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Biomedical subjects

Jens Flensted Lassen

Publications and source records attributed to Jens Flensted Lassen.

At least 19 recordsLinked to original sources
PubMed2006

Target lesion revascularisation in patients treated with a sirolimus-eluting or paclitaxel-eluting stent.

OBJECTIVE: To identify risk factors for clinical-driven target lesion revascularisation (TLR) in patients treated with sirolimus-eluting (Cypher) or paclitaxel-eluting (Taxus) stents in a real-world scenario. DESIGN: From 1 January 2003 to 18 May 2005, all patients treated with a Cypher or Taxus stent were consecutively registered and followed for 9 months. Re-intervention was driven by clinical symptoms. SETTING: Western Denmark Heart Registry. PATIENTS: 4432 patients with 6102 lesions treated with a Cypher (n = 3791 lesions) or Taxus (n = 2311 lesions) stent. INTERVENTIONS: Percutaneous coronary intervention. MAIN OUTCOME MEASURES: TLR, defined as either new percutaneous coronary intervention or coronary artery bypass graft operation of the target lesion, within 9 months from the index procedure. RESULTS: TLR within 9 months was performed in 2.5% of lesions treated with the Cypher stent and in 3.3% of lesions treated with the Taxus stent (OR 1.36, 95% CI 1.00 to 1.84). After adjustment by multivariate logistic regression, Taxus stent implantation was an independent predictor of TLR (OR 1.43, 95% CI 1.05 to 1.95). Implantation of >1 stent per lesion (OR 1.62, 95% CI 1.13 to 2.33) and reference diameter <2.8 mm (OR 1.42, 95% CI 1.00 to 2.02) were also identified as independent predictors of TLR. CONCLUSIONS: These data from the registry reflect a real-world clinical scenario with operator-driven use of drug-eluting stents and symptom-driven re-intervention. In this setting, use of the Taxus stent, implantation of multiple stents per lesion and stent implantation in small vessels were independent predictors of TLR.

Analysis of Variance↗
PubMed2006

Routine thrombectomy in percutaneous coronary intervention for acute ST-segment-elevation myocardial infarction: a randomized, controlled trial.

BACKGROUND: Distal embolization during primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction may result in reduced myocardial perfusion, infarct extension, and impaired prognosis. METHODS AND RESULTS: In a prospective randomized trial, we studied the effect of routine thrombectomy in 215 patients with ST-segment-elevation myocardial infarction lasting <12 hours undergoing primary PCI. Patients were randomized to thrombectomy pretreatment or standard PCI. The primary end point was myocardial salvage measured by sestamibi SPECT, calculated as the difference between area at risk and final infarct size determined after 30 days (percent). Secondary end points included final infarct size, ST-segment resolution, and troponin T release. Baseline variables, including ST-segment elevation and area at risk, were similar. Salvage was not statistically different in the thrombectomy and control groups (median, 13% [interquartile range, 9% to 21%] and 18% [interquartile range, 7% to 25%]; P=0.12), but 24 patients in the thrombectomy group and 12 patients in the control group did not have an early SPECT scan, mainly because of poor general or cardiac condition (P=0.04). In the thrombectomy group, final infarct size was increased (median, 15%; [interquartile range, 4% to 25%] versus 8% [interquartile range, 2% to 18%]; P=0.004). CONCLUSIONS: Thrombectomy performed as routine therapy in primary PCI for ST-elevation myocardial infarction does not increase myocardial salvage. The study suggests a possible deleterious effect of thrombectomy, resulting in an increased final infarct size, and does not support the use of thrombectomy in unselected primary PCI patients.

Aged↗
PubMed2005

Potential significance of spontaneous and interventional ST-changes in patients transferred for primary percutaneous coronary intervention: observations from the ST-MONitoring in Acute Myocardial Infarction study (The MONAMI study).

AIMS: In patients with ST-elevation myocardial infarction (STEMI) scheduled for primary percutaneous coronary intervention (primary PCI), acute risk-assessment may be valuable for tailoring of adjunctive therapy at the time of coronary intervention. The present study was designed to quantify pre-, per-, and post-interventional ST-changes, to evaluate whether a pre-specified continuous ST-monitoring classification provides potential prognostic information in the pre- and per-interventional phase, and to compare post-interventional ST-resolution parameters derived from continuous ST-monitoring and snapshot ECGs, respectively. METHODS AND RESULTS: In 92 STEMI patients, continuous ST-monitoring was initiated in the pre-hospital phase and continued during and 90 min following PCI. Patients were divided into three groups: (A) patients achieving spontaneous ST-resolution before PCI; (B) patients with preserved ST-elevation immediately before PCI and with no increase in ST-elevation during PCI; and (C) patients with preserved ST-elevation immediately before PCI and with increase in ST-elevation during PCI. Groups A (n=22), B (n=43), and C (n=27) differed in peak level of troponin-T (1.4, 4.7, and 7.2 microg/L, P<0.001), creatinine kinase MB isoenzyme (35, 150, and 325 microg/L, P<0.001), and N-terminal pro-brain natriuretic peptide (Nt-pro-BNP) (183, 175, and 269 pmol/L, P=0.084) during admission, and left ventricular ejection fraction evaluated within 2 h of PCI (0.53, 0.48, and 0.45, P=0.047) and after 3 months (0.58, 0.54, and 0.45, P<0.001). Groups B and C also differed in time from first balloon inflation to > or =70% resolution of ST-elevation (14 vs. 42 min, P=0.002), whereas no differences were observed in traditional 90 min ST-resolution analysis or angiographically assessed parameters. CONCLUSION: STEMI patients transferred for primary PCI are heterogeneous with respect to pre- and per-interventional ST-changes, and a pre-specified ST-monitoring classification seems useful for stratification of patients at time of PCI into groups with low, intermediate, and high risk profile. Furthermore, post-interventional ST-monitoring indicates that traditional 90 min ST-resolution analysis may have limited value in the era of primary PCI.

Aged↗
PubMed2005

[Primary percutanous intervention in acute mycardial infarction. A comparison with the DANAMI-2 results].

INTRODUCTION: Several studies, including the DANAMI-2 trial, have shown that primary percutanous intervention (PCI) results in better survival, fewer reinfarctions and fewer cerebrovascular incidents than thrombolysis in the treatment of acute ST-elevation myocardial infarction (STEMI). The aim of this study was to follow the implementation of primary PCI as a routine treatment for patients with STEMI and to compare the results with those of DANAMI-2. MATERIALS AND METHODS: We performed a prospective analysis of 212 patients admitted to our department from 1 April 2002 to 31 December 2002 with STEMI. Acute coronary angiography and, if indicated, primary PCI were performed. RESULTS: At 30 days, the mortality rate was 6.6%, the reinfarction rate 1.4% and the rate of disabling stroke 1.4%. Combined endpoints were present in 8% of the patients. The results are in agreement with those from the DANAMI-2 trial. DISCUSSION: Primary PCI can be performed in daily clinical practice in accordance with the DANAMI-2 protocol. The results are in agreement with data from newly published meta-analyses.

Angioplasty, Balloon, Coronary↗
PubMed2005

Reduction of treatment delay in patients with ST-elevation myocardial infarction: impact of pre-hospital diagnosis and direct referral to primary percutanous coronary intervention.

AIMS: The majority of patients with ST-elevation myocardial infarction (STEMI) are admitted to local hospitals without primary percutaneous coronary intervention (primary PCI) facilities. Acute transferral to an interventional centre is necessary to treat these patients with primary PCI. The present study assessed the reduction in treatment delay achieved by pre-hospital diagnosis and referral directly to an interventional centre. METHODS AND RESULTS: Two local hospitals without primary PCI facilities were serving the study region. Pre-hospital diagnoses were established with the use of telemedicine, by ambulance physicians, or by general practitioners. Primary PCI was accepted as the preferred reperfusion therapy in patients with STEMI. From 31 October 2002 to 31 January 2004 all patients transported by ambulance and transferred for primary PCI were registered. Patients with STEMI were divided into three groups: (A) patients diagnosed at a local hospital (n = 55), (B) patients diagnosed pre-hospitally and admitted to a local hospital (n = 85), and (C) patients diagnosed pre-hospitally and referred directly to the interventional centre (n = 21). When comparing group A with group B and C, no difference was found in age, sex, infarct location, or distance from the scene of event to the interventional centre, whereas the median time from ambulance call to first balloon inflation was 41 min shorter in group B compared with group A (P<0.001) and 81 min shorter in group C compared with group A (P<0.001). CONCLUSION: In a cohort of patients scheduled for admission to a local hospital and subsequent transferral to an interventional centre for primary PCI, those diagnosed pre-hospitally had shorter treatment delay compared with those diagnosed in hospital, both in the setting of initial admission to a local hospital, and to an even larger extent in the setting of referral directly to the interventional centre.

Aged↗
PubMed2005

Prehospital evaluation in ST-elevation myocardial infarction patients treated with primary percutaneous coronary intervention.

In patients with ST-elevation myocardial infarction, fast initiation of reperfusion therapy is mandatory. It is well established that prehospital diagnosis results in earlier initiation of fibrinolysis, but there is limited evidence concerning the value of prehospital evaluation in patients treated with primary percutaneous coronary intervention (PCI). The present paper proposes various prehospital strategies that may be of relevance in treating the latter patients: (1) a substantial reduction in treatment delay may be achieved by prehospital diagnosis, especially if combined with rerouting of patients directly to interventional hospital; (2) use of telemedicine may allow a widespread implementation of a prehospital diagnostic program; (3) a rerouting strategy may result in prolonged transportation. In this setting, continuous real-time 1-lead ECG transmission from ambulance to hospital may allow physicians to support ambulance personnel in the treatment of arrhythmias during transportation; and (4) equipment used for prehospital ECG acquisition and transmission has built-in features for continuous ST-segment monitoring. It is hypothesized that continuous ST-segment monitoring performed in the prehospital phase and during primary PCI may provide important prognostic information, with the potential of triaging future pharmacological and interventional treatment at time of PCI.

Ambulances↗
PubMed2005

Risk assessment and treatment of dyslipidemia in primary health care.

INTRODUCTION: The aim was to evaluate the practices of routine management of dyslipidemia performed by general practitioners in a large geographic area. METHODOLOGY: Patients were identified by three or more plasma cholesterol measurements registered in the electronic laboratory information system (LIS) covering the total geographic area, and the study population was characterised by information from general practitioners' records, and from a questionnaire sent to the patients. Further information on ischaemic heart disease (IHD) was obtained from the National Hospital register, and information on prescriptions on lipid lowering medications from the National Health Service. PARTICIPANTS: A sample of 1163 subjects, monitored by 134 different general practices. RESULTS: One third of the patients monitored for dyslipidemia had IHD, and two thirds were monitored as part of primary intervention. Dietary counselling was reported by 76%, and 54% were treated with lipid-lowering medications. The treatment frequency was related to cardiovascular risk, increasing from 25% of those with the lowest risk to 72% of the patients with IHD. The treatment goal was not reached in 74% of the cases, but overall a 20% reduction in plasma cholesterol was achieved. CONCLUSION: Subjects monitored for dyslipidemia were relevantly monitored because of IHD or high risk of IHD, and initiated treatment of dyslipidemia was clearly related to the individual assessed risk of IHD. Only a minority reached the treatment goals (< 5 mmol/l), and the statin doses used were generally lower than the doses used in clinical trials.

Cholesterol↗
PubMed2004

Mortality rates in patients with ST-elevation vs. non-ST-elevation acute myocardial infarction: observations from an unselected cohort.

AIMS: Acute myocardial infarction (AMI) is categorized, according to the presenting electrocardiogram, into non-ST-elevation myocardial infarction (non-STEMI), ST-elevation myocardial infarction (STEMI), or bundle branch block myocardial infarction (BBBMI). Data on the prognostic significance of these categories mainly originate from voluntary based registries or large-scale clinical trials and may be hampered by selection and information bias. The aim of this historical cohort study was to evaluate the prognostic significance of different categories of AMI in an unselected cohort. METHODS AND RESULTS: From 1 November 1999 to 31 October 2001, patient records were reviewed from all admissions to hospitals serving a study region with 139,000 inhabitants. An Endpoint Committee determined whether patients fulfilled the European Society of Cardiology criteria of AMI. A total of 654 patients with AMI were identified. The proportion having non-STEMI, STEMI, and BBBMI was 54, 39 and 6%, and the associated 1 year mortality was 31, 21, and 55%, respectively (log rank 54, P<0.001). The more favourable outcome observed in patients with STEMI remained significant according to multivariable analysis (P=0.044). CONCLUSION: In an unselected cohort of patients admitted with AMI, the mortality was considerably higher than expected from voluntary-based registries and large-scale clinical trials. The most favourable outcome is observed in patients with STEMI.

Aged↗
PubMed2004

Haemostatic activity in patients with atrial fibrillation treated with low-molecular-weight heparin before and after electrical cardioversion.

BACKGROUND: Electrical cardioversion of atrial fibrillation (AF) is associated with a thromboembolic risk, and this risk can be reduced by the use of antithrombotic therapy. International guidelines recommend an effective oral anticoagulant therapy (OAT) for at least 3 weeks before, and 4 weeks after cardioversion. We studied whether electrical cardioversion in it self causes changes in the level of activity in the haemostatic system during treatment with either low-molecular-weight heparin (LMWH). METHODS: Thirty-eight patients with AF were randomised consecutively to either LMWH administered subcutaneous in a fixed daily dose, or conventional OAT. Changes in the biochemical markers prothrombin fragment 1+2 (F1+2), D-Dimer, and soluble fibrin, all reflecting the activity in the haemostatic system, were assessed at baseline, before and after electrical cardioversion in patients treated with LMWH for 3 weeks prior to cardioversion. A follow up compared the time spent on anticoagulation prior to cardioversion, and eventual complications in the two group (LMWH vs. OAT). RESULTS AND CONCLUSIONS: No significant differences between the levels of the biochemical markers measured before, and after cardioversion were seen, indicating that during anticoagulant therapy with LMWH, electrical cardioversion in itself, does not cause an increased activity in the haemostatic system. Also the level of F1+2 had declined significantly after cardioversion, when compared to baseline level in patients, whom had a normal sinus rhythm (NSR) re-established. This indicates that even in patients on a stable anticoagulant treatment, restoration of a NSR can cause a further decrease in thrombin generation. The median time spent on antithrombotic treatment prior to cardioversion, was significantly different between the LMWH (27 days) and the OAT group (138 days). Our study indicates that cardioversion in patients on LMWH does not cause a hypercoagulable state and that LMWH significantly shortens the time spent on anticoagulant therapy prior to cardioversion.

Aged↗
PubMed2004

Routine screening for diabetic eye complications in a population based cohort of 4.438 persons with type 2 diabetes in a Danish county.

OBJECTIVES: This study aims to describe the use of routine screening for diabetic eye complications in a large population based cohort of type 2 diabetic patients in the County of Vejle, Denmark. Furthermore, it aims to identify characteristics of patients and general practitioners related to the frequency of eye examinations. METHODS: The type 2 diabetic population alive and resident in the County of Vejle on 1st January 1997. Data concerning eye examinations were collected from public data files for the period of January 1993 to December 1997. RESULTS: In a population of 4438 type 2 diabetic patients, 46% had had one annual eye examination in 1997 and 26% had not had a single eye examination within the last five years. Patient characteristics related to an eye examination included: treatment with insulin or oral hypoglycaemic agents, females and long duration of diabetes. The number of diabetic patients who had had an eye examination varied substantially between the general practices. The characteristics of general practitioners were not related to this variation. CONCLUSIONS: The results of this study indicate a great need for quality improvement of ophthalmologic service in diabetes care. To achieve this improvement, more focus should be given to cooperation between the general practitioners and the ophthalmologists.

Adult↗
PubMed2004

Surveillance of routine practice for screening and monitoring of dyslipidaemia. A population based study in a large geographical area.

INTRODUCTION: The aim was to develop a method for continuous monitoring of routine practice of screening and monitoring of dyslipidaemia, and to present the present status of cholesterol screening and monitoring in a large well-defined geographic area in Denmark. METHODOLOGY: Population based register survey, based on the electronic laboratory information system (LIS) as primary data source. All lipid measurements from both hospitals and primary health care, were included for a five-year period (1995.8.1.-2000.7.31.), and civil registration number was used to separate measurements from subjects living in an area comprising 248,475 adult inhabitants. RESULTS: An increasing number of subjects was screened every year, and during the five-year period approximately 25% of the total population older than 16 years were screened for dyslipidaemia (61,102), and half the subjects between 60 and 69 years were screened. The proportion of measurements prescribed from general practice increased significantly from 62.2% to 66.8%. The fraction of laboratory request forms including LDL-cholesterol increased from 39.8% to 58.5%. The number of subjects monitored for dyslipidaemia, by three plasma cholesterol measurements during 1 1/2 years increased by 71%. CONCLUSIONS: The method adequately identified subjects monitored for dyslipidaemia, and provided important information on routine practice for screening and monitoring of dyslipidaemia.

Adolescent↗