Triple Therapy: Triple Safety or Triple Danger?
We read the report by Zinn and Feit with great interest. We learned from the article by Zinn and Feit to individualize care and tailor therapy according to the risk for bleeding but also to ischemic and embolic complications. Zinn and Feit state that all data were retrospective and that most came from single-center series. A randomized trial with head-to-head assessment of differing antithrombotic regimens is needed. Zinn and Feit state that there are no randomized trials prospectively addressing a comparison of triple therapy and dual-antiplatelet therapy to guide clinical decision making. In patients with indication for long-term oral anticoagulation (OAC) who need to undergo percutaneous coronary intervention, there are theoretically 4 possibilities: the combinations of aspirin plus clo......
POSTED 02/05/2010 at 07:55 AM --
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Predictive Value of ST Resolution Analysis Performed Immediately Versus at Ninety Minutes After Primary Percutaneous Coronary Intervention
ST segment resolution (STR) predicts epicardial and microvascular reperfusion after primary percutaneous coronary intervention (PPCI) or thrombolysis for ST-elevation myocardial infarction. Immediate restoration of epicardial coronary flow, with improved microvascular perfusion, is much more likely with PPCI. However, the predictive value of immediate STR compared to 90 minutes after PPCI remains unknown. In 622 consecutive patients with ST-elevation myocardial infarction (mean age 59 ± 13 years), 217 had complete STR immediately after PPCI (group A), 188 had complete STR only at 90 minutes (group B), and 217 had incomplete STR at either point (group C). The primary end point was mortality and adverse cardiovascular events ([MACE] death, nonfatal repeat myocardial infarction, and heart fa......
POSTED 02/05/2010 at 07:55 AM --
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Patient radiation doses in the most common interventional cardiology procedures in Croatia: first results
Apart from its benefits, the interventional cardiology (IC) is known to generate high radiation doses to patients and medical staff involved. The European Union Medical Exposures Directive 97/43/Euroatom strongly recommend patient dosimetry in interventional radiology, including IC. IC patient radiation doses in four representative IC rooms in Croatia were investigated. Setting reference levels for these procedures have difficulties due to the large difference in procedure complexity. Nevertheless, it is important that some guideline values are available as a benchmark to guide the operators during these potentially high-dose procedures. Local and national diagnostic reference levels (DRLs) were proposed as a guidance. A total of 138 diagnostic (coronary angiography, CA) and 151 therapeuti......
POSTED 02/05/2010 at 06:52 AM --
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Review Article: Examining Treatment of ST-Elevation Myocardial Infarction: The Importance of Early Intervention
Early reperfusion in ST-segment elevation myocardial infarction (STEMI) is imperative. Acute reperfusion may be achieved with fibrinolytic agents and/or percutaneous coronary intervention (PCI); however, PCI is associated with lower rates of death and myocardial infarction compared with fibrinolysis. As treatment delays are associated with worse outcomes, current guidelines recommend minimizing time from symptom onset to treatment initiation. Regardless of the reperfusion strategy, patients with STEMI are at increased risk of early recurrent ischemic events and death. These risks can be significantly reduced by promptly initiating a combination of pharmacotherapies that includes antiplatelet and anticoagulant agents, β-blockers, and inhibitors of the renin-angiotensin-aldosterone syst......
POSTED 02/04/2010 at 05:55 PM --
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Novel Polymeric Coatings with the Potential to Control In-stent Restenosis -- An In Vitro Study
This study evaluates the influence of polymer coatings on human aortic endothelial cells (HAEC) and coronary artery smooth muscle cells (HCASMC) in vitro, in terms of morphology, cell number, and phenotype. It was demonstrated that the polymer coatings can be tailored to enhance adhesion and growth of HAECs whilst suppressing that of HCASMCs. It is concluded that one of the polymer coatings (BTL 01015) shows potential as a stent coating to enhance re-endothelialization. (Source: Journal of Biomaterials Applications)...
POSTED 02/04/2010 at 11:00 AM --
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Infarct size and left ventricular function in the PRoximal Embolic Protection in Acute myocardial infarction and Resolution of ST-segment Elevation (PREPARE) trial: ancillary cardiovascular magnetic resonance study
Conclusions
Primary PCI with combined proximal embolic protection and thrombus aspiration in STEMI patients did not result in significant differences in final infarct size or left ventricular function at follow-up CMR. In addition, there was no difference in the incidence of major adverse cardiac and cerebral events at 6 months.
Trial registration number
ISRCTN71104460. (Source: Heart)...
POSTED 02/04/2010 at 09:44 AM --
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Correction
In the article by Kushner FG, Hand M, Smith SC, et al., “2009 Focused Updates: ACC/AHA Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction (Updating the 2004 Guideline and 2007 Focused Update) and ACC/AHA/SCAI Guidelines on Percutaneous Coronary Intervention (Updating the 2005 Guideline and 2007 Focused Update): A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines,” which published ahead of print on November 18, 2009, and appeared in the December 1, 2009, issue of the journal (J Am Coll Cardiol 2009;54:2205–41), the following correction is needed to Appendix 4: (Source: Journal of the American College of Cardiology)...
POSTED 02/04/2010 at 07:51 AM --
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Hemodynamics, Disease Extent Affect Thrombosis Risk for PCI During ACS
When percutaneous coronary intervention (PCI) is done during acute coronary syndrome (ACS), hemodynamic instability and multivessel coronary disease increase the risk of early stent thrombosis, Israeli researchers report in the January issue of the American Heart Journal. Reuters Health Information (Source: Medscape Medical News Headlines)...
POSTED 02/03/2010 at 10:59 AM --
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Prevention of Contrast-induced Nephropathy: A Single Center Randomized Study
Contrast-induced nephropathy (CIN) is the third cause of acute deterioration of renal function in hospitalized patients.The purpose of the study was to compare the efficacy of saline infusion, saline infusion plus N-acetylcysteine (NAC), and sodium bicarbonate (SB) infusion to prevent CIN in patients undergoing coronary angiography and/or percutaneous coronary intervention.We prospectively studied 156 patients with a baseline creatinine level [ge] 1.2 mg/dL. The primary endpoint was the development of CIN, defined as an increase in serum creatinine concentration [ge] 25% over the baseline value within 5 days from contrast exposure.Contrast-induced nephropathy developed in 23 patients (14.7%). Incidence of the primary endpoint was similar in the 3 groups of treatment, occurring in 7 patient......
POSTED 02/01/2010 at 06:00 PM --
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Impact of genetic variation on cardiovascular outcomes in clopidogrel-treated patients with PCI
Source: Circulation
Area: News
Recent research has suggested that the CYP2C19*17 allelic variant is associated with increased transcriptional activity, leading to extensive metabolisation of CYP2C19 substrates, which may lead to an enhanced platelet response to clopidogrel treatment. To investigate this further, this study assessed the impact of CYP2C19*17 on ADP-induced platelet aggregation, the risk of bleeding, and stent thrombosis in clopidogrel-treated patients undergoing percutaneous coronary intervention (PCI).
Study investigators enrolled 1524 patients undergoing PCI after pre-treatment with a loading dose of 600 mg clopidogrel. The primary safety end point was the 30-day incidence of bleeding defined according to Thrombolysis in Myocardial Infarction (TIMI) criteria, a......
POSTED 02/01/2010 at 06:00 PM --
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Clopidogrel non-responsiveness and risk of cardiovascular morbidity. An updated meta-analysis.
Authors: Sofi F, Marcucci R, Gori AM, Giusti B, Abbate R, Gensini GF
We performed this meta-analysis to update the clinical evidences on the relation between clopidogrel non-responsiveness and clinical outcomes in patients with coronary artery disease (CAD) who underwent percutaneous coronary intervention. An electronic literature search through MEDLINE, EMBASE, Web of Science, and the Cochrane Library and bibliographies of retrieved articles up to January, 2009 was conducted. Studies were included if they had a cohort prospective design, if they analysed clopidogrel responsiveness in CAD patients in relation to death and/or occurrence of adverse coronary events during follow-up, and if they reported an adequate statistical analysis. Fourteen studies, totalling 4,564 CAD patients follo......
POSTED 02/01/2010 at 06:00 PM --
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No Rebound Seen After Antiplatelet Withdrawal (CME/CE)
No evidence of a platelet aggregation rebound occurs with abrupt discontinuation of clopidogrel (Plavix) in patients undergoing percutaneous coronary intervention (PCI), investigators in a randomized clinical trial concluded. (Source: MedPage Today Cardiovascular)...
POSTED 02/01/2010 at 06:43 AM --
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Letter to the Editor
Blankenship et al report that ST-elevation myocardial infarction patients may be enrolled in clinical trials with no significant delay in door-to-balloon time. Specifically, the authors estimate an 11-minute trial enrollment–associated delay for patients presenting directly to a primary percutaneous coronary intervention (PCI) center and a 4-minute delay among patients arriving via interhospital transfer. The authors find these differences to be statistically nonsignificant and thus infer that “enrollment can be accomplished without significantly delaying therapy” for patients undergoing primary PCI. We respectfully disagree. (Source: American Heart Journal)...
POSTED 01/31/2010 at 06:00 PM --
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Delivery of Glycoprotein IIb/IIIa Inhibitor Therapy for Percutaneous Coronary Intervention. Why Not Take the Intracoronary Highway?
Authors: Gurbel PA, Tantry US
PMID: 20124130 [PubMed - as supplied by publisher] (Source: Circulation)...
POSTED 01/31/2010 at 06:00 PM --
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Intracoronary Eptifibatide Bolus Administration During Percutaneous Coronary Revascularization for Acute Coronary Syndromes With Evaluation of Platelet Glycoprotein IIb/IIIa Receptor Occupancy and Platelet Function. The Intracoronary Eptifibatide (ICE) Trial.
Conclusions-Intracoronary bolus administration of eptifibatide during PCI in patients with acute coronary syndromes results in higher local platelet glycoprotein IIb/IIIa receptor occupancy, which is associated with improved microvascular perfusion demonstrated by an improved cTFC.
PMID: 20124127 [PubMed - as supplied by publisher] (Source: Circulation)...
POSTED 01/31/2010 at 06:00 PM --
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Low adiponectin blood concentration predicts left ventricular remodeling after ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention.
CONCLUSIONS: Baseline low blood adiponectin concentration, along with WMSI, can be considered as a predictor of the LVR in male patients one year after myocardial infarction and pPCI.
PMID: 20104457 [PubMed - in process] (Source: Cardiology Journal)...
POSTED 01/30/2010 at 12:48 AM --
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Duration of clopidogrel treatment and risk of mortality and recurrent myocardial infarction among 11 680 patients with myocardial infarction treated with percutaneous coronary intervention: a cohort study
Conclusions:
We found comparable rates of death and recurrent MI in patients treated with 6- and 12-months' clopidogrel. The potential benefit of prolonged clopidogrel treatment in a real-life setting remains uncertain. (Source: BMC Cardiovascular Disorders)...
POSTED 01/28/2010 at 06:00 PM --
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[Correspondence] HORIZONS-AMI
The 12-month results of HORIZONS-AMI (Oct 3, p 1149) show that, in patients with ST-segment-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI), anticoagulation with bivalirudin reduced net adverse clinical events and major bleeding at 1 year compared with heparin plus a glycoprotein IIb/IIIa inhibitor. The difference, evident almost immediately after the procedure, was due to reduced bleeding with bivalirudin. Very early, but not 12-month, stent thrombosis was increased in the bivalirudin group. Of interest, major adverse cardiac events were lower in those given a 600 mg clopidogrel loading dose than in those given 300 mg, irrespective of antithrombin treatment. (Source: LANCET)...
POSTED 01/28/2010 at 06:00 PM --
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Balancing the benefits and risks of antiplatelet agents in patients with non-ST-segment elevated acute coronary syndromes and undergoing percutaneous coronary intervention
Abstract Selecting appropriate antiplatelet therapy requires close attention to the delicate balance between reducing risk of ischemic
events while minimizing bleeding risk. The broad range of available agents, while permitting tailoring of pharmacotherapy
to individual patients, also complicates selection of optimal regimens. Platelet physiology provides an underpinning for the
rationale behind pharmacotherapeutic strategies for patients with non-ST-segment elevated acute coronary syndromes (NSTE ACS)
undergoing percutaneous coronary intervention (PCI). The same mechanisms of action that confer anti-ischemic benefit with
antiplatelet agents may also be associated with increased risk. In the context of ACS and PCI, antiplatelet agents are used
in complex strategies and com......
POSTED 01/28/2010 at 12:01 PM --
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Timing of PCI clopidogrel does not affect bleeding outcomes
Treatment with a high dose of clopidogrel immediately before or after percutaneous coronary intervention results in short-term ischemic outcomes and long-term mortality similar to those of patients who receive clopidogrel according to the current guidelines, research shows. (Source: MedWire News - Thrombosis)...
POSTED 01/27/2010 at 09:44 AM --
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