Publications by authors named "Christian J Terkelsen"

Article Synopsis
  • This study examines how age influences the effectiveness of microaxial flow pump (mAFP) treatment for patients suffering from ST-elevation myocardial infarction (STEMI) and cardiogenic shock (CS), using data from the DanGer Shock trial involving 355 participants.
  • Findings reveal that mortality rates significantly increase with age, from 31% in the youngest group to 73% in the oldest, showing younger patients (<77 years) benefit more from mAFP treatment (lower mortality), while older patients (≥77 years) do not have the same advantage.
  • The study also notes that complications were more common in the mAFP group, but overall, age significantly impacted survival outcomes, highlighting
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Background: Transradial access is recommended for coronary angiography and angioplasty, and is associated with fewer complications when compared to femoral access. Nevertheless, there is a risk of hematoma and radial artery occlusion (RAO), and substantial time may elapse until hemostasis is achieved.

Aims: We aimed to evaluate if an oximetry-guided deflation technique compared to a traditional rapid deflation technique was associated with earlier removal of the transradial band (TR-band) and lower rates of RAO following radial coronary intervention.

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Aims: Concomitant coronary artery disease (CAD) is frequent in transcatheter aortic valve implantation (TAVI) candidates. Despite societal recommendations of performing invasive coronary angiography (ICA) for coronary assessment in the pre-TAVI diagnostic workup, the prognostic value of ICA and beneficial effect of revascularization in these patients remains unclear. We aimed to determine feasibility and outcomes following a strategy of cardiac CT + coronary CT angiography (cCTA) rather than cardiac CT + ICA before TAVI.

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Article Synopsis
  • Out-of-hospital cardiac arrest is a major global health issue, necessitating effective vascular access for drug administration during resuscitation.
  • A clinical trial comparing intraosseous and intravenous methods found that both had similar effectiveness for restoring circulation, with around 30% of patients in each group succeeding.
  • At 30 days post-arrest, survival rates and favorable neurologic outcomes also showed no significant differences between the two methods, indicating both approaches are equally viable.
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Background: In DanGer Shock (the Danish-German Cardiogenic Shock trial), use of a microaxial flow pump (mAFP) in patients with ST-segment-elevation myocardial infarction-related cardiogenic shock led to lower all-cause mortality but higher rates of renal replacement therapy (RRT). In this prespecified analysis, rates and predictors of acute kidney injury (AKI) and RRT were assessed.

Methods: In this international, randomized, open-label, multicenter trial, 355 adult patients with ST-segment-elevation myocardial infarction-related cardiogenic shock were randomized to mAFP (n=179) or standard care alone (n=176).

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Importance: Mechanical circulatory support with a microaxial flow pump (MAFP) has been shown to improve survival in ST-elevation myocardial infarction-induced cardiogenic shock (STEMI-CS). Understanding the impact on hemodynamic stability over time is crucial for optimizing patient treatment.

Objective: To determine if an MAFP reduces the need for pharmacological circulatory support without compromising hemodynamics compared with standard care in STEMI-CS.

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In-stent restenosis (ISR) still occurs after percutaneous coronary intervention (PCI). Few studies have compared the outcomes of PCI for de novo stenosis with those of PCI for ISR, and the results are conflicting. The present study aimed to conduct this comparison.

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Background: Transcatheter aortic valve replacement (TAVR) has become the standard-of-care treatment for a majority of patients with severe, symptomatic aortic stenosis. The postprocedural antithrombotic therapeutic management is still a topic of debate and could affect the incidence of HALT, a phenomenon which can be assessed by 4-dimensional computed tomography (4DCT).

Trial Design: The NOTION-4 trial is a randomized controlled trial comprising TAVR patients with no indication for oral anticoagulant (OAC) therapy, comparing lifelong single antiplatelet therapy (standard arm) versus early 3-month direct oral anticoagulant (DOAC) therapy followed by single antiplateletet therapy (experimental arm).

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Article Synopsis
  • * In a trial with 455 patients, those who received PCI had a lower rate of major adverse cardiac events (26%) compared to those with conservative treatment (36%) at a two-year follow-up.
  • * However, the PCI group experienced a higher rate of bleeding events (28% vs. 20%) and had some minor procedure-related complications, indicating that while PCI may reduce cardiac risks, it also carries potential safety concerns.
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Background: Evaluation of left ventricle (LV) systolic function in patients with aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI) is challenging, as LV ejection fraction (LVEF) and global longitudinal strain are afterload dependent. LV global work indices (GWIs) estimate the afterload corrected systolic function.

Objectives: The purpose of this study was to evaluate changes in and prognostic implications of GWIs in subtypes of AS patients before and 1 month after TAVI.

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Cardiogenic shock due to ST-elevation myocardial infarction remains a critical condition with a high mortality rate, even with current revascularization techniques. The use of mechanical circulatory support, such as the microaxial flow pump device (Impella CP®), presents a promising approach to enhance cardiac output and systemic perfusion. The DanGer Shock trial explored the efficacy of Impella CP® in addition to standard care compared to standard care alone in improving survival outcomes for these patients.

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Introduction: Based on technical advancements and clinical evidence, transcatheter aortic valve implantation (TAVI) has been widely adopted. New generation TAVI valve platforms are continually being developed. Ideally, new valves should be superior or at least non-inferior regarding efficacy and safety, when compared to best-in-practice contemporary TAVI valves.

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Background: Cardiac troponins are the preferred biomarkers for the diagnosis of acute myocardial infarction. Although sex-specific 99th percentile thresholds of troponins are recommended in international guidelines, the clinical effect of their use is poorly investigated. The DANSPOT Study (The Danish Study of Sex- and Population-Specific 99th percentile upper reference limits of Troponin) aims to evaluate the clinical effect of a prospective implementation of population- and sex-specific diagnostic thresholds of troponins into clinical practice.

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Article Synopsis
  • A study examined the impact of using a microaxial flow pump alongside standard care for patients with STEMI and cardiogenic shock, focusing on mortality and safety outcomes.
  • In a trial with 360 patients, those using the pump had a lower death rate (45.8%) compared to those receiving only standard care (58.5%).
  • However, the pump group experienced a higher rate of adverse events (24.0% vs. 6.2%) and significantly more patients required renal-replacement therapy (41.9% vs. 26.7%).
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Background: Extracorporeal cardiopulmonary resuscitation (ECPR) is increasingly used for refractory out-of-hospital cardiac arrest (OHCA). However, survivors managed with ECPR are at risk of poor functional status. The purpose of this study was to investigate return to work (RTW) after refractory OHCA.

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Article Synopsis
  • The study aimed to evaluate the impact of mandatory preoperative dental screening (PDS) on the risk of infective endocarditis (IE) in patients undergoing transcatheter aortic valve implantation (TAVI), contrasting those who received mandatory PDS with those who did not.
  • Among 1,133 patients analyzed, the incidence of IE was similar between those who underwent mandatory PDS and those who did not, with 2.7% overall developing IE during the follow-up period, showing no significant difference in all-cause mortality.
  • The findings suggest that implementing mandatory PDS does not reduce the incidence of IE or improve overall mortality rates in TAVI patients, casting doubt on its
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Background: Patients with acute coronary syndromes (ACS) may have worse outcomes after percutaneous coronary intervention compared to patients without ACS.

Aims: To compare 5-year efficacy and safety outcomes in patients with and without ACS treated with biodegradable polymers, the ultrathin strut sirolimus-eluting Orsiro stent (O-SES) or the biolimus-eluting Nobori stent (N-BES).

Methods: The Scandinavian Organisation for Randomized Trials with Clinical Outcome VII is a randomized trial comparing O-SES and N-BES in an all-comer setting.

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With increased use of transcatheter aortic valve implantation (TAVI) in treatment of aortic stenosis, it is important to evaluate real life data trends in outcomes. This nationwide register-based study aimed to present an outlook on temporal trends in characteristics and outcomes, including mortality. First-time consecutive Danish patients who underwent TAVI from 2010 to 2019 were included in this study.

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Background: Transcatheter aortic valve implantation is an effective treatment for patients with aortic stenosis; however, complications related to paravalvular leakage (PVL) persist, including increased risk of mortality, cardiovascular mortality, and rehospitalisation.

Aims: We sought to evaluate the clinical outcomes and valve performance at 1 year in patients with severe aortic stenosis treated with the ACURATE neo2 valve in a post-market clinical setting.

Methods: Valve Academic Research Consortium-2 safety events were assessed up to 1 year.

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Background: Target lesion failure (TLF) remains an issue with contemporary drug-eluting stents. The dual-therapy sirolimus-eluting and CD34 antibody-coated COMBO stent (DTS) was designed to improve early healing.

Aims: We aimed to compare the 3-year outcomes of the DTS and the sirolimus-eluting Orsiro stent (SES) in all-comer patients treated with percutaneous coronary intervention.

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Paravalvular leak (PVL) is a shortcoming that can erode the clinical benefits of transcatheter valve replacement (TAVR) and therefore a readily applicable method (aortography) to quantitate PVL objectively and accurately in the interventional suite is appealing to all operators. The ratio between the areas of the time-density curves in the aorta and left ventricular outflow tract (LVOT-AR) defines the regurgitation fraction (RF). This technique has been validated in a mock circulation; a single injection in diastole was further tested in porcine and ovine models.

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Aims: The present acute myocardial infarction (AMI) rule-out strategies are challenged by the late temporal release of cardiac troponin. Copeptin is a non-specific biomarker of endogenous stress and rises early in AMI, covering the early period where troponin is still normal. An accelerated dual-marker rule-out strategy combining prehospital copeptin and in-hospital high-sensitivity troponin T could reduce length of hospital stay and thus the burden on the health care systems worldwide.

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Background: Reversible P2Y12 inhibition can be obtained with cangrelor administered intravenously. More experience with cangrelor use in acute PCI with unknown bleeding risk is needed.

Objectives: To describe real-world use of cangrelor including patient and procedure characteristics and patient outcomes.

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Background: Bicuspid aortic valve (BAV) affects approximately 1.5% of the general population and is seen in nearly 50% of candidates for aortic valve replacement (AVR). Despite increasingly utilised transcatheter aortic valve implantation (TAVI) in aortic stenosis (AS) patients, its use among patients with severe bicuspid AS is limited as BAV is a heterogeneous disease associated with multiple and complex anatomical challenges.

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Introduction: In Denmark, the incidence of and mortality from ischaemic heart disease (IHD) has been declining. In this context, it is of interest to assess any regional differences in diagnostication and invasive treatment of IHD.

Methods: We intended to describe the diagnostication and invasive treatment of IHD in Western Denmark at the regional/municipal level using the Western Denmark Heart Registry.

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