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Li Y, Li J, Wang B, Jing Q, Zeng Y, Hou A, Wang Z, Liu A, Zhang J, Zhang Y, Zhang P, Jiang D, Liu B, Fan J, Zhang J, Li L, Su G, Yang M, Jiang W, Qu P, Zeng H, Li L, Qiu M, Ru L, Chen S, Zhou Y, Qiao S, Stone GW, Angiolillo DJ, Han Y. Extended Clopidogrel Monotherapy vs DAPT in Patients With Acute Coronary Syndromes at High Ischemic and Bleeding Risk: The OPT-BIRISK Randomized Clinical Trial. JAMA Cardiol 2024; 9:523-531. [PMID: 38630489 PMCID: PMC11024736 DOI: 10.1001/jamacardio.2024.0534] [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] [Received: 07/04/2023] [Accepted: 02/02/2024] [Indexed: 04/20/2024]
Abstract
Importance Purinergic receptor P2Y12 (P2Y12) inhibitor monotherapy after a certain period of dual antiplatelet therapy (DAPT) may be an attractive option of maintenance antiplatelet treatment for patients undergoing percutaneous coronary intervention (PCI) who are at both high bleeding and ischemic risk (birisk). Objective To determine if extended P2Y12 inhibitor monotherapy with clopidogrel is superior to ongoing DAPT with aspirin and clopidogrel after 9 to 12 months of DAPT after PCI in birisk patients with acute coronary syndromes (ACS). Design, Setting, and Participants This was a multicenter, double-blind, placebo-controlled, randomized clinical trial including birisk patients with ACS who had completed 9 to 12 months of DAPT after drug-eluting stent implantation and were free from adverse events for at least 6 months at 101 China centers between February 2018 and December 2020. Study data were analyzed from April 2023 to May 2023. Interventions Patients were randomized either to clopidogrel plus placebo or clopidogrel plus aspirin for an additional 9 months. Main Outcomes and Measures The primary end point was Bleeding Academic Research Consortium (BARC) types 2, 3, or 5 bleeding 9 months after randomization. The key secondary end point was major adverse cardiac and cerebral events (MACCE; the composite of all-cause death, myocardial infarction, stroke or clinically driven revascularization). The primary end point was tested for superiority, and the MACCE end point was tested for sequential noninferiority and superiority. Results A total of 7758 patients (mean [SD] age, 64.8 [9.0] years; 4575 male [59.0%]) were included in this study. The primary end point of BARC types 2, 3, or 5 bleeding occurred in 95 of 3873 patients (2.5%) assigned to clopidogrel plus placebo and 127 of 3885 patients (3.3%) assigned to clopidogrel plus aspirin (hazard ratio [HR], 0.75; 95% CI, 0.57-0.97; difference, -0.8%; 95% CI, -1.6% to -0.1%; P = .03). The incidence of MACCE was 2.6% (101 of 3873 patients) in the clopidogrel plus placebo group and 3.5% (136 of 3885 patients) in the clopidogrel plus aspirin group (HR, 0.74; 95% CI, 0.57-0.96; difference, -0.9%; 95% CI, -1.7% to -0.1%; P < .001 for noninferiority; P = .02 for superiority). Conclusions and Relevance Among birisk patients with ACS who completed 9 to 12 months of DAPT after drug-eluting stent implantation and were free from adverse events for at least 6 months before randomization, an extended 9-month clopidogrel monotherapy regimen was superior to continuing DAPT with clopidogrel in reducing clinically relevant bleeding without increasing ischemic events. Trial Registration ClinicalTrials.gov Identifier: NCT03431142.
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Affiliation(s)
- Yi Li
- State Key Laboratory of Frigid Zone Cardiovascular Disease, General Hospital of Northern Theater Command, Shenyang, China
| | - Jing Li
- State Key Laboratory of Frigid Zone Cardiovascular Disease, General Hospital of Northern Theater Command, Shenyang, China
| | - Bin Wang
- State Key Laboratory of Frigid Zone Cardiovascular Disease, General Hospital of Northern Theater Command, Shenyang, China
| | - Quanmin Jing
- State Key Laboratory of Frigid Zone Cardiovascular Disease, General Hospital of Northern Theater Command, Shenyang, China
| | - Yujie Zeng
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Aijie Hou
- The People’s Hospital of Liaoning Province, Shenyang, China
| | | | - Aijun Liu
- Benxi Central Hospital, Benxi, China
| | | | | | - Ping Zhang
- Beijing Tsinghua Changgung Hospital, Beijing, China
| | | | - Bin Liu
- The Second Hospital of Jilin University, Changchun, China
| | | | - Jun Zhang
- Cangzhou Central Hospital, Cangzhou, China
| | - Li Li
- Guangzhou Red Cross Hospital, Guangzhou, China
| | - Guohai Su
- Central Hospital Affiliated to Shandong First Medical University, Ji’nan, China
| | - Ming Yang
- Yingkou Central Hospital, Yingkou, China
| | - Weihong Jiang
- The Third Xiangya Hospital of Central South University, Changsha, China
| | - Peng Qu
- The Second Hospital of Dalian Medical University, Dalian, China
| | - Hesong Zeng
- Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Lu Li
- The Second Affiliated Hospital of Shenyang Medical College, Shenyang, China
| | - Miaohan Qiu
- State Key Laboratory of Frigid Zone Cardiovascular Disease, General Hospital of Northern Theater Command, Shenyang, China
| | - Leisheng Ru
- Bethune International Peace Hospital, Shijiazhuang, China
| | | | - Yujie Zhou
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Shubin Qiao
- Fuwai Hospital Chinese Academy of Medical Sciences, Beijing, China
| | - Gregg W. Stone
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Yaling Han
- State Key Laboratory of Frigid Zone Cardiovascular Disease, General Hospital of Northern Theater Command, Shenyang, China
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Xi Z, Qiu Z, Li J, Qiu H, Guo T, Wang Y, Zheng J, Gao Y, Gao R. Clopidogrel versus ticagrelor in East Asian patients aged 75 years or older with acute coronary syndrome: observations from the GF-APT registry. Platelets 2022; 33:1270-1278. [PMID: 36050819 DOI: 10.1080/09537104.2022.2118250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
The benefits of potent antithrombotic therapy usually come at the expense of a higher risk of bleeding. The efficacy and safety of ticagrelor in elderly East Asian populations remains debated due to the concerns about the imbalance of ischemic and bleeding risks. This study aimed to compare the impact of clopidogrel with ticagrelor on clinical outcomes in East Asian patients aged ≥75 years with acute coronary syndrome (ACS) using data from an institutional registry. We assessed the treatment effect of ticagrelor versus clopidogrel based on propensity scores and multivariate Cox proportional hazards models. A total of 2775 ACS patients were included, of which 235 (8.5%) were treated with ticagrelor. The primary efficacy outcome occurred in 11.9% of patients treated with ticagrelor versus 8.8% treated with clopidogrel. There was no significant association between treatment with ticagrelor and a lower risk of the primary efficacy outcome (p = .156). However, the incidences of all-cause death (hazard ratio [HR] 1.69, 95% confidence interval [CI] 1.02 to 2.79) and major bleeding (adjusted HR 2.20, 95% CI 1.06 to 4.56) were significantly higher in patients treated with ticagrelor than clopidogrel. In elderly patients with ACS from East Asia, the efficacy of clopidogrel was comparable to ticagrelor, while ticagrelor is associated with an increased risk of mortality and major bleeding.
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Affiliation(s)
- Ziwei Xi
- Department of Cardiology, Coronary Artery Disease Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, HE, China
| | - Zifeng Qiu
- Peking University Health Science Center, Beijing, HE, China
| | - Jianan Li
- Department of Cardiology and Macrovascular Disease, Beijing Tiantan Hospital, Capital Medical University, Beijing, HE, China
| | - Hong Qiu
- Department of Cardiology, Coronary Artery Disease Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, HE, China
| | - Tingting Guo
- Thrombosis Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, HE, China
| | - Yong Wang
- Department of Cardiology, Coronary Artery Disease Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, HE, China
| | - Jianfeng Zheng
- Department of Cardiology, Coronary Artery Disease Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, HE, China
| | - Yanan Gao
- Department of Cardiology, Coronary Artery Disease Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, HE, China
| | - Runlin Gao
- Department of Cardiology, Coronary Artery Disease Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, HE, China
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Li Y, Li J, Qiu M, Ma S, Na K, Li X, Qi Z, Chen S, Li Y, Han Y. Ticagrelor versus clopidogrel in patients with acute coronary syndrome undergoing complex percutaneous coronary intervention. Catheter Cardiovasc Interv 2022; 99 Suppl 1:1395-1402. [PMID: 35032148 DOI: 10.1002/ccd.30077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 01/02/2022] [Indexed: 12/29/2022]
Abstract
OBJECTIVES To evaluate the effectiveness and safety of ticagrelor versus clopidogrel in patients with acute coronary syndromes (ACS) undergoing complex percutaneous coronary intervention (PCI). BACKGROUND It remains inconclusive whether ticagrelor is superior to clopidogrel in ACS patients undergoing complex PCI in real-world practice. METHODS Based on an all-comers PCI registry, we compared the long-term effectiveness and safety between ticagrelor and clopidogrel in ACS patients undergoing complex PCI, defined as PCI procedures for complex lesions including bifurcation, chronic total occlusion, ostial, tortuous, calcific, diffused, thrombus-containing, and restenotic lesions. The primary ischemic outcome was a composite of cardiac death, myocardial infarction, or stroke. The safety outcome comprised Bleeding Academic Research Consortium (BARC) types 2, 3, and 5 bleeding. Propensity score matching (PSM) was performed to reduce bias. RESULTS Among ACS patients who underwent complex PCI, 4373 (35.2%) and 8065 (64.8%) received dual antiplatelet therapy based on ticagrelor and clopidogrel, respectively. The incidences of composite ischemic events (before PSM: 1.74% vs. 2.84%; after PSM: 1.50% vs. 2.65%; p < 0.01 for both) and all-cause death (before PSM: 1.23% vs. 2.12%, p < 0.01; after PSM: 1.09% vs. 1.81%, p = 0.02) were significantly lower in the ticagrelor-treated than in the clopidogrel-treated group. There was no significant difference in BARC types 2, 3, and 5 bleeding between groups. CONCLUSIONS Whilst the risk of major bleeding was comparable between the two drugs, ticagrelor was associated with a significantly lower risk of ischemic events than clopidogrel in ACS patients undergoing complex PCI.
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Affiliation(s)
- Yuzhuo Li
- Postgraduate Training Base of The General Hospital of Northern Theater Command, Jinzhou Medical University, Jinzhou, Liaoning, China.,Department of Cardiology, The General Hospital of Northern Theater Command, Shenyang, China
| | - Jing Li
- Department of Cardiology, The General Hospital of Northern Theater Command, Shenyang, China
| | - Miaohan Qiu
- Department of Cardiology, The General Hospital of Northern Theater Command, Shenyang, China
| | - Sicong Ma
- Department of Cardiology, The General Hospital of Northern Theater Command, Shenyang, China
| | - Kun Na
- Department of Cardiology, The General Hospital of Northern Theater Command, Shenyang, China
| | - Xiaoying Li
- Department of Cardiology, The General Hospital of Northern Theater Command, Shenyang, China
| | - Zizhao Qi
- Department of Cardiology, The General Hospital of Northern Theater Command, Shenyang, China
| | - Sanbao Chen
- Department of Cardiology, The General Hospital of Northern Theater Command, Shenyang, China
| | - Yi Li
- Department of Cardiology, The General Hospital of Northern Theater Command, Shenyang, China
| | - Yaling Han
- Department of Cardiology, The General Hospital of Northern Theater Command, Shenyang, China
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Li J, He K, Ge J, Li C, Jing Z. Short-term vs long-term dual antiplatelet therapy after drug-eluting stent implantation in patients undergoing percutaneous coronary intervention: A systematic review and meta-analysis. Int J Clin Pract 2021; 75:e13938. [PMID: 33341109 DOI: 10.1111/ijcp.13938] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 12/14/2020] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE The optimal duration of dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) is under controversial. The aim of the present systematic review and meta-analysis was to evaluate the safety and efficacy of short-term (≤6 months) DAPT vs long-term (≥12 months) DAPT after PCI with a drug-eluting stent (DES). METHODS We systematically searched the Cochrane Library, PubMed and Embase databases to identify randomised controlled trials (RCTs) that compared short-term (≤6 months) and long-term (≥12 months) DAPT. The endpoints included major bleeding, any bleeding, death from any cause, cardiac death, myocardial infarction, stroke, stent thrombosis and target vessel revascularisation. The primary outcome was major bleeding. A fixed-effects model was used to calculate the risk ratio (RR) and 95% confidence interval (CI) of each endpoint. RESULTS Eighteen trials involving 57,940 patients were included. Compared with long-term DAPT, short-term DAPT resulted in lower rates of major bleeding [RR 0.75, 95% CI 0.65-0.87, P = .0002] and any bleeding [RR 0.61, 95% CI 0.54-0.69, P < .00001]. No significant difference was observed in the outcomes of death from any cause, cardiac death, myocardial infarction, stroke, stent thrombosis, or target vessel revascularisation. The subgroup analysis according to different DAPT durations, mono antiplatelet therapies (MAPTs), countries and P2Y12 inhibitors produced similar outcomes as comprehensive outcomes. CONCLUSIONS Compared with long-term DAPT, short-term DAPT did not increase the risk of ischemic complications but did reduce the risks of major bleeding and any bleeding by over 25%. This study showed that short-term DAPT could be considered for most patients after DES implantation.
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Affiliation(s)
- Jingxin Li
- Department of Chinese pharmacy, Hebei Maternity Hospital, Shijiazhuang, Hebei Province, China
| | - Ke He
- Department of Pharmacy, The Fourth Hospital of Shijiazhuang, Shijiazhuang, Hebei Province, China
| | - Jun Ge
- Department of Pharmacy, The Fourth Hospital of Shijiazhuang, Shijiazhuang, Hebei Province, China
| | - Caixia Li
- Department of Pharmacy, The Fourth Hospital of Shijiazhuang, Shijiazhuang, Hebei Province, China
| | - Zeng Jing
- Department of Pharmacy, The Fourth Hospital of Shijiazhuang, Shijiazhuang, Hebei Province, China
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Ueda Y, Tahara Y, Itoh T, Tsujita K, Sakuma M, Amano T, Sato K, Taniguchi T, Nishiyama C, Konno S, Iwami T, Murohara T, Node K. New Strategy to Prevent Acute Myocardial Infarction by Public Education - A Position Statement of the Committee on Public Education About Emergency Medical Care of the Japanese Circulation Society. Circ J 2021; 85:319-322. [PMID: 33563866 DOI: 10.1253/circj.cj-20-1308] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Although many efforts have been made to prevent death from acute myocardial infarction (MI) by quick revascularization therapy and use of mechanical circulation support devices, and to prevent the occurrence of acute MI by optimal medical therapy, acute MI is still a leading cause of death worldwide. Because the majority of fatal MI cases occur outside hospital and death occurs so rapidly after MI onset, it is difficult to effectively prevent deaths from acute MI by improving the in-hospital treatment strategy of acute MI or by reducing the prehospital delay in the treatment. Therefore, we need a new strategy to prevent death from acute MI, mainly by preventing the occurrence of acute MI itself. In this review, we summarize the present status and propose a new strategy, the "STOP MI Campaign", to prevent acute MI by public education.
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Affiliation(s)
- Yasunori Ueda
- Cardiovascular Division, National Hospital Organization Osaka National Hospital
| | - Yoshio Tahara
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Tomonori Itoh
- Division of Cardiology, Department of Internal Medicine, Iwate Medical University
| | - Kenichi Tsujita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University
| | - Masashi Sakuma
- Department of Cardiovascular Medicine, Dokkyo Medical University
| | | | - Kayoko Sato
- Department of Cardiology, Tokyo Women's Medical University
| | | | - Chika Nishiyama
- Department of Critical Care Nursing, Graduate School of Medicine, Kyoto University
| | | | | | - Toyoaki Murohara
- Department of Cardiology, Graduate School of Medicine, Nagoya University
| | - Koichi Node
- Department of Cardiovascular Medicine, Saga University
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Wang WL, Ge TY, Chen X, Mao Y, Zhu YZ. Advances in the Protective Mechanism of NO, H 2S, and H 2 in Myocardial Ischemic Injury. Front Cardiovasc Med 2020; 7:588206. [PMID: 33195476 PMCID: PMC7661694 DOI: 10.3389/fcvm.2020.588206] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 09/28/2020] [Indexed: 12/30/2022] Open
Abstract
Myocardial ischemic injury is among the top 10 leading causes of death from cardiovascular diseases worldwide. Myocardial ischemia is caused mainly by coronary artery occlusion or obstruction. It usually occurs when the heart is insufficiently perfused, oxygen supply to the myocardium is reduced, and energy metabolism in the myocardium is abnormal. Pathologically, myocardial ischemic injury generates a large number of inflammatory cells, thus inducing a state of oxidative stress. This sharp reduction in the number of normal cells as a result of apoptosis leads to organ and tissue damage, which can be life-threatening. Therefore, effective methods for the treatment of myocardial ischemic injury and clarification of the underlying mechanisms are urgently required. Gaseous signaling molecules, such as NO, H2S, H2, and combined gas donors, have gradually become a focus of research. Gaseous signaling molecules have shown anti-apoptotic, anti-oxidative and anti-inflammatory effects as potential therapeutic agents for myocardial ischemic injury in a large number of studies. In this review, we summarize and discuss the mechanism underlying the protective effect of gaseous signaling molecules on myocardial ischemic injury.
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Affiliation(s)
| | | | - Xu Chen
- Guilin Medical College, Guilin, China
| | - Yicheng Mao
- Shanghai Key Laboratory of Bioactive Small Molecules, Department of Pharmacology, School of Pharmacy, Fudan University, Shanghai, China
| | - Yi-Zhun Zhu
- Guilin Medical College, Guilin, China.,Shanghai Key Laboratory of Bioactive Small Molecules, Department of Pharmacology, School of Pharmacy, Fudan University, Shanghai, China.,State Key Laboratory of Quality Research in Chinese Medicine and School of Pharmacy, Macau University of Science and Technology, Macau, China
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Ye Y, Zhao X, Tu C, Li Q, Zeng Y. Elevated Serum Levels of Alkaline Phosphatase and the Risk of Low Responsiveness to Clopidogrel. Int Heart J 2020; 61:1135-1141. [PMID: 33116024 DOI: 10.1536/ihj.20-285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The elevated serum levels of alkaline phosphatase (ALP) serve as independent predictors of stent thrombosis after percutaneous coronary intervention (PCI). Our study aims at investigating the relationship between the serum ALP and the responsiveness to clopidogrel. Patients undergoing elective PCI were enrolled for the study, and all participants received a 300-mg clopidogrel loading dose. The responsiveness to clopidogrel was determined by thromboelastography (TEG), and low responsiveness to clopidogrel was defined based on two aspects: (1) adenosine diphosphate (ADP) -induced platelet-fibrin clot strength (MAADP) of > 47 mm and (2) ADP-induced platelet inhibition rate of < 50%. A logistic regression model analysis was used to calculate the risks of responsiveness to clopidogrel as odd ratios (OR) and 95% confidence intervals (CIs). Overall, 809 patients were considered for the study. They were divided into four quartile groups based on the serum ALP levels. A positive linear trend was observed in MAADP across the ALP quartiles (P for linear trend < 0.001), whereas ADP-induced platelet inhibition rate decreased across the ALP quartiles (P for linear trend = 0.007). When multiple confounders were adjusted, the highest ALP quartile correlated with an increased risk of low responsiveness to clopidogrel compared to the lowest ALP quartile (OR, 1.423; 95% CI, 1.017-1.991; P = 0.039). In the sensitivity analysis, the association remained significant for different definitions of low responsiveness to clopidogrel. The elevated serum levels of ALP are independently associated with an increased risk of low responsiveness to clopidogrel.
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Affiliation(s)
- Yicong Ye
- Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Capital Medical University
| | - Xiliang Zhao
- Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Capital Medical University
| | - Chenchen Tu
- Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Capital Medical University
| | - Quan Li
- Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Capital Medical University
| | - Yong Zeng
- Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Capital Medical University
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Ueda Y, Kosugi S, Abe H, Ozaki T, Mishima T, Date M, Uematsu M, Koretsune Y. Transient increase in blood thrombogenicity may be a critical mechanism for the occurrence of acute myocardial infarction. J Cardiol 2020; 77:224-230. [PMID: 32921530 DOI: 10.1016/j.jjcc.2020.08.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 07/15/2020] [Accepted: 07/30/2020] [Indexed: 12/09/2022]
Abstract
Although the mechanism for the occurrence of acute myocardial infarction (MI) has been investigated by many pathological and clinical studies, it has not been adequately clarified yet. Although the disruption of vulnerable plaque is a well-known cause of acute MI, there are many silent plaque disruptions detected in the coronary artery by intravascular imaging studies. Therefore, many vulnerable plaques may disrupt and heal without causing acute MI. Some additional mechanisms other than the disruption of vulnerable plaque would be essential for the onset of acute MI. On the other hand, blood thrombogenicity would change dynamically due to circadian rhythms and many other factors. The combination of plaque and blood thrombogenicity would play an important and determinant role for the onset of acute MI.
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Affiliation(s)
- Yasunori Ueda
- Cardiovascular Division, National Hospital Organization Osaka National Hospital, Osaka, Japan.
| | - Shumpei Kosugi
- Cardiovascular Division, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Haruhiko Abe
- Cardiovascular Division, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Tatsuhisa Ozaki
- Cardiovascular Division, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Tsuyoshi Mishima
- Cardiovascular Division, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Motoo Date
- Cardiovascular Division, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Masaaki Uematsu
- Cardiovascular Division, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Yukihiro Koretsune
- Cardiovascular Division, National Hospital Organization Osaka National Hospital, Osaka, Japan
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Völz S, Petursson P, Odenstedt J, Ioanes D, Haraldsson I, Angerås O, Dworeck C, Hirlekar G, Myredal A, Albertsson P, Råmunddal T, Redfors B, Omerovic E. Ticagrelor is Not Superior to Clopidogrel in Patients With Acute Coronary Syndromes Undergoing PCI: A Report from Swedish Coronary Angiography and Angioplasty Registry. J Am Heart Assoc 2020; 9:e015990. [PMID: 32662350 PMCID: PMC7660716 DOI: 10.1161/jaha.119.015990] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Ticagrelor reduces ischaemic end points in acute coronary syndromes. However, outcomes of ticagrelor versus clopidogrel in real‐world patients with acute coronary syndromes treated with percutaneous coronary intervention (PCI) remain unclear. We sought to examine whether treatment with ticagrelor is superior to clopidogrel in unselected patients with acute coronary syndromes treated with PCI. Methods and Results We used data from SCAAR (Swedish Coronary Angiography and Angioplasty Registry) for PCI performed in Västra Götaland County, Sweden. The database contains information about all PCI performed at 5 hospitals (∼20% of all data in SCAAR). All procedures between January 2005 and January 2015 for unstable angina/non‒ST‐segment‒elevation myocardial infarction and ST‐segment‒elevation myocardial infarction were included. We used instrumental variable 2‐stage least squares regression to adjust for confounders. The primary combined end point was mortality or stent thrombosis at 30 days, secondary end points were mortality at 30 days and 1‐year, stent thrombosis at 30 days, in‐hospital bleeding, in‐hospital neurologic complications and long‐term mortality. A total of 15 097 patients were included in the study of which 2929 (19.4%) were treated with ticagrelor. Treatment with ticagrelor was not associated with a lower risk for the primary end point (adjusted odds ratio [aOR], 1.20; 95% CI, 0.87–1.61; P=0.250). Estimated risk of death at 30 days (aOR, 1.18; 95% CI, 0.88–1.64; P=0.287) and at 1‐year (aOR, 1.28; 95% CI, 0.86–1.64; P=0.556) was not different between the groups. The risk of in‐hospital bleeding was higher with ticagrelor (aOR, 2.88; 95% CI, 1.53–5.44; P=0.001). Conclusions In this observational study, treatment with ticagrelor was not superior to clopidogrel in patients with acute coronary syndromes treated with PCI.
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Affiliation(s)
- Sebastian Völz
- Department of Cardiology Sahlgrenska University Hospital Gothenburg Sweden
| | - Petur Petursson
- Department of Cardiology Sahlgrenska University Hospital Gothenburg Sweden
| | - Jacob Odenstedt
- Department of Cardiology Sahlgrenska University Hospital Gothenburg Sweden
| | - Dan Ioanes
- Department of Cardiology Sahlgrenska University Hospital Gothenburg Sweden
| | - Inger Haraldsson
- Department of Cardiology Sahlgrenska University Hospital Gothenburg Sweden
| | - Oskar Angerås
- Department of Cardiology Sahlgrenska University Hospital Gothenburg Sweden
| | - Christian Dworeck
- Department of Cardiology Sahlgrenska University Hospital Gothenburg Sweden
| | - Geir Hirlekar
- Department of Cardiology Sahlgrenska University Hospital Gothenburg Sweden
| | - Anna Myredal
- Department of Cardiology Sahlgrenska University Hospital Gothenburg Sweden
| | - Per Albertsson
- Department of Cardiology Sahlgrenska University Hospital Gothenburg Sweden
| | - Truls Råmunddal
- Department of Cardiology Sahlgrenska University Hospital Gothenburg Sweden
| | - Björn Redfors
- Department of Cardiology Sahlgrenska University Hospital Gothenburg Sweden
| | - Elmir Omerovic
- Department of Cardiology Sahlgrenska University Hospital Gothenburg Sweden
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