scholarly journals Multifactorial Prognostication of the Development of Stent Thrombosis in Patients with Acute Coronary Syndrome after Percutaneous Coronary Intervention on the background of Dual Antiplatelet Therapy

Kardiologiia ◽  
2019 ◽  
Vol 59 (11) ◽  
pp. 5-13
Author(s):  
E. S. Korotaeva ◽  
L. Y. Koroleva ◽  
V. P. Nosov ◽  
G. V. Kovaleva ◽  
E. A. Kuzmenko
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Acute Coronary Syndrome ◽  
Logistic Regression ◽  
Secondary Prevention ◽  
Stent Thrombosis ◽  
Coronary Intervention ◽  
First Year ◽  
Coronary Syndrome ◽  
Percutaneous Coronary ◽  
Definite Stent Thrombosis

Aim: to identify predictors of stent thrombosis in patients with acute coronary syndrome (ACS) after percutaneous coronary intervention (PCI) for 12 months by creating a miathematical logistic regression model to optimize rehabilitation, secondary prevention of ischemic events in the first year after ACS, as well as a personalized approach to treatment. Materials and methods. The analysis used data from the hospital register, which contained information on all PCIs, performed in the Semashko hospital between September 2016 and August 2018 (2378 patients). For this study we selected a sample of 183 ACS patients (146 men and 37 women) after PCI: 25 with definite stent thrombosis confirmed by repeated coronary angiography (CAG) (the main study group), and 158 without developing definite stent thrombosis (the comparison group) according to the observation for 12 months. All patients during hospitalization and 1 year after discharge received standard medical therapy ACS, according to international recommendations. Laboratory tests, electrocardiography (ECG), echocardiography, 24-hour ECG monitoring were performed for in patients. For determining predictors of the development of stent thrombosis we performed a logistic regression analysis. Results. A mathematical model of multifactorial prognostication of stent thrombosis in patients with ACS after PCI was created. The model included the following predictors: Killip class >II; life-threatening paroxysmal tachyarrhythmias (atrial fibrillation and/or ventricular fibrillation) as ACS complication of; left ventricular ejection fraction ≤45%; CA dissection; CAG confirmed CA thrombosis before PCI. Conclusion. The proposed model in patients with ACS allows us to estimate the risk of stent thrombosis after PCI, as well as to improve the accuracy of the event prediction. The model is easy to use, can be applied by practicing cardiologists during hospitalization. This model allows us to personalize secondary prevention in the first year after ACS, and thus help to reduce cardiovascular mortality, incidence of recurrent myocardial infarctions, unstable angina, and emergency revascularization.

scholarly journals Primary percutaneous coronary intervention for acute coronary syndrome due to stent thrombosis

2013 ◽  
Vol 34 (suppl 1) ◽  
pp. P1264-P1264
Author(s):  
Z. Mehmedbegovic ◽  
A. Janicijevic ◽  
V. Dedovic ◽  
M. Zivkovic ◽  
D. Milasinovic ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Acute Coronary Syndrome ◽  
Stent Thrombosis ◽  
Primary Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Coronary Syndrome ◽  
Percutaneous Coronary

scholarly journals Use of medicines recommended for secondary prevention of acute coronary syndrome

2015 ◽  
Vol 49 (0) ◽  
Author(s):  
Mari Ângela Gaedke ◽  
Juvenal Soares Dias da Costa ◽  
Euler Roberto Fernandes Manenti ◽  
Ruth Liane Henn ◽  
Vera Maria Vieira Paniz ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Acute Coronary Syndrome ◽  
Secondary Prevention ◽  
Hospital Discharge ◽  
Coronary Intervention ◽  
Independent Variables ◽  
Coronary Syndrome ◽  
Percutaneous Coronary ◽  
Simultaneous Use ◽  
Crude Analysis

ABSTRACT OBJECTIVE : To analyze if the demographic and socioeconomic variables, as well as percutaneous coronary intervention are associated with the use of medicines for secondary prevention of acute coronary syndrome. METHODS : In this cohort study, we included 138 patients with acute coronary syndrome, aged 30 years or more and of both sexes. The data were collected at the time of hospital discharge, and after six and twelve months. The outcome of the study was the simultaneous use of medicines recommended for secondary prevention of acute coronary syndrome: platelet antiaggregant, beta-blockers, statins and angiotensin-converting-enzyme inhibitor or angiotensin receptor blocker. The independent variables were: sex, age, education in years of attending, monthly income in tertiles and percutaneous coronary intervention. We described the prevalence of use of each group of medicines with their 95% confidence intervals, as well as the simultaneous use of the four medicines, in all analyzed periods. In the crude analysis, we verified the outcome with the independent variables for each period through the Chi-square test. The adjusted analysis was carried out using Poisson Regression. RESULTS : More than a third of patients (36.2%; 95%CI 28.2;44.3) had the four medicines prescribed at the same time, at the moment of discharge. We did not observe any differences in the prevalence of use in comparison with the two follow-up periods. The most prescribed class of medicines during discharge was platelet antiaggregant (91.3%). In the crude analysis, the demographic and socioeconomic variables were not associated to the outcome in any of the three periods. CONCLUSIONS : The prevalence of simultaneous use of medicines at discharge and in the follow-ups pointed to the under-utilization of this therapy in clinical practice. Intervention strategies are needed to improve the quality of care given to patients that extend beyond the hospital discharge, a critical point of transition in care.

scholarly journals Five-Year Comparative Efficacy of Everolimus-Eluting vs. Resolute Zotarolimus-Eluting Stents in Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention

2021 ◽  
Vol 10 (6) ◽  
pp. 1278
Author(s):  
Endrin Koni ◽  
Wojciech Wanha ◽  
Jakub Ratajczak ◽  
Zhongheng Zhang ◽  
Przemysław Podhajski ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Acute Coronary Syndrome ◽  
Primary Endpoint ◽  
Coronary Intervention ◽  
First Year ◽  
Comparative Efficacy ◽  
Coronary Syndrome ◽  
Durable Polymer ◽  
Percutaneous Coronary

Among drug-eluting stents (DESs), the durable polymer everolimus-eluting stent (EES) and resolute zotarolimus-eluting stent (R-ZES) are widely used in clinical practice and have contributed to improve the outcomes of patients undergoing percutaneous coronary intervention (PCI). Few studies addressed their long-term comparative performance in patients with acute coronary syndrome (ACS). We aimed to investigate the 5 year comparative efficacy of EES and R-ZES in ACS. We queried ACTION-ACS, a large-scale database of ACS patients undergoing PCI. The treatment groups were analyzed using propensity score matching. The primary endpoint was a composite of mortality, myocardial infarction (MI), stroke, repeat PCI, and definite or probable stent thrombosis, which was addressed at the five-year follow-up. A total of 3497 matched patients were analyzed. Compared with R-ZES, a significant reduction in the primary endpoint at 5 years was observed in patients treated with EES (hazard ratio (HR) [95%CI] = 0.62 [0.54–0.71], p < 0.001). By landmark analysis, differences between the two devices emerged after the first year and were maintained thereafter. The individual endpoints of mortality (HR [95%CI] = 0.70 [0.58–0.84], p < 0.01), MI (HR [95%CI] = 0.55 [0.42–0.74], p < 0.001), and repeat PCI (HR [95%CI] = 0.65 [0.53–0.73], p < 0.001) were all significantly lower in the EES-treated patients. Stroke risk did not differ between EES and R-ZES. In ACS, a greater long-term clinical efficacy with EES vs. R-ZES was observed. This difference became significant after the first year of the ACS episode and persisted thereafter.

scholarly journals Independent Predictors of Adverse Cardiovascular Events in Patients With Acute Coronary Syndrome After Percutaneous Coronary Intervention During Hospitalization

Kardiologiia ◽  
2018 ◽  
Vol 58 (12) ◽  
pp. 22-29 ◽  
Author(s):  
J. A. Mansurova ◽  
L. K. Karazhanova
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Acute Coronary Syndrome ◽  
Regression Analysis ◽  
Stent Thrombosis ◽  
Cardiovascular Events ◽  
Coronary Intervention ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Coronary Syndrome ◽  
Percutaneous Coronary

Purpose: to elucidate independent clinical and laboratory predictors of adverse cardiovascular events (ACVE) in patients with acute coronary syndrome (ACS) after percutaneous coronary intervention (PCI) with stenting in early inhospital period.Materials and methods. We included in this prospective single center study 130 patients with ACS who underwent PCI with stenting. All patients prior to and after PCI received dual antiplatelet therapy with acetylsalicylic acid and clopidogrel. In 12–48 hours after PCI we measured residual platelet reactivity (RPR) using light aggregometry. In 57 patients simultaneously we performed genotyping of CYP2C19*2 polymorphisms. The following ACVE were used as end­points and were registered during inhospital observation (mean duration 9.7±3.2 days): sudden death, stent thrombosis, arterial thrombosis of other localization, recurrent angina, cardiac rhythm disturbances requiring special therapy.Results. Repetitive ACVE were observed in 32 patients. According to unifactorial regression analysis risk factors of their development were, ADP F­induced RPR (р<0.001), levels of creatinine (р<0.001), hemoglobin (р<0.001), and glucose (р=0.026), age (р=0.01), iron­deficiency anemia (р=0.01), left ventricular ejection fraction (р=0.004), number of stents (р=0.015). According to results of multifactorial regression analysis independent predictors of ACVE were: ADP­induced RPR >76 % (р=0.003), levels of creatinine >189 µmol / L (р=0.003), and hemoglobin <114 g / L (р=0.004). Significant effect of homozygous carriage of CYP2C19*2 (G681A) (А / А) on development of stent thrombosis was also detected (р=0.028).Conclusion. ADP­induced RPR, levels of creatinine and hemoglobin were found to be independent predictors of inhospital ACVE after myocardial revascularization with stenting in patients with ACS.

scholarly journals The Clinical and Angiographic Outcomes of Postdilation after Percutaneous Coronary Intervention in Patients with Acute Coronary Syndrome: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 2021 ◽  
pp. 1-11
Author(s):  
Yan Li ◽  
Xiying Liang ◽  
Wenjiao Zhang ◽  
Xuan Qiao ◽  
Zhilu Wang
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Acute Coronary Syndrome ◽  
Stent Thrombosis ◽  
Meta Analysis ◽  
Coronary Intervention ◽  
Target Vessel ◽  
Target Vessel Revascularization ◽  
Coronary Syndrome ◽  
Percutaneous Coronary

Objective. The effect of postdilation in patients with acute coronary syndrome is still controversial. This meta-analysis aims to analyze the clinical and angiographic outcomes of postdilation after percutaneous coronary intervention in patients with acute coronary syndrome. Methods. PubMed, Embase, the Cochrane Library, Web of Science, CNKI, and Wangfang databases were searched from inception to August 30, 2020. Eligible studies from acute coronary syndrome patients treated with postdilation were included. The primary clinical outcome was major adverse cardiovascular events (MACE), the secondary clinical outcomes comprised all-cause death, stent thrombosis, myocardial infarction, and target vessel revascularization, and the angiographic outcomes were no reflow and slow reflow. Results. 11 studies met inclusion criteria. In clinical outcomes, our pooled analysis demonstrated that the postdilation had a tendency of decreasing MACE (OR = 0.67, 95% CI 0.45–1.00; P  = 0.05) but significantly increased all-cause death (OR = 1.49, 95% CI 1.05–2.12; P  = 0.03). No significant difference existed in stent thrombosis (OR = 0.71, 95% CI 0.40–1.26; P  = 0.24), myocardial infarction (OR = 1.40, 95% CI 0.51–3.83; P  = 0.51), and target vessel revascularization (OR = 0.61, 95% CI 0.21–1.80; P  = 0.37) between postdilation and non-postdilation groups. In angiographic outcomes, there were no significant differences in no reflow (OR = 1.19, 95% CI 0.54–2.65; P  = 0.66) and slow reflow (OR = 1.12, 95% CI 0.93–1.35; P  = 0.24) between two groups. Conclusions. The postdilation tends to reduce the risk of MACE but significantly increases all-cause death, without significantly affecting stent thrombosis, myocardial infarction, target vessel revascularization, and coronary TIMI flow grade. However, more randomized controlled trials are required for investigating the effect of postdilation for patients with acute coronary syndrome (registered by PROSPERO, CRD42020160748).

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