Coronary Revascularization in Patients With Stable Coronary Artery Disease: The Role of Imaging

Protective effects of combined eptifibatide and ticagrelor in patients with unstable angina undergoing percutaneous coronary intervention: a single-center experience

BACKGROUND

We evaluated the safety and effectiveness of combined eptifibatide and ticagrelor in patients with unstable angina pectoris undergoing percutaneous coronary intervention (PCI).

METHODS

Patients with unstable angina pectoris who underwent PCI from January 2019 to December 2020 were included. All patients were treated with aspirin and ticagrelor as dual antiplatelet therapy and divided into two groups: the eptifibatide + ticagrelor group (180 µg/kg bolus plus 1 µg/kg/min continuous intravenous eptifibatide infusion after PCI for 24 h [n = 152]) and the ticagrelor group (without eptifibatide infusion [n = 152]). Thromboelastography and light transmission aggregometry were used to measure the adenosine diphosphate-induced platelet aggregation rate (PAR). High sensitivity troponin T (hs-TnT), N-terminal pro-brain natriuretic peptide (NT-proBNP), high-sensitivity C-reactive protein (hs-CRP), and heart-type fatty acid-binding protein (h-FABP) were measured. In-hospital and 12-month major adverse cardiovascular events (MACEs) and bleeding events were evaluated.

RESULTS

The PAR significantly declined at 1, 12, and 24 h after continuous intravenous eptifibatide and returned to the pretreatment level 24 h after discontinuation. All patients in the eptifibatide + ticagrelor group achieved a PAR < 10%. The percentage of patients with a PAR < 10% was significantly higher than in the ticagrelor group (P < 0.001). The increases in hs-TnT (P < 0.001), NT-proBNP (P < 0.05), and h-FABP (P < 0.05) were less pronounced. The eptifibatide + ticagrelor group exhibited lower rates of in-hospital and 12-month myocardial infarction (MI) and in-hospital MACEs (P < 0.05). The rate of bleeding events was not significantly different.

CONCLUSION

Eptifibatide rapidly reduced the PAR in patients with unstable angina pectoris and reduced the rates of MI, in-hospital MACEs, and 12-month MI, without increasing bleeding events. The combined use of eptifibatide and ticagrelor was safe and effective.

TRIAL REGISTRATION

The registry was registered in the Chinese Clinical Trial Registry (ChiCTR2500096895). The date of registration was 2025-02-08, and it was "Retrospectively registered".

Cardiac Imaging on COVID-19 Pandemic Era: the Stand, The Lost, and Found

Purpose of Review

The present review will outline the main effects of COVID-19 pandemic on cardiovascular pathologies, focusing on the role of modern non-invasive cardiac imaging techniques in this setting.

Recent Findings

Multimodality cardiac imaging seems particularly suited for the in-depth characterization of patients with COVID-19, allowing the assessment of the variegated impact of the disease on the different aspects of myocardial perfusion, structure, and function.

Summary

The infection of SARS-CoV-2, leading to the coronavirus disease-19 (COVID-19), has represented a consistent challenge for the organization of the healthcare systems, associating to a significant increase of the fatality rate of different acute and chronic disease. Moreover, the reallocation of healthcare providers led to a significant reduction of the availability of tests and therapies, with the deferral of non-urgent tests and non-lifesaving procedures.