Intracoronary abciximab reduces death and major adverse cardiovascular events in acute coronary syndromes: A meta-analysis of clinical trials

Postdilation is frequently used during coronary interventions to prevent stent malapposition. Currently there are contradictory findings regarding the benefits of postdilation for both intraprocedural and long-term outcomes. We evaluated the impact of postdilation among patients who presented with acute coronary syndromes (ACS) and underwent percutaneous coronary interventions (PCI). A total of 258 consecutive patients who presented with ACS and underwent PCI were included in the study. The patients were followed up for 25±1.7 months for the occurrence of major adverse cardiovascular events (MACE). During follow-up, 65 patients (25.2%) had MACE. Among patients without MACE, intracoronary nitrate infusion was less frequently used (P=0.005), myocardial blush grade was higher (P<0.001), and a drug-eluting stent was more frequently used (P=0.005). No significant differences were noted between groups regarding the predilation, recurrent dilation, postdilation, and other angiographic characteristics. In multivariate analysis, female sex (P=0.047), myocardial blush grade (P=0.038), previous coronary artery disease (P=0.030), and peak troponin level (P=0.002) were found to be predictors of MACE. In patients who were treated with PCI for ACS, performing postdilation did not predict final Thrombolysis in Myocardial Infarction (TIMI) flow grade, corrected TIMI frame count, myocardial blush grade, or MACE.

Download Full-text

Cardiovascular Events after Community-Acquired Pneumonia: A Global Perspective with Systematic Review and Meta-Analysis of Observational Studies

Journal of Clinical Medicine ◽

10.3390/jcm9020414 ◽

2020 ◽

Vol 9 (2) ◽

pp. 414 ◽

Cited By ~ 9

Author(s):

António Tralhão ◽

Pedro Póvoa

Keyword(s):

Heart Failure ◽

Acute Coronary Syndromes ◽

Cardiovascular Events ◽

Observational Studies ◽

Meta Analysis ◽

Community Acquired Pneumonia ◽

Cardiac Complications ◽

Short Term ◽

Short Term Mortality ◽

Coronary Syndromes

Acute cardiovascular disease after community-acquired pneumonia is a well-accepted complication for which definitive treatment strategies are lacking. These complications share some common features but have distinct diagnostic and treatment approaches. We therefore undertook an updated systematic review and meta-analysis of observational studies reporting the incidence of overall complications, acute coronary syndromes, new or worsening heart failure, new or worsening arrhythmias and acute stroke, as well as short-term mortality outcomes. To set a framework for future research, we further included a holistic review of the interplay between the two conditions. From 1984 to 2019, thirty-nine studies were accrued, involving 92,188 patients, divided by setting (inpatients versus outpatients) and clinical severity (low risk versus high risk). Overall cardiac complications occurred in 13.9% (95% confidence interval (CI) 9.6–18.9), acute coronary syndromes in 4.5% (95% CI 2.9–6.5), heart failure in 9.2% (95% CI 6.7–12.2), arrhythmias in 7.2% (95% CI 5.6–9.0) and stroke in 0.71% (95% CI 0.1–3.9) of pooled inpatients. During this period, meta-regression analysis suggests that the incidence of overall and individual cardiac complications is decreasing. After adjusting for confounders, cardiovascular events taking place after community-acquired pneumonia independently increase the risk for short-term mortality (range of odds-ratio: 1.39–5.49). These findings highlight the need for effective, large trial based, preventive and therapeutic interventions in this important patient population.

Download Full-text

Antithrombotic therapy in the early phase of non-ST-elevation acute coronary syndromes: a systematic review and meta-analysis

European Heart Journal - Cardiovascular Pharmacotherapy ◽

10.1093/ehjcvp/pvz031 ◽

2019 ◽

Vol 6 (1) ◽

pp. 43-56 ◽

Cited By ~ 6

Author(s):

Mattia Galli ◽

Felicita Andreotti ◽

Domenico D’Amario ◽

Rocco Vergallo ◽

Giovanni Maria Vescovo ◽

...

Keyword(s):

Major Bleeding ◽

Antithrombotic Therapy ◽

Acute Coronary Syndromes ◽

Meta Analysis ◽

Bleeding Risk ◽

Major Adverse Cardiovascular Events ◽

Clear Trend ◽

Early Management ◽

Coronary Syndromes ◽

St Elevation

Abstract Aims Despite the increasing use of early invasive strategies in non-ST-elevation acute coronary syndromes (NSTE-ACS), optimal initial antithrombotic therapy (ATT) based on the safety/efficacy profile of all guideline-recommended combinations remains crucial for the early management of both medically and invasively treated NSTE-ACS patients. Methods and results Randomized controlled trials on ATT in NSTE-ACS/unstable angina reporting early (within 14 days) major adverse cardiovascular events (MACE) and major bleeding were selected. Overall, 3799 studies were screened, 117 clinical trials were assessed as potentially eligible, 20 trials were included in the study. According to treatment and type of intervention, nine different meta-analyses were performed including a total of 88 748 patients. A significant reduction of trial-defined MACE was found for aspirin vs. placebo [odds ratio (OR), 0.57; 95% confidence interval (CI), 0.34–0.96], heparin vs. placebo (OR, 0.38; 95% CI, 0.15–0.97), aspirin + heparin vs. placebo (OR, 0.32; 95% CI, 0.18–0.59), aspirin + heparin vs. aspirin (OR, 0.57; 95% CI, 0.42–0.79), aspirin + low molecular weight heparin (LMWH) vs. aspirin + unfractionated heparin (UFH; OR, 0.81; 95% CI, 0.69–0.95) and aspirin + ticagrelor/prasugrel + heparins vs. aspirin + clopidogrel + heparins (OR, 0.76; 95% CI, 0.62–0.94). A significant decrease in major bleeding was found only for fondaparinux vs. LMWH on the background of aspirin + clopidogrel (OR, 0.52; 95% CI, 0.44–0.62) despite a clear trend towards increased bleeding for heparin compared to aspirin, aspirin + heparin compared to placebo, aspirin + heparin compared to aspirin, aspirin + P2Y12inhibitors + UFH/LMWH compared to aspirin + UFH/LMWH, and aspirin + ticagrelor/prasugrel + heparins compared to aspirin + clopidogrel + heparins. Conclusion To our knowledge, these findings are the first to report the safety and efficacy of all the various combinations of currently recommended ATT for the early management of NSTE-ACS, providing a comprehensive evidence-base to guide decisions depending on the patients’ bleeding risk and treatment strategy.

Download Full-text

Gender is Not a Predictor of Mortality or Major Adverse Cardiovascular Events in Patients Undergoing Percutaneous Coronary Intervention for Acute Coronary Syndromes

Heart Lung and Circulation ◽

10.1016/j.hlc.2018.03.020 ◽

2019 ◽

Vol 28 (5) ◽

pp. 727-734 ◽

Cited By ~ 3

Author(s):

Angeline Josiah ◽

Ahmad Farshid

Keyword(s):

Percutaneous Coronary Intervention ◽

Acute Coronary Syndromes ◽

Cardiovascular Events ◽

Coronary Intervention ◽

Major Adverse Cardiovascular Events ◽

Percutaneous Coronary ◽

Coronary Syndromes

Download Full-text

41 Meta-analysis of clinical trials comparing triple versus dual antithrombotic therapy in patients with atrial fibrillation and acute coronary syndromes or coronary artery disease requiring percutaneous intervention

10.1136/heartjnl-2021-bcs.41 ◽

2021 ◽

Author(s):

Omar Assaf ◽

Sabeeh Shams ◽

Aysha Basir ◽

Tawfiq Choudhury ◽

Kenneth Wong

Keyword(s):

Atrial Fibrillation ◽

Coronary Artery Disease ◽

Clinical Trials ◽

Coronary Artery ◽

Antithrombotic Therapy ◽

Acute Coronary Syndromes ◽

Meta Analysis ◽

Percutaneous Intervention ◽

Coronary Syndromes ◽

Artery Disease

Download Full-text

New genetic variants associated with major adverse cardiovascular events in patients with acute coronary syndromes and treated with clopidogrel and aspirin

The Pharmacogenomics Journal ◽

10.1038/s41397-021-00245-5 ◽

2021 ◽

Author(s):

Xiaomin Liu ◽

Hanshi Xu ◽

Huaiqian Xu ◽

Qingshan Geng ◽

Wai-Ho Mak ◽

...

Keyword(s):

Genetic Variants ◽

Acute Coronary Syndromes ◽

Cardiovascular Events ◽

Large Scale ◽

Predictive Performance ◽

Coronary Intervention ◽

Major Adverse Cardiovascular Events ◽

Sequencing Data ◽

Coronary Syndromes ◽

High Depth

AbstractAlthough a few studies have reported the effects of several polymorphisms on major adverse cardiovascular events (MACE) in patients with acute coronary syndromes (ACS) and those undergoing percutaneous coronary intervention (PCI), these genotypes account for only a small fraction of the variation and evidence is insufficient. This study aims to identify new genetic variants associated with MACE end point during the 18-month follow-up period by a two-stage large-scale sequencing data, including high-depth whole exome sequencing of 168 patients in the discovery cohort and high-depth targeted sequencing of 1793 patients in the replication cohort. We discovered eight new genotypes and their genes associated with MACE in patients with ACS, including MYOM2 (rs17064642), WDR24 (rs11640115), NECAB1 (rs74569896), EFR3A (rs4736529), AGAP3 (rs75750968), ZDHHC3 (rs3749187), ECHS1 (rs140410716), and KRTAP10-4 (rs201441480). Notably, the expressions of MYOM2 and ECHS1 are downregulated in both animal models and patients with phenotypes related to MACE. Importantly, we developed the first superior classifier for predicting 18-month MACE and achieved high predictive performance (AUC ranged between 0.92 and 0.94 for three machine-learning methods). Our findings shed light on the pathogenesis of cardiovascular outcomes and may help the clinician to make a decision on the therapeutic intervention for ACS patients.

Download Full-text