1,721,071 research outputs found
Ticagrelor and Endothelial Function: An Effect That Persists Far From the Acute Phase and in Monotherapy
No full textTicagrelor is an oral reversible inhibitor of the P2Y12 platelet receptor. From the first randomized clinical trial, which presented this drug to the cardiovascular panorama, it was clear that ticagrelor has something different compared with other P2Y12 inhibitors. In the PLATO trial (Study of Platelet Inhibition and Patient Outcomes), ticagrelor was superior to clopidogrel in the reduction of major cardiac and cerebrovascular adverse events.1 Surprisingly, the reduction of the composite primary end point was not only driven by a reduction in myocardial infarction (which was similar to the other newer P2Y12 inhibitor prasugrel), but also in cardiovascular mortality. This finding cannot be explained only by a stronger platelet inhibition as compared with clopidogrel. Indeed, prasugrel shows a similar platelet inhibition as compared with ticagrelor but did not affect cardiovascular mortality in any trials. Therefore, investigators looked for pleiotropic effects of ticagrelor, different from the one mediated by P2Y12 inhibition. Although with conflicting results, many studies reported that ticagrelor increased adenosine plasma level in patients with acute coronary syndrome (ACS) by inhibiting adenosine uptake by red blood cells2 and improved endothelial function, which is significantly impaired in patients with ACS or in other conditions characterized by acute/chronic inflammation
Complex coexistence of COPD and cardiovascular disease
No full textCardiovascular disease (CVD) and chronic obstructive pulmonary disease (COPD) are two of the leading causes of morbidity and mortality worldwide, ranking first and third, respectively, among causes of death. These two diseases are linked by an important modifiable risk factor: smokin
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No full textThe main aim of meta-analyses is to analyze aggregate data from already published randomized or nonrandomized clinical trial
Strategie per la gestione della sotto-espansione dello stent [Management of stent under-expansion]
No full textStent under-expansion represents a negative prognostic factor, because of the risk to develop intrastent restenosis and stent thrombosis. It is often due to excessive calcium burden at the target lesion level. The list of devices available for the treatment of stent under-expansion includes super high-pressure non-com- pliant (NC) balloons, excimer laser and intravascular lithotripsy.
NC OPNTM balloons (SIS Medical AG, Winterthur, Switzerland) reach much higher pressures than those of standard NC balloons (up to 35 atm), so they are able to overcome the resistance given by the calcific plaque. The excimer laser catheter instead generates ultraviolet light pulses with low penetration power. This one fragments the atherosclerotic material surrounding the implanted stent. This technology has proven to be extremely effective, however it requires specific operator experience to reduce the risk of serious complica- tions. Intravascular lithotripsy is the most recent method, and it has shown very promising results so far. The Shockwave Medical device (S-IVL; Shockwave Medical Inc, Santa Clara, CA, USA) emits sound waves that act selectively on the calcific component, breaking it up and making the vessel more compliant
‘All roads lead to Rome’: the long journey of ticagrelor effect on endothelial function
No full text‘All roads lead to Rome’: the long journey of ticagrelor effect on endothelial functio
How the functional assessment of culprit and non-culprit lesions may improve stratification and treatment of STEMI patients
No full textReperfusion therapy of the infarct-related artery (IRA) with primary percutaneous coronary intervention is the cornerstone for the treatment of patients with ST-elevation myocardial infarction (STEMI). However, up to 30% of STEMI patients present a multi-vessel coronary artery disease. Several methods are now available for the assessment of functional severity of a coronary stenosis both for IRA and non-culprit coronary lesions. The functional assessment of the IRA has mainly a prognostic implication in terms of major adverse cardiovascular events, recovery of left ventricular function and evaluation myocardial viability. Conversely, the functional assessment of the non-culprit coronary lesions has a fundamental role to guide staged revascularization. The aim of this review is to revise the most validated methods to perform the functional assessment of both culprit and non-culprit lesion in ST-elevation myocardial infarction
Uric acid and coronary artery disease: An elusive link deserving further attention
No full textUric acid is the final product of purine metabolism. Classically it is recognized as the cause of gouty arthritis and kidney stones. Western civilization has increased serum levels of uric acid which is no longer considered a benign plasma solute. It has been postulated and recently demonstrated that it can penetrate cell membrane and exerts damaging intracellular actions such as oxidation and inflammation. These observations have stimulated several epidemiological researches suggesting that hyperuricemia is linked or even provokes hypertension and coronary artery disease. In this review we summarize the current evidences regarding uric acid which contribute in the pathophysiology of coronary artery disease
The DAPT study
No full textBackground. Dopo impianto di stent è raccomandata la duplice terapia antiaggregante allo scopo di prevenire l’insorgenza di complicanze trombotiche, ma restano ancora da chiarire i benefici ed i rischi associati al prolungamento della doppia antiaggregazione oltre i 12 mesi. Metodi. Sono stati arruolati pazienti sottoposti ad angioplastica coronarica con impianto di stent medicato. Dopo 12 mesi di trattamento con tienopiridina (clopidogrel o prasugrel) e aspirina, i pazienti sono stati randomizzati a mantenimento della terapia con tienopiridina o a placebo per altri 18 mesi, in entrambi i casi con prosecuzione del trattamento con aspirina. Gli endpoint co-primari di efficacia erano rappresentati dalla trombosi di stent e dagli eventi avversi maggiori cardio- e cerebrovascolari (un composito di morte, infarto o ictus) nel periodo compreso fra 12 e 30 mesi. L’endpoint primario di sicurezza era costituito dalle emorragie moderate o severe. Risultati. Un totale di 9961 pazienti sono stati randomizzati a prosecuzione della terapia con tienopiridina o a placebo. Il mantenimento della duplice antiaggregazione rispetto al trattamento con placebo è risultato associato ad una riduzione della trombosi di stent (0.4 vs 1.4%; hazard ratio 0.29; intervallo di confidenza [IC] 95% 0.17-0.48; p<0.001) e degli eventi avversi maggiori cardio- e cerebrovascolari (4.3 vs 5.9%; hazard ratio 0.71; IC 95% 0.59-0.85; p<0.001). L’incidenza di infarto miocardico è stata inferiore nel gruppo a doppia antiaggregazione prolungata rispetto a quello trattato con placebo (2.1 vs 4.1%; hazard ratio 0.47; p<0.001). La mortalità da ogni causa è stata del 2.0% nel gruppo a doppia antiaggregazione prolungata e dell’1.5% nel gruppo placebo (hazard ratio 1.36; IC 95% 1.00-1.85; p=0.05). Il tasso di emorragie moderate o severe è risultato più elevato nel gruppo a doppia antiaggregazione prolungata (2.5 vs 1.6%; p=0.001). In entrambi i gruppi è stato osservato un rischio elevato di trombosi di stent e di infarto miocardico nei 3 mesi successivi alla sospensione della duplice terapia antiaggregante. Conclusioni. Dopo impianto di stent medicato, il prolungamento della doppia antiaggregazione oltre i 12 mesi, rispetto alla sola terapia con aspirina, ha determinato una significativa riduzione del rischio di trombosi di stent e di eventi avversi maggiori cardio- e cerebrovascolari ma è risultato associato ad un aumento del rischio emorragico. [N Engl J Med 2014;371:2155-66
Pulmonary Valve Stenosis: From Diagnosis to Current Management Techniques and Future Prospects
No full textPulmonary stenosis (PS) is mainly a congenital defect that accounts for 7-12% of congenital heart diseases (CHD). It can be isolated or, more frequently, associated with other congenital defects (25-30%) involving anomalies of the pulmonary vascular tree. For the diagnosis of PS an integrated approach with echocardiography, cardiac computed tomography and cardiac magnetic resonance (CMR) is of paramount importance for the planning of the interventional treatment. In recent years, transcatheter approaches for the treatment of PS have increased however, meaning surgery is a possible option for complicated cases with anatomy not suitable for percutaneous treatment. The present review aims to summarize current knowledge regarding diagnosis and treatment of PS
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