Preventing future acute coronary events:Can we find and treat either the vulnerable plaque or the vulnerable, high risk patient?

2016 ◽  
Vol 2 (11) ◽  
Author(s):  
John Ambrose
Keyword(s):  
Cardiac Death ◽  
American Heart ◽  
High Risk Patient ◽  
Heart Association ◽  
Coronary Intervention ◽  
The United States ◽  
Percutaneous Coronary ◽  
Coronary Syndromes ◽  
Coronary Events ◽  
Cardiovascular Care

<p>Acute myocardial infarction (AMI) and sudden cardiac death (SCD) contribute to the leading cause of mortality for adults in the United States – cardiovascular disease.  Over the last 3 decades, there have been tremendous improvements in our ability to: rapidly detect (eg. Troponin utilization) and treat acute coronary syndromes (eg.new medications, percutaneous coronary intervention), lower cardiovascular risk (eg. statins) and standardize cardiovascular care through widely available guideline-directed medical therapies.  Nevertheless, according to the American Heart Association, in 2010 there were still an estimated 915,000 new or recurrent AMIs and 278,000 SCD events.<sup>1</sup>So this begs the question, what more can we do to prevent devastating future acute coronary events?</p>

Bivalirudin, a bivalent, thrombin specific anticoagulant as an alternative to heparin in interventional procedures

2002 ◽  
Vol 22 (03) ◽  
pp. 142-148 ◽  
Author(s):  
D. P. Chew
Keyword(s):  
Artery Bypass ◽  
Bypass Graft ◽  
Coronary Intervention ◽  
The United States ◽  
Bleeding Complications ◽  
Amino Acid Residues ◽  
Artery Bypass Graft ◽  
Small Peptide ◽  
Percutaneous Coronary ◽  
Coronary Syndromes

SummaryAmong the antithrombotic therapies evaluated to date, the synthetic peptide bivalirudin is unique in its ability to reduce both ischemic and bleeding complications associated with percutaneous coronary intervention (PCI). Bivalirudin is a small peptide consisting of 20 amino acid residues that binds thrombin in a direct, reversible, and bivalent fashion. The agent is approved for use in the United States and New Zealand as an anticoagulant in patients with unstable angina undergoing PCI and may also prove beneficial in patients with acute coronary syndromes (ACS), acute myocardial infarction (AMI) and in patients undergoing coronary artery bypass graft (CABG) procedures. This article examines bivalirudin in more detail.

scholarly journals ACC/AHA guidelines for percutaneous coronary intervention (revision of the 1993 PTCA guidelines)—executive summary21When citing this document, the American College of Cardiology and the American Heart Association would appreciate the following citation format: Smith SC, Jr, Dove JT, Jacobs AK, Kennedy JW, Kereiakes D, Kern MJ, Kuntz RE, Popma JJ, Schaff HV, Williams DO. ACC/AHA guidelines for percutaneous coronary intervention: executive summary and recommendations: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the 1993 Guidelines for Percutaneous Transluminal Coronary Angioplasty). J Am Coll Cardiol 2001;37:2215–38.22Address for reprints: a single reprint of this document is available by calling 800-253-4636 (US only) or writing the American College of Cardiology, Educational Services, 9111 Old Georgetown Road, Bethesda, MD 20814-1699. This document (reprint no. 71-0205), as well as the companion full-text guideline (reprint no. 71-0206), are available on the ACC Web site at www.acc.organd the AHA Web site at http://www.americanheart.org. To purchase additional reprints (specify version): up to 999 copies, call 800-611-6083 (US only) or fax 413-665-2671; 1000 or more copies, call 214-706-1466, fax 214-691-6342; or E-mail: [email protected].

2001 ◽  
Vol 37 (8) ◽  
pp. 2215-2238 ◽  
Author(s):  
Sidney C Smith ◽  
James T Dove ◽  
Alice K Jacobs ◽  
J Ward Kennedy ◽  
Dean Kereiakes ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Web Site ◽  
American Heart Association ◽  
American Heart ◽  
Task Force ◽  
Heart Association ◽  
Coronary Intervention ◽  
Percutaneous Transluminal Coronary Angioplasty ◽  
Executive Summary ◽  
Percutaneous Coronary

scholarly journals 2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines

Circulation ◽  
2021 ◽  
Author(s):  
Jennifer S. Lawton ◽  
Jacqueline E. Tamis-Holland ◽  
Sripal Bangalore ◽  
Eric R. Bates ◽  
Theresa M. Beckie ◽  
...  
Keyword(s):  
Coronary Artery ◽  
American Heart ◽  
Coronary Revascularization ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Heart Association ◽  
Coronary Intervention ◽  
Executive Summary ◽  
Coronary Artery Revascularization ◽  
Percutaneous Coronary

Aim: The executive summary of the American College of Cardiology/American Heart Association/Society for Cardiovascular Angiography and Interventions coronary artery revascularization guideline provides the top 10 items readers should know about the guideline. In the full guideline, the recommendations replace the 2011 coronary artery bypass graft surgery guideline and the 2011 and 2015 percutaneous coronary intervention guidelines. This summary offers a patient-centric approach to guide clinicians in the treatment of patients with significant coronary artery disease undergoing coronary revascularization, as well as the supporting documentation to encourage their use. Methods: A comprehensive literature search was conducted from May 2019 to September 2019, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Collaboration, CINHL Complete, and other relevant databases. Additional relevant studies, published through May 2021, were also considered. Structure: Recommendations from the earlier percutaneous coronary intervention and coronary artery bypass graft surgery guidelines have been updated with new evidence to guide clinicians in caring for patients undergoing coronary revascularization. This summary includes recommendations, tables, and figures from the full guideline that relate to the top 10 take-home messages. The reader is referred to the full guideline for graphical flow charts, supportive text, and tables with additional details about the rationale for and implementation of each recommendation, and the evidence tables detailing the data considered in the development of this guideline.

scholarly journals Evolving Concepts in Post-PCI Antiplatelets Therapy

2020 ◽  
Vol 1 (3-4) ◽  
pp. 186-194
Author(s):  
Kartik Pandurang Jadhav ◽  
Pankaj V. Jariwala
Keyword(s):  
Medical Therapy ◽  
American Heart ◽  
Heart Association ◽  
Coronary Intervention ◽  
P2y12 Inhibitor ◽  
Therapeutic Drugs ◽  
Percutaneous Coronary ◽  
Standard Duration ◽  
Large Randomized Clinical Trial ◽  
European Society Of Cardiology

The standard duration dual antiplatelet therapy (DAPT) is considered as gold standard for post percutaneous coronary intervention (PCI) medical therapy, as mentioned in American College of Cardiology/American Heart Association 2016 and European Society of Cardiology 2017 guidelines. Recently it has been challenged, in terms of duration and composition of this therapy. Many newer regimens and therapeutic drugs are being tried in large randomized clinical trial studies and found to be as effective as DAPT if not superior. There is general trend to introduce better antiplatelets like P2Y12 inhibitor (prasugrel and ticagrelor) as monotherapy for longer duration and restricting use of aspirin beyond 3 months. This review article helps us in understanding the evolution of DAPT therapy, formation of guidelines, and what are the new and evolving concepts in post-PCI medical therapy.

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