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"von Beckerath, Nicolas"
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Impact of COVID-19 outbreak on regional STEMI care in Germany
AimsTo assess the impact of the lockdown due to coronavirus disease 2019 (COVID-19) on key quality indicators for the treatment of ST-segment elevation myocardial infarction (STEMI) patients.MethodsData were obtained from 41 hospitals participating in the prospective Feedback Intervention and Treatment Times in ST-Elevation Myocardial Infarction (FITT-STEMI) study, including 15,800 patients treated for acute STEMI from January 2017 to the end of March 2020.ResultsThere was a 12.6% decrease in the total number of STEMI patients treated at the peak of the pandemic in March 2020 as compared to the mean number treated in the March months of the preceding years. This was accompanied by a significant difference among the modes of admission to hospitals (p = 0.017) with a particular decline in intra-hospital infarctions and transfer patients from other hospitals, while the proportion of patients transported by emergency medical service (EMS) remained stable. In EMS-transported patients, predefined quality indicators, such as percentages of pre-hospital ECGs (both 97%, 95% CI = − 2.2–2.7, p = 0.846), direct transports from the scene to the catheterization laboratory bypassing the emergency department (68% vs. 66%, 95% CI = − 4.9–7.9, p = 0.641), and contact-to-balloon-times of less than or equal to 90 min (58.3% vs. 57.8%, 95%CI = − 6.2–7.2, p = 0.879) were not significantly altered during the COVID-19 crisis, as was in-hospital mortality (9.2% vs. 8.5%, 95% CI = − 3.2–4.5, p = 0.739).ConclusionsClinically important indicators for STEMI management were unaffected at the peak of COVID-19, suggesting that the pre-existing logistic structure in the regional STEMI networks preserved high-quality standards even when challenged by a threatening pandemic.Clinical trial registrationNCT00794001
Journal Article
Patient delay and benefit of timely reperfusion in ST-segment elevation myocardial infarction
BackgroundIn patients with ST-segment elevation myocardial infarction (STEMI), it is unknown how patient delay modulates the beneficial effects of timely reperfusion.AimsTo assess the prognostic significance of a contact-to-balloon time of less than 90 min on in-hospital mortality in different categories of symptom-onset-to-first-medical-contact (S2C) times.MethodsA total of 20 005 consecutive patients from the Feedback Intervention and Treatment Times in ST-segment Elevation Myocardial Infarction (FITT-STEMI) programme treated with primary percutaneous coronary intervention (PCI) were included.ResultsThere were 1554 deaths (7.8%) with a J-shaped relationship between mortality and S2C time. Mortality was 10.0% in patients presenting within 1 hour, and 4.9%, 6.0% and 7.3% in patient groups with longer S2C intervals of 1–2 hours, 2–6 hours and 6–24 hours, respectively. Patients with a short S2C interval of less than 1 hour (S2C<60 min) had the highest survival benefit from timely reperfusion with PCI within 90 min (OR 0.27, 95% CI 0.23 to 0.31, p<0.0001) as compared with the three groups with longer S2C intervals of 1 hour
Journal Article
Platelet dysfunction and inhibition of multiple electrode platelet aggregometry caused by penicillin
Beta-lactam antibiotics, e.g. penicillin, may inhibit platelet function and lead to reduced response in light transmission aggregometry and adhesion. However, influence on platelet function tests more commonly used in clinical practice, such as multiple electrode platelet aggregometry (MEA), have not been described so far. We report a case of a patient with local streptococcus infection. Treatment with penicillin resulted in mild bleeding tendency after 3 days. While coagulation parameters were normal, assessment of platelet function by MEA revealed strong platelet inhibition of both ADP and arachidonic acid induced platelet aggregation comparable to normal responders to antiplatelet therapy. Change of antibiotic regime resulted in recovery of platelet function. Thus, penicillin therapy may impact on platelet function and consecutively commonly used platelet function assays, e.g. MEA.
Journal Article
Paclitaxel-Eluting or Sirolimus-Eluting Stents to Prevent Restenosis in Diabetic Patients
Drug-eluting coronary-artery stents are more effective than bare-metal stents in reducing the frequency of coronary restenosis in patients with diabetes. In a randomized, controlled trial in patients with diabetes, the sirolimus-eluting stent was associated with a smaller extent of late luminal loss than was the paclitaxel-eluting stent, suggesting that the risk of restenosis was also reduced.
In patients with diabetes, the sirolimus-eluting stent was associated with a smaller extent of late luminal loss than was the paclitaxel-eluting stent, suggesting that the risk of restenosis was also reduced.
Coronary artery disease is a major cause of complications and death among patients with diabetes mellitus.
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In particular, patients with diabetes are prone to a diffuse and rapidly progressive form of atherosclerosis, which increases their likelihood of requiring revascularization.
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Percutaneous coronary intervention and aortocoronary bypass surgery are recommended revascularization strategies for such patients. However, because of the increased risk of restenosis after percutaneous coronary interventions in these patients,
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aortocoronary bypass surgery has been considered to be the preferred revascularization strategy for many.
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Drug-eluting stents markedly reduce the incidence of restenosis as compared with bare-metal stents, both in . . .
Journal Article
Lack of association between circulating levels of plasma oxidized low-density lipoproteins and clinical outcome after coronary stenting
We undertook this study to investigate whether there is an association between circulating oxidized low-density lipoproteins (OxLDLs) and outcome after coronary stenting.
The study included 687 patients with coronary artery disease who underwent coronary stenting. Oxidized low-density lipoproteins were measured before coronary angiography. The median of OxLDL concentrations was 67.7 U/L. Patients were divided into 2 groups: the group with OxLDL levels
Journal Article
Restrictive cardiomyopathy in inherited ATTR amyloidosis (TTR-Ser23Asn) in a patient of German-Italian extraction
Amyloidosis occurs when certain soluble proteins are transformed into amyloid fibrils in the extracellular space. Most common are the light-chain amyloidoses; less common is the AA-amyloidosis, which follows chronic inflammatory diseases, and the amyloidoses of transthyretin (TTR) origin. We report on a women of Italian-German origin with the mutation TTR (Ser23Asn). Whole body scintigraphy using TC99m-DPD showed end stage hereditary amyloidosis caused by ATTR with predominant tracer retention in the myocardium. Myocardial biopsies revealed the presence of amyloid by Congo red staining. Further immunohistochemical analysis showed ATTR amyloidosis. DNA sequencing revealed a point mutation of the transthyretin gene leading to a single amino acid substitution. The only effective treatment in patients with manifest cardiac ATTR amyloidosis is combined heart and liver transplantation. Our patient was placed on a list for this procedure, but unfortunately she died during the standby procedure due to urosepsis.
Journal Article
CD14 gene −159C/T polymorphism is not associated with coronary artery disease and myocardial infarction
Background Monocyte differentiation antigen CD14 is considered an important cell-activating mediator of inflammatory responses that may result in atherosclerosis, coronary artery disease (CAD), thrombus formation, and myocardial infarction (MI). We assessed the possibility that a C → T nucleotide substitution polymorphism in the promoter (position −159) of the gene encoding CD14 constitutes a risk factor for CAD and MI. Methods Consecutive patients with significant, angiographically documented coronary stenoses but without symptoms or signs of old or acute MI constituted the group with CAD (n = 998). Consecutive patients with angiographic examination with old or acute MI constituted the group with MI (n = 793). Subjects matched with patients for age and gender but without angiographic evidence of CAD and without symptoms or signs of MI (n = 340) and a group of healthy blood donors (n = 104) served as controls. Results Genotype distributions of the −159C/T polymorphism were similar across the groups; CC:CT:TT was 26.9%:51.0%:22.1% in blood donors, 25.9%:52.0%:22.1% in matched control subjects, 27.4%:49.9%:22.7% in patients with CAD, and 29.2%:49.2%:21.6% in patients with MI. The lack of association persisted also after adjustment for the presence of conventional cardiovascular risk factors. In addition, no significant differences were found between genotype distributions of control subjects and selected subgroups of patients with CAD or MI. Conclusion These findings indicate that, in the sample of patients examined in this study, the −159C/T polymorphism of the CD14 gene is not related to CAD or MI. (Am Heart J 2002;143:971-6.)
Journal Article
4G/5G polymorphism of the plasminogen activator inhibitor-1 gene and risk of restenosis after coronary artery stenting
Plasminogen activator inhibitor-1 (PAI-1) has been proposed as a candidate risk factor for restenosis after coronary artery stenting. Transcription, level, and activity of PAI-1 are influenced by the 4G/5G polymorphism in the promoter region of PAI-1 gene. The polymorphism may therefore affect wound-healing processes in injured blood vessels and influence restenosis.
In 1850 consecutive patients, angiographic measures of restenosis and the clinical outcome at 30 days and 1 year after stent implantation were evaluated. Angiographic restenosis was defined as ≥50% diameter stenosis determined at follow-up angiography, performed 6 months after stenting. The 4G/5G genotypes were determined with TaqMan technique.
Among the patients, the frequency of the 4G allele was 0.55. Follow-up angiography was done in 84% of the patients. We observed restenosis in 32.5% of 4G/4G carriers, 32.2% of 4G/5G carriers, and 35.7% of 5G/5G carriers (
P = .52). The occurrence of a major adverse event (death, myocardial infarction, or target vessel revascularization due to restenosis-induced ischemia) was 5.6% in 4G/4G carriers, 5.3% in 4G/5G carriers, and 4.6% in 5G/5G carriers at 30 days (
P = .80), and 24.7% in 4G/4G carriers, 23.0% in 4G/5G carriers, and 26.2% in 5G/5G carriers at 1 year (
P = .45).
The 4G/5G polymorphism of the PAI-1 gene is not associated with an increased risk of thrombotic and restenotic events after coronary artery stenting.
Journal Article
C825T polymorphism of the G-protein beta3 subunit gene and atrial fibrillation: association of the TT genotype with a reduced risk for atrial fibrillation
A polymorphism consisting of a C825T substitution in the G-protein beta(3) subunit gene (GNB3) has been associated with enhanced human atrial inward rectifier potassium currents regarding the TT genotype. Therefore, we investigated a possible impact of the GNB3 C825T polymorphism on atrial fibrillation in an association study.
Two hundred ninety-one consecutive patients admitted to our center with atrial fibrillation (age, 58 +/- 10 years) and 292 consecutive control patients without atrial tachyarrhythmias (59 +/- 11 years) were genotyped for the C825T polymorphism. Patients with coronary heart disease, valvular heart disease, or cardiomyopathy were excluded from the study. Both patient groups had a similar incidence of cardiovascular risk factors (hypertension, hypercholesterolemia, body mass index).
The prevalence of the GNB3 TT genotype was significantly lower in patients with atrial fibrillation (5.8%) than in the control group (12.0%); however, no significant differences in the frequencies of the CT and CC genotypes were found. The TT genotype was associated with a 54% decrease in the adjusted risk (OR from a multivariant model, 0.46; 95% CI, 0.24 to 0.87; P =.02) for the occurrence of atrial fibrillation.
The current study suggests an association between the GNB3 TT genotype and a reduced risk for the occurrence of atrial fibrillation.
Journal Article