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Article: Management von Patienten mit akutem Koronarsyndrom und koronarer Mehrgefäßerkrankung

Feistritzer, Hans-Josef / Jobs, Alexander / Thiele, Holger

2024 Volume 13, Issue 02, Page(s) 129–132

Abstract: Der Anteil an Patienten mit koronarer Mehrgefäßerkrankung bei Patienten mit akutem Koronarsyndrom (ACS) variiert je nach Alter und Risikokonstellation. Bei Patienten mit ST-Strecken-Hebungsinfarkt (STEMI) wurde der prognostische Vorteil der vollständigen ...

Abstract	Der Anteil an Patienten mit koronarer Mehrgefäßerkrankung bei Patienten mit akutem Koronarsyndrom (ACS) variiert je nach Alter und Risikokonstellation. Bei Patienten mit ST-Strecken-Hebungsinfarkt (STEMI) wurde der prognostische Vorteil der vollständigen Revaskularisation in mehreren randomisierten Studien gezeigt. Entsprechende Daten fehlen bisher bei Patienten mit akutem Koronarsyndrom ohne ST-Strecken-Hebungen (NSTE-ACS), eine große randomisierte Studie ist jedoch vor Kurzem gestartet. Im infarktbedingten kardiogenen Schock ist die frühe Revaskularisation die einzige, mit in randomisierten Studien belegten Daten, prognoseverbessernde Therapie, allerdings sollte sich in der Akutphase die perkutane Koronarintervention (PCI) auf die Culprit Lesion beschränken.
Keywords	Revaskularisation ; akutes Koronarsyndrom ; koronare Mehrgefäßerkrankung ; acute coronary syndrome ; multivessel coronary artery disease ; revascularization
Language	German
Publishing date	2024-04-01
Publisher	Georg Thieme Verlag KG
Publishing place	Stuttgart ; New York
Document type	Article
ZDB-ID	2654127-0
ISSN	2193-5211 ; 2193-5203
ISSN (online)	2193-5211
ISSN	2193-5203
DOI	10.1055/a-2236-8642
Database	Thieme publisher's database

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Article: Revascularization Strategy in Myocardial Infarction with Multivessel Disease.

Jobs, Alexander / Desch, Steffen / Freund, Anne / Feistritzer, Hans-Josef / Thiele, Holger

Journal of clinical medicine

2024 Volume 13, Issue 7

Abstract: The proportion of patients with multivessel coronary artery disease in individuals experiencing acute coronary syndrome (ACS) varies based on age and ACS subtype. In patients with ST-segment elevation myocardial infarction (STEMI) without cardiogenic ... ...

Abstract	The proportion of patients with multivessel coronary artery disease in individuals experiencing acute coronary syndrome (ACS) varies based on age and ACS subtype. In patients with ST-segment elevation myocardial infarction (STEMI) without cardiogenic shock, the prognostic benefit of complete revascularization has been demonstrated by several randomized trials and meta-analyses, leading to a strong guideline recommendation. However, similar data are lacking for ACS without ST-segment elevation (NSTE-ACS). Non-randomized data suggesting a benefit from complete revascularization in non-ST-segment elevation myocardial infarction (NSTEMI) are prone to selection bias and should be interpreted with caution. A series of large randomized controlled trials have been initiated recently to address these open questions.
Language	English
Publishing date	2024-03-26
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2662592-1
ISSN	2077-0383
ISSN	2077-0383
DOI	10.3390/jcm13071918
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Management des akuten Koronarsyndroms : ESC-Leitlinie 2023.

Buske, Maria / Feistritzer, Hans-Josef / Jobs, Alexander / Thiele, Holger

Herz

2023 Volume 49, Issue 1, Page(s) 5–14

Abstract: The new guidelines of the European Society of Cardiology (ESC) on the management of acute coronary syndrome (ACS) in 2023 encompass updates for both the guidelines pertaining to ST elevation myocardial infarction (STEMI) and acute coronary syndrome ... ...

Title translation	Management of acute coronary syndrome : ESC guidelines 2023.
Abstract	The new guidelines of the European Society of Cardiology (ESC) on the management of acute coronary syndrome (ACS) in 2023 encompass updates for both the guidelines pertaining to ST elevation myocardial infarction (STEMI) and acute coronary syndrome without ST segment elevation (NSTE-ACS). The previously separated guidelines from 2017 and 2020 were therefore revised and summarized. These guidelines address various topics, including diagnostics, acute management, antithrombotic treatment, out-of-hospital cardiac arrest, cardiogenic shock, invasive strategies, and long-term treatment. The notable updates compared to earlier guidelines address the recommendation regarding the timing of invasive diagnostics in NSTE-ACS (Non-ST elevation acute coronary syndrome), the procedure of revascularization in multivessel coronary artery disease and alternative regimens for antithrombotic treatment in patients with a high risk of bleeding.
MeSH term(s)	Humans ; Acute Coronary Syndrome/therapy ; Acute Coronary Syndrome/drug therapy ; Fibrinolytic Agents/therapeutic use ; Coronary Artery Disease/drug therapy ; Shock, Cardiogenic/diagnosis ; Shock, Cardiogenic/etiology ; Shock, Cardiogenic/therapy ; ST Elevation Myocardial Infarction/drug therapy ; Cardiology
Chemical Substances	Fibrinolytic Agents
Language	German
Publishing date	2023-11-30
Publishing country	Germany
Document type	English Abstract ; Journal Article
ZDB-ID	8262-4
ISSN	1615-6692 ; 0340-9937 ; 0946-1299
ISSN (online)	1615-6692
ISSN	0340-9937 ; 0946-1299
DOI	10.1007/s00059-023-05222-1
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Article ; Online: Cardiogenic shock: role of invasive cardiology.

Feistritzer, Hans-Josef / Thiele, Holger / Desch, Steffen

Current opinion in critical care

2020 Volume 26, Issue 4, Page(s) 398–402

Abstract: Purpose of review: Early revascularization significantly improved the outcome of patients with cardiogenic shock following acute myocardial infarction (AMI). Nevertheless, the mortality remains substantial, ranging between 40 and 50% after 30 days. The ... ...

Abstract	Purpose of review: Early revascularization significantly improved the outcome of patients with cardiogenic shock following acute myocardial infarction (AMI). Nevertheless, the mortality remains substantial, ranging between 40 and 50% after 30 days. The present review summarizes the current evidence regarding revascularization strategies, vascular access site and concomitant antiplatelet and antithrombotic treatment in infarct-related cardiogenic shock. Recent findings: On the basis of the SHOCK trial, early revascularization is the most relevant procedure to improve the outcome of patients with infarct-related cardiogenic shock. The majority of these patients present with multivessel coronary disease. The randomized CULPRIT-SHOCK trial showed that in the emergency setting, percutaneous coronary intervention (PCI) should be confined to the culprit lesion. Regarding vascular access site, no data derived from randomized controlled trials in cardiogenic shock are available. Emergency coronary artery bypass grafting (CABG) is nowadays rarely performed in cardiogenic shock with rates less than 5% but is still a treatment option if coronary anatomy is not amenable to PCI. Regarding antiplatelet treatment, a randomized trial testing the intravenous P2Y12 inhibitor cangrelor versus an oral P2Y12 inhibitor in infarct-related cardiogenic shock is currently being performed. Summary: Early revascularization is the cornerstone of treatment of infarct-related cardiogenic shock and should be confined to the culprit lesion in the emergency setting.
MeSH term(s)	Cardiology ; Coronary Artery Disease ; Humans ; Myocardial Infarction/complications ; Myocardial Infarction/therapy ; Percutaneous Coronary Intervention ; Shock, Cardiogenic/etiology ; Shock, Cardiogenic/therapy ; Treatment Outcome
Language	English
Publishing date	2020-05-25
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	1235629-3
ISSN	1531-7072 ; 1070-5295
ISSN (online)	1531-7072
ISSN	1070-5295
DOI	10.1097/MCC.0000000000000738
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: Reperfusion Injury: How Can We Reduce It by Pre-, Per-, and Postconditioning.

Buske, Maria / Desch, Steffen / Heusch, Gerd / Rassaf, Tienush / Eitel, Ingo / Thiele, Holger / Feistritzer, Hans-Josef

Journal of clinical medicine

2023 Volume 13, Issue 1

Abstract: While early coronary reperfusion via primary percutaneous coronary intervention (pPCI) is established as the most efficacious therapy for minimizing infarct size (IS) in acute ST-elevation myocardial infarction (STEMI), the restoration of blood flow also ...

Abstract	While early coronary reperfusion via primary percutaneous coronary intervention (pPCI) is established as the most efficacious therapy for minimizing infarct size (IS) in acute ST-elevation myocardial infarction (STEMI), the restoration of blood flow also introduces myocardial ischemia-reperfusion injury (IRI), leading to cardiomyocyte death. Among diverse methods, ischemic conditioning (IC), achieved through repetitive cycles of ischemia and reperfusion, has emerged as the most promising method to mitigate IRI. IC can be performed by applying the protective stimulus directly to the affected myocardium or indirectly to non-affected tissue, which is known as remote ischemic conditioning (RIC). In clinical practice, RIC is often applied by serial inflations and deflations of a blood pressure cuff on a limb. Despite encouraging preclinical studies, as well as clinical studies demonstrating reductions in enzymatic IS and myocardial injury on imaging, the observed impact on clinical outcome has been disappointing so far. Nevertheless, previous studies indicate a potential benefit of IC in high-risk STEMI patients. Additional research is needed to evaluate the impact of IC in such high-risk cohorts. The objective of this review is to summarize the pathophysiological background and preclinical and clinical data of IRI reduction by IC.
Language	English
Publishing date	2023-12-27
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2662592-1
ISSN	2077-0383
ISSN	2077-0383
DOI	10.3390/jcm13010159
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: Corin as novel biomarker for myocardial infarction.

Feistritzer, Hans-Josef / Metzler, Bernhard

Annals of translational medicine

2016 Volume 4, Issue 20, Page(s) 405

Language	English
Publishing date	2016-11-04
Publishing country	China
Document type	Editorial ; Comment
ZDB-ID	2893931-1
ISSN	2305-5847 ; 2305-5839
ISSN (online)	2305-5847
ISSN	2305-5839
DOI	10.21037/atm.2016.08.17
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Article ; Online: Reperfusion Injury

Maria Buske / Steffen Desch / Gerd Heusch / Tienush Rassaf / Ingo Eitel / Holger Thiele / Hans-Josef Feistritzer

Journal of Clinical Medicine, Vol 13, Iss 1, p

How Can We Reduce It by Pre-, Per-, and Postconditioning

2023 Volume 159

Abstract	While early coronary reperfusion via primary percutaneous coronary intervention (pPCI) is established as the most efficacious therapy for minimizing infarct size (IS) in acute ST-elevation myocardial infarction (STEMI), the restoration of blood flow also introduces myocardial ischemia-reperfusion injury (IRI), leading to cardiomyocyte death. Among diverse methods, ischemic conditioning (IC), achieved through repetitive cycles of ischemia and reperfusion, has emerged as the most promising method to mitigate IRI. IC can be performed by applying the protective stimulus directly to the affected myocardium or indirectly to non-affected tissue, which is known as remote ischemic conditioning (RIC). In clinical practice, RIC is often applied by serial inflations and deflations of a blood pressure cuff on a limb. Despite encouraging preclinical studies, as well as clinical studies demonstrating reductions in enzymatic IS and myocardial injury on imaging, the observed impact on clinical outcome has been disappointing so far. Nevertheless, previous studies indicate a potential benefit of IC in high-risk STEMI patients. Additional research is needed to evaluate the impact of IC in such high-risk cohorts. The objective of this review is to summarize the pathophysiological background and preclinical and clinical data of IRI reduction by IC.
Keywords	ischemia-reperfusion injury ; acute myocardial infarction ; infarct size ; myocardial injury ; ischemic conditioning ; percutaneous coronary intervention ; Medicine ; R
Subject code	610
Language	English
Publishing date	2023-12-01T00:00:00Z
Publisher	MDPI AG
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: A study of bailout plug-based closure after failed suture-based closure in patients undergoing transfemoral TAVI.

Dumpies, Oliver / Abdelhafez, Ahmed / Rotta Detto Loria, Johannes / Richter, Ines / Feistritzer, Hans-Josef / Majunke, Nicolas / Desch, Steffen / Noack, Thilo / Thiele, Holger / Abdel-Wahab, Mohamed

EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology

2024 Volume 20, Issue 6, Page(s) e344–e353

Abstract: Background: Percutaneous suture-based arterial access site closure (ProGlide) is commonly applied in patients undergoing transfemoral transcatheter aortic valve implantation (TAVI). However, the failure of a suture-based vascular closure device (VCD) ... ...

Abstract	Background: Percutaneous suture-based arterial access site closure (ProGlide) is commonly applied in patients undergoing transfemoral transcatheter aortic valve implantation (TAVI). However, the failure of a suture-based vascular closure device (VCD) may require additional treatment. Aims: We aimed to evaluate the efficacy and safety of bailout access site closure using a large-bore plug-based device (MANTA) in patients with failed suture-based closure during transfemoral TAVI. Methods: Patients undergoing a bailout attempt with the MANTA VCD were identified from a prospectively enrolling, institutional registry. Efficacy was defined as haemostasis at the access site without the need for alternative treatment other than manual compression or endovascular ballooning. Safety was defined as freedom from vascular dissection, stenosis and occlusion requiring intervention. Results: Of 2,505 patients, 66 underwent a bailout attempt with MANTA as a result of ProGlide failure, which occurred before the large-bore sheath insertion in 16.7% of patients and after the sheath removal in 83.3% of patients. Bailout MANTA was deemed effective in 75.8% of patients (50/66), and the technique was considered safe in 86.4% (57/66) of patients. Failure of bailout MANTA occurred because of its superficial application, resulting in persistent bleeding in 18.2% of patients (12/66), and because of its deep application, resulting in stenosis or occlusion in 6.1% of patients (4/66). Operator experience with the technique (odds ratio [OR] 12.29, 95% confidence interval [CI]: 1.99-75.99; p=0.007) and prior use of three ProGlides (OR 0.02, 95% CI: <0.01-0.39; p=0.010) were the only independent predictors of the efficacy endpoint. Conclusions: Bailout MANTA after ProGlide failure was effective and safe, but operator experience seems to be crucial. Further technological refinements to facilitate accurate placement appear necessary.
MeSH term(s)	Humans ; Constriction, Pathologic ; Transcatheter Aortic Valve Replacement ; Odds Ratio ; Patients
Language	English
Publishing date	2024-03-18
Publishing country	France
Document type	Journal Article
ZDB-ID	2457174-X
ISSN	1969-6213 ; 1774-024X
ISSN (online)	1969-6213
ISSN	1774-024X
DOI	10.4244/EIJ-D-23-00750
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Article ; Online: Impact of anaemia and iron deficiency on outcomes in cardiogenic shock complicating acute myocardial infarction.

Obradovic, Danilo / Loncar, Goran / Zeymer, Uwe / Pöss, Janine / Feistritzer, Hans-Josef / Freund, Anne / Jobs, Alexander / Fuernau, Georg / Desch, Steffen / Ceglarek, Uta / Isermann, Berend / von Haehling, Stephan / Anker, Stefan D / Büttner, Petra / Thiele, Holger

European journal of heart failure

2024 Volume 26, Issue 2, Page(s) 448–457

Abstract: Aims: Anaemia and iron deficiency (ID) are common comorbidities in cardiovascular patients and are associated with a poor clinical status, as well as a worse outcome in patients with heart failure and acute myocardial infarction (AMI). Nevertheless, ... ...

Abstract	Aims: Anaemia and iron deficiency (ID) are common comorbidities in cardiovascular patients and are associated with a poor clinical status, as well as a worse outcome in patients with heart failure and acute myocardial infarction (AMI). Nevertheless, data concerning the impact of anaemia and ID on clinical outcomes in patients with cardiogenic shock (CS) are scarce. This study aimed to assess the impact of anaemia and ID on clinical outcomes in patients with CS complicating AMI. Methods and results: The presence of anaemia (haemoglobin <13 g/dl in men and <12 g/dl in women) or ID (ferritin <100 ng/ml or transferrin saturation <20%) was determined in patients with CS due to AMI from the CULPRIT-SHOCK trial. Blood samples were collected in the catheterization laboratory during initial percutaneous coronary intervention. Clinical outcomes were compared in four groups of patients having neither anaemia nor ID, against patients with anaemia with or without ID and patients with ID only. A total of 427 CS patients were included in this analysis. Anaemia without ID was diagnosed in 93 (21.7%), anaemia with ID in 54 study participants (12.6%), ID without anaemia in 72 patients (16.8%), whereas in 208 patients neither anaemia nor ID was present (48.9%). CS patients with anaemia without ID were older (73 ± 10 years, p = 0.001), had more frequently a history of arterial hypertension (72.8%, p = 0.01), diabetes mellitus (47.8%, p = 0.001), as well as chronic kidney disease (14.1%, p = 0.004) compared to CS patients in other groups. Anaemic CS patients without ID presence were at higher risk to develop a composite from all-cause death or renal replacement therapy at 30-day follow-up (odds ratio [OR] 3.83, 95% confidence interval [CI] 2.23-6.62, p < 0.001) than CS patients without anaemia/ID. The presence of ID in CS patients, with and without concomitant anaemia, did not increase the risk for the primary outcome (OR 1.17, 95% CI 0.64-2.13, p = 0.64; and OR 1.01, 95% CI 0.59-1.73, p = 0.54; respectively) within 30 days of follow-up. In time-to-event Kaplan-Meier analysis, anaemic CS patients without ID had a significantly higher hazard ratio (HR) for the primary outcome (HR 2.11, 95% CI 1.52-2.89, p < 0.001), as well as for death from any cause (HR 1.90, 95% CI 1.36-2.65, p < 0.001) and renal replacement therapy during 30-day follow-up (HR 2.99, 95% CI 1.69-5.31, p < 0.001). Conclusion: Concomitant anaemia without ID presence in patients with CS at hospital presentation is associated with higher risk for death from any cause or renal replacement therapy and the individual components of this composite endpoint within 30 days after hospitalization. ID has no relevant impact on clinical outcomes in patients with CS.
MeSH term(s)	Male ; Humans ; Female ; Shock, Cardiogenic/etiology ; Shock, Cardiogenic/therapy ; Shock, Cardiogenic/diagnosis ; Heart Failure/complications ; Treatment Outcome ; Myocardial Infarction/complications ; Myocardial Infarction/therapy ; Anemia/complications ; Anemia, Iron-Deficiency/etiology ; Percutaneous Coronary Intervention/adverse effects
Language	English
Publishing date	2024-01-01
Publishing country	England
Document type	Journal Article
ZDB-ID	1483672-5
ISSN	1879-0844 ; 1388-9842
ISSN (online)	1879-0844
ISSN	1388-9842
DOI	10.1002/ejhf.3099
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Zs.A 5299: Show issues

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Article ; Online: Multivessel vs. culprit-lesion only percutaneous coronary intervention in ST-elevation myocardial infarction.

Feistritzer, Hans-Josef / Jobs, Alexander / Desch, Steffen / Thiele, Holger

Herz

2020 Volume 45, Issue 6, Page(s) 542–547

Abstract: The optimal treatment of non-infarct-related coronary arteries in patients presenting with ST-elevation myocardial infarction (STEMI) has been a subject of debate for many years. Earlier medium-sized randomized controlled trials reported a benefit of ... ...

Title translation	Mehrgefäßrevaskularisation verglichen mit isolierter Revaskularisation der Zielläsion bei ST-Hebungsinfarkt.
Abstract	The optimal treatment of non-infarct-related coronary arteries in patients presenting with ST-elevation myocardial infarction (STEMI) has been a subject of debate for many years. Earlier medium-sized randomized controlled trials reported a benefit of multivessel percutaneous coronary intervention (PCI) primarily due to a reduction of subsequent revascularizations. Recently, the well-powered COMPLETE trial showed a reduction in the composite endpoint of cardiovascular mortality and myocardial reinfarction through complete revascularization. The present review summarizes the current evidence regarding revascularization strategies in STEMI patients.
MeSH term(s)	Coronary Artery Disease/surgery ; Humans ; Percutaneous Coronary Intervention ; ST Elevation Myocardial Infarction/surgery ; Treatment Outcome
Language	English
Publishing date	2020-05-06
Publishing country	Germany
Document type	Journal Article ; Review
ZDB-ID	8262-4
ISSN	1615-6692 ; 0340-9937 ; 0946-1299
ISSN (online)	1615-6692
ISSN	0340-9937 ; 0946-1299
DOI	10.1007/s00059-020-04937-9
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