114 research outputs found
Developing drugs for use before, during and soon after percutaneous coronary intervention.
No full textINTRODUCTION
Percutaneous coronary intervention (PCI) is a milestone for treating coronary artery disease (CAD). Antithrombotic therapy is essential to prevent ischemic complications, including the microvascular no-reflow, while minimizing bleeding events. Areas covered: This overview discusses available and developing drugs for PCI including anticoagulants, antiplatelets and treatment of no-reflow. Expert opinion: For years unfractionated heparin (UFH) has been the unique anticoagulant to be used before and during PCI. Enoxaparin showed similar efficacy and safety, yet, based on recent trials, bivalirudin has been shown to have some benefits, particularly for patients with ST-segment elevation myocardial infarction (STEMI). The evidence concerning new anticoagulants is still preliminary, except for new oral anticoagulants, particularly rivaroxaban that showed intriguing findings and is currently under investigation. Dual antiplatelet therapy (DAPT) is the standard of care after PCI, but new developments have recently emerged. Indeed, ticagrelor and prasugrel are currently recommended over clopidogrel due to their significant reduction of ischemic events in acute coronary syndrome (ACS) whereas clopidogrel remains the choice in stable CAD. Among new agents, vorapaxar and cangrelor showed positive but limited evidence and might be considered at least in selected patients. Conversely, evidence on effective treatments for no-reflow remains limited and would require future dedicated research
Percutaneous coronary interventions in Europe in 2006
No full textThis registry has aimed to collect data on cardiac catheterisation procedures in Europe in 2006
Are adapted guidelines required for patients with prior bypass surgeries and heart failure in acute myocardial infarction?
No full textUse of the dual-antiplatelet therapy score to guide treatment duration after percutaneous coronary intervention
No full textBackground
The dual-antiplatelet therapy (DAPT) score was developed to identify patients more likely to derive harm (score <2) or benefit (score ≥2) from prolonged DAPT after percutaneous coronary intervention (PCI).
Objective
To evaluate the safety and efficacy of DAPT duration according to DAPT score.
Design
Retrospective assessment of DAPT score-guided treatment duration in a randomized clinical trial. (ClinicalTrials.gov: NCT00611286).
Setting
PCI patients.
Patients
1970 patients undergoing PCI.
Intervention
DAPT (aspirin and clopidogrel) for 24 versus 6 months.
Measurements
Primary efficacy outcomes were death, myocardial infarction, or cerebrovascular accident. The primary safety outcome was type 3 or 5 bleeding according to the Bleeding Academic Research Consortium definition. Outcomes were assessed between 6 and 24 months.
Results
884 patients (44.9%) had a DAPT score of at least 2, and 1086 (55.1%) had a score less than 2. The reduction in the primary efficacy outcome with 24- versus 6-month DAPT was greater in patients with high scores (risk difference [RD] for score ≥2, -2.05 percentage points [95% CI, -5.04 to 0.95 percentage points]; RD for score <2, 2.91 percentage points [CI, -0.43 to 6.25 percentage points]; P = 0.030). However, the difference by score for the primary efficacy outcome varied by stent type; prolonged DAPT with high scores was effective only in patients receiving paclitaxel-eluting stents (RD, -7.55 percentage points [CI, -12.85 to -2.25 percentage points]). The increase in the primary safety outcome with 24- versus 6-month DAPT was greater in patients with low scores (RD for score ≥2, 0.20 percentage point [CI, -1.20 to 1.60 percentage points]; RD for score <2, 2.58 percentage points [CI, 0.71 to 4.46 percentage points]; P = 0.046).
Limitation
Retrospective calculation of the DAPT score.
Conclusion
Prolonged DAPT resulted in harm in patients with low DAPT scores undergoing PCI but reduced risk for ischemic events in patients with high scores receiving paclitaxel-eluting stents. Whether prolonged DAPT benefits patients with high scores treated with contemporary drug-eluting stents requires further study.
Primary Funding Source
None
Impact of chronic kidney disease on 2-year clinical outcomes in patients treated with 6-month or 24-month DAPT duration: An analysis from the PRODIGY trial
No full textTo assess whether moderate-to-severe CKD is a treatment modifier for benefit or harm in patients randomly allocated to 24-month versus 6-month DAPT
Safety and efficacy of concurrent administration of clopidogrel and prasugrel loading doses among patients with acute myocardial infarction undergoing primary percutaneous coronary intervention
No full text
Serial greyscale and virtual histology IVUS findings in patients undergoing primary PCI with biodegradable polymer biolimus-eluting stents versus bare metal stents
No full textProlonged vs Short Duration of Dual Antiplatelet Therapy After Percutaneous Coronary Intervention in Patients With or Without Peripheral Arterial Disease: A Subgroup Analysis of the PRODIGY Randomized Clinical Trial.
No full textImportance
Patients with concomitant peripheral arterial disease (PAD) experience worse cardiovascular outcomes after percutaneous coronary intervention (PCI).
Objective
To assess the efficacy and safety of prolonged (24 months) vs short (≤6 months) dual antiplatelet therapy (DAPT) in patients with PAD undergoing PCI.
Design, Setting, and Participants
This subanalysis of the randomized Prolonging Dual Antiplatelet Treatment After Grading Stent-Induced Intimal Hyperplasia Study (PRODIGY) trial assessed unselected patients from tertiary care hospitals with stable coronary artery disease or acute coronary syndromes with or without concomitant PAD from December 2006 to December 2008. Data analysis was performed from January 7 to April 4, 2016.
Interventions
Percutaneous coronary intervention.
Main Outcomes and Measures
Rates of the primary efficacy end point, composite of death, myocardial infarction, or cerebrovascular accidents, and occurrence of the key safety end point, a composite of Bleeding Academic Research Consortium type 2, 3, or 5.
Results
This analysis comprised 246 and 1724 patients with and without PAD, respectively. In the patients with PAD, mean (SD) age was 73.2 (9.2) in the prolonged group and 75.7 (8.7) years in the short DAPT group, and 97 (82.2%) were male in the prolonged group and 92 (71.9%) were male in the short DAPT group. In the patients without PAD, mean (SD) age was 67.1 (11.2) years in the prolonged group and 66.8 (11.3) years in the short DAPT group, and 667 (76.8%) were male in the prolonged group and 655 (76.6%) were male in the short DAPT group. Status of PAD was associated with a higher risk of death and ischemic events (hazard ratio [HR], 2.80; 95% CI, 2.05-3.83; P < .001). Prolonged vs short DAPT conveyed a lower risk of the primary efficacy end point in patients with PAD (19 [16.1%] vs 35 [27.3%]; HR, 0.54; 95% CI, 0.31-0.95; P = .03) but not in patients without PAD (81 [9.3%] vs 63 [7.4%]; HR, 1.28; 95% CI, 0.92-1.77; P = .15), with positive interaction (P = .01). The risk of definite or probable stent thrombosis was significantly lower in patients with PAD treated with prolonged compared with short DAPT (HR, 0.07; 95% CI, 0-1.21; P = .01). Bleeding Academic Research Consortium type 2, 3, or 5 bleeding occurred in 6 patients with PAD (5.2%) receiving prolonged DAPT relative to 8 (6.9%) of those receiving short DAPT (HR, 0.77; 95% CI, 0.27-2.21; P = .62), with a significant interaction (P = .04) compared with patients without PAD.
Conclusions and Relevance
Peripheral artery disease confers a poor prognosis in patients undergoing PCI in the setting of stable coronary artery disease or acute coronary syndromes. Prolonged DAPT lowers the risk of ischemic events with no apparent bleeding liability in this high-risk group.
Trial Registration
clinicaltrials.gov Identifier: NCT00611286
Computed tomography detection and quantification of left atrial appendage residual patency as collateral finding after percutaneous closure.
No full textBackground: Peridevice leaks after left atrial appendage closure (LAAC) may increase the risk of embolic stroke. This study appraises the value of a clinically indicated angio-computed tomography (CT) to assess the presence and size of LAA patency after percutaneous closure. Methods: We retrospectively analysed patients who underwent LAAC in our centre for a clinically indicated angio-CT to quantify Hounsfield units (HU) in LAA and in the left atrium (LA) and correlated them with the presence and size of LAA leaks at TEE. Results: CT scan was available in 56 patients of whom 40 also underwent TEE assessment. Any LAA leak at TEE was present in 9/40 (22.5%) patients of whom all had HU >100 in the LAA. However, HU measured in the LAA was >100 HU in 8 additional patients with no leak at TEE, leading to a sensitivity of 100% (9/9), specificity of 74.1% (23/31) and diagnostic accuracy of 80% (32/40). LAA HU or LAA/LA HU ratio did not discriminate LAA leak size at angio-CT. However, a coaptation gap >3 mm at angio-CT between device and LAA ostium was present in all cases with leak size >3 mm at TEE. Conclusions: HU > 100 in the LAA and a coaptation gap >3 mm between device and LAA ostium at angio-CT identified all LAA leaks and those >3 mm at TEE, respectively
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