scholarly journals Efficacy and safety of pharmacoinvasive strategy compared with primary PCI in patients with STEMI presenting to non-PCI hubs: A real world study

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
A Gallardo-Grajeda ◽  
C Dattoli-Garcia ◽  
C Jackson-Pedroza ◽  
G Gopar-Nieto ◽  
O Ruiz-Fuentes ◽  
...  
Keyword(s):  
Real World ◽  
Composite Endpoint ◽  
Coronary Intervention ◽  
Reperfusion Therapy ◽  
Cardiovascular Death ◽  
Primary Pci ◽  
Efficacy And Safety ◽  
Funding Sources ◽  
Primary Composite Endpoint ◽  
Speed Up

Abstract Funding Acknowledgements Type of funding sources: None. Background Primary percutaneous coronary intervention (PPCI) is the treatment of choice for ST-elevation myocardial infarction (STEMI). Clinical practice guidelines recommend performing pPCI <120 minutes after the diagnosis of STEMI. Nevertheless, in a real world model this treatment is not always the fastest option. This is mostly due to the transfer delays when patients arrive to non-PCI capable hubs. These delays can decrease the benefits of the PPCI. Regional networks have been created to speed up these times and administer reperfusion therapy as early as possible. The pharmacoinvasive strategy (PIs) consists of the administration of fibrinolytic drugs in the non-pPCI setting followed by the immediate transfer of the patient to a pPCI center. Purpose To compare the efficacy and safety of pharmacoinvasive strategy compared with referral for primary PCI in patients with STEMI presenting to non PCI hubs. Methods A retrospective analysis of the PHASE-MX study (ClinicalTrials.gov Identifier: NCT03974581) including patients with STEMI whom initially presented to non-PCI hospitals and underwent either systemic fibrinolysis followed by pharmaco-invasive strategy or were transfer to perform primary PCIc according to the decision made by the doctor in the non-PCI center, the ease of referring the patient and the proximity of the PCI center. The primary composite endpoint included the occurrence of cardiovascular death, cardiogenic shock, recurrent MI or congestive heart failure at 30 days of follow-up. Results A total of 448 patients were included, of whom 273 (60.9%) underwent PIs and 175 (39.0%) were transfered for pPCI. Mean age was 58+-10 years, and most patients (86.8%) were male. No statistically significant differences in risk factors and other clinically meaningful variables were found. There was a 40% reduction in the risk of the primary composite endpoint (HR 0.60 for PIs: 95% CI:0.36-0.99; p = 0.048) for those undergoing PIs compared with pPCI, (Figure 1). Conclusion The pPCI main limitation is the impossibility to use it in the entire population due to its limited geographic availability and the delays involved in the transfer of patients from non-pPCI centers to reference hospitals. Through the PIs patients who arrive at non-PCI hospitals with STEMI and receive thrombolysis and then are redirect to PCI center there was a 40% reduction in the risk of a major endpoint occurring. Abstract Figure 1

scholarly journals Time to percutaneous coronary intervention in patients with ST-elevation myocardial infarction undergoing successful systemic fibrinolysis: does early or late make a difference?

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
C Jackson-Pedroza ◽  
A Gallardo-Grajeda ◽  
C Dattoli-Alejo ◽  
R Gopar-Nieto ◽  
D Alfaro-Ponce ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Congestive Heart Failure ◽  
Percutaneous Coronary Intervention ◽  
Composite Endpoint ◽  
Coronary Intervention ◽  
Cardiovascular Death ◽  
Primary Composite Endpoint ◽  
Percutaneous Coronary ◽  
Reduced Risk

Abstract Funding Acknowledgements Type of funding sources: None. OnBehalf PHASE-MX Background/Introduction: Early routine angiography with subsequent Percutaneous Coronary Intervention (PCI) (if needed) after fibrinolysis reduced the rates of reinfarction and recurrent ischemia compared with a ‘watchful waiting’ strategy. A crucial issue is the optimal time delay between successful lysis and PCI, there is a wide variation in delay in trials from a median of 1.3 h to 17h (CAPITAL AMI, GRACIA-1 and STREAM trials). At present a time window of 2-24h after successful lysis is recommended. Purpose   To analyze the incidence of major cardiovascular outcomes in patients with ST-segment elevation myocardial infarction (STEMI) according to the timing of PCI after lysis (pharmacoinvasive strategy, less/more than 24h). Methods A retrospective analysis of the PHASE-MX study (ClinicalTrials.gov Identifier: NCT03974581) including patients with STEMI whom underwent pharmacoinvasive strategy during the first 12h since symptom onset. Patients were further stratified according to the time from the use of fibrinolysis to sheat insertion (<24h or >24h) in the completion of pharmacoinvasive strategy. The primary composite endpoint included the occurrence of cardiovascular death, cardiogenic shock, recurrent myocardial infarction or congestive heart failure at 30 days of follow-up. Results A total of 171 patients were included, of whom 34 underwent PCI after fibrinolysis in less than 24 hours and 137 underwent PCI in more than 24 hours (95% CI 24-120h). Mostly were male (86.4%), mean age was 56.4 ±12.1 years. The primary composite endpoint occurred in 2 patients (5.8%) in PCI < 24 hours and 12 patients (8.6%) in PCI >24 hours (p 0.58). PCI in <24h after lysis was not associated with a reduced risk of the primary endpoint (HR 0.66 95%CI: 0.14-2.97). Conclusion In patients with successful fibrinolysis undergoing to PCI the first 24 h was not associated with a reduced risk of cardiovascular death, cardiogenic shock, recurrent MI or congestive heart failure at 30 days comparing with PCI after 24 h. Abstract Figure. Kaplan-Meier in primary endpoint

Comparison of prasugrel and ticagrelor for patient with acute coronary syndrome: a systematic review and meta-analysis

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
L.C.W Fong ◽  
N Lee ◽  
A.T Yan ◽  
M.Y Ng
Keyword(s):  
Acute Coronary Syndrome ◽  
Stent Thrombosis ◽  
Meta Analysis ◽  
Composite Endpoint ◽  
Cardiovascular Death ◽  
Coronary Syndrome ◽  
Primary Composite Endpoint ◽  
Significant Difference ◽  
St Elevation

Abstract Background Prasugrel and ticagrelor are both effective anti-platelet drugs for patients with acute coronary syndrome. However, there has been limited data on the direct comparison of prasugrel and ticagrelor until the recent ISAR-REACT 5 trial. Purpose To compare the efficacy of prasugrel and ticagrelor in patients with acute coronary syndrome with respect to the primary composite endpoint of myocardial infarction (MI), stroke or cardiac cardiovascular death, and secondary endpoints including MI, stroke, cardiovascular death, major bleeding (Bleeding Academic Research Consortium (BARC) type 2 or above), and stent thrombosis within 1 year. Methods Meta-analysis was performed on randomised controlled trials (RCT) up to December 2019 that randomised patients with acute coronary syndrome to either prasugrel or ticagrelor. RCTs were identified from Medline, Embase and ClinicalTrials.gov using Cochrane library CENTRAL by 2 independent reviewers with “prasugrel” and “ticagrelor” as search terms. Effect estimates with confidence intervals were generated using the random effects model by extracting outcome data from the RCTs to compare the primary and secondary clinical outcomes. Cochrane risk-of-bias tool for randomised trials (Ver 2.0) was used for assessment of all eligible RCTs. Results 411 reports were screened, and we identified 11 eligible RCTs with 6098 patients randomised to prasugrel (n=3050) or ticagrelor (n=3048). The included trials had a follow up period ranging from 1 day to 1 year. 330 events on the prasugrel arm and 408 events on the ticagrelor arm were recorded. There were some concerns over the integrity of allocation concealment over 7 trials otherwise risk of other bias was minimal. Patients had a mean age of 61±4 (76% male; 50% with ST elevation MI; 35% with non-ST elevation MI; 15% with unstable angina; 25% with diabetes mellitus; 64% with hypertension; 51% with hyperlipidaemia; 42% smokers). There was no significant difference in risk between the prasugrel group and the ticagrelor group on the primary composite endpoint (Figure 1) (Risk Ratio (RR)=1.17; 95% CI=0.97–1.41; p=0.10, I2=0%). There was no significant difference between the use of prasugrel and ticagrelor with respect to MI (RR=1.24; 95% CI=0.81–1.90; p=0.31); stroke (RR=1.05; 95% CI=0.66–1.67; p=0.84); cardiovascular death (RR=1.01; 95% CI=0.75–1.36; p=0.95); BARC type 2 or above bleeding (RR=1.17; 95% CI =0.90–1.54; p=0.24); stent thrombosis (RR=1.58; 95% CI =0.90–2.76; p=0.11). Conclusion Compared with ticagrelor, prasugrel did not reduce the primary composite endpoint of MI, stroke and cardiovascular death within 1 year. There was also no significant difference in the risk of MI, stroke, cardiovascular death, major bleeding and stent thrombosis respectively. Figure 1. Primary Objective Funding Acknowledgement Type of funding source: None

Implementation and clinical outcomes of pharmacogenetic CYP2C19 testing for clopidogrel therapy in real-world clinical practice.

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
POD O"drisceoil ◽  
TK Kiernan ◽  
SA Arnous
Keyword(s):  
Real World ◽  
Point Of Care ◽  
Coronary Intervention ◽  
Buccal Swab ◽  
Loss Of Function ◽  
Gain Of Function ◽  
Funding Sources ◽  
Patients At Risk ◽  
Clopidogrel Therapy ◽  
Stable Cad

Abstract Funding Acknowledgements Type of funding sources: None. BACKGROUNDCYP2C19 loss-of-function (LOF) polymorphisms are associated with adverse ischaemic events after PCI. The use of a point-of-care assay (POC) to routinely genotype patients immediately post PCI could rapidly identify patients at risk of adverse cardiac outcomes. PURPOSE To investigate the incidence of CYP2C19 polymorphisms (*2, *17) and 30-day MACE in patients presenting to catheter laboratory for PCI (See table 1).METHODS We performed a single centre prospective analysis of patients presenting to a cardiac catheterisation laboratory for percutaneous coronary intervention. Participants underwent prospective rapid point-of-care genotyping of CYP2C19 major alleles (2*,17*), using the SpartanRx PCR device via buccal swab sample. All patients provided written consent. RESULTS:A total of 120 tests were performed, 51 patients were normal allele carriers (*1), 31 patients were carriers of LOF alleles (*2) and 38 patients were carriers of gain of function alleles (*17). All tests results returned in one hour. Rate of dyslipidaemia was significantly different between three groups (55% vs. 63% vs. 36%; p = 0.050). A numerically higher proportion of LOF allele carriers received clopidogrel prior to undergoing pharmacogenetic testing but this was not statistically significant (52% vs. 35% vs. 34%; p = 0.09). Two cases of MACE at 30 day follow up occurred in the loss-of-function group. Both cases received clopidogrel.CONCLUSIONSWe have demonstrated that a rapid POC of CYP2C19 testing can take place in a real-world setting. Our incidence rate of LOF carriers is concordant with international published literature. We found 52% of LOF carriers were commenced on clopidogrel therapy prior to genetic analysis. Comparison of CPY2C19 Metabolisers genotype Loss of function normal Gain of function p values baseline characteristics age in years, median (range) 65 (43-82) 64 (43-85) 65 (42-89) 0.717 Male, N (%) 21 (68%) 43 (64%) 27 (71%) 0.198 Hypertensive, N (%) 16 (52%) 29 (57%) 24 (50%) 0.623 Dyslipidaemia. N (%) 17 (55%) 32 (63%) 14 (36%) 0.050 Indication, N (%) St-Elevation MI 12 (39%) 18 (35%) 11 (29%) 0.558 NSTEMI 5 (16%) 15 (29%) 14 (37%) 0.142 Unstable Angina 5 (16%) 7 (14%) 3 (8%) 0.518 Stable CAD 9 (29%) 11 (22%) 10 (26%) 0.731 Antiplatelet, N (%) Ticagrelor 15 (48%) 33 (65%) 25 (66%) 0.09 Clopidogrel 16 (52%) 18 (35%) 13 (34%) Complication, N (%) 30-day MACE 2 (6.5%) 0 0 0.01

Abstract P023: Relationship Between Vitamin D Status and Incidence of Macro-vascular Events in the Veterans Affairs Diabetes Trial (VADT)

Circulation ◽  
2012 ◽  
Vol 125 (suppl_10) ◽  
Author(s):  
Jimmy D Alele ◽  
Kelly J Hunt ◽  
Bruce W Hollis ◽  
Deirdre K Luttrell ◽  
Louis M Luttrell ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Type 2 Diabetes ◽  
Vitamin D ◽  
Composite Endpoint ◽  
Cardiovascular Death ◽  
Veterans Affairs ◽  
Vitamin D Status ◽  
Primary Composite Endpoint

BACKGROUND: Few studies have examined the relationship between vitamin D levels and incident cardiovascular events in large well-characterized type 2 diabetes cohorts. METHODS: We performed prospective analyses to determine associations between vitamin D status and vascular endpoints among 936 Veterans Affairs Diabetes Trial (VADT) participants (mean age 59.7 years; 96.7% male; 40.4% minority). 25 (OH)-vitamin D was measured a median of two years after entry into the VADT study and participants were subsequently followed an average of 3.7 years for outcomes. Cox proportional hazard models were used to calculate hazard ratios (HRs) for macrovascular endpoints in relation to vitamin D quartile. The primary composite endpoint included documented myocardial infarction; stroke; death from cardiovascular causes; new or worsening congestive heart failure; surgical intervention for cardiac, cerebrovascular, or peripheral vascular disease; inoperable coronary artery disease; and amputation for ischemic gangrene. RESULTS: On average VADT participants had high cardiovascular risk at entry into the study: 65.3% of the patients recruited were obese, 38.5% had previously had a vascular event, 78.7% had hypertension and 59.5% were using statins. During follow-up, 17.2%, 5.0%, 5.9%, 2.4% and 6.6% of participants had a primary composite endpoint, myocardial infarction, chronic heart failure, cardiovascular death or all-cause death, respectively. After adjusting for age, minority status, treatment arm and history of prior event, individuals in the lowest quartile of vitamin D (i.e., 1 to 15.9 ng/ml) were at similar risk of the primary composite endpoint [HR=1.26 (95% CI: 0.81, 1.96)], myocardial infarction [HR=1.13 (95% CI: 0.53, 2.42)], congestive heart failure [HR=1.44 (95% CI: 0.67, 3.06)], cardiovascular death [HR=0.86 (95% CI: 0.28, 2.63)], and death from any cause [HR=1.04 (95% CI: 0.53, 2.04)] as individuals in the highest quartile of vitamin D (i.e., 29.9 to 77.2 ng/ml). CONCLUSIONS: These data indicate that vitamin D status had no significant impact on the incidence of macrovascular events in a cohort of high-risk veterans with type 2 diabetes mellitus in which traditional risk factors were managed according to current treatment guidelines. SUPPORT: This work was supported by American Heart Association Grant-in-Aid AHA0755466U and the Research Service of the Charleston SC VA Medical Center.

Mortality from all causes in patients with myocardial infarction with elevation of st segment depending on the type of reperfusion therapy (data of ryazan region, 2018-2020)

2020 ◽  
Vol 28 (4) ◽  
pp. 479-487
Author(s):  
Elena Parshikova ◽  
Evgenii Filippov
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Reperfusion Therapy ◽  
Primary Pci ◽  
Coronary Syndrome ◽  
End Point ◽  
St Segment ◽  
Percutaneous Coronary ◽  
The Given

Aim. To assess mortality from all causes in patients with past myocardial infarction with elevation of ST segment (STEMI) depending on the type of reperfusion therapy. Materials and Methods. Of 1456 patients hospitalized with acute coronary syndrome with elevation of ST segment, 848 cases were randomly selected for analysis. Acquisition of information of the end point (death from any causes) continued within 18 months. The present data were obtained by 01.10.2020, median of observation was 20.8 [17.4;23.6] months. Results. The highest 18-month mortality (42.3%) was seen in the group of patients who did not receive reperfusion therapy. With this, mortality rate for 30 days in the group of thrombolytic therapy (TLT) and in the group without reperfusion did not show any significant differences (20.3% vs 26.2%, р0.05). Hospital, 30-day, 12-month, 18-month mortality from all causes in the group of percutaneous coronary intervention (PCI) made 8.4, 10.6, 16.6 and 18.3%, respectively, and was significantly lower compared to the group who did not receive reperfusion (19.5, 26.2, 36.2 and 42.3%, respectively, р0,05). The most significant differences in the frequency of the end point were recorded on achievement of 18-month limit: in the group without reperfusion mortality was 42.3%, that was higher (р0.05) compared to the given parameter in the group with TLT (27.1%), PCI (18.3%) and TLT+PCI (13.1%). Conclusion. During 18 months of observation, the lowest mortality from all causes was observed in the group with use of pharmacoinvasive approach and primary PCI, the highest mortality was in the group of patients who did not receive reperfusion therapy.

scholarly journals Trends in reperfusion therapy for acute ST-segment elevation myocardial infarction in an academic PCI centre in the metropolitan area of a developing country

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S Dharma ◽  
I Dakota ◽  
H Andriantoro ◽  
I Firdaus ◽  
I.G Limadhy ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Metropolitan Area ◽  
Coronary Intervention ◽  
Reperfusion Therapy ◽  
Primary Pci ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Percutaneous Coronary

Abstract Background Long-term reports on reperfusion therapy for acute ST-segment elevation myocardial infarction (STEMI) in developing countries are scarce. Purpose We reported changes in acute reperfusion therapy for STEMI that have been observed over time in an academic tertiary care percutaneous coronary intervention (PCI) centre that hosting a STEMI network in the large metropolitan area of Jakarta, Indonesia since 2010 and covering around 11 million inhabitants. Methods A retrospective analysis was performed in 6336 patients with STEMI who admitted to the emergency department of a PCI centre in 2008 (before STEMI network introduction), and during 2011 to 2018. Results Among STEMI patients admitted during 2011–2018 (mean age: 56±10 years, 86% male), 57.6% had anterior wall myocardial infarction, and 71.3% presented with Killip classification I. Compared with the period 2011–2014 (N=2766), patients who were admitted in the period 2015–2018 (N=3250) were receiving more primary percutaneous coronary intervention (PCI) (61.6% vs. 44.2%, P<0.001) with shorter door-to-device time (median 72 min versus 97 min, P<0.001), and less in-hospital fibrinolytic therapy (2.7% vs. 4.8%, P<0.001). The percentage of STEMI patients who did not receive reperfusion treatment decreased from 51% to 35.5% (P<0.001). In-hospital mortality declined from 10% in 2008 (before the STEMI network was initiated) and 8% in 2011 to 6.4% in 2018 (P for trends = 0.05). Multivariable analysis showed that primary PCI was significantly associated with better in-hospital survival (adjusted odds ratio, 0.52; 95% confidence interval, 0.42 to 0.65, P<0.001). Conclusion The data indicate that the introduction of a STEMI network resulted in more patients receiving timely primary PCI and lower early mortality rates in recent years. Funding Acknowledgement Type of funding source: None

scholarly journals Acute atrial ischemia associates with early but not late new-onset atrial fibrillation in STEMI patients treated with primary PCI: relationship with in-hospital outcomes

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
FG Biccire ◽  
I Cardillo ◽  
V Chianta ◽  
AC De Luca ◽  
I Ferrari ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cardiogenic Shock ◽  
Coronary Intervention ◽  
Primary Pci ◽  
Killip Class ◽  
Reactive Protein ◽  
Funding Sources ◽  
Long Term Prognosis ◽  
Onset Atrial Fibrillation ◽  
New Onset

Abstract Funding Acknowledgements Type of funding sources: None. OnBehalf N/A Background. New-onset atrial fibrillation (NOAF) is known to be a common complication in STEMI patients undergoing primary percutaneous coronary intervention (PCI), which is associated with a negative short- and long-term prognosis. Recently, two distinct phenotypes of NOAF have been described, namely early (EAF) and late NOAF (LAF). However, whether EAF and LAF recognize different pathogenetic mechanisms is unknown. Purpose. To investigate atrial branches occlusion and EAF or LAF onset in STEMI patients undergoing primary PCI. Methods. Retrospective cohort study including 155 STEMI patients. Patients were divided into 3 groups: sinus rhythm (SR), EAF or LAF. Clinical characteristics, angiographic features including occlusion of atrial branches, namely ramus ostia cavae superioris (ROCS), atrio-ventricular node artery (AVNA), right intermediate atrial artery (RIAA) and left intermediate atrial artery (LIAA), were assessed. We also investigated in-hospital complications, death, and a composite of major post-NOAF adverse events (AEs) including cardiogenic shock, acute pulmonary edema, sustained ventricular tachycardia and ventricular fibrillation. Results. Mean age was 63.8 ± 11.9 years; 78.7% of men. NOAF was detected in 22 (14.2%) patients: 10 (6.4%) EAF and 12 LAF (7.7%). Compared to EAF, LAF patients were older (p = 0.013), with higher GRACE risk score (p = 0.014) and Killip class (p = 0.015), depressed ejection fraction (p = 0.007), elevated filling pressures (p = 0.029), higher c-reactive protein (p = 0.014) and more TIMI flow <3 (p = 0.015). As shown in Figure 1, EAF was associated with higher prevalence of occluded ROCS (p = 0.010), AVNA (p = 0.005) and RIAA (p < 0.001), compared to SR. Moreover, EAF patients had more frequently ≥2 diseased atrial branches than SR (19.5%, p < 0.001) and LAF (25%, p < 0.030) patients. In LAF patients, a higher incidence of pre-PCI cardiogenic shock, post-PCI AEs (p = 0.019 vs SR; p = 0.029 vs EAF) and death (p = 0.004 vs SR) was found. Conclusions. The occlusion of atrial branches is associated with early but not late NOAF following STEMI. LAF patients had worse in-hospital AEs and mortality. Abstract Figure.

scholarly journals Angka Keberhasilan Terapi Reperfusi pada Pasien ST Elevasi Miokard Infark

e-CliniC ◽  
2017 ◽  
Vol 5 (2) ◽  
Author(s):  
. . Ermiati ◽  
Starry H. Rampengan ◽  
Victor F.F Joseph
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Success Rate ◽  
Primary Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Reperfusion Therapy ◽  
Fibrinolytic Therapy ◽  
High Rate ◽  
Primary Pci ◽  
Consecutive Sampling ◽  
Percutaneous Coronary

Abstract: ST-Elevation Myocardial Infarction (STEMI) is a kind of acute myocardial infarctions (AMI) with a high rate of mortality. Patients with STEMI are usually treated with reperfusion therapy consisting of primary percutaneous coronary intervention (primary PCI) and fibrinolytic therapy. This study was aimed to determine the success rate of reperfusion therapy in patients with STEMI at Prof. Dr. R. D Kandou Hospital Manado from January to December 2016. This was a descriptive observational study with a retrospective approach. Samples were patients with STEMI treated with reperfusion therapy at Prof. Dr. R. D Kandou Hospital Manado from January to December 2016, obtained by using consecutive sampling method. There were 73 patients in this study consisted of 82.2% of males and 17.8% of females. Most patients were >60 years old; 39.0% treated with primary PCI and 43.8% with fibrinolytic therapy. According to duration of therapy administration, most primary PCI were given at >90 minutes (80.5%) and fibrinolytic therapy at >30 minutes (75%). The success rate of primary PCI was higher in patients treated at ≤90 minutes (100%) compared to patients treated at >90 minutes. Moreover, the success rate of fibrinolytic therapy was higher in patients treated at ≤30 minutes (100%) compared to patients treated at >30 minutes (75%). Ventricular tachycardia (34.6%) was the most common type of reperfusion arrhythmia. Conclusion: The success rate of reperfusion therapy (primary PCI and fibrinolytic) in STEMI patients was higher if it was administered according to the optimum recommendations and targets.Keywords: STEMI, success rate of reperfusion therapy Abstrak: ST elevasi miokard infark (STEMI) merupakan jenis infark miokard akut (IMA) dengan mortalitas yang tinggi. Penatalaksanaan pasien STEMI dilakukan dengan terapi reperfusi yang terdiri primary percutaneous coronary intervention (primary PCI) dan fibrinolitik. Penelitian ini bertujuan untuk mengetahui angka keberhasilan terapi reperfusi pada pasien STEMI di RSUP Prof. Dr. R. D. Kandou Manado periode Januari-Desember 2016. Jenis penelitian ialah deskriptif observasional dengan pendekatan retrospektif. Sampel penelitian ialah pasien STEMI yang menerima terapi reperfusi, dirawat di RSUP Prof. Dr. R. D. Kandou Manado periode Januari-Desember 2016, yang diperoleh dengan teknik consecutive sampling. Dari total 73 pasien STEMI didapatkan pasien berjenis kelamin laki-laki (82,2%) lebih banyak dibandingkan perempuan (17,8%). Kelompok usia terbanyak ialah >60 tahun; 39,0% untuk terapi primary PCI dan 43,8% untuk terapi fibrinolitik. Waktu dilakukannya terapi reperfusi terbanyak dengan waktu terapi >90 menit untuk terapi primary PCI (80,5%) dan >30 menit (75%) untuk terapi fibrinolitik. Angka keberhasilan terapi primary PCI <90 menit lebih tinggi (100%) dibandingkan dengan terapi primary PCI >90 menit (96,6%), dan angka keberhasilan terapi fibrinolitik <30 menit lebih tinggi (100%) dibandingkan dengan terapi fibrinolitik >30 menit (75%). Jenis aritmia reperfusi ditemukan terbanyak ialah aritmia ventrikel takikardi 34,6%). Simpulan: Angka keberhasilan terapi reperfusi (primary PCI dan fibrinolitik) pada pasien STEMI lebih tinggi jika dilakukan tepat waktu sesuai dengan sasaran terapi optimal.Kata kunci: STEMI, angka keberhsilan terapi reperfusi.

Abstract 17862: Benefit and Safety of Adding Ezetimibe to Statin Therapy on Cardiovascular Outcomes in 4416 Women in the IMPROVE-IT Trial

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Eri Toda Kato ◽  
Robert P Giugliano ◽  
Michael A Blazing ◽  
Erin Bohula May ◽  
Sema Guneri ◽  
...  
Keyword(s):  
Statin Therapy ◽  
Coronary Revascularization ◽  
Composite Endpoint ◽  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
Efficacy And Safety ◽  
Primary And Secondary Prevention ◽  
Primary Composite Endpoint ◽  
Lowering Therapy ◽  
Prevention Guidelines

Background: Statin therapy is established in primary and secondary prevention guidelines both for men and women, although some people have questioned the benefits in women, where data are more limited. Adding the non-statin ezetimibe to statin therapy further reduced future CV events post ACS in IMPROVE-IT, but detailed analyses by sex have not been reported. Methods: In the IMPROVE-IT trial, patients hospitalized with ACS and LDL-C ≤125 mg/dL were randomized to ezetimibe/simvastatin 40mg (E/S) or placebo/simvastatin 40mg (P/S) and were followed up for a median of 6 yrs. The primary composite endpoint was CVD, MI, hospitalization for UA, coronary revascularization >30 days, and stroke. Efficacy and safety outcomes in women vs men were compared, one of 23 pre-specified subgroups. Results: Among 18144 patients from IMPROVE-IT, 4416 (24%) were women. Compared with men, women were more likely to be older, diabetic, and hypertensive, but less likely to have prior revascularization or multiple vessel disease. At 12 months, the median difference in LDL-C in both women and men was 16 mg/dl between E/S and P/S. Women receiving E/S had a 12% RRR of the primary endpoint (HR vs P/S, 0.88; 95% CI, 0.79 to 0.99), compared with a 5% reduction for men (HR vs P/S; 0.95, 95% CI, 0.90 to 1.01; p interaction p=0.26). There were no differences between E/S and P/S in this or safety events (E/S vs. P/S; AST and/or ALT>3ULN, 2.5% vs. 2.6%, 2.5% vs. 2.2%, cholecystectomy, 1.8% vs. 1.6%, 1.4% vs. 1.4%, myopathy, 0.2% vs. 0.2%, 0.1% vs. 0.1%, gallbladder-related AEs, 3.9% vs. 4.3%, 2.9% vs. 3.3%, in women and in men, respectively, p=all NS). Conclusion: IMPROVE-IT demonstrated that adding ezetimibe to statin reduces LDL-C and CV events in both women and men. A safety profile of ezetimibe supports the use of intensive, combination lipid lowering therapy to optimize CV outcomes in women as well as men.

scholarly journals Sodium-glucose co-transporter-2 inhibitors improve cardiovascular outcomes in heart failure with reduced ejection fraction regardless of ischemic etiology

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
D Patoulias ◽  
A Boulmpou ◽  
C Tsavousoglou ◽  
M Toumpourleka ◽  
F Siskos ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Composite Endpoint ◽  
Cardiovascular Death ◽  
Cardiovascular Outcomes ◽  
Composite Outcome ◽  
Reduced Ejection Fraction ◽  
Funding Sources ◽  
Diabetes Status ◽  
Primary Composite Outcome

Abstract Background Coronary artery disease remains the main underlying cause of heart failure (HF), despite the progress in prevention, diagnosis and treatment. Sodium-glucose co-transporter-2 inhibitors have been shown to improve surrogate cardiovascular outcomes in patients with HF with reduced ejection fraction (HFrEF), regardless of diabetes status. Purpose We sought to determine the effect of SGLT-2 inhibitors on the primary composite endpoint (cardiovascular death or hospitalization for HF) across the two hallmark trials in the HFrEF population (EMPEROR Reduced and DAPA-HF), according to ischemic or non-ischemic etiology of HF. Methods We pooled data from EMPEROR reduced and DAPA-HF trials in a total of 8,474 patients with HFrEF, performing a sub-analysis according to the presence of ischemic cardiomyopathy as the underlying cause of HFrEF. Results Treatment with SGLT-2 inhibitors resulted in a significant decrease in the risk for the primary composite outcome in patients with HFrEF of ischemic etiology, equal to 18% (RR=0.82, 95% CI: 0.73–0.92, I2=0%). In patients with HFrEF of non-ischemic etiology, SGLT-2 inhibitors produced a significant decrease in the risk for the primary composite outcome equal to 18% (RR=0.72, 95% CI: 0.63–0.82, I2=0%). Despite the greater effect in patients with non-ischemic HFrEF, no subgroup difference was detected (p=0.16). Generated results are summarized in Figure 1. Conclusions SGLT-2 inhibitors improve surrogate cardiovascular outcomes both in patients with ischemic and non-ischemic HFrEF. FUNDunding Acknowledgement Type of funding sources: None. Figure 1

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