Publications by authors named "Maarten A H van Leeuwen"
Background: Results from the Distal vs Conventional Radial Access (DISCO RADIAL) trial confirmed distal radial access (DRA) as a valid alternative to conventional transradial access, with equally low rates of radial artery occlusion (RAO), yet higher crossovers but shorter hemostasis.
Objectives: The purpose of the study was to investigate whether patient anthropometric measures influence the effect of randomized access on key secondary outcomes.
Methods: DISCO RADIAL was an international, multicenter, randomized controlled trial in which patients with indications for percutaneous coronary procedure using a 6-F Slender sheath were randomized to DRA (n = 650) or transradial access (n = 657) implementing best practices to reduce RAO.
High-risk plaques in non-culprit lesions and clinical outcome after NSTEMI vs. STEMI.
Eur Heart J Cardiovasc Imaging
January 2025
Article Synopsis
- The study investigates the impact of non-culprit (NC) lesions in patients with NSTEMI compared to those with STEMI, focusing on high-risk plaque features and their influence on clinical outcomes.
- Among 438 patients, both NSTEMI and STEMI groups showed similar prevalence of high-risk plaques, but NSTEMI patients had a higher rate of major adverse cardiovascular events (MACE) after two years.
- The findings suggest that the presence of high-risk plaques in NC lesions is critical for dictating future cardiovascular events, indicating the need for further research on effective revascularization strategies in NSTEMI patients.
Article Synopsis
- Recurrent events after myocardial infarction (MI) often arise from non-flow limiting lesions, which may differ between sexes, prompting this study to investigate these potential differences among MI patients.
- The study examined 420 patients, finding that female patients had longer NC lesions and smaller lumen areas and diameters, as well as thinner fibrous caps compared to male patients.
- Despite females exhibiting more high-risk plaque characteristics, both genders experienced similar rates of major cardiovascular events at two years, suggesting the need for further research on long-term outcomes related to these differences.
Background: Microvascular obstruction (MVO) measured by cardiac magnetic resonance (CMR) after ST-segment elevation myocardial infarction (STEMI) has important prognostic implications. While invasive index of microvascular resistance (IMR) have been shown to predict the occurrence and extent of MVO, the role of the angiography-based microvascular resistance (Angio-IMR) for this purpose remains unknown. The present study aims to perform a head-to-head comparison of wire-based and angiography-derived microcirculatory resistance (IMR and Angio-IMR, respectively) for the detection of MVO.
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- The microvascular resistance reserve (MRR) is a new index developed to evaluate the vasodilatory capacity of the microcirculation, particularly relevant for patients with ST-segment elevation myocardial infarction (STEMI), whose prognostic value was previously unknown.
- This study analyzed data from 1,265 STEMI patients, focusing on a subgroup where both MRR and index of microcirculatory resistance (IMR) were available, to compare their effectiveness in predicting long-term outcomes.
- The findings revealed that MRR is a significant predictor of long-term all-cause mortality or heart failure hospitalization, with a cutoff value of 1.25 indicating higher risk when below this level.
Background: Transfemoral access is often used when large-bore guide catheters are required for percutaneous coronary intervention (PCI) of complex coronary lesions, especially when large-bore transradial access is contraindicated. Whether the risk of access site complications for these procedures may be reduced by ultrasound-guided puncture is unclear.
Aims: We aimed to show the superiority of ultrasound-guided femoral puncture compared to fluoroscopy-guided access in large-bore complex PCI with regard to access site-related Bleeding Academic Research Consortium 2, 3 or 5 bleeding and/or vascular complications requiring intervention during hospitalisation.
Article Synopsis
- Despite primary PCI treatment for STEMI, patients still face high risks of heart failure and late death due to microvascular dysfunction, measured by IMR.
- The study aims to determine if IMR is an independent predictor of cardiac death, identify the optimal cutoff value of IMR, and compare it to other cardiac parameters.
- Results from 1,265 patients show that a higher IMR (especially >40) is associated with increased cardiac mortality and hospitalization for heart failure, establishing an optimal cutoff value of 70 for predicting cardiac death.
Impact of symptom-to-reperfusion-time on transmural infarct extent and left ventricular strain in patients with ST-segment elevation myocardial infarction: a 3D view on the wavefront phenomenon.
Eur Heart J Cardiovasc Imaging
February 2024
Article Synopsis
- The study explored how the timing of treatment (symptom-to-reperfusion time) affects heart damage in patients with ST-segment elevation myocardial infarction (STEMI) after undergoing primary percutaneous coronary intervention (PPCI).
- Researchers divided 108 STEMI patients into two groups based on their reperfusion time and found that shorter reperfusion times were linked to less heart damage (smaller infarct size) and better heart function measured by cardiovascular magnetic resonance (CMR).
- The findings suggest that a quicker treatment response correlates with better recovery of heart muscle function, particularly in circumferential and radial strain measurements, which are important for assessing heart health after an infarction.
Article Synopsis
- Patients who undergo FFR-guided revascularization after a myocardial infarction still face high rates of repeat major cardiovascular events, often due to nonculprit lesions identified as high-risk by optical coherence tomography (OCT).
- The study, called PECTUS-obs, evaluates how OCT can help detect high-risk plaques in nonculprit lesions, which were defined by specific characteristics such as lipid content and plaque stability.
- Out of 438 enrolled patients, 34% had at least one high-risk plaque, and 15.4% of those with high-risk plaques experienced recurrent major adverse cardiovascular events within a two-year period.
Article Synopsis
- Outcomes for chronic total occlusion percutaneous coronary intervention (PCI) have significantly improved over the past ten years, with a focus on enhancing safety during procedures.
- Vascular access site bleeding is a common complication that can occur during these procedures.
- The review discusses various strategies that have been developed to minimize vascular access site complications in chronic total occlusion PCI.
Author Correction: Effect of ticagrelor and prasugrel on remote myocardial inflammation in patients with acute myocardial infarction with ST-elevation: a CMR T1 and T2 mapping study.
Int J Cardiovasc Imaging
June 2023
Effect of ticagrelor and prasugrel on remote myocardial inflammation in patients with acute myocardial infarction with ST-elevation: a CMR T1 and T2 mapping study.
Int J Cardiovasc Imaging
April 2023
Purpose: Acute myocardial ischaemia triggers a non-specific inflammatory response of remote myocardium through the increase of plasma concentrations of acute-phase proteins, which causes myocardial oedema. As ticagrelor has been shown to significantly decrease circulating levels of several pro-inflammatory cytokines in patients after acute myocardial infarction with ST-elevation (STEMI), we sought to investigate a potential suppressive effect of ticagrelor over prasugrel on cardiac magnetic resonance (CMR) T1 and T2 values in remote myocardium.
Methods: Ninety STEMI patients were prospectively included and randomised to receive either ticagrelor or prasugrel maintenance treatment after successful primary percutaneous coronary intervention.
Article Synopsis
- Recent studies suggest that while transradial access (TRA) is preferred for complex coronary procedures, many patients still require femoral access, especially for chronic total occlusions (CTO), and using ultrasound for puncture may reduce complications.
- A study involving 542 patients is designed to compare ultrasound-guided puncture and fluoroscopy-guided puncture for accessing the femoral artery during complex PCI, focusing on access site complications and major adverse cardiovascular events.
- Ethical approval has been obtained from multiple committees, and the outcomes of the trial will be shared in peer-reviewed journals, with details available on ClinicalTrials.gov under identifier NCT03846752.
The Dynamic Relationship Between Invasive Microvascular Function and Microvascular Injury Indicators, and Their Association With Left Ventricular Function and Infarct Size at 1-Month After Reperfused ST-Segment-Elevation Myocardial Infarction.
Circ Cardiovasc Interv
November 2022
Background: The invasive microvascular function indices, coronary flow reserve (CFR) and the index of microcirculatory resistance (IMR), exhibit a dynamic pattern after ST-segment-elevation myocardial infarction. The effects of microvascular injury on the evolution of the microvascular function and the prognostic significance of the evolution of microvascular function are unknown. We investigated the relationship between the temporal changes of CFR and IMR, and cardiovascular magnetic resonance-derived microvascular injury characteristics in reperfused ST-segment-elevation myocardial infarction patients, and their association with 1-month left ventricular ejection fraction and infarct size (IS).
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- Recent advancements in pharmacological treatments for acute coronary syndrome (ACS) focus on developing more effective antithrombotic agents, including new P2Y receptor inhibitors and anticoagulants.
- Despite improvements in antithrombotic regimens, many ACS patients still face ischemic events, highlighting ongoing challenges in minimizing ischemic risk while managing bleeding risks.
- The review surveys both established antithrombotic agents and potential new treatment strategies aimed at improving outcomes during the initial stages of ACS.
Effects on Mortality and Major Bleeding of Radial Versus Femoral Artery Access for Coronary Angiography or Percutaneous Coronary Intervention: Meta-Analysis of Individual Patient Data From 7 Multicenter Randomized Clinical Trials.
Circulation
November 2022
Article Synopsis
- Researchers studied two access methods for heart procedures—transradial access (TRA) and transfemoral access (TFA)—to see which one leads to lower mortality and bleeding in coronary artery disease patients.
- A meta-analysis of data from 21,600 patients across 7 clinical trials found that TRA significantly reduced all-cause mortality (1.6% vs. 2.1%) and major bleeding (1.5% vs. 2.7%) compared to TFA.
- The benefits of TRA were especially notable in patients with moderate or severe anemia, with TRA linked to a 24% reduction in death risk and a 51% reduction in bleeding
Article Synopsis
- The study compares distal radial access (DRA) and conventional transradial access (TRA) for coronary procedures, focusing on the incidence of radial artery occlusion (RAO), a common complication of TRA.
- In a trial with 1,307 patients, results showed no significant difference in RAO rates between the two methods (0.91% for TRA vs 0.31% for DRA), but DRA had a higher crossover rate (7.4% vs 3.5%) and shorter hemostasis time (153 minutes vs 180 minutes).
- Both methods resulted in similar rates of overall bleeding and complications, suggesting that DRA could be an effective alternative to
Extremity Dysfunction After Large-Bore Radial and Femoral Arterial Access.
J Am Heart Assoc
January 2022
Article Synopsis
- The study examined the effects of large-bore arterial access through either the transradial (TRA) or transfemoral (TFA) methods on upper and lower-extremity function in patients undergoing complex coronary intervention.
- Results showed that patients generally maintained their upper and lower-extremity functionality over time, with minimal clinically relevant dysfunction reported (6% for TRA and 9% for TFA).
- Additionally, some trends indicated higher upper-limb dysfunction rates in female patients after TRA and greater lower-extremity pain linked to complications from femoral access.
Article Synopsis
- Fast and proper platelet inhibition is crucial for treating patients with ST-elevation myocardial infarction (STEMI), and this study focuses on sex differences in platelet inhibition during acute treatment.
- The analysis compared platelet reactivity units (PRU) and ticagrelor plasma levels between 195 STEMI patients (58 females and 137 males) after administration of crushed ticagrelor, aspirin, and heparin.
- Results showed that PRU values were similar between females and males, but females had higher ticagrelor concentrations at the start and 6 hours after primary PCI, indicating that while platelet inhibition is effective for both sexes, females exhibited higher drug levels in the bloodstream.
Background: Transradial access (TRA) has become the default access method for coronary diagnostic and interventional procedures. As compared to transfemoral access, TRA has been shown to be safer, cost-effective and more patient-friendly. Radial artery occlusion (RAO) represents the most frequent complication of TRA, and precludes future coronary procedures through the radial artery, the use of the radial artery as a conduit for coronary artery bypass grafting or as arteriovenous fistula for patients on hemodialysis.
View Article and Find Full Text PDFLeft ventricular function, strain, and infarct characteristics in patients with transient ST-segment elevation myocardial infarction compared to ST-segment and non-ST-segment elevation myocardial infarctions.
Eur Heart J Cardiovasc Imaging
June 2022
Aims: This study aims to explore cardiovascular magnetic resonance (CMR)-derived left ventricular (LV) function, strain, and infarct size characteristics in patients with transient ST-segment elevation myocardial infarction (TSTEMI) compared to patients with ST-segment and non-ST-segment elevation myocardial infarctions (STEMI and NSTEMI, respectively).
Methods And Results: In total, 407 patients were enrolled in this multicentre observational prospective cohort study. All patients underwent CMR examination 2-8 days after the index event.
Objectives: The aim of this study was to investigate whether transradial (TR) percutaneous coronary intervention (PCI) is superior to transfemoral (TF) PCI in complex coronary lesions with large-bore guiding catheters with respect to clinically relevant access site-related bleeding or vascular complications.
Background: The femoral artery is currently the most applied access site for PCI of complex coronary lesions, especially when large-bore guiding catheters are required. With downsizing of TR equipment, TR PCI may be increasingly applied in these patients and might be a safer alternative compared with the TF approach.