Sex differences in characteristics and outcome in acute coronary syndrome patients in the Netherlands.

BACKGROUND: Sex differences in acute coronary syndrome (ACS) have been reported, but little is known about the situation in the Netherlands. METHODS: This registry is a merge of available data on ACS patients in the electronic data capture systems of 11 centres with 24/7 interventional cardiology services. We included patients >18 years undergoing a cardiac catheterisation between 2010-2012. We evaluated sex differences in clinical and procedural characteristics and 1­year mortality. RESULTS: A total of 29,265 ACS patients (8,720 women and 20,545 men) were registered. Women were on average 4.5 years older (68.5 vs 63.0 years, p < 0.001) and had a higher prevalence of hypertension (62.7 vs 49.8%, p < 0.001) and insulin-dependent diabetes mellitus (9.6 vs 6.8%, p < 0.001) than men. Women less often presented with ST-elevation myocardial infarction (43.7% vs 47.6%, p < 0.001) and appeared to have less extensive coronary artery disease than men. Women less often underwent coronary angiography by radial access (52.5 vs 55.9%, p < 0.001). One-year mortality was higher in women than in men (7.3% and 5.6%, p < 0.001). More specific, the relationship between sex and mortality was age-dependent and showed higher mortality in women ≤71 years, but lower mortality in older women compared with men (p-interaction <0.001). CONCLUSION: We found differences in clinical and procedural characteristics and outcome between women and men admitted for ACS, which are in line with other Western countries. The limitations of our registry, based on existing local databases, can be overcome by the use of the prospective Netherlands Heart Registry that is currently in development.

One-year efficacy and safety of routine prasugrel in patients with acute coronary syndromes treated with percutaneous coronary intervention: results of the prospective rijnmond collective cardiology research study.

OBJECTIVE: To investigate 1­year outcomes with routine prasugrel treatment after acute coronary syndrome (ACS) in a large-scale registry. METHODS: The Rijnmond Collective Cardiology Research registry is a prospective, observational study that enrolled 4,258 consecutive ACS patients treated with percutaneous coronary intervention (PCI) with 1­year follow-up. Patients received prasugrel as first-choice antiplatelet agent, except for increased bleeding risk patients in which clopidogrel was recommended. Events were validated by an independent clinical endpoint committee. RESULTS: A total number of 2,677 patients received prasugrel at discharge after the index event. Eighty-one percent of the target population was on prasugrel treatment at hospital discharge. At 1 year, the primary endpoint, a composite of all-cause mortality and myocardial infarction, occurred in 2.4% of patients receiving prasugrel. All-cause mortality occurred in 1.0%, myocardial infarction in 1.5%, target-vessel revascularisation in 3.1%, stent thrombosis in 0.6%, and stroke in 0.5% of the patients treated with prasugrel. Thrombolysis in Myocardial Infarction defined major bleeding episodes not related to coronary artery bypass grafting were observed in 1.4% of patients receiving prasugrel. CONCLUSIONS: In routine practice, a tailored approach of prasugrel prescription in ACS patients undergoing PCI, resulted in low ischaemic and low bleeding rates up to 1 year post PCI.

An activity stimulation programme during a child's first year reduces some indicators of adiposity at the age of two-and-a-half.

AIM: Obesity tracks from childhood into adulthood. We evaluated the effect of early stimulation of physical activity on growth, body composition, motor activity and motor development in toddlers. METHODS: We performed a cluster randomised controlled single-blinded trial in Dutch Well Baby Clinics, with seven nurses and 96 children (40% girls) randomised to the intervention group and six nurses and 65 children (57% girls) to the control group. Intervention nurses advised parents on stimulating motor development and physical activity during regular visits at 2 weeks and two, four, eight and 11 months. Baseline characteristics such as birthweight and mode of feeding were comparable. Outcomes at two-and-a-half years included anthropometry, skinfold thicknesses, bioelectrical impedance analyses, motor development and daily physical activity. We used linear mixed models with nurses as cluster. RESULTS: We evaluated 143 children (89 intervention, 54 control) as 18 dropped out. Skinfolds were significantly lower in intervention children (29.6 ± 4.7 mm) than controls (32.4 ± 6.0 mm), without differences in motor development or daily physical activity. Female interventions showed lower weight, skinfolds, waist and hip circumference. CONCLUSION: An activity stimulating programme during the child's first year improved indicators of adiposity when they were toddlers, especially in girls. Further research should determine whether these effects persist.

Adoption of prasugrel into routine practice: rationale and design of the Rijnmond Collective Cardiology Research (CCR) study in percutaneous coronary intervention for acute coronary syndromes.

BACKGROUND: Platelet inhibition is crucial in reducing both short- and long-term atherothrombotic risks in patients with acute coronary syndromes (ACS) managed with percutaneous coronary intervention (PCI). Based on randomised trials, recent recommendations in the current guidelines include the endorsement of prasugrel as a first-choice adenosine diphosphate receptor inhibitor. Yet, there is limited experience with the use of prasugrel in routine practice. METHODS: The Rijnmond Collective Cardiology Research (CCR) registry is a prospective, observational study that will follow-up 4000 PCI-treated ACS patients in the larger region of Rotterdam, the Netherlands. Based on recently implemented hospital protocols, all patients will receive prasugrel as first-choice antiplatelet agent, unless contraindicated, in accordance with European guidelines, and will be followed for up to 1 year post-discharge for longitudinal assessment of outcomes and bleeding events. This registry exemplifies a collaborative study design that employs a regional PCI registry platform and provides feedback to participating sites regarding their practice patterns, thereby supporting and promoting improvement of quality of care. CONCLUSION: The CCR registry will evaluate the adoption of prasugrel into routine clinical practice and thus, will provide important evidence with regard to the benefits and risks of real-world utilisation of prasugrel as antiplatelet therapy in PCI-treated ACS patients.

Current discharge management of acute coronary syndromes: data from the Rijnmond Collective Cardiology Research (CCR) study.

BACKGROUND: Medical discharge management of acute coronary syndromes (ACS) remains suboptimal outside randomised trials and constitutes an essential quality benchmark for ACS. We sought to evaluate the rates of key guideline-recommended pharmacological agents after ACS and characteristics associated with optimal treatment at discharge. METHODS: The Rijnmond Collective Cardiology Research (CCR) registry is an ongoing prospective, observational study in the Netherlands that aims to enrol 4000 patients with ACS. We examined discharge and 1-month follow-up medication use among the first 1000 patients enrolled in the CCR registry. Logistic regression was performed to identify patient and hospital characteristics associated with collective guideline-recommended pharmacotherapy at hospital discharge. RESULTS: At discharge, 94 % of patients received aspirin, 100 % thienopyridines, 80 % angiotensin-converting enzyme inhibitors/angiotensin-II receptor blockers, 87 % ß-blockers, 96 % statins, and 65 % the combination of all 5 agents. ST-segment elevation myocardial infarction, hypertension, hypercholesterolaemia, and enrolment in an interventional centre were positive independent predictors of 5-drug combination therapy at discharge. Negative independent predictors were unstable angina and advanced age. CONCLUSION: Current data from the CCR registry reflect a high quality of care for ACS discharge management in the Rotterdam-Rijnmond region. However, potential still remains for further optimisation.

The role of major genes and DNA technology in selection for meat quality in pigs.

The aim of this paper is to discuss the role of major genes and DNA technology in selection for meat quality in modern breeding schemes. An overview of major genes, including genes that affect water-binding, colour, marbling, boar taint and tenderness, is given. Two different approaches for the development of DNA tests as selection tools are described: (1) localization of relevant genes on the genome map using DNA markers, and (2) research on mutations in targeted functional genes (candidate genes). It is concluded that major genes for meat quality provide excellent opportunities, not only for increasing the level of meat quality, but also for decreasing variability. Furthermore, major genes can be exploited for differentiation for specific markets. It is stressed that phenotypic data on culled nucleus animals provide an important basis for the development of DNA tests for selection for meat quality. More fundamental research is recommended to understand the interactions of genes with each other and with environmental factors.

Genetics of the interval from weaning to estrus in first-litter sows: distribution of data, direct response of selection, and heritability.

A selection experiment with a selection and a control line maintained for eight generations was set up to study efficacy of selection for a short interval from weaning to estrus after weaning the first litter and to estimate genetic variation in the Dutch Landrace population. Intervals were recorded without truncation (i.e., intervals up to 234 d were observed). A mating scheme with 10 mating groups was used to avoid inbreeding. Distribution of intervals from weaning to estrus was described by a mixture of a normal and an exponential distribution. Between lines, both underlying distributions were similar, but the contribution to the total distribution was different. From generation 4 onward, intervals were significantly shorter in the selection line than in the control line. Variances within lines, generations, and mating groups varied to a large extent. Response per unit selection differential was calculated for original data and three sets of transformed data, both with and without correction for unequal subclass numbers. Standardized responses were more precise and linear, when data were log-transformed, and when corrected for unequal subclass numbers. The assumed best estimate of the realized heritability was .17. The heritability in the foundation population was estimated at .36 +/- .05, using an animal model including all genetic relationships in the data. It was concluded that genetic selection decreases the average interval from weaning to estrus by reducing the number of sows with a record in the exponential part of the distribution.

Acute myocardial infarction while using the nicotine patch.

A 39-year-old man developed an acute myocardial infarction 20 days after starting treatment with nicotine patches. He had not smoked while using the patches. He recovered without complications. Coronary angiography did not reveal coronary stenoses. He had no history of myocardial infarction, hypertension, or diabetes mellitus. Although coincidence cannot be excluded, it is recommended that all patients should be strongly advised not to smoke while using the nicotine patch and to consult a physician if chest pain develops.

Predictive value of slaughterhouse measurements of ultimate pork quality in seven halothane negative Yorkshire populations.

An experiment with 1969 pigs, belonging to Yorkshire sire lines, was set up in cooperation with seven Dutch breeding organizations. The pigs, which were claimed to be halothane negative, were slaughtered in weekly batches. Light reflectance was determined with the Hennessy Grading Probe (HGP) and Fibre Optic Probe (FOP), in addition to pH(1) and rigor mortis at 45 min post mortem (p.m.). Further meat quality determinations were performed either in the slaughterhouse at 20 h p.m., or in the laboratory at 24 h p.m.. At first sight, both the scatter of light (HGP-PSE, FOP) and pH, measured at 45 min p.m., appeared to be indicative of the ultimate meat quality score. More accurate analyses, however, showed that the value of reflectance values is limited and less suitable in comparison to pH(1), especially with reference to the prediction of ultimate quality characteristics of water holding capacity. The correlations for pH(1) with drip loss were rather consistent, ranging from -0·34 to -0·52 per breeding population. In contrast, HGP-reflectance values ranged from -0·27 to 0·34, while those based on FOP(1) had a range from nearly zero (0·02) to 0·20. The proportion of variation (R(2) × 100%) in drip loss, explained by a set of slaughterline measurements, ranged from 13 to about 28% per breeding population. The use of measurements carried out at 20 h p.m. improved the R(2) × 100% for drip loss to a range from 50 to 62%.

Gametic imprinting effects on rate and composition of pig growth.

Genetic improvement schemes in livestock are based on the assumption that the expression of relevant genes is independent of parent of origin. Until now no evidence has been found to reject this assumption. The present study on three purebred pig populations, however, shows that a significant proportion of the phenotypic variance in backfat thickness (5-7%) can be explained by genes subject to paternal imprinting. The implication is that there are genes affecting backfat that are expressed only when derived from the paternal gamete. Paternal imprinted effects explained 1-4% of the phenotypic variation for growth rate. Maternal imprinted effects were heavily confounded with heritable maternal environmental effects. When modelled separately, these effects explained 2-5% and 3-4% of the phenotypic variance in backfat thickness and growth rate, respectively. Gametic imprinting may have consequences for the optimization of breeding programmes, especially in crossbreeding systems with specialized sire and dam lines.

Management of fixed subaortic stenosis: a retrospective study of 57 cases.

Although recommended by several investigators, the benefit of early surgery in patients with fixed subaortic stenosis has not been proved. Findings were reviewed of 57 patients with isolated fixed subaortic stenosis, including 27 surgically treated patients, with special emphasis on the occurrence of aortic regurgitation during a mean follow-up period of 6.7 years. The number of patients with aortic regurgitation increased preoperatively in the total group (23% at diagnosis to 54% after 3.7 years of follow-up). The prevalence of aortic regurgitation in the 27 surgically treated patients was higher (81%) than that in the nonsurgically treated group but remained unchanged after a mean postoperative period of 4.7 years. In all patients but one, aortic regurgitation remained of minor hemodynamic significance. One patient died during follow-up. After surgery, 15 patients (55%) showed a relapse; 11 redeveloped a subvalvular pressure gradient greater than 30 mm Hg and discrete subvalvular ridges (range 6 months to 24 years after surgery, mean 7 years). In those patients with fixed subaortic stenosis, follow-up did not reveal any benefit from early surgery. The unpredictable course and sometimes very severe progression of this disease make frequent and careful follow-up necessary.

The value of colour flow mapping in the diagnosis of a combined pseudoaneurysm and large true left ventricular aneurysm.

During ultrasound assessment of a large postinfarct apical left ventricular aneurysm, a related localized area of ventricular wall rupture was discovered by colour flow mapping. Other non-invasive and invasive techniques failed to demonstrate the pseudoaneurysm. The rare combination of a true and false left ventricular aneurysm in one patient and the diagnostic difficulties in this case uniquely illustrate the recent controversy concerning the definition and diagnosis of pseudoaneurysm. The clinical importance of colour flow mapping, as the most sensitive technique in detecting pseudoaneurysm, is emphasized.