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Coronary Artery Disease: HELP
Articles by Juhani K. E. Airaksinen
Based on 20 articles published since 2009
(Why 20 articles?)
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Between 2009 and 2019, J. Airaksinen wrote the following 20 articles about Coronary Artery Disease.
 
+ Citations + Abstracts
1 Review Basic data from 176 studies on the immediate outcome after aortic valve replacement with or without coronary artery bypass surgery. 2014

Biancari, Fausto / Martin, Marta / Bordin, Giulia / Vettore, Elia / Vinco, Giulia / Anttila, Vesa / Airaksinen, Juhani / Vasques, Francesco. ·Department of Surgery, Oulu University Hospital, Oulu, Finland. Electronic address: faustobiancari@yahoo.it. · Department of Surgery, Oulu University Hospital, Oulu, Finland. · Heart Center, Turku University Hospital, Turku, Finland. ·J Cardiothorac Vasc Anesth · Pubmed #24290746.

ABSTRACT: OBJECTIVE: The aim of this study was to summarize the immediate outcome after aortic valve replacement (AVR) with or without coronary artery bypass grafting (CABG). DESIGN: Systematic review and meta-analysis. SETTING: University hospitals. PARTICIPANTS: Participants were 683,286 patients who underwent AVR with or without CABG. Patients undergoing other major cardiac procedures were excluded from this analysis. INTERVENTIONS: AVR with or without CABG. MEASUREMENTS AND MAIN RESULTS: Operative mortality after AVR with or without concomitant CABG was 4.3%, stroke 2.1%, pacemaker implantation 5.9%, and dialysis 2.2%. After isolated AVR, operative mortality was 3.3%, stroke 1.7%, pacemaker implantation 3.3%, and dialysis 1.6%. Mortality was increased among very elderly (< 60 years: 3.3%, 60-69 years: 2.7%, 70-79 years: 3.8%,≥ 80 years: 6.1%, p < 0.001). Prevalence of minimally invasive AVR (mini-AVR) was associated with significantly lower operative mortality (p = 0.039, 46 studies). Mini-AVR only tended toward lower mortality when included in meta-regression analysis as a dichotomous variable (mini-AVR 4,367 patients: 2.3%, 95% CI 1.8-2.9% v full sternotomy 11,076 patients: 3.5%, 95% CI 28-4.1%, p = 0.088). Operative mortality after AVR plus CABG was 5.5% (versus isolated AVR: p < 0.001), stroke 3.0%, pacemaker implantation 3.9%, and dialysis 5.6%. Mortality was high in all age strata, particularly among very elderly (mean age < 70 years: 4.8%, mean age 70-79 years: 4.7%; mean age ≥ 80 years: 8.4%, p = 0.002). CONCLUSIONS: Isolated AVR is associated with low mortality and morbidity. Coronary artery disease requiring concomitant CABG increases the operative mortality. Patients requiring AVR and CABG should be the main target of less-invasive treatment strategies.

2 Clinical Trial Sleep apnoea is associated with major cardiac events in peripheral arterial disease. 2014

Utriainen, Karri T / Airaksinen, Juhani K / Polo, Olli / Laitio, Ruut / Pietilä, Mikko J / Scheinin, Harry / Vahlberg, Tero / Leino, Kari A / Kentala, Erkki S / Jalonen, Jouko R / Hakovirta, Harri / Parkkola, Riitta / Virtanen, Sami / Laitio, Timo T. ·Division of Medicine, Turku University Hospital, Turku Sleep Research Unit, University of Turku, Turku. · Heart Centre, Turku University Hospital and University of Turku, Turku. · Sleep Research Unit, University of Turku, Turku Dept of Pulmonology, Tampere University Hospital, Tampere. · Division of Perioperative Services, Intensive Care Medicine and Pain Management, Turku University Hospital, Turku. · Dept of Biostatistics, University of Turku, Turku. · Dept of Vascular Surgery, Turku University Hospital, Turku. · Dept of Radiology, Turku University Hospital, Turku, Finland. · Division of Perioperative Services, Intensive Care Medicine and Pain Management, Turku University Hospital, Turku timo.laitio@elisanet.fi. ·Eur Respir J · Pubmed #24558173.

ABSTRACT: Obstructive sleep apnoea (OSA) is associated with atherosclerosis and cardiovascular events. Peripheral arterial disease (PAD) represents severe atherosclerosis with a high mortality after vascular surgery. The role of OSA in the prognosis of these patients is not yet established. 84 patients (aged 67 ± 9 years) scheduled for sub-inguinal surgical revascularisation were enrolled for preoperative polysomnography. The threshold for significant OSA was an apnoea/hypopnoea index ≥ 20 events·h(-1). Major adverse cardiovascular and cerebrovascular events (MACCE), including cardiac death, myocardial infarction, coronary revascularisation, angina pectoris requiring hospitalisation and stroke, were used as a combined end-point. During follow-up (median 52 months), 17 out of 39 patients with and six out of 45 patients without significant OSA suffered MACCE. In the multivariate Cox regression, the primary predictors of MACCE were significant OSA (hazard ratio (HR) 5.1 (95% CI 1.9-13.9); p=0.001) and pre-existing coronary artery disease (HR 4.4 (95% CI 1.8-10.6); p=0.001). Other significant predictors were a ≥ 4 year history of PAD (HR 3.8 (95% CI 1.3-11.5); p=0.02) and decreasing high-density lipoprotein/total cholesterol ratio (HR 0.95 per percentage (95% CI 0.90-1.00); p=0.048). OSA is associated with poor long-term outcome in patients with PAD following revascularisation. OSA might have an important role in the pathogenesis of cardiovascular morbidity and mortality in these patients.

3 Clinical Trial Randomized comparison of final kissing balloon dilatation versus no final kissing balloon dilatation in patients with coronary bifurcation lesions treated with main vessel stenting: the Nordic-Baltic Bifurcation Study III. 2011

Niemelä, Matti / Kervinen, Kari / Erglis, Andrejs / Holm, Niels R / Maeng, Michael / Christiansen, Evald H / Kumsars, Indulis / Jegere, Sanda / Dombrovskis, Andis / Gunnes, Pål / Stavnes, Sindre / Steigen, Terje K / Trovik, Thor / Eskola, Markku / Vikman, Saila / Romppanen, Hannu / Mäkikallio, Timo / Hansen, Knud N / Thayssen, Per / Aberge, Lars / Jensen, Lisette O / Hervold, Anders / Airaksinen, Juhani / Pietilä, Mikko / Frobert, Ole / Kellerth, Thomas / Ravkilde, Jan / Aarøe, Jens / Jensen, Jan S / Helqvist, Steffen / Sjögren, Iwar / James, Stefan / Miettinen, Heikki / Lassen, Jens F / Thuesen, Leif / Anonymous1020682. ·Division of Cardiology, Department of Internal Medicine, University of Oulu, Finland. matti.niemela@ppshp.fi ·Circulation · Pubmed #21173348.

ABSTRACT: BACKGROUND: It is unknown whether the preferred 1-stent bifurcation stenting approach with stenting of the main vessel (MV) and optional side branch stenting using drug-eluting stents should be finalized by a kissing balloon dilatation (FKBD). Therefore, we compared strategies of MV stenting with and without FKBD. METHODS AND RESULTS: We randomized 477 patients with a bifurcation lesion to FKBD (n=238) or no FKBD (n=239) after MV stenting. The primary end point was major adverse cardiac events: cardiac death, non-procedure-related index lesion myocardial infarction, target lesion revascularization, or stent thrombosis within 6 months. The 6-month major adverse cardiac event rates were 2.1% and 2.5% (P=1.00) in the FKBD and no-FKBD groups, respectively. Procedure and fluoroscopy times were longer and more contrast media was needed in the FKBD group than in the no-FKBD group. Three hundred twenty-six patients had a quantitative coronary assessment. At 8 months, the rate of binary (re)stenosis in the entire bifurcation lesion (MV and side branch) was 11.0% versus 17.3% (P=0.11), in the MV was 3.1% versus 2.5% (P=0.68), and in the side branch was 7.9% versus 15.4% (P=0.039) in the FKBD versus no-FKBD groups, respectively. In patients with true bifurcation lesions, the side branch restenosis rate was 7.6% versus 20.0% (P=0.024) in the FKBD and no-FKBD groups, respectively. CONCLUSIONS: MV stenting strategies with and without FKBD were associated with similar clinical outcomes. FKBD reduced angiographic side branch (re)stenosis, especially in patients with true bifurcation lesions. The simple no-FKBD procedures resulted in reduced use of contrast media and shorter procedure and fluoroscopy times. Long-term data on stent thrombosis are needed. Clinical Trial Registration- URL: http://clinicaltrials.gov. Unique identifier: NCT00914199.

4 Clinical Trial Cardiac positron emission tomography/computed tomography imaging accurately detects anatomically and functionally significant coronary artery disease. 2010

Kajander, S / Joutsiniemi, E / Saraste, M / Pietilä, M / Ukkonen, H / Saraste, A / Sipilä, H T / Teräs, M / Mäki, M / Airaksinen, J / Hartiala, J / Knuuti, J. ·Turku PET Centre, Turku, Finland. ·Circulation · Pubmed #20660808.

ABSTRACT: BACKGROUND: Computed tomography (CT) is increasingly used to detect coronary artery disease, but the evaluation of stenoses is often uncertain. Perfusion imaging has an established role in detecting ischemia and guiding therapy. Hybrid positron emission tomography (PET)/CT allows combination angiography and perfusion imaging in short, quantitative, low-radiation-dose protocols. METHODS AND RESULTS: We enrolled 107 patients with an intermediate (30% to 70%) pretest likelihood of coronary artery disease. All patients underwent PET/CT (quantitative PET with (15)O-water and CT angiography), and the results were compared with the gold standard, invasive angiography, including measurement of fractional flow reserve when appropriate. Although PET and CT angiography alone both demonstrated 97% negative predictive value, CT angiography alone was suboptimal in assessing the severity of stenosis (positive predictive value, 81%). Perfusion imaging alone could not always separate microvascular disease from epicardial stenoses, but hybrid PET/CT significantly improved this accuracy to 98%. The radiation dose of the combined PET and CT protocols was 9.3 mSv (86 patients) with prospective triggering and 21.8 mSv (21 patients) with spiral CT. CONCLUSIONS: Cardiac hybrid PET/CT imaging allows accurate noninvasive detection of coronary artery disease in a symptomatic population. The method is feasible and can be performed routinely with <10 mSv in most patients. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00627172.

5 Article Prognostic Impact of Asymptomatic Carotid Artery Stenosis in Patients Undergoing Coronary Artery Bypass Grafting. 2018

Santarpino, Giuseppe / Nicolini, Francesco / De Feo, Marisa / Dalén, Magnus / Fischlein, Theodor / Perrotti, Andrea / Reichart, Daniel / Gatti, Giuseppe / Onorati, Francesco / Franzese, Ilaria / Faggian, Giuseppe / Bancone, Ciro / Chocron, Sidney / Khodabandeh, Sorosh / Rubino, Antonino S / Maselli, Daniele / Nardella, Saverio / Gherli, Riccardo / Salsano, Antonio / Zanobini, Marco / Saccocci, Matteo / Bounader, Karl / Rosato, Stefano / Tauriainen, Tuomas / Mariscalco, Giovanni / Airaksinen, Juhani / Ruggieri, Vito G / Biancari, Fausto. ·Cardiovascular Centre, Paracelsus Medical University, Nuremberg, Germany; Città di Lecce Hospital, GVM Care&Research, Lecce, Italy. · Division of Cardiac Surgery, University of Parma, Parma, Italy. · Department of Cardiothoracic and Respiratory Sciences, University of Campania, Naples, Italy. · Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden; Department of Cardiac Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden. · Cardiovascular Centre, Paracelsus Medical University, Nuremberg, Germany. · Department of Thoracic and Cardio-Vascular Surgery, University Hospital Jean Minjoz, Besançon, France. · Hamburg University Heart Centre, Hamburg, Germany. · Division of Cardiac Surgery, Ospedali Riuniti, Trieste, Italy. · Division of Cardiovascular Surgery, Verona University Hospital, Verona, Italy. · Centro Clinico-Diagnostico "G.B. Morgagni", Centro Cuore, Pedara, Italy. · Department of Cardiac Surgery, St. Anna Hospital, Catanzaro, Italy. · Department of Cardiovascular Sciences, Cardiac Surgery Unit, S. Camillo-Forlanini Hospital, Rome, Italy. · Division of Cardiac Surgery, University of Genoa, Genoa, Italy. · Department of Cardiac Surgery, Centro Cardiologico - Fondazione Monzino IRCCS, University of Milan, Milan, Italy. · Division of Cardiothoracic and Vascular Surgery, Pontchaillou University Hospital, Rennes, France. · National Centre of Global Health, Istituto Superiore di Sanità, Rome, Italy. · Department of Surgery, Oulu University Hospital and University of Oulu, Oulu, Finland. · Department of Cardiovascular Sciences, Clinical Sciences Wing, University of Leicester, Glenfield Hospital, Leicester, UK. · Heart Centre, Turku University Hospital, and University of Turku, Turku, Finland. · Division of Cardiothoracic and Vascular Surgery, Robert Debré University Hospital, Reims, France. · Department of Surgery, Oulu University Hospital and University of Oulu, Oulu, Finland; Heart Centre, Turku University Hospital, and University of Turku, Turku, Finland. Electronic address: faustobiancari@yahoo.it. ·Eur J Vasc Endovasc Surg · Pubmed #30197287.

ABSTRACT: OBJECTIVES: The aim of this study was to evaluate the prognostic impact of untreated asymptomatic carotid artery stenosis (CS) in patients undergoing isolated coronary artery bypass grafting (CABG). METHODS: This was a post hoc analysis of data from a prospective multicentre observational study. Patients without history of stroke or transient ischaemic attack from the multicentre E-CABG registry who were screened for CS before isolated CABG were included. RESULTS: Among 2813 patients screened by duplex ultrasound and who did not undergo carotid intervention for asymptomatic CS, 11.1% had a stenosis of 50-59%, 6.0% of 60-69%, 3.1% of 70-79%, 1.4% of 80-89%, 0.5% of 90-99%, and 1.1% had carotid occlusion. In the screened population post-operative stroke occurred in 25 patients (0.9%), with an incidence of 1.5% among patients with CS ≥ 50% (n = 649). Pre-operative screening had not found a relevant CS in 15 of 25 patients suffering stroke after CABG. Brain imaging identified cerebral ischaemic injury in 20 patients, which was bilateral in five patients (25%), ipsilateral to a CS ≥ 50% in six (30%), and ipsilateral to a CS ≥ 70% in three (15%). In univariable analysis, the severity of CS was associated with a significantly increased risk of stroke (CS < 50%, 0.7%; 50-59%, 1.0%; 60-69%, 0.6%; 70-79%, 1.2%; 80-89%, 5.1%; 90-99%, 7.7%; occluded, 6.7%, p < .001). In multivariable analysis, a CS of 90-99% (OR 12.03, 95% CI 1.34-108.23) and the presence of an occluded internal carotid artery (OR 8.783, 95% CI 1.820-42.40) were independent predictors of stroke along with urgency of the procedure, severe massive bleeding according to the E-CABG classification, and the presence of a porcelain ascending aorta. CONCLUSIONS: Among screened patients with untreated asymptomatic patients, CS ≥ 90% was an independent predictor of post-operative stroke. As this condition has a low prevalence and when left untreated is associated with a relatively low rate of stroke, pre-operative screening of asymptomatic CS before CABG may not be justified. CLINICAL TRIAL REGISTRATION: https://clinicaltrials.gov. Unique identifier: NCT02319083.

6 Article Prior Percutaneous Coronary Intervention and Mortality in Patients Undergoing Surgical Myocardial Revascularization: Results From the E-CABG (European Multicenter Study on Coronary Artery Bypass Grafting) With a Systematic Review and Meta-Analysis. 2018

Mariscalco, Giovanni / Rosato, Stefano / Serraino, Giuseppe F / Maselli, Daniele / Dalén, Magnus / Airaksinen, Juhani K E / Reichart, Daniel / Zanobini, Marco / Onorati, Francesco / De Feo, Marisa / Gherli, Riccardo / Santarpino, Giuseppe / Rubino, Antonino S / Gatti, Giuseppe / Nicolini, Francesco / Santini, Francesco / Perrotti, Andrea / Bruno, Vito D / Ruggieri, Vito G / Biancari, Fausto. ·From the Department of Cardiovascular Sciences, University of Leicester, Glenfield Hospital, United Kingdom (G.M., G.F.S.) · National Center for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Rome, Italy (S.R.) · Cardiac Surgery Unit, Magna Graecia University of Catanzaro, Italy (G.F.S.) · Department of Cardiac Surgery, St. Anna Hospital, Catanzaro, Italy (D.M.) · Department of Molecular Medicine and Surgery (M.D.) and Department of Cardiothoracic Surgery and Anesthesiology (M.D.), Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden · Heart Center, Turku University Hospital (J.K.E.A., F.B.) and Department of Surgery (F.B.), University of Turku, Finland · Hamburg University Heart Center, Germany (D.R.) · Department of Cardiac Surgery, Centro Cardiologico-Fondazione Monzino IRCCS, University of Milan, Italy (M.Z.) · Division of Cardiovascular Surgery, Verona University Hospital, Italy (F.O.) · Division of Cardiac Surgery, Department of Cardiothoracic Sciences, Second University of Naples, Italy (M.D.F.) · Department of Cardiovascular Sciences, Cardiac Surgery Unit, S. Camillo-Forlanini Hospital, Rome, Italy (R.G.) · Città di Lecce Hospital, GVM Care and Research, Italy (G.S.) · Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany (G.S.) · Centro Clinico Diagnostico G.B. Morgagni, Centro Cuore, Pedara, Italy (A.S.R.) · Division of Cardiac Surgery, Ospedali Riuniti, Trieste, Italy (G.G.) · Division of Cardiac Surgery, University of Parma, Italy (F.N.) · Division of Cardiac Surgery, University of Genoa, Italy (F.S.) · Department of Thoracic and Cardiovascular Surgery, University Hospital Jean Minjoz, Besançon, France (A.P.) · Heart Centre, Bristol University, United Kingdom (V.D.B.) · Division of Cardiothoracic and Vascular Surgery, Pontchaillou University Hospital, Rennes, France (V.G.R.) · and Department of Surgery, Oulu University Hospital, Finland (F.B.). ·Circ Cardiovasc Interv · Pubmed #29440275.

ABSTRACT: BACKGROUND: The clinical impact of prior percutaneous coronary intervention (PCI) in patients requiring coronary artery bypass grafting (CABG) remains unsettled. We sought to determine whether prior PCI is associated with adverse outcome after CABG. METHODS AND RESULTS: Data from the prospective E-CABG (European Multicenter Study on Coronary Artery Bypass Grafting) conducted between January 2015 and March 2016 at 16 European centres were analyzed using propensity weighted methodology to adjust for confounding. A parallel systematic review/meta-analysis (MEDLINE, Embase, SCOPUS, and Cochrane Library) through September 2017 was accomplished. Of a total of 3641 adult patients included in the E-CABG study, 685 (19%) patients had a history of PCI. At multivariable level, prior PCI was not associated with an increased hospital mortality in both unweighted and weighted patient groups (odds ratio, 0.73; 95% confidence interval, 0.29-1.38; CONCLUSIONS: Our prospective multicenter study showed that prior PCI was not associated with an increased risk of mortality or other adverse outcomes in patients undergoing CABG. In light of a trend toward increased mortality observed in the meta-analysis, further studies are needed to ascertain the prognostic impact of prior PCI in the outcome after CABG. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT02319083.

7 Article Early Outcome of Bilateral Versus Single Internal Mammary Artery Grafting in the Elderly. 2018

Rubino, Antonino S / Gatti, Giuseppe / Reichart, Daniel / Tauriainen, Tuomas / De Feo, Marisa / Onorati, Francesco / Pappalardo, Aniello / Chocron, Sidney / Gulbins, Helmut / Dalén, Magnus / Svenarud, Peter / Faggian, Giuseppe / Franzese, Ilaria / Santarpino, Giuseppe / Fischlein, Theodor / Maselli, Daniele / Nardella, Saverio / Gherli, Riccardo / Ahmed, Aamer / Santini, Francesco / Salsano, Antonio / Nicolini, Francesco / Zanobini, Marco / Saccocci, Matteo / Ruggieri, Vito G / Bounader, Karl / Mignosa, Carmelo / D'Errigo, Paola / Rosato, Stefano / Airaksinen, Juhani / Perrotti, Andrea / Biancari, Fausto. ·Centro Clinico-Diagnostico "G.B. Morgagni," Centro Cuore, Pedara, Italy. · Division of Cardiac Surgery, Ospedali Riuniti, Trieste, Italy. · Hamburg University Heart Center, Hamburg, Germany. · Department of Surgery, Oulu University Hospital and University of Oulu, Oulu, Finland. · Division of Cardiac Surgery, Department of Cardiothoracic Sciences, Second University of Naples, Naples, Italy. · Division of Cardiovascular Surgery, Verona University Hospital, Verona, Italy. · Department of Thoracic and Cardio-Vascular Surgery, University Hospital Jean Minjoz, Besançon, France. · Department of Molecular Medicine and Surgery, Department of Cardiothoracic Surgery and Anesthesiology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden. · Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany. · Department of Cardiac Surgery, St. Anna Hospital, Catanzaro, Italy. · Department of Cardiovascular Sciences, Cardiac Surgery Unit, S. Camillo-Forlanini Hospital, Rome, Italy. · Department of Cardiovascular Sciences, Clinical Sciences Wing, University of Leicester, Glenfield Hospital, Leicester, United Kingdom. · Division of Cardiac Surgery, University of Genoa, Genoa, Italy. · Division of Cardiac Surgery, University of Parma, Parma, Italy. · Department of Cardiac Surgery, Centro Cardiologico-Fondazione Monzino IRCCS, University of Milan, Milan, Italy. · Division of Cardiothoracic and Vascular Surgery, Pontchaillou University Hospital, Rennes, France. · National Centre for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Rome, Italy. · Heart Center, Turku University Hospital, Turku, Finland. · Department of Surgery, Oulu University Hospital and University of Oulu, Oulu, Finland; Heart Center, Turku University Hospital, Turku, Finland; Department of Surgery, University of Turku, Turku, Finland. Electronic address: faustobiancari@yahoo.it. ·Ann Thorac Surg · Pubmed #29410264.

ABSTRACT: BACKGROUND: Bilateral internal mammary artery (BIMA) grafting is increasingly used in elderly patients without evidence of its risks or benefits compared with single internal mammary artery (SIMA) grafting. METHODS: In all, 2,899 patients aged 70 years or older (855 [29.5%] underwent BIMA grafting) operated on from January 2015 to December 2016 and included in the prospective multicenter Outcome After Coronary Artery Bypass Grafting (E-CABG) study were considered in this analysis. RESULTS: One-to-one propensity matching resulted in 804 pairs with similar preoperative risk profile. Propensity score matched analysis showed that BIMA grafting was associated with a nonstatistically significant increased risk of inhospital death (2.7% versus 1.6%, p = 0.117). The BIMA grafting cohort had a significantly increased risk of any sternal wound infection (7.7% versus 5.1%, p = 0.031) as well as higher risk of deep sternal wound infection/mediastinitis (4.0% versus 2.2%, p = 0.048). The BIMA grafting cohort required more frequently extracorporeal membrane oxygenation (1.0% versus 0.1%, p = 0.02), and the intensive care unit stay (mean 3.6 versus 2.6 days, p < 0.001) and inhospital stay (mean 11.3 versus 10.0 days, p < 0.001) were significantly longer compared with the SIMA grafting cohort. Test for interaction showed that urgent operation in patients undergoing BIMA grafting was associated with higher risk of inhospital death (5.6% versus 1.3%, p = 0.009). CONCLUSIONS: Bilateral internal mammary artery grafting in elderly patients seems to be associated with a worse early outcome compared with SIMA grafting, particularly in patients undergoing urgent operation. Until more conclusive results are gathered, BIMA grafting should be reserved only for elderly patients with stable coronary artery disease, without significant baseline comorbidities and with long life expectancy.

8 Article Transfusion and blood stream infections after coronary surgery. 2018

Tauriainen, Tuomas / Kinnunen, Eeva-Maija / Laitinen, Idamaria / Anttila, Vesa / Kiviniemi, Tuomas / Airaksinen, Juhani K E / Biancari, Fausto. ·Department of Surgery, Oulu University Hospital, Oulu, Finland. · Department of cardiothoracic surgery, Heart Center, Turku University Hospital, University of Turku, Turku, Finland. · Department of Surgery, University of Turku, Turku, Finland. ·Interact Cardiovasc Thorac Surg · Pubmed #29049748.

ABSTRACT: The aim of this study was to evaluate the impact of blood transfusion on bloodstream infections. This study included 2764 patients who underwent isolated coronary artery bypass grafting. Blood cultures were drawn in 27.9% of patients and were positive in 3.5% of them. Blood transfusion before blood cultures were drawn (4.7% vs 1.2%, odds ratio 3.75, 95% confidence interval 1.11-12.67) and deep sternal wound infection/mediastinitis (20.0% vs 2.8%, odds ratio 7.43, 95% confidence interval 2.72-20.32) were independent predictors of a positive postoperative blood culture. Positive blood culture increased the risk of 5-year mortality (among patients with blood cultures drawn: 44.7% vs 19.6%, adjusted hazard ratio 2.10, 95% confidence interval 1.18-3.71). Exposure to blood products may increase the risk of bloodstream infection after cardiac surgery. Positive blood cultures after coronary artery bypass grafting are associated with poor late survival. These findings require validation in prospective studies.

9 Article Prediction of severe bleeding after coronary surgery: the WILL-BLEED Risk Score. 2017

Biancari, Fausto / Brascia, Debora / Onorati, Francesco / Reichart, Daniel / Perrotti, Andrea / Ruggieri, Vito G / Santarpino, Giuseppe / Maselli, Daniele / Mariscalco, Giovanni / Gherli, Riccardo / Rubino, Antonino S / De Feo, Marisa / Gatti, Giuseppe / Santini, Francesco / Dalén, Magnus / Saccocci, Matteo / Kinnunen, Eeva-Maija / Airaksinen, Juhani K E / D'Errigo, Paola / Rosato, Stefano / Nicolini, Francesco. ·Prof. Fausto Biancari, Department of Surgery, Oulu University Hospital, PL 21, 90029 Oulu, Finland, Tel.: +358 40 7333 973, Fax: +358 8 315 2486, E-mail: faustobiancari@yahoo.it. ·Thromb Haemost · Pubmed #27904903.

ABSTRACT: Severe perioperative bleeding after coronary artery bypass grafting (CABG) is associated with poor outcome. An additive score for prediction of severe bleeding was derived (n=2494) and validated (n=1250) in patients from the E-CABG registry. Severe bleeding was defined as E-CABG bleeding grades 2-3 (transfusion of >4 units of red blood cells or reoperation for bleeding). The overall incidence of severe bleeding was 6.4 %. Preoperative anaemia (3 points), female gender (2 points), eGFR <45 ml/min/1.73 m

10 Article Comparison of two different sampling intervals for optical coherence tomography evaluation of neointimal healing response after coronary stent implantation. 2017

Varho, Ville / Nammas, Wail / Kiviniemi, Tuomas O / Sia, Jussi / Romppanen, Hannu / Pietilä, Mikko / Airaksinen, Juhani K / Karjalainen, Pasi P. ·Heart Center, Turku University Hospital, University of Turku, Turku, Finland. Electronic address: viveva@utu.fi. · Heart Centre, Satakunta Central Hospital, Pori, Finland. · Heart Center, Turku University Hospital, University of Turku, Turku, Finland; Heart Centre, Satakunta Central Hospital, Pori, Finland. · Department of Cardiology, Central Ostrobothnia Central Hospital, Kokkola, Finland. · Cardiology Unit, Kuopio University Hospital, Kuopio, Finland. · Heart Center, Turku University Hospital, University of Turku, Turku, Finland. ·Int J Cardiol · Pubmed #27839810.

ABSTRACT: BACKGROUND/OBJECTIVES: Optical coherence tomography (OCT) is widely used for evaluation of healing response to stent implantation. We sought to test the agreement between the 1-mm and 0.6-mm sampling intervals for assessment of the percentage of uncovered and malapposed struts by OCT. METHODS: Thirty-eight patients presenting with acute coronary syndrome were randomized to receive either a titanium-nitride-oxide-coated stent (n=19) or an everolimus-eluting stent (n=19). Neointimal strut coverage and strut apposition were evaluated by OCT at 2-month follow-up. Two independent investigators performed offline OCT image analysis at 1-mm intervals. One investigator repeated the measurements at 0.6-mm intervals and measurements were compared between the two sampling intervals. RESULTS: At a median follow-up of 60 [8] days, 694 cross-sections (7603 struts) and 1138 cross-sections (12,331 struts) were analysed at 1-mm and at 0.6-mm intervals, respectively. The median [IQR] percentage of uncovered struts was 3.27% [11.1] versus 3.38% [9.76] (p=0.001), and the mean (±SD) percentage was 7.69±9.99% versus 6.27±8.14% (p=0.004), for the 1-mm sampling interval versus the 0.6-mm sampling interval analysis, respectively; the median percentage of malapposed struts was 0.42% [2.04] versus 0.12% [1.63], respectively, (p=0.003). The intraclass correlation coefficient between the two observers for the percentage of uncovered struts was 0.95. CONCLUSIONS: The OCT-evaluated strut-level measurements of neointimal healing after stent implantation differ significantly between the 1-mm and the 0.6-mm sampling intervals.

11 Article Incidence and predictors of 30-day cardiovascular complications in patients undergoing head and neck cancer surgery. 2016

Haapio, Eeva / Kiviniemi, T / Irjala, H / Koivunen, P / Airaksinen, J K E / Kinnunen, I. ·Department of Otorhinolaryngology, Turku University Hospital and University of Turku, Kiinamyllynkatu 4-8, 20521, Turku, Finland. eeva.haapio@tyks.fi. · Heart Center, Turku University Hospital and University of Turku, Turku, Finland. · Department of Otorhinolaryngology, Turku University Hospital and University of Turku, Kiinamyllynkatu 4-8, 20521, Turku, Finland. · Department of Otorhinolaryngology, Oulu University Hospital and University of Oulu, Oulu, Finland. ·Eur Arch Otorhinolaryngol · Pubmed #27376645.

ABSTRACT: Incidence and predictors of peri-operative or post-operative cardiovascular complications in head and neck cancer surgery remain poorly elucidated. In this retrospective study, we investigated the rate and pre-operative risk factors for cardiovascular and cerebrovascular complications. This study included all patients (n = 456) operated for head and neck cancer between 1999 and 2008. Patients' medical records were reviewed and the adjudication of endpoints was performed by adjudication committee. The 30-day incidence of cardiovascular and cerebrovascular complications was 7.2 %. Cardiac mortality at 30 days was 1.0 %. Univariate predictors of MACCE (major adverse cardiac and cerebrovascular events) at the 30-day follow-up were history of myocardial infarction (OR 4.56, 95 % CI 1.73-11.97, p = 0.002); history of heart failure (OR 4.14, 95 % CI 1.32-13.02, p = 0.015); pre-existing coronary artery disease (OR 3.98, 95 % CI 1.75-9.06, p = 0.001); prior aspirin medication (OR 3.73, 95 % CI 1.81-7.71, p < 0.001); prior betablocker medication (OR 3.67, 95 % CI 1.79-7.51, p < 0.001); hypertension (OR 2.55, 95 % CI 1.25-5.19, p = 0.010); and increasing age (OR 1.08, 95 % CI 1.05-1.12, p < 0.001). In a multivariate model, independent predictors of MACCE were pre-existing coronary artery disease (OR 2.45, 95 % CI 1.03-5.80, p = 0.042) and increasing age (OR 1.08, 95 % CI 1.04-1.11, p < 0.001). Patients having surgery for head and neck cancer are at high (>5 %) risk of developing vascular complications. Prior coronary artery disease and increasing age are independent risk factors for MACCE.

12 Article Absolute flow or myocardial flow reserve for the detection of significant coronary artery disease? 2014

Joutsiniemi, Esa / Saraste, Antti / Pietilä, Mikko / Mäki, Maija / Kajander, Sami / Ukkonen, Heikki / Airaksinen, Juhani / Knuuti, Juhani. ·Heart Center, Turku University Hospital, Turku, Finland. · Heart Center, Turku University Hospital, Turku, Finland Turku PET Centre, University of Turku, Kiinamyllynkatu 4-8, Turku 20520, Finland. · Turku PET Centre, University of Turku, Kiinamyllynkatu 4-8, Turku 20520, Finland Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, Turku, Finland. · Turku PET Centre, University of Turku, Kiinamyllynkatu 4-8, Turku 20520, Finland. · Turku PET Centre, University of Turku, Kiinamyllynkatu 4-8, Turku 20520, Finland juhani.knuuti@utu.fi. ·Eur Heart J Cardiovasc Imaging · Pubmed #24408930.

ABSTRACT: OBJECTIVES: We compared the accuracy of quantified myocardial flow reserve and absolute stress myocardial blood flow (MBF) alone in the detection of coronary artery disease (CAD). BACKGROUND: Myocardial flow reserve, i.e. ratio of stress and rest flow, has been commonly used to detect CAD with many imaging modalities. However, it is not known whether absolute stress flow alone is sufficient for detection of significant CAD. METHODS: We enrolled 104 patients with moderate (30-70%) pre-test likelihood of CAD without previous myocardial infarction. MBF was measured by positron emission tomography and O-15-water at rest and during the adenosine stress in the regions of the left anterior descending, left circumflex, and right coronary artery. All the patients underwent invasive coronary angiography including the measurement of fractional flow reserve when appropriate. RESULTS: Quantified myocardial flow reserve (optimal cut-off value 2.5) detected significant coronary stenosis with sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of 81, 87, 66 and 94%, respectively. When compared with flow reserve, absolute MBF at stress (optimal cut-off value of 2.4 mL/min/g) was more accurate in detecting significant coronary stenosis [area under the curve (AUC) 0.94 vs. 0.90, P = 0.02] with sensitivity, specificity, PPV, and NPV of 95% (P = 0.03 vs. flow reserve), 90, 73, and 98%, respectively. An absolute increase of MBF from rest to stress by <1.5 mL/g/min had also similar accuracy in detecting CAD (AUC: 0.95). The results were comparable in patients who did and did not receive i.v. beta-blockers prior imaging. CONCLUSIONS: Absolute stress perfusion alone was superior to perfusion reserve in the detection of haemodynamically significant CAD and allows shorter imaging protocols with smaller radiation dose.

13 Article Determinants of outcome after isolated coronary artery bypass grafting in patients aged ≤50 years (from the Coronary aRtery diseAse in younG adultS study). 2014

Biancari, Fausto / Onorati, Francesco / Faggian, Giuseppe / Heikkinen, Jouni / Anttila, Vesa / Jeppsson, Anders / Mignosa, Carmelo / Rubino, Antonino S / Gunn, Jarmo / Wistbacka, Jan-Ola / Axelsson, Tomas A / Mennander, Ari / De Feo, Marisa / Gudbjartsson, Tomas / Airaksinen, Juhani. ·Department of Surgery, Oulu University Hospital, Oulu, Finland. Electronic address: fausto.biancari@ppshp.fi. · Division of Cardiac Surgery, University of Verona Medical School, Italy. · Department of Surgery, Oulu University Hospital, Oulu, Finland. · Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Göteborg, Sweden. · Cardiac Surgery Unit, Azienda Ospedaliera Universitaria. Policlinico-Vittorio Emanuele, University of Catania, Italy. · Heart Center, Turku University Hospital, Turku, Finland. · Department of Anesthesiology, Vaasa Central Hospital, Vaasa, Finland. · Department of Cardiothoracic Surgery, Landspitali University Hospital, Faculty of Medicine, University of Iceland, Reykjavík, Iceland. · Heart Center, Tampere University Hospital, Tampere, Finland. · Department of Cardiothoracic and Respiratory Sciences, Second University of Naples, c/o V. Monaldi Hospital, Naples, Italy. ·Am J Cardiol · Pubmed #24161142.

ABSTRACT: This study was planned to identify the determinants of outcome after coronary artery bypass (CABG) in young patients. Data on 592 patients aged ≤50 years who underwent CABG from 9 European institutions were collected retrospectively. Twenty-eight percent of patients received at least 2 arterial grafts. Clopidogrel was used at discharge in 16.2% and statins in 67.2% of patients. Freedom from major adverse cardiac and cerebrovascular events at 1, 3, and 5 years was 93.8%, 90.1%, and 85.0%; survival rate was 98.3%, 96.3%, and 94.9%; freedom from myocardial infarction was 96.3%, 95.1%, and 92.5%; and freedom from repeat revascularization was 96.3%, 95.1%, and 92.5%, respectively. Neither types of grafts nor medication at discharge had any impact on the late outcome. Age <40 years (relative risk [RR] 2.19, 95% confidence interval [CI] 1.17 to 4.11), diabetes (RR 1.71, 95% CI 1.02 to 2.88), estimated glomerular filtration rate <60 ml/min/1.73 m(2) (RR 2.44, 95% CI 1.26 to 4.72), non-ST-elevation myocardial infarction/ST-elevation myocardial infarction (RR 2.12, 95% CI 1.27 to 3.55), emergency procedure (RR 2.34, 95% CI 1.13 to 4.88), and left ventricular ejection fraction <30% (RR 3.18, 95% CI 1.41 to 7.16) were independent predictors of major adverse cardiac and cerebrovascular events. Patients with left ventricular ejection fraction <30% had a particularly poor survival rate (at 5 years 67.7% vs 96.1%; adjusted analysis RR 14.01, 95% CI 5.16 to 38.03). Poor left ventricular function, myocardial infarction, diabetes, renal failure, and age <40 years are major determinants of late outcome after CABG in young patients. In conclusion, data from this real-world registry indicate that multiple arterial grafts and statin treatment are largely underutilized in these patients.

14 Article Long-term results after simple versus complex stenting of coronary artery bifurcation lesions: Nordic Bifurcation Study 5-year follow-up results. 2013

Maeng, Michael / Holm, Niels R / Erglis, Andrejs / Kumsars, Indulis / Niemelä, Matti / Kervinen, Kari / Jensen, Jan S / Galløe, Anders / Steigen, Terje K / Wiseth, Rune / Narbute, Inga / Gunnes, Pål / Mannsverk, Jan / Meyerdierks, Oliver / Rotevatn, Svein / Nikus, Kjell / Vikman, Saila / Ravkilde, Jan / James, Stefan / Aarøe, Jens / Ylitalo, Antti / Helqvist, Steffen / Sjögren, Iwar / Thayssen, Per / Virtanen, Kari / Puhakka, Mikko / Airaksinen, Juhani / Christiansen, Evald H / Lassen, Jens F / Thuesen, Leif / Anonymous3470757. ·Department of Cardiology, Aarhus University Hospital, Skejby, Denmark. michael.maeng@ki.au.dk ·J Am Coll Cardiol · Pubmed #23644088.

ABSTRACT: OBJECTIVES: This study sought to report the 5-year follow-up results of the Nordic Bifurcation Study. BACKGROUND: Randomized clinical trials with short-term follow-up have indicated that coronary bifurcation lesions may be optimally treated using the optional side branch stenting strategy. METHODS: A total of 413 patients with a coronary bifurcation lesion were randomly assigned to a simple stenting strategy of main vessel (MV) and optional stenting of side branch (SB) or to a complex stenting strategy, namely, stenting of both MV and SB. RESULTS: Five-year clinical follow-up data were available for 404 (98%) patients. The combined safety and efficacy endpoint of cardiac death, non-procedure-related myocardial infarction, and target vessel revascularization were seen in 15.8% in the optional SB stenting group as compared to 21.8% in the MV and SB stenting group (p = 0.15). All-cause death was seen in 5.9% versus 10.4% (p = 0.16) and non-procedure-related myocardial infarction in 4% versus 7.9% (p = 0.09) in the optional SB stenting group versus the MV and SB stenting group, respectively. The rates of target vessel revascularization were 13.4% versus 18.3% (p = 0.14) and the rates of definite stent thrombosis were 3% versus 1.5% (p = 0.31) in the optional SB stenting group versus the MV and SB stenting group, respectively. CONCLUSIONS: At 5-year follow-up in the Nordic Bifurcation Study, the clinical outcomes after simple optional side branch stenting remained at least equal to the more complex strategy of planned stenting of both the main vessel and the side branch.

15 Article Feasibility and safety of frequency-domain optical coherence tomography for coronary artery evaluation: a single-center study. 2013

Lehtinen, Tuomas / Nammas, Wail / Airaksinen, Juhani K E / Karjalainen, Pasi P. ·Heart Center, Satakunta Central Hospital, Sairaalantie 3, 28500 Pori, Finland. tutleht@utu.fi ·Int J Cardiovasc Imaging · Pubmed #23417516.

ABSTRACT: We assessed the feasibility and safety of frequency-domain optical coherence tomography (FD-OCT) in a variety of indications. We conducted a retrospective analysis of all FD-OCT examinations performed for research and clinical indications, including stable angina, acute coronary syndromes, diagnostic procedures and percutaneous coronary intervention (PCI), at the Satakunta Central Hospital (Pori, Finland) between August 12th 2009 and February 9th 2011. All pullbacks were screened for image quality. Data on complications and clinical implications of examinations was obtained from patient records. The mean age of the patients was 65.9 ± 10.9 years (81.7% males). A total of 230 examinations were performed on 210 patients; 523 pullbacks were eventually attempted (519 successful). On average, 2.3 ± 1.1 pullbacks were performed, and 1.1 ± 0.4 vessels were scanned per examination. PCI was performed in 44.3% of examinations. Radial access was used in 70.3% of cases. Examination was successful in 202 (87.8%) examinations. One patient died of heart failure later after PCI for acute myocardial infarction. No cases of major bleeding, myocardial infarction, contrast-induced nephropathy, or pericardial tamponade were encountered. Chest pain occurred in 10.9% of examinations, minor bleeding in 4.8%, and myocardial ischemia in 2.6%. Femoral access was associated with fewer blood and decentration artefacts and a trend towards better image quality when compared to radial access, with no difference in complications. After the first 50 examinations, there appeared to be fewer artefacts in the subsequent examinations. The current study demonstrated that FD-OCT is feasible, with infrequent complications.

16 Article Resting coronary flow velocity in the functional evaluation of coronary artery stenosis: study on sequential use of computed tomography angiography and transthoracic Doppler echocardiography. 2012

Joutsiniemi, Esa / Saraste, Antti / Pietilä, Mikko / Ukkonen, Heikki / Kajander, Sami / Mäki, Maija / Koskenvuo, Juha / Airaksinen, Juhani / Hartiala, Jaakko / Saraste, Markku / Knuuti, Juhani. ·Department of Cardiology, Turku University Hospital, Kiinamyllynkatu 4-8, 20520 Turku, Finland. ·Eur Heart J Cardiovasc Imaging · Pubmed #21880607.

ABSTRACT: AIMS: Accelerated flow at the site of flow-limiting stenosis can be detected by transthoracic Doppler echocardiography (TTDE). We studied feasibility and accuracy of sequential coronary computed tomography angiography (CTA) and TTDE in detection of haemodynamically significant coronary artery disease (CAD). METHODS AND RESULTS: We prospectively enrolled 107 patients with intermediate (30-70%) pre-test likelihood of CAD. All patients underwent CTA using a 64-slice scanner. Using TTDE, the ratio of maximal diastolic flow velocity to pre-stenotic flow velocity (M/P ratio) was measured in the coronary segments with stenosis in CTA. In all patients, the results were compared with invasive coronary angiography, including measurement of fractional flow reserve when appropriate. All analyses were done blinded. TTDE was feasible in 276 of 285 evaluated coronary segments. Significant coronary stenoses were associated with a higher M/P ratio than non-significant stenoses (3.59 ± 1.82 vs. 1.28 ± 0.60, P < 0.001). The optimal M/P ratio for detection of significant stenosis was 2.2 (area under receiver operating characteristic curve 0.92, P < 0.001). Compared with the strategy of CTA alone, sequential CTA and focused TTDE had a better positive predictive value (PPV; 61 vs. 78%) and diagnostic accuracy (93 vs. 96%, P = 0.006) without impairment of the negative predictive value (97 vs. 97%). CONCLUSION: Sequential use of CTA and TTDE is feasible for combined anatomic and functional evaluation of coronary stenoses. Compared with coronary CTA alone, addition of TTDE improved PPV for detection of significant CAD.

17 Article Clinical value of absolute quantification of myocardial perfusion with (15)O-water in coronary artery disease. 2011

Kajander, Sami A / Joutsiniemi, Esa / Saraste, Markku / Pietilä, Mikko / Ukkonen, Heikki / Saraste, Antti / Sipilä, Hannu T / Teräs, Mika / Mäki, Maija / Airaksinen, Juhani / Hartiala, Jaakko / Knuuti, Juhani. ·Turku PET Centre, University of Turku, Turku, Finland. sami.kajander@tyks.fi ·Circ Cardiovasc Imaging · Pubmed #21926262.

ABSTRACT: BACKGROUND: The standard interpretation of perfusion imaging is based on the assessment of relative perfusion distribution. The limitations of that approach have been recognized in patients with multivessel disease and endothelial dysfunction. To date, however, no large clinical studies have investigated the value of measuring quantitative blood flow and compared that with relative uptake. METHODS AND RESULTS: One hundred four patients with moderate (30%-70%) pretest likelihood of coronary artery disease (CAD) underwent PET imaging during adenosine stress using (15)O-water and dynamic imaging. Absolute myocardial blood flow was calculated from which both standard relative myocardial perfusion images and images scaled to a known absolute scale were produced. The patients and the regions then were classified as normal or abnormal and compared against the reference of conventional angiography with fractional flow reserve. In patient-based analysis, the positive predictive value, negative predictive value, and accuracy of absolute perfusion in the detection of any obstructive CAD were 86%, 97%, and 92%, respectively, with absolute quantification. The corresponding values with relative analysis were 61%, 83%, and 73%, respectively. In region-based analysis, the receiver operating characteristic curves confirmed that the absolute quantification was superior to relative assessment. In particular, the specificity and positive predictive value were low using just relative differences in flow. Only 9 of 24 patients with 3-vessel disease were correctly assessed using relative analysis. CONCLUSIONS: The measurement of myocardial blood flow in absolute terms has a significant impact on the interpretation of myocardial perfusion. As expected, multivessel disease is more accurately detected.

18 Article Five-year clinical outcome of titanium-nitride-oxide-coated bioactive stent implantation in a real-world population: a comparison with paclitaxel-eluting stents: the PORI registry. 2011

Karjalainen, Pasi P / Ylitalo, Antti / Airaksinen, Juhani Ke / Nammas, Wail. ·Department of Cardiology, Satakunta Central Hospital, Sairaalantie 3, FIN-28100, Pori, Finland. pasi.karjalainen@satshp.fi ·J Interv Cardiol · Pubmed #21039884.

ABSTRACT: AIMS: We sought to present the 5-year clinical outcome of the titanium-nitride-oxide-coated bioactive stents (BAS), as compared to paclitaxel-eluting stents (PES), in a real-world patient population. METHODS: From May 2003 to November 2004, we enrolled 405 consecutive patients who underwent percutaneous coronary intervention with either BAS or PES implantation. Patients were prospectively followed up for 5 years. The primary end-point was major adverse cardiac events (MACE) at 5-year follow-up including cardiac death, nonfatal myocardial infarction (MI), or target lesion revascularization. RESULTS: A total of 201 patients received BAS (218 lesions/221 stents) while 204 patients received PES (244 lesions/247 stents). Clinical follow-up for 5 years was completed in all patients. Cumulative MACE at the end of 5-year follow-up occurred in 34 (16.9%) patients in the BAS group, as compared to 53 (26%) in the PES group (OR 1.7, 95% CI 1.1-2.8, P = 0.03). This difference was mainly driven by a lower incidence of MI in the BAS group as compared with the PES group (9.5% vs. 20.6%, OR 2.5, 95% CI 1.4-4.4, P = 0.002). Stent thrombosis occurred in 16 (7.8%) patients in the PES group, while no one suffered stent thrombosis in the BAS group. CONCLUSION: BAS implantation in a real-world patient population achieves an excellent clinical outcome over 5-year follow-up, with a significantly lower incidence of MI, MACE, and stent thrombosis as compared to PES.

19 Article Valvular calcification and its relationship to atherosclerosis in chronic kidney disease. 2009

Leskinen, Yrjö / Paana, Tuomas / Saha, Heikki / Groundstroem, Kaj / Lehtimäki, Terho / Kilpinen, Sanna / Huhtala, Heini / Airaksinen, Juhani. ·Department of Internal Medicine, Tampere University Hospital, Tampere, Finland. yrjo.leskinen@uta.fi ·J Heart Valve Dis · Pubmed #19852148.

ABSTRACT: BACKGROUND AND AIM OF THE STUDY: Cardiovascular calcification is a common complication in patients with chronic kidney disease (CKD). The study aim was to identify the characteristics and risk factors of valvular calcification, and its relationship to atherosclerosis, in CKD. METHODS: In this cross-sectional study, a total of 135 patients with CKD (mean age 52 +/- 11 years) included 58 pre-dialysis patients, 36 dialysis patients, and 41 renal transplant recipients. A control group of 58 subjects was also examined. The characteristics of valvular calcification were assessed using transthoracic echocardiography. RESULTS: The combined prevalences of mitral or aortic valve calcification were 31% in pre-dialysis patients, 50% in dialysis patients, 29% in renal transplant recipients, and 12% in controls (p = 0.001). The prevalences of mitral annular calcification were 17%, 31%, 27% and 2%, respectively (p = 0.001). In multivariate analysis, the risk factors for valvular calcification in CKD were age, duration of dialysis treatment and interleukin-6 level. Mitral annular calcification proved to be five-fold more common in diabetic patients than among non-diabetics. A close association between valvular calcification and patients with or without increased carotid intima-media thickness (44% versus 15%, p < 0.001), carotid plaque (77% versus 49%, p = 0.002), calcified carotid plaque (65% versus 26%, p = 0.001), coronary artery disease (40% versus 15%, p = 0.003) and peripheral arterial disease (46% versus 9%, p < 0.001) was found. CONCLUSION: Valvular calcification is common in CKD, and is closely associated with findings of intimal arterial disease. The presence of inflammation and the duration of dialysis treatment contribute to this complication. Diabetes is also a prominent risk factor for mitral annular calcification in CKD.

20 Minor Bleeding after coronary stenting in patients on oral anticoagulation: who is guilty? 2010

Rubboli, Andrea / Schlitt, Axel / Airaksinen, Juhani / Lip, Gregory Y H. · ·EuroIntervention · Pubmed #20142211.

ABSTRACT: -- No abstract --