Primary PCI for Acute Myocardial Infarction. Clinical and Angiographic Features. José P. S. Henriques
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1 Primary PCI for Acute Myocardial Infarction Clinical and Angiographic Features José P. S. Henriques
2 ISBN: ISBN: (electronic version) Financial support by the Zwols Wetenschapsfonds Isala Klinieken ZWIK and the Netherlands Heart Foundation for the publication of this thesis is gratefully acknowledged J.P.S.Henriques All righst are reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, mechanically or by photocopying, recording or otherwise, without the written permission of the author Cover: S.E. Kramer Printing: Krips, Meppel
3 RIJKSUNIVERSITEIT GRONINGEN Primary PCI for Acute Myocardial Infarction Clinical and Angiographic Features Proefschrift ter verkrijging van het doctoraat in de Medische Wetenschappen aan de Rijksuniversiteit Groningen op gezag van de Rector Magnificus, dr. F. Zwarts, in het openbaar te verdedigen op maandag 16 juni 2003 om uur door José Paulo Simão Henriques geboren op 16 maart 1966 te Amsterdam
4 Promotor: Prof. dr. F. Zijlstra Co-promotor: Dr. J. C. A. Hoorntje Beoordelingscommissie : Prof. dr. D. J. van Veldhuisen Prof. dr. J. J. Piek Prof. dr. A. A. M. Wilde
5 Ter nagedachtenis aan mijn vader Luís Lopes Henriques ( ) Aan mijn moeder Voor Sophia
6
7 Contents CONTENTS CHAPTER 1. General Introduction 11 CHAPTER 2. Long-term results of the Zwolle trial Prognostic importance of left ventricular function 27 after angioplasty or thrombolysis for acute myocardial infarction: Long-term results of the Zwolle trial. Neth Heart J 2001;9: Additional benefits of primary PCI compared to 41 thrombolytic therapy in acute anterior STEMI patients during long-term follow up. The importance of left ventricular function. Submitted. CHAPTER 3. Ventricular fibrillation in acute myocardial 57 infarction 3.1. Out-of-hospital ventricular fibrillation in patients with 59 acute myocardial infarction: coronary angiographic determinants. J Am Coll Cardiol 2000;35: Preinfarction angina protects against out-of-hospital 77 ventricular fibrillation in patients with acute occlusion of the left coronary artery. J Am Coll Cardiol 2001;38:
8 Contents 3.3. Predictors of early ventricular fibrillation before 91 reperfusion therapy for acute ST elevation myocardial infarction. Submitted. CHAPTER 4. Angiographic success of reperfusion Incidence and clinical significance of distal embolization 107 during primary angioplasty for acute myocardial infarction. Eur Heart J 2002;23: Angiographic determinants of infarct size after 121 successful percutaneous intervention for acute ST elevation myocardial infarction; The impact of distal embolization. Neth Heart J 2002;10: Angiographic predictors of left ventricular ejection fraction 139 after successful angioplasty in acute myocardial infarction. An angiographic risk score for use in the catheterization laboratory. Submitted Frequency and sequelae of ST elevation acute 153 myocardial infarction caused by spontaneous distal embolization from unstable coronary lesions. Am J Cardiol 2003;91:
9 Dankwoord Dr J-H.E. Dambrink, beste Jan-Henk, bedankt voor de late uurtjes, waarin je mij de beginselen van de echocardiografie bijbracht. Dr. H. Suryapranata en Dr. A.T.M. Gosselink, dank voor het creeren van een sfeer waarin dit proefschrift tot stand heeft kunnen komen. Dr. A.R. Ramdat Misier en W.P. Beukema, beste Anand en Willem, het electrische duo uit de Weezenlanden. Jullie kennis, onderwijs en enthousiasme tijdens de woensdagmiddag besprekingen zijn motiverend. A.H.E.M. Maas, W.J. Louridtz, A. Breeman en P.P. Delnoy, beste Angela, Willem Jan, Arno en Peter Paul, bedankt voor de goede en leerzame tijd in het Sophiaanse. Dr. E. de Kluiver, beste Ed, dank voor alles. Je bent je s net eerder kwijt dan ik. De maatschappen Thoraxchirurgie en Thoraxanaesthesie van de Weezenlanden bedank ik voor de prettige samenwerking. Dank aan de maatschappen thoraxchirurgie van het O.L.V.G. in Amsterdam en van het St. Antonius ziekenhuis in Nieuwegein. Speciale dank aan dr. J.M.P.G. Ernst en Prof. dr. N.M. van Hemel, cardiologen van het St. Antonius ziekenhuis in Nieuwegein. Dr. P. Gheeraert, cardioloog van het universitair ziekenhuis in Gent, beste Peter, dank voor de ongoing samenwerking, waarvoor je zelfs sneeuwbuien op de motor hebt getrotseerd. Prof. dr. Luís Silva-Carvalho, since you are almost as English as you are Portuguese, I would like to thank you (in English) for the first steps you allowed me to make in Experimental Circulatory Physiological Research in your laboratory at the Medical Faculty of the University of Lisbon. You have importantly contributed to my interest in research. Muito obrigado! Dank aan alle arts-assistenten in de Isala Klinieken, waar ik door de jaren heen mee heb samengewerkt. Ik dank de verpleegkundigen op de hartbewaking, intensive care en verpleegafdelingen van de Isala klinieken voor de goede sfeer. Heel bijzonder bedank ik de personeelsleden van de hartcatherisatie teams van beide locaties van de Isala Klinieken voor de uitstekende tijd die ik bij hen heb 228
10 Dankwoord gehad. Met name het team van de lokatie de Weezenlanden. De bijzondere werksfeer, samen met een geweldig enthousiasme, heeft mede geleid tot het feit dat Zwolle op de wereldkaart is gezet in de behandeling van het acute hartinfarct. Speciale dank aan Dirk Dijkstra en Henk Eenhuizen! Ook de echoclub en de overige medewerkers van de functie afdeling dank ik voor de goede en leerzame tijd in een uitstekende sfeer. Zeer veel dank aan de medewerkers van het medische archief van De Weezenlanden. Meer dan 4000 (!) status moesten voor dit proefschirft boven water komen. Het secretariaat Cardiologie van beide lokaties dank ik voor de prettige werksfeer. Dank aan Edwin Nibbering, Nasia Gerritsen, Dini Amo (hoeveel coronair angio s hebben we bekeken?) en Joep Dille voor hun ondersteuning vanuit Diagram. Graag dank ik de leden van de leescommissie, Prof. dr. J.J. Piek, Prof. dr. A. A. M. Wilde en Prof. dr. D. J. Van Veldhuisen, voor het kritisch doorlezen van het manuscript. Een woord tot mijn paranimfen dr. J.P. Ottervanger en A.P. Haasdijk. Beste Arnout, we hebben een uitstekende tijd gehad tijdens onze opleiding en daarbij is er een vriendschap ontstaan die we moeten koesteren. Jouw organisatorische kwaliteiten, laten gevoelens verdwijnen en feiten naar de oppervlakte komen. Beste Jan Paul, jouw kwaliteiten zijn inmiddels niet alleen in Zwolle bekend, maar ook landelijk. Van jou heb ik veel geleerd, ik heb het gevoel dat je een ook beetje mijn copromotor was. Arnout en Jan Paul, ik teken voor een club met ons drieën. Vera Derks, beste Vera, je bent een hoeksteen voor de cardiologie in de Weezenlanden. In de wetenschappelijke output vervul je een centrale rol. Bedankt voor je hulp en ik ga je missen. Dank aan Joost Keyer, Gerard Stroomberg en Bob Witsiers voor hun jarenlange vriendschap. Ook dank aan mijn schoonfamilie en in het bijzonder mijn schoonouders voor de altijd getoonde belangstelling. 229
11 Dankwoord Speciale dank aan mijn ouders. De herinneringen aan mijn vader zijn van onschatbare waarde. Van hem heb ik veel geleerd. Ook mijn moeder heeft me veel bijgebracht. Ze heeft me altijd gesteund en liefde gegegeven. Mamã, muito obrigado por tudo! Lieve Sophia, vijf jaar geleden heb jij je proefschrift verdedigd. Jij hebt het gehele proces omtrent dit proefschrift met mij meegemaakt en meegeleefd. Zoals altijd, zeg je op belangrijke momenten de juiste woorden. Bedankt voor je onmisbare en zeer belangrijke hulp en steun. Ik hou van je! Ten slotte, maar vooral dank ik God. De Naam des Heren zij geprezen tot in eeuwigheid. 230
12
13 Additional financial support by the following sponsors for the publication of this thesis is gratefully acknowledged: -Guidant BV -St. Jude Medical BV -AstraZeneca BV -MSD BV -Bristol-Myers Squibb BV -Medtronic BV -Boehringer Ingelheim BV -Roche Nederland BV 232
14 STELLINGEN BEHORENDE BIJ HET PROEFSCHRIFT Primary PCI for Acute Myocardial Infarction Clinical and Angiographic Features 1- De belangrijkste voorspeller van korte en lange termijn overleving na een hartinfarct is infarctgrootte of linker kamer restfunctie. 2- Primaire coronaire angioplastiek is beter voor de patiënt dan thrombolyse omdat de infarctgrootte kleiner is en de linker kamer restfunctie beter behouden blijft. 3- Primaire coronaire angioplastiek is beter voor de patiënt dan thrombolyse als behandeling van het acute hartinfarct, zowel op de korte als op de lange termijn! 4- Het meeste gebeurt buiten ons gezichtveld en daarom zien we het anders. Plotse dood voor en na behandeling van een acuut hartinfarct gebeurt buiten ons gezichtsveld. Beide vormen ze de belangrijkste doodsoorzaak van een acuut hartinfarct heden ten dage. 5- Het optreden van ventrikel fibrilleren (hartstilstand) tijdens een hartinfarct komt vaker voor bij: patiënten met een voorwandinfarct, patiënten zonder eerder pijn op de borst klachten en patiënten met hartfalen. 6- Angiografisch zichtbare distale embolisatie zowel voor de coronaire angioplastiek als na de coronaire angioplastiek leidt tot verminderde reperfusie met alle gevolgen van dien.
15 7- Na een geslaagde primaire coronaire angioplastiek (TIMI 3) heeft de patiënt een goede prognose. 8- Na een zeer goed geslaagde primaire coronaire angioplastiek (TIMI 3 & Myocardial Blush Grade 2/3) heeft de patiënt een zeer goede prognose. 9- Na een primaire coronaire angioplastiek tijdens de diensturen heeft de patiënt een minder goede prognose. 10- Leeftijd en hartfalen bepalen het risico bij een acuut hartinfarct. 11- Het Zwolle model voor de behandeling van het acute hartinfarct is niet alleen toepasbaar in Nederland maar in de gehele verstedelijkte westerse wereld. 12- Shock and Awe : een juiste weergave van het tot op heden gevoerde beleid van de Nederlandse regering voor de gezondheidszorg. 13- Elk nadeel heeft zijn nadeel en maar een gering voordeel. 14- Stellingen zouden moeten worden afgeschaft bij een promotie! José P. S. Henriques, 16 juni 2003
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