Ticagrelor in the management of coronary artery disease

2020 ◽  
Author(s):  
Krithika Loganath ◽  
Philip D Adamson ◽  
Alastair J Moss
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Stable Coronary Artery Disease ◽  
Phase Iii ◽  
Major Cardiovascular Events ◽  
Increased Risk ◽  
Effective Inhibition ◽  
Phase Iii Trials ◽  
Artery Disease ◽  
Orally Active

Ticagrelor is a potent and orally active P2Y12 inhibitor. Ticagrelor has been extensively tested in Phase II and Phase III trials in patients with coronary artery disease. The pharmacokinetics and pharmacodynamics of Ticagrelor result in more rapid and effective inhibition of platelet activation compared with other P2Y12 inhibitors. This has resulted in a reduction in recurrent major cardiovascular events in initial randomized controls trials comparing Ticagrelor with clopidogrel. More recently, clinical trials have investigated the use of Ticagrelor in patients with stable coronary artery disease and a high residual risk of coronary thrombotic events. In patients with stable coronary artery disease, the potent antiplatelet effect of Ticagrelor is counterbalanced by an increased risk of major bleeding. Further research is ongoing to determine the optimal duration of Ticagrelor therapy.

scholarly journals Prognostic value of serum soluble ST2 in stable coronary artery disease: a prospective observational study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Hack-Lyoung Kim ◽  
Jung Pyo Lee ◽  
Nathan Wong ◽  
Woo-Hyun Lim ◽  
Jae-Bin Seo ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Stable Coronary Artery Disease ◽  
Stable Condition ◽  
Baseline Serum ◽  
Soluble St2 ◽  
Increased Risk ◽  
Artery Disease ◽  
Stable Cad

AbstractThe role of ST2 in stable coronary artery disease (CAD) has not yet been well defined. This study was performed to investigate baseline serum soluble ST2 (sST2) level can predict clinical outcomes in patients with stable CAD. A total of 388 consecutive patients with suspected CAD (65 years and 63.7% male) in stable condition referred for elective invasive coronary angiography (ICA) was prospectively recruited. Major adverse cardiovascular event (MACE), including cardiac death, non-fatal myocardial infarction, coronary revascularization (90 days after ICA), and ischemic stroke during clinical follow-up was assessed. Most of the patients (88.0%) had significant CAD (stenosis ≥ 50%). During median follow-up of 834 days, there was 29 case of MACE (7.5%). The serum sST2 level was significantly higher in patients with MACE than those without (47.3 versus 30.6 ng/ml, P < 0.001). In multiple Cox regression model, higher sST2 level (≥ 26.8 ng/ml) was an independent predictor of MACE even after controlling potential confounders (hazard ratio, 13.7; 95% confidence interval 1.80–104.60; P = 0.011). The elevated level of baseline sST2 is associated with an increased risk of adverse clinical events in stable CAD patients. Studies with larger sample size are needed to confirm our findings.

scholarly journals The Role of Rivaroxaban in the Treatment of Patients with Stable Coronary Artery Disease

2019 ◽  
pp. 34-41
Author(s):  
O. V. Averkov
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Acetylsalicylic Acid ◽  
Stable Coronary Artery Disease ◽  
Antiplatelet Agent ◽  
Alternative Possibilities ◽  
Efficacy And Safety ◽  
Increased Risk ◽  
Long Term Treatment ◽  
Artery Disease

An analytical article discusses the design and results of the recent COMPASS study. Particular attention is paid to the details of comparison of the efficacy and safety of rivaroxaban combined with acetylsalicylic acid and the efficacy and safety of drugs containing acetylsalicylic acid only in patients with stable coronary artery disease. In addition to a significant reduction in the risk of the sum of traditionally recognizable events (myocardial infarction, stroke, cardiovascular mortality), among the arguments in favour of fairly widespread prolonged use of the antiplatelet agent combined with anticoagulant is an attractive effect of the debated antithrombotic strategy on the overall mortality of patients, an acceptable ratio of efficacy and hemorrhagic safety, first of all the absence of the increased risk of fatal bleeding and the risk of intracranial bleeding. The article describes approaches to the selection of patients with coronary artery disease for the participation in the long-term treatment with rivaroxaban combined with acetylsalicylic acid. Alternative possibilities for enhancement of the secondary prophylactic effects of acetylsalicylic acid are mentioned, the arguments supporting the preference of the approach discussed in the article are presented.

scholarly journals Decreased heart rate recovery may predict a high SYNTAX score in patients with stable coronary artery disease

2019 ◽  
Vol 19 (1) ◽  
pp. 109-115
Author(s):  
Sadık Volkan Emren ◽  
Rahman Bilal Gediz ◽  
Oktay Şenöz ◽  
Uğur Karagöz ◽  
Ersin Çağrı Şimşek ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Heart Rate ◽  
Coronary Artery ◽  
Heart Rate Recovery ◽  
Stable Coronary Artery Disease ◽  
Recovery Period ◽  
Multivariate Logistic Regression Analysis ◽  
Syntax Score ◽  
Increased Risk ◽  
Artery Disease

An impaired heart rate recovery (HRR) has been associated with increased risk of cardiovascular events, cardiovascular, and all‐cause mortality. However, the diagnostic ability of HRR for the presence and severity of coronary artery disease (CAD) has not been clearly elucidated. Our aim was to investigate the relationship between HRR and the SYNTAX (SYNergy between percutaneous coronary intervention with TAXus and cardiac surgery) score in patients with stable CAD (SCAD). A total of 406 patients with an abnormal treadmill exercise test and ≥50% coronary stenosis on coronary angiography were included. The HRR was calculated by subtracting the HR in the first minute of the recovery period from the maximum HR during exercise. The SYNTAX score ≥23 was accepted as high. Correlation of HRR with SYNTAX score and independent predictors of high SYNTAX score were determined. A high SYNTAX score was present in 172 (42%) patients. Mean HRR was lower in patients with a high SYNTAX score (9.8 ± 4.5 vs. 21.3 ± 9, p < 0.001). The SYNTAX score was negatively correlated with HRR (r: -0.580, p < 0.001). In multivariate logistic regression analysis, peripheral arterial disease (OR: 13.3; 95% CI: 3.120–34.520; p < 0.001), decreased HRR (OR: 0.780; 95% CI: 0.674–0.902; p = 0.001), peak systolic blood pressure (OR: 1.054; 95% CI: 1.023–1.087; p = 0.001), and peak HR (OR: 0.950; 95% CI: 0.923–0.977; p < 0.001) were found to be independent predictors of a high SYNTAX score. Our results showed that HRR is significantly correlated with the SYNTAX score, and a decreased HRR is an independent predictor of a high SYNTAX score in patients with SCAD.

Abstract 4448: Clopidogrel Effect Depends on Body Weight and Abolishes Platelet Leukocyte Interaction in Patients with Coronary Artery Disease Treated by Stenting

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Philipp Diehl ◽  
Christoph Olivier ◽  
Christoph Halscheid ◽  
Thomas Helbing ◽  
Christoph Bode ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Body Weight ◽  
Coronary Artery ◽  
Stable Coronary Artery Disease ◽  
Obese Patients ◽  
Platelet Activity ◽  
Impedance Aggregometry ◽  
Increased Risk ◽  
Leukocyte Counts ◽  
Artery Disease

Background: Poor response to aspirin and clopidogrel has been associated with an increased risk for thrombotic events after PCI. The optimal dose of clopidogrel is unknown as platelet aggregability (PA) is not routinely measured in clopidogrel treated patients. Methods and Results : In order to assess potential mechanisms of clopidogrel responsiveness we have performed bedside platelet impedance aggregometry in patients with stable coronary artery disease (group CAD; n=62) and patients who underwent elective PCI (group PCI; n=90) compared to control individuals in whom coronary artery disease was excluded by coronary angiography (group control; n=28). Control patients did not receive antiplatelet therapy, CAD patients were treated with aspirin 100mg/d, and PCI patients with aspirin 100mg/d and clopidogrel 75mg/d. Impedance aggregometry was performed using arachidonic acid [AA] (final conc [fc]: 0.5mM) or ADP (fc: 6.5μM) and the area under the curve (AUC) was quantified to detect the effect of aspirin or clopidogrel, respectively. Indeed, PA was specifically reduced by either drug (AA: [control vs. CAD vs. PCI] 877±300 vs. 183±134 vs. 111±90; ADP: [control vs. PCI] 725±275 vs. 288±174 AUC). We detected a negative correlation between body weight and clopidogrel response (r=0.28; p=0.008), suggesting that clopidogrel may have been underdosed in obese patients. Furthermore, we found a positive correlation between leukocyte counts and PA (r=0.4, p=0.028) confirming that platelets and leucocytes interact functionally. Administration of clopidogrel abolished this interaction as detected by comparison of control individuals with PCI patients but also in intra-individual follow-up tests before and after introduction of clopidogrel. Conclusion: Impedance aggregometry is useful to assess PA routinely. Dosage of clopidogrel may need to be adjusted in obese patients. PA depends on leukocyte counts confirming that platelet activity is modulated by leukocytes; this interaction is effectively inhibited by clopidogrel.

Insulin resistance is associated with increased risk of major cardiovascular events in patients with preexisting coronary artery disease

2007 ◽  
Vol 153 (4) ◽  
pp. 559-565 ◽  
Author(s):  
Alexander Tenenbaum ◽  
Yehuda Adler ◽  
Valentina Boyko ◽  
Helena Tenenbaum ◽  
Enrique Z. Fisman ◽  
...  
Keyword(s):  
Insulin Resistance ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Cardiovascular Events ◽  
Major Cardiovascular Events ◽  
Increased Risk ◽  
Artery Disease

scholarly journals Pericoronary Adipose Tissue Attenuation Is Associated with High-Risk Plaque and Subsequent Acute Coronary Syndrome in Patients with Stable Coronary Artery Disease

Cells ◽  
2021 ◽  
Vol 10 (5) ◽  
pp. 1143
Author(s):  
Jeremy Yuvaraj ◽  
Andrew Lin ◽  
Nitesh Nerlekar ◽  
Ravi K. Munnur ◽  
James D. Cameron ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Acute Coronary Syndrome ◽  
Adipose Tissue ◽  
Coronary Artery ◽  
High Risk ◽  
Stable Coronary Artery Disease ◽  
Coronary Syndrome ◽  
Increased Risk ◽  
Artery Disease ◽  
Stable Cad

Background: High-risk plaques (HRP) detected on coronary computed tomography angiography (CTA) confer an increased risk of acute coronary syndrome (ACS). Pericoronary adipose tissue attenuation (PCAT) is a novel biomarker of coronary inflammation. This study aimed to evaluate the association of PCAT with HRP and subsequent ACS development in patients with stable coronary artery disease (CAD). Methods: Patients with stable CAD who underwent coronary CTA from 2011 to 2016 and had available outcome data were included. We studied 41 patients with HRP propensity matched to 41 controls without HRP (60 ± 10 years, 67% males). PCAT was assessed using semi-automated software on a per-patient basis in the proximal right coronary artery (PCATRCA) and a per-lesion basis (PCATLesion) around HRP in cases and the highest-grade stenosis lesions in controls. Results: PCATRCA and PCATLesion were higher in HRP patients than controls (PCATRCA: −80.7 ± 6.50 HU vs. −84.2 ± 8.09 HU, p = 0.03; PCATLesion: −79.6 ± 7.86 HU vs. −84.2 ± 10.3 HU, p = 0.04), and were also higher in men (PCATRCA: −80.5 ± 7.03 HU vs. −86.1 ± 7.08 HU, p < 0.001; PCATLesion: −79.6 ± 9.06 HU vs. −85.2 ± 7.96 HU, p = 0.02). Median time to ACS was 1.9 years, within a median follow-up of 5.3 years. PCATRCA alone was higher in HRP patients who subsequently presented with ACS (−76.8 ± 5.69 HU vs. −82.0 ± 6.32 HU, p = 0.03). In time-dependent analysis, ACS was associated with HRP and PCATRCA. Conclusions: PCAT attenuation is increased in stable CAD patients with HRP and is associated with subsequent ACS development. Further investigation is required to determine the clinical implications of these findings.

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