scholarly journals Antithrombotics in Complex Percutaneous Coronary Interventions: Type and Duration of Treatment

2021 ◽  
Vol 15 ◽  
Author(s):  
Despoina-Rafailia Benetou ◽  
Charalampos Varlamos ◽  
Christos Pappas ◽  
Fotios Kolokathis ◽  
Dimitrios Alexopoulos
Keyword(s):  
Antiplatelet Agents ◽  
Coronary Intervention ◽  
Prolonged Treatment ◽  
Current Evidence ◽  
Bleeding Complications ◽  
Duration Of Treatment ◽  
Beneficial Effects ◽  
Increased Risk ◽  
Percutaneous Coronary ◽  
Ischemic Events

Patients undergoing complex percutaneous coronary intervention (PCI) are at an increased risk of atherothrombotic complications. Although dual antiplatelet therapy is the mainstay of treatment for patients undergoing PCI with stent implantation, deciding its type and duration in complex PCI patients has long been considered a challenge for clinicians. This is because the beneficial effects of prolonged treatment and/or more potent antiplatelet agents’ use in preventing ischemic events are hindered by a concomitant increase in bleeding complications. The aim of this review is to highlight current evidence regarding the optimal antithrombotic therapy regimens used in complex PCI patients, focusing on the evaluation of both safety and efficacy outcomes as well as addressing future perspectives.

scholarly journals Association Between Smoking Status and Outcomes in ST-Segment Elevation and Non-ST-Segment Elevation Myocardial Infarction Patients Undergoing Percutaneous Coronary Intervention

2021 ◽  
Author(s):  
Ching-Hui Sia ◽  
Junsuk Ko ◽  
Huili Zheng ◽  
Andrew Ho ◽  
David Foo ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Clinical Outcomes ◽  
Smoking Status ◽  
Coronary Intervention ◽  
St Segment Elevation ◽  
Beneficial Effects ◽  
St Segment ◽  
Increased Risk ◽  
Percutaneous Coronary

Abstract Smoking is one of the leading risk factors for cardiovascular diseases, including ischemic heart disease and hypertension. However, in acute myocardial infarction (AMI) patients, smoking has been associated with better clinical outcomes, a phenomenon termed the “smoker’s paradox.” Given the known detrimental effects of smoking on the cardiovascular system, it has been proposed that the beneficial effects of smoking on outcomes is due to age differences between smokers and non-smokers and is therefore a smoker’s pseudoparadox. The aim of this study was to evaluate the association between smoking status and clinical outcomes in ST-segment elevation (STEMI) and non-STEMI (NSTEMI) patients treated by percutaneous coronary intervention (PCI), using a national multi-ethnic Asian registry. In unadjusted analyses, current smokers had better clinical outcomes following STEMI and NSTEMI. However, after adjusting for age, the protective effect of smoking was lost, confirming a smoker’s pseudoparadox. Interestingly, although current smokers had increased risk for recurrent MI within 1 year after PCI in both STEMI and NSTEMI patients, there was no increase in mortality. In summary, we confirm the existence of a smoker’s pseudoparadox in a multi-ethnic Asian cohort of STEMI and NSTEMI patients and report increased risk of recurrent MI, but not mortality, in smokers.

scholarly journals Percutaneous treatment of anomalous right coronary artery with malignant course. Report of three cases

2021 ◽  
pp. 1-7
Author(s):  
Maurício Prudente ◽  
Henrique Guimarães ◽  
Débora Rocha ◽  
Flavio Barbosa ◽  
Frederico Nacruth ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Right Coronary Artery ◽  
Surgical Intervention ◽  
Coronary Intervention ◽  
Percutaneous Treatment ◽  
Coronary Anomalies ◽  
Increased Risk ◽  
Percutaneous Coronary ◽  
The Right ◽  
Ischemic Events

Coronary anomalies are rare congenital malformations that are associated with an increased risk of arrhythmias, ischemic events and sudden death. Many remain asymptomatic throughout the patient’s life, and are diagnosed incidentally by imaging tests. The treatment is necessary when ischemia is confirmed or in the presence of symptoms, and surgical intervention is the method of choice. However, some studies allow percutaneous treatment to be used as an alternative, especially in anomalies of the right coronary artery. In view of this, the objective of this study was to report three cases of congenital malformation of the right coronary artery treated by percutaneous coronary intervention.

Abstract 13529: Percutaneous Coronary Intervention in Ambulatory Surgery Centers: Is It Safe?

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Kevin Li ◽  
Neil M Kalwani ◽  
Paul A Heidenreich ◽  
William F Fearon
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Ambulatory Surgery ◽  
Coronary Intervention ◽  
Bleeding Complications ◽  
Intravascular Imaging ◽  
Ambulatory Surgery Centers ◽  
Increased Risk ◽  
Percutaneous Coronary

Introduction: In January 2020, Medicare began reimbursing for percutaneous coronary intervention (PCI) performed in ambulatory surgery centers (ASCs), but little is known about characteristics and outcomes of patients who have undergone ASC PCI previously. Methods: Using commercial insurance claims from the MarketScan® Databases, we characterized patients 18 years or older who underwent hospital outpatient department (HOPD) or ASC PCI for stable ischemic heart disease between April 1, 2007, and December 1, 2016. We used propensity score matching of HOPD and ASC PCI cohorts to measure the association between treatment setting and 30-day outcomes (myocardial infarction, bleeding complications, and all-cause admission). Results: The unmatched sample consisted of 95,492 HOPD and 849 ASC PCI patients. Patients were more likely to undergo ASC PCI if they were younger than 65 (OR 1.72, 95% CI 1.43-2.06), lived in the southern U.S., or were covered by managed (OR 2.31, 95% CI 1.73-3.08) or consumer-driven (OR 2.57, 95% CI 1.73-3.82) compared to comprehensive health plans. ASC PCI was less likely in patients with a history of stroke (OR 0.45, 95% CI 0.28-0.72). Intravascular imaging and physiology testing were more frequently performed in HOPD than in ASC PCI (18.3% vs. 12.5%, respectively; p < 0.001). After propensity-score matching, ASC PCI was associated with increased odds of bleeding complications (OR 2.43, 95% CI 1.22-4.84, p = 0.011). Differences in other outcomes were not statistically significant. Conclusions: Patients undergoing outpatient elective PCI in ASCs were younger and more likely to live in the southern U.S or have managed or consumer-driven health insurance plans. Intravascular imaging and physiology testing were performed more frequently in HOPD than in ASC PCI. PCI in the ASC setting was also associated with an increased risk of bleeding complications. Further study of this population is warranted as ASC PCI volume increases under Medicare.

scholarly journals Aspirin-free antiplatelet regimens after PCI: insights from the GLOBAL LEADERS trial and beyond

2021 ◽  
Author(s):  
Rutao Wang ◽  
Sijing Wu ◽  
Amr Gamal ◽  
Chao Gao ◽  
Hironori Hara ◽  
...  
Keyword(s):  
Coronary Intervention ◽  
Primary Treatment ◽  
Clinical Settings ◽  
P2y12 Inhibitors ◽  
Increased Risk ◽  
Percutaneous Coronary ◽  
Clinical Benefits ◽  
Patient Groups ◽  
Artery Disease ◽  
Ischemic Events

Abstract Historically, aspirin has been the primary treatment for the prevention of ischemic events in patients with coronary artery disease. For patients undergoing percutaneous coronary intervention (PCI) standard treatment has been 12-months of dual anti-platelet therapy (DAPT) with aspirin and clopidogrel, followed by aspirin monotherapy; however, DAPT is undeniably associated with an increased risk of bleeding. For over a decade novel P2Y12 inhibitors, which have increased specificity, potency and efficacy have been available, prompting studies which have tested whether these newer agents can be used in aspirin-free anti-platelet regimens to augment clinical benefits in patients post-PCI. Among these studies, the GLOBAL LEADERS trial is the largest by cohort size, and so far has provided a wealth of evidence in a variety of clinical settings and patient groups. This article summarizes the state-of-the-art evidence obtained from the GLOBAL LEADERS and other trials of aspirin-free strategies.

scholarly journals Thrombosis and Coagulopathy in COVID-19: Current Understanding and Implications for Antithrombotic Treatment in Patients Treated With Percutaneous Coronary Intervention

2021 ◽  
Vol 7 ◽  
Author(s):  
Hangkuan Liu ◽  
Zhijia Wang ◽  
Haonan Sun ◽  
Tianming Teng ◽  
Yongle Li ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Antithrombotic Therapy ◽  
Dual Antiplatelet Therapy ◽  
Coronary Intervention ◽  
Multiple Organ ◽  
Bleeding Complications ◽  
Global Pandemic ◽  
Percutaneous Coronary ◽  
Ischemic Events ◽  
Activation Status

Coronavirus disease 2019 (COVID-19), a respiratory syndrome, is a global pandemic. Therefore, there is an urgent need to explore mechanisms implicated in the pathogenesis of the disease. Clinical and autopsy studies show a complex chain of events preceding COVID-19-related death. The disease is characterized by endothelial dysfunction, platelet activation, thrombosis, coagulopathy, and multiple organ failure. Globally, millions of patients with coronary heart disease undergo percutaneous coronary intervention (PCI) each year. These patients undergo high-intensity antithrombotic therapy during hospitalization and dual antiplatelet therapy (DAPT) for at least 6 months post PCI. COVID-19 is characterized by changes in platelet counts. Treatment of ischemic events that occur during stent implantation is associated with bleeding complications in patients following PCI complicated by COVID-19. This review summarizes recent progress in activation status and levels of COVID-19-related platelet changes. These findings will provide information on the effectiveness of antithrombotic therapy for the management of platelet changes in COVID-19 patients.

Characterization of patients with bleeding complications who are at increased risk of death after percutaneous coronary intervention

2010 ◽  
Vol 25 (4) ◽  
pp. 294-298 ◽  
Author(s):  
Gjin Ndrepepa ◽  
Dritan Keta ◽  
Stefanie Schulz ◽  
Julinda Mehilli ◽  
Anette Birkmeier ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Bleeding Complications ◽  
Risk Of Death ◽  
Increased Risk ◽  
Percutaneous Coronary

scholarly journals Prognosis of Atrial Fibrillation Patients Undergoing PCI According to Anticoagulants and Antiplatelet Agents

2021 ◽  
Vol 10 (15) ◽  
pp. 3370
Author(s):  
Gwang-Seok Yoon ◽  
Sun-Hwa Kim ◽  
Si-Hyuck Kang ◽  
Chang-Hwan Yoon ◽  
Young-Seok Cho ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Antiplatelet Therapy ◽  
Antiplatelet Agents ◽  
Coronary Intervention ◽  
Bleeding Complications ◽  
Cardiac Events ◽  
Safety Outcome ◽  
Adverse Cardiac Events ◽  
Percutaneous Coronary ◽  
Korean National Health Insurance

There are limited data evaluating conformation of antithrombotic therapy usage to the guideline recommendations. We investigated clinical trends and prognoses of patients with atrial fibrillation (AF) according to anticoagulants and antiplatelet agents beyond 1 year after percutaneous coronary intervention (PCI). We analyzed the records of patients with AF who underwent PCI using the Korean National Health Insurance Service database. The primary endpoint was a composite of major adverse cardiac events (MACE). The safety outcome was bleeding complications. Of 4193 participants, 81.6% received antiplatelet therapy, whereas 27.3% had oral anticoagulant (OAC)-based therapy at 18 months after PCI. The dominant therapy was dual antiplatelet therapy (37.2%), and only 3.3% of participants had OAC monotherapy. At the 1-year follow-up, the incidence of MACE was significantly lower among those receiving a combination of OAC and single antiplatelet therapy (SAPT) than among those receiving OAC monotherapy (4.78% vs. 9.42%, p = 0.017). Bleeding complication events (5.01% vs. 5.80%, p = 0.587) did not differ between the groups. In clinical practice, most patients with AF who underwent PCI continued to receive antiplatelet agents beyond 1-year post-PCI. OAC with SAPT seemed to be more effective than OAC monotherapy, without a difference in safety.

scholarly journals Pharmacodynamic Effects of a 6-Hour Regimen of Enoxaparin in Patients Undergoing Primary Percutaneous Coronary Intervention (PENNY PCI Study)

2018 ◽  
Vol 118 (07) ◽  
pp. 1250-1256 ◽  
Author(s):  
Wael Sumaya ◽  
William Parker ◽  
Rebekah Fretwell ◽  
Ian Hall ◽  
David Barmby ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Stent Thrombosis ◽  
Primary Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Bleeding Complications ◽  
Pharmacodynamic Effects ◽  
Delayed Onset ◽  
Increased Risk ◽  
Percutaneous Coronary ◽  
Acute Stent Thrombosis

AbstractDelayed onset of action of oral P2Y12 inhibitors in ST-elevation myocardial infarction (STEMI) patients may increase the risk of acute stent thrombosis. Available parenteral anti-thrombotic strategies, to deal with this issue, are limited by added cost and increased risk of bleeding. We investigated the pharmacodynamic effects of a novel regimen of enoxaparin in STEMI patients undergoing primary percutaneous coronary intervention (PPCI). Twenty patients were recruited to receive 0.75 mg/kg bolus of enoxaparin (pre-PPCI) followed by infusion of enoxaparin 0.75 mg/kg/6 h. At four time points (pre-anti-coagulation, end of PPCI, 2–3 hours into infusion and at the end of infusion), anti-Xa levels were determined using chromogenic assays, fibrin clots were assessed by turbidimetric analysis and platelet P2Y12 inhibition was determined by VerifyNow P2Y12 assay. Clinical outcomes were determined 14 hours after enoxaparin initiation. Nineteen of 20 patients completed the enoxaparin regimen; one patient, who developed no-reflow phenomenon, was switched to tirofiban after the enoxaparin bolus. All received ticagrelor 180 mg before angiography. Mean (± standard error of the mean) anti-Xa levels were sustained during enoxaparin infusion (1.17 ± 0.06 IU/mL at the end of PPCI and 1.003 ± 0.06 IU/mL at 6 hours), resulting in prolonged fibrin clot lag time and increased lysis potential. Onset of platelet P2Y12 inhibition was delayed in opiate-treated patients. No patients had thrombotic or bleeding complications. In conclusion, enoxaparin 0.75 mg/kg bolus followed by 0.75 mg/kg/6 h provides sustained anti-Xa levels in PPCI patients. This may protect from acute stent thrombosis in opiate-treated PPCI patients who frequently have delayed onset of oral P2Y12 inhibition.

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