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The Prevention of the organ damage after out of hospital cardiac arrest
Karásek, Jiří ; Widimský, Petr (advisor) ; Vojáček, Jan (referee) ; Moťovská, Zuzana (referee) ; Bonaventura, Jiří (referee)
The publication summarises in four original papers the authors' results in out-of-hospital cardiac arrest (OHCA). The first paper presents a prospective observational study comparing the effect of mechanical chest compression (LUCAS) and manual chest compression (non-LUCAS) on the 30-day and 180-day survival rate of the patients affected by OHCA. The study included 278 patients (144 underwent mechanical chest compression - LUCAS, and 134 manual chest compression - non-LUCAS). There were no significant differences in restoration of spontaneous circulation (ROSC): (25% in LUCAS vs 30.6% in non-LUCAS, p = 0,35). However, we observed significantly more conversions to shock rhythm in the LUCAS group (20.7% vs 10.10%, p = 0,04). The 30-day survival rate was significantly worse in the LUCAS group (5.07% vs 16.31% in non-LUCAS, p = 0,044). In the case of 180-day survival, no significant differences were detected (9.42% in LUCAS vs 5.45% in non-LUCAS, p = 0,25). The second study examined mechanical chest compression-related injuries as a possible explanation for the mechanical compression failure in survival rates. This retrospective observational study relied on 630 patients who died during CPR that involved mechanical or manual chest compressions. The data were drawn from autopsy reports of all patients....
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Current interventional approach to coronary artery disease
Klinčeva, Milka ; Widimský, Petr (advisor) ; Čelko, Alexander (referee) ; Hradec, Jaromír (referee)
Coronary artery disease is the main cause of death in both genders worldwide. Many preclinical and clinical studies present the concept of modifiable and non modifiable cardiovascular risk factors. The basic management of the coronary artery disease is medical, but the prognosis in many patients can be improved by potentially invasive procedures, such as the percutaneous coronary intervention (PCI) and the coronary artery bypass grafting (CABG). The cardiovascular risk scores may help cardiologists and cardiac surgeons alike to individualize the risk profile of patients in order to better define the revascularization strategy and to appropriately counsel the patient, in same time reducing the morbidity and mortality. The first part of the thesis evaluates the validity of both forms of the most used cardiovascular tool in the present day, the European System for Cardiac Operative Risk Evaluation (EuroSCORE). The second part of the thesis concentrates on the prevalence of stress-induced myocardial stunning (Tako-Tsubo syndrome) among patients undergoing urgent coronary angiography for suspected acute myocardial infarction. The third part of the thesis obtains a realistic contemporary picture of how patients with STelevation myocardial infarction (STEMI) are treated in different European countries.
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Ischemic heart disease-from pathophysiology of ischemic mitral regurgitation to percutaneous coronary intervention
Kočka, Viktor ; Widimský, Petr (advisor) ; Mates, Martin (referee) ; Želízko, Michael (referee)
Ischemic heart disease - from pathophysiology of ischemic mitral regurgitation to percutaneous coronary intervention As. MUDr. Viktor Kočka Summary Ischemic mitral regurgitation (IMR) and myocardial revascularization are from pathophysiological perspective closely linked. We first defined the incidence of IMR in current cardiology to be 129 patients per 1 million population annually. These patients have high mortality of 54% during 5 year follow-up. There is pathophysiological hypothesis of association between myocardial viability and IMR and we have proven this thesis to be correct. The presence of at least 5 viable segments of myocardium is a significant predictor of IMR improvement after revascularization. It is noteworthy that dimension of left ventricle indexed to body surface area is a better predictor of long term prognosis than the hemodynamic significance of IMR. We have also found surprisingly robust association between previous revascularization and better prognosis, even after in average 10 years. Further we have focused on the topic of percutaneous coronary intervention (PCI). Pathophysiology of neointimal hyperplasia (NIH) as a basis of clinical in-stent restenosis was examined on animal model. First, novel nanocrystalline diamond (NCD) coronary stent coating was developed with the help of...
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Treatment of acute myocardial infarction in the era of percutaneous coronary intervention
Knot, Jiří ; Widimský, Petr (advisor) ; Adámková, Věra (referee) ; Červinka, Pavel (referee)
Univerzita Karlova v Praze 3. lékařská fakulta Treatment of acute myocardial infarction in the era of percutaneous coronary intervention MUDr. Jiří Knot 2014 When treating patients with acute myocardial infarction (AMI), a very important prognostic factor is a time from the occurrence of myocardial ischemia until achievement of reperfusion. The shortest delays are being achieved in countries with well-functioning health care network. Another very important factor is the form of used reperfusion therapy. Between individual European countries there is a significant difference in using of reperfusion strategy in the treatment of AMI. In countries where the primary percutaneous coronary intervention (PCI) is a dominant reperfusion strategy, there is significantly higher total number of reperfused patients with AMI. In addition, a reduction in mortality related with primary PCI is in real practice higher than the randomized clinical trials report. The aim of this work was to map the health care system for patients with AMI in five European countries and work out guidance for optimal cooperation of all segment of the health system that are involved in this care and thereby reduce individual delays. Urgent coronary catheterization or possibly PCI is commonly provided to patients with AMI with ST segments...
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Transportation to primary percutaneous coronary intervention is a strong independent predictor of functional status after myocardial infarction with ST elevation. Five-year follow-up of the Prague-2 trial
Mocová, Danuše ; Widimský, Petr (advisor) ; Češka, Richard (referee) ; Vítovec, Jiří (referee)
Aim. Randomized trials in ST-elevation myocardial infarction (STEMI) showed improved early outcomes after primary percutaneous coronary intervention (pPCI) compared with thrombolysis (TL). It is less known whether the early benefit is sustained during the long-term follow-up. Methods. The PRAGUE-2 study enrolled 850 patients with STEMI. The patients were randomized into two groups - transport to a primary percutaneous coronary intervention center (pPCI) (n = 429) vs. thrombolysis in community hospitals (n = 421). The data was collected from primary hospitals and PCI centers or with questionnaires. Results. The mean follow-up was 58 months. At 5 year follow-up, the cumulative incidence of composite endpoint (death from any cause or recurrent infarction or stroke or revascularization) was 53% in TL patients compared with 40% in pPCI patients (HR 1.8; 95% CI 1.38-2.33; p < 0.001). The respective cumulative incidence of recurrent infarction was 19 vs. 12 % (HR 1.72; 95% CI 1.15-2.58; p = 0.009), stroke 8 vs. 8% (HR 1.65; 95% CI 0.84- 2.23; p = 0.18), revascularization 51 vs. 34% (HR 1.81; 95% CI 1.21-2.35; p < 0.001). At 5- years, 45.4 % of patients after primary percutaneous coronary intervention vs. 31.8 % of those treated with TL were in class I of the New York Heart Association (NYHA) (HR 2.02; 95%...
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Ischemic heart disease-from pathophysiology of ischemic mitral regurgitation to percutaneous coronary intervention
Kočka, Viktor ; Widimský, Petr (advisor) ; Mates, Martin (referee) ; Želízko, Michael (referee)
Ischemic heart disease - from pathophysiology of ischemic mitral regurgitation to percutaneous coronary intervention As. MUDr. Viktor Kočka Summary Ischemic mitral regurgitation (IMR) and myocardial revascularization are from pathophysiological perspective closely linked. We first defined the incidence of IMR in current cardiology to be 129 patients per 1 million population annually. These patients have high mortality of 54% during 5 year follow-up. There is pathophysiological hypothesis of association between myocardial viability and IMR and we have proven this thesis to be correct. The presence of at least 5 viable segments of myocardium is a significant predictor of IMR improvement after revascularization. It is noteworthy that dimension of left ventricle indexed to body surface area is a better predictor of long term prognosis than the hemodynamic significance of IMR. We have also found surprisingly robust association between previous revascularization and better prognosis, even after in average 10 years. Further we have focused on the topic of percutaneous coronary intervention (PCI). Pathophysiology of neointimal hyperplasia (NIH) as a basis of clinical in-stent restenosis was examined on animal model. First, novel nanocrystalline diamond (NCD) coronary stent coating was developed with the help of...
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Treatment of acute myocardial infarction in the era of percutaneous coronary intervention
Knot, Jiří ; Widimský, Petr (advisor) ; Adámková, Věra (referee) ; Červinka, Pavel (referee)
Univerzita Karlova v Praze 3. lékařská fakulta Treatment of acute myocardial infarction in the era of percutaneous coronary intervention MUDr. Jiří Knot 2014 When treating patients with acute myocardial infarction (AMI), a very important prognostic factor is a time from the occurrence of myocardial ischemia until achievement of reperfusion. The shortest delays are being achieved in countries with well-functioning health care network. Another very important factor is the form of used reperfusion therapy. Between individual European countries there is a significant difference in using of reperfusion strategy in the treatment of AMI. In countries where the primary percutaneous coronary intervention (PCI) is a dominant reperfusion strategy, there is significantly higher total number of reperfused patients with AMI. In addition, a reduction in mortality related with primary PCI is in real practice higher than the randomized clinical trials report. The aim of this work was to map the health care system for patients with AMI in five European countries and work out guidance for optimal cooperation of all segment of the health system that are involved in this care and thereby reduce individual delays. Urgent coronary catheterization or possibly PCI is commonly provided to patients with AMI with ST segments...
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Transportation to primary percutaneous coronary intervention is a strong independent predictor of functional status after myocardial infarction with ST elevation. Five-year follow-up of the Prague-2 trial
Mocová, Danuše ; Widimský, Petr (advisor) ; Češka, Richard (referee) ; Vítovec, Jiří (referee)
Aim. Randomized trials in ST-elevation myocardial infarction (STEMI) showed improved early outcomes after primary percutaneous coronary intervention (pPCI) compared with thrombolysis (TL). It is less known whether the early benefit is sustained during the long-term follow-up. Methods. The PRAGUE-2 study enrolled 850 patients with STEMI. The patients were randomized into two groups - transport to a primary percutaneous coronary intervention center (pPCI) (n = 429) vs. thrombolysis in community hospitals (n = 421). The data was collected from primary hospitals and PCI centers or with questionnaires. Results. The mean follow-up was 58 months. At 5 year follow-up, the cumulative incidence of composite endpoint (death from any cause or recurrent infarction or stroke or revascularization) was 53% in TL patients compared with 40% in pPCI patients (HR 1.8; 95% CI 1.38-2.33; p < 0.001). The respective cumulative incidence of recurrent infarction was 19 vs. 12 % (HR 1.72; 95% CI 1.15-2.58; p = 0.009), stroke 8 vs. 8% (HR 1.65; 95% CI 0.84- 2.23; p = 0.18), revascularization 51 vs. 34% (HR 1.81; 95% CI 1.21-2.35; p < 0.001). At 5- years, 45.4 % of patients after primary percutaneous coronary intervention vs. 31.8 % of those treated with TL were in class I of the New York Heart Association (NYHA) (HR 2.02; 95%...
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Current interventional approach to coronary artery disease
Klinčeva, Milka ; Widimský, Petr (advisor) ; Čelko, Alexander (referee) ; Hradec, Jaromír (referee)
Coronary artery disease is the main cause of death in both genders worldwide. Many preclinical and clinical studies present the concept of modifiable and non modifiable cardiovascular risk factors. The basic management of the coronary artery disease is medical, but the prognosis in many patients can be improved by potentially invasive procedures, such as the percutaneous coronary intervention (PCI) and the coronary artery bypass grafting (CABG). The cardiovascular risk scores may help cardiologists and cardiac surgeons alike to individualize the risk profile of patients in order to better define the revascularization strategy and to appropriately counsel the patient, in same time reducing the morbidity and mortality. The first part of the thesis evaluates the validity of both forms of the most used cardiovascular tool in the present day, the European System for Cardiac Operative Risk Evaluation (EuroSCORE). The second part of the thesis concentrates on the prevalence of stress-induced myocardial stunning (Tako-Tsubo syndrome) among patients undergoing urgent coronary angiography for suspected acute myocardial infarction. The third part of the thesis obtains a realistic contemporary picture of how patients with STelevation myocardial infarction (STEMI) are treated in different European countries.
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