1201
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Costa F, Adamo M, Ariotti S, Ferrante G, Navarese EP, Leonardi S, Garcia-Garcia H, Vranckx P, Valgimigli M. Left main or proximal left anterior descending coronary artery disease location identifies high-risk patients deriving potentially greater benefit from prolonged dual antiplatelet therapy duration. EUROINTERVENTION 2016; 11:e1222-30. [DOI: 10.4244/eijy15m08_04] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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1202
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Han Y, Xu B, Xu K, Guan C, Jing Q, Zheng Q, Li X, Zhao X, Wang H, Zhao X, Li X, Yu P, Zang H, Wang Z, Cao X, Zhang J, Pang W, Li J, Yang Y, Dangas GD. Six Versus 12 Months of Dual Antiplatelet Therapy After Implantation of Biodegradable Polymer Sirolimus-Eluting Stent. Circ Cardiovasc Interv 2016; 9:e003145. [PMID: 26858080 DOI: 10.1161/circinterventions.115.003145] [Citation(s) in RCA: 111] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
There are no reports on a large-scale randomized trial exploring optimal dual antiplatelet therapy (DAPT) duration after biodegradable polymer sirolimus-eluting stent implantation. We sought to report the outcomes of a randomized substudy of the prospective Evaluate Safety and Effectiveness of the Tivoli DES and the Firebird DES for Treatment of Coronary Revascularization (I-LOVE-IT 2) trial.
Methods and Results—
In the prospective noninferiority randomized I-LOVE-IT 2 trial, 1829 patients allocated to the biodegradable polymer sirolimus-eluting stent group were also randomized to receive either 6-month (n=909) or 12-month DAPT (n=920). The primary end points of this noninferiority substudy were 12-month target lesion failure (composite of cardiac death, target vessel myocardial infarction or clinically indicated target lesion revascularization), and the major secondary end points were 12-month net adverse clinical and cerebral events (composite of all-cause death, all myocardial infarction, stroke, or major bleeding [Bleeding Academic Research Consortium type ≥3]). The 12-month target lesion failure in 6-month DAPT group was comparable with the 12-month DAPT group (6.8% versus 5.9%; difference and 95% confidence interval, 0.87% [−1.37% to 3.11%],
P
for noninferiority=0.0065). Further follow-up at 18 months showed that incidence of target lesion failure and net adverse clinical and cerebral events were similar between the 2 groups (7.5% versus 6.3%, log-rank
P
=0.32; 7.8% versus 7.3%, log-rank
P
=0.60; respectively), as well as their individual end point components.
Conclusions—
This study indicated noninferiority in safety and efficacy of 6-month versus 12-month DAPT after implantation of a novel biodegradable polymer sirolimus-eluting stent.
Clinical Trial Registration—
URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT01681381.
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Affiliation(s)
- Yaling Han
- From the Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, China (Y.H., K.X., Q.J., J.L.); Catheterization Laboratory, Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China (B.X., C.G.); Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China (Y.Y.); Department of Cardiology, Affiliated Tangdu Hospital of the Fourth Military Medical University, Xi’an, China (Q.Z.); Department of Cardiology, Fourth
| | - Bo Xu
- From the Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, China (Y.H., K.X., Q.J., J.L.); Catheterization Laboratory, Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China (B.X., C.G.); Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China (Y.Y.); Department of Cardiology, Affiliated Tangdu Hospital of the Fourth Military Medical University, Xi’an, China (Q.Z.); Department of Cardiology, Fourth
| | - Kai Xu
- From the Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, China (Y.H., K.X., Q.J., J.L.); Catheterization Laboratory, Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China (B.X., C.G.); Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China (Y.Y.); Department of Cardiology, Affiliated Tangdu Hospital of the Fourth Military Medical University, Xi’an, China (Q.Z.); Department of Cardiology, Fourth
| | - Changdong Guan
- From the Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, China (Y.H., K.X., Q.J., J.L.); Catheterization Laboratory, Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China (B.X., C.G.); Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China (Y.Y.); Department of Cardiology, Affiliated Tangdu Hospital of the Fourth Military Medical University, Xi’an, China (Q.Z.); Department of Cardiology, Fourth
| | - Quanmin Jing
- From the Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, China (Y.H., K.X., Q.J., J.L.); Catheterization Laboratory, Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China (B.X., C.G.); Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China (Y.Y.); Department of Cardiology, Affiliated Tangdu Hospital of the Fourth Military Medical University, Xi’an, China (Q.Z.); Department of Cardiology, Fourth
| | - Qiangsun Zheng
- From the Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, China (Y.H., K.X., Q.J., J.L.); Catheterization Laboratory, Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China (B.X., C.G.); Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China (Y.Y.); Department of Cardiology, Affiliated Tangdu Hospital of the Fourth Military Medical University, Xi’an, China (Q.Z.); Department of Cardiology, Fourth
| | - Xueqi Li
- From the Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, China (Y.H., K.X., Q.J., J.L.); Catheterization Laboratory, Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China (B.X., C.G.); Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China (Y.Y.); Department of Cardiology, Affiliated Tangdu Hospital of the Fourth Military Medical University, Xi’an, China (Q.Z.); Department of Cardiology, Fourth
| | - Xianxian Zhao
- From the Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, China (Y.H., K.X., Q.J., J.L.); Catheterization Laboratory, Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China (B.X., C.G.); Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China (Y.Y.); Department of Cardiology, Affiliated Tangdu Hospital of the Fourth Military Medical University, Xi’an, China (Q.Z.); Department of Cardiology, Fourth
| | - Haichang Wang
- From the Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, China (Y.H., K.X., Q.J., J.L.); Catheterization Laboratory, Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China (B.X., C.G.); Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China (Y.Y.); Department of Cardiology, Affiliated Tangdu Hospital of the Fourth Military Medical University, Xi’an, China (Q.Z.); Department of Cardiology, Fourth
| | - Xuezhong Zhao
- From the Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, China (Y.H., K.X., Q.J., J.L.); Catheterization Laboratory, Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China (B.X., C.G.); Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China (Y.Y.); Department of Cardiology, Affiliated Tangdu Hospital of the Fourth Military Medical University, Xi’an, China (Q.Z.); Department of Cardiology, Fourth
| | - Xiaoyan Li
- From the Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, China (Y.H., K.X., Q.J., J.L.); Catheterization Laboratory, Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China (B.X., C.G.); Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China (Y.Y.); Department of Cardiology, Affiliated Tangdu Hospital of the Fourth Military Medical University, Xi’an, China (Q.Z.); Department of Cardiology, Fourth
| | - Pengfei Yu
- From the Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, China (Y.H., K.X., Q.J., J.L.); Catheterization Laboratory, Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China (B.X., C.G.); Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China (Y.Y.); Department of Cardiology, Affiliated Tangdu Hospital of the Fourth Military Medical University, Xi’an, China (Q.Z.); Department of Cardiology, Fourth
| | - Hongyun Zang
- From the Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, China (Y.H., K.X., Q.J., J.L.); Catheterization Laboratory, Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China (B.X., C.G.); Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China (Y.Y.); Department of Cardiology, Affiliated Tangdu Hospital of the Fourth Military Medical University, Xi’an, China (Q.Z.); Department of Cardiology, Fourth
| | - Zhifang Wang
- From the Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, China (Y.H., K.X., Q.J., J.L.); Catheterization Laboratory, Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China (B.X., C.G.); Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China (Y.Y.); Department of Cardiology, Affiliated Tangdu Hospital of the Fourth Military Medical University, Xi’an, China (Q.Z.); Department of Cardiology, Fourth
| | - Xuebin Cao
- From the Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, China (Y.H., K.X., Q.J., J.L.); Catheterization Laboratory, Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China (B.X., C.G.); Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China (Y.Y.); Department of Cardiology, Affiliated Tangdu Hospital of the Fourth Military Medical University, Xi’an, China (Q.Z.); Department of Cardiology, Fourth
| | - Jun Zhang
- From the Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, China (Y.H., K.X., Q.J., J.L.); Catheterization Laboratory, Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China (B.X., C.G.); Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China (Y.Y.); Department of Cardiology, Affiliated Tangdu Hospital of the Fourth Military Medical University, Xi’an, China (Q.Z.); Department of Cardiology, Fourth
| | - Wenyue Pang
- From the Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, China (Y.H., K.X., Q.J., J.L.); Catheterization Laboratory, Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China (B.X., C.G.); Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China (Y.Y.); Department of Cardiology, Affiliated Tangdu Hospital of the Fourth Military Medical University, Xi’an, China (Q.Z.); Department of Cardiology, Fourth
| | - Jing Li
- From the Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, China (Y.H., K.X., Q.J., J.L.); Catheterization Laboratory, Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China (B.X., C.G.); Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China (Y.Y.); Department of Cardiology, Affiliated Tangdu Hospital of the Fourth Military Medical University, Xi’an, China (Q.Z.); Department of Cardiology, Fourth
| | - Yuejin Yang
- From the Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, China (Y.H., K.X., Q.J., J.L.); Catheterization Laboratory, Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China (B.X., C.G.); Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China (Y.Y.); Department of Cardiology, Affiliated Tangdu Hospital of the Fourth Military Medical University, Xi’an, China (Q.Z.); Department of Cardiology, Fourth
| | - George D. Dangas
- From the Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, China (Y.H., K.X., Q.J., J.L.); Catheterization Laboratory, Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China (B.X., C.G.); Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China (Y.Y.); Department of Cardiology, Affiliated Tangdu Hospital of the Fourth Military Medical University, Xi’an, China (Q.Z.); Department of Cardiology, Fourth
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1203
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Li Q, Ren X, Yu X, He J, Gao Y, Zhang X, Wu C, Luo Y, Zhang Y, Chen F. The Importance of the Mean Platelet Aggregation Degree in Long-term Dual Antiplatelet Therapy Following Drug-Eluting Stent Implantation. Cardiovasc Ther 2016; 34:127-37. [PMID: 26826703 DOI: 10.1111/1755-5922.12177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION The dual antiplatelet therapy (DAPT) and the response of clopidogrel were two pivotal issues in drug-eluting stent (DES) era. AIMS To analyze the combined impacts of DAPT and the response to clopidogrel to evaluate their long-term effect on patients undergoing DES implantation. METHODS Platelet aggregation was serially measured by light transmission aggregometry in all eligible patients during the course of treatment with DAPT, and the mean platelet aggregation degree of each participant was calculated. Based on the duration of DAPT and the mean platelet aggregation degree, all the enrolled patients were then divided into four groups. The primary endpoint was a composite of major adverse cardiovascular events. RESULTS We analyzed 1245 suitable patients in this study. They were divided into four groups: Group A (12-month DAPT & low platelet aggregation degree) with 233 subjects, Group B (12-month DAPT & high platelet aggregation degree) with 260 subjects, Group C (>12-month DAPT & low platelet aggregation degree) with 374 subjects, and Group D (>12-month DAPT & high platelet aggregation degree) with 378 subjects. Group C was associated with a decreased incidence of primary endpoints [HR 0.512, 95%CI (0.27-0.97); P = 0.040]. The Cox proportional hazard model was further analyzed with Groups A and B combined as the reference category [HR for Group C vs. Group A, 0.84, 95%CI (0.33-2.15); P = 0.719; HR for Group C vs. Group B, 0.45, 95%CI (0.21-0.98); P = 0.043]. Their respective multivariate Cox proportional hazard regressions confirmed these trends. CONCLUSIONS The mean platelet aggregation degree is of importance in long-term use of DAPT; extension of DAPT beyond 1 year should be implemented cautiously in patients implanted with DESs.
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Affiliation(s)
- Quan Li
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing, China
| | - Xuejun Ren
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing, China
| | - Xianpeng Yu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing, China
| | - Jiqiang He
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing, China
| | - Yuechun Gao
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing, China
| | - Xiaoling Zhang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing, China
| | - Changyan Wu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing, China
| | - Yawei Luo
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing, China
| | - Yuchen Zhang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing, China
| | - Fang Chen
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing, China
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1204
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What is the appropriate duration of dual antiplatelet therapy? JAAPA 2016; 29:16-9. [PMID: 26818642 DOI: 10.1097/01.jaa.0000476219.65432.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Healthcare providers often are faced with the challenge of determining an appropriate length of dual antiplatelet therapy (DAPT) for patients who have had percutaneous coronary intervention and stent placement. This is an especially challenging clinical decision for patients with drug-eluting stents, as several studies show different results when assessing risk and benefit.
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1205
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Abstract
Antiplatelet agents are recommended for the reduction of major adverse cardiovascular events among all patients with symptomatic peripheral artery disease. However, the optimal antiplatelet regimen and duration of therapy in peripheral artery disease (PAD) remains unclear, largely due to limited and conflicting data in this patient population. This article reviews current data on antithrombotic therapy in PAD and discusses the implications of this data for current practice and future research.
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Affiliation(s)
- T Raymond Foley
- VA Eastern Colorado Healthcare System and Division of Cardiology, University of Colorado, Denver, CO, USA
| | - Stephen W Waldo
- VA Eastern Colorado Healthcare System and Division of Cardiology, University of Colorado, Denver, CO, USA
| | - Ehrin J Armstrong
- VA Eastern Colorado Healthcare System and Division of Cardiology, University of Colorado, Denver, CO, USA
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1206
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1207
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Généreux P, Redfors B, Witzenbichler B, Maehara A, Yadav M, Weisz G, Francese DP, Parvataneni R, Brener SJ, Mehran R, Kirtane AJ, Stone GW. Angiographic predictors of 2-year stent thrombosis in patients receiving drug-eluting stents: Insights from the ADAPT-DES study. Catheter Cardiovasc Interv 2016; 89:26-35. [DOI: 10.1002/ccd.26409] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 12/26/2015] [Indexed: 12/25/2022]
Affiliation(s)
- Philippe Généreux
- Cardiovascular Research Foundation; New York New York
- New York-Presbyterian Hospital/Columbia University Medical Center; New York New York
- Hôpital Du Sacré-Coeur De Montréal, Université De Montréal; Montréal, Québec Canada
| | - Björn Redfors
- Cardiovascular Research Foundation; New York New York
- Sahlgrenska University Hospital; Gothenburg Sweden
| | | | - Akiko Maehara
- Cardiovascular Research Foundation; New York New York
- New York-Presbyterian Hospital/Columbia University Medical Center; New York New York
| | - Mayank Yadav
- Cardiovascular Research Foundation; New York New York
| | - Giora Weisz
- Cardiovascular Research Foundation; New York New York
- New York-Presbyterian Hospital/Columbia University Medical Center; New York New York
- Shaare Zedek Medical Center; Jerusalem Israel
| | | | | | | | - Roxana Mehran
- Cardiovascular Research Foundation; New York New York
- Icahn School of Medicine at Mount Sinai; New York New York
| | - Ajay J. Kirtane
- Cardiovascular Research Foundation; New York New York
- New York-Presbyterian Hospital/Columbia University Medical Center; New York New York
| | - Gregg W. Stone
- Cardiovascular Research Foundation; New York New York
- New York-Presbyterian Hospital/Columbia University Medical Center; New York New York
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1208
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Bossard M, Jeger R. Prolonged dual antiplatelet therapy in renal failure: a challenging trade-off. J Thorac Dis 2016; 7:E625-8. [PMID: 26793376 DOI: 10.3978/j.issn.2072-1439.2015.12.44] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Matthias Bossard
- 1 Division of Cardiology, Hamilton General Hospital, Hamilton Health Sciences, McMaster University, Hamilton, ON L8L 2X2, Canada ; 2 Population Health Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, McMaster University, Hamilton, ON L8L 2X2, Canada ; 3 Cardiology Division, Department of Medicine, University Hospital Basel, Basel, Switzerland ; 4 Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Raban Jeger
- 1 Division of Cardiology, Hamilton General Hospital, Hamilton Health Sciences, McMaster University, Hamilton, ON L8L 2X2, Canada ; 2 Population Health Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, McMaster University, Hamilton, ON L8L 2X2, Canada ; 3 Cardiology Division, Department of Medicine, University Hospital Basel, Basel, Switzerland ; 4 Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
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1209
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Capodanno D. Long-term EXAMINATION of drug-eluting stents in acute myocardial infarction. Lancet 2016; 387:316-318. [PMID: 26520232 DOI: 10.1016/s0140-6736(15)00677-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Davide Capodanno
- Cardio-Thoracic-Vascular Department, Ferrarotto Hospital, University of Catania, Catania 95124, Italy.
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1210
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Lemesle G, Schurtz G, Meurice T, Tricot O, Lemaire N, Caudmont S, Philias A, Ketelers R, Lamblin N, Bauters C. Clopidogrel Use as Single Antiplatelet Therapy in Outpatients with Stable Coronary Artery Disease: Prevalence, Correlates and Association with Prognosis (from the CORONOR Study). Cardiology 2016; 134:11-8. [DOI: 10.1159/000442706] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 11/23/2015] [Indexed: 11/19/2022]
Abstract
Background: Clopidogrel use as single antiplatelet therapy (SAPT) has never been evaluated in stable coronary artery disease (CAD) outpatients either as compared to placebo or aspirin. Methods: We therefore studied 2,823 outpatients included in a prospective registry. The patients were divided into 2 groups according to their antiplatelet therapy regimen: patients treated with clopidogrel were compared with those treated with aspirin alone. Results: The mean time since CAD diagnosis was 7.9 years. Altogether, 776 (27.5%) patients received clopidogrel as SAPT. Factors independently associated with clopidogrel use were prior aortic or peripheral intervention, drug-eluting stent implantation, stroke, carotid endarterectomy and time since CAD diagnosis. Clopidogrel tended to be used in higher-risk patients: composite of cardiovascular death, myocardial infarction or stroke at 5.8 versus 4.2% (p = 0.056). However, after propensity score matching, similar event rates were observed between the groups: 5.9% when treated with clopidogrel versus 4.4% with aspirin (p = 0.207). The rate of bleeding was also similar between the groups. Conclusions: Our study shows that a significant proportion of stable CAD patients are treated with clopidogrel as SAPT in modern practice. Several correlates of such an attitude were identified. Our results suggest that this strategy is not beneficial as compared to aspirin alone in terms of ischaemic or bleeding events.
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1211
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Optimal duration of dual antiplatelet therapy after drug-eluting stent implantation: conceptual evolution based on emerging evidence. Eur Heart J 2016; 37:353-64. [DOI: 10.1093/eurheartj/ehv712] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
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1212
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Lüscher TF. The search for optimal dual antiplatelet therapy after PCI: fine-tuning of initiation and duration. Eur Heart J 2016; 37:319-21. [DOI: 10.1093/eurheartj/ehv769] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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1213
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Parker WAE, Storey RF. Choosing a perspective on mortality with DAPT. Eur Heart J 2016; 37:386-9. [PMID: 26685135 DOI: 10.1093/eurheartj/ehv610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- William A E Parker
- Department of Cardiovascular Science, University of Sheffield, Sheffield, UK
| | - Robert F Storey
- Department of Cardiovascular Science, University of Sheffield, Sheffield, UK
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1214
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Ariotti S, Gargiulo G, Windecker S, Valgimigli M. Time for science to catch up with clinical practice? J Thorac Dis 2016; 7:E603-6. [PMID: 26793370 DOI: 10.3978/j.issn.2072-1439.2015.12.26] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Sara Ariotti
- 1 Department of Cardiology, Bern University Hospital, Bern, Switzerland ; 2 Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Giuseppe Gargiulo
- 1 Department of Cardiology, Bern University Hospital, Bern, Switzerland ; 2 Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Stephan Windecker
- 1 Department of Cardiology, Bern University Hospital, Bern, Switzerland ; 2 Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Marco Valgimigli
- 1 Department of Cardiology, Bern University Hospital, Bern, Switzerland ; 2 Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
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1215
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Alfredsson J, Roe MT. Risks and benefits of triple oral anti-thrombotic therapies after acute coronary syndromes and percutaneous coronary intervention. Drug Saf 2016; 38:481-91. [PMID: 25829216 DOI: 10.1007/s40264-015-0286-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The key pathophysiological process underlying symptomatic coronary artery disease, including acute coronary syndromes (ACS), is usually a rupture or an erosion of an atherosclerotic plaque, followed by platelet activation and subsequent thrombus formation. Early clinical trials showed benefit with long-term aspirin treatment, and later-based on large clinical trials-dual anti-platelet therapy (DAPT), initially with clopidogrel, and more recently with prasugrel or ticagrelor, has become the established treatment in the post-ACS setting and after percutaneous coronary intervention (PCI). Treatment with DAPT is recommended for both ST-elevation myocardial infarction and non-ST-elevation ACS, as well as after PCI with stenting, in American and European clinical guidelines. Notwithstanding the benefits observed with DAPT, including third-generation P2Y12 receptor inhibitors plus aspirin, ACS patients remain at high risk for a recurrent cardiovascular event, suggesting that other treatment strategies, including the addition of a third oral anti-platelet agent or a novel oral anticoagulant (NOAC) to standard DAPT regimens, may provide additional benefit for post-ACS patients and for patients undergoing PCI. Adding a third anti-thrombotic agent to DAPT after an ACS event or a PCI procedure has been shown to have modest benefit in terms of ischemic event reduction, but has consistently been associated with increased bleeding complications. Therefore, the quest to optimize anti-thrombotic therapies post-ACS and post-PCI continues unabated but is tempered by the historical experiences to date that indicate that careful patient and dose selection will be critical features of future randomized trials.
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Affiliation(s)
- Joakim Alfredsson
- Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden,
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1216
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Zeymer U. Coronary intervention in 2015: Improvement of long-term outcomes after PCI. Nat Rev Cardiol 2016; 13:69-70. [PMID: 26763540 DOI: 10.1038/nrcardio.2015.204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Uwe Zeymer
- Klinikum Ludwigshafen and the Institut für Herzinfarktforschung Ludwigshafen, Bremser Strasse 79, 67063 Ludwigshafen, Germany
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1217
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Affiliation(s)
- Hidehira Fukaya
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
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1218
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1219
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Abstract
Ischemic heart disease is the major isolated cause of death worldwide, responsible for 7,249,000 deaths in 2008, 12.7% of deaths from any causes. The inhibition of platelet activation and aggregation is an important therapeutic target. Cyclooxygenase inhibitors and thienopyridines are currently the 2 most used pharmacological classes, but novel antiplatelet agents have currently an important role. The most recent thienopyridine, prasugrel, allows an irreversible inhibition of the P2Y12 platelet receptor associated to a faster and more consistent onset of action rather the previous antiplatelet agents of the same class. Cyclopentyl-triazolo-pyrimidines, a newer pharmacological class from which ticagrelor is an example, also act at the P2Y12 platelet receptor, and like prasugrel, ticagrelor inhibits platelet aggregation in a fast and consistent manner, however, in a reversible way. This article aims to conduct a review on the literature about the most recent information and guidelines on oral antiplatelet agents available for the management of coronary disease.
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1220
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Keach JW, Yeh RW, Maddox TM. Dual Antiplatelet Therapy in Patients with Stable Ischemic Heart Disease. Curr Atheroscler Rep 2016; 18:5. [DOI: 10.1007/s11883-015-0553-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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1221
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Iliescu CA, Grines CL, Herrmann J, Yang EH, Cilingiroglu M, Charitakis K, Hakeem A, Toutouzas KP, Leesar MA, Marmagkiolis K. SCAI Expert consensus statement: Evaluation, management, and special considerations of cardio-oncology patients in the cardiac catheterization laboratory (endorsed by the cardiological society of india, and sociedad Latino Americana de Cardiologıa intervencionista). Catheter Cardiovasc Interv 2016; 87:E202-23. [PMID: 26756277 DOI: 10.1002/ccd.26379] [Citation(s) in RCA: 127] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 11/28/2015] [Indexed: 12/24/2022]
Abstract
In the United States alone, there are currently approximately 14.5 million cancer survivors, and this number is expected to increase to 20 million by 2020. Cancer therapies can cause significant injury to the vasculature, resulting in angina, acute coronary syndromes (ACS), stroke, critical limb ischemia, arrhythmias, and heart failure, independently from the direct myocardial or pericardial damage from the malignancy itself. Consequently, the need for invasive evaluation and management in the cardiac catheterization laboratory (CCL) for such patients has been increasing. In recognition of the need for a document on special considerations for cancer patients in the CCL, the Society for Cardiovascular Angiography and Interventions (SCAI) commissioned a consensus group to provide recommendations based on the published medical literature and on the expertise of operators with accumulated experience in the cardiac catheterization of cancer patients.
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Affiliation(s)
- Cezar A Iliescu
- MD Anderson Cancer Center, University of Texas, Houston, Texas
| | - Cindy L Grines
- Detroit Medical Center, Cardiovascular Institute, Detroit, Michigan
| | - Joerg Herrmann
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Eric H Yang
- Division of Cardiology, University of California at Los Angeles, Los Angeles, California
| | - Mehmet Cilingiroglu
- School of Medicine, Arkansas Heart Hospital, Little Rock, Arkansas.,Department of Cardiology, Koc University, Istanbul, Turkey
| | | | - Abdul Hakeem
- Department of Cardiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | | | - Massoud A Leesar
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama
| | - Konstantinos Marmagkiolis
- Department of Cardiology, Citizens Memorial Hospital, Bolivar, Missouri.,Department of Medicine, University of Missouri, Columbia, Missouri
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1222
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Bonello L, Dignat-George F, Laine M. Personalized Antiplatelet Therapy: The Odyssey Continues. JACC Cardiovasc Interv 2016; 9:105-106. [PMID: 26762919 DOI: 10.1016/j.jcin.2015.10.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 10/07/2015] [Indexed: 11/28/2022]
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1223
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The Tradeoff Between Shorter and Longer Courses of Dual Antiplatelet Therapy After Implantation of Newer Generation Drug-Eluting Stents. Curr Cardiol Rep 2016; 18:8. [PMID: 26732901 DOI: 10.1007/s11886-015-0683-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The benefit of prolonged dual antiplatelet therapy (DAPT) after implantation of drug-eluting stents (DESs) remains uncertain. In 10 randomized controlled trials (RCTs) of 31,666 predominantly low-risk patients undergoing DES implantation, shorter courses (3-12 months) of DAPT resulted in lower mortality (odds ratio [OR] 0.83, 95 % confidence interval [CI] 0.69-0.98) and major hemorrhage (OR 0.60, 95 % CI 0.48-0.75) but increased myocardial infarction (MI, OR 1.34, 95 % CI 1.04-1.73) and stent thrombosis (ST, OR 1.75, 95 % CI 1.08-2.82) than did longer courses (12-36 months) of DAPT. A risk-benefit analysis identified 3 fewer deaths and 5 fewer bleeds but 4 more MIs and 3 more STs annually for every 1000 patients treated with the shorter courses. In the predominantly low-risk population enrolled in RCTs, limiting DAPT to 3 to 12 months after DES implantation saved lives and prevented bleeding at the expense of increased ST and MI.
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1224
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Jaffer FA. High-Risk Stents Harboring Neoatherosclerosis: Light From Near-Infrared Spectroscopy? Circ Cardiovasc Imaging 2016; 9:CIRCIMAGING.115.004354. [PMID: 26729856 DOI: 10.1161/circimaging.115.004354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Farouc A Jaffer
- From the Cardiovascular Research Center, Cardiac Catheterization Laboratory, Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston.
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1225
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Stone GW, Hochman JS, Williams DO, Boden WE, Ferguson TB, Harrington RA, Maron DJ. Medical Therapy With Versus Without Revascularization in Stable Patients With Moderate and Severe Ischemia: The Case for Community Equipoise. J Am Coll Cardiol 2016; 67:81-99. [PMID: 26616030 PMCID: PMC5545795 DOI: 10.1016/j.jacc.2015.09.056] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 09/10/2015] [Accepted: 09/22/2015] [Indexed: 12/21/2022]
Abstract
All patients with stable ischemic heart disease (SIHD) should be managed with guideline-directed medical therapy (GDMT), which reduces progression of atherosclerosis and prevents coronary thrombosis. Revascularization is also indicated in patients with SIHD and progressive or refractory symptoms, despite medical management. Whether a strategy of routine revascularization (with percutaneous coronary intervention or coronary artery bypass graft surgery as appropriate) plus GDMT reduces rates of death or myocardial infarction, or improves quality of life compared to an initial approach of GDMT alone in patients with substantial ischemia is uncertain. Opinions run strongly on both sides, and evidence may be used to support either approach. Careful review of the data demonstrates the limitations of our current knowledge, resulting in a state of community equipoise. The ongoing ISCHEMIA trial (International Study of Comparative Health Effectiveness With Medical and Invasive Approaches) is being performed to determine the optimal approach to managing patients with SIHD, moderate-to-severe ischemia, and symptoms that can be controlled medically. (International Study of Comparative Health Effectiveness With Medical and Invasive Approaches [ISCHEMIA]; NCT01471522).
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Affiliation(s)
- Gregg W Stone
- Department of Medicine, Columbia University Medical Center, New York Presbyterian Hospital and the Cardiovascular Research Foundation, New York, New York.
| | - Judith S Hochman
- Department of Medicine, Cardiovascular Clinical Research Center, New York University School of Medicine, New York, New York
| | - David O Williams
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - William E Boden
- Department of Medicine, Samuel S. Stratton VA Medical Center, Albany Medical Center and Albany Medical College, Albany, New York
| | - T Bruce Ferguson
- Department of Cardiovascular Sciences, East Carolina Heart Institute, East Carolina University, Greenville, North Carolina
| | - Robert A Harrington
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - David J Maron
- Department of Medicine, Stanford University School of Medicine, Stanford, California
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1226
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Montalescot G, Crea F. The year in cardiology 2015: acute coronary syndromes. Eur Heart J 2016; 37:221-8. [DOI: 10.1093/eurheartj/ehv686] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 11/26/2015] [Indexed: 11/12/2022] Open
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1227
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Bueno H, Martín Asenjo R. Long-term Cardiovascular Risk After Acute Coronary Syndrome, An Ongoing Challenge. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2016; 69:1-2. [PMID: 26613869 DOI: 10.1016/j.rec.2015.08.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 08/28/2015] [Indexed: 06/05/2023]
Affiliation(s)
- Héctor Bueno
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Instituto de Investigación i+12 y Departamento de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain; Universidad Complutense de Madrid, Madrid, Spain.
| | - Roberto Martín Asenjo
- Instituto de Investigación i+12 y Departamento de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain; Universidad Complutense de Madrid, Madrid, Spain
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1228
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Hillegass WB. Insulin-treated diabetes mellitus: An important, actionable risk marker after coronary stenting. Catheter Cardiovasc Interv 2016; 87:63-4. [PMID: 27410954 DOI: 10.1002/ccd.26385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Accepted: 12/05/2015] [Indexed: 11/11/2022]
Abstract
Insulin treatment for diabetes is a simple but important risk marker for doubled adjusted death and myocardial infarction rates and tripled stent thrombosis risk after coronary stenting. Insulin treatment does not predict meaningfully increased major bleeding or additional revascularization procedures after drug eluting coronary stent implantation. Third generation P2 Y12 receptor antagonists substantially lower risk of events in diabetics after stenting with insulin treated diabetics having twice the magnitude of benefit of diabetics not needing insulin.
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Affiliation(s)
- William B Hillegass
- Heart South Cardiovascular Group, Department of Biostatistics, University of Alabama at Birmingham, Alabaster and Birmingham, Alabama
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1229
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Pang S, Shi SY, Zhang YJ, Iqbal J, Chen XY, Ren XM, Zhu H, Zeng YP, Bioh G, Bourantas CV, Xu B, Serruys PW, Chen SL. The impact of dual antiplatelet therapy duration on primary composite endpoint after drug-eluting stent implantation: A meta-analysis of 10 randomized trials. Int J Cardiol 2016; 202:504-6. [DOI: 10.1016/j.ijcard.2015.09.091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 09/24/2015] [Indexed: 11/25/2022]
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1230
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Bueno H, Martín Asenjo R. Riesgo cardiovascular a largo plazo tras un síndrome coronario agudo, todavía un reto. Rev Esp Cardiol 2016. [DOI: 10.1016/j.recesp.2015.08.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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1231
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Fan Z, Yang J, Yang C, Yang J, Zeng P, Guo X. Duration of dual antiplatelet therapy following drug-eluting coronary stents: Longer or shorter? Int J Cardiol 2016; 202:936-7. [PMID: 26422194 DOI: 10.1016/j.ijcard.2015.09.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 09/21/2015] [Indexed: 11/18/2022]
Affiliation(s)
- Zhixing Fan
- Department of Cardiology, The First College of Clinical Medical Sciences, China Three Gorges University, Yichang 443000 Hubei Province, China
| | - Jian Yang
- Department of Cardiology, The First College of Clinical Medical Sciences, China Three Gorges University, Yichang 443000 Hubei Province, China.
| | - Chaojun Yang
- Department of Cardiology, The First College of Clinical Medical Sciences, China Three Gorges University, Yichang 443000 Hubei Province, China
| | - Jun Yang
- Department of Cardiology, The First College of Clinical Medical Sciences, China Three Gorges University, Yichang 443000 Hubei Province, China
| | - Ping Zeng
- Department of Cardiology, The First College of Clinical Medical Sciences, China Three Gorges University, Yichang 443000 Hubei Province, China
| | - Xin Guo
- Department of Cardiology, The First College of Clinical Medical Sciences, China Three Gorges University, Yichang 443000 Hubei Province, China
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Costa RA, Abizaid A, Mehran R, Schofer J, Schuler GC, Hauptmann KE, Magalhães MA, Parise H, Grube E. Polymer-Free Biolimus A9-Coated Stents in the Treatment of De Novo Coronary Lesions. JACC Cardiovasc Interv 2016; 9:51-64. [DOI: 10.1016/j.jcin.2015.09.008] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 09/23/2015] [Accepted: 09/24/2015] [Indexed: 10/22/2022]
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1233
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Gurbel PA, Myat A, Kubica J, Tantry US. State of the art: Oral antiplatelet therapy. JRSM Cardiovasc Dis 2016; 5:2048004016652514. [PMID: 27298725 PMCID: PMC4892624 DOI: 10.1177/2048004016652514] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 04/05/2016] [Indexed: 11/17/2022] Open
Abstract
Platelet adhesion, activation, and aggregation are central to the propagation of coronary thrombosis following rupture, fissure, or erosion of an atherosclerotic plaque. This chain of deleterious events underlies the pathophysiological process leading to an acute coronary syndrome. Therefore, oral antiplatelet therapy has become the cornerstone of therapy for the management of acute coronary syndrome and the prevention of ischemic complications associated with percutaneous coronary intervention. Landmark trials have established aspirin, and the addition of clopidogrel to aspirin, as key therapeutic agents in the context of acute coronary syndrome and percutaneous coronary intervention. Dual antiplatelet therapy has been the guideline-mandated standard of care in acute coronary syndrome and percutaneous coronary intervention. Despite the proven efficacy of dual antiplatelet therapy, adverse ischemic events continue to occur and this has stimulated the development of novel, more potent antiplatelet agents. We focus this state-of-the-art review on the most recent advances in oral antiplatelet therapy, treading the tightrope of potency versus bleeding risk, the quest to determine the optimal duration of dual antiplatelet therapy and future of personalized antiplatelet therapy.
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Affiliation(s)
- Paul A Gurbel
- Inova Center for Thrombosis Research and Drug Development, Inova Heart and Vascular Institute, Falls Church, Virginia, USA
| | - Aung Myat
- Cardiology Department, University Hospital Coventry, University Hospitals of Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry, UK
| | - Jacek Kubica
- Department of Cardiology, and Internal Medicine, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Udaya S Tantry
- Inova Center for Thrombosis Research and Drug Development, Inova Heart and Vascular Institute, Falls Church, Virginia, USA
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1234
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Abu-Assi E, López-López A, González-Salvado V, Redondo-Diéguez A, Peña-Gil C, Bouzas-Cruz N, Raposeiras-Roubín S, Riziq-Yousef Abumuaileq R, García-Acuña JM, González-Juanatey JR. El riesgo de eventos cardiovasculares tras un evento coronario agudo persiste elevado a pesar de la revascularización, especialmente durante el primer año. Rev Esp Cardiol 2016. [DOI: 10.1016/j.recesp.2015.06.016] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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1235
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Is Prolonged DAPT Apt or a Study in Zero-Sum Games? JACC Cardiovasc Interv 2016; 9:148-50. [DOI: 10.1016/j.jcin.2015.11.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Accepted: 11/19/2015] [Indexed: 11/20/2022]
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1236
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1237
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Park Y, Franchi F, Rollini F, Angiolillo DJ. Antithrombotic Therapy for Secondary Prevention in Patients With Diabetes Mellitus and Coronary Artery Disease. Circ J 2016; 80:791-801. [DOI: 10.1253/circj.cj-16-0208] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Yongwhi Park
- University of Florida College of Medicine–Jacksonville
- Gyeongsang National University School of Medicine and Gyeongsang National University Hospital
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1238
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Hermiller JB, Krucoff MW, Kereiakes DJ, Windecker S, Steg PG, Yeh RW, Cohen DJ, Cutlip DE, Massaro JM, Hsieh WH, Mauri L. Benefits and Risks of Extended Dual Antiplatelet Therapy After Everolimus-Eluting Stents. JACC Cardiovasc Interv 2016; 9:138-47. [DOI: 10.1016/j.jcin.2015.10.001] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 09/29/2015] [Accepted: 10/01/2015] [Indexed: 11/26/2022]
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1239
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Capodanno D, Gargiulo G, Buccheri S, Giacoppo D, Capranzano P, Tamburino C. Meta-Analyses of Dual Antiplatelet Therapy Following Drug-Eluting Stent Implantation: Do Bleeding and Stent Thrombosis Weigh Similar on Mortality? J Am Coll Cardiol 2015; 66:1639-1640. [PMID: 26429096 DOI: 10.1016/j.jacc.2015.05.085] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Revised: 05/27/2015] [Accepted: 05/29/2015] [Indexed: 11/30/2022]
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1240
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Sibbing D, Kastrati A, Berger PB. Pre-treatment with P2Y12inhibitors in ACS patients: who, when, why, and which agent? Eur Heart J 2015; 37:1284-95. [DOI: 10.1093/eurheartj/ehv717] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 12/06/2015] [Indexed: 12/22/2022] Open
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1241
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Leschke M, Waliszewski M, Pons M, Champin S, Nait Saidi L, Mok Heang T, Maskon O, Azman Bin Wan Ahmad W, Herberger D, Moulichon ME, Rischner J, Robin C, Leclercq F, Peyre JP, Faurie B, Schneider A. Thin strut bare metal stents in patients with atrial fibrillation: Is there still a need for BMS? Catheter Cardiovasc Interv 2015; 88:358-66. [PMID: 26650913 DOI: 10.1002/ccd.26261] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 09/16/2015] [Indexed: 11/06/2022]
Abstract
OBJECTIVES This observational study assessed the 9-month clinical outcomes in an « all comers » population with a focus on patients with atrial fibrillation (AF) after thin strut bare metal stenting. BACKGROUND Drug eluting stent (DES) implantation is the treatment of choice for coronary artery disease (CAD) leaving only marginal indications for the use of bare metal stents (BMS). However, selected treatment populations with DES contraindications such as patients who cannot sustain 6-12 months of dual antiplatelet therapy (DAPT) remain candidates for BMS implantations. METHODS Thin strut bare metal stenting in a priori defined subgroups were investigated in a non-randomized, international, multicenter «all comers» observational study. Primary endpoint was the 9-month TLR rate whereas secondary endpoints included the 9-month MACE and procedural success rates. RESULTS A total of 783 patients of whom 98 patients had AF underwent BMS implantation. Patient age was 70.4 ± 12.8 years. Cardiovascular risk factors in the overall population were male gender (78.2%, 612/783), diabetes (25.2%, 197/783), hypertension (64.1%, 502/783), cardiogenic shock (4.9%, 38/783) and end stage renal disease (4.9%, 38/783). In-hospital MACE was 4.1% (30/783) in the overall population. The 9-month TLR rate was 4.5% (29/645) in the non-AF group and 3.3% (3/90) in the AF group (P = 0.613). At 9 months, the MACE rate in the AF-group and non-AF group was not significantly different either (10.7%, 69/645 vs. 6.7%, 6/90; P = 0.237). Accumulated stroke rates were 0.3% (2/645) in the non-AF subgroup at baseline and 1.1% (1/90) in the AF subgroup (P = 0.264). CONCLUSION Bare metal stenting in AF patients delivered acceptably low TLR and MACE rates while having the benefit of a significantly shorter DAPT duration in a DES dominated clinical practice. © 2015 Wiley Periodicals, Inc.
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Affiliation(s)
- Matthias Leschke
- Klinik für Kardiologie, Angiologie und Pneumologie, Klinikum Esslingen, Esslingen, Germany.
| | | | - Maxime Pons
- Cardiologie Interventionelle, Clinique Du Millénaire, Grenoble, France
| | - Stanislas Champin
- Cardiologie et Rythmologie interventionnelle, Centre Hospitalier De Valence, France
| | - Lyassine Nait Saidi
- Pôle Cardiologie vasculaire, Cardiologie, Centre Hospitalier Sainte Musse, France
| | - Tay Mok Heang
- Cardiology, Pantai Hospital Ayer Keroh, Malacca, Malaysia
| | - Oteh Maskon
- Cardiology, Pusat Perubatan UKM, Kuala Lumpur, Malaysia
| | | | - Denny Herberger
- Medical Scientific Affairs B. Braun Vascular Systems, Berlin, Germany
| | - Marc-Eric Moulichon
- Cardiologie interventionnelle, électrophysiologie, Clinique Saint-Pierre Perpignan, France
| | | | | | - Florence Leclercq
- Département Cardiologie et Maladies Vasculaire, Centre Hospitalier Universitaire Montpellier, France
| | - Jean-Pascal Peyre
- Cardiologie - Pathologie cardio vasculaire, Hôpital Privé Beauregard, Marseille, France
| | - Benjamin Faurie
- Cardiologie, Groupe Hospitalier Mutualiste, Grenoble, France
| | - André Schneider
- Klinik für Kardiologie, Angiologie und Pneumologie, Klinikum Esslingen, Esslingen, Germany
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1242
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Picard F, Tadros VX, Asgar AW. Triple Antithrombotic Therapy in Atrial Fibrillation Patients With an Indication for Oral Anticoagulation Undergoing Percutaneous Coronary Intervention: A Case-Based Review of the Current Evidence. Circ Cardiovasc Interv 2015; 8:e003217. [PMID: 26643741 DOI: 10.1161/circinterventions.115.003217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Fabien Picard
- From the Interventional Cardiology, Department of Medicine, Montreal Heart Institute, Université de Montréal, Montréal, QC, Canada
| | - Victor-Xavier Tadros
- From the Interventional Cardiology, Department of Medicine, Montreal Heart Institute, Université de Montréal, Montréal, QC, Canada
| | - Anita W Asgar
- From the Interventional Cardiology, Department of Medicine, Montreal Heart Institute, Université de Montréal, Montréal, QC, Canada.
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1243
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Costa F, Tijssen JG, Ariotti S, Giatti S, Moscarella E, Guastaroba P, De Palma R, Andò G, Oreto G, Zijlstra F, Valgimigli M. Incremental Value of the CRUSADE, ACUITY, and HAS-BLED Risk Scores for the Prediction of Hemorrhagic Events After Coronary Stent Implantation in Patients Undergoing Long or Short Duration of Dual Antiplatelet Therapy. J Am Heart Assoc 2015; 4:e002524. [PMID: 26643501 PMCID: PMC4845267 DOI: 10.1161/jaha.115.002524] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 10/07/2015] [Indexed: 12/19/2022]
Abstract
BACKGROUND Multiple scores have been proposed to stratify bleeding risk, but their value to guide dual antiplatelet therapy duration has never been appraised. We compared the performance of the CRUSADE (Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the ACC/AHA Guidelines), ACUITY (Acute Catheterization and Urgent Intervention Triage Strategy), and HAS-BLED (Hypertension, Abnormal Renal/Liver Function, Stroke, Bleeding History or Predisposition, Labile INR, Elderly, Drugs/Alcohol Concomitantly) scores in 1946 patients recruited in the Prolonging Dual Antiplatelet Treatment After Grading Stent-Induced Intimal Hyperplasia Study (PRODIGY) and assessed hemorrhagic and ischemic events in the 24- and 6-month dual antiplatelet therapy groups. METHODS AND RESULTS Bleeding score performance was assessed with a Cox regression model and C statistics. Discriminative and reclassification power was assessed with net reclassification improvement and integrated discrimination improvement. The C statistic was similar between the CRUSADE score (area under the curve 0.71) and ACUITY (area under the curve 0.68), and higher than HAS-BLED (area under the curve 0.63). CRUSADE, but not ACUITY, improved reclassification (net reclassification index 0.39, P=0.005) and discrimination (integrated discrimination improvement index 0.0083, P=0.021) of major bleeding compared with HAS-BLED. Major bleeding and transfusions were higher in the 24- versus 6-month dual antiplatelet therapy groups in patients with a CRUSADE score >40 (hazard ratio for bleeding 2.69, P=0.035; hazard ratio for transfusions 4.65, P=0.009) but not in those with CRUSADE score ≤40 (hazard ratio for bleeding 1.50, P=0.25; hazard ratio for transfusions 1.37, P=0.44), with positive interaction (Pint=0.05 and Pint=0.01, respectively). The number of patients with high CRUSADE scores needed to treat for harm for major bleeding and transfusion were 17 and 15, respectively, with 24-month rather than 6-month dual antiplatelet therapy; corresponding figures in the overall population were 67 and 71, respectively. CONCLUSIONS Our analysis suggests that the CRUSADE score predicts major bleeding similarly to ACUITY and better than HAS BLED in an all-comer population with percutaneous coronary intervention and potentially identifies patients at higher risk of hemorrhagic complications when treated with a long-term dual antiplatelet therapy regimen. CLINICAL TRIAL REGISTRATION URL: http://clinicaltrials.gov. Unique identifier: NCT00611286.
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Affiliation(s)
- Francesco Costa
- ThoraxcenterErasmus Medical CenterRotterdamThe Netherlands
- Department of Clinical and Experimental Medicine, Policlinico “G. Martino”University of MessinaItaly
| | - Jan G. Tijssen
- Department of CardiologyAcademic Medical CenterUniversity of AmsterdamThe Netherlands
| | - Sara Ariotti
- ThoraxcenterErasmus Medical CenterRotterdamThe Netherlands
| | - Sara Giatti
- Cardiology ClinicsCitta’ di Rovigo HospitalRovigoItaly
| | - Elisabetta Moscarella
- Division of CardiologyDepartment of Cardiothoracic SciencesSecond University of NaplesItaly
| | | | | | - Giuseppe Andò
- Department of Clinical and Experimental Medicine, Policlinico “G. Martino”University of MessinaItaly
| | - Giuseppe Oreto
- Department of Clinical and Experimental Medicine, Policlinico “G. Martino”University of MessinaItaly
| | - Felix Zijlstra
- ThoraxcenterErasmus Medical CenterRotterdamThe Netherlands
| | - Marco Valgimigli
- ThoraxcenterErasmus Medical CenterRotterdamThe Netherlands
- Swiss Cardiovascular Center BernBern University HospitalBernSwitzerland
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1244
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Roe MT, Cyr DD, Eckart D, Schulte PJ, Morse MA, Blackwell KL, Ready NE, Zafar SY, Beaven AW, Strickler JH, Onken JE, Winters KJ, Houterloot L, Zamoryakhin D, Wiviott SD, White HD, Prabhakaran D, Fox KAA, Armstrong PW, Ohman EM. Ascertainment, classification, and impact of neoplasm detection during prolonged treatment with dual antiplatelet therapy with prasugrel vs. clopidogrel following acute coronary syndrome. Eur Heart J 2015; 37:412-22. [PMID: 26637834 DOI: 10.1093/eurheartj/ehv611] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 10/15/2015] [Indexed: 12/19/2022] Open
Abstract
AIMS Studies have suggested increased cancer incidence associated with long-term dual antiplatelet therapy (DAPT) for acute coronary syndrome (ACS). We evaluated cancer incidence and treatment-related differences in an analysis of DAPT for ACS. METHODS AND RESULTS The Targeted Platelet Inhibition to Clarify the Optimal Strategy to Medically Manage Acute Coronary Syndromes trial enrolled 9326 participants with ACS, who received aspirin plus clopidogrel or prasugrel. Median treatment exposure was 15 months. Cancer history and screening procedures were collected. Suspected non-benign neoplasm events were reported and adjudicated. The primary outcome was detection of new, non-benign neoplasm. Factors associated with neoplasm events, the relationship of these events to cardiovascular and bleeding endpoints, and treatment-related differences in neoplasm detection were studied. Among 9240 participants who received ≥1 dose of study drug, 1.8% had a confirmed neoplasm event. The efficacy composite of cardiovascular death, myocardial infarction, or stroke occurred more frequently among those with a neoplasm event vs. those without (18.2 vs. 13.5%) as did Global Use of Strategies to Open Occluded Coronary Arteries severe/moderate bleeding (11.2 vs. 1.5%). Screening rates were substantially higher in North America and Western Europe/Scandinavia vs. other regions. Factors most strongly associated with detection of neoplasm events were older age, region, male sex, and current/recent smoking. Among the pre-specified population without a history of neoplasm or previous curative treatment for neoplasm (n = 9105), the incidence of neoplasm events was similar with prasugrel vs. clopidogrel (1.8 vs. 1.7%; HR = 1.04; 95% CI 0.77-1.42; P = 0.79). CONCLUSIONS Neoplasm events were infrequent during long-term DAPT after ACS, were associated with differential cancer-screening practices across regions, and the frequency of neoplasm detection was similar with prasugrel vs. clopidogrel. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT00699998.
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Affiliation(s)
- Matthew T Roe
- Duke Clinical Research Institute, 2400 Pratt Street, Rm 7035, Durham, NC 27705, USA Division of Cardiology, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Derek D Cyr
- Duke Clinical Research Institute, 2400 Pratt Street, Rm 7035, Durham, NC 27705, USA
| | - Debra Eckart
- Duke Clinical Research Institute, 2400 Pratt Street, Rm 7035, Durham, NC 27705, USA
| | - Phillip J Schulte
- Duke Clinical Research Institute, 2400 Pratt Street, Rm 7035, Durham, NC 27705, USA
| | - Michael A Morse
- Division of Medicine - Oncology, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Kimberly L Blackwell
- Division of Medicine - Oncology, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Neal E Ready
- Division of Medicine - Oncology, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - S Yousuf Zafar
- Division of Medicine - Oncology, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Anne W Beaven
- Division of Medicine - Oncology, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - John H Strickler
- Division of Medicine - Oncology, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Jane E Onken
- Division of Gastroenterology, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | | | | | | | - Stephen D Wiviott
- Brigham and Women's Hospital/Harvard Medical School, Boston, MA, USA
| | - Harvey D White
- Auckland City Hospital, Green Lane Cardiovascular Service, Auckland, New Zealand
| | - Dorairaj Prabhakaran
- Centre for Chronic Disease Control and Public Health Foundation of India, New Delhi, India
| | - Keith A A Fox
- British Heart Foundation Centre for Cardiovascular Sciences, University of Edinburgh, Edinburgh, UK
| | - Paul W Armstrong
- Division of Cardiology, University of Alberta, Edmonton, AB, Canada
| | - E Magnus Ohman
- Duke Clinical Research Institute, 2400 Pratt Street, Rm 7035, Durham, NC 27705, USA Division of Cardiology, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
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1245
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Rossello X, Pocock SJ, Julian DG. Long-Term Use of Cardiovascular Drugs: Challenges for Research and for Patient Care. J Am Coll Cardiol 2015; 66:1273-1285. [PMID: 26361160 DOI: 10.1016/j.jacc.2015.07.018] [Citation(s) in RCA: 98] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Accepted: 07/07/2015] [Indexed: 01/21/2023]
Abstract
Little is known about the benefits and risks of the long-term use of cardiovascular drugs. Evidence from randomized clinical trials (RCTs) rarely goes beyond a few years of follow-up, but patients are often given continuous treatment with multiple drugs well into old age. We focus on 4 commonly used cardiovascular drug classes: aspirin, statins, beta-blockers, and angiotensin-converting enzyme inhibitors given to patients after myocardial infarction. However, the issues raised apply more broadly to all long-term medications across cardiovascular diseases and the whole of medicine. The evidence and limitations of RCTs are addressed, as well as current practice in pre-licensing trials, the increasing problems of polypharmacy (especially in the elderly), the lack of trial evidence for withdrawal of drugs, the role of regulatory authorities and other stakeholders in this challenging situation, and the potential educational solutions for the medical profession. We conclude with a set of recommendations on how to improve the situation of long-term drug use.
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Affiliation(s)
- Xavier Rossello
- Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain; Hatter Cardiovascular Institute, University College London, London, United Kingdom
| | - Stuart J Pocock
- Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain; London School of Hygiene and Tropical Medicine, London, United Kingdom
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1246
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Liou K, Nagaraja V, Jepson N, Ooi SY. Optimal duration of dual antiplatelet therapy following drug-eluting stents implantation: A meta-analysis of 7 randomised controlled trials. Int J Cardiol 2015; 201:578-80. [DOI: 10.1016/j.ijcard.2015.03.073] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Revised: 01/20/2015] [Accepted: 03/03/2015] [Indexed: 10/23/2022]
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1247
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Dohi T, Maehara A, Witzenbichler B, Rinaldi MJ, Mazzaferri EL, Duffy PL, Weisz G, Neumann FJ, Henry TD, Cox DA, Stuckey TD, Brodie BR, Litherland C, Brener SJ, Kirtane AJ, Mintz GS, Stone GW. Etiology, Frequency, and Clinical Outcomes of Myocardial Infarction After Successful Drug-Eluting Stent Implantation. Circ Cardiovasc Interv 2015; 8:e002447. [DOI: 10.1161/circinterventions.114.002447] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Tomotaka Dohi
- From the Center for Interventional Vascular Therapy, Division of Cardiology, Columbia University Medical Center/NewYork-Presbyterian Hospital, New York (T.D., A.M., G.W., A.J.K., G.W.S.); Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (T.D., A.M., G.W., C.L., S.J.B., A.J.K., G.S.M., G.W.S.); Department of Cardiology and Pneumology, Helios Amper-Klinikum, Dachau, Germany (B.W.); Sanger Heart & Vascular Institute/Carolinas HealthCare System, Charlotte, NC (M.J.R.); The
| | - Akiko Maehara
- From the Center for Interventional Vascular Therapy, Division of Cardiology, Columbia University Medical Center/NewYork-Presbyterian Hospital, New York (T.D., A.M., G.W., A.J.K., G.W.S.); Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (T.D., A.M., G.W., C.L., S.J.B., A.J.K., G.S.M., G.W.S.); Department of Cardiology and Pneumology, Helios Amper-Klinikum, Dachau, Germany (B.W.); Sanger Heart & Vascular Institute/Carolinas HealthCare System, Charlotte, NC (M.J.R.); The
| | - Bernhard Witzenbichler
- From the Center for Interventional Vascular Therapy, Division of Cardiology, Columbia University Medical Center/NewYork-Presbyterian Hospital, New York (T.D., A.M., G.W., A.J.K., G.W.S.); Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (T.D., A.M., G.W., C.L., S.J.B., A.J.K., G.S.M., G.W.S.); Department of Cardiology and Pneumology, Helios Amper-Klinikum, Dachau, Germany (B.W.); Sanger Heart & Vascular Institute/Carolinas HealthCare System, Charlotte, NC (M.J.R.); The
| | - Michael J. Rinaldi
- From the Center for Interventional Vascular Therapy, Division of Cardiology, Columbia University Medical Center/NewYork-Presbyterian Hospital, New York (T.D., A.M., G.W., A.J.K., G.W.S.); Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (T.D., A.M., G.W., C.L., S.J.B., A.J.K., G.S.M., G.W.S.); Department of Cardiology and Pneumology, Helios Amper-Klinikum, Dachau, Germany (B.W.); Sanger Heart & Vascular Institute/Carolinas HealthCare System, Charlotte, NC (M.J.R.); The
| | - Ernest L. Mazzaferri
- From the Center for Interventional Vascular Therapy, Division of Cardiology, Columbia University Medical Center/NewYork-Presbyterian Hospital, New York (T.D., A.M., G.W., A.J.K., G.W.S.); Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (T.D., A.M., G.W., C.L., S.J.B., A.J.K., G.S.M., G.W.S.); Department of Cardiology and Pneumology, Helios Amper-Klinikum, Dachau, Germany (B.W.); Sanger Heart & Vascular Institute/Carolinas HealthCare System, Charlotte, NC (M.J.R.); The
| | - Peter L. Duffy
- From the Center for Interventional Vascular Therapy, Division of Cardiology, Columbia University Medical Center/NewYork-Presbyterian Hospital, New York (T.D., A.M., G.W., A.J.K., G.W.S.); Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (T.D., A.M., G.W., C.L., S.J.B., A.J.K., G.S.M., G.W.S.); Department of Cardiology and Pneumology, Helios Amper-Klinikum, Dachau, Germany (B.W.); Sanger Heart & Vascular Institute/Carolinas HealthCare System, Charlotte, NC (M.J.R.); The
| | - Giora Weisz
- From the Center for Interventional Vascular Therapy, Division of Cardiology, Columbia University Medical Center/NewYork-Presbyterian Hospital, New York (T.D., A.M., G.W., A.J.K., G.W.S.); Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (T.D., A.M., G.W., C.L., S.J.B., A.J.K., G.S.M., G.W.S.); Department of Cardiology and Pneumology, Helios Amper-Klinikum, Dachau, Germany (B.W.); Sanger Heart & Vascular Institute/Carolinas HealthCare System, Charlotte, NC (M.J.R.); The
| | - Franz-Josef Neumann
- From the Center for Interventional Vascular Therapy, Division of Cardiology, Columbia University Medical Center/NewYork-Presbyterian Hospital, New York (T.D., A.M., G.W., A.J.K., G.W.S.); Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (T.D., A.M., G.W., C.L., S.J.B., A.J.K., G.S.M., G.W.S.); Department of Cardiology and Pneumology, Helios Amper-Klinikum, Dachau, Germany (B.W.); Sanger Heart & Vascular Institute/Carolinas HealthCare System, Charlotte, NC (M.J.R.); The
| | - Timothy D. Henry
- From the Center for Interventional Vascular Therapy, Division of Cardiology, Columbia University Medical Center/NewYork-Presbyterian Hospital, New York (T.D., A.M., G.W., A.J.K., G.W.S.); Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (T.D., A.M., G.W., C.L., S.J.B., A.J.K., G.S.M., G.W.S.); Department of Cardiology and Pneumology, Helios Amper-Klinikum, Dachau, Germany (B.W.); Sanger Heart & Vascular Institute/Carolinas HealthCare System, Charlotte, NC (M.J.R.); The
| | - David A. Cox
- From the Center for Interventional Vascular Therapy, Division of Cardiology, Columbia University Medical Center/NewYork-Presbyterian Hospital, New York (T.D., A.M., G.W., A.J.K., G.W.S.); Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (T.D., A.M., G.W., C.L., S.J.B., A.J.K., G.S.M., G.W.S.); Department of Cardiology and Pneumology, Helios Amper-Klinikum, Dachau, Germany (B.W.); Sanger Heart & Vascular Institute/Carolinas HealthCare System, Charlotte, NC (M.J.R.); The
| | - Thomas D. Stuckey
- From the Center for Interventional Vascular Therapy, Division of Cardiology, Columbia University Medical Center/NewYork-Presbyterian Hospital, New York (T.D., A.M., G.W., A.J.K., G.W.S.); Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (T.D., A.M., G.W., C.L., S.J.B., A.J.K., G.S.M., G.W.S.); Department of Cardiology and Pneumology, Helios Amper-Klinikum, Dachau, Germany (B.W.); Sanger Heart & Vascular Institute/Carolinas HealthCare System, Charlotte, NC (M.J.R.); The
| | - Bruce R. Brodie
- From the Center for Interventional Vascular Therapy, Division of Cardiology, Columbia University Medical Center/NewYork-Presbyterian Hospital, New York (T.D., A.M., G.W., A.J.K., G.W.S.); Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (T.D., A.M., G.W., C.L., S.J.B., A.J.K., G.S.M., G.W.S.); Department of Cardiology and Pneumology, Helios Amper-Klinikum, Dachau, Germany (B.W.); Sanger Heart & Vascular Institute/Carolinas HealthCare System, Charlotte, NC (M.J.R.); The
| | - Claire Litherland
- From the Center for Interventional Vascular Therapy, Division of Cardiology, Columbia University Medical Center/NewYork-Presbyterian Hospital, New York (T.D., A.M., G.W., A.J.K., G.W.S.); Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (T.D., A.M., G.W., C.L., S.J.B., A.J.K., G.S.M., G.W.S.); Department of Cardiology and Pneumology, Helios Amper-Klinikum, Dachau, Germany (B.W.); Sanger Heart & Vascular Institute/Carolinas HealthCare System, Charlotte, NC (M.J.R.); The
| | - Sorin J. Brener
- From the Center for Interventional Vascular Therapy, Division of Cardiology, Columbia University Medical Center/NewYork-Presbyterian Hospital, New York (T.D., A.M., G.W., A.J.K., G.W.S.); Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (T.D., A.M., G.W., C.L., S.J.B., A.J.K., G.S.M., G.W.S.); Department of Cardiology and Pneumology, Helios Amper-Klinikum, Dachau, Germany (B.W.); Sanger Heart & Vascular Institute/Carolinas HealthCare System, Charlotte, NC (M.J.R.); The
| | - Ajay J. Kirtane
- From the Center for Interventional Vascular Therapy, Division of Cardiology, Columbia University Medical Center/NewYork-Presbyterian Hospital, New York (T.D., A.M., G.W., A.J.K., G.W.S.); Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (T.D., A.M., G.W., C.L., S.J.B., A.J.K., G.S.M., G.W.S.); Department of Cardiology and Pneumology, Helios Amper-Klinikum, Dachau, Germany (B.W.); Sanger Heart & Vascular Institute/Carolinas HealthCare System, Charlotte, NC (M.J.R.); The
| | - Gary S. Mintz
- From the Center for Interventional Vascular Therapy, Division of Cardiology, Columbia University Medical Center/NewYork-Presbyterian Hospital, New York (T.D., A.M., G.W., A.J.K., G.W.S.); Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (T.D., A.M., G.W., C.L., S.J.B., A.J.K., G.S.M., G.W.S.); Department of Cardiology and Pneumology, Helios Amper-Klinikum, Dachau, Germany (B.W.); Sanger Heart & Vascular Institute/Carolinas HealthCare System, Charlotte, NC (M.J.R.); The
| | - Gregg W. Stone
- From the Center for Interventional Vascular Therapy, Division of Cardiology, Columbia University Medical Center/NewYork-Presbyterian Hospital, New York (T.D., A.M., G.W., A.J.K., G.W.S.); Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (T.D., A.M., G.W., C.L., S.J.B., A.J.K., G.S.M., G.W.S.); Department of Cardiology and Pneumology, Helios Amper-Klinikum, Dachau, Germany (B.W.); Sanger Heart & Vascular Institute/Carolinas HealthCare System, Charlotte, NC (M.J.R.); The
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1248
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Costa F, Adamo M, Ariotti S, Navarese EP, Biondi-Zoccai G, Valgimigli M. Impact of greater than 12-month dual antiplatelet therapy duration on mortality: Drug-specific or a class-effect? A meta-analysis. Int J Cardiol 2015; 201:179-81. [PMID: 26298373 DOI: 10.1016/j.ijcard.2015.08.058] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 08/01/2015] [Accepted: 08/04/2015] [Indexed: 02/08/2023]
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1249
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Fanari Z, Weiss S, Weintraub WS. Cost Effectiveness of Antiplatelet and Antithrombotic Therapy in the Setting of Acute Coronary Syndrome: Current Perspective and Literature Review. Am J Cardiovasc Drugs 2015; 15:415-27. [PMID: 26068886 PMCID: PMC4661116 DOI: 10.1007/s40256-015-0131-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Acute coronary syndromes (ACS) are associated with high rates of morbidity and mortality. The advances of antiplatelet and anticoagulation therapy over several years time have resulted in improved in cardiac outcomes, but with increased health care costs. Multiple cost-effectiveness studies have been performed to evaluate the use of available antiplatelet agents and anticoagulation in the setting of both ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation acute coronary syndrome (NSTE-ACS). Early on, the use of glycoprotein IIb/IIIa receptor inhibitors (GPIs) proved to be economically attractive in the management of ACS; however, the introduction of P2Y12 receptor antagonists limited their use to a bail out agents in complex interventions. Generic clopidogrel is probably still an economically attractive P2Y12 receptor antagonist choice, especially in low-risk ACS, while both ticagrelor and prasugrel present an economically attractive alternative option, especially in high-risk ACS and patients at risk for stent thrombosis. While enoxaparin presents an economically dominant alternative to heparin in NSTE-ACS, its role in STEMI in the contemporary era is unclear. During percutaneous coronary intervention (PCI), bivalirudin monotherapy was shown to be an economically dominant alternative to the combination of heparin and GPI in ACS. However, new studies may suggest that using heparin monotherapy may offer an attractive alternative. The comparative and cost effectiveness of different combinations of antiplatelet and antithrombotic therapy will be the focus of future expected clinical and economic assessments.
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Affiliation(s)
- Zaher Fanari
- Section of Cardiology, Christiana Care Health System, 4755 Ogletown-Stanton Rd., Newark, DE, 19718, USA.
| | - Sandra Weiss
- Section of Cardiology, Christiana Care Health System, 4755 Ogletown-Stanton Rd., Newark, DE, 19718, USA
| | - William S Weintraub
- Section of Cardiology, Christiana Care Health System, 4755 Ogletown-Stanton Rd., Newark, DE, 19718, USA
- Value Institute, Christiana Care Health System, Newark, DE, USA
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1250
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Chandrasekhar J, Mastoris I, Baber U, Sartori S, Schoos M, Bansilal S, Dangas G, Mehran R. Antithrombotic strategy variability in ATrial fibrillation and obstructive coronary disease revascularized with PCI-rationale and study design of the prospective observational multicenter AVIATOR 2 registry. Am Heart J 2015; 170:1234-42. [PMID: 26678646 DOI: 10.1016/j.ahj.2015.08.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Accepted: 08/13/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND In the era of novel antithrombotic therapy, the optimal treatment for patients with nonvalvular atrial fibrillation (AF) or flutter undergoing percutaneous coronary intervention (PCI) is undetermined. STUDY DESIGN The AVIATOR 2 study is a multicenter prospective observational registry that will enroll approximately 2,500 patients with nonvalvular AF or flutter undergoing PCI starting March 2015 over an 18-month enrollment period. Antithrombotic therapy selection will be at the discretion of the treating physician. An integral feature of this study is the use of a smartphone-based survey to capture physician and patient perspectives regarding antithrombotic therapies after PCI. Survey-derived patient treatment concerns, perceived need, and affordability will be used to calculate the risk of non-adherence. Subjective risk for ischemic or bleeding events will be correlated with previously validated risk scores as well as observed event rates at 1, 6, or 12 months post-PCI. ENDPOINTS The primary efficacy end point will be major adverse cardiac and cerebrovascular events, a composite occurrence of death, nonfatal myocardial infarction, stroke, stent thrombosis, and clinically driven target lesion revascularization at 1 year. The primary safety end point will be major bleeding as per Bleeding Academic Research Consortium criteria types 2, 3, or 5. The secondary end points will include (i) net adverse clinical events, a composite occurrence of all major adverse cardiac and cerebrovascular events, and major bleeding at 1 year; (ii) correlation between estimated subjective and objective (CHADS2, CHA2DS2-VASc, stent thrombosis score, HAS-BLED, and ATRIA scores) ischemic and bleeding risks; (iii) modes of antithrombotic therapy cessation and their impact on outcomes; and (iv) correlation between observed and expected non-adherence to treatment. SUMMARY AVIATOR 2 is a real-world registry designed to evaluate ischemic and bleeding outcomes according to conventional and novel antithrombotic regimens in patients with nonvalvular AF or flutter undergoing PCI. The study will also provide insights in to physician- and patient-centered factors affecting treatment selection and adherence and their overall impact on clinical outcomes. The study is registered on clinicaltrials.gov NCT02362659.
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