Explore the vast range of titles available.

Zusammenfassung Die Positronen-Emissions-Tomographie (PET) hat sich in den letzten Jahren vor allem in zwei Indikationsbereichen einen festen Platz in der Diagnostik und Therapiekontrolle der koronaren Herzkrankheit (KHK) erworben: einerseits im Rahmen der Perfusionsuntersuchungen bei der Diagnostik der KHK und zur Schweregradbeurteilung von Koronarstenosen, andererseits bei der Vitalitätsbeurteilung zur Frage der Reversibilität von ischämisch bedingten Kontraktilitätsstörungen.¶   Perfusionsuntersuchungen sind im klinischen Alltag vor allem als qualitativer und semiquantitativer Vergleich von gesunden und erkrankten Regionen als Untersuchungsprotokolle in Verbindung mit körperlicher oder medikamentöser Belastung üblich. Die Erkennung des Vorliegens einer KHK ist mit einer Sensitivität von >90% bei hoher Spezifität möglich. Bedingt durch die methodischen Vorteile gegenüber der konventionellen Szintigraphie ist die diagnostische Genauigkeit höher einzustufen, was allerdings durch die Kosten relativiert wird. Semiquantitative und v.a. quantitative Untersuchungen sind in der Lage, bereits relativ geringe Einschränkungen der myokardialen Perfusionsreserve zu diagnostizieren und somit für die nichtinvasive Diagnostik im Rahmen der Primär- und Sekundärprophylaxe sowie der Verlaufskontrolle bei manifester KHK und zur Erfolgsbeurteilung bei revaskularisierenden Maßnahmen hervorragend geeignet. Insbesondere ein Monitoring von asymptomatischen Risiko-Patienten für eine KHK (Diabetiker, familiäre Hypercholesterinämie, Raucher etc.) aber auch die Früherkennung einer Transplantatvakulopathie sind mit der PET hervorragend nicht-invasiv möglich. Quantitative Perfusionsmessungen haben zunehmende Bedeutung auch im Rahmen der Vitalitätsdiagnostik bekommen. Dennoch sind, v.a. aus logistischen und Kostengründen, quantitative Perfusionsuntersuchungen überwiegend wissenschaftlichen Fragestellungen vorbehalten. Quantitative Untersuchungen mit regionalen Messungen der Perfusion sowie des Myokardstoffwechsels ermöglichen aber ebenso wie die Untersuchungen zur kardialen Innervation und zur Pharmakotherapie des Herzens einzigartige nichtinvasive Einblicke in die Physiologie und Pathophysiologie bei verschiedenen Erkrankungen des Herzens.

PurposeThis study evaluated whether patient support, administered via an electronic device-based app, increased adherence to treatment and lifestyle changes in patients with acute coronary syndrome (ACS) treated with ticagrelor in routine clinical practice.MethodsPatients (aged ≥ 18 years) with diagnosed ACS treated with ticagrelor co-administered with low-dose acetylsalicylic acid were randomized into an active group (with support tool app for medication intake reminders and motivational messages) and a control group (without support tool app), and observed for 48 weeks (ClinicalTrials.gov Identifier: NCT02615704). Patients were asked to complete the 36-item Short-Form Health Survey (SF-36) and Lifestyle Changes Questionnaire (LSQ), and were assessed for blood pressure and body mass index (BMI) at baseline (visit 1) and at the end of the study (visit 2). Medication adherence was measured using the Brilique Adherence Questionnaire (BAQ).ResultsPatients (N = 676) were randomized to an active (n = 342) or a control (n = 334) group. BAQ data were available for 174 patients in the active group and 174 patients in the control group. Over the 48-week period, mean (standard deviation) adherence for the active and control groups was 96.4% (13.2%) and 91.5% (23.1%), respectively (effect of app intervention, p < 0.05). There were no significant differences in blood pressure and BMI between visits. General improvements in SF-36 and LSQ scores were observed for both groups.ConclusionThe patient support tool app was associated with significant improvements in patient-reported treatment adherence compared with a data collection app alone in patients prescribed ticagrelor for ACS.

PurposeReported antibiotic use in coronavirus disease 2019 (COVID-19) is far higher than the actual rate of reported bacterial co- and superinfection. A better understanding of antibiotic therapy in COVID-19 is necessary.Methods6457 SARS-CoV-2-infected cases, documented from March 18, 2020, until February 16, 2021, in the LEOSS cohort were analyzed. As primary endpoint, the correlation between any antibiotic treatment and all-cause mortality/progression to the next more advanced phase of disease was calculated for adult patients in the complicated phase of disease and procalcitonin (PCT) ≤ 0.5 ng/ml. The analysis took the confounders gender, age, and comorbidities into account.ResultsThree thousand, six hundred twenty-seven cases matched all inclusion criteria for analyses. For the primary endpoint, antibiotic treatment was not correlated with lower all-cause mortality or progression to the next more advanced (critical) phase (n = 996) (both p > 0.05). For the secondary endpoints, patients in the uncomplicated phase (n = 1195), regardless of PCT level, had no lower all-cause mortality and did not progress less to the next more advanced (complicated) phase when treated with antibiotics (p > 0.05). Patients in the complicated phase with PCT > 0.5 ng/ml and antibiotic treatment (n = 286) had a significantly increased all-cause mortality (p = 0.029) but no significantly different probability of progression to the critical phase (p > 0.05).ConclusionIn this cohort, antibiotics in SARS-CoV-2-infected patients were not associated with positive effects on all-cause mortality or disease progression. Additional studies are needed. Advice of local antibiotic stewardship- (ABS-) teams and local educational campaigns should be sought to improve rational antibiotic use in COVID-19 patients.

A novel smartphone‐based patient support tool was developed to increase the adherence to antiplatelet therapy and lifestyle changes in patients after coronary angioplasty for acute coronary syndrome (ACS). The eMocial study (ClinicalTrials.gov Identifier: NCT02615704) investigates whether an electronic support tool will improve adherence to comedication and lifestyle changes in ACS patients. The primary hypothesis of this trial is that an electronic support tool can increase adherence to comedication (primary endpoint) thereby supporting positive lifestyle changes (secondary endpoints). Patients hospitalized with ACS (ST elevation myocardial infarction [STEMI], non‐ST elevation myocardial infarction [NSTEMI], or unstable angina pectoris) and treated with ticagrelor coadministered with low‐dose acetylsalicylic acid will be randomized 1:1 to an active group receiving the patient support tool via a smartphone‐based application or to a control group without the patient support tool. Patient questionnaires to evaluate lifestyle changes and quality of life will be used at baseline and at the end of the 48‐week observation phase. Patients are asked to fill out questionnaires to determine their adherence, treatment attitudes, health‐care utilization and risk factors on a monthly basis. The study was started in February 2016 and the completion date is scheduled for October 2019. For final analysis 664 patients are expected be available. Preliminary baseline demographics were unstable angina pectoris (13.7%), NSTEMI (49.9%), STEMI (36.4%), male gender (86.3%), and diabetes mellitus (17.6%). Our study could significantly help to understand how inadequate adherence to antiplatelet therapy in ACS patients could be improved with a smartphone‐based application.

Unsatisfactory results and restenosis rates of up to 70% in complex coronary lesions created the necessity for alternative methods of percutaneous revascularization. Debulking of excess tissue seemed a promising approach in comparison to conventional PTCA. Most frequently used techniques included directional coronary atherectomy (DCA), laser angioplasty (ELCA), and rotational atherectomy (rotablation, RA). Neither of these techniques managed to establish a clear advantage over conventional PTCA so that they are indicated only under special circumstances. Even in a randomized controlled comparison of PTCA and rotablation in the treatment of in-stent restenosis, rotablation failed to show a clear advantage. This review aims to give an overview over currently used atherectomy techniques and their role in interventional cardiology.

Percutaneous coronary interventions using stents were investigated in patients with multivessel disease. Acute and long-term results were compared with those of the German Angioplasty Bypass Surgery Investigation trial in a prospective multicenter study. The study included 134 patients in whom 277 lesions were treated. Angiographic success and procedural success were achieved in 268 of 277 lesions (97%) and 118 of 134 patients (88%), respectively. Control angiography performed in 90 of 118 eligible patients (76%) exhibited restenosis in 43 of 182 lesions (24%). Multivariate regression analysis found that a diffuse lesion, the lesion and stent length, and the final luminal diameter were predictive for restenosis. Thus, immediate and long-term results of multivessel coronary intervention utilizing stents were improved compared to percutaneous transluminal coronary angioplasty of multivessel lesions. However, there is still need for improvement of long-term results, especially in particular lesion subgroups.