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Lee W, Suh JW, Park JJ, Yoon CH, Cho YS, Youn TJ, Chae IH. Effect of tailored use of tirofiban in patients with Non-ST-elevation acute coronary syndrome undergoing percutaneous coronary intervention: a randomized controlled trial. BMC Cardiovasc Disord 2018; 18:201. [PMID: 30348101 PMCID: PMC6198526 DOI: 10.1186/s12872-018-0938-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 10/10/2018] [Indexed: 11/30/2022] Open
Abstract
Background We conducted a randomized controlled trial to investigate whether an additional platelet inhibition with tirofiban would reduce the extent of myocardial damage and prevent periprocedural myonecrosis in patients with Non-ST-elevation acute coronary syndrome (NSTE-ACS) with a high residual platelet activity (HPR). Methods Patients with an HPR, defined as P2Y12 reaction unit (PRU) > 230, were randomly assigned to group A (tirofiban treatment, n = 30) or C1 (n = 30) and patients without an HPR to C2 (n = 78). Periprocedural myocardial damage was assessed using the area under the curve (AUC) of serial cardiac enzyme levels from the time of the procedure to post-36 h. Periprocedural myonecrosis incidence was evaluated. Results The troponin I AUC was not different between the groups (197.2 [41.5395.7], 37.9 [8.9313.9], 121.3 [43.7481.8] h∙ng/mL; p = 0.088). The results did not change when the baseline levels were adjusted (365.3 [279.5, 451.1], 293.0 [207.1, 379.0], and 298.0 [244.7, 351.3] h∙ng/mL; p = 0.487). The rate of periprocedural myonecrosis was also not different between the groups (53.0% vs. 50.0% vs. 33.3%, p = 0.092). The CK-MB isoenzyme analysis showed similar results. No difference in complications was noted. Conclusion Additional tirofiban administration was not beneficial to patients with NSTE-ACS even with an HPR. Trial registration Clinical trial no. NCT03114995, registered 11 April, 2017, retrospectively. Electronic supplementary material The online version of this article (10.1186/s12872-018-0938-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Wonjae Lee
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Seoul National University, Seongnam-si, Gyeonggi-do, Korea.,Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea
| | - Jung-Won Suh
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Seoul National University, Seongnam-si, Gyeonggi-do, Korea.,Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea
| | - Jin Joo Park
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Seoul National University, Seongnam-si, Gyeonggi-do, Korea.,Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea
| | - Chang-Hwan Yoon
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Seoul National University, Seongnam-si, Gyeonggi-do, Korea.,Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea
| | - Young-Seok Cho
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Seoul National University, Seongnam-si, Gyeonggi-do, Korea.,Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea
| | - Tae-Jin Youn
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Seoul National University, Seongnam-si, Gyeonggi-do, Korea. .,Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea.
| | - In-Ho Chae
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Seoul National University, Seongnam-si, Gyeonggi-do, Korea.,Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea
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Verdoia M, Barbieri L, Schaffer A, Cassetti E, Di Giovine G, Nardin M, Bellomo G, Marino P, De Luca G. Effect of diabetes mellitus on periprocedural myocardial infarction in patients undergoing coronary stent implantation. Diabetes Metab Res Rev 2015; 31:85-92. [PMID: 24898423 DOI: 10.1002/dmrr.2567] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Revised: 05/07/2014] [Accepted: 05/31/2014] [Indexed: 01/25/2023]
Abstract
BACKGROUND Diabetic patients undergoing percutaneous coronary interventions are still regarded as a very high risk category because of an increased platelet reactivity and risk of complications, especially in patients with inadequate glycaemic control. However, although its prognostic effect on long-term outcome is well-defined, still unclear is the effect of diabetes on the risk of periprocedural myocardial infarction in patients undergoing percutaneous coronary interventions, which was therefore the aim of our study. METHODS Myonecrosis biomarkers were dosed at intervals from 6 to 48 h after nonemergent percutaneous coronary interventions. Periprocedural myocardial infarction was defined as creatine kinase-MB increase by three times the upper limit normal or by 50% of an elevated baseline value, whereas periprocedural myonecrosis as troponin I increase by three times the upper limit normal or 50% of baseline. RESULTS Of 1311 patients, diabetes mellitus was found in 458 patients (34.9%) and associated with age (p = 0.03), hypertension (p < 0.001), renal failure (p = 0.01), previous MI (p = 0.03), previous coronary revascularization (p < 0.001), higher fasting glycaemia and lower haemoglobin (p < 0.001), more severe coronary disease (p < 0.001), multivessel percutaneous coronary interventions (p = 0.03), coronary calcification (p = 0.003) and in-stent restenosis (p < 0.001) but lower presence of thrombus (p = 0.03). Diabetic patients were receiving significantly more frequent specific pharmacological treatment at admission. Diabetic status did not influence the risk of periprocedural myocardial infarction or periprocedural myonecrosis [adjusted OR(95%CI) = 0.90(0.64-1.27), p = 0.57 and adjusted OR(95%CI) = 0.92(0.70-1.21), p = 0.55]. Amongst diabetic patients, we did not observe any effect of chronic glycaemic control on periprocedural myocardial infarction. CONCLUSIONS Diabetic status, independent of chronic glycaemic control, is not associated with increased risk of periprocedural myocardial infarction and myonecrosis in patients undergoing percutaneous coronary interventions.
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Affiliation(s)
- Monica Verdoia
- Division of Cardiology, Azienda Ospedaliera-Universitaria 'Maggiore della Carità', Eastern Piedmont University, Novara, Italy
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Li J, Jian Z, Song M, Guo W, Chen G, Lu W, Qian D, Ouyang J, Yu J, Hu H, Jin J, Wu X, Huang L. Tailored antiplatelet therapy and clinical adverse outcomes. Heart 2013; 100:41-6. [PMID: 24192977 DOI: 10.1136/heartjnl-2013-304461] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE The clinical evidence regarding the influence of tailored antiplatelet strategy on adverse outcomes has been controversial. The aim of the study was to evaluate the significance of tailored antiplatelet therapy with respect to clinical adverse events in antiplatelet-resistant patients. METHODS Randomised studies that assess clinical relevance of personalised antiplatelet treatment in antiplatelet-resistant patients were identified through a literature search: PubMed, EMBASE, Web of Science and the Cochrane Library. The primary endpoint was the composite of death from any cause and stent thrombosis. All total clinical adverse events and bleeding complications were evaluated. RESULTS Data were combined across seven randomised studies comprising 12 048 subjects, of whom 3738 (31.0%) were found to be antiplatelet-resistant. Antiplatelet-resistant patients provided with tailored antiplatelet therapy showed less risk of death or stent thrombosis than those assigned conventional antiplatelet treatment (0.5% vs. 2.2%; OR (95% CI) 0.25 (0.13 to 0.49), p<0.0001). A significant benefit in terms of total adverse event risk reduction was observed during follow-up for tailored vs conventional antiplatelet therapy (5.5% vs. 10.0%; OR (95% CI) 0.40 (0.20 to 0.77), p=0.006). No statistical difference in bleeding complications was observed between these two groups (p=0.08). CONCLUSIONS In the study, personalised antiplatelet treatment for antiplatelet resistance was found to be associated with less occurrence of death or stent thrombosis and the less risk of total clinical adverse events than conventional treatment, without increasing the risk of bleeding complications.
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Affiliation(s)
- Jiabei Li
- Institute of Cardiovascular Science, Xinqiao Hospital, Third Military Medical University, , Chongqing, China
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Litvinov IV, Radu A, Garfield N. Diabetic muscle infarction in a 57 year old male: a case report. BMC Res Notes 2012; 5:701. [PMID: 23270501 PMCID: PMC3577448 DOI: 10.1186/1756-0500-5-701] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Accepted: 12/21/2012] [Indexed: 11/17/2022] Open
Abstract
Background Diabetic muscle infarction is a rare complication of diabetes mellitus (DM) and is often misdiagnosed as cellulitis. This complication is usually associated with poor disease prognosis and high mortality with previous studies reporting a risk of 50% recurrence or another macrovascular complication occurring within one year. Thus, there needs to be greater awareness of this complication of diabetes. Case presentation In the current work, we present a case report and literature review of DMI occurring in a calf of a 57 year old male. However, unlike the suspected trend, our patient has performed well after this incident and has not sustained another macrovascular event now > 15 month since his original diabetic muscle infarction. Conclusion Even though diabetic muscle infarction is an uncommon condition, it is important to consider this diagnosis in a diabetic patient. We hope that our findings and literature review will aid clinicians to better diagnose and manage this condition.
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Affiliation(s)
- Ivan V Litvinov
- Division of Dermatology, McGill University Health Centre, 687 Pine Ave.West, H7.87, Montreal, Quebec H3A1A1, Canada
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