Abstract 2003: The Characteristics of Non-Culprit Coronary Plaques in Patients with Acute Coronary Syndrome: Noninvasive Assessment by 64-Slice Computed Tomography

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Hirohiko Ando ◽  
Tetsuya Amano ◽  
Tadayuki Uetani ◽  
Michio Nanki ◽  
Nobuyuki Marui ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Coronary Intervention ◽  
Coronary Plaque ◽  
Plaque Composition ◽  
Fibrous Plaque ◽  
Coronary Syndrome ◽  
Significant Difference ◽  
Remodeling Index ◽  
Coronary Lesions ◽  
Soft Plaque

Some invasive imaging modalities such as intravascular ultrasound and angioscopy have shown the vulnerability of non-culprit plaques in patients with acute coronary syndrome (ACS). Recently multi-slice CT (MSCT) has been used to assess the characteristics of coronary plaque and the major advantage of MSCT is that it can evaluate all coronary plaques noninvasively. The purposes of this study are to assess coronary plaques noninvasively by MSCT and compare the differences of plaque composition between culprit and non-culprit lesions in patients with ACS and stable lesions in the patients with stable angina pectoris (SAP). 64-slice CT was performed in 27 patients with ACS and 33 patients with SAP before percutaneous coronary intervention. According to CT value, we defined plaque components as soft plaque (SP <50 HU), fibrous plaque (50 HU <FP <150 HU) and calcified plaque (CP >500 HU). In all obstructive lesions, we evaluated plaque characteristics by calculating the volume of SP, FP and CP. On the basis of clinical presentation, electrocardiogram and angiographic appearance, coronary lesions in the patients with ACS are divided into culprit or non-culprit lesions. Coronary lesions in the patients with SAP are defined as stable lesions. We analyzed 89 lesions with excellent image quality. Culprit lesions (n=19) and non-culprit lesions (n=25) had significantly larger volumetric percentage of SP and higher remodeling index compared to stable lesions (n=40) (34.4% vs. 29.3% vs. 21.0%, p<0.0001 and 1.061 vs. 1.061 vs. 0.971, p=0.01, respectively). But there was no significant difference in plaque composition between culprit lesions and non-culprit lesions. We assessed coronary plaques noninvasively by MSCT and found that non-culprit lesions in the patients with ACS, as well as culprit lesions, had significantly larger volumetric percentage of SP and higher remodeling index compared to stable lesions in the patients with SAP, supporting the concept of multiple vulnerable plaques in patients with ACS.

scholarly journals Coronary Plaque Structural Stress Is Associated With Plaque Composition and Subtype and Higher in Acute Coronary Syndrome

2014 ◽  
Vol 7 (3) ◽  
pp. 461-470 ◽  
Author(s):  
Zhongzhao Teng ◽  
Adam J. Brown ◽  
Patrick A. Calvert ◽  
Richard A. Parker ◽  
Daniel R. Obaid ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Coronary Plaque ◽  
Structural Stress ◽  
Plaque Composition ◽  
Coronary Syndrome

scholarly journals Relationship of PRECISE-DAPT and DAPT scores with mortality in patients admitted with acute coronary syndrome who undergo coronary stent implantation

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
C Alak ◽  
E Ozpelit ◽  
D Cirgamis ◽  
M Abusharekh ◽  
N Baris
Keyword(s):  
Acute Coronary Syndrome ◽  
Major Bleeding ◽  
Coronary Intervention ◽  
Bleeding Events ◽  
Coronary Syndrome ◽  
Coronary Stent Implantation ◽  
Number Of Patients ◽  
Percutaneous Coronary ◽  
Significant Difference ◽  
Relationship Of

Abstract Introduction International guidelines recommend using risk score tools that allow us to assess the risk of bleeding and ischemia when deciding on DAPT. In our research, we aimed to examine the mortality relationship of new risk scores, DAPT and PRECISE-DAPT scores. Method Between 2013–2014, 948 patients admitted to our clinic with ACS were included in our study. We excluded 688 patient (no contact number,CABG, medical treatment, use of oral anticoagulation, active malignant cancer). 260 patients admitted with acute coronary syndrome (58%, 8 STEMI, 35%, 4 non-STEMI, 5%, 4 Unstable angina pectoris) who undergo coronary stent implantation were included in the study. We aimed to focus on the patients who undergo percutaneous coronary intervention and their risk of mortality. The patients' records were retrospectively analyzed through the hospital information system and archive records. Laboratory results, echocardiography and CAG reports of the patients, disease histories were obtained from the information recorded through the system. With these data, PRECISE-DAPT and DAPT scores of patients were calculated. Results The number of patients with a PRECISE-DAPT Score ≥25 was 62 (23.8%). The number of patients with DAPT Score ≥2 was 193 (74.2%). Mortality occurred in 49 (18.8%) patients. Patients with PRECISE-DAPT ≥25 and those with PRECISE-DAPT &lt;25 were compared in terms of mortality and mortality was significantly higher in the high-scoring group [P &lt;0.001 OR 6.94 C (3.53–13.62)]. The patients were divided into 4 groups (PRECISE-DAPT 25 and DAPT ≥2, PRECISE-DAPT ≥25 and DAPT ≥2, PRECISE-DAPT 25 and DAPT 2, PRECISE-DAPT ≥25 and DAPT 2) according to PRECISE-DAPT and DAPT score. Mortality was significantly higher regardless of DAPT score in patients with high PRECISE-DAPT scores (p&lt;0.001). We evaluated the relationship between PRECISE-DAPT score and major bleeding and all bleeding. Compared to the group there was no significant difference in all bleeding events (P=0.56) and major bleeding events (P=0.23). The relationship between bleeding events and mortality was evaluated. There was no significant difference in mortality (p=0.689) with all bleeding events; but mortality was significantly increased in patients with major bleeding [P=0.025 OR 6.16 (1,33–28,49)]. Conclusion In our study, we observed that the patient group with a high PRECISE-DAPT score had a high mortality rate regardless of the DAPT score. The PRECISE-DAPT score is a useful tool in determining the group with high long-term mortality in patients who present with acute coronary syndrome and undergo percutaneous coronary intervention. The clinician should use the PRECISE-DAPT score when deciding on the duration of dual antiplatelet therapy in this patient group and these patients with high scores need to be monitored more closely. The data we have obtained from our study is retrospective and these results need to be supported by prospective and large studies. FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals Early aspirin discontinuation following acute coronary syndrome or percutaneous coronary intervention: a systematic review and meta-analysis of randomized controlled trials

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
P Guedeney ◽  
J Mesnier ◽  
S Sorrentino ◽  
F Abcha ◽  
M Zeitouni ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Acute Coronary Syndrome ◽  
Randomized Controlled Trials ◽  
Major Bleeding ◽  
Coronary Intervention ◽  
Controlled Trials ◽  
Coronary Syndrome ◽  
Randomized Controlled ◽  
Percutaneous Coronary ◽  
Significant Difference

Abstract Background The respective ischemic and bleeding risks of early aspirin discontinuation following an acute coronary syndrome (ACS) or percutaneous coronary intervention (PCI) remains uncertain. Objectives To evaluate the safety and efficacy of early aspirin discontinuation in ACS or PCI patients treated with P2Y12 inhibitors with or without anticoagulants. Methods We performed a review of randomized controlled trials (RCTs) comparing a P2Y12 inhibitor-based single antiplatelet strategy following early aspirin discontinuation to a strategy of sustained dual antiplatelet therapy (DAPT) in ACS or PCI patients requiring or not anticoagulation for another indication. The primary safety endpoint was major bleeding while non-major bleeding and all bleeding were secondary safety endpoints. The primary efficacy endpoint was all-cause mortality while secondary efficacy endpoints included major adverse cardiovascular and cerebrovascular events (MACCE), myocardial infarction (MI), definite stent thrombosis (ST) or any stroke. We estimated risk ratios (RR) and 95% confidence intervals (CI) using random effect models. The study is registered in PROSPERO (CRD42019139576). Results We included 9 RCTs comprising 40,621 patients.Compared to prolonged DAPT, major bleeding (2.2% vs. 2.8%; RR 0.68; 95% CI: 0.54 to 0.87; p=0.002; I2: 63%), non-major bleeding (5.0% vs. 6.1%; RR: 0.66; 95% CI: 0.47 to 0.94; p=0.02; I2:87%) and all bleeding (7.4% vs. 9.9%; RR: 0.65; 95% CI: 0.53 to 0.79; p&lt;0.0001; I2: 88%) were significantly reduced with early aspirin discontinuation (Figure 1), without significant difference for all-cause death (p=0.60), MACCE (p=0.60), MI (p=0.77), definite ST (p=0.63), and any stroke (p=0.59). Results were consistent in patients with or without anticoagulation, without significant interaction for any outcomes but MI (p=0.04). Conclusions In patients on DAPT after an ACS or a PCI, early aspirin discontinuation prevents bleeding events with no effect on the ischemic risk or mortality. Figure 1. Central illustration Funding Acknowledgement Type of funding source: None

Women and men diagnosed with acute coronary syndrome – sex-related differences

2018 ◽  
Vol 87 (2) ◽  
pp. 92-98
Author(s):  
Magdalena Dudek ◽  
Marta Kałużna-Oleksy ◽  
Jacek Migaj ◽  
Ewa Straburzyńska-Migaj
Keyword(s):  
Acute Coronary Syndrome ◽  
Troponin I ◽  
Sudden Cardiac Arrest ◽  
Coronary Intervention ◽  
Cardiac Biomarkers ◽  
Invasive Treatment ◽  
Coronary Syndrome ◽  
Significant Difference ◽  
Choice Of Treatment ◽  
Artery Disease

Background. Coronary artery disease (CAD) is one of the most important causes of death in both men and women. There are many gender differences among patients with CAD, including risk factors and acute coronary syndrome (ACS) outcomes. The latest reports showed that mortality due to CAD is higher in women than in men. Cardiac biomarkers play an important role in risk stratification and choice of treatment strategy in patients with ACS, however some of cardiac biomarkers show worse sensitivity and specificity in women.Aim. The aim was to investigate the sex-related differences in patients with acute coronary syndrome and to compare their sex-related risk of in-hospital mortality.Material and Methods. Single-center study of patients diagnosed with ACS who underwent precutaneous coronary intervention (PCI). Patients were diagnosed and treated according to ESC Guidelines. Statistical analysis was performed using StatSoft Statistica.Results. Of the 297 patients included in this study, 32% were women and 68% were men. There were 26.94% STEMI patients, 22.22% NSTEMI patients and 50.84% unstable angina patients. Compared with males, females were significant older (68.2 ± 10.6 vs. 64.8 ± 11.0; p = 0.0175). Levels of biomarkers of myocardial injury were significantly lower in women: CK-MB (p = 0.0241), troponin I (p = 0.0417) and CK (p = 0.0035) than in men. Women were less frequently treated with PCI or CABG (p = 0.0016) but the in-hospital outcomes (cardiogenic shock, sudden cardiac arrest or cardiac death) were similar in both groups (p = 0.8557).Conclusions. Women with ACS were older and have higher incidence of non-ST-elevation ACS than men.. In-hospital mortality show no significant difference between genders. Women were less likely to receive invasive treatment.

Transferring from clopidogrel loading dose to prasugrel loading dose in acute coronary syndrome patients

2014 ◽  
Vol 112 (08) ◽  
pp. 311-322 ◽  
Author(s):  
Jorge F. Saucedo ◽  
Tracy E. Cardillo ◽  
Joseph A. Jakubowski ◽  
Carsten Henneges ◽  
Mark B. Effron ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Platelet Reactivity ◽  
Coronary Intervention ◽  
Loading Dose ◽  
Coronary Syndrome ◽  
Percutaneous Coronary ◽  
Significant Difference ◽  
High Prevalence ◽  
The Impact ◽  
Time Point

SummaryHigh on-treatment platelet reactivity (HPR) has been identified as an independent risk factor for ischaemic events. The randomised, doubleblind, TRIPLET trial included a pre-defined comparison of HPR in acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI) following a placebo/600-mg clopidogrel loading dose (LD) immediately before a subsequent prasugrel 60-mg or 30-mg LD. Platelet reactivity was assessed using the VerifyNow® P2Y12 assay (P2Y12 Reaction Units, PRU) within 24 hours (h) following the placebo/clopidogrel LD (immediately prior to prasugrel LD), and at 2, 6, 24, 72 h following prasugrel LDs. The impact of CYP2C19 predicted metaboliser phenotype (extensive metaboliser [EM] and reduced metabolisers [RM]) on HPR status was also assessed. HPR (PRU ≥240) following the clopidogrel LD (prior to the prasugrel LD) was 58.5% in the combined clopidogrel LD groups. No significant difference was noted when stratified by time between the clopidogrel and prasugrel LDs (≤6 hs vs >6 h). At 6 h following the 2nd loading dose in the combined prasugrel LD groups, HPR was 7.1%, with 0% HPR by 72 h. There was no significant effect of CYP2C19 genotype on pharmacodynamic (PD) response following either prasugrel LD treatments at any time point, regardless of whether it was preceded by a clopidogrel 600-mg LD. In conclusion, in this study, patients with ACS intended for PCI showed a high prevalence of HPR after clopidogrel 600-mg LD regardless of metaboliser status. When prasugrel LD was added, HPR decreased substantially by 6 h, and was not seen by 72 h.

Ticagrelor monotherapy vs clopidogrel monotherapy in patients with acute coronary syndrome undergoing percutaneous coronary intervention

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
W Feng ◽  
P.W Chen ◽  
M.Y Ho ◽  
C.H Su ◽  
S.W Huang ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Acute Coronary Syndrome ◽  
Primary Endpoint ◽  
Major Bleeding ◽  
Lower Risk ◽  
Coronary Intervention ◽  
Coronary Syndrome ◽  
Percutaneous Coronary ◽  
Significant Difference ◽  
All Cause Mortality

Abstract Background P2Y12 inhibitor monotherapy with either clopidogrel or ticagrelor becomes an alternative antiplatelet strategy in patients (pts) undergoing percutaneous coronary intervention (PCI). The purpose of this study was to compare the efficacy and safety of clopidogrel vs. ticagrelor monotherapy in pts with acute coronary syndrome (ACS) undergoing PCI who cannot tolerate aspirin. Methods and results From January 1, 2014 to December 31, 2018, a total of 610 ACS pts (mean age 70.4±13.1 years, 72.1% men, 28.5% STEMI) that aspirin was stopped prematurely for various reasons and received either clopidogrel (n=369) or ticagrelor (n=241) monotherapy were included from 8 major hospitals in Taiwan. The duration (median and the 25th and 75th percentile) of aspirin treatment was 9 (1.39–37.00) days in the clopidogrel group and 10 (1.00–55.00) days in the ticagrelor group (p=0.514). Gastrointestinal bleeding (36.9%) was the most common reason to stop aspirin in both groups. The primary endpoint is the composite of all-cause mortality, recurrent ACS or unplanned revascularization, and stroke within 12 months after discharge. The safety endpoint was the major bleeding defined as BARC 3 or 5 bleedings. The covariates were balanced between groups after using inverse probability of treatment weighting. Overall, 84 patients developed events of primary endpoint, with 57 (15.4%) in the clopidogrel group and 27 (11.2%) in the ticagrelor group. After multivariate adjustment in the Cox proportional-hazards models, ticagrelor was associated with a lower risk of primary endpoint compared with clopidogrel (adjusted hazard ratio [aHR] 0.67, 95% CI 0.49–0.93). Among the primary endpoint, ticagrelor significantly reduced the risk of recurrent ACS or unplanned revascularization (aHR 0.46, 95% CI 0.28–0.75). There was no significant difference of all-cause mortality between the 2 groups (aHR 0.92, 95% CI 0.52–1.61). The risk of BARC 3 or 5 bleeding was also similar (aHR 0.71, 95% CI 0.35–1.45). Conclusions Among ACS patients undergoing PCI who cannot tolerate aspirin, ticagrelor monotherapy was associated with a significantly lower risk of a composite of cardiovascular events compared to clopidogrel monotherapy. The major bleeding risk was similar between groups. Funding Acknowledgement Type of funding source: None

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