scholarly journals Ticagrelor in patients with acute coronary syndrome without ST elevation and a conservative treatment strategy

2016 ◽  
Vol 7 (1) ◽  
pp. 51-55
Author(s):  
A. D Erlikh
Keyword(s):  
Acute Coronary Syndrome ◽  
Conservative Treatment ◽  
Adverse Events ◽  
Treatment Strategy ◽  
Coronary Intervention ◽  
Cardiovascular Death ◽  
P Value ◽  
Correct Treatment ◽  
Coronary Syndrome ◽  
Study Results

The article provides an overview of the relevance of the use of dual antiplatelet therapy (DAT) in patients with acute coronary syndrome (ACS) without lifting ST (ACSwl ST ) receiving conservative treatment. Compared with those patients with ACSwl ST who underwent percutaneous coronary intervention, conservative treatment, patients traditionally have more comorbidities, risk factors and prognosis is worse. It is in this subgroup of patients to improve outcomes most important to carry out the most correct treatment of ACS, most strictly corresponding to current clinical guidelines. In particular this applies to that therapy, with which you can try to influence the mechanism of development of ACS, namely antirombocit therapy. The results of a clinical study PLATO showed that the use as a DAT combination with acetylsalicylic acid (ASA) and ticagrelor due to a decrease in the incidence of cardiovascular death, heart attack or stroke (primary adverse events) as compared to the combination of ASA and clopidogrel. The results of further analysis of PLATO study showed that when comparing the groups of patients with ACSwl ST treatment of invasive and conservative, noted a similar proportional reduction in the incidence of primary adverse events when using ticagrelor compared to clopidogrel group (hazard ratio of 0.86 compared with 0.85; p-value for interaction 0.89), which is consistent with the overall results of the study. Among patients with ACSwl ST treated conservatively, receiving ticagrelor as compared with clopidogrel was associated with a significantly smaller number of all deaths (relative risk, 0.73; 95 CI 0.57-0.93). The frequency of the "big" bleeding among patients treated conservatively with ACSwl ST treated with ticagrelor and clopidogrel did not differ significantly. PLATO study results identified the mandatory use of ticagrelor as DAT in patients with ACSwl ST regardless of the chosen treatment strategy.

scholarly journals EVALUATION OF THE INTERNAL PICTURE OF HEALTH IN PATIENTS WITH ACUTE CORONARY SYNDROME IN PRESENTING WITHOUT ST-SEGMENT AFTER PERCUTANEOUS CORONARY INTERVENTIONS AND IN THE PROCESS OF REHABILITATION

2019 ◽  
Vol 3 ◽  
pp. 9-17
Author(s):  
Roksolana Nesterak
Keyword(s):  
Acute Coronary Syndrome ◽  
Heart Disease ◽  
Conservative Treatment ◽  
Ischemic Heart Disease ◽  
Coronary Intervention ◽  
Ischemic Heart ◽  
Life Questionnaire ◽  
Actual Problem ◽  
Coronary Syndrome ◽  
St Segment

Ischemic heart disease remains an actual problem of modern clinical and rehabilitation medicine. One of the forms of ischemic heart disease (IHD) is an acute coronary syndrome (ACS) in patients presenting without persistent ST-segment, the treatment of which involves the use of conservative treatment and reperfusion techniques. An integral part of the management of patients after acute coronary syndrome is rehabilitation and restoration with the search for methods of changing the attitude of the patient to his health. To improve the rehabilitation of patients it is important to assess the internal picture of health with the formation of the correct attitude of the patient to his health. Aim. To study the peculiarities of the components of the internal picture of health in patients with acute coronary syndrome in patients presenting without persistent ST-segment in the process of treatment and rehabilitation. Materials and methods. There were examined 135 patients with ACS presenting without persistent ST-segment, who were divided into the groups depending on the treatment performed; 60 patients with conservative treatment tactics and 75 patients with the performed PCI. The analysis of the internal picture of health was carried out with the help of methods: hospital scale for the detection of anxiety and depression (HADS); patient health questionnaire (PHQ-9); scale for measuring the level of reactive (situational) and personality anxiety of Spielberg-Hanin; SF-36; indicators of the Seattle Quality of Life Questionnaire for Patients with Angine Pectoris (Seattle Angina Questionnaire - SAQ). Results. The study of the internal picture of health in patients with ACS presenting without persistent ST-segment showed low levels of emotional, sensory, cognitive, value-motivational, behavioral components on the appropriate scales, which also depend on the method of treatment used. The revealed peculiarities of patients with ACS presenting without persistent ST-segment need to increase the knowledge of the patient about the disease and the importance of rehabilitation measures. Conclusions. In assessment of the internal picture of health in patients with ACS presenting without persistent ST-segment after transcutaneous coronary intervention and in the process of rehabilitation, it has been determined that the course of ischemic heart disease in patients with ACS presenting without persistent ST-segment, both during conservative treatment and in the course of PCI at the stages of rehabilitation, is accompanied by significant changes of the internal picture of health (IPH); the most significant changes in patients with ACS presenting without persistent ST-segment is the value-motivational and behavioral components of the internal picture of health. In order to increase the effectiveness of rehabilitation after ACS, it is advisable to apply programs that will significantly affect the positive changes in the rehabilitation of patients with ACS.

Abstract 320: Healthcare Resource Utilization Among Patients with Acute Coronary Syndrome Managed with Percutaneous Coronary Intervention and Using Prasugrel or Ticagrelor: A Retrospective Database Analysis

2014 ◽  
Vol 7 (suppl_1) ◽  
Author(s):  
Cliff Molife ◽  
Mark B Effron ◽  
Mitch DeKoven ◽  
Swapna Karkare ◽  
Feride Frech-Tamas ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Acute Coronary Syndrome ◽  
Resource Utilization ◽  
Healthcare Resource ◽  
Coronary Intervention ◽  
Healthcare Resource Utilization ◽  
P Value ◽  
Post Discharge ◽  
Coronary Syndrome ◽  
Percutaneous Coronary

Objective: To show that prasugrel (pras) was non-inferior to ticagrelor (ticag) in terms of healthcare resource utilization (HCRU) based upon 30- and 90-day all-cause rehospitalization rates among patients (pts) with acute coronary syndrome (ACS) managed with percutaneous coronary intervention (PCI). Methods: This retrospective study used anonymized hospital data from the IMS Patient-Centric Data Warehouse to identify ACS-PCI pts aged ≥18 years with ≥1 in-hospital claim for pras or ticag between 8/1/11-4/30/13. Three cohorts were predefined and analyzed: ACS-PCI (primary cohort), ACS-PCI without prior TIA or stroke (label cohort), and ACS-PCI pts without prior TIA or stroke and if age ≥75 years required evidence of diabetes or prior MI (core cohort). The McNemar’s test was used to evaluate adjusted outcome differences between propensity matched (PM) groups. P-value for non-inferiority (p-NI) test was obtained through a one-sided Z test by comparing log (RR) with log(1.2), a predefined margin. Results: Among 16,098 eligible pts, 13,134 (82%) received pras and 2,964 (18%) received ticag. Compared to ticag pts, pras pts were younger, more likely men, and less likely to have cardiovascular or bleeding risk factors (P<0.05). Of the total population, 1,375 (8.54%) and 2,374 (14.75%) were rehospitalized for any reason within 30 and 90 days post discharge, respectively. After PM adjustment, pras was non-inferior to ticag for 30- and 90-day all-cause rehospitalization rates in all 3 cohorts (p-NI < 0.01). Data are summarized in Table 1. All-cause rehospitalization for the label and core cohorts showed non-inferiority and a significantly lower 90-day rehospitalization rate with pras compared with ticag (Table). Conclusions: All-cause rehospitalizations at 30-and 90-days post discharge in ACS-PCI pts were non-inferior with pras vs. ticag in all 3 cohorts. Pras was associated with significantly lower risk for 90-day all-cause rehospitalizations compared with ticag in the label and core cohorts, which are the majority of pts receiving pras. Although there appears to be inherent bias and unmeasured confounders related to use of pras vs. ticag, these data show reductions in HCRU with pras compared with ticag in the real-world setting at 30- and 90-days post-discharge.

scholarly journals ACUTE CORONARY SYNDROME;

2017 ◽  
Vol 24 (03) ◽  
pp. 409-413
Author(s):  
Naveed Aslam Lashari ◽  
Nadia Irum Lakho ◽  
Sarfaraz Ahmed Memon ◽  
Ayaz Ahmed ◽  
Muhammad Fahad Waseem
Keyword(s):  
Acute Coronary Syndrome ◽  
Chest Pain ◽  
Cross Sectional Study ◽  
P Value ◽  
Cross Sectional ◽  
Coronary Syndrome ◽  
Study Results ◽  
Artery Obstruction ◽  
Conventional Risk Factors ◽  
Typical Chest Pain

Introduction: ACS is defined as the cluster of symptoms arising due to the rapiddrop of blood flow to the heart because of coronary artery obstruction. It is stated that worldwidearound 17 million people die due to cardiovascular diseases of which half of the deaths arereported due to ACS. Chest pain is known to be the most leading factor associated with ACS.Objectives: To determine the frequency of acute coronary syndrome, its types and commoncontributing factors in patients presenting with typical chest pain in a secondary care hospital.Study Design: Cross sectional study. Setting: Medical Unit, PAF Hospital Mushaf Sargodha.Period: October 2013 to March 2014. Methodology: A total of 280 patients of either gender,aged 20 to 80 years presented with typical chest pain with or without conventional risk factorswere included in the study. Results: Majority (68.9%) was males and 31.1% were female. Acutecoronary syndrome was observed in 131(46.8%) patients. Out of these 131 patients, 55% hadNSTEMI, 28.2% had unstable angina and 16.8% had STEMI. A higher proportion of femaleswere found to have ACS as compared to males (75.9% vs 33.7%, P-value<0.0001). Out of131 patients, 40.5% were diabetic, 29.8% were hypertensive 16% were hyperlipidemic, while13.7% were smokers. Conventional risk factors except smoking were observed more in femalesas compared to males. Conclusion: Majority of patients with acute coronary syndrome werefemales and diabetic. NSTEMI was the most common type of ACS. Prevalence of conventionalrisk factors was found more in females with ACS.

Long versus short dual antiplatelet therapy in acute coronary syndrome patients treated with prasugrel or ticagrelor and coronary revascularization: Insights from the RENAMI registry

2019 ◽  
Vol 27 (7) ◽  
pp. 696-705 ◽  
Author(s):  
Fabrizio D'Ascenzo ◽  
Maurizio Bertaina ◽  
Francesco Fioravanti ◽  
Federica Bongiovanni ◽  
Sergio Raposeiras-Roubin ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Acute Coronary Syndrome ◽  
Propensity Score ◽  
Dual Antiplatelet Therapy ◽  
Coronary Intervention ◽  
Cardiovascular Death ◽  
Coronary Syndrome ◽  
Increased Risk ◽  
Percutaneous Coronary

Introduction The benefits of short versus long-term dual antiplatelet therapy (DAPT) based on the third generation P2Y12 antagonists prasugrel or ticagrelor, in patients with acute coronary syndromes treated with percutaneous coronary intervention remain to be clearly defined due to current evidences limited to patients treated with clopidogrel. Methods All acute coronary syndrome patients from the REgistry of New Antiplatelets in patients with Myocardial Infarction (RENAMI) undergoing percutaneous coronary intervention and treated with aspirin, prasugrel or ticagrelor were stratified according to DAPT duration, that is, shorter than 12 months (D1 group), 12 months (D2 group) and longer than 12 months (D3 group). The three groups were compared before and after propensity score matching. Net adverse clinical events (NACEs), defined as a combination of major adverse cardiac events (MACEs) and major bleedings (including therefore all cause death, myocardial infarction and Bleeding Academic Research Consortium (BARC) 3–5 bleeding), were the primary end points, MACEs (a composite of all cause death and myocardial infarction) the secondary one. Single components of NACEs were co-secondary end points, along with BARC 2–5 bleeding, cardiovascular death and stent thrombosis. Results A total of 4424 patients from the RENAMI registry with available data on DAPT duration were included in the model. After propensity score matching, 628 patients from each group were selected. After 20 months of follow up, DAPT for 12 months and DAPT for longer than 12 months significantly reduced the risk of NACE (D1 11.6% vs. D2 6.7% vs. D3 7.2%, p = 0.003) and MACE (10% vs. 6.2% vs. 2.4%, p < 0.001) compared with DAPT for less than 12 months. These differences were driven by a reduced risk of all cause death (7.8% vs. 1.3% vs. 1.6%, p < 0.001), cardiovascular death (5.1% vs. 1.0% vs. 1.2%, p < 0.0001) and recurrent myocardial infarction (8.3% vs. 5.2% vs. 3.5%, p = 0.002). NACEs were lower with longer DAPT despite a higher risk of BARC 2–5 bleedings (4.6% vs. 5.7% vs. 6.2%, p = 0.04) and a trend towards a higher risk of BARC 3–5 bleedings (2.4% vs. 3.3% vs. 3.9%, p = 0.06). These results were not consistent for female patients and those older than 75 years old, due to an increased risk of bleedings which exceeded the reduction in myocardial infarction. Conclusion In unselected real world acute coronary syndrome patients treated with percutaneous coronary intervention, DAPT with prasugrel or ticagrelor prolonged beyond 12 months markedly reduces fatal and non-fatal ischaemic events, offsetting the increased risk deriving from the higher bleeding risk. On the contrary, patients >75 years old and female ones showed a less favourable risk–benefit ratio for longer DAPT due to excess of bleedings.

Is it Possible to Improve Results in the Conservative Treatment Strategy in Patients With Acute Coronary Syndrome?

Kardiologiia ◽  
2016 ◽  
Vol 9_2016 ◽  
pp. 69-74 ◽  
Author(s):  
M.G. Gleser Gleser ◽  
E.I. Astashkin Astashkin ◽  
A.E. Kiseleva Kiseleva ◽  
Keyword(s):  
Acute Coronary Syndrome ◽  
Conservative Treatment ◽  
Treatment Strategy ◽  
Coronary Syndrome

scholarly journals Evaluation of applying chest pain guidelines in coronary care patients on their health outcome

2017 ◽  
Vol 6 (2) ◽  
pp. 99
Author(s):  
Eman Shahin ◽  
Mona Hasan
Keyword(s):  
Health Outcome ◽  
Acute Coronary Syndrome ◽  
Chest Pain ◽  
Nursing Care ◽  
University Hospital ◽  
Respiratory Pattern ◽  
P Value ◽  
Coronary Syndrome ◽  
Study Results ◽  
Coronary Care

Background: the National Heart, Lung, and blood Institute estimate that each year approximately 785,000 Americans will have a new coronary attack and approximately 470,000 will have a recurrent attack. Chest pain is one of the most common symptoms   of coronary artery disease or acute coronary syndrome. Objectives: this study aims to compare between routine nursing care of chest pain and chest pain guidelines in patients with acute coronary syndrome and assess health outcome after application of chest pain guidelines in acute coronary syndrome patients. Method: Quasi experimental research design was used in the current study. The study was conducted at the coronary care unit of Suez canal University Hospital. Sample; consecutive of 70 patients was included in the study.  Four tools were used for study data collection that named the chest pain guidelines evidence based nursing care in patients with angina pectoris, visual analog scale to assess chest pain, dyspnea scale to assess breathing pattern and fourth one was lab investigation to assess patient health prognosis. Results: The study results revealed an improvement of patients’ health outcome represented in a significant reduction in complain of chest pain, blood pressure and insufficient sleeping with P-value of 0.000 after applying guidelines of care regarding chest pain. Additionally, the respiratory pattern and respiratory rate improved significantly with P-value of 0.000. Moreover, lab investigation showed significantly decrease in LHD level with P-value of 0.000. Conclusion: The current study concluded that application of chest pain guidelines intervention could be improved patients health outcomes.        

scholarly journals The 1-Year Safety and Efficacy Outcomes of Magmaris, Novel Magnesium Bioresorbable Vascular Scaffolds in Diabetes Mellitus Patients with Acute Coronary Syndrome

2021 ◽  
Vol 10 (14) ◽  
pp. 3166
Author(s):  
Adrian Włodarczak ◽  
Magdalena Łanocha ◽  
Marek Szudrowicz ◽  
Mateusz Barycki ◽  
Alicja Gosiewska ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Acute Coronary Syndrome ◽  
Coronary Intervention ◽  
Cardiovascular Death ◽  
Target Lesion ◽  
Bioresorbable Scaffold ◽  
Coronary Syndrome ◽  
Increased Risk ◽  
Coronary Syndromes ◽  
Target Lesion Failure

Background: Diabetes mellitus (DM) is one of the major risk factors contributing to Acute Coronary Syndromes (ACS) and is associated with an increased risk of adverse clinical outcomes following percutaneous coronary intervention (PCI), even when the second generation of drug-eluting stents (DES) is used. In order to overcome the disadvantages of permanent caging of a vessel with metallic DES, bioresorbable scaffold (BRS) technology has been recently developed. However, the prognosis of patients with DM and ACS treated with PCI via subsequent implantation of Magmaris (Biotronik, Berlin, Germany)—a novel magnesium-bioresorbable scaffold—is poorly investigated. Methods: A total of 193 consecutive subjects with non-ST elevation acute coronary syndrome (NSTE-ACS) who, from October 2016 to March 2020, received one or more Magmaris scaffolds were enrolled in this study. The diabetic group was compared with non-diabetic subjects. Results: There were no significant differences in the occurrence of primary endpoints (cardiovascular death, myocardial infarction, and in-stent thrombosis) and principal secondary endpoints (target-lesion failure, scaffold restenosis, death from any reason, and other cardiovascular events) between the two compared groups in a 1-year follow-up period. Conclusions: The early 1-year-outcome of magnesium bioresorbable scaffold (Magmaris) seems to be favorable and suggests that this novel BRS is safe and effective in subjects with NSTE-ACS and co-existing DM.

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