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Kaufmann CC, Muthspiel M, Lunzer L, Pogran E, Zweiker D, Burger AL, Wojta J, Huber K. Antiplatelet Therapy and Anticoagulation before, during, and after Acute Coronary Syndrome. J Clin Med 2024; 13:2313. [PMID: 38673585 PMCID: PMC11051414 DOI: 10.3390/jcm13082313] [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: 03/14/2024] [Revised: 04/09/2024] [Accepted: 04/10/2024] [Indexed: 04/28/2024] Open
Abstract
Acute coronary syndrome (ACS) remains a major challenge in clinical practice, requiring rapid and effective antithrombotic treatment to mitigate adverse ischemic events while minimizing the risk of bleeding. In recent years, results from several clinical trials addressing this issue through various approaches have substantially improved the treatment landscape for patients presenting with ACS. The emergence of new, potent P2Y12 inhibitors has significantly enhanced thrombotic risk reduction and different strategies for de-escalating and shortening dual antiplatelet therapy (DAPT) have demonstrated promising outcomes in reducing bleeding rates. Furthermore, data from ongoing trials focusing on novel therapeutic agents and investigating alternative treatment strategies to optimize outcomes for ACS patients are expected in the next few years. In this review, we summarize the current knowledge and emphasize the critical role of individualized treatment approaches tailored to patient-specific risk factors and individual clinical scenarios.
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Affiliation(s)
- Christoph C. Kaufmann
- 3rd Medical Department with Cardiology and Intensive Care Medicine, Klinik Ottakring (Wilhelminenhospital), A-1160 Vienna, Austria; (M.M.); (L.L.); (E.P.); (D.Z.); (A.L.B.); (K.H.)
- Faculty of Medicine, Sigmund Freud University, A-1020 Vienna, Austria
| | - Marie Muthspiel
- 3rd Medical Department with Cardiology and Intensive Care Medicine, Klinik Ottakring (Wilhelminenhospital), A-1160 Vienna, Austria; (M.M.); (L.L.); (E.P.); (D.Z.); (A.L.B.); (K.H.)
- Faculty of Medicine, Sigmund Freud University, A-1020 Vienna, Austria
| | - Laura Lunzer
- 3rd Medical Department with Cardiology and Intensive Care Medicine, Klinik Ottakring (Wilhelminenhospital), A-1160 Vienna, Austria; (M.M.); (L.L.); (E.P.); (D.Z.); (A.L.B.); (K.H.)
| | - Edita Pogran
- 3rd Medical Department with Cardiology and Intensive Care Medicine, Klinik Ottakring (Wilhelminenhospital), A-1160 Vienna, Austria; (M.M.); (L.L.); (E.P.); (D.Z.); (A.L.B.); (K.H.)
- Faculty of Medicine, Sigmund Freud University, A-1020 Vienna, Austria
| | - David Zweiker
- 3rd Medical Department with Cardiology and Intensive Care Medicine, Klinik Ottakring (Wilhelminenhospital), A-1160 Vienna, Austria; (M.M.); (L.L.); (E.P.); (D.Z.); (A.L.B.); (K.H.)
| | - Achim Leo Burger
- 3rd Medical Department with Cardiology and Intensive Care Medicine, Klinik Ottakring (Wilhelminenhospital), A-1160 Vienna, Austria; (M.M.); (L.L.); (E.P.); (D.Z.); (A.L.B.); (K.H.)
- Faculty of Medicine, Sigmund Freud University, A-1020 Vienna, Austria
| | - Johann Wojta
- Ludwig Boltzmann Institute for Cardiovascular Research, A-1090 Vienna, Austria;
- Core Facilities, Medical University of Vienna, A-1090 Vienna, Austria
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - Kurt Huber
- 3rd Medical Department with Cardiology and Intensive Care Medicine, Klinik Ottakring (Wilhelminenhospital), A-1160 Vienna, Austria; (M.M.); (L.L.); (E.P.); (D.Z.); (A.L.B.); (K.H.)
- Faculty of Medicine, Sigmund Freud University, A-1020 Vienna, Austria
- Ludwig Boltzmann Institute for Cardiovascular Research, A-1090 Vienna, Austria;
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Licordari R, Costa F, Garcia-Ruiz V, Mamas MA, Marquis-Gravel G, de la Torre Hernandez JM, Gomez Doblas JJ, Jimenez-Navarro M, Rodriguez-Capitan J, Urbano-Carrillo C, Ortega-Paz L, Piccolo R, Versace AG, Di Bella G, Andò G, Angiolillo DJ, Valgimigli M, Micari A. The Evolving Field of Acute Coronary Syndrome Management: A Critical Appraisal of the 2023 European Society of Cardiology Guidelines for the Management of Acute Coronary Syndrome. J Clin Med 2024; 13:1885. [PMID: 38610650 PMCID: PMC11012418 DOI: 10.3390/jcm13071885] [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: 02/19/2024] [Revised: 03/20/2024] [Accepted: 03/21/2024] [Indexed: 04/14/2024] Open
Abstract
Acute coronary syndromes (ACS), encompassing conditions like ST-elevation myocardial infarction (STEMI) and non-ST-elevation acute coronary syndromes (NSTE-ACS), represent a significant challenge in cardiovascular care due to their complex pathophysiology and substantial impact on morbidity and mortality. The 2023 European Society of Cardiology (ESC) guidelines for ACS management introduce several updates in key areas such as invasive treatment timing in NSTE-ACS, pre-treatment strategies, approaches to multivessel disease, and the use of imaging modalities including computed tomography (CT) coronary angiography, magnetic resonance imaging (MRI), and intracoronary imaging techniques, such as optical coherence tomography (OCT) and intravascular ultrasound (IVUS). They also address a modulation of antiplatelet therapy, taking into consideration different patient risk profiles, and introduce new recommendations for low-dose colchicine. These guidelines provide important evidence-based updates in practice, reflecting an evolution in the understanding and management of ACS, yet some potentially missed opportunities for more personalized care and technology adoption are discussed.
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Affiliation(s)
- Roberto Licordari
- Department of Biomedical and Dental Sciences and of Morphological and Functional Images, University of Messina, 98122 Messina, Italy; (R.L.); (A.M.)
| | - Francesco Costa
- Department of Biomedical and Dental Sciences and of Morphological and Functional Images, University of Messina, 98122 Messina, Italy; (R.L.); (A.M.)
| | | | - Mamas A. Mamas
- Keele Cardiovascular Research Group, Keele University, Keele ST5 5BG, UK;
| | - Guillaume Marquis-Gravel
- Montréal Heart Institute, Faculty of Medicine, Université de Montréal, Montréal, QC H3T 1J4, Canada;
| | | | - Juan Jose Gomez Doblas
- Área del Corazón, Hospital Universitario Virgen de la Victoria, CIBERCV, IBIMA Plataforma BIONAND, Departamento de Medicina UMA, 29010 Malaga, Spain; (J.J.G.D.); (M.J.-N.); (J.R.-C.)
| | - Manuel Jimenez-Navarro
- Área del Corazón, Hospital Universitario Virgen de la Victoria, CIBERCV, IBIMA Plataforma BIONAND, Departamento de Medicina UMA, 29010 Malaga, Spain; (J.J.G.D.); (M.J.-N.); (J.R.-C.)
| | - Jorge Rodriguez-Capitan
- Área del Corazón, Hospital Universitario Virgen de la Victoria, CIBERCV, IBIMA Plataforma BIONAND, Departamento de Medicina UMA, 29010 Malaga, Spain; (J.J.G.D.); (M.J.-N.); (J.R.-C.)
| | | | - Luis Ortega-Paz
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, FL 32209, USA (D.J.A.)
| | - Raffaele Piccolo
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80138 Naples, Italy;
| | | | - Gianluca Di Bella
- Department of Clinical and Experimental Medicine, University of Messina, 98122 Messina, Italy; (G.D.B.); (G.A.)
| | - Giuseppe Andò
- Department of Clinical and Experimental Medicine, University of Messina, 98122 Messina, Italy; (G.D.B.); (G.A.)
| | - Dominick J. Angiolillo
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, FL 32209, USA (D.J.A.)
| | - Marco Valgimigli
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, 6500 Lugano, Switzerland;
| | - Antonio Micari
- Department of Biomedical and Dental Sciences and of Morphological and Functional Images, University of Messina, 98122 Messina, Italy; (R.L.); (A.M.)
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Coughlan J, Durand R. Cangrelor to optimise platelet inhibition in STEMI patients pre-treated with ticagrelor: A Sisyphean task? IJC HEART & VASCULATURE 2024; 50:101355. [PMID: 38419607 PMCID: PMC10899725 DOI: 10.1016/j.ijcha.2024.101355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Affiliation(s)
- J.J. Coughlan
- Dept. of Cardiology & Cardiovascular Research Institute, Mater Private Network, Eccles Street 73, Dublin 7 D07 WKW8, Ireland
| | - Rory Durand
- Dept. of Cardiology & Cardiovascular Research Institute, Mater Private Network, Eccles Street 73, Dublin 7 D07 WKW8, Ireland
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Stouffer GA, Friede KA, Rossi JS. Pretreating With P2Y 12 Inhibitors in STEMI: Does It Make Any Difference? JACC Cardiovasc Interv 2024; 17:29-31. [PMID: 38199750 DOI: 10.1016/j.jcin.2023.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 11/13/2023] [Indexed: 01/12/2024]
Affiliation(s)
- George A Stouffer
- Division of Cardiology, University of North Carolina, Chapel Hill, North Carolina, USA; McAllister Heart Institute, University of North Carolina, Chapel Hill, North Carolina, USA.
| | - Kevin A Friede
- Division of Cardiology, University of North Carolina, Chapel Hill, North Carolina, USA; McAllister Heart Institute, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Joseph S Rossi
- Division of Cardiology, University of North Carolina, Chapel Hill, North Carolina, USA
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