Showing papers by "Anselm K. Gitt published in 2002"

A prospective survey of the characteristics, treatments and outcomes of patients with acute coronary syndromes in Europe and the Mediterranean basin. The Euro Heart Survey of Acute Coronary Syndromes (Euro Heart Survey ACS)

Abstract: AIMS: To better delineate the characteristics, treatments, and outcomes of patients with acute coronary syndromes (ACS) in representative countries across Europe and the Mediterranean basin, and to examine adherence to current guidelines. METHODS AND RESULTS: We performed a prospective survey (103 hospitals, 25 countries) of 10484 patients with a discharge diagnosis of acute coronary syndromes. The initial diagnosis was ST elevation ACS in 42.3%, non-ST elevation ACS in 51.2%, and undetermined electrocardiogram ACS in 6.5%. The discharge diagnosis was Q wave myocardial infarction in 32.8%, non-Q wave myocardial infarction in 25.3%, and unstable angina in 41.9%. The use of aspirin, beta-blockers, angiotensin converting enzyme inhibitors, and heparins for patients with ST elevation ACS were 93.0%, 77.8%, 62.1%, and 86.8%, respectively, with corresponding rates of 88.5%, 76.6%, 55.8%, and 83.9% for non-ST elevation ACS patients. Coronary angiography, percutaneous coronary interventions, and coronary bypass surgery were performed in 56.3%, 40.4%, and 3.4% of ST elevation ACS patients, respectively, with corresponding rates of 52.0%, 25.4%, and 5.4% for non-ST elevation ACS patients. Among patients with ST elevation ACS, 55.8% received reperfusion treatment; 35.1% fibrinolytic therapy and 20.7% primary percutaneous coronary interventions. The in-hospital mortality of patients with ST elevation ACS was 7.0%, for non-ST elevation ACS 2.4%, and for undetermined electrocardiogram ACS 11.8%. At 30 days, mortality was 8.4%, 3.5%, and 13.3%, respectively. CONCLUSIONS: This survey demonstrates the discordance between existing guidelines for ACS and current practice across a broad region in Europe and the Mediterranean basin and more extensively reflects the outcomes of ACS in real practice in this region

Exercise Anaerobic Threshold and Ventilatory Efficiency Identify Heart Failure Patients for High Risk of Early Death

Abstract: Background— The maximal oxygen uptake (peak Vo2) is used in risk stratification of patients with chronic heart failure (CHF) Peak Vo2 might be lower than maximally possible if exercise is stopped early because of lack of patient motivation or premature cessation by the investigator In contrast, the anaerobic threshold (Vo2AT) and the ventilatory efficiency (Ve versus Vco2 slope) are less subject to these influences Thus, we compared these parameters with peak Vo2 in identifying patients with CHF at increased risk for death within 6 months after evaluation Methods and Results— We performed cardiopulmonary exercise tests with gas exchange measurements in 223 consecutive patients with CHF (114 coronary artery disease, 92 dilated cardiomyopathy, 17 others) at the Herzzentrum Ludwigshafen between 1995 and 1998 We measured peak Vo2, Vo2AT and Ve versus Vco2 slope We selected peak Vo2 of ≤14 mL/kg per minute, Vo2AT of 34 as threshold values f

Gender differences in acute myocardial infarction in the era of reperfusion (the MITRA registry)

Abstract: There is conflicting information about gender differences in presentation, treatment, and outcome after acute ST elevation myocardial infarction (STEMI) in the era of thrombolytic therapy and primary percutaneous coronary intervention. From June 1994 to January 1997, we enrolled 6,067 consecutive patients with STEMI admitted to 54 hospitals in southwest Germany in the Maximal Individual TheRapy of Acute myocardial infarction (MITRA), a community-based registry. Women were 9 years older than men, more often had hypertension, diabetes mellitus, and congestive heart failure, and had a history of previous myocardial infarction less often. Women had a longer prehospital delay (45 minutes), had anterior wall infarction more often (odds ratio [OR] 1.21; 95% confidence interval [CI] 1.08 to 1.36), and received reperfusion therapy less often (OR 0.83; 95% CI 0.74 to 0.94). The percentage of patients who were eligible for thrombolysis and received no reperfusion was higher in women (OR 1.7; 95% CI 1.56 to 1.89). Women had recurrent angina (OR 1.45; 95% CI 1.23 to 1.71) and congestive heart failure (OR 1.26; 95% CI 1.01 to 1.56) more often. There was a trend toward a higher hospital mortality in women (age-adjusted OR 1.16, 95% CI 0.99 to 1.35; multivariate OR 1.21, 95% CI 0.96 to 1.51), but there was no gender difference in long-term mortality after multivariate analysis (age-adjusted OR 0.95, 95% CI 0.78 to 1.15; multivariate OR 0.93, 95% CI 0.72 to 1.19). Thus, women with STEMI receive reperfusion therapy less often than men. They experience recurrent angina and congestive heart failure more often during their hospital stay. The age-adjusted long-term mortality is not different between men and women, but there is a trend for a higher short-term mortality in women.

Impact of ramipril versus other angiotensin-converting enzyme inhibitors on outcome of unselected patients with ST-elevation acute myocardial infarction

Abstract: We examined the impact of treatment with ramipril versus other angiotensin-converting enzyme (ACE) inhibitors on clinical outcome in unselected patients of the prospective multicenter registry Maximal Individual Therapy of Acute Myocardial Infarction PLUS registry (MITRA PLUS) Of 14,608 consecutive patients with ST-elevation acute myocardial infarction, 47% received acute therapy with ramipril, 390% received other ACE inhibitor therapy, and 563% received no ACE inhibitor therapy In a multivariate analysis, the treatment with ramipril compared with the treatment without ACE inhibitors was associated with a significantly lower hospital mortality and a lower rate of nonfatal major adverse coronary and cerebrovascular events Compared with other generic ACE inhibitors, ramipril therapy was independently associated with a significantly lower hospital mortality (odds ratio [OR] 054, 95% confidence interval [CI] 032 to 090) and a lower rate of nonfatal major adverse coronary and cerebrovascular events (OR 065, 95% CI 046 to 093), but not with a lower rate of heart failure at discharge (OR 079, 95% CI 050 to 127)

[Long-term follow-up of patients with acute myocardial infarction treated with primary angioplasty or thrombolysis. Results of the MITRA trial].

Abstract: Uber den Verlauf nach der Entlassung aus der Klinik bei Patienten mit einem akuten Myokardinfarkt die mittels Primar-Dilatation oder Thrombolyse behandelt wurden, gibt es bisher nur unzureichend Daten. Wir analysierten hierzu die Daten der „Maximale Individuelle Optimierte Therapie beim Akuten Myokardinfarkt” (MITRA-1)-Studie. Von 2195 lebend entlassenen lysierten Patienten konnten 2090 (95%), von den Patienten, die eine Primar-Dilatation erhielten, 94% (293/312) uber einen Zeitraum von im Median 17 Monate nachverfolgt werden. Es zeigten sich nur geringe Unterschiede bezuglich der Patientencharakteristika zwischen beiden Therapiegruppen: Im Vergleich zu den lysierten Patienten hatten Patienten, die eine Primar-Dilatation erhielten, haufiger einen fruheren Myokardinfarkt (16,4% versus 12,2%, p=0,04), eine um 10 Minuten langere Prahospitalzeit (130 Minuten versus 120 Minuten, p=0,002) und eine um 45 Minuten langere Zeit von Aufnahme bis zum Behandlungsbeginn (p<0,001). Bei Entlassung erhielten dilatierte Patienten haufiger einen β-Blocker (Primar-Dilatation 79,8% versus Thrombolyse 66,2%, p<0,001) und haufiger Statine (24,5% versus 16,5%, p<0,001). Weder bezuglich der Uberlebenswahrscheinlichkeit nach Krankenhausentlassung (p=0,90) noch bezuglich des ereignisfreien Uberlebens (Tod oder Reinfarkt; p=0,85) zeigten sich signifikante Unterschiede zwischen den Gruppen. Wurde auch die Durchfuhrung einer perkutanen transluminalen Ballondilatation und/oder einer aortokoronaren Bypassoperation in das ereignisfreie Uberleben (neben Tod und Reinfarkt) berucksichtigt, so zeigte sich nun ein deutlicher Unterschied zu Gunsten der Primar-Dilatation zwischen den Gruppen (p=0,02). Dieses Ergebnis bestatigte sich nach Adjustierung fur Unterschiede zwischen den Gruppen in der multivariaten Analyse: multivariate odds ratio: 0,62, 95% Konfidenzintervall: 0,42–0,91. Der wahrend des initialen Krankenhausaufenthaltes durch eine Primar-Dilatation im Vergleich zur Thrombolyse erreichte Benefit bleibt auch im Langzeitverlauf von im Median 17 Monaten erhalten.

Clinical practice of primary angioplasty for the treatment of acute myocardial infarction in Germany: results from the MITRA and MIR registries.

Abstract: The pooled data of two German AMI registries: the Maximal Individual Therapy in Acute Myocardial Infarction (MITRA) study and the Myocardial Infarction Registry (MIR) were analysed in order to 1) describe current clinical practice of primary angioplasty in Germany, 2) compare the results of primary angioplasty with those of thrombolysis in the “real world” and 3) define subgroups of patients profiting probably most from primary angioplasty

Stellenwert des Heparins in der aktuellen Therapie des akuten Myokardinfarktes in Deutschland – Ergebnisse der MITRA- und MIR-Register

Abstract: Hintergrund Heparin gehort zu den am haufigsten verwandten Medikamenten in der Therapie des akuten Myokardinfarktes (AMI). Die Daten groser Studien zum Einfluss des Heparins auf den Therapieerfolg im Rahmen des AMI sind jedoch uneinheitlich. Ziel dieser Arbeit war die Darstellung des Einsatzes und der Komplikationsraten von Heparin im klinischen Alltag. Methoden MITRA und MIR waren Register von Patienten mit AMI in Deutschland. Von 1994 bis 1998 wurden 22697 Patienten in die Register eingeschlossen. 49,9% der Patienten erhielten eine rekanalisierende Therapie. Ergebnisse 21004 Patienten (92%) erhielten Heparin. Folgende Faktoren waren mit fehlender Heparingabe assoziiert: Blutung bei Aufnahme (OR 4,7; CI 3,2–6,8), kardiogener Schock (OR 1,8; CI 1,4–2,3), und Streptokinase-Lyse (OR 2,1; CI 1,8–2,3). Die Komplikationsraten der Patienten mit Heparin lagen nur wenig uber denen der Patienten ohne Heparin: Schlaganfalle traten unter Fibrinolyse mit Heparin in 1,7%, Blutungen in 1,9% der Falle auf. Ohne Heparin traten Schlaganfalle in 1,3% und Blutungen in 1,4% der Falle auf (p=ns). Die Mortalitat der Patienten ohne Heparin war etwa doppelt so hoch wie die der Patienten mit Heparin (27,3% vs. 14,1%; p<0,001). Schlussfolgerung 92% der Patienten in MITRA und MIR erhielten Heparin. Heparin wurde auser bei aktiver Blutung insbesondere bei Patienten in klinisch kritischem Zustand seltener gegeben. Unter anderem als Resultat dieser Selektion war die Mortalitat der Patienten ohne Heparin doppelt so hoch wie die der Patienten mit Heparin. Die Komplikationsraten der Patienten mit Heparin lagen nur geringfugig uber den aus randomisierten Studien bekannten Zahlen.