Impact of reduced-dose prasugrel vs. standard-dose clopidogrel on in-hospital outcomes of percutaneous coronary intervention in 62 737 patients with acute coronary syndromes: a nationwide registry study in Japan

2019 ◽  
Vol 6 (4) ◽  
pp. 231-238 ◽  
Author(s):  
Keitaro Akita ◽  
Taku Inohara ◽  
Kyohei Yamaji ◽  
Shun Kohsaka ◽  
Yohei Numasawa ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Acute Coronary Syndrome ◽  
Hospital Mortality ◽  
Stent Thrombosis ◽  
Standard Dose ◽  
Coronary Intervention ◽  
Coronary Syndrome ◽  
Risk Of Bleeding ◽  
Reduced Dose ◽  
Percutaneous Coronary

Abstract Aims  In Japan, reduced-dose prasugrel (loading/maintenance dose, 20/3.75 mg) has been approved for use in acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI), because of the higher bleeding risk among East Asians. However, its safety in the real-world population has not been investigated. We aimed to evaluate the effectiveness and safety of reduced-dose prasugrel vs. standard-dose clopidogrel in ACS patients undergoing PCI. Methods and results  Acute coronary syndrome patients who underwent PCI in 2016, who were treated with either reduced-dose prasugrel or standard-dose clopidogrel in addition to aspirin, were identified from the nationwide Japanese PCI registry. The primary outcome was in-hospital mortality following PCI. Secondary outcomes included stent thrombosis and bleeding complication after PCI. Among 62 737 ACS patients who underwent PCI at any of 986 participating centres across Japan (clopidogrel 31.9%; prasugrel 68.1%), we identified 12 016 propensity score-matched pairs (24 032 patients; age 69.4 ± 12.2 years; female 24.9%; ST-elevation myocardial infarction 42.3%). Compared with standard-dose clopidogrel, reduced-dose prasugrel was associated with increased risk of bleeding [odds ratio (OR) 1.65, 95% confidence interval (CI) 1.10–2.51; P = 0.016], but both had similar rates of mortality (OR 1.11, 95% CI 0.89–1.38; P = 0.371) and stent thrombosis (OR 1.29, 95% CI 0.73–2.30; P = 0.387) as well as similar falsification endpoints of cardiac tamponade and emergent operation. Conclusion  In Japanese ACS patients undergoing PCI, the risk of bleeding is higher when using reduced-dose prasugrel than when using standard-dose clopidogrel, but there is no significant difference in in-hospital mortality and incidence of stent thrombosis between the two antiplatelet regimens.

scholarly journals Echocardiographic Parameters as Predictors of In-Hospital Mortality in Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention

2014 ◽  
Vol 2014 ◽  
pp. 1-9 ◽  
Author(s):  
Miroslava Sladojevic ◽  
Srdjan Sladojevic ◽  
Dubravko Culibrk ◽  
Snezana Tadic ◽  
Robert Jung
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Acute Coronary Syndrome ◽  
Hospital Mortality ◽  
Right Ventricle ◽  
Validation Cohort ◽  
Coronary Intervention ◽  
Left Ventricular Ejection ◽  
Coronary Syndrome ◽  
Percutaneous Coronary ◽  
Echocardiographic Parameters

Different ways have been used to stratify risk in acute coronary syndrome (ACS) patients. The aim of the study was to examine the usefulness of echocardiographic parameters as predictors of in-hospital outcome in patients with ACS after percutaneous coronary intervention (PCI). A data of 2030 patients with diagnosis of ACS hospitalized from December 2008 to December 2011 was used to develop a risk model based on echocardiographic parameters using the binary logistic regression. This model was independently evaluated in validation cohort prospectively (954 patients admitted during 2012). In-hospital mortality in derivation cohort was 7.73%, and 6.28% in validation cohort. Developed model has been designed with 4 independent echocardiographic predictors of in-hospital mortality: left ventricular ejection fraction (LVEF RR=0.892; 95%CI=0.854–0.932,P<0.0005), aortic leaflet separation diameter (AOvs RR=0.131; 95%CI=0.027–0.627,P=0.011), right ventricle diameter (RV RR=2.675; 95%CI=1.109–6.448,P=0.028) and right ventricle systolic pressure (RVSP RR=1.036; 95%CI=1.000–1.074,P=0.048). Model has good prognostic accuracy (AUROC=0.84) and it retains good (AUROC=0.78) when testing on the validation cohort. Risks for in-hospital mortality after PCI in ACS patients using echocardiographic measurements could be accurately predicted in contemporary practice. Incorporation of such developed model should facilitate research, clinical decisions, and optimizing treatment strategy in selected high risk ACS patients.

scholarly journals Primary percutaneous coronary intervention for acute coronary syndrome due to stent thrombosis

2013 ◽  
Vol 34 (suppl 1) ◽  
pp. P1264-P1264
Author(s):  
Z. Mehmedbegovic ◽  
A. Janicijevic ◽  
V. Dedovic ◽  
M. Zivkovic ◽  
D. Milasinovic ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Acute Coronary Syndrome ◽  
Stent Thrombosis ◽  
Primary Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Coronary Syndrome ◽  
Percutaneous Coronary

scholarly journals P2Y12 Receptor Inhibitors in the Treatment of Patients with Acute Coronary Syndrome and Percutaneous Coronary Intervention: Possibilities of Prasugrel

2019 ◽  
Vol 14 (6) ◽  
pp. 935-943
Author(s):  
N. M. Vorobyeva
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Acute Coronary Syndrome ◽  
Coronary Intervention ◽  
Efficacy And Safety ◽  
Acceptable Risk ◽  
Coronary Syndrome ◽  
Risk Of Bleeding ◽  
Percutaneous Coronary ◽  
Ischemic Complications ◽  
Complications And Mortality

The possibilities of P2Y12 receptor inhibitors application in the treatment of patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI) are discussed in the article. The results of 4 registries in which a comparative analysis of the efficacy and safety of prasugrel with clopidogrel or ticagrelor was performed, as well as of all 3 P2Y12-receptor inhibitors among themselves, are considered in detail. The feasibility of replacing clopidogrel to prasugrel during the inpatient treatment of patients with ACS and PCI was evaluated additionally in the MULTIPRAC registry. The results of the registries demonstrate that the use of prasugrel in patients with ACS and PCI is associated with a significant reduction in the risk of ischemic complications and mortality with an acceptable risk of bleeding. At the same time, prasugrel was more effective and safer than clopidogrel and at least was non-inferior to ticagrelor, and according to some registries, even surpasses it in a number of indicators. 

scholarly journals Independent Predictors of Adverse Cardiovascular Events in Patients With Acute Coronary Syndrome After Percutaneous Coronary Intervention During Hospitalization

Kardiologiia ◽  
2018 ◽  
Vol 58 (12) ◽  
pp. 22-29 ◽  
Author(s):  
J. A. Mansurova ◽  
L. K. Karazhanova
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Acute Coronary Syndrome ◽  
Regression Analysis ◽  
Stent Thrombosis ◽  
Cardiovascular Events ◽  
Coronary Intervention ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Coronary Syndrome ◽  
Percutaneous Coronary

Purpose: to elucidate independent clinical and laboratory predictors of adverse cardiovascular events (ACVE) in patients with acute coronary syndrome (ACS) after percutaneous coronary intervention (PCI) with stenting in early inhospital period.Materials and methods. We included in this prospective single center study 130 patients with ACS who underwent PCI with stenting. All patients prior to and after PCI received dual antiplatelet therapy with acetylsalicylic acid and clopidogrel. In 12–48 hours after PCI we measured residual platelet reactivity (RPR) using light aggregometry. In 57 patients simultaneously we performed genotyping of CYP2C19*2 polymorphisms. The following ACVE were used as end­points and were registered during inhospital observation (mean duration 9.7±3.2 days): sudden death, stent thrombosis, arterial thrombosis of other localization, recurrent angina, cardiac rhythm disturbances requiring special therapy.Results. Repetitive ACVE were observed in 32 patients. According to unifactorial regression analysis risk factors of their development were, ADP F­induced RPR (р<0.001), levels of creatinine (р<0.001), hemoglobin (р<0.001), and glucose (р=0.026), age (р=0.01), iron­deficiency anemia (р=0.01), left ventricular ejection fraction (р=0.004), number of stents (р=0.015). According to results of multifactorial regression analysis independent predictors of ACVE were: ADP­induced RPR >76 % (р=0.003), levels of creatinine >189 µmol / L (р=0.003), and hemoglobin <114 g / L (р=0.004). Significant effect of homozygous carriage of CYP2C19*2 (G681A) (А / А) on development of stent thrombosis was also detected (р=0.028).Conclusion. ADP­induced RPR, levels of creatinine and hemoglobin were found to be independent predictors of inhospital ACVE after myocardial revascularization with stenting in patients with ACS.

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