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Response to Comment on Stiermaier et al. Prevalence and Prognostic Impact of Diabetes in Takotsubo Syndrome: Insights From the International, Multicenter GEIST Registry. Diabetes Care 2018;41:1084-1088
No full textEconomic implications of intra-aortic balloon support for myocardial infarction with cardiogenic shock: an analysis from the IABP-SHOCK II-trial
No full textThe Intra-aortic Balloon Pump in Cardiogenic Shock II (IABP-SHOCK II) trial has demonstrated the safety of intra-aortic balloon (IABP) support in patients with acute myocardial infarction (AMI) complicated by cardiogenic shock, but no beneficial effect on mortality. Currently, intra-aortic balloon pumping is still the most widely used support device. However, little is known about the economic implications associated with this device. Data of 600 patients included in the IABP-SHOCK II trial (registered at ClinicalTrials.gov, NCT00491036) with follow-up at 30 days, 6 and 12 months were subjected to an economic analysis. Patients with cardiogenic shock complicating AMI were randomly assigned to IABP additionally to optimal medical therapy (OMT; n = 301) or OMT alone (n = 299) before early revascularization. Costs were calculated from the perspective of a German healthcare payer. Cost-effectiveness and cost-utility analyses were performed using quality-adjusted life years (QALY) and reduction in New York Heart Association (NYHA) and Canadian Cardiac Society (CCS) class as effectiveness measures. There was a statistically significant difference in overall costs between the IABP (33,155 +/- A 14,593 a,not sign) and the control group (32,538 +/- A 14,031 a,not sign, p < 0.00001). This was predominantly attributed to the IABP costs in the IABP (760 +/- A 174 a,not sign) versus control group (64 +/- A 218 a,not sign, p < 0.0001) whilst the intensive care unit costs did not differ between the groups (29,177 +/- A 12,013 a,not sign and 29,401 +/- A 12,063 a,not sign, p = 0.82). There was no significant difference in QALY or NYHA and CCS reduction, respectively (p = n.s.). IABP support is associated with higher healthcare costs as compared to conservative treatment regimens. Clinically, IABP support cannot generally be recommended in AMI complicated by cardiogenic shock in the absence of a mortality benefit. However, economically considering the relatively little contribution to overall costs generated by IABP therapy it may still be considered if clinical scenarios with an IABP-induced benefit may be identified in the future
1-Year Outcomes With Intracoronary Abciximab in Diabetic Patients Undergoing Primary Percutaneous Coronary Intervention
No full textBACKGROUND:
Diabetic patients are at increased risk for future cardiovascular events after ST-segment elevation myocardial infarction (STEMI). Administration of an intracoronary abciximab bolus during primary percutaneous coronary intervention (PCI) may be beneficial in this high-risk subgroup.
OBJECTIVES:
This study sought to report the 1-year clinical outcomes and cardiac magnetic resonance (CMR) findings in STEMI patients with and without diabetes randomized to intracoronary or intravenous abciximab bolus at the time of primary PCI.
METHODS:
Patient-level data from 3 randomized trials were pooled. The primary endpoint was the composite of death or reinfarction. Comprehensive CMR imaging was performed in 1 study.
RESULTS:
Of 2,470 patients, 473 (19%) had diabetes and 1,997 (81%) did not. At 1 year, the primary endpoint was significantly reduced in diabetic patients randomized to intracoronary abciximab compared with those randomized to intravenous bolus (9.2% vs. 17.6%; hazard ratio [HR]: 0.49; 95% confidence interval [CI]: 0.28 to 0.83; p = 0.009). The intracoronary abciximab bolus did not reduce the primary endpoint in patients without diabetes (7.4% vs. 7.5%; HR: 0.95; 95% CI: 0.68 to 1.33; p = 0.77), resulting in a significant interaction (p = 0.034). Among diabetic patients, intracoronary versus intravenous abciximab bolus was associated with a significantly reduced risk of death (5.8% vs. 11.2%; HR: 0.51; 95% CI: 0.26 to 0.98; p = 0.043) and definite/probable stent thrombosis (1.3% vs. 4.8%; HR: 0.27; 95% CI: 0.08 to 0.98; p = 0.046). At CMR (n = 792), the myocardial salvage index was significantly increased only in diabetic patients randomized to intracoronary compared with intravenous abciximab (54.4; interquartile range: 35.1 to 78.2 vs. 39.0, interquartile range: 24.7 to 61.7; p = 0.011; p for interaction vs. no diabetes = 0.016).
CONCLUSIONS:
In diabetic patients with STEMI, the administration of intracoronary abciximab improved the effectiveness of primary PCI compared with the intravenous bolus
Competence and innovation in cardiovascular MRI: statement of the German Cardiac Society
No full textDer Zusammenhang zwischen der Konzentration zirkulierender MicroRNA-133a im Blut und dem Myokardschaden sowie der klinischen Prognose bei ST-Hebungs-Myokardinfarkt
No full textOral anticoagulation in high risk Takotsubo syndrome: when should it be considered and when not?
No full textAbstract Standard pharmacological therapy in Takotsubo syndrome (TTS) is still debated and there is a lack of prospective data. In their recent work in BMC Cardiovascular Disorders Abanador-Kamper et al. found that stroke in TTS has an event rate of 2.8% after 30 days and 4.2% after 12 months and they question which patients need oral anticoagulation. According to our clinical data, TTS patients with LV thrombi may be at high risk of stroke. These patients are characterized by apical ballooning pattern, high prevalence of ST-elevation and higher troponin I levels. We have recently proposed a therapeutic algorithm for oral anticoagulation in TTS. In case of apical ballooning pattern and increased admission levels of troponin-I (> 10 ng/mL), oral anticoagulation should be considered, while in case of midventricular/basal ballooning or apical ballooning associated with troponin-I levels < 10 ng/ml, oral anticoagulation should not be considered. A simple combination of echocardiographic parameters (apical ballooning pattern),ECG data (ST-elevation at admission and persistent after 72 h) and laboratory values (troponin serum levels) could be useful for an appropriate therapeutic management of oral anticoagulation in TTS
Efficacy and safety of Glycoprotein IIb/IIIa receptor antagonists in patients with infarct-related cardiogenic shock
No full textOptimierte Wandanalyse der linksventrikulären Kinetikstörung bei Patienten mit Takotsubo-Syndrom analysiert mittels kardialer Magnetresonanztomographie
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