scholarly journals Telephone-Based Reminder To Improve Safety After Percutaneous Coronary Intervention

2021 ◽  
Author(s):  
Jeffrey Chidester ◽  
Daniel Bennett ◽  
Chris Mathew ◽  
Tiffany Denkins ◽  
Rebecca Vigen ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Dual Antiplatelet Therapy ◽  
Coronary Intervention ◽  
Reminder System ◽  
Post Procedure ◽  
Contemporary Sample ◽  
Percutaneous Coronary ◽  
Significant Difference ◽  
Proportion Of Days Covered ◽  
Patient Concerns

Abstract Introduction: Dual Antiplatelet Therapy (DAPT) is a class I guideline indication after Percutaneous Coronary Intervention (PCI). Our population is high-risk for low medication adherence. With a multidisciplinary team we developed a telephone-based intervention to improve DAPT adherence post-PCI. Methods: Patients undergoing PCI at our center were contacted by nursing staff via telephone at 1 week, 30 days, and 60 days post-procedure. Calls included a reminder of the importance of DAPT and elicited any patient concerns. Concerns were relayed to the team who could take appropriate action. For patients filling their medications at any pharmacies within our closed system the proportion of days covered (PDC) was calculated. These were compared to data for patients undergoing PCI in the seven months prior to program initiation. Information on interventions performed as a result of calls was also collected. Results: During the study period, 452 patients underwent PCI. Of these, 70% were contacted and 244 filled their prescription at our system pharmacies. Twelve-month median PDC was 74%, with 45% of patients having PDC >80%. There was no significant difference when compared to the group prior to the intervention, median PDC 79% and 50% of patients having PDC >80%. In 26 patients calls led to interventions, removing barriers that would have otherwise prevented continued adherence. Conclusion: A telephone-based reminder system led to directed interventions in nearly 1 in 10 patients contacted. It was not able to significantly improve PDC when compared to a contemporary sample. This highlights the difficulty in using PDC to detect barriers to adherence.

scholarly journals Analysis of Platelet Function from Thromboelastography Examination in Patients with Single and Multiple Antiplatelet Therapy after Percutaneous Coronary Intervention in Dr. Saiful Anwar Malang

2020 ◽  
Vol 7 (1) ◽  
pp. 19-28
Author(s):  
Sasmojo Widito ◽  
Dadang Hendrawan ◽  
Dedy Irawan
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Antiplatelet Therapy ◽  
Platelet Function ◽  
Dual Antiplatelet Therapy ◽  
Coronary Intervention ◽  
Primary Therapy ◽  
Research Subjects ◽  
Platelet Function Test ◽  
Percutaneous Coronary ◽  
Significant Difference

Each year, approximately 3 million people with coronary heart disease worldwide undergo percutaneous coronary intervention (PCI). Dual antiplatelet therapy (DAPT) with aspirin and P2Y12 inhibitors became the primary therapy for 6-12 months after PCI. DAPT can be continued > 12 months at a high risk of thrombosis. About 9-10% of patients with dual antiplatelet therapy still experience ischemia. The platelet function examination by thromboelastography (TEG). This research is an analytic observational study using a cross-sectional method. This study was conducted in Saiful Anwar General Hospital. Patients were divided into two groups: (1) on-single antiplatelet therapy; (2) on-dual antiplatelet therapy. The outcome measured result of the platelet function test was divided into standard, low platelet function, and platelet hypercoagulability. An analysis of the differences between single or multiple antiplatelet administration and the platelet function results was performed. There were 52 research subjects, each group of single and multiple antiplatelet therapies as many as 26 people, most of the subjects were male (82.6%) with a mean age of 57. The results of this study showed that there was no significant difference in the results of platelet function examinations between single and multiple antiplatelet therapies after 12 months of dual antiplatelet therapy.

scholarly journals Bailout Thrombectomy: Its Outcomes in Patients Undergoing Primary Percutaneous Coronary Intervention

2021 ◽  
Vol 15 (5) ◽  
pp. 1765-1767
Author(s):  
Mahboob ur Rehman ◽  
Farhan Faisal ◽  
Amjad Abrar ◽  
Amjad Ali Shah ◽  
Muhammad Shoaib ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Renal Impairment ◽  
Primary Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Post Procedure ◽  
Percutaneous Coronary ◽  
Significant Difference ◽  
Group A ◽  
Group B

Aim: To determine the clinical outcomes of patients who received bailout thrombectomy for primary percutaneous coronary intervention. Study Design: Cross-sectional/observational Place & Duration: Study was conducted at Cardiac Centre, Cardiology Department, Pakistan Institute of Medical Sciences (PIMS) Islamabad from January 2020 to December 2020 (for one year). Methods: 200 hundred patients of both genders undergoing primary percutaneous coronary intervention(PPCI)for ST elevation myocardial infarction(STEMI) were analyzed in this study. All patients were divided into two groups. Group A contains 100 patients and received PPCI with bailout thrombectomy and Group B contains 100 patients and received PPCI alone. Informed written consent was taken. Outcomes such as mortality, re-infarction, heart failure, cardiogenic shock, renal impairment, excess bleeding, post procedure stroke and hospital stay were examined and compare between both groups. Results: In Group A there were 53% males and 47% females with mean age 56.45+10.88 years. In Group B 55% were males and 45% were females with mean age 58.35+9.23 years. In Groups A there were more diabetic patients 45% than Group B 32% (p-value 0.005), Group B had more smokers 60%. There was a significant difference between group A and B regarding family history of coronary artery disease 35% vs 20% (p=0.003). In Group A 3% patients were died and in Group B 2% patients were died with no significant difference. Group A patients had more renal impairment 9% vs 5% and stroke 3% vs 1% than Group B. Hospital stay was high in Group A patients 7.12+2.05 vs 5.34+1.02 days of Group B. Conclusion: It is concluded that patients received bailout thrombectomy for percutaneous coronary intervention (PCI) had high rate of comorbidities. There was no significant difference in term of mortality between both groups. However, patients with bailout thrombectomy had more renal impairment and post-procedure stroke. Keywords: ST-segment elevated myocardial infarction, bailout thrombectomy, PPCI, Outcomes

Abstract 15313: Analysis of Survival in Octogenarian and Nonagenarian Patients Treated With Primary Percutaneous Coronary Intervention for ST Elevation Myocardial Infarction

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Aaruni Saxena ◽  
Hedra Ghobrial ◽  
Ahmed Sayed G AlSayed Ahmed ◽  
Shahnaz Jamil-Copley ◽  
Nikola Sprigg ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
St Elevation Myocardial Infarction ◽  
Female Population ◽  
Male And Female ◽  
Post Procedure ◽  
Percutaneous Coronary ◽  
Significant Difference ◽  
St Elevation

Introduction: With advancement in interventional cardiology an increase in the number of percutaneous coronary intervention (PCI) procedures has been noted in the elderly. However, the post procedure complication and mortality remain a challenge for the physicians. This study aimed to estimate the survival among men and women above 80 years of age who undergo primary PCI for treatment of ST elevation myocardial infarction. Methods: We analyzed the data collected prospectively from our cardiac center. The patients were followed up over 10 years. Most patient received stents followed by anti-platelet drugs and preventive measures to avoid further cardiac event. Kaplan Meier curves were generated to study survival post PCI (SPSS v2.2). Survival curves were developed to determine the influence of age, sex, type of stent and degree of coronary flow (TIMI 0-3) on post procedure survival. Results: From 2010 to 2019, total 502 patients >80 years received PCI (282 males, 218 females). The median survival in the male and female population were 2.16 yrs. (95% CI 1.66 - 2.66) and 2.36 yrs. (95% CI 1.72-2.99)(P= 0.18). Significant difference of around 1 year (2.7 yrs. octogenarian vs 1.6 yrs. nonagenarian, p<0.001, see figure 1) was found in post PCI survival between octogenarian and nonagenarian. However, the survival was longer in case of Bare metal stents (BMS)(n= 113) as compared to Drug eluting stents(DES)(n= 274) (2.7 yrs. vs. 2.0yr, p<0.001). Similarly, post procedure TIMI flow analysis shows maximum survival in TIMI 3 followed by TIMI 2 and TIMI 1 ensuring the significance of TIMI grade flow. Conclusions: Our results demonstrate that PPCI in elderly patients have a better outcome and longer survival in octogenarians than nonagenarians. Similarly, use of BMS could be considered over DES in population above 80 years of age irrespective of gender. No difference in post PCI survival in male and female population.

TWILIGHT: A Randomized Trial of Ticagrelor Monotherapy Versus Ticagrelor Plus Aspirin Beginning at 3 Months in High-risk Patients Undergoing Percutaneous Coronary Intervention

2020 ◽  
Vol 14 ◽  
Author(s):  
Johny Nicolas ◽  
Usman Baber ◽  
Roxana Mehran
Keyword(s):  
Percutaneous Coronary Intervention ◽  
High Risk ◽  
Antiplatelet Therapy ◽  
Dual Antiplatelet Therapy ◽  
Coronary Intervention ◽  
Bleeding Events ◽  
High Risk Patients ◽  
Risk Of Death ◽  
Percutaneous Coronary ◽  
Risk Patients

A P2Y12 inhibitor-based monotherapy after a short period of dual antiplatelet therapy is emerging as a plausible strategy to decrease bleeding events in high-risk patients receiving dual antiplatelet therapy after percutaneous coronary intervention. Ticagrelor With Aspirin or Alone in High-Risk Patients After Coronary Intervention (TWILIGHT), a randomized double-blind trial, tested this approach by dropping aspirin at 3 months and continuing with ticagrelor monotherapy for an additional 12 months. The study enrolled 9,006 patients, of whom 7,119 who tolerated 3 months of dual antiplatelet therapy were randomized after 3 months into two arms: ticagrelor plus placebo and ticagrelor plus aspirin. The primary endpoint of interest, Bleeding Academic Research Consortium type 2, 3, or 5 bleeding, occurred less frequently in the experimental arm (HR 0.56; 95% CI [0.45–0.68]; p<0.001), whereas the secondary endpoint of ischemic events was similar between the two arms (HR 0.99; 95% CI [0.78–1.25]). Transition from dual antiplatelet therapy consisting of ticagrelor plus aspirin to ticagrelor-based monotherapy in high-risk patients at 3 months after percutaneous coronary intervention resulted in a lower risk of bleeding events without an increase in risk of death, MI, or stroke.

scholarly journals Prasugrel versus ticagrelor in patients with myocardial infarction undergoing percutaneous coronary intervention

Heart ◽  
2021 ◽  
pp. heartjnl-2020-318694
Author(s):  
Dimitrios Venetsanos ◽  
Erik Träff ◽  
David Erlinge ◽  
Emil Hagström ◽  
Johan Nilsson ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Similar Efficacy ◽  
Efficacy And Safety ◽  
Adjusted Risk ◽  
Cerebrovascular Events ◽  
Percutaneous Coronary ◽  
Significant Difference ◽  
Evidence Based Care

ObjectiveThe comparative efficacy and safety of prasugrel and ticagrelor in patients with myocardial infarction (MI) treated with percutaneous coronary intervention (PCI) remain unclear. We aimed to investigate the association of treatment with clinical outcomes.MethodsIn the SWEDEHEART (Swedish Web-system for enhancement and development of evidence-based care in heart disease evaluated according to recommended therapies) registry, all patients with MI treated with PCI and discharged on prasugrel or ticagrelor from 2010 to 2016 were included. Outcomes were 1-year major adverse cardiac and cerebrovascular events (MACCE, death, MI or stroke), individual components and bleeding. Multivariable adjustment, inverse probability of treatment weighting (IPTW) and propensity score matching (PSM) were used to adjust for confounders.ResultsWe included 37 990 patients, 2073 in the prasugrel group and 35 917 in the ticagrelor group. Patients in the prasugrel group were younger, more often admitted with ST elevation MI and more likely to have diabetes. Six to twelve months after discharge, 20% of patients in each group discontinued the P2Y12 receptor inhibitor they received at discharge. The risk for MACCE did not significantly differ between prasugrel-treated and ticagrelor-treated patients (adjusted HR 1.03, 95% CI 0.86 to 1.24). We found no significant difference in the adjusted risk for death, recurrent MI or stroke alone between the two treatments. There was no significant difference in the risk for bleeding with prasugrel versus ticagrelor (2.5% vs 3.2%, adjusted HR 0.92, 95% CI 0.69 to 1.22). IPTW and PSM analyses confirmed the results.ConclusionIn patients with MI treated with PCI, prasugrel and ticagrelor were associated with similar efficacy and safety during 1-year follow-up.

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