P2553Combined with ticagrelor, 50 mg aspirin daily can reduce bleeding events without increasing ischaemic risk compared with 75–100 mg aspirin daily in coronary artery disease patients

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
J Li
Keyword(s):  
Cardiovascular Events ◽  
Major Adverse Cardiovascular Events ◽  
P Value ◽  
Severe Bleeding ◽  
Efficacy And Safety ◽  
Bleeding Events ◽  
Risk Of Bleeding ◽  
Dose Aspirin ◽  
Hs Crp ◽  
Artery Disease

Abstract Aim To investigate the efficacy and safety of ticagrelor combined with a lower dose of aspirin than that recommended by guidelines. Methods Hospitalized patients received ticagrelor (90 mg twice daily) plus aspirin (50–100 mg/day) for up to 12 months. The rates of major adverse cardiovascular events (MACEs), bleeding events and ticagrelor adherence were compared among the groups treated with 50 mg and 75–100 mg aspirin. Results MACE risk was not significantly different between the two groups (OR=0.829, 95% CI: 0.279–2.461, P=0.736). However, 75–100 mg aspirin was associated with a greater risk of bleeding events (OR=1.524, 95% CI: 1.082–2.146, P=0.016), particularly mild and moderate bleeding events (OR=1.480, 95% CI: 1.047–2.092, P=0.026). Moreover, lower-dose aspirin was associated with a lower rate of ticagrelor withdrawal (OR=1.850, 95% CI: 1.025–3.339, P=0.041), mainly because of the decrease in ticagrelor withdrawal due to bleeding (OR=4.565, 95% CI: 1.081–19.270, P=0.039). MACEs and bleeding events within 1 year Endpoint 75–100 mg (n=744) 50 mg (n=188) Unadjusted (95% CI) P value Adjusted# (95% CI) P value MACEs 18 (2.4) 4 (2.1) 0.876 (0.296–2.588) * 0.876 0.829 (0.279–2.461)* 0.736 Bleeding 311 (41.8) 60 (31.9) 1.532 (1.091–2.152)** 0.014 1.524 (1.082–2.146)** 0.016 Severe bleeding 14 (1.9) 2 (1.1) 1.784 (0.402–7.916)** 0.447 1.807 (0.405–8.069)** 0.438 Mild bleeding 297 (39.9) 58 (30.8) 1.489 (1.057–2.098)** 0.023 1.480 (1.047–2.092)** 0.026 #Adjusted for age, sex, LDL-C, hs-CRP, diabetes mellitus, hypertension, hyperlipidaemia and MI history. *Hazard ratio (high vs low); **Odds ratio (high vs low). Conclusion Among patients who took ticagrelor (90 mg twice daily), 50 mg aspirin daily is associated with a lower rate of bleeding events and ticagrelor withdrawal but does not increase the MACE risk compared with 75–100 mg aspirin daily. Acknowledgement/Funding The study was supported by AstraZeneca's fund for the TIFU study (ESR-15-11199).

P5515Circulating galectin 1 is associated with severity of coronary artery disease and adverse cardiovascular events in patients undergoing coronary angiography

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
R.-H Chou ◽  
Y.-W Lu ◽  
P.-H Huang
Keyword(s):  
Heart Failure ◽  
Stable Angina ◽  
Cardiovascular Events ◽  
Ventricular Remodeling ◽  
Major Adverse Cardiovascular Events ◽  
Syntax Score ◽  
Cardiac Inflammation ◽  
Hs Crp ◽  
Artery Disease ◽  
Stable Cad

Abstract Background Galectin-1, a β-galactoside-binding lectin, was reported to attenuate the cardiac inflammation and ventricular remodeling after AMI. Its role in stable CAD was not fully elaborated. This study aimed to identify the relationship between galectin-1 and severity of CAD in patients with stable angina. Methods Totally 834 subjects underwent elective CAG were enrolled. Pre-procedure galectin-1 and hsCRP concentrations were determined. Subjects were grouped into tertiles according to their galectin-1 concentrations. SYNTAX scores were calculated to evaluate the severity of CAD. All patients were followed until January 2019, or the occurrence of major adverse cardiovascular events (MACE). Results Patients with higher galectin-1 concentrations were older and had higher prevalence of hypertension, diabetes, heart failure, and with higher levels of hsCRP and STNYAX scores. Patients with the highest tertile of galectin-1 were associated with higher risk of MACE (Fig 1A), even after adjusting age, gender, hypertension, diabetes, hemoglobin, creatinine, and LVEF (aHR: 2.13, 95% CI: 1.04–4.33, p=0.038). Gelection-1 (AUC: 0.802) showed better discriminatory performance than hsCRP (AUC: 0.696) in prediction the incidence of MACE (Fig 1B). Table 1 Tertile 1 (n=278) Tertile 2 (n=278) Tertile 3 (n=278) P Age (years) 61.0 (54.8–71.0) 67.0 (60.0–75.0) 72.0 (61.0–80.3) <0.001 Male, n (%) 188 (67.6) 184 (66.2) 197 (70.9) 0.479 Hypertension, n (%) 153 (55.0) 185 (66.5) 219 (78.8) <0.001 Diabetes, n (%) 67 (24.1) 90 (32.4) 123 (44.2) <0.001 Heart failure, n (%) 10 (3.6) 8 (2.9) 44 (15.8) <0.001 Hemoglobin (g/dL) 13.5 (12.5–14.3) 13.4 (12.4–14.3) 12.3 (10.8–13.7) <0.001 Creatinine (mg/dL) 0.9 (0.8–1.1) 1.0 (0.9–1.2) 1.3 (1.1–1.9) <0.001 Hs-CRP (mg/dL) 0.1 (0.0–0.2) 0.1 (0.0–0.3) 0.2 (0.1–0.7) <0.001 Galectin 1 (ng/mL) 13.3 (10.2–14.7) 18.7 (17.4–20.5) 29.3 (25.5–38.5) <0.001 SYNTAX score 0.0 (0.0–5.0) 0.0 (0.0–7.0) 7.0 (0.0–16.1) <0.001 LVEF (%) 59.0 (54.6–62.2) 58.0 (52.0–63.0) 55.9 (49.0–60.9) 0.009 MACE: revascularization, n (%) 17 (6.1) 13 (4.7) 43 (15.5) <0.001 MACE: nonfatal MI, n (%) 1 (0.4) 1 (0.4) 7 (2.5) 0.018 MACE: nonfatal stroke, n (%) 0 (0.0) 1 (0.4) 2 (0.7) 0.367 MACE: death, n (%) 4 (1.4) 1 (0.4) 13 (4.7) 0.001 Conclusion Serum galectin-1 levels were associated with the severity of CAD and subsequent MACE in patients with stable angina. Acknowledgement/Funding This study was supported in part by research grants from the Taipei Veterans General Hospital and Taiwan Ministry of Science and Technology Academic E

scholarly journals Galectin-1 is associated with the severity of coronary artery disease and adverse cardiovascular events in patients undergoing coronary angiography

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Ruey-Hsing Chou ◽  
Shao-Sung Huang ◽  
Chin-Sung Kuo ◽  
Shen-Chih Wang ◽  
Yi-Lin Tsai ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Cardiovascular Events ◽  
Ventricular Remodeling ◽  
Stable Coronary Artery Disease ◽  
High Sensitivity ◽  
Major Adverse Cardiovascular Events ◽  
Hs Crp ◽  
Artery Disease

AbstractGalectin-1, a β-galactoside-binding lectin mediating inflammation and neovascularization, is reported to attenuate ventricular remodeling after myocardial infarction. But its role in stable coronary artery disease (CAD) has not been fully elucidated. This study aimed to identify the relationship between the circulating galectin-1 level and the severity of CAD in patients with suspected CAD. Pre-procedure galectin-1 and high-sensitivity C-reactive protein (hs-CRP) concentrations were measured in 834 subjects who underwent scheduled coronary angiography. Subjects were grouped into tertiles of the galectin-1 levels. SYNTAX scores were calculated to evaluate the severity of CAD. All patients were followed until January 2019 or the occurrence of major adverse cardiovascular events (MACE). Patients with higher galectin-1 concentrations were older; had greater prevalence of hypertension, diabetes, chronic kidney disease, and heart failure; and were more likely to present with higher hs-CRP levels and SYNTAX scores. During the follow-up period of 1.3 ± 1.1 years, patients in the highest tertile of galectin-1 were associated with a greater risk of MACE after adjustment for age, sex, comorbidities, co-medications, serum levels of hemoglobin, creatinine, hs-CRP, ejection fraction, SYNTAX scores, and revascularization modalities (adjusted hazard ratio 10.95, 95% confidence interval 2.29–52.47, p = 0.003). Galectin-1 showed better discriminatory performance than hs-CRP, and non-inferior performance to SYNTAX scores, in predicting the incidence of MACE.

scholarly journals Impact of premature ovarian insufficiency on cardiovascular health

2018 ◽  
Vol 7 (9) ◽  
pp. 3837
Author(s):  
Kavitha Abraham ◽  
Vaibhav Londhe ◽  
Tunny Sebastian ◽  
Thomas Paul ◽  
Aruna Kekre
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Cardiovascular Health ◽  
Menopausal Symptoms ◽  
Premature Ovarian Insufficiency ◽  
P Value ◽  
Ovarian Insufficiency ◽  
Hs Crp ◽  
Artery Disease ◽  
The Impact

Background: The objectives of the study were to identify the causes of premature ovarian insufficiency (POI) and to assess the severity of menopausal symptoms as well as the impact on cardiovascular health in these patients.Methods: Authors did a cross sectional case control study with 100 cases and 100 age matched controls. Women <40years of age with amenorrhoea >4months and FSH >25mIU/ml were identified with POI. Women <40years with normal cycles were the controls. Causes were identified from medical records and menopausal symptoms were categorized using menopause rating score questionnaire. Hypercholesterolemia (≥200mg/dl), hypoalbuminemia (<3.5g/dl) and high sensitive C reactive protein (HS-CRP ≥3mg/dl) were assessed as the early markers of coronary artery disease. Statistical methods included Chi square test and logistic regression analysis. P value <0.05 was considered significant.Results: 64% of the patients were between 31-40 years. 66% of them were into menopause for <5 years. The cause was idiopathic in 62%. 91% had no or minimal menopausal symptoms. Hypoalbuminemia (6 versus 1, 95% CI 1.8-2.4, OR 2.1, p=0.01) and hypercholesterolemia (75 versus 51, 95%CI 2.5-3.1, OR 2.8, p= 0.001) were significantly high in cases. HS-CRP was not found to be different between the groups (59 versus 49, OR 1.5, 95%CI 0.8-2.6, p=0.2).Conclusions: In majority with POI the cause is idiopathic and menopausal symptoms are minimal. Hypoalbuminemia and hypercholesterolemia, markers of coronary artery disease, were significantly elevated in POI. Early screening for these variables within 5 years of menopause would reduce the cardiovascular mortality in these patients.

scholarly journals Comparison of In-hospital Major Adverse Cardiovascular Events in Patients of Acute Inferior Myocardial Infarction With or Without Precordial ST Segment Depression

2017 ◽  
pp. 180-9
Author(s):  
Jaya Suganti ◽  
Abdullah Afif Siregar ◽  
Harris Hasan
Keyword(s):  
Myocardial Infarction ◽  
Cardiovascular Events ◽  
Multiple Logistic Regression Analysis ◽  
Major Adverse Cardiovascular Events ◽  
Bivariate Analysis ◽  
P Value ◽  
Inferior Myocardial Infarction ◽  
St Segment ◽  
Increased Risk ◽  
Acute Inferior Myocardial Infarction

Background: The clinical implications of precordial ST segment depression (PSTD) during acute inferior myocardial infarction has been an area of debate, and still under investigation with conflicting results. Based on previous studies, the presence of PSTD defines a high risk subset of patients with acute inferior myocardial infarction due to a more extensive myocardial ischemia that lead to a higher incidence of major adverse cardiovascular events (MACE). Despite of these results, others still considered this ECG finding as a benign electrical phenomenon. The aim of this study is to compare the incidence of in-hospital MACE in patients of acute inferior myocardial infarction with or without PSTD and to know whether PSTD can be used as a predictor of in-hospital MACE in acute inferior myocardial infarction.Methods: A total of 96 acute inferior myocardial infarction patients admitted from December 2013-2015 at Cardiology Department of Haji Adam Malik General Hospital were retrospectively analyzed. Patients were divided into two groups based on the presence of PSTD on admission ECG. Bivariate and multivariate analyses were performed to study the association between PSTD and in-hospital MACE, p value<0.05 was considered statistically significant.Results: The bivariate analysis showed that in-hospital MACE was significantly higher in patients of acute inferior myocardial infarction with PSTD than without PSTD (92% vs 8%, p<0.001). On multiple logistic regression analysis, patients of acute inferior myocardial infarction with PSTD have a 5.4 fold increased risk of in-hospital MACE than patients without PSTD (OR 5.480; 95% CI 1.759-17.067, p=0.003).Conclusion: The presence of precordial ST segment depression on admission ECG in acute inferior myocardial infarction patients was associated with a higher in-hospital MACE and was an independent predictor of in-hospital MACE.

scholarly journals Contemporary Review of Antithrombotic Therapy in Peripheral Artery Disease

2020 ◽  
Vol 13 (10) ◽  
Author(s):  
Connie N. Hess ◽  
Marc P. Bonaca
Keyword(s):  
Peripheral Artery Disease ◽  
Antithrombotic Therapy ◽  
Cardiovascular Events ◽  
Plaque Rupture ◽  
Risk Profile ◽  
Major Adverse Cardiovascular Events ◽  
Peripheral Artery ◽  
Different Populations ◽  
Artery Disease ◽  
Concomitant Coronary Artery Disease

Patients with peripheral artery disease (PAD) are at heightened risk for ischemic events related to atherothrombosis. Antithrombotic therapies can reduce the risk of atherothrombotic events but increase bleeding. Importantly, there is growing appreciation of the heterogeneity in risk profile and effect of antithrombotic therapies in different populations, including those with PAD. Further, patients with PAD are at risk for not only major adverse cardiovascular events but also major adverse limb events, and the drivers of risk for each are different. Within PAD populations, data from trials may be difficult to interpret due to differences among the studies with regards to patient population, clinical settings, and outcomes examined. The acute setting of peripheral revascularization which involves plaque rupture and endothelial disruption confers very high risk of major adverse limb events early postprocedure. Among patients with chronic PAD for whom the goal of antithrombotic therapy is secondary prevention, concomitant coronary artery disease, particularly with prior myocardial infarction, is associated with greatest risk for major adverse cardiovascular events, while prior peripheral revascularization or amputation is associated with greatest risk for major adverse limb events. Understanding of the potential impact of clinical setting and patient risk profile is important to guide evidence-based decisions regarding antithrombotic therapy in patients with PAD. In this article, we provide a contemporary review of data supporting the use of antithrombotic therapy in PAD, as well as a clinical framework for analysis and translation of these data into practice, highlighting areas in need of further investigation.

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