Ahmed Farah

Incidence and predictors of ventricular arrhythmias after ST-segment elevation myocardial infarction.

BACKGROUND Sustained ventricular arrhythmias (VA) complicate 7% to 20% of acute myocardial infarctions. We hypothesized that primary angioplasty (percutaneous coronary intervention [PCI]) and contemporary medical treatment will result in a lower incidence of VA and shorten the time frame of their occurrence. Thus, an electrocardiographic monitoring period of 24 hours should be sufficient to detect more than 95% of all malignant VA. METHODS We continuously monitored all patients with ST-segment elevation myocardial infarction (STEMI) for 48 hours. RESULTS Of the 510 patients who underwent PCI for STEMI, 24 (4.7%) developed sustained VA. Sixty percent of sustained VA occurred during the first 24 hours; and 92%, during the first 48 hours. In univariate analysis, heart rate greater than 100 beats per minute, Thrombolysis in Myocardial Infarction flow grade less than 3, elevated creatinine (≥1 mg/dL), elevated C-reactive protein (≥0.8 mg/dL), higher white blood cell count (≥12 × 10(3)/μL), use of diuretics, and lower hematocrit (≤39%) were associated with an increased risk of VA. Symptom-onset-to-balloon time of 4 hours or more in patients with postprocedural Thrombolysis in Myocardial Infarction 3 flow, treatment with β-blockers, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, and statins were associated with a reduced risk of VA. After multivariate adjustment, independent predictors of sustained VA included total white blood cell count of 12 × 10(3)/μL or more, hematocrit of 39% or less, and lack of β-blocker medication. CONCLUSIONS In this study, we could demonstrate that primary PCI results in a lower incidence of VA compared with data from the literature but did not shorten the time frame of VA occurrence. Thus, an electrocardiographic monitoring period for VA of 48 hours should be performed in patients with STEMI.

Acute coronary syndrome without critical epicardial coronary disease: prevalence, characteristics, and outcome

BACKGROUND Absence of significant epicardial coronary artery stenosis in patients with acute onset of chest pain and elevation of myocardial necrosis markers is occasionally observed. The aim of this study was to retrospectively analyze the clinical characteristics and the outcome of such patients. METHODS All patients with myocardial infarction (MI) but without significant coronary artery stenosis (≥50%) on angiography from May 2002 to April 2011 were compared with patients undergoing percutaneous coronary intervention due to non-ST-elevation MI (NSTEMI). RESULTS Of 4311 consecutive patients with MI, 272 patients (6.3%) did not show significant coronary artery stenosis (group I) and were compared with 253 NSTEMI patients (group II). Younger age (61.9±14.0 vs 65.4±12.0 years; P=.003), female sex (49.3% vs 28.9%; P<.001), less severe anginal symptoms (Canadian Cardiovascular Society class III/IV 41.9% vs 49.8%; P=.05), lower level of myocardial necrosis marker (1.9±6.7 vs 27.4±68.7 ng/mL [troponin], 3.3±4 vs 14.2±20 mmol/L [creatine kinase]; P<.001 for both), and higher left ventricular ejection fraction (58.7%±12.6% vs 48.1%±12.4%; P<.01) were associated with group I patients. At a mean follow-up of 22.3±22.9 months, all-cause and cardiac mortality was lower in group I patients (4.9% vs 14.3%; and 2.9% vs 10.1%; P<.01, for both). Event-free survival was more frequent in group I patients (58.4% vs 28.8%; P<.0001) and inversely related to the troponin level. CONCLUSIONS Absence of significant coronary stenosis accounts for a minority of patients presenting with MI and is associated with a better outcome compared to patients with NSTEMI, and the prognosis is inversely related to the troponin level.

Incidence of adverse cardiac events 5 years after polymer-free sirolimus eluting stent implantation: Results from the prospective Bad Berka Yukon Choice™ registry

Drug‐eluting stents (DES) constitute a major achievement in preventing re‐stenosis, concerns remain regarding the increased inflammatory responses associated with the polymers used. This analysis focuses on outcomes in patients receiving the polymer‐free sirolimus‐eluting stent system YUKON‐Choice (Yukon‐DES, Translumina, Germany).

Comparative Case–Control analysis of a dedicated self‐expanding Biolimus A9‐eluting Bifurcation stent versus provisional or mandatory side branch intervention strategies in the treatment of coronary bifurcation lesions

In a number of coronary bifurcation lesions, both the main vessel and the side branch (SB) need stent coverage.

Drug-coated balloons for de novo lesions in small coronary arteries: rationale and design of BASKET-SMALL 2

The treatment of coronary small vessel disease (SVD) remains an unresolved issue. Drug‐eluting stents (DES) have limited efficacy due to increased rates of instent‐restenosis, mainly caused by late lumen loss. Drug‐coated balloons (DCB) are a promising technique because native vessels remain structurally unchanged. Basel Stent Kosten‐Effektivitäts Trial: Drug‐Coated Balloons vs. Drug‐Eluting Stents in Small Vessel Interventions (BASKET‐SMALL 2) is a multicenter, randomized, controlled, noninferiority trial of DCB vs DES in native SVD for clinical endpoints. Seven hundred fifty‐eight patients with de novo lesions in vessels <3 mm in diameter and an indication for percutaneous coronary intervention such as stable angina pectoris, silent ischemia, or acute coronary syndromes are randomized 1:1 to angioplasty with DCB vs implantation of a DES after successful initial balloon angioplasty. The primary endpoint is the combination of cardiac death, nonfatal myocardial infarction, and target‐vessel revascularization up to 1 year. Secondary endpoints include stent thrombosis, Bleeding Academic Research Consortium (BARC) type 3 to 5 bleeding, and long‐term outcome up to 3 years. Based on clinical endpoints after 1 year, we plan to assess the noninferiority of DCB compared to DES in patients undergoing primary percutaneous coronary intervention for SVD. Results will be available in the second half of 2018. This study will compare DCB and DES regarding long‐term safety and efficacy for the treatment of SVD in a large all‐comer population.

Patients ≥75 years with acute coronary syndrome but without critical epicardial coronary disease: prevalence, characteristics, and outcome

Objective Absence of significant epicardial coronary artery disease (CAD) in patients with acute onset of chest pain and elevation of myocardial necrosis markers is occasionally observed. The aim of this study was to analyse the clinical characteristics and outcome of such patients with advanced age. Methods We retrospectively analysed 4,311 patients with acute onset of chest pain plus necrosis marker elevation. Two hundred and seventy two patients without CAD on angiogram (6.3%) were identified. Out of them, 50 (1.2%) patients ≥ 75 years (Group I) were compared with (1) 222 acute coronary syndrome (ACS) patients without CAD on angiogram < 75 years (Group II), and (2) 610 consecutive patients ≥ 75 years with Non-ST-elevation Myocardial Infarction (NSTEMI) undergoing percutaneous coronary intervention (Group III). Results Group I compared to Group III patients made up for more females (64.0% vs. 49.2%; P < 0.0001), and had more severe anginal symptoms on presentation [Canadian Cardiovascular Society (CCS) class I/II, 26.0% vs. 49.8%; P = 0.02]. Group I patients also had lower troponin levels (0.62 ± 0.8 ng/mL vs. 27 ± 74 ng/mL; P < 0.02), lower leukocyte count (9.4 ± 3.13 × 109 vs. 12 ± 5.1 × 109; P = 0.001) and better preserved left ventricular function (56.7% ± 14.3% vs. 45% ± 11%; P < 0.0001). Event-free survival (cardiac death, myocardial infarction, recurrent angina, and re-hospitalisation) was more frequent in Group I and II patients compared to Group III patients (64.9%, 66.7%, and 41.6%, respectively; P < 0.0001). Conclusions ACS in patients ≥ 75 years without CAD is very infrequent, associated with a (1) similar outcome compared to ACS patients < 75 years without CAD, and (2) significant better outcome compared to NSTEMI patients ≥ 75 years.

Arzt-Patient-Kommunikation in der invasiven Kardiologie

ZusammenfassungHintergrund:Kommunikation stellt einen zentralen Schritt des Interaktionsprozesses zwischen Arzt und Patient dar.Patienten und Methodik:15 min nach Besprechung der Ergebnisse einer Linksherzkatheteruntersuchung wurden 288 konsekutiven Patienten folgende Fragen gestellt: 1. Wurden Ihnen die Ergebnisse der Herzkatheteruntersuchung erläutert? 2. Wie hieß Ihr Untersucher? 3. Fanden sich an Ihren Herzkranzgefäßen Engstellen? 4. Ist die Pumpkraft Ihres Herzens normal? 5. Welche Therapie ist notwendig?Ergebnisse:Mit 98,6% der befragten Patienten wurden die Ergebnisse der Herzkatheteruntersuchung besprochen, im Mittel wurden nur 53,4% der gestellten Fragen richtig beantwortet. 31,2% der Patienten konnten sich an den Namen des Untersuchers erinnern. 52,8% kannten ihren Koronarstatus, 36,8% die Pumpleistung ihres Herzens und 92,7% die abgegebene Therapieempfehlung. Ursächlich für die falschen Antworten war in 85,4%, dass der Inhalt der Befundbesprechung vom Patienten nicht verstanden wurde, in 14,6% war eine Schwerhörigkeit des Patienten die Ursache. Eine höhere Rate an falschen Antworten zeigte sich bei komplexen angiographischen Befunden, sprachlicher Diskordanz zwischen Untersucher und Patient sowie Erläuterungen der Ergebnisse durch Nichtfachärzte (jeweils p < 0,001).Schlussfolgerung:Direkt nach Durchführung einer Linksherzkatheteruntersuchung mündlich erläuterte Ergebnisse werden nur unzureichend von den Patienten verstanden. Hier sind insbesondere die kommunikativen Fähigkeiten der Ärzte weiter verbesserungsbedürftig.AbstractBackground:Communication between patient and physician remains a central step of interaction.Patients and Methods:15 min after receiving the results of their coronary angiography via a standard verbal report, a total of 288 patients were asked the following questions: (1) Were the results of coronary angiography explained to you? (2) Who performed your procedure? (3) Were there any narrowings in your coronary arteries? (4) Was your left ventricular ejection fraction normal? (5) What kind of therapy was recommended to you?Results:98.6% of the patients were informed about the results of their coronary angiography. 31.2% were able to recall the name of the interventionalist. 52.8% knew about their coronary arteries, 36.8% knew their left ventricular function, and 92.7% were able to recall the recommendations for therapy (mean 53.4% correct answers). In 14.6%, the causes of incorrect answers were related to the patient, in 85.4% to the doctor. The number of incorrect answers increased significantly in patients with complex angiographic results, cultural discordance between physician and patient, and presentation of the results by noncardiologists (p < 0.001 for all).Conclusion:Communication of coronary angiography results to patients via standard verbal reports leads to frequent misunderstanding. To resolve communication problems in the cathlab as effective as possible, communication skills of physicians should be improved.BACKGROUND Communication between patient and physician remains a central step of interaction. PATIENTS AND METHODS 15 min after receiving the results of their coronary angiography via a standard verbal report, a total of 288 patients were asked the following questions: (1) Were the results of coronary angiography explained to you? (2) Who performed your procedure? (3) Were there any narrowings in your coronary arteries? (4) Was your left ventricular ejection fraction normal? (5) What kind of therapy was recommended to you? RESULTS 98.6% of the patients were informed about the results of their coronary angiography. 31.2% were able to recall the name of the interventionalist. 52.8% knew about their coronary arteries, 36.8% knew their left ventricular function, and 92.7% were able to recall the recommendations for therapy (mean 53.4% correct answers). In 14.6%, the causes of incorrect answers were related to the patient, in 85.4% to the doctor. The number of incorrect answers increased significantly in patients with complex angiographic results, cultural discordance between physician and patient, and presentation of the results by noncardiologists (p < 0.001 for all). CONCLUSION Communication of coronary angiography results to patients via standard verbal reports leads to frequent misunderstanding. To resolve communication problems in the cathlab as effective as possible, communication skills of physicians should be improved.

[Doctor-patient communication in the cathlab. How to deliver the news].

ZusammenfassungHintergrund:Kommunikation stellt einen zentralen Schritt des Interaktionsprozesses zwischen Arzt und Patient dar.Patienten und Methodik:15 min nach Besprechung der Ergebnisse einer Linksherzkatheteruntersuchung wurden 288 konsekutiven Patienten folgende Fragen gestellt: 1. Wurden Ihnen die Ergebnisse der Herzkatheteruntersuchung erläutert? 2. Wie hieß Ihr Untersucher? 3. Fanden sich an Ihren Herzkranzgefäßen Engstellen? 4. Ist die Pumpkraft Ihres Herzens normal? 5. Welche Therapie ist notwendig?Ergebnisse:Mit 98,6% der befragten Patienten wurden die Ergebnisse der Herzkatheteruntersuchung besprochen, im Mittel wurden nur 53,4% der gestellten Fragen richtig beantwortet. 31,2% der Patienten konnten sich an den Namen des Untersuchers erinnern. 52,8% kannten ihren Koronarstatus, 36,8% die Pumpleistung ihres Herzens und 92,7% die abgegebene Therapieempfehlung. Ursächlich für die falschen Antworten war in 85,4%, dass der Inhalt der Befundbesprechung vom Patienten nicht verstanden wurde, in 14,6% war eine Schwerhörigkeit des Patienten die Ursache. Eine höhere Rate an falschen Antworten zeigte sich bei komplexen angiographischen Befunden, sprachlicher Diskordanz zwischen Untersucher und Patient sowie Erläuterungen der Ergebnisse durch Nichtfachärzte (jeweils p < 0,001).Schlussfolgerung:Direkt nach Durchführung einer Linksherzkatheteruntersuchung mündlich erläuterte Ergebnisse werden nur unzureichend von den Patienten verstanden. Hier sind insbesondere die kommunikativen Fähigkeiten der Ärzte weiter verbesserungsbedürftig.AbstractBackground:Communication between patient and physician remains a central step of interaction.Patients and Methods:15 min after receiving the results of their coronary angiography via a standard verbal report, a total of 288 patients were asked the following questions: (1) Were the results of coronary angiography explained to you? (2) Who performed your procedure? (3) Were there any narrowings in your coronary arteries? (4) Was your left ventricular ejection fraction normal? (5) What kind of therapy was recommended to you?Results:98.6% of the patients were informed about the results of their coronary angiography. 31.2% were able to recall the name of the interventionalist. 52.8% knew about their coronary arteries, 36.8% knew their left ventricular function, and 92.7% were able to recall the recommendations for therapy (mean 53.4% correct answers). In 14.6%, the causes of incorrect answers were related to the patient, in 85.4% to the doctor. The number of incorrect answers increased significantly in patients with complex angiographic results, cultural discordance between physician and patient, and presentation of the results by noncardiologists (p < 0.001 for all).Conclusion:Communication of coronary angiography results to patients via standard verbal reports leads to frequent misunderstanding. To resolve communication problems in the cathlab as effective as possible, communication skills of physicians should be improved.BACKGROUND Communication between patient and physician remains a central step of interaction. PATIENTS AND METHODS 15 min after receiving the results of their coronary angiography via a standard verbal report, a total of 288 patients were asked the following questions: (1) Were the results of coronary angiography explained to you? (2) Who performed your procedure? (3) Were there any narrowings in your coronary arteries? (4) Was your left ventricular ejection fraction normal? (5) What kind of therapy was recommended to you? RESULTS 98.6% of the patients were informed about the results of their coronary angiography. 31.2% were able to recall the name of the interventionalist. 52.8% knew about their coronary arteries, 36.8% knew their left ventricular function, and 92.7% were able to recall the recommendations for therapy (mean 53.4% correct answers). In 14.6%, the causes of incorrect answers were related to the patient, in 85.4% to the doctor. The number of incorrect answers increased significantly in patients with complex angiographic results, cultural discordance between physician and patient, and presentation of the results by noncardiologists (p < 0.001 for all). CONCLUSION Communication of coronary angiography results to patients via standard verbal reports leads to frequent misunderstanding. To resolve communication problems in the cathlab as effective as possible, communication skills of physicians should be improved.

Arzt-Patient-Kommunikation in der invasiven Kardiologie@@@Doctor-Patient Communication in the Cathlab. How to Deliver the News: Ist die Ergebnisbesprechung unmittelbar nach einer Herzkatheteruntersuchung sinnvoll?

ZusammenfassungHintergrund:Kommunikation stellt einen zentralen Schritt des Interaktionsprozesses zwischen Arzt und Patient dar.Patienten und Methodik:15 min nach Besprechung der Ergebnisse einer Linksherzkatheteruntersuchung wurden 288 konsekutiven Patienten folgende Fragen gestellt: 1. Wurden Ihnen die Ergebnisse der Herzkatheteruntersuchung erläutert? 2. Wie hieß Ihr Untersucher? 3. Fanden sich an Ihren Herzkranzgefäßen Engstellen? 4. Ist die Pumpkraft Ihres Herzens normal? 5. Welche Therapie ist notwendig?Ergebnisse:Mit 98,6% der befragten Patienten wurden die Ergebnisse der Herzkatheteruntersuchung besprochen, im Mittel wurden nur 53,4% der gestellten Fragen richtig beantwortet. 31,2% der Patienten konnten sich an den Namen des Untersuchers erinnern. 52,8% kannten ihren Koronarstatus, 36,8% die Pumpleistung ihres Herzens und 92,7% die abgegebene Therapieempfehlung. Ursächlich für die falschen Antworten war in 85,4%, dass der Inhalt der Befundbesprechung vom Patienten nicht verstanden wurde, in 14,6% war eine Schwerhörigkeit des Patienten die Ursache. Eine höhere Rate an falschen Antworten zeigte sich bei komplexen angiographischen Befunden, sprachlicher Diskordanz zwischen Untersucher und Patient sowie Erläuterungen der Ergebnisse durch Nichtfachärzte (jeweils p < 0,001).Schlussfolgerung:Direkt nach Durchführung einer Linksherzkatheteruntersuchung mündlich erläuterte Ergebnisse werden nur unzureichend von den Patienten verstanden. Hier sind insbesondere die kommunikativen Fähigkeiten der Ärzte weiter verbesserungsbedürftig.AbstractBackground:Communication between patient and physician remains a central step of interaction.Patients and Methods:15 min after receiving the results of their coronary angiography via a standard verbal report, a total of 288 patients were asked the following questions: (1) Were the results of coronary angiography explained to you? (2) Who performed your procedure? (3) Were there any narrowings in your coronary arteries? (4) Was your left ventricular ejection fraction normal? (5) What kind of therapy was recommended to you?Results:98.6% of the patients were informed about the results of their coronary angiography. 31.2% were able to recall the name of the interventionalist. 52.8% knew about their coronary arteries, 36.8% knew their left ventricular function, and 92.7% were able to recall the recommendations for therapy (mean 53.4% correct answers). In 14.6%, the causes of incorrect answers were related to the patient, in 85.4% to the doctor. The number of incorrect answers increased significantly in patients with complex angiographic results, cultural discordance between physician and patient, and presentation of the results by noncardiologists (p < 0.001 for all).Conclusion:Communication of coronary angiography results to patients via standard verbal reports leads to frequent misunderstanding. To resolve communication problems in the cathlab as effective as possible, communication skills of physicians should be improved.BACKGROUND Communication between patient and physician remains a central step of interaction. PATIENTS AND METHODS 15 min after receiving the results of their coronary angiography via a standard verbal report, a total of 288 patients were asked the following questions: (1) Were the results of coronary angiography explained to you? (2) Who performed your procedure? (3) Were there any narrowings in your coronary arteries? (4) Was your left ventricular ejection fraction normal? (5) What kind of therapy was recommended to you? RESULTS 98.6% of the patients were informed about the results of their coronary angiography. 31.2% were able to recall the name of the interventionalist. 52.8% knew about their coronary arteries, 36.8% knew their left ventricular function, and 92.7% were able to recall the recommendations for therapy (mean 53.4% correct answers). In 14.6%, the causes of incorrect answers were related to the patient, in 85.4% to the doctor. The number of incorrect answers increased significantly in patients with complex angiographic results, cultural discordance between physician and patient, and presentation of the results by noncardiologists (p < 0.001 for all). CONCLUSION Communication of coronary angiography results to patients via standard verbal reports leads to frequent misunderstanding. To resolve communication problems in the cathlab as effective as possible, communication skills of physicians should be improved.