1351
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1352
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De Rango P. Dual Antiplatelet Therapy after Carotid Stenting: Lessons from ‘Big Brother’. Eur J Vasc Endovasc Surg 2015; 49:621-622. [DOI: 10.1016/j.ejvs.2015.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Accepted: 02/04/2015] [Indexed: 01/22/2023]
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1353
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Zhang XL, Zhu QQ, Zhu L, Shi SQ, Chen JZ, Xie J, Huang W, Xu B. Optimize the duration of DAPT following DES implantation: An updated system review and meta-analysis of 10 randomized trials. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.ctrsc.2015.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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1354
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Percutaneous Coronary Intervention. J Am Coll Cardiol 2015; 65:2508-10. [DOI: 10.1016/j.jacc.2015.04.041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 04/13/2015] [Accepted: 04/20/2015] [Indexed: 11/23/2022]
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Abstract
The current standard care for acute coronary syndromes is dual antiplatelet therapy combining the COX1 inhibitor aspirin with a drug targeting the P2Y12 receptor, together with anticoagulation during and after early revascularization by percutaneous intervention. In very high-risk patients, glycoprotein (GP) IIb/IIIa antagonists may also be used. Secondary prevention of ischemic events requires dual antiplatelet therapy for several months followed by lifelong low-dose aspirin. The duration of treatment and the drugs to combine nevertheless remain matters of debate and the focus of ongoing research. Despite great progress, there is still room for improved efficacy and this could involve new targets for both antiplatelet drugs (like the thrombin receptor PAR1) and anticoagulants. However, improved efficacy is offset by an increased risk of bleeding. Stroke patients are still waiting for better treatment, their bleeding risk being particularly high. New targets including the collagen receptor, glycoprotein VI (GPVI), and the GPIb-von Willebrand factor axis, governing platelet interaction with the diseased vessel wall, should enable us to complete the armamentarium of antiplatelet drugs.
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Affiliation(s)
- C Gachet
- UMR_S949, INSERM, Strasbourg, France
- Etablissement Français du Sang-Alsace (EFS-Alsace), Strasbourg, France
- Université de Strasbourg, Strasbourg, France
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1356
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Costa F, Ariotti S, Valgimigli M, Kolh P, Windecker S. Perspectives on the 2014 ESC/EACTS Guidelines on Myocardial Revascularization : Fifty Years of Revascularization: Where Are We and Where Are We Heading? J Cardiovasc Transl Res 2015; 8:211-20. [PMID: 25986910 PMCID: PMC4473080 DOI: 10.1007/s12265-015-9632-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Accepted: 04/28/2015] [Indexed: 02/06/2023]
Abstract
The joint European Society of Cardiology and European Association of Cardio-Thoracic Surgery (ESC/EACTS) guidelines on myocardial revascularization collect and summarize the evidence regarding decision-making, diagnostics, and therapeutics in various clinical scenarios of coronary artery disease, including elective, urgent, and emergency settings. The 2014 document updates and extends the effort started in 2010, year of the first edition of these guidelines. Importantly, this latest edition provides a systematic review of all randomized clinical trials performed since 1980, comparing different strategies of myocardial revascularization, including coronary artery bypass graft (CABG), balloon angioplasty, percutaneous coronary intervention (PCI) with bare-metal stents (BMS) and first- and second-generation drug-eluting stents (DES). This review aims to highlight the most relevant novelties introduced by the 2014 edition of the ESC/EACTS myocardial revascularization guidelines as compared with the previous edition and to describe similarities and differences with the American societies' guidelines.
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Affiliation(s)
- Francesco Costa
- />Thoraxcenter, Erasmus Medical Center, 3015 CE Rotterdam, The Netherlands
- />Department of Clinical and Experimental Medicine, Policlinico “G. Martino”, University of Messina, Messina, Italy
| | - Sara Ariotti
- />Thoraxcenter, Erasmus Medical Center, 3015 CE Rotterdam, The Netherlands
- />Division of Cardiology of the Department of Medicine, University of Verona, Verona, Italy
| | - Marco Valgimigli
- />Thoraxcenter, Erasmus Medical Center, 3015 CE Rotterdam, The Netherlands
| | - Philippe Kolh
- />Cardiovascular Surgery Department, University Hospital (CHU, ULg) of Liege, Liege, Belgium
| | - Stephan Windecker
- />Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - on behalf of the Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS)
- />Thoraxcenter, Erasmus Medical Center, 3015 CE Rotterdam, The Netherlands
- />Department of Clinical and Experimental Medicine, Policlinico “G. Martino”, University of Messina, Messina, Italy
- />Division of Cardiology of the Department of Medicine, University of Verona, Verona, Italy
- />Cardiovascular Surgery Department, University Hospital (CHU, ULg) of Liege, Liege, Belgium
- />Department of Cardiology, Bern University Hospital, Bern, Switzerland
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1357
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Angoulvant D, Bejan Angoulvant T, Fauchier L. Dual antiplatelet therapy after acute coronary syndrome: a cardiologist-based optimal decision. BRITISH HEART JOURNAL 2015; 101:832-3. [DOI: 10.1136/heartjnl-2014-307356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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1358
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The optimal duration of dual antiplatelet therapy after drug-eluting stent implantation: chasing a mirage. J Am Coll Cardiol 2015; 65:1311-1313. [PMID: 25835442 DOI: 10.1016/j.jacc.2015.02.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Accepted: 02/05/2015] [Indexed: 11/24/2022]
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1359
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Abstract
INTRODUCTION Over the last year, multiple, potentially practice-changing, cardiology trials or studies have been published or presented at international meetings including the American College of Cardiology, European Association for Percutaneous Cardiovascular Interventions, European Society of Cardiology, Transcatheter Cardiovascular Therapeutics, Heart Failure Congress, Heart Rhythm Society, Heart Failure Society of America, American Society of Hypertension and the American Heart Association. METHODS Clinical trial results presented at major cardiology conferences during 2014 were reviewed by the authors. Search terms included heart failure (HF), acute coronary syndrome, stable coronary disease, interventional cardiology, atrial fibrillation, electrophysiology and coronary prevention. Selection criteria were trials of broad relevance to the cardiology community, those with potential to change current practice and those with potential to guide further phase III research. RESULTS In this paper, the authors describe and place in clinical context, new HF, data including neprilysin inhibitors, intravenous ferric carboxymaltose, potassium-absorbing compounds, quadripolar leads for cardiac resynchronization therapy and intraventricular device intervention. New trial data are also described for acute coronary syndromes (clopidogrel, prasugrel, ticagrelor), stable coronary artery disease (ivabradine), percutaneous coronary intervention (the role of thrombectomy or treatment of non-culprit lesions during primary intervention, pressure wire studies and outcomes of new stent designs), transcatheter aortic valve intervention data, atrial fibrillation (anticoagulation and direct current cardioversion), electrophysiology (leadless pacemaker devices, use of quinidine in Brugada syndrome) and coronary prevention (landmark Ezetimibe outcome data, PCSK9 clinical trials, childhood prevalence of hypertension, renal denervation for resistant hypertension and the role of cardiac computerized tomography in cardiovascular screening). CONCLUSION This paper summarizes key clinical trials during 2014 and should be of practical interest to clinicians and cardiology researchers.
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Affiliation(s)
- Peter McKavanagh
- Craigavon Cardiac Centre, Southern Trust, Craigavon, BT63 5QQ, Northern Ireland, UK,
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1360
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Yeh RW, Elmariah S, Doros G, Kereiakes DJ, Mauri L. Dual antiplatelet therapy duration and mortality - Authors' reply. Lancet 2015; 385:2149-50. [PMID: 26068262 DOI: 10.1016/s0140-6736(15)61019-4] [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: 11/30/2022]
Affiliation(s)
- Robert W Yeh
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Harvard Clinical Research Institute, Boston, MA, USA.
| | - Sammy Elmariah
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Harvard Clinical Research Institute, Boston, MA, USA
| | - Gheorghe Doros
- Harvard Clinical Research Institute, Boston, MA, USA; Boston University, Boston MA, USA
| | - Dean J Kereiakes
- The Lindner Research Center, The Christ Hospital Heart and Vascular Center, Cincinnati, OH, USA
| | - Laura Mauri
- Harvard Clinical Research Institute, Boston, MA, USA; Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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1361
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Affiliation(s)
- Johann Auer
- Cardiology and Intensive Care, General Hospital Braunau, Braunau, Austria.
| | | | - Franz Gurtner
- Cardiology and Intensive Care, General Hospital Braunau, Braunau, Austria
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1362
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Kirtane AJ, King SB. Should all stent patients have prolonged dual antiplatelet therapy? JACC Cardiovasc Interv 2015; 8:873-875. [PMID: 25999115 DOI: 10.1016/j.jcin.2015.04.001] [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: 11/19/2022]
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1363
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Yeh RW, Cohen DJ, Mauri L. Close encounters with errors of the second kind: evaluating risks and benefits of long-term dual antiplatelet therapy. Eur Heart J 2015; 36:1216-8. [PMID: 25796054 DOI: 10.1093/eurheartj/ehv082] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Robert W Yeh
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - David J Cohen
- St. Luke's Mid America Heart Institute, Kansas City, MO, USA
| | - Laura Mauri
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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1364
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1365
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Ruparelia N, Chieffo A. Dual antiplatelet therapy following drug-eluting stent implantation: how long is long enough? Expert Rev Cardiovasc Ther 2015; 13:585-7. [DOI: 10.1586/14779072.2015.1046435] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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1366
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Aradi D, Sibbing D. ATLANTIC: another reason to investigate the disconnect between stent thrombosis and mortality? Thromb Haemost 2015; 114:9-10. [PMID: 25947260 DOI: 10.1160/th15-02-0159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 02/20/2015] [Indexed: 11/05/2022]
Affiliation(s)
- Daniel Aradi
- Dániel Aradi, MD, PhD, 2 Gyogy Ter Balatonfüred, 8230 Hungary, Tel.: +36 302355639, E-mail:
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1367
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Affiliation(s)
- John F Keaney
- From the Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester
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1368
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Bonaca MP, Bhatt DL, Cohen M, Steg PG, Storey RF, Jensen EC, Magnani G, Bansilal S, Fish MP, Im K, Bengtsson O, Oude Ophuis T, Budaj A, Theroux P, Ruda M, Hamm C, Goto S, Spinar J, Nicolau JC, Kiss RG, Murphy SA, Wiviott SD, Held P, Braunwald E, Sabatine MS. Long-term use of ticagrelor in patients with prior myocardial infarction. N Engl J Med 2015; 372:1791-800. [PMID: 25773268 DOI: 10.1056/nejmoa1500857] [Citation(s) in RCA: 1316] [Impact Index Per Article: 146.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND The potential benefit of dual antiplatelet therapy beyond 1 year after a myocardial infarction has not been established. We investigated the efficacy and safety of ticagrelor, a P2Y12 receptor antagonist with established efficacy after an acute coronary syndrome, in this context. METHODS We randomly assigned, in a double-blind 1:1:1 fashion, 21,162 patients who had had a myocardial infarction 1 to 3 years earlier to ticagrelor at a dose of 90 mg twice daily, ticagrelor at a dose of 60 mg twice daily, or placebo. All the patients were to receive low-dose aspirin and were followed for a median of 33 months. The primary efficacy end point was the composite of cardiovascular death, myocardial infarction, or stroke. The primary safety end point was Thrombolysis in Myocardial Infarction (TIMI) major bleeding. RESULTS The two ticagrelor doses each reduced, as compared with placebo, the rate of the primary efficacy end point, with Kaplan-Meier rates at 3 years of 7.85% in the group that received 90 mg of ticagrelor twice daily, 7.77% in the group that received 60 mg of ticagrelor twice daily, and 9.04% in the placebo group (hazard ratio for 90 mg of ticagrelor vs. placebo, 0.85; 95% confidence interval [CI], 0.75 to 0.96; P=0.008; hazard ratio for 60 mg of ticagrelor vs. placebo, 0.84; 95% CI, 0.74 to 0.95; P=0.004). Rates of TIMI major bleeding were higher with ticagrelor (2.60% with 90 mg and 2.30% with 60 mg) than with placebo (1.06%) (P<0.001 for each dose vs. placebo); the rates of intracranial hemorrhage or fatal bleeding in the three groups were 0.63%, 0.71%, and 0.60%, respectively. CONCLUSIONS In patients with a myocardial infarction more than 1 year previously, treatment with ticagrelor significantly reduced the risk of cardiovascular death, myocardial infarction, or stroke and increased the risk of major bleeding. (Funded by AstraZeneca; PEGASUS-TIMI 54 ClinicalTrials.gov number, NCT01225562.).
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Affiliation(s)
- Marc P Bonaca
- From the Thrombolysis in Myocardial Infarction (TIMI) Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston (M.P.B., D.L.B., G.M., M.P.F., K.I., S.A.M., S.D.W., E.B., M.S.S.); the Cardiovascular Division, Department of Medicine, Newark Beth Israel Medical Center, Rutgers-New Jersey Medical School, Newark (M.C.); French Alliance for Cardiovascular Trials, Département Hospitalo-Universitaire Fibrosis, Inflammation, Remodeling, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, INSERM Unité 1148, and Université Paris-Diderot, Sorbonne Paris Cité - all in Paris (P.G.S.); National Heart and Lung Institute, Royal Brompton Hospital, Imperial College, London (P.G.S.), and Department of Cardiovascular Science, University of Sheffield, Sheffield, United Kingdom (R.F.S.); AstraZeneca, Mölndal, Sweden (E.C.J., O.B., P.H.); Icahn School of Medicine at Mount Sinai, New York (S.B.); Canisius-Wilhelmina Hospital, Nijmegen, the Netherlands (T.O.O.); Postgraduate Medical School, Grochowski Hospital, Warsaw, Poland (A.B.); Montreal Heart Institute, Université de Montréal, Montreal (P.T.); Cardiology Research Center, Moscow (M.R.); Kerckhoff Heart Center, Bad Nauheim, and University of Giessen, Giessen - both in Germany (C.H.); Department of Medicine (Cardiology), Tokai University School of Medicine, Isehara, Japan (S.G.); University Hospital, Jihlavska, Brno, Czech Republic (J.S.); Heart Institute (InCor)-University of São Paulo Medical School, São Paulo (J.C.N.); and the Department of Cardiology, Military Hospital, Budapest, Hungary (R.G.K.)
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1369
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Managing Residual Risk After Myocardial Infarction Among Individuals with Low Cholesterol Levels. Cardiol Clin 2015; 33:299-308. [DOI: 10.1016/j.ccl.2015.01.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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1370
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Capodanno D, Joner M, Zimarino M. What about the risk of thrombosis with bioresorbable scaffolds? EUROINTERVENTION 2015; 11 Suppl V:V181-4. [DOI: 10.4244/eijv11sva43] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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1371
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Tsoumani ME, Ntalas IV, Goudevenos JA, Tselepis AD. Evaluating the bioequivalence of clopidogrel generic formulations. Curr Med Res Opin 2015; 31:861-4. [PMID: 25764150 DOI: 10.1185/03007995.2015.1028912] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- M E Tsoumani
- Atherothrombosis Research Centre, Laboratory of Biochemistry, Department of Chemistry, University of Ioannina , Ioannina , Greece
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1372
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Ruparelia N, Chieffo A, Colombo A. How long should dual antiplatelet therapy be continued following implantation of drug eluting stents? ANNALS OF TRANSLATIONAL MEDICINE 2015; 3:S10. [PMID: 26046055 PMCID: PMC4437953 DOI: 10.3978/j.issn.2305-5839.2015.02.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 02/05/2015] [Indexed: 01/20/2023]
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1373
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Gilard M, Morice MC. Double Antiplatelet Therapy Duration. J Am Coll Cardiol 2015; 65:2222-4. [DOI: 10.1016/j.jacc.2015.03.541] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 03/22/2015] [Indexed: 11/24/2022]
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1374
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Valgimigli M, Costa F, Byrne R, Haude M, Baumbach A, Windecker S. Dual antiplatelet therapy duration after coronary stenting in clinical practice: results of an EAPCI survey. EUROINTERVENTION 2015; 11:68-74. [DOI: 10.4244/eijv11i1a11] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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1375
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Cortese B, Buccheri D, Piraino D, Silva-Orrego P, Seregni R. Drug-coated balloon angioplasty: An intriguing alternative for the treatment of coronary chronic total occlusions. Int J Cardiol 2015; 187:238-9. [DOI: 10.1016/j.ijcard.2015.03.223] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 03/17/2015] [Indexed: 10/23/2022]
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1376
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Vranckx P, Leebeek FWG, Tijssen JGP, Koolen J, Stammen F, Herman JPR, de Winter RJ, van T Hof AWJ, Backx B, Lindeboom W, Kim SY, Kirsch B, van Eickels M, Misselwitz F, Verheugt FWA. Peri-procedural use of rivaroxaban in elective percutaneous coronary intervention to treat stable coronary artery disease. The X-PLORER trial. Thromb Haemost 2015; 114:258-67. [PMID: 25925992 DOI: 10.1160/th15-01-0061] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 03/04/2015] [Indexed: 12/12/2022]
Abstract
Patients on rivaroxaban requiring percutaneous coronary intervention (PCI) represent a clinical conundrum. We aimed to investigate whether rivaroxaban, with or without an additional bolus of unfractionated heparin (UFH), effectively inhibits coagulation activation during PCI. Stable patients (n=108) undergoing elective PCI and on stable dual antiplatelet therapy were randomised (2:2:2:1) to a short treatment course of rivaroxaban 10 mg (n=30), rivaroxaban 20 mg (n=32), rivaroxaban 10 mg plus UFH (n=30) or standard peri-procedural UFH (n=16). Blood samples for markers of thrombin generation and coagulation activation were drawn prior to and at 0, 0.5, 2, 6-8 and 48 hours (h) after start of PCI. In patients treated with rivaroxaban (10 or 20 mg) and patients treated with rivaroxaban plus heparin, the levels of prothrombin fragment 1 + 2 at 2 h post-PCI were 0.16 [0.1] nmol/l (median) [interquartile range, IQR] and 0.17 [0.2] nmol/l, respectively. Thrombin-antithrombin complex values at 2 h post-PCI were 3.90 [6.8]µg/l and 3.90 [10.1] µg/l, respectively, remaining below the upper reference limit (URL) after PCI and stenting. This was comparable to the control group of UFH treatment alone. However, median values for thrombin-antithrombin complex passed above the URL with increasing tendency, starting at 2 h post-PCI in the UFH-alone arm but not in rivaroxaban-treated patients. In this exploratory trial, rivaroxaban effectively suppressed coagulation activation after elective PCI and stenting.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - F W A Verheugt
- Prof. Freek W. A. Verheugt MD, PhD, Department of Cardiology, Heartcenter, Oosterpark 9, AC Amsterdam 1091, the Netherlands, Tel.: + 31 20 5993421, Fax: +31 20 5993997, E-mail: f. w.
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1377
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Yeh RW, Mauri L, Kereiakes DJ. Dual Antiplatelet Therapy Duration Following Coronary Stenting. [Corrected]. J Am Coll Cardiol 2015; 65:787-790. [PMID: 25720621 DOI: 10.1016/j.jacc.2015.01.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 12/28/2014] [Accepted: 01/07/2015] [Indexed: 10/24/2022]
Affiliation(s)
- Robert W Yeh
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Laura Mauri
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Dean J Kereiakes
- The Christ Hospital Heart and Vascular Center/The Lindner Research Center, Cincinnati, Ohio.
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1378
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Post-PCI Antithrombotic Therapy in Patients Requiring Long-Term Anticoagulation. Curr Cardiol Rep 2015; 17:41. [PMID: 25899659 DOI: 10.1007/s11886-015-0598-4] [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] [Indexed: 10/23/2022]
Abstract
The number of patients who undergo percutaneous coronary intervention (PCI) and additionally require chronic anticoagulation for a variety of indications is not insignificant. The choice of antithrombotic therapy after PCI in patients with chronic indications for anticoagulation therapy remains a challenge for interventional cardiologists, as the risk of bleeding must be adequately weighed against the benefit of preventing future ischemic events. While these clinical scenarios are encountered in approximately 10 % of patients undergoing PCI, current practice guidelines do not sufficiently guide physicians as to how to best treat these PCI patients requiring chronic anticoagulation. Notwithstanding the clinical difficulties of treating such patients, there are several recent studies and analyses that have assessed optimal antithrombotic strategies in the PCI population, and there are several others that are currently underway. This review evaluates the currently available data and clinical scenarios commonly encountered by treating physicians.
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1379
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Prolonged dual antiplatelet therapy after drug-eluting stenting: meta-analysis of randomized trials. Clin Res Cardiol 2015; 104:887-901. [DOI: 10.1007/s00392-015-0860-1] [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: 02/04/2015] [Accepted: 04/15/2015] [Indexed: 01/07/2023]
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1380
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Navarese EP, Andreotti F, Schulze V, Kołodziejczak M, Buffon A, Brouwer M, Costa F, Kowalewski M, Parati G, Lip GYH, Kelm M, Valgimigli M. Optimal duration of dual antiplatelet therapy after percutaneous coronary intervention with drug eluting stents: meta-analysis of randomised controlled trials. BMJ 2015; 350:h1618. [PMID: 25883067 PMCID: PMC4410620 DOI: 10.1136/bmj.h1618] [Citation(s) in RCA: 253] [Impact Index Per Article: 28.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To assess the benefits and risks of short term (<12 months) or extended (>12 months) dual antiplatelet therapy (DAPT) versus standard 12 month therapy, following percutaneous coronary intervention with drug eluting stents. DESIGN Meta-analysis of randomised controlled trials. DATA SOURCES PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, Scopus, Web of Science, Cochrane Library, and major congress proceedings, searched from 1 January 2002 to 16 February 2015. REVIEW METHODS Trials comparing short term (<12 months) or extended (>12 months) DAPT regimens with standard 12 month duration of therapy. Primary outcomes were cardiovascular mortality, myocardial infarction, stent thrombosis, major bleeding, and all cause mortality. RESULTS 10 randomised controlled trials (n=32,287) were included. Compared to 12 month DAPT, a short term course of therapy was associated with a significant reduction in major bleeding (odds ratio 0.58 (95% confidence interval 0.36 to 0.92); P=0.02) with no significant differences in ischaemic or thrombotic outcomes. Extended versus 12 month DAPT yielded a significant reduction in the odds of myocardial infarction (0.53 (0.42 to 0.66); P<0.001) and stent thrombosis (0.33 (0.21 to 0.51); P<0.001), but more major bleeding (1.62 (1.26 to 2.09); P<0.001). All cause but not cardiovascular death was also significantly increased (1.30 (1.02 to 1.66); P=0.03). CONCLUSIONS Compared with a standard 12 month duration, short term DAPT (<12 months) after drug eluting stent implementation yields reduced bleeding with no apparent increase in ischaemic complications, and could be considered for most patients. In selected patients with low bleeding risk and very high ischaemic risk, extended DAPT (>12 months) could be considered. The increase in all cause but not cardiovascular death with extended DAPT requires further investigation.
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Affiliation(s)
- Eliano Pio Navarese
- Department of Internal Medicine, Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University, 40225 Düsseldorf, Germany Systematic Investigation and Research on Interventions and Outcomes (SIRIO) MEDICINE research network, Düsseldorf, Germany
| | - Felicita Andreotti
- Systematic Investigation and Research on Interventions and Outcomes (SIRIO) MEDICINE research network, Düsseldorf, Germany Department of Cardiovascular Science, Catholic University, Rome, Italy
| | - Volker Schulze
- Department of Internal Medicine, Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University, 40225 Düsseldorf, Germany Systematic Investigation and Research on Interventions and Outcomes (SIRIO) MEDICINE research network, Düsseldorf, Germany
| | - Michalina Kołodziejczak
- Department of Internal Medicine, Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University, 40225 Düsseldorf, Germany Systematic Investigation and Research on Interventions and Outcomes (SIRIO) MEDICINE research network, Düsseldorf, Germany Collegium Medicum in Bydgoszcz, University of Nicolaus Copernicus, Toruń, Poland
| | - Antonino Buffon
- Department of Cardiovascular Science, Catholic University, Rome, Italy Systematic Investigation and Research on Interventions and Outcomes (SIRIO) MEDICINE research network, Düsseldorf, Germany
| | - Marc Brouwer
- Department of Cardiology, University Medical Centre St Radboud, Nijmegen, Netherlands Systematic Investigation and Research on Interventions and Outcomes (SIRIO) MEDICINE research network, Düsseldorf, Germany
| | - Francesco Costa
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, Netherlands
| | - Mariusz Kowalewski
- Systematic Investigation and Research on Interventions and Outcomes (SIRIO) MEDICINE research network, Düsseldorf, Germany Department of Cardiology, 10th Military Research Hospital and Polyclinic, Bydgoszcz, Poland
| | - Gianfranco Parati
- Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, University of Milan-Bicocca, Milan, Italy
| | - Gregory Y H Lip
- Department of Cardiology, University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, UK Systematic Investigation and Research on Interventions and Outcomes (SIRIO) MEDICINE research network, Düsseldorf, Germany
| | - Malte Kelm
- Department of Internal Medicine, Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University, 40225 Düsseldorf, Germany Systematic Investigation and Research on Interventions and Outcomes (SIRIO) MEDICINE research network, Düsseldorf, Germany
| | - Marco Valgimigli
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, Netherlands
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Liu F, Tantry US, Gurbel PA. P2Y12receptor inhibitors for secondary prevention of ischemic stroke. Expert Opin Pharmacother 2015; 16:1149-65. [DOI: 10.1517/14656566.2015.1035256] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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1382
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Geng X, Hussain M, Du H, Zhao L, Chen J, Su W, Ma L, Gao Z, Ding Y, Ji X. Comparison of self-expanding stents with distal embolic protection to balloon-expandable stents without a protection device in the treatment of symptomatic vertebral artery origin stenosis: a prospective randomized trial. J Endovasc Ther 2015; 22:436-44. [PMID: 25862360 DOI: 10.1177/1526602815579406] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To compare the angiographic and clinical outcomes of self-expanding stents (SES) with distal embolic protection devices (EPD) vs balloon-expandable stents (BES) without EPD in the treatment of symptomatic atherosclerotic vertebral artery ostial stenosis (VAOS). METHODS Between July 2011 and March 2013, a prospective randomized trial was conducted involving 127 patients (mean age 67.3±10.2 years; 94 men) with symptomatic VAOS randomly assigned to treatment with SES + EPD (Precise RX or RX Acculink stent + Spider FX EPD; n=61) or BES (Palmaz Blue or Resolute RX; n=66) without EPD. In-stent restenosis (ISR) >50% detected by duplex ultrasound was the primary endpoint. Technical success, clinical success, complications within 30 days, and signal intensity abnormalities on diffusion weighted imaging (DWI) after stenting were compared. RESULTS The 30-day technical success rate was 95.5% (63/66) for SES+EPD vs 100% (70/70) for BES without EPD (p=0.072). DWI at 24 hours poststenting showed 2 hyperintense lesions in 2 (3.3%) SES + EPD cases and 15 hyperintense lesions in 13 (18.6%) BES patients (p<0.01). At a mean 18-month follow-up, the clinical success rate was 93.9% (62/66) for the SES + EPD group vs 85.7% (60/70) for the BES group (p=0.115). The ISR was seen in 16/70 (22.9%) arteries in the BES group and 2/66 (3.1%) arteries in SES + EPD group (p<0.01). Target vessel revascularization was performed in 7 (10.0%) BES arteries vs none in the SES + EPD group (p<0.01). CONCLUSION SES with EPD in the treatment of symptomatic VAOS is technically feasible and safe, with low rates of ISR and significantly reduced thromboembolic events on imaging when compared to BES without EPD.
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Affiliation(s)
- Xiaokun Geng
- China-America Institute of Neuroscience, Luhe Hospital, Capital Medical University, Beijing, China Department of Neurological Surgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - Mohammed Hussain
- Department of Neurological Surgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - Huishan Du
- China-America Institute of Neuroscience, Luhe Hospital, Capital Medical University, Beijing, China
| | - Liang Zhao
- China-America Institute of Neuroscience, Luhe Hospital, Capital Medical University, Beijing, China Department of Vascular Surgery, Luhe Hospital, Capital Medical University, Beijing, China
| | - Jian Chen
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Wei Su
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Linlin Ma
- China-America Institute of Neuroscience, Luhe Hospital, Capital Medical University, Beijing, China
| | - Zongen Gao
- Department of Neurology, Central Hospital of Shengli Oilfield, Dongying, China
| | - Yuchuan Ding
- China-America Institute of Neuroscience, Luhe Hospital, Capital Medical University, Beijing, China Department of Neurological Surgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - Xunming Ji
- China-America Institute of Neuroscience, Luhe Hospital, Capital Medical University, Beijing, China Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
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Tremmel JA, Bhatt DL, Pinto DS, Grines CL. Late breaking trials of 2014 in coronary artery disease: Commentary covering ACC, EuroPCR, SCAI, TCT, ESC, and AHA. Catheter Cardiovasc Interv 2015; 86:73-9. [PMID: 25854985 DOI: 10.1002/ccd.25942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 03/15/2015] [Indexed: 11/08/2022]
Abstract
With the plethora of clinical trials, it is difficult for busy interventional cardiologists to stay up to date. Therefore, the SCAI Publications Committee concisely summarizes and provides editorial commentary on the most important coronary trials from the large international meetings of 2014. The intent is to allow quick assimilation of trial results into interventional practice.
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Affiliation(s)
- Jennifer A Tremmel
- Department of Medicine (Cardiovascular), Stanford University Medical Center, Stanford, California
| | - Deepak L Bhatt
- Department of Medicine (Cardiovascular), VA Boston Healthcare System, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts
| | - Duane S Pinto
- Department of Medicine (Cardiovascular), Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston, Massachusetts
| | - Cindy L Grines
- Department of Medicine (Cardiovascular), Detroit Medical Center Cardiovascular Institute, Detroit, Michigan
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1384
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Watanabe H, Morimoto T, Natsuaki M, Furukawa Y, Nakagawa Y, Kadota K, Yamaji K, Ando K, Shizuta S, Shiomi H, Tada T, Tazaki J, Kato Y, Hayano M, Abe M, Tamura T, Shirotani M, Miki S, Matsuda M, Takahashi M, Ishii K, Tanaka M, Aoyama T, Doi O, Hattori R, Kato M, Suwa S, Takizawa A, Takatsu Y, Shinoda E, Eizawa H, Takeda T, Lee JD, Inoko M, Ogawa H, Hamasaki S, Horie M, Nohara R, Kambara H, Fujiwara H, Mitsudo K, Nobuyoshi M, Kita T, Kastrati A, Kimura T. Antiplatelet therapy discontinuation and the risk of serious cardiovascular events after coronary stenting: observations from the CREDO-Kyoto Registry Cohort-2. PLoS One 2015; 10:e0124314. [PMID: 25853836 PMCID: PMC4390156 DOI: 10.1371/journal.pone.0124314] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2014] [Accepted: 02/27/2015] [Indexed: 02/02/2023] Open
Abstract
Relation of antiplatelet therapy (APT) discontinuation with the risk of serious cardiovascular events has not been fully addressed yet. This study is aimed to evaluate the risk of ischemic event after APT discontinuation based on long-term APT status of large cohort. In the CREDO-Kyoto Registry Cohort-2 enrolling 15939 consecutive patients undergoing first coronary revascularization, 10470 patients underwent percutaneous coronary intervention either with bare-metal stents (BMS) only (N=5392) or sirolimus-eluting stents (SES) only (N=5078). Proportions of patients taking dual-APT were 67.3% versus 33.4% at 1-year, and 48.7% versus 24.3% at 5-year in the SES and BMS strata, respectively. We evaluated daily APT status (dual-, single- and no-APT) and linked the adverse events to the APT status just 1-day before the events. No-APT as compared with dual- or single-APT was associated with significantly higher risk for stent thrombosis (ST) beyond 1-month after SES implantation (cumulative incidence rates beyond 1-month: 1.23 versus 0.15/0.29, P<0.001/P<0.001), while higher risk of no-APT for ST was evident only until 6-month after BMS implantation (incidence rates between 1- and 6-month: 8.43 versus 0.71/1.20, P<0.001/P<0.001, and cumulative incidence rates beyond 6-month: 0.31 versus 0.11/0.08, P=0.16/P=0.08). No-APT as compared with dual- or single-APT was also associated with significantly higher risk for spontaneous myocardial infarction (MI) and stroke regardless of the types of stents implanted. Single-APT as compared with dual-APT was not associated with higher risk for serious adverse events, except for the marginally higher risk for ST in the SES stratum. In conclusion, discontinuation of both aspirin and thienopyridines was associated with increased risk for serious cardiovascular events including ST, spontaneous MI and stroke beyond 1-month after coronary stenting.
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Affiliation(s)
- Hirotoshi Watanabe
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takeshi Morimoto
- Division of Genera Medicine, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Masahiro Natsuaki
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yutaka Furukawa
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | | | - Kazushige Kadota
- Division of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Kyohei Yamaji
- Division of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Kenji Ando
- Division of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Satoshi Shizuta
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hiroki Shiomi
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Tomohisa Tada
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Junichi Tazaki
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yoshihiro Kato
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Mamoru Hayano
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Mitsuru Abe
- Division of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Takashi Tamura
- Division of Cardiology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Manabu Shirotani
- Division of Cardiology, Nara Hospital, Kinki University Faculty of Medicine, Nara, Japan
| | - Shinji Miki
- Division of Cardiology, Mitsubishi Kyoto Hospital, Kyoto, Japan
| | - Mitsuo Matsuda
- Division of Cardiology, Kishiwada City Hospital, Kishiwada, Japan
| | | | - Katsuhisa Ishii
- Division of Cardiology, Kansai Electric Power Hospital, Osaka, Japan
| | - Masaru Tanaka
- Division of Cardiology, Osaka Red Cross Hospital, Osaka, Japan
| | - Takeshi Aoyama
- Division of Cardiology, Shimada Municipal Hospital, Shimada, Japan
| | - Osamu Doi
- Division of Cardiology, Shizuoka General Hospital, Shizuoka, Japan
| | - Ryuichi Hattori
- Division of Cardiology, Shimada Municipal Hospital, Shimada, Japan
| | - Masayuki Kato
- Division of Cardiology, Maizuru Kyosai Hospital, Maizuru, Japan
| | - Satoru Suwa
- Division of Cardiology, Juntendo University Shizuoka Hospital, Shizuoka, Japan
| | - Akinori Takizawa
- Division of Cardiology, Shizuoka City Shizuoka Hospital, Shizuoka, Japan
| | - Yoshiki Takatsu
- Division of Cardiology, Hyogo Prefectural Amagasaki Hospital, Amagasaki, Japan
| | - Eiji Shinoda
- Division of Cardiology, Hamamatsu Rosai Hospital, Hamamatsu, Japan
| | - Hiroshi Eizawa
- Division of Cardiology, Nishi-Kobe Medical Center, Kobe, Japan
| | - Teruki Takeda
- Division of Cardiology, Koto Memorial Hospital, Higashioumi, Japan
| | - Jong-Dae Lee
- Division of Cardiology, University of Fukui Hospital, Fukui, Japan
| | - Moriaki Inoko
- Cardiovascular Center, the Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan
| | - Hisao Ogawa
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Shuichi Hamasaki
- Department of Cardiovascular, Respiratory and Metabolic Medicine, Graduate School of Medicine, Kagoshima University, Kagoshima, Japan
| | - Minoru Horie
- Department of Cardiovascular and Respiratory, Shiga University of Medical Science, Otsu, Japan
| | - Ryuji Nohara
- Division of Cardiology, Hirakata Kohsai Hospital, Hirakata, Japan
| | - Hirofumi Kambara
- Division of Cardiology, Shizuoka General Hospital, Shizuoka, Japan
| | - Hisayoshi Fujiwara
- Division of Cardiology, Hyogo Prefectural Amagasaki Hospital, Amagasaki, Japan
| | - Kazuaki Mitsudo
- Division of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan
| | | | - Toru Kita
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | | | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- * E-mail:
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Binder RK, Luscher TF. Duration of dual antiplatelet therapy after coronary artery stenting: where is the sweet spot between ischaemia and bleeding? Eur Heart J 2015; 36:1207-11. [DOI: 10.1093/eurheartj/ehv103] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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1388
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Chow CL, Scott P, Farouque O, Clark DJ. Drug-coated balloons: a novel advance in the percutaneous treatment of coronary and peripheral artery disease. Interv Cardiol 2015. [DOI: 10.2217/ica.15.4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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1389
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Moschonas I, Goudevenos J, Tselepis A. Protease-activated receptor-1 antagonists in long-term antiplatelet therapy. Current state of evidence and future perspectives. Int J Cardiol 2015; 185:9-18. [DOI: 10.1016/j.ijcard.2015.03.049] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 01/23/2015] [Accepted: 03/03/2015] [Indexed: 11/29/2022]
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1390
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The Conundrum of Reducing Ischemic and Bleeding Events After PCI. J Am Coll Cardiol 2015; 65:1421-3. [DOI: 10.1016/j.jacc.2015.02.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Accepted: 02/01/2015] [Indexed: 11/20/2022]
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1391
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Waksman R. Do you still have an appetite for a short DAPT trial? CARDIOVASCULAR REVASCULARIZATION MEDICINE 2015; 16:133-4. [DOI: 10.1016/j.carrev.2015.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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1392
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Giustino G, Baber U, Sartori S, Mehran R, Mastoris I, Kini AS, Sharma SK, Pocock SJ, Dangas GD. Duration of Dual Antiplatelet Therapy After Drug-Eluting Stent Implantation. J Am Coll Cardiol 2015; 65:1298-1310. [DOI: 10.1016/j.jacc.2015.01.039] [Citation(s) in RCA: 232] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Revised: 01/16/2015] [Accepted: 01/20/2015] [Indexed: 10/24/2022]
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Sabouret P, Rushton-Smith SK, Kerneis M, Silvain J, Collet JP, Montalescot G. Dual antiplatelet therapy: optimal timing, management, and duration. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2015; 1:198-204. [PMID: 27533996 DOI: 10.1093/ehjcvp/pvv015] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Accepted: 03/18/2015] [Indexed: 12/27/2022]
Abstract
Platelet activation and aggregability play a key role in the genesis of arterial thrombus secondary to plaque rupture. For coronary patients, inhibition of platelet function is crucial to decrease the rate of major adverse cardiac events but may expose them to excess bleeding risk. Switching P2Y12 inhibitors is common, yet the clinical consequences are unknown. The aim of this review is to provide an overview of the evidence from randomized, clinical trials and epidemiological studies, with a focus on the optimal duration of dual antiplatelet therapy (DAPT) and appropriate agent and dose selection. The report discusses the latest evidence regarding switching therapies during DAPT, the potential benefits of a personalized strategy, management of the preoperative period, and other clinical perspectives in this complex and rapidly changing field. Ongoing trials will be useful to answer to some important unresolved questions.
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Affiliation(s)
- Pierre Sabouret
- Institut du Cœur, Pitié-Salpêtrière Hospital (AP-HP), Pierre and Marie Curie University, 47-83, boulevard de l'Hôpital, Paris 75013, France, ACTION Group, www.action-coeur.org
| | | | - Mathieu Kerneis
- Institut du Cœur, Pitié-Salpêtrière Hospital (AP-HP), Pierre and Marie Curie University, 47-83, boulevard de l'Hôpital, Paris 75013, France, ACTION Group, www.action-coeur.org
| | - Johanne Silvain
- Institut du Cœur, Pitié-Salpêtrière Hospital (AP-HP), Pierre and Marie Curie University, 47-83, boulevard de l'Hôpital, Paris 75013, France, ACTION Group, www.action-coeur.org
| | - Jean-Philippe Collet
- Institut du Cœur, Pitié-Salpêtrière Hospital (AP-HP), Pierre and Marie Curie University, 47-83, boulevard de l'Hôpital, Paris 75013, France, ACTION Group, www.action-coeur.org
| | - Gilles Montalescot
- Institut du Cœur, Pitié-Salpêtrière Hospital (AP-HP), Pierre and Marie Curie University, 47-83, boulevard de l'Hôpital, Paris 75013, France, ACTION Group, www.action-coeur.org
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1394
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Schiele F, Puymirat E, Bonello L, Dentan G, Meneveau N, Collet JP, Motreff P, Ravan R, Leclercq F, Ennezat PV, Ferrières J, Berard L, Simon T, Danchin N. Impact of prolonged dual antiplatelet therapy after acute myocardial infarction on 5-year mortality in the FAST-MI 2005 registry. Int J Cardiol 2015; 187:354-60. [PMID: 25839641 DOI: 10.1016/j.ijcard.2015.03.333] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Revised: 02/19/2015] [Accepted: 03/20/2015] [Indexed: 12/28/2022]
Abstract
BACKGROUND We document dual antiplatelet therapy (DAPT) use from discharge to 4 years after acute myocardial infarction (AMI), and investigate whether prolonged DAPT (beyond 1 year) is related to 5-year mortality. METHODS The French Registry of Acute ST-elevation or non-ST-elevation Myocardial Infarction (FAST-MI 2005) included 3670 patients with AMI in 223 French centres. We identified predictors of DAPT (aspirin+clopidogrel) beyond 1 and 2 years, and relation with all-cause 5-year mortality. RESULTS Among 3319 (96%) patients with discharge data, 2432 (73%) had DAPT, 582 (17%) single antiplatelet therapy (SAPT), and 305 (9%) no antiplatelet treatment. DAPT decreased from 75% at 1 year to 29% at 4 years, with a corresponding increase in SAPT (p<0.05 for trend). Patients with DAPT were more often male, treated with a drug-eluting stent (DES), and without oral anticoagulants. Independent predictors at 1 year of prolonged DAPT were age<75 years, in-hospital bleeding, history of MI, use of DES, discharge use of beta-blockers or statins and no chronic anticoagulation. Predictors at 2 years were age<75 years, male gender, previous MI, diabetes, DES implantation, no chronic oral anticoagulation. By multivariate analysis, there was no difference in 5-year mortality between those on SAPT vs DAPT at 1 year. DAPT at 2 years was also not significantly related to 5-year mortality (Hazard Ratio 1.3, 95% CI [0.9; 1.8], p=0.21). CONCLUSION Prolonged DAPT in selected AMI patients, observed in 47% at 1 year and 21% at 2 years, had no impact on 5-year mortality. These findings do not support the use of DAPT beyond 1 year after an initial ACS.
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Affiliation(s)
| | - Etienne Puymirat
- Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou, Paris, France
| | | | | | | | | | - Pascal Motreff
- University Hospital Gabriel Montpied, Clermont Ferrand, France
| | | | | | | | | | - Laurence Berard
- APHP-Hôpital Saint Antoine, Paris, France; INSERM U-698, UPMC, Paris 06, Paris, France
| | - Tabassome Simon
- APHP-Hôpital Saint Antoine, Paris, France; INSERM U-698, UPMC, Paris 06, Paris, France
| | - Nicolas Danchin
- Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou, Paris, France
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Alfredsson J, Roe MT. Balancing the risks and benefits of long-term antiplatelet therapies for cardiovascular disease: clinical, research, and regulatory implications. J Am Heart Assoc 2015; 4:e001897. [PMID: 25792126 PMCID: PMC4392454 DOI: 10.1161/jaha.115.001897] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Matthew T. Roe
- Duke Clinical Research Institute, Durham, NC (J.A., M.T.R.)
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Rohla M, Weiss TW, Wojta J, Niessner A, Huber K. Double or triple antithrombotic combination therapy in patients who need anticoagulation and antiplatelet therapy in parallel. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2015; 1:191-7. [DOI: 10.1093/ehjcvp/pvv014] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 03/16/2015] [Indexed: 01/28/2023]
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Raffoul J, Klein AJP. Dual antiplatelet therapy duration after the placement of a drug-eluting stent: what are the data? CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2015; 17:367. [PMID: 25773476 DOI: 10.1007/s11936-015-0367-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OPINION STATEMENT The data supporting the immediate use of dual antiplatelet therapy (DAPT) post implantation of drug-eluting stents (DESs) is irrefutable. DAPT in this early period is necessary to prevent stent thrombosis during endothelialization of the stent, a process known to be delayed when DESs are placed. In addition, DAPT helps prevent thrombosis from plaque rupture that occurs outside of the initial stented area and/or at neo-atherosclerotic lesions within a previously coated stent. The ACC/AHA current guidelines (Levine et al. J Am Coll Cardiol. 58(24):e44-122, 2011) recommend 12 months of DAPT post DES implantation. As the result of several randomized clinical trials (Task Force on Myocardial Revascularization of the European Society of Cardio-Thoracic Surgery (EACTS) et al. Eur Heart J. 31(20):2501-55, 2010) showing the safety of a shorter duration of DAPT, the European Heart Society altered their recommendations to 6-12 months of DAPT post DES implantation. However, recent data from the DAPT trial (Mauri et al. N Engl J Med. 371(23):2156-66, 2014) clearly demonstrated less ischemic events with 30 months of DAPT. This trial and others have established that an increased DAPT duration increases bleeding risk which, in turn, increases subsequent morbidity and mortality. The current conundrum lies in defining the optimal time of DAPT post DES to adequately reduce ischemic events while minimizing bleeding risks. Future studies are required to better stratify patients into low and high risk for both ischemic and bleeding risks to assess whether shorter or longer courses of DAPT are the most appropriate for any specific patients. Until then, instead of a "one size fits all" approach to patients who receive DESs, the treating physician must consider both procedural and patient factors when deciding the optimal duration of DAPT for each patient.
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Affiliation(s)
- Jad Raffoul
- Department of Internal Medicine, Saint Louis University School of Medicine, 1402 South Grand Blvd., Saint Louis, MO, 63104, USA,
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1398
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Kereiakes DJ, Yeh RW, Massaro JM, Driscoll-Shempp P, Cutlip DE, Steg PG, Gershlick AH, Darius H, Meredith IT, Ormiston J, Tanguay JF, Windecker S, Garratt KN, Kandzari DE, Lee DP, Simon DI, Iancu AC, Trebacz J, Mauri L. Antiplatelet therapy duration following bare metal or drug-eluting coronary stents: the dual antiplatelet therapy randomized clinical trial. JAMA 2015; 313:1113-21. [PMID: 25781440 PMCID: PMC4481320 DOI: 10.1001/jama.2015.1671] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
IMPORTANCE Despite antirestenotic efficacy of coronary drug-eluting stents (DES) compared with bare metal stents (BMS), the relative risk of stent thrombosis and adverse cardiovascular events is unclear. Although dual antiplatelet therapy (DAPT) beyond 1 year provides ischemic event protection after DES, ischemic event risk is perceived to be less after BMS, and the appropriate duration of DAPT after BMS is unknown. OBJECTIVE To compare (1) rates of stent thrombosis and major adverse cardiac and cerebrovascular events (MACCE; composite of death, myocardial infarction, or stroke) after 30 vs 12 months of thienopyridine in patients treated with BMS taking aspirin and (2) treatment duration effect within the combined cohorts of randomized patients treated with DES or BMS as prespecified secondary analyses. DESIGN, SETTING, AND PARTICIPANTS International, multicenter, randomized, double-blinded, placebo-controlled trial comparing extended (30-months) thienopyridine vs placebo in patients taking aspirin who completed 12 months of DAPT without bleeding or ischemic events after receiving stents. The study was initiated in August 2009 with the last follow-up visit in May 2014. INTERVENTIONS Continued thienopyridine or placebo at months 12 through 30 after stent placement, in 11,648 randomized patients treated with aspirin, of whom 1687 received BMS and 9961 DES. MAIN OUTCOMES AND MEASURES Stent thrombosis, MACCE, and moderate or severe bleeding. RESULTS Among 1687 patients treated with BMS who were randomized to continued thienopyridine vs placebo, rates of stent thrombosis were 0.5% vs 1.11% (n = 4 vs 9; hazard ratio [HR], 0.49; 95% CI, 0.15-1.64; P = .24), rates of MACCE were 4.04% vs 4.69% (n = 33 vs 38; HR, 0.92; 95% CI, 0.57-1.47; P = .72), and rates of moderate/severe bleeding were 2.03% vs 0.90% (n = 16 vs 7; P = .07), respectively. Among all 11,648 randomized patients (both BMS and DES), stent thrombosis rates were 0.41% vs 1.32% (n = 23 vs 74; HR, 0.31; 95% CI, 0.19-0.50; P < .001), rates of MACCE were 4.29% vs 5.74% (n = 244 vs 323; HR, 0.73; 95% CI, 0.62-0.87; P < .001), and rates of moderate/severe bleeding were 2.45% vs 1.47% (n = 135 vs 80; P < .001). CONCLUSIONS AND RELEVANCE Among patients undergoing coronary stent placement with BMS and who tolerated 12 months of thienopyridine, continuing thienopyridine for an additional 18 months compared with placebo did not result in statistically significant differences in rates of stent thrombosis, MACCE, or moderate or severe bleeding. However, the BMS subset may have been underpowered to identify such differences, and further trials are suggested. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00977938.
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Affiliation(s)
- Dean J Kereiakes
- The Christ Hospital Heart and Vascular Center, Cincinnati, Ohio2Lindner Research Center, Cincinnati, Ohio
| | - Robert W Yeh
- Harvard Clinical Research Institute, Boston, Massachusetts4Massachusetts General Hospital, Boston
| | - Joseph M Massaro
- Harvard Clinical Research Institute, Boston, Massachusetts5Boston University, Boston, Massachusetts
| | | | - Donald E Cutlip
- Harvard Clinical Research Institute, Boston, Massachusetts6Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - P Gabriel Steg
- Université Paris-Diderot, Paris, France8Département Hospitalo-Universitaire FIRE, Hôpital Bichat, Paris, France9National Heart and Lung Institute, Imperial College, Royal Brompton Hospital, London, United Kingdom
| | | | | | | | | | | | | | | | | | | | - Daniel I Simon
- University Hospitals Case Medical Center, Cleveland, Ohio
| | | | | | - Laura Mauri
- Harvard Clinical Research Institute, Boston, Massachusetts22Brigham and Women's Hospital, Boston, Massachusetts
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1399
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Liu Y, Zhou X, Jiang H, Gao M, Wang L, Shi Y, Gao J. Percutaneous coronary intervention strategies and prognosis for graft lesions following coronary artery bypass grafting. Exp Ther Med 2015; 9:1656-1664. [PMID: 26136874 DOI: 10.3892/etm.2015.2366] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2014] [Accepted: 01/09/2015] [Indexed: 11/06/2022] Open
Abstract
The purpose of this study was to compare the prognosis of graft-percutaneous coronary intervention (PCI) and native vessel (NV)-PCI, drug-eluting stents (DESs) and bare-metal stents (BMSs) for the treatment of graft lesions following coronary artery bypass grafting (CABG), and to determine the risk factors for major adverse cardiac events (MACEs). A total of 289 patients who underwent PCI following CABG between August 2005 and March 2010 were retrospectively analyzed. The effects on survival were compared among patients who underwent NV- and graft-PCI, and DES and BMS implantation. Additionally, the risk factors for MACEs following PCI for graft lesions were analyzed. The findings showed that MACE-free and revascularization-free survival rates were significantly higher in the NV-PCI group compared with those in the graft-PCI group. There were 63 cases (29.0%) of MACEs in the DES group and 25 cases (52.1%) in the BMS group. In patients undergoing NV-PCI, the DES group had significantly fewer MACEs and less target vessel revascularization (TVR) than the BMS group. In patients undergoing graft-PCI, the DES group showed a tendency for fewer MACEs and a lower incidence of cardiac mortality, myocardial infarction and TVR compared with the BMS group. Diabetes, an age of >70 years and graft-PCI were independent risk factors for MACEs in patients post-PCI. It is concluded that NV-PCI has superior long-term outcomes compared with graft-PCI, and should therefore be considered as the first-line treatment for graft disease following CABG. Despite this, graft-PCI remains a viable option. DESs are the first choice for graft-PCI due to their safety and efficacy and their association with reduced mortality and MACE rate. Diabetes, older age and graft-PCI are independent risk factors for MACEs in patients post-CABG who are undergoing revascularization.
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Affiliation(s)
- Yin Liu
- Department of Cardiology, Tianjin Chest Hospital, Tianjin 300051, P.R. China
| | - Xiujun Zhou
- Department of Cardiology, Tianjin Chest Hospital, Tianjin 300051, P.R. China
| | - Hua Jiang
- Department of Cardiology, Tianjin Chest Hospital, Tianjin 300051, P.R. China
| | - Mingdong Gao
- Department of Cardiology, Tianjin Chest Hospital, Tianjin 300051, P.R. China
| | - Lin Wang
- Department of Cardiology, Tianjin Chest Hospital, Tianjin 300051, P.R. China
| | - Yutian Shi
- Department of Cardiology, Tianjin Chest Hospital, Tianjin 300051, P.R. China
| | - Jing Gao
- Cardiovascular Institute, Department of Cardiology, Tianjin Chest Hospital, Tianjin 300051, P.R. China
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1400
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Yeh RW, Kereiakes DJ, Steg PG, Windecker S, Rinaldi MJ, Gershlick AH, Cutlip DE, Cohen DJ, Tanguay JF, Jacobs A, Wiviott SD, Massaro JM, Iancu AC, Mauri L. Benefits and Risks of Extended Duration Dual Antiplatelet Therapy After PCI in Patients With and Without Acute Myocardial Infarction. J Am Coll Cardiol 2015; 65:2211-21. [PMID: 25787199 DOI: 10.1016/j.jacc.2015.03.003] [Citation(s) in RCA: 205] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Revised: 03/02/2015] [Accepted: 03/04/2015] [Indexed: 01/06/2023]
Abstract
BACKGROUND The benefits and risks of prolonged dual antiplatelet therapy may be different for patients with acute myocardial infarction (MI) compared with more stable presentations. OBJECTIVES This study sought to assess the benefits and risks of 30 versus 12 months of dual antiplatelet therapy among patients undergoing coronary stent implantation with and without MI. METHODS The Dual Antiplatelet Therapy Study, a randomized double-blind, placebo-controlled trial, compared 30 versus 12 months of dual antiplatelet therapy after coronary stenting. The effect of continued thienopyridine on ischemic and bleeding events among patients initially presenting with versus without MI was assessed. The coprimary endpoints were definite or probable stent thrombosis and major adverse cardiovascular and cerebrovascular events (MACCE). The primary safety endpoint was GUSTO (Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Arteries) moderate or severe bleeding. RESULTS Of 11,648 randomized patients (9,961 treated with drug-eluting stents, 1,687 with bare-metal stents), 30.7% presented with MI. Between 12 and 30 months, continued thienopyridine reduced stent thrombosis compared with placebo in patients with and without MI at presentation (MI group, 0.5% vs. 1.9%, p < 0.001; no MI group, 0.4% vs. 1.1%, p < 0.001; interaction p = 0.69). The reduction in MACCE for continued thienopyridine was greater for patients with MI (3.9% vs. 6.8%; p < 0.001) compared with those with no MI (4.4% vs. 5.3%; p = 0.08; interaction p = 0.03). In both groups, continued thienopyridine reduced MI (2.2% vs. 5.2%, p < 0.001 for MI; 2.1% vs. 3.5%, p < 0.001 for no MI; interaction p = 0.15) but increased bleeding (1.9% vs. 0.8%, p = 0.005 for MI; 2.6% vs. 1.7%, p = 0.007 for no MI; interaction p = 0.21). CONCLUSIONS Compared with 12 months of therapy, 30 months of dual antiplatelet therapy reduced the risk of stent thrombosis and MI in patients with and without MI, and increased bleeding. (The Dual Antiplatelet Therapy Study [The DAPT Study]; NCT00977938).
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Affiliation(s)
- Robert W Yeh
- Massachusetts General Hospital, Boston, Massachusetts; Harvard Clinical Research Institute, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Dean J Kereiakes
- The Christ Hospital Heart and Vascular Center and The Lindner Center for Research and Education, Cincinnati, Ohio
| | - Philippe Gabriel Steg
- Université Paris-Diderot, Paris, France, INSERM U-1148, Paris, France; Hôpital Bichat, Département Hospitalo-Universitaire FIRE, Assistance Publique-Hôpitaux de Paris, Paris, France; NHLI, Imperial College, Royal Brompton Hospital, London, United Kingdom
| | | | - Michael J Rinaldi
- The Sanger Heart and Vascular Institute, Carolinas HealthCare System, Charlotte, North Carolina
| | - Anthony H Gershlick
- Department of Cardiovascular Sciences, University of Leicester and National Institute of Health Research Leicester Cardiovascular Biomedical Research Unit, University Hospitals of Leicester, Leicester, United Kingdom
| | - Donald E Cutlip
- Harvard Clinical Research Institute, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - David J Cohen
- Saint Luke's Mid-America Heart Institute, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
| | | | - Alice Jacobs
- Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
| | - Stephen D Wiviott
- Harvard Medical School, Boston, Massachusetts; Brigham and Women's Hospital, Boston, Massachusetts
| | - Joseph M Massaro
- Harvard Clinical Research Institute, Boston, Massachusetts; Boston University School of Public Health, Boston, Massachusetts
| | - Adrian C Iancu
- Heart Institute, University of Medicine Iuliu Hatieganu, Cluj Napoca, Romania
| | - Laura Mauri
- Harvard Clinical Research Institute, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Brigham and Women's Hospital, Boston, Massachusetts.
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