1401
|
Valgimigli M, Ariotti S, Costa F. Duration of dual antiplatelet therapy after drug-eluting stent implantation: will we ever reach a consensus? Eur Heart J 2015; 36:1219-22. [DOI: 10.1093/eurheartj/ehv053] [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: 01/10/2023] Open
|
1402
|
2014 update on interventional cardiology. ACTA ACUST UNITED AC 2015; 68:324-30. [PMID: 25749393 DOI: 10.1016/j.rec.2014.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Accepted: 12/15/2014] [Indexed: 11/22/2022]
Abstract
This article reviews the most relevant publications and studies in the field of interventional cardiology in 2014. In the area of coronary interventional procedures, integrated treatment of acute coronary syndrome continues to be the subject of numerous studies that evaluate different devices and pharmacological and mechanical strategies that can be used without increasing the risk of hemorrhage or the need for reintervention. Certain anatomical substrates continue to generate a considerable number of publications, both on the outcomes with different stents and on the use of specific techniques. Bioabsorbable drug-eluting stents are used in increasingly complex lesions with promising results. The development of interventional procedures for structural heart disease continues to advance, with new evidence on percutaneously placed aortic valve prostheses, the outcome of percutaneous mitral valve repair, and the safety and efficacy of left atrial appendage occlusion. Finally, renal denervation has generated one of the major debates of the year.
Collapse
|
1403
|
Palmerini T, Sangiorgi D, Valgimigli M, Biondi-Zoccai G, Feres F, Abizaid A, Costa RA, Hong MK, Kim BK, Jang Y, Kim HS, Park KW, Mariani A, Della Riva D, Genereux P, Leon MB, Bhatt DL, Bendetto U, Rapezzi C, Stone GW. Short- Versus Long-Term Dual Antiplatelet Therapy After Drug-Eluting Stent Implantation. J Am Coll Cardiol 2015; 65:1092-102. [PMID: 25790880 DOI: 10.1016/j.jacc.2014.12.046] [Citation(s) in RCA: 141] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 12/18/2014] [Indexed: 02/05/2023]
Affiliation(s)
- Tullio Palmerini
- Dipartimento Cardio-Toraco-Vascolare, University of Bologna, Bologna, Italy
| | - Diego Sangiorgi
- Dipartimento Cardio-Toraco-Vascolare, University of Bologna, Bologna, Italy
| | - Marco Valgimigli
- Erasmus Medical Center, Thoraxcenter, Rotterdam, the Netherlands
| | - Giuseppe Biondi-Zoccai
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy; VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia
| | - Fausto Feres
- Istituto Dante Pazzanese de Cardiologia, Sao Paulo, Brazil
| | | | | | - Myeong-Ki Hong
- Severance Cardiovascular Hospital and Science Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Byeong-Keuk Kim
- Severance Cardiovascular Hospital and Science Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Yangsoo Jang
- Severance Cardiovascular Hospital and Science Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Hyo-Soo Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Kyung Woo Park
- Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Andrea Mariani
- Dipartimento Cardio-Toraco-Vascolare, University of Bologna, Bologna, Italy
| | - Diego Della Riva
- Dipartimento Cardio-Toraco-Vascolare, University of Bologna, Bologna, Italy
| | - Philippe Genereux
- Columbia University Medical Center/New York-Presbyterian Hospital and the Cardiovascular Research Foundation, New York, New York
| | - Martin B Leon
- Columbia University Medical Center/New York-Presbyterian Hospital and the Cardiovascular Research Foundation, New York, New York
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, Massachusetts
| | | | - Claudio Rapezzi
- Dipartimento Cardio-Toraco-Vascolare, University of Bologna, Bologna, Italy
| | - Gregg W Stone
- Columbia University Medical Center/New York-Presbyterian Hospital and the Cardiovascular Research Foundation, New York, New York.
| |
Collapse
|
1404
|
Mehran R, Giustino G, Baber U. DAPT Duration After DES. J Am Coll Cardiol 2015; 65:1103-6. [DOI: 10.1016/j.jacc.2015.01.024] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Accepted: 01/25/2015] [Indexed: 11/26/2022]
|
1405
|
Noncompliance and Cessation of Dual Antiplatelet Therapy After Coronary Stenting. JACC Cardiovasc Interv 2015; 8:411-413. [PMID: 25703881 DOI: 10.1016/j.jcin.2014.12.005] [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] [Received: 11/14/2014] [Revised: 12/05/2014] [Accepted: 12/18/2014] [Indexed: 02/05/2023]
|
1406
|
Affiliation(s)
- Gilles Lemesle
- Hôpital Cardiologique, Centre Hospitalier Régional et Universitaire de Lille, 59000 Lille, France; Faculté de Médecine de Lille, Lille, France; INSERM UMR744, Institut Pasteur de Lille, Lille, France.
| |
Collapse
|
1407
|
Elmariah S, Mauri L, Doros G, Galper BZ, O'Neill KE, Steg PG, Kereiakes DJ, Yeh RW. Extended duration dual antiplatelet therapy and mortality: a systematic review and meta-analysis. Lancet 2015; 385:792-8. [PMID: 25467565 PMCID: PMC4386690 DOI: 10.1016/s0140-6736(14)62052-3] [Citation(s) in RCA: 132] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Treatment with aspirin and a P2Y12 inhibitor is commonly used in patients with cardiovascular disorders. The overall effect of such treatment on all-cause mortality is unknown. In the Dual Antiplatelet Therapy (DAPT) Study, continuation of dual antiplatelet therapy beyond 12 months after coronary stenting was associated with an unexpected increase in non-cardiovascular death. In view of the potential public health importance of these findings, we aimed to assess the effect of extended duration dual antiplatelet therapy on mortality by doing a meta-analysis of all randomised, controlled trials of treatment duration in various cardiovascular disorders. METHODS We searched Medline, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL) to identify randomised controlled trials assessing the effect of extended duration versus no or short duration dual antiplatelet therapy, published before Oct 1, 2014. We did a meta-analysis to pool results with a hierarchical Bayesian random-effects model. The primary outcomes were hazard ratios comparing rates of all-cause, cardiovascular, and non-cardiovascular death. FINDINGS Including the DAPT Study, we identified 14 eligible trials that randomly assigned 69,644 participants to different durations of dual antiplatelet therapy. Compared with aspirin alone or short duration dual antiplatelet therapy (≤6 months), continued treatment was not associated with a difference in all-cause mortality (hazard ratio [HR] 1·05, 95% credible interval [CrI] 0·96-1·19; p=0·33). Similarly, cardiovascular (1·01, 0·93-1·12; p=0·81) and non-cardiovascular mortality (1·04, 0·90-1·26; p=0·66) were no different with extended duration versus short duration dual antiplatelet therapy or aspirin alone. INTERPRETATION Extended duration dual antiplatelet therapy was not associated with a difference in the risk of all-cause, cardiovascular, or non-cardiovascular death compared with aspirin alone or short duration dual antiplatelet therapy. FUNDING None.
Collapse
Affiliation(s)
- Sammy Elmariah
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Harvard Clinical Research Institute, Boston, MA, USA
| | - Laura Mauri
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Harvard Clinical Research Institute, Boston, MA, USA
| | - Gheorghe Doros
- Harvard Clinical Research Institute, Boston, MA, USA; Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Benjamin Z Galper
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Kelly E O'Neill
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Philippe Gabriel Steg
- Université Paris-Diderot, Sorbonne Paris-Cité, Paris, France; Département Hospitalo-Universitaire FIRE (Fibrosis, Inflammation and Remodeling), INSERM U-1148 and Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris, France; National Heart Lung Institute, Imperial College, Royal Brompton Hospital, London, UK
| | - Dean J Kereiakes
- The Lindner Research Center, The Christ Hospital Heart and Vascular Center, Cincinnati, OH, USA
| | - Robert W Yeh
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Harvard Clinical Research Institute, Boston, MA, USA.
| |
Collapse
|
1408
|
Costa F, Vranckx P, Leonardi S, Moscarella E, Ando G, Calabro P, Oreto G, Zijlstra F, Valgimigli M. Impact of clinical presentation on ischaemic and bleeding outcomes in patients receiving 6- or 24-month duration of dual-antiplatelet therapy after stent implantation: a pre-specified analysis from the PRODIGY (Prolonging Dual-Antiplatelet Treatment After Grading Stent-Induced Intimal Hyperplasia) trial. Eur Heart J 2015; 36:1242-51. [DOI: 10.1093/eurheartj/ehv038] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 01/22/2015] [Indexed: 12/24/2022] Open
|
1409
|
Abstract
Antiplatelet therapies play a central role in reducing the risk of cardiovascular events such as myocardial infarction and stroke. While aspirin, a cyclo-oxygenase-1 inhibitor has been the cornerstone of antithrombotic treatment for several decades, P2Y12 receptor inhibitors cangrelor, clopidogrel, prasugrel, and ticagrelor and protease-activated receptor-1 antagonist vorapaxar, have emerged as additional therapies to reduce the risk of recurrent cardiovascular events in high-risk patients. Recent clinical trials evaluating the role of these agents and major society guideline updates for use of antiplatelet therapies for secondary prevention of cardiovascular events will be examined. The latest studies regarding the appropriate duration of dual antiplatelet therapy after percutaneous coronary intervention will be presented. The current state of genetic and platelet function testing will be reviewed.
Collapse
Affiliation(s)
- Eugene Yang
- Division of Cardiology, University of Washington Medical Center, 1959 NE Pacific Street, Box 365005, Seattle, WA, 98195, USA,
| |
Collapse
|
1410
|
Vetrovec GW. Another challenge for the presumed safety advantage of bare metal stents: noncardiac surgery. Catheter Cardiovasc Interv 2015; 85:542-3. [PMID: 25702906 DOI: 10.1002/ccd.25844] [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: 01/15/2015] [Accepted: 01/16/2015] [Indexed: 11/11/2022]
Affiliation(s)
- George W Vetrovec
- VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia
| |
Collapse
|
1411
|
Husted S. Antithrombotic therapy for long-term secondary prevention of acute coronary syndrome in high-risk patients. Ther Clin Risk Manag 2015; 11:263-77. [PMID: 25733842 PMCID: PMC4337714 DOI: 10.2147/tcrm.s75024] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Patients with acute coronary syndrome (ACS) represent a major clinical burden, because they tend to experience recurrent ischemic events. Acute management of patients with ACS includes combination antithrombotic therapy composed of a parenteral anticoagulant and dual-antiplatelet therapy. Dual-antiplatelet therapy is also recommended for long-term secondary prevention of ACS. Despite advances in the antithrombotic therapies available, clinical trials suggest that patients with ACS still faceã10% risk of another event within 12-15 months of the index event. Certain patient populations, such as elderly patients and those with renal impairment or heart failure, are at higher risk of recurrent ACS events, because these patients have more vascular ischemic and bleeding risk factors than most other patients. Evidence from the GRACE and CRUSADE registries suggests underuse of the guideline-recommended evidence-based therapies for the management of ACS in such patients. This review summarizes the current standard of care for patients with ACS, focusing on long-term secondary antithrombotic strategies. Registry data are used to identify high-risk patient populations; the recent antiplatelet and anticoagulant Phase III trial data are summarized to highlight any patient populations who receive greater or lesser benefit from specific long-term antithrombotic strategies. Guideline recommendations are discussed and suggestions are provided to help improve implementation of long-term secondary prevention strategies and patient prognosis after an ACS event.
Collapse
Affiliation(s)
- Steen Husted
- Department of Biomedicine, Centre for Clinical Pharmacology, Aarhus, Denmark
- Department of Medicine, Hospital Unit West, Herning, Denmark
| |
Collapse
|
1412
|
Iqbal J, Serruys PW, Albuquerque FN, Wijns W. The year in cardiology 2014: coronary intervention. Eur Heart J 2015; 36:347-52b. [PMID: 25559135 DOI: 10.1093/eurheartj/ehu487] [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] [Indexed: 11/14/2022] Open
Affiliation(s)
- Javaid Iqbal
- Manchester Heart Centre, Manchester Royal Infirmary, Manchester, UK
| | - Patrick W Serruys
- Erasmus Medical Centre, Rotterdam, the Netherlands Imperial College, London, UK
| | - Felipe N Albuquerque
- Montefiore Medical Centre, Albert Einstein College of Medicine, New York, NY, USA
| | - William Wijns
- Cardiovascular Research Centre, OLV Hospital, Aalst, Belgium
| |
Collapse
|
1413
|
Gilchrist IC. Vignettes of DES failure. Catheter Cardiovasc Interv 2015; 85:522-3. [PMID: 25647280 DOI: 10.1002/ccd.25846] [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: 01/12/2015] [Accepted: 01/16/2015] [Indexed: 11/06/2022]
Affiliation(s)
- Ian C Gilchrist
- Division of Cardiology, College of Medicine, Penn State University, Heart & Vascular Institute, MS Hershey Medical Center, Hershey, Pennsylvania
| |
Collapse
|
1414
|
Avanzas P, Bayes-Genis A, Isla LPD, Sanchis J. Resumen de los ensayos clínicos presentados en las Sesiones Científicas Anuales de la American Heart Association (Chicago, Illinois, Estados Unidos, 15•19 de noviembre de 2014)1. Rev Esp Cardiol (Engl Ed) 2015. [DOI: 10.1016/j.recesp.2014.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
1415
|
Lhermusier T, Waksman R. Prasugrel hydrochloride for the treatment of acute coronary syndromes. Expert Opin Pharmacother 2015; 16:585-96. [DOI: 10.1517/14656566.2015.1005602] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
|
1416
|
Abstract
Stent thrombosis is an uncommon but serious complication which carries with it significant mortality and morbidity. This review analyzes the entity of stent thrombosis from a historical and clinical perspective, and chronicles the evolution of this condition through the various generations of stent development, from bare metal to first-generation, second-generation, and third-generation drug-eluting stents. It also delineates the specific risk factors associated with stent thrombosis and comprehensively examines the literature related to each of these risks. Finally, it highlights the preventative strategies that can be garnered from the existing data, and concludes that a multifactorial approach is necessary to combat the occurrence of stent thrombosis, with higher risk groups, such as patients with ST segment elevation myocardial infarction, meriting further research.
Collapse
Affiliation(s)
| | - Amir S Lotfi
- Division of Cardiology, Baystate Medical Center, Springfield, MA, USA
| |
Collapse
|
1417
|
Collet JP, Vicaut E, Montalescot G. Dual antiplatelet treatment after stenting - Authors' reply. Lancet 2015; 385:326. [PMID: 25706846 DOI: 10.1016/s0140-6736(15)60113-1] [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: 11/16/2022]
Affiliation(s)
- Jean-Philippe Collet
- ACTION Study Group, Unité de Recherche Clinique-Hôpital Lariboisière (APHP) and Université Paris 6, INSERM, Paris, France.
| | | | - Gilles Montalescot
- ACTION Study Group, Unité de Recherche Clinique-Hôpital Lariboisière (APHP) and Université Paris 6, INSERM, Paris, France
| |
Collapse
|
1418
|
Schulz-Schupke S, Byrne RA, ten Berg JM, Neumann FJ, Han Y, Adriaenssens T, Tolg R, Seyfarth M, Maeng M, Zrenner B, Jacobshagen C, Mudra H, von Hodenberg E, Wohrle J, Angiolillo DJ, von Merzljak B, Rifatov N, Kufner S, Morath T, Feuchtenberger A, Ibrahim T, Janssen PWA, Valina C, Li Y, Desmet W, Abdel-Wahab M, Tiroch K, Hengstenberg C, Bernlochner I, Fischer M, Schunkert H, Laugwitz KL, Schomig A, Mehilli J, Kastrati A. ISAR-SAFE: a randomized, double-blind, placebo-controlled trial of 6 vs. 12 months of clopidogrel therapy after drug-eluting stenting. Eur Heart J 2015; 36:1252-63. [DOI: 10.1093/eurheartj/ehu523] [Citation(s) in RCA: 321] [Impact Index Per Article: 35.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Accepted: 12/11/2014] [Indexed: 11/14/2022] Open
|
1419
|
|
1420
|
Capodanno D, Lip GY, Windecker S, Huber K, Kirchhof P, Boriani G, Lane D, Gilard M, Collet JP, Valgimigli M, Byrne RA. Triple antithrombotic therapy in atrial fibrillation patients with acute coronary syndromes or undergoing percutaneous coronary intervention or transcatheter aortic valve replacement. EUROINTERVENTION 2015; 10:1015-21. [DOI: 10.4244/eijv10i9a174] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
1421
|
Affiliation(s)
- Cheol Whan Lee
- Division of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan
| |
Collapse
|
1422
|
Kandan SR, Johnson TW. Contemporary Antiplatelet Strategies in the Treatment of STEMI using Primary Percutaneous Coronary Intervention. Interv Cardiol 2015; 10:26-31. [PMID: 29588670 DOI: 10.15420/icr.2015.10.1.26] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Reperfusion therapy for patients presenting with an acute ST-segment elevation myocardial infarction (STEMI) involves primary percutaneous coronary intervention (PPCI) and concomitant oral antiplatelet and intravenous antithrombotic pharmacotherapy. There is a conflict between the desire to reduce the time between first medical contact and coronary re-canalisation and achieving effective platelet inhibition with oral antiplatelet agents. This review outlines the currently available antiplatelet treatments, and their place within the therapeutic timeline of a patient presenting with STEMI. Additionally, we focus on current challenges associated with effective antiplatelet treatment, including acute stent thrombosis (AST), the effect of morphine, platelet function assessment and concomitant anticoagulant therapy.
Collapse
|
1423
|
Cortese B, Piraino D, La Franca E, Buccheri D, Silva Orrego P, Andolina G, Seregni R. Coronary Stent Thrombosis in 2015: A Comprehensive and Uptodated Review. AIMS MEDICAL SCIENCE 2015. [DOI: 10.3934/medsci.2015.3.131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
|
1424
|
Huang QY, Bista M, Yang RQ. Is the Duration of Dual Antiplatelet Therapy after Implantation of Drug-Eluting Stents the Longer the Better? Med Princ Pract 2015; 24:398. [PMID: 25924625 PMCID: PMC5588245 DOI: 10.1159/000381955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Accepted: 03/30/2015] [Indexed: 12/04/2022] Open
Affiliation(s)
| | | | - Ren-Qiang Yang
- *Ren-Qiang Yang, Department of Cardiology, The Second Affiliated Hospital of Nanchang University, Mingde Road 1, Nanchang, Jiangxi Province 330006 (PR China), E-Mail
| |
Collapse
|
1425
|
Habib A, Finn AV. Endothelialization of drug eluting stents and its impact on dual anti-platelet therapy duration. Pharmacol Res 2014; 93:22-7. [PMID: 25533811 DOI: 10.1016/j.phrs.2014.12.003] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 12/12/2014] [Accepted: 12/13/2014] [Indexed: 01/12/2023]
Abstract
Coronary artery disease is a leading cause of death and disability worldwide with contemporary treatment strategies employing both optimal medical therapy and catheter based percutaneous coronary intervention (PCI) with drug eluting stents (DES). While DES have dramatically reduced restenosis rates, their use has been associated with an increased risk of late stent thrombosis and accelerated neointimal atherosclerosis (i.e. "neoatherosclerosis") both major contributors to late stent failure. The underlying substrate of late DES failure is likely related to vascular endothelial dysfunction such as poor endothelial regrowth and barrier function (i.e. "endothelial healing"). Initial concerns with 1st generation DES have lead to improvements in mechanical and biologic properties of current 2nd generation DES, which inhibit endothelial regrowth to a lesser extent, lessening late stent failure and resulting in an overall improved safety profile. Current guidelines recommend duration of at least one year of dual anti-platelet therapy with aspirin and a thienopyridine agent such as clopidogrel or prasugrel as sufficient to prevent late thrombotic complications. Recent studies, however, suggest a shorter duration of dual anti-platelet therapy may be equally as safe and efficacious in preventing stent thrombosis with newer generation DES. However, higher risk populations such as patients receiving 1st generation DES or those with increased risk for future ischemic events may benefit from a longer duration (i.e. 30 months) of DAPT to prevent major cardiovascular events with the caveat that such an approach may be associated with an increased risk for bleeding. This review examines the vascular responses to 1st and second generation DES and recent clinical trials examining DAPT duration.
Collapse
Affiliation(s)
- Anwer Habib
- Department of Internal Medicine, Division of Cardiology, Emory University School of Medicine, 101 Woodruff Circle, WMB319B, Atlanta, GA 30322, United States
| | - Aloke V Finn
- Department of Internal Medicine, Division of Cardiology, Emory University School of Medicine, 101 Woodruff Circle, WMB319B, Atlanta, GA 30322, United States.
| |
Collapse
|
1426
|
AlJaroudi WA, Hage FG. Review of Cardiovascular Literature. J Nucl Cardiol 2014. [DOI: 10.1007/s12350-014-0043-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
1427
|
Abstract
The American Heart Association (AHA) Scientific Sessions were held in Chicago on November 15-19, 2014. The meeting attracted more than 17,000 participants, including physicians, research scientists, students, and paramedical personnel, from more than 100 countries. Sessions over the 5 days included comprehensive and unparalleled education delivered via more than 5,000 presentations, with 1,000 invited faculty members and 4,000 abstract presentations from world leaders in cardiovascular (CV) disease. There were 16 trials scheduled in 4 late-breaking clinical trial sessions. The Dual Antiplatelet Therapy study revealed that aspirin plus a thienopyridine beyond 1 year subsequent to placement of a drug-eluting stent, as compared with aspirin therapy alone, significantly reduced stent thrombosis and major CV and cerebrovascular events but was associated with increased risk of bleeding. The IMPROVE-IT research showed that, relative to simvastatin with placebo, simvastatin with 10 mg of ezetimibe daily led to a significantly lower primary combined endpoint in moderate- to high-risk patients, who stabilized following acute coronary syndrome. This was the first trial to demonstrate incremental clinical benefit by adding a nonstatin agent to statin therapy and reaffirmed the low-density lipoprotein (LDL) hypothesis stating that reducing LDL-cholesterol prevents CV events. Summaries and overviews of both the late-breaking trials and the sessions to which members of the Japanese Circulation Society contributed are presented.
Collapse
Affiliation(s)
- Takashi Kohno
- Division of Cardiology, Department of Medicine, Keio University School of Medicine
| |
Collapse
|
1428
|
Shimohama T, Ako J. Intrastent thrombus – what you see is what you get? Circ J 2014; 79:41-2. [PMID: 25482296 DOI: 10.1253/circj.cj-14-1271] [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]
|
1429
|
Affiliation(s)
- Antonio Colombo
- From the Interventional Cardiology Unit, San Raffaele Scientific Institute (A. Colombo and A. Chieffo), and EMO-GVM Columbus Hospital (A. Colombo) - both in Milan
| | | |
Collapse
|