1,721,393 research outputs found
Intracoronary Insights in Diabetes Mellitus
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176469.pdf (Publisher’s version ) (Open Access)Radboud University, 18 oktober 2017Promotor : Suryapranata, H. Co-promotor : Kedhi, E
Platelets and antithrombotic therapies in coronary artery disease
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142567.pdf (Publisher’s version ) (Open Access)Radboud Universiteit Nijmegen, 04 september 2015Promotor : Suryapranata, H. Co-promotores : De Luca, G., Brouwer, M.A
Optimizing primary PCI for ST Elevation Myocardial Infarction.
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91221.pdf (Publisher’s version ) (Open Access)Radboud Universiteit Nijmegen, 20 april 2011Promotores : Suryapranata, H., Boer, M.J. de Co-promotor : Ottervanger, J.P.197 p
Prehospital triage and risk assessment in STEMI patients
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139521.pdf (Publisher’s version ) (Open Access)Radboud Universiteit Nijmegen, 24 april 2015Promotor : Suryapranata, H. Co-promotores : Hof, A.W.J. van ’t, Berg, J.M. te
Non-ST-elevation acute coronary syndromes: Optimal timing of invasive treatment
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191603.pdf (Publisher’s version ) (Open Access)Radboud University, 19 juni 2018Promotores : Suryapranata, H., Hof, A.W.J. van ’t Co-promotores : Wijngaarden, J. van, Riet, E. van '
Prediction of (super) response to cardiac resynchronization therapy
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160827.pdf (Publisher’s version ) (Open Access)Radboud University, 24 november 2016Promotores : Boer, M.J. de, Suryapranata, H. Co-promotores : Delnoy, P.P.M., Ottevanger, J.P
Recent Advances in Optimal Adjunctive Antithrombotic Therapy in STEMI Patients Undergoing Primary Angioplasty: An Overview
No full textItem does not contain fulltextThere has been a considerable effort to improve adjunctive antithrombotic therapies to reperfusion strategies in the treatment of ST-segment elevation Myocardial Infarction (STEMI). Therefore, the aim of this article is to provide a critical and updated overview of recent advances on adjunctive antithrombotic therapies in patients undergoing primary angioplasty for STEMI. Due to very low costs, early Unfractionated Heparin (UFH) plus additional periprocedural administration should still be regarded as the gold standard in antithrombotic therapy, whereas subsequent subcutaneous administration of Low Molecular Weight Heparins (LMWHs) or fondaparinux should be considered, especially in patients at higher risk of thromboembolic complications. Periprocedural bivalirudin should be considered instead of a strategy of combined UFH and Glycoprotein (Gp) IIb/IIIa inhibitors, especially among patients at higher risk of bleeding complications. New oral ADP antagonists should be administrated as early as possible soon after diagnosis, whereas the use of clopidogrel should be limited to the cases when the new ADP antagonists are not available or contraindicated. However, rivaroxaban has obtained indication for Acute Coronary Syndromes (ACS), and therefore its combination with aspirin and clopidogrel will gain recognition especially among STSegment Elevation Myocardial Infarction (STEMI) patients. Future trials are needed to compare different possible strategies with oral antithrombotic therapies and in particular optimal duration, especially in the era of new DES that have been shown to reduce the risk of stent thrombosis. Early Gp IIb/IIIa inhibitor use may be considered as upstream therapy especially in high-risk patients, whereas the choice of periprocedural administration may be based on thrombus burden or in case of impaired haemodynamic conditions that may compromise oral drug absorption. Overall, a more aggressive antithrombotic approach should be considered within the first hours from symptom onset, when the considerable viability justifies aggressiveness. The use of radial approach and potential protamine administration should be considered in order to minimize the risk of bleeding complications. Due to the very low mortality currently achieved by primary angioplasty and stenting, a further reduction in short or mediumterm mortality would be not easy to demonstrate. Therefore, additional endpoints, such as infarct size and myocardial perfusion, may be considered in future randomized trials especially for the evaluation of new periprocedural antithrombotic therapies among patients undergoing mechanical revascularization for STEMI
A meta-analytic overview of thrombectomy during primary angioplasty
No full textItem does not contain fulltextINTRODUCTION: Even though primary angioplasty restores TIMI 3 flow in more than 90% of STEMI patients, the results in terms of myocardial perfusion are still unsatisfactory in a relatively large proportion of patients. Great interest has been focused in the last years on distal embolization as major determinant of poor reperfusion and clinical outcome after primary angioplasty. The aim of this article is to perform an updated meta-analysis of thrombectomy devices in STEMI patients undergoing primary angioplasty. METHODS: The literature was scanned by formal searches of electronic databases (MEDLINE, Pubmed) from January 1990 to December 2010, the scientific session abstracts (from January 1990 to December 2010) and oral presentation and/or expert slide presentations (from January 2002 to December 2010) (on TCT, AHA, ESC, ACC and EuroPCR websites). No language restrictions were enforced. RESULTS: A total of 21 randomized trials were finally included in the meta-analysis, involving 4514 patients (2270 or 50.3% randomized to thrombectomy and 2244 or 49.7% to standard angioplasty). Overall thrombectomy did not reduce 30-day mortality, with more benefits observed only with manual thrombectomy. No difference was observed in the 30-day reinfarction rate, whereas a trend in higher risk of stroke was observed with thrombectomy (p=0.06). Manual but not mechanical thrombectomy significantly improved postprocedural TIMI 3 flow, however, both devices significantly improved myocardial reperfusion as evaluated by ST-segment resolution. By meta-regression analysis a linear relationship was observed between benefits from thrombectomy in ST-segment resolution and in the presence of thrombus at baseline angiography (p=0.0016). CONCLUSIONS: The present meta-analysis has demonstrated that, among patients with STEMI, manual thrombectomy significantly improved myocardial perfusion, with a trend in short-term mortality benefits, whereas mechanical thrombectomy, despite the benefits in myocardial perfusion, did not impact on short-term survival. However, the benefits in myocardial perfusion were significantly related to prevalence of coronary thrombus. In light of the observed higher risk of stroke, thrombectomy cannot be routinely recommended, but should be used in case of evident intracoronary thrombus. Mechanical thrombectomy devices may be considered as well to further improve reperfusion and facilitate optimal stent implantation, especially in the presence of large thrombus burden
Prevention of distal embolization in patients undergoing mechanical revascularization for acute myocardial infarction. A review of current status
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