scholarly journals A PHARMACOGENOMIC APPROACH TO ANTIPLATELET THERAPY IN STEMI PATIENTS: REASSESSMENT OF ANTI-PLATELET THERAPY USING AN INDIVIDUALIZED STRATEGY IN PATIENTS WITH ST-ELEVATION MYOCARDIAL INFARCTION (THE RAPID STEMI STUDY)

2013 ◽  
Vol 61 (10) ◽  
pp. E5
Author(s):  
Derek Yiu Fai So ◽  
George Wells ◽  
Ruth McPherson ◽  
Marino Labinaz ◽  
Chris Glover ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Antiplatelet Therapy ◽  
St Elevation Myocardial Infarction ◽  
Anti Platelet Therapy ◽  
St Elevation

Early vascular responses to ultrathin biodegradable polymer sirolimus-eluting stent for the treatment of st-elevation myocardial infarction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
Y Oishi ◽  
T Shinke ◽  
H Tanaka ◽  
K Ogura ◽  
K Arai ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Clinical Outcomes ◽  
Antiplatelet Therapy ◽  
St Elevation Myocardial Infarction ◽  
Current Generation ◽  
Vascular Responses ◽  
Post Procedure ◽  
St Elevation ◽  
Sirolimus Eluting Stent

Abstract Background Recent clinical study suggests newer-generation drug-eluting stents (DES) that combine ultrathin strut and nano-coating with biodegradable polymers sirolimus-eluting stent (BP-SES) could improve long-term clinical outcomes in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) over current generation DES. However, safety profiles in very early phase have not been systematically addressed. Objective and method We exploratory investigate early vascular response following BP-SES implantation in patients with STEMI to reveal mechanism of the favorable clinical outcomes in recent studies using frequency domain-optical coherence tomography (FD-OCT). Consecutive twenty patients with STEMI who underwent FD-OCT immediately after primary PCI and were eligible for follow-up FD-OCT at 2 weeks after implantation were enrolled between June 2018 and November 2019. Results Twenty patients (age 62.7±11.3 years, male 85.0%) were enrolled with frequencies of hypertension (45.0%), diabetes mellitus (35.0%), dyslipidemia (55.0%) and smoking (80.0%). Aspiration catheter were used in all patients, and 1.13±0.34 stents were used. Only one patient (5.0%) received chronic antiplatelet therapy with aspirin prior to the onset of STEMI. All patients started to receive prasugrel as thienopyridine from this event and continued dual antiplatelet therapy for 2 weeks. The percentage of uncovered struts significantly decreased from post-procedure to 2W follow-up (69±18% post-procedure versus 30±11% at 2W follow up, p<0.0001). Malapposed struts also decreased (5.6±5.7% post-procedure versus0.9±1.2% at 2W follow up, p<0.0001).The average protrusion area of athero-thrombotic burden numerically decreased (0.37±0.19 at post-procedure versus 0.34±0.14 mm2 at 2W follow up, p=0.19) and its volume showed similar tendency (10.60±6.40 at post-procedure versus 9.36±5.14 mm3 at 2W follow up, p=0.19). Conclusion(s) This study firstly elucidated very early vascular responses following ultrathin strut BP-SES implantation in STEMI patients, showing early progression of strut coverage and resolution of athero-thrombotic materials. This technology may have a potential to overcome the current generation DESs in this clinical setting. Thrombus, uncovered and malapposed struts Funding Acknowledgement Type of funding source: None

scholarly journals A 64-year-old man suffering from ST-elevation myocardial infarction and severe thrombocytopenia: Procedures in the case of a patient not fitting the guidelines

2019 ◽  
Vol 7 ◽  
pp. 2050313X1984052
Author(s):  
Dawid Ilnicki ◽  
Rafał Wyderka ◽  
Przemysław Nowicki ◽  
Alicja Sołtowska ◽  
Jakub Adamowicz ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Platelet Count ◽  
Coronary Angiography ◽  
Antiplatelet Therapy ◽  
St Elevation Myocardial Infarction ◽  
Severe Thrombocytopenia ◽  
Therapeutic Decisions ◽  
Increased Risk ◽  
Low Platelet Count ◽  
St Elevation

The objective of this case report is to present how the chronic condition significantly complicates life-saving procedures and influences further treatment decisions. A 64-year-old man suffering from arterial hypertension and immune thrombocytopenic purpura presented to the Emergency Department with anterior ST-elevation myocardial infarction. An immediate coronary angiography was performed where critical stenosis of the proximal left anterior descending was found. It was followed by primary percutaneous intervention with bare metal stent. In first laboratory results, extremely low platelet count was found (13 × 109/L). Consulting haematologist advised the use of single antiplatelet therapy and from the second day of hospitalisation only clopidogrel was prescribed. On the sixth day of hospital stay, patient presented acute chest pain with ST elevation in anterior leads. Emergency coronary angiography confirmed acute stent thrombosis and aspiration thrombectomy was performed. It was therefore agreed to continue dual antiplatelet therapy for 4 weeks. As there are no clinical trials where patients with low platelet count are included, all therapeutic decisions must be made based on clinician’s experience and experts’ consensus. Both the risk of haemorrhagic complications and increased risk of thrombosis must be taken into consideration when deciding on patient’s treatment.

scholarly journals TIME RELATED BENEFIT OF ANTIPLATELET THERAPY ON CORONARY REPERFUSION IN ST-ELEVATION MYOCARDIAL INFARCTION (STEMI) PATIENTS

2017 ◽  
Vol 69 (11) ◽  
pp. 257
Author(s):  
Martino Pepe ◽  
Filippo Masi ◽  
Nicola Signore ◽  
Alessandro Santo Bortone ◽  
Annagrazia Cecere ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Antiplatelet Therapy ◽  
St Elevation Myocardial Infarction ◽  
Coronary Reperfusion ◽  
St Elevation

P3629Invasive versus medical management of non-ST elevation myocardial infarction in cancer patients: knowledge is bliss

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
D V Balanescu ◽  
T Donisan ◽  
M Lee ◽  
P Tran ◽  
S De Sirkar ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Chest Pain ◽  
Cancer Patients ◽  
Antiplatelet Therapy ◽  
Single Agent ◽  
St Elevation Myocardial Infarction ◽  
Invasive Treatment ◽  
Prior Chemotherapy ◽  
St Elevation ◽  
Active Cancer

Abstract Background Cancer patients with non-ST elevation myocardial infarction (NSTEMI) frequently present with comorbidities (e.g., anaemia, thrombocytopenia) that discourage invasive treatment. Purpose To compare outcomes of cancer patients with NSTEMI treated with optimal medical therapy (OMT) + percutaneous coronary intervention (PCI) versus OMT alone and to identify variables associated with overall survival (OS). Methods All cancer patients diagnosed with NSTEMI between March 2016 and December 2018 at our institution were included. Patients were classified based on treatment of NSTEMI into 2 groups: invasive strategy or OMT alone. The invasive group was further classified into early (PCI≤72 hours since presentation) or delayed strategy (PCI>72 hours). Clinical and laboratory data, oncologic history, major adverse cardiovascular events, and survival were collected. Univariate Cox proportional hazards regression analyses were conducted to identify variables associated with OS. Results We included 201 patients with a mean age of 68±11 years, 136 (68%) of which were women. Median OS was 13 months. Factors influencing OS are presented in Table I. Patients receiving PCI had better OS compared to patients treated with OMT only (Figure 1, p<0.0001). Procedure-related complications were non-fatal and present in 2 (1.85%) cases. Table I Covariate Hazard Ratio (95% confidence interval) p-value Early invasive treatment (≤72 hours) 0.327 (0.207–0.516) <0.0001 Delayed invasive treatment (>72 hours) 0.496 (0.252–0.977) 0.0426 Presenting symptom: chest pain 0.406 (0.254–0.649) 0.0002 Presenting symptom: others 1.869 (1.223–2.855) 0.0039 Single agent antiplatelet therapy 0.434 (0.263–0.716) 0.0011 Dual agent antiplatelet therapy 0.294 (0.174–0.496) <0.0001 Statins 0.440 (0.276–0.703) 0.0006 Active cancer 4.487 (1.646–12.234) 0.0033 Prior chemotherapy 2.312 (1.328–4.023) 0.0030 Prior chest radiation 1.752 (1.065–2.884) 0.0272 Active chemotherapy 1.931 (1.271–2.934) 0.0021 Figure 1 Conclusions An invasive management of NSTEMI in cancer patients, especially within 72 hours, appears to be associated with improved OS. Patients presenting with symptoms other than chest pain were less likely to undergo PCI and had worse outcomes. Active cancer, a history of chest radiation, and active or prior chemotherapy were also associated with decreased OS. Acknowledgement/Funding None

scholarly journals Pretreatment with dual antiplatelet therapy in patients with ST-elevation myocardial infarction

2017 ◽  
Vol 92 (2) ◽  
pp. E98-E105
Author(s):  
Matias B. Yudi ◽  
Omar Farouque ◽  
Nick Andrianopoulos ◽  
Andrew E. Ajani ◽  
Angela Brennan ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Antiplatelet Therapy ◽  
Dual Antiplatelet Therapy ◽  
St Elevation Myocardial Infarction ◽  
St Elevation
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