scholarly journals Patient after myocardial infarction: how to reduce the risk of recurrent ischemic events?

2015 ◽  
Vol 6 (2) ◽  
pp. 12-19
Author(s):  
O. L Barbarash ◽  
V. N Karetnikova ◽  
V. V Kashtalap
Keyword(s):  
Myocardial Infarction ◽  
Dual Antiplatelet Therapy ◽  
Patient Adherence ◽  
Review Article ◽  
Efficacy And Safety ◽  
Factors Affecting ◽  
Coronary Syndromes ◽  
Coronary Events ◽  
Current Guidelines ◽  
Ischemic Events

The review article highlights concerns related to a low survival rate in patients after myocardial infarction (MI) and factors affecting it. The pivotal role is given to the issue of patient adherence to therapy after acute coronary events. The options to improve it as well as mechanisms to optimize medical therapy for patients after myocardial infarction, particularly the need for prolonged dual antiplatelet therapy (DAPT), have been identified. The rationale for changing the current guidelines for the management of patients with acute coronary syndromes (ACS) is based on the findings of the recently completed international clinical trial PE- GASUS-TIMI 54 with ticagrelor (Brilinta®), utilized as part of a DAPT regimen, that have demonstrated the efficacy and safety of DAPT prolongation after 12-month period in post-MI patients.

12-lead ST-segment monitoring vs single-lead maximum ST-segment monitoring for detecting ongoing ischemia in patients with unstable coronary syndromes

1998 ◽  
Vol 7 (5) ◽  
pp. 355-363 ◽  
Author(s):  
BJ Drew ◽  
MM Pelter ◽  
MG Adams ◽  
SF Wung ◽  
TM Chou ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Cardiac Care ◽  
Computer Assisted ◽  
Balloon Inflation ◽  
Routine Monitoring ◽  
St Segment ◽  
Coronary Syndromes ◽  
Ecg Leads ◽  
Ischemic Events ◽  
Cardiac Care Unit

BACKGROUND: 12-lead ECG monitoring of the ST segment is more sensitive than patients' symptoms for detecting ischemia after thrombolytic therapy or catheter-based interventions, but it is unclear whether monitoring of the single lead showing maximum ST deviation would be as efficacious. OBJECTIVE: To determine whether monitoring all 12 ECG leads for changes in the ST segment is necessary to detect ongoing ischemia in patients with unstable coronary syndromes. METHODS: Continuous 12-lead ST segment monitoring was performed in 422 patients from the onset of myocardial infarction or during balloon inflation in catheter-based interventions until the patient's discharge from the cardiac care unit. Computer-assisted techniques were used to determine (1) which lead showed the maximum ST deviation at the onset of myocardial infarction or during balloon inflation and (2) what proportion of later ischemic events were associated with ST deviation in this lead. RESULTS: The lead with the maximum ST deviation could be determined in 312 patients (74%). The remaining 110 (26%) had non-Q wave infarction without ST deviation or no ST changes during balloon inflation. During 18,394 hours of 12-lead ST monitoring, 118 (28%) of the 312 patients had a total of 463 ischemic events, 80% of which were silent. Of 377 ischemic events in which a maximum ST lead was detected, 159 (42%) did not show ST deviation in this lead (sensitivity, 58%; 95% CI, 53%-63%). Routine monitoring of leads V1 and II showed ST deviation in only 152 of the 463 events (sensitivity, 33%; 95% CI, 29%-37%). CONCLUSIONS: Monitoring of all 12 ECG leads for changes in the ST segment is necessary to detect ongoing ischemia in patients with unstable coronary syndromes.

Epidemiology of acute coronary syndromes

ESC CardioMed ◽  
2018 ◽  
pp. 1213-1218
Author(s):  
Héctor Bueno
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Cardiovascular Diseases ◽  
Acute Coronary Syndromes ◽  
Case Fatality ◽  
Risk Scores ◽  
St Segment Elevation ◽  
St Segment ◽  
Coronary Syndromes ◽  
Coronary Events

Cardiovascular diseases cause approximately one-third of all deaths in the world, of which 7.5 million deaths are estimated to be due to ischaemic heart disease (IHD). Acute coronary syndromes (ACS) and sudden death cause most IHD-related deaths, which represent 1.8 million deaths per year. The incidence of IHD in general, and of ACS, increases with age although, on average, this occurs 7–10 years earlier in men compared with women. ACS occurs far more often in men than in women below the age of 60 years but women represent the majority of patients over 75 years of age. The risk of acute coronary events in life is related to the exposure to traditional cardiovascular risk factors. This can be estimated using risk scores, such as the European Society of Cardiology SCORE system. Huge differences within European and world regions can be found in the incidence and prevalence of IHD and ACS as well as in case fatality rates. However, information on the incidence of ACS is still limited for Europe. While the incidence of non ST-segment elevation ACS has remained relatively stable, the incidence of ST-segment elevation myocardial infarction has suffered a significant decrease in recent years. Furthermore, the majority of European countries experienced substantial decreases in age-standardized death rates for cardiovascular diseases and IHD in the last decades, particularly for myocardial infarction. This is the consequence of the improvement in cardiovascular prevention and ACS treatment but this trend may be reverting due to population ageing and the increase in some risk factors.

scholarly journals Efficiency and safety of various dual antiplatelet therapy strategies in patients undergoing percutaneous coronary intervention due to myocardial infarction

2021 ◽  
Vol 26 (7) ◽  
pp. 4525
Author(s):  
S. B. Aksentiev ◽  
A. V. Solovieva ◽  
D. S. Yunevich
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Antiplatelet Therapy ◽  
Dual Antiplatelet Therapy ◽  
Coronary Intervention ◽  
Efficacy And Safety ◽  
Reperfusion Arrhythmias ◽  
Percutaneous Coronary ◽  
Secondary Endpoints

Aim. To compare the efficacy and safety of prasugrel, ticagrelor, or clopidogrel as part of dual antiplatelet therapy (DAPT) in patients undergoing percutaneous coronary intervention (PCI) due to myocardial infarction (MI).Material and methods. The observational study included 74 patients who underwent PCI due to MI within the first 24 hours after the onset. The patients were devided into 3 groups: group 1 — patients who received ticagrelor as part of DAPT; group 2 — clopidogrel, group 3 — prasugrel. The follow-up period was 28 days. To assess the efficacy and safety of therapy, a composite endpoint was assessed (death + nonfatal recurrent MI (and/or stent rethrombosis) + nonfatal ischemic stroke (IS). Additional secondary endpoints were any moderate and severe (major) bleeding according to the GUSTO and/or TIMI scales. We assessed the incidence of reperfusion arrhythmias, an opening of an infarct-related coronary artery (IRCA), and non-ST elevation myocardial infarction (non-STEMI).Results. The analysis showed no significant differences in the cumulative incidence of adverse outcomes in the study groups within 28 days. The prevalence of secondary endpoints over a 28-day follow-up period was 3,1% in the ticagrelor group and 5,9% in the clopidogrel group, while no moderate and life-threatening bleeding was recorded in the prasugrel group during. There were no significant differences in the incidence of reperfusion arrhythmias, opening of an IRCA, and non-STEMI between the groups.Conclusion. The obtained results suggest the comparable efficacy and safety profiles of prasugrel, ticagrelor and clopidogrel as a part of DAPT in patients undergoing PCI due to MI. There were no significant differences in endpoint event rates. In particular, prasugrel has been shown to be as effective and safe as ticagrelor.

scholarly journals Selection of P2Y12 antagonist in patients with myocardial infarction who received thrombolytic therapy. Results of annual follow-up of TREAT study patients

2019 ◽  
pp. 64-70
Author(s):  
O. V. Averkov ◽  
V. I. Vechorko
Keyword(s):  
Myocardial Infarction ◽  
Thrombolytic Therapy ◽  
Dual Antiplatelet Therapy ◽  
Clinical Results ◽  
Evidence Base ◽  
Efficacy And Safety ◽  
Coronary Syndrome ◽  
P2y12 Antagonist ◽  
Selection Of

Dual antiplatelet therapy serves to improve the clinical results of thrombolytic therapy after STEMI, until recently consisted of acetylsalicylic acid and clopidogrel. In this category of patients, ticagrelor, widely used by acute coronary syndrome as more effective than clopidogrel, had no serious evidence of efficacy and safety. The TREAT study discussed in this article has been implemented to supply a gap in the evidence base of ticagrelor. The results of observation within 12 months after randomization to taking ticagrelor or clopidogrel of patients who received thrombolytic showed that the hemorrhagic safety regarding the major bleeding of ticagrelor is comparable with clopidogrel. The results of the TREAT study with the previously obtained results of the PLATO study make it possible to broaden indications for the use of ticagrelor (or switching from clopidogrel) in the first 24 hours from the onset of a myocardial infarction in patients who received thrombolytic therapy as an initial reperfusion.

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