groups at the median value, TnT elevation of 10 to 14 ng/L was also associated with increased 1-year mortality (HR 2.51; 95% CI 1.09-5.74; P = .03)., Conclusions: Among patients with AF admitted to the ED, increased TnT levels were associated with increased early and mid-term all-cause mortality irrespective of baseline covariates and type of AF., (© 2021 Stichting European Society for Clinical Investigation Journal Foundation. Published by John Wiley & Sons Ltd.)

Published
2021
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10. Cardiac troponin elevations in marathon runners. Role of coronary atherosclerosis and skeletal muscle injury. The MaraCat Study.

Author

Paana T, Jaakkola S, Bamberg K, Saraste A, Tuunainen E, Wittfooth S, Kallio P, Heinonen OJ, Knuuti J, Pettersson K, and Airaksinen KEJ

Subjects
Adult, Atherosclerosis diagnosis, Biomarkers blood, Coronary Artery Disease diagnosis, Humans, Male, Muscular Diseases diagnosis, Prognosis, Atherosclerosis blood, Coronary Artery Disease blood, Muscle, Skeletal physiopathology, Muscular Diseases blood, Running physiology, Troponin T blood
Abstract

Background: Marathon running is associated with transient risk of sudden cardiac death and high cardiac troponin levels are common after race. There is limited data whether coronary atherosclerosis or skeletal muscle injury are related to troponin release caused by strenuous exercise. We aimed to assess whether coronary artery calcification (CAC), plaque vulnerability or skeletal muscle injury relate to cardiac troponin T (cTnT) elevations after marathon race., Methods: In this observational study, 40 male runners participating in Paavo Nurmi 2018 Marathon were recruited with an open email invitation to evaluate the prevalence of post-race cTnT elevations and their predictors. In addition to baseline and post-race laboratory investigations, 28 runners aged >44 years underwent CAC measurement with computed tomography. Coronary plaque vulnerability was evaluated by free pregnancy-associated plasma protein A (fPAPP-A) concentration and skeletal muscle injury by skeletal troponin I (skTnI) measurement., Results: The post-marathon cTnT concentrations rose above the normal reference limit in 38 (95%) participants. A 10-fold increase in skTnI concentrations was observed and elevated post-race values were seen in all participants. The correlation between the post-race cTnT and post-race skTnI (r s  = -0.26, p = 0.11) was non-significant. CAC was detected (Agatston score > 0) in 15 (53.6%) participants, with a median score of 2.0 (interquartile range [IQR] 80). There was no correlation between cTnT with CAC score or post-race fPAPP-A levels., Conclusions: Asymptomatic cardiac troponin elevations are common after prolonged strenuous exercise, but are not related to markers of coronary atherosclerosis, plaque vulnerability or skeletal muscle injury., (Copyright © 2019 The Authors. Published by Elsevier B.V. All rights reserved.)

Published
2019
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11. Etiology of Minor Troponin Elevations in Patients with Atrial Fibrillation at Emergency Department-Tropo-AF Study.

Author

Jaakkola S, Paana T, Nuotio I, Kiviniemi TO, Pouru JP, Porela P, Biancari F, and Airaksinen KEJ

Abstract

Patients with atrial fibrillation (AF) presenting to the emergency department (ED) often have elevated cardiac troponin T (TnT) levels without evidence of type 1 myocardial infarction. We sought to explore the causes and significance of minor TnT elevations in patients with AF at the ED. All patients with AF admitted to the ED of Turku University Hospital between 1 March, 2013 and 11 April, 2016, and at least two TnT measurements, were screened. Overall, 2911 patients with a maximum TnT of 100 ng/L during hospitalization were analyzed. TnT was between 15 and 100 ng/L in 2116 patients. The most common primary discharge diagnoses in this group were AF (18.1%), infection (18.3%), ischemic stroke/transient ischemic attack (10.7%), and heart failure (5.0%). Acute coronary syndrome (ACS) was equally uncommon both in patients with normal TnT and elevated TnT (4.4% vs. 4.5%). Age ≥75 years, low estimated glomerular filtration rate (eGFR), high C-reactive protein (CRP), and hemoglobin <10.0 g/dL, were the most important predictors of elevated TnT. Importantly, TnT elevation was a very frequent (>93%) finding in elderly (≥75 years) AF patients with either low eGFR or high CRP. In conclusion, minor TnT elevations carry limited diagnostic value in elderly AF patients with comorbidities.

Published
2019
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12. Optical coherence tomography follow-up 18 months after titanium-nitride-oxide-coated versus everolimus-eluting stent implantation in patients with acute coronary syndrome.

Author

Karjalainen P, Paana T, Ylitalo A, Sia J, and Nammas W

Subjects
Coated Materials, Biocompatible, Female, Follow-Up Studies, Humans, Male, Middle Aged, Neointima, Titanium, Treatment Outcome, Acute Coronary Syndrome drug therapy, Drug-Eluting Stents, Everolimus administration & dosage, Immunosuppressive Agents administration & dosage, Tomography, Optical Coherence
Abstract

Background Inadequate neointimal coverage of stent struts is associated with late stent thrombosis. Purpose To demonstrate the extent of neointimal coverage and strut malapposition in titanium-nitride-oxide-coated bioactive stents (BAS) versus everolimus-eluting stents (EES) by optical coherence tomography (OCT) performed at 18-month follow-up. Material and Methods In the BASE-ACS trial, 827 patients presenting with acute coronary syndrome were randomized to receive either BAS or EES. Forty patients (20 BAS, 20 EES) underwent OCT at 18-month follow-up for evaluation of stent strut coverage, malapposition, and neointimal hyperplasia (NIH). Primary endpoint was binary stent strut coverage (ratio of covered struts to all analyzed struts multiplied by 100). Co-primary endpoint was the percentage of malapposed struts. Results We analyzed 3465 struts in 330 cross-sections of BAS and 3327 struts in 316 cross-sections of EES. Binary stent strut coverage, based on strut-level analysis, was higher with BAS versus EES (99.5% versus 94.2%, respectively; P < 0.001), the strut-level percentage of malapposed struts was lower with BAS (0.6% versus 2.5%, respectively; P < 0.001). Yet, the mean NIH thickness was greater with BAS (237 ± 125 versus 108 ± 62 µm, respectively; P < 0.001). Conclusion In the current post-hoc analysis with OCT performed at 18 months, binary strut coverage, based on strut-level analysis, was higher with BAS versus EES; strut-level malapposed struts were fewer with BAS; yet, BAS induced thicker NIH.

Published
2017
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13. Renal sympathetic denervation for treatment of patients with heart failure: summary of the available evidence.

Author

Nammas W, Koistinen J, Paana T, and Karjalainen PP

Subjects
Blood Pressure, Heart Failure physiopathology, Humans, Kidney metabolism, Kidney surgery, Norepinephrine metabolism, Stroke Volume, Ventricular Function, Left, Heart Failure surgery, Kidney innervation, Sympathectomy methods
Abstract

Heart failure syndrome results from compensatory mechanisms that operate to restore - back to normal - the systemic perfusion pressure. Sympathetic overactivity plays a pivotal role in heart failure; norepinephrine contributes to maintenance of the systemic blood pressure and increasing preload. Cardiac norepinephrine spillover increases in patients with heart failure; norepinephrine exerts direct toxicity on cardiac myocytes resulting in a decrease of synthetic activity and/or viability. Importantly, cardiac norepinephrine spillover is a powerful predictor of mortality in patients with moderate to severe HF. This provided the rationale for trials that demonstrated survival benefit associated with the use of beta adrenergic blockers in heart failure with reduced ejection fraction. Nevertheless, the MOXCON trial demonstrated that rapid uptitration of moxonidine (inhibitor of central sympathetic outflow) in patients with heart failure was associated with excess mortality and morbidity, despite reduction of plasma norepinephrine. Interestingly, renal norepinephrine spillover was the only independent predictor of adverse outcome in patients with heart failure, in multivariable analysis. Recently, renal sympathetic denervation has emerged as a novel approach for control of blood pressure in patients with treatment-resistant hypertension. This article summarizes the available evidence for the effect of renal sympathetic denervation in the setting of heart failure. Key messages Experimental studies supported a beneficial effect of renal sympathetic denervation in heart failure with reduced ejection fraction. Clinical studies demonstrated improvement of symptoms, and left ventricular function. In heart failure and preserved ejection fraction, renal sympathetic denervation is associated with improvement of surrogate endpoints.

Published
2017
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14. Neointimal Healing Evaluated by Optical Coherence Tomography after Drug-Eluting Absorbable Metal Scaffold Implantation in de novo Native Coronary Lesions: Rationale and Design of the Magmaris-OCT Study.

Author

Karjalainen P, Paana T, Sia J, and Nammas W

Subjects
Absorbable Implants, Aged, Coronary Angiography, Coronary Restenosis etiology, Coronary Restenosis prevention & control, Female, Humans, Male, Middle Aged, Neointima pathology, Prospective Studies, Prosthesis Design, Sirolimus administration & dosage, Tissue Scaffolds, Tomography, Optical Coherence, Cardiovascular Agents administration & dosage, Coronary Artery Disease therapy, Drug-Eluting Stents, Neointima diagnostic imaging, Percutaneous Coronary Intervention instrumentation
Abstract

Objectives: We sought to explore neointimal healing assessed by optical coherence tomography (OCT) following implantation of the Magmaris sirolimus-eluting absorbable metal scaffold., Methods: The Magmaris-OCT is a prospective, multicenter, single-arm observational clinical study, intended to enrol 60 consecutive patients with up to 2 de novo native coronary lesions, each located in different major epicardial vessels, with a reference vessel diameter of 2.5-3.5 mm, and a maximum lesion length of 20 mm. Patients will undergo Magmaris scaffold implantation in the target lesion, according to the standard practice. Clinical follow-up will take place at 30 days, and at 3, 6, 9, and 12 months. For invasive-imaging follow-up, patients will be classified into 3 groups: cohort A will be scheduled for follow-up at 3 months, cohort B at 6 months, and cohort C at 12 months. Invasive imaging will include quantitative coronary angiography, OCT evaluation, and coronary flow reserve measurement. The primary end point will be the percentage of uncovered scaffold struts assessed by OCT at the prespecified follow-up., Conclusions: This study will provide insight into the short- and mid-term healing properties following Magmaris scaffold implantation, with special emphasis on the neointimal coverage of scaffold struts., (© 2017 S. Karger AG, Basel.)

Published
2017
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15. Renal sympathetic denervation for treatment of patients with atrial fibrillation: Reappraisal of the available evidence.

Author

Nammas W, Airaksinen JK, Paana T, and Karjalainen PP

Subjects
Humans, Treatment Outcome, Atrial Fibrillation surgery, Kidney innervation, Sympathectomy methods, Sympathetic Nervous System physiopathology, Sympathetic Nervous System surgery
Abstract

Afferent renal sympathetic nerve signaling regulates central sympathetic outflow. In this regard, renal sympathetic denervation has emerged as a novel interventional strategy for treatment of patients with resistant hypertension. Despite the disappointing results of the Simplicity HTN-3 randomized controlled trial, promoters of renal denervation argue that the negative results were due to ineffective denervation technique and poor patient selection. Yet, long-term "pathologic" increase of efferent sympathetic nerve activity is observed in many chronic disease states characterized by sympathetic overactivity, such as arrhythmia, heart failure, insulin resistance, and chronic kidney disease. In this review, we highlight the contemporary evidence on the safety/efficacy of renal denervation in the treatment of patients with atrial fibrillation., (Copyright © 2016 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.)

Published
2016
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16. Transcatheter leadless pacemaker implantation in a patient with a transvenous dual-chamber pacemaker already in place.

Author

Karjalainen PP, Nammas W, and Paana T

Subjects
Adult, Atrial Fibrillation complications, Atrioventricular Block complications, Cardiac Catheterization instrumentation, Combined Modality Therapy instrumentation, Combined Modality Therapy methods, Electrodes, Implanted, Female, Humans, Prosthesis Failure, Prosthesis Implantation instrumentation, Treatment Outcome, Atrial Fibrillation prevention & control, Atrioventricular Block prevention & control, Cardiac Catheterization methods, Pacemaker, Artificial, Prosthesis Implantation methods
Abstract

An 83-year-old lady had a DDDR pacemaker inserted in 1997 for symptomatic atrioventricular block. She underwent battery replacement in 2008. In 2010, she developed atrial fibrillation; the pacemaker was switched to VVIR mode. During the last 2years, ventricular lead threshold increased progressively. In December 2015, she presented for elective battery replacement. After successful battery replacement, the ventricular lead threshold remained high; therefore, we implanted a leadless transcatheter pacemaker, via femoral vein access, using a dedicated catheter delivery system. Electrical measurements at this stage revealed a pacing threshold of 0.28V at 0.24msec, and an impedance of 650Ω., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Published
2016
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17. Clinical outcome of titanium-nitride-oxide-coated cobalt-chromium stents in patients with de novo coronary lesions: 12-month results of the OPTIMAX first-in-man study.

Author

Karjalainen PP, Mikkelsson J, Paana T, and Nammas W

Subjects
Aged, Coronary Angiography, Coronary Artery Disease diagnostic imaging, Coronary Artery Disease mortality, Coronary Stenosis diagnostic imaging, Coronary Stenosis mortality, Coronary Thrombosis etiology, Coronary Thrombosis mortality, Female, Humans, Male, Middle Aged, Myocardial Infarction etiology, Myocardial Infarction mortality, Percutaneous Coronary Intervention adverse effects, Percutaneous Coronary Intervention mortality, Prospective Studies, Prosthesis Design, Risk Factors, Time Factors, Treatment Outcome, Chromium Alloys, Coated Materials, Biocompatible, Coronary Artery Disease therapy, Coronary Stenosis therapy, Oxides, Percutaneous Coronary Intervention instrumentation, Stents, Titanium
Abstract

Objectives: We explored the 12-month clinical outcome of the titanium-nitride-oxide-coated OPTIMAX stent based on cobalt-chromium platform., Background: The OPTIMAX stent demonstrated a satisfactory 6-month clinical outcome in de novo coronary lesions., Methods: We enrolled 224 consecutive symptomatic patients with significant (50%) stenosis in de novo coronary lesions, who were treated with OPTIMAX stent implantation. The primary endpoint was major adverse cardiac events at 12-month follow-up, defined as a composite of cardiac death, non-fatal myocardial infarction (MI), or ischemia-driven target lesion revascularization (TLR). Stent thrombosis was adjudicated according to the definition of the Academic Research Consortium., Results: The mean age of the cohort was 67 ± 8 years (75% males). Patients presented with acute coronary syndrome in 62.1%. Radial access was used in 92%; complex (type B and C) lesions were treated in 79.9%. Both procedural and clinical success occurred in 100% of the cases. The mean follow-up period was 366 ± 22 days. At 12-month follow-up, the primary endpoint occurred in 14 (6.3%) patients. Cardiac death occurred in three (1.3%) patients, non-fatal MI in seven (3.1%) patients, and ischemia-driven TLR in seven (3.1%) patients. No definite stent thrombosis occurred., Conclusions: In the current prospective observational study, implantation of the OPTIMAX stent demonstrated an adequate 12-month clinical outcome, with a low rate of major adverse cardiac events, and no stent thrombosis., (© 2015 Wiley Periodicals, Inc.)

Published
2016
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18. Personalized ADP-receptor inhibition strategy and outcomes following primary PCI for STEMI (PASTOR study).

Author

Mikkelsson J, Paana T, Lepantalo A, and Karjalainen PP

Subjects
Aged, Antithrombins administration & dosage, Clopidogrel, Female, Humans, Male, Middle Aged, Myocardial Infarction drug therapy, Myocardial Infarction surgery, Platelet Aggregation Inhibitors administration & dosage, Platelet Aggregation Inhibitors adverse effects, Prospective Studies, Purinergic P2Y Receptor Antagonists adverse effects, Purinergic P2Y Receptor Antagonists therapeutic use, Ticlopidine administration & dosage, Ticlopidine adverse effects, Treatment Outcome, Myocardial Infarction blood, Myocardial Infarction therapy, Percutaneous Coronary Intervention methods, Precision Medicine methods, Purinergic P2Y Receptor Antagonists administration & dosage, Ticlopidine analogs & derivatives
Abstract

Background: Adequate antiplatelet therapy in patients with myocardial infarction with ST-elevation (STEMI) is vital in order to avoid ischemic complications. However, especially with the novel potent oral drugs, bleeding is a major concern. We aimed to investigate whether STEMI patients switched to novel ADP receptor inhibitors due to high platelet reactivity (HPR) on clopidogrel have similar outcomes compared to patients with adequate response to clopidogrel., Methods: A prospective cohort of 175 STEMI patients (mean age 62.3 years) undergoing primary PCI were included in the PASTOR study. Patients were loaded with 600 mg clopidogrel before the index PCI procedure. Bedside VerifyNow P2Y12 platelet function testing was performed the following morning., Results: 46 patients (26.3%) were found to have HPR on clopidogrel (PRU>235) and were switched to novel ADP receptor antagonists. The remaining 129 patients were treated with clopidogrel. The mean duration of dual antiplatelet therapy (DAPT) was 6.7 months. Duration of entire follow-up of patients was approximately 2 years. Major adverse cardiac events (MACE) while patients were on DAPT occurred in 7.0% in the clopidogrel group compared to 8.7% in the novel ADP receptor antagonist group (p=0.70). No differences were observed between groups off-DAPT either., Conclusions: Following primary PCI for STEMI, patients with adequate response to clopidogrel show similar outcomes compared to patients switched to novel ADP receptor antagonists due to HPR on clopidogrel. Platelet reactivity testing can be used to guide the choice of antiplatelet therapy in patients with STEMI treated by primary PCI., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)

Published
2016
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19. Mid-term clinical outcome of titanium-nitride-oxide-coated cobalt-chromium stents in patients with de novo coronary lesions: OPTIMAX first-in-man study.

Author

Karjalainen PP, Mikkelsson J, Ylitalo A, Paana T, and Nammas W

Subjects
Aged, Blood Vessel Prosthesis Implantation instrumentation, Blood Vessel Prosthesis Implantation methods, Chromium Alloys, Female, Humans, Male, Titanium administration & dosage, Treatment Outcome, Coronary Stenosis surgery, Drug-Eluting Stents, Titanium therapeutic use
Published
2014
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20. Valvular calcification and its relationship to atherosclerosis in chronic kidney disease.

Author

Leskinen Y, Paana T, Saha H, Groundstroem K, Lehtimäki T, Kilpinen S, Huhtala H, and Airaksinen J

Subjects
Adult, Aged, Aortic Valve pathology, Carotid Artery Diseases epidemiology, Chronic Disease, Comorbidity, Coronary Artery Disease epidemiology, Cross-Sectional Studies, Diabetic Angiopathies epidemiology, Diabetic Angiopathies pathology, Female, Humans, Kidney Diseases pathology, Male, Middle Aged, Mitral Valve pathology, Peripheral Vascular Diseases epidemiology, Prevalence, Risk Factors, Atherosclerosis epidemiology, Calcinosis epidemiology, Heart Valve Diseases epidemiology, Kidney Diseases epidemiology
Abstract

Background and Aim of the Study: Cardiovascular calcification is a common complication in patients with chronic kidney disease (CKD). The study aim was to identify the characteristics and risk factors of valvular calcification, and its relationship to atherosclerosis, in CKD., Methods: In this cross-sectional study, a total of 135 patients with CKD (mean age 52 +/- 11 years) included 58 pre-dialysis patients, 36 dialysis patients, and 41 renal transplant recipients. A control group of 58 subjects was also examined. The characteristics of valvular calcification were assessed using transthoracic echocardiography., Results: The combined prevalences of mitral or aortic valve calcification were 31% in pre-dialysis patients, 50% in dialysis patients, 29% in renal transplant recipients, and 12% in controls (p = 0.001). The prevalences of mitral annular calcification were 17%, 31%, 27% and 2%, respectively (p = 0.001). In multivariate analysis, the risk factors for valvular calcification in CKD were age, duration of dialysis treatment and interleukin-6 level. Mitral annular calcification proved to be five-fold more common in diabetic patients than among non-diabetics. A close association between valvular calcification and patients with or without increased carotid intima-media thickness (44% versus 15%, p < 0.001), carotid plaque (77% versus 49%, p = 0.002), calcified carotid plaque (65% versus 26%, p = 0.001), coronary artery disease (40% versus 15%, p = 0.003) and peripheral arterial disease (46% versus 9%, p < 0.001) was found., Conclusion: Valvular calcification is common in CKD, and is closely associated with findings of intimal arterial disease. The presence of inflammation and the duration of dialysis treatment contribute to this complication. Diabetes is also a prominent risk factor for mitral annular calcification in CKD.

Published
2009

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