Colchicine Use in Acute Coronary Syndromes: An Update

Angiology ◽  
2021 ◽  
pp. 000331972098564
Author(s):  
Laura Tapoi ◽  
Laura Benchea ◽  
Dimitrie Siriopol ◽  
Mehmet Kanbay ◽  
Adrian Covic
Keyword(s):  
Acute Coronary Syndromes ◽  
Coronary Intervention ◽  
Coronary Plaque ◽  
Present Moment ◽  
Cardiac Events ◽  
Adverse Cardiac Events ◽  
Acute Mi ◽  
Coronary Syndromes ◽  
Artery Disease ◽  
Atherosclerotic Process

Coronary artery disease is the leading cause of death worldwide, and its main pathological substrate is represented by atherosclerosis. Inflammation is a major promoter of the atherosclerotic process and is involved in both the initiation and progression of atherosclerosis, as well as in the occurrence of fatal complications. Until the present moment, Colchicine Cardiovascular Outcomes Trial is the largest trial to demonstrate a major benefit of low-dose colchicine on major adverse cardiac events in patients with recent myocardial infarction (MI), but the mechanisms behind this relation are not completely known. The purpose of this review is to emphasize the possible pathways through which colchicine improves the clinical outcomes in the acute setting of acute coronary syndromes by referring to the results of the studies published in the past 5 years. Aside from its stated systemic anti-inflammatory effect, colchicine could be a valuable addition to the therapeutic approach of acute MI by reducing the infarct size, stabilizing the coronary plaque, as well as reducing platelet aggregation. Moreover, colchicine may improve endothelial function, reduce the transcoronary release of cytokines, and prevent a rise in inflammatory markers after percutaneous coronary intervention, thus diminishing the residual inflammatory risk.

scholarly journals The Clinical Short-term Outcome of Atorvastatin and Trimetazidine Combination Treatment in Patients with Non-ST Segment Elevation Acute Coronary Syndromes Undergoing Percutaneous Coronary Intervention

2016 ◽  
Vol 8 ◽  
Author(s):  
Jiangyou Wang ◽  
Han Chen ◽  
Dan Song ◽  
Jian Peng ◽  
Xi Su
Keyword(s):  
Cardiac Function ◽  
Acute Coronary Syndromes ◽  
Coronary Intervention ◽  
Cardiac Events ◽  
Short Term ◽  
St Segment Elevation ◽  
St Segment ◽  
Adverse Cardiac Events ◽  
Percutaneous Coronary ◽  
Coronary Syndromes

<p><strong>Background and Objectives: </strong>To investigate the effects of atorvastatin (ATV) and trimetazidine (TMZ) combination treatment in patients with non-ST segment elevation acute coronary syndromes (NSTE-ACS) undergoing percutaneous coronary intervention. <strong></strong></p><p><strong>Subjects and Methods: </strong>A total of 92 patients with NSTE-ACS were randomly divided into the pretreatment with ATV group (80mg 12h before PCI, with a further 20mg every day to 30th days after PCI, n=44) or the pretreatment with ATV (as the ATV group) and TMZ (60mg 30min before PCI, with a further 20mg tid to 30th days after PCI, n=48). Echocardiography was executed and plasma N-terminal pro brain natriuretic peptide (NT-pro-BNP) levels were measured just prior to the PCI and 30th days after PCI. The main end point was a 30-day incidence of major adverse cardiac events.</p><p><strong>Result: </strong>Major adverse cardiac events occurred in 9.1% of patients in the ATV group and 4.2% of those in the ATV+TMZ group (P=0.189). NT-pro-BNP of the two groups were decreased 30th days after PCI, however, NT-pro-BNP in the ATV+TMZ group were significantly lower than those in the ATV group (P&lt;0.05). Cardiac function in NSTE-ACS patients, as reflected by the increased LVEF, FS as well as decreased LVEDd (P&lt;0.05) in all groups at 30 days after intervention, but cardiac function parameters were more obviously improved in the group administered with ATV+TMZ (p&lt;0.05).</p><p><strong>Conclusion: </strong>Short-term pretreatment with the combination of ATV and TMZ administration prior to PCI can prominently decrease NT-pro-BNP and improve cardiac function compared to a single administration of the ATV. </p>

Prognostic Impact of Red Cell Distribution Width on the Development of Contrast Induced Nephropathy, Major Adverse Cardiac Events, and Mortality in Coronary Artery Disease Patients Undergoing Percutaneous Coronary Intervention.

2021 ◽  
Vol 17 ◽  
Author(s):  
Azka Latif ◽  
Muhammad Junaid Ahsan ◽  
Noman Lateef ◽  
Vikas Kapoor ◽  
Hafiz Muhammad Fazeel ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Coronary Intervention ◽  
Cardiac Events ◽  
Distribution Width ◽  
Adverse Cardiac Events ◽  
Percutaneous Coronary ◽  
All Cause Mortality ◽  
Artery Disease

: Red cell distribution width (RDW) serves as an independent predictor towards the prognosis of coronary artery disease (CAD) in patients undergoing percutaneous coronary intervention (PCI). A systematic search of databases such as PubMed, Embase, Web of Science, and Cochrane library was performed on October 10th, 2019 to elaborate the relationship between RDW and in hospital and long term follow up all-cause and cardiovascular mortality, major adverse cardiac events (MACE) and development of contrast-induced nephropathy (CIN) in patients with CAD undergoing PCI. Twenty-one studies qualified this strict selection criteria (number of patients = 56,425): one study was prospective, and the rest were retrospective cohorts. Our analysis showed that patients undergoing PCI with high RDW had a significantly higher risk of in-hospital all-cause mortality (OR 2.41), long-term all-cause mortality (OR 2.44), cardiac mortality (OR 2.65), MACE (OR: 2.16) and odds of developing CIN (OR: 1.42) when compared to the patients with low RDW. Therefore, incorporating RDW in the predictive models for the development of CIN, MACE, and mortality can help in triage to improve the outcomes in coronary artery disease patients who undergo PCI.

Association between the rs342293 polymorphism and adverse cardiac events in patients undergoing percutaneous coronary intervention

2014 ◽  
Vol 111 (06) ◽  
pp. 1060-1066 ◽  
Author(s):  
Iciar Arbesu ◽  
Bernd Jilma ◽  
Gerald Maurer ◽  
Irene M. Lang ◽  
Christine Mannhalter ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Adverse Events ◽  
Coronary Intervention ◽  
Cardiovascular Outcome ◽  
Cardiac Events ◽  
Adverse Cardiac Events ◽  
Percutaneous Coronary ◽  
Artery Disease ◽  
Cardiac Adverse Events

SummaryThe single nucleotide polymorphism (SNP) rs342293 has been shown to influence platelet number and mean platelet volume (MPV). We investigated the association between the rs342293 polymorphism and cardiovascular outcome in a prospective cohort study. The rs342293 polymorphism was analysed in 404 patients with coronary artery disease undergoing percutaneous coronary intervention. The rates of cardiac adverse events were recorded during two years of follow-up. The polymorphism was associated with MPV (median 10.1 fL, interquartile range [IQR]: 9.6 to 10.6 in patients with the CC-allele vs 10.4 fL, IQR: 9.9 to 11.1 in G>C SNP carriers; p<0.001), but not with platelet count. Survival analysis indicated that carriers of the rs342293 G variant had a substantially higher risk to develop cardiac adverse events compared with wild type carriers during two years of follow-up (33% vs 22%; adjusted hazard ratio = 1.63, 95% confidence interval = 1.06–2.52, p=0.027). The rs342293 SNP could explain 2.9% of the variability in MPV (p=0.01). In conclusion, patients undergoing coronary stenting who carry the G-variant of the rs342293 SNP which is associated with larger MPV are at higher risk for adverse cardiovascular outcome.

scholarly journals Practical considerations for cangrelor use in patients with acute coronary syndromes

2017 ◽  
Vol 8 (1) ◽  
pp. 39-44 ◽  
Author(s):  
Sergio Leonardi ◽  
Deepak L Bhatt
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Acute Coronary Syndromes ◽  
Development Program ◽  
Concomitant Administration ◽  
Coronary Intervention ◽  
Acute Setting ◽  
Percutaneous Coronary ◽  
Transition Strategies ◽  
Coronary Syndromes ◽  
Artery Disease

Cangrelor, the first and currently only available intravenous P2Y12 receptor antagonist, has been approved and is now being used in patients with coronary artery disease requiring percutaneous coronary intervention. The rationale for cangrelor use is most robust in patients requiring an immediate, profound, and predictable level of P2Y12 inhibition – especially in patients with acute coronary syndromes. Herein we summarize the drug development program and reflect on practical considerations for clinicians on cangrelor use in the acute setting surrounding percutaneous coronary intervention, including selection of patients, concomitant administration of glycoprotein IIb/IIIa inhibitors and transition strategies from intravenous to oral P2Y12 receptor antagonists.

scholarly journals Comparative Evaluation of Stainless Steel Stent (Sirolimus) and Cobalt Chromium Stent (Sirolimus) In Patient with Coronary Artery Disease

2016 ◽  
Vol 8 (04) ◽  
Author(s):  
J. Shah ◽  
J. Patel ◽  
S. Dani
Keyword(s):  
Coronary Artery Disease ◽  
Stainless Steel ◽  
Coronary Artery ◽  
Coronary Intervention ◽  
Cobalt Chromium ◽  
Cardiac Events ◽  
Target Vessel Revascularization ◽  
Adverse Cardiac Events ◽  
Cobalt Chromium Stent ◽  
Artery Disease

Coronary Artery Disease (CAD) occurs when the arteries of the heart that normally provide blood and oxygen to the heart are narrowed or even completely blocked due to clot formation. The Stenting implantation composes 84.2% of all Percutaneous coronary intervention (PCI). Despite the widespread use of these devices, bare metal stents (BMS) have been associated with a 20-30% restenosis rate which requires reintervention. In December 2006, US Food and Drug Administration cardiovascular experts concluded that for many patients, such as those with uncomplicated medical histories who undergo elective stenting of simple coronary blockages, drug-eluting stents remain a safe and appropriate therapy. Previously reports are suggestive of similar clinical outcomes for stainless steel and cobalt chromium bare metal stent. No reports are available for comparison of sirolimus eluting stainless steel stent and sirolimus eluting cobalt chromium stent. The present study was undertaken with the objective of comparative evaluation of Stainless Steel Stent (Sirolimus) and Cobalt Chromium Stent (Sirolimus) in Patient with Coronary Artery Disease. A single centric, retrospective, nonrandomized study involving 118 patients who have undergone PCI from January 2011 to March 2012 implanted with either Sirolimus Stainless Steel Stent (SSSS) or Sirolimus Cobalt Chromium Stents (SCCS) were included in the study. Primary objective was to determine and compare the clinical outcome and rates of target vessel revascularization (TVR) in patients undergoing primary PCI for CAD patients who were treated with Sirolimus cobalt-chromium stents and Sirolimus stainless steel stents. The secondary outcomes of study were Major Adverse Cardiac Events, mortality at the end of 1 month, 6 month and 1 year of outcomes. At 1 month follow up there was no significant difference between two groups (p = 0.96). The individual clinical component showed no difference in occurrence of death (p = 0.29), MI (p = 0.29) and TLR (p = 0.96) at end of 6 month. The cumulative clinical outcome at 1 year rate of target vessel revascularization TVR (SSSS 1.75% versus SCCS 0%, p = 0.29), target lesion revascularization (SSSS 5.27% versus SCCS 1.63%, p = 0.27), and Major Adverse Cardiac Events (SSSS 22.80% versus SCCS 13.11%, p = 0.16). This study showed that among Coronary artery disease (CAD) patients undergoing primary percutaneous coronary intervention, sirolimus stainless steel stent showed similar efficacy and safety to sirolimus cobalt chromium stent.

Relationship between platelet count and 30-day clinical outcomes after percutaneous coronary interventions

2007 ◽  
Vol 98 (10) ◽  
pp. 852-857 ◽  
Author(s):  
Gjin Ndrepepa ◽  
Julinda Mehilli ◽  
Olga Bruskina ◽  
Stefanie Schulz ◽  
Albert Schömig ◽  
...  
Keyword(s):  
Platelet Count ◽  
Coronary Intervention ◽  
Cardiac Events ◽  
Baseline Platelet Count ◽  
Lower Tertile ◽  
Adverse Cardiac Events ◽  
Percutaneous Coronary ◽  
Pre Treatment ◽  
Artery Disease ◽  
The Impact

SummaryPlatelets play an important role in the development of major adverse cardiac events (MACE) following percutaneous coronary intervention (PCI). The impact of platelet count on the outcome of patients undergoing PCI after pre-treatment with clopidogrel is unknown. The study included 5,256 patients enrolled in four randomized trials – ISAR-REACT, ISAR-SMART2, ISAR-SWEET, and ISAR-REACT2 – which assessed the value of abciximab in patients with coronary artery disease (CAD) undergoing PCI after pre-treatment with 600 mg of clopidogrel. Platelet count was measured at baseline before PCI. Primary endpoint was the 30-day incidence of MACE, secondary endpoint was mortality. The tertiles of platelet counts were: lower tertile (<198x109/L; n=1,726), middle tertile (198–244x109/L; n=1,750) and upper tertile (>244x109/L; n=1,780). The 30-day incidence of MACE was 6.7% (n=116) among patients of the lower tertile, 6.3% (n=111) among patients of the middle tertile, and 7.0% (n=124) among patients of the upper tertile (P=0.76). The 30-day mortality was 1.2% (n=22) among patients of the upper tertile, 0.5% (n=9) among patients of middle tertile and 0.6% (n=11) among patients of the lower tertile (P=0.04). Q-wave myocardial infarction occurred in 1.3% of patients (n=23) in the upper tertile, 0.7% of patients (n=13) in the middle tertile and 0.5% of patients (n=8) in the lower tertile (P=0.02). Platelet count was an independent correlate of 30-day mortality (hazard ratio 2.69, 95% confidence interval 1.08–6.67; P=0.033 for the third vs. the first tertile). In conclusion, in patients with CAD undergoing PCI after pre-treatment with 600 mg clopidogrel, baseline platelet count predicts 30-day mortality.

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