scholarly journals Development of 1- and 5-year outcomes between 2006 and 2018 in patients with uncomplicated ST-elevation myocardial infarctions and successful percutaneous coronary intervention

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J Schmucker ◽  
A Fach ◽  
R Osteresch ◽  
T Retzlaff ◽  
D Garstka ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Public Institution ◽  
Funding Source ◽  
P2y12 Inhibitors ◽  
Percutaneous Coronary ◽  
Table Analysis ◽  
St Elevation ◽  
Few Data ◽  
Event Rates

Abstract Introduction While modern P2Y12-inhibitors and drug eluting stents (DES) have changed therapeutic options in patients with ST-elevation mycoardial infarctions (STEMI) during the last decade, there is few data on their impact in real world registries. Aim of the present study was to analyze changes in mortality and major adverse cardiac and cererobrovascular event rates (MACCE: death, reinfarction,stroke) during the last 13 years in patients with uncomplicated STEMI after successful percutaneous coronary intervention (PCI). Methods All consecutive STEMI-patients, admitted between 2006 and 2018 and successfully treated with PCI (TIMI flow ≥2) in a large German heart center entered analysis. To reduce confounding pts. with STEMI complicated by heart failure and pts. >70 yrs. of age were excluded. Results A STEMI-cohort of 5016 pts. was analysed, with a mean age of 55.9±8 yrs., 19% females, 16% diabetics and 59% smokers. At the beginning of the study period (2006) no patient was treated with ticagrelor/prasugrel and only 5% had a DES implanted. In 2018 92% were treated with prasugrel or ticagrelor and 96% with a DES. The reduction in 1-year-mortality during the study period was not significant: 2006–11: 3.4%, 2012–19: 3.1%, p=0.4, however the reduction in 1-year-MACCE was: 2006–11: 8.3%, 2012–18: 5.7%, p<0.01. This could mainly be attributed to a reduction in reinfarctions: 2006–11: 4.9%, 2012–18: 2.8%, p<0.01. Subgroup analysis revealed that with the exception of diabetics all subgroups showed a significant decline in MACCE-rates during the study period. It was more pronounced in women, non-smokers and patients with a high socioeconomic status (SES) (Table). Analysis of 5-year-data revealed a significant reduction in both 5-year-mortality (2006–09: 9.1%, 2010–13: 6.8%, p<0.01) and 5-year-MACCE-rates: 2006–09: 19.3%, 2010–13: 14.5%, p<0.01. Conclusions This analysis of registry data over a study period of 13 years reveals, that for patients with uncomplicated STEMI and successful PCI a significantly better 1- and 5-year-outcome could be achieved during the last years. This improvement of prognosis was more pronounced in specific subgroups, such as women, non-diabetics and patients with higher SES. Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): Stiftung Bremer Herzen, Gesundheit Nord

scholarly journals De-Escalation of Antiplatelet Treatment in Patients with Myocardial Infarction Who Underwent Percutaneous Coronary Intervention: A Review of the Current Literature

2020 ◽  
Vol 9 (9) ◽  
pp. 2983 ◽  
Author(s):  
Daniel MF Claassens ◽  
Dirk Sibbing
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Bleeding Complication ◽  
Thrombotic Event ◽  
Coronary Intervention ◽  
Antiplatelet Treatment ◽  
P2y12 Inhibitors ◽  
Coronary Syndrome ◽  
Percutaneous Coronary ◽  
Event Rates ◽  
Function Testing

In acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI), treatment with the P2Y12 inhibitors ticagrelor or prasugrel is recommended over clopidogrel due to a better efficacy, albeit having more bleeding complication. These higher bleeding rates have provoked trials investigating de-escalation from ticagrelor or prasugrel to clopidogrel in the hope of reducing bleeding without increasing thrombotic event rates. In this review, we sought to present an overview of the major trials investigating several different options for de-escalation; unguided, platelet function testing- and genotype-guided. Based on these results, and on other established literature sources, such as guidelines and expert consensus papers, we provide an overview to help decide when and how to de-escalate antiplatelet therapy in ACS patients undergoing PCI.

scholarly journals Post-infectious myocardial infarction: does percutaneous coronary intervention improves outcomes?

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Putot ◽  
F Chague ◽  
P Manckoundia ◽  
Y Cottin ◽  
M Zeller
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Coronary Intervention ◽  
Public Institution ◽  
Funding Source ◽  
Percutaneous Coronary ◽  
One Year ◽  
Post Infectious

Abstract Introduction and objectives Acute infections are frequent triggers for myocardial infarction (MI), and associated with poor prognosis. However, whether percutaneous coronary intervention (PCI) improves post-infectious MI prognosis remains unknown. We aimed to evaluate the prognostic impact of PCI at the acute phase of post-infectious MI in patients with significant coronary stenosis. Methods Observational study in 4573 consecutive MI patients of the RICO Survey in coronary units, of whom 476 patients (10%) had a concurrent diagnosis of acute infection at admission. Among them, 321 patients with a significant stenosis (>50%) at coronary angiography were analysed. After propensity score matching based on clinical and angiography data, in-hospital and one-year outcomes were compared between patients with and without PCI. Results Among the 321 patients (mean age 74y), most (n=195 (61%)) underwent PCI. Acute atherothrombotic event (type 1 MI) and STEMI were much more frequent in the PCI group (53 vs 19%, p<0.001, and 51% vs 32%, p=0.001, respectively). As expected, Troponin Ic peak was almost 3 times higher in the PCI group (17 [4–72] vs 6 [1–20] ng/mL, p<0.001). Coronary lesions were less severe in the PCI group (3-vessels disease: 36% vs 52%, p<0.004; SYNTAX score: 11 [6–19] vs 19 [11–28], p<0.001). At one year follow up, recurrence rate (5% for both groups, p=0.8), and cardiovascular (CV) mortality (15% vs 13%, p=0.6) were similar for both groups. After propensity score matching, in-hospital (OR = 1.45 (0.43–4.85), p=0.5) and 1-year CV mortality: OR = 1.73 (0.66–4.54), p=0.3) were similar in patients with and without PCI. Conclusion In this first observational work investigating treatment strategy in post-infectious MI, PCI might not improve short and long-term prognosis. These findings do not support the use of systematic invasive procedures after post-infectious MI. Interventional studies are urgently needed to confirm these findings. Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): Agence Régionale de Santé Bourgogne Franche Comté, CHU Dijon Bourgogne

scholarly journals Bivalirudin versus heparin monotherapy in non-ST-segment elevation myocardial infarction

2018 ◽  
Vol 8 (6) ◽  
pp. 492-501 ◽  
Author(s):  
David Erlinge ◽  
Sasha Koul ◽  
Elmir Omerovic ◽  
Ole Fröbert ◽  
Rikard Linder ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Primary Endpoint ◽  
Major Bleeding ◽  
Coronary Intervention ◽  
Hazard Ratio ◽  
St Elevation Myocardial Infarction ◽  
P2y12 Inhibitors ◽  
Percutaneous Coronary ◽  
St Elevation

Background: The optimal anti-coagulation strategy for patients with non-ST-elevation myocardial infarction treated with percutaneous coronary intervention is unclear in contemporary clinical practice of radial access and potent P2Y12-inhibitors. The aim of this study was to investigate whether bivalirudin was superior to heparin monotherapy in patients with non-ST-elevation myocardial infarction without routine glycoprotein IIb/IIIa inhibitor use. Methods: In a large pre-specified subgroup of the multicentre, prospective, randomised, registry-based, open-label clinical VALIDATE-SWEDEHEART trial we randomised patients with non-ST-elevation myocardial infarction undergoing percutaneous coronary intervention, treated with ticagrelor or prasugrel, to bivalirudin or heparin monotherapy with no planned use of glycoprotein IIb/IIIa inhibitors during percutaneous coronary intervention. The primary endpoint was the rate of a composite of all-cause death, myocardial infarction or major bleeding within 180 days. Results: A total of 3001 patients with non-ST-elevation myocardial infarction, were enrolled. The primary endpoint occurred in 12.1% (182 of 1503) and 12.5% (187 of 1498) of patients in the bivalirudin and heparin groups, respectively (hazard ratio of bivalirudin compared to heparin treatment 0.96, 95% confidence interval 0.78–1.18, p=0.69). The results were consistent in all major subgroups. All-cause death occurred in 2.0% versus 1.7% (hazard ratio 1.15, 0.68–1.94, p=0.61), myocardial infarction in 2.3% versus 2.5% (hazard ratio 0.91, 0.58–1.45, p=0.70), major bleeding in 8.9% versus 9.1% (hazard ratio 0.97, 0.77–1.24, p=0.82) and definite stent thrombosis in 0.3% versus 0.2% (hazard ratio 1.33, 0.30–5.93, p=0.82). Conclusion: Bivalirudin as compared to heparin during percutaneous coronary intervention for non-ST-elevation myocardial infarction did not reduce the composite of all-cause death, myocardial infarction or major bleeding in non-ST-elevation myocardial infarction patients receiving current recommended treatments with modern P2Y12-inhibitors and predominantly radial access.

Safety and Efficacy of Triple Therapy With Ticagrelor or Prasugrel Versus Clopidogrel After Percutaneous Coronary Intervention for ST-Elevation Myocardial Infarction

2021 ◽  
pp. 107424842110314
Author(s):  
Kristina Gill ◽  
Nicholas Servati ◽  
Julie Flahive ◽  
Kyle Fraielli
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Antithrombotic Therapy ◽  
Coronary Intervention ◽  
St Elevation Myocardial Infarction ◽  
Clinical Event ◽  
P2y12 Inhibitors ◽  
Percutaneous Coronary ◽  
St Elevation ◽  
Triple Antithrombotic Therapy

Background: Patients on dual antiplatelet therapy following percutaneous coronary intervention often have indications for concomitant oral anticoagulation, known as triple antithrombotic therapy. Majority of literature evaluating triple antithrombotic therapy fails to adequately represent patients with ST-elevation myocardial infarction and those prescribed potent P2Y12 inhibitors, ticagrelor or prasugrel. The purpose of this study was to evaluate the safety and efficacy of triple antithrombotic regimens containing ticagrelor or prasugrel versus clopidogrel after percutaneous coronary intervention in the setting of ST-elevation myocardial infarction. Methods: This was a single-center, retrospective cohort trial. The primary endpoint was net adverse clinical event, defined as the primary efficacy endpoint of death, myocardial infarction, or cerebrovascular accident and the primary safety endpoint of any bleeding event. Results: Between October 2017 and October 2019, a total of 65 patients with ST-elevation myocardial infarction were initiated on triple therapy. Forty-six patients were included in the primary analysis, of which 26 were discharged on triple antithrombotic therapy with clopidogrel and 20 discharged on potent P2Y12 inhibitors (ticagrelor or prasugrel). The primary endpoint occurred in 27% of the clopidogrel group and 40% of the potent P2Y12 inhibitor group ( P = 0.35). Bleeding occurred in 23% of the clopidogrel group and 35% of the potent P2Y12 inhibitor group ( P = 0.37). Conclusions: This small cohort study suggests, in patients with ST-elevation myocardial infarction undergoing percutaneous coronary intervention, the net adverse clinical event rate does not differ between clopidogrel and potent P2Y12 inhibitors in the setting of triple antithrombotic therapy. The results of this exploratory analysis warrant confirmation in a larger, randomized study.

scholarly journals Efficacy of Drug-Eluting Stents in Diabetic Patients Admitted with ST-Elevation Myocardial Infarctions Treated with Primary Percutaneous Coronary Intervention

2021 ◽  
Vol 8 (8) ◽  
pp. 83
Author(s):  
Johannes Schmucker ◽  
Andreas Fach ◽  
Rico Osteresch ◽  
Luis Alberto Mata Marin ◽  
Stephan Ruehle ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Myocardial Infarctions ◽  
Drug Eluting Stents ◽  
Diabetic Patients ◽  
Ischemic Event ◽  
Percutaneous Coronary ◽  
Drug Eluting ◽  
St Elevation ◽  
Event Rates

Background: Diabetic patients show higher adverse ischemic event rates and mortality when undergoing percutaneous coronary intervention (PCI) in acute myocardial infarctions. Therefore, diabetic patients might benefit even more from modern-generation drug-eluting stents (DES). The aim of the present study was to compare adverse ischemic events and mortality rates between bare-metal stents (BMS) and DES in diabetic patients admitted with ST-elevation-myocardial infarction (STEMI) with non-diabetic patients as the control group. Methods: All STEMI patients undergoing emergency PCI and stent implantation documented between 2006 and 2019 in the Bremen STEMI registry entered the analysis. Efficacy was defined as a combination of in-stent thrombosis, myocardial re-infarction or additional target lesion revascularization at one year. Results: Of 8356 patients which entered analysis, 1554 (19%) were diabetics, while 6802 (81%) were not. 879 (57%) of the diabetics received a DES. In a multivariate model, DES implantation in diabetics compared to BMS was associated with lower rates of in-stent thrombosis (OR 0.16, 95% CI 0.05–0.6), myocardial re-infarctions (OR 0.35, 95%CI, 0.2–0.7, p < 0.01) and of the combined endpoint at 1 year ((ST + MI + TLR): OR 0.31, 95% CI 0.2–0.6, p < 0.01), with a trend towards lower 5-year mortality (OR 0.56, 95% CI 0.3–1.0, p = 0.058). When comparing diabetic to non-diabetic patients, an elevation in event rates for diabetics was only detectable in BMS (OR 1.78, 95% CI 0.5–0.7, p < 0.01); however, this did not persist when treated with a DES (OR 1.03 95% CI 0.7–1.6, p = 0.9). Conclusions: In STEMI patients with diabetes, the use of DES significantly reduced ischemic event rates and, unlike with BMS, adverse ischemic event rates became similar to non-diabetic patients.

Clinical presentation and hospital outcome of patients with ST-elevation myocardial infarction – Hungarian Myocardial Infarction Registry data

2012 ◽  
Vol 153 (37) ◽  
pp. 1465-1468 ◽  
Author(s):  
András Jánosi ◽  
Péter Ofner ◽  
László Voith
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
St Elevation Myocardial Infarction ◽  
Previous Myocardial Infarction ◽  
Hospital Outcome ◽  
Percutaneous Coronary ◽  
St Elevation ◽  
Few Data ◽  
Registry Database

Introduction: There are only very few data on gender differences in patients with ST-elevation myocardial infarction. Aim: To compare the clinical data and prognosis of patients with ST-elevation myocardial infarction in the Hungarian Myocardial Infarction Registry database. Patients and methods: Between January 1, 2010 and December 31, 2011 4981 patients (3038 men) were included in the database. Results: Women were significantly older (67.7±13.5 vs. 60.5±12.5 years; p<0.001). Hypertension, diabetes, and stroke were more frequent among women, whereas smoking and previous myocardial infarction were found more often among men. Percutaneous coronary intervention was significantly more frequently performed in men than in women (82.4% vs. 75.3%; p<0.001), and the time between the onset of pain and arrival of patients to the site of percutaneous coronary intervention was longer in women than in men. Hospital mortality was higher among women than men (7.5% vs. 4.4%; p<0.001). Conclusions: At present women have a poorer hospital outcome than men. By increasing the revascularization treatment ratio in women an improvement may be achieved in the prognosis. Orv. Hetil., 2012, 153, 1465–1468.

scholarly journals Gender disparities in management and treatment in acute myocardial infarction – a German nationwide real-life analysis

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
L Kuehnemund ◽  
J Koeppe ◽  
J Feld ◽  
A Wiederhold ◽  
J Illner ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Hospital Mortality ◽  
Bypass Surgery ◽  
Coronary Bypass ◽  
Coronary Intervention ◽  
Funding Source ◽  
Percutaneous Coronary ◽  
St Elevation

Abstract Background/Introduction Acute myocardial infarction (AMI) continues to be one of the most frequent diseases worldwide, remaining among the most common causes of mortality in both women and men of industrialised nations. Female sex has been reported to be associated with an unfavourable outcome in AMI. Differences related to patients' sex have been reported for incidence, symptom presentation, pathophysiological characteristics as well as treatment strategies and outcome. Purpose Objective of this routine-data based analysis was to explore sex differences of recent nationwide trends in in-patient healthcare and acute outcome of AMI. Methods The data base provided by the Federal Statistical Offices comprises all in-patient treated patients on a case base per year. We identified all cases with a main diagnosis of ST elevation myocardial infarction (STEMI) and non-ST elevation myocardial infarction (NSTEMI) between 01.01.2014 and 31.12.2017. Further, data on concomitant diseases, risk constellations and selected cardiovascular procedures were acquired for sex-specific analysis. Results In total, we identified 280,515 STEMI and 595,220 NSTEMI cases over the four-year period. STEMI cases decreased from 72,894 in 2014, to 70,230 in 2015, to 69,178 in 2016, and to 68,213 in 2017 with 70% of STEMI cases assignable to men. Female sex was associated with older age (74 vs. 62 yrs), and higher prevalence of cardiovascular risk factors such as chronic kidney disease (19.21% vs. 12.5%), diabetes (26.4% vs. 21.7%), left ventricular heart failure (36% vs. 32.1%), or atrial fibrillation (17.6% vs. 13%). However, dyslipidemia (43.9% vs. 49.3%) and smoking (7.4% vs. 12.1%) were more frequent in male STEMI cases than in female STEMI cases. Overall, 74.3% of female and 81.3% of male STEMI cases received percutaneous coronary intervention (PCI; p&lt;0.0001; s. Figure); coronary bypass surgery was performed in 2.7% of female vs. 4.2% of male cases (p&lt;0.0001). There were 5,125 female and 2,015 male STEMI patients aged 90 years and older. These received less frequent percutaneous coronary intervention (42.5% female vs. 52.8% male; p&lt;0.0001) and coronary bypass surgery (0.1% female vs. 0.4% male; p=0.0063) compared to younger age groups. Observed in-hospital mortality was significantly increased in female patients with STEMI (15% female vs. 9.6% male; p&lt;0.0001) and NSTEMI (8.4% vs. 6.3%; p&lt;0.0001). Conclusion In a nationwide real-world setting, in-patient STEMI cases continue to decrease over the recent past in both, male and female patients. Women with AMI are older and continue to be less likely to receive revascularization therapies than men. In addition, women present with significantly higher observed in-hospital mortality compared to men. It is important to draw attention to the peculiarities of women with AMI and to supply revascularization therapy equally in high risk clientele. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): Innovationsfonds des gemeinsame Bundesausschusses

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