P2816Antithrombotic strategy for patients with anticoagulation indication undergoing percutaneous coronary intervention: meta-analysis of randomised controlled trials

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
Y W Liao ◽  
T K M Wang
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Odds Ratio ◽  
Cardiovascular Events ◽  
Oral Anticoagulants ◽  
Coronary Intervention ◽  
Minor Bleeding ◽  
Randomised Trials ◽  
Odds Ratios ◽  
Percutaneous Coronary

Abstract Background A significant proportion of patients having acute coronary syndrome and/or undergoing percutaneous coronary intervention (PCI) have indications for long-term anticoagulation such as atrial fibrillation. Their optimal antithrombotic strategy despite recent randomised trials. We meta-analysed outcomes comparing dual versus triple, and non-vitamin K oral anticoagulants (NOAC) versus vitamin K oral anticoagulants (VKA) antithrombotic regimens. Methods MEDLINE, Embase and Cochrane databases were searched for original randomised trials with relevant search terms. Two authors evaluated these studies for inclusion and extracted data pooling bleeding and cardiovascular events. Results The search yielded 308 articles, with 19 full-texts reviewed and 4 randomised trials totalling 6,029 patients included. Dual antithrombotic strategies were associated with significant reductions in TIMI major and minor bleeding (odds ratios 0.55, 95% confidence interval 0.36–0.83), and other bleeding endpoints including all, major, minor and intracranial bleeding (odds ratios 0.45–0.62, all P<0.05), compared with triple antithrombotic strategies in four trials, with no differences in mortality, myocardial infarction, stroke, stent thrombosis or composite cardiovascular events (odds ratio 0.79–1.13, all P>0.05). NOAC regimens were associated with significant reductions in TIMI major and minor bleeding odds ratio 0.49 (0.37–0.65), as well as major, minor and intracranial bleeding (odds ratios 0.29–0.52, all P<0.05), but again no differences in mortality or all cardiovascular endpoints (odds ratios 0.98–1.49, all P>0.05). Conclusion Antithrombotic strategies involving dual instead of triple agents, and NOAC instead of VKA had significantly less bleeding without increasing mortality and cardiovascular events, and are therefore preferred options in patients undergoing PCI who also require long-term anticoagulation.

Optimal antithrombotic strategy for patients with atrial fibrillation and acute coronary syndrome or percutaneous coronary intervention: updated meta-analysis of randomised controlled trials

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
B Liao ◽  
T.K.M Wang
Keyword(s):  
Vitamin K ◽  
Odds Ratio ◽  
Cardiovascular Events ◽  
Oral Anticoagulants ◽  
Anticoagulation Therapy ◽  
Minor Bleeding ◽  
Randomised Trials ◽  
Odds Ratios ◽  
Coronary Syndrome

Abstract Background The optimal antithrombotic strategy for the growing proportion of patients with indications for both dual antiplatelet therapy and long-term anticoagulation remains controversial, with recent randomized trials published and mixed recommendations in guidelines. We meta-analysed bleeding and cardiovascular outcomes comparing dual versus triple and non-vitamin K oral anticoagulants (NOAC) versus vitamin K oral anticoagulants (VKA) antithrombotic regimens. Methods MEDLINE, Embase and Cochrane databases were searched for original randomised trials with relevant search terms from January 1980-December 2019. Two authors evaluated studies for inclusion and extracted data to pool efficacy and safety endpoints. Results The search yielded 331 articles, with 22 full-texts reviewed and six randomised trials totalling 12,146 patients included. Dual antithrombotic strategies had reduced TIMI major and minor bleeding (odds ratios 0.59, 95% confidence interval 0.44–0.80), as well as all, major, and minor bleeding (odds ratios 0.55–0.59, all P&lt;0.05), with no differences in mortality, myocardial infarction, stroke, stent thrombosis or composite cardiovascular events (odds ratio 0.91–1.26, all P&gt;0.05), compared with triple antithrombotic strategies in six trials. NOAC regimens had lower TIMI major and minor bleeding (odds ratio 0.64, 0.49–0.85), as well as major, minor and intracranial bleeding (odds ratios 0.36–0.66, all P&lt;0.05), and similar no differences in mortality or all cardiovascular endpoints (odds ratios 0.85–1.13, all P&gt;0.05), compared with VKA regimens in four trials. Conclusion Dual antithrombotic therapy with NOAC had significantly reduced bleeding without increase in cardiovascular events and mortality compared to their counterparts, and should generally be recommended in patients needing dual antiplatelet and long term anticoagulation therapy. Funding Acknowledgement Type of funding source: None

scholarly journals Discharge Hemoglobin Association with Long-Term Outcomes of ST-Elevation Myocardial Infarction Patients Undergoing Primary Percutaneous Coronary Intervention

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Ming Gao ◽  
Xinying Zhang ◽  
Ling Qin ◽  
Yang Zheng ◽  
Zhiguo Zhang ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Primary Percutaneous Coronary Intervention ◽  
Bleeding Event ◽  
Coronary Intervention ◽  
Minor Bleeding ◽  
Percutaneous Coronary ◽  
All Cause Mortality ◽  
Lower Discharge

Background. Anemia following acute myocardial infarction (AMI) is associated with poor outcomes. While previous studies in patients with AMI have focused on anemia at admission, we hypothesized that hemoglobin (Hb) decline during hospitalization and lower discharge Hb would be associated with greater long-term mortality in patients undergoing primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI). Methods. We analyzed records of 983 STEMI patients who were treated with primary PCI. The primary end point was all-cause mortality at 1 year and 2 years. The relationship between discharge Hb levels, decline in Hb levels, bleeding event classification, and all-cause mortality was determined. Results. Overall, 16.4% of patients had bleeding events, which were classified by the Thrombolysis in Myocardial Infarction (TIMI) score as 7% minimal, 8.6% minor, and 0.9% major. No significant gastrointestinal bleed and cerebral hemorrhage occurred in hospitals among these patients. The incidence rate of the 2-year all-cause mortality increased with severity of the bleeding event score (8.78% for no bleeding vs. 11.59% for minimal bleeding vs. 20.24% for minor bleeding vs. 55.56% for major bleeding, P<0.001). Discharge Hb was significantly associated with 2-year mortality in an unadjusted model (hazard ratio (HR) per 1 g/L decrease in discharge Hb = 1.020, 95% confidence interval (CI): 1.006–1.034, P=0.004) and in a confounder-adjusted model (HR per 1 g/L decrease in discharge Hb = 1.024, 95% CI: 1.011–1.037, P<0.001). The odds ratio (OR) for all-cause mortality at 2 years for participants with Hb below the twentieth percentile was 3.529 (95% CI: 1.976–6.302) and 2.968 (95% CI: 1.614–5.456) after adjustment for age and gender and 2.485 (95% CI: 1.310–4.715) after adjustment for all covariates. Conclusions. In this population of patients hospitalized for STEMI, all-cause mortality increased with lower discharge Hb, and discharge Hb was a significant predictor of mortality risk.

Hospital and Operator Variation in Cardiac Rehabilitation Referral and Participation After Percutaneous Coronary Intervention: Insights From Blue Cross Blue Shield of Michigan Cardiovascular Consortium

2021 ◽  
Author(s):  
Devraj Sukul ◽  
Milan Seth ◽  
Michael P. Thompson ◽  
Steven J. Keteyian ◽  
Thomas F. Boyden ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Cardiac Rehabilitation ◽  
Odds Ratio ◽  
Coronary Intervention ◽  
Administrative Claims ◽  
Odds Ratios ◽  
Clinical Registry ◽  
Hospital Referral ◽  
Percutaneous Coronary ◽  
Ratio Range

BACKGROUND: Despite its established benefit and strong endorsement in international guidelines, cardiac rehabilitation (CR) use remains low. Identifying determinants of CR referral and use may help develop targeted policies and quality improvement efforts. We evaluated the variation in CR referral and use across percutaneous coronary intervention (PCI) hospitals and operators. Methods: We performed a retrospective observational cohort study of all patients who underwent PCI at 48 nonfederal Michigan hospitals between January 1, 2012 and March 31, 2018 and who had their PCI clinical registry record linked to administrative claims data. The primary outcomes included in-hospital CR referral and CR participation, defined as at least one outpatient CR visit within 90 days of discharge. Bayesian hierarchical regression models were fit to evaluate the association between PCI hospital and operator with CR referral and use after adjusting for patient characteristics. Results: Among 54 217 patients who underwent PCI, 76.3% received an in-hospital referral for CR, and 27.1% attended CR within 90 days after discharge. There was significant hospital and operator level variation in in-hospital CR referral with median odds ratios of 3.88 (95% credible interval [CI], 3.06–5.42) and 1.64 (95% CI, 1.55–1.75), respectively, and in CR participation with median odds ratios of 1.83 (95% CI, 1.63–2.15) and 1.40 (95% CI, 1.35–1.47), respectively. In-hospital CR referral was significantly associated with an increased likelihood of CR participation (adjusted odds ratio, 1.75 [95% CI, 1.52–2.01]), and this association varied by treating PCI hospital (odds ratio range, 0.92–3.75) and operator (odds ratio range, 1.26–2.82). Conclusions: In-hospital CR referral and 90-day CR use after PCI varied significantly by hospital and operator. The association of in-hospital CR referral with downstream CR use also varied across hospitals and less so across operators suggesting that specific hospitals and operators may more effectively translate CR referrals into downstream use. Understanding the factors that explain this variation will be critical to developing strategies to improve CR participation overall.

scholarly journals Impact of atrial fibrillation on long-term outcomes in patients with coronary artery bifurcation lesions undergoing percutaneous coronary intervention

2021 ◽  
Vol 25 (4) ◽  
pp. 85
Author(s):  
D. A. Khelimskii ◽  
O. V. Krestyaninov ◽  
A. G. Badoian ◽  
A. A. Baranov ◽  
R. B. Utegenov ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Percutaneous Coronary Intervention ◽  
Cardiovascular Events ◽  
Coronary Intervention ◽  
Major Adverse Cardiovascular Events ◽  
Coronary Bifurcation ◽  
Coronary Bifurcation Lesions ◽  
Percutaneous Coronary ◽  
Bifurcation Lesions

<p><strong>Background.</strong> Atrial fibrillation is one of the most common types of cardiac arrhythmias. The frequent combination of atrial fibrillation and coronary artery disease in clinical practice can be attributed to common risk factors and relationships among pathogenetic mechanisms.</p><p><strong>Aim. </strong>This study aims to evaluate the impact of atrial fibrillation on immediate and long-term clinical outcomes in patients undergoing percutaneous coronary intervention for coronary bifurcation lesions.</p><p><strong>Methods.</strong> This study included 709 patients who underwent percutaneous coronary intervention for coronary bifurcation lesions. All patients were divided into two groups: those with and without atrial fibrillation.</p><p><strong>Results.</strong> This multicentre registry showed that the incidence of atrial fibrillation was 11.7%. Compared to patients without a history of atrial fibrillation, those that did were older (66.8 ± 8.5 vs. 62.9 ± 9.0 years, p = 0.0002) and more often had cerebrovascular (22.9% vs. 10.4%, p = 0.003) and peripheral artery disease (18.1% vs. 7.2%, p = 0.002). The overall incidence of major adverse cardiovascular events at the hospital stage was 1.8%. The average follow-up duration was 476 ± 94 days. No difference in long-term major adverse cardiovascular events (15.0% vs. 13.1%, p = 0.6) was observed between patients with and without atrial fibrillation. Patients with atrial fibrillation were more likely to have adverse events, such as bleeding (13.8% vs. 9.3%, p = 0.22), stroke (2.5% vs. 1.0%, p = 0.23) and myocardial infarction (7.6% vs. 5.0%, p = 0.28), although differences between the groups were insignificant.</p><p><strong>Conclusion.</strong> Atrial fibrillation was not associated with mortality and major adverse cardiovascular events in patients undergoing percutaneous coronary intervention for coronary bifurcation lesions.</p><p><strong>ClinicalTrials.gov Identifier: </strong>NCT03450577</p><p>Received 4 August 2021. Revised 27 September 2021. Accepted 28 September 2021.</p><p><strong>Funding: </strong>The study did not have sponsorship.</p><p><strong>Conflict of interest:</strong> Authors declare no conflict of interest.</p><p><strong>Contribution of the authors<br /> </strong>Conception and study design: D.A. Khelimskii, O.V. Krestyaninov, A.G. Badoian, A.A. Baranov, R.B. Utegenov, I.S. Bessonov, S.S. Sapozhnikov<br /> Data collection and analysis: D.A. Khelimskii, A.G. Badoian, A.A. Baranov, R.B. Utegenov, I.S. Bessonov, S.S. Sapozhnikov<br /> Statistical analysis: D.A. Khelimskii, A.G. Badoian, I.S. Bessonov<br /> Drafting the article: D.A. Khelimskii, O.V. Krestyaninov, A.G. Badoian, A.A. Baranov, R.B. Utegenov, I.S. Bessonov, S.S. Sapozhnikov<br /> Critical revision of the article: D.A. Khelimskii, O.V. Krestyaninov, A.G. Badoian, A.A. Baranov, R.B. Utegenov, I.S. Bessonov, S.S. Sapozhnikov<br /> Final approval of the version to be published: D.A. Khelimskii, O.V. Krestyaninov, A.G. Badoian, A.A. Baranov, R.B. Utegenov, I.S. Bessonov, S.S. Sapozhnikov</p>

Abstract 2535: The Adverse Long-Term Impact of Renal Impairment on Patients undergoing Percutaneous Coronary Intervention in the DES Era

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Clare Appleby ◽  
Joan Ivanov ◽  
Karen Mackie ◽  
Shahar Lavi ◽  
Doug Ing ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Renal Impairment ◽  
Cardiovascular Events ◽  
Independent Predictor ◽  
Coronary Intervention ◽  
Late Mortality ◽  
Percutaneous Coronary ◽  
Long Term Impact

Renal impairment (RI) is known to be associated with poor in-hospital outcomes following percutaneous coronary intervention (PCI) but its effect on outcomes beyond one year, particularly in the drug eluting stent (DES) era has not been reported. We undertook an observational study to determine the long-term impact of renal impairment on patients undergoing PCI at a large, tertiary cardiac referral centre. Baseline creatinine was available for 11,969 of the 15,012 consecutive patients undergoing PCI at our institution between April 2000 and Sept 2007. Patients were stratified into those with or without at least moderate RI, defined as a creatinine clearance <60ml/min (CKD class ≤ 3). In-hospital mortality and morbidity were calculated for each cohort. Follow up data was obtained through linkage to a provincial registry. Kaplan-Meier analysis was performed and Cox multiple regression analysis was used to identify independent predictors of late mortality and MACE (major adverse cardiovascular events), and to examine the association between DES use and late outcomes in the presence or absence of RI. Of the 11,953 patients with available long-term follow-up, 3070 had RI (25.7%). In hospital mortality and MACE were significantly increased in those patients (3.34% vs 0.44%, p<0.001, and 5.73% vs 2.2%, p<0.001, respectively). At 7 year follow-up, survival and MACE-free survival were both reduced (64.5 ± 1.4% vs 89.4 ± 0.5%, p<0.001, and 44.0 ± 1.4% vs 63.4 ± 0.8%, p<0.001). RI was identified as an independent predictor of both late mortality and cardiovascular events (HR 2.2, p<0.0001 and HR 1.4, p<0.0001) but DES use was associated with a significant risk reduction for these events (HR 0.7, p<0.0001). In patients with RI, DES use, rather than bare metal stents, was associated with a reduction in mortality (HR 0.83, CI 0.66 –1.0, p=0.1) and reduced subsequent CABG (HR 0.46, CI 0.22– 0.97, p=0.041) but had no effect on repeat PCI (p=0.63). In a large registry of “all-comers” for PCI, RI was an independent predictor of adverse late outcomes at 7 year follow-up. DES use however was associated with improved long-term outcomes in this high risk cohort.

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