Abstract 294: Microrna-208a: A Marker of No-Reflow in STEMI Patients Undergoing Primary Percutaneuos Coronary Intervention

2020 ◽  
Vol 127 (Suppl_1) ◽  
Author(s):  
Abou Bakr M Salama ◽  
Wael A Khalil ◽  
MAnar M Al-Zaky ◽  
Somia H Abdallah ◽  
Nader T Kandil ◽  
...  
Keyword(s):  
Clinical Application ◽  
Troponin T ◽  
Quantitative Polymerase Chain Reaction ◽  
Coronary Intervention ◽  
Cardiac Biomarkers ◽  
Cardiac Events ◽  
University Hospitals ◽  
No Reflow ◽  
Creatine Kinase Mb ◽  
Area Difference

Background: Biomarkers are the corner stone for diagnosis of myocardial infarction (MI). MicroRNA-208a (miR-208a) is known to be heart specific. So, this study was designed to explore its role as a marker for diagnosis of MI as well as a predictor of outcome of primary percutaneuos coronary angiography especially no-reflow phenomenon. Methods: This study was carried out between January 2018 and August 2019 in Cardiology Department, Zagazig University Hospitals, Egypt. Approval was obtained from institutional review board adhering to the guidelines of the Declaration of Helsinki. Patients (n=75) presented by chest pain were recruited into two groups. Group 1 (n=40) had STEMI and underwent primary PCI: 21 patients with sufficient reperfusion and 19 with no-reflow. Group 2 (n= 35) had negative troponin T (cTnT). Plasma miR-208a expression was assessed using quantitative polymerase chain reaction and patients were followed for occurrence of in-hospital (3 days average) major adverse cardiac events (MACE). Results: Analysis of relative expression values shows that miR-208a has reasonable sensitivity and specificity for MI diagnosis (AUC= 0.92, sensitivity = 92.5, Specificity = 80) which is comparable to the routine cardiac biomarkers; creatine kinase-MB (CK-MB) (area difference 0.0439, P= 0.235) and cTnT (area difference 0.0614, P= 0.06). The no-reflow group (b) had higher expression compared to subgroup (a). ROC analysis shows it to be a good predictor of no-reflow (AUC= 0.88, sensitivity = 73.7, Specificity = 95.2) which is significantly superior to cTnT (AUC difference of 0.231, P= 0.0233). As well, it was superior to cTnT as a predictor of in-hospital MACE (AUC difference of 0.367, P= 0.0053). Conclusion: This study highlights the value of miR-208a as a diagnostic and prognostic marker in STEMI context. To the best of our knowledge, this is the first study to investigate the value of miR-208a in no-reflow and almost the second to investigate the role of any known miRNA in no-reflow. Although still far from clinical application due to long time needed for the assay, the future introduction of new fast nucleic acids assays could support its clinical application. The study points to a possible mechanism for no-reflow development that needs to be thoroughly investigated.

Abstract 2832: Which Cardiac Marker is Most Useful to Predict Final Infarct Size and Cardiac Function Following Primary Percutaneous Coronary Intervention For Acute Myocardial Infarction?

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Stanley Chia ◽  
O. Christopher Raffel ◽  
Faisal Merchant ◽  
Frans J Wackers ◽  
Fred Senatore ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Infarct Size ◽  
Troponin I ◽  
Troponin T ◽  
Coronary Intervention ◽  
Left Ventricular ◽  
Cardiac Biomarkers ◽  
Primary Pci ◽  
Percutaneous Coronary

Background: Assessment of cardiac biomarker release has been traditionally used to estimate the size of myocardial damage after acute myocardial infarction (AMI). However, the significance of cardiac biomarkers in the setting of primary percutaneous coronary intervention (PCI) has not been systematically studied in a large patient cohort. We evaluated the usefulness of serial and single time-point measures of various cardiac biomarkers (creatine kinase (CK), CK-MB, troponin T and I) in predicting infarct size and left ventricular ejection fraction (LVEF) after primary PCI. Methods: EVOLVE (Evaluation of MCC-135 for Left Ventricular Salvage in AMI) was a randomized double-blind, placebo-controlled trial comparing the efficacy of intracellular calcium modulator as an adjunct to primary PCI in patients with first large AMI. Levels of cardiac biomarkers (CK, CK-MB mass, troponin T and I) were determined in 375 patients at baseline before PCI and 2, 4, 12, 24, 48 and 72 hours thereafter. Single photon emission computed tomography imaging was performed to measure infarct size and LVEF on day 5. Results: Area under curve and peak concentrations of all cardiac markers: CK, CK-MB mass, troponin T and troponin I were significantly correlated with myocardial infarct size and LVEF determined on day 5 (Spearman correlation, all P< 0.001; Table ). Troponin I, however provided the best predictor and a single measure at 72 hr was a strong indicator of both infarct size and LVEF. Using receiver operator characteristics curve, troponin I cutoff value of >55 pg/mL at 72 hr has 90% sensitivity and 70% specificity for detection of large infarct size≥10% ( c =0.88; P< 0.001). Conclusions: Plasma levels of CK, CK-MB, troponin T and troponin I remain useful predictors of infarct size and cardiac function in the era of primary PCI for AMI. A single measurement of circulating troponin I at 72 hours can provide an effective and convenient indicator of infarct size and LVEF in clinical practice. Correlation of cardiac biomarkers with Day 5 SPECT determined infarct size and LVEF

scholarly journals Clinical outcomes of nicorandil administration in patients with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention: a systematic review and meta-analysis of randomized controlled trials

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ning Geng ◽  
Li Ren ◽  
Lisheng Xu ◽  
Deling Zou ◽  
Wenyue Pang
Keyword(s):  
Primary Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Major Adverse Cardiac Events ◽  
Controlled Trials ◽  
Cardiac Events ◽  
St Segment Elevation ◽  
No Reflow ◽  
St Segment ◽  
Adverse Cardiac Events ◽  
No Reflow Phenomenon

Abstract Background Primary percutaneous coronary intervention is the treatment of choice in ST-segment elevation myocardial infarction and no-reflow phenomenon is still an unsolved problem. Methods We searched PubMed, EmBase, and Cochrane Central Register of Controlled Trials for relevant randomized controlled trials. The primary endpoint was the incidence of major adverse cardiac events and the secondary endpoint was the incidences of no-reflow phenomenon and complete resolution of ST-segment elevation. Results Eighteen randomized controlled trials were enrolled. Nicorandil significantly reduced the incidence of no-reflow phenomenon (OR, 0.46; 95% CI, 0.36–0.59; P < 0.001; I2 = 0%) and major adverse cardiac events (OR, 0.42; 95% CI, 0.27–0.64; P < 0.001; I2 = 52%). For every single outcome of major adverse cardiac events, only heart failure and ventricular arrhythmia were significantly improved with no heterogeneity (OR, 0.36; 95% CI, 0.23–0.57, P < 0.001; OR, 0.43; 95% CI, 0.31–0.60, P < 0.001 respectively). A combination of intracoronary and intravenous nicorandil administration significantly reduced the incidence of major adverse cardiac events with no heterogeneity (OR, 0.24; 95% CI, 0.13–0.43, P < 0.001; I2 = 0%), while a single intravenous administration could not (OR, 0.66; 95% CI, 0.40–1.06, P = 0.09; I2 = 52%). Conclusions Nicorandil can significantly improve no-reflow phenomenon and major adverse cardiac events in patients undergoing primary percutaneous coronary intervention. The beneficial effects on major adverse cardiac events might be driven by the improvements of heart failure and ventricular arrhythmia. A combination of intracoronary and intravenous administration might be an optimal usage of nicorandil.

scholarly journals LO03: Prospective comparative evaluation of the ESC 1-hour and a 2-hour rapid diagnostic algorithm for myocardial infarction using high-sensitivity troponin-T

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S7-S7
Author(s):  
J. Andruchow ◽  
T. Boyne ◽  
I. Seiden-Long ◽  
D. Wang ◽  
S. Vatanpour ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Cardiac Troponin ◽  
Comparative Evaluation ◽  
Troponin T ◽  
Diagnostic Algorithm ◽  
High Sensitivity ◽  
Coronary Intervention ◽  
Secondary Outcome ◽  
Cardiac Events ◽  
Diagnostic Algorithms

Introduction: Rapid diagnostic algorithms using high-sensitivity cardiac troponin can rapidly diagnose or exclude acute myocardial infarction (MI). However, multiple algorithms have been proposed and it is unclear if some outperform others. The objective of this study was to prospectively compare the diagnostic performance of 1- and 2-hour algorithms in clinical practice in a Canadian population. Methods: Emergency department patients with chest pain had high-sensitivity cardiac troponin-T (hs-cTnT) collected on presentation and 1- and 2-hours later at a single academic tertiary hospital and regional percutaneous coronary intervention site over a 2-year period. The primary outcome was index MI, the secondary outcome was 30-day major adverse cardiac events (MACE). All outcomes were 2 physician adjudicated. Results: We enrolled 1,167 patients with hs-cTnT collected on ED presentation. Of these, 350 had a valid 1-hour and 550 had a 2-hour hs-cTnT sample. Index MI prevalence was ~11%. Sensitivity of the 1- and 2-hour algorithms for index MI was 97.3% (95% CI 85.8-99.9%) and 100% (95% CI 91.6-100%) and for 30-day MACE was 80.9% (95% CI 66.7-90.9%) and 83.3% (95% CI 73.2-90.8%), respectively. The 1-hour algorithm was 96.3% specific for index MI (95% CI 93.8-98.2%) whereas specificity for the 2-hour algorithm was 97.9% (95% CI 96.3-100%). Both algorithms classified about one-quarter of patients in an indeterminate observational zone with an ~11% MI prevalence. Conclusion: Both the 1- and 2-hour algorithms were highly sensitive and specific for MI, but were less sensitive for 30-day MACE. However, the 2-hour algorithm trended toward better performance, likely because its larger delta cutoffs reduce the risk of misclassification owing to analytic variability. These findings suggest algorithms using larger delta cutoffs may provide a greater margin of safety. Further comparative evaluation of rapid diagnostic algorithms using different cutoffs and characterization of patients in the observational zone is warranted.

scholarly journals Release Kinetics of Cardiac Biomarkers in Patients Undergoing Transcoronary Ablation of Septal Hypertrophy

2012 ◽  
Vol 58 (6) ◽  
pp. 1049-1054 ◽  
Author(s):  
Christoph Liebetrau ◽  
Helge Möllmann ◽  
Holger Nef ◽  
Sebastian Szardien ◽  
Johannes Rixe ◽  
...  
Keyword(s):  
Cardiac Troponin ◽  
Troponin T ◽  
Release Kinetics ◽  
High Sensitivity ◽  
Cardiac Biomarkers ◽  
Fourth Generation ◽  
Cardiac Troponin T ◽  
Creatine Kinase Mb ◽  
Septal Hypertrophy ◽  
Kinetics Of

Abstract BACKGROUND The release kinetics of cardiac troponin T measured with conventional vs high-sensitivity cardiac troponin T (hs-cTnT) assays in patients with acute myocardial infarction (AMI) is difficult to establish. METHODS We analyzed the release kinetics of cTnT measured by fourth generation and high-sensitivity assays, creatine kinase-MB (CK-MB), and myoglobin in patients with hypertrophic obstructive cardiomyopathy undergoing transcoronary ablation of septal hypertrophy (TASH), a model of AMI. Consecutive patients (n = 21) undergoing TASH were included. Serum and EDTA-plasma samples were collected before and at 15, 30, 45, 60, 75, 90, and 105 min, and 2, 4, 8, and 24 h after TASH. RESULTS cTnT concentrations measured by the hs assay were significantly increased at 15 min [21.4 ng/L, interquartile range (IQR) 13.3–39.7 ng/L vs 11.3 ng/L, IQR 6.0–18.8 ng/L at baseline; P = 0.031]. In comparison, cTnT concentrations measured by the conventional fourth generation assay increased significantly at 60 min (30.0 ng/L, IQR 20.0–30.0 ng/L vs &lt;10.0 ng/L, IQR &lt;10.0–10.0 ng/L; P &lt; 0.01), CK-MB at 90 min (8.4 μg/L, IQR 6.9–14.4 μg/L vs 0.9 μg/L, IQR 0.4–1.1 μg/L; P &lt; 0.01), and myoglobin at 30 min (188.0 μg/L, IQR 154.0–233.0 μg/L vs 38.0 μg/L, IQR 28.0–56.0; P &lt; 0.01). CONCLUSIONS cTnT concentrations measured by the hs assay were significantly increased after TASH at all of the time points, with a doubling at 15 min after induction of AMI, confirming earlier evidence of myocardial injury compared to the fourth generation cTnT assay and CK-MB and myoglobin.

scholarly journals Automatizáltan mérhető biomarkerek az akut myocardialis infarctus diagnosztikájában

2015 ◽  
Vol 156 (24) ◽  
pp. 964-971
Author(s):  
Ferenc Kovács ◽  
Ibolya Kocsis ◽  
Marina Varga ◽  
Enikő Sárváry ◽  
György Bicsák
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Creatine Kinase ◽  
Troponin I ◽  
Troponin T ◽  
High Sensitivity ◽  
Cardiac Biomarkers ◽  
Fatty Acid Binding ◽  
High Sensitivity Troponin ◽  
Creatine Kinase Mb

Introduction: Cardiac biomarkers have a prominent role in the diagnosis of acute myocardial infarction. Aim: The aim of the authors was to study the diagnostic effectiveness of automated measurement of cardiac biomarkers. Method: Myeloperoxidase, high-sensitivity C-reactive protein, myoglobin, heart-type fatty acid binding protein, creatine kinase, creatine kinase MB, high-sensitivity troponin I and T were measured. Results: The high-sensitivity troponin I was the most effective (area under curve: 0.86; 95% confidence interval: 0.77–0.95; p<0.001) for the diagnosis of acute myocardial infarction. Considering a critical value of 0.35 ng/mL, its sensitivity and specificity were 81%, and 74%, respectively. Combined evaluation of the high-sensitivity troponin T and I, chest pain, and the electrocardiogram gave the best results for separation of acute myocardial infarction from other diseases (correct classification in 62.5% and 98.9% of patients, respectively). Conclusions: Until a more sensitive and specific cardiac biomarker becomes available, the best method for the diagnosis of acute myocardial infarction is to evaluate electrocardiogram and biomarker concentration and to repeat them after 3–6 hours. Orv. Hetil., 2015, 156(24), 964–971.

scholarly journals Cardiac biomarkers in premature calves with respiratory distress syndrome

2016 ◽  
Vol 64 (1) ◽  
pp. 38-46 ◽  
Author(s):  
Ugur Aydogdu ◽  
Ramazan Yildiz ◽  
Hasan Guzelbektes ◽  
Alparslan Coskun ◽  
Ismail Sen
Keyword(s):  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Troponin I ◽  
Troponin T ◽  
Venous Blood ◽  
Gas Analysis ◽  
Cardiac Biomarkers ◽  
Control Group ◽  
Creatine Kinase Mb

The aim of this study was to determine the clinical relevance of cardiac biomarkers [troponin I and T, creatine kinase-MB fraction (CK-MB) and lactate dehydrogenase (LDH)] in premature calves with respiratory distress syndrome. Seventy premature calves were admitted to the clinic within 24 h after birth. Respiratory distress syndrome was diagnosed in premature calves by clinical examination and venous blood gas analysis. Ten healthy calves, aged 5 days, were used as control. Cardiac troponin I and T were analysed using ELISA and ELFA, respectively. Serum CK-MB and LDH were also analysed in an automatic analyser. The calves had low venous pH, pO2, O2 saturation and high pCO2 values consistent with dyspnoea, hypoxaemia, and inadequate oxygen delivery. Mean serum troponin I, troponin T, CK-MB and LDH levels were increased in the premature calves compared to the control group. In conclusion, the results in this study demonstrated that serum CK-MB, troponin I and troponin T concentrations could be used for evaluating myocardial injury in premature calves with respiratory distress syndrome.

The ATRIA and Modified-ATRIA Scores in Evaluating the Risk of No-Reflow in Patients With STEMI Undergoing Primary Percutaneous Coronary Intervention

Angiology ◽  
2021 ◽  
pp. 000331972110264
Author(s):  
Ozge Ozcan Abacioglu ◽  
Arafat Yildirim ◽  
Nermin Yildiz Koyunsever ◽  
Salih Kilic
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Atrial Fibrillation ◽  
Percutaneous Coronary Intervention ◽  
Primary Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Coronary Syndrome ◽  
No Reflow ◽  
Percutaneous Coronary ◽  
Creatine Kinase Mb

The no-reflow (NR) phenomenon is frequently encountered in acute coronary syndrome. We evaluated the association between anticoagulation and risk factors in atrial fibrillation (ATRIA) and modified ATRIA risk scores and NR in ST-elevation myocardial infarction (STEMI). Consecutive patients (n = 551) who underwent primary percutaneous coronary intervention between December 2019 and June 2020 due to STEMI were included. The mean age of the patients was 60.5 ± 10.8 years (n = 369, 67% male). The ATRIA and modified anticoagulation and risk factors in atrial fibrillation-hyperlipidemia, smoking, male (m-ATRIA-HS) scores were calculated. The NR group had higher frequency of diabetes mellitus (DM), serum creatine kinase-MB (CK-MB) levels, and corrected thrombolysis in myocardial infarction frame count (cTFC) ( P = .002, P = .006, and P < .001, respectively). In regression analysis, ATRIA, m-ATRIA-HS, thrombus grade, and cTFC were independent predictors of NR. Age, higher CK-MB, and neutrophil-to-lymphocyte ratio and DM were the other predictors for NR. Pairwise comparison of receiver operating characteristics curve analysis showed that the m-ATRIA-HS (>2, area under curve [AUC]: 0.715) has better performance than ATRIA score (>1, AUC: 0.656), with a P < .022 and z statistics 2.279. In conclusion, ATRIA, especially the m-ATRIA-HS, can be used to evaluate NR risk in STEMI.

scholarly journals The Importance of Magnesium Values in Patients With STEMI Admitted to the Emergency Department

2016 ◽  
Vol 23 (4) ◽  
pp. 329-335 ◽  
Author(s):  
Melih Yuksel ◽  
Turgay Isik ◽  
Ibrahim Halil Tanboga ◽  
Erkan Ayhan ◽  
Mehmet Emre Erimsah ◽  
...  
Keyword(s):  
Independent Predictor ◽  
Characteristic Curve ◽  
Coronary Intervention ◽  
Cardiac Events ◽  
St Segment Elevation ◽  
No Reflow ◽  
St Segment ◽  
Hs Crp ◽  
Long Term Mortality

Aim: The aim of this study is to examine the relationship between initial magnesium (Mg) levels, electrocardiographic no-reflow, and long-term mortality in patients who underwent primary percutaneous coronary intervention (pPCI) due to ST-segment elevation myocardial infarction (STEMI). Methods: A total of 111 patients with pPCI participated in the study. Magnesium and high-sensitive C-reactive protein (hs-CRP) were measured. The sum of ST-segment elevation was measured immediately before and 60 minutes after the restoration of coronary flow. The difference between the 2 measurements was taken as the amount of ST-segment resolution and defined as sum of ST-segment resolution (∑STR). The ∑STR <50% was determined as electrocardiographic sign of no-reflow phenomenon. After the patients were discharged, they were followed up for major adverse cardiac events for up to 51 months after discharge. Results: Forty patients in the no-reflow group and 71 patients in the normal-flow group were included in the study. Magnesium value ≤1.87 mg/dL initially measured had 77% sensitivity and 59% specificity in predicting no-reflow on receiver operating characteristic curve analysis. In multivariate analyses, Mg (odds ratio [OR]: 0.01, <95% confidence interval [CI]: 0.01-0.12; P = .004), hs-CRP (OR: 1.06, <95% CI: 1.00-1.14; P = .05), left anterior descending artery lesion (OR: 6.66, <95% CI: 1.45-3.05; P = .01), and reperfusion time (OR: 1.01, <95% CI: 1.00-1.01; P = .03) were still independent predictors of electrocardiographic no-reflow, and only Mg (OR: 0.08, <95% CI: 0.01-1.03; P = .05) was still an independent predictor of long-term mortality. Conclusion: Serum Mg level is an independent predictor of electrocardiographic no-reflow and long-term mortality in patients with STEMI.

scholarly journals Clinical Outcomes of Nicorandil Administration In Patients With Acute ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention: A Systematic Review And Meta-Analysis of Randomized Controlled Trials

2021 ◽  
Author(s):  
Ning Geng ◽  
Li Ren ◽  
Lisheng Xu ◽  
Deling Zou ◽  
Wenyue Pang
Keyword(s):  
Primary Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Major Adverse Cardiac Events ◽  
Controlled Trials ◽  
Cardiac Events ◽  
St Segment Elevation ◽  
No Reflow ◽  
St Segment ◽  
Adverse Cardiac Events ◽  
No Reflow Phenomenon

Abstract Background: Primary percutaneous coronary intervention is the treatment of choice in ST-segment elevation myocardial infarction and no-reflow phenomenon is still an unsolved problem.Methods: We searched PubMed, EmBase, and Cochrane Central Register of Controlled Trials for relevant randomized controlled trials. The primary endpoint was the incidence of major adverse cardiac events and the secondary endpoint was the incidences of no-reflow phenomenon and complete resolution of ST-segment elevation. Results: Eighteen randomized controlled trials were enrolled. Nicorandil significantly reduced the incidence of no-reflow phenomenon (OR, 0.46; 95% CI, 0.36 to 0.59; P＜0.001; I2=0%) and major adverse cardiac events (OR, 0.42; 95% CI, 0.27 to 0.64; P＜0.001; I2=52%). For every single outcome of major adverse cardiac events, only heart failure and ventricular arrhythmia were significantly improved with no heterogeneity (OR, 0.36; 95% CI, 0.23 to 0.57, P＜0.001; OR, 0.43; 95% CI, 0.31 to 0.60, P＜0.001 respectively). A combination of intracoronary and intravenous nicorandil administration significantly reduced the incidence of major adverse cardiac events with no heterogeneity (OR, 0.24; 95% CI, 0.13 to 0.43, p＜0.001), while a single intravenous administration could not (OR, 0.66; 95% CI, 0.40 to 1.06, p=0.09; I2=52%). Conclusions: Nicorandil can significantly improve no-reflow phenomenon and major adverse cardiac events in patients undergoing primary percutaneous coronary intervention. The beneficial effects on major adverse cardiac events might be driven by the improvements of heart failure and ventricular arrhythmia. A combination of intracoronary and intravenous administration might be an optimal usage of nicorandil.

Antithrombotic treatment in patients with atrial fibrillation and acute coronary syndromes: results of the European Heart Rhythm Association survey

EP Europace ◽  
2019 ◽  
Vol 21 (7) ◽  
pp. 1116-1125 ◽  
Author(s):  
Deirdre A Lane ◽  
Nikolaos Dagres ◽  
Gheorghe-Andrei Dan ◽  
Javier García Seara ◽  
Konstantinos Iliodromitis ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Vitamin K ◽  
Heart Rhythm ◽  
Dual Therapy ◽  
Coronary Intervention ◽  
Vitamin K Antagonist ◽  
Cardiac Events ◽  
University Hospitals ◽  
Antithrombotic Treatment ◽  
Coronary Syndrome

Abstract The management of an acute coronary syndrome (ACS) in a patient with existing atrial fibrillation (AF) often presents a management dilemma both in the acute phase and post-ACS, since the majority of AF patients will already be receiving oral anticoagulation (OAC) for stroke prevention and will require further antithrombotic treatment to reduce the risk of in-stent thrombosis or recurrent cardiac events. Current practice recommendations are based largely on consensus option as there is limited evidence from randomized controlled trials. Prior to the launch of the new European Heart Rhythm Association (EHRA) consensus document, a survey was undertaken to examine current clinical management of these patients across centres in Europe. Forty-seven centres submitted valid responses, with the majority (70.2%) being university hospitals. This EHRA survey demonstrated overall the management of ACS in AF patients is consistent with the available guidance. Most centres would use triple therapy for a short duration (4 weeks) and predominantly utilize a strategy of OAC (vitamin K antagonist, VKA or non-vitamin K antagonist oral anticoagulant, NOAC) plus aspirin and clopidogrel, followed by dual therapy [(N)OAC plus clopidogrel] until 12 months post-percutaneous coronary intervention, followed by (N)OAC monotherapy indefinitely. Where NOAC was used in combination with antiplatelet(s), the lower dose of the respective NOAC was preferred, in accordance with current recommendations.

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