Publications by authors named "Jan Tijssen"
Background: Meticulous implantation strategies (i.e. lesion predilatation, stent sizing and postdilatation) are known to decrease lesion-oriented adverse events (LOCE) following percutaneous coronary intervention (PCI) with bioresorbable scaffolds.
View Article and Find Full Text PDFBackground: Concomitant coronary artery disease (CAD) is highly prevalent in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation (TAVI). The optimal treatment strategy for CAD is a topic of debate. An initial conservative strategy for CAD in patients undergoing TAVI may be favorable as multiple studies have failed to show an evident beneficial effect of percutaneous coronary intervention (PCI) on mortality after TAVI.
View Article and Find Full Text PDFInappropriate Therapy and Shock Rates Between the Subcutaneous and Transvenous Implantable Cardiac Defibrillator: A Secondary Analysis of the PRAETORIAN Trial.
Circ Arrhythm Electrophysiol
December 2024
Article Synopsis
- Inappropriate therapy (IAT) is a significant issue associated with implantable cardiac defibrillator (ICD) therapy, particularly highlighted in early subcutaneous ICD (S-ICD) studies which showed high rates of inappropriate shocks (IAS).
- The PRAETORIAN trial, an international study with 849 patients, found no major differences in IAT and IAS rates between S-ICD and transvenous ICD (TV-ICD) groups, as both groups had similar cumulative incidences.
- Key predictors for IAT varied between the two groups, with TV-ICD patients experiencing IAT mainly from supraventricular tachycardias, while S-ICD patients faced issues from cardiac oversensing
Article Synopsis
- The S-ICD was created to eliminate lead-related issues found in the TV-ICD, as it is an external device that sits under the skin rather than using leads inside the body.
- This analysis comes from the PRAETORIAN trial, where patients were randomly assigned to either S-ICD or TV-ICD and assessed for quality of life through various questionnaires at different stages.
- Results showed no significant differences in physical and mental well-being between the groups, but patients who experienced a shock recently reported lower social functioning and emotional health compared to those who did not.
Objectives: To evaluate real-time (day-to-day) adaptation of randomized controlled trials (RCTs) with delayed endpoints - a "forward-looking optimal-experimentation" form of response-adaptive randomization. To identify the implied tradeoffs between lowered mortality, CIs, statistical power, potential arm misidentification, and endpoint rate change during the trial.
Study Design And Setting: Using data from RCTs in acute myocardial infarction (30,732 patients in the Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries, GUSTO-1) and coronary heart disease (12,218 patients in the EURopean trial On reduction of cardiac events with Perindopril in stable coronary Artery disease, EUROPA), we resample treatment-arm assignments and expected endpoints to simulate (1) real-time assignment, (2) forward-looking assignments adapted after observing a fixed number of patients ("blocks"), and (3) a variant that balances RCT and real-time assignments.
Preventive catheter ablation for ventricular arrhythmias in patients with end-stage heart failure referred for heart transplantation evaluation: Rationale for and design of the CASTLE-VT trial.
Eur J Heart Fail
November 2024
Aims: Timely referrals for transplantation and left ventricular assist device (LVAD) play a key role in favourable outcomes in patients with advanced heart failure (HF). Cardiovascular mortality, driven by sudden cardiac death, is the main reason for dying while waiting for heart transplantation (HTx). The purpose of the Preventive Catheter Ablation for ventricular arrhythmiaS in patients with end-sTage heart faiLure rEferred for heart transplantation eValuaTion (CASTLE-VT) trial is to test the hypothesis that prophylactic catheter ablation of arrhythmogenic ventricular scar tissue will reduce mortality, need for LVAD implantation, and urgent HTx in patients with end-stage HF related to ischaemic cardiomyopathy (ICM).
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- - This study examined the effects of transcatheter aortic valve replacement (TAVR) on patients with heart failure and moderate aortic stenosis, comparing TAVR with clinical surveillance followed by valve replacement if the condition worsened.
- - A total of 178 patients were randomly assigned to either TAVR or surveillance, and results indicated that TAVR was associated with better clinical outcomes, though the statistical significance was borderline.
- - TAVR led to a more substantial improvement in heart failure symptoms, as measured by the Kansas City Cardiomyopathy Questionnaire, compared to the surveillance group after one year of follow-up.
Aims: Inflammatory lipoprotein(a) [Lp(a)] and oxidized phospholipids (OxPLs) on lipoproteins convey residual cardiovascular disease risk. The LoDoCo2 (low-dose colchicine 2) trial showed that colchicine reduced the risk for cardiovascular events occurring on standard therapies in patients with chronic coronary disease (CCS). We explored the effects of colchicine on Lp(a) and oxidized lipoprotein associated risk in a LoDoCo2 biomarker subpopulation.
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- * In a study of 194 patients, those who underwent catheter ablation showed a significant decrease in AF recurrence and improvement in their heart function, with left ventricular ejection fraction (LVEF) rising from 29.2% to 39.1% after 12 months.
- * Overall, AF ablation not only lowered AF burden but also successfully shifted patients from persistent AF to a less severe form, benefiting those with or without left atrial cardiomyopathy.
Article Synopsis
- Guidelines suggest low-dose colchicine can help prevent secondary cardiovascular issues, but its effectiveness for stroke and safety risks are still uncertain.
- A meta-analysis of six trials with nearly 15,000 patients showed colchicine reduces the risk of ischaemic stroke and major cardiovascular events by 27% without increasing serious safety concerns.
- Colchicine's benefits were consistent across different patient groups, and it didn't raise the risk of hospitalization for serious conditions or all-cause mortality.
Article Synopsis
- This study looks at how well doctors can predict sudden cardiac death after someone has a heart attack using a measurement called left ventricular ejection fraction (LVEF).
- They combined information from over 140,000 heart attack patients to see if LVEF alone is good enough for deciding who should get a heart device called a defibrillator.
- The results showed that LVEF didn't do a great job at predicting sudden cardiac death, which means doctors need better ways to tell who is at risk.
Background: The Low Dose Colchicine 2 (LoDoCo2) trial randomized 5,522 patients with chronic coronary disease to colchicine 0.5mg daily or placebo in a 1:1 ratio and demonstrated the cardiovascular benefits of colchicine. In the trial, which was conducted in Australia and The Netherlands, a prespecified subgroup analysis suggested a difference in magnitude of treatment effect of colchicine by region (Australia: HR 0.
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- * In a trial with 858 patients, results showed no significant difference in major complications between those who continued anticoagulation (16.5% experienced primary outcomes) and those who interrupted it (14.8%).
- * Continuation of anticoagulation led to higher incidences of major bleeding (31.1% vs. 21.3%), suggesting that interrupting anticoagulation is safer in this patient population undergoing TAVI.
Aims: Digoxin is the oldest drug in cardiovascular (CV) medicine, and one trial conducted >25 years ago showed a reduction in heart failure (HF) hospitalizations but no effect on mortality. However, later studies suggested that the dose of digoxin used in that trial (and other studies) may have been too high. The DECISION (Digoxin Evaluation in Chronic heart failure: Investigational Study In Outpatients in the Netherlands) trial will examine the efficacy and safety of low-dose digoxin in HF patients with reduced or mildly reduced left ventricular ejection fraction (LVEF) with a background of contemporary HF treatment.
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- Young patients with cryptogenic stroke and a patent foramen ovale (PFO) sometimes receive device closure to prevent future strokes, but about 25% may still have a residual right-to-left shunt after 6 months.
- In a study of 227 patients, it was found that at 6 months post-closure, 72.7% had no shunt, while the rest had varying degrees of residual shunt.
- By 12 months, many of these residual shunts had either diminished or closed completely, indicating that while residual shunts are common at 6 months, most are small and tend to close over time.
Article Synopsis
- The optimal management of patients with atrial fibrillation (AF) requiring oral anticoagulation (OAC) during percutaneous coronary intervention (PCI) is debated, with current guidelines suggesting a temporary triple therapy regimen that includes aspirin, which raises bleeding risks.
- A new study, the WOEST-3 trial, seeks to compare a 30-day dual antiplatelet therapy (DAPT) strategy that temporarily omits OAC against guideline-directed therapy post-PCI for AF patients, aiming to reduce bleeding without sacrificing efficacy.
- With a sample of 2,000 patients, the trial will evaluate the rates of major bleeding and adverse ischemic events, making it the first randomized controlled trial to explore the omission of OAC
Article Synopsis
- - The current clinical practice utilizes qualitative and semi-quantitative measures to assess coronary artery disease via cardiac CT, but advancements in technology are paving the way for more quantitative approaches.
- - Quantitative coronary CT angiography offers significant potential benefits for both patient management and research in the field of cardiology.
- - This document seeks to establish clear definitions and standards for how quantitative measures of coronary artery disease should be performed and reported using cardiac CT.
Article Synopsis
- - The EXPLORE trial was a 10-year study comparing chronic total occlusion (CTO) percutaneous coronary intervention (PCI) to no-CTO PCI in patients who had a ST-segment-elevation myocardial infarction (STEMI).
- - The trial found that after a median follow-up of 10 years, there was no significant difference in major adverse cardiac events or overall mortality between the two groups, but the CTO PCI group experienced higher cardiovascular mortality.
- - Although the CTO PCI group had more effective relief from dyspnea (83% vs. 65%), the findings suggest that the benefits of symptom relief should be carefully considered against the increased risk of cardiovascular mortality.
Background: The CASTLE-HTx trial demonstrated the benefit of atrial fibrillation (AF) ablation compared with medical therapy in decreasing mortality, need for left ventricular assist device implantation, or heart transplantation (HTx) in patients with end-stage heart failure (HF).
Objective: This analysis aimed to identify risk factors related to adverse outcomes in patients with end-stage HF and to assess the impact of ablation.
Methods: The CASTLE-HTx protocol randomized 194 patients with end-stage HF and AF to ablation vs medical therapy.
Introduction: Long-term endurance exercise is suspect to elevate the risk of atrial fibrillation (AF), but little is known about cardiovascular outcome and disease progression in this subgroup of AF patients. We investigated whether previous exercise level determines cardiovascular outcome.
Methods: In this post hoc analysis of the RACE 4 randomized trial, we analyzed all patients with a completed questionnaire on sports participation.
Cost-effectiveness of low-dose colchicine in patients with chronic coronary disease in The Netherlands.
Eur Heart J Qual Care Clin Outcomes
January 2025
Aims: Recent trials have shown that low-dose colchicine (0.5 mg once daily) reduces major cardiovascular events in patients with acute and chronic coronary syndromes. We aimed to estimate the cost-effectiveness of low-dose colchicine therapy in patients with chronic coronary disease when added to standard background therapy.
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