PhD ceremony Ms. M.L. Fokkema: Outcome after percutaneous coronary intervention

PhD ceremony: Ms. M.L. Fokkema, 16.15 uur, Academiegebouw, Broerstraat 5, Groningen

Dissertation: Outcome after percutaneous coronary intervention

Promotor(s): prof. A.A. Voors

Faculty: Medical Sciences

This thesis describes outcomes after percutaneous coronary intervention (PCI) in patients with different presentations of coronary artery disease. A PCI procedure, usually consisting of balloon dilatation and/or stenting, is often part of the standard treatment in these patients. During the past decades, technical, procedural and pharmacologic developments have resulted in improvements in clinical outcome after PCI.

The first part of this thesis describes population trends and clinical outcomes after PCI in patients with different presentations of coronary artery disease. This was investigated in a national registry study of all PCI procedures performed in Sweden over the last 20 years. The PCI population and their risks substantially changed over time. Outcomes after PCI considerably differed between the different indications of PCI. Based on outcome, it was suggested that improvements in therapy are needed in the acute phase as well as on the long term after PCI.

In the second part, different parameters influencing outcome after primary PCI in patients with ST-elevation myocardial infarction (STEMI) were investigated. One of the findings was that STEMI patients, whose time from symptom onset until treatment was more than 5 hours, had worse prognosis than patients who were treated earlier.

In the third part, clinical effects of erythropoiesis-stimulating agents were investigated, as additional treatment after primary PCI in STEMI patients. This was done in a randomized controlled trial as well as in a meta-analysis on individual patient data. The administration of these agents did not result in an improved clinical outcome after PCI.