Publications by authors named "Thomas Engstrom"
Background: Elevated Lp(a) (lipoprotein[a]) is a risk marker for atherosclerotic disease, but the underlying mechanisms remain elusive. We examined the association of Lp(a) with changes in coronary atherosclerosis following intensive lipid-lowering therapy.
Methods: In the PACMAN-AMI trial (Effects of the PCSK9 Antibody Alirocumab on Coronary Atherosclerosis in Patients With Acute Myocardial Infarction), 300 patients with acute myocardial infarction were randomized to receive biweekly alirocumab 150 mg or placebo in addition to high-intensity statins.
Background: Inflammation and neurohormonal activation play a significant role in the adverse outcome seen in acute myocardial infarction (AMI) and the development of cardiogenic shock (CS), which is associated with a mortality rate up to 50%. Treatment with anti-inflammatory drugs such as tocilizumab, an interleukin-6 receptor antagonist, has been shown to reduce troponin release and reduce the myocardial infarct size in AMI patients and it may therefore have cardioprotective properties.
Methods: This is a double-blind, placebo-controlled, single-center randomized clinical trial, including adult AMI patients without CS at hospital arrival, undergoing percutaneous coronary intervention (PCI) within 24 h from symptom onset, and at intermediate to high risk of developing CS (ORBI risk score ≥ 10).
Article Synopsis
- Cardiogenic shock (CS) affects 5-10% of acute myocardial infarction (AMI) patients and has a high 30-day mortality rate, with many patients showing signs of risk upon hospital arrival, highlighting the need for effective prevention strategies.
- The study aims to determine if administering low-dose dobutamine after revascularization can prevent hemodynamic instability in AMI patients at risk for in-hospital CS.
- A clinical trial will involve 100 patients, comparing dobutamine's effects on biomarkers and hemodynamic parameters to a placebo, with outcomes measured over several days to assess cardiac function.
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).
Article Synopsis
- Lipid content in nonobstructive coronary lesions can lead to poor clinical outcomes, particularly in relation to complications after stenting during percutaneous coronary intervention (PCI).
- A study using near-infrared spectroscopy and intravascular ultrasound evaluated the relationship between lipid levels and major adverse cardiac events (MACE) in patients who underwent PCI for myocardial infarction.
- Findings showed that high lipid levels and plaque burden at stent edges increased the risk of stent edge-related MACE, while pre- and post-PCI lipid content did not correlate with in-stent MACE.
Importance: Previous studies investigated atherosclerotic changes induced by lipid-lowering therapy in extensive coronary segments irrespective of baseline disease burden (a vessel-level approach).
Objective: To investigate the effects of lipid-lowering therapy on coronary lesions with advanced atherosclerotic plaque features and presumably higher risk for future events.
Design, Setting, And Participants: The PACMAN-AMI randomized clinical trial (enrollment: May 2017 to October 2020; final follow-up: October 2021) randomized patients with acute myocardial infarction to receive alirocumab or placebo in addition to high-intensity statin therapy.
Article Synopsis
- Complete revascularization is the standard treatment for older STEMI patients with multivessel disease, offering benefits shown in the FIRE trial, though long-term effects remain uncertain.
- A meta-analysis of several randomized clinical trials analyzed data from 1733 patients aged 75 and older, comparing complete versus culprit-only revascularization strategies.
- Results indicated that complete revascularization significantly reduced the risk of cardiovascular death or myocardial infarction in the long term, but did not show a difference in overall death rates compared to culprit-only revascularization.
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.
Importance: In patients with ST-segment elevation myocardial infarction (STEMI), acute inflammation is related to the extent of myocardial damage and may increase infarct size. Thus, administration of pulse-dose glucocorticoid in the very early phase of infarction may reduce infarct size.
Objective: To determine the cardioprotective effect of prehospital pulse-dose glucocorticoid in patients with STEMI.
A Systematic Approach to the Evaluation of the Coronary Microcirculation Using Bolus Thermodilution: CATH CMD.
J Soc Cardiovasc Angiogr Interv
July 2024
Article Synopsis
- Coronary microvascular dysfunction (CMD) can lead to chest pain (angina) even when there are no blockages in the major coronary arteries (ANOCA).
- The thermodilution technique is a useful method for measuring microvascular resistance, from which two key indices (coronary flow reserve and index of microcirculatory resistance) can be derived to assess coronary microcirculation.
- The text presents the bolus thermodilution method and an algorithm (CATH CMD) to standardize measurements and improve the diagnosis of CMD.
Article Synopsis
- Early percutaneous coronary intervention (PCI) is crucial for treating STEMI, yet the impact of delays in PCI timing has not been thoroughly evaluated.
- A study in Copenhagen analyzed the effects of delays caused by system factors or hospital distance on outcomes for STEMI patients, finding significant differences based on time from distress call to PCI.
- Results showed that delays over one hour substantially increased the risk of death, recurrent heart attacks, or heart failure, highlighting the importance of reducing the time from the first contact to PCI for better patient outcomes.
Article Synopsis
- A study was done to see if cooling a part of the heart during a heart attack (called STEMI) would help reduce damage to it.
- 200 patients were divided into two groups: one group received cooling while the other did not.
- The results showed that the cooling didn’t make a significant difference in heart damage size compared to just the standard treatment.
Background: Diffuse coronary artery disease affects the safety and efficacy of percutaneous coronary intervention (PCI). Pathophysiologic coronary artery disease patterns can be quantified using fractional flow reserve (FFR) pullbacks incorporating the pullback pressure gradient (PPG) calculation. This study aimed to establish the capacity of PPG to predict optimal revascularization and procedural outcomes.
View Article and Find Full Text PDFArticle Synopsis
- - The study investigated whether fractional flow reserve (FFR)-guided complete revascularization improved outcomes compared to treating only the culprit lesion in patients with STEMI or high-risk NSTEMI and multivessel coronary artery disease.
- - A total of 1542 patients participated, with similar rates of adverse event occurrences (death, myocardial infarction, or unplanned revascularization) between the complete revascularization group (19.0%) and the culprit-lesion-only group (20.4%) over a median follow-up of 4.8 years.
- - The findings suggest that FFR-guided complete revascularization did not significantly reduce the risk of major adverse outcomes compared to only addressing the culprit lesion, indicating
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%).
Article Synopsis
- The study aimed to assess if having a family history of unexplained heart failure (HF) in first-degree relatives increases the likelihood of developing unexplained HF themselves.
- An analysis of Danish nationwide registry data from 1978 to 2017 found that first-degree relatives of probands with unexplained HF had a significantly higher incidence rate of HF, particularly among siblings and when the proband was diagnosed at a younger age.
- The findings suggest that relatives of individuals with early-onset unexplained HF should be screened more closely due to the increased risk of developing the condition themselves.
Background And Aims: The effects of protein convertase subtilisin/kexin type 9 (PCSK9) inhibitors on endothelial function as assessed by flow-mediated dilation (FMD) in patients with acute myocardial infarction (AMI) are unknown. Therefore, we aimed to investigate the effects of the PCSK9 inhibitor alirocumab added to high-intensity statin on FMD, and its association with coronary atherosclerosis in non-infarct related arteries using intracoronary intravascular ultrasound (IVUS), near-infrared spectroscopy (NIRS), and optical coherence tomography (OCT).
Methods: This was a pre-specified substudy among patients recruited at Bern University Hospital, Switzerland, for the randomized-controlled, double-blind, PACMAN-AMI trial, which compared the effects of biweekly alirocumab 150 mg vs.
Background: Intracoronary physiology, particularly fractional flow reserve (FFR), has been used as a guide for revascularization for patients with coronary artery disease (CAD). The optimal treatment in the physiological grey-zone area has been unclear and remains subject to ongoing debate.
Methods: We conducted a systematic review of randomized controlled trials and observational studies comparing the prognostic effect of percutaneous coronary revascularization (PCI) and optimal medical therapy (OMT) in patients with CAD.
Aims: Remnant cholesterol (RC) is the cholesterol content within triglyceride-rich lipoproteins. It promotes atherosclerotic cardiovascular disease beyond LDL cholesterol (LDL-C). The prognostic role of RC in patients with ST-segment elevation myocardial infarction (STEMI) is unknown.
View Article and Find Full Text PDFBackground: We examined obstructive and nonobstructive plaque volumes in populations with subclinical and clinically manifested coronary artery disease (CAD) using quantitative computed tomography (QCT).
Methods: 855 participants with CAD (274 asymptomatic individuals, 254 acute chest pain patients without acute coronary syndrome (ACS), and 327 patients with ACS) underwent QCT of proximal coronary segments to assess participant-level plaque volumes of dense calcium, fibrous, fibrofatty, and necrotic core tissue.
Results: Nonobstructive (<50% stenosis) plaque volumes were greater than obstructive plaque volumes, irrespective of population (all p<0.
The concept that the culprit lesion in non-ST segment elevation myocardial infarction (NSTEMI) is caused by sudden plaque rupture with acute thrombus formation has recently been challenged. While angiography is an old gold-standard for culprit identification it merely visualizes the lumen contour. Optical coherence tomography (OCT) provides a detailed view of culprit features.
View Article and Find Full Text PDFBackground: Inflammation in ST-segment elevation myocardial infarction (STEMI) is an important contributor to both acute myocardial ischemia and reperfusion injury after primary percutaneous coronary intervention (PCI). Methylprednisolone is a glucocorticoid with potent anti-inflammatory properties with an acute effect and is used as an effective and safe treatment of a wide range of acute diseases. The trial aims to investigate the cardioprotective effects of pulse-dose methylprednisolone administered in the pre-hospital setting in patients with STEMI transferred for primary PCI.
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