scholarly journals Prasugrel versus ticagrelor in patients with myocardial infarction undergoing percutaneous coronary intervention

Heart ◽  
2021 ◽  
pp. heartjnl-2020-318694
Author(s):  
Dimitrios Venetsanos ◽  
Erik Träff ◽  
David Erlinge ◽  
Emil Hagström ◽  
Johan Nilsson ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Similar Efficacy ◽  
Efficacy And Safety ◽  
Adjusted Risk ◽  
Cerebrovascular Events ◽  
Percutaneous Coronary ◽  
Significant Difference ◽  
Evidence Based Care

ObjectiveThe comparative efficacy and safety of prasugrel and ticagrelor in patients with myocardial infarction (MI) treated with percutaneous coronary intervention (PCI) remain unclear. We aimed to investigate the association of treatment with clinical outcomes.MethodsIn the SWEDEHEART (Swedish Web-system for enhancement and development of evidence-based care in heart disease evaluated according to recommended therapies) registry, all patients with MI treated with PCI and discharged on prasugrel or ticagrelor from 2010 to 2016 were included. Outcomes were 1-year major adverse cardiac and cerebrovascular events (MACCE, death, MI or stroke), individual components and bleeding. Multivariable adjustment, inverse probability of treatment weighting (IPTW) and propensity score matching (PSM) were used to adjust for confounders.ResultsWe included 37 990 patients, 2073 in the prasugrel group and 35 917 in the ticagrelor group. Patients in the prasugrel group were younger, more often admitted with ST elevation MI and more likely to have diabetes. Six to twelve months after discharge, 20% of patients in each group discontinued the P2Y12 receptor inhibitor they received at discharge. The risk for MACCE did not significantly differ between prasugrel-treated and ticagrelor-treated patients (adjusted HR 1.03, 95% CI 0.86 to 1.24). We found no significant difference in the adjusted risk for death, recurrent MI or stroke alone between the two treatments. There was no significant difference in the risk for bleeding with prasugrel versus ticagrelor (2.5% vs 3.2%, adjusted HR 0.92, 95% CI 0.69 to 1.22). IPTW and PSM analyses confirmed the results.ConclusionIn patients with MI treated with PCI, prasugrel and ticagrelor were associated with similar efficacy and safety during 1-year follow-up.

scholarly journals The effect of unguided de-escalation of P2Y12 receptor inhibitor therapy after acute myocardial infarction in patients undergoing percutaneous coronary intervention: a nationwide cohort study

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J.S Yeh ◽  
C.Y Hsu ◽  
C.Y Huang ◽  
W.T Chen ◽  
Y.C Hsieh ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Bleeding Complications ◽  
Funding Source ◽  
P2y12 Inhibitor ◽  
Risk Of Death ◽  
Percutaneous Coronary ◽  
Significant Difference

Abstract Aims To examine the effect of de-escalation of P2Y12 inhibitor in dual antiplatelet therapy (DAPT) on major adverse cardiovascular events (MACE) and bleeding complications after acute myocardial infarction (AMI) in Taiwanese patients undergoing percutaneous coronary intervention (PCI). Methods and results We retrospectively evaluated patients who had received PCI during AMI hospitalisation and were initially on aspirin and ticagrelor and without adverse events at 3 months between 2013 and 2016. In total, 1,901 and 8,199 patients were identified as switched DAPT (switched to aspirin and clopidogrel) and unswitched DAPT (continued on aspirin and ticagrelor) cohorts, respectively. With a mean follow-up of 8 months, the incidence rates (per 100 person-year) of death, AMI readmission and MACE were 2.89, 3.68 and 4.91 in the switched cohort and 2.42, 3.28 and 4.72 in the unswitched cohort, respectively based on an inverse probability of treatment weighted method. (Table) After adjustment for patients' clinical variables, two groups were no significant difference in death (A), AMI admission (B) and MACE (C). Additionally, there was no difference in the risk of major (D) or non-major clinically relevant bleeding (E) (Figure 1). Conclusions Unguided de-escalation of P2Y12 inhibitor in DAPT was not associated with higher risk of death, MACE, AMI readmission in Taiwanese patients with AMI undergoing PCI. Figure 1 Funding Acknowledgement Type of funding source: Private hospital(s). Main funding source(s): Taipei Medical University

scholarly journals Bailout Thrombectomy: Its Outcomes in Patients Undergoing Primary Percutaneous Coronary Intervention

2021 ◽  
Vol 15 (5) ◽  
pp. 1765-1767
Author(s):  
Mahboob ur Rehman ◽  
Farhan Faisal ◽  
Amjad Abrar ◽  
Amjad Ali Shah ◽  
Muhammad Shoaib ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Renal Impairment ◽  
Primary Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Post Procedure ◽  
Percutaneous Coronary ◽  
Significant Difference ◽  
Group A ◽  
Group B

Aim: To determine the clinical outcomes of patients who received bailout thrombectomy for primary percutaneous coronary intervention. Study Design: Cross-sectional/observational Place & Duration: Study was conducted at Cardiac Centre, Cardiology Department, Pakistan Institute of Medical Sciences (PIMS) Islamabad from January 2020 to December 2020 (for one year). Methods: 200 hundred patients of both genders undergoing primary percutaneous coronary intervention(PPCI)for ST elevation myocardial infarction(STEMI) were analyzed in this study. All patients were divided into two groups. Group A contains 100 patients and received PPCI with bailout thrombectomy and Group B contains 100 patients and received PPCI alone. Informed written consent was taken. Outcomes such as mortality, re-infarction, heart failure, cardiogenic shock, renal impairment, excess bleeding, post procedure stroke and hospital stay were examined and compare between both groups. Results: In Group A there were 53% males and 47% females with mean age 56.45+10.88 years. In Group B 55% were males and 45% were females with mean age 58.35+9.23 years. In Groups A there were more diabetic patients 45% than Group B 32% (p-value 0.005), Group B had more smokers 60%. There was a significant difference between group A and B regarding family history of coronary artery disease 35% vs 20% (p=0.003). In Group A 3% patients were died and in Group B 2% patients were died with no significant difference. Group A patients had more renal impairment 9% vs 5% and stroke 3% vs 1% than Group B. Hospital stay was high in Group A patients 7.12+2.05 vs 5.34+1.02 days of Group B. Conclusion: It is concluded that patients received bailout thrombectomy for percutaneous coronary intervention (PCI) had high rate of comorbidities. There was no significant difference in term of mortality between both groups. However, patients with bailout thrombectomy had more renal impairment and post-procedure stroke. Keywords: ST-segment elevated myocardial infarction, bailout thrombectomy, PPCI, Outcomes

scholarly journals Arrhythmias following Revascularization Procedures in the Course of Acute Myocardial Infarction: Are They Indicators of Reperfusion or Ongoing Ischemia?

2013 ◽  
Vol 2013 ◽  
pp. 1-7 ◽  
Author(s):  
Ersan Tatli ◽  
Güray Alicik ◽  
Ali Buturak ◽  
Mustafa Yilmaztepe ◽  
Meryem Aktoz
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
St Elevation Myocardial Infarction ◽  
Reperfusion Arrhythmias ◽  
Percutaneous Coronary ◽  
Significant Difference ◽  
Vessel Patency ◽  
St Elevation ◽  
Revascularization Procedures

Objective. The most important step in the treatment of ST elevation myocardial infarction is to sustain myocardial blood supply as soon as possible. The two main treatment methods used today to provide myocardial reperfusion are thrombolytic therapy and percutaneous coronary intervention. In our study, reperfusion arrhythmias were investigated as if they are indicators of coronary artery patency or ongoing ischemia after revascularization.Methods. 151 patients with a diagnosis of acute ST elevation myocardial infarction were investigated. 54 patients underwent primary percutaneous coronary intervention and 97 patients were treated with thrombolytic therapy. The frequency of reperfusion arrythmias following revascularization procedures in the first 48 hours after admission was examined. The relation between reperfusion arrhythmias, ST segment regression, coronary artery patency, and infarct related artery documented by angiography were analyzed.Results. There was no statistically significant difference between the two groups in the frequency of reperfusion arrhythmias (P=0.355). Although angiographic vessel patency was higher in patients undergoing percutaneous coronary intervention, there was no significant difference between the patency rates of each group with and without reperfusion arrythmias.Conclusion. Our study suggests that recorded arrhythmias following different revascularization procedures in acute ST elevation myocardial infarction may not always indicate vessel patency and reperfusion. Ongoing vascular occlusion and ischemia may lead to various arrhythmias which may not be distinguished from reperfusion arrhythmias.

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