scholarly journals Prevention of ischaemic events in subjects with polydistrict vascular disease

2021 ◽  
Vol 23 (Supplement_E) ◽  
pp. E103-E108
Author(s):  
Giuseppe Patti ◽  
Chiara Ghiglieno
Keyword(s):  
Cardiovascular Events ◽  
Recurrent Events ◽  
Low Dose ◽  
Antiplatelet Agent ◽  
Multivessel Coronary Artery Disease ◽  
Thrombotic Risk ◽  
Coronary Syndrome ◽  
Artery Disease ◽  
Net Clinical Benefit ◽  
The Individual

Abstract The incidence of new cardiovascular events in patients with chronic coronary syndrome remains high, particularly in the presence of concomitant high thrombotic risk factors (diabetes mellitus, renal failure, multivessel coronary artery disease, multiple district atherosclerosis, recurrent events, heart failure). The risk of such recurrent events can be reduced by implementing various strategies, which include careful individual stratification of ischaemic and haemorrhagic risk and the choice of the most appropriate antithrombotic therapy for the individual patient, also by combining aspirin with a second antiplatelet agent/a low-dose anticoagulant, in order to achieve the maximum net clinical benefit.

scholarly journals Ticagrelor Versus Clopidogrel in Older Patients with NSTE-ACS Using Oral Anticoagulation: A Sub-Analysis of the POPular Age Trial

2020 ◽  
Vol 9 (10) ◽  
pp. 3249
Author(s):  
Marieke E. Gimbel ◽  
Anne H. Tavenier ◽  
Wilbert Bor ◽  
Renicus S. Hermanides ◽  
Evelyn de Vrey ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Oral Anticoagulation ◽  
Clinical Benefit ◽  
Antiplatelet Agent ◽  
Platelet Inhibition ◽  
Cardiovascular Death ◽  
Minor Bleeding ◽  
Thrombotic Risk ◽  
Coronary Syndrome ◽  
Net Clinical Benefit

There are no randomised data on which antiplatelet agent to use in elderly patients with non-ST-elevation acute coronary syndrome (NSTE-ACS) and an indication for oral anticoagulation (OAC). The randomised POPular Age trial, in patients of 70 years or older with NSTE-ACS, showed a reduction in bleeding without increasing thrombotic events in patients using clopidogrel as compared to ticagrelor. In this sub-analysis of the POPular AGE trial, we compare clopidogrel with ticagrelor in patients with a need for oral anticoagulation. The follow-up duration was one year. The primary bleeding outcome was Platelet Inhibition and Patient Outcomes (PLATO) major and minor bleeding. The primary thrombotic outcome consisted of cardiovascular death, myocardial infarction and stroke. The primary net clinical benefit outcome was a composite of all-cause death, myocardial infarction, stroke, and PLATO major and minor bleeding. A total of 184/1011 (18.2%) patients on OAC were included in this subanalysis; 83 were randomized to clopidogrel and 101 to ticagrelor. The primary bleeding outcome was lower in the clopidogrel group (17/83, 20.9%) compared to the ticagrelor group (33/101, 33.5%; p = 0.051), as was the thrombotic outcome (7/83, 8.4% vs. 19/101, 19.2%; p = 0.035) and the primary net clinical benefit outcome (23/83, 27.7% vs. 49/101, 48.5%; p = 0.003). In this subgroup of patients using OAC, clopidogrel reduced PLATO major and minor bleeding compared to ticagrelor without increasing thrombotic risk. This analysis therefore suggests that, in line with the POPular Age trial, clopidogrel is a better option than ticagrelor in NSTE-ACS patients ≥70 years using OAC.

Genetic variability in response to clopidogrel therapy and its clinical implications

2011 ◽  
Vol 105 (S 06) ◽  
pp. S55-S59 ◽  
Author(s):  
Matthias Freynhofer ◽  
Jolanta Siller-Matula ◽  
Karsten Schrör ◽  
Kurt Huber ◽  
Liana Yukhanyan
Keyword(s):  
Antiplatelet Therapy ◽  
Cardiovascular Events ◽  
Clinical Importance ◽  
Coronary Intervention ◽  
Loss Of Function ◽  
Platelet Response ◽  
Genetic Profiling ◽  
Coronary Syndrome ◽  
Artery Disease ◽  
The Individual

SummaryThis article concentrates on individual genetic differences responsible for variations of action of clopidogrel, which have been found to be partially responsible for increased cardiovascular events in patients with coronary artery disease under dual antiplatelet therapy. According to these results, genotyping for the relevant gene polymorphisms, especially for the CYP2C19 loss-of-function alleles, has been discussed to be an effective method of individualising and optimising clopidogrel treatment. However, due to the facts that 1) there are no prospective studies demonstrating a clinical benefit of personalising antiplatelet therapy based on genotyping; 2) CYP2C19 polymorphisms account for only approximately 12% of variability in clopidogrel platelet response; 3) the positive predictive value of CYP2C19 loss-of-function polymorphisms for cardiovascular events in patients with acute coronary syndrome undergoing percutaneous coronary intervention is only approximately 12% – 20%; 4) it is likely that other clinical factors and risk constellations might be of greater clinical importance; and 5) it is unknown whether a specific genetic polymorphism is capable of influencing outcome for the individual patient; genetic profiling cannot be recommended for routine use at present but will remain of considerable scientific interest.

P6157Indexed coronary volume - A potential novel low-dose CCTA derived predictor for cardiovascular events

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
G Benetos ◽  
M Goncalves ◽  
E Von Felten ◽  
G Rampidis ◽  
O Clerc ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Events ◽  
Low Dose ◽  
Cox Regression ◽  
Calcium Score ◽  
Kaplan Meier ◽  
Lv Mass ◽  
Traditional Risk Factors ◽  
Artery Disease

Abstract Background Coronary computed tomography angiography (CCTA) provides incremental prognostic information over traditional risk factors in patients with suspected coronary artery disease. However, little is known about the long-term predictive performance of CCTA-derived coronary volumes and mid-diastolic left ventricular (LV) mass. Purpose To assess long-term prognostic value of coronary volumes and mid-diastolic LV mass as novel potential imaging predictors derived from low-dose prospectively ECG-triggered CCTA. Methods Consecutive patients with suspected or known coronary artery disease, referred for low-dose CCTA, were included. Patients with previous revascularization were excluded. The following parameters were evaluated: calcium score, segment involvement score (SIS: 1 point for each coronary segment with presence of plaque), coronary volume, mid-diastolic LV mass and coronary volume indexed to LV mass. Major adverse cardiovascular events (MACE) were defined as all-cause death, non-fatal myocardial infarction and revascularization (PCI or CABG). The association between CCTA measures and the occurrence of events was quantified using cox regression hazard and Kaplan Meier analysis. Results A total of 147 consecutive patients were included in the study. Of them, 93 (63.3%) were male and 79 (53.7%) hat one or more traditional cardiovascular risk factors. There was a weak but statistical significant inverse correlation between indexed coronary volume and both calcium score (R=-0.3, p=0.01) and SIS (R=-0.24, p=0.005). After a median follow-up of 5.8 years 30 MACE occurred in 25 patients, including 3 deaths, 26 revascularizations and 1 non-fatal myocardial infarction. In univariate cox regression hazard analysis calcium score (HR=12.69, 95% CI 2.99–53.83, p<0.001), SIS (HR=1.66, 95% CI 1.43–1.94, p<0.001), LV mass (HR=1.02, 95% CI 1.01–1.03, p=0.007) and indexed coronary volume (HR=0.89, 95% 0.82–0.96, p=0.004) were associated with outcome. In multivariate analysis, indexed coronary volume, remained an independent predictor for MACE when adjusted for traditional risk factors and SIS (HR=0.93, 95% CI 0.87–1.00, p=0.05), while LV mass did not reach statistical significance (p=0.46). By ROC curve analysis, a value of 21.85 mm3/gr was defined as optimal cutoff for indexed coronary volume. In Kaplan Meier plots, patients with low indexed coronary volume (<21.85 mm3/gr) showed higher event rates (log rank p<0.001) compared to high indexed coronary volume (≥21.85 mm3/gr). Conclusions Indexed coronary volume, derived from low-dose CCTA, independently predicts cardiovascular events. Larger studies are mandated to confirm the predictive value of this potential new biomarker.

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