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Mehrpooya M, Koohsari P, Farsani EM. The miracle of IVUS for unforeseen stent thrombosis: A case report. Clin Case Rep 2024; 12:e8935. [PMID: 38799531 PMCID: PMC11126907 DOI: 10.1002/ccr3.8935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 03/26/2024] [Accepted: 05/01/2024] [Indexed: 05/29/2024] Open
Abstract
Stent thrombosis is a serious complication with high morbidity and mortality rates resulting in cardiac death or nonfatal myocardial infarction that occurs following stent placement during percutaneous coronary intervention (PCI). Stent underexpansion or malapposition are avoidable risk factors for stent thrombosis. Sufficient postdilation should be considered to mitigate this risk, especially with the guidance of intravascular ultrasound (IVUS). We present the case of a 60-year-old man developing a thrombotic lesion inside a stent 2 weeks after PCI for Non-ST-Segment Elevation Myocardial Infarction (NSTEMI), which was strongly related to stent underexpansion and malapposition. This case highlights the importance of IVUS in evaluating procedural success, particularly in assessing stent expansion and apposition.
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Affiliation(s)
- Maryam Mehrpooya
- Department of CardiologyImam Khomeini Hospital ComplexTehran University of Medical SciencesTehranIran
| | - Parisa Koohsari
- School of MedicineImam Khomeini Hospital ComplexTehran University of Medical SciencesTehranIran
| | - Ehsan Moradi Farsani
- Department of CardiologyImam Khomeini Hospital ComplexTehran University of Medical SciencesTehranIran
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Pallangyo P, Bhalia SV, Komba M, Mkojera ZS, Mayala HA, Kifai E, Kisenge PR. A nightmare of clopidogrel resistance in a resource-limited setting: case report of subacute stent thrombosis. Egypt Heart J 2023; 75:85. [PMID: 37823944 PMCID: PMC10570241 DOI: 10.1186/s43044-023-00408-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 09/13/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Stent thrombosis, a life-threatening complication of percutaneous coronary intervention (PCI) continues to occur despite effective antiplatelet regimens and improved stenting methods. Noncompliance with dual antiplatelet therapy is the most common etiology; however, in spite of timely and their optimum administration the rates of recurrent myocardial infarction (MI) and stent thrombosis remain high. Clopidogrel resistance is increasingly evoked with elevated risk of anterothrombotic events particularly in the setting of stent implantation. In this case report, we present a case of subacute stent thrombosis associated with clopidogrel resistance in a resource-constrained setting. CASE PRESENTATION A 60 year old man with a long standing history of hypertension presented with a 6-month history of progressive shortness of breath. Initial electrocardiogram (ECG) revealed T-wave inversion on lateral leads and echocardiogram revealed akinetic basal lateral wall and hypokinetic mid lateral wall with reduced systolic functions. An elective coronary angiography (CAG) revealed a 90% stenosis of mid left anterior descending (LAD) artery and an 80% stenosis on the proximal left circumflex artery. He underwent a successful PCI with a drug-eluting stent implantation to mid LAD. He was discharged in a stable state 48 h post revascularization with dual antiplatelet (clopidogrel and acetylsalicylic acid). Seven days later, he presented with a crushing substernal chest pain. Cardiac enzymes were elevated and ECG revealed anterior ST-elevation MI. An emergency CAG revealed a high thrombus burden with 100% occlusion of mid LAD. Following unsuccessful ballooning, intravenous and intracoronary thrombolysis with tenecteplase was given. A TIMI II flow was achieved and the patient was sent to the coronary care unit. However, 14 h later there was yet a new onset of severe chest pain. A 12-lead ECG previewed anterior ST-elevation MI and the cardiac enzymes were high. Urgent CAG revealed in-stent thrombotic total occlusion of mid LAD. A stent in stent was then implanted and TIMI III flow was restored. Clopidogrel resistance was suspected and the patient was transitioned to ticagrelol. There were no further ischemic events during the remainder of hospitalization and the patient was discharged in a hemodynamically stable state three days later. During follow-up after one and three months, he was fairly stable without any further cardiac events. CONCLUSIONS Owing to clopidogrel resistance, stent thrombosis in the setting of dual antiplatelet therapy compliance may occur. While in a situation of clopidogrel resistance newer and more potent antiplatelet drugs should be used, their availability and cost remains a significant barrier particularly in the developing world. Nonetheless, a high index of suspicion and timely revascularization is fundamental to restore patency of the thrombosed vessel and confer better risk-adjusted survival rates.
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Affiliation(s)
- Pedro Pallangyo
- Department of Research and Training, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania.
- Department of Cardiology, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania.
| | - Smita V Bhalia
- Department of Cardiology, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania
| | - Makrina Komba
- Department of Research and Training, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania
| | - Zabella S Mkojera
- Department of Research and Training, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania
| | - Henry A Mayala
- Department of Clinical Support Services, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania
| | - Engerasiya Kifai
- Department of Clinical Support Services, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania
| | - Peter R Kisenge
- Department of Cardiology, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania
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Hussain KM, Jain A, Rane RP, Sweedan YG, Shahab A, Alam MDU, Hussain KMA. A Rare Case of Coronary Stent Thrombosis in the Modern Era. Cureus 2022; 14:e25207. [PMID: 35747031 PMCID: PMC9211379 DOI: 10.7759/cureus.25207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2022] [Indexed: 11/22/2022] Open
Abstract
In patients with acute coronary syndrome or obstructive coronary artery disease, stents, especially drug-eluting stents (DESs), are used for percutaneous coronary interventions (PCI). DES prevents abrupt closure of the stented artery. Stent thrombosis is an uncommon but serious complication of PCI, especially with the recent advancement of stent technology. We present a case of a 75-year-old male who initially suffered a non-ST segment elevation myocardial infarction (NSTEMI) treated appropriately with PCI and subsequently developed stent thrombosis after 10 days of initial stent placement. He then underwent emergent repeat PCI with successful replacement of stents overlapping previous stents. The patient did well following the procedure. His clopidogrel was changed to a more potent antiplatelet ticagrelor. He remained stable throughout the hospital stay and was discharged home without any further complications following the next 90 days.
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Moukarbel GV. Coronary Stent Thrombosis and Mortality: Does the Relationship Stand the Test of Time? J Am Heart Assoc 2022; 11:e025341. [PMID: 35377162 PMCID: PMC9075428 DOI: 10.1161/jaha.122.025341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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5
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Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM, Bischoff JM, Bittl JA, Cohen MG, DiMaio JM, Don CW, Fremes SE, Gaudino MF, Goldberger ZD, Grant MC, Jaswal JB, Kurlansky PA, Mehran R, Metkus TS, Nnacheta LC, Rao SV, Sellke FW, Sharma G, Yong CM, Zwischenberger BA. 2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2021; 145:e18-e114. [PMID: 34882435 DOI: 10.1161/cir.0000000000001038] [Citation(s) in RCA: 135] [Impact Index Per Article: 45.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
AIM The guideline for coronary artery revascularization replaces the 2011 coronary artery bypass graft surgery and the 2011 and 2015 percutaneous coronary intervention guidelines, providing a patient-centric approach to guide clinicians in the treatment of patients with significant coronary artery disease undergoing coronary revascularization as well as the supporting documentation to encourage their use. METHODS A comprehensive literature search was conducted from May 2019 to September 2019, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Collaboration, CINHL Complete, and other relevant databases. Additional relevant studies, published through May 2021, were also considered. Structure: Coronary artery disease remains a leading cause of morbidity and mortality globally. Coronary revascularization is an important therapeutic option when managing patients with coronary artery disease. The 2021 coronary artery revascularization guideline provides recommendations based on contemporary evidence for the treatment of these patients. The recommendations present an evidence-based approach to managing patients with coronary artery disease who are being considered for coronary revascularization, with the intent to improve quality of care and align with patients' interests.
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Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM, Bischoff JM, Bittl JA, Cohen MG, DiMaio JM, Don CW, Fremes SE, Gaudino MF, Goldberger ZD, Grant MC, Jaswal JB, Kurlansky PA, Mehran R, Metkus TS, Nnacheta LC, Rao SV, Sellke FW, Sharma G, Yong CM, Zwischenberger BA. 2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 2021; 79:e21-e129. [PMID: 34895950 DOI: 10.1016/j.jacc.2021.09.006] [Citation(s) in RCA: 480] [Impact Index Per Article: 160.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
AIM The guideline for coronary artery revascularization replaces the 2011 coronary artery bypass graft surgery and the 2011 and 2015 percutaneous coronary intervention guidelines, providing a patient-centric approach to guide clinicians in the treatment of patients with significant coronary artery disease undergoing coronary revascularization as well as the supporting documentation to encourage their use. METHODS A comprehensive literature search was conducted from May 2019 to September 2019, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Collaboration, CINHL Complete, and other relevant databases. Additional relevant studies, published through May 2021, were also considered. STRUCTURE Coronary artery disease remains a leading cause of morbidity and mortality globally. Coronary revascularization is an important therapeutic option when managing patients with coronary artery disease. The 2021 coronary artery revascularization guideline provides recommendations based on contemporary evidence for the treatment of these patients. The recommendations present an evidence-based approach to managing patients with coronary artery disease who are being considered for coronary revascularization, with the intent to improve quality of care and align with patients' interests.
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Han S, Han S, Jang SW, Lee MY, On YK, Bang OY, Lee JM, Park YJ, Shin JS, Kang S, Suh HS, Kim YH. Treatment Pattern of Antithrombotic Therapy over Time after Percutaneous Coronary Intervention in Patients with Atrial Fibrillation in Real-World Practice in Korea. Healthcare (Basel) 2021; 9:healthcare9091185. [PMID: 34574959 PMCID: PMC8472294 DOI: 10.3390/healthcare9091185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 09/03/2021] [Accepted: 09/06/2021] [Indexed: 11/20/2022] Open
Abstract
We examined antithrombotic treatment patterns with clinical characteristics and therapy changes over time in patients with atrial fibrillation (AF) after percutaneous coronary intervention (PCI). Using the Health Insurance Review and Assessment service claims database (01JAN2007-30NOV2016) in Korea, we included adult patients with AF and PCI: (1) who underwent PCI with stenting between 01JAN2008 and 30NOV2016; (2) with ≥1 claim for AF (ICD code: I48) (3) with antithrombotics 1 day prior to or at the date of PCI; and (4) with CHADS2-VASc of ≥2. In this study, 7749 patients with AF who underwent PCI, triple therapy, dual therapy, dual antiplatelet therapy (DAPT), and single antiplatelet therapy were prescribed to 24.6%, 3.4%, 60.8%, and 11.0%, respectively. In the triple therapy group, 23.1% persisted with triple therapy for 12 months, whereas the remaining patients switched to a different therapy. In the entire cohort and several subgroups, the median treatment duration of triple therapy was 55–87 days. DAPT use for 12 months was the most common treatment pattern (62.6%) in the DAPT group (median treatment duration, 324–345 days). A significant discrepancy exists between the current guidelines and real-world practice regarding antithrombotic treatment with PCI for patients with AF. Appropriate use of anticoagulants should be emphasized.
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Affiliation(s)
- Seongwook Han
- Division of Cardiology, Department of Internal Medicine, Dongsan Hospital, Keimyung University School of Medicine, Daegu 42601, Korea;
| | - Sola Han
- Pharmaceutical Economics, Big Data Analysis & Policy, College of Pharmacy, Kyung Hee University, Seoul 02447, Korea;
| | - Sung-Won Jang
- Division of Cardiology, Department of Internal Medicine, Catholic University of Korea, Seoul 06591, Korea;
| | - Myung-Yong Lee
- Division of Cardiology, Department of Internal Medicine, Dankook University, Cheonan 31116, Korea;
| | - Young-Keun On
- Department of Cardiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06355, Korea;
| | - Oh Young Bang
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06355, Korea;
| | - Ji-Min Lee
- Pfizer Korea Ltd., Seoul 04631, Korea; (J.-M.L.); (Y.-J.P.); (J.-S.S.); (S.K.)
| | - Yoo-Jung Park
- Pfizer Korea Ltd., Seoul 04631, Korea; (J.-M.L.); (Y.-J.P.); (J.-S.S.); (S.K.)
| | - Ji-Soo Shin
- Pfizer Korea Ltd., Seoul 04631, Korea; (J.-M.L.); (Y.-J.P.); (J.-S.S.); (S.K.)
| | - Seongsik Kang
- Pfizer Korea Ltd., Seoul 04631, Korea; (J.-M.L.); (Y.-J.P.); (J.-S.S.); (S.K.)
| | - Hae Sun Suh
- Pharmaceutical Economics, Big Data Analysis & Policy, College of Pharmacy, Kyung Hee University, Seoul 02447, Korea;
- Correspondence: (H.S.S.); (Y.-H.K.); Tel.: +82-2-9619492 (H.S.S.); +82-2-9206394 (Y.-H.K.)
| | - Young-Hoon Kim
- Division of Cardiology, Department of Internal Medicine, Korea University, Seoul 02841, Korea
- Correspondence: (H.S.S.); (Y.-H.K.); Tel.: +82-2-9619492 (H.S.S.); +82-2-9206394 (Y.-H.K.)
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8
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Dahal K, Mosleh W, Almnajam M, Khaddr M, Adeel MY, Vashist A, Robinson P, Azrin M, Lee J. NOAC-Based Sual Therapy Versus Warfarin-Based Triple Therapy After Percutaneous Coronary Intervention or Acute Coronary Syndrome in Patients With Atrial Fibrillation: A Systematic Review and Meta-Analysis. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 21:1202-1208. [DOI: 10.1016/j.carrev.2020.03.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 02/04/2020] [Accepted: 03/05/2020] [Indexed: 12/24/2022]
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9
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Terrier J, Daali Y, Fontana P, Csajka C, Reny JL. Towards Personalized Antithrombotic Treatments: Focus on P2Y 12 Inhibitors and Direct Oral Anticoagulants. Clin Pharmacokinet 2020; 58:1517-1532. [PMID: 31250210 DOI: 10.1007/s40262-019-00792-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Oral anticoagulants and antiplatelet drugs are commonly prescribed to lower the risk of cardiovascular diseases, such as venous and arterial thrombosis, which represent the leading causes of mortality worldwide. A significant percentage of patients taking antithrombotics will nevertheless experience bleeding or recurrent ischemic events, and this represents a major public health issue. Cardiovascular medicine is now questioning the one-size-fits-all policy, and more personalized approaches are increasingly being considered. However, the available tools are currently limited and they are only moderately able to predict clinical events or have a significant impact on clinical outcomes. Predicting concentrations of antithrombotics in blood could be an effective means of personalization as they have been associated with bleeding and recurrent ischemia. Target concentration interventions could take advantage of physiologically based pharmacokinetic (PBPK) and population-based pharmacokinetic (POPPK) models, which are increasingly used in clinical settings and have attracted the interest of governmental regulatory agencies, to propose dosages adapted to specific population characteristics. These models have the benefit of combining parameters from different sources, such as experimental in vitro data and patients' demographic, genetic, and physiological in vivo data, to characterize the dose-concentration relationships of compounds of interest. As such, they can be used to predict individual drug exposure. In the near future, these models could therefore be a valuable means of predicting personalized antithrombotic blood concentrations and, hopefully, of preventing clinical non-response or bleeding in a given patient. Existing approaches for personalization of antithrombotic prescriptions will be reviewed using practical examples for P2Y12 inhibitors and direct oral anticoagulants. The review will additionally focus on the existing PBPK and POPPK models for these two categories of drugs. Lastly, we address potential scenarios for their implementation in clinics, along with the main limitations and challenges.
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Affiliation(s)
- Jean Terrier
- Division of General Internal Medicine, Geneva University Hospitals, Geneva, Switzerland.,Geneva Platelet Group, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Youssef Daali
- Geneva Platelet Group, Faculty of Medicine, University of Geneva, Geneva, Switzerland.,School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Geneva, Switzerland.,Clinical Pharmacology and Toxicology Service, Anesthesiology, Pharmacology and Intensive Care Department, Geneva University Hospitals, Geneva, Switzerland
| | - Pierre Fontana
- Geneva Platelet Group, Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Division of Angiology and Haemostasis, Geneva University Hospitals, Geneva, Switzerland
| | - Chantal Csajka
- School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Geneva, Switzerland
| | - Jean-Luc Reny
- Division of General Internal Medicine, Geneva University Hospitals, Geneva, Switzerland. .,Geneva Platelet Group, Faculty of Medicine, University of Geneva, Geneva, Switzerland. .,Division of Internal Medicine and Rehabilitation, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland.
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Tovar Forero MN, Zanchin T, Masdjedi K, van Zandvoort LJ, Kardys I, Zijlstra F, Häner J, Windecker S, Van Mieghem NM, Räber L, Daemen J. Incidence and predictors of outcomes after a first definite coronary stent thrombosis. EUROINTERVENTION 2020; 16:e344-e350. [DOI: 10.4244/eij-d-19-00219] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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11
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Luo CF, Mo P, Li GQ, Liu SM. Aspirin-omitted dual antithrombotic therapy in non-valvular atrial fibrillation patients presenting with acute coronary syndrome or undergoing percutaneous coronary intervention: results of a meta-analysis. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2020; 7:218-224. [PMID: 32129850 DOI: 10.1093/ehjcvp/pvaa016] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 01/31/2020] [Accepted: 02/27/2020] [Indexed: 11/12/2022]
Abstract
AIMS To investigate the effects of aspirin-omitted dual antithrombotic therapy (DAT) on myocardial infarction and stent thrombosis in non-valvular atrial fibrillation (NVAF) patients presenting with acute coronary syndrome (ACS) or undergoing percutaneous coronary intervention (PCI). METHODS AND RESULTS A systematic review and meta-analysis were performed using PubMed to search for randomized clinical trials comparing DAT with triple antithrombotic therapy (TAT) in this setting. Three trials involving 8845 patients were included (4802 and 4043 patients treated with DAT and TAT, respectively). There were no significant differences in all-cause death and stroke between the aspirin-omitted DAT group and TAT group. Otherwise, the incidence of myocardial infarction was significantly higher with aspirin-omitted DAT vs. TAT [odds ratio (OR): 1.29, 95% confidence interval (CI): 1.02-1.63; P = 0.04; I2 = 0%]. Similarly, the incidence of stent thrombosis increased in patients treated with aspirin-omitted DAT vs. TAT (OR: 1.61, 95% CI: 1.02-2.53; P = 0.04; I2 = 0%). The occurrence of major bleeding and clinically relevant non-major bleeding events, as defined by the International Society on Thrombosis and Haemostasis, was significantly lower with aspirin-omitted DAT vs. TAT (OR: 0.61, 95% CI: 0.48-0.78; P = 0.02; I2 = 76%). Similar results were found according to the International Society on Thrombosis and Haemostasis major bleeding, Thrombolysis in Myocardial Infarction major or minor bleeding, and Thrombolysis in Myocardial Infarction major bleeding scales. CONCLUSION Aspirin-omitted DAT reduces the occurrence of bleeding episodes, with a higher rate of myocardial infarction and stent thrombosis in NVAF patients presenting with ACS or undergoing PCI.
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Affiliation(s)
- Cheng-Feng Luo
- Department of Cardiology, Guangzhou Institute of Cardiovascular Disease, the Second Affiliated Hospital of Guangzhou Medical University, Guangdong Key Laboratory of Vascular Diseases, State Key Laboratory of Respiratory Disease, Changgangdong Road, 250, Guangzhou, China
| | - Pei Mo
- Department of Cardiology, Guangzhou Institute of Cardiovascular Disease, the Second Affiliated Hospital of Guangzhou Medical University, Guangdong Key Laboratory of Vascular Diseases, State Key Laboratory of Respiratory Disease, Changgangdong Road, 250, Guangzhou, China
| | - Guo-Qiang Li
- Department of Cardiology, Guangzhou Institute of Cardiovascular Disease, the Second Affiliated Hospital of Guangzhou Medical University, Guangdong Key Laboratory of Vascular Diseases, State Key Laboratory of Respiratory Disease, Changgangdong Road, 250, Guangzhou, China
| | - Shi-Ming Liu
- Department of Cardiology, Guangzhou Institute of Cardiovascular Disease, the Second Affiliated Hospital of Guangzhou Medical University, Guangdong Key Laboratory of Vascular Diseases, State Key Laboratory of Respiratory Disease, Changgangdong Road, 250, Guangzhou, China
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12
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Mintz GS. Intravascular ultrasound guidance improves patient survival (mortality) after drug-eluting stent implantation: review and updated bibliography. Cardiovasc Interv Ther 2019; 35:37-43. [PMID: 31482290 DOI: 10.1007/s12928-019-00616-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 08/26/2019] [Indexed: 12/11/2022]
Abstract
Individual studies IVUS vs angiography-guided DES implantation studies, whether randomized clinical trials or registries are underpowered, to show a reduction in mortality, especially at 1 year of follow-up. However, either meta-analyses or the few studies with long-term (> 5 year) follow-up showed that IVUS guidance reduced mortality and improved patient survival, even with second-generation DES.
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Affiliation(s)
- Gary S Mintz
- Cardiovascular Research Foundation, 1700 Broadway, 9th floor, New York, NY, 10019, USA.
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13
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Secemsky EA, Yeh RW, Kereiakes DJ, Cutlip DE, Cohen DJ, Steg PG, Cannon CP, Apruzzese PK, D'Agostino RB, Massaro JM, Mauri L. Mortality Following Cardiovascular and Bleeding Events Occurring Beyond 1 Year After Coronary Stenting: A Secondary Analysis of the Dual Antiplatelet Therapy (DAPT) Study. JAMA Cardiol 2019; 2:478-487. [PMID: 28297015 DOI: 10.1001/jamacardio.2017.0063] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Importance Early cardiovascular and bleeding events after coronary stenting are associated with high risk of morbidity and mortality. Objective To assess the prognosis of cardiovascular and bleeding events occurring beyond 1 year after coronary stenting. Design, Setting, and Participants This secondary analysis is derived from data from the Dual Antiplatelet Therapy (DAPT) Study, a multicenter trial involving 220 US and international clinical sites from 11 countries. The study dates were August 2009 to May 2014. Individuals who underwent coronary stenting and completed 12 months of thienopyridine plus aspirin therapy without ischemic or bleeding events remained on an aspirin regimen and were randomized to continued thienopyridine therapy vs placebo for 18 additional months. Individuals were then followed up for 3 additional months while receiving aspirin therapy alone. The analysis began in August 2015. Exposures Ischemic events (myocardial infarction not related to stent thrombosis, stent thrombosis, and ischemic stroke) and bleeding events (Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Arteries [GUSTO] classification moderate or severe bleeding). Main Outcomes and Measures Ischemic events (myocardial infarction not related to stent thrombosis, stent thrombosis, and ischemic stroke) and bleeding events (GUSTO classification moderate or severe bleeding). Death at 21 months after randomization (33 months after coronary stenting). Results In total, 25 682 individuals older than 18 years with an indication for coronary stenting were enrolled, and 11 648 (mean age, 61.3 years; 25.1% female) were randomized. After randomization, 478 individuals (4.1%) had 502 ischemic events (306 with myocardial infarction, 113 with stent thrombosis, and 83 with ischemic stroke), and 232 individuals (2.0%) had 235 bleeding events (155 with moderate and 80 with severe bleeding). Among individuals with ischemic events, 52 (10.9%) died. The annualized mortality rate after an ischemic event was 27.2 (95% CI, 20.3-35.7) per 100 person-years. The cumulative incidence of death after an ischemic event among the total randomized study population was 0.5% (0.3% with myocardial infarction, 0.1% with stent thrombosis, and 0.1% with ischemic stroke). Among individuals with bleeding events, 41 (17.7%) died. The annualized mortality rate after a bleeding event was 21.5 (95% CI, 15.4-29.1) per 100 person-years. The cumulative incidence of death after a bleeding event among the total randomized study population was 0.3% (0.1% with moderate and 0.2% with severe bleeding). Conclusions and Relevance In patients treated with dual antiplatelet therapy for at least 1 year after coronary stenting, ischemic events were more frequent than bleeding events, and both events were associated with high risk of mortality. Trial Registration clinicaltrials.gov Identifier: NCT00977938.
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Affiliation(s)
- Eric A Secemsky
- Division of Cardiology, Massachusetts General Hospital, Boston 2Harvard Medical School, Boston, Massachusetts 3Center for Clinical Biometrics, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts 4Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts 5Baim Institute for Clinical Research, Boston, Massachusetts
| | - Robert W Yeh
- Harvard Medical School, Boston, Massachusetts 4Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts 5Baim Institute for Clinical Research, Boston, Massachusetts 6Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Dean J Kereiakes
- Christ Hospital Heart and Vascular Center, Cincinnati, Ohio 8Lindner Center for Research and Education, Cincinnati, Ohio
| | - Donald E Cutlip
- Harvard Medical School, Boston, Massachusetts 5Baim Institute for Clinical Research, Boston, Massachusetts 6Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - David J Cohen
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri10University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
| | - P Gabriel Steg
- Université Paris-Diderot, Institut National de la Santé et de la Récherche Médicale U-1148, Hôpital Bichat, Paris, France 12Département Hospitalo-Universitaire Fibrosis, Inflammation, and Remodeling, Assistance Publique, Hôpitaux de Paris, Paris, France 13National Heart and Lung Institute, Institute of Cardiovascular Medicine and Science, Royal Brompton Hospital, Imperial College, London, England
| | - Christopher P Cannon
- Harvard Medical School, Boston, Massachusetts 5Baim Institute for Clinical Research, Boston, Massachusetts 14Division of Cardiology, Brigham and Women's Hospital, Boston, Massachusetts
| | | | - Ralph B D'Agostino
- Baim Institute for Clinical Research, Boston, Massachusetts 15Boston University School of Public Health, Boston, Massachusetts
| | - Joseph M Massaro
- Baim Institute for Clinical Research, Boston, Massachusetts 15Boston University School of Public Health, Boston, Massachusetts
| | - Laura Mauri
- Harvard Medical School, Boston, Massachusetts 3Center for Clinical Biometrics, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts 5Baim Institute for Clinical Research, Boston, Massachusetts 14Division of Cardiology, Brigham and Women's Hospital, Boston, Massachusetts
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Therapeutic Challenges in Patients With Noncardioembolic Acute Ischemic Stroke in Need of Double Antiplatelet Therapy for Coronary Artery Disease. Am J Ther 2019; 26:e213-e221. [DOI: 10.1097/mjt.0000000000000924] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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15
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Mihatov N, Secemsky EA, Elmariah S. Triple Therapy: When, if Ever? CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2018; 20:61. [DOI: 10.1007/s11936-018-0639-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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16
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Kerkmeijer LS, Claessen BE, Baber U, Sartori S, Chandrasekhar J, Stefanini GG, Stone GW, Steg PG, Chieffo A, Weisz G, Windecker S, Mikhail GW, Kastrati A, Morice MC, Dangas GD, de Winter RJ, Mehran R. Incidence, determinants and clinical impact of definite stent thrombosis on mortality in women: From the WIN-DES collaborative patient-level pooled analysis. Int J Cardiol 2018; 263:24-28. [DOI: 10.1016/j.ijcard.2018.04.047] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 04/06/2018] [Accepted: 04/10/2018] [Indexed: 11/30/2022]
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17
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Singh K, Rashid M, So DY, Glover CA, Froeschl M, Hibbert B, Chong AY, Dick A, Labinaz M, Le May M. Incidence, predictors, and clinical outcomes of early stent thrombosis in acute myocardial infarction patients treated with primary percutaneous coronary angioplasty (insights from the University of Ottawa Heart Institute STEMI registry). Catheter Cardiovasc Interv 2018; 91:842-848. [PMID: 28733995 DOI: 10.1002/ccd.27215] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 06/06/2017] [Accepted: 06/24/2017] [Indexed: 11/06/2022]
Abstract
BACKGROUND Early stent thrombosis (ST) remains an important complication of primary percutaneous intervention (PCI). To date, our information on angiographic and clinical predictors of early ST in ST-segment elevation myocardial infarction (STEMI) patients treated with primary PCI is limited. METHODS We tried to evaluate the incidence, predictors, and outcomes of early ST in real-world patients treated with primary PCI. We identified all the patients presenting with STEMI between June 2004 and January 2011 who underwent primary PCI as the primary mode of revascularization. Diagnosis of ST was made as per the standard definition proposed by the Academic Research Consortium. RESULTS The incidence of early ST was 1% among 2,303 patients treated with primary PCI. Definite and probable early ST occurred in 22 and 2 patients, respectively. Patients with early ST had higher in-hospital (P = 0.03) and 30-day mortality (P = 0.048). The rate of cardiogenic shock (P = 0.0006) and cerebrovascular accident (P = 0.0004) was also greater in the early ST group. Smaller stent diameter and lower use of intracoronary glycoprotein IIb/IIIa inhibitor were associated with higher rate of early ST. There was a trend of higher bivalirudin use in ST group, which did not reach significance (P = 0.07) On IVUS imaging, stent malapposition and uncovered plaque area were noted in 6 out of 11 cases. CONCLUSION The incidence of early ST in primary PCI cohort is low. However, it is still associated with higher mortality and morbidity. Small stent diameter and disuse of intracoronary glycoprotein IIb/IIIa inhibitor may be associated with early ST.
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Affiliation(s)
- Kuljit Singh
- Department of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, K1Y1J7, Canada.,Department of Cardiology, Gold Coast University Hospital, Southport QLD, 4215, Australia.,Department of Medicine, Griffith University, School of Medicine, Gold Coast QLD, Australia.,Department of Medicine, University of Adelaide, 5000, Australia
| | - Mohammed Rashid
- Department of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, K1Y1J7, Canada
| | - Derek Y So
- Department of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, K1Y1J7, Canada
| | - Christopher A Glover
- Department of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, K1Y1J7, Canada
| | - Michael Froeschl
- Department of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, K1Y1J7, Canada
| | - Benjamin Hibbert
- Department of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, K1Y1J7, Canada
| | - Aun-Yeong Chong
- Department of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, K1Y1J7, Canada
| | - Alexander Dick
- Department of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, K1Y1J7, Canada
| | - Marino Labinaz
- Department of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, K1Y1J7, Canada
| | - Michel Le May
- Department of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, K1Y1J7, Canada
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18
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Tahir UA, Yeh RW. Individualizing dual antiplatelet therapy duration after percutaneous coronary intervention: from randomized control trials to personalized medicine. Expert Rev Cardiovasc Ther 2017; 15:681-693. [PMID: 28764572 DOI: 10.1080/14779072.2017.1362980] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Improved stent technologies have lead to reduced minimum durations of dual antiplatelet therapy (DAPT) to prevent stent thrombosis. However, the anti-ischemic benefits seen in extended DAPT in both stent and non-stent related lesions have called into question the optimum duration of DAPT after stent placement. Areas covered: We review the evidence for varying durations of DAPT after drug eluting stent placement including for patients on oral anticoagulation; decision tools available for clinicians to optimize patient selection for extended therapy and insight into application of these risk assessment tools in clinical practice. Expert commentary: The use of risk assessment tools in optimizing DAPT duration after stent placement provides an opportunity for improved outcomes by means of a personalized approach to care while allowing clinicians to engage with patients in shared-decision making.
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Affiliation(s)
- Usman A Tahir
- a Smith Center for Outcomes Research in Cardiology , Beth Israel Deaconess Medical Center , Boston , MA , USA
| | - Robert W Yeh
- a Smith Center for Outcomes Research in Cardiology , Beth Israel Deaconess Medical Center , Boston , MA , USA
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19
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Sethi A, Singbal Y, Rastogi U, Prasad VS. Late Incomplete stent apposition is associated with late/very late stent thrombosis: A meta-analysis. Catheter Cardiovasc Interv 2017; 91:365-375. [DOI: 10.1002/ccd.27102] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 03/02/2017] [Accepted: 03/29/2017] [Indexed: 11/07/2022]
Affiliation(s)
- Ankur Sethi
- Department of Interventional Cardiology; Icahn School of Medicine at Mount Sinai; New York
| | - Yash Singbal
- Department of Cardiology; University of Queensland; Brisbane Australia
| | - Ujjwal Rastogi
- Department of Interventional Cardiology; Icahn School of Medicine at Mount Sinai; New York
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20
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Seelhammer TG, Wittwer ED, Nei SD, Skiba J. Maintenance of Drug-Eluting Stent Patency Through Use of a Cangrelor Infusion in the Clinical Setting of Massive Pulmonary Hemorrhage and Venoarterial Extracorporeal Membrane Oxygenation. J Cardiothorac Vasc Anesth 2017; 31:2147-2151. [PMID: 28693931 DOI: 10.1053/j.jvca.2017.03.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Indexed: 01/06/2023]
Affiliation(s)
- Troy G Seelhammer
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN.
| | - Erica D Wittwer
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Scott D Nei
- Department of Pharmacy Services, Mayo Clinic, Rochester, MN
| | - James Skiba
- Emergency Medicine, Chelsea Community Hospital, Chelsea, MI
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21
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Kanei Y, Nallu K, Makker P, Behuria S, Fox J. ST-segment Elevation Myocardial Infarction Resulting from Stent Thrombosis in Contemporary Real-World Practice. Int J Angiol 2016; 26:32-35. [PMID: 28255213 DOI: 10.1055/s-0036-1593828] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Stent thrombosis (ST) is a rare but devastating complication after percutaneous coronary intervention. Newer generation drug-eluting stents (DES) and newer antiplatelet therapies have been shown to decrease the incidence of ST, but we continue to observe ST-segment elevation myocardial infarction (STEMI) due to ST in contemporary practice. A retrospective analysis of 527 patients who presented with STEMI was performed; 57 patients (11%) with angiographically confirmed ST were compared with the patients with STEMI due to de novo lesion. The type of previous stent, the timing of ST, and the use of antiplatelet therapy were reviewed in patients with ST. Patients with ST had higher prevalence of comorbid conditions, such as hypertension, diabetes mellitus, and coronary artery disease, and had lower left ventricular ejection fraction (37 ± 5 vs. 44 ± 16%, p = 0.0011). There was no difference in in-hospital mortality (2 vs. 4%, p = 0.7082). ST was seen most commonly as "very late" (56%), and with previous second-generation DES (40%). Eighty-two percent of patients among early ST, compared with 22% of patients with very late ST were on dual antiplatelet therapy (DAPT). In 12% of patients, ST happened after DAPT was stopped by physician for procedures. ST is seen in a variety of clinical settings with the most common presentation being very late ST and in second-generation DES, which most likely represent the growing population with previous second-generation stents.
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Affiliation(s)
- Yumiko Kanei
- Department of Cardiology, Mount Sinai Beth Israel, New York, New York
| | - Kishore Nallu
- Department of Cardiology, Mount Sinai Beth Israel, New York, New York
| | - Parth Makker
- Department of Cardiology, Mount Sinai Beth Israel, New York, New York
| | - Supreeti Behuria
- Department of Cardiology, Mount Sinai Beth Israel, New York, New York
| | - John Fox
- Department of Cardiology, Mount Sinai Beth Israel, New York, New York
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22
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Prevalence and outcomes of early versus late stent thrombosis presenting as ST-segment elevation myocardial infarction. Coron Artery Dis 2016; 27:667-672. [DOI: 10.1097/mca.0000000000000421] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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23
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Levine GN, Bates ER, Bittl JA, Brindis RG, Fihn SD, Fleisher LA, Granger CB, Lange RA, Mack MJ, Mauri L, Mehran R, Mukherjee D, Newby LK, O'Gara PT, Sabatine MS, Smith PK, Smith SC, Halperin JL, Levine GN, Al-Khatib SM, Birtcher KK, Bozkurt B, Brindis RG, Cigarroa JE, Curtis LH, Fleisher LA, Gentile F, Gidding S, Hlatky MA, Ikonomidis JS, Joglar JA, Pressler SJ, Wijeysundera DN. 2016 ACC/AHA guideline focused update on duration of dual antiplatelet therapy in patients with coronary artery disease. J Thorac Cardiovasc Surg 2016; 152:1243-1275. [DOI: 10.1016/j.jtcvs.2016.07.044] [Citation(s) in RCA: 173] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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24
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Levine GN, Bates ER, Bittl JA, Brindis RG, Fihn SD, Fleisher LA, Granger CB, Lange RA, Mack MJ, Mauri L, Mehran R, Mukherjee D, Newby LK, O’Gara PT, Sabatine MS, Smith PK, Smith SC. 2016 ACC/AHA Guideline Focused Update on Duration of Dual Antiplatelet Therapy in Patients With Coronary Artery Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines: An Update of the 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention, 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery, 2012 ACC/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease, 2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction, 2014 AHA/ACC Guideline for the Management of Patients With Non–ST-Elevation Acute Coronary Syndromes, and 2014 ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery. Circulation 2016; 134:e123-55. [PMID: 27026020 DOI: 10.1161/cir.0000000000000404] [Citation(s) in RCA: 910] [Impact Index Per Article: 113.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Glenn N. Levine
- Focused Update writing group members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ACC/AHA Representative. Evidence Review Committee Chair. American Society of Anesthesiologists/Society of Cardiovascular Anesthesiologists Representative. American Association for Thoracic Surgery/Society of Thoracic Surgeons Representative
| | - Eric R. Bates
- Focused Update writing group members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ACC/AHA Representative. Evidence Review Committee Chair. American Society of Anesthesiologists/Society of Cardiovascular Anesthesiologists Representative. American Association for Thoracic Surgery/Society of Thoracic Surgeons Representative
| | - John A. Bittl
- Focused Update writing group members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ACC/AHA Representative. Evidence Review Committee Chair. American Society of Anesthesiologists/Society of Cardiovascular Anesthesiologists Representative. American Association for Thoracic Surgery/Society of Thoracic Surgeons Representative
| | - Ralph G. Brindis
- Focused Update writing group members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ACC/AHA Representative. Evidence Review Committee Chair. American Society of Anesthesiologists/Society of Cardiovascular Anesthesiologists Representative. American Association for Thoracic Surgery/Society of Thoracic Surgeons Representative
| | - Stephan D. Fihn
- Focused Update writing group members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ACC/AHA Representative. Evidence Review Committee Chair. American Society of Anesthesiologists/Society of Cardiovascular Anesthesiologists Representative. American Association for Thoracic Surgery/Society of Thoracic Surgeons Representative
| | - Lee A. Fleisher
- Focused Update writing group members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ACC/AHA Representative. Evidence Review Committee Chair. American Society of Anesthesiologists/Society of Cardiovascular Anesthesiologists Representative. American Association for Thoracic Surgery/Society of Thoracic Surgeons Representative
| | - Christopher B. Granger
- Focused Update writing group members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ACC/AHA Representative. Evidence Review Committee Chair. American Society of Anesthesiologists/Society of Cardiovascular Anesthesiologists Representative. American Association for Thoracic Surgery/Society of Thoracic Surgeons Representative
| | - Richard A. Lange
- Focused Update writing group members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ACC/AHA Representative. Evidence Review Committee Chair. American Society of Anesthesiologists/Society of Cardiovascular Anesthesiologists Representative. American Association for Thoracic Surgery/Society of Thoracic Surgeons Representative
| | - Michael J. Mack
- Focused Update writing group members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ACC/AHA Representative. Evidence Review Committee Chair. American Society of Anesthesiologists/Society of Cardiovascular Anesthesiologists Representative. American Association for Thoracic Surgery/Society of Thoracic Surgeons Representative
| | - Laura Mauri
- Focused Update writing group members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ACC/AHA Representative. Evidence Review Committee Chair. American Society of Anesthesiologists/Society of Cardiovascular Anesthesiologists Representative. American Association for Thoracic Surgery/Society of Thoracic Surgeons Representative
| | - Roxana Mehran
- Focused Update writing group members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ACC/AHA Representative. Evidence Review Committee Chair. American Society of Anesthesiologists/Society of Cardiovascular Anesthesiologists Representative. American Association for Thoracic Surgery/Society of Thoracic Surgeons Representative
| | - Debabrata Mukherjee
- Focused Update writing group members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ACC/AHA Representative. Evidence Review Committee Chair. American Society of Anesthesiologists/Society of Cardiovascular Anesthesiologists Representative. American Association for Thoracic Surgery/Society of Thoracic Surgeons Representative
| | - L. Kristin Newby
- Focused Update writing group members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ACC/AHA Representative. Evidence Review Committee Chair. American Society of Anesthesiologists/Society of Cardiovascular Anesthesiologists Representative. American Association for Thoracic Surgery/Society of Thoracic Surgeons Representative
| | - Patrick T. O’Gara
- Focused Update writing group members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ACC/AHA Representative. Evidence Review Committee Chair. American Society of Anesthesiologists/Society of Cardiovascular Anesthesiologists Representative. American Association for Thoracic Surgery/Society of Thoracic Surgeons Representative
| | - Marc S. Sabatine
- Focused Update writing group members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ACC/AHA Representative. Evidence Review Committee Chair. American Society of Anesthesiologists/Society of Cardiovascular Anesthesiologists Representative. American Association for Thoracic Surgery/Society of Thoracic Surgeons Representative
| | - Peter K. Smith
- Focused Update writing group members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ACC/AHA Representative. Evidence Review Committee Chair. American Society of Anesthesiologists/Society of Cardiovascular Anesthesiologists Representative. American Association for Thoracic Surgery/Society of Thoracic Surgeons Representative
| | - Sidney C. Smith
- Focused Update writing group members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ACC/AHA Representative. Evidence Review Committee Chair. American Society of Anesthesiologists/Society of Cardiovascular Anesthesiologists Representative. American Association for Thoracic Surgery/Society of Thoracic Surgeons Representative
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25
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Brener SJ, Kirtane AJ, Stuckey TD, Witzenbichler B, Rinaldi MJ, Neumann FJ, Metzger DC, Henry TD, Cox DA, Duffy PL, Mazzaferri EL, Mehran R, Parvataneni R, Brodie BR, Stone GW. The Impact of Timing of Ischemic and Hemorrhagic Events on Mortality After Percutaneous Coronary Intervention: The ADAPT-DES Study. JACC Cardiovasc Interv 2016; 9:1450-7. [PMID: 27372190 DOI: 10.1016/j.jcin.2016.04.037] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 03/29/2016] [Accepted: 04/07/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVES The aim of this study was to understand the impact of the timing of ischemic and hemorrhagic events after percutaneous coronary intervention (PCI) with drug-eluting stents on subsequent mortality. BACKGROUND These events have been strongly associated with subsequent death. METHODS In the multicenter, prospective ADAPT-DES (Assessment of Dual Antiplatelet Therapy With Drug Eluting Stents) study, patients at 11 clinical sites with successful PCI with drug-eluting stents underwent assessment of platelet function and were followed for 2 years. Events occurring after PCI-definite or probable stent thrombosis (ST), myocardial infarction (MI) not related to ST, and clinically relevant bleeding (CB)-were classified as early (≤30 days), late (31 to 365 days), or very late (>365 days). Mortality within 30 days of each event was estimated by Kaplan-Meier methodology. Cox regression multivariate modeling was used to analyze the relationship between each event (as a time-updated variable) and mortality over the entire study period. RESULTS Among 8,582 patients, 1,060 (12.4%) had events-691 (8.1%) had CB, 294 (3.4%) had MI, and 75 (0.9%) had ST-and 7,522 (87.6%) had no events. The highest risk was associated with early ST (38.5% mortality at 30 days after the event), whereas very late MI (7.5%) and late CB (7.3%) were less dangerous. By multivariate analysis, each event was independently predictive of death, with hazard ratios of 2.4, 1.8, and 11.4, respectively (p < 0.0001). CONCLUSIONS Approximately 1 in 8 patients successfully undergoing PCI with drug-eluting stents had CB, MI, or ST during the ensuing 2 years. These events are associated with an increased hazard of mortality, particularly within the first 30 days following the event, warranting efforts to prevent their occurrence.
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Affiliation(s)
| | - Ajay J Kirtane
- Cardiovascular Research Foundation, New York, New York; New York Presbyterian-Columbia University Medical Center, New York, New York
| | - Thomas D Stuckey
- LeBauer Cardiovascular Research Foundation/Cone Health, Greensboro, North Carolina
| | | | - Michael J Rinaldi
- Sanger Heart & Vascular Institute/Carolinas HealthCare System, Charlotte, North Carolina
| | | | | | - Timothy D Henry
- Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota; Cedars-Sinai Heart Institute, Los Angeles, California
| | - David A Cox
- Lehigh Valley Health Network, Allentown, Pennsylvania
| | - Peter L Duffy
- Reid Heart Center, First Health of the Carolinas, Pinehurst, North Carolina
| | | | - Roxana Mehran
- Cardiovascular Research Foundation, New York, New York; Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Bruce R Brodie
- LeBauer Cardiovascular Research Foundation/Cone Health, Greensboro, North Carolina
| | - Gregg W Stone
- Cardiovascular Research Foundation, New York, New York; New York Presbyterian-Columbia University Medical Center, New York, New York
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Lim S, Koh YS, Kim PJ, Kim HY, Park CS, Lee JM, Kim DB, Yoo KD, Jeon DS, Her SH, Yim HW, Chang K, Ahn Y, Jeong MH, Seung KB. Incidence, Implications, and Predictors of Stent Thrombosis in Acute Myocardial Infarction. Am J Cardiol 2016; 117:1562-1568. [PMID: 27020664 DOI: 10.1016/j.amjcard.2016.02.029] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 02/23/2016] [Accepted: 02/23/2016] [Indexed: 10/22/2022]
Abstract
Stent thrombosis (ST) remains a catastrophic problem in patients undergoing percutaneous coronary intervention (PCI). However, a paucity of data exist regarding the incidence, implications, and predictors of ST in patients with acute myocardial infarction (AMI). We consecutively enrolled patients with AMI in the CardiOvascular Risk and idEntificAtion of potential high-risk population in AMI registry who underwent PCI from January 2004 to December 2009 and analyzed definite or probable ST according to Academic Research Consortium definitions. The median follow-up duration was 41.9 months. Definite or probable ST occurred in 136 patients (3.7%), including 44 with early ST (1.0%), 38 with late ST (0.9%), and 54 with very late ST (2.0%). The annual incidence of very late ST ranged from 0.5% to 0.6%. The all-cause mortality rate after ST was 29%, which was higher than that for patients without ST (17%; p <0.001). The independent predictors of ST were no-reflow phenomenon (hazard ratio [HR] 1.96, 95% confidence interval [CI] 1.28 to 3.03), decreased left ventricular ejection fraction (HR 1.70, 95% CI 1.21 to 2.40), anemia (HR 1.54, 95% CI 1.09 to 2.18), and a mean stent diameter <3.0 mm (HR 1.53, 95% CI 1.04 to 2.27). ST is not uncommon in patients with AMI and continues to occur beyond 1 year after PCI, irrespective of the stent type or clinical presentation. Patients with ST are associated with higher mortality than patients without ST. No reflow, decreased left ventricular ejection fraction, anemia, and a mean stent diameter <3.0 mm are independent predictors of ST.
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27
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Levine GN, Bates ER, Bittl JA, Brindis RG, Fihn SD, Fleisher LA, Granger CB, Lange RA, Mack MJ, Mauri L, Mehran R, Mukherjee D, Newby LK, O'Gara PT, Sabatine MS, Smith PK, Smith SC. 2016 ACC/AHA Guideline Focused Update on Duration of Dual Antiplatelet Therapy in Patients With Coronary Artery Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol 2016; 68:1082-115. [PMID: 27036918 DOI: 10.1016/j.jacc.2016.03.513] [Citation(s) in RCA: 1002] [Impact Index Per Article: 125.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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28
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Lempereur M, Bogale N, Fahmy P, Shiekh I, Starovoytov A, Aymong E, Boone R, Robinson S, Charania J, Townley R, Thompson C, Kmetic A, Ding L, Fung A. Clinical characteristics, angiographic findings, and one-year outcome of 101 consecutive stent thrombosis cases in British Columbia. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2016; 17:74-80. [PMID: 26905061 DOI: 10.1016/j.carrev.2015.12.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 12/13/2015] [Accepted: 12/22/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND Stent thrombosis (ST) is rare, but is associated with significant morbidity and mortality. METHODS We analyzed data from the British Columbia (BC) Registry from April 2011-January 2012. RESULTS 101 ST cases were reported and verified. Based on timing, ST was considered early (≤30days) in 35.6%, late (>30days-1year) in 17.8% and very late (>1year) in 46.5%. The majority (68.5%) presented with STEMI, and the remaining with non-STEMI (31.5%). Most vessels were functionally occluded (TIM1 flow grade ≤1 in 67.1%). Thrombus burden was high (TIMI thrombus grade ≥4 in 77.2%). Aspiration thrombectomy was performed in 41% of cases. New stents were implanted in 62.4% cases. Intra-coronary imaging was low (11%). At the original stent implantation, STEMI was the clinical presentation in 39.6%, the lesion was complex in 62.1%, and thrombus was visualized in 23.0%. Prognosis after ST was unfavorable with high mortality (11.9% at 30days and 16.8% at one year), and further revascularization (5.0% repeat PCI and 6.9% coronary artery bypass graft surgery). Early ST was associated with worse clinical outcome compared to late/very late ST: 30-day mortality at 22.2% versus 6.2% (p=0.02), and 1-year mortality at 27.8% versus 10.8% (p=0.05). CONCLUSIONS In this prospective registry from BC, all ST presented with myocardial infarction, and the majority was treated with emergency PCI. Additional stents were commonly implanted with infrequent use of intracoronary imaging. Mortality rate was higher for early ST in comparison with late/very late ST. A comprehensive approach should be developed to treat this difficult complication.
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Affiliation(s)
- Mathieu Lempereur
- Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia
| | - Nigussie Bogale
- Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia
| | - Peter Fahmy
- Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia
| | - Imran Shiekh
- Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia
| | - Andrew Starovoytov
- Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia
| | - Eve Aymong
- St. Paul's Hospital, Vancouver, British Columbia
| | - Robert Boone
- St. Paul's Hospital, Vancouver, British Columbia
| | | | | | | | | | | | - Lillian Ding
- Cardiac Services BC, Vancouver, British Columbia
| | - Anthony Fung
- Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia.
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Rumiz E, Vilar JV, Berenguer A. Excessive stent overhang as an uncommon cause of very late stent thrombosis: Usefulness of optical coherence tomography. Int J Cardiol 2016; 203:123-5. [PMID: 26519671 DOI: 10.1016/j.ijcard.2015.10.147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 10/18/2015] [Indexed: 10/22/2022]
Affiliation(s)
- Eva Rumiz
- Cardiology Department, Hospital General Universitario, Valencia, Spain.
| | - Juan V Vilar
- Cardiology Department, Hospital General Universitario, Valencia, Spain
| | - Alberto Berenguer
- Cardiology Department, Hospital General Universitario, Valencia, Spain
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Capodanno D, Gargiulo G, Buccheri S, Giacoppo D, Capranzano P, Tamburino C. Meta-Analyses of Dual Antiplatelet Therapy Following Drug-Eluting Stent Implantation: Do Bleeding and Stent Thrombosis Weigh Similar on Mortality? J Am Coll Cardiol 2015; 66:1639-1640. [PMID: 26429096 DOI: 10.1016/j.jacc.2015.05.085] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Revised: 05/27/2015] [Accepted: 05/29/2015] [Indexed: 11/30/2022]
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31
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Mauri L, Elmariah S, Yeh RW, Cutlip DE, Steg PG, Windecker S, Wiviott SD, Cohen DJ, Massaro JM, D'Agostino RB, Braunwald E, Kereiakes DJ. Causes of late mortality with dual antiplatelet therapy after coronary stents. Eur Heart J 2015; 37:378-85. [PMID: 26586780 DOI: 10.1093/eurheartj/ehv614] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 10/16/2015] [Indexed: 11/12/2022] Open
Abstract
AIMS In the dual antiplatelet therapy (DAPT) study, continued thienopyridine beyond 12 months after drug-eluting stent placement was associated with increased mortality compared with placebo. We sought to evaluate factors related to mortality in randomized patients receiving either drug-eluting or bare metal stents in the DAPT study. METHODS AND RESULTS Patients were enrolled after coronary stenting, given thienopyridine and aspirin for 12 months, randomly assigned to continued thienopyridine or placebo for an additional 18 months (while taking aspirin), and subsequently treated with aspirin alone for another 3 months. A blinded independent adjudication committee evaluated deaths. Among 11 648 randomized patients, rates of all-cause mortality rates were 1.9 vs. 1.5% (continued thienopyridine vs. placebo, P = 0.07), cardiovascular mortality, 1.0 vs. 1.0% (P = 0.97), and non-cardiovascular mortality, 0.9 vs. 0.5% (P = 0.01) over the randomized period (Months 12-30). Rates of fatal bleeding were 0.2 vs. 0.1% (P = 0.81), and deaths related to any prior bleeding were 0.3 vs. 0.2% (P = 0.36), Months 12-33). Cancer incidence did not differ (2.0 vs. 1.6%, P = 0.12). Cancer-related deaths occurred in 0.6 vs. 0.3% (P = 0.02) and were rarely related to bleeding (0.1 vs. 0, P = 0.25). After excluding those occurring in patients with cancer diagnosed before enrolment, rates were 0.4 vs. 0.3% (P = 0.16). CONCLUSION Bleeding accounted for a minority of deaths among patients treated with continued thienopyridine. Cancer-related death in association with thienopyridine therapy was mainly not related to bleeding and may be a chance finding. Caution is warranted when considering extended thienopyridine in patients with advanced cancer. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00977938.
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Affiliation(s)
- Laura Mauri
- Harvard Clinical Research Institute, Boston, USA Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA Harvard Medical School , Boston, USA
| | - Sammy Elmariah
- Harvard Clinical Research Institute, Boston, USA Harvard Medical School , Boston, USA Massachusetts General Hospital, Boston, USA
| | - Robert W Yeh
- Harvard Clinical Research Institute, Boston, USA Harvard Medical School , Boston, USA Massachusetts General Hospital, Boston, USA
| | - Donald E Cutlip
- Harvard Clinical Research Institute, Boston, USA Harvard Medical School , Boston, USA Beth Israel Deaconess Medical Center, Boston, USA
| | - P Gabriel Steg
- Département Hospitalo-Universitaire Fibrosis, Inflammation, and Remodeling, Assistance Publique - Hôpitaux de Paris, Paris, France National Heart and Lung Institute, Imperial College, Royal Brompton Hospital, London, UK
| | | | - Stephen D Wiviott
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA Harvard Medical School , Boston, USA
| | - David J Cohen
- Saint Luke's Mid America Heart Institute, Kansas City, MO, USA University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Joseph M Massaro
- Harvard Clinical Research Institute, Boston, USA Boston University School of Public Health, Boston, USA Université Paris-Diderot, INSERM U-1148, Hôpital Bichat, Paris, France
| | - Ralph B D'Agostino
- Harvard Clinical Research Institute, Boston, USA Boston University School of Public Health, Boston, USA
| | - Eugene Braunwald
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA Harvard Medical School , Boston, USA
| | - Dean J Kereiakes
- The Christ Hospital Heart and Vascular Center, The Lindner Center for Research and Education, Cincinnati, OH, USA
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Cortese B, Piraino D, La Franca E, Buccheri D, Silva Orrego P, Andolina G, Seregni R. Coronary Stent Thrombosis in 2015: A Comprehensive and Uptodated Review. AIMS MEDICAL SCIENCE 2015. [DOI: 10.3934/medsci.2015.3.131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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