TY  - JOUR
AB  - Background: The decline of cardiovascular disease (CVD) mortality has slowed in many countries, including Germany. We examined the implications of this trend for future coronary heart disease (CHD) and stroke mortality in Germany considering persistent mortality inequalities between former East and West Germany. Methods: We retrieved demographic and mortality data from 1991 to 2019 from the German Federal Statistical Office. Using a Bayesian age-period-cohort framework, we projected CHD and stroke mortality from 2019 to 2035, stratified by sex and German region. We decomposed annual changes in deaths into three components (mortality rates, population age structure and population size) and assessed regional inequalities with age-sex-standardized mortality ratios. Results: We confirmed that declines of CVD mortality rates in Germany will likely stagnate. From 2019 to 2035, we projected fewer annual CHD deaths (114,600 to 103,500 [95%-credible interval: 81,700; 134,000]) and an increase in stroke deaths (51,300 to 53,700 [41,400; 72,000]). Decomposing past and projected mortality, we showed that population ageing was and is offset by declining mortality rates. This likely reverses after 2030 leading to increased CVD deaths thereafter. Inequalities between East and West declined substantially since 1991 and are projected to stabilize for CHD but narrow for stroke. Conclusions: CVD deaths in Germany likely keep declining until 2030, but may increase thereafter due to population ageing if the reduction in mortality rates slows further. East-West mortality inequalities for CHD remain stable but may converge for stroke. Underlying risk factor trends need to be monitored and addressed by public health policy.
AU  - Emmert-Fees, K.
AU  - Luhar, S.*
AU  - O'Flaherty, M.*
AU  - Kypridemos, C.*
AU  - Laxy, M.
C1  - 68192
C2  - 54832
CY  - Elsevier House, Brookvale Plaza, East Park Shannon, Co, Clare, 00000, Ireland
TI  - Forecasting the mortality burden of coronary heart disease and stroke in Germany: National trends and regional inequalities.
JO  - Int. J. Cardiol.
VL  - 393
PB  - Elsevier Ireland Ltd
PY  - 2023
SN  - 0167-5273
ER  - 

TY  - JOUR
AB  - INTRODUCTION: Heart failure (HF) is a heterogeneous syndrome, and the specific sub-category HF with mildly reduced ejection fraction (EF) range (HFmrEF; 41-49% EF) is only recently recognised as a distinct entity. Cluster analysis can characterise heterogeneous patient populations and could serve as a stratification tool in clinical trials and for prognostication. The aim of this study was to identify clusters in HFmrEF and compare cluster prognosis. METHODS AND RESULTS: Latent class analysis to cluster HFmrEF patients based on their characteristics was performed in the Swedish HF registry (n = 7316). Identified clusters were validated in a Dutch cross-sectional HF registry-based dataset CHECK-HF (n = 1536). In Sweden, mortality and hospitalisation across the clusters were compared using a Cox proportional hazard model, with a Fine-Gray sub-distribution for competing risks and adjustment for age and sex. Six clusters were discovered with the following prevalence and hazard ratio with 95% confidence intervals (HR [95%CI]) vs. cluster 1: 1) low-comorbidity (17%, reference), 2) ischaemic-male (13%, HR 0.9 [95% CI 0.7-1.1]), 3) atrial fibrillation (20%, HR 1.5 [95% CI 1.2-1.9]), 4) device/wide QRS (9%, HR 2.7 [95% CI 2.2-3.4]), 5) metabolic (19%, HR 3.1 [95% CI 2.5-3.7]) and 6) cardio-renal phenotype (22%, HR 2.8 [95% CI 2.2-3.6]). The cluster model was robust between both datasets. CONCLUSION: We found robust clusters with potential clinical meaning and differences in mortality and hospitalisation. Our clustering model could be valuable as a clinical differentiation support and prognostic tool in clinical trial design.
AU  - Meijs, C.
AU  - Brugts, J.J.*
AU  - Lund, L.H.*
AU  - Linssen, G.C.M.*
AU  - Rocca, H.B.*
AU  - Dahlström, U.*
AU  - Vaartjes, I.*
AU  - Koudstaal, S.*
AU  - Asselbergs, F.W.*
AU  - Savarese, G.*
AU  - Uijl, A.*
C1  - 67919
C2  - 54397
CY  - Elsevier House, Brookvale Plaza, East Park Shannon, Co, Clare, 00000, Ireland
SP  - 83-90
TI  - Identifying distinct clinical clusters in heart failure with mildly reduced ejection fraction.
JO  - Int. J. Cardiol.
VL  - 386
PB  - Elsevier Ireland Ltd
PY  - 2023
SN  - 0167-5273
ER  - 

TY  - JOUR
AB  - Background: We estimated the association of changes in body weight, waist circumference (WC), fat mass (FM) and fat-freemass (FFM) with changes in blood pressure and incident hypertension using data from four German population-based studies.Methods: We analyzed data from 4467 participants, aged 21 to 82 years not taking antihypertensive medication and not having type 2 diabetes mellitus or a history of myocardial infarction at baseline and follow-up, from four population-based studies conducted in Germany. Body weight, WC, and blood pressure were measured at baseline and follow-up (median follow-up of the single studies 4 to 7 years). FM and FFM were calculated based on height-weight models derived from bioelectrical impedance studies. Hypertension was defined as systolic blood pressure >= 140 mmHg or diastolic blood pressure >= 90 mmHg. Confounder-adjusted linear and logistic regressions were used to associate changes in anthropometric markers with changes in blood pressure, incident hypertension, and incident normalization of blood pressure.Results: In a pooled dataset including all four studies, increments in body weight, WC, FM, and FFM were statistically significantly associated with incident hypertension and changes in systolic and diastolic blood pressure over time. Decreases in body weight, FM, and FFM were significantly associated with incident normalization of blood pressure.Conclusions: Our data suggests that the well-established association between obesity and blood pressure levels might be more related to body composition rather than to total body weight per se. Our findings indicate that gaining or losing FFM has substantial impact on the development or reversion of hypertension. (c) 2018 Elsevier B.V. All rights reserved.
AU  - Ittermann, T.*
AU  - Werner, N.*
AU  - Lieb, W.*
AU  - Merz, B.*
AU  - Nöthlings, U.*
AU  - Kluttig, A.*
AU  - Tiller, D.*
AU  - Greiser, K.H.*
AU  - Vogt, S.
AU  - Thorand, B.
AU  - Peters, A.
AU  - Völzke, H.*
AU  - Dörr, M.*
AU  - Schipf, S.*
AU  - Markus, M.R.P.*
C1  - 54321
C2  - 45502
CY  - Elsevier House, Brookvale Plaza, East Park Shannon, Co, Clare, 00000, Ireland
SP  - 372-377
TI  - Changes in fat mass and fat-free-mass are associated with incident hypertension in four population-based studies from Germany.
JO  - Int. J. Cardiol.
VL  - 274
PB  - Elsevier Ireland Ltd
PY  - 2019
SN  - 0167-5273
ER  - 

TY  - JOUR
AU  - Ladwig, K.-H.
C1  - 55033
C2  - 46062
CY  - Elsevier House, Brookvale Plaza, East Park Shannon, Co, Clare, 00000, Ireland
SP  - 261-262
TI  - Anxiety weights down the heart - New evidence for a toxic cardiovascular risk factor.
JO  - Int. J. Cardiol.
VL  - 278
PB  - Elsevier Ireland Ltd
PY  - 2019
SN  - 0167-5273
ER  - 

TY  - JOUR
AB  - BACKGROUND: Cardiovascular comorbidities are common in chronic obstructive pulmonary disease (COPD). We examined the association between airflow limitation, hyperinflation and the left ventricle (LV). METHODS: Patients from the COPD cohort COSYCONET underwent evaluations including forced expiratory volume in 1 s (FEV), forced vital capacity (FVC), effective airway resistance (R), intrathoracic gas volume (ITGV), and echocardiographic LV end-diastolic volume (LVEDV), stroke volume (LVSV), end-systolic volume (LVESV), and end-diastolic and end-systolic LV wall stress. Data from Visit 1 (baseline) and Visit 3 (18 months later) were used. In addition to comparisons of both visits, multivariate regression analysis was conducted, followed by structural equation modelling (SEM) with latent variables "Lung" and "Left heart". RESULTS: A total of 641 participants were included in this analysis. From Visit 1 to Visit 3, there were significant declines in FEV and FEV/FVC, and increases in R, ITGV and LV end-diastolic wall stress, and a borderline significant decrease in LV mass. There were significant correlations of: FEV% predicted with LVEDV and LVSV; R with LVSV; and ITGV with LV mass and LV end-diastolic wall stress. The SEM fitted the data of both visits well (comparative fit index: 0.978, 0.962), with strong correlation between "Lung" and "Left heart". CONCLUSIONS: We demonstrated a relationship between lung function impairment and LV wall stress in patients with COPD. This supports the hypothesis that LV impairment in COPD could be initiated or promoted, at least partly, by mechanical factors exerted by the lung disorder.
AU  - Alter, P.*
AU  - Jörres, R.A.*
AU  - Watz, H.*
AU  - Welte, T.*
AU  - Gläser, S.*
AU  - Schulz, H.
AU  - Bals, R.*
AU  - Karch, A.*
AU  - Wouters, E.F.M.*
AU  - Vestbo, J.*
AU  - Young, D.M.*
AU  - Vogelmeier, C.F.*
C1  - 53410
C2  - 44680
SP  - 172-178
TI  - Left ventricular volume and wall stress are linked to lung function impairment in COPD.
JO  - Int. J. Cardiol.
VL  - 261
PY  - 2018
SN  - 0167-5273
ER  - 

TY  - JOUR
AB  - Background Percutaneous coronary intervention (PCI) reduces mortality in most myocardial infarction (MI) patients but the effect on elderly patients with comorbidities is unclear. Our aim was to analyse the effect of PCI on in-hospital mortality of MI patients, by age, sex, ST elevation on presentation, diabetes mellitus (DM) and chronic kidney disease (CKD). Methods Cohort study of 79,791 MI patients admitted at European hospitals during 2000–2014. The effect of PCI on in-hospital mortality was analysed by age group (18–74, ≥ 75 years), sex, presence of ST elevation, DM and CKD, using propensity score matching. The number needed to treat (NNT) to prevent a fatal event was calculated. Sensitivity analyses were conducted. Results PCI was associated with lower in-hospital mortality in ST and non-ST elevation MI (STEMI and NSTEMI) patients. The effect was stronger in men [Odds ratio (95% confidence interval) 0.30 (0.25–0.35)] than in women [0.46 (0.39–0.54)] aged ≥ 75 years, and in NSTEMI [0.22 (0.17–0.28)] than in STEMI patients [0.40 (0.31–0.5)] aged < 75 years. PCI reduced in-hospital mortality risk in patients with and without DM or CKD (54–72% and 52–73% reduction in DM and CKD patients, respectively). NNT was lower in patients with than without CKD [≥ 75 years: STEMI = 6(5–8) vs 9(8–10); NSTEMI = 10(8–13) vs 16(14–20)]. Sensitivity analyses such as exclusion of hospital stays < 2 days yielded similar results. Conclusions PCI decreased in-hospital mortality in MI patients regardless of age, sex, and presence of ST elevation, DM and CKD. This supports the recommendation for PCI in elderly patients with DM or CKD.
AU  - Dégano, I.R.*
AU  - Subirana, I.*
AU  - Fusco, D.*
AU  - Tavazzi, L.*
AU  - Kirchberger, I.
AU  - Farmakis, D.*
AU  - Ferrieres, J.*
AU  - Azevedo, A.*
AU  - Torre, M.*
AU  - Garel, P.*
AU  - Brosa, M.*
AU  - Davoli, M.*
AU  - Meisinger, C.
AU  - Bongard, V.*
AU  - Araújo, C.*
AU  - Lekakis, J.*
AU  - Francès, A.*
AU  - Castell, C.*
AU  - Elosua, R.*
AU  - Marrugat, J.*
C1  - 52304
C2  - 43873
CY  - Clare
SP  - 83-89
TI  - Percutaneous coronary intervention reduces mortality in myocardial infarction patients with comorbidities: Implications for elderly patients with diabetes or kidney disease.
JO  - Int. J. Cardiol.
VL  - 249
PB  - Elsevier Ireland Ltd
PY  - 2017
SN  - 0167-5273
ER  - 

TY  - JOUR
AB  - Background: Takotsubo syndrome (TS) is an acute non-ischemic cardiomyopathy characterized by transient regional systolic dysfunction of the left and/or right ventricle with still unknown etiology. The aim of the current study was to conduct for the first time a genome-wide association study (GWAS) in a cohort of TS patients to identify potential genetic risk variants. Methods: This single-center study was conducted at the University Heart Center Lübeck from 2008 to 2016. DNA isolation was done according to standard protocols. Imputation of genotypes were performed at the Michigan Imputation Server (https://imputationserver.sph.umich.edu) using the 1000G Phase 3 v5 reference panel. Results: The study population consisted of 96 TS patients (91 females, 5 males) with a mean age of 71.9±10.4years and 475 healthy controls (268 males, 207 females). The results of GWAS analysis showed several promising candidate loci (68 loci after applying threshold of p<5*10-4 and MAF>5%). Of these 68 loci, 18 loci contained top single nucleotide polymorphisms (SNPs) that were supported by SNPs in high Linkage Disequilibrium (r2>0.8) with p<10-3. Two out of the 18 loci contained SNP with hits in the GWAS catalog (traits: blood pressure, thyroid stimulating hormone). Conclusion: This first GWAS analysis in a larger cohort of patients with TS showed promising preliminary results. Further intensive research efforts of international collaborators are now necessary to enable deep-phenotyping of TS patients to ultimately assess a potential genetic cause of TS.
AU  - Eitel, I.*
AU  - Moeller, C.*
AU  - Munz, M.*
AU  - Stiermaier, T.*
AU  - Meitinger, T.
AU  - Thiele, H.*
AU  - Erdmann, J.*
C1  - 50412
C2  - 42429
CY  - Clare
SP  - 335-339
TI  - Genome-wide association study in takotsubo syndrome - Preliminary results and future directions.
JO  - Int. J. Cardiol.
VL  - 236
PB  - Elsevier Ireland Ltd
PY  - 2017
SN  - 0167-5273
ER  - 

TY  - JOUR
AB  - BACKGROUND: Hospital performance models in acute myocardial infarction (AMI) are useful to assess patient management. While models are available for individual countries, mainly US, cross-European performance models are lacking. Thus, we aimed to develop a system to benchmark European hospitals in AMI and percutaneous coronary intervention (PCI), based on predicted in-hospital mortality. METHODS AND RESULTS: We used the EURopean HOspital Benchmarking by Outcomes in ACS Processes (EURHOBOP) cohort to develop the models, which included 11,631 AMI patients and 8276 acute coronary syndrome (ACS) patients who underwent PCI. Models were validated with a cohort of 55,955 European ACS patients. Multilevel logistic regression was used to predict in-hospital mortality in European hospitals for AMI and PCI. Administrative and clinical models were constructed with patient- and hospital-level covariates, as well as hospital- and country-based random effects. Internal cross-validation and external validation showed good discrimination at the patient level and good calibration at the hospital level, based on the C-index (0.736-0.819) and the concordance correlation coefficient (55.4%-80.3%). Mortality ratios (MRs) showed excellent concordance between administrative and clinical models (97.5% for AMI and 91.6% for PCI). Exclusion of transfers and hospital stays ≤1day did not affect in-hospital mortality prediction in sensitivity analyses, as shown by MR concordance (80.9%-85.4%). Models were used to develop a benchmarking system to compare in-hospital mortality rates of European hospitals with similar characteristics. CONCLUSIONS: The developed system, based on the EURHOBOP models, is a simple and reliable tool to compare in-hospital mortality rates between European hospitals in AMI and PCI.
AU  - Dégano, I.R.*
AU  - Subirana, I.*
AU  - Torre, M.*
AU  - Grau, M.*
AU  - Vila, J.*
AU  - Fusco, D.*
AU  - Kirchberger, I.
AU  - Ferrieres, J.*
AU  - Malmivaara, A.*
AU  - Azevedo, A.*
AU  - Meisinger, C.
AU  - Bongard, V.*
AU  - Farmakis, D.*
AU  - Davoli, M.*
AU  - Häkkinen, U.*
AU  - Araujo, C.*
AU  - Lekakis, J.*
AU  - Elosua, R.*
AU  - Marrugat, J.*
C1  - 43239
C2  - 36347
CY  - Clare
SP  - 509-516
TI  - A European benchmarking system to evaluate in-hospital mortality rates in acute coronary syndrome: The EURHOBOP project.
JO  - Int. J. Cardiol.
VL  - 182
PB  - Elsevier Ireland Ltd
PY  - 2015
SN  - 0167-5273
ER  - 

TY  - JOUR
AB  - BACKGROUND: Scarce evidence yields conflicting results regarding the effect of prodromal chest pain (PCP) on pre-hospital delay during an acute myocardial infarction (AMI). We aimed to assess the impact of PCP on delay. METHODS: Data was collected on 619 ST-elevated MI patients from the multicenter Munich Examination of Delay in Patients Experiencing Acute Myocardial Infarction (MEDEA) study. Patients with any PCP (which was subdivided into undefined PCP, possible and definite angina) within a year before AMI were identified using the Rose questionnaire, administered in bedside interviews. The influence of PCP and its subdivisions (all compared to no PCP) was assessed using logistic regression (with cut-offs of 2h, 6h, and a 4-category ordinal outcome). RESULTS: Any type of PCP was reported by men (50.6%) more than women (34.6%) (OR=1.9; 95% CI: 1.3 to 2.8; p=.001). The median delay of patients with PCP was not significantly different to delay in patients with no PCP (p=.327). Prolonged delay times were observed in women with PCPs of lesser degree of cardiac confirmation, while the opposite was observed in men. In women, possible angina was more strongly associated with delay <2h (OR=6.8; 95% CI=2 to 23.8) than any PCP (OR=2.6; 95% CI=1.2 to 5.7). CONCLUSIONS: For men, PCPs of increasing cardiac confirmation are associated with prolonged delay. For women, PCPs of lesser cardiac confirmation are more likely to lead to prolonged delay. Future studies should investigate mediating factors.
AU  - von Eisenhart Rothe, A.
AU  - Albarqouni, L.
AU  - Gärtner, C.*
AU  - Walz, L.*
AU  - Smenes, K.R.*
AU  - Ladwig, K.-H.
C1  - 46721
C2  - 37771
SP  - 581-586
TI  - Sex specific impact of prodromal chest pain on pre-hospital delay time during an acute myocardial infarction: Findings from the multicenter MEDEA study with 619 STEMI patients.
JO  - Int. J. Cardiol.
VL  - 201
PY  - 2015
SN  - 0167-5273
ER  - 

TY  - JOUR
AB  - BACKGROUND: The effects of smoking on central aortic pressures and the age-related increase in left ventricular mass (LVM) are largely unknown. We studied the relationship between smoking, arterial distensibility, central aortic pressures and left ventricular mass in two population-based studies. METHODS: Data was obtained from two German population-based studies (KORA and SHIP, participants' ages 25-84years). We identified 114 normotensive current smokers and 185 normotensive all-time non-smokers in KORA as well as 400 and 588 such individuals in SHIP. Echocardiographic LVM was obtained at baseline (T0) and follow-up after ten years (T1) in KORA and at follow-up (T1) in SHIP. Additionally, pulse-wave analysis-based central aortic pressure and augmentation index (AIx) were measured at T1 in KORA. RESULTS: Cross-sectional analysis, using KORA T0 and SHIP T1, revealed in both studies a higher covariate-adjusted LVM and left ventricular mass index (LVMI) in smokers as compared with non-smokers. Moreover, in the KORA T1 examination, the smokers demonstrated a more pronounced increase, relative to baseline, of LVM (+13.5%) and LVMI (+13.4%) compared to non-smokers (+8.59% and +8.65%; p=0.036 and 0.042, respectively). Additionally, at KORA T1 smokers had a higher central systolic blood pressure and higher AIx than non-smokers (p=0.012 and p=0.001, respectively). CONCLUSIONS: The difference in central aortic pressure due to enhanced and more prolonged wave reflection may explain our finding of a further pronounced increase in left ventricular wall thickness and mass over time in smokers.
AU  - Markus, M.R.*
AU  - Stritzke, J.*
AU  - Baumeister, S.E.*
AU  - Siewert, U.*
AU  - Baulmann, J.*
AU  - Hannemann, A.*
AU  - Schipf, S.*
AU  - Meisinger, C.
AU  - Dörr, M.*
AU  - Felix, S.B.*
AU  - Keil, U.*
AU  - Völzke, H.*
AU  - Hense, H.W.*
AU  - Schunkert, H.*
C1  - 25226
C2  - 31849
SP  - 2593-2601
TI  - Effects of smoking on arterial distensibility, central aortic pressures and left ventricular mass.
JO  - Int. J. Cardiol.
VL  - 168
IS  - 3
PB  - Elsevier Ireland
PY  - 2013
SN  - 0167-5273
ER  - 

TY  - JOUR
AU  - Aydin, A.*
AU  - Mortensen, K.*
AU  - Rybczynski, M.*
AU  - Sheikhzadeh, S.*
AU  - Willmann, S.*
AU  - Bernhardt, A.M.J.*
AU  - Hillebrand, M.*
AU  - Stritzke, J.*
AU  - Baulmann, J.*
AU  - Schunkert, H.*
AU  - Keil, U.*
AU  - Hense, H.W.*
AU  - Meisinger, C.
AU  - Robinson, P.N.*
AU  - Berger, J.*
AU  - Willems, S.*
AU  - Meinertz, T.*
AU  - von Kodolitsch, Y.*
C1  - 6469
C2  - 28772
SP  - 466-468
TI  - Central pulse pressure and augmentation index in asymptomatic bicuspid aortic valve disease.
JO  - Int. J. Cardiol.
VL  - 147
IS  - 3
PB  - Elsevier
PY  - 2011
SN  - 0167-5273
ER  - 

TY  - JOUR
AB  - BACKGROUND: With increasing life expectancy the management of acute myocardial infarction (AMI) in patients of an older age is of growing importance. However, long-term data are limited regarding 'hard' endpoints and quality of life in unselected elderly patients in 'real world' settings. METHODS AND RESULTS: From March 2005 to March 2006 all 75-84-year old patients consecutively hospitalised due to an incident AMI in a large community teaching hospital were analyzed (N=235). Evidence-based therapy included the treatment with aspirin (93%), clopidogrel (65%), betablockers (93%), angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (84%), and statins (83%). Percutaneous coronary intervention (PCI) was performed in 45.5% and bypass grafting (CABG) in 10.2%. The 28-day-case fatality was 17.4%. Long-term follow-up was obtained in 95.9% of all hospital survivors at a mean of 18.7 ± 6.4 months; during this time 19.9% of patients died. After multivariate analysis the only significantly negative predictor for survival and MACCE was diabetes, and the only significantly positive predictor was revascularisation during hospital stay. Patients with PCI/CABG had lower NYHA class (81% vs. 48%; p<0.04). Patients with PCI also had a higher EQ-5D index score (75 ± 18 vs. 67 ± 17, p<0.04) compared to patients not receiving PCI. CONCLUSION: The positive long-time effect of revascularisation procedures during hospitalisation, not only on 'hard' endpoints but also on functional outcome and quality of life emphasizes that invasive therapies should not be considered less valuable in elderly people and that age alone should not preclude aggressive treatment during AMI.
AU  - Kuch, B.*
AU  - Wende, R.*
AU  - Barac, M.*
AU  - von Scheidt, W.*
AU  - Kling, B.*
AU  - Greschik, C.
AU  - Meisinger, C.
C1  - 6676
C2  - 29228
SP  - 205-210
TI  - Prognosis and outcomes of elderly (75-84 years) patients with acute myocardial infarction 1-2 years after the event - AMI-elderly study of the MONICA/KORA Myocardial Infarction Registry.
JO  - Int. J. Cardiol.
VL  - 149
IS  - 2
PB  - Elsevier
PY  - 2011
SN  - 0167-5273
ER  - 

TY  - JOUR
AB  - Prompt initiation of treatment after symptom onset of ST-elevation myocardial infarction (STEMI) is a central goal in limiting myocardial damage because of the time-dependent nature of reperfusion therapies. We examined time patterns and long term time trends of pre-hospital delay time (PHDT) of STEMI patients. PHDT from 3093 STEMI patients derived from the Augsburg Myocardial Infarction Registry (1985-2004) surviving >24h after admission was obtained by a standardized bedside interview. Patients with in-hospital MI (n=140) and resuscitation (n=157) were excluded. Linear regression models were used to examine monthly median PHDT and individual PHDT over time.Female sex was associated with longer PHDT (189 (98-542quartiles) min vs. 154 (85-497) min; p<0.0003). Median PHDT in the youngest male subgroup (25-54 years) was 128 (73-458) min and mounted to 205 (107-600) min in the oldest female subgroup (65-74 years). A minority of 12.4% of patients reached hospital within 1h of delay ranging from 8.7% (in oldest women) to 15.9% (in youngest men). The age-adjusted linear regression model for monthly PHDT revealed no significant change over 20-year time in both sexes. The corresponding average annual percentage change estimates were -0.45 (95% CI: -1.40 to 0.54) for men and -0.08 (95% CI: -1.80 to 1.67) for women. Emergency ambulance use increased over time, however transportation time remained stable.PHDT in STEMI patients is constantly high over a 20-year observation period. Room for improvement especially in older women was evidenced. Preventive strategies with focused efforts on this subgroup are warranted.
AU  - Ladwig, K.-H.
AU  - Meisinger, C.*
AU  - Hymer, H.
AU  - Wolf, K.*
AU  - Heier, M.*
AU  - von Scheidt, W.*
AU  - Kuch, B.*
C1  - 6899
C2  - 29448
CY  - Amsterdam, Netherlands
SP  - 350-355
TI  - Sex and age specific time patterns and long term time trends of pre-hospital delay of patients presenting with acute ST-segment elevation myocardial infarction.
JO  - Int. J. Cardiol.
VL  - 152
IS  - 3
PB  - Elsevier
PY  - 2011
SN  - 0167-5273
ER  - 

TY  - JOUR
AB  - BACKGROUND: The purpose of the study was to test whether an elevated surface expression of platelet collagen receptor glycoprotein VI (GPVI) is an appropriate marker for the diagnosis of the acute coronary syndrome (ACS), especially when the electrocardiogram (ECG) is ambiguous. METHODS: Between 2007 to 2008, we consecutively evaluated 378 patients with ACS and ambiguous ECG on hospital admission. In all patients, GPVI surface expression was determined by flow cytometry. In addition, the myocardial necrosis markers troponin-I (Tn-I) and creatine kinase-MB (CKMB) were measured. RESULTS: We found that in patients with ACS and unclear ECG in whom GPVI levels (mean fluorescence intensity (MFI) >/=18.6) were elevated, the relative risk for ACS was 2.6-fold enhanced. Binary logistic regression analysis revealed that an elevated platelet GPVI level is indicating an ACS independent of biomarkers of myocardial necrosis including Tn-I, creatine kinase (CK), CKMB (GPVI: p=0.011; Tn-I: p=0.180; CKMB: p=0.250; CK: p=0.127). Patients with evident T-wave inversion and/or ST-depression showed a strong association between ACS and GPVI expression. CONCLUSIONS: Platelet GPVI surface expression is enhanced in patients with ACS with unclear ECG findings and is strongly associated with myocardial ischemia. Additional to the classical markers of myocardial necrosis Tn-I and CK, GPVI is an early biomarker for the diagnosis of ACS, especially when the ECG is ambiguous.
AU  - Bigalke, B.*
AU  - Stellos, K.*
AU  - Geisler, T.*
AU  - Kremmer, E.
AU  - Seizer, P.*
AU  - May, A.E.*
AU  - Lindemann, S.*
AU  - Gawaz, M.*
C1  - 5308
C2  - 27582
SP  - 164-168
TI  - Glycoprotein VI for diagnosis of acute coronary syndrome when ECG is ambiguous.
JO  - Int. J. Cardiol.
VL  - 149
IS  - 2
PB  - Elsevier
PY  - 2010
SN  - 0167-5273
ER  - 

TY  - JOUR
AB  - ECG (electrocardiogram) markers reflecting abnormal heart rate variability and abnormal repolarization as well as several biochemical markers reflecting inflammation, endothelial dysfunction, and procoagulation states were reported to show an association with increased cardiovascular mortality. ECG and biochemical markers could operate independently or they could interrelate in pathogenetic pathways of coronary disease. In this study, we aimed to explore the relationship between ECG and biochemical markers in a longitudinal study of coronary patients. METHODS: A total of 499 observations from 52 patients with up to 12 repeated measurements were collected providing data on series of ECG (heart rate variability and repolarization) parameters and biochemical parameters. Generalized estimating equation models adjusting for repeated measurements were used for the analyses. RESULTS: There was a significant association between ECG parameters reflecting abnormal repolarization (prolonged QT interval, lower T wave amplitude) and elevated levels of C-reactive protein and fibrinogen. Abnormal heart rate variability, increased sympathetic tone (low-frequency power) was associated with increased concentrations of soluble E-selectin, a marker of endothelial cell activation. There was no association between ECG markers and parameters reflecting increased procoagulation states. CONCLUSION: These results indicate that there is an association between ECG parameters and blood markers reflecting endothelial function and inflammation in coronary artery disease patients. The pathophysiologic mechanisms of these associations remain to be elucidated.
AU  - Yue, W.
AU  - Schneider, A.E.
AU  - Rückerl, R.
AU  - Koenig, W.*
AU  - Marder, V.*
AU  - Wang, S.*
AU  - Wichmann, H.-E.
AU  - Peters, A.
AU  - Zareba, W.*
C1  - 4587
C2  - 24623
SP  - 85-191
TI  - Relationship between electrocardiographic and biochemical variables in coronary artery disease.
JO  - Int. J. Cardiol.
VL  - 119
PB  - Elsevier
PY  - 2007
SN  - 0167-5273
ER  - 

TY  - JOUR
AU  - Meisinger, C.
AU  - Hörmann, A.
AU  - Heier, M.
AU  - Kuch, B.*
AU  - Löwel, H.
C1  - 4581
C2  - 24275
SP  - 229-235
TI  - Admission blood glucose and adverse outcomes in non-diabetic patients with myocardial infarction in the reperfusion era.
JO  - Int. J. Cardiol.
VL  - 113
PY  - 2006
SN  - 0167-5273
ER  - 

TY  - JOUR
AU  - Lieb, W.*
AU  - Pavlik, R.*
AU  - Erdmann, J.*
AU  - Mayer, B.*
AU  - Holmer, S.R.*
AU  - Fischer, M.*
AU  - Baessler, A.*
AU  - Hengstenberg, C.*
AU  - Löwel, H.
AU  - Döring, A.
AU  - Riegger, G.A.*
C1  - 1405
C2  - 22245
SP  - 205-212
TI  - No association of interleukin-6 gene polymorphism (-174 G/C) with myocardial infarction or traditional cardiovascular risk factors.
JO  - Int. J. Cardiol.
VL  - 97
PY  - 2004
SN  - 0167-5273
ER  -