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Ozaki Y, Hong SJ, Heg D, Frigoli E, Vranckx P, Morice MC, Chevalier B, Onuma Y, Windecker S, Di Biasi M, Whitbourn R, Dudek D, Raffel OC, Shimizu K, Calabrò P, Fröbert O, Cura F, Berg JT, Smits PC, Valgimigli M. Geographical Variations in the Effectiveness and Safety of Abbreviated or Standard Antiplatelet Therapy After Percutaneous Coronary Intervention in Patients at High Bleeding Risk. Can J Cardiol 2024:S0828-282X(24)00080-1. [PMID: 38309468 DOI: 10.1016/j.cjca.2024.01.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 01/24/2024] [Accepted: 01/27/2024] [Indexed: 02/05/2024] Open
Affiliation(s)
- Yukio Ozaki
- Department of Cardiology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Sung-Jin Hong
- Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Dik Heg
- Clinical Trial Unit, University of Bern, Bern, Switzerland
| | - Enrico Frigoli
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Pascal Vranckx
- Department of Cardiology and Critical Care Medicine, Jessa Ziekenhuis, Hasselt, Belgium; Faculty of Medicine and Life Sciences, University of Hasselt, Hasselt, Belgium
| | - Marie-Claude Morice
- Institut Cardiovasculaire Paris Sud, Ramsay Santé, Massy, France; Cardiovascular European Research Center, Massy, France
| | | | - Yoshinobu Onuma
- University of Galway, Galway University Hospital, Galway, Ireland
| | - Stephan Windecker
- Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | | | | | - Dariusz Dudek
- Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland; Interventional Cardiology Unit GVM Care and Research, Maria Cecilia Hospital, Cotignola, Italy
| | - Owen Christopher Raffel
- Cardiology Department, The Prince Charles Hospital, Brisbane, Queensland, Australia; Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Kiyokazu Shimizu
- Department of Cardiology, Ichinomiya Municipal Hospital, Ichinomiya, Japan
| | - Paolo Calabrò
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli," Caserta, Italy; Azienda Ospedaliera di Rilievo Nazionale "Sant'Anna e San Sebastiano," Caserta, Italy
| | - Ole Fröbert
- Faculty of Health, Department of Cardiology, Örebro University, Södra Grev Rosengatan, Örebro, Sweden
| | - Fernando Cura
- Instituto Cardiovascularde Buenos Aires, Buenos Aires, Argentina
| | - Jurrien Ten Berg
- Department of Cardiology, St Antonius Hospital, Nieuwegein, The Netherlands; Department of Cardiology, University Medical Center Maastricht, Maastricht, The Netherlands
| | - Pieter C Smits
- Department of Cardiology, Maasstad Hospital, Rotterdam, The Netherlands
| | - Marco Valgimigli
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland; Department of Biomedical Sciences, University of Italian Switzerland, Lugano, Switzerland.
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Roule V, Beygui F, Cayla G, Rangé G, Motovska Z, Delarche N, Jourda F, Goube P, Guedeney P, Zeitouni M, El Kasty M, Laredo M, Dumaine R, Ducrocq G, Derimay F, Van Belle E, Manigold T, Cador R, Combaret N, Vicaut E, Montalescot G, Silvain J. P2Y 12 Inhibitor Loading Time Before Elective PCI and the Prevention of Myocardial Necrosis. Can J Cardiol 2024; 40:31-39. [PMID: 37660934 DOI: 10.1016/j.cjca.2023.08.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 08/21/2023] [Accepted: 08/27/2023] [Indexed: 09/05/2023] Open
Abstract
BACKGROUND There are dated and conflicting data about the optimal timing of initiation of P2Y12 inhibitors in elective percutaneous coronary intervention (PCI). Peri-PCI myocardial necrosis is associated with poor outcomes. We aimed to assess the impact of the P2Y12 inhibitor loading time on periprocedural myocardial necrosis in the population of the randomized Assessment of Loading With the P2Y12 Inhibitor Ticagrelor or Clopidogrel to Halt Ischemic Events in Patients Undergoing Elective Coronary Stenting (ALPHEUS) trial, which compared ticagrelor with clopidogrel in high-risk patients who received elective PCI. METHODS The ALPHEUS trial divided 1809 patients into quartiles of loading time. The ALPHEUS primary outcome was used (type 4 [a or b] myocardial infarction or major myocardial injury) as well as the main secondary outcome (type 4 [a or b] myocardial infarction or any type of myocardial injury). RESULTS Patients in the first quartile group (Q1) presented higher rates of the primary outcome (P = 0.01). When compared with Q1, incidences of the primary outcome decreased in patients with longer loading times (adjusted odds ratio [adjOR], 0.70 [0.52.-0.95]; P = 0.02 for Q2; adjOR 0.65 [0.48-0.88]; P < 0.01 for Q3; adjOR 0.66 [0.49-0.89]; P < 0.01 for Q4). Concordant results were found for the main secondary outcome. There was no interaction with the study drug allocated by randomization (clopidogrel or ticagrelor). Bleeding complications (any bleeding ranging between 4.9% and 7.3% and only 1 major bleeding at 48 hours) and clinical ischemic events were rare and did not differ among groups. CONCLUSIONS In elective PCI, administration of the oral P2Y12 inhibitor at the time of PCI could be associated with more frequent periprocedural myocardial necrosis than an earlier administration. The long-term clinical consequences remain unknown.
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Affiliation(s)
- Vincent Roule
- ACTION Study Group, Sorbonne Université, INSERM UMRS1166, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France; Département de Cardiologie, CHU de Caen, Caen, France
| | - Farzin Beygui
- Département de Cardiologie, CHU de Caen, Caen, France
| | - Guillaume Cayla
- Cardiology Department, Nîmes University Hospital, Montpellier University, ACTION Study Group, Nîmes, France
| | - Grégoire Rangé
- Département de Cardiologie, CH de Chartres, Chartres, France
| | - Zuzana Motovska
- Cardiocentre, 3rd Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | | | | | - Pascal Goube
- Service de Cardiologie, Centre Hospitalier Sud-Francilien, Corbeil-Essonnes, France
| | - Paul Guedeney
- ACTION Study Group, Sorbonne Université, INSERM UMRS1166, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France
| | - Michel Zeitouni
- ACTION Study Group, Sorbonne Université, INSERM UMRS1166, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France
| | - Mohamad El Kasty
- Department of Cardiology, Grand Hôpital de l'Est Francilien, Jossigny, France
| | - Mikael Laredo
- ACTION Study Group, Sorbonne Université, INSERM UMRS1166, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France
| | - Raphaëlle Dumaine
- Les Grands Prés Cardiac Rehabilitation Centre, Villeneuve St Denis, France
| | - Gregory Ducrocq
- Université de Paris, AP-HP, French Alliance for Cardiovascular Trials (FACT), INSERM U1148, Paris, France
| | - François Derimay
- Service de Cardiologie Interventionnelle, Hospices Civils de Lyon and CARMEN INSERM 1060, Lyon, France
| | - Eric Van Belle
- CHU Lille, Institut Cœur Poumon, Cardiology, and Department of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases, INSERM U1011, Institut Pasteur de Lille, EGID, Université de Lille, Lille, France
| | | | - Romain Cador
- Department of Cardiology Saint Joseph Hospital, Paris, France
| | - Nicolas Combaret
- Department of Cardiology, Clermont-Ferrand University Hospital, CNRS, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Eric Vicaut
- Unité de Recherche Clinique, ACTION Study Group, Hôpital Fernand Widal (AP-HP), Paris, France and SAMM (Statistique, Analyse et Modélisation Multidisciplinaire) EA 4543, Université Paris 1 Panthéon, Sorbonne, France
| | - Gilles Montalescot
- ACTION Study Group, Sorbonne Université, INSERM UMRS1166, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France. http://www.action-cœur.org
| | - Johanne Silvain
- ACTION Study Group, Sorbonne Université, INSERM UMRS1166, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France
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Lee K, Kang J, Park KW, Park TH, Kim BS, Lim SW, Cho YH, Jeon DW, Kim SH, Yang HM, Kang HJ, Han JK, Shin ES, Koo BK, Kim HS. Impact of Age on Antiplatelet Monotherapy in the Chronic Maintenance Period After Percutaneous Coronary Intervention: A Post Hoc Analysis From the HOST-EXAM Extended Study. Can J Cardiol 2024; 40:43-52. [PMID: 37742741 DOI: 10.1016/j.cjca.2023.09.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 09/03/2023] [Accepted: 09/18/2023] [Indexed: 09/26/2023] Open
Abstract
BACKGROUNDS The HOST-EXAM Extended study reported the benefit of clopidogrel monotherapy over aspirin monotherapy in secondary prevention after percutaneous coronary intervention (PCI). This age-specific subgroup analysis of the study aimed to assess the impact of age on antiplatelet monotherapy after PCI. METHODS We analysed data from the per-protocol population (4717 patients) with a median follow-up of 5.8 years. The old age group comprised 2033 patients (43.1%), defined as those 65 years of age or older. The primary end point was the composite of all-cause death, nonfatal myocardial infarction, stroke, readmission due to acute coronary syndrome (ACS), and Bleeding Academic Research Consortium (BARC) bleeding type 3 or greater. The secondary end points were thrombotic composite outcomes and any bleeding. RESULTS Age correlated with an elevated risk of adverse events, particularly from age 65. Clopidogrel monotherapy was associated with a reduction of the primary end point in both the old age group (19.4% vs 23.1%, hazard ratio [HR] 0.802, 95% confidence interval [CI] 0.664-0.968; P = 0.022) and the young age group (7.8% vs 11.7%, HR 0.646, 95% CI 0.506-0.825; P < 0.001), without significant interaction (interaction P = 0.167). These findings were consistent for the secondary composite thrombotic end point and any bleeding events (interaction P value of secondary thrombotic end point: 0.786; interaction P value of any bleeding end point: 0.565). Consistent results were observed in analyses with a 75-year age cutoff and in subgroup analyses by 10-year age intervals. CONCLUSIONS In patients requiring antiplatelet monotherapy after PCI, occurrence of both ischemic and bleeding events dramatically increased from age 65. The beneficial impact of clopidogrel over aspirin monotherapy was consistent regardless of age. CLINICAL TRIAL REGISTRATION INFORMATION ClinicalTrials.gov Identifier: NCT02044250.
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Affiliation(s)
- Keehwan Lee
- Seoul National University Hospital, Seoul, Korea
| | - Jeehoon Kang
- Seoul National University Hospital, Seoul, Korea
| | - Kyung Woo Park
- Seoul National University Hospital, Seoul, Korea; Seoul National University College of Medicine, Seoul, Korea.
| | | | | | | | - Yoon Haeng Cho
- Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Dong Woon Jeon
- National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Sang-Hyun Kim
- Seoul National University College of Medicine, Seoul, Korea; Boramae Medical Centre, Seoul, Korea
| | - Han-Mo Yang
- Seoul National University Hospital, Seoul, Korea; Seoul National University College of Medicine, Seoul, Korea
| | - Hyun-Jae Kang
- Seoul National University Hospital, Seoul, Korea; Seoul National University College of Medicine, Seoul, Korea
| | - Jung-Kyu Han
- Seoul National University Hospital, Seoul, Korea; Seoul National University College of Medicine, Seoul, Korea
| | | | - Bon-Kwon Koo
- Seoul National University Hospital, Seoul, Korea; Seoul National University College of Medicine, Seoul, Korea
| | - Hyo-Soo Kim
- Seoul National University Hospital, Seoul, Korea; Seoul National University College of Medicine, Seoul, Korea
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Alkasab M, Bainey KR. Clopidogrel Monotherapy in Older Stable Ischemic Heart Disease Patients Receiving Percutaneous Coronary Intervention: A Paradigm Shift? Can J Cardiol 2024; 40:53-55. [PMID: 37924968 DOI: 10.1016/j.cjca.2023.10.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 10/30/2023] [Accepted: 10/31/2023] [Indexed: 11/06/2023] Open
Affiliation(s)
- Mohammed Alkasab
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Kevin R Bainey
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada.
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Aukema HM, Ravandi A. Factors affecting variability in free oxylipins in mammalian tissues. Curr Opin Clin Nutr Metab Care 2023; 26:91-98. [PMID: 36892958 DOI: 10.1097/mco.0000000000000892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF THE REVIEW Along with the growing interest in oxylipins is an increasing awareness of multiple sources of variability in oxylipin data. This review summarizes recent findings that highlight the experimental and biological sources of variation in free oxylipins. RECENT FINDINGS Experimental factors that affect oxylipin variability include different methods of euthanasia, postmortem changes, cell culture reagents, tissue processing conditions and timing, storage losses, freeze-thaw cycles, sample preparation techniques, ion suppression, matrix effects, use and availability of oxylipin standards, and postanalysis procedures. Biological factors include dietary lipids, fasting, supplemental selenium, vitamin A deficiency, dietary antioxidants and the microbiome. Overt, but also more subtle differences in health affect oxylipin levels, including during resolution of inflammation and long-term recovery from disease. Sex, genetic variation, exposure to air pollution and chemicals found in food packaging and household and personal care products, as well as many pharmaceuticals used to treat health conditions also affect oxylipin levels. SUMMARY Experimental sources of oxylipin variability can be minimized with proper analytical procedures and protocol standardization. Fully characterizing study parameters will help delineate biological factors of variability, which are rich sources of information that can be used to probe oxylipin mechanisms of action and to investigate their roles in health.
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Affiliation(s)
- Harold M Aukema
- Department of Food and Human Nutritional Sciences, University of Manitoba
- Canadian Centre for Agri-Food Research in Health and Medicine, St Boniface Hospital Albrechtsen Research Centre
- Precision Cardiovascular Medicine Group, St Boniface Hospital Albrechtsen Research Centre
| | - Amir Ravandi
- Precision Cardiovascular Medicine Group, St Boniface Hospital Albrechtsen Research Centre
- Department of Physiology and Pathophysiology, University of Manitoba
- Institute of Cardiovascular Sciences, St Boniface Hospital Albrechtsen Research Centre, Winnipeg, Manitoba, Canada
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Marquis-Gravel G, Tanguay JF. Forty Years of Innovations: The Past, Present, and Future of Interventional Cardiology. Can J Cardiol 2022; 38:S1-S2. [PMID: 35870692 DOI: 10.1016/j.cjca.2022.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 07/14/2022] [Accepted: 07/15/2022] [Indexed: 12/30/2022] Open
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