# Felix Zijlstra
**Felix Zijlstra** (F. Zijlstra) is a Dutch interventional cardiologist who was head of cardiology at [Erasmus MC](https://www.edgepedia.org/erasmus-mc) in [Rotterdam](https://www.edgepedia.org/rotterdam), known for the Zwolle randomized trials that established primary angioplasty over thrombolytic drugs in acute myocardial infarction and for chairing the TAPAS thrombus-aspiration trial.[1](https://pure.eur.nl/en/persons/felix-zijlstra/) • [3](https://amazingerasmusmc.nl/hart-vaat/dotteren-bracht-een-revolutie-teweeg-in-de-cardiologie/) He trained as a cardiologist in Rotterdam in the 1980s, earned his doctorate at Erasmus Universiteit Rotterdam in 1988, became professor in [Groningen](https://www.edgepedia.org/groningen) in 2002, and led the Erasmus MC cardiology department from 2010 to 2022.[2](https://repub.eur.nl/pub/51079/880914_ZIJLSTRA-Felix.pdf) • [3](https://amazingerasmusmc.nl/hart-vaat/dotteren-bracht-een-revolutie-teweeg-in-de-cardiologie/) The Dutch healthcare registry lists him as a practicing cardiologist at Erasmus MC, Rotterdam.[4](https://www.zorgkaartnederland.nl/zorgverlener/cardioloog-zijlstra-f-145536)
| Key fact | Detail |
|---|---|
| Field | Interventional cardiology; fractional flow reserve, percutaneous coronary intervention, and ST-segment elevation myocardial infarction are his profile's leading research areas[1](https://pure.eur.nl/en/persons/felix-zijlstra/) |
| Doctorate | Erasmus Universiteit Rotterdam, thesis defended 14 September 1988, promotor Prof. Dr. J.R.T.C. Roelandt[2](https://repub.eur.nl/pub/51079/880914_ZIJLSTRA-Felix.pdf) |
| Professorship | Professor (hoogleraar) in Groningen from 2002; professor and head of Cardiology at Erasmus MC from 2010[3](https://amazingerasmusmc.nl/hart-vaat/dotteren-bracht-een-revolutie-teweeg-in-de-cardiologie/) |
| Department leadership | Head of Cardiology, Erasmus MC, for 12 years, stepping down in 2022.[3](https://amazingerasmusmc.nl/hart-vaat/dotteren-bracht-een-revolutie-teweeg-in-de-cardiologie/) |
| Honor | Appointed Officer in the Order of Orange-Nassau at his official farewell[3](https://amazingerasmusmc.nl/hart-vaat/dotteren-bracht-een-revolutie-teweeg-in-de-cardiologie/) |
| Signature work | "A Comparison of Immediate Coronary Angioplasty with Intravenous Streptokinase in Acute Myocardial Infarction", New England Journal of Medicine, 1993[5](https://doi.org/10.1056/nejm199303113281002) |
## Career record
Zijlstra completed his cardiology training in Rotterdam during the 1980s.[3](https://amazingerasmusmc.nl/hart-vaat/dotteren-bracht-een-revolutie-teweeg-in-de-cardiologie/) He received his doctorate from Erasmus Universiteit Rotterdam on 14 September 1988 with the thesis *Coronary flow reserve: a functional measure of stenosis severity*; his promotor was Prof. Dr. J.R.T.C. Roelandt.[2](https://repub.eur.nl/pub/51079/880914_ZIJLSTRA-Felix.pdf)
In 2002 he became professor in Groningen.[3](https://amazingerasmusmc.nl/hart-vaat/dotteren-bracht-een-revolutie-teweeg-in-de-cardiologie/) In 2010 he returned to Rotterdam as head of the [Cardiology](https://www.edgepedia.org/cardiology) department and professor at Erasmus MC, where he led the department for 12 years before stepping down in the summer of 2022; at the official farewell Zijlstra was appointed Officer in the [Order of Orange-Nassau](https://www.edgepedia.org/order-of-orange-nassau).[3](https://amazingerasmusmc.nl/hart-vaat/dotteren-bracht-een-revolutie-teweeg-in-de-cardiologie/) The Zwolle hospital where his trial work originated appears in the literature as Ziekenhuis de Weezenlanden and later Hospital De Weezenlanden.[6](https://europepmc.org/article/MED/8433726) • [7](https://europepmc.org/article/MED/10547403)
## Representative work
His signature paper, "A Comparison of Immediate Coronary Angioplasty with Intravenous Streptokinase in Acute Myocardial Infarction" ([New England Journal of Medicine, 1993 reported on 142 patients with acute myocardial infarction randomized to intravenous streptokinase or immediate angioplasty at the Department of Cardiology, Ziekenhuis de Weezenlanden, Zwolle.[6](https://europepmc.org/article/MED/8433726) • [5](https://doi.org/10.1056/nejm199303113281002) • [6](https://europepmc.org/article/MED/8433726) [Infarction](https://www.edgepedia.org/infarction) recurred in nine streptokinase patients but in none of the angioplasty patients (P = 0.003); and the infarct-related artery was patent in 91 percent of the angioplasty group versus 68 percent of the streptokinase group (P = 0.001).[5](https://doi.org/10.1056/nejm199303113281002)
## The Zwolle trials and TAPAS
The Zwolle group built the 1993 result into a long-term case for primary angioplasty. A randomized trial of 301 patients (152 angioplasty, 149 streptokinase) found cardiac death in 5 percent versus 11 percent (P = 0.031) and cardiac death or nonfatal reinfarction in 7 percent versus 28 percent (P < 0.001).[8](https://repub.eur.nl/pub/5523) A larger randomized trial, reported in 1999, assigned 395 patients to primary angioplasty or intravenous streptokinase and followed them for a mean of 5 ± 2 years.[9](https://doi.org/10.1056/nejm199911043411901) Five-year mortality was 13 percent in the angioplasty group versus 24 percent in the streptokinase group (relative risk 0.54; 95 percent confidence interval 0.36 to 0.87), and nonfatal reinfarction occurred in 6 percent versus 22 percent (relative risk 0.27; 95 percent confidence interval 0.15 to 0.52).[9](https://doi.org/10.1056/nejm199911043411901) The 1999 paper appeared in the New England Journal of Medicine, volume 341, pages 1413 to 1419, with the Zwolle team at Hospital De Weezenlanden.[7](https://europepmc.org/article/MED/10547403) • [10](https://doi.org/10.1097/00132586-200010000-00011)
Zijlstra chaired the study committee of TAPAS, a randomized trial that assigned about 900 patients to thrombus aspiration or conventional PCI before coronary angiography.[11](https://www.nejm.org/doi/full/10.1056/NEJMoa0706416) The primary endpoint, a myocardial blush grade of 0 or 1 (absent or minimal myocardial reperfusion), occurred in 17.1 percent of the aspiration group versus 26.3 percent of the conventional-PCI group (P < 0.001).[11](https://www.nejm.org/doi/full/10.1056/NEJMoa0706416) The registry lists secondary endpoints including enzymatic infarct size, ST-segment resolution, post-procedural distal embolization, and major adverse cardiac events at 30 days and 1 year.[12](https://onderzoekmetmensen.nl/en/trial/20434)
## How it compares with other STEMI trials
The Zwolle and PAMI studies of the 1990s showed primary PCI was superior to fibrinolysis in patients admitted to invasive centers; DANAMI-2 then extended the question to patients who needed transfer.[13](https://www.medscape.com/viewarticle/917576) DANAMI-2 randomized 1,572 patients to angioplasty or accelerated intravenous alteplase; among patients randomized at referral hospitals, the 30-day composite endpoint of death, reinfarction, or disabling stroke was reached by 8.5 percent of the angioplasty group versus 14.2 percent of the fibrinolysis group (P = 0.002), and 96 percent of transferred patients reached an invasive-treatment center within two hours.[14](https://med.stanford.edu/content/dam/sm/criticalcare/documents/angioplasty_vs_thrombolysis.pdf) At 16-year follow-up, DANAMI-2 patients treated with primary PCI still had a lower composite endpoint rate (58.7 percent versus 62.3 percent; hazard ratio 0.86, 95 percent confidence interval 0.76 to 0.98) and reduced cardiac death (18.3 percent versus 22.7 percent; hazard ratio 0.78, 95 percent confidence interval 0.63 to 0.98).[15](https://doi.org/10.1093/eurheartj/ehz595)
## Thrombus aspiration after TAPAS
The TOTAL trial randomized 10,732 STEMI patients to routine manual thrombectomy versus PCI alone: the primary composite outcome occurred in 6.9 percent versus 7.0 percent (hazard ratio 0.99; 95 percent confidence interval 0.85 to 1.15; P = 0.86), and stroke within 30 days occurred in 0.7 percent of the thrombectomy group versus 0.3 percent of the PCI-alone group (hazard ratio 2.06; 95 percent confidence interval 1.13 to 3.75; P = 0.02).[16](https://www.nejm.org/doi/full/10.1056/NEJMoa1415098)
Zijlstra remained active in trial work at the Thoraxcenter: he was a primary sponsor of the Postconditioning Rotterdam trial testing thrombectomy combined with [ischemic postconditioning](https://www.edgepedia.org/ischemic-postconditioning) after primary PCI, with an anticipated start date of 17 May 2013.[17](https://onderzoekmetmensen.nl/en/trial/26072)
## References
1. Felix Zijlstra, Erasmus University Rotterdam research profile. https://pure.eur.nl/en/persons/felix-zijlstra/
2. Coronary flow reserve: a functional measure of stenosis severity (doctoral thesis). https://repub.eur.nl/pub/51079/880914_ZIJLSTRA-Felix.pdf
3. Dotteren bracht een revolutie teweeg in de cardiologie, Erasmus MC. https://amazingerasmusmc.nl/hart-vaat/dotteren-bracht-een-revolutie-teweeg-in-de-cardiologie/
4. Cardioloog Zijlstra, F., Zorgkaart Nederland. https://www.zorgkaartnederland.nl/zorgverlener/cardioloog-zijlstra-f-145536
5. A Comparison of Immediate Coronary Angioplasty with Intravenous Streptokinase in Acute Myocardial Infarction, NEJM 1993. https://doi.org/10.1056/nejm199303113281002
6. Europe PMC record, PMID 8433726. https://europepmc.org/article/MED/8433726
7. Europe PMC record, PMID 10547403. https://europepmc.org/article/MED/10547403
8. Mortality, reinfarction, left ventricular ejection fraction and costs following reperfusion therapies, Erasmus repository. https://repub.eur.nl/pub/5523
9. Long-Term Benefit of Primary Angioplasty as Compared with Thrombolytic Therapy, NEJM 1999. https://doi.org/10.1056/nejm199911043411901
10. Publisher record, NEJM 341:1413-1419. https://doi.org/10.1097/00132586-200010000-00011
11. Thrombus Aspiration during Primary Percutaneous Coronary Intervention (TAPAS), NEJM 2008. https://www.nejm.org/doi/full/10.1056/NEJMoa0706416
12. TAPAS trial registry record. https://onderzoekmetmensen.nl/en/trial/20434
13. DANAMI-2: PCI Still Beats Lysis in STEMI Even 16 Years On, Medscape. https://www.medscape.com/viewarticle/917576
14. DANAMI-2 trial document, NEJM 2003. https://med.stanford.edu/content/dam/sm/criticalcare/documents/angioplasty_vs_thrombolysis.pdf
15. 16-year follow-up of DANAMI-2, European Heart Journal. https://doi.org/10.1093/eurheartj/ehz595
16. TOTAL trial, NEJM. https://www.nejm.org/doi/full/10.1056/NEJMoa1415098
17. Postconditioning Rotterdam Trial registry record. https://onderzoekmetmensen.nl/en/trial/26072
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*Topic: Encyclopedia › Life and health › Life and health scientists › Medical and health researchers › Researchers in cardiovascular, metabolic, and endocrine research › Interventional cardiology researchers*
*Initially written Sep 21, 2026 · Reviewed: Sep 25, 2026; Sep 30, 2026 · Edited: Sep 25, 2026; Sep 30, 2026 · Last review: Sep 30, 2026*
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