scholarly journals Potential Additive Effects of Ticagrelor, Ivabradine, and Carvedilol on Sinus Node

2014 ◽  
Vol 2014 ◽  
pp. 1-4 ◽  
Author(s):  
Luigi Di Serafino ◽  
Francesco Luigi Rotolo ◽  
Augusto Boggi ◽  
Riccardo Colantonio ◽  
Roberto Serdoz ◽  
...  
Keyword(s):  
Beta Blockers ◽  
Sinus Node ◽  
Cyclic Adenosine Monophosphate ◽  
Adenosine Monophosphate ◽  
Angiotensin Ii Receptor ◽  
Reduce Heart Rate ◽  
Coronary Syndrome ◽  
Adenosine Uptake ◽  
St Elevation ◽  
Symptomatic Bradycardia

A 51-year-old male patient presented to the emergency room with an anterior ST-elevation myocardial infarction. After a loading dose of both ticagrelor and aspirin, the patient underwent primary-PCI on the left anterior descending coronary artery with stent implantation. After successful revascularization, medical therapy included beta-blockers, statins, and angiotensin II receptor antagonists. Two days later, ivabradine was also administered in order to reduce heart rate at target, but the patient developed a severe symptomatic bradycardia and sinus arrest, even requiring administration of both atropine and adrenaline. Ivabradine and ticagrelor have been then suspended and this latter changed with prasugrel. Any other similar event was not reported during the following days. This clinical case raised concerns about the safety of the combination of beta-blockers and ivabradine in patients treated with ticagrelor, particularly during the acute phase of an acute coronary syndrome. These two latter drugs, in particular, might interact with the same receptor. In fact, ivabradine directly modulates the If-channel which is also modulated by the cyclic adenosine monophosphate levels. These latter have been shown to increase after ticagrelor assumption via inhibition of adenosine uptake by erythrocytes. Further studies are warrant to better clarify the safety of this association.

scholarly journals Acute Myocardial Infarction Caused by an Anomalous Right Coronary Artery Occlusion Presenting with Precordial ST Elevation

2017 ◽  
Vol 2017 ◽  
pp. 1-4 ◽  
Author(s):  
Bruno da Silva Matte ◽  
Alexandre Damiani Azmus
Keyword(s):  
Myocardial Infarction ◽  
Right Ventricular ◽  
Sinus Node ◽  
Artery Occlusion ◽  
Inferior Wall ◽  
St Segment Elevation ◽  
Right Ventricular Infarction ◽  
Coronary Syndrome ◽  
St Elevation ◽  
Ventricular Infarction

Acute coronary syndrome with precordial ST segment elevation is usually related to left anterior descending artery occlusion, although isolated right ventricular infarction has been described as a cause of ST elevation in V1–V3 leads. We present a case of a patient with previous inferior wall infarction and new acute ST elevation myocardial infarction (STEMI) due to proximal right coronary thrombotic occlusion resulting in right ventricular infarction with precordial ST elevation and sinus node dysfunction. The patient was treated with successful rescue angioplasty achieving resolution of acute symptoms and electrocardiographic abnormalities.

Abstract 162: Evolution of Acute Coronary Syndrome Treatment During Last Years in Russian Hospitals (Based on Results of RECORDs Registries)

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Alexey D Erlikh
Keyword(s):  
Acute Coronary Syndrome ◽  
Beta Blockers ◽  
Hospital Death ◽  
Evaluation Tool ◽  
Pooled Data ◽  
Coronary Syndrome ◽  
Statin Prescription ◽  
St Elevation ◽  
Clear Increase ◽  
Made In

Background and Purpose: The prospective registries are the most powerful evaluation tool to characterize patients and features of acute coronary syndrome (ACS) treatment. There have been a lot of changes in ACS treatment in Russian hospitals in recent 5-7 years. The aim of our study was to evaluate changes in the ACS treatment occurred in Russia during the last few years. Methods: We conducted the series of independent registries of ACS which were organized by the initiative of their participants - RECORD registries. The first regi stry was held in 2007 (18 centers in 13 cities, n=796). The RECORD-2 registry was conducted in 2009-2011 (7 centers in 7 cities, n=1656). In this analysis pooled data of the RECORD and RECORD-2 (“old” registries; n=2452) were compared with data of the RECORD-3 (“new” registry), conducted in March-April 2015 (47 centers in 37 cities, n=2370). Results: In comparison with “old” registries significantly more patients from “new” registry were hospitalized in PCI-capability hospitals (72.5% vs 56.7%; p<0.0001). The rate of troponin detection was also higher in “new” registry (75.7% vs 41.5%; p<0.0001). The rate of primary PCI (pPCI) in ST-elevation myocardial infarction (STEMI ) was 39.0% in “new” and 36.3% in “old” registry (p=0.24). The rate of pPCI in PCI-capability centers wasn’t also significantly higher in “new” registry (47.2% vs 45.8%). The rate of fibrinolysis in STEMI was nearly similar (32.1% vs 32.2%; p=0.98), but the rate of prehospital fibrinolysis and the rate of PCI after fibrinolysis became more frequent in “new” registry (50.9% vs 23.5%; p<0.0001 and 52.4% vs 25.0%; p<0.0001 respectively). In patients with non-ST elevation ACS (NSTEACS) the rate of diagnostic coronarography (CAG) and the rate of PCI within 72 hours after admission weren’t significantly different in “new” and “old” registries (68.2% vs 71.8%; p=0.15 and 26.6% vs 23.6%; p=0.19 respectively). Among discharge medication from “old” to “new” registries decreasing of aspirin and beta-blockers prescription (89.7% and 91.3%; p=0.009 and 86.0% vs 90.2%; p<0.0001 respectively) and increasing of dual antiplatelet therapy and statin prescription (82.6% vs 43.7%; p<0.0001 and 90.9% vs 78.1%; p<0.0001 respectively) were obtained.The duration of in-hospital stay in “new” registry was shorter than in “old” registries (10,2 vs 13.4 days; p<0.0001), the proportion of patients transferred in non-PCI-capability centers to CAG was higher (16.3% vs 2.2%; p<0.0001) and the rate of in-hospital death was lower (5.1% vs 6.6%; p=0.041). Conclusion: A series of prospective independent registries RECORDs showed that in recent years some progress towards better adherence to the guidelines has been made in the treatment of ACS in Russian hospitals participating in those registries. However, there wasn’t a clear increase in the rate of pPCI and fibrinolysis in STEMI and the rate of invasive strategy in NSTEACS.

scholarly journals Medication Adherence After Acute Coronary Syndrome in Women Compared With Men: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 2 ◽  
Author(s):  
Sophie H. Bots ◽  
Jose A. Inia ◽  
Sanne A. E. Peters
Keyword(s):  
Acute Coronary Syndrome ◽  
Beta Blockers ◽  
Meta Analysis ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Lipid Lowering ◽  
Angiotensin Ii Receptor ◽  
Converting Enzyme Inhibitors ◽  
Coronary Syndrome ◽  
Adherence To Medication ◽  
Antiplatelet Medication

Introduction: Pharmacological treatment is an important component of secondary prevention in acute coronary syndrome (ACS) survivors. However, adherence to medication regimens is often suboptimal, reducing the effectiveness of treatment. It has been suggested that sex influences adherence to cardiovascular medication, but results differ across studies, and a systematic overview is lacking.Methods: We performed a systematic search of PubMed and EMBASE on 16 October 2019. Studies that reported sex-specific adherence for one or more specific medication classes for ACS patients were included. Odds ratios, or equivalent, were extracted per medication class and combined using a random effects model.Results: In total, we included 28 studies of which some had adherence data for more than one medication group. There were 7 studies for angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs) (n = 100,909, 37% women), 8 studies for antiplatelet medication (n = 37,804, 27% women), 11 studies for beta-blockers (n = 191,339, 38% women), and 17 studies for lipid-lowering medication (n = 318,837, 35% women). Women were less adherent to lipid-lowering medication than men (OR = 0.87, 95% CI 0.82–0.92), but this sex difference was not observed for antiplatelet medication (OR = 0.95, 95% CI 0.83–1.09), ACEIs/ARBs (OR = 0.95, 95% CI 0.78–1.17), or beta-blockers (OR = 0.97, 95% CI 0.86–1.11).Conclusion: Women with ACS have poorer adherence to lipid-lowering medication than men with the same condition. There are no differences in adherence to antiplatelet medication, ACEIs/ARBs, and beta-blockers between women and men with ACS.

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