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Cited by Other Article(s)

Castiello DS, Buongiorno F, Manzi L, Narciso V, Forzano I, Florimonte D, Sperandeo L, Canonico ME, Avvedimento M, Paolillo R, Spinelli A, Cristiano S, Simonetti F, Semplice F, D’Alconzo D, Vallone DM, Giugliano G, Sciahbasi A, Cirillo P, Gragnano F, Calabrò P, Esposito G, Gargiulo G. Procedural and Antithrombotic Therapy Optimization in Patients with Atrial Fibrillation Undergoing Percutaneous Coronary Intervention: A Narrative Review. J Cardiovasc Dev Dis 2025;12:142. [PMID: 40278201 PMCID: PMC12028227 DOI: 10.3390/jcdd12040142] [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: 02/25/2025] [Revised: 04/03/2025] [Accepted: 04/05/2025] [Indexed: 04/26/2025] Open

Affiliation(s)

Domenico Simone Castiello Department of Advanced Biomedical Sciences, University of Naples Federico II, 80138 Naples, Italy; (D.S.C.); (F.B.); (L.M.); (V.N.); (I.F.); (D.F.); (L.S.); (M.E.C.); (M.A.); (R.P.); (A.S.); (S.C.); (F.S.); (F.S.); (D.D.); (D.M.V.); (G.G.); (P.C.); (G.E.)
Federica Buongiorno Department of Advanced Biomedical Sciences, University of Naples Federico II, 80138 Naples, Italy; (D.S.C.); (F.B.); (L.M.); (V.N.); (I.F.); (D.F.); (L.S.); (M.E.C.); (M.A.); (R.P.); (A.S.); (S.C.); (F.S.); (F.S.); (D.D.); (D.M.V.); (G.G.); (P.C.); (G.E.)
Lina Manzi Department of Advanced Biomedical Sciences, University of Naples Federico II, 80138 Naples, Italy; (D.S.C.); (F.B.); (L.M.); (V.N.); (I.F.); (D.F.); (L.S.); (M.E.C.); (M.A.); (R.P.); (A.S.); (S.C.); (F.S.); (F.S.); (D.D.); (D.M.V.); (G.G.); (P.C.); (G.E.)
Viviana Narciso Department of Advanced Biomedical Sciences, University of Naples Federico II, 80138 Naples, Italy; (D.S.C.); (F.B.); (L.M.); (V.N.); (I.F.); (D.F.); (L.S.); (M.E.C.); (M.A.); (R.P.); (A.S.); (S.C.); (F.S.); (F.S.); (D.D.); (D.M.V.); (G.G.); (P.C.); (G.E.)
Imma Forzano Department of Advanced Biomedical Sciences, University of Naples Federico II, 80138 Naples, Italy; (D.S.C.); (F.B.); (L.M.); (V.N.); (I.F.); (D.F.); (L.S.); (M.E.C.); (M.A.); (R.P.); (A.S.); (S.C.); (F.S.); (F.S.); (D.D.); (D.M.V.); (G.G.); (P.C.); (G.E.)
Domenico Florimonte Department of Advanced Biomedical Sciences, University of Naples Federico II, 80138 Naples, Italy; (D.S.C.); (F.B.); (L.M.); (V.N.); (I.F.); (D.F.); (L.S.); (M.E.C.); (M.A.); (R.P.); (A.S.); (S.C.); (F.S.); (F.S.); (D.D.); (D.M.V.); (G.G.); (P.C.); (G.E.)
Luca Sperandeo Department of Advanced Biomedical Sciences, University of Naples Federico II, 80138 Naples, Italy; (D.S.C.); (F.B.); (L.M.); (V.N.); (I.F.); (D.F.); (L.S.); (M.E.C.); (M.A.); (R.P.); (A.S.); (S.C.); (F.S.); (F.S.); (D.D.); (D.M.V.); (G.G.); (P.C.); (G.E.)
Mario Enrico Canonico Department of Advanced Biomedical Sciences, University of Naples Federico II, 80138 Naples, Italy; (D.S.C.); (F.B.); (L.M.); (V.N.); (I.F.); (D.F.); (L.S.); (M.E.C.); (M.A.); (R.P.); (A.S.); (S.C.); (F.S.); (F.S.); (D.D.); (D.M.V.); (G.G.); (P.C.); (G.E.)
Marisa Avvedimento Department of Advanced Biomedical Sciences, University of Naples Federico II, 80138 Naples, Italy; (D.S.C.); (F.B.); (L.M.); (V.N.); (I.F.); (D.F.); (L.S.); (M.E.C.); (M.A.); (R.P.); (A.S.); (S.C.); (F.S.); (F.S.); (D.D.); (D.M.V.); (G.G.); (P.C.); (G.E.)
Roberta Paolillo Department of Advanced Biomedical Sciences, University of Naples Federico II, 80138 Naples, Italy; (D.S.C.); (F.B.); (L.M.); (V.N.); (I.F.); (D.F.); (L.S.); (M.E.C.); (M.A.); (R.P.); (A.S.); (S.C.); (F.S.); (F.S.); (D.D.); (D.M.V.); (G.G.); (P.C.); (G.E.)
Alessandra Spinelli Department of Advanced Biomedical Sciences, University of Naples Federico II, 80138 Naples, Italy; (D.S.C.); (F.B.); (L.M.); (V.N.); (I.F.); (D.F.); (L.S.); (M.E.C.); (M.A.); (R.P.); (A.S.); (S.C.); (F.S.); (F.S.); (D.D.); (D.M.V.); (G.G.); (P.C.); (G.E.)
Stefano Cristiano Department of Advanced Biomedical Sciences, University of Naples Federico II, 80138 Naples, Italy; (D.S.C.); (F.B.); (L.M.); (V.N.); (I.F.); (D.F.); (L.S.); (M.E.C.); (M.A.); (R.P.); (A.S.); (S.C.); (F.S.); (F.S.); (D.D.); (D.M.V.); (G.G.); (P.C.); (G.E.)
Fiorenzo Simonetti Department of Advanced Biomedical Sciences, University of Naples Federico II, 80138 Naples, Italy; (D.S.C.); (F.B.); (L.M.); (V.N.); (I.F.); (D.F.); (L.S.); (M.E.C.); (M.A.); (R.P.); (A.S.); (S.C.); (F.S.); (F.S.); (D.D.); (D.M.V.); (G.G.); (P.C.); (G.E.)
Federica Semplice Department of Advanced Biomedical Sciences, University of Naples Federico II, 80138 Naples, Italy; (D.S.C.); (F.B.); (L.M.); (V.N.); (I.F.); (D.F.); (L.S.); (M.E.C.); (M.A.); (R.P.); (A.S.); (S.C.); (F.S.); (F.S.); (D.D.); (D.M.V.); (G.G.); (P.C.); (G.E.)
Dario D’Alconzo Department of Advanced Biomedical Sciences, University of Naples Federico II, 80138 Naples, Italy; (D.S.C.); (F.B.); (L.M.); (V.N.); (I.F.); (D.F.); (L.S.); (M.E.C.); (M.A.); (R.P.); (A.S.); (S.C.); (F.S.); (F.S.); (D.D.); (D.M.V.); (G.G.); (P.C.); (G.E.)
Donato Maria Vallone Department of Advanced Biomedical Sciences, University of Naples Federico II, 80138 Naples, Italy; (D.S.C.); (F.B.); (L.M.); (V.N.); (I.F.); (D.F.); (L.S.); (M.E.C.); (M.A.); (R.P.); (A.S.); (S.C.); (F.S.); (F.S.); (D.D.); (D.M.V.); (G.G.); (P.C.); (G.E.)
Giuseppe Giugliano Department of Advanced Biomedical Sciences, University of Naples Federico II, 80138 Naples, Italy; (D.S.C.); (F.B.); (L.M.); (V.N.); (I.F.); (D.F.); (L.S.); (M.E.C.); (M.A.); (R.P.); (A.S.); (S.C.); (F.S.); (F.S.); (D.D.); (D.M.V.); (G.G.); (P.C.); (G.E.)
Alessandro Sciahbasi Interventional Cardiology, Sandro Pertini Hospital, 00157 Rome, Italy;
Plinio Cirillo Department of Advanced Biomedical Sciences, University of Naples Federico II, 80138 Naples, Italy; (D.S.C.); (F.B.); (L.M.); (V.N.); (I.F.); (D.F.); (L.S.); (M.E.C.); (M.A.); (R.P.); (A.S.); (S.C.); (F.S.); (F.S.); (D.D.); (D.M.V.); (G.G.); (P.C.); (G.E.)
Felice Gragnano Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (F.G.); (P.C.) Division of Cardiology, Azienda Ospedaliera di Rilievo Nazionale Sant’Anna e San Sebastiano, 81100 Caserta, Italy
Paolo Calabrò Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (F.G.); (P.C.) Division of Cardiology, Azienda Ospedaliera di Rilievo Nazionale Sant’Anna e San Sebastiano, 81100 Caserta, Italy
Giovanni Esposito Department of Advanced Biomedical Sciences, University of Naples Federico II, 80138 Naples, Italy; (D.S.C.); (F.B.); (L.M.); (V.N.); (I.F.); (D.F.); (L.S.); (M.E.C.); (M.A.); (R.P.); (A.S.); (S.C.); (F.S.); (F.S.); (D.D.); (D.M.V.); (G.G.); (P.C.); (G.E.)
Giuseppe Gargiulo Department of Advanced Biomedical Sciences, University of Naples Federico II, 80138 Naples, Italy; (D.S.C.); (F.B.); (L.M.); (V.N.); (I.F.); (D.F.); (L.S.); (M.E.C.); (M.A.); (R.P.); (A.S.); (S.C.); (F.S.); (F.S.); (D.D.); (D.M.V.); (G.G.); (P.C.); (G.E.)

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Brieger D, Cullen L, Briffa T, Zaman S, Scott I, Papendick C, Bardsley K, Baumann A, Bennett AS, Clark RA, Edelman JJ, Inglis SC, Kuhn L, Livori A, Redfern J, Schneider H, Stewart J, Thomas L, Wing-Lun E, Zhang L, Ho E, Matthews S. National Heart Foundation of Australia & Cardiac Society of Australia and New Zealand: Comprehensive Australian Clinical Guideline for Diagnosing and Managing Acute Coronary Syndromes 2025. Heart Lung Circ 2025;34:309-397. [PMID: 40180468 DOI: 10.1016/j.hlc.2025.02.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2025] [Accepted: 02/17/2025] [Indexed: 04/05/2025]

Affiliation(s)

David Brieger Department of Cardiology, Concord Repatriation General Hospital, Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
Louise Cullen Emergency and Trauma Centre, Royal Brisbane and Woman's Hospital Health Service District, Metro North Health, Herston, Qld, Australia; School of Medicine, Faculty of Health, Queensland University of Technology, Brisbane, Qld, Australia
Tom Briffa School of Population and Global Health, The University of Western Australia, Nedlands, WA, Australia
Sarah Zaman Department of Cardiology, Westmead Hospital, Westmead, NSW, Australia; Westmead Applied Research Centre, The University of Sydney, Sydney, NSW, Australia
Ian Scott Metro South Digital Health and Informatics, Qld, Australia; Centre for Health Services Research, The University of Queensland, Brisbane, Qld, Australia
Cynthia Papendick Department of Emergency Medicine, The Royal Adelaide Hospital, Adelaide, SA, Australia
Kimberley Bardsley The Prince Charles Hospital, Brisbane, Qld, Australia
Angus Baumann Department of Cardio-respiratory Medicine, Alice Springs Hospital, The Gap, NT, Australia
Alexandra Sasha Bennett Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; NSW Therapeutic Advisory Group, Sydney, NSW, Australia
Robyn A Clark Caring Futures Institute, Flinders University, Bedford Park, SA, Australia
J James Edelman Department of Cardiothoracic Surgery and Transplantation, Fiona Stanley Hospital, The University of Western Australia, Perth, WA, Australia
Sally C Inglis Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
Lisa Kuhn School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Fitzroy, Vic, Australia; Monash Emergency Research Collaborative, Monash Health, Clayton, Vic, Australia
Adam Livori Grampians Health, Ballarat, Vic, Australia; Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Vic, Australia
Julie Redfern Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Qld, Australia
Hans Schneider Department of Pathology, Alfred Health, Melbourne, Vic, Australia; School of Public Health and Preventative Medicine, Monash University, Melbourne, Vic, Australia
Jeanine Stewart The Prince Charles Hospital, Brisbane, Qld, Australia; School of Nursing and Midwifery, Griffith University, Qld, Australia
Liza Thomas Department of Cardiology, Westmead Hospital, Westmead, NSW, Australia; Westmead Applied Research Centre, The University of Sydney, Sydney, NSW, Australia; Westmead Clinical School, The University of Sydney, Sydney, NSW, Australia; South West Sydney School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia
Edwina Wing-Lun Department of Cardiology, Royal Darwin Hospital, Darwin, NT, Australia
Ling Zhang Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
Elaine Ho National Heart Foundation of Australia
Stacey Matthews National Heart Foundation of Australia

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Maqsood MH, Tamis-Holland JE, Feit F, Bangalore S. Revisiting the Efficacy and Safety of Bivalirudin in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Percutaneous Coronary Intervention: Insights From a Mixed Treatment Comparison Meta-Analysis of Randomized Trials. Catheter Cardiovasc Interv 2025;105:54-67. [PMID: 39506500 DOI: 10.1002/ccd.31276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2024] [Revised: 09/29/2024] [Accepted: 10/14/2024] [Indexed: 11/08/2024]

Abstract

BACKGROUND

Randomized trials of bivalirudin in patients with ST elevation myocardial infarction (STEMI) have yielded heterogeneous results.

AIMS

Our aim was to evaluate the efficacy and safety of four antithrombin regimens-unfractionated heparin (UFH), bivalirudin (stopped soon after percutaneous coronary intervention [PCI]), extended bivalirudin (continued for a few hours after PCI), and combined UFH and a Gp2b3a inhibitors (GPI) in patients who present with STEMI.

METHODS

A PubMed, EMBASE, and clinicaltrials.gov databases were searched for randomized clinical trials (RCTs) of the above antithrombin in patients with STEMI. The primary outcome was net adverse cardiovascular events (NACE). The primary ischemic endpoint was major adverse cardiovascular events (MACE), and the primary safety endpoint was major bleeding, and other endpoints included all-cause mortality and stent thrombosis. The primary analysis compared the effect of these antithrombin regimens in reference to UFH using a mixed treatment comparison meta-analysis.

RESULTS

In the 14 RCTs evaluating 25,415 patients with STEMI, when compared to UFH monotherapy, extended bivalirudin lowered NACE (OR = 0.71 with 95% CI: 0.53-0.96; moderate level of confidence) driven by a significant decrease in major bleeding (OR = 0.42 with 95% CI: 0.26-0.68; high level of confidence) without any significant difference in MACE or all-cause mortality. When compared with UFH monotherapy, UFH+GPI reduced risk of MACE (OR = 0.76 with 95% CI: 0.60-0.97; high level of confidence) but at the expense of an increase in major bleeding (OR = 1.48 with 95% CI: 1.11-1.98; high level of confidence) with no difference in NACE or all-cause mortality. For major bleeding, extended bivalirudin infusion ranked #1, bivalirudin ranked #2, UFH monotherapy ranked #3, and combined UFH and GPI ranked #4. For NACE, extended bivalirudin infusion ranked #1, bivalirudin ranked #2, combined UFH and GPI ranked #3, and UFH monotherapy ranked #4. Cluster plots for MACE and major bleeding demonstrated that extended bivalirudin had the best balance for efficacy and safety.

CONCLUSIONS

In patients undergoing PCI for STEMI, extended bivalirudin offers the best balance for primary ischemic (MACE) and safety (major bleeding) outcomes.

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Sultana R, Kamihira M. Multifaceted Heparin: Diverse Applications beyond Anticoagulant Therapy. Pharmaceuticals (Basel) 2024;17:1362. [PMID: 39459002 PMCID: PMC11510354 DOI: 10.3390/ph17101362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2024] [Revised: 10/07/2024] [Accepted: 10/09/2024] [Indexed: 10/28/2024] Open

Ozaki Y, Tobe A, Onuma Y, Kobayashi Y, Amano T, Muramatsu T, Ishii H, Yamaji K, Kohsaka S, Ismail TF, Uemura S, Hikichi Y, Tsujita K, Ako J, Morino Y, Maekawa Y, Shinke T, Shite J, Igarashi Y, Nakagawa Y, Shiode N, Okamura A, Ogawa T, Shibata Y, Tsuji T, Hayashida K, Yajima J, Sugano T, Okura H, Okayama H, Kawaguchi K, Zen K, Takahashi S, Tamura T, Nakazato K, Yamaguchi J, Iida O, Ozaki R, Yoshimachi F, Ishihara M, Murohara T, Ueno T, Yokoi H, Nakamura M, Ikari Y, Serruys PW, Kozuma K. CVIT expert consensus document on primary percutaneous coronary intervention (PCI) for acute coronary syndromes (ACS) in 2024. Cardiovasc Interv Ther 2024;39:335-375. [PMID: 39302533 PMCID: PMC11436458 DOI: 10.1007/s12928-024-01036-y] [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] [Received: 08/04/2024] [Accepted: 08/04/2024] [Indexed: 09/22/2024]

Affiliation(s)

Yukio Ozaki Department of Cardiology, Fujita Health University Okazaki Medical Center, Fujita Health University School of Medicine, 1-98 Dengaku, Kutsukake, Toyoake, Aichi, 470-1192, Japan.
Akihiro Tobe Department of Cardiology, University of Galway, Galway, Ireland
Yoshinobu Onuma Department of Cardiology, University of Galway, Galway, Ireland
Yoshio Kobayashi Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
Tetsuya Amano Department of Cardiology, Aichi Medical University, Nagakute, Japan
Takashi Muramatsu Department of Cardiology, Fujita Health University Okazaki Medical Center, Fujita Health University School of Medicine, 1-98 Dengaku, Kutsukake, Toyoake, Aichi, 470-1192, Japan
Hideki Ishii Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
Kyohei Yamaji Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
Shun Kohsaka Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
Tevfik F Ismail King's College London, London, UK Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
Shiro Uemura Cardiovascular Medicine, Kawasaki Medical School, Kurashiki, Japan
Yutaka Hikichi Heart Center, Saga Medical Center Koseikan, Saga, Japan
Kenichi Tsujita Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
Junya Ako Department of Cardiology, Kitasato University Hospital, Sagamihara, Japan
Yoshihiro Morino Department of Cardiology, Iwate Medical University Hospital, Shiwa, Japan
Yuichiro Maekawa Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, Hamamatsu, Japan
Toshiro Shinke Division of Cardiology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
Junya Shite Cardiology Division, Osaka Saiseikai Nakatsu Hospital, Osaka, Japan
Yasumi Igarashi Division of Cardiology, Sapporo-Kosei General Hospital, Sapporo, Japan
Yoshihisa Nakagawa Division of Cardiovascular Medicine, Department of Internal Medicine, Shiga University of Medical Science, Otsu, Japan
Nobuo Shiode Division of Cardiology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
Atsunori Okamura Division of Cardiology, Sakurabashi Watanabe Advanced Healthcare Hospital, Osaka, Japan
Takayuki Ogawa Division of Cardiology, The Jikei University School of Medicine, Tokyo, Japan
Yoshisato Shibata Division of Cardiology, Miyazaki Medical Association Hospital, Miyazaki, Japan
Takafumi Tsuji Kusatsu Heart Center, Kusatsu, Japan
Kentaro Hayashida Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
Junji Yajima Department of Cardiovascular Medicine, The Cardiovascular Institute, Tokyo, Japan
Teruyasu Sugano Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
Hiroyuki Okura Department of Cardiology, Gifu University Graduate School of Medicine, Gifu, Japan
Hideki Okayama Division of Cardiology, Ehime Prefectural Central Hospital, Matsuyama, Japan
Katsuhiro Kawaguchi Department of Cardiology, Komaki City Hospital, Komaki, Japan
Kan Zen Department of Cardiovascular Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
Saeko Takahashi Division of Cardiology, Tokushukai Shonan Oiso Hospital, Oiso, Japan
Toshihiro Tamura Division of Cardiology, Tenri Hospital, Tenri, Japan
Kazuhiko Nakazato Department of Cardiology, Fukushima Medical University Hospital, Fukushima, Japan
Junichi Yamaguchi Department of Cardiology, Tokyo Women's Medical University Hospital, Tokyo, Japan
Osamu Iida Cardiovascular Division, Osaka Police Hospital, Osaka, Japan
Reina Ozaki Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
Fuminobu Yoshimachi Department of Cardiology, Tokai University Hachioji Hospital, Hachioji, Japan
Masaharu Ishihara Department of Cardiovascular and Renal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
Toyoaki Murohara Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
Takafumi Ueno Division of Cardiology, Marin Hospital, Fukuoka, Japan
Hiroyoshi Yokoi Cardiovascular Center, Fukuoka Sanno Hospital, Fukuoka, Japan
Masato Nakamura Division of Cardiovascular Medicine, Ohashi Medical Center, Toho University School of Medicine, Tokyo, Japan
Yuji Ikari Department of Cardiology, Tokai University School of Medicine, Isehara, Japan
Patrick W Serruys Department of Cardiology, University of Galway, Galway, Ireland
Ken Kozuma Department of Cardiology, Teikyo University Hospital, Tokyo, Japan

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Liao J, Qiu M, Feng X, Chen K, Zhang D, Zou Y, Zheng X, Zhao G, Tian N, Zheng Z, Peng X, Yang Q, Liang Z, Li Y, Han Y, Stone GW. Bivalirudin versus heparin in patients with or without bail-out GPI use: a pre-specified subgroup analysis from the BRIGHT-4 trial. BMC Med 2024;22:410. [PMID: 39334129 PMCID: PMC11438164 DOI: 10.1186/s12916-024-03579-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Accepted: 08/22/2024] [Indexed: 09/30/2024] Open

Abstract

BACKGROUND

Conflicting results comparing bivalirudin versus heparin anticoagulation in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI), in part due to the confounding effect of glycoprotein IIb/IIIa inhibitors (GPI). The aim of the study was to compare the safety and effectiveness of bivalirudin plus a post-PCI high-dose infusion vs heparin with or without bail-out GPI use.

METHODS

We conducted a pre-specified subgroup analysis from the BRIGHT-4 trial that randomized 6016 STEMI patients who underwent primary PCI to receive either bivalirudin plus a post-PCI high-dose infusion for 2-4 h or heparin monotherapy. GPI use was only reserved as bail-out therapy for procedural thrombotic complications. The primary outcome was a composite of all-cause death or Bleeding Academic Research Consortium (BARC) types 3-5 bleeding at 30 days.

RESULTS

A total of 5250 (87.4%) patients received treatment without GPI while 758 (12.6%) received bail-out GPI. Bail-out GPI use was associated with an increased risk of the primary outcome compared to non-GPI use (5.28% vs. 3.41%; adjusted hazard ratio (aHR), 1.62; 95% confidence interval (CI), 1.13-2.33; P = 0.009) and all-cause death (5.01% vs. 3.12%; aHR, 1.74; 95% CI, 1.20-2.52; P = 0.004) but not in the risk of BARC types 3-5 bleeding (0.53% vs. 0.48%; aHR, 0.90; 95% CI, 0.31-2.66; P = 0.85). Among patients without GPI use, bivalirudin was associated with lower rates of the primary outcome (2.63% vs. 4.21%; aHR, 0.55; 95% CI, 0.39-0.77; P = 0.0005), all-cause death (2.52% vs. 3.74%; aHR, 0.58; 95% CI, 0.41-0.83; P = 0.003), and BARC types 3-5 bleeding (0.15% vs. 0.81%; aHR, 0.19; 95% CI, 0.06-0.57; P = 0.003) compared with heparin. However, among patients requiring bail-out GPI, there were no significant differences observed in the rates of the primary outcome (5.76% vs. 4.87%; aHR, 0.77; 95% CI, 0.36-1.66; P = 0.50; Pinteraction = 0.07) or its individual components between bivalirudin and heparin groups.

CONCLUSIONS

Bivalirudin plus a post-PCI high-dose infusion was associated with significantly reduced 30-day composite rate of all-cause death or BARC types 3-5 bleeding compared with heparin monotherapy in STEMI patients undergoing primary PCI without GPI use. However, these benefits might be less pronounced in patients requiring bail-out GPI due to thrombotic complications during primary PCI.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03822975.

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Affiliation(s)

Jia Liao State Key Laboratory of Frigid Zone Cardiovascular Disease, Department of Cardiology, General Hospital of Northern Theater Command, Cardiovascular Research Institute, Shenyang, 110016, China Department of Cardiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
Miaohan Qiu State Key Laboratory of Frigid Zone Cardiovascular Disease, Department of Cardiology, General Hospital of Northern Theater Command, Cardiovascular Research Institute, Shenyang, 110016, China
Xiaojian Feng Department of Cardiology, Yueyang Central Hospital, Yueyang , Hunan, 414000, China
Kui Chen Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450000, China
Dingbao Zhang Department of Cardiology, People's Hospital Of Pingchang County, Pingchang, Sichuan, 636400, China
Yuncheng Zou Department of Cardiology, Yunnan St. John's Hospital, Kunming, 650000, China
Xiaohui Zheng Department of Emergency, Fuwai Central China Cardiovascular Hospital, Central China Fuwai Hospital of Zhengzhou University, Henan Provincial People's Hospital, Zhengzhou, 450000, China
Gang Zhao Department of Cardiology, The First Hospital Of Liangshan, Xichang , Sichuan, 615000, China
Nailiang Tian Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210000, China
Zeqi Zheng Department of Cardiology, The First Affiliated Hospital Of Nanchang University, Nanchang, 330006, China
Xiaoping Peng Department of Cardiology, The First Affiliated Hospital Of Nanchang University, Nanchang, 330006, China
Qing Yang Department of Cardiology, Tianjin Medical University General Hospital, Tianjin, 300052, China
Zhenyang Liang State Key Laboratory of Frigid Zone Cardiovascular Disease, Department of Cardiology, General Hospital of Northern Theater Command, Cardiovascular Research Institute, Shenyang, 110016, China
Yi Li State Key Laboratory of Frigid Zone Cardiovascular Disease, Department of Cardiology, General Hospital of Northern Theater Command, Cardiovascular Research Institute, Shenyang, 110016, China.
Yaling Han State Key Laboratory of Frigid Zone Cardiovascular Disease, Department of Cardiology, General Hospital of Northern Theater Command, Cardiovascular Research Institute, Shenyang, 110016, China.
Gregg W Stone Icahn School of Medicine at Mount Sinai, Zena and Michael A Wiener Cardiovascular Institute, New York, NY, USA

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Mushahid H, Shah SA, Farhan SH, Shuja MH, Balasingam K, Siddiqui AA, Hameed I, Akram K, Mushahid S, Usman MS. Differential Use of Glycoprotein IIb/IIIa Inhibitors with Bivalirudin in Patients with STEMI Undergoing PCI: A Systematic Review and Meta-Analysis. Am J Cardiovasc Drugs 2024;24:385-398. [PMID: 38683263 DOI: 10.1007/s40256-024-00636-6] [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] [Accepted: 02/29/2024] [Indexed: 05/01/2024]

Al-Abdouh A, Mhanna M, Jabri A, Madanat L, Alhuneafat L, Mostafa MR, Kundu A, Gupta V. Bivalirudin versus unfractionated heparin in patients with myocardial infarction undergoing percutaneous coronary intervention: A systematic review and meta-analysis of randomized controlled trials. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024;61:52-61. [PMID: 37872022 DOI: 10.1016/j.carrev.2023.10.014] [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] [Received: 07/13/2023] [Revised: 10/17/2023] [Accepted: 10/17/2023] [Indexed: 10/25/2023]

Cohen M, Sohal S. Editorial: Bivalirudin versus unfractionated heparin in acute myocardial infarction: Why are we still debating? CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024;61:62-63. [PMID: 37980264 DOI: 10.1016/j.carrev.2023.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 11/09/2023] [Indexed: 11/20/2023]

Zhang Y, Zou Z, Xu B, Chen B, Ge H, Ding S, Pu J. Impact of Bivalirudin on Ischemia/Reperfusion Injury in Patients with Reperfused STEMI Assessed by Cardiac Magnetic Resonance. Pharmaceuticals (Basel) 2024;17:196. [PMID: 38399411 PMCID: PMC10893429 DOI: 10.3390/ph17020196] [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: 12/16/2023] [Revised: 01/07/2024] [Accepted: 01/11/2024] [Indexed: 02/25/2024] Open

Laudani C, Capodanno D, Angiolillo DJ. Bleeding in acute coronary syndrome: from definitions, incidence, and prognosis to prevention and management. Expert Opin Drug Saf 2023;22:1193-1212. [PMID: 38048099 DOI: 10.1080/14740338.2023.2291865] [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] [Received: 06/24/2023] [Accepted: 11/22/2023] [Indexed: 12/05/2023]

Coughlan JJ, Kastrati A. Bivalirudin in patients with ST-segment elevation myocardial infarction. Lancet 2022;400:1822-1823. [PMID: 36351460 DOI: 10.1016/s0140-6736(22)02162-6] [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] [Received: 10/20/2022] [Accepted: 10/28/2022] [Indexed: 11/08/2022]

Li Y, Liang Z, Qin L, Wang M, Wang X, Zhang H, Liu Y, Li Y, Jia Z, Liu L, Zhang H, Luo J, Dong S, Guo J, Zhu H, Li S, Zheng H, Liu L, Wu Y, Zhong Y, Qiu M, Han Y, Stone GW. Bivalirudin plus a high-dose infusion versus heparin monotherapy in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention: a randomised trial. Lancet 2022;400:1847-1857. [PMID: 36351459 DOI: 10.1016/s0140-6736(22)01999-7] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 10/09/2022] [Accepted: 10/11/2022] [Indexed: 11/07/2022]

Abstract

BACKGROUND

Previous randomised trials of bivalirudin versus heparin in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) have reported conflicting results, in part because of treatment with different pharmacological regimens. We designed a large-scale trial examining bivalirudin with a post-PCI high-dose infusion compared with heparin alone, the regimens that previous studies have shown to have the best balance of safety and efficacy.

METHODS

BRIGHT-4 was an investigator-initiated, open-label, randomised controlled trial conducted at 87 clinical centres in 63 cities in China. Patients with STEMI undergoing primary PCI with radial artery access within 48 h of symptom onset who had not received previous fibrinolytic therapy, anticoagulants, or glycoprotein IIb/IIIa inhibitors were randomly assigned (1:1) to receive bivalirudin with a post-PCI high-dose infusion for 2-4 h or unfractionated heparin monotherapy. There was no masking. Glycoprotein IIb/IIIa inhibitor use was reserved for procedural thrombotic complications in both groups. The primary endpoint was a composite of all-cause mortality or Bleeding Academic Research Consortium (BARC) types 3-5 bleeding at 30 days. This trial is registered with ClinicalTrials.gov (NCT03822975), and is ongoing.

FINDINGS

Between Feb 14, 2019, and April 7, 2022, a total of 6016 patients with STEMI undergoing primary PCI were randomly assigned to receive either bivalirudin plus a high-dose infusion after PCI (n=3009) or unfractionated heparin monotherapy (n=3007). Radial artery access was used in 5593 (93·1%) of 6008 patients. Compared with heparin monotherapy, bivalirudin reduced the 30-day rate of the primary endpoint (132 events [4·39%] in the heparin group vs 92 events [3·06%] in the bivalirudin group; difference, 1·33%, 95% CI 0·38-2·29%; hazard ratio [HR] 0·69, 95% CI 0·53-0·91; p=0·0070). All-cause mortality within 30 days occurred in 118 (3·92%) heparin-assigned patients and in 89 (2·96%) bivalirudin-assigned patients (HR 0·75; 95% CI 0·57-0·99; p=0·0420), and BARC types 3-5 bleeding occurred in 24 (0·80%) heparin-assigned patients and five (0·17%) bivalirudin-assigned patients (HR 0·21; 95% CI 0·08-0·54; p=0·0014). There were no significant differences in the 30-day rates of reinfarction, stroke, or ischaemia-driven target vessel revascularisation between the groups. Within 30 days, stent thrombosis occurred in 11 (0·37%) of bivalirudin-assigned patients and 33 (1·10%) of heparin-assigned patients (p=0·0015).

INTERPRETATION

In patients with STEMI undergoing primary PCI predominantly with radial artery access, anticoagulation with bivalirudin plus a post-PCI high-dose infusion for 2-4 h significantly reduced the 30-day composite rate of all-cause mortality or BARC types 3-5 major bleeding compared with heparin monotherapy.

FUNDING

Chinese Society of Cardiology Foundation (CSCF2019A01), and a research grant from Jiangsu Hengrui Pharmaceuticals.

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Boytsov SA, Shakhnovich RM, Tereschenko SN, Erlikh AD, Pevsner DV, Gulyan RG. Features of Parenteral Anticoagulant Therapy in Patients With Myocardial Infarction According to the Russian Register of Acute Myocardial Infarction – REGION-IM. KARDIOLOGIIA 2022;62:3-15. [DOI: 10.18087/cardio.2022.10.n2238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 07/20/2022] [Indexed: 11/18/2022]

Abstract Aim To study specific features of the parenteral anticoagulant therapy for acute myocardial infarction (MI) in the Russian Federation and to evaluate the consistency of the prescribed parenteral anticoagulant therapy with the effective clinical guidelines.Material and methods REGION-MI, the Russian rEGIstry for acute myOcardial iNfarction, is a multicenter observational study. This registry includes all patients admitted to hospitals with a documented diagnosis of ST-elevation acute MI (STEMI) and non-ST-elevation acute MI (NSTEMI) based on the criteria of the Forth Universal Definition of MI of the European Society of Cardiology. Risk of bleeding was assessed with the Academic Research Consortium for High Bleeding Risk (ARC-HBR) scale, and risk of major bleeding in patients with NSTEMI was additionally assessed with the CRUSADE scale.Results From November 01, 2020 through April 03, 2022, 5025 patients were included into the REGION-MI registry. At primary vascular departments, 70.5% of patients were administered unfractionated heparin (NFH); at regional vascular centers, 37.1 % of patients were administered NFH, 29.6 % enoxaparin, 20,2% NFH in combination with enoxaparin, 6.8 % fondaparinux, 4.2 % NFH in combination with fondaparinux, and 1.9 % nadroparin. At the prehospital stage, NFH was used as an anticoagulant support for the thrombolytic therapy (TLT) in 84% of patients, and low-molecular heparins (LMH) were used in 16 %. At the hospital stage, UFH was administered to 64.4 % of patients, and enoxaparin was administered to 23.9 % of patients. Among the patients who had undergone primary percutaneous coronary intervention (PCI), 40 % received NFH, 25 % enoxaparin, 22 % NFH in combination with enoxaparin, 7 % fondaparinux, and 4 % NFH in combination with fondaparinux. In conservative and invasive tactics of therapy for NSTEMI, NFH was also administered more frequently (43 and 43 %, respectively), followed by (according to frequency of administration) enoxaparin (36 and 34 %, respectively), NFH in combination with enoxaparin (10 and 16 %, respectively), fondaparinux (7 and 6 %, respectively), and NFH in combination with fondaparinux (3 and 1 %, respectively).Conclusion According to the Russian registry of acute MI, REGION-MI, with all strategies for the treatment of MI, parenteral anticoagulants are not prescribed in full consistency with clinical guidelines. The most frequently used parenteral anticoagulant is NFH. Despite the high efficacy and safety of fondaparinux, the frequency of its administration remains unjustifiably low not only in the Russian Federation but also in other countries. The same can be said about the administration of enoxaparin to patients who had received TLT. Attention should be paid to physicians’ awareness of recent clinical guidelines, to minimize the prehospital treatment with parenteral anticoagulants, to limit this treatment to the TLT support, and to provide continuity between all stages of medical care. Collapse

Zheng H, Wang Z, Li Q, Zhao Y, Liu Y, Chen A, Deng J, Su G. Comprehensive safety profile evaluation of bivalirudin in Chinese ST-segment elevation myocardial infarction patients receiving percutaneous coronary intervention: a prospective, multicenter, intensive monitoring study. BMC Cardiovasc Disord 2022;22:290. [PMID: 35752771 PMCID: PMC9233771 DOI: 10.1186/s12872-022-02716-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 01/12/2022] [Indexed: 11/30/2022] Open

Abstract

Background

This prospective, multi-center, intensive monitoring study aimed to systematically assess the occurrence of adverse events (AEs) and adverse drug reactions (ADRs), especially thrombocytopenia and bleeding, as well as their risk factors in Chinese ST-segment elevation myocardial infraction (STEMI) patients receiving bivalirudin as anticoagulant for percutaneous coronary intervention (PCI).

Methods

In total, 1244 STEMI patients undergoing PCI and receiving bivalirudin as anticoagulant were enrolled in the present study. Safety data were collected from hospital admission to 72 h after bivalirudin administration; in addition, patients were further followed up at the 30th day with safety data collected at that time.

Results

AEs, severe AEs, ADRs and severe ADRs were reported in 224 (18.0%), 15 (1.2%), 49 (3.9%) and 5 (0.4%) patients, respectively. Importantly, 4 (0.3%) patients were submitted to hospitalization and 6 (0.5%) patients died due to AEs, while 1 (0.1%) patient was submitted to hospitalization but no (0.0%) patient died due to ADRs. Meanwhile, thrombocytopenia and bleeding occurred in 24 (1.9%) and 21 (1.7%) patients, respectively. Further multivariate logistic analysis identified several important independent factors related to AEs, ADRs, thrombocytopenia or bleeding, which included history of cardiac surgery and renal function impairment, high CRUSADE risk stratification, elective operation and combination with glycoprotein IIb/IIIa inhibitors. Moreover, 4 multivariate models were constructed based on the above-mentioned factors, which all showed acceptable predictive value for AEs, ADRs, thrombocytopenia and bleeding, respectively.

Conclusion

Bivalirudin is a well-tolerant anticoagulant in Chinese STEMI patients undergoing PCI procedure.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12872-022-02716-4.

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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 2022;79:e21-e129. [PMID: 34895950 DOI: 10.1016/j.jacc.2021.09.006] [Citation(s) in RCA: 771] [Impact Index Per Article: 257.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]

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 2022;145:e18-e114. [PMID: 34882435 DOI: 10.1161/cir.0000000000001038] [Citation(s) in RCA: 263] [Impact Index Per Article: 87.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]

Ozaki Y, Hara H, Onuma Y, Katagiri Y, Amano T, Kobayashi Y, Muramatsu T, Ishii H, Kozuma K, Tanaka N, Matsuo H, Uemura S, Kadota K, Hikichi Y, Tsujita K, Ako J, Nakagawa Y, Morino Y, Hamanaka I, Shiode N, Shite J, Honye J, Matsubara T, Kawai K, Igarashi Y, Okamura A, Ogawa T, Shibata Y, Tsuji T, Yajima J, Iwabuchi K, Komatsu N, Sugano T, Yamaki M, Yamada S, Hirase H, Miyashita Y, Yoshimachi F, Kobayashi M, Aoki J, Oda H, Katahira Y, Ueda K, Nishino M, Nakao K, Michishita I, Ueno T, Inohara T, Kohsaka S, Ismail TF, Serruys PW, Nakamura M, Yokoi H, Ikari Y. CVIT expert consensus document on primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) update 2022. Cardiovasc Interv Ther 2022;37:1-34. [PMID: 35018605 PMCID: PMC8789715 DOI: 10.1007/s12928-021-00829-9] [Citation(s) in RCA: 101] [Impact Index Per Article: 33.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 11/15/2021] [Indexed: 12/14/2022]

Abstract

Primary Percutaneous Coronary Intervention (PCI) has significantly contributed to reducing the mortality of patients with ST-segment elevation myocardial infarction (STEMI) even in cardiogenic shock and is now the standard of care in most of Japanese institutions. The Task Force on Primary PCI of the Japanese Association of Cardiovascular Interventional and Therapeutics (CVIT) society proposed an expert consensus document for the management of acute myocardial infarction (AMI) focusing on procedural aspects of primary PCI in 2018. Updated guidelines for the management of AMI were published by the European Society of Cardiology (ESC) in 2017 and 2020. Major changes in the guidelines for STEMI patients included: (1) radial access and drug-eluting stents (DES) over bare-metal stents (BMS) were recommended as a Class I indication, (2) complete revascularization before hospital discharge (either immediate or staged) is now considered as Class IIa recommendation. In 2020, updated guidelines for Non-ST-Elevation Myocardial Infarction (NSTEMI) patients, the followings were changed: (1) an early invasive strategy within 24 h is recommended in patients with NSTEMI as a Class I indication, (2) complete revascularization in NSTEMI patients without cardiogenic shock is considered as Class IIa recommendation, and (3) in patients with atrial fibrillation following a short period of triple antithrombotic therapy, dual antithrombotic therapy (e.g., DOAC and single oral antiplatelet agent preferably clopidogrel) is recommended, with discontinuation of the antiplatelet agent after 6 to 12 months. Furthermore, an aspirin-free strategy after PCI has been investigated in several trials those have started to show the safety and efficacy. The Task Force on Primary PCI of the CVIT group has now proposed the updated expert consensus document for the management of AMI focusing on procedural aspects of primary PCI in 2022 version.

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Affiliation(s)

Yukio Ozaki Department of Cardiology, Fujita Health University School of Medicine, Aichi, Japan.
Hironori Hara Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
Yoshinobu Onuma Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
Yuki Katagiri Department of Cardiology, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan
Tetsuya Amano Department of Cardiology, Aichi Medical University, Aichi, Japan
Yoshio Kobayashi Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
Takashi Muramatsu Department of Cardiology, Fujita Health University School of Medicine, Aichi, Japan
Hideki Ishii Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Gunma, Japan
Ken Kozuma Department of Cardiology, Teikyo University Hospital, Tokyo, Japan
Nobuhiro Tanaka Division of Cardiology, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
Hitoshi Matsuo Gifu Heart Center, Gifu, Japan
Shiro Uemura Cardiovascular Medicine, Kawasaki Medical School, Kurashiki, Japan
Kazushige Kadota Kurashiki Central Hospital, Kurashiki, Japan
Yutaka Hikichi Heart Center, Saga Medical Center Koseikan, Saga, Japan
Kenichi Tsujita Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
Junya Ako Department of Cardiology, Kitasato University Hospital, Sagamihara, Japan
Yoshihisa Nakagawa Division of Cardiovascular Medicine, Department of Internal Medicine, Shiga University of Medical Science, Otsu, Japan
Yoshihiro Morino Department of Cardiology, Iwate Medical University Hospital, Morioka, Japan
Ichiro Hamanaka Cardiovascular Intervention Center, Rakuwakai Marutamachi Hospital, Kyoto, Japan
Nobuo Shiode Division of Cardiology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
Junya Shite Cardiology Division, Osaka Saiseikai Nakatsu Hospital, Osaka, Japan
Junko Honye Kikuna Memorial Hospital, Yokohama, Japan
Tetsuo Matsubara Toyohashi Heart Center, Toyohashi, Japan
Kazuya Kawai Chikamori Hospital, Kochi, Japan
Yasumi Igarashi Sapporo-Kosei General Hospital, Sapporo, Japan
Atsunori Okamura Sakurabashi Watanabe Hospital, Osaka, Japan
Takayuki Ogawa Division of Cardiology, The Jikei University School of Medicine, Tokyo, Japan
Yoshisato Shibata Miyazaki Medical Association Hospital, Miyazaki, Japan
Takafumi Tsuji Kusatsu Heart Center, Kusatsu, Japan
Junji Yajima The Cardiovascular Institute, Tokyo, Japan
Kaoru Iwabuchi Osaki Citizen Hospital, Osaki, Japan
Nobuo Komatsu Ota Nishinouchi Hospital, Fukushima, Japan
Teruyasu Sugano Yokohama City University Hospital, Yokohama, Japan
Masaru Yamaki Nayoro City General Hospital, Nayoro, Japan
Shinichiro Yamada Kitaharima Medical Center, Ono, Japan
Hiroaki Hirase Takaoka Minami Heart Center, Takaoka, Japan
Yuusuke Miyashita Nagano Red Cross Hospital, Nagano, Japan
Fuminobu Yoshimachi Tokai University Hachioji Hospital, Tokyo, Japan
Masakazu Kobayashi Department of Cardiology, Fujita Health University School of Medicine, Aichi, Japan
Jiro Aoki Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
Hirotaka Oda Niigata City General Hospital, Niigata, Japan
Yoshiaki Katahira Department of Cardiology, Katta General Hospital, Shiroishi, Japan
Kinzo Ueda Takase Clinic, Takasaki, Japan
Masami Nishino Division of Cardiology, Osaka Rosai Hospital, Osaka, Japan
Koichi Nakao Division of Cardiology, Saiseikai Kumamoto Hospital, Cardiovascular Center, Kumamoto, Japan
Ichiro Michishita Yokohama Sakae Kyosai Hospital, Yokohama, Japan
Takafumi Ueno Fukuoka Kinen Hospital, Fukuoka, Japan
Taku Inohara Keio University School of Medicine, Tokyo, Japan
Shun Kohsaka Keio University School of Medicine, Tokyo, Japan
Tevfik F Ismail Department of Cardiology, Fujita Health University School of Medicine, Aichi, Japan King's College London & Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
Patrick W Serruys Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland NHLI, Imperial College London, London, UK
Masato Nakamura Division of Cardiovascular Medicine, Ohashi Medical Center, Toho University School of Medicine, Tokyo, Japan
Hiroyoshi Yokoi Cardiovascular Center, Fukuoka Sanno Hospital, Fukuoka, Japan
Yuji Ikari Department of Cardiology, Tokai University School of Medicine, Isehara, Japan

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Nef HM, Achenbach S, Birkemeyer R, Bufe A, Dörr O, Elsässer A, Gaede L, Gori T, Hoffmeister HM, Hofmann FJ, Katus HA, Liebetrau C, Massberg S, Pauschinger M, Schmitz T, Süselbeck T, Voelker W, Wiebe J, Zahn R, Hamm C, Zeiher AM, Möllmann H. Manual der Arbeitsgruppe Interventionelle Kardiologie (AGIK) der Deutschen Gesellschaft für Kardiologie – Herz- und Kreislaufforschung e.V. (DGK). DER KARDIOLOGE 2021. [DOI: 10.1007/s12181-021-00504-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]

Faour A, Collins N, Williams T, Khan A, Juergens CP, Lo S, Walters DL, Chew DP, French JK. Reperfusion After Fibrinolytic Therapy (RAFT): An open-label, multi-centre, randomised controlled trial of bivalirudin versus heparin in rescue percutaneous coronary intervention. PLoS One 2021;16:e0259148. [PMID: 34699549 PMCID: PMC8547635 DOI: 10.1371/journal.pone.0259148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 10/04/2021] [Indexed: 11/18/2022] Open

Abstract

BACKGROUND

The safety and efficacy profile of bivalirudin has not been examined in a randomised controlled trial of patients undergoing rescue PCI.

OBJECTIVES

We conducted an open-label, multi-centre, randomised controlled trial to compare bivalirudin with heparin ± glycoprotein IIb/IIIa inhibitors (GPIs) in patients undergoing rescue PCI.

METHODS

Between 2010-2015, we randomly assigned 83 patients undergoing rescue PCI to bivalirudin (n = 42) or heparin ± GPIs (n = 41). The primary safety endpoint was any ACUITY (Acute Catheterization and Urgent Intervention Triage Strategy) bleeding at 90 days. The primary efficacy endpoint was infarct size measured by peak troponin levels as a multiple of the local upper reference limit (Tn/URL). Secondary endpoints included periprocedural change in haemoglobin adjusted for red cells transfused, TIMI (Thrombolysis in Myocardial Infarction) bleeding, ST-segment recovery and infarct size determined by the Selvester QRS score.

RESULTS

The trial was terminated due to slow recruitment and futility after an interim analysis of 83 patients. The primary safety endpoint occurred in 6 (14%) patients in the bivalirudin group (4.8% GPIs) and 3 (7.3%) in the heparin ± GPIs group (54% GPIs) (risk ratio, 1.95, 95% confidence interval [CI], 0.52-7.3, P = 0.48). Infarct size was similar between the two groups (mean Tn/URL, 730 [±675] for bivalirudin, versus 984 [±1585] for heparin ± GPIs, difference, 254, 95% CI, -283-794, P = 0.86). There was a smaller decrease in the periprocedural haemoglobin level with bivalirudin than heparin ± GPIs (-7.5% [±15] versus -14% [±17], difference, -6.5%, 95% CI, -0.83-14, P = 0.0067). The rate of complete (≥70%) ST-segment recovery post-PCI was higher in patients randomised to heparin ± GPIs compared with bivalirudin.

CONCLUSIONS

Whether bivalirudin compared with heparin ± GPI reduces bleeding in rescue PCI could not be determined. Slow recruitment and futility in the context of lower-than-expected bleeding event rates led to the termination of this trial (ANZCTR.org.au, ACTRN12610000152022).

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Nagaraja V, Rao SV, George S, Mamas M, Nolan J. Evidence-based arterial access site practice in patients with acute coronary syndromes: Has SAFARI-STEMI changed the landscape? Catheter Cardiovasc Interv 2021;97:1417-1421. [PMID: 33837993 DOI: 10.1002/ccd.29684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 02/18/2021] [Accepted: 03/14/2021] [Indexed: 11/12/2022]

Voll F, Kuna C, Ndrepepa G, Kastrati A, Cassese S. Antithrombotic treatment in primary percutaneous coronary intervention. Expert Rev Cardiovasc Ther 2021;19:313-324. [PMID: 33705211 DOI: 10.1080/14779072.2021.1902807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]

Choudry FA, Rathod KS, Baumbach A, Mathur A, Jones DA. Reply: Pitfalls of Unfractionated Heparin Use During ST-Segment Elevation Myocardial Infarction in Patients With COVID-19 Infection. J Am Coll Cardiol 2021;77:105-106. [PMID: 33413933 PMCID: PMC7834880 DOI: 10.1016/j.jacc.2020.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 10/26/2020] [Accepted: 11/02/2020] [Indexed: 11/18/2022]

Kelham M, Choudry FA, Hamshere S, Beirne AM, Rathod KS, Baumbach A, Ahluwalia A, Mathur A, Jones DA. Therapeutic Implications of COVID-19 for the Interventional Cardiologist. J Cardiovasc Pharmacol Ther 2020;26:203-216. [PMID: 33331160 DOI: 10.1177/1074248420982736] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]

Affiliation(s)

Matthew Kelham Department of Cardiology, 560754Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom
Fizzah A Choudry Department of Cardiology, 560754Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom.,Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, 4617Queen Mary University of London, London, United Kingdom
Stephen Hamshere Department of Cardiology, 560754Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom
Anne-Marie Beirne Department of Cardiology, 560754Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom.,Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, 4617Queen Mary University of London, London, United Kingdom
Krishnaraj S Rathod Department of Cardiology, 560754Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom.,Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, 4617Queen Mary University of London, London, United Kingdom
Andreas Baumbach Department of Cardiology, 560754Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom.,Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, 4617Queen Mary University of London, London, United Kingdom
Amrita Ahluwalia Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, 4617Queen Mary University of London, London, United Kingdom
Anthony Mathur Department of Cardiology, 560754Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom.,Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, 4617Queen Mary University of London, London, United Kingdom
Daniel A Jones Department of Cardiology, 560754Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom.,Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, 4617Queen Mary University of London, London, United Kingdom

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Kumar V, Sharma AK, Kumar T, Nath RK. Large intracoronary thrombus and its management during primary PCI. Indian Heart J 2020;72:508-516. [PMID: 33357638 PMCID: PMC7772595 DOI: 10.1016/j.ihj.2020.11.009] [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: 03/23/2020] [Revised: 05/22/2020] [Accepted: 11/07/2020] [Indexed: 11/07/2022] Open

Chen M, Kan J, Zhang JJ, Tian N, Ye F, Yang S, Chen SL. Improvement of clinical outcome in patients with ST-elevation myocardial infarction between 1999 and 2016 in China: The Prospective, Multicentre Registry MOODY study. Eur J Clin Invest 2020;50:e13197. [PMID: 31883102 DOI: 10.1111/eci.13197] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 11/01/2019] [Accepted: 12/22/2019] [Indexed: 01/21/2023]

Abstract

BACKGROUND

Reports showed no change of 7-day mortality after primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI) between 2001 and 2011 in China. National rolling one-year interventional standardized training programme began in September 2009. However, the improvement in clinical outcome following STEMI PCI after 2011 remains unclear.

METHODS AND RESULTS

This multicentre MOODY registry study aimed to analyse the clinical improvement after STEMI PCI. Of a total of 9265 acute MI patients registered from 24 centres, 3142 STEMIs having a first medical contact time ≤12 hours and undergoing primary PCI were assigned to the Pre Group (n = 1014, between March 1999 and October 2010) or the Post Group (n = 2128, between 2010 November and 2016 October). The primary endpoint was in-hospital cardiac death. Study endpoints were also compared between trained and untrained operators and between experienced (≥50 primary PCIs/year) and inexperienced personnel. In-hospital death after PCI was 3.0% in the Pre Group, significantly higher than 1.6% in the Post Group (P = .035). The improvements in clinical outcome after PCI between the 2016 and Pre Groups were stably sustained through one-year follow-up. The significant reduction for in-hospital death was noted when primary PCI was performed by trained (1.4% vs 5.4%, P < .001) or experienced (2.7% vs 4.8%, P = .001) operators, compared to untrained or inexperienced operators, respectively. Inclusion of the untrained operator into the conventional risk model strongly enhanced the prediction for endpoints. Age, Killip Class 3, diabetes, trans-radial approach and system delay were five predictors of in-hospital death after primary PCI.

CONCLUSION

PCI for STEMI by a trained and experienced operator was associated with significant reduction of in-hospital death. Our results strongly warrant the need for promoting the current system response and patient education.

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Liu XQ, Luo XD, Wu YQ. Efficacy and safety of bivalirudin vs heparin in patients with coronary heart disease undergoing percutaneous coronary intervention: A meta-analysis of randomized controlled trials. Medicine (Baltimore) 2020;99:e19064. [PMID: 32028428 PMCID: PMC7015623 DOI: 10.1097/md.0000000000019064] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open

Abstract

BACKGROUND

This meta-analysis is to evaluate the efficacy and safety of bivalirudin in patients with ST-elevation myocardial infarction (STEMI).

METHODS

PubMed, Cochrane Library, Embase, CNKI, CBMdisc, and VIP database were searched. Randomized controlled trial (RCT) was selected and the meta-analysis was conducted by RevMan 5.1. The primary efficacy endpoint was the incidence of major adverse cardiovascular events (MACE) and the primary safety endpoint was the incidence of major bleeding. Secondary efficacy endpoints were myocardial infarction (MI), target vessel revascularization (TVR), stent thrombosis (ST), stock, mortality, and thrombocytopenia. The pooled risk ratios (RRs) with the corresponding 95% confidence intervals (CI) were used to assess the efficacy and safety of bivalirudin vs heparin.

RESULTS

Seven RCTs met the inclusion criteria, and 16,640 patients were included. We found that bivalirudin associated with lower risk of mortality (RR = 1.05; 95% CI = 0.74-1.49; P = .03; I = 2%), major bleeding (RR = 0.64; 95% CI = 0.54-0.75; P < .00001; I = 70%) and thrombocytopenia (RR = 0.39; 95% CI = 0.25-0.61; P < .0001; I = 0) compared with heparin. However, the use of bivalirudin increase the risk of MI(RR = 1.37; 95% CI = 1.10-1.71; P = .004; I = 25%) and ST(RR = 1.61; 95% CI = 1.05-2.47; P = .03; I = 70%) and has similar risk of MACE (RR = 1.00; 95% CI = 0.90-1.11; P = .97; I = 16%), TVR (RR = 1.43; 95% CI = 0.92-2.22; P = .11; I = 46%) and stock (RR = 1.43; 95% CI = 0.92-2.22; P = .11; I = 46%) compared with heparin used in STEMI patients.

CONCLUSION

Bivalirudin associated with lower risk of mortality, major bleeding and thrombocytopenia compared with heparin. However, the use of bivalirudin increase the risk of MI and ST and has similar risk of MACE, TVR and stock compared with heparin used in STEMI patients.

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Post-Procedural Bivalirudin Infusion at Full or Low Regimen in Patients With Acute Coronary Syndrome. J Am Coll Cardiol 2020;73:758-774. [PMID: 30784669 DOI: 10.1016/j.jacc.2018.12.023] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 12/03/2018] [Accepted: 12/10/2018] [Indexed: 11/24/2022]

Abstract

BACKGROUND

The value of prolonged bivalirudin infusion after percutaneous coronary intervention (PCI) in acute coronary syndrome (ACS) patients with or without ST-segment elevation remains unclear.

OBJECTIVES

The purpose of this study was to assess efficacy and safety of a full or low post-PCI bivalirudin regimen in ACS patients with or without ST-segment elevation.

METHODS

The MATRIX program assigned bivalirudin to patients without or with a post-PCI infusion at either a full (1.75 mg/kg/h for ≤4 h) or reduced (0.25 mg/kg/h for ≤6 h) regimen at the operator's discretion. The primary endpoint was the 30-day composite of urgent target-vessel revascularization, definite stent thrombosis, or net adverse clinical events (composite of all-cause death, myocardial infarction, or stroke, or major bleeding).

RESULTS

Among 3,610 patients assigned to bivalirudin, 1,799 were randomized to receive and 1,811 not to receive a post-PCI bivalirudin infusion. Post-PCI full bivalirudin was administered in 612 (ST-segment elevation myocardial infarction [STEMI], n = 399; non-ST-segment elevation acute coronary syndromes [NSTE-ACS], n = 213), whereas the low-dose regimen was administered in 1,068 (STEMI, n = 519; NSTE-ACS, n = 549) patients. The primary outcome did not differ in STEMI or NSTE-ACS patients who received or did not receive post-PCI bivalirudin. However, full compared with low bivalirudin regimen remained associated with a significant reduction of the primary endpoint after multivariable (rate ratio: 0.21; 95% CI: 0.12 to 0.35; p < 0.001) or propensity score (rate ratio: 0.16; 95% CI: 0.09 to 0.26; p < 0.001) adjustment. Full post-PCI bivalirudin was associated with improved outcomes consistently across ACS types compared with the no post-PCI infusion or heparin groups.

CONCLUSIONS

In ACS patients with or without ST-segment elevation, the primary endpoint did not differ with or without post-PCI bivalirudin infusion but a post-PCI full dose was associated with improved outcomes when compared with no or low-dose post-PCI infusion or heparin (Minimizing Adverse Haemorrhagic Events by TRansradial Access Site and Systemic Implementation of angioX [MATRIX]; NCT01433627).

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2019 Canadian Cardiovascular Society/Canadian Association of Interventional Cardiology Guidelines on the Acute Management of ST-Elevation Myocardial Infarction: Focused Update on Regionalization and Reperfusion. Can J Cardiol 2019;35:107-132. [PMID: 30760415 DOI: 10.1016/j.cjca.2018.11.031] [Citation(s) in RCA: 114] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 11/29/2018] [Accepted: 11/29/2018] [Indexed: 12/15/2022] Open

Abstract

Rapid reperfusion of the infarct-related artery is the cornerstone of therapy for the management of acute ST-elevation myocardial infarction (STEMI). Canada's geography presents unique challenges for timely delivery of reperfusion therapy for STEMI patients. The Canadian Cardiovascular Society/Canadian Association of Interventional Cardiology STEMI guideline was developed to provide advice regarding the optimal acute management of STEMI patients irrespective of where they are initially identified: in the field, at a non-percutaneous coronary intervention-capable centre or at a percutaneous coronary intervention-capable centre. We had also planned to evaluate and incorporate sex and gender considerations in the development of our recommendations. Unfortunately, inadequate enrollment of women in randomized trials, lack of publication of main outcomes stratified according to sex, and lack of inclusion of gender as a study variable in the available literature limited the feasibility of such an approach. The Grading Recommendations, Assessment, Development, and Evaluation system was used to develop specific evidence-based recommendations for the early identification of STEMI patients, practical aspects of patient transport, regional reperfusion decision-making, adjunctive prehospital interventions (oxygen, opioids, antiplatelet therapy), and procedural aspects of mechanical reperfusion (access site, thrombectomy, antithrombotic therapy, extent of revascularization). Emphasis is placed on integrating these recommendations as part of an organized regional network of STEMI care and the development of appropriate reperfusion and transportation pathways for any given region. It is anticipated that these guidelines will serve as a practical template to develop systems of care capable of providing optimal treatment for a wide range of STEMI patients.

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Han S, Kim YH, Choi HY, Kim MJ, Kim WJ, Park H, Bae KS, Lim HS. Pharmacokinetic and Pharmacodynamic Modeling and Simulation Analysis of CTB-001, a Recently Developed Generic of Bivalirudin. Pharm Res 2019;36:146. [DOI: 10.1007/s11095-019-2676-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 07/21/2019] [Indexed: 10/26/2022]

Gargiulo G, Carrara G, Frigoli E, Vranckx P, Leonardi S, Ciociano N, Campo G, Varbella F, Calabrò P, Garducci S, Iannone A, Briguori C, Andò G, Crimi G, Limbruno U, Garbo R, Sganzerla P, Russo F, Lupi A, Cortese B, Ausiello A, Ierna S, Esposito G, Zavalloni D, Santarelli A, Sardella G, Tresoldi S, de Cesare N, Sciahbasi A, Zingarelli A, Tosi P, van 't Hof A, Omerovic E, Brugaletta S, Windecker S, Valgimigli M. Bivalirudin or Heparin in Patients Undergoing Invasive Management of Acute Coronary Syndromes. J Am Coll Cardiol 2019;71:1231-1242. [PMID: 29544607 DOI: 10.1016/j.jacc.2018.01.033] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Revised: 01/11/2018] [Accepted: 01/12/2018] [Indexed: 11/15/2022]

Abstract

BACKGROUND

Contrasting evidence exists on the comparative efficacy and safety of bivalirudin and unfractionated heparin (UFH) in relation to the planned use of glycoprotein IIb/IIIa inhibitors (GPIs).

OBJECTIVES

This study assessed the efficacy and safety of bivalirudin compared with UFH with or without GPIs in patients with acute coronary syndrome (ACS) who underwent invasive management.

METHODS

In the MATRIX (Minimizing Adverse Haemorrhagic Events by Transradial Access Site and Systemic Implementation of AngioX) program, 7,213 patients were randomly assigned to receive either bivalirudin or UFH with or without GPIs at discretion of the operator. The 30-day coprimary outcomes were major adverse cardiovascular events (MACEs) (a composite of death, myocardial infarction, or stroke), and net adverse clinical events (NACEs) (a composite of MACEs or major bleeding).

RESULTS

Among 3,603 patients assigned to receive UFH, 781 (21.7%) underwent planned treatment with GPI before coronary intervention. Bailout use of GPIs was similar between the bivalirudin and UFH groups (4.5% and 5.4%) (p = 0.11). At 30 days, the 2 coprimary endpoints of MACEs and NACEs, as well as individual endpoints of mortality, myocardial infarction, stent thrombosis or stroke did not differ among the 3 groups after adjustment. Compared with the UFH and UFH+GPI groups, bivalirudin reduced bleeding, mainly the most severe bleeds, including fatal and nonaccess site-related events, as well as transfusion rates and the need for surgical access site repair. These findings were not influenced by the administered intraprocedural dose of UFH and were confirmed at multiple sensitivity analyses, including the randomly allocated access site.

CONCLUSIONS

In patients with ACS, the rates of MACEs and NACEs were not significantly lower with bivalirudin than with UFH, irrespective of planned GPI use. However, bivalirudin significantly reduced bleeding complications, mainly those not related to access site, irrespective of planned use of GPIs. (Minimizing Adverse Haemorrhagic Events by Transradial Access Site and Systemic Implementation of AngioX [MATRIX]; NCT01433627).

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Affiliation(s)

Giuseppe Gargiulo Department of Cardiology, Bern University Hospital, Bern, Switzerland; Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
Greta Carrara Advice Pharma Group S.r.l., Milan, Italy
Enrico Frigoli Department of Cardiology, Bern University Hospital, Bern, Switzerland
Pascal Vranckx Department of Cardiology and Critical Care Medicine, Hartcentrum Hasselt, Jessa Ziekenhuis, and Faculty of Medicine and Life Sciences Hasselt University, Hasselt, Belgium
Sergio Leonardi SC Terapia Intensiva Cardiologica, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
Nestor Ciociano EUSTRATEGY Association, Forli', Italy
Gianluca Campo Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona (FE), Italy; Maria Cecilia Hospital, GVM Care and Research, Cotignola (RA), Italy
Ferdinando Varbella Cardiology Unit, Ospedali Riuniti di Rivoli, ASL Torino 3, Turin, Italy
Paolo Calabrò Division of Cardiology, Department of Cardiothoracic Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
Stefano Garducci Struttura complessa di Cardiologia ASST di Vimercate, Italy
Alessandro Iannone Department of Cardiology, ASL3 Ospedale Villa Scassi, Genoa, Italy
Carlo Briguori Interventional Cardiology Unit, Clinica Mediterranea, Naples, Italy
Giuseppe Andò Azienda Ospedaliera Universitaria Policlinico "Gaetano Martino", University of Messina, Messina, Italy
Gabriele Crimi Department of Cardiology and Critical Care Medicine, Hartcentrum Hasselt, Jessa Ziekenhuis, and Faculty of Medicine and Life Sciences Hasselt University, Hasselt, Belgium; SC Cardiologia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
Ugo Limbruno UO Cardiologia, Azienda USL Toscana Sudest, Grosseto, Italy
Roberto Garbo Interventional Cardiology Unit, Ospedale San Giovanni Bosco, Turin, Italy
Paolo Sganzerla ASST Bergamo ovest, Ospedale di Treviglio (BG), Italy
Filippo Russo Cardiovascular Interventional Unit, Cardiology Department, S.Anna Hospital, Como, Italy
Alessandro Lupi University Hospital "Maggiore della Carità", Novara, Italy
Bernardo Cortese ASST Fatebenefratelli-Sacco, Milan, Italy; Fondazione Monasterio-CNR-Regione Toscana, Toscana, Italy
Arturo Ausiello Casa di Cura Villa Verde, Taranto, Italy
Salvatore Ierna Simple Departmental Emodynamic Structure, Ospedale Sirai-Carbonia, Carbonia, Italy
Giovanni Esposito Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
Dennis Zavalloni Humanitas Research Hospital, IRCCS, Rozzano, Italy
Andrea Santarelli Cardiovascular Department, Infermi Hospital, Rimini, Italy
Gennaro Sardella Department of Cardiovascular, Respiratory, Nephrologic, Anesthesiologic and Geriatric Sciences, Policlinico Umberto I, "Sapienza", University of Rome, Rome, Italy
Simone Tresoldi Struttura complessa di Emodinamica, ASST Monza, Ospedale di Desio, Italy
Nicoletta de Cesare Policlinico San Marco, Zingonia, Italy
Alessandro Sciahbasi Interventional Cardiology, Sandro Pertini Hospital, Rome, Italy
Antonio Zingarelli Clinic of Cardiovascular Disease, IRCCS Policlinico San Martino, Genoa, Italy
Paolo Tosi Mater Salutis Hospital-Legnago, Verona, Italy
Arnoud van 't Hof Maastricht University Medical Center, and Zuyderland MC, Maastricht, the Netherlands
Elmir Omerovic Sahlgrenska University Hospital, Göteborg, Sweden
Salvatore Brugaletta Clinic Cardiovascular Institute, University Hospital Clinic, IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer), Barcelona, Spain
Stephan Windecker Department of Cardiology, Bern University Hospital, Bern, Switzerland
Marco Valgimigli Department of Cardiology, Bern University Hospital, Bern, Switzerland.

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Gaudino M, Angiolillo DJ, Di Franco A, Capodanno D, Bakaeen F, Farkouh ME, Fremes SE, Holmes D, Girardi LN, Nakamura S, Head SJ, Park S, Mack M, Serruys PW, Ruel M, Stone GW, Tam DY, Vallely M, Taggart DP. Stroke After Coronary Artery Bypass Grafting and Percutaneous Coronary Intervention: Incidence, Pathogenesis, and Outcomes. J Am Heart Assoc 2019;8:e013032. [PMID: 31242821 PMCID: PMC6662343 DOI: 10.1161/jaha.119.013032] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]

Choudry FA, Weerackody RP, Jones DA, Mathur A. Thrombus Embolisation: Prevention is Better than Cure. ACTA ACUST UNITED AC 2019;14:95-101. [PMID: 31178936 PMCID: PMC6545997 DOI: 10.15420/icr.2019.11] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 04/23/2019] [Indexed: 12/16/2022]

Anticoagulation in Acute Coronary Syndrome: Review of Major Therapeutic Advances. Am J Ther 2019;26:e184-e197. [PMID: 30839367 DOI: 10.1097/mjt.0000000000000913] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]

Abstract

BACKGROUND

In patients with acute coronary syndrome (ACS), a persistent hypercoagulable state has been demonstrated and antithrombin therapy in addition to platelet inhibition has been proposed.

AREAS OF UNCERTAINTY

Vitamin K antagonists (VKAs) were used as oral anticoagulant (OAC) therapy and produced mixed results whereas trials are still ongoing with non-vitamin K OACs (NOACs).

DATA SOURCES

A literature search regarding benefits and risks of different OAC therapies in ACS was conducted through MEDLINE and EMBASE (last 20 years until September 2018).

THERAPEUTIC ADVANCES

Patients receiving dual antiplatelet therapy (DAPT) in combination with NOAC are to be considered at high bleeding risk. Rivaroxaban 2.5 mg BID in triple therapy with DAPT, rivaroxaban 15 mg, or dabigatran 110/150 mg BID in dual therapy with P2Y12 inhibitor (mainly clopidogrel) is safer in terms of bleeding risk than triple therapy with VKA plus DAPT. The reduction in ischemic events by NOACs was most promising when added to single antiplatelet therapy. Ongoing trials with apixaban and edoxaban could clarify whether dual therapy NOACs with P2Y12 inhibitor sufficiently protect against stent thrombosis or myocardial infarction and are safer in terms of bleeding risk than a dual therapy with a VKA and clopidogrel. In the absence of randomized trials, it is unknown whether dual therapy with NOAC and aspirin could be an alternative to NOAC and a P2Y12 inhibitor. Thus, the overall benefit of adding NOAC to antiplatelet treatment after ACS in patients without clear indication for long-term OAC is still unknown.

CONCLUSIONS

Different OACs have been tested as antithrombotic therapy after ACS in combination with single or DAPT and led to a modest reduction in ischemic events. Further studies evaluating NOACs in combination with single antiplatelet therapy or shorter duration of triple antithrombotic therapy are warranted.

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Anticoagulation in CKD and ESRD. J Nephrol 2019;32:719-731. [DOI: 10.1007/s40620-019-00592-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 01/22/2019] [Indexed: 12/11/2022]

Manolis AS. Is Atherothromboaspiration a Possible Solution for the Prevention of No-Reflow Phenomenon in Acute Coronary Syndromes? Single Centre Experience and Review of the Literature. Curr Vasc Pharmacol 2019;17:164-179. [DOI: 10.2174/1570161116666180101150956] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 11/23/2017] [Accepted: 11/24/2017] [Indexed: 12/16/2022]

Abstract Background: Intracoronary thrombus in acute Myocardial Infarction (MI) confers higher rates of no-reflow with attendant adverse consequences. Earlier Randomized-Controlled-Trials (RCTs) of routine thromboaspiration during Percutaneous Coronary Intervention (PCI) indicated a clinical benefit, but more recent RCTs were negative. However, data of selective use of this adjunctive approach remain scarce. Objective: The aim of this single-centre prospective study was to report the results of selective thromboaspiration during PCI in patients with intracoronary thrombi, and also to provide an extensive literature review on current status of thromboaspiration. Methods: The study included 90 patients (77 men; aged 59.3±12.7 years) presenting with acute MI (STElevation MI (STEMI) in 74, non-STEMI in 16) who had intracoronary thrombi and were submitted to thromboaspiration. Results: Total (n=67) or subtotal (n=18) vessel occlusions were present in 85 (94%) patients. Thromboaspiration and subsequent PCI were successful in 89/90 (98.9%) patients, with coronary stenting in 86 (96.6%). In 4 patients with residual thrombus, a mesh-covered stent was implanted. IIb/IIIa-inhibitors were administered in 57 (63.3%) patients. No-reflow occurred in only 1 (1.1%) patient. The postprocedural course was uneventful. Review of the literature revealed several early observational and RCTs and meta-analyses favouring manual, not mechanical, thrombectomy. However, newer RCTs and meta-analyses significantly curtailed the initial enthusiasm for the clinical benefits of routine use of thromboaspiration. Conclusion: Selective thromboaspiration for angiographically visible thrombi in MI patients undergoing PCI, as an adjunct to mechanical reperfusion and to IIb/IIIa-inhibitors, may be an option since this manoeuvre may improve procedural and clinical outcome. Collapse

Cavallari I, Patti G. Clinical effects with inhibition of multiple coagulative pathways in patients admitted for acute coronary syndrome. Intern Emerg Med 2018;13:1019-1028. [PMID: 29564693 DOI: 10.1007/s11739-018-1834-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 03/16/2018] [Indexed: 12/01/2022]

Efficacy and safety of bivalirudin for percutaneous coronary intervention in acute coronary syndromes: a meta-analysis of randomized-controlled trials. Clin Res Cardiol 2018;107:807-815. [DOI: 10.1007/s00392-018-1251-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 04/09/2018] [Indexed: 11/25/2022]

Ozaki Y, Katagiri Y, Onuma Y, Amano T, Muramatsu T, Kozuma K, Otsuji S, Ueno T, Shiode N, Kawai K, Tanaka N, Ueda K, Akasaka T, Hanaoka KI, Uemura S, Oda H, Katahira Y, Kadota K, Kyo E, Sato K, Sato T, Shite J, Nakao K, Nishino M, Hikichi Y, Honye J, Matsubara T, Mizuno S, Muramatsu T, Inohara T, Kohsaka S, Michishita I, Yokoi H, Serruys PW, Ikari Y, Nakamura M. CVIT expert consensus document on primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) in 2018. Cardiovasc Interv Ther 2018;33:178-203. [PMID: 29594964 PMCID: PMC5880864 DOI: 10.1007/s12928-018-0516-y] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 02/27/2018] [Indexed: 12/28/2022]

Affiliation(s)

Yukio Ozaki Department of Cardiology, Fujita Health University School of Medicine, Toyoake, Japan.
Yuki Katagiri Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
Yoshinobu Onuma Department of Cardiology, Fujita Health University School of Medicine, Toyoake, Japan.,Thoraxcenter, Erasmus MC, Erasmus University, Rotterdam, The Netherlands
Tetsuya Amano Department of Cardiology, Aichi Medical University, Nagakute, Japan
Takashi Muramatsu Department of Cardiology, Fujita Health University School of Medicine, Toyoake, Japan
Ken Kozuma Department of Cardiology, Teikyo University Hospital, Tokyo, Japan
Satoru Otsuji Higashi Takarazuka Satoh Hospital, Takarazuka, Japan
Takafumi Ueno Division of Cardio-vascular Medicine, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Japan
Nobuo Shiode Division of Cardiology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
Kazuya Kawai Department of Cardiology, Chikamori Hospital, Kochi, Japan
Nobuhiro Tanaka Division of Cardiology, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
Kinzo Ueda Rakuwakai Kyoto Cardiovascular Intervention Center, Rakuwakai Marutamachi Hospital, Kyoto, Japan
Takashi Akasaka Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
Keiichi Igarashi Hanaoka Hanaoka Seisyu Memorial Cardiovascular Clinic, Sapporo, Japan
Shiro Uemura Cardiovascular Medicine, Kawasaki Medical School, Kurashiki, Japan
Hirotaka Oda Department of Cardiology, Niigata City General Hospital, Niigata, Japan
Yoshiaki Katahira Department of Cardiology, Katta General Hospital, Shiroishi, Japan
Kazushige Kadota Kurashiki Central Hospital, Kurashiki, Japan
Eisho Kyo Kusatsu Heart Center, Kusatsu, Japan
Katsuhiko Sato Sapporo Cardiovascular Clinic, Sapporo, Japan
Tadaya Sato Saka General Hospital, Shiogama, Japan
Junya Shite Cardiology Division, Osaka Saiseikai Nakatsu Hospital, Osaka, Japan
Koichi Nakao Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center, Kumamoto, Japan
Masami Nishino Division of Cardiology, Osaka Rosai Hospital, Sakai, Japan
Yutaka Hikichi Department of Cardiovascular Medicine, Saga University, Saga, Japan
Junko Honye Kikuna Memorial Hospital, Yokohama, Japan
Tetsuo Matsubara Toyohashi Heart Center, Toyohashi, Japan
Sumio Mizuno Murakami Clinic, Murakami, Japan
Toshiya Muramatsu Tokyo General Hospital, Tokyo, Japan
Taku Inohara Keio University School of Medicine, Tokyo, Japan
Shun Kohsaka Keio University School of Medicine, Tokyo, Japan
Ichiro Michishita Yokohama Sakae Kyosai Hospital, Federation of National Public Service Personnel Mutual Associations, Yokohama, Japan
Hiroyoshi Yokoi Cardiovascular Center, Fukuoka Sanno Hospital, Fukuoka, Japan
Patrick W Serruys Imperial College, London, UK
Yuji Ikari Department of Cardiology, Tokai University School of Medicine, Kanagawa, Japan
Masato Nakamura Division of Cardiovascular Medicine, Ohashi Medical Center, Toho University School of Medicine, Tokyo, Japan

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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;76:229-313. [PMID: 29457615 DOI: 10.1093/eurheartj/ehx393] [Citation(s) in RCA: 6527] [Impact Index Per Article: 932.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 10/24/2017] [Indexed: 02/06/2023] Open

Anticoagulation in Acute Coronary Syndrome-State of the Art. Prog Cardiovasc Dis 2018;60:508-513. [DOI: 10.1016/j.pcad.2018.01.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 01/10/2018] [Indexed: 12/14/2022]

Elgendy IY, Capodanno D. Heparin versus bivalirudin for percutaneous coronary intervention: has the debate come to an end? J Thorac Dis 2017;9:4305-4307. [PMID: 29268497 PMCID: PMC5721029 DOI: 10.21037/jtd.2017.10.23] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 10/09/2017] [Indexed: 08/29/2023]

Análisis de los resultados económicos y en salud de un programa dirigido a la reducción de hemorragia en pacientes con síndrome coronario agudo. Rev Esp Cardiol 2017. [DOI: 10.1016/j.recesp.2016.12.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]

de Lorenzo-Pinto A, Herranz-Alonso A, Cuéllar-Basterrechea B, Bellón-Cano JM, Sanjurjo-Sáez M, Bueno H. Clinical and Economic Impact of a Multisciplinary Intervention to Reduce Bleeding Risk in Patients With Acute Coronary Syndrome. ACTA ACUST UNITED AC 2017;70:825-831. [PMID: 28411029 DOI: 10.1016/j.rec.2016.12.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Accepted: 12/19/2016] [Indexed: 10/19/2022]

Franchi F, Rollini F, Angiolillo DJ. Antithrombotic therapy for patients with STEMI undergoing primary PCI. Nat Rev Cardiol 2017;14:361-379. [DOI: 10.1038/nrcardio.2017.18] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]

Buccheri S, Capranzano P, Condorelli A, Scalia M, Tamburino C, Capodanno D. Risk stratification after ST-segment elevation myocardial infarction. Expert Rev Cardiovasc Ther 2016;14:1349-1360. [PMID: 27817218 DOI: 10.1080/14779072.2017.1256201] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]

Savonitto S, De Luca G, Goldstein P, van T' Hof A, Zeymer U, Morici N, Thiele H, Montalescot G, Bolognese L. Antithrombotic therapy before, during and after emergency angioplasty for ST elevation myocardial infarction. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2016;6:173-190. [PMID: 26124456 DOI: 10.1177/2048872615590148] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]

Primary left main coronary artery thrombus aspiration as a standalone treatment: sailing in uncharted waters. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2016;12:258-61. [PMID: 27625690 PMCID: PMC5011543 DOI: 10.5114/aic.2016.61649] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 12/24/2015] [Indexed: 11/25/2022] Open

Impact of bivalirudin on mortality and bleeding complications in acute coronary syndrome patients undergoing invasive revascularization : A real world experience. Wien Klin Wochenschr 2016;128:906-915. [PMID: 27624328 PMCID: PMC5161760 DOI: 10.1007/s00508-016-1078-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Accepted: 08/05/2016] [Indexed: 11/30/2022]

Raffoul J, Nasir A, Klein AJP. Antithrombotic Selection in ST-Segment Elevation Myocardial Infarction: a Year in Review. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2016;18:53. [DOI: 10.1007/s11936-016-0473-7] [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: 10/21/2022]