Abstract 291: Platelet Function Monitoring After Percutaneous Coronary Intervention: Updated Meta-analysis of Randomized Trials.

2017 ◽  
Vol 121 (suppl_1) ◽  
Author(s):  
Akintunde M Akinjero ◽  
Oluwole Adegbala ◽  
Esosa Edo-Osagie ◽  
Nike Akinjero ◽  
Tomi Akinyemiju
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Platelet Function ◽  
Meta Analysis ◽  
Coronary Intervention ◽  
Cardiovascular Death ◽  
Bleeding Complications ◽  
Major Adverse Cardiovascular Events ◽  
Future Research ◽  
Funnel Plot ◽  
Percutaneous Coronary

Background: The need to balance bleeding and clotting risks after percutaneous coronary intervention (PCI) has led to interest in platelet function monitoring as a strategy to improve post-PCI outcomes. The prognostic value of platelet function testing in monitoring response to antiplatelet therapy after PCI remains unclear. Prior studies have been inconclusive. We sought to conduct an updated meta-analysis to address this gap in knowledge. Methods: We conducted a systematic search of EMBASE, PUBMED and the Cochrane libraries for studies since inception to December 2016 on platelet function monitoring. Our search yielded 203 studies, out of which 83 were extracted for full-text review. Only 3 studies met inclusion criteria. We pooled odds ratios using random-effects statistics, Mantel-Haenszel method. I2 and Chi- squared statistic was used to evaluate for heterogeneity. Publication bias was assessed using the funnel plot. Primary outcome was major adverse cardiovascular events (MACE). This was defined in the studies as a composite of cardiovascular death, myocardial infarction, stroke, stent thrombosis, and bleeding complications. Results: The 3 randomized controlled trials that were analyzed involved 3701 patients. There were 550 MACE (29.76%) in the platelet function monitored group compared with 514 (27.74%) in the control. MACE (Figure 1) was not significantly higher for the platelet function monitored group during follow-up compared with control (pooled Odds Ratio:1.11 [95% CI: 0.96-1.28], p = 0.15). Tests for heterogeneity were not significant, with I2 of 0%, Chi2 = 1.52 (p = 0.47); and small study bias was absent on visual inspection of the funnel plot. Conclusions: Platelet function monitoring continues to be used in practice. Results from this meta-analysis show no benefit of platelet function monitoring compared with conventional strategy with regards to MACE after PCI. Future research is needed to further evaluate this finding.

Trends of Use and Outcomes Associated With Glycoprotein-IIb/IIIa Inhibitors in Patients With Acute Coronary Syndromes Undergoing Percutaneous Coronary Intervention

2019 ◽  
Vol 54 (5) ◽  
pp. 414-422 ◽  
Author(s):  
Rochelle M. Gellatly ◽  
Cia Connell ◽  
Christianne Tan ◽  
Nick Andrianopoulos ◽  
Andrew E. Ajani ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Acute Coronary Syndromes ◽  
Coronary Intervention ◽  
Bleeding Complications ◽  
Major Adverse Cardiovascular Events ◽  
P2y12 Inhibitors ◽  
Percutaneous Coronary ◽  
Safety Endpoint ◽  
Coronary Syndromes ◽  
Practice Methods

Background: Glycoprotein IIb/IIIa inhibitors (GPIs) are a treatment option in the management of acute coronary syndromes (ACSs). Evidence supporting the use of GPIs predates trials establishing the benefits of P2Y12 inhibitors, routine early invasive therapy, and thrombectomy devices in patients with ACS. Objective: The aim of this study was to determine trends in GPI use and their associated outcomes in contemporary practice. Methods: We assessed GPI use in patients with ACS undergoing percutaneous coronary intervention (PCI) from the Melbourne Interventional Group registry (2005-2013). The primary endpoint was the 30-day incidence of major adverse cardiovascular events (MACE). The safety endpoint was in-hospital major bleeding. Results: GPIs were used in 40.5% of 12 357 patients with ACS undergoing PCI. GPI use decreased over the study period ( P for trend <0.0001). Patients were more likely to receive GPIs if they were younger, presented with a ST-elevation myocardial infarction (STEMI), had more complex (B2/C-type) lesions, and when thrombectomy devices were used (all P < 0.0001). MACE were higher in patients receiving GPI (4.9% vs 4.1%, P = 0.03). Propensity score matching revealed no difference in 30-day mortality and 30-day MACE (odds ratio [OR] = 1.00; 95% CI = 0.99-1.004 and OR = 1.01; 95% CI = 0.99-1.02, respectively). GPI use was associated with more bleeding complications (3.6% vs 1.8%, P < 0.0001). Conclusion and Relevance: GPI use in ACS patients undergoing PCI has declined, and use appears to be dictated by ACS type and lesion complexity, as opposed to high-risk comorbidities. GPI use was associated with a doubling in bleeding complications.

Impact of clopidogrel and potent P2Y12-inhibitors on mortality and stroke in patients with acute coronary syndrome or undergoing percutaneous coronary intervention

2013 ◽  
Vol 109 (01) ◽  
pp. 93-101 ◽  
Author(s):  
András Komócsi ◽  
András Vorobcsuk ◽  
Victor L. Serebruany ◽  
Dániel Aradi
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Meta Analysis ◽  
Coronary Intervention ◽  
Cardiovascular Death ◽  
P2y12 Receptor ◽  
P2y12 Inhibitors ◽  
Coronary Syndrome ◽  
Receptor Inhibition ◽  
Percutaneous Coronary ◽  
P2y12 Receptor Antagonist

SummaryAdministration of a P2Y12-receptor antagonist in addition to aspirin is mandatory in patients with acute coronary syndromes (ACS) or undergoing percutaneous coronary intervention (PCI) to reduce the occurrence of thrombotic events; however, their impact on mortality and stroke is unclear. We aimed to evaluate the influence of moderate (clopidogrel) or potent (prasugrel/ticagrelor) P2Y12-receptor inhibition on major cardiovascular outcomes among patients with ACS or undergoing PCI. Systematic literature search was performed to find randomised, controlled clinical trials comparing the clinical impact of clopidogrel with placebo or prasugrel/ticagrelor versus clopidogrel. Outcome measures included cardiovascular death, myocardial infarction (MI), total stroke and intracranial haemorrhage (ICH). Random-effects model with Mantel-Heanszel weighting was used to pool outcomes into a meta-analysis. Four studies comparing clopidogrel with placebo and five trials comparing clopidogrel with new P2Y12-receptor inhibitors were identified including a total of 107,473 patients. Compared to placebo, clopidogrel reduced the risk of cardiovascular death (odds ratio [OR]: 0.93; 95% confidence interval [CI]: 0.87–0.99, p=0.02), MI (OR 0.80; 95%CI 0.74–0.88, p<0.00001) and stroke (OR 0.84; 95%CI 0.72–0.97, p=0.02), without influencing risk for ICH (OR 0.96;& 95%CI 0.69–1.33, p=0.79). Treatment with prasugrel/ticagrelor provided additional benefit over clopidogrel regarding cardiovascular mortality (OR 0.86; 95%CI 0.78–0.94, p=0.002) and MI (OR: 0.83; 95%CI 0.74–0.93, p<0.001), but no advantage in stroke (OR: 1.06; 95%CI 0.88–1.26, p=0.55) and in ICH (OR: 1.16; 95%CI 0.75–1.81; p=0.49) was observed. Increased potency of P2Y12-receptor inhibition is associated with decreased risk in cardiovascular death and MI; however, this association is not true in case of stroke, where potent P2Y12-receptor antagonists have no incremental benefit over clopidogrel.

Switching to Clopidogrel in Patients With Acute Coronary Syndrome Managed With Percutaneous Coronary Intervention Initially Treated With Prasugrel or Ticagrelor: Systematic Review and Meta-analysis

2019 ◽  
Vol 53 (10) ◽  
pp. 997-1004 ◽  
Author(s):  
Jenny Hong ◽  
Ricky D. Turgeon ◽  
Glen J. Pearson
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Acute Coronary Syndrome ◽  
Major Bleeding ◽  
Meta Analysis ◽  
Coronary Intervention ◽  
Secondary Outcome ◽  
Major Adverse Cardiovascular Events ◽  
Case Control Studies ◽  
Coronary Syndrome ◽  
Percutaneous Coronary

Objective: To evaluate the effects of switching from ticagrelor or prasugrel to clopidogrel in acute coronary syndrome (ACS) patients managed with percutaneous coronary intervention on major adverse cardiovascular events (MACEs) and bleeding. Data Sources: We searched MEDLINE, EMBASE, CENTRAL, bibliographies of relevant articles, and clinicaltrials.gov for eligible articles published from inception to January 27, 2019. Study Selection and Data Extraction: We included randomized controlled trials (RCTs) and cohort and case-control studies that reported on ≥1 outcome of interest. Primary outcomes were MACE and major bleeding, and the secondary outcome was any bleeding. Data Synthesis: From 483 articles, we included 7 relevant studies (2 RCTs, 5 cohort studies) at high/unclear risk of bias. Random-effects meta-analysis revealed inconclusive effects on MACE (hazard ratio [HR] = 1.00, 95% CI = 0.59-1.68; I2 = 82%), major bleeding (HR = 0.51; 0.19-1.35; I2 = 91%), and any bleeding (HR = 0.64; 0.38-1.07; I2 = 85%). Similar nonsignificant results were obtained in secondary analyses evaluating risk ratios. Relevance to Patient Care and Clinical Practice: Ticagrelor and prasugrel, are now considered preferred therapy over clopidogrel in patients with ACS. Switching from these potent P2Y12 inhibitors to clopidogrel is commonly performed to reduce bleeding risk, other adverse effects, or costs. Current best-available evidence is inconclusive regarding the effects of switching to clopidogrel on the risk of MACE and bleeding. Overall, studies were underpowered to detect clinically important differences. Conclusions: Until adequately powered trials demonstrate an advantage to switching to clopidogrel from prasugrel or ticagrelor, clinicians may consider this approach as clinically indicated on an individual, case-by-case basis.

scholarly journals Frailty Predicts Poor Prognosis of Patients After Percutaneous Coronary Intervention: A Meta-Analysis of Cohort Studies

2021 ◽  
Vol 8 ◽  
Author(s):  
Peng Wang ◽  
Shutang Zhang ◽  
Ke Zhang ◽  
Jie Tian
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Cohort Studies ◽  
Cardiovascular Events ◽  
Poor Prognosis ◽  
Meta Analysis ◽  
Coronary Intervention ◽  
Sensitivity Analyses ◽  
Major Adverse Cardiovascular Events ◽  
Percutaneous Coronary ◽  
Subgroup Analyses

Background: Frailty has been related to a higher risk of cardiovascular events, while the association between frailty and outcomes for patients with coronary artery disease (CAD) after percutaneous coronary intervention (PCI) remains unclear. We performed a meta-analysis of cohort studies to evaluate the above association.Methods: Cohort studies aiming to determine the potential independent association between frailty and clinical outcomes after PCI were identified by search of PubMed, Embase, and Web of Science databases from inception to February 22, 2021. A random-effects model that incorporates the possible heterogeneity among the included studies was used to combine the results.Results: Ten cohort studies with 7,449,001 patients were included. Pooled results showed that frailty was independently associated with higher incidence of all-cause mortality [adjusted risk ratio (RR) = 2.94, 95% confidence intervals (CI): 1.90–4.56, I2 = 56%, P &lt; 0.001] and major adverse cardiovascular events [(MACEs), adjusted RR = 2.11, 95% CI: 1.32–3.66, I2 = 0%, P = 0.002]. Sensitivity analyses limited to studies including elderly patients showed consistent results (mortality: RR = 2.27, 95% CI: 1.51–3.41, I2 = 23%, P &lt; 0.001; MACEs: RR = 2.44, 95% CI: 1.44–4.31, I2 = 0%, P = 0.001). Subgroup analyses showed that characteristics of study design, follow-up duration, or type of PCI did not seem to significantly affect the associations (P-values for subgroup analyses all &gt;0.05).Conclusions: Frailty may be an independent risk factor of poor prognosis for patients with CAD after PCI.

scholarly journals 719 Prevalence and clinical impact of high platelet reactivity in patients with chronic kidney disease treated with percutaneous coronary intervention: an updated systematic review and meta-analysis

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Fabio Mangiacapra ◽  
Luca Paolucci ◽  
Michele Mattia Viscusi ◽  
Roberto Mangiacapra ◽  
Pietro Manuel Ferraro ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Percutaneous Coronary Intervention ◽  
Kidney Disease ◽  
Platelet Reactivity ◽  
Meta Analysis ◽  
Coronary Intervention ◽  
Cochrane Library ◽  
Major Adverse Cardiovascular Events ◽  
High Platelet Reactivity ◽  
Percutaneous Coronary

Abstract Aims High platelet reactivity (HPR) on clopidogrel and chronic kidney disease (CKD) are recognized as potent risk factors for adverse outcomes in patients suffering coronary artery disease (CAD) and undergoing percutaneous coronary intervention (PCI). However, conclusive evidence regarding their reciprocal interaction and the consequent impact on clinical events is still lacking. We performed a meta-analysis with the aim to evaluate the prevalence of HPR in patients with and without CKD and the incidence of major adverse cardiovascular events (MACE) according to the renal and platelet function status in current literature (co-primary endpoints). Secondary endpoints were myocardial infarction (MI), all cause death and definite/probable stent thrombosis (ST). Methods and results We searched on PubMed, EMBASE, and Cochrane Library studies investigating CKD and HPR on clopidogrel in patients suffering CAD who underwent PCI and their related outcomes. Overall, 13 studies including 22.464 patients were selected. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using random-effects model with the Mantel–Haenszel method. Patients with CKD presented significantly higher odds of HPR compared with those without CKD [OR: 1.51 (95% CI: 1.29–1.76)]. In patients without CKD, HPR was associated with increased odds of MACE [OR: 1.31 (95% CI: 1.01–1.72)], MI [OR: 1.48 (95% CI: 1.17–1.86)] and definite/probable ST [OR: 2.45 (95% CI: 1.08–5.60)]. In patients with CKD, HPR was associated with higher odds of both MACE [OR: 1.61 (95% CI: 1.14–2.27)] and MI [OR: 1.69 (95% CI: 1.11–2.59)], compared to those without HPR. Conclusions Our analysis shows that HPR on clopidogrel is more frequent in patients with CKD treated with PCI. Patients with HPR are exposed to a high risk of MACE after PCI, regardless of the renal function status.

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

PLoS ONE ◽  
2021 ◽  
Vol 16 (1) ◽  
pp. e0246029
Author(s):  
Jong-Shiuan Yeh ◽  
Chien-Yi Hsu ◽  
Chun-Yao Huang ◽  
Wan-Ting Chen ◽  
Yi-Chen Hsieh ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Cox Regression ◽  
Coronary Intervention ◽  
Bleeding Complications ◽  
Major Adverse Cardiovascular Events ◽  
Real World Data ◽  
Risk Of Death ◽  
Percutaneous Coronary

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). Patients who had received PCI during hospitalization for AMI (between 2013 and 2016) and were initially treated with aspirin and ticagrelor and without adverse events after 3 months of treatment were retrospectively evaluated. In total, 1,901 and 8,199 patients were identified as “de-escalated DAPT” (switched to aspirin and clopidogrel) and “unchanged 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 de-escalated cohort and 2.42, 3.28, and 4.72 in the unchanged cohort, respectively, based on an inverse probability of treatment weighted approach that adjusting for baseline characteristics of the patients. Multivariate Cox regression analyses showed the two groups had no significant differences in the hazard risk of death, AMI admission, and MACE. Additionally, there was no observed difference in the risk of bleeding, including major or clinically relevant non-major bleeding. The real-world data revealed that de-escalation of P2Y12 inhibitor in DAPT was not associated with a higher risk of death or AMI readmission in Taiwanese patients with AMI undergoing successful PCI.

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