Effectiveness and safety of carotid artery stenting for significant carotid stenosis in patients with contralateral occlusion (from the German ALKK-CAS Registry experience).

Data on the safety of carotid artery stenting (CAS) in a large number of unselected patients with contralateral occlusion and significant ipsilateral stenosis are less known. Accordingly, we evaluated 3,137 patients undergoing CAS who were enrolled in a German Registry from 2000 to 2008 and compared the clinical features and in-hospital outcomes of those with and without contralateral carotid occlusion. Contralateral carotid occlusion was present in 191 patients (6.

EuroCMR (European Cardiovascular Magnetic Resonance) registry: results of the German pilot phase.

Objectives: During its German pilot phase, the EuroCMR (European Cardiovascular Magnetic Resonance) registry sought to evaluate indications, image quality, safety, and impact on patient management of routine CMR.

Background: CMR has a broad range of applications and is increasingly used in clinical practice.

Methods: This was a multicenter registry with consecutive enrollment of patients in 20 German centers.

Sirolimus-eluting stent treatment at high-volume centers confers lower mortality at 6-month follow-up: results from the prospective multicenter German Cypher Registry.

Background: Studies continue to identify percutaneous coronary intervention procedural volume both at the institutional level and at the operator level as being strongly correlated with outcome. High-volume centers have been defined as those that perform >400 percutaneous coronary intervention procedures per year. The relationship between drug-eluting stent procedural volume and outcome is unknown.

Beneficial effect of reperfusion therapy beyond the preservation of left ventricular function in patients with acute ST-segment elevation myocardial infarction.

Background: Reperfusion therapy has been shown to improve mortality in patients with acute ST-segment elevation myocardial infarction. However, in randomized clinical trials there was only a modest improvement in left ventricular ejection fraction with reperfusion therapy, despite a larger improvement in mortality.

Methods: In the prospective MITRA-Plus registry we compared 1-year mortality of inhospital survivors of ST-segment elevation myocardial infarction (STEMI) divided into nine groups with preserved (>55%), moderately reduced (41-55%) and severely reduced (≤40%) left ventricular ejection fraction (LVEF) and treated with no early reperfusion therapy, fibrinolysis or primary percutaneous coronary intervention (PCI) within 24 h after admission.

In-hospital outcomes after elective and non-elective percutaneous coronary interventions in hospitals with and without on-site cardiac surgery backup.

Background: Guidelines recommend on-site surgery backup (SB) when elective percutaneous coronary intervention (PCI) is performed. The evidence for this recommendation is however weak.

Objectives: The objective of the present study was to compare clinical outcomes in patients undergoing PCI in hospitals with SB or without surgery backup (non-SB).

Risk Factors and Event Rates in Patients With Atherothrombotic Disease in Germany: Results of the REACH Registry.

Introduction: The aim of the international Reduction of Atherothrombosis for Continued Health (REACH) registry was to identify prospectively characteristics, risk factors, treatments, and cardiovascular event rates in stable outpatients with atherothrombotic disease, as well as in asymptomatic patients with risk factors for atherothrombotic disease.

Methods: A total of 512 physicians in Germany enrolled 4986 outpatients with documented atherothrombotic disease, as well as 608 asymptomatic patients with at least three risk factors for atherothrombotic disease, in the REACH registry. Patients will be followed for up to four years, with assessments being performed at regular intervals; the results of the one-year follow-up are presented here.

Reperfusion therapy for acute ST-elevation and non ST-elevation myocardial infarction: what can be achieved in daily clinical practice in unselected patients at an interventional center?

Background: In the year 2000 a new definition of acute myocardial infarction (AMI) was introduced, now differentiating ST segment elevation AMI (STEMI) from non-ST segment elevation AMI (NSTEMI). The characterization of AMI patients according to this definition is still incomplete.

Methods And Results: 888 consecutive AMI patients at a single interventional center were included: 493 (55.

Guideline-oriented ambulatory lipid-lowering therapy of patients at high risk for cardiovascular events by cardiologists in clinical practice: the 2L cardio registry.

Background: Lipid-lowering treatment has been proven to decrease the rate of cardiovascular events in high-risk patients with manifest coronary artery disease (CAD) or CAD equivalent risk profile. Current treatment guidelines recommend low-density lipoprotein-cholesterol (LDL-C) less than 100 mg/dl (optional <70 mg/dl) as the target level for this high-risk population. Little is known about the ambulatory treatment of high-risk patients in clinical practice and the achievement of guideline recommended target values.

Carotid artery stenting: do procedural complications relate to the side intervened upon?: results from the Carotid Artery Stent (CAS)-Registry of the Arbeitsgemeinschaft Leitende Kardiologische Krankenhausärzte (ALKK).

Objectives: To determine the influence of the side intervened upon on outcomes during carotid artery stenting (CAS).

Background: Anatomic and technical aspects may influence the results of CAS. The value of the side intervened upon has not been analyzed yet.

Chronic total coronary occlusions in patients with stable angina pectoris: impact on therapy and outcome in present day clinical practice.

Background: Chronic total coronary occlusions (CTOs) represent a subgroup of coronary lesions with a low procedural success and high recurrence rate. However, there is evidence for a prognostic benefit of revascularizing a CTO.

Objective: This study assessed the prevalence of CTOs among patients with stable angina pectoris and its impact on therapeutic strategies.

Efficacy and safety of enoxaparin in combination with and without GP IIb/IIIa inhibitors in unselected patients with ST segment elevation myocardial infarction treated with primary percutaneous coronary intervention.

Aims: We sought to determine the efficacy of enoxaparin in unselected patients with STEMI treated with primary percutaneous coronary intervention in clinical practice.

Methods And Results: In a retrospective analysis of the prospective MITRA-plus registry we compared the outcomes of patients with primary PCI and either enoxaparin or unfractionated heparin. A total of 2,655 patients with STEMI < 12 hours were included in this analysis, 374 (14%) were treated with enoxaparin and 2,281 (86%) with unfractionated heparin.

Impact of admission blood glucose on outcomes of nondiabetic patients with acute ST-elevation myocardial infarction (from the German Acute Coronary Syndromes [ACOS] Registry).

High blood glucose in patients with acute coronary syndromes have been associated with adverse short-term outcomes in patients without diabetes. However, the relation of admission glucose to long-term outcomes in these patients was less well established. Accordingly, consecutive patients with ST-elevation myocardial infarction (STEMI) without diabetes enrolled at 155 sites from July 2000 to November 2002 in the ACOS Registry were evaluated.

Effect of chronic statin pretreatment on hospital outcome in patients with acute non-ST-elevation myocardial infarction.

Purpose: We sought to investigate the impact of prior statin therapy on in-hospital outcome in patients presenting with acute non-ST-elevation myocardial infarction.

Methods And Results: We analyzed the data of consecutive patients with non-ST-elevation myocardial infarction who were prospectively enrolled in the German Acute Coronary Syndrome Registry between July 2000 and November 2002. Overall, 6358 patients were included, and we compared the patients who received statins before hospital admission (n = 1247, 19.

Reperfusion rate and inhospital mortality of patients with ST segment elevation myocardial infarction diagnosed already in the prehospital phase: results of the German Prehospital Myocardial Infarction Registry (PREMIR).

Aims: We sought to evaluate the in-hospital fate of patients with ST segment elevation myocardial infarction (STEMI) diagnosed already in the prehospital phase by physican equipped ambulances.

Methods: A total of 2326 consecutive STEMI patients were included in PREMIR. For this analysis 218 patients with prehospital cardiopulmonary resuscitation were excluded.

[Temporal trends in the use of drug-eluting stents in German clinical practice].

Background And Purpose: : Drug-eluting stents (DES) have been shown to reduce the risk of in-stent stenosis, one of the major problems of percutaneous coronary intervention (PCI) with implantation of baremetal stents. DES are approved in Germany since 2002. The following study is based on data of the ALKK PCI registry and assesses the use of DES depending on patient characteristics, indication and coronary status comparing the treatment years 2003 and 2005.

Efficacy and safety of optimized antithrombotic therapy with aspirin, clopidogrel and enoxaparin in patients with non-ST segment elevation acute coronary syndromes in clinical practice.

In randomized clinical trials enoxaparin in non ST-elevation acute coronary syndromes (NSTE-ACS) has been shown to be more effective than unfractionated heparin in preventing the combined endpoint of death and myocardial infarction. Clopidogrel in combination with aspirin reduced the combined endpoint of death, myocardial infarction and stroke in NSTE-ACS patients compared to aspirin alone. Aim of the present study was to determine the clinical impact of optimized antithrombotic therapy with enoxaparin, clopidogrel and aspirin compared to standard therapy with unfractionated heparin (UFH) and aspirin in NSTE-ACS in clinical practice.

Efficacy of a 24-h primary percutaneous coronary intervention service on outcome in patients with ST elevation myocardial infarction in clinical practice.

Background: Primary percutaneous coronary intervention (PCI) for ST elevation myocardial infarction (STEMI) improves outcome in comparison to fibrinolysis. However, it is unclear whether patients treated in interventional facilities with 24-h primary PCI service have lower rates of adverse events.

Methods: We analyzed data of consecutive patients with STEMI prospectively enrolled in the German Acute Coronary Syndromes registry between July 2000 and November 2002 who were admitted to hospitals with catheterisation laboratory.

Angioplasty within 24 h after thrombolysis in patients with acute ST-elevation myocardial infarction: current use, predictors and outcome. Results of the MITRA plus registry.

Background: Percutaneous coronary intervention (PCI) early after thrombolysis (early PCI) in patients with ST-elevation myocardial infarction (STEMI) is currently advised by clinical guidelines, but little is known about its use in clinical practice.

Methods: We analysed the MITRA (Maximal Individual Therapy of Acute Myocardial Infarction) plus registry.

Results: Out of a total of 34276 patients with STEMI, 10600 (30.

Clinical, angiographic and cardiovascular magnetic resonance findings in consecutive patients with Takotsubo cardiomyopathy.

Background: The aim was to assess clinical, angiographic and cardiovascular magnetic resonance (CMR) findings in patients with Takotsubo cardiomyopathy.

Methods: Between 2003 and 2007, 20 consecutive patients admitted to our hospital with suspected acute myocardial infarction and presenting with apical ballooning in the left ventricular (LV) angiogram in the absence of a significant coronary artery disease, were included in the study. Echocardiography and CMR was performed in all patients.

Incidence and clinical impact of right bundle branch block in patients with acute myocardial infarction: ST elevation myocardial infarction versus non-ST elevation myocardial infarction.

Background: Both left bundle branch block and right bundle branch block (RBBB) have been associated with increased inhospital and long-term mortality in patients with acute ST elevation myocardial infarction (STEMI). However, the prognostic role of RBBB in acute non-ST elevation myocardial infarction (NSTEMI) is not well known. Therefore, the aim of the study was to evaluate the incidence and clinical impact of RBBB in patients with NSTEMI compared to patients with STEMI.

Prehospital cardiac arrest: a marker for higher mortality in patients with acute myocardial infarction and moderately reduced left ventricular function: results from the MITRA plus registry.

Background: According to the current guidelines for acute myocardial infarction, ventricular fibrillation during the acute phase of myocardial infarction is no indication for specific treatment like ICD implantation. Primary objective of our study was to evaluate the prognostic significance of cardiac arrest within the acute phase of myocardial infarction in patients with moderately reduced left ventricular function.

Methods And Results: From 1994 until 2004, we included 7111 patients with acute STEMI and an LVEF >30% from the MITRA plus registry who were discharged alive from hospital and had a complete follow up.

Influence of presentation at the weekend on treatment and outcome in ST-elevation myocardial infarction in hospitals with catheterization laboratories.

Background: Studies about the influence of various factors on clinical therapy and course in acute coronary syndromes have shown that the outcome is related to admission time to the hospital, with an impaired prognosis in patients admitted out of regular working hours. However little is known about the impact of admission on weekend in hospitals with catheterisation laboratories.

Methods: We analyzed data of the prospective MITRA-PLUS registry of 11,516 patients with ST-elevation myocardial infarction (STEMI) admitted to hospitals with catheterization facilities for differences of in-hospital mortality between patients admitted during regular working hours, at night and on weekends.

Treatment of in-stent restenosis with sirolimus-eluting-stents: results from the prospective German Cypher stent registry.

Aims: Drug-eluting stents have been reported to effectively reduce in-stent restenosis (ISR). However, the effectiveness and safety have yet been investigated only in small trials or case series. The aim of this prospective large scale registry was to show that treatment of ISR with sirolimus eluting stents (SES) is safe, effective and feasible in daily routine.

Prognostic value of the modified American College of Cardiology/American Heart Association lesion morphology classification for clinical outcome after sirolimus-eluting stent placement (results of the prospective multicenter German Cypher Registry).

The modified American College of Cardiology/American Heart Association (ACC/AHA) lesion morphology classification scheme has prognostic impact for early and late outcomes when bare-metal stents are used. Its value after drug-eluting stent placement is unknown. The predictive value of this lesion morphology classification system in patients treated using sirolimus-eluting stents included in the German Cypher Registry was prospectively examined.