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Felix Zijlstra

Publications and source records attributed to Felix Zijlstra.

At least 37 records · Page 2Linked to original sources
PubMed2006

Impact of infarct location on left ventricular ejection fraction after correction for enzymatic infarct size in acute myocardial infarction treated with primary coronary intervention.

BACKGROUND: Left ventricular function and infarct size are strong predictors for prognosis after acute myocardial infarction (MI). Anterior MI is associated with greater reduction of left ventricular ejection fraction (LVEF) and worse prognosis. Our objective was to study whether the impact of infarct size on global LVEF is dependent of infarct location. METHODS: We analyzed 888 patients treated with primary percutaneous coronary intervention for acute MI. Enzymatic infarct size and LVEF within 1 week were measured. In 490 patients (55%), LVEF was measured a second time at 6 months. RESULTS: Every 1000 U/L of cumulative lactate dehydrogense release corresponded to a decrease of 4.7% (95% CI 4.1-5.3) in LVEF measured within 1 week post MI for left anterior descending coronary artery (LAD)-related infarcts and to a decrease of 2.4% (95% CI 1.7-3.1) in LVEF measured within 1 week post MI for non-LAD-related infarcts (P < .0001). Left ventricular ejection fraction measured 6 months post MI showed a decrease for every 1000 U/L cumulative lactate dehydrogense release of 4.8% (95% CI 4.2-5.3) for LAD and 2.4% (95% CI 1.7-3.1) for non-LAD-related infarcts (P < .0001). Multivariate correction for relevant clinical and angiographic data did not change these results. CONCLUSION: In patients with a first acute MI treated with primary percutaneous coronary intervention, LAD-related infarcts show for a similar amount of myocardial necrosis as determined by enzymatic infarct size, a lower residual LVEF when compared with non-LAD-related infarcts.

Angioplasty, Balloon, Coronary↗
PubMed2006

Intracoronary infusion of autologous mononuclear bone marrow cells or peripheral mononuclear blood cells after primary percutaneous coronary intervention: rationale and design of the HEBE trial--a prospective, multicenter, randomized trial.

BACKGROUND: Recently, several preliminary reports have demonstrated that cell transplantation after acute myocardial infarction in humans is safe and leads to better preserved left ventricular function and improved myocardial perfusion and coronary flow reserve. METHODS: The HEBE trial is a multicenter, prospective, randomized, 3-arm open trial with blinded evaluation of end points. Patients with acute large myocardial infarction treated with primary percutaneous coronary intervention (PCI) will undergo magnetic resonance imaging (MRI) and echocardiography. A total of 200 patients are randomized to treatment with (1) intracoronary infusion of autologous mononuclear bone marrow cells, (2) intracoronary infusion of peripheral mononuclear blood cells, or (3) standard therapy. Mononuclear cells are isolated from bone marrow aspirate or venous blood by density gradient centrifugation. Within 7 days after PCI and within 24 hours after bone marrow aspiration or blood collection, a catheterization for intracoronary infusion of the mononuclear cells in the infarct-related artery is performed. In all patients, follow-up will be obtained at 1, 4, and 12 months. MRI and catheterization are repeated at 4 months, and all images are analyzed by a core laboratory blinded to randomization. The primary end point of the study is the change in regional myocardial function in dysfunctional segments at 4 months relative to baseline, based on segmental analysis as measured by MRI. IMPLICATIONS: If intracoronary infusion of autologous mononuclear bone marrow cells or peripheral mononuclear blood cells is proven to be beneficial after primary PCI; it could be a valuable tool in preventing heart failure-related morbidity and mortality after myocardial infarction.

Angioplasty, Balloon, Coronary↗
PubMed2006

Feasibility and benefit of prehospital diagnosis, triage, and therapy by paramedics only in patients who are candidates for primary angioplasty for acute myocardial infarction.

BACKGROUND: Despite data showing that time to treatment is very important in ST-elevation myocardial infarct patients, unacceptable long delays to reperfusion remain present in daily life practice. We sought to evaluate the feasibility and effect of improving logistics by early infarct diagnosis in the ambulance and immediate triage to a percutaneous coronary intervention (PCI) center performed by paramedics only without interference of a physician. METHODS: In the On-TIME study, 209 patients were included after prehospital infarct diagnosis and triage in the ambulance (ambulance group, n = 209). Infarct diagnosis was made by highly trained paramedics with the help of a computerized electrocardiographic algorithm. The accuracy of diagnosis, time to treatment, left ventricular function, and clinical outcome were compared with the patients who were diagnosed and triaged at a referral non-PCI center (referred group, n = 258). Left ventricular function was assessed before discharge using a nuclear technique. RESULTS: Acute myocardial infarction was accurately diagnosed in 95% of patients in the ambulance group, as compared with 99% in the referred group (P = .01). The percentage of patients in whom pharmacologic pretreatment (heparin, aspirin, tirofiban, or placebo) was initiated in the ambulance within 90 minutes after the onset of symptoms was 59% in the ambulance group versus 43% in the referred group (P < .01). A left ventricular ejection fraction of <40% was present in 25% in the ambulance group, as compared with 38% in the referred group (P = .013). After multivariate analysis, ambulance triage was independently associated with a left ventricular ejection fraction >40% and a favorable long-term clinical outcome. CONCLUSIONS: Early, prehospital infarct diagnosis, triage, and therapy in the ambulance with direct transportation to the nearest PCI center, performed by trained paramedics only, is feasible in 95% of patients. Ambulance triage resulted in earlier diagnosis and initiation of therapy and was independently associated with a better left ventricular function and clinical outcome, as compared with triage and transportation from a referral non-PCI center.

Angioplasty, Balloon, Coronary↗
PubMed2006

Implantable defibrillator early after primary percutaneous intervention for ST-elevation myocardial infarction: rationale and design of the Defibrillator After Primary Angioplasty (DAPA) trial.

BACKGROUND: It has been shown that an implantable cardioverter defibrillator (ICD) may be beneficial when added to optimal drug treatment in patients with reduced left ventricular function who survive a myocardial infarction (MI). However, it is not known whether patients with increased risk of death after primary percutaneous coronary intervention (PCI) for ST-elevation MI also have benefit of prophylactic ICD therapy to reduce sudden cardiac death. METHODS AND STUDY DESIGN: The DAPA trial is designed to evaluate the efficacy and safety of ICD in high-risk patients after primary PCI for ST-elevation MI. In this randomized multicenter controlled study, a total of 700 patients will be included. Enrolment started in October 2004. Inclusion criteria are thrombolysis in myocardial infarction flow less than 3 after primary PCI or left ventricular ejection fraction lower than 30% as measured short after admission for the index MI. Patients will be randomized between 30 and 60 days after their MI. The primary end point will be total death during the follow-up period of at least 3 years for each patient. CONCLUSIONS: This multicenter trial of patients at high risk of death after primary angioplasty for ST-elevation MI will evaluate prophylactic ICD therapy in addition to the current standard of care.

Adult↗
PubMed2006

Skin autofluorescence, a novel marker for glycemic and oxidative stress-derived advanced glycation endproducts: an overview of current clinical studies, evidence, and limitations.

BACKGROUND: Advanced glycation endproducts (AGEs) predict long-term complications in agerelated diseases. However, there are no clinically applicable markers for measuring AGEs in vivo. METHODS: We have recently introduced the AGE-Reader (DiagnOptics B.V., Groningen, The Netherlands) to noninvasively measure AGE accumulation in the human skin of the forearm, making use of the characteristic autofluorescence (AF) pattern that AGEs encompass. Skin AF is calculated as a ratio of mean intensities detected from the skin between 420-600 nm and 300-420 nm. It correlates with collagen-linked fluorescence and specific skin AGE levels from skin biopsies in diabetes, renal failure, and control subjects. Skin AF levels are increased in patients with diabetes and renal failure and are associated with the presence of vascular complications. Additionally, skin AF is strongly related to the progression of coronary heart disease and mortality, independently of traditional risk factors. Since skin pigmentation might influence skin AF, we have investigated the relation of relative skin reflectance (R%) to skin AF in subjects with varying skin phototypes (SPT). RESULTS: The data presented in this article suggest that only in subjects with an SPT of V and VI or R% <12%, no reliable measurement can be performed. Therefore, the current prototype of the AGE-Reader is suitable for subjects with SPT I-IV or R% >12%, and more research is needed for a broader application. CONCLUSION: The AGE-Reader is useful as a noninvasive clinical tool for assessment of risk for long-term vascular complications in diabetes and in other conditions associated with AGE accumulation.

Biomarkers↗
PubMed2006

Restenosis after percutaneous coronary intervention is associated with the angiotensin-II type-1 receptor 1166A/C polymorphism but not with polymorphisms of angiotensin-converting enzyme, angiotensin-II receptor, angiotensinogen or heme oxygenase-1.

OBJECTIVES: The renin-angiotensin system (RAS) is thought to play a major role in the pathophysiology of de-novo restenotic lesions and in-stent restenosis after percutaneous coronary intervention (PCI). Heme oxygenase-1 (HO-1), is thought to beneficially influence these processes. We examined the effect of pharmacologic as well as genetic RAS interactions on restenosis in a large population of consecutive patients undergoing PCI, and evaluated possible gene-gene interactions in both systems. METHODS: The GENDER project is a multicenter prospective follow-up study, including 3146 patients after successful PCI. Genotyping in these patients was performed for the ACE gene insertion/deletion, the angiotensinogen 235Met/Thr, T174M and A(-6)G, the angiotensin-II type 1 receptor (AT1R) 1166A/C and T810A, the angiotensin-II type 2 receptor (AT2R) 1675G/A and 3123A polymorphisms and the length polymorphism in the HO-1 promoter region. RESULTS: A total of 3104 patients were followed for 10 months. In 2975 patients at least one of the nine genotypes could be determined. The AT1R 1166 CC genotype showed a significant association with TVR; the other polymorphisms did not. RAS-inhibitory drugs were not associated with the incidence of TVR, nor did they interact with any of the investigated polymorphisms. Patients with the ACE I/I polymorphism showed a trend towards a better outcome if they had a short number of repeats in the HO-1 promoter. This relationship was inversely present in carriers of the ACE D/D polymorphism. CONCLUSION: We could only establish a role for the AT1R 1166A/C polymorphism in restenosis after PCI. However, significant gene-gene interaction was suggested for the ACE gene and the HO-1 promotor. The RAS and HO-1 relation in restenosis merits further investigation.

Alleles↗
PubMed2006

Hyperglycemia has a stronger relation with outcome in trauma patients than in other critically ill patients.

BACKGROUND: Acute hyperglycemia is associated with adverse outcome in critically ill patients. Glucose control with insulin improves outcome in surgical intensive care unit (SICU) patients, but the effect in trauma patients is unknown. We investigated hyperglycemia and outcome in SICU patients with and without trauma. METHODS: A 12-year retrospective study was performed at a 12-bed SICU. We collected the reason for admission, Injury Severity Scores (ISS), and 30-day mortality rates. Glucose measurements were used to calculate the hyperglycemic index (HGI), a measure indicative of overall hyperglycemia during the entire SICU stay. RESULTS: In all, 5234 nontrauma and 865 trauma patients were studied. Trauma patients were younger, more frequently male, and had both lower median admission glucose (123 versus 133 mg/dL) and HGI levels (8.9 vs. 18.4 mg/dL) than nontrauma patients (p < 0.001). Mortality was 12% in both groups. Area under the receiver-operator characteristic for HGI and mortality was 0.76 for trauma patients and 0.58 for nontrauma patients (p < 0.001). In multivariate analysis, HGI correlated better with mortality in trauma patients than in nontrauma patients (p < 0.001). Head-injury and nonhead-injury trauma patients showed similar glucose levels and relation between glucose and mortality. CONCLUSIONS: The relation of hyperglycemia and mortality is more pronounced in trauma patients than in SICU patients admitted for other reasons. The different behavior of hyperglycemia in these patients underscores the need for evaluation of intensive insulin therapy in these patients.

Adult↗
PubMed2006

Pre-treatment with clopidogrel and postprocedure troponin elevation after elective percutaneous coronary intervention.

Elevated troponin after elective percutaneous coronary intervention (PCI) has been associated with a worse prognosis. Pretreatment with clopidogrel may be beneficial in patients undergoing PCI. Therefore, a prospective observational study was conducted to address the potential role of clopidogrel in reducing troponin release after elective PCI. TroponinT was measured 12 hours after elective PCI in 656 patients without elevated troponin before PCI. To assess the independent association between pre-treatment with clopidogrel and increased troponin, multivariate analyses were performed. Mean age of the 656 patients was 63.5 years (SD 10.2), 194 patients (30%) were female and 114 patients (17.4%) had diabetes. In 217 patients (33%) troponin was increased after PCI. Of the 330 patients who were not pre-treated with clopidogrel, 118 patients (34%) had increased troponin after the PCI compared to 99 patients (30%) of the 326 patients who were treated with clopidogrel longer than 24 hours before the procedure (p = 0.14). Stratified analyses showed that patients with older age (p = 0.03), previous PCI (p = 0.013), angina CCS 4 (p = 0.03) and multivessel disease (p = 0.04) had a significantly lower risk of troponin increase after pre-treatment with clopidogrel compared to patients without pre-treatment. After adjusting for differences in the other variables, patients who were pre-treated with clopidogrel had a significant lower risk of post-PCI increase of troponin T (odds ratio 0.69, 95% confidence interval 0.49-0.99). Pre-treatment with clopidogrel is associated with a significantly lower incidence of increased troponin after elective PCI. Combined with results of other studies, pre-treatment should be advised in patients waiting for elective PCI.

Aged↗
PubMed2006

Predictors of elevated cardiac troponin T on admission in ST-segment elevation myocardial infarction.

BACKGROUND: In patients with ST-segment elevation acute myocardial infarction (STEMI), elevated cardiac troponin T (cTnT) on admission is associated with poorer outcomes despite early reperfusion. Presentation delay is thought to be the most important factor for the elevation of cTnT on admission. We evaluated presentation delay and other potential predictors of elevated cTnT on admission in patients treated with primary percutaneous coronary interventions (PCI) for STEMI. METHODS: CTnT was measured upon arrival in the PCI centre in 444 patients with acute STEMI. An elevated cTnT was defined as > 0.05 microg/L. RESULTS: The mean age was 61.7 years and patients were admitted at a median of 155 min after symptom onset. Almost 50% had an elevated cTnT on admission. Patients with a positive cTnT on admission were less likely to have successful primary PCI (87 versus 93%, P=0.048) and had significantly higher rates of one-year mortality (4.9 versus 1.3%, P=0.031). There was a significant association between presentation delay and the prevalence of elevated admission cTnT, but even patients with early presentation (<120 min after symptom onset) still had a high prevalence of elevated cTnT (33%). After multivariate analysis, apart from presentation delay, anterior MI location and higher age were independent predictors of elevated cTnT on admission. CONCLUSION: In patients with STEMI, the prevalence of elevated cTnT on admission is high, even in patients with early presentation. Independent predictors of elevated cTnT on admission are presentation delay, increasing age and anterior MI location.

Aged↗
PubMed2005

Design and implementation of GRIP: a computerized glucose control system at a surgical intensive care unit.

BACKGROUND: Tight glucose control by intensive insulin therapy has become a key part of critical care and is an important field of study in acute coronary care. A balance has to be found between frequency of measurements and the risk of hypoglycemia. Current nurse-driven protocols are paper-based and, therefore, rely on simple rules. For safety and efficiency a computer decision support system that employs complex logic may be superior to paper protocols. METHODS: We designed and implemented GRIP, a stand-alone Java computer program. Our implementation of GRIP will be released as free software. Blood glucose values measured by a point-of-care analyzer were automatically retrieved from the central laboratory database. Additional clinical information was asked from the nurse and the program subsequently advised a new insulin pump rate and glucose sampling interval. RESULTS: Implementation of the computer program was uneventful and successful. GRIP treated 179 patients for a total of 957 patient-days. Severe hypoglycemia (< 2.2 mmol/L) only occurred once due to human error. With a median (IQR) of 4.9 (4.2-6.2) glucose measurements per day the median percentage of time in which glucose fell in the target range was 78%. Nurses rated the program as easy to work with and as an improvement over the preceding paper protocol. They reported no increase in time spent on glucose control. CONCLUSION: A computer driven protocol is a safe and effective means of glucose control at a surgical ICU. Future improvements in the recommendation algorithm may further improve safety and efficiency.

Aged↗
PubMed2005

Ventricular fibrillation in acute myocardial infarction before and during primary PCI.

BACKGROUND: There are scarce and sometimes contradictory data about ventricular fibrillation (VF) during the acute phase of MI. In-hospital VF most often occurs with inferior MI, when treated with fibrinolytics. Out-of-hospital VF seems to be associated with anterior MI. We studied characteristics of patients with VF during reperfusion therapy by primary angioplasty (PCI) versus patients with VF before PCI. METHODS: From January 1995 until December 2001, we treated 2826 patients for acute MI and reviewed clinical records of all patients who developed VF and classified the patients according to the first episode of VF: either before or during the angioplasty procedure. RESULTS: VF developed in 219 (8%) patients. Patients with VF during reperfusion therapy (n=74, 3%) were older (p=0.03), more frequently female (0.04), less often had heart failure (p=0.04), when compared with patient with VF before PCI (n=145, 5%). Patients with VF during PCI experienced more often preinfarction angina (p=0.009) and suffered more often from inferior MI (p=0.001), when compared with patients with VF before PCI. CONCLUSIONS: Patients with early VF before reperfusion have different characteristics when compared with patients with VF during reperfusion. Infarct location is a major determinant of timing of VF, when both groups are compared (p<0.001).

Angioplasty, Balloon, Coronary↗
PubMed2005

Long-term follow-up after invasive approach of coronary artery disease in daily practice.

BACKGROUND: To assess long-term survival in unselected patients with coronary artery disease in who an invasive approach is considered. METHODS: All patients with significant coronary artery disease who were presented for coronary revascularisation to two tertiary centres in 1992 were included. Follow-up data were collected in September 2002. Multivariate Cox' proportional-hazards regression analysis was applied to assess the independent relation between variables and 10-year survival. RESULTS: A total of 877 patients were included in this analysis. Mean age was 62 and the most common clinical diagnosis was chronic stable angina (60%). Diabetes was present in 12% of the patients. During the follow-up period, 233 patients (27%) died. Predictors of long-term survival were increasing age, diabetes, peripheral vascular disease and a decreased left ventricular function. Compared to medical treated patients, those treated with revascularisation (either by PCI or CABG) had a decreased long-term mortality (p<0.05). Of the patients with PCI 27% had died, compared to 24% in those who had CABG and 36% of those who were treated medically. However, after adjusting for differences in baseline variables, conservative treatment was no significant predictor of long-term mortality. After multivariable analyses, increasing age, decreased left ventricular function and diabetes were independent predictors of long-term mortality. CONCLUSIONS: In patients with coronary artery disease in whom an invasive approach is considered, increasing age, impaired left ventricular function and diabetes are the strongest predictors of long-term mortality. After adjustments for differences in baseline variables, invasive treatment is not associated with a lower long-term mortality.

Coronary Angiography↗
PubMed2005

Impact of failed mechanical reperfusion in patients with acute myocardial infarction treated with primary angioplasty.

Percutaneous coronary intervention is not successful in all patients whose acute myocardial infarction is controlled with primary angioplasty, and, after an initial successful procedure, reperfusion is not always sustained due to subacute (stent) thrombosis. In a studied population that had acute myocardial infarction, failed mechanical reperfusion occurred in 108 patients (6.9%). Killip's class >I at admission, a left anterior descending artery as the infarct-related vessel, or a preprocedural Thrombolysis In Myocardial Infarction grade 0 or 1 flow was an independent predictor of failed reperfusion. Outcome after successful early and sustained mechanical reperfusion is excellent. Failure of the initial procedure and reocclusion of the infarct-related vessel are important determinants of adverse outcome.

Angioplasty, Balloon, Coronary↗
PubMed2005

The impact of glucose-insulin-potassium infusion in acute myocardial infarction on infarct size and left ventricular ejection fraction [ISRCTN56720616].

BACKGROUND: Favorable clinical outcomes have been observed with glucose-insulin-potassium infusion (GIK) in acute myocardial infarction (MI). The mechanisms of this beneficial effect have not been delineated clearly. GIK has metabolic, anti-inflammatory and profibrinolytic effects and it may preserve the ischemic myocardium. We sought to assess the effect of GIK infusion on infarct size and left ventricular function, as part of a randomized controlled trial. METHODS: Patients (n = 940) treated for acute MI by primary percutaneous coronary intervention (PCI) were randomized to GIK infusion or no infusion. Endpoints were the creatinine kinase MB-fraction (CK-MB) and left ventricular ejection fraction (LVEF). CK-MB levels were determined 0, 2, 4, 6, 24, 48, 72 and 96 hours after admission and the LVEF was measured before discharge. RESULTS: There were no differences between the two groups in the time course or magnitude of CK-MB release: the peak CK-MB level was 249 +/- 228 U/L in the GIK group and 240 +/- 200 U/L in the control group (NS). The mean LVEF was 43.7 +/- 11.0 % in the GIK group and 42.4 +/- 11.7% in the control group (P = 0.12). A LVEF < or = 30% was observed in 18% in the controls and in 12% of the GIK group (P = 0.01). CONCLUSION: Treatment with GIK has no effect on myocardial function as determined by LVEF and by the pattern or magnitude of enzyme release. However, left ventricular function was preserved in GIK treated patients.

Aged↗
PubMed2005

Comparison of myocardial perfusion after successful primary percutaneous coronary intervention in patients with ST-elevation myocardial infarction with versus without diabetes mellitus.

Patients with diabetes mellitus (DM) have an adverse prognosis after ST-segment elevation myocardial infarction (STEMI). Whether DM was associated with impaired myocardial reperfusion after successful primary percutaneous coronary intervention for STEMI was investigated. Myocardial reperfusion was assessed by ST-segment resolution and myocardial blush grade (MBG). A total of 386 patients were studied, of whom 64 (17%) had DM. These patients more frequently had reduced MBG (20% vs 10%, p = 0.02) and incomplete ST-segment resolution (55% vs 35%, p = 0.02) compared with patients without DM. After multivariate analysis, DM was still associated with impaired ST resolution (odds ratio 2.1, p = 0.03) and reduced MBG (odds ratio 2.2, p = 0.03).

Angioplasty, Balloon, Coronary↗