scholarly journals Effect of Timing of Staged Percutaneous Coronary Intervention on Clinical Outcomes in Patients With Acute Coronary Syndromes

2021 ◽  
Author(s):  
Tatsuhiko Otsuka ◽  
Sarah Bär ◽  
Sylvain Losdat ◽  
Raminta Kavaliauskaite ◽  
Yasushi Ueki ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Hospital Discharge ◽  
Acute Coronary Syndromes ◽  
Coronary Intervention ◽  
Target Vessel ◽  
End Point ◽  
Recurrent Myocardial Infarction ◽  
Percutaneous Coronary ◽  
Coronary Syndromes

Background Complete revascularization reduces cardiovascular events in patients with acute coronary syndromes (ACSs) and multivessel disease. The optimal time point of non–target‐vessel percutaneous coronary intervention (PCI) remains a matter of debate. The aim of this study was to investigate the impact of early (<4 weeks) versus late (≥4 weeks) staged PCI of non–target‐vessels in patients with ACS scheduled for staged PCI after hospital discharge. Methods and Results All patients with ACS undergoing planned staged PCI from 2009 to 2017 at Bern University Hospital, Switzerland, were analyzed. Patients with cardiogenic shock, in‐hospital staged PCI, staged cardiac surgery, and multiple staged PCIs were excluded. The primary end point was all‐cause death, recurrent myocardial infarction and urgent premature non–target‐vessel PCI. Of 8657 patients with ACS, staged revascularization was planned in 1764 patients, of whom 1432 patients fulfilled the eligibility criteria. At 1 year, there were no significant differences in the crude or adjusted rates of the primary end point (7.8% early versus 10.8% late, hazard ratio [HR], 0.72 [95% CI, 0.47–1.10], P =0.129; adjusted HR, 0.80 [95% CI, 0.50–1.28], P =0.346) and its individual components (all‐cause death: 1.5% versus 2.9%, HR, 0.52 [95% CI, 0.20–1.33], P =0.170; adjusted HR, 0.62 [95% CI, 0.23–1.67], P =0.343; recurrent myocardial infarction: 4.2% versus 4.4%, HR, 0.97 [95% CI, 0.475–1.10], P =0.924; adjusted HR, 1.03 [95% CI, 0.53–2.01], P =0.935; non–target‐vessel PCI, 3.9% versus 5.7%, HR, 0.97 [95% CI, 0.53–1.80], P =0.928; adjusted HR, 1.19 [95% CI, 0.61–2.34], P =0.609). Conclusions In this single‐center cohort study of patients with ACS scheduled to undergo staged PCI after hospital discharge, early (<4 weeks) versus late (≥4 weeks) staged PCI was associated with a similar rate of major adverse cardiac events at 1 year follow‐up. Registration URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02241291.

The 90s are the new 70s: approach to nonagenarian patients with myocardial infarction: data from the Real World Portuguese Registry on Acute Coronary Syndromes (ProACS)

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J Grade Santos ◽  
A Briosa ◽  
A.R Pereira ◽  
A Marques ◽  
D Sebaiti ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Percutaneous Coronary Intervention ◽  
Logistic Regression ◽  
Acute Coronary Syndromes ◽  
Intervention Group ◽  
Coronary Intervention ◽  
Mechanical Complication ◽  
Percutaneous Coronary ◽  
Coronary Syndromes

Abstract Introduction The approach to Acute Coronary Syndromes is based on robust high quality evidence, currently systematized in European endorsed guidelines. However most trials that support such guidelines excluded or included a small percentage of the very elderly, namely nonagenarian patients, and the clinical decision in this age range is subjected to high interpersonal and inter-hospital variability. Purpose Our aim was to assess the approach to nonagenarian patients with Acute Coronary Syndromes (ACS), in what regards the choice of percutaneous coronary intervention or conservative management and determine in-hospital and at 1 year outcomes. Methods We performed a 9 year retrospective analysis of all patients with age equal or greater than ninety (90) admitted with ACS in Portugal. Medical records were analysed for demographic, procedural data and outcomes. Results Seven hundred and fourteen (714) nonagenarian patients were admitted with ACS, which corresponded to 2.4% of the total cohort. The mean age was 92±2 with a female preponderance (58.7%). There was a high rate of cardiovascular risk factor with hypertension in 81.3%; Dyslipidemia in 46.1% Diabetes Mellitus in 23.4%; and other comorbidities with 21% of prior ACS, 14.4% with Heart Failure, 11% with cerebrovascular events and 15.4% with chronic kidney failure. The ACS was categorized as ST elevation Myocardial Infarction (STEMI) in 43.9%, non- STEMI (NSTEMI) in 45.8%, and unstable angina (UA) in 2%. Two hundred and sixty-eight (268), 37.8% of the cohort, were submitted to percutaneous coronary intervention (PCI), mainly due to STEMI (68.3%). This cohort were composed of patients with less comorbidities (statistically significant less valvular heart disease, heart failure, peripherical artery disease and dementia although more oncological diseases). There was no difference in the severity of ACS, as categorized by the Kilip Kimbal (KK) classification, mechanical complication or depressed ejection fraction between the 2 groups. (p&gt;0.05 for all) There was a statistically significant increase of advanced atrioventricular block (10.6 vs 4.4%; p 0.002; Logistic regression OR 3.12; IC95 [1.37–7.15], p 0.007) and major bleeding (1.8 vs 5.5%; p 0.008; Logistic regression OR 3.36; IC95 [1.36–8.32] p 0.009) in the PCI group. There was no difference in in-hospital re-infarction, cardiac arrest, stroke or death. (p&gt;0.05 for all) The follow up at 1 year was performed in two hundred and fifty-six (256) patients, 30.9% submitted to PCI. Although the survival analysis demonstrated a trend towards improvement in 1-year survival and cardiovascular readmissions in the intervention group, it did not reach statistical significance. (p&gt;0.05 for all) Conclusions PCI was performed in about a third of nonagenarians presenting with ACS. Our cohort demonstrated a greater rate of in-hospital complications without a significant in-hospital or at 1 year clinical benefit. Funding Acknowledgement Type of funding source: None

Tirofiban optimizes platelet inhibition for immediate percutaneous coronary intervention in high-risk acute coronary syndromes

2008 ◽  
Vol 100 (10) ◽  
pp. 648-654 ◽  
Author(s):  
Frieder Keck ◽  
Peter Staritz ◽  
Stephanie Lehrke ◽  
Hugo A. Katus ◽  
Evangelos Giannitsis ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Body Weight ◽  
Platelet Aggregation ◽  
Acute Coronary Syndromes ◽  
Coronary Intervention ◽  
Platelet Inhibition ◽  
Percutaneous Coronary ◽  
Coronary Syndromes ◽  
Pre Treatment

SummaryIt was the aim of this study to compare the efficacy of early platelet inhibition by 600 mg clopidogrel and acetylsalicylic acid (ASA) to a triple therapy including a glycoprotein IIb-IIIa receptor blocker. Immediate percutaneous coronary intervention (PCI) is recommended for high-risk acute coronary syndromes. In this setting the efficacy of platelet inhibition is unknown. One hundred patients were randomized to receive ASA and 600 mg clopidogrel, or additional open-label tirofiban (bolus of 10 µg/kg body weight followed by continued infusion of 0.15 µg/kg body weight per minute) as soon as non-ST - segment elevation myocardial infarction was diagnosed. The primary endpoint was the reduction of infarct size determined by post-interventional increases of cardiac troponin T (cTnT). Secondary endpoints included platelet function measured by optical and impedance aggregometry using ADP (5 and 20 µM) and collagen (1 µg/ml) as platelet agonists. Tirofiban maximized platelet inhibition (p<0.0001) immediately and was associated with significantly lower post-interventional cTnT concentrations (p=0.0352). In the dual platelet inhibition arm, clopidogrel was not effective in 69% of patients at the time of coronary intervention, and still in 47%, if pre-treatment time was >120 minutes. The frequency of cardiovascular (death, myocardial infarction, revascularization) and bleeding events was comparable. Platelet aggregation is not adequately inhibited in cTnT - positive patients in the setting of immediate PCI with very short pre-treatment times. Only tirofiban provided consistent and effective inhibition of platelet aggregation at the time of immediate or very early invasive therapy.

2-year real-world outcomes of prasugrel, ticagrelor or clopidogrel therapy following percutaneous coronary intervention from a large multi-centre Australian registry

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
D Pol ◽  
E Chowdhury ◽  
S Delacroix ◽  
S Worthley ◽  
D Eccleston
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Major Bleeding ◽  
Real World ◽  
Coronary Intervention ◽  
Real World Data ◽  
End Point ◽  
Percutaneous Coronary ◽  
Clopidogrel Therapy ◽  
Coronary Syndromes

Abstract Background Real-world data comparing outcomes for prasugrel, ticagrelor or clopidogrel use in patients undergoing percutaneous coronary intervention (PCI) is limited, with only smaller cohorts or 12-month observations available. Methods Data was collected prospectively from a total of 14 sites around Australia, from November 2008 until March 2019. The cohort included consecutively enrolled patients presenting electively or following acute coronary syndromes who were prescribed dual antiplatelet therapy following PCI. There were no exclusion criteria. The primary end point was the composite of death, myocardial infarction, or stroke at 1 year and 2 years after PCI. Secondary end points included safety, which was the incidence of major bleeding (BARC 3,4 or 5) at discharge. Results A total of 12,940 patients were included over a 11-year period. Patients receiving prasugrel were more likely to be male, younger (mean age 62.3+8.7 years), obese and present with STEMI than those receiving either ticagrelor or clopidogrel (all p&lt;0.001). At 2 years the primary end point occurred in 120 of the 2968 patients (2.8 per 1000pyr) in the ticagrelor group, 446 of 9280 (2.7 per 1000pyr) patients in the clopidogrel group and 21 of 692 (1.8 per 1000pyr) prasugrel group (p=0.03). Major bleeding was observed in 0.2% in the ticagrelor group, 0.4% clopidogrel group and 0.1% in the prasugrel group (p=0.21). Conclusion For the first time we have shown in a large cohort of patients treated by PCI for ACS or CAD significantly lower 2-year rates of death, myocardial infarction and stroke amongst patients who received prasugrel than among those who received either clopidogrel or ticagrelor. The incidence of major bleeding did not differ between antiplatelet therapies. Funding Acknowledgement Type of funding source: None

scholarly journals Assessment of quality of care of patients with ST-segment elevation myocardial infarction

2019 ◽  
Vol 9 (8) ◽  
pp. 893-901
Author(s):  
Bartosz Hudzik ◽  
Andrzej Budaj ◽  
Marek Gierlotka ◽  
Adam Witkowski ◽  
Wojciech Wojakowski ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Quality Indicators ◽  
Acute Coronary Syndromes ◽  
Coronary Intervention ◽  
St Elevation Myocardial Infarction ◽  
Percutaneous Coronary ◽  
Patient Reported ◽  
Coronary Syndromes ◽  
St Elevation

Aims: The 2017 European Society of Cardiology guidelines for the management of ST-elevation myocardial infarction recommended assessing quality of care to establish measurable quality indicators in order to ensure that every ST-elevation myocardial infarction patient receives the best possible care. We investigated the quality indicators of healthcare services in Poland provided to ST-elevation myocardial infarction patients. Methods and results: The Polish Registry of Acute Coronary Syndromes is a nationwide, multicentre, prospective study of acute coronary syndrome patients in Poland. For the purpose of assessing quality indicators, we included 8279 patients from the Polish Registry of Acute Coronary Syndromes hospitalised with ST-elevation myocardial infarction in 2018. Four hundred and eight of 8279 patients (4.9%) arrived at percutaneous coronary intervention centre by self-transport, 4791 (57.9%) arrived at percutaneous coronary intervention centre by direct emergency medical system transport, and 2900 (37.2%) were transferred from non-percutaneous coronary intervention facilities. Whilst 95.1% of ST-elevation myocardial infarction patients arriving in the first 12 h received reperfusion therapy, the rates of timely reperfusion were much lower (ranging from 39.4% to 55.0% for various ST-elevation myocardial infarction pathways). The median left ventricular ejection fraction was 46% and was assessed before discharge in 86.0% of patients. Four hundred and eighty-nine of 8279 patients (5.9%) died during hospital stay. Optimal medical therapy is prescribed in 50–85% of patients depending on various clinical settings. Only one in two ST-elevation myocardial infarction patients is enrolled in a cardiac rehabilitation program at discharge. No patient-reported outcomes were recorded in the Polish Registry of Acute Coronary Syndromes. Conclusions: The results of this study identified areas of healthcare system that require solid improvement. These include direct transport to percutaneous coronary intervention centre, timely reperfusion, guidelines-based medical therapy (in particular in patients with heart failure), referral to cardiac rehabilitation/secondary prevention programs. Also, there is a need for recording quality indicators associated with patient-reported outcomes.

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