Optimal medical therapy in percutaneous coronary intervention patients: statins and ACE inhibitors as disease-modifying agents

2010 ◽  
pp. 456-475
Author(s):  
Simon J. Corbett ◽  
Kim F. Fox
Keyword(s):  
Research Effort ◽  
Treatment Strategies ◽  
Coronary Intervention ◽  
Evidence Base ◽  
Pathological Process ◽  
Atherosclerotic Burden ◽  
Coronary Stenoses ◽  
Coronary Syndromes ◽  
Artery Disease ◽  
Disease Modifying Agents

The majority of this textbook is concerned with the indications for, and applications of, the numerous techniques that interventional cardiologists have at their disposal to assess and treat significant coronary stenoses. However, it is well recognized that atherosclerosis is far from being a discrete pathological process, such that by the time a person presents with clinically apparent coronary artery disease (CAD), they will often have widespread atheroma throughout their coronary tree. Combined with the reproducible observation that the majority of acute coronary syndromes arise from lesions that were not previously flow-limiting, much research effort has been directed at identifying treatment strategies that will favourably modify all of the patient’s atherosclerotic burden, not just that which can be targeted by percutaneous or surgical revascularization. In this chapter, we focus on the rationale and evidence base supporting the use of statins and renin–angiotensin–aldosterone system (RAAS) inhibition in patients with CAD.

Optimal medical therapy in percutaneous coronary intervention patients: statins and angiotensin-converting enzyme inhibitors as disease-modifying agents

2018 ◽  
pp. 417-431
Author(s):  
Simon J. Corbett ◽  
Nick Curzen
Keyword(s):  
Enzyme Inhibitors ◽  
Research Effort ◽  
Treatment Strategies ◽  
Coronary Intervention ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Evidence Base ◽  
Converting Enzyme Inhibitors ◽  
Atherosclerotic Burden ◽  
Artery Disease ◽  
Disease Modifying Agents

The majority of this textbook is concerned with the indications for, and applications of, the numerous techniques that interventional cardiologists have at their disposal to assess and treat significant coronary stenosis. However, it is well recognized that atherosclerosis is far from being a discrete pathological process, such that by the time people present with clinically apparent coronary artery disease (CAD), they will often have widespread atheroma throughout their coronary tree. Combined with the reproducible observation that the majority of acute coronary syndromes arise from lesions that were not previously flow-limiting, much research effort has been directed at identifying treatment strategies that will favourably modify all of the patient’s atherosclerotic burden, not just that which can be targeted by percutaneous or surgical revascularization. In this chapter, we focus on the rationale and evidence base supporting the use of statins and renin–angiotensin–aldosterone system inhibition in patients with CAD.

scholarly journals Bivalirudin in the Treatment of Coronary Artery Disease

2014 ◽  
Vol 5 (2) ◽  
pp. 67-80
Author(s):  
Rohan Jayasinghe ◽  
Ryan Maxwell ◽  
Vaishnavi Sridhar
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Coronary Intervention ◽  
Evidence Base ◽  
Myocardial Infarctions ◽  
Percutaneous Coronary ◽  
Coronary Syndromes ◽  
St Elevation ◽  
Artery Disease

Periprocedural anticoagulation continues to be a vital aspect in the management of coronary artery disease. Bivalirudin is a relatively new drug that has caught much attention in the last decade, especially in the context of percutaneous coronary intervention for acute coronary syndromes. Multiple clinical trials have shown the efficacy, safety profile and limitations of bivalirudin in contrast to previously used heparin and glycoprotein IIb/IIIa inhibitors. These trials have included patients with moderate to high-risk stable angina, unstable angina, non-ST-elevation and ST-elevation myocardial infarctions requiring PCI. The growing body of evidence on bivalirudin has also improved the understanding of its applicability and efficacy over other hirudin-based anticoagulants, however continual review of more recent evidence is important in order to integrate bivalirudin more widely across the various guidelines. This article aims to study the cross-section of the evidence base to date on the clinical use, efficacy and risks related to the use of bivalirudin and attempts to provide the clinician with a practical overview of the role of bivalirudin in the most recent guidelines.

CABG versus PCI in the Treatment of Unprotected Left Main Disease in Diabetics: A Literature Review

2021 ◽  
Vol 30 (03) ◽  
pp. 187-193
Author(s):  
Daniel Lambert ◽  
Allan Mattia ◽  
Angel Hsu ◽  
Frank Manetta
Keyword(s):  
Coronary Artery ◽  
Artery Bypass ◽  
Treatment Strategies ◽  
Coronary Intervention ◽  
Diabetic Patients ◽  
Left Main ◽  
Left Main Disease ◽  
Unprotected Left Main Disease ◽  
Long Term Follow Up ◽  
Artery Disease

AbstractThe approach to left main coronary artery disease (CAD) in diabetic patients has been extensively debated. Diabetic patients have an elevated risk of left main disease in addition to multivessel disease. Previous trials have shown increased revascularization rates in percutaneous coronary intervention compared with coronary artery bypass grafting (CABG) but overall comparable outcomes, although many of these studies were not using the latest stent technology or CABG with arterial revascularization. Our aim is to review the most recent trials that have recently published long-term follow-up, as well as other literature pertaining to left main disease in diabetic patients. Furthermore, we will be discussing some future treatment strategies that could likely create a paradigm shift in how left main CAD is managed.

scholarly journals Practical considerations for cangrelor use in patients with acute coronary syndromes

2017 ◽  
Vol 8 (1) ◽  
pp. 39-44 ◽  
Author(s):  
Sergio Leonardi ◽  
Deepak L Bhatt
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Acute Coronary Syndromes ◽  
Development Program ◽  
Concomitant Administration ◽  
Coronary Intervention ◽  
Acute Setting ◽  
Percutaneous Coronary ◽  
Transition Strategies ◽  
Coronary Syndromes ◽  
Artery Disease

Cangrelor, the first and currently only available intravenous P2Y12 receptor antagonist, has been approved and is now being used in patients with coronary artery disease requiring percutaneous coronary intervention. The rationale for cangrelor use is most robust in patients requiring an immediate, profound, and predictable level of P2Y12 inhibition – especially in patients with acute coronary syndromes. Herein we summarize the drug development program and reflect on practical considerations for clinicians on cangrelor use in the acute setting surrounding percutaneous coronary intervention, including selection of patients, concomitant administration of glycoprotein IIb/IIIa inhibitors and transition strategies from intravenous to oral P2Y12 receptor antagonists.

scholarly journals ORBITA: What Goes Around, Comes Around… Or Does It?

2018 ◽  
Vol 13 (3) ◽  
pp. 135
Author(s):  
Matthew Jackson ◽  
Azfar Zaman ◽  
◽  
Keyword(s):  
Medical Therapy ◽  
Stable Angina ◽  
Coronary Intervention ◽  
Evidence Base ◽  
Current Evidence ◽  
Placebo Control ◽  
Percutaneous Coronary ◽  
Significant Difference ◽  
Current Evidence Base ◽  
Artery Disease

Current guidelines recommend percutaneous coronary intervention (PCI) in patients with ongoing stable angina symptoms despite optimal medical therapy (OMT), although trials have shown no reduction in death or myocardial infarction. The recently published ORBITA trial compared OMT + PCI with OMT + ‘placebo’ PCI in patients with angina and single-vessel coronary artery disease (CAD), and found no significant difference in treadmill exercise time between the two groups after six weeks. The trial concluded that invasive procedures can be assessed with placebo control while numerous editorials interpreted the trial as showing that PCI has no role in the management of stable angina. However, the highly selected patient population, low ischaemic burden and level of symptoms and high proportion of nonflow-limiting stenoses on invasive physiological testing mean that, while ground-breaking in terms of its methodology, ORBITA does not add to the current evidence base supporting ischaemia-guided revascularisation if symptoms are not controlled on medical therapy alone.

Troponin for acute coronary syndromes: has NICE got it right?

2002 ◽  
Vol 39 (3) ◽  
pp. 194-195 ◽  
Author(s):  
JDR Thomson ◽  
AF MacKintosh ◽  
JH Barth
Keyword(s):  
Acute Coronary Syndromes ◽  
Case Reports ◽  
Clinical Excellence ◽  
Evidence Base ◽  
Appropriate Treatment ◽  
Patients With Heart Failure ◽  
Accepted Standard ◽  
Coronary Syndromes ◽  
Artery Disease ◽  
Documented Coronary Artery Disease

The guidelines on the use of glycoprotein IIb/IIIa inhibitors for acute coronary syndromes issued by the National Institute for Clinical Excellence (NICE) recommend that blood troponin is used to identify patients who might benefit from therapy. There are, however, a number of circumstances in which troponin results may be misleading. Firstly, the trials which comprise the evidence base for the therapeutic effect were only based on patients with documented coronary artery disease. Secondly, troponin is elevated in patients with heart failure and concentrations fall with appropriate treatment. Thirdly, there is no internationally accepted standard for troponin, and there are therefore important differences at the 'cut-off' values between the methods of different manufacturers. Fourthly, immunoassays suffer from interfering antibodies and at least 17 case reports have been published outlining false positive tests. It is important that the shortfalls of troponin tests in the diagnosis of acute coronary syndromes are widely recognized.

scholarly journals High-dose clopidogrel, prasugrel or ticagrelor: trying to unravel a skein into a ball

2011 ◽  
Vol 1 (1) ◽  
pp. 13
Author(s):  
Alessandro Aprile ◽  
Raffaella Marzullo ◽  
Giuseppe Biondi Zoccai ◽  
Maria Grazia Modena
Keyword(s):  
Acute Coronary Syndromes ◽  
Antiplatelet Agents ◽  
Bleeding Risk ◽  
Coronary Intervention ◽  
Platelet Inhibition ◽  
High Dose ◽  
Comprehensive Overview ◽  
Increased Risk ◽  
Coronary Syndromes ◽  
Artery Disease

Antiplatelet therapy is a mainstay in the management of coronary artery disease. Indeed, optimal and rapid inhibition of platelet function is a key therapeutic goal in patients with acute coronary syndromes and those undergoing percutaneous coronary intervention. Currently, dual antiplatelet treatment with aspirin and clopidogrel is the gold standard care in patients with acute coronary syndromes or receiving coronary stents without prohibitive bleeding risk. However, recent data show that the efficacy of clopidogrel is hampered by its slow and variable platelet inhibition, with ensuing increased risk of ischemic events, including death, myocardial infarction and stent thrombosis. Novel agents such as prasugrel and ticagrelor have been developed to clopidogrel limits and thus improve cardiovascular outcomes. This article presents a comprehensive overview of the benefits and limitations of current and shortly available antiplatelet agents, providing detailed arguments in favor and against prasugrel and ticagrelor.

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