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Coronary Artery Disease: HELP
Articles by Troels Thim
Based on 16 articles published since 2010
(Why 16 articles?)
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Between 2010 and 2020, Troels Thim wrote the following 16 articles about Coronary Artery Disease.
 
+ Citations + Abstracts
1 Guideline Consensus standards for acquisition, measurement, and reporting of intravascular optical coherence tomography studies: a report from the International Working Group for Intravascular Optical Coherence Tomography Standardization and Validation. 2012

Tearney, Guillermo J / Regar, Evelyn / Akasaka, Takashi / Adriaenssens, Tom / Barlis, Peter / Bezerra, Hiram G / Bouma, Brett / Bruining, Nico / Cho, Jin-man / Chowdhary, Saqib / Costa, Marco A / de Silva, Ranil / Dijkstra, Jouke / Di Mario, Carlo / Dudek, Darius / Falk, Erling / Feldman, Marc D / Fitzgerald, Peter / Garcia-Garcia, Hector M / Gonzalo, Nieves / Granada, Juan F / Guagliumi, Giulio / Holm, Niels R / Honda, Yasuhiro / Ikeno, Fumiaki / Kawasaki, Masanori / Kochman, Janusz / Koltowski, Lukasz / Kubo, Takashi / Kume, Teruyoshi / Kyono, Hiroyuki / Lam, Cheung Chi Simon / Lamouche, Guy / Lee, David P / Leon, Martin B / Maehara, Akiko / Manfrini, Olivia / Mintz, Gary S / Mizuno, Kyiouchi / Morel, Marie-angéle / Nadkarni, Seemantini / Okura, Hiroyuki / Otake, Hiromasa / Pietrasik, Arkadiusz / Prati, Francesco / Räber, Lorenz / Radu, Maria D / Rieber, Johannes / Riga, Maria / Rollins, Andrew / Rosenberg, Mireille / Sirbu, Vasile / Serruys, Patrick W J C / Shimada, Kenei / Shinke, Toshiro / Shite, Junya / Siegel, Eliot / Sonoda, Shinjo / Suter, Melissa / Takarada, Shigeho / Tanaka, Atsushi / Terashima, Mitsuyasu / Thim, Troels / Uemura, Shiro / Ughi, Giovanni J / van Beusekom, Heleen M M / van der Steen, Antonius F W / van Es, Gerrit-Anne / van Soest, Gijs / Virmani, Renu / Waxman, Sergio / Weissman, Neil J / Weisz, Giora / Anonymous6690720. ·The Massachusetts General Hospital and the Wellman Center for Photomedicine, Boston, Massachusetts 02114, USA. gtearney@partners.org ·J Am Coll Cardiol · Pubmed #22421299.

ABSTRACT: OBJECTIVES: The purpose of this document is to make the output of the International Working Group for Intravascular Optical Coherence Tomography (IWG-IVOCT) Standardization and Validation available to medical and scientific communities, through a peer-reviewed publication, in the interest of improving the diagnosis and treatment of patients with atherosclerosis, including coronary artery disease. BACKGROUND: Intravascular optical coherence tomography (IVOCT) is a catheter-based modality that acquires images at a resolution of ~10 μm, enabling visualization of blood vessel wall microstructure in vivo at an unprecedented level of detail. IVOCT devices are now commercially available worldwide, there is an active user base, and the interest in using this technology is growing. Incorporation of IVOCT in research and daily clinical practice can be facilitated by the development of uniform terminology and consensus-based standards on use of the technology, interpretation of the images, and reporting of IVOCT results. METHODS: The IWG-IVOCT, comprising more than 260 academic and industry members from Asia, Europe, and the United States, formed in 2008 and convened on the topic of IVOCT standardization through a series of 9 national and international meetings. RESULTS: Knowledge and recommendations from this group on key areas within the IVOCT field were assembled to generate this consensus document, authored by the Writing Committee, composed of academicians who have participated in meetings and/or writing of the text. CONCLUSIONS: This document may be broadly used as a standard reference regarding the current state of the IVOCT imaging modality, intended for researchers and clinicians who use IVOCT and analyze IVOCT data.

2 Article Platelet aggregation and response to aspirin therapy in cardiac allograft vasculopathy. 2020

Bjerre, Kamilla P / Clemmensen, Tor S / Berg, Katrine / Poulsen, Steen H / Hvas, Anne-Mette / Grove, Erik L / Løgstrup, Brian B / Jakobsen, Lars / Thim, Troels / Kristensen, Steen D / Eiskjær, Hans. ·Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark. Electronic address: kambje@rm.dk. · Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark. · Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark. · Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark; Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark. ·J Heart Lung Transplant · Pubmed #32067865.

ABSTRACT: BACKGROUND: Long-term survival after heart transplantation (HTx) is compromised by cardiac allograft vasculopathy (CAV) characterized by coronary macro- and microvascular disease. The pathogenesis of CAV is unclear and may involve coronary thrombosis. We investigated whether HTx patients with CAV had higher platelet aggregation and turnover than HTx patients without CAV and healthy controls. Furthermore, we investigated the anti-platelet effect of low-dose aspirin in HTx patients. METHODS: We included 57 patients who had undergone HTx (median 8.3 years from HTx) and 57 healthy controls. Platelet aggregation was measured on-aspirin and off-aspirin using impedance aggregometry with adenosine diphosphate (ADP) and arachidonic acid (AA). We evaluated platelet turnover by flow cytometry, CAV burden by coronary angiography and echocardiography, and microvascular function by echocardiographic coronary flow velocity reserve (CFVR). RESULTS: Off-aspirin, HTx patients with CAV (n = 21) had higher ADP-induced platelet aggregation than healthy controls (p < 0.01) and HTx patients without CAV (n = 36) (p < 0.05). Aspirin treatment reduced AA-induced platelet aggregation in both HTx groups, but HTx patients with CAV had higher platelet aggregation on-aspirin than HTx patients without CAV (p < 0.05). Platelet turnover did not differ between HTx patients with CAV and HTx patients without CAV (p > 0.34). HTx patients with lower CFVR values had higher platelet aggregation than HTx patients with higher CFVR values (p < 0.05). CONCLUSIONS: Off-aspirin, platelet aggregation was higher in HTx patients with CAV than in HTx patients without CAV and healthy controls. On-aspirin, platelet aggregation was higher in HTx patients with CAV than in HTx patients without CAV. Aspirin monotherapy may not provide sufficient platelet inhibition in HTx patients with CAV.

3 Article Diabetes Mellitus Is Associated With Increased Risk of Ischemic Stroke in Patients With and Without Coronary Artery Disease. 2019

Olesen, Kevin K W / Madsen, Morten / Gyldenkerne, Christine / Thrane, Pernille G / Würtz, Morten / Thim, Troels / Jensen, Lisette O / Eikelboom, John / Bøtker, Hans Erik / Sørensen, Henrik T / Maeng, Michael. ·From the Department of Cardiology (K.K.W.O., C.G., P.G.T., T.T., H.E.B., M. Maeng), Aarhus University Hospital, Denmark. · Department of Clinical Epidemiology (K.K.W.O., M. Madsen, H.T.S.), Aarhus University Hospital, Denmark. · Department of Cardiology, Regional Hospital West Jutland, Herning, Denmark (M.W.). · Department of Cardiology, Odense University Hospital, Denmark (L.O.J.). · Population Health Research Institute, Hamilton Health Sciences and McMaster University, Ontario, Canada (J.E.). ·Stroke · Pubmed #31690249.

ABSTRACT: Background and Purpose- Diabetes mellitus (DM) and non-DM patients without coronary artery disease (CAD) have a similar low risk of myocardial infarction after coronary angiography. The risk of ischemic stroke in DM patients dependent on CAD status is less explored. We examined whether DM patients without CAD have a risk of ischemic stroke similar to that in patients with neither DM nor CAD. Methods- We conducted a cohort study of patients who underwent coronary angiography between 2004 and 2012 in Western Denmark. Patients diagnosed with previous ischemic stroke or transient ischemic attack were excluded. Patients were stratified according to the presence of DM and CAD. Follow-up started 30 days after coronary angiography. We computed event rates and adjusted incidence rate ratios using patients without DM or CAD as reference. We examined the trend between CAD extent and ischemic stroke in patients with DM. Results- A total of 81 909 patients were included. Median follow-up was 3.8 years. Patients with both DM and CAD were at the highest risk of ischemic stroke (1.32 events per 100 person-years; adjusted incidence rate ratio, 2.00 [95% CI, 1.72-2.32]). Patients with CAD alone (0.77 events per 100 person-years; adjusted incidence rate ratio, 1.27 [95% CI, 1.12-1.44]) or DM alone (0.95 events per 100 person-years; adjusted incidence rate ratio, 1.74 [95% CI, 1.42-2.15]) were at intermediate risk, whereas patients with neither DM nor CAD (0.52 events per 100 person-years) were at the lowest risk. Among patients with DM, extent of CAD was further predictive of risk (

4 Article Everolimus-Eluting Versus Biolimus-Eluting Coronary Stent Implantation in Patients With and Without Diabetes Mellitus. 2019

Gyldenkerne, Christine / Olesen, Kevin K W / Jensen, Lisette O / Junker, Anders / Veien, Karsten T / Terkelsen, Christian J / Kristensen, Steen D / Thim, Troels / Jensen, Svend E / Raungaard, Bent / Aaroe, Jens / Kahlert, Johnny / Villadsen, Anton B / Bøtker, Hans Erik / Christiansen, Evald H / Maeng, Michael. ·Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark. · Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark. · Department of Cardiology, Odense University Hospital, Odense, Denmark. · Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark. · Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark. · Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark. Electronic address: michael.maeng@ki.au.dk. ·Am J Cardiol · Pubmed #31279405.

ABSTRACT: Diabetes mellitus is associated with a higher risk of target lesion revascularization after percutaneous coronary intervention. We compared clinical outcomes in patients with and without diabetes mellitus, treated with everolimus-eluting stents (EES; Synergy; Boston Scientific, Marlborough, Massachusetts) or biolimus-eluting stents (BES; BioMatrix NeoFlex; Biosensors Interventional Technologies Pte Ltd., Singapore). In total, 2,764 patients were randomized to stent implantation with EES (n = 1,385, diabetes: n = 250) or the BES (n = 1,379, diabetes: n = 262), stratified by gender and diabetes. The primary end point, target lesion failure (TLF), was a composite of cardiac death, target-lesion myocardial infarction, or target lesion revascularization at 12 months. Secondary end points included individual components of TLF, all-cause death, and stent thrombosis. TLF was 2.1% lower in the EES versus the BES groups in patients with diabetes (3.6% vs 5.7%; rate ratios 0.61, 95% confidence interval [CI] 0.27 to 1.41) and similar in patients without diabetes (4.1% vs 4.0%; rate ratios 0.99, 95% CI 0.66 to 1.51). In patients with diabetes, the point estimates of the individual components of TLF also favored the EES but CIs were wide. No interaction between stent type and presence of diabetes was found. The current subgroup analysis found that a thin-strut EES as compared with a thicker strut BES had a numerically lower TLF rate in patients with diabetes, but the subgroup analysis was underpowered for definite conclusions.

5 Article Risk stratification by assessment of coronary artery disease using coronary computed tomography angiography in diabetes and non-diabetes patients: a study from the Western Denmark Cardiac Computed Tomography Registry. 2019

Olesen, Kevin K W / Riis, Anders H / Nielsen, Lene H / Steffensen, Flemming H / Nørgaard, Bjarne L / Jensen, Jesper M / Poulsen, Per L / Thim, Troels / Bøtker, Hans Erik / Sørensen, Henrik T / Maeng, Michael. ·Department of Cardiology, Aarhus University Hospital, Palle Juel Jensens Boulevard 99, Aarhus, Denmark. · Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Alle 43-45, Aarhus, Denmark. · Department of Cardiology, Lillebaelt Hospital, Beriderbakken 4, Vejle, Denmark. · Departments of Endocrinology and Internal Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus, Denmark. ·Eur Heart J Cardiovasc Imaging · Pubmed #31220229.

ABSTRACT: AIMS: We examined whether severity of coronary artery disease (CAD) measured by coronary computed tomography angiography can be used to predict rates of myocardial infarction (MI) and death in patients with and without diabetes. METHODS AND RESULTS: A cohort study of consecutive patients (n = 48 731) registered in the Western Denmark Cardiac Computed Tomography Registry from 2008 to 2016. Patients were stratified by diabetes status and CAD severity (no, non-obstructive, or obstructive). Endpoints were MI and death. Event rates per 1000 person-years, unadjusted and adjusted incidence rate ratios were computed. Median follow-up was 3.6 years. Among non-diabetes patients, MI event rates per 1000 person-years were 1.4 for no CAD, 4.1 for non-obstructive CAD, and 9.1 for obstructive CAD. Among diabetes patients, the corresponding rates were 2.1 for no CAD, 4.8 for non-obstructive CAD, and 12.6 for obstructive CAD. Non-diabetes and diabetes patients without CAD had similar low rates of MI [adjusted incidence rate ratio 1.40, 95% confidence interval (CI): 0.71-2.78]. Among diabetes patients, the adjusted risk of MI increased with severity of CAD (no CAD: reference; non-obstructive CAD: adjusted incidence rate ratio 1.71, 95% CI: 0.79-3.68; obstructive CAD: adjusted incidence rate ratio 4.42, 95% CI: 2.14-9.17). Diabetes patients had higher death rates than non-diabetes patients, irrespective of CAD severity. CONCLUSION: In patients without CAD, diabetes patients have a low risk of MI similar to non-diabetes patients. Further, MI rates increase with CAD severity in both diabetes and non-diabetes patients; with diabetes patients with obstructive CAD having the highest risk of MI.

6 Article Association between anti-diabetes treatments and cardiovascular risk in diabetes patients with and without coronary artery disease. 2019

Gyldenkerne, Christine / Olesen, Kevin Kris Warnakula / Madsen, Morten / Thim, Troels / Jensen, Lisette Okkels / Raungaard, Bent / Sørensen, Henrik Toft / Bøtker, Hans Erik / Maeng, Michael. ·1 Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark. · 2 Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark. · 3 Department of Cardiology, Odense University Hospital, Odense, Denmark. · 4 Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark. ·Diab Vasc Dis Res · Pubmed #30939916.

ABSTRACT: OBJECTIVE: We examined the risk of myocardial infarction associated with glucose-lowering therapy among diabetes patients with and without obstructive coronary artery disease. METHODS: A cohort of patients with type 1 or type 2 diabetes (n = 12,030), who underwent coronary angiography from 2004 to 2012, were stratified by presence of obstructive (any stenosis ⩾50%) coronary artery disease and by type of diabetes treatment: diet, non-insulin treatment and insulin (±oral anti-diabetics). The primary endpoint was myocardial infarction. Adjusted hazard ratios were calculated using diet-treated patients without coronary artery disease as reference. RESULTS: In patients without coronary artery disease, risk of myocardial infarction was similar in patients treated with non-insulin medication (adjusted hazard ratio 0.70, 95% confidence interval 0.27-1.81) and insulin (adjusted hazard ratio 0.76, 95% confidence interval 0.27-2.08) as compared to diet only. In patients with coronary artery disease, the risk of myocardial infarction was higher than in the reference group and an incremental risk was observed being lowest in patients treated with diet (adjusted hazard ratio 3.79, 95% confidence interval 1.61-8.88), followed by non-insulin medication (adjusted hazard ratio 5.42, 95% confidence interval 2.40-12.22), and highest in insulin-treated patients (adjusted hazard ratio 7.91, 95% confidence interval 3.51-17.82). CONCLUSION: The presence of obstructive coronary artery disease defines the risk of myocardial infarction in diabetes patients. Glucose-lowering therapy, in particular insulin, was associated with risk of myocardial infarction only in the presence of coronary artery disease.

7 Article External applicability of the COMPASS trial: the Western Denmark Heart Registry. 2019

Würtz, Morten / Olesen, Kevin Kris Warnakula / Thim, Troels / Kristensen, Steen Dalby / Eikelboom, John W / Maeng, Michael. ·Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK Aarhus, Denmark. · Department of Cardiology, Regional Hospital West Jutland, Gl. Landevej 61, DK Herning, Denmark. · Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, DK Aarhus, Denmark. · Department of Clinical Medicine, Faculty of Health, Institute of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, DK Aarhus, Denmark. · Population Health Research Institute, Hamilton Health Sciences, McMaster University, 237 Barton Street East, Ontario, Canada. ·Eur Heart J Cardiovasc Pharmacother · Pubmed #30916315.

ABSTRACT: AIMS: In the COMPASS trial, combined aspirin and rivaroxaban treatment reduced ischaemic events in patients with stable coronary artery disease (CAD) or peripheral artery disease (PAD). We estimated the proportion of COMPASS eligible patients among unselected patients undergoing coronary angiography (CAG) and compared outcome rates among COMPASS eligible and non-eligible patients. METHODS AND RESULTS: We applied the COMPASS study criteria on patients undergoing CAG in Western Denmark (2004-11). Both COMPASS eligible and non-eligible patients had CAD/PAD and met no exclusion criteria, but only COMPASS eligible patients met the inclusion criteria. We assessed the COMPASS primary endpoint of cardiovascular death, ischaemic stroke, haemorrhagic stroke, or myocardial infarction (MI). We computed event rates and adjusted incidence rate ratios (aIRRs). Of 80 071 patients undergoing CAG, 27 939 did not have CAD or PAD and were not considered. Of the 52 132 patients remaining, 11 930 were COMPASS eligible. Rates of the primary endpoint were 4.8 (95% confidence interval 4.6-5.0) events per 100 person-years among COMPASS eligible patients and 2.3 (2.2-2.4) among COMPASS non-eligible patients [aIRR 1.7 (1.6-1.9)]. COMPASS eligible patients also had higher risks of cardiovascular death [aIRR 2.5 (2.1-3.0)], ischaemic stroke [aIRR 1.4 (1.2-1.6)], and MI [aIRR 1.9 (1.7-2.1)]. CONCLUSION: In this all-comers CAG cohort, 15% were eligible for combined aspirin and rivaroxaban treatment. COMPASS eligible patients had up to 2.5-fold higher rates of cardiovascular events than non-eligible patients. The higher incidence of ischaemic events in COMPASS eligible patients highlights an unmet need for additional preventive measures.

8 Article Predicting stroke in patients without atrial fibrillation. 2019

Steensig, Kamilla / Olesen, Kevin K W / Thim, Troels / Nielsen, Jens C / Madsen, Morten / Jensen, Svend E / Jensen, Lisette O / Kristensen, Steen D / Lip, Gregory Y H / Maeng, Michael. ·Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark. · Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark. · Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark. · Department of Cardiology, Odense University Hospital, Odense, Denmark. · Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK. · Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark. ·Eur J Clin Invest · Pubmed #30883728.

ABSTRACT: BACKGROUND: Only few studies in selected cohorts have examined whether the CHA MATERIALS AND METHODS: Patients with coronary angiography performed between 2004 and 2012 were grouped according to CHA RESULTS: In total, 78 233 patients were included with group sizes varying between 8299 (CHA CONCLUSIONS: Among patients undergoing coronary angiography, the CHA

9 Article Comparison of Frequency of Ischemic Stroke in Patients With Versus Without Coronary Heart Disease and Without Atrial Fibrillation. 2019

Olesen, Kevin Kris Warnakula / Steensig, Kamilla / Madsen, Morten / Thim, Troels / Jensen, Lisette Okkels / Raungaard, Bent / Eikelboom, John / Kristensen, Steen Dalby / Bøtker, Hans Erik / Maeng, Michael. ·Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark. Electronic address: kevole@clin.au.dk. · Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark. · Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark. · Department of Cardiology, Odense University Hospital, Odense, Denmark. · Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark. · Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada. ·Am J Cardiol · Pubmed #30389089.

ABSTRACT: Recent trials of antithrombotic therapy in patients with coronary artery disease (CAD) have demonstrated substantial reductions in ischemic stroke. Our aim was to examine ischemic stroke risk in patients with CAD and to identify those at highest risk. We examined ischemic stroke risk in patients without atrial fibrillation who underwent coronary angiography between 2004 and 2012. Patients were stratified according to presence or absence of CAD and further stratified by extent of CAD (0 vessel disease [VD], 1 VD, 2 VD, 3 VD, and diffuse VD). End points were composites of ischemic stroke, transient ischemic attack (TIA), and systemic embolism, as well as major adverse cardiovascular and cerebrovascular events (MACCE) defined as cardiac death, myocardial infarction, plus ischemic stroke, TIA, and systemic embolism. Adjusted incidence rate ratios (IRRs) were estimated. A total of 68,829 patients were included, 25,032 had 0 VD, 4,736 had diffuse VD, 18,471 had 1 VD, 10,588 had 2 VD, and 10,002 had 3 VD. Median follow-up was 4.0 years. CAD extent was associated with an increased risk of stroke, TIA, and systemic embolism (1 VD: adjusted IRR 1.02, 95% confidence interval [CI] 0.90 to 1.16; diffuse VD: adjusted IRR 1.22, 95% CI 1.02 to 1.47; 2 VD: adjusted IRR 1.28, 95% CI 1.12 to 1.45; 3 VD: adjusted IRR 1.37, 95% CI 1.20 to 1.55) compared with patients with 0 VD. Presence and extent of CAD were also associated with MACCE. In conclusion, CAD is associated with an increased risk of stroke, TIA, and systemic embolism and MACCE in patients without atrial fibrillation, and patients with coronary multi-VD are at highest risk and may be candidates for treatment strategies aiming at reducing ischemic stroke incidence.

10 Article Should the Presence or Extent of Coronary Artery Disease be Quantified in the CHA2DS2-VASc Score in Atrial Fibrillation? A Report from the Western Denmark Heart Registry. 2018

Steensig, Kamilla / Olesen, Kevin K W / Thim, Troels / Nielsen, Jens C / Jensen, Svend E / Jensen, Lisette O / Kristensen, Steen D / Bøtker, Hans Erik / Lip, Gregory Y H / Maeng, Michael. ·Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark. · Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark. · Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark. · Department of Cardiology, Odense University Hospital, Odense, Denmark. · Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom. · Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, University of Liverpool, Liverpool, United Kingdom. · Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark. ·Thromb Haemost · Pubmed #30419601.

ABSTRACT: BACKGROUND:  Patients with atrial fibrillation (AF) have an increased risk of ischaemic stroke. The risk can be predicted by the CHA OBJECTIVES:  This article explores whether CAD per se or extent provides independent prognostic information of future stroke among patients with AF. MATERIALS AND METHODS:  Consecutive patients with AF and coronary angiography performed between 2004 and 2012 were included. The endpoint was a composite of ischaemic stroke, transient ischaemic attack and systemic embolism. The risk of ischaemic events was estimated according to the presence and extent of CAD. Incidence rate ratios (IRR) were calculated in reference to patients without CAD and adjusted for parameters included in the CHA RESULTS:  Of 96,430 patients undergoing coronary angiography, 12,690 had AF. Among patients with AF, 7,533 (59.4%) had CAD. Mean follow-up was 3 years. While presence of CAD was an independent risk factor for the composite endpoint (adjusted IRR, 1.25; 1.06-1.47), extent of CAD defined as 1-, 2-, 3- or diffuse vessel disease did not add additional independent risk information. CONCLUSION:  Presence, but not extent, of CAD was an independent risk factor of the composite thromboembolic endpoint beyond the components already included in the CHA

11 Article Coronary artery disease and risk of adverse cardiac events and stroke. 2017

Olesen, Kevin Kris Warnakula / Madsen, Morten / Lip, Gregory Y H / Egholm, Gro / Thim, Troels / Jensen, Lisette Okkels / Raungaard, Bent / Nielsen, Jens Cosedis / Bøtker, Hans Erik / Sørensen, Henrik Toft / Maeng, Michael. ·Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark. · Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark. · Institute of Cardiovascular Sciences, City Hospital, University of Birmingham, Birmingham, United Kingdom. · Department of Cardiology, Odense University Hospital, Odense, Denmark. · Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark. ·Eur J Clin Invest · Pubmed #28804899.

ABSTRACT: BACKGROUND: Patients with acute myocardial infarction are at increased risk of ischaemic stroke. Previous myocardial infarction is an important part of risk assessment for ischaemic stroke. However, there is a lack of information regarding the association between the severity and extent of coronary artery disease and long-term risk of ischaemic stroke. MATERIALS AND METHODS: A cohort study of coronary angiographies performed in western Denmark from 1 January 2003 to 31 December 2012. Patients were stratified according to the number of vessels affected by obstructive coronary artery disease (lumen narrowing ≥50%) at the time of angiography: zero-, one-, two- or three-vessel disease and diffuse vessel disease. We followed patients for a maximum of 7 years. Endpoints were all-cause death, cardiac death, myocardial infarction and ischaemic stroke. Cumulative risks and crude and adjusted rate ratios were estimated. RESULTS: The study population included 78 195 patients. Of these, 32 061 (41·0%) had zero-vessel disease, 6205 (7·9%) had diffuse vessel disease, 20 202 (25·8%) had one-vessel disease, 10 675 (13·7%) had two-vessel disease, and 9038 (11·6%) had three-vessel disease. Median follow-up was 3·6 years (interquartile range 1·7-6·0 years). Increasing severity of obstructive coronary artery disease was associated with an increasing risk of all-cause death, cardiac death, myocardial infarction (MI) and ischaemic stroke during follow-up. CONCLUSIONS: The presence and extent of coronary artery disease was associated with an incremental risk of not only death, cardiac death, myocardial infarction, but also ischaemic stroke over a 7-year period.

12 Article Patients With Diabetes Without Significant Angiographic Coronary Artery Disease Have the Same Risk of Myocardial Infarction as Patients Without Diabetes in a Real-World Population Receiving Appropriate Prophylactic Treatment. 2017

Olesen, Kevin K W / Madsen, Morten / Egholm, Gro / Thim, Troels / Jensen, Lisette O / Raungaard, Bent / Bøtker, Hans E / Sørensen, Henrik T / Maeng, Michael. ·Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark. · Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark. · Department of Cardiology, Odense University Hospital, Odense, Denmark. · Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark. · Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark michael.maeng@ki.au.dk. ·Diabetes Care · Pubmed #28596210.

ABSTRACT: OBJECTIVE: The risk of myocardial infarction (MI) in patients with diabetes is greater than for patients without diabetes. Consequently, prophylactic treatment is recommended for patients with diabetes and risk factors for ischemic heart disease. We aimed to estimate the risk of adverse cardiac events in patients with and without diabetes with and without coronary artery disease (CAD) after coronary angiography (CAG). RESEARCH DESIGN AND METHODS: A population-based cohort of patients registered in the Western Denmark Heart Registry who underwent CAG between 1 January 2003 and 31 December 2012 was stratified according to the presence or absence of obstructive CAD and diabetes. End points were death, cardiac death, and MI. Unadjusted and adjusted rate ratios (RRs) were calculated by using patients without diabetes and without CAD as the reference group. RESULTS: We included 93,866 patients of whom 12,544 (13.4%) had diabetes at the time of CAG. Median follow-up was 4.1 years. Patients with and without diabetes without obstructive CAD had the same adjusted risk of death (RR 1.03 [95% CI 0.92-1.15]), cardiac death (RR 1.21 [95% CI 0.90-1.64]), and MI (RR 0.88 [95% CI 0.65-1.17]). Patients with diabetes without CAD were more often treated with statins (75.3% vs. 46.0%) and aspirin (65.7% vs. 52.7%) than patients without diabetes and CAD. CONCLUSIONS: In a real-world population, patients with diabetes with high rates of statin and aspirin treatment had the same risk of cardiovascular events as patients without diabetes in the absence of angiographically significant CAD.

13 Article Risk Associated With Surgery Within 12 Months After Coronary Drug-Eluting Stent Implantation. 2016

Egholm, Gro / Kristensen, Steen Dalby / Thim, Troels / Olesen, Kevin K W / Madsen, Morten / Jensen, Svend E / Jensen, Lisette O / Sørensen, Henrik T / Bøtker, Hans E / Maeng, Michael. ·Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark. Electronic address: grochi@rm.dk. · Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark. · Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark. · Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark. · Department of Cardiology, Odense University Hospital, Odense, Denmark. ·J Am Coll Cardiol · Pubmed #27978946.

ABSTRACT: BACKGROUND: Guidelines recommend postponing surgery for at least 6 months after treatment with a drug-eluting stent by percutaneous coronary intervention (DES-PCI). OBJECTIVES: The goal of this study was to evaluate the surgical risk associated with DES-PCI compared with that in nonstented patients without ischemic heart disease (IHD). METHODS: Between 2005 and 2012, a total of 22,590 patients underwent DES-PCI in western Denmark. By record-linking the Western Denmark Heart Registry and the Danish National Patient Register, we evaluated 4,303 DES-PCI-treated patients with a surgical procedure and compared them with a control group of patients without previous IHD undergoing similar surgical procedures (n = 20,232). Events of interest were myocardial infarction (MI), cardiac death, and all-cause mortality within 30 days after surgery. RESULTS: Surgery in DES-PCI-treated patients was associated with an increased risk of MI (1.6% vs. 0.2%; odds ratio [OR]: 4.82; 95% confidence interval [CI]: 3.25 to 7.16) and cardiac death (1.0% vs. 0.2%; OR: 5.87; 95% CI: 3.60 to 9.58) but not all-cause mortality (3.1% vs. 2.7%; OR: 1.12; 95% CI: 0.91 to 1.38). When stratified for time from PCI to surgery, only surgery within the first month was associated with a significant increased risk of events. CONCLUSIONS: Patients requiring surgery within 12 months after DES-PCI had an increased risk of MI and cardiac death compared with patients without IHD. The increased risk was only present within the first month after DES-PCI, suggesting that surgery might be undertaken earlier than currently recommended.

14 Article Determination of edema in porcine coronary arteries by T2 weighted cardiovascular magnetic resonance. 2011

Pedersen, Steen Fjord / Thrysøe, Samuel A / Paaske, William P / Thim, Troels / Falk, Erling / Ringgaard, Steffen / Kim, Won Yong. ·Dept. of Cardiothoracic and Vascular Surgery T, Aarhus University Hospital Skejby, Brendstrupsgaardsvej 100, DK-8200 Aarhus N, Denmark. fjord@mr.au.dk ·J Cardiovasc Magn Reson · Pubmed #21936914.

ABSTRACT: BACKGROUND: Inflammation plays a pivotal role in all stages of atherosclerosis. Since edema is known to be an integral part of inflammation, a noninvasive technique that can identify edema in the coronary artery wall may provide unique information regarding plaque activity. In this study, we aimed to determine whether edema induced in porcine coronary arteries by balloon injury could be reliably detected by cardiovascular magnetic resonance (CMR) using a water sensitive T2-weighted short tau inversion recovery sequence (T2-STIR). We also aimed to compare these results to those of conventional T2-weighted (T2W) imaging. METHODS: Edema was induced in the proximal left anterior descending (LAD) coronary artery wall in seven pigs by balloon injury. At baseline, and 1-10 days (average four) post injury, the proximal LAD was assessed by water sensitive T2-STIR and conventional T2W sequences in cross-sectional planes. CMR images were matched to histopathology, validated against Evans blue as a marker of increased vessel wall permeability, and correlated with the arterial amount of fibrinogen used as an edema surrogate marker. RESULTS: Post injury, the T2-STIR images of the injured LAD vessel wall showed a significant 72%, relative signal intensity (SI) increase compared with baseline (p = 0.028). Using a threshold value of SI 7 SD above the average SI of the myocardium, T2-STIR detected edema in the vessel wall (i.e. enhancement) with a sensitivity of 100 and a specificity of 71. Twelve out of the 14 (86%) T2-STIR images displaying coronary artery wall enhancement also showed Evans blue uptake in the corresponding histology. The relative signal intensity showed a linear correlation with the amount of fibrinogen detected on the corresponding histopathology (ρ = 0.750, p = 0.05). The conventional T2W images did not show significant changes in SI post injury. CONCLUSION: T2-STIR CMR enabled detection of coronary artery wall edema and could therefore be a non-invasive diagnostic tool for evaluation of inflammatory coronary artery wall activity.

15 Article Familial hypercholesterolaemic downsized pig with human-like coronary atherosclerosis: a model for preclinical studies. 2010

Thim, Troels / Hagensen, Mette Kallestrup / Drouet, Ludovic / Bal Dit Sollier, Claire / Bonneau, Michel / Granada, Juan F / Nielsen, Lars Bo / Paaske, William P / Bøtker, Hans Erik / Falk, Erling. ·Atherosclerosis Research Unit, Department of Cardiology, Aarhus University Hospital (Skejby) and Institute of Clinical Medicine, Aarhus University, Denmark. troels.thim@ki.au.dk ·EuroIntervention · Pubmed #20562079.

ABSTRACT: AIMS: A manageable and reproducible large animal model of human-like coronary atherosclerosis is lacking but highly needed for translational research in percutaneous coronary interventions and imaging. Farm pigs with familial hypercholesterolaemia develop advanced atherosclerosis in two to three years but then weigh >200 kg making them impractical and costly. We aimed at down-sizing this pig and accelerating coronary plaque development to make the model more useful and affordable. METHODS AND RESULTS: Familial hypercholesterolaemic farm pigs were downsized by crossing them with smaller pigs while preserving their hypercholesterolaemic trait ascribed to a mutation in the low density lipoprotein receptor. We accelerated coronary plaque development by atherogenic diet feeding whereby plasma total cholesterol rose to >20 mmol/l (>800 mg/dl). We further accelerated coronary plaque development site-specifically by inflicting coronary artery balloon injury. Both spontaneously developed and balloon accelerated coronary plaques mirrored pertinent human plaque features, including a large necrotic core covered by a thin and inflamed fibrous cap as seen in the most common type of thrombosis-prone (vulnerable) plaque in humans. Associated vulnerable plaque features included neovascularisation, intraplaque haemorrhage, and expansive remodelling. CONCLUSIONS: This human-like porcine model of coronary atherosclerosis is practical and highly relevant for translational research in percutaneous coronary interventions and imaging.

16 Minor CAD Is an Independent Risk Factor for Stroke Among Patients With Atrial Fibrillation. 2018

Steensig, Kamilla / Olesen, Kevin K W / Thim, Troels / Nielsen, Jens C / Jensen, Svend E / Jensen, Lisette O / Kristensen, Steen D / Bøtker, Hans Erik / Lip, Gregory Y H / Maeng, Michael. · ·J Am Coll Cardiol · Pubmed #30157457.

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