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Möckel M. The new ESC acute coronary syndrome guideline and its impact in the CPU and emergency department setting. Herz 2024; 49:185-189. [PMID: 38467788 DOI: 10.1007/s00059-024-05241-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2024] [Indexed: 03/13/2024]
Abstract
The new guideline on acute coronary syndrome (ACS) of the European Society of Cardiology (ESC) replaces two separate guidelines on ST-elevation myocardial infarction (STEMI) and non-ST-elevation (NSTE) ACS. This change of paradigm reflects the experts view that the ACS is a continuum, starting with unstable angina and ending in cardiogenic shock or cardiac arrest due to severe myocardial ischemia. Secondary, partly non-atherosclerotic-caused myocardial infarctions ("type 2") are not integrated in this concept.With respect to acute care in the setting of emergency medicine and the chest pain unit structures, the following new aspects have to be taken into account:1. New procedural approach as "think A.C.S." meaning "abnormal ECG," "clinical context," and "stable patient"2. New recommendation regarding a holistic approach for frail patients3. Revised recommendations regarding imaging and timing of invasive strategy in suspected NSTE-ACS4. Revised recommendations for antiplatelet and anticoagulant therapy in STEMI5. Revised recommendations for cardiac arrest and out-of-hospital cardiac arrest6. Revised recommendations for in-hospital management (starting in the CPU/ED) and ACS comorbid conditionsIn summary, the changes are mostly gradual and are not based on extensive new evidence, but more on focused and healthcare process-related considerations.
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Affiliation(s)
- Martin Möckel
- Notfall- und Akutmedizin mit Chest Pain Units, Charité-Universitätsmedizin Berlin, Campus Mitte und Virchow-Klinikum, Charitéplatz 1, 10117, Berlin, Germany.
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2
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Zabel KM, Blankenship JC. High BMI: Another Barrier to Rapid Platelet Inhibition After STEMI PCI. Cardiovasc Drugs Ther 2024; 38:9-11. [PMID: 37594651 DOI: 10.1007/s10557-023-07504-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/11/2023] [Indexed: 08/19/2023]
Affiliation(s)
- Kenneth M Zabel
- Department of Internal Medicine, University of New Mexico Health Sciences Center, MSC 10 5550, 1 University of New Mexico, Albuquerque, NM, 87131, USA
| | - James C Blankenship
- Division of Cardiology, University of New Mexico Health Sciences Center, MSC 10 5550, 1 University of New Mexico, Albuquerque, NM, 87131, USA.
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3
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Presume J, Gomes DA, Ferreira J, Albuquerque F, Almeida M, Uva MS, Aguiar C, Mendes M. Effectiveness and Safety of P2Y12 Inhibitor Pretreatment for Primary PCI in STEMI: Systematic Review and Meta-analysis. J Cardiovasc Pharmacol 2023; 82:298-307. [PMID: 37506674 DOI: 10.1097/fjc.0000000000001460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 07/10/2023] [Indexed: 07/30/2023]
Abstract
ABSTRACT Dual antiplatelet therapy with aspirin and P2Y12 inhibitors in patients with ST-segment elevation myocardial infarction (STEMI) has been shown to be associated with better outcomes. Yet, there is uncertainty regarding the optimal timing for its initiation. We performed a systematic review and meta-analysis of evidence on pretreatment with P2Y12 inhibitors in combination with aspirin in patients with STEMI undergoing primary percutaneous coronary intervention (PCI). We performed a systematic search of electronic databases PubMed, CENTRAL, and Scopus until April 2022. Studies were eligible if they compared P2Y12 inhibitor upstream administration with downstream use in patients with STEMI submitted to PCI. Studies with patients receiving fibrinolysis or medical therapy only were excluded. Outcomes were assessed at the shortest follow-up available. Of 2491 articles, 3 RCT and 16 non-RCT studies were included, with a total of 79,300 patients (66.1% pretreated, 66.0% treated with clopidogrel). Pretreatment was associated with reduction in definite stent thrombosis (odds ratio [OR] 0.61 [0.38-0.98]), all-cause death (OR 0.77 [0.60-0.97]), and cardiogenic shock (OR 0.60 [0.48-0.75]). It was also associated with a lower incidence of thrombolysis in myocardial infarction flow <3 pre-PCI (OR 0.78 [0.67-0.92]). However, incidence of recurrent MI was not significantly reduced (OR 0.93 [0.57-1.52]). Regarding safety, pretreatment was not associated with a higher risk of major bleeding events (OR 0.83 [0.75-0.92]). Pretreatment with dual antiplatelet therapy, including a P2Y12 inhibitor, was associated with better pre-PCI coronary perfusion, lower incidence of definite stent thrombosis, cardiogenic shock, and, possibly, all-cause mortality with no sign of potential harm encountered.
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Affiliation(s)
- João Presume
- Cardiology Department, Hospital de Santa Cruz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal; and
- Comprehensive Health Research Centre, NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Daniel A Gomes
- Cardiology Department, Hospital de Santa Cruz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal; and
| | - Jorge Ferreira
- Cardiology Department, Hospital de Santa Cruz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal; and
| | - Francisco Albuquerque
- Cardiology Department, Hospital de Santa Cruz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal; and
| | - Manuel Almeida
- Cardiology Department, Hospital de Santa Cruz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal; and
- Comprehensive Health Research Centre, NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Miguel Sousa Uva
- Cardiology Department, Hospital de Santa Cruz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal; and
| | - Carlos Aguiar
- Cardiology Department, Hospital de Santa Cruz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal; and
- Comprehensive Health Research Centre, NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Miguel Mendes
- Cardiology Department, Hospital de Santa Cruz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal; and
- Comprehensive Health Research Centre, NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal
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4
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Niezgoda P, Ostrowska M, Adamski P, Gajda R, Kubica J. Pretreatment with P2Y 12 Receptor Inhibitors in Acute Coronary Syndromes-Is the Current Standpoint of ESC Experts Sufficiently Supported? J Clin Med 2023; 12:jcm12062374. [PMID: 36983373 PMCID: PMC10054246 DOI: 10.3390/jcm12062374] [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: 12/30/2022] [Revised: 02/22/2023] [Accepted: 03/16/2023] [Indexed: 03/30/2023] Open
Abstract
Excessive platelet reactivity plays a pivotal role in the pathogenesis of acute myocardial infarction. Today, the vast majority of patients presenting with acute coronary syndromes qualify for invasive treatment strategy and thus require fast and efficient platelet inhibition. Since 2008, in cases of ST-elevation myocardial infarction, the European Society of Cardiology guidelines have recommended pretreatment with a P2Y12 inhibitor. This approach has become the standard of care in the majority of centers worldwide. Nevertheless, the latest guidelines for the management of patients presenting with acute coronary syndrome without persisting ST-elevation preclude routine pretreatment with the P2Y12 receptor inhibitor. Those who oppose pretreatment support their stance with trials failing to prove the benefits of this strategy at the cost of an increased risk of major bleeding, especially in individuals inappropriately diagnosed with an acute coronary syndrome, thus having no indication for platelet inhibition. However, adequate platelet inhibition requires even up to several hours after application of a loading dose of P2Y12 receptor inhibitors. Omission of data from pharmacokinetic and pharmacodynamic studies in the absence of data from clinical studies makes generalization of the pretreatment recommendations difficult to accept. We aimed to review the scientific evidence supporting the current recommendations regarding pretreatment with P2Y12 inhibitors.
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Affiliation(s)
- Piotr Niezgoda
- Department of Cardiology and Internal Medicine, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University in Toruń, 85-094 Bydgoszcz, Poland
| | - Małgorzata Ostrowska
- Department of Cardiology and Internal Medicine, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University in Toruń, 85-094 Bydgoszcz, Poland
| | - Piotr Adamski
- Department of Cardiology and Internal Medicine, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University in Toruń, 85-094 Bydgoszcz, Poland
| | - Robert Gajda
- Gajda-Med Medical Center, 06-100 Pułtusk, Poland
| | - Jacek Kubica
- Department of Cardiology and Internal Medicine, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University in Toruń, 85-094 Bydgoszcz, Poland
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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: 136] [Impact Index Per Article: 45.3] [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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6
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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: 488] [Impact Index Per Article: 162.7] [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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7
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Fabris E, Korjian S, Coller BS, Ten Berg JM, Granger CB, Gibson CM, van 't Hof AWJ. Pre-Hospital Antiplatelet Therapy for STEMI Patients Undergoing Primary Percutaneous Coronary Intervention: What We Know and What Lies Ahead. Thromb Haemost 2021; 121:1562-1573. [PMID: 33677829 PMCID: PMC8604087 DOI: 10.1055/a-1414-5009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Early recanalization of the infarct-related artery to achieve myocardial reperfusion is the primary therapeutic goal in patients with ST-elevation myocardial infarction (STEMI). To decrease the duration of ischaemia, continuous efforts have been made to improve pre-hospital treatment and to target the early period after symptom onset. In this period the platelet content of the fresh coronary thrombus is maximal and the thrombi are dynamic, and thus more susceptible to powerful antiplatelet agents. There have been substantial advances in antiplatelet therapy in the last three decades with several classes of oral and intravenous antiplatelet agents with different therapeutic targets, pharmacokinetics, and pharmacodynamic properties. New parenteral drugs achieve immediate inhibition of platelet aggregation, and fast and easy methods of administration may create the opportunity to bridge the initial gap in platelet inhibition observed with oral P2Y12 inhibitors. Moreover, potential future management of STEMI could directly involve patients in the process of care with self-administered antiplatelet agents designed to achieve rapid reperfusion. However, the potential anti-ischaemic benefits of potent antiplatelet agents will need to be balanced against their risk of increased bleeding. This study presents a comprehensive and updated review of pre-hospital antiplatelet therapy among STEMI patients undergoing primary percutaneous intervention and explores new therapies under development.
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Affiliation(s)
- Enrico Fabris
- Cardiovascular Department, University of Trieste, Trieste, Italy
| | - Serge Korjian
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States
| | - Barry S Coller
- Allen and Frances Adler Laboratory of Blood and Vascular Biology, Rockefeller University, New York, New York, United States
| | - Jurrien M Ten Berg
- Department of Cardiology, St Antonius Hospital, Nieuwegein, The Netherlands
| | - Christopher B Granger
- Duke Clinical Research Institute and the Division of Cardiology, Duke University Medical Center, Durham, North Carolina, United States
| | - C Michael Gibson
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States
| | - Arnoud W J van 't Hof
- Department of Cardiology, Zuyderland Medical Centre, Heerlen, The Netherlands
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
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8
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Govea A, Lipinksi J, Patel MP. Prehospital Evaluation, ED Management, Transfers, and Management of Inpatient STEMI. Interv Cardiol Clin 2021; 10:293-306. [PMID: 34053616 DOI: 10.1016/j.iccl.2021.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
ST elevation myocardial infarction diagnoses have reduced in number over the past 10 years; however, associated morbidity and mortality remain high. Societal guidelines focus on early diagnosis and timely access to reperfusion, preferably percutaneous coronary intervention (PCI), with fibrinolytics reserved for those who cannot receive timely PCI. Proposed algorithms recommend emergency department bypass in stable patients with a clear diagnosis to reduced door-to-balloon time. Emergency providers should limit their evaluation, focusing on life-threatening comorbidities, unstable vitals, or contraindications to a catheterization laboratory. In-hospital patients prove diagnostically challenging because they may be unable to express symptoms, and reperfusion strategies can complicate other diagnoses.
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Affiliation(s)
- Alayn Govea
- Division of Cardiovascular Medicine, UC San Diego, San Diego, CA, USA; UC San Diego Sulpizio Cardiovascular Center, 9452 Medical Center Drive #7411, La Jolla, CA 92037, USA
| | - Jerry Lipinksi
- UC San Diego Sulpizio Cardiovascular Center, 9452 Medical Center Drive #7411, La Jolla, CA 92037, USA; Department of Internal Medicine, UC San Diego, San Diego, CA, USA
| | - Mitul P Patel
- UC San Diego Sulpizio Cardiovascular Center, 9452 Medical Center Drive #7411, La Jolla, CA 92037, USA; Division of Cardiovascular Medicine, UC San Diego Cardiovascular Institute, San Diego, CA, USA.
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9
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Boytsov SA, Shakhnovich RM, Erlikh AD, Tereschenko SN, Kukava NG, Rytova YK, Pevsner DV, Reitblat OM, Konstantinov SL, Kletkina AS, Shirikova GA, Nedbaikin AM, Borisova TV, Makarov SA, Chesnokova LY, Bykov AN, Shilko YV, Nikolaev DS, Istomina TA, Eremin SA, Romakh IV, Platonov DY, Rabinovich RM, Veselova NA, Urvantseva IA, Zalototskaya YI, Kostina GV, Potapova AN, Dubrovina YA, Shedrova YA, Sodnomova LB, Donirova YS, Hkludeeva EA, Khegya DV, Ivanov KI, Stepanova NV, Philippov EV, Moseychuk KA, Devyatova LS, Kolcheva YG, Rachkova SA, Nazarova OA, Menshikova IG, Pogorelova NA, Sanabasova GK, Azarin OG, Sviridova AV, Zyazina VO, Ilyamakova NA, Kuklina YA, Pronin AA, Vajnshtejn IV, Ustyugov SA, Anohina AR, Gindler AI, Shchepinova LV, Grigoreva TV, Melnik II, Sotnikova MI, Kalashnikova MV, Khramtsova NA, Medvedeva NA, Vahrakova MV, Belousov OV, Doronkina OA, Reprinceva NV, Komarov AV, Lebedev SV, Belskaya EV. Registry of Acute Myocardial Infarction. REGION-MI - Russian Registry of Acute Myocardial Infarction. ACTA ACUST UNITED AC 2021; 61:41-51. [PMID: 34311687 DOI: 10.18087/cardio.2021.6.n1595] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 04/12/2021] [Indexed: 11/18/2022]
Abstract
Aim To study features of diagnosis and treatment of acute myocardial infarction (AMI) in Russian hospitals, results of the treatment, and early and late outcomes (6 and 12 months after AMI diagnosis); to evaluate the consistence of the treatment with clinical guidelines; and to evaluate patients' compliance with the treatment.Material and methods The program was designed for 3 years, including 24 months for recruitment of patients to the study. The study will include 10, 000 patients hospitalized with a confirmed diagnosis (I21 according to ICD-10) of ST segment elevation acute myocardial infarction (MI) (STEMI) or non-ST segment elevation MI (NSTEMI) based on criteria of the European Society of Cardiology Guidelines on Forth Universal Definition of Myocardial Infarction (2018). The follow-up period was divided into three stages: observation during the stay in the hospital and at 6 and 12 months following inclusion into the registry. The primary endpoint included cardiac death, nonfatal MI during the hospitalization and after one-year follow-up. Secondary endpoints were 6-months and one-year incidence of repeated MI, heart failure, ischemic stroke, clinically significant hemorrhage, unscheduled revascularization after discharge from the hospital, and the proportion of patients who continue on statins, antiplatelet drugs, and drugs of other groups for 6 months and 1 year.Results The inclusion of patients into the registry started in 2020 and will continue for 24 months. By the time of the article publication (June, 2021), more than 2,000 patients will be included.Conclusion REGION-MI (Russian rEGIstry Of acute myocardial iNfarction) is a multicenter, retrospective and prospective observational cohort study that excludes any interference with the clinical practice. Results of the registry will help to analyze a real picture of medical care provided to patients with myocardial infarction and to schedule ways to improve the situation.
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Affiliation(s)
- S A Boytsov
- National Medical Scientific Center for Cardiology, Moscow
| | | | - A D Erlikh
- City Clinical Hospital №29 Named. N.E. Bauman" Department of Health of the City of Moscow, Moscow
| | | | - N G Kukava
- National Medical Scientific Center for Cardiology, Moscow
| | - Y K Rytova
- National Medical Scientific Center for Cardiology, Moscow
| | - D V Pevsner
- National Medical Scientific Center for Cardiology, Moscow
| | | | - S L Konstantinov
- Belgorod Regional Clinical Hospital Named after Svyatitelya Iosafa, Belgorod
| | - A S Kletkina
- Belgorod Regional Clinical Hospital Named after Svyatitelya Iosafa, Belgorod
| | | | | | - T V Borisova
- Bryansk Regional Cardiologic Dispensary, Bryansk
| | - S A Makarov
- Kuzbass Clinical Cardiology Dispensary Named after Academician L.S.Barbarash, Kemerovo
| | - L Yu Chesnokova
- Kuzbass Clinical Cardiology Dispensary Named after Academician L.S.Barbarash, Kemerovo
| | - A N Bykov
- Sverdlovsk Regional Clinical Hospital № 1, Ekaterinburg
| | - Yu V Shilko
- Sverdlovsk Regional Clinical Hospital № 1, Ekaterinburg
| | - D S Nikolaev
- Krasnoufimsk Regional Hospital № 1, Krasnoufimsk
| | - T A Istomina
- Tambov Regional Clinical Hospital im. V. D. Babenko, Tambov
| | - S A Eremin
- Tambov Regional Clinical Hospital im. V. D. Babenko, Tambov
| | - I V Romakh
- Morshansk Central Regional Hospital, Morshansk
| | | | | | | | - I A Urvantseva
- The Khanty-Mansi Autonomous Okrug - Yugra Diagnostics and Cardiovascular Surgery Center (cardiology clinic), a public-sector entity, Surgut
| | - Yu I Zalototskaya
- The Khanty-Mansi Autonomous Okrug - Yugra Diagnostics and Cardiovascular Surgery Center (cardiology clinic), a public-sector entity, Surgut
| | - G V Kostina
- Yaroslavl Regional Clinical Hospital, Yaroslavl
| | | | | | | | - L B Sodnomova
- Ulan-Ude Republican Clinical Hospital Named After N.A. Semashko, Ulan-Ude
| | - Yo S Donirova
- Ulan-Ude Republican Clinical Hospital Named After N.A. Semashko, Ulan-Ude
| | - E A Hkludeeva
- Primorsaya regional clinical hospital № 1, Vladivostok
| | - D V Khegya
- Primorsaya regional clinical hospital № 1, Vladivostok
| | - K I Ivanov
- The Republican Hospital №1 - The National Center of the Medicine, Yakutsk
| | - N V Stepanova
- The Republican Hospital №1 - The National Center of the Medicine, Yakutsk
| | | | | | | | | | | | - O A Nazarova
- Ivanovo Regional Clinical Hospital, Regional Vascular Center, Ivanovo
| | | | | | | | - O G Azarin
- Voronezh Regional Clinical Hospital № 1, Voronezh
| | | | - Vi O Zyazina
- Voronezh Regional Clinical Hospital № 1, Voronezh
| | | | | | | | | | | | | | | | | | | | | | | | | | - N A Khramtsova
- Irkutsk Regional Clinical Hospital, Winner of the "Mark of the Honor", Irkutsk
| | - N A Medvedeva
- Irkutsk Regional Clinical Hospital, Winner of the "Mark of the Honor", Irkutsk
| | | | | | | | | | | | | | - E V Belskaya
- Novomoskovsk City Clinical Hospital, Novomoskovsk
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10
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Hasun M, Dörler J, Alber HF, Bauer A, Berger R, Christ G, Frick M, Hoppe UC, Huber K, Lamm G, Laßnig E, von Lewinski D, Rab A, Roithinger FX, Schuchlenz H, Siostrzonek P, Sipötz J, Stefenelli T, Steinwender C, Edlinger M, Weidinger F. Improved in-hospital outcome for radial access in a large contemporary cohort of primary percutaneous coronary intervention. Cardiovasc Diagn Ther 2021; 11:726-735. [PMID: 34295699 DOI: 10.21037/cdt-20-977] [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: 12/04/2020] [Accepted: 03/28/2021] [Indexed: 11/06/2022]
Abstract
Background Randomised controlled trials have shown diverse results for radial access in patients undergoing primary percutaneous coronary intervention (PPCI). Moreover, it is questionable whether radial access improves outcome in patients with cardiogenic shock undergoing PPCI. We aimed to investigate the outcome according to access site in patients with or without cardiogenic shock, in daily clinical practice. Methods For the present analysis we included 9,980 patients undergoing PPCI between 2012 and 2018, registered in the multi-centre, nationwide registry on PCI for myocardial infarction (MI). In-hospital mortality, major adverse cardiovascular events (MACE), and net adverse clinical events (NACE) until discharge were compared between 4,498 patients with radial (45%) and 5,482 patients with femoral (55%) access. Results Radial compared to femoral access was associated with lower in-hospital mortality (3.5% vs. 7.7%; P<0.01). Multivariable logistic regression analysis confirmed reduced in-hospital mortality [odds ratio (OR) 0.57, 95% confidence interval (CI): 0.43 to 0.75]. Furthermore, MACE (OR 0.60, 95% CI: 0.47 to 0.78) as well as NACE (OR 0.59, 95% CI: 0.46 to 0.75) occurred less frequently in patients with radial access. Interaction analysis with cardiogenic shock showed an effect modification, resulting in lower mortality in PCI via radial access in patients without, but no difference in those with cardiogenic shock (OR 1.78, 95% CI: 1.07 to 2.96). Conclusions Radial access for patients with acute MI undergoing PPCI is associated with improved survival in a large contemporary cohort of daily practice. However, this beneficial effect is restricted to hemodynamically stable patients.
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Affiliation(s)
- Matthias Hasun
- 2nd Medical Department with Cardiology and Intensive Care Medicine, KA Rudolfstiftung, Vienna, Austria
| | - Jakob Dörler
- Department of Internal Medicine III, Cardiology and Angiology, Medical University Innsbruck, Innsbruck, Austria
| | - Hannes F Alber
- Department of Internal Medicine and Cardiology, Klinikum Klagenfurt am Wörthersee, Klagenfurt, Austria
| | - Axel Bauer
- Department of Internal Medicine III, Cardiology and Angiology, Medical University Innsbruck, Innsbruck, Austria
| | - Rudolf Berger
- Department of Internal Medicine I, Cardiology and Nephrology, Krankenhaus der Barmherzigen Brüder Eisenstadt, Eisenstadt, Austria
| | - Günter Christ
- 5th Medical Department with Cardiology, Sozialmedizinisches Zentrum Süd - Kaiser Franz Josef Hospital, Vienna, Austria
| | - Matthias Frick
- 1st Department of Internal Medicine, Landeskrankenhaus Feldkirch, Feldkirch, Austria
| | - Uta C Hoppe
- Department of Internal Medicine II, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Kurt Huber
- 3rd Department of Internal Medicine, Cardiology and Intensive Care Medicine, Wilhelminenspital, and Medical School, Sigmund Freud University, Vienna, Austria
| | - Gudrun Lamm
- Department of Internal Medicine III, Universitätsklinikum St. Pölten, St. Pölten, Austria
| | - Elisabeth Laßnig
- Department of Internal Medicine II, Cardiology and Intensive Care Medicine, Klinikum Wels-Grieskirchen, Wels, Austria
| | - Dirk von Lewinski
- Department of Internal Medicine, Cardiology, Medical University Graz, Graz, Austria
| | - Anna Rab
- Department for Internal Medicine, Landeskrankenhaus Villach, Villach, Austria
| | - Franz X Roithinger
- Department of Internal Medicine, Cardiology and Nephrology, Landesklinikum Wiener Neustadt, Wiener Neustadt, Austria
| | - Herwig Schuchlenz
- Department of Internal Medicine, Cardiology and Intensive Care Medicine, Landeskrankenhaus Graz West, Graz, Austria
| | - Peter Siostrzonek
- Department of Internal Medicine II - Cardiology, Ordensklinikum Linz Barmherzige Schwestern, Linz, Austria
| | - Johann Sipötz
- 2nd Department of Internal Medicine, Hanusch Hospital, Vienna, Austria
| | - Thomas Stefenelli
- Department of Internal Medicine I, Sozialmedizinisches Zentrum Ost - Donauspital, Vienna, Austria
| | - Clemens Steinwender
- Department of Internal Medicine I, Cardiology and Internal Intensive Medicine, Kepler Universitätsklinikum, Linz, Austria
| | - Michael Edlinger
- Department of Medical Statistics, Informatics, and Health Economics, Medical University Innsbruck, Innsbruck, Austria.,Department of Development and Regeneration, KU Leuven, Belgium
| | - Franz Weidinger
- 2nd Medical Department with Cardiology and Intensive Care Medicine, KA Rudolfstiftung, Vienna, Austria
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11
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The influence of pre-hospital medication administration in ST-elevation myocardial infarction patients on left ventricular ejection fraction and intra-hospital death. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2021; 17:39-45. [PMID: 33868416 PMCID: PMC8039926 DOI: 10.5114/aic.2021.104766] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 12/30/2020] [Indexed: 11/17/2022] Open
Abstract
Introduction Currently, invasive cardiology techniques are the preferred method of treatment for patients with ST-elevation myocardial infarction (STEMI). Improving the care of patients with STEMI is possible by minimizing the time that elapses from the onset of pain to the start of treatment. As studies indicate, early pharmacotherapy, especially with antiplatelet and anticoagulant medications, allows for their early effectiveness. Aim To assess the influence of early administration of antiplatelet (clopidogrel) and anticoagulant medications in the pre-hospital period in patients with ST-elevated myocardial infarction on the frequency of in-hospital deaths and on the left ventricular ejection fraction evaluated at hospital discharge. Material and methods In this study, a retrospective analysis of 573 patients hospitalized due to ST-segment elevation myocardial infarction in one of Krakow’s hospitals from January 2011 to December 2015 (excluding the whole of 2013) was used as a research method. Results As many as 97% of patients received pre-hospital pharmacotherapy, but only 46.0% of respondents received unfractionated heparin, and 19.2% received clopidogrel. The in-hospital mortality rate was 6.7%, but among patients prehospitally treated with clopidogrel and unfractionated heparin, the in-hospital mortality rate was 1.1%. Prehospital administration of clopidogrel significantly decreased the possibility of reduced left ventricular ejection fraction (OR = 0.27; 95% CI: 0.09–0.90). Conclusions Among pre-hospital procedures, only administration of a second antiplatelet drug (clopidogrel) significantly decreased the risk of reduced left ventricular ejection fraction, and administration of clopidogrel or heparin, or a combination of both, significantly decreased the risk of in-hospital death in patients with STEMI.
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12
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Abdel-Hady E, Mohamed F, Ahmed M, Abdel-Salam M, Ayobe M. Supplementation of Lipoic Acid, Zinc and Clopidogrel Reduces Mortality Rate and Incidence of Ventricular Arrhythmia in Experimental Myocardial Infarction. Front Physiol 2021; 12:582223. [PMID: 33815129 PMCID: PMC8009994 DOI: 10.3389/fphys.2021.582223] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 02/26/2021] [Indexed: 11/21/2022] Open
Abstract
Despite the significant advances in management of coronary heart diseases, myocardial infarction (MI) is still associated with a high mortality rate. The present study was planned to investigate the possible protective effects of the anti-oxidants lipoic acid and zinc sulfate as well as the anti-platelet clopidogrel on cardiac dysfunction in experimental isoproterenol (ISO)-induced MI, aiming at achieving useful means for protection and therapy against MI. Wistar rats of both sexes were allocated into five groups: control, untreated MI and MI pre-treated with lipoic acid, zinc, or clopidogrel. All rats were subjected to ECG recording and measurement of plasma levels of troponin I, creatine kinase-MB (CK-MB) unit, triglycerides and total cholesterol. The hearts were isolated and studied on Langendorff preparation for assessment of intrinsic cardiac activities. The results revealed that the percent mortality was markedly reduced upon pre-treatment and the total arrhythmia was also decreased except for the zinc pre-treated rats. The ST-segment elevation was significantly reduced and the plasma levels of CK-MB were only decreased in lipoic acid and clopidogrel pre-treated rats with variable hypolipidemic effect. Hearts of clopidogrel pre-treated rats showed augmented inotropic activity both basal and in response to β-adrenergic stimulation. While zinc pre-treated hearts revealed improved rate of contraction and increased myocardial flow rate. Overall, these results indicate that lipoic acid, zinc and clopidogrel were variably effective in modifying the ISO-induced MI insults and offered partial protection against experimental myocardial damage.
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Affiliation(s)
- Enas Abdel-Hady
- Department of Physiology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Fatma Mohamed
- Department of Physiology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Mona Ahmed
- Department of Physiology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Mohamed Abdel-Salam
- Department of Physiology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Mahmoud Ayobe
- Department of Physiology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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13
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Moura Guedes JP, Marques N, Azevedo P, Mota T, Bispo J, Fernandes R, Costa H, Vinhas H, Mimoso J, de Jesus I. P2Y 12 inhibitor loading dose before catheterization in ST-segment elevation myocardial infarction: Is this the best strategy? Rev Port Cardiol 2020; 39:553-561. [PMID: 33023777 DOI: 10.1016/j.repc.2020.09.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 08/18/2020] [Accepted: 09/04/2020] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION AND OBJECTIVES In ST-segment elevation myocardial infarction (STEMI) the benefit of dual antiplatelet therapy is unequivocal, but the optimal time to administer the loading dose (LD) of a P2Y12 inhibitor is the subject of debate and disagreement. The main aim of this study was characterize current practice in Portugal and to assess the prognostic impact of P2Y12 inhibitor LD administration strategy, before versus during or after primary percutaneous coronary intervention (PCI). METHODS This multicenter retrospective study based on the Portuguese National Registry on Acute Coronary Syndromes included patients with STEMI and PCI performed between October 1, 2010 and September 19, 2017. Two groups were established: LD before PCI (LD-PRE) and LD during or after PCI (LD-CATH). RESULTS A total of 4123 patients were included, 66.3% in the LD-PRE group and 32.4% in the LD-CATH group. Prehospital use of a P2Y12 inhibitor was a predictor of the composite bleeding endpoint (major bleeding, need for transfusion or hemoglobin [Hb] drop >2g/dl), Hb drop >2g/dl and reinfarction. There were no differences between groups in major adverse events (MAE) (in-hospital mortality, reinfarction and stroke) or in-hospital mortality. CONCLUSIONS Prehospital use of a P2Y12 inhibitor was associated with an increased risk of bleeding, predicting the composite bleeding outcome and Hb drop >2g/dl, with no differences in mortality or MAE, calling into question the benefit of this strategy.
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Affiliation(s)
- João Pedro Moura Guedes
- Centro Hospitalar Universitário do Algarve, Faro, Portugal; Algarve Biomedical Center, Faro, Portugal; Registo Nacional de Síndromes Coronárias Agudas, Sociedade Portuguesa de Cardiologia, Lisboa, Portugal.
| | - Nuno Marques
- Centro Hospitalar Universitário do Algarve, Faro, Portugal; Algarve Biomedical Center, Faro, Portugal; Departamento de Ciências Biomédicas e de Medicina da Universidade do Algarve, Faro, Portugal; Registo Nacional de Síndromes Coronárias Agudas, Sociedade Portuguesa de Cardiologia, Lisboa, Portugal
| | - Pedro Azevedo
- Centro Hospitalar Universitário do Algarve, Faro, Portugal; Algarve Biomedical Center, Faro, Portugal; Registo Nacional de Síndromes Coronárias Agudas, Sociedade Portuguesa de Cardiologia, Lisboa, Portugal
| | - Teresa Mota
- Centro Hospitalar Universitário do Algarve, Faro, Portugal; Algarve Biomedical Center, Faro, Portugal; Registo Nacional de Síndromes Coronárias Agudas, Sociedade Portuguesa de Cardiologia, Lisboa, Portugal
| | - João Bispo
- Centro Hospitalar Universitário do Algarve, Faro, Portugal; Algarve Biomedical Center, Faro, Portugal; Registo Nacional de Síndromes Coronárias Agudas, Sociedade Portuguesa de Cardiologia, Lisboa, Portugal
| | - Raquel Fernandes
- Centro Hospitalar Universitário do Algarve, Faro, Portugal; Algarve Biomedical Center, Faro, Portugal; Registo Nacional de Síndromes Coronárias Agudas, Sociedade Portuguesa de Cardiologia, Lisboa, Portugal
| | - Hugo Costa
- Centro Hospitalar Universitário do Algarve, Faro, Portugal; Algarve Biomedical Center, Faro, Portugal
| | - Hugo Vinhas
- Centro Hospitalar Universitário do Algarve, Faro, Portugal; Algarve Biomedical Center, Faro, Portugal
| | - Jorge Mimoso
- Centro Hospitalar Universitário do Algarve, Faro, Portugal; Algarve Biomedical Center, Faro, Portugal; Departamento de Ciências Biomédicas e de Medicina da Universidade do Algarve, Faro, Portugal; Registo Nacional de Síndromes Coronárias Agudas, Sociedade Portuguesa de Cardiologia, Lisboa, Portugal
| | - Ilídio de Jesus
- Centro Hospitalar Universitário do Algarve, Faro, Portugal; Algarve Biomedical Center, Faro, Portugal
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14
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P2Y12 inhibitor loading dose before catheterization in ST-segment elevation myocardial infarction: Is this the best strategy? REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2020. [DOI: 10.1016/j.repce.2020.09.001] [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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15
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Acute Coronary Syndrome, Antiplatelet Therapy, and Bleeding: A Clinical Perspective. J Clin Med 2020; 9:jcm9072064. [PMID: 32630233 PMCID: PMC7408729 DOI: 10.3390/jcm9072064] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 06/27/2020] [Accepted: 06/29/2020] [Indexed: 02/06/2023] Open
Abstract
Inhibition of platelet function by means of dual antiplatelet therapy (DAPT) is the cornerstone of treatment of acute coronary syndrome (ACS). While preventing ischemic recurrences, inhibition of platelet function is clearly associated with an increased bleeding risk, a feared complication that may lead to significant morbidity and mortality. Since bleeding risk management is intrinsically associated with therapeutic adjustments undertaken during the whole clinical history of patients with acute coronary syndrome, single decisions taken from the very first day to years of follow-up might be decisive. This review aims at providing a clinically oriented, patient-tailored approach in reducing the risk and manage bleeding complications in ACS patients treated with DAPT. The steps in clinical decision making from the day of ACS to follow-up are analyzed. New treatment strategies to enhance the safety of DAPT are also described.
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16
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Li YH, Lee CH, Huang WC, Wang YC, Su CH, Sung PH, Chien SC, Hwang JJ. 2020 Focused Update of the 2012 Guidelines of the Taiwan Society of Cardiology for the Management of ST-Segment Elevation Myocardial Infarction. ACTA CARDIOLOGICA SINICA 2020; 36:285-307. [PMID: 32675921 PMCID: PMC7355116 DOI: 10.6515/acs.202007_36(4).20200619a] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 06/19/2020] [Indexed: 12/22/2022]
Abstract
One of the major missions of the Taiwan Society of Cardiology is to publish practice guidelines that are suitable for local use in Taiwan. The ultimate purpose is to continuously improve cardiovascular health care from the implementation of the recommendations in the guidelines. Despite recent improvement of medical care, patients with ST-segment elevation myocardial infarction (STEMI) still carry a high morbidity and mortality. There have been many changes in the concepts of STEMI diagnosis and treatment in recent years. The 2020 focused update of the 2012 guidelines of the Taiwan Society of Cardiology for the management of STEMI is an amendment of the 2012 guidelines based on the newest published scientific data. The recommendations in this focused update provide the diagnosis and treatment strategy for STEMI that should be generally implemented in Taiwan. Nevertheless, guidelines never completely replace clinical judgment and medical decision still should be determined individually.
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Affiliation(s)
- Yi-Heng Li
- Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University
| | - Cheng-Han Lee
- Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University
- Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan
| | - Wei-Chun Huang
- Department of Critical Care Medicine, Kaohsiung Veterans General Hospital, Kaohsiung
- School of Medicine, National Yang Ming University, Taipei
- Department of Physical Therapy, Fooyin University, Kaohsiung
| | - Yu-Chen Wang
- Division of Cardiology, Department of Internal Medicine, Asia University Hospital
- Department of Biotechnology, Asia University
- Division of Cardiology, Department of Internal Medicine, China Medical University College of Medicine and Hospital
| | - Chun-Hung Su
- Division of Cardiology, Department of Internal Medicine, Chung Shan Medical University Hospital
- Institute of Medicine, School of Medicine, Chung Shan Medical University, Taichung
| | - Pei-Hsun Sung
- Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University, College of Medicine
| | - Shih-Chieh Chien
- Department of Critical Care Medicine, MacKay Memorial Hospital, Taipei
| | - Juey-Jen Hwang
- Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
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17
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Sharma RK, Pinto DS. Mind the Gap: Platelet Inhibition in Low‐Risk Acute Coronary Syndrome Undergoing Percutaneous Revascularization. J Am Heart Assoc 2019; 8:e014498. [PMID: 31766972 PMCID: PMC6912963 DOI: 10.1161/jaha.119.014498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Ravi K. Sharma
- Cardiovascular Institute Beth Israel Deaconess Medical Center Harvard Medical School Boston MA
| | - Duane S. Pinto
- Cardiovascular Institute Beth Israel Deaconess Medical Center Harvard Medical School Boston MA
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18
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Krohn J, Gleißner CA, Zirlik A, Staudacher DL. Antikoagulanzien und Blutplättchenaggregationshemmer bei Patienten mit akutem Koronarsyndrom. Notf Rett Med 2019. [DOI: 10.1007/s10049-018-0535-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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19
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Bergmeijer TO, van Oevelen M, Janssen PWA, Godschalk TC, Lichtveld RA, Kelder JC, Voskuil M, Mosterd A, Montalescot G, Ten Berg JM. Safety of Ticagrelor Compared to Clopidogrel after Prehospital Initiation of Treatment. TH OPEN 2019; 2:e357-e368. [PMID: 31249961 PMCID: PMC6524899 DOI: 10.1055/s-0038-1673389] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 08/22/2018] [Indexed: 10/28/2022] Open
Abstract
Objectives The objective of this registry was to study the safety of prehospital initiation of ticagrelor compared with clopidogrel. Background Ticagrelor has replaced clopidogrel in many hospitals as the routinely used antiplatelet drug in patients with ST-segment elevation myocardial infarction (STEMI). Nevertheless, in the PLATelet inhibition and patient Outcomes (PLATO) trial, ticagrelor was associated with an increase in non-CABG (non-coronary artery bypass grafting)-related major bleeding. Data comparing the safety of ticagrelor and clopidogrel after prehospital initiation of treatment are not available. Methods A retrospective, multicenter registry was performed. Selection criteria were the administration of a prehospital loading dose of ticagrelor or clopidogrel according to the ambulance STEMI treatment protocol and the presentation to a percutaneous coronary intervention-capable hospital in our region between January 2011 and December 2012. Follow-up was performed using the electronic patient files for the time period between the antiplatelet loading dose and hospital discharge. The data were analyzed using a primary bleeding end point (any bleeding) and a secondary thrombotic end point (all-cause mortality, spontaneous myocardial infarction, definite stent thrombosis, stroke, or transient ischemic attack). Results Data of 304 clopidogrel-treated and 309 ticagrelor-treated patients were available for analysis. No significant difference in bleeding rate was observed between both groups, using univariate (17.8 vs. 20.1%; p = 0.47; odds ratio, 1.16 [95% confidence interval, 0.78-1.74]) and multivariate ( p = 0.42) analysis. Also for the secondary thrombotic end point (6.3 vs. 4.9%, p = 0.45), no significant differences were observed. Conclusion In this real-world registry, no significant differences in bleeding or thrombotic event rate were found between ticagrelor and clopidogrel after prehospital initiation of treatment.
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Affiliation(s)
- Thomas O Bergmeijer
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Mathijs van Oevelen
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Paul W A Janssen
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Thea C Godschalk
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | | | - Johannes C Kelder
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Michiel Voskuil
- Division of Heart and Lungs, Department of Cardiology, UMC Utrecht, The Netherlands
| | - Arend Mosterd
- Department of Cardiology, Meander Medical Center, Amersfoort, The Netherlands
| | - Gilles Montalescot
- ACTION Study Group, UPMC Sorbonne Universités, Pitié-Salpêtrière Hospital (AP-HP), Paris, France
| | - Jurriën M Ten Berg
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
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20
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Pepe M, Cafaro A, Paradies V, Signore N, Addabbo F, Bortone AS, Navarese EP, Contegiacomo G, Forleo C, Bartolomucci F, Di Cillo O, Bianchi FP, Zanna D, Favale S. Time‐dependent benefits of pre‐treatment with new oral P2Y
12
‐inhibitors in patients addressed to primary PCI for acute ST‐elevation myocardial infarction. Catheter Cardiovasc Interv 2018; 93:592-601. [DOI: 10.1002/ccd.27863] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 08/02/2018] [Accepted: 08/12/2018] [Indexed: 11/06/2022]
Affiliation(s)
- Martino Pepe
- Division of Cardiology, Department of Emergency and Organ TransplantationUniversity of Bari Bari Italy
| | - Alessandro Cafaro
- Cardiovascular DepartmentF. Miulli Hospital Acquaviva delle Fonti Italy
| | - Valeria Paradies
- Department of CardiologyMaasstad Ziekenhuis Hospital Rotterdam Netherlands
| | - Nicola Signore
- Division of CardiologyAzienda Ospedaliero Universitaria Consorziale Policlinico di Bari Bari Italy
| | - Francesco Addabbo
- Department of Biomedical Sciences & Human OncologyUniversity of Bari Medical School Bari Italy
| | - Alessandro Santo Bortone
- Division of Heart Surgery, Department of Emergency and Organ TransplantationUniversity of Bari Bari Italy
| | - Eliano Pio Navarese
- Inova Heart and Vascular Institute Falls Church Virginia
- Interventional Cardiology and Cardiovascular Research, Mater Dei Hospital Bari Italy
| | - Gaetano Contegiacomo
- Interventional Cardiology and Cardiovascular ResearchMater Dei Hospital Bari Italy
| | - Cinzia Forleo
- Division of Cardiology, Department of Emergency and Organ TransplantationUniversity of Bari Bari Italy
| | | | - Ottavio Di Cillo
- Chest Pain Unit, Cardiology EmergencyUniversity of Bari Bari Italy
| | | | - Domenico Zanna
- Division of Cardiology, Department of Emergency and Organ TransplantationUniversity of Bari Bari Italy
| | - Stefano Favale
- Division of Cardiology, Department of Emergency and Organ TransplantationUniversity of Bari Bari Italy
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21
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Koul S, Smith JG, Götberg M, Omerovic E, Alfredsson J, Venetsanos D, Persson J, Jensen J, Lagerqvist B, Redfors B, James S, Erlinge D. No Benefit of Ticagrelor Pretreatment Compared With Treatment During Percutaneous Coronary Intervention in Patients With ST-Segment–Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention. Circ Cardiovasc Interv 2018; 11:e005528. [DOI: 10.1161/circinterventions.117.005528] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Accepted: 02/15/2018] [Indexed: 11/16/2022]
Abstract
Background—
The effects of ticagrelor pretreatment in patients with ST-segment–elevation myocardial infarction undergoing primary percutaneous coronary intervention (PCI) is debated. This study investigated the effects of ticagrelor pretreatment on clinical outcomes in this patient group.
Methods and Results—
Patients with ST-segment–elevation myocardial infarction undergoing primary PCI were included from October 2010 to October 2014 in Sweden. Screening was done using the SWEDEHEART register (Swedish Web-System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies). A total of 7433 patients were included for analysis with 5438 patients receiving ticagrelor pretreatment and 1995 patients with ticagrelor given only in the catheterization laboratory. The primary end point of the study was 30-day event rates of a composite of all-cause mortality, myocardial infarction (MI), and stent thrombosis. Secondary end points were mortality, MI, or stent thrombosis alone and major in-hospital bleeding. Crude event rates showed no difference in 30-day composite end point (6.2% versus 6.5%;
P=0
.69), mortality (4.5% versus 4.7%;
P=0
.86), MI (1.6% versus 1.7%;
P=0
.72), or stent thrombosis (0.5% versus 0.4%;
P=0
.80) with ticagrelor pretreatment. Three different statistical models were used to correct for baseline differences. No difference in the composite end point, mortality, MI, or stent thrombosis was seen between the 2 groups after statistical adjustment. No increase in in-hospital major bleeding rate was observed with ticagrelor pretreatment.
Conclusions—
Ticagrelor pretreatment versus ticagrelor given in the catheterization laboratory in patients with ST-segment–elevation myocardial infarction undergoing primary PCI did not improve the composite end point of all-cause mortality or MI or stent thrombosis or its individual components at 30 days.
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Affiliation(s)
- Sasha Koul
- From the Department of Cardiology (S.K., J.G.S., M.G., D.E.) and Department of Clinical Sciences (S.K., J.G.S., M.G., D.E.), Skane University Hospital Lund, Lund University, Sweden; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden (E.O., B.R.); Department of Cardiology (J.A., D.V.) and Department of Medical and Health Sciences (J.A., D.V.), Linköping University, Sweden; Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd University Hospital (J
| | - J. Gustav Smith
- From the Department of Cardiology (S.K., J.G.S., M.G., D.E.) and Department of Clinical Sciences (S.K., J.G.S., M.G., D.E.), Skane University Hospital Lund, Lund University, Sweden; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden (E.O., B.R.); Department of Cardiology (J.A., D.V.) and Department of Medical and Health Sciences (J.A., D.V.), Linköping University, Sweden; Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd University Hospital (J
| | - Matthias Götberg
- From the Department of Cardiology (S.K., J.G.S., M.G., D.E.) and Department of Clinical Sciences (S.K., J.G.S., M.G., D.E.), Skane University Hospital Lund, Lund University, Sweden; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden (E.O., B.R.); Department of Cardiology (J.A., D.V.) and Department of Medical and Health Sciences (J.A., D.V.), Linköping University, Sweden; Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd University Hospital (J
| | - Elmir Omerovic
- From the Department of Cardiology (S.K., J.G.S., M.G., D.E.) and Department of Clinical Sciences (S.K., J.G.S., M.G., D.E.), Skane University Hospital Lund, Lund University, Sweden; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden (E.O., B.R.); Department of Cardiology (J.A., D.V.) and Department of Medical and Health Sciences (J.A., D.V.), Linköping University, Sweden; Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd University Hospital (J
| | - Joakim Alfredsson
- From the Department of Cardiology (S.K., J.G.S., M.G., D.E.) and Department of Clinical Sciences (S.K., J.G.S., M.G., D.E.), Skane University Hospital Lund, Lund University, Sweden; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden (E.O., B.R.); Department of Cardiology (J.A., D.V.) and Department of Medical and Health Sciences (J.A., D.V.), Linköping University, Sweden; Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd University Hospital (J
| | - Dimitrios Venetsanos
- From the Department of Cardiology (S.K., J.G.S., M.G., D.E.) and Department of Clinical Sciences (S.K., J.G.S., M.G., D.E.), Skane University Hospital Lund, Lund University, Sweden; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden (E.O., B.R.); Department of Cardiology (J.A., D.V.) and Department of Medical and Health Sciences (J.A., D.V.), Linköping University, Sweden; Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd University Hospital (J
| | - Jonas Persson
- From the Department of Cardiology (S.K., J.G.S., M.G., D.E.) and Department of Clinical Sciences (S.K., J.G.S., M.G., D.E.), Skane University Hospital Lund, Lund University, Sweden; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden (E.O., B.R.); Department of Cardiology (J.A., D.V.) and Department of Medical and Health Sciences (J.A., D.V.), Linköping University, Sweden; Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd University Hospital (J
| | - Jens Jensen
- From the Department of Cardiology (S.K., J.G.S., M.G., D.E.) and Department of Clinical Sciences (S.K., J.G.S., M.G., D.E.), Skane University Hospital Lund, Lund University, Sweden; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden (E.O., B.R.); Department of Cardiology (J.A., D.V.) and Department of Medical and Health Sciences (J.A., D.V.), Linköping University, Sweden; Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd University Hospital (J
| | - Bo Lagerqvist
- From the Department of Cardiology (S.K., J.G.S., M.G., D.E.) and Department of Clinical Sciences (S.K., J.G.S., M.G., D.E.), Skane University Hospital Lund, Lund University, Sweden; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden (E.O., B.R.); Department of Cardiology (J.A., D.V.) and Department of Medical and Health Sciences (J.A., D.V.), Linköping University, Sweden; Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd University Hospital (J
| | - Björn Redfors
- From the Department of Cardiology (S.K., J.G.S., M.G., D.E.) and Department of Clinical Sciences (S.K., J.G.S., M.G., D.E.), Skane University Hospital Lund, Lund University, Sweden; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden (E.O., B.R.); Department of Cardiology (J.A., D.V.) and Department of Medical and Health Sciences (J.A., D.V.), Linköping University, Sweden; Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd University Hospital (J
| | - Stefan James
- From the Department of Cardiology (S.K., J.G.S., M.G., D.E.) and Department of Clinical Sciences (S.K., J.G.S., M.G., D.E.), Skane University Hospital Lund, Lund University, Sweden; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden (E.O., B.R.); Department of Cardiology (J.A., D.V.) and Department of Medical and Health Sciences (J.A., D.V.), Linköping University, Sweden; Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd University Hospital (J
| | - David Erlinge
- From the Department of Cardiology (S.K., J.G.S., M.G., D.E.) and Department of Clinical Sciences (S.K., J.G.S., M.G., D.E.), Skane University Hospital Lund, Lund University, Sweden; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden (E.O., B.R.); Department of Cardiology (J.A., D.V.) and Department of Medical and Health Sciences (J.A., D.V.), Linköping University, Sweden; Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd University Hospital (J
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Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H, Caforio ALP, Crea F, Goudevenos JA, Halvorsen S, Hindricks G, Kastrati A, Lenzen MJ, Prescott E, Roffi M, Valgimigli M, Varenhorst C, Vranckx P, Widimský P. [2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation.]. Eur Heart J 2018; 39:119-177. [PMID: 29457615 DOI: 10.1093/eurheartj/ehx393] [Citation(s) in RCA: 6011] [Impact Index Per Article: 1001.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- Borja Ibanez
- Department of Cardiology, IIS-Fundación Jiménez Díaz University Hospital, Madrid, Spain.
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23
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In-Hospital Outcome Comparing Bivalirudin to Heparin in Real-World Primary Percutaneous Coronary Intervention. Am J Cardiol 2017; 120:2135-2140. [PMID: 29103603 DOI: 10.1016/j.amjcard.2017.08.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 08/23/2017] [Accepted: 08/25/2017] [Indexed: 11/21/2022]
Abstract
Randomized controlled trials have shown conflicting results regarding the outcome of bivalirudin in primary percutaneous coronary intervention (PPCI). The aim of this study was to evaluate the in-hospital outcomes of patients receiving heparin or bivalirudin in a real-world setting of PPCI: 7,023 consecutive patients enrolled in the Austrian Acute PCI Registry were included between January 2010 and December 2014. Patients were classified according to the peri-interventional anticoagulation regimen receiving heparin (n = 6430) or bivalirudin (n = 593) with or without GpIIb/IIIa inhibitors (GPIs). In-hospital mortality (odds ratio [OR] 1.13, 95% confidence interval [CI] 0.57 to 2.25, p = 0.72), major adverse cardiovascular events (OR 1.18, 95% CI 0.65 to 2.14, p = 0.59), net adverse clinical events (OR 1.01, 95% CI 0.57 to 1.77, p = 0.99), and TIMI non-coronary artery bypass graft-related major bleeding (OR 0.41, 95% CI 0.09 to 1.86, p = 0.25) were not significantly different between the groups. However, we detected potential effect modifications of anticoagulants on mortality by GPIs (OR 0.12, 95% CI 0.01 to 1.07, p = 0.06) and access site (OR 0.25, 95% CI 0.06 to 1.03, p = 0.06) favoring bivalirudin in femoral access. In conclusion, this large real-world cohort of PPCI, heparin-based anticoagulation showed similar results of short-term mortality compared with bivalirudin. We observed a potential effect modification by additional GPI use and access favoring bivalirudin over heparin in femoral, but not radial, access.
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24
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El Ghannudi S, Hess S, Reydel A, Crimizade U, Jesel L, Radulescu B, Wiesel ML, Gachet C, Ohlmann P, Morel O. The extent of P2Y12 inhibition by clopidogrel in diabetes mellitus patients with acute coronary syndrome is not related to glycaemic control: Roles of white blood cell count and body weight. Thromb Haemost 2017; 108:338-48. [DOI: 10.1160/th11-12-0876] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2011] [Accepted: 05/11/2012] [Indexed: 11/05/2022]
Abstract
SummaryIt was the study objective to determine whether glycaemic control affects the extent of platelet inhibition by thienopyridines as assessed by vasodilator-stimulated phosphoprotein flow cytometry (VASP-FCT) in patients with diabetes mellitus (DM) undergoing percutaneous coronary intervention (PCI) during acute coronary syndrome (ACS). Although the proportion of high on-treatment residual platelet reactivity is higher in DM, the contributions of glycaemic control and other factors associated with DM, such as excess body weight and inflammation, to this impaired platelet inhibition by thienopyridines have not yet been fully characterised. In this study, the extent of P2Y12 ADP receptor pathway inhibition was evaluated by the VASP-FCT. Platelet activation was expressed as the platelet reactivity index (PRI). Low response to clopidogrel (LR) was defined as a PRI of >61%. Four hundred forty-five consecutive ACS patients (DM = 160, NDM = 285) were enrolled. The proportion of LR was higher in DM patients (50 vs. 37.5%). In DM, PRI was not correlated with glycosylated haemoglobin (HbA1c) or glycaemia. In a univariate analysis, LR was associated with age, male sex, overweight, and white blood cell count (WBC). In a multivariate analysis, WBC >10,000 and body weight >80 kg were the sole independent predictors of LR to clopidogrel (hazard ratio (HR) 3.02 [1.36–6.68], p=0.006 and HR 2.47 [1.14–5.35], p = 0.021, respectively). Conversely, in non-DM patients, ST-elevation myocardial infarction was the sole independent predictor of LR. In conclusion, in ACS DM patients undergoing PCI, the extent of P2Y12 inhibition by clopidogrel is not related to glycaemic control but is related to body weight and inflammatory status as assessed by the WBC.
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Postma S, Dambrink JH, Ottervanger JP, Gosselink M, Koopmans P, ten Berg J, Suryapranata H, van ’t Hof A. Early ambulance initiation versus in-hospital initiation of high dose clopidogrel in ST-segment elevation myocardial infarction. Thromb Haemost 2017; 112:606-13. [DOI: 10.1160/th13-11-0951] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Accepted: 03/27/2014] [Indexed: 11/05/2022]
Abstract
SummaryPre-hospital infarct diagnosis gives the opportunity to start anti-platelet and anti-thrombotic agents before arrival at the PCI centre. However, more evidence is necessary to demonstrate whether high dose (HD) clopidogrel (600 mg) administered in the ambulance is associated with improved initial patency of the infarct related vessel (IRV) and/or clinical outcome compared to in-hospital initiation of HD clopidogrel. From 2001 until 2009 all consecutive ST-Segment Elevation Myocardial Infarction (STEMI) patients who underwent pre-hospital diagnosis and therapy in the ambulance were prospectively included in our single-centre cohort study. We compared initial patency of the IRV and clinical outcome in patients treated from 2001 until June 2006 (in-hospital HD clopidogrel) with patients treated from July 2006 until 2009 (ambulance HD clopidogrel). A total of 2,475 patients with STEMI were registered; of these 1,110 (44.8%) received in-hospital HD clopidogrel and 1,365 (55.2%) received ambulance HD clopidogrel. Ambulance HD clopidogrel was not independently associated with initial patency (TIMI-2/3-flow pre-PCI (odds ratio: 1.18, 95% confidence interval [CI] 0.96–1.44); however, it was associated with fewer recurrent myocardial infarctions at 30 days (hazard ratio [HR]: 0.45, 95% CI 0.22–0.93) and at one year (HR: 0.45, 95% CI 0.25–0.80). No difference in TIMI 2/3 flow post-PCI, major bleeding, mortality, MACE – and the combination of mortality and recurrent myocardial infarction at 30-days and at one year was present between the two groups. In conclusion, early in-ambulance as compared to in-hospital initiation of HD clopidogrel in STEMI patients did not improve initial patency of the IRV or clinical outcome, except for a reduction of recurrent myocardial infarction. Therefore, early administration of HD clopidogrel seems to have net clinical benefit for these patients .
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26
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Benefits and risks of P2Y12 inhibitor preloading in patients with acute coronary syndrome and stable angina. J Thromb Thrombolysis 2017; 44:303-315. [DOI: 10.1007/s11239-017-1529-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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27
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Meta-analysis of clopidogrel pretreatment in acute coronary syndrome patients undergoing invasive strategy. Int J Cardiol 2017; 229:82-89. [DOI: 10.1016/j.ijcard.2016.11.226] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 11/07/2016] [Indexed: 11/21/2022]
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28
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Alyasin N. Clopidogrel loading dose in the management of ST elevation myocardial infarction: Still a debate! JOURNAL OF VASCULAR NURSING 2016; 34:44-6. [DOI: 10.1016/j.jvn.2016.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 01/10/2016] [Accepted: 01/10/2016] [Indexed: 10/21/2022]
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29
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Goldstein P, Grieco N, Ince H, Danchin N, Ramos Y, Goedicke J, Clemmensen P. Mortality in primary angioplasty patients starting antiplatelet therapy with prehospital prasugrel or clopidogrel: a 1-year follow-up from the European MULTIPRAC Registry. Vasc Health Risk Manag 2016; 12:143-51. [PMID: 27143908 PMCID: PMC4844294 DOI: 10.2147/vhrm.s95391] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aim MULTIPRAC was designed to provide insights into the use and outcomes associated with prehospital initiation of antiplatelet therapy with either prasugrel or clopidogrel in the context of primary percutaneous coronary intervention. After a previous report on efficacy and safety outcomes during hospitalization, we report here the 1-year follow-up data, including cardiovascular (CV) mortality. Methods and results MULTIPRAC is a multinational, prospective registry of patients with ST-elevation myocardial infarction (STEMI) from 25 hospitals in nine countries, all of which had an established practice of prehospital start of dual antiplatelet therapy in place. The key outcome was CV death at 1 year. Among 2,036 patients followed-up through 1 year, 49 died (2.4%), 10 during the initial hospitalization and 39 within 1 year after hospital discharge. The primary analysis was based on the P2Y12-inhibitor, used from prehospital loading dose through hospital discharge. Prasugrel (n=824) was more commonly used than clopidogrel (n=425). The observed 1-year rates for CV death were 0.5% with prasugrel and 2.6% with clopidogrel. After adjustment for differences in baseline characteristics, treatment with prasugrel was associated with a significantly lower risk of CV death than treatment with clopidogrel (odds ratio 0.248; 95% confidence interval 0.06–0.89). Conclusion In STEMI patients from routine practice undergoing primary angioplasty, who were able to start oral antiplatelet therapy prehospital, treatment with prasugrel as compared to clopidogrel was associated with a lower risk of CV death at 1-year follow-up.
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Affiliation(s)
- Patrick Goldstein
- Emergency Department, Lille Regional University Hospital, Lille, France
| | - Niccolò Grieco
- Department of Cardiology, Hospital Niguarda Cà Granda Milano, Milan, Italy
| | - Hüseyin Ince
- Internal Medicine Centre, Cardiology Department, Rostock University Clinic, Rostock, Germany; Department of Cardiology, Vivantes Klinikum im Friedrichshain and Am Urban, Berlin, Germany
| | - Nicolas Danchin
- Department of Cardiology, European Hospital Georges-Pompidou, Paris, France
| | - Yvonne Ramos
- Medical Department, Daiichi Sankyo Europe, Munich, Germany
| | - Jochen Goedicke
- Medical Department, Lilly Deutschland GmbH, Bad Homburg, Germany
| | - Peter Clemmensen
- Department of Medicine, Division of Cardiology, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark; Department of Medicine, Division of Cardiology, Nykoebing F Hospital, Copenhagen, Denmark
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30
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Capranzano P, Capodanno D, Bucciarelli-Ducci C, Gargiulo G, Tamburino C, Francaviglia B, Ohno Y, La Manna A, Antonella S, Attizzani GF, Angiolillo DJ, Tamburino C. Impact of residual platelet reactivity on reperfusion in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2016; 5:475-86. [DOI: 10.1177/2048872615624849] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 12/09/2015] [Indexed: 11/15/2022]
Affiliation(s)
- Piera Capranzano
- Cardiovascular Department, Ferrarotto Hospital, University of Catania, Catania, Italy
| | - Davide Capodanno
- Cardiovascular Department, Ferrarotto Hospital, University of Catania, Catania, Italy
| | - Chiara Bucciarelli-Ducci
- Bristol Heart Institute, Bristol NIHR Cardiovascular Biomedical Research Unit, University of Bristol, UK
| | - Giuseppe Gargiulo
- Cardiovascular Department, Ferrarotto Hospital, University of Catania, Catania, Italy
| | - Claudia Tamburino
- Cardiovascular Department, Ferrarotto Hospital, University of Catania, Catania, Italy
| | - Bruno Francaviglia
- Cardiovascular Department, Ferrarotto Hospital, University of Catania, Catania, Italy
| | - Yohei Ohno
- Cardiovascular Department, Ferrarotto Hospital, University of Catania, Catania, Italy
| | - Alessio La Manna
- Cardiovascular Department, Ferrarotto Hospital, University of Catania, Catania, Italy
| | - Salemi Antonella
- Cardiovascular Department, Ferrarotto Hospital, University of Catania, Catania, Italy
| | - Guilherme F Attizzani
- Cardiovascular Department, Ferrarotto Hospital, University of Catania, Catania, Italy
| | | | - Corrado Tamburino
- Cardiovascular Department, Ferrarotto Hospital, University of Catania, Catania, Italy
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31
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Mont'Alverne-Filho JR, Rodrigues-Sobrinho CRM, Medeiros F, Falcão FC, Falcão JL, Silva RC, Croce KJ, Nicolau JC, Valgimigli M, Serruys PW, Lemos PA. Upstream clopidogrel, prasugrel, or ticagrelor for patients treated with primary angioplasty: Results of an angiographic randomized pilot study. Catheter Cardiovasc Interv 2015; 87:1187-93. [PMID: 26614123 DOI: 10.1002/ccd.26334] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 09/25/2015] [Accepted: 10/24/2015] [Indexed: 11/08/2022]
Abstract
OBJETIVES The main objective of the present randomized pilot study was to explore the effects of upstream prasugrel or ticagrelor or clopidogrel for patients with ST-segment-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). BACKGROUND Administration of clopidogrel "as soon as possible" has been advocated for STEMI. Pretreatment with prasugrel and ticagrelor may improve reperfusion. Currently, the angiographic effects of upstream administration of these agents are poorly understood. METHODS A total of 132 patients with STEMI within the first 12 hr of chest pain referred to primary angioplasty were randomized to upstream clopidogrel (600 mg), prasugrel (60 mg), or ticagrelor (180 mg) while still in the emergency room. All patients underwent protocol-mandated thrombus aspiration. RESULTS Macroscopic thrombus material was retrieved in 79.5% of the clopidogrel group, 65.9% of the prasugrel group, and 54.3% of the ticagrelor group (P = 0.041). At baseline angiography, large thrombus burden was 97.7% vs. 87.8% vs. 80.4% in the clopidogrel, prasugrel, and ticagrelor groups, respectively (P = 0.036). Also, at baseline, 97.7% presented with an occluded target vessel in the clopidogrel group, 87.8% in the prasugrel group and 78.3% in the ticagrelor group (P = 0.019). At the end of the procedure, the percentages of patients with combined TIMI grade III flow and myocardial blush grade III were 52.3% for clopidogrel, 80.5% for prasugrel, and 67.4% for ticagrelor (P = 0.022). CONCLUSIONS In patients with STEMI undergoing primary PCI within 12 hr, upstream clopidogrel, prasugrel or ticagrelor have varying angiographic findings, with a trend toward better results for the latter two agents. © 2015 Wiley Periodicals, Inc.
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Affiliation(s)
- José R Mont'Alverne-Filho
- Catheterization Laboratory, Hospital De Messejana, Dr. Carlos Alberto Studart Gomes, Fortaleza-CE, Brazil.,Department of Cardiology, Federal University of Ceara, Fortaleza-CE, Brazil
| | | | - Fernando Medeiros
- Catheterization Laboratory, Hospital De Messejana, Dr. Carlos Alberto Studart Gomes, Fortaleza-CE, Brazil.,Department of Cardiology, Federal University of Ceara, Fortaleza-CE, Brazil
| | - Francisco C Falcão
- Department of Cardiology, Federal University of Ceara, Fortaleza-CE, Brazil
| | - Joao L Falcão
- Catheterization Laboratory, Hospital De Messejana, Dr. Carlos Alberto Studart Gomes, Fortaleza-CE, Brazil.,Department of Cardiology, Federal University of Ceara, Fortaleza-CE, Brazil
| | - Rafael C Silva
- Department of Interventional Cardiology, Heart Institute (InCor), University of São Paulo Medical School, Sao Paulo-SP, Brazil
| | - Kevin J Croce
- Brigham and Women's Hospital, Harvard Medical School, Cardiovascular Division, Boston, Massachusetts
| | - Jose C Nicolau
- Department of Interventional Cardiology, Heart Institute (InCor), University of São Paulo Medical School, Sao Paulo-SP, Brazil
| | - Marco Valgimigli
- Department of Interventional Cardiology, Erasmus University Medical Centre, Thoraxcenter, Rotterdam, The Netherlands
| | - Patrick W Serruys
- Department of Interventional Cardiology, Erasmus University Medical Centre, Thoraxcenter, Rotterdam, The Netherlands.,International Centre for Circulatory Health, NHLI, Imperial College London, London, United Kingdom
| | - Pedro A Lemos
- Department of Interventional Cardiology, Heart Institute (InCor), University of São Paulo Medical School, Sao Paulo-SP, Brazil
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32
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Jukema JW, Lettino M, Widimský P, Danchin N, Bardaji A, Barrabes JA, Cequier A, Claeys MJ, De Luca L, Dörler J, Erlinge D, Erne P, Goldstein P, Koul SM, Lemesle G, Lüscher TF, Matter CM, Montalescot G, Radovanovic D, Lopez-Sendón J, Tousek P, Weidinger F, Weston CF, Zaman A, Zeymer U. Contemporary registries on P2Y12 inhibitors in patients with acute coronary syndromes in Europe: overview and methodological considerations: Table 1. EUROPEAN HEART JOURNAL - CARDIOVASCULAR PHARMACOTHERAPY 2015; 1:232-244. [DOI: 10.1093/ehjcvp/pvv024] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Windecker S, Kolh P, Alfonso F, Collet JP, Cremer J, Falk V, Filippatos G, Hamm C, Head SJ, Jüni P, Kappetein AP, Kastrati A, Knuuti J, Landmesser U, Laufer G, Neumann FJ, Richter DJ, Schauerte P, Sousa Uva M, Stefanini GG, Taggart DP, Torracca L, Valgimigli M, Wijns W, Witkowski A. 2014 ESC/EACTS guidelines on myocardial revascularization. EUROINTERVENTION 2015; 10:1024-94. [PMID: 25187201 DOI: 10.4244/eijy14m09_01] [Citation(s) in RCA: 211] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Stephan Windecker
- Cardiology, Bern University Hospital, Freiburgstrasse 4, CH-3010 Bern, Switzerland
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De Luca L, Danchin N, Valgimigli M, Goldstein P. Effectiveness of Pretreatment With Dual Oral Antiplatelet Therapy. Am J Cardiol 2015; 116:660-8. [PMID: 26092274 DOI: 10.1016/j.amjcard.2015.05.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Revised: 05/07/2015] [Accepted: 05/07/2015] [Indexed: 11/29/2022]
Abstract
Several observational studies, randomized controlled trials, and meta-analyses suggested that pretreatment with clopidogrel in addition to aspirin could reduce the rate of ischemic events, especially in the setting of acute coronary syndromes. Newer P2Y12 inhibitors like prasugrel and ticagrelor, which provide faster and stronger platelet inhibition compared with clopidogrel, would enhance the benefits of pretreatment. However, 2 recent randomized trials, A Comparison of Prasugrel at PCI or Time of Diagnosis of Non-ST Elevation Myocardial Infarction and the Administration of Ticagrelor in the Cath Lab or in the Ambulance for New ST Elevation Myocardial Infarction to Open the Coronary Artery studies, aimed at assessing the effects of the timing of administration of novel P2Y12 inhibitors in acute coronary syndromes, failed to meet their primary end points. In this report, we review clinical data on pretreatment with dual oral antiplatelet therapy and comment on some criticisms raised from recent trials.
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Affiliation(s)
- Leonardo De Luca
- Department of Cardiovascular Sciences, European Hospital, Rome, Italy.
| | - Nicolas Danchin
- Department of Cardiology, European Hospital Georges-Pompidiou, Paris, France
| | - Marco Valgimigli
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
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Alexopoulos D, Bhatt DL, Hamm CW, Steg PG, Stone GW. Early P2Y12 inhibition in ST-segment elevation myocardial infarction: Bridging the gap. Am Heart J 2015; 170:3-12. [PMID: 26093859 DOI: 10.1016/j.ahj.2015.04.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 04/12/2015] [Indexed: 11/25/2022]
Abstract
Rapid and consistent platelet inhibition represents the cornerstone of pharmacologic treatment in the early hours of ST-segment elevation myocardial infarction (STEMI). Oral P2Y12 inhibitors are recommended to be administered as early as possible in patients with STEMI undergoing primary percutaneous coronary intervention. However, a delay in the onset of antiplatelet agent effects has been recently described in the first several hours after oral administration of clopidogrel, prasugrel, and ticagrelor. As a result, primary percutaneous coronary intervention is performed in most cases with P2Y12 inhibition that may be inadequate. Several strategies may be applied in order to "bridge the gap" in platelet inhibition after oral P2Y12 inhibitors in STEMI, such as upstream administration of P2Y12 inhibitors, loading dose modification, use of an intravenous P2Y12 inhibitor, or glycoprotein IIb/IIIa inhibitors' administration. These strategies may further improve clinical outcomes in this high-risk "golden window."
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36
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Costa F, Ariotti S, Valgimigli M, Kolh P, Windecker S. Perspectives on the 2014 ESC/EACTS Guidelines on Myocardial Revascularization : Fifty Years of Revascularization: Where Are We and Where Are We Heading? J Cardiovasc Transl Res 2015; 8:211-20. [PMID: 25986910 PMCID: PMC4473080 DOI: 10.1007/s12265-015-9632-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Accepted: 04/28/2015] [Indexed: 02/06/2023]
Abstract
The joint European Society of Cardiology and European Association of Cardio-Thoracic Surgery (ESC/EACTS) guidelines on myocardial revascularization collect and summarize the evidence regarding decision-making, diagnostics, and therapeutics in various clinical scenarios of coronary artery disease, including elective, urgent, and emergency settings. The 2014 document updates and extends the effort started in 2010, year of the first edition of these guidelines. Importantly, this latest edition provides a systematic review of all randomized clinical trials performed since 1980, comparing different strategies of myocardial revascularization, including coronary artery bypass graft (CABG), balloon angioplasty, percutaneous coronary intervention (PCI) with bare-metal stents (BMS) and first- and second-generation drug-eluting stents (DES). This review aims to highlight the most relevant novelties introduced by the 2014 edition of the ESC/EACTS myocardial revascularization guidelines as compared with the previous edition and to describe similarities and differences with the American societies' guidelines.
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Affiliation(s)
- Francesco Costa
- />Thoraxcenter, Erasmus Medical Center, 3015 CE Rotterdam, The Netherlands
- />Department of Clinical and Experimental Medicine, Policlinico “G. Martino”, University of Messina, Messina, Italy
| | - Sara Ariotti
- />Thoraxcenter, Erasmus Medical Center, 3015 CE Rotterdam, The Netherlands
- />Division of Cardiology of the Department of Medicine, University of Verona, Verona, Italy
| | - Marco Valgimigli
- />Thoraxcenter, Erasmus Medical Center, 3015 CE Rotterdam, The Netherlands
| | - Philippe Kolh
- />Cardiovascular Surgery Department, University Hospital (CHU, ULg) of Liege, Liege, Belgium
| | - Stephan Windecker
- />Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - on behalf of the Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS)
- />Thoraxcenter, Erasmus Medical Center, 3015 CE Rotterdam, The Netherlands
- />Department of Clinical and Experimental Medicine, Policlinico “G. Martino”, University of Messina, Messina, Italy
- />Division of Cardiology of the Department of Medicine, University of Verona, Verona, Italy
- />Cardiovascular Surgery Department, University Hospital (CHU, ULg) of Liege, Liege, Belgium
- />Department of Cardiology, Bern University Hospital, Bern, Switzerland
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Pre-hospital ticagrelor in ST-segment elevation myocardial infarction: Ready for prime time? Int J Cardiol 2015; 194:41-3. [PMID: 26011263 DOI: 10.1016/j.ijcard.2015.05.064] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 04/26/2015] [Accepted: 05/09/2015] [Indexed: 11/21/2022]
Abstract
In ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI) peri-procedural P2Y12 antagonism - although of great importance - is often suboptimal, even with the novel oral antiplatelet agents prasugrel and ticagrelor. The concept of pre-hospital ticagrelor loading, investigated in the recently published Administration of Ticagrelor in the Cath Lab or in the Ambulance for New ST Elevation Myocardial Infarction to Open the Coronary Artery (ATLANTIC) trial, appears quite a promising strategy to optimize peri-procedural platelet inhibition and potentially clinical outcome. Implementation of such an approach when treating low risk STEMI patients in 'real life' practice might prove even more beneficial than expected from the ATLANTIC results, given the reported delays from first medical contact to primary PCI performance.
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Aradi D, Sibbing D. ATLANTIC: another reason to investigate the disconnect between stent thrombosis and mortality? Thromb Haemost 2015; 114:9-10. [PMID: 25947260 DOI: 10.1160/th15-02-0159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 02/20/2015] [Indexed: 11/05/2022]
Affiliation(s)
- Daniel Aradi
- Dániel Aradi, MD, PhD, 2 Gyogy Ter Balatonfüred, 8230 Hungary, Tel.: +36 302355639, E-mail:
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Almendro-Delia M, Gonzalez-Torres L, Garcia-Alcantara Á, Reina-Toral A, Arboleda Sánchez JA, Rodríguez Yañez JC, Hidalgo-Urbano R, García Rubira JC. Prognostic impact of clopidogrel pretreatment in patients with acute coronary syndrome managed invasively. Am J Cardiol 2015; 115:1019-26. [PMID: 25728644 DOI: 10.1016/j.amjcard.2015.01.531] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 01/20/2015] [Accepted: 01/20/2015] [Indexed: 11/15/2022]
Abstract
Pretreatment with antiP2Y12 agents before angiography in acute coronary syndrome (ACS) is associated with a reduction in thrombotic events. However, recent evidences have questioned the benefits of upstream antiP2Y12, reporting a higher incidence of bleeding. We analyzed the prognostic impact of clopidogrel pretreatment in a large cohort of invasively managed patients with ACS. In hospital, safety and efficacy of clopidogrel pretreatment were retrospectively analyzed in patients included in the ARIAM-Andalucía Registry (Analysis of Delay in Acute Myocardial Infarction). Propensity score and inverse probability of treatment weighting analysis were performed to control treatment selection bias. Results were stratified by ACS type. Sensitivity analyses were used to explore stability of the overall treatment effect. Of 9,621 patients managed invasively, 69% received clopidogrel before coronary angiography. In the ST-elevation myocardial infarction group, pretreatment was associated with a significant reduction in reinfarction (odds ratio 0.53, 95% confidence interval [CI] 0.27 to 0.96; p = 0.027), stent thrombosis (odds ratio 0.15, 95% CI 0.06 to 0.38; p <0.0001), and mortality (odds ratio 0.67, 95% CI 0.48 to 0.94; p = 0.020), with an increase in minor bleeding but remained as a net clinical benefit strategy. Those benefits were not present in patients without ST elevation (non-ST elevation ACS). The weighting and propensity analysis confirmed the same results. An interaction between pretreatment duration and bleeding was observed. In conclusion, pretreatment with clopidogrel reduced the occurrence of death and thrombotic outcomes at the cost of minor bleeding. Those benefits exclusively affected ST-elevation myocardial infarction cases. The potential benefit of routine upstream pretreatment in patients with non-ST-elevation ACS should be reappraised at the present.
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Affiliation(s)
- Manuel Almendro-Delia
- Coronary Care Unit, UGC Área del Corazón Sevilla, Hospital Universitario Virgen Macarena, Sevilla, Spain.
| | - Luis Gonzalez-Torres
- Coronary Care Unit, UGC Área del Corazón Sevilla, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | | | | | | | | | - Rafael Hidalgo-Urbano
- Coronary Care Unit, UGC Área del Corazón Sevilla, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - Juan C García Rubira
- Coronary Care Unit, UGC Área del Corazón Sevilla, Hospital Universitario Virgen Macarena, Sevilla, Spain
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Capodanno D, Angiolillo DJ. Pretreatment With Antiplatelet Drugs in Invasively Managed Patients With Coronary Artery Disease in the Contemporary Era. Circ Cardiovasc Interv 2015; 8:e002301. [DOI: 10.1161/circinterventions.114.002301] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Davide Capodanno
- From the Department of General Surgery and Medical-Surgical Specialties, Ferrarotto Hospital, University of Catania, Catania, Italy (D.C.); and Division of Cardiology, University of Florida College of Medicine-Jacksonville (D.J.A.)
| | - Dominick J. Angiolillo
- From the Department of General Surgery and Medical-Surgical Specialties, Ferrarotto Hospital, University of Catania, Catania, Italy (D.C.); and Division of Cardiology, University of Florida College of Medicine-Jacksonville (D.J.A.)
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Ferlini M, Marino M, Visconti LO, Bramucci E. Will cangrelor become the favored agent for acute coronary syndrome treatment? Interv Cardiol 2014. [DOI: 10.2217/ica.14.48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Bellemain-Appaix A, Kerneis M, O'Connor SA, Silvain J, Cucherat M, Beygui F, Barthélémy O, Collet JP, Jacq L, Bernasconi F, Montalescot G. Reappraisal of thienopyridine pretreatment in patients with non-ST elevation acute coronary syndrome: a systematic review and meta-analysis. BMJ 2014; 349:g6269. [PMID: 25954988 PMCID: PMC4208629 DOI: 10.1136/bmj.g6269] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To investigate the effect of pretreatment with P2Y12 receptor inhibitors compared with no pretreatment on efficacy and safety of treatment of non-ST elevation acute coronary syndrome (ACS). DATA SOURCES Two reviewers independently searched Medline, Embase, Cochrane Controlled Trials, and BioMed Central databases for randomized placebo controlled trials and observational studies from August 2001 to March 2014. STUDY ELIGIBILITY Studies must have reported both all-cause mortality (primary efficacy endpoint) and major bleeding (safety endpoint) outcomes. DATA EXTRACTION Data on sample size, characteristics, drug dose and delay of administration, and outcomes were independently extracted and analyzed. DATA SYNTHESIS A random-effect model was applied. The analysis was performed (i) in all patients independently of the management strategy and (ii) only in patients undergoing percutaneous coronary intervention. RESULTS Of the 393 titles identified, seven (four randomized controlled trials, one observational analysis from a randomized controlled trial, and three observational studies) met the inclusion criteria. No study was identified for ticagrelor or cangrelor, and analyses were thus limited to thienopyridines. A total of 32,383 non-ST elevation ACS patients were included, 18,711 coming from randomized controlled trials. Of these, 55% underwent percutaneous coronary intervention (PCI). Pretreatment was not associated with a significant lower risk of mortality in all patients (odds ratio 0.90 (95% confidence interval 0.75 to 1.07), P=0.24), in particular when considering only the randomized controlled trials (odds ratio 0.90 (0.71 to 1.14), P=0.39). Similar results were observed in the cohort of patients undergoing PCI. A significant 30-45% excess of major bleeding was consistently observed in all patients (odds ratio 1.32 (1.16 to 1.49), P<0.0001) and in those undergoing PCI, as well as in the subset analyses of randomized controlled trials of these two cohorts of patients. There was a reduction in major adverse cardiovascular events in the analysis of all patients (odds ratio 0.84 (0.72 to 0.98), P=0.02), driven by the old clopidogrel studies (CURE and CREDO), but the difference was not significant for the cohort of patients undergoing PCI. Stent thrombosis, stroke, and urgent revascularization did not differ between groups (pretreatment v no pretreatment). The results were consistent for both thienopyridines and confirmed in sensitivity analyses. LIMITATIONS Analysis was not performed on individual patient's data. CONCLUSION In patients presenting with non-ST elevation ACS, pretreatment with thienopyridines is associated with no significant reduction of mortality but with a significant excess of major bleeding no matter the strategy adopted, invasive or not. Our results do not support a strategy of routine pretreatment in patients with non-ST elevation ACS.
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Affiliation(s)
- Anne Bellemain-Appaix
- Service de Cardiologie-La Fontonne Hospital, Antibes, France ACTION Study Group, Paris, France
| | - Mathieu Kerneis
- Institut de Cardiologie, INSERM UMRS1166, Pitié-Salpêtrière Hospital (AP-HP), Université Paris 6, France ACTION Study Group, Paris, France
| | - Stephen A O'Connor
- Institut de Cardiologie, INSERM UMRS1166, Pitié-Salpêtrière Hospital (AP-HP), Université Paris 6, France ACTION Study Group, Paris, France
| | - Johanne Silvain
- Institut de Cardiologie, INSERM UMRS1166, Pitié-Salpêtrière Hospital (AP-HP), Université Paris 6, France ACTION Study Group, Paris, France
| | | | - Farzin Beygui
- Institut de Cardiologie, INSERM UMRS1166, Pitié-Salpêtrière Hospital (AP-HP), Université Paris 6, France ACTION Study Group, Paris, France
| | - Olivier Barthélémy
- Institut de Cardiologie, INSERM UMRS1166, Pitié-Salpêtrière Hospital (AP-HP), Université Paris 6, France ACTION Study Group, Paris, France
| | - Jean-Philippe Collet
- Institut de Cardiologie, INSERM UMRS1166, Pitié-Salpêtrière Hospital (AP-HP), Université Paris 6, France ACTION Study Group, Paris, France
| | - Laurent Jacq
- Service de Cardiologie-La Fontonne Hospital, Antibes, France
| | | | - Gilles Montalescot
- Institut de Cardiologie, INSERM UMRS1166, Pitié-Salpêtrière Hospital (AP-HP), Université Paris 6, France ACTION Study Group, Paris, France
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[Antiplatelet therapy in acute coronary syndrome. Prehospital phase: nothing, aspirin or what?]. Herz 2014; 39:803-7. [PMID: 25315248 DOI: 10.1007/s00059-014-4157-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
In most cases of ST segment elevation myocardial infarction (STEMI) a major coronary vessel is occluded by a thrombus. This is why early and effective antiplatelet therapy plays a key role. The current guidelines recommend the administration of dual antiplatelet therapy as early as possible. Despite the lack of convincing clinical evidence, prehospital administration appears reasonable, primarily because of pharmacokinetic considerations. Ticagrelor should be preferentially administered because the largest amount of evidence is available and it appears to be safe. In high-risk patients undergoing transfer to a catheterization laboratory, upstream use of a glycoprotein (GP) IIb/IIIa receptor antagonist (tirofiban) may be considered. Acute coronary syndrome without ST segment elevation (NSTE-ACS) represents a clinically heterogeneous group. Current guidelines recommend that antiplatelet therapy should be initiated as early as possible when the diagnosis of NSTE-ACS is made. If there is high clinical suspicion of NSTE-ACS acetylsalicylic acid (ASA) should be given before hospital admission. In high-risk patients prehospital administration of ticagrelor may be considered.
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Windecker S, Kolh P, Alfonso F, Collet JP, Cremer J, Falk V, Filippatos G, Hamm C, Head SJ, Jüni P, Kappetein AP, Kastrati A, Knuuti J, Landmesser U, Laufer G, Neumann FJ, Richter DJ, Schauerte P, Sousa Uva M, Stefanini GG, Taggart DP, Torracca L, Valgimigli M, Wijns W, Witkowski A. 2014 ESC/EACTS Guidelines on myocardial revascularization: The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS)Developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur Heart J 2014; 35:2541-619. [PMID: 25173339 DOI: 10.1093/eurheartj/ehu278] [Citation(s) in RCA: 3287] [Impact Index Per Article: 328.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Ashrafi R, Hussain H, Brisk R, Boardman L, Weston C. Clinical disease registries in acute myocardial infarction. World J Cardiol 2014; 6:415-423. [PMID: 24976913 PMCID: PMC4072831 DOI: 10.4330/wjc.v6.i6.415] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2013] [Accepted: 04/16/2014] [Indexed: 02/07/2023] Open
Abstract
Disease registries, containing systematic records of cases, have for nearly 100 years been valuable in exploring and understanding various aspects of cardiology. This is particularly true for myocardial infarction, where such registries have provided both epidemiological and clinical information that was not readily available from randomised controlled trials in highly-selected populations. Registries, whether mandated or voluntary, prospective or retrospective in their analysis, have at their core a common study population and common data definitions. In this review we highlight how registries have diversified to offer information on epidemiology, risk modelling, quality assurance/improvement and original research-through data mining, transnational comparisons and the facilitation of enrolment in, and follow-up during registry-based randomised clinical trials.
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Kubica J, Kozinski M, Navarese EP, Tantry U, Kubica A, Siller-Matula JM, Jeong YH, Fabiszak T, Andruszkiewicz A, Gurbel PA. Cangrelor: an emerging therapeutic option for patients with coronary artery disease. Curr Med Res Opin 2014; 30:813-28. [PMID: 24393016 DOI: 10.1185/03007995.2014.880050] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To perform a systematic up-to-date review and critical discussion of potential clinical applications of cangrelor based on its pharmacologic properties and the main findings from randomized clinical studies. METHODS A database search (PubMed, CENTRAL and Google Scholar) by two independent investigators, including proceedings from scientific sessions of ACC, AHA, ESC, TCT and EuroPCR, from January 1998 through December 2013. RESULTS Cangrelor is a potent, intravenous, direct-acting P2Y12 antagonist with rapid onset and quickly reversible action. In contrast to ticagrelor, cangrelor's interaction with thienopiridines requires termination of cangrelor infusion before switching to clopidogrel or prasugrel. According to randomized trials, a cangrelor-clopidogrel combination is relatively safe and more effective than the standard clopidogrel regimen in both urgent and elective percutaneous coronary intervention (PCI) settings, with the advantage of this drug combination fully evident when the universal definition of myocardial infarction is applied. In contrast to available antiplatelet drugs with delayed onset and offset of action, its favorable properties make cangrelor a desirable agent for ad hoc elective PCI, high risk acute coronary syndromes treated with immediate coronary stenting and for bridging those surgery patients who require periprocedural P2Y12 inhibition. Current evidence on cangrelor therapy is limited by the lack of adequately powered studies assessing cangrelor co-administration either with prasugrel or ticagrelor, suboptimal design of some of the trials favoring cangrelor, potentially attenuated benefits with modern stent design, and finally, by the lack of survival advantage. CONCLUSIONS With its pharmacokinetic and pharmacodynamic advantages, allowing consistent and strong P2Y12 inhibition, and with its rapid onset and swift reversal of action devoid of need for an antidote, cangrelor might improve clinical outcomes in clopidogrel-treated patients by reducing ischemic events, while maintaining a favorable safety profile. However, further studies, addressing the safety and efficacy of cangrelor on top of novel oral P2Y12 inhibitors, are warranted.
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Affiliation(s)
- Jacek Kubica
- Collegium Medicum, Nicolaus Copernicus University , Bydgoszcz , Poland
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CardioPulse Articles. Eur Heart J 2014; 35:531-2. [DOI: 10.1093/eurheartj/ehu003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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de Waha S, Eitel I, Desch S, Fuernau G, Lurz P, Schuler G, Thiele H. Association of upstream clopidogrel administration and myocardial reperfusion assessed by cardiac magnetic resonance imaging in patients with ST-elevation myocardial infarction. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2014; 3:110-7. [DOI: 10.1177/2048872614520752] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Beigel R, Fefer P, Rosenberg N, Novikov I, Elian D, Fink N, Segev A, Guetta V, Hod H, Matetzky S. Antiplatelet effect of thienopyridine (clopidogrel or prasugrel) pretreatment in patients undergoing primary percutaneous intervention for ST elevation myocardial infarction. Am J Cardiol 2013; 112:1551-6. [PMID: 23972349 DOI: 10.1016/j.amjcard.2013.07.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Revised: 07/12/2013] [Accepted: 07/12/2013] [Indexed: 10/26/2022]
Abstract
Although previous retrospective studies have suggested the clinical benefits of clopidogrel pretreatment in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI), the antiplatelet effect of thienopyridines during a narrow door-to-balloon time frame has not been evaluated. Seventy-nine consecutive patients with STEMI were treated with either 600 mg of clopidogrel (n = 49) or 60 mg of prasugrel (n = 30) loading on admission. All patients underwent PPCI with a door-to-balloon time of 48 ± 20 minutes. Adenosine diphosphate (ADP)-induced platelet aggregation (PA) was determined by light transmission aggregometry before thienopyridine loading, at PPCI, and after 72 hours. Baseline ADP-induced PA was comparable in clopidogrel- and prasugrel-treated patients (79 ± 10% vs 76 ± 9%, p = 0.2). Although ADP-induced PA was reduced significantly in both clopidogrel- and prasugrel-treated patients (p <0.01 for both), it was significantly lesser in prasugrel-treated patients (63 ± 18% vs 74 ± 12%, p = 0.002). Yet, <50% of the prasugrel-treated patients achieved adequate platelet inhibition (ADP-induced PA <70%) at PPCI. Prasugrel-treated patients, compared with clopidogrel-treated patients, were more likely to have Thrombolysis In Myocardial Infarction myocardial perfusion grade of ≥2 (79% vs 49%, p = 0.01), lower Thrombolysis In Myocardial Infarction frame count (10.2 ± 5.7 vs 13.6 ± 7.2, p = 0.03), and a numerically greater incidence of early ST-segment resolution >50% (26 of 30 [87%] vs 35 of 49 [71%], p = 0.1), suggesting better myocardial reperfusion. In conclusion, overall, prasugrel compared with clopidogrel pretreatment resulted in greater platelet inhibition at PPCI, but even with prasugrel, only <50% of the patients achieved early adequate platelet response.
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Clemmensen P, Dridi NP, Holmvang L. Dual antiplatelet therapy with prasugrel or ticagrelor versus clopidogrel in interventional cardiology. Cardiovasc Drugs Ther 2013; 27:239-45. [PMID: 23380983 DOI: 10.1007/s10557-013-6444-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
For several years, clopidogrel plus aspirin has been the dual antiplatelet therapy (DAPT) of choice for patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI) with stent implantation. More recently, prasugrel and ticagrelor have demonstrated greater efficacy than clopidogrel. In TRITON-TIMI 38, the risk of TIMI major bleeding unrelated to coronary artery bypass graft (CABG) surgery was similar for prasugrel and clopidogrel after excluding subgroups with increased bleeding risk (previous stroke or transient ischemic event; age ≥75 years; weight <60 kg). In the PLATO trial, rates of TIMI major bleeding were similar for ticagrelor and clopidogrel, but ticagrelor was associated with a significantly higher rate of non-CABG-related TIMI major bleeding. Current evidence suggests that prasugrel or ticagrelor plus aspirin should be the DAPT of choice in patients with ACS undergoing PCI unless they are at particularly high risk of bleeding. No studies have yet compared prasugrel and ticagrelor in ACS patients, however prasugrel and ticagrelor have different side effect profiles, and the choice of agent should be made either as a default choice and/or on an individual patient basis. Ongoing trials in ACS patients will increase the evidence base for new P2Y(12) receptor inhibitors and help to establish the most effective DAPT regimens.
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Affiliation(s)
- Peter Clemmensen
- Department of Cardiology B, The Heart Centre, Rigshospitalet - Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark.
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