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Research Interests: Cardiology, Medicine, Echocardiography, Prospective studies, Humans, and 14 moreInternal Medicine, Female, Male, Clinical Sciences, Middle Aged, Percutaneous Coronary Intervention, Myocardial Infarction, Trials, Retrospective Studies, Ventricular Remodeling, Ejection Fraction, Logistic Models, Revascularization, and Cardiovascular medicine and haematology
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It has been shown that primary percutaneous transluminal coronary angioplasty (PTCA) for acute myocardial infarction results in higher patency rates than thrombolytic therapy. However, no data are available on differences in long-term... more
It has been shown that primary percutaneous transluminal coronary angioplasty (PTCA) for acute myocardial infarction results in higher patency rates than thrombolytic therapy. However, no data are available on differences in long-term angiographic outcome after successful primary PTCA compared with successful thrombolysis. Therefore, we compared angiographic data of the Antithrombotics in the Prevention of Reocclusion In COronary Thrombolysis (APRICOT) trial and the Zwolle primary PTCA trial. In the APRICOT trial 248 patients underwent coronary angiography at a mean of 24 hours after thrombolysis and had a patent infarct-related vessel (Thrombolysis In Myocardial Infarction-3 trial flow) when entering the study. Reocclusion rates were assessed at a second angiography after 3 months. In the Zwolle trial 136 patients had a successful primary PTCA. At 3 months 131 patients underwent a second angiography. Quantitative coronary angiography showed a significant lower mean diameter stenosis of the infarct-related vessel after primary PTCA (27 +/- 12% vs 57 +/-12%; p = 0.00001). At 3 months this difference was sustained (35 +/- 22% vs 63 +/- 26%; p = 0.00001). After thrombolysis the reocclusion rate at 3 months was 29% compared with 5% after primary PTCA (p = 0.0001). Results show that compared with successful thrombolytic therapy, primary PTCA for acute myocardial infarction results in an improved infarct-related vessel status not only short term but also long term, with a low reocclusion rate.
Research Interests: Cardiology, Comparative Study, Medicine, Complication, Humans, and 15 moreInternal Medicine, Female, Male, Exploration, Acute Myocardial Infarction, Incidence, Angioplasty, Angiography, Aged, Middle Aged, Coronary Angiography, Myocardial Infarction, Chi Square Distribution, Clinical Trials as Topic, and Cardiovascular medicine and haematology
Research Interests: Cardiology, Emergency Room, Female, Confidence intervals, Acute Myocardial Infarction, and 15 moreAnticoagulants, Aspirin, Angioplasty, Aged, Coronary Angiography, Adult, Coronary Circulation, Hemorrhage, Confidence Interval, Case Control Studies, Combined Modality Therapy, Cause of death, Cardiovascular medicine and haematology, Coronary Vessels, and Coronary Angioplasty
Research Interests: Cardiology, Humans, Internal Medicine, Heparin, Female, and 15 moreAcute Myocardial Infarction, Anticoagulants, Aspirin, Clinical Sciences, Coumarins, Coronary Angiography, Coronary heart disease, First Year, Circulation, Combination drug therapy, Flow Rate, Hemorrhage, Disease Free Survival, International normalized ratio, and Cardiovascular medicine and haematology
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Aspirin plus medium intensity coumadin versus aspirin alone in the prevention of reocclusion after successful thrombolysis for suspected acute myocardial infarction: Results of the APRICOT-2 trial Marc A. Brouwer, Paul J.P.C. van den Bergh, Ralf P.J.W. Vromans, Wim R.M. Aengevaeren, Gerrit Veen, ...more
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Research Interests: Animal Studies, Treatment Outcome, Adolescent, Emergency Medical Services, Humans, and 15 moreFemale, Feasibility Studies, Male, Clinical Sciences, Aged, Middle Aged, Pilot study, Myocardial Infarction, Adult, Adverse Event, Microbubbles, Pilot Projects, Thrombolytic Therapy, Control Group, and primary percutaneous coronary intervention
Research Interests: Medicine and Cardiologie
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Left ventricular remodeling after acute myocardial infarction: the influence of viability and revascularization- an echocardiographic substudy
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Background: The Myocardial Infarction Triage and Intervention Trial of prehospital versus hospital administration of thromoblytic therapy markedly reduced hospital treatment times and the 2 groups had similar outcomes. However, patients... more
Background: The Myocardial Infarction Triage and Intervention Trial of prehospital versus hospital administration of thromoblytic therapy markedly reduced hospital treatment times and the 2 groups had similar outcomes. However, patients treated < 70 minutes from symptom onset had better short-term outcomes. The purpose of this study was to determine the long-term influence of very early thrombolytic treatment for acute myocardial infarction. Methods and Results: A total of 360 patients were followed for vital status and cardiac-related hospital admissions over a period of 34 ± 16 months. Patients enrolled in the trial had symptoms for < 6 hours, ST-segment elevation on the prehospital electrocardiogram, and no risk factors for serious bleeding. They received aspirin and recombinant tissue plasminogen activator either before or after hospital arrival. Primary end points in this study included long-term survival and survival free of readmission to the hospital for myocardial inf...
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Background: The Antithrombotics in the Prevention of Reocclusion In COronary Thrombolysis (APRICOT)-2 trial showed that medium intensity coumadin (INR 2–3) added to aspirin reduces angiographic and clinical reocclusion in the first three... more
Background: The Antithrombotics in the Prevention of Reocclusion In COronary Thrombolysis (APRICOT)-2 trial showed that medium intensity coumadin (INR 2–3) added to aspirin reduces angiographic and clinical reocclusion in the first three months after successful thrombolysis. This analysis assesses whether the observed early clinical benefit is sustained at 5-year follow-up. Methods: In the APRICOT-2 trial 251 patients ( Results: Reocclusion rates (TIMI flow Conclusions: The early clinical benefit from medium intensity coumadin added to aspirin after successful thrombolysis is sustained at five-year follow-up. This benefit is attributed to a reduced risk for reocclusion. These observations support a role for prolonged anticoagulation in this setting.
Research Interests: Medicine and Circulation
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Objectives: This study investigated early electrocardiographic characteristics after acute myocardial infarction (AMI) to evaluate their predictive value for myocardial viability with the intention to develop an ECG prediction model.... more
Objectives: This study investigated early electrocardiographic characteristics after acute myocardial infarction (AMI) to evaluate their predictive value for myocardial viability with the intention to develop an ECG prediction model. Background: In the VIAMI-trial we demonstrated a beneficial effect of early in-hospital stenting of the infarct-related coronary artery in patients with viability in the infarct-area after AMI. Low dose dobutamine echocardiography (LDDE) is a time-consuming test with a less than 100% yield due to poor acoustic windows. It would be even more practical when simple electrocardiographic measures could help clinicians in the selection of patients with viability. Therefore, we used the electrocardiogram for detecting myocardial viability early after AMI. Methods: We retrospectively investigated 285 patients who were initially included in the VIAMI-trial. Eventually, 213 patients with proven viability and 72 patients without viability had well evaluable electr...
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Stenting of coarctation of the aorta (CoA) generally results in good angiographic results and a decrease in transcoarctation pressure gradient. However, effect on blood pressure control is less clear. The goal of the current retrospective... more
Stenting of coarctation of the aorta (CoA) generally results in good angiographic results and a decrease in transcoarctation pressure gradient. However, effect on blood pressure control is less clear. The goal of the current retrospective analysis was to investigate the effects of CoA stenting on blood pressure control. A retrospective analysis was conducted in consecutive adult patients with a CoA who underwent a percutaneous intervention at one of the three participating hospitals. Measurements included office blood pressure, invasive peak-to-peak systolic pressure over the CoA, diameter of the intima lumen at the narrowest part of the CoA and use of medication. The follow-up data were obtained, based on the most recent examination date. There were 26 native CoA and 17 recurrent CoAs (total n = 43). Seven of them underwent two procedures. Mean peak-to-peak gradient decreased from 27 mmHg to 3 mmHg (p < 0.001), and minimal diameter increased from a mean of 11 mm to 18 mm (p <...
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Research Interests: Cardiology, Prediction, Forecasting, Treatment, Treatment Outcome, and 15 morePrevention, Multivariate Analysis, Observation, Humans, Female, Male, Heart, Follow-up studies, Aged, Middle Aged, Myocardial Infarction, Public health systems and services research, Time Factors, Predictive value of tests, and Thrombolytic Therapy
Research Interests: Cardiology, Treatment, Evolution, Treatment Outcome, Humans, and 14 moreReduction, Anticoagulants, Aspirin, Recurrence, Aged, Acute Coronary Syndrome, Coumarins, Myocardial Infarction, Public health systems and services research, Combination drug therapy, Long Term, Hemorrhage, Thrombolytic Therapy, and Confidence Interval
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Research Interests: Multivariate Analysis, Humans, Heparin, Female, Male, and 14 moreFollow-up studies, Risk factors, Aspirin, Recurrence, Aged, Middle Aged, Coronary Angiography, Myocardial Infarction, Warfarin, Public health systems and services research, Prognosis, Risk Factors, Logistic Models, and Thrombolytic Therapy
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Contrast enhancement by microbubble infusion has proven its applicability in the field of diagnostic ultrasound. Recent studies also indicate a therapeutic effect of the combined use of ultrasound and microbubbles. Results from animal... more
Contrast enhancement by microbubble infusion has proven its applicability in the field of diagnostic ultrasound. Recent studies also indicate a therapeutic effect of the combined use of ultrasound and microbubbles. Results from animal studies demonstrate that diagnostic ultrasound in combination with intravenous microbubbles can dissolve thrombi. So far, this effect has never been tested in patients with an acute ST-elevation myocardial infarction (STEMI). We recently launched a pilot study in acute STEMI patients to assess safety, feasibility and efficacy of the treatment in this patient group with transthoracic three-dimensional diagnostic ultrasound and intravenous microbubbles immediately after prehospital thrombolysis, but prior to primary percutaneous coronary intervention.
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To investigate whether exercise-induced hypertension in successfully repaired adult post-coarctectomy patients is associated with hypertension on 24-h blood pressure measurement and increased left ventricular mass. One hundred and... more
To investigate whether exercise-induced hypertension in successfully repaired adult post-coarctectomy patients is associated with hypertension on 24-h blood pressure measurement and increased left ventricular mass. One hundred and forty-four consecutive post-coarctectomy patients (mean age 31.5 years, range 17-74 years; mean age at repair 7.9 years, range 0-45 years) from three tertiary referral centres were studied using ambulatory blood pressure monitoring, treadmill exercise testing and echocardiography. Of the 144 patients, 27 (19%) were known to have sustained hypertension, based on their history, and all were on antihypertensive medication. However, 32 (27%) of the remaining 117 patients showed elevated mean daytime systolic blood pressure readings at 24-h ambulatory blood pressure monitoring (systolic blood pressure &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; or = 140 mmHg). Of the remaining 85 patients with normal mean daytime systolic blood pressure, 18 patients (21%) had exercise-induced hypertension (maximal exercise systolic blood pressure &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 200 mmHg). Mean daytime systolic blood pressure was higher in the exercise-induced hypertensive patients compared to the normotensive patients with normal exercise blood pressure (134 +/- 5 versus 129 +/- 7 mmHg, P = 0.008). By multivariate analysis, both maximal exercise systolic blood pressure (P = 0.007) and resting systolic blood pressure (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001) were independently associated with mean daytime systolic blood pressure. Maximal exercise systolic blood pressure had no independent predictive value for left ventricular mass (P = 0.132). In adult post-coarctectomy patients, maximal exercise systolic blood pressure is independently associated with mean daytime systolic blood pressure at ambulatory blood pressure monitoring. In this study no independent predictive value of maximal exercise systolic blood pressure for left ventricular mass could be demonstrated.
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It has been shown that primary percutaneous transluminal coronary angioplasty (PTCA) for acute myocardial infarction results in higher patency rates than thrombolytic therapy. However, no data are available on differences in long-term... more
It has been shown that primary percutaneous transluminal coronary angioplasty (PTCA) for acute myocardial infarction results in higher patency rates than thrombolytic therapy. However, no data are available on differences in long-term angiographic outcome after successful primary PTCA compared with successful thrombolysis. Therefore, we compared angiographic data of the Antithrombotics in the Prevention of Reocclusion In COronary Thrombolysis (APRICOT) trial and the Zwolle primary PTCA trial. In the APRICOT trial 248 patients underwent coronary angiography at a mean of 24 hours after thrombolysis and had a patent infarct-related vessel (Thrombolysis In Myocardial Infarction-3 trial flow) when entering the study. Reocclusion rates were assessed at a second angiography after 3 months. In the Zwolle trial 136 patients had a successful primary PTCA. At 3 months 131 patients underwent a second angiography. Quantitative coronary angiography showed a significant lower mean diameter stenosis of the infarct-related vessel after primary PTCA (27 +/- 12% vs 57 +/-12%; p = 0.00001). At 3 months this difference was sustained (35 +/- 22% vs 63 +/- 26%; p = 0.00001). After thrombolysis the reocclusion rate at 3 months was 29% compared with 5% after primary PTCA (p = 0.0001). Results show that compared with successful thrombolytic therapy, primary PTCA for acute myocardial infarction results in an improved infarct-related vessel status not only short term but also long term, with a low reocclusion rate.