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Stolpe S, Kowall B, Werdan K, Zeymer U, Bestehorn K, Weber MA, Schneider S, Stang A. OECD indicator 'AMI 30-day mortality' is neither comparable between countries nor suitable as indicator for quality of acute care. Clin Res Cardiol 2023:10.1007/s00392-023-02296-z. [PMID: 37682307 DOI: 10.1007/s00392-023-02296-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 08/24/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND Hospital mortality after acute myocardial infarction (AMI, ICD-10: I21-I22) is used as OECD indicator of the quality of acute care. The reported AMI hospital mortality in Germany is more than twice as high as in the Netherlands or Scandinavia. Yet, in Europe, Germany ranks high in health spending and availability of cardiac procedures. We provide insights into this contradictory situation. METHODS Information was collected on possible factors causing the reported differences in AMI mortality such as prevalence of risk factors or comorbidities, guideline conform treatment, patient registration, and health system structures of European countries. International experts were interviewed. Data on OECD indicators 'AMI 30-day mortality using unlinked data' and 'average length of stay after AMI' were used to describe the association between these variables graphically and by linear regression. RESULTS Differences in prevalence of risk factors or comorbidities or in guideline conform acute care account only to a smaller extent for the reported differences in AMI hospital mortality. It is influenced mainly by patient registration rules and organization of health care. Non-reporting of day cases as patients and centralization of AMI care-with more frequent inter-hospital patient transfers-artificially lead to lower calculated hospital mortality. Frequency of patient transfers and national reimbursement policies affect the average length of stay in hospital which is strongly associated with AMI hospital mortality (adj R2 = 0.56). AMI mortality reported from registries is distorted by different underlying populations. CONCLUSION Most of the variation in AMI hospital mortality is explained by differences in patient registration and organization of care instead of differences in quality of care, which hinders cross-country comparisons of AMI mortality. Europe-wide sentinel regions with comparable registries are necessary to compare (acute) care after myocardial infarction.
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Affiliation(s)
- Susanne Stolpe
- Institute for Medical Informatics, Biometry and Epidemiology (IMIBE), University Hospital Essen, Hufelandstr 55, 45147, Essen, Germany.
| | - Bernd Kowall
- Institute for Medical Informatics, Biometry and Epidemiology (IMIBE), University Hospital Essen, Hufelandstr 55, 45147, Essen, Germany
| | - Karl Werdan
- Center for Health Services Research of the German Cardiac Society, Düsseldorf, Germany
- Department of Medicine III, University Hospital Halle (Saale), Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Uwe Zeymer
- Center for Health Services Research of the German Cardiac Society, Düsseldorf, Germany
- Foundation IHF, Institute for Myocardial Infarction Research, Hospital Ludwigshafen, Ludwigshafen, Germany
| | - Kurt Bestehorn
- Center for Health Services Research of the German Cardiac Society, Düsseldorf, Germany
- German Society for Prevention and Rehabilitation of Cardiovascular Diseases e.V., Koblenz, Germany
- Institute for Clinical Pharmacology, Technical University Dresden, Dresden, Germany
| | - Michael A Weber
- Center for Health Services Research of the German Cardiac Society, Düsseldorf, Germany
- Association of Senior Hospital Physicians in Germany e.V., Düsseldorf, Germany
| | - Steffen Schneider
- Center for Health Services Research of the German Cardiac Society, Düsseldorf, Germany
- Foundation IHF, Institute for Myocardial Infarction Research, Hospital Ludwigshafen, Ludwigshafen, Germany
| | - Andreas Stang
- Institute for Medical Informatics, Biometry and Epidemiology (IMIBE), University Hospital Essen, Hufelandstr 55, 45147, Essen, Germany
- Department of Epidemiology, School of Public Health, Boston, MA, USA
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Na K, Qiu M, Wei N, Li J, Yan C, Li J, Li Y, Han Y. Effect of dual antiplatelet therapy prolongation in acute coronary syndrome patients with both high ischemic and bleeding risk: insight from the OPT-CAD study. Front Cardiovasc Med 2023; 10:1201091. [PMID: 37745130 PMCID: PMC10514577 DOI: 10.3389/fcvm.2023.1201091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 08/25/2023] [Indexed: 09/26/2023] Open
Abstract
Background In current clinical practice, controversy remains regarding the clinical benefits of prolonged dual antiplatelet therapy (DAPT) in acute coronary syndrome (ACS) patients facing high risks of both ischemia and bleeding ("bi-risk") following percutaneous coronary intervention (PCI). This study aimed to investigate the feasibility of identifying a group of bi-risk ACS patients after PCI using the OPT-BIRISK criteria, emphasizing extended DAPT treatment safety and efficacy beyond 12 months in these bi-risk ACS after PCI in real-world conditions. Methods This analysis compared extended DAPT and single antiplatelet therapy (SAPT) at 12-24 months in ACS patients undergoing PCI complicated with both ischemic and bleeding risk as defined by OPT-BIRISK criteria without premature DAPT discontinuation before 9 months or major clinical adverse events within 12 months. This was a post hoc analysis of the Optimal antiPlatelet Antiplatelet Therapy for Chinese Patients with Coronary Artery Disease (OPT-CAD) study. The main research outcome was the incidence of ischemic events within 12-24 months, which was determined as a composite of stroke, myocardial infarction, and cardiac death events. Through propensity score matching (PSM), groups were balanced. For the external validation of the OPT-BIRISK criteria to identify a bi-risk ACS patient, ischemic events, BARC 2, 3, 5 bleeding events, and BARC 3, 5 bleeding events at 5 years were analyzed. Results The total number of ACS patients analyzed in this analysis was 7,049, of whom 4,146 (58.8%) were bi-risk patients and 2,903 (41.2%) were not. The frequency of ischemic events was significantly different between the two groups at 5 years (11.70% vs. 5.55%, P < 0.001), and the incidence of BARC 2,3,5 bleeding was significantly higher in the bi-risk group (6.90% vs. 4.03%, P < 0.001) than in the non-bi-risk group. Among the bi-risk patients without any clinical adverse events within 12 months that underwent extended DAPT treatment (n = 2,374, 75.7%) exhibited a lower risk of stroke at 12-24 months (1.10% vs. 2.10%, P = 0.036) relative to those that underwent SAPT (n = 763, 24.3%), while bleeding risk did not differ significantly between these groups. PSM cohort analysis results were consistent with those of overall group analyses. Conclusion In conclusion, the findings showed that using the OPT-BIRISK criteria could help physicians identify ACS patients at a high risk of developing recurrent ischemia and bleeding episodes after PCI. Compared to antiplatelet monotherapy, a strategy of extended DAPT may offer potential benefits in lowering the risk of stroke without carrying a disproportionately high risk of serious bleeding problems among these patients who were event-free after a year of DAPT.
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Affiliation(s)
- Kun Na
- Department of Cardiology, Cardiovascular Research Institute, General Hospital of Northern Theater Command, Shenyang, China
- College of Life Sciences and Biopharmacy, Shenyang Pharmaceutical University, Shenyang, China
| | - Miaohan Qiu
- Department of Cardiology, Cardiovascular Research Institute, General Hospital of Northern Theater Command, Shenyang, China
| | - Ningxin Wei
- Department of Cardiology, Cardiovascular Research Institute, General Hospital of Northern Theater Command, Shenyang, China
- College of Life Sciences and Biopharmacy, Shenyang Pharmaceutical University, Shenyang, China
| | - Jiayin Li
- Department of Cardiology, Cardiovascular Research Institute, General Hospital of Northern Theater Command, Shenyang, China
- College of Life Sciences and Health, Northeastern University, Shenyang, China
| | - Chenghui Yan
- Department of Cardiology, Cardiovascular Research Institute, General Hospital of Northern Theater Command, Shenyang, China
| | - Jing Li
- Department of Cardiology, Cardiovascular Research Institute, General Hospital of Northern Theater Command, Shenyang, China
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yi Li
- Department of Cardiology, Cardiovascular Research Institute, General Hospital of Northern Theater Command, Shenyang, China
| | - Yaling Han
- Department of Cardiology, Cardiovascular Research Institute, General Hospital of Northern Theater Command, Shenyang, China
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In-hospital outcomes of Ticagrelor versus Clopidogrel in high bleeding risk patients with acute coronary syndrome: Findings from the CCC-ACS project. Thromb Res 2022; 216:43-51. [DOI: 10.1016/j.thromres.2022.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 03/31/2022] [Accepted: 04/11/2022] [Indexed: 11/15/2022]
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4
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Toušek P, Bauer D, Neuberg M, Nováčková M, Mašek P, Tu Ma P, Kočka V, Moťovská Z, Widimský P. Patient characteristics, treatment strategy, outcomes, and hospital costs of acute coronary syndrome: 3 years of data from a large high-volume centre in Central Europe. Eur Heart J Suppl 2022; 24:B3-B9. [PMID: 35370502 PMCID: PMC8971736 DOI: 10.1093/eurheartjsupp/suac001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Managing patients with acute coronary syndrome (ACS) in an ageing population with comorbidities is clinically and economically challenging. Well-conducted unselected registries are essential for providing information on real-day clinical practice. The aim was to create a long term, very detail-controlled registry of unselected patients admitted with ACS to a high-volume centre in Central Europe. Consecutive patients admitted with confirmed ACS were entered into the prospective registry from 1 October 2018 to 30 September 2021. Data on 214 parameters, including clinical characteristics, angiographic findings, laboratory and therapeutic findings, financial costs, and in-hospital mortality, were obtained for all patients. Analyses were performed on the complete dataset of 1804 patients. Of these patients, 694 (38.5%) were admitted for ST-segment elevation myocardial infarction (STEMI) and 1110 (61.5%) were admitted for non-ST-elevation (NSTE)-ACS [779 with NSTE myocardial infarction (NSTE-MI) and 331 with unstable angina (UA)]. Almost all patients (99%) underwent coronary angiography. Primary percutaneous coronary intervention (PCI) was performed in 93.4% of STEMI patients and 74.5% of NSTE-ACS patients. Patients with NSTE-MI had the longest total hospital stay (8.1 ± 9.1 days) and highest financial costs (8579.5 ± 7173.2 euros). In-hospital mortality was 1.2% in UA, 6.2% in NSTE-MI, and 10.9% in STEMI patients. Age older than 75 years, pre-hospital cardiac arrest and/or mechanical ventilation, subacute STEMI, and ejection fraction below 40% were the most powerful predictors of in-hospital mortality as assessed by multivariate analyses. The in-hospital mortality of unselected NSTE-MI and STEMI patients in daily practice is not low despite very good implementation of guideline-recommended therapy with a high rate of revascularization. The highest financial costs are associated with NSTE-MI.
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Affiliation(s)
- Petr Toušek
- Department of Cardiology, Third Faculty of Medicine, University Hospital Královské Vinohrady, Charles University, Prague, Czech Republic
| | - David Bauer
- Department of Cardiology, Third Faculty of Medicine, University Hospital Královské Vinohrady, Charles University, Prague, Czech Republic
| | - Marek Neuberg
- Medtronic Czechia, Partner of INTERCARDIS Project, Prosecká 852/66, Prague, 190 00, Czech Republic
| | - Markéta Nováčková
- Department of Cardiology, Third Faculty of Medicine, University Hospital Královské Vinohrady, Charles University, Prague, Czech Republic
| | - Petr Mašek
- Medtronic Czechia, Partner of INTERCARDIS Project, Prosecká 852/66, Prague, 190 00, Czech Republic
| | - Petr Tu Ma
- Medtronic Czechia, Partner of INTERCARDIS Project, Prosecká 852/66, Prague, 190 00, Czech Republic
| | - Viktor Kočka
- Department of Cardiology, Third Faculty of Medicine, University Hospital Královské Vinohrady, Charles University, Prague, Czech Republic
| | - Zuzana Moťovská
- Department of Cardiology, Third Faculty of Medicine, University Hospital Královské Vinohrady, Charles University, Prague, Czech Republic
| | - Petr Widimský
- Department of Cardiology, Third Faculty of Medicine, University Hospital Královské Vinohrady, Charles University, Prague, Czech Republic
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García-Blas S, Cordero A, Diez-Villanueva P, Martinez-Avial M, Ayesta A, Ariza-Solé A, Mateus-Porta G, Martínez-Sellés M, Escribano D, Gabaldon-Perez A, Bodi V, Bonanad C. Acute Coronary Syndrome in the Older Patient. J Clin Med 2021; 10:jcm10184132. [PMID: 34575243 PMCID: PMC8467899 DOI: 10.3390/jcm10184132] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 09/06/2021] [Accepted: 09/07/2021] [Indexed: 01/21/2023] Open
Abstract
Coronary artery disease is one of the leading causes of morbidity and mortality, and its prevalence increases with age. The growing number of older patients and their differential characteristics make its management a challenge in clinical practice. The aim of this review is to summarize the state-of-the-art in diagnosis and treatment of acute coronary syndromes in this subgroup of patients. This comprises peculiarities of ST-segment elevation myocardial infarction (STEMI) management, updated evidence of non-STEMI therapeutic strategies, individualization of antiplatelet treatment (weighting ischemic and hemorrhagic risks), as well as assessment of geriatric conditions and ethical issues in decision making.
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Affiliation(s)
- Sergio García-Blas
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA Biomedical Research Institute, University of Valencia, 46010 Valencia, Spain; (S.G.-B.); (A.G.-P.); (V.B.)
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain; (A.C.); (M.M.-S.); (D.E.)
| | - Alberto Cordero
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain; (A.C.); (M.M.-S.); (D.E.)
- Cardiology Department, Hospital Universitario de San Juan, 03550 Alicante, Spain
| | - Pablo Diez-Villanueva
- Cardiology Department, Hospital Universitario de La Princesa, 28006 Madrid, Spain; (P.D.-V.); (M.M.-A.)
| | - Maria Martinez-Avial
- Cardiology Department, Hospital Universitario de La Princesa, 28006 Madrid, Spain; (P.D.-V.); (M.M.-A.)
| | - Ana Ayesta
- Cardiology Department, Hospital Central de Asturias, 33011 Oviedo, Spain;
| | - Albert Ariza-Solé
- Cardiology Department, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (A.A.-S.); (G.M.-P.)
| | - Gemma Mateus-Porta
- Cardiology Department, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (A.A.-S.); (G.M.-P.)
| | - Manuel Martínez-Sellés
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain; (A.C.); (M.M.-S.); (D.E.)
- Cardiology Department, Hospital Universitario Gregorio Marañón, Universidad Europea, Universidad Complutense, 28007 Madrid, Spain
| | - David Escribano
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain; (A.C.); (M.M.-S.); (D.E.)
- Cardiology Department, Hospital Universitario de San Juan, 03550 Alicante, Spain
| | - Ana Gabaldon-Perez
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA Biomedical Research Institute, University of Valencia, 46010 Valencia, Spain; (S.G.-B.); (A.G.-P.); (V.B.)
| | - Vicente Bodi
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA Biomedical Research Institute, University of Valencia, 46010 Valencia, Spain; (S.G.-B.); (A.G.-P.); (V.B.)
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain; (A.C.); (M.M.-S.); (D.E.)
| | - Clara Bonanad
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA Biomedical Research Institute, University of Valencia, 46010 Valencia, Spain; (S.G.-B.); (A.G.-P.); (V.B.)
- Correspondence:
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Tsukada J, Mela P, Jinzaki M, Tsukada H, Schmitz-Rode T, Vogt F. Development of In Vitro Endothelialised Stents - Review. Stem Cell Rev Rep 2021; 18:179-197. [PMID: 34403073 DOI: 10.1007/s12015-021-10238-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2021] [Indexed: 01/12/2023]
Abstract
Endovascular treatment is prevalent as a primary treatment for coronary and peripheral arterial diseases. Although the introduction of drug-eluting stents (DES) dramatically reduced the risk of in-stent restenosis, stent thrombosis persists as an issue. Notwithstanding improvements in newer generation DES, they are yet to address the urgent clinical need to abolish the late stent complications that result from in-stent restenosis and are associated with late thrombus formation. These often lead to acute coronary syndromes with high mortality in coronary artery disease and acute limb ischemia with a high risk of limb amputation in peripheral arterial disease. Recently, a significant amount of research has focused on alternative solutions to improve stent biocompatibility by using tissue engineering. There are two types of tissue engineering endothelialisation methods: in vitro and in vivo. To date, commercially available in vivo endothelialised stents have failed to demonstrate antithrombotic or anti-stenosis efficacy in clinical trials. In contrast, the in vitro endothelialisation methods exhibit the advantage of monitoring cell type and growth prior to implantation, enabling better quality control. The present review discusses tissue-engineered candidate stents constructed by distinct in vitro endothelialisation approaches, with a particular focus on fabrication processes, including cell source selection, stent material composition, stent surface modifications, efficacy and safety evidence from in vitro and in vivo studies, and future directions.
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Affiliation(s)
- Jitsuro Tsukada
- Department of Diagnostic Radiology, Nihon University School of Medicine, 30-1, Oyaguchikamicho, Itabashi-ku, Tokyo, 173-8610, Japan. .,Department of Diagnostic Radiology, Keio University School of Medicine, 35, Shinanomachi, Shinjyuku-ku, Tokyo, 160-8582, Japan.
| | - P Mela
- Department of Mechanical Engineering and Munich School of BioEngineering, Technical University of Munich, Boltzmannstr. 15, Garching, Munich, 85748, Germany
| | - M Jinzaki
- Department of Diagnostic Radiology, Keio University School of Medicine, 35, Shinanomachi, Shinjyuku-ku, Tokyo, 160-8582, Japan
| | - H Tsukada
- Department of Surgery II, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - T Schmitz-Rode
- AME - Institute of Applied Medical Engineering, Helmholtz Institute, RWTH Aachen University, Pauwelsstrasse 30, Aachen, 52074, Germany
| | - F Vogt
- Department of Cardiology, University Hospital RWTH Aachen, Pauwelsstrasse 30, Aachen, 52074, Germany
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Yoshida R, Takagi K, Ishii H, Morishima I, Tanaka A, Morita Y, Kanzaki Y, Nagai H, Watanabe N, Furui K, Shibata N, Yoshioka N, Yamauchi R, Komeyama S, Sugiyama H, Tsuboi H, Murohara T. Myocardial salvage after ST-segment-elevation myocardial infarction: comparison between prasugrel and clopidogrel in the presence or absence of high-residual platelet reactivity. J Nucl Cardiol 2021; 28:1422-1434. [PMID: 31428979 DOI: 10.1007/s12350-019-01852-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 08/01/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND The effect of prasugrel over clopidogrel on myocardial salvage in ST-segment-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (p-PCI) is not fully elucidated. METHODS Among 854 consecutive STEMI patients who underwent p-PCI, 446 patients were evaluated by two-phase (7 days and 3 months) single-photo emission computed tomography (SPECT). Patients were divided into two groups based on the loading P2Y12 inhibitor. The clopidogrel group was further divided based on the result of platelet function testing. Thus, the prasugrel group included 227 patients; the clopidogrel without high-residual platelet reactivity (HRPR) group, 109 patients; and the clopidogrel with HRPR group, 107 patients. The primary endpoint was the Myocardial Salvage Index (MSI), determined by SPECT. RESULTS The incidence of final TIMI 0/1 and TIMI myocardial perfusion grade 0/1 was higher in the clopidogrel with HRPR group (0.9%, 1.8%, and 7.5%, P = .002; 19.8%, 29.4%, and 41.1%, P = .0002, in the prasugrel, clopidogrel without HRPR, and clopidogrel with HRPR groups, respectively). The MSI was significantly lower in the clopidogrel with HRPR group (48% [27-66], 44% [30-72], and 36% [15-55], P = .006, respectively). CONCLUSIONS Prasugrel in STEMI patients was associated with an increased MSI compared with clopidogrel in the presence of HRPR.
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Affiliation(s)
- Ruka Yoshida
- Department of Cardiology, Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8560, Japan.
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan.
| | - Kensuke Takagi
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Hideki Ishii
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Itsuro Morishima
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Akihito Tanaka
- Department of Cardiology, Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8560, Japan
| | - Yasuhiro Morita
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Yasunori Kanzaki
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Hiroaki Nagai
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Naoki Watanabe
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Koichi Furui
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Naoki Shibata
- Department of Cardiology, Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8560, Japan
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Naoki Yoshioka
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Ryota Yamauchi
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Shotaro Komeyama
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Hiroki Sugiyama
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Hideyuki Tsuboi
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Voll F, Kuna C, Ndrepepa G, Kastrati A, Cassese S. Antithrombotic treatment in primary percutaneous coronary intervention. Expert Rev Cardiovasc Ther 2021; 19:313-324. [PMID: 33705211 DOI: 10.1080/14779072.2021.1902807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Despite a timely mechanical reperfusion with primary percutaneous coronary intervention (pPCI) patients presenting with ST-elevation myocardial infarction (STEMI) display an increased risk of adverse cardiovascular events. Several studies have demonstrated that guideline-directed antithrombotic therapy is effective to reduce this risk. However, there is still much to be accomplished to improve antithrombotic therapies in this clinical setting. AREAS COVERED This paper reviews current data on antithrombotic therapy in STEMI patients undergoing pPCI. EXPERT OPINION Antithrombotic therapy for STEMI patients undergoing pPCI should take into account the variability of thrombotic and bleeding risk in the short and long term. Patients with STEMI profit from the administration of early onset antiplatelet agents and anticoagulation to achieve sufficient and predictable antithrombotic effect at the time of pPCI. Thereafter, antithrombotic therapies should be tailored to individual risk of recurrence over the long term, to avoid excess bleeding, while ensuring adequate secondary ischemic prevention.
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Affiliation(s)
- Felix Voll
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Constantin Kuna
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Gjin Ndrepepa
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Adnan Kastrati
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Salvatore Cassese
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
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Modified Strategies for Invasive Management of Acute Coronary Syndrome during the COVID-19 Pandemic. J Clin Med 2020; 10:jcm10010024. [PMID: 33374167 PMCID: PMC7795165 DOI: 10.3390/jcm10010024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 12/06/2020] [Accepted: 12/22/2020] [Indexed: 12/28/2022] Open
Abstract
The COVID-19 pandemic presents several challenges for managing patients with acute coronary syndrome (ACS). Modified treatment algorithms have been proposed for the pandemic. We assessed new algorithms proposed by The European Association of Percutaneous Cardiovascular Interventions (EAPCI) and the Acute Cardiovascular Care Association (ACCA) on patients with ACS admitted to the hospital during the COVID-19 pandemic. The COVID-19 period group (CPG) consisted of patients admitted into a high-volume centre in Prague between 1 February 2020 and 30 May 2020 (n = 181). The reference group (RG) included patients who had been admitted between 1 October 2018 and 31 January 2020 (n = 834). The proportions of patients with different types of ACS admitted before and during the pandemic did not differ significantly: in all ACS patients, KILLIP III-IV class was present in 13.9% in RG and in 9.4% of patients in CPG (p = 0.082). In NSTE-ACS patients, the ejection fraction was lower in the CPG than in the RG (44.7% vs. 50.7%, respectively; p < 0.001). The time from symptom onset to first medical contact did not differ between CPG and RG patients in the respective NSTE-ACS and STEMI groups. The time to early invasive treatment in NSTE-ACS patients and the time to reperfusion in STEMI patients were not significantly different between the RG and the CPG. In-hospital mortality did not differ between the groups in NSTE-ACS patients (odds ratio in the CPG 0.853, 95% confidence interval (CI) 0.247 to 2.951; p = 0.960) nor in STEMI patients (odds ratio in CPG 1.248, 95% CI 0.566 to 2.749; p = 0.735). Modified treatment strategies for ACS during the COVID-19 pandemic did not cause treatment delays. Hospital mortality did not differ.
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Sulzgruber P, Niessner A. Prasugrel vs. ticagrelor after acute coronary syndrome: a critical appraisal of the ISAR-REACT 5 trial. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2020; 6:273-274. [PMID: 31865384 DOI: 10.1093/ehjcvp/pvz077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Patrick Sulzgruber
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Austria
| | - Alexander Niessner
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Austria
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11
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Ray A, Najmi A, Khandelwal G, Jhaj R, Sadasivam B. Prasugrel Versus Ticagrelor in Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention: a Systematic Review and Meta-analysis of Randomized Trials. Cardiovasc Drugs Ther 2020; 35:561-574. [PMID: 32816142 DOI: 10.1007/s10557-020-07056-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/13/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Dual antiplatelet therapy (DAPT) with aspirin and ticagrelor or prasugrel is the mainstay of treatment for patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI). We aimed to systematically perform a head-to-head comparison of ticagrelor vs prasugrel in terms of efficacy and safety. METHODS We searched PubMed/Medline, EMBASE and Cochrane Central Register of Controlled Trials (CENTRAL) for relevant published randomized controlled trials (RCTs). The primary outcome was adverse cardiovascular events and secondary outcome was bleeding events. A random-effects meta-analysis was used to obtain the pooled estimate of each outcome. RESULTS Nine RCTs with a total number of 6990 patients (3550 treated with prasugrel and 3481 treated with ticagrelor) were included. No significant difference between prasugrel and ticagrelor was observed in terms of mortality (OR 0.86, 95% CI 0.66 to 1.13, P = 0.28), major adverse cardiovascular events (MACEs) (OR 0.85, 95% CI 0.70 to 1.03, P = 0.10), non-fatal myocardial infarction (OR 0.78, 95% CI 0.57 to 1.06, P = 0.11), stroke (OR 1.02, 95% CI 0.60 to 1.72, P = 0.95), stent thrombosis (OR 0.76, 95% CI 0.47 to 1.21, P = 0.25), thrombolysis in myocardial infarction (TIMI) defined major (OR 0.94, 95% CI 0.19 to 4.67, P = 0.94), minor (OR 0.35, 95% CI 0.08 to 1.62, P = 0.18) and minimal (OR 0.48, 95% CI 0.19 to 1.18, P = 0.11) bleeding and Bleeding Academic Research Consortium (BARC) defined bleeding (OR 1.06, 95% CI 0.82 to 1.36, P = 0.68). CONCLUSION In patients with ACS undergoing PCI, both prasugrel and ticagrelor were associated with similar cardiovascular outcomes and adverse bleeding events.
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Affiliation(s)
- Avik Ray
- Department of Pharmacology, All India Institute of Medical Sciences Bhopal, Bhopal, Madhya Pradesh, 462020, India.
| | - Ahmad Najmi
- Department of Pharmacology, All India Institute of Medical Sciences Bhopal, Bhopal, Madhya Pradesh, 462020, India
| | - Gaurav Khandelwal
- Department of Cardiology, All India Institute of Medical Sciences Bhopal, Bhopal, Madhya Pradesh, 462020, India
| | - Ratinder Jhaj
- Department of Pharmacology, All India Institute of Medical Sciences Bhopal, Bhopal, Madhya Pradesh, 462020, India
| | - Balakrishnan Sadasivam
- Department of Pharmacology, All India Institute of Medical Sciences Bhopal, Bhopal, Madhya Pradesh, 462020, India
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12
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No Differences in Gastrointestinal Bleeding Risk among Clopidogrel-, Ticagrelor-, or Prasugrel-Based Dual Antiplatelet Therapy. J Clin Med 2020; 9:jcm9051526. [PMID: 32443621 PMCID: PMC7290690 DOI: 10.3390/jcm9051526] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 05/09/2020] [Accepted: 05/13/2020] [Indexed: 12/25/2022] Open
Abstract
The risk for gastrointestinal bleeding from dual antiplatelet therapy (DAPT) with new antiplatelets (prasugrel/ticagrelor) compared to clopidogrel is unclear. AIM To determine the risk and type of major (gastrointestinal bleeding requiring hospitalization) and minor (anemia and iron deficiency) gastrointestinal events with different types of DAPT. METHODS Retrospective observational cohort study of patients who started DAPT after percutaneous coronary intervention. Follow-up was censored after 12 months of DAPT, when a major gastrointestinal event occurred, or when DAPT was discontinued. RESULTS Among 1,327 patients (54.03% were treated with clopidogrel-based DAPT, 38.13% with ticagrelor-based DAPT, and 7.84% with prasugrel-based DAPT), 29.5% had at least one gastrointestinal event. Patients taking clopidogrel-DAPT were older, with more comorbidities, and higher gastrointestinal risk compared to those taking other DAPT regimens. Adjusted hazard ratios (HRs) showed no between-group differences in the risk for major (clopidogrel vs. new antiplatelets: HR 0.996; 95% confidence interval 0.497-1.996) and minor (HR 0.920; 0.712-1.189) gastrointestinal events. Most patients received proton pump inhibitors while on DAPT (93.3%) and after withdrawal (83.2%). CONCLUSION Prasugrel- or ticagrelor-based DAPT was not associated with increased gastrointestinal bleeding risk when compared to clopidogrel-DAPT. New antiplatelets do not necessarily need to be restricted to patients with low gastrointestinal risk.
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13
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Patti G, Micieli G, Cimminiello C, Bolognese L. The Role of Clopidogrel in 2020: A Reappraisal. Cardiovasc Ther 2020; 2020:8703627. [PMID: 32284734 PMCID: PMC7140149 DOI: 10.1155/2020/8703627] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 01/31/2020] [Indexed: 01/01/2023] Open
Abstract
Antiplatelet therapy is the mainstay of treatment and secondary prevention of cardiovascular disease (CVD), including acute coronary syndrome (ACS), transient ischemic attack (TIA) or minor stroke, and peripheral artery disease (PAD). The P2Y12 inhibitors, of which clopidogrel was the first, play an integral role in antiplatelet therapy and therefore in the treatment and secondary prevention of CVD. This review discusses the available evidence concerning antiplatelet therapy in patients with CVD, with a focus on the role of clopidogrel. In combination with aspirin, clopidogrel is often used as part of dual antiplatelet therapy (DAPT) for the secondary prevention of ACS. Although newer, more potent P2Y12 inhibitors (prasugrel and ticagrelor) show a greater reduction in ischemic risk compared with clopidogrel in randomized trials of ACS patients, these newer P2Y12 inhibitors are often associated with an increased risk of bleeding. Deescalation of DAPT by switching from prasugrel or ticagrelor to clopidogrel may be required in some patients with ACS. Furthermore, real-world studies of ACS patients have not confirmed the benefits of the newer P2Y12 inhibitors over clopidogrel. In patients with very high-risk TIA or stroke, short-term DAPT with clopidogrel plus aspirin for 21-28 days, followed by clopidogrel monotherapy for up to 90 days, is recommended. Clopidogrel monotherapy may also be used in patients with symptomatic PAD. In conclusion, there is strong evidence supporting the use of clopidogrel antiplatelet therapy in several clinical settings, which emphasizes the importance of this medication in clinical practice.
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Affiliation(s)
- Giuseppe Patti
- Dipartimento Universitario di Medicina Traslazionale, Università Piemonte Orientale, Azienda Ospedaliero-Universitaria Maggiore della Carità di Novara, Novara, Italy
| | - Giuseppe Micieli
- Dipartimento di Neurologia d'Urgenza, IRCCS Fondazione Istituto Neurologico Nazionale C. Mondino, Pavia, Italy
| | - Claudio Cimminiello
- Studies and Research Center of the Italian Society of Angiology and Vascular Pathology (Società Italiana di Angiologia e Patologia Vascolare, SIAPAV), Milan, Italy
| | - Leonardo Bolognese
- Dipartimento Cardio Neuro Vascolare, Ospedale, San Donato, Arezzo, Italy
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14
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Faridi KF, Garratt KN, Kennedy KF, Maddox TM, Secemsky EA, Butala NM, Yeh RW. Physician and Hospital Utilization of P2Y12 Inhibitors in ST-Segment–Elevation Myocardial Infarction in the United States. Circ Cardiovasc Qual Outcomes 2020; 13:e006275. [DOI: 10.1161/circoutcomes.119.006275] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Ticagrelor and prasugrel are potent P2Y12 inhibitors with superior efficacy compared with clopidogrel among patients with ST-segment–elevation myocardial infarction (STEMI), though use in recent practice is not well described. In this retrospective study, we assessed trends, predictors, and variation in use of P2Y12 inhibitors in patients with STEMI in the United States.
Methods and Results:
We identified 169 505 STEMI patients in the Chest Pain-Myocardial Infarction Registry from October 2013 through March 2017. We determined national utilization rates of P2Y12 inhibitors at discharge, patient predictors for each medication, and variation in use between hospitals. In a subset of 9655 Medicare patients ≥65 years old, we compared 1-year adjusted risks of death, myocardial infarction, stroke, and bleeding based on hospital quartile of potent P2Y12 inhibitor use. Rates of ticagrelor use increased from 18.0% to 44.0%, while rates of prasugrel and clopidogrel use decreased from 24.6% to 13.5% and 57.4% to 42.6%, respectively. Prior percutaneous coronary intervention was the strongest clinical predictor for use of ticagrelor (adjusted odds ratio, 1.13 [95% CI, 1.09–1.18]) and prasugrel (adjusted odds ratio, 1.27 [95% CI, 1.21–1.34]) compared with clopidogrel. Predictors of clopidogrel use included no insurance, insurance with Medicare or Medicaid, and features associated with higher bleeding risk. The median hospital usage rate for newer P2Y12 inhibitors was 51.3% (interquartile range, 35.0%–65.9%), with substantial variation between hospitals (adjusted median odds ratio, 2.92 [95% CI, 2.77–3.10]). Among patients ≥65 years old, there were no differences in adjusted 1-year risks of adverse outcomes across hospital quartiles of potent P2Y12 inhibitor use.
Conclusions:
Almost one-half of STEMI patients by 2017 were discharged on ticagrelor while far fewer received prasugrel. Patient characteristics are associated with P2Y12 inhibitor selection, though substantial hospital variation exists. Identifying barriers to use of more potent P2Y12 inhibitors may improve patient-centered decision-making for STEMI patients.
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Affiliation(s)
- Kamil F. Faridi
- Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT (K.F.F.)
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (R.W.Y., K.F.F., E.A.S.)
| | | | - Kevin F. Kennedy
- Mid American Heart Institute, St. Luke’s Health System, Kansas City, MO (K.F.K.)
| | - Thomas M. Maddox
- Division of Cardiology, Washington University School of Medicine; Healthcare Innovation Lab, BJC HealthCare/Washington University School of Medicine, St Louis, MO (T.M.M.)
| | - Eric A. Secemsky
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (R.W.Y., K.F.F., E.A.S.)
| | - Neel M. Butala
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA (N.M.B.)
| | - Robert W Yeh
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (R.W.Y., K.F.F., E.A.S.)
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15
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Crimi G, De Rosa R, Mandurino-Mirizzi A, Morici N, Alberti LP, Savonitto S, De Servi S. De-escalating dual antiplatelet therapy in patients with acute coronary syndromes: the right strategy to harmonize time-dependent ischemic and bleeding risk in elderly patients? J Cardiovasc Med (Hagerstown) 2020; 21:281-285. [PMID: 32108125 DOI: 10.2459/jcm.0000000000000929] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
: The European Society of Cardiology guidelines for myocardial revascularization state that de-escalation of P2Y12 inhibitor treatment guided by platelet function testing may be considered for acute coronary syndrome (ACS) patients deemed unsuitable for 12-month potent platelet inhibition. De-escalation strategy aim is to harmonize the time-dependency of thrombotic risk, which is high in the first month after ACS, then decreases exponentially, with bleeding risk, which tends to remain more stable after the procedure-related peak. Harmonizing time-dependency of clinical events may be particularly relevant in those at high risk, such as the elderly patients with ACS in whom an individualized antiplatelet therapy may be more appropriate than a 'one-size-fits all' approach. In this review, we outline the current medical evidence on the topic of dual antiplatelet therapy de-escalation. In addition, we include insights from the Elderly ACS 2 study and recently published post-hoc analyses conducted by the authors' consortium, which further expands current knowledge.
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Affiliation(s)
- Gabriele Crimi
- SC. Cardiologia, Fondazione Policlinico San Matteo, Pavia.,Cardiologia Interventistica, Dipartimento CardioToracoVascolare, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Roberta De Rosa
- Department of Medicine, Surgery and Dentistry, Schola Medica Salernitana, University of Salerno
| | | | - Nuccia Morici
- Intensive Cardiac Care Unit and De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan
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16
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Verdoia M, Nardin M, Negro F, Tonon F, Gioscia R, Rolla R, De Luca G. Impact of aging on immature platelet count and its relationship with coronary artery disease. Platelets 2020; 31:1060-1068. [PMID: 31973643 DOI: 10.1080/09537104.2020.1714572] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Despite the fact that elderly patients represent a prevalent and challenging population in the current practice, few data exist on the impact of platelet parameters on cardiovascular risk in these patients. Therefore, the aim of the present study was to evaluate the impact of age on the immature platelet count (IPC) and their relationship with CAD. We included a total of 2236 consecutive patients undergoing coronary angiography in a single center. Elderly patients (age ≥ 75 years) were 756 (33.7%). IPC was measured at admission. Elderly patients were more often females (p < .001), with lower BMI and prevalence of smokers (p < .001), and a more complex cardiovascular risk profile and coronary disease (p = .02). Platelet count decreased with aging (p = .05), whereas no difference in the mean IPC was found between patients < or ≥75 years. In fact, advanced age did not emerge as an independent predictor of IPC above III tertile (≥8.6*10^6/ml), (adjusted OR[95%CI] = 0.97[0.78-1.21], p = .79). When considering elderly patients according to tertiles values of IPC (<5.1,5.1-8.59; ≥8.6*10^6/ml), we found no impact of IPC on the prevalence of CAD (81.1% vs 84.5% vs 81.5%, p = .92; adjusted OR[95%CI] = 1.08[0.67-1.72], p = .75) and its extent (37.7% vs 34.5% vs 40.2%, p = .57; adjusted OR[95%CI] = 1.22[0.85-1.73], p = .28). However, we observed a higher rate of calcified and type C lesions in elderly patients with higher IPC (p = .03 and p < .001, respectively). Therefore, advanced age is not associated with higher immature platelet count and the prevalence and severity of CAD. Moreover, IPC does not contribute to explain the higher prevalence and extent of coronary artery disease observed in elderly patients.
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Affiliation(s)
- Monica Verdoia
- Department of Cardiology, Ospedale "Maggiore della Carità", Eastern Piedmont University , Novara, Italy
| | - Matteo Nardin
- Department of Cardiology, Ospedale "Maggiore della Carità", Eastern Piedmont University , Novara, Italy.,Department of Medicine, ASST "Spedali Civili", University of Brescia , Brescia, Italy
| | - Federica Negro
- Department of Cardiology, Ospedale "Maggiore della Carità", Eastern Piedmont University , Novara, Italy
| | - Francesco Tonon
- Department of Cardiology, Ospedale "Maggiore della Carità", Eastern Piedmont University , Novara, Italy
| | - Rocco Gioscia
- Department of Cardiology, Ospedale "Maggiore della Carità", Eastern Piedmont University , Novara, Italy
| | - Roberta Rolla
- Department of Clinical Chemistry, Ospedale "Maggiore della Carità", Eastern Piedmont University , Novara, Italy
| | - Giuseppe De Luca
- Department of Cardiology, Ospedale "Maggiore della Carità", Eastern Piedmont University , Novara, Italy
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17
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De Luca L, Zeymer U, Claeys MJ, Dörler J, Erne P, Matter CM, Radovanovic D, Weidinger F, Lüscher TF, Jukema JW. Comparison of P2Y12 receptor inhibitors in patients with ST-elevation myocardial infarction in clinical practice: a propensity score analysis of five contemporary European registries. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2020; 7:94-103. [PMID: 31965164 PMCID: PMC7957904 DOI: 10.1093/ehjcvp/pvaa002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 12/13/2019] [Accepted: 01/13/2020] [Indexed: 01/12/2023]
Abstract
Aims Among acute coronary syndromes (ACS), ST-segment elevation myocardial infarction (STEMI) has the most severe early clinical course. Recent randomized clinical trials have demonstrated that novel antithrombotic therapies improve in-hospital outcomes in STEMI patients. We aimed to describe the effectiveness and safety of P2Y12 receptor inhibitors in clinical practice in patients with STEMI based on data from contemporary European ACS registries. Methods and results Five registries from the PIRAEUS initiative (AAPCI/ADPAT, ALKK-PIC, AMIS Plus, Belgium STEMI, and EYESHOT) provided data for the assessment of P2Y12 receptor inhibitor-based dual antiplatelet therapy. Registries were heterogeneous in terms of setting, patient characteristics, and treatment selection. Matched pair analysis and propensity score matching were used to assess all-cause in-hospital death rates based on data from 25 250 patients (8577 patients on prasugrel, 5995 on ticagrelor, and 10 678 on clopidogrel). The odds ratio (OR) for the death of any cause when compared with clopidogrel was 0.72 [95% confidence interval (CI) 0.62–0.84, P < 0.001] in favour of the new P2Y12 receptor inhibitors (prasugrel and ticagrelor combined). In the comparison between prasugrel and ticagrelor, there were no relevant differences (OR 0.97, 95% CI 0.77–1.23; P = 0.81). Event rates of cardiovascular death and stroke were also substantially lower for the new P2Y12 receptor inhibitors. The differences between clopidogrel and prasugrel or ticagrelor on major bleeding were numerically in the same order as for death of any cause but were not statistically significant. No differences in ischaemic and bleeding outcomes were observed between prasugrel and ticagrelor. Conclusion This analysis suggests that the prasugrel or ticagrelor compared with clopidogrel have favourable outcomes in clinical practice while not being inferior in terms of safety.
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Affiliation(s)
- Leonardo De Luca
- Interventional Cardiology Unit, Division of Cardiology, San Giovanni Evangelista Hospital, Via A. Parrozzani 3, I-00019 Tivoli, Rome, Italy
| | - Uwe Zeymer
- Interventional Cardiology, Institut für Herzinfarktforschung, Ludwigshafen, Germany
| | - Marc J Claeys
- Department of Cardiology, University Hospital Antwerp, Edegem, Belgium
| | - Jakob Dörler
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Paul Erne
- Faculty of Biomedical Science, Università della Svizzera italiana, Lugano, Switzerland
| | - Christian M Matter
- Cardiology Department, University Heart Center, AQ8University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Dragana Radovanovic
- AMIS Plus Data Center, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Franz Weidinger
- 2nd Department of Medicine with Cardiology and Intensive Care, Hospital Rudolfstiftung, Vienna, Austria
| | - Thomas F Lüscher
- Heart Division, Royal Brompton & Harefield Hospital, Imperial College London, London, UK.,Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland
| | - Johan Wouter Jukema
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
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18
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Díez-Villanueva P, Méndez CJ, Alfonso F. Non-ST elevation acute coronary syndrome in the elderly. J Geriatr Cardiol 2020; 17:9-15. [PMID: 32133032 PMCID: PMC7008102 DOI: 10.11909/j.issn.1671-5411.2020.01.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Affiliation(s)
| | | | - Fernando Alfonso
- Cardiology Department, Hospital Universitario La Princesa, Universidad Autónoma de Madrid, Madrid, Spain
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19
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Elderly Patients with ST-Segment Elevation Myocardial Infarction: A Patient-Centered Approach. Drugs Aging 2019; 36:531-539. [DOI: 10.1007/s40266-019-00663-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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20
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Serebruany VL, Kim MH, Marciniak TA. Worldwide reporting of fatal outcomes after ticagrelor to the US Food and Drug Administration. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2019; 4:6-9. [PMID: 29240872 DOI: 10.1093/ehjcvp/pvx024] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Victor L Serebruany
- Division of Neurology, School of Medicine, Johns Hopkins University, 14110 Rover Mills Road, West Friendship, Baltimore, MD, 21794, USA
| | - Moo Hyun Kim
- Division of Cardiology, Dong-A University, Busan, South Korea; and
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21
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Cherepanov V, Fortmann SD, Hyun Kim M, Marciniak TA, Litvinov O, Mihalev K, Serebruany VL. Annual adverse event profiles after clopidogrel, prasugrel, and ticagrelor in the Food and Drug Administration Adverse Event Reporting System. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2019; 4:69-71. [PMID: 29272379 DOI: 10.1093/ehjcvp/pvx038] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 12/19/2017] [Indexed: 11/14/2022]
Affiliation(s)
- Vasily Cherepanov
- HeartDrug Research LLC, 7600 Osler Drive, Suite 307, Towson, MD 21294, USA
| | - Seth D Fortmann
- HeartDrug Research LLC, 7600 Osler Drive, Suite 307, Towson, MD 21294, USA
| | - Moo Hyun Kim
- Dong-A University, Hospital, Division of Cardiology, 26 Daesingongwon-ro, Seo-gu, Busan 602-812, South Korea
| | | | - Oleg Litvinov
- HeartDrug Research LLC, 7600 Osler Drive, Suite 307, Towson, MD 21294, USA
| | - Kyryl Mihalev
- Center for Preventive and Clinical Medicine, Verhnyaya Str. 5, Kiev, 01014, Ukraine
| | - Victor L Serebruany
- HeartDrug Research LLC, 7600 Osler Drive, Suite 307, Towson, MD 21294, USA.,Division of Neurology, Johns Hopkins University,14110 Rover Mill Road, West Friendship, MD 21794, USA
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22
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Agewall S. Adherence to guidelines and registry data. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2018; 3:183-184. [PMID: 28922837 DOI: 10.1093/ehjcvp/pvx027] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Stefan Agewall
- Oslo University Hospital Ullevål and Institute of Clinical Sciences, University of Oslo, Oslo, Norway
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23
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Serebruany VL, Hall TS, Atar D, Agewall S, Hyun Kim M, Geudelin B, Lomakin N, Marciniak TA. Mortality and adverse events with brand and generic clopidogrel in the US Food and Drug Administration Adverse Event Reporting System. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2018; 5:210-215. [PMID: 30192939 DOI: 10.1093/ehjcvp/pvy035] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 08/31/2018] [Accepted: 09/04/2018] [Indexed: 11/15/2022]
Abstract
Abstract
Aims
Clopidogrel is commonly used even after expiring patents. The brand clopidogrel (BC) was dealt by single company, while numerous manufacturers produce generic clopidogrel (GC). There are no convincing data to compare the safety of different formulations. Therefore, the data yielded from international, uniform, government-mandated registries may be useful.
Methods and results
We assessed primary causative adverse events (PCAE) after BC and GC in the US Food and Drug Administration (FDA) Adverse Event Reporting System (FAERS). The outcomes were divided into death, cardiac, thrombotic/embolic, haemorrhagic, and rash/dermal complications. These primary endpoints were then examined by proportional reporting ratios (PRR) and chi-square (χ2). Among total FAERS (n = 9 466 679) reports, overall BC (n = 88 863) cases were more common than after GC (n = 36 559). When triaged by PCAE role, BC (n = 18 328) was also more abundant than GC (n = 3987). The reported death rates were more than doubled after BC [18.4% vs. 7.0%; PRR = 0.38; 95% confidence interval (95% CI) 0.32–0.43; χ2=369.7; P<0.0001] for total FAERS, and consistent for late 2010–2017 (17.6% vs. 7.0% PRR = 0.40; 95% CI 0.37–0.45; χ2=286.2; P<0.004) PCAE cases. In contrast, GC trended to co-report more cardiac (14.6% vs. 13.3%; PRR = 1.12; 95% CI 1.0–1.25; χ2=3.5; P<0.06). The haemorrhagic (40.9% vs. 32.3%; PRR = 1.45; 95% CI 1.33–1.57; χ2=75.8; P<0.0001), and rash/dermal (5.4% vs. 4.6%; PRR = 1.20; 95% CI 1.0–1.44; χ2=3.75; P<0.05) events were also more common for GC. Thrombotic/embolic events were reported equally (at 7.0%) after each formulation.
Conclusion
The PCAE profiles differ with BC and GC in FAERS. While deaths reports were higher, the rates of cardiac, haemorrhagic, and skin complications were less common for BC. Despite expected reporting bias, this may indicate that the manufacturers of GC are reluctant to report deaths to the FDA. However, the overall adverse event profile suggests potentially better safety of BC over GC formulations.
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Affiliation(s)
- Victor L Serebruany
- Department of Neurology, Stroke Unit, Johns Hopkins University, 14110 Rover Mill Road, West Friendship, MD, USA
| | - Trygve S Hall
- Department of Cardiology B, Oslo University Hospital Ullevål, and University of Oslo, Oslo Norway
| | - Dan Atar
- Department of Cardiology B, Oslo University Hospital Ullevål, and University of Oslo, Oslo Norway
| | - Stefan Agewall
- Department of Cardiology B, Oslo University Hospital Ullevål, and University of Oslo, Oslo Norway
| | - Moo Hyun Kim
- Department of Cardiology, Dong-A University, Busan, South Korea
| | | | - Nikita Lomakin
- Department of Intensive Cardiology, Central Clinical Hospital of the Administrative Affairs of the President of the Russian Federation, Moscow, Russia
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Adamski P, Adamska U, Ostrowska M, Navarese EP, Kubica J. Evaluating current and emerging antithrombotic therapy currently available for the treatment of acute coronary syndrome in geriatric populations. Expert Opin Pharmacother 2018; 19:1415-1425. [PMID: 30132731 DOI: 10.1080/14656566.2018.1510487] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Acute coronary syndromes (ACS) represent one of the most perilous presentations of ischemic heart disease. Temporal trends clearly demonstrate that ACS occur later and later in life. Elderly patients with ACS comprise a populous and growing group, with more than half of individuals presenting with myocardial infarction being 75 years or older. Nevertheless, geriatric patients are greatly underrepresented in the landmark ACS trials evaluating innovative pharmacological strategies. AREAS COVERED The authors critically summarize recently published research on contemporary and emerging antithrombotic therapy for the treatment of ACS in geriatric patients. EXPERT OPINION Elderly ACS patients are characterized by simultaneously increased risk of cardiovascular events and bleeding. Very few studies assessing the efficacy and safety of novel ACS pharmacotherapy in geriatric patients are currently available. Guidelines on the treatment of ACS are based on the overall results of major randomized clinical trials (RCTs), and data supporting the recommended therapy in elderly mainly derive from subanalyses of these RCTs. Properly designed and powered RCTs are necessary to properly evaluate the net effect of current and emerging pharmacotherapy in geriatric patients. Until such data are available, elderly ACS patients should receive treatment according to the general recommendations.
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Affiliation(s)
- Piotr Adamski
- a Collegium Medicum , Nicolaus Copernicus University , Bydgoszcz , Poland
| | - Urszula Adamska
- a Collegium Medicum , Nicolaus Copernicus University , Bydgoszcz , Poland
| | | | - Eliano Pio Navarese
- a Collegium Medicum , Nicolaus Copernicus University , Bydgoszcz , Poland.,b Interventional Cardiology and Cardiovascular Medicine Research, Inova Center for Thrombosis Research and Drug Development , Inova Heart and Vascular Institute , Falls Church , VA , USA.,c SIRIO MEDICINE Research Network, Inova Heart and Vascular Institute, Inova Center for Thrombosis Research and Drug Development , Fairfax , VA , USA
| | - Jacek Kubica
- a Collegium Medicum , Nicolaus Copernicus University , Bydgoszcz , Poland
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Zocca P, van der Heijden LC, Kok MM, Löwik MM, Hartmann M, Stoel MG, Louwerenburg JW, de Man FHAF, Linssen GCM, Knottnerus IL, Doggen CJM, van Houwelingen KG, von Birgelen C. Clopidogrel or ticagrelor in acute coronary syndrome patients treated with newer-generation drug-eluting stents: CHANGE DAPT. EUROINTERVENTION 2018; 13:1168-1176. [PMID: 29151439 DOI: 10.4244/eij-d-17-00634] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS Acute coronary syndrome (ACS) guidelines have been changed, favouring more potent antiplatelet drugs. We aimed to evaluate the safety and efficacy of a ticagrelor- instead of a clopidogrel-based primary dual antiplatelet (DAPT) regimen in ACS patients treated with newer-generation drug-eluting stents (DES). METHODS AND RESULTS CHANGE DAPT (clinicaltrials.gov: NCT03197298) assessed 2,062 consecutive real-world ACS patients, treated by percutaneous coronary intervention (PCI), the primary composite endpoint being net adverse clinical and cerebral events (NACCE: all-cause death, any myocardial infarction, stroke or major bleeding). In the clopidogrel (CP; December 2012-April 2014) and ticagrelor periods (TP; May 2014-August 2015), 1,009 and 1,053 patients were treated, respectively. TP patients were somewhat older, underwent fewer transfemoral procedures, and received fewer glycoprotein IIb/IIIa inhibitors. In the TP, the one-year NACCE rate was higher (5.1% vs. 7.8%; HR 1.53 [95% CI: 1.08-2.17]; p=0.02). Assessment of non-inferiority (pre-specified margin: 2.7%) was inconclusive (risk difference: 2.64 [95% CI: 0.52-4.77]; pnon-inferiority=0.48). TP patients had more major bleeding (1.2% vs. 2.7%; p=0.02) while there was no benefit in ischaemic endpoints. Propensity score-adjusted multivariate analysis confirmed higher NACCE (adj. HR 1.75 [95% CI: 1.20-2.55]; p=0.003) and major bleeding risks during TP (adj. HR 2.75 [95% CI: 1.34-5.61]; p=0.01). CONCLUSIONS In this observational study, the guideline-recommended ticagrelor-based primary DAPT regimen was associated with an increased event risk in consecutive ACS patients treated with newer-generation DES.
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Affiliation(s)
- Paolo Zocca
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, the Netherlands
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Savonitto S, Ferri LA, Piatti L, Grosseto D, Piovaccari G, Morici N, Bossi I, Sganzerla P, Tortorella G, Cacucci M, Ferrario M, Murena E, Sibilio G, Tondi S, Toso A, Bongioanni S, Ravera A, Corrada E, Mariani M, Di Ascenzo L, Petronio AS, Cavallini C, Vitrella G, Rogacka R, Antonicelli R, Cesana BM, De Luca L, Ottani F, De Luca G, Piscione F, Moffa N, De Servi S, Bolognese L, Bovenzi F, Steffenino G, Santilli I, Bassanelli G, Sacco A, Canziani F, Ferri M, Lo Jacono E, Canosi U, Fornaro G, Leoncini M, Rosa Conte M, Farina R, Stefanin C, Di Pede F, Chella P, Chiara Nardoni M, Tamburrini P, Trimarco B, Galasso G, Elia R, Bolognese L, Grotti S, Bovenzi F, Borrelli L, Tamburino C, Capranzano P, Francaviglia B, Campana C, Bonatti R, Martinoni A, Abate F, Coscarelli S, Rubartelli P, Villani GQ, Rossini R. Comparison of Reduced-Dose Prasugrel and Standard-Dose Clopidogrel in Elderly Patients With Acute Coronary Syndromes Undergoing Early Percutaneous Revascularization. Circulation 2018; 137:2435-2445. [DOI: 10.1161/circulationaha.117.032180] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 02/02/2018] [Indexed: 11/16/2022]
Abstract
Background:
Elderly patients are at elevated risk of both ischemic and bleeding complications after an acute coronary syndrome and display higher on-clopidogrel platelet reactivity compared with younger patients. Prasugrel 5 mg provides more predictable platelet inhibition compared with clopidogrel in the elderly, suggesting the possibility of reducing ischemic events without increasing bleeding.
Methods:
In a multicenter, randomized, open-label, blinded end point trial, we compared a once-daily maintenance dose of prasugrel 5 mg with the standard clopidogrel 75 mg in patients >74 years of age with acute coronary syndrome undergoing percutaneous coronary intervention. The primary end point was the composite of mortality, myocardial infarction, disabling stroke, and rehospitalization for cardiovascular causes or bleeding within 1 year. The study was designed to demonstrate superiority of prasugrel 5 mg over clopidogrel 75 mg.
Results:
Enrollment was interrupted, according to prespecified criteria, after a planned interim analysis, when 1443 patients (40% women; mean age, 80 years) had been enrolled with a median follow-up of 12 months, because of futility for efficacy. The primary end point occurred in 121 patients (17%) with prasugrel and 121 (16.6%) with clopidogrel (hazard ratio, 1.007; 95% confidence interval, 0.78–1.30;
P
=0.955). Definite/probable stent thrombosis rates were 0.7% with prasugrel versus 1.9% with clopidogrel (odds ratio, 0.36; 95% confidence interval, 0.13–1.00;
P
=0.06). Bleeding Academic Research Consortium types 2 and greater rates were 4.1% with prasugrel versus 2.7% with clopidogrel (odds ratio, 1.52; 95% confidence interval, 0.85–3.16;
P
=0.18).
Conclusions:
The present study in elderly patients with acute coronary syndromes showed no difference in the primary end point between reduced-dose prasugrel and standard-dose clopidogrel. However, the study should be interpreted in light of the premature termination of the trial.
Clinical Trial Registration:
URL:
https://www.clinicaltrials.gov
. Unique identifier: NCT01777503.
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Affiliation(s)
| | | | - Luigi Piatti
- Ospedale Manzoni, Lecco, Italy (S.S., L.A.F., L.P.)
| | | | | | - Nuccia Morici
- Azienda Socio-Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milano, Italy (N. Morici, I.B.)
| | - Irene Bossi
- Azienda Socio-Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milano, Italy (N. Morici, I.B.)
| | | | - Giovanni Tortorella
- Istituto di Ricerca e Cura a Carattere Scientifico Arcispedale S. Maria Nuova, Reggio Emilia, Italy (G.T.)
| | | | | | - Ernesto Murena
- Ospedale S. Maria delle Grazie, Pozzuoli, Italy (E.M., G.S.)
| | | | | | - Anna Toso
- Ospedale S. Stefano, Prato, Italy (A.T.)
| | | | | | - Elena Corrada
- Humanitas Clinical and Research Center, Rozzano, Italy (E.C.)
| | | | | | | | | | | | - Renata Rogacka
- Azienda Ospedaliera di Desio e Vimercate, Desio, Italy (R.R.)
| | | | - Bruno M. Cesana
- Statistics and Biomathematics Unit, Department of Molecular and Transactional Medicine, University of Brescia, Italy (B.M.C.)
| | | | | | - Giuseppe De Luca
- Azienda Ospedaliera-Universitaria “Maggiore della Carità,” Eastern Piedmont University, Novara, Italy (G.D.L.)
| | - Federico Piscione
- Department of Medicine, Surgery and Dentistry–Schola Medica Salernitana, University of Salerno, Italy (F.P.)
| | - Nadia Moffa
- Mediolanum Cardio Research, Milan, Italy (N. Moffa)
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Rosano GM. Cardiovascular pharmacotherapy a growing sub-speciality across all areas of cardiology. J Cardiovasc Med (Hagerstown) 2018; 19:263-266. [DOI: 10.2459/jcm.0000000000000640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Gulizia MM, Colivicchi F, Abrignani MG, Ambrosetti M, Aspromonte N, Barile G, Caporale R, Casolo G, Chiuini E, Di Lenarda A, Faggiano P, Gabrielli D, Geraci G, La Manna AG, Maggioni AP, Marchese A, Massari FM, Mureddu GF, Musumeci G, Nardi F, Panno AV, Pedretti RFE, Piredda M, Pusineri E, Riccio C, Rossini R, di Uccio FS, Urbinati S, Varbella F, Zito GB, De Luca L. Consensus Document ANMCO/ANCE/ARCA/GICR-IACPR/GISE/SICOA: Long-term Antiplatelet Therapy in Patients with Coronary Artery Disease. Eur Heart J Suppl 2018; 20:F1-F74. [PMID: 29867293 PMCID: PMC5978022 DOI: 10.1093/eurheartj/suy019] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 receptor inhibitor is the cornerstone of pharmacologic management of patients with acute coronary syndrome (ACS) and/or those receiving coronary stents. Long-term (>1 year) DAPT may further reduce the risk of stent thrombosis after a percutaneous coronary intervention (PCI) and may decrease the occurrence of non-stent-related ischaemic events in patients with ACS. Nevertheless, compared with aspirin alone, extended use of aspirin plus a P2Y12 receptor inhibitor may increase the risk of bleeding events that have been strongly linked to adverse outcomes including recurrent ischaemia, repeat hospitalisation and death. In the past years, multiple randomised trials have been published comparing the duration of DAPT after PCI and in ACS patients, investigating either a shorter or prolonged DAPT regimen. Although the current European Society of Cardiology guidelines provide a backup to individualised treatment, it appears to be difficult to identify the ideal patient profile which could safely reduce or prolong the DAPT duration in daily clinical practice. The aim of this consensus document is to review contemporary literature on optimal DAPT duration, and to guide clinicians in tailoring antiplatelet strategies in patients undergoing PCI or presenting with ACS.
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Affiliation(s)
- Michele Massimo Gulizia
- U.O.C. di Cardiologia, Ospedale Garibaldi-Nesima, Azienda di Rilievo Nazionale e Alta Specializzazione “Garibaldi”, Catania, Italy
| | - Furio Colivicchi
- U.O.C. Cardiologia e UTIC, Ospedale San Filippo Neri, Roma, Italy
| | | | - Marco Ambrosetti
- Servizio di Cardiologia Riabilitativa, Clinica Le Terrazze Cunardo, Varese, Italy
| | - Nadia Aspromonte
- U.O. Scompenso e Riabilitazione Cardiologica, Polo Scienze Cardiovascolari, Toraciche, Policlinico Agostino Gemelli, Roma, Italy
| | | | - Roberto Caporale
- U.O.C. Cardiologia Interventistica, Ospedale Annunziata, Cosenza, Italy
| | - Giancarlo Casolo
- S.C. Cardiologia, Nuovo Ospedale Versilia, Lido di Camaiore (LU), Italy
| | - Emilia Chiuini
- Specialista Ambulatoriale Cardiologo, ASL Umbria 1, Perugia, Italy
| | - Andrea Di Lenarda
- S.C. Cardiovascolare e Medicina dello Sport, Azienda Sanitaria Universitaria Integrata di Trieste, Italy
| | | | - Domenico Gabrielli
- ASUR Marche - Area Vasta 4 Fermo, Ospedale Civile Augusto Murri, Fermo, Italy
| | - Giovanna Geraci
- U.O.C. Cardiologia Azienda Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy
| | | | | | | | - Ferdinando Maria Massari
- U.O.C. Malattie Cardiovascolari "Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italy
| | | | | | - Federico Nardi
- S.C. Cardiologia, Ospedale Santo Spirito, Casale Monferrato (AL), Italy
| | | | | | - Massimo Piredda
- Centro Cardiotoracico, Divisione di Cardiologia, Istituto Clinico Sant'Ambrogio, Milano, Italy
| | - Enrico Pusineri
- U.O.C. di Cardiologia, Ospedale Civile di Vigevano, A.S.S.T., Pavia, Italy
| | - Carmine Riccio
- Prevenzione e Riabilitazione Cardiopatico, AZ. Ospedaliera S. Anna e S. Sebastiano, Caserta, Italy
| | | | | | - Stefano Urbinati
- U.O.C. Cardiologia, Ospedale Bellaria, AUSL di Bologna, Bologna, Italy
| | | | | | - Leonardo De Luca
- U.O.C. Cardiologia, Ospedale San Giovanni Evangelista, Tivoli, Roma, Italy
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Kim MC, Jeong MH, Sim DS, Hong YJ, Kim JH, Ahn Y, Ahn TH, Seung KB, Choi DJ, Kim HS, Gwon HC, Seong IW, Hwang KK, Chae SC, Hur SH, Cha KS, Oh SK, Chae JK. Comparison of Clinical Outcomes Between Ticagrelor and Prasugrel in Patients With ST-Segment Elevation Myocardial Infarction - Results From the Korea Acute Myocardial Infarction Registry-National Institutes of Health. Circ J 2018; 82:1866-1873. [PMID: 29643279 DOI: 10.1253/circj.cj-18-0112] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND There is little information regarding comparison of ticagrelor and prasugrel in patients with ST-segment elevation myocardial infarction (STEMI). We sought to compare clinical outcomes between ticagrelor and prasugrel in STEMI.Methods and Results:A total of 1,440 patients with STEMI who underwent successful primary percutaneous coronary intervention were analyzed; the data were obtained from the Korea Acute Myocardial Infarction Registry-National Institutes of Health. Of the patients, 963 received ticagrelor, and 477 received prasugrel. The primary study endpoint was 12-month major adverse cardiac events (MACE), including cardiac death, myocardial infarction (MI), and target vessel revascularization (TVR). MACE occurred in 91 patients (6.3%) over the 1-year follow-up, and there were no differences in the incidence of MACE (hazard ratio [HR] 1.20, 95% confidence interval [CI] 0.76-1.91, P=0.438) between the 2 groups. Analysis by propensity score matching (429 pairs) did not significantly affect the results. The incidence of in-hospital major bleeding events was still comparable between the 2 groups (2.4% vs. 2.5%, odds ratio 0.75, 95% CI 0.30-1.86, P=0.532), and there was no significant difference in the incidence of MACE (5.4% vs. 5.8%, HR 0.98, 95% CI 0.56-1.74, P=0.951) after matching. CONCLUSIONS Ticagrelor and prasugrel showed similar efficacy and safety profiles for treating STEMI in this Korean multicenter registry.
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Affiliation(s)
- Min Chul Kim
- Heart Center of Chonnam National University Hospital
| | | | - Doo Sun Sim
- Heart Center of Chonnam National University Hospital
| | | | - Ju Han Kim
- Heart Center of Chonnam National University Hospital
| | - Youngkeun Ahn
- Heart Center of Chonnam National University Hospital
| | | | - Ki Bae Seung
- The Catholic University of Korea Seoul St. Mary's Hospital
| | - Dong-Ju Choi
- Department of Internal Medicine, Seoul National University Bundang Hospital
| | - Hyo-Soo Kim
- Department of Internal Medicine, Seoul National University Hospital
| | | | - In Whan Seong
- Department of Internal Medicine, Chungnam National University Hospital
| | - Kyoung-Kook Hwang
- Department of Internal Medicine, Chungbuk National University Hospital
| | - Shung Chull Chae
- Department of Internal Medicine, Kyungpook National University Hospital
| | | | - Kwang Soo Cha
- Department of Internal Medicine, Pusan National University Hospital
| | - Seok Kyu Oh
- Department of Internal Medicine, Wonkwang University Hospital
| | - Jei Keon Chae
- Department of Internal Medicine, Chonbuk National University Hospital
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31
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Shahzad A, Khanna V, Kemp I, Shaw M, Mars C, Cooper R, Wilson K, Curzen N, Stables RH. Comparison of the effects of P2Y12 receptor antagonists on platelet function and clinical outcomes in patients undergoing Primary PCI: A substudy of the HEAT-PPCI trial. EUROINTERVENTION 2018; 13:1931-1938. [PMID: 29336311 DOI: 10.4244/eij-d-17-00408] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS The HEAT-PPCI trial compared bivalirudin and unfractionated heparin in patients undergoing primary percutaneous coronary intervention (PPCI). The aim of this study was to report pre-specified, secondary analyses comparing the effects of P2Y12 inhibiting agents on platelet reactivity and clinical events. METHODS AND RESULTS All patients received preprocedural oral antiplatelet therapy. During the early stages of the trial, the P2Y12 inhibitor of choice was prasugrel with some use of clopidogrel. Later, routine therapy switched to ticagrelor. For cases performed during working hours, multiple electrode aggregometry (MEA) was used to assess ADP-induced platelet aggregation at the end of the index procedure. The effect of P2Y12 inhibitors on the primary efficacy (major adverse cardiac events [MACE]) and safety (major bleeding) outcomes was assessed in all patients. Multiple logistic regression was used to adjust for differences in baseline characteristics. With MEA data from 469 patients, prasugrel therapy resulted in significantly greater suppression of ADP-induced platelet aggregation at 40 U (23, 78) (median; interquartile range [IQR]) when compared against ticagrelor 75 U (41, 100.75); p<0.001 or clopidogrel 79 U (56, 96); p<0.001. In the entire study population (N=1,803), prasugrel therapy was associated with significantly fewer MACE (26/497; 5.2%) in comparison to ticagrelor (83/1,123; 7.4%) or clopidogrel (18/183; 9.8%); odds ratio (OR) 0.64, confidence interval (CI): 0.41-0.99, p=0.045. For major bleeding, there were no significant differences among the three groups - clopidogrel (3/183; 1.6%), prasugrel (13/497; 2.6%) and ticagrelor (43/1,123; 3.8%); OR 0.73, CI: 0.39-1.35, p=0.31. Patients treated with clopidogrel had more high-risk features and clopidogrel use was more common as an alternative to prasugrel. After adjustment, there were no significant differences in the rates of MACE (OR 0.70, CI: 0.41-1.21, p=0.20) or major bleeding (OR 0.80, CI: 0.41-1.60, p=0.53). CONCLUSIONS In HEAT-PPCI, patients who received prasugrel (rather than clopidogrel or ticagrelor) had significantly greater suppression of ADP-induced platelet aggregation at the end of the procedure. After adjustment for differences in baseline characteristics, there were no significant differences in ischaemic or bleeding outcomes among the antiplatelet therapies.
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Affiliation(s)
- Adeel Shahzad
- Institute of Cardiovascular Medicine and Science, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, United Kingdom
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32
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Fournier S, Guenat F, Fournier A, Alberio L, Bonny O, Bertaggia Calderara D, Bardy D, Lauriers N, Harbaoui B, Monney P, Pascale P, Eeckhout E, Muller O. Circadian variation of ticagrelor-induced platelet inhibition in healthy adulty. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2018; 4:166-171. [DOI: 10.1093/ehjcvp/pvy003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 01/19/2018] [Indexed: 01/09/2023]
Affiliation(s)
- Stephane Fournier
- Department of Cardiology, Lausanne University Hospital, Rue du Bugnon 21, 1011 Lausanne, Switzerland
| | - Florine Guenat
- Department of Cardiology, Lausanne University Hospital, Rue du Bugnon 21, 1011 Lausanne, Switzerland
| | - Anne Fournier
- Department of Pharmacy, Lausanne University Hospital, Rue du Bugnon 21, 1011 Lausanne, Switzerland
| | - Lorenzo Alberio
- Department of Hematology, Lausanne University Hospital, Rue du Bugnon 21, 1011 Lausanne, Switzerland
| | - Olivier Bonny
- Department of Nephrology, Lausanne University Hospital, Rue du Bugnon 21, 1011 Lausanne, Switzerland
| | | | - Daniel Bardy
- Laboratory Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Nathalie Lauriers
- Department of Cardiology, Lausanne University Hospital, Rue du Bugnon 21, 1011 Lausanne, Switzerland
| | - Brahim Harbaoui
- Department of Cardiology, Lausanne University Hospital, Rue du Bugnon 21, 1011 Lausanne, Switzerland
| | - Pierre Monney
- Department of Cardiology, Lausanne University Hospital, Rue du Bugnon 21, 1011 Lausanne, Switzerland
| | - Patrizio Pascale
- Department of Cardiology, Lausanne University Hospital, Rue du Bugnon 21, 1011 Lausanne, Switzerland
| | - Eric Eeckhout
- Department of Cardiology, Lausanne University Hospital, Rue du Bugnon 21, 1011 Lausanne, Switzerland
| | - Olivier Muller
- Department of Cardiology, Lausanne University Hospital, Rue du Bugnon 21, 1011 Lausanne, Switzerland
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Castini D, Persampieri S, Cazzaniga S, Ferrante G, Centola M, Lucreziotti S, Salerno-Uriarte D, Sponzilli C, Carugo S. Real-world clopidogrel utilization in acute coronary syndromes: patients selection and outcomes in a single-center experience. Ther Adv Cardiovasc Dis 2017; 11:323-331. [PMID: 29134853 DOI: 10.1177/1753944717738911] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND With this study, we sought to identify patient characteristics associated with clopidogrel prescription and its relationship with in-hospital adverse events in an unselected cohort of ACSs patients. MATERIALS AND METHODS We studied all consecutive patients admitted at our institution for ACSs from 2012 to 2014. Patients were divided into two groups based on clopidogrel or novel P2Y12 inhibitors (prasugrel or ticagrelor) prescription and the relationship between clopidogrel use and patient clinical characteristics and in-hospital adverse events was evaluated using logistic regression analysis. RESULTS The population median age was 68 years (57-77 year) and clopidogrel was prescribed in 230 patients (46%). Patients characteristics associated with clopidogrel prescription were older age, female sex, non-ST-elevation ACS diagnosis, the presence of diabetes mellitus and anemia, worse renal and left ventricular functions and a higher Killip class. Patients on clopidogrel demonstrated a significantly higher incidence of in-hospital mortality (4.8%) than prasugrel and ticagrelor-treated patients (0.4%), while a nonstatistically significant trend emerged considering bleeding events. However, on multivariable logistic regression analysis female sex, the presence of anemia and Killip class were the only variables independently associated with in-hospital death. CONCLUSION Patients treated with clopidogrel showed a higher in-hospital mortality. However, clinical variables associated with its use identify a population at high risk for adverse events and this seems to play a major role for the higher in-hospital mortality observed in clopidogrel-treated patients.
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Affiliation(s)
- Diego Castini
- Division of Cardiology, San Paolo Hospital, Department of Health Sciences, University of Milan, Via A. di Rudinì 8, 20142 Milan, Italy
| | - Simone Persampieri
- Division of Cardiology, San Paolo Hospital, Department of Health Sciences, University of Milan, Italy
| | - Sara Cazzaniga
- Division of Cardiology, San Paolo Hospital, Department of Health Sciences, University of Milan, Italy
| | - Giulia Ferrante
- Division of Cardiology, San Paolo Hospital, Department of Health Sciences, University of Milan, Italy
| | - Marco Centola
- Division of Cardiology, San Paolo Hospital, Department of Health Sciences, University of Milan, Italy
| | - Stefano Lucreziotti
- Division of Cardiology, San Paolo Hospital, Department of Health Sciences, University of Milan, Italy
| | - Diego Salerno-Uriarte
- Division of Cardiology, San Paolo Hospital, Department of Health Sciences, University of Milan, Italy
| | - Carlo Sponzilli
- Division of Cardiology, San Paolo Hospital, Department of Health Sciences, University of Milan, Italy
| | - Stefano Carugo
- Division of Cardiology, San Paolo Hospital, Department of Health Sciences, University of Milan, Italy
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Claeys MJ, Sinnaeve PR, Convens C, Dubois P, Pourbaix S, Vranckx P, Gevaert S, De Raedt H, Beauloye C, Argacha JF, Evrard P, Coussement P. Quality assessment in Belgian ST elevation myocardial infarction patients: results from the Belgian STEMI database. Acta Cardiol 2017; 73:1-5. [PMID: 29228878 DOI: 10.1080/00015385.2017.1414344] [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: 10/24/2017] [Accepted: 12/02/2017] [Indexed: 10/18/2022]
Abstract
The present report describes the quality of care, including in hospital mortality for more than 22.000 STEMI patients admitted in 60 Belgian hospitals for the period 2008-2016. We found a strong increase in the use of primary PCI over time, particularly for patients that were admitted first in a non-PCI capable hospital, reaching a penetration rate of >95%. The transition of thrombolysis to transfer for pPCI in the setting of a STEMI network was, however, associated with an increase of the proportion of patients with prolonged (>120 min) diagnosis-to-balloon time (from 16 to 22%), suggesting still suboptimal interhospital transfer. The in-hospital mortality of the total study population was 6.5%. For non-cardiac arrest patients in-hospital mortality decreased from 5.1% to 3.7%, while it increased for cardiac arrest patients from 29 to 37%. The observation that quality indicators (QI's), such as modalities and timing of reperfusion therapy, were associated with lower levels of mortality, underscores the potential of QIs for STEMI to improve care and reduce unwarranted variation and premature death from STEMI.
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Affiliation(s)
- Marc J Claeys
- a Department of Cardiology, University Hospital Antwerp , Edegem , Belgium
| | | | - Carl Convens
- c Department of Cardiology, ZNA Antwerpen , Antwerp , Belgium
| | - Philippe Dubois
- d Department of Cardiology, CHU Charleroi , Charleroi , Belgium
| | - Suzanne Pourbaix
- e Department of Cardiology, CHR Citadelle Liège , Liège , Belgium
| | - Pascal Vranckx
- f Department of Cardiology, Virga Jesse Hasselt , Hasselt , Belgium
| | - Sofie Gevaert
- g Department of Cardiology, UZ Gent , Gent , Belgium
| | - Herbert De Raedt
- h Department of Cardiology, OLV Ziekenhuis Aalst , Aalst , Belgium
| | | | | | - Patrick Evrard
- k Department of Cardiology, UCL Mont-Godinne , Yvoir , Belgium
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Watti H, Dahal K, Zabher HG, Katikaneni P, Modi K, Abdulbaki A. Comparison of prasugrel and ticagrelor in patients with acute coronary syndrome undergoing percutaneous coronary intervention: A meta-analysis of randomized and non-randomized studies. Int J Cardiol 2017; 249:66-72. [DOI: 10.1016/j.ijcard.2017.07.103] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 07/24/2017] [Accepted: 07/26/2017] [Indexed: 01/19/2023]
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Seguridad y eficacia clínica con prasugrel y ticagrelor en síndrome coronario agudo. Resultados de un registro multicéntrico en el mundo real. Rev Esp Cardiol 2017. [DOI: 10.1016/j.recesp.2017.02.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Tousek P, Staskova K, Mala A, Sluka M, Vodzinska A, Jancar R, Maluskova D, Jarkovsky J, Widimsky P. Incidence, treatment strategies and outcomes of acute coronary syndrome with and without ongoing myocardial ischaemia: results from the CZECH-3 registry. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2017; 8:687-694. [PMID: 28730895 DOI: 10.1177/2048872617720929] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Patients with acute coronary syndrome with signs of ongoing myocardial ischaemia at first medical contact should be indicated for immediate invasive treatment. AIM To assess the incidence, treatment strategies and outcomes of acute coronary syndrome in a large unselected cohort of patients with respect to the signs of ongoing myocardial ischaemia. METHODS The CZECH-3 registry included 1754 consecutive patients admitted for suspected acute coronary syndrome to 43 hospitals during a 2-month period in the autumn of 2015. Acute coronary syndrome with ongoing myocardial ischaemia was defined by the presence of persistent/recurrent chest pain/dyspnoea and at least one of the following: persistent ST-segment elevation or depression, bundle branch block, haemodynamic or electric instability due to suspected ischaemia. Major adverse cardiac events (death, reinfarction, stroke, unexpected revascularisation, stent thrombosis) and severe bleeding according to Bleeding Academic Research Consortium criteria were evaluated at 30 days. RESULTS Acute coronary syndrome was ruled out during the hospital stay in 434 (24.7%) patients. Out of 1280 patients with confirmed acute coronary syndrome, 732 (57%) had clinical signs of ongoing myocardial ischaemia at first medical contact. Coronary angiography was performed in 94.7% of patients with confirmed acute coronary syndrome with ongoing myocardial ischaemia and 89% of patients with confirmed acute coronary syndrome without ongoing myocardial ischaemia (P<0.001). The major adverse cardiac event rate was 9.8% for patients with confirmed acute coronary syndrome with ongoing myocardial ischaemia and 5.5% for patients without ongoing myocardial ischaemia (P=0.005), the 30-day severe bleeding rate was 1.6% and 1.5% (P=1.0). Patients with ongoing myocardial ischaemia admitted to regional hospitals had higher major adverse cardiac event rates compared with patients admitted directly to cardiocentres with percutaneous coronary intervention capability (13.3% vs. 8.2%, P=0.034). CONCLUSIONS Ongoing myocardial ischaemia was present in more than half of patients hospitalised with acute coronary syndrome. These very high-risk patients may benefit from direct admission to percutaneous coronary intervention-capable centres.
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Affiliation(s)
- Petr Tousek
- Cardiocenter, University Hospital Kralovske Vinohrady and Third Faculty of Medicine, Czech Republic
| | - Klara Staskova
- Regional Hospital Ceske Budejovice, Department of Cardiology, Czech Republic
| | - Anna Mala
- Cardiocenter, University Hospital Kralovske Vinohrady and Third Faculty of Medicine, Czech Republic
| | - Martin Sluka
- Cardiocenter, Univesity Hospital Olomouc, Czech Republic
| | | | - Radek Jancar
- Department of Cardiology, Municipal Hospital Ostrava, Czech Republic
| | - Denisa Maluskova
- Institute of Biostatistics and Analyses, Masaryk University, Faculty of Medicine, Czech Republic
| | - Jiri Jarkovsky
- Institute of Biostatistics and Analyses, Masaryk University, Faculty of Medicine, Czech Republic
| | - Petr Widimsky
- Cardiocenter, University Hospital Kralovske Vinohrady and Third Faculty of Medicine, Czech Republic
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Safety and Efficacy of Prasugrel and Ticagrelor in Acute Coronary Syndrome. Results of a "Real World" Multicenter Registry. ACTA ACUST UNITED AC 2017; 70:952-959. [PMID: 28576388 DOI: 10.1016/j.rec.2017.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 02/07/2017] [Indexed: 11/21/2022]
Abstract
INTRODUCTION AND OBJECTIVES The incorporation of the new antiplatelet agents (NAA) prasugrel and ticagrelor into routine clinical practice is irregular and data from the "real world" remain scarce. We aimed to assess the time trend of NAA use and the clinical safety and efficacy of these drugs compared with those of clopidogrel in a contemporary cohort of patients with acute coronary syndromes (ACS). METHODS A multicenter retrospective observational study was conducted in patients with ACS admitted to coronary care units and prospectively included in the ARIAM-Andalusia registry between 2013 and 2015. In-hospital rates of major cardiovascular events and bleeding with NAA vs clopidogrel were analyzed using propensity score matching and multivariate regression models. RESULTS The study included 2906 patients: 55% received clopidogrel and 45% NAA. A total of 60% had ST-segment elevation ACS. Use of NAA significantly increased throughout the study. Patients receiving clopidogrel were older and were more likely to have comorbidities. Total mortality, ischemic stroke, and stent thrombosis were lower with NAA (2% vs 9%, P < .0001; 0.1% vs 0.5%, P = .025; 0.07% vs 0.5%, P = .025, respectively). There were no differences in the rate of total bleeding (3% vs 4%; P = NS). After propensity score matching, the mortality reduction with NAA persisted (OR, 0.37; 95%CI, 0.13 to 0.60; P < .0001) with no increase in total bleeding (OR, 1.07; 95%CI, 0.18 to 2.37; P = .094). CONCLUSIONS In a "real world" setting, NAA are selectively used in younger patients with less comorbidity and are associated with a reduction in major cardiac events, including mortality, without increasing bleeding compared with clopidogrel.
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Doll JA, Li S, Chiswell K, Roe MT, Kosiborod M, Scirica BM, Wang TY. Clopidogrel reloading for patients with acute myocardial infarction already on clopidogrel therapy. Eur Heart J 2017; 39:193-200. [DOI: 10.1093/eurheartj/ehx255] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 04/27/2017] [Indexed: 11/12/2022] Open
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Atar D. European Heart Journal-Cardiovascular Pharmacotherapy in 2016: entering a new level of international recognition. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2017; 3:3-4. [PMID: 28062654 DOI: 10.1093/ehjcvp/pvw024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Dan Atar
- Department of Cardiology B, Oslo University Hospital and Institute of Clinical Sciences, University of Oslo, Kirkeveien 166, N - 0407 Oslo, Norway
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Cardiovascular pharmacotherapy. Int J Cardiol 2016; 224:412-415. [PMID: 27690338 DOI: 10.1016/j.ijcard.2016.09.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 09/16/2016] [Indexed: 11/21/2022]
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Shavelle DM. Newer P2Y
12
Inhibitors: How Does the Interventional Cardiologist Choose? J Am Heart Assoc 2016; 5:JAHA.116.004460. [PMID: 27663416 PMCID: PMC5079058 DOI: 10.1161/jaha.116.004460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- David M. Shavelle
- Division of Cardiovascular Medicine, University of Southern California Los Angeles, CA
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Motovska Z, Hlinomaz O, Miklik R, Hromadka M, Varvarovsky I, Dusek J, Knot J, Jarkovsky J, Kala P, Rokyta R, Tousek F, Kramarikova P, Majtan B, Simek S, Branny M, Mrozek J, Cervinka P, Ostransky J, Widimsky P. Prasugrel Versus Ticagrelor in Patients With Acute Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention: Multicenter Randomized PRAGUE-18 Study. Circulation 2016; 134:1603-1612. [PMID: 27576777 DOI: 10.1161/circulationaha.116.024823] [Citation(s) in RCA: 138] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 08/19/2016] [Indexed: 01/23/2023]
Abstract
BACKGROUND No randomized head-to-head comparison of the efficacy and safety of ticagrelor and prasugrel has been published in the 7 years since the higher efficacy of these newer P2Y12 inhibitors were first demonstrated relative to clopidogrel. METHODS This academic study was designed to compare the efficacy and safety of prasugrel and ticagrelor in acute myocardial infarction treated with primary or immediate percutaneous coronary intervention. A total of 1230 patients were randomly assigned across 14 sites to either prasugrel or ticagrelor, which was initiated before percutaneous coronary intervention. Nearly 4% were in cardiogenic shock, and 5.2% were on mechanical ventilation. The primary end point was defined as death, reinfarction, urgent target vessel revascularization, stroke, or serious bleeding requiring transfusion or prolonging hospitalization at 7 days (to reflect primarily the in-hospital phase). This analysis presents data from the first 30 days (key secondary end point). The total follow-up will be 1 year for all patients and will be completed in 2017. RESULTS The study was prematurely terminated for futility. The occurrence of the primary end point did not differ between groups receiving prasugrel and ticagrelor (4.0% and 4.1%, respectively; odds ratio, 0.98; 95% confidence interval, 0.55-1.73; P=0.939). No significant difference was found in any of the components of the primary end point. The occurrence of key secondary end point within 30 days, composed of cardiovascular death, nonfatal myocardial infarction, or stroke, did not show any significant difference between prasugrel and ticagrelor (2.7% and 2.5%, respectively; odds ratio, 1.06; 95% confidence interval, 0.53-2.15; P=0.864). CONCLUSIONS This head-to-head comparison of prasugrel and ticagrelor does not support the hypothesis that one is more effective or safer than the other in preventing ischemic and bleeding events in the acute phase of myocardial infarction treated with a primary percutaneous coronary intervention strategy. The observed rates of major outcomes were similar but with broad confidence intervals around the estimates. These interesting observations need to be confirmed in a larger trial. CLINICAL TRIAL REGISTRATION URL: http://www.ClinicalTrials.gov. Unique identifier: NCT02808767.
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Affiliation(s)
- Zuzana Motovska
- From Cardiocenter, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic (Z.M., J.K., P.W.); First Department of Internal Medicine-Cardioangiology, ICRC, Faculty of Medicine of Masaryk University and St. Anne's University Hospital, Brno, Czech Republic (O.H., P. Kramarikova); Department of Internal Medicine and Cardiology, Faculty of Medicine of Masaryk University and University Hospital Brno, Brno, Czech Republic (R.M., P. Kala); Department of Cardiology, University Hospital and Faculty of Medicine in Pilsen, Charles University, Prague, Czech Republic (M.H., R.R.); Cardiology Centre AGEL, Pardubice, Czech Republic (I.V.); First Department of Internal Medicine, University Hospital Hradec Kralove, Charles University in Prague, Faculty of Medicine in Hradec Kralove, Czech Republic (J.D.); Institute of Biostatistics and Analyses at the Faculty of Medicine and the Faculty of Science of the Masaryk University, Brno, Czech Republic (J..J.); Cardiocenter, Department of Cardiology, Regional Hospital, Ceske Budejovice, Czech Republic (F.T.); Cardiocenter, Regional Hospital, Karlovy Vary, Czech Republic (B.M.); Cardiocenter, Hospital Na Homolce, Prague, Czech Republic (B.M.); Second Department of Medicine-Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic (S.S.); AGEL Research and Training Institute, Trinec Branch, Cardiovascular Center, Podlesi Hospital, Trinec, Czech Republic (M.B.); Cardiovascular Department, University Hospital Ostrava, Ostrava, Czech Republic (J.M.); Department of Cardiology, Krajska zdravotni a.s., Masaryk Hospital and UJEP, Usti nad Labem, Czech Republic (P.C.); and First Internal Cardiology Clinic, University Hospital Olomouc, Olomouc, Czech Republic (J.O.).
| | - Ota Hlinomaz
- From Cardiocenter, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic (Z.M., J.K., P.W.); First Department of Internal Medicine-Cardioangiology, ICRC, Faculty of Medicine of Masaryk University and St. Anne's University Hospital, Brno, Czech Republic (O.H., P. Kramarikova); Department of Internal Medicine and Cardiology, Faculty of Medicine of Masaryk University and University Hospital Brno, Brno, Czech Republic (R.M., P. Kala); Department of Cardiology, University Hospital and Faculty of Medicine in Pilsen, Charles University, Prague, Czech Republic (M.H., R.R.); Cardiology Centre AGEL, Pardubice, Czech Republic (I.V.); First Department of Internal Medicine, University Hospital Hradec Kralove, Charles University in Prague, Faculty of Medicine in Hradec Kralove, Czech Republic (J.D.); Institute of Biostatistics and Analyses at the Faculty of Medicine and the Faculty of Science of the Masaryk University, Brno, Czech Republic (J..J.); Cardiocenter, Department of Cardiology, Regional Hospital, Ceske Budejovice, Czech Republic (F.T.); Cardiocenter, Regional Hospital, Karlovy Vary, Czech Republic (B.M.); Cardiocenter, Hospital Na Homolce, Prague, Czech Republic (B.M.); Second Department of Medicine-Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic (S.S.); AGEL Research and Training Institute, Trinec Branch, Cardiovascular Center, Podlesi Hospital, Trinec, Czech Republic (M.B.); Cardiovascular Department, University Hospital Ostrava, Ostrava, Czech Republic (J.M.); Department of Cardiology, Krajska zdravotni a.s., Masaryk Hospital and UJEP, Usti nad Labem, Czech Republic (P.C.); and First Internal Cardiology Clinic, University Hospital Olomouc, Olomouc, Czech Republic (J.O.)
| | - Roman Miklik
- From Cardiocenter, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic (Z.M., J.K., P.W.); First Department of Internal Medicine-Cardioangiology, ICRC, Faculty of Medicine of Masaryk University and St. Anne's University Hospital, Brno, Czech Republic (O.H., P. Kramarikova); Department of Internal Medicine and Cardiology, Faculty of Medicine of Masaryk University and University Hospital Brno, Brno, Czech Republic (R.M., P. Kala); Department of Cardiology, University Hospital and Faculty of Medicine in Pilsen, Charles University, Prague, Czech Republic (M.H., R.R.); Cardiology Centre AGEL, Pardubice, Czech Republic (I.V.); First Department of Internal Medicine, University Hospital Hradec Kralove, Charles University in Prague, Faculty of Medicine in Hradec Kralove, Czech Republic (J.D.); Institute of Biostatistics and Analyses at the Faculty of Medicine and the Faculty of Science of the Masaryk University, Brno, Czech Republic (J..J.); Cardiocenter, Department of Cardiology, Regional Hospital, Ceske Budejovice, Czech Republic (F.T.); Cardiocenter, Regional Hospital, Karlovy Vary, Czech Republic (B.M.); Cardiocenter, Hospital Na Homolce, Prague, Czech Republic (B.M.); Second Department of Medicine-Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic (S.S.); AGEL Research and Training Institute, Trinec Branch, Cardiovascular Center, Podlesi Hospital, Trinec, Czech Republic (M.B.); Cardiovascular Department, University Hospital Ostrava, Ostrava, Czech Republic (J.M.); Department of Cardiology, Krajska zdravotni a.s., Masaryk Hospital and UJEP, Usti nad Labem, Czech Republic (P.C.); and First Internal Cardiology Clinic, University Hospital Olomouc, Olomouc, Czech Republic (J.O.)
| | - Milan Hromadka
- From Cardiocenter, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic (Z.M., J.K., P.W.); First Department of Internal Medicine-Cardioangiology, ICRC, Faculty of Medicine of Masaryk University and St. Anne's University Hospital, Brno, Czech Republic (O.H., P. Kramarikova); Department of Internal Medicine and Cardiology, Faculty of Medicine of Masaryk University and University Hospital Brno, Brno, Czech Republic (R.M., P. Kala); Department of Cardiology, University Hospital and Faculty of Medicine in Pilsen, Charles University, Prague, Czech Republic (M.H., R.R.); Cardiology Centre AGEL, Pardubice, Czech Republic (I.V.); First Department of Internal Medicine, University Hospital Hradec Kralove, Charles University in Prague, Faculty of Medicine in Hradec Kralove, Czech Republic (J.D.); Institute of Biostatistics and Analyses at the Faculty of Medicine and the Faculty of Science of the Masaryk University, Brno, Czech Republic (J..J.); Cardiocenter, Department of Cardiology, Regional Hospital, Ceske Budejovice, Czech Republic (F.T.); Cardiocenter, Regional Hospital, Karlovy Vary, Czech Republic (B.M.); Cardiocenter, Hospital Na Homolce, Prague, Czech Republic (B.M.); Second Department of Medicine-Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic (S.S.); AGEL Research and Training Institute, Trinec Branch, Cardiovascular Center, Podlesi Hospital, Trinec, Czech Republic (M.B.); Cardiovascular Department, University Hospital Ostrava, Ostrava, Czech Republic (J.M.); Department of Cardiology, Krajska zdravotni a.s., Masaryk Hospital and UJEP, Usti nad Labem, Czech Republic (P.C.); and First Internal Cardiology Clinic, University Hospital Olomouc, Olomouc, Czech Republic (J.O.)
| | - Ivo Varvarovsky
- From Cardiocenter, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic (Z.M., J.K., P.W.); First Department of Internal Medicine-Cardioangiology, ICRC, Faculty of Medicine of Masaryk University and St. Anne's University Hospital, Brno, Czech Republic (O.H., P. Kramarikova); Department of Internal Medicine and Cardiology, Faculty of Medicine of Masaryk University and University Hospital Brno, Brno, Czech Republic (R.M., P. Kala); Department of Cardiology, University Hospital and Faculty of Medicine in Pilsen, Charles University, Prague, Czech Republic (M.H., R.R.); Cardiology Centre AGEL, Pardubice, Czech Republic (I.V.); First Department of Internal Medicine, University Hospital Hradec Kralove, Charles University in Prague, Faculty of Medicine in Hradec Kralove, Czech Republic (J.D.); Institute of Biostatistics and Analyses at the Faculty of Medicine and the Faculty of Science of the Masaryk University, Brno, Czech Republic (J..J.); Cardiocenter, Department of Cardiology, Regional Hospital, Ceske Budejovice, Czech Republic (F.T.); Cardiocenter, Regional Hospital, Karlovy Vary, Czech Republic (B.M.); Cardiocenter, Hospital Na Homolce, Prague, Czech Republic (B.M.); Second Department of Medicine-Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic (S.S.); AGEL Research and Training Institute, Trinec Branch, Cardiovascular Center, Podlesi Hospital, Trinec, Czech Republic (M.B.); Cardiovascular Department, University Hospital Ostrava, Ostrava, Czech Republic (J.M.); Department of Cardiology, Krajska zdravotni a.s., Masaryk Hospital and UJEP, Usti nad Labem, Czech Republic (P.C.); and First Internal Cardiology Clinic, University Hospital Olomouc, Olomouc, Czech Republic (J.O.)
| | - Jaroslav Dusek
- From Cardiocenter, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic (Z.M., J.K., P.W.); First Department of Internal Medicine-Cardioangiology, ICRC, Faculty of Medicine of Masaryk University and St. Anne's University Hospital, Brno, Czech Republic (O.H., P. Kramarikova); Department of Internal Medicine and Cardiology, Faculty of Medicine of Masaryk University and University Hospital Brno, Brno, Czech Republic (R.M., P. Kala); Department of Cardiology, University Hospital and Faculty of Medicine in Pilsen, Charles University, Prague, Czech Republic (M.H., R.R.); Cardiology Centre AGEL, Pardubice, Czech Republic (I.V.); First Department of Internal Medicine, University Hospital Hradec Kralove, Charles University in Prague, Faculty of Medicine in Hradec Kralove, Czech Republic (J.D.); Institute of Biostatistics and Analyses at the Faculty of Medicine and the Faculty of Science of the Masaryk University, Brno, Czech Republic (J..J.); Cardiocenter, Department of Cardiology, Regional Hospital, Ceske Budejovice, Czech Republic (F.T.); Cardiocenter, Regional Hospital, Karlovy Vary, Czech Republic (B.M.); Cardiocenter, Hospital Na Homolce, Prague, Czech Republic (B.M.); Second Department of Medicine-Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic (S.S.); AGEL Research and Training Institute, Trinec Branch, Cardiovascular Center, Podlesi Hospital, Trinec, Czech Republic (M.B.); Cardiovascular Department, University Hospital Ostrava, Ostrava, Czech Republic (J.M.); Department of Cardiology, Krajska zdravotni a.s., Masaryk Hospital and UJEP, Usti nad Labem, Czech Republic (P.C.); and First Internal Cardiology Clinic, University Hospital Olomouc, Olomouc, Czech Republic (J.O.)
| | - Jiri Knot
- From Cardiocenter, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic (Z.M., J.K., P.W.); First Department of Internal Medicine-Cardioangiology, ICRC, Faculty of Medicine of Masaryk University and St. Anne's University Hospital, Brno, Czech Republic (O.H., P. Kramarikova); Department of Internal Medicine and Cardiology, Faculty of Medicine of Masaryk University and University Hospital Brno, Brno, Czech Republic (R.M., P. Kala); Department of Cardiology, University Hospital and Faculty of Medicine in Pilsen, Charles University, Prague, Czech Republic (M.H., R.R.); Cardiology Centre AGEL, Pardubice, Czech Republic (I.V.); First Department of Internal Medicine, University Hospital Hradec Kralove, Charles University in Prague, Faculty of Medicine in Hradec Kralove, Czech Republic (J.D.); Institute of Biostatistics and Analyses at the Faculty of Medicine and the Faculty of Science of the Masaryk University, Brno, Czech Republic (J..J.); Cardiocenter, Department of Cardiology, Regional Hospital, Ceske Budejovice, Czech Republic (F.T.); Cardiocenter, Regional Hospital, Karlovy Vary, Czech Republic (B.M.); Cardiocenter, Hospital Na Homolce, Prague, Czech Republic (B.M.); Second Department of Medicine-Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic (S.S.); AGEL Research and Training Institute, Trinec Branch, Cardiovascular Center, Podlesi Hospital, Trinec, Czech Republic (M.B.); Cardiovascular Department, University Hospital Ostrava, Ostrava, Czech Republic (J.M.); Department of Cardiology, Krajska zdravotni a.s., Masaryk Hospital and UJEP, Usti nad Labem, Czech Republic (P.C.); and First Internal Cardiology Clinic, University Hospital Olomouc, Olomouc, Czech Republic (J.O.)
| | - Jiri Jarkovsky
- From Cardiocenter, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic (Z.M., J.K., P.W.); First Department of Internal Medicine-Cardioangiology, ICRC, Faculty of Medicine of Masaryk University and St. Anne's University Hospital, Brno, Czech Republic (O.H., P. Kramarikova); Department of Internal Medicine and Cardiology, Faculty of Medicine of Masaryk University and University Hospital Brno, Brno, Czech Republic (R.M., P. Kala); Department of Cardiology, University Hospital and Faculty of Medicine in Pilsen, Charles University, Prague, Czech Republic (M.H., R.R.); Cardiology Centre AGEL, Pardubice, Czech Republic (I.V.); First Department of Internal Medicine, University Hospital Hradec Kralove, Charles University in Prague, Faculty of Medicine in Hradec Kralove, Czech Republic (J.D.); Institute of Biostatistics and Analyses at the Faculty of Medicine and the Faculty of Science of the Masaryk University, Brno, Czech Republic (J..J.); Cardiocenter, Department of Cardiology, Regional Hospital, Ceske Budejovice, Czech Republic (F.T.); Cardiocenter, Regional Hospital, Karlovy Vary, Czech Republic (B.M.); Cardiocenter, Hospital Na Homolce, Prague, Czech Republic (B.M.); Second Department of Medicine-Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic (S.S.); AGEL Research and Training Institute, Trinec Branch, Cardiovascular Center, Podlesi Hospital, Trinec, Czech Republic (M.B.); Cardiovascular Department, University Hospital Ostrava, Ostrava, Czech Republic (J.M.); Department of Cardiology, Krajska zdravotni a.s., Masaryk Hospital and UJEP, Usti nad Labem, Czech Republic (P.C.); and First Internal Cardiology Clinic, University Hospital Olomouc, Olomouc, Czech Republic (J.O.)
| | - Petr Kala
- From Cardiocenter, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic (Z.M., J.K., P.W.); First Department of Internal Medicine-Cardioangiology, ICRC, Faculty of Medicine of Masaryk University and St. Anne's University Hospital, Brno, Czech Republic (O.H., P. Kramarikova); Department of Internal Medicine and Cardiology, Faculty of Medicine of Masaryk University and University Hospital Brno, Brno, Czech Republic (R.M., P. Kala); Department of Cardiology, University Hospital and Faculty of Medicine in Pilsen, Charles University, Prague, Czech Republic (M.H., R.R.); Cardiology Centre AGEL, Pardubice, Czech Republic (I.V.); First Department of Internal Medicine, University Hospital Hradec Kralove, Charles University in Prague, Faculty of Medicine in Hradec Kralove, Czech Republic (J.D.); Institute of Biostatistics and Analyses at the Faculty of Medicine and the Faculty of Science of the Masaryk University, Brno, Czech Republic (J..J.); Cardiocenter, Department of Cardiology, Regional Hospital, Ceske Budejovice, Czech Republic (F.T.); Cardiocenter, Regional Hospital, Karlovy Vary, Czech Republic (B.M.); Cardiocenter, Hospital Na Homolce, Prague, Czech Republic (B.M.); Second Department of Medicine-Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic (S.S.); AGEL Research and Training Institute, Trinec Branch, Cardiovascular Center, Podlesi Hospital, Trinec, Czech Republic (M.B.); Cardiovascular Department, University Hospital Ostrava, Ostrava, Czech Republic (J.M.); Department of Cardiology, Krajska zdravotni a.s., Masaryk Hospital and UJEP, Usti nad Labem, Czech Republic (P.C.); and First Internal Cardiology Clinic, University Hospital Olomouc, Olomouc, Czech Republic (J.O.)
| | - Richard Rokyta
- From Cardiocenter, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic (Z.M., J.K., P.W.); First Department of Internal Medicine-Cardioangiology, ICRC, Faculty of Medicine of Masaryk University and St. Anne's University Hospital, Brno, Czech Republic (O.H., P. Kramarikova); Department of Internal Medicine and Cardiology, Faculty of Medicine of Masaryk University and University Hospital Brno, Brno, Czech Republic (R.M., P. Kala); Department of Cardiology, University Hospital and Faculty of Medicine in Pilsen, Charles University, Prague, Czech Republic (M.H., R.R.); Cardiology Centre AGEL, Pardubice, Czech Republic (I.V.); First Department of Internal Medicine, University Hospital Hradec Kralove, Charles University in Prague, Faculty of Medicine in Hradec Kralove, Czech Republic (J.D.); Institute of Biostatistics and Analyses at the Faculty of Medicine and the Faculty of Science of the Masaryk University, Brno, Czech Republic (J..J.); Cardiocenter, Department of Cardiology, Regional Hospital, Ceske Budejovice, Czech Republic (F.T.); Cardiocenter, Regional Hospital, Karlovy Vary, Czech Republic (B.M.); Cardiocenter, Hospital Na Homolce, Prague, Czech Republic (B.M.); Second Department of Medicine-Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic (S.S.); AGEL Research and Training Institute, Trinec Branch, Cardiovascular Center, Podlesi Hospital, Trinec, Czech Republic (M.B.); Cardiovascular Department, University Hospital Ostrava, Ostrava, Czech Republic (J.M.); Department of Cardiology, Krajska zdravotni a.s., Masaryk Hospital and UJEP, Usti nad Labem, Czech Republic (P.C.); and First Internal Cardiology Clinic, University Hospital Olomouc, Olomouc, Czech Republic (J.O.)
| | - Frantisek Tousek
- From Cardiocenter, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic (Z.M., J.K., P.W.); First Department of Internal Medicine-Cardioangiology, ICRC, Faculty of Medicine of Masaryk University and St. Anne's University Hospital, Brno, Czech Republic (O.H., P. Kramarikova); Department of Internal Medicine and Cardiology, Faculty of Medicine of Masaryk University and University Hospital Brno, Brno, Czech Republic (R.M., P. Kala); Department of Cardiology, University Hospital and Faculty of Medicine in Pilsen, Charles University, Prague, Czech Republic (M.H., R.R.); Cardiology Centre AGEL, Pardubice, Czech Republic (I.V.); First Department of Internal Medicine, University Hospital Hradec Kralove, Charles University in Prague, Faculty of Medicine in Hradec Kralove, Czech Republic (J.D.); Institute of Biostatistics and Analyses at the Faculty of Medicine and the Faculty of Science of the Masaryk University, Brno, Czech Republic (J..J.); Cardiocenter, Department of Cardiology, Regional Hospital, Ceske Budejovice, Czech Republic (F.T.); Cardiocenter, Regional Hospital, Karlovy Vary, Czech Republic (B.M.); Cardiocenter, Hospital Na Homolce, Prague, Czech Republic (B.M.); Second Department of Medicine-Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic (S.S.); AGEL Research and Training Institute, Trinec Branch, Cardiovascular Center, Podlesi Hospital, Trinec, Czech Republic (M.B.); Cardiovascular Department, University Hospital Ostrava, Ostrava, Czech Republic (J.M.); Department of Cardiology, Krajska zdravotni a.s., Masaryk Hospital and UJEP, Usti nad Labem, Czech Republic (P.C.); and First Internal Cardiology Clinic, University Hospital Olomouc, Olomouc, Czech Republic (J.O.)
| | - Petra Kramarikova
- From Cardiocenter, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic (Z.M., J.K., P.W.); First Department of Internal Medicine-Cardioangiology, ICRC, Faculty of Medicine of Masaryk University and St. Anne's University Hospital, Brno, Czech Republic (O.H., P. Kramarikova); Department of Internal Medicine and Cardiology, Faculty of Medicine of Masaryk University and University Hospital Brno, Brno, Czech Republic (R.M., P. Kala); Department of Cardiology, University Hospital and Faculty of Medicine in Pilsen, Charles University, Prague, Czech Republic (M.H., R.R.); Cardiology Centre AGEL, Pardubice, Czech Republic (I.V.); First Department of Internal Medicine, University Hospital Hradec Kralove, Charles University in Prague, Faculty of Medicine in Hradec Kralove, Czech Republic (J.D.); Institute of Biostatistics and Analyses at the Faculty of Medicine and the Faculty of Science of the Masaryk University, Brno, Czech Republic (J..J.); Cardiocenter, Department of Cardiology, Regional Hospital, Ceske Budejovice, Czech Republic (F.T.); Cardiocenter, Regional Hospital, Karlovy Vary, Czech Republic (B.M.); Cardiocenter, Hospital Na Homolce, Prague, Czech Republic (B.M.); Second Department of Medicine-Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic (S.S.); AGEL Research and Training Institute, Trinec Branch, Cardiovascular Center, Podlesi Hospital, Trinec, Czech Republic (M.B.); Cardiovascular Department, University Hospital Ostrava, Ostrava, Czech Republic (J.M.); Department of Cardiology, Krajska zdravotni a.s., Masaryk Hospital and UJEP, Usti nad Labem, Czech Republic (P.C.); and First Internal Cardiology Clinic, University Hospital Olomouc, Olomouc, Czech Republic (J.O.)
| | - Bohumil Majtan
- From Cardiocenter, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic (Z.M., J.K., P.W.); First Department of Internal Medicine-Cardioangiology, ICRC, Faculty of Medicine of Masaryk University and St. Anne's University Hospital, Brno, Czech Republic (O.H., P. Kramarikova); Department of Internal Medicine and Cardiology, Faculty of Medicine of Masaryk University and University Hospital Brno, Brno, Czech Republic (R.M., P. Kala); Department of Cardiology, University Hospital and Faculty of Medicine in Pilsen, Charles University, Prague, Czech Republic (M.H., R.R.); Cardiology Centre AGEL, Pardubice, Czech Republic (I.V.); First Department of Internal Medicine, University Hospital Hradec Kralove, Charles University in Prague, Faculty of Medicine in Hradec Kralove, Czech Republic (J.D.); Institute of Biostatistics and Analyses at the Faculty of Medicine and the Faculty of Science of the Masaryk University, Brno, Czech Republic (J..J.); Cardiocenter, Department of Cardiology, Regional Hospital, Ceske Budejovice, Czech Republic (F.T.); Cardiocenter, Regional Hospital, Karlovy Vary, Czech Republic (B.M.); Cardiocenter, Hospital Na Homolce, Prague, Czech Republic (B.M.); Second Department of Medicine-Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic (S.S.); AGEL Research and Training Institute, Trinec Branch, Cardiovascular Center, Podlesi Hospital, Trinec, Czech Republic (M.B.); Cardiovascular Department, University Hospital Ostrava, Ostrava, Czech Republic (J.M.); Department of Cardiology, Krajska zdravotni a.s., Masaryk Hospital and UJEP, Usti nad Labem, Czech Republic (P.C.); and First Internal Cardiology Clinic, University Hospital Olomouc, Olomouc, Czech Republic (J.O.)
| | - Stanislav Simek
- From Cardiocenter, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic (Z.M., J.K., P.W.); First Department of Internal Medicine-Cardioangiology, ICRC, Faculty of Medicine of Masaryk University and St. Anne's University Hospital, Brno, Czech Republic (O.H., P. Kramarikova); Department of Internal Medicine and Cardiology, Faculty of Medicine of Masaryk University and University Hospital Brno, Brno, Czech Republic (R.M., P. Kala); Department of Cardiology, University Hospital and Faculty of Medicine in Pilsen, Charles University, Prague, Czech Republic (M.H., R.R.); Cardiology Centre AGEL, Pardubice, Czech Republic (I.V.); First Department of Internal Medicine, University Hospital Hradec Kralove, Charles University in Prague, Faculty of Medicine in Hradec Kralove, Czech Republic (J.D.); Institute of Biostatistics and Analyses at the Faculty of Medicine and the Faculty of Science of the Masaryk University, Brno, Czech Republic (J..J.); Cardiocenter, Department of Cardiology, Regional Hospital, Ceske Budejovice, Czech Republic (F.T.); Cardiocenter, Regional Hospital, Karlovy Vary, Czech Republic (B.M.); Cardiocenter, Hospital Na Homolce, Prague, Czech Republic (B.M.); Second Department of Medicine-Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic (S.S.); AGEL Research and Training Institute, Trinec Branch, Cardiovascular Center, Podlesi Hospital, Trinec, Czech Republic (M.B.); Cardiovascular Department, University Hospital Ostrava, Ostrava, Czech Republic (J.M.); Department of Cardiology, Krajska zdravotni a.s., Masaryk Hospital and UJEP, Usti nad Labem, Czech Republic (P.C.); and First Internal Cardiology Clinic, University Hospital Olomouc, Olomouc, Czech Republic (J.O.)
| | - Marian Branny
- From Cardiocenter, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic (Z.M., J.K., P.W.); First Department of Internal Medicine-Cardioangiology, ICRC, Faculty of Medicine of Masaryk University and St. Anne's University Hospital, Brno, Czech Republic (O.H., P. Kramarikova); Department of Internal Medicine and Cardiology, Faculty of Medicine of Masaryk University and University Hospital Brno, Brno, Czech Republic (R.M., P. Kala); Department of Cardiology, University Hospital and Faculty of Medicine in Pilsen, Charles University, Prague, Czech Republic (M.H., R.R.); Cardiology Centre AGEL, Pardubice, Czech Republic (I.V.); First Department of Internal Medicine, University Hospital Hradec Kralove, Charles University in Prague, Faculty of Medicine in Hradec Kralove, Czech Republic (J.D.); Institute of Biostatistics and Analyses at the Faculty of Medicine and the Faculty of Science of the Masaryk University, Brno, Czech Republic (J..J.); Cardiocenter, Department of Cardiology, Regional Hospital, Ceske Budejovice, Czech Republic (F.T.); Cardiocenter, Regional Hospital, Karlovy Vary, Czech Republic (B.M.); Cardiocenter, Hospital Na Homolce, Prague, Czech Republic (B.M.); Second Department of Medicine-Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic (S.S.); AGEL Research and Training Institute, Trinec Branch, Cardiovascular Center, Podlesi Hospital, Trinec, Czech Republic (M.B.); Cardiovascular Department, University Hospital Ostrava, Ostrava, Czech Republic (J.M.); Department of Cardiology, Krajska zdravotni a.s., Masaryk Hospital and UJEP, Usti nad Labem, Czech Republic (P.C.); and First Internal Cardiology Clinic, University Hospital Olomouc, Olomouc, Czech Republic (J.O.)
| | - Jan Mrozek
- From Cardiocenter, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic (Z.M., J.K., P.W.); First Department of Internal Medicine-Cardioangiology, ICRC, Faculty of Medicine of Masaryk University and St. Anne's University Hospital, Brno, Czech Republic (O.H., P. Kramarikova); Department of Internal Medicine and Cardiology, Faculty of Medicine of Masaryk University and University Hospital Brno, Brno, Czech Republic (R.M., P. Kala); Department of Cardiology, University Hospital and Faculty of Medicine in Pilsen, Charles University, Prague, Czech Republic (M.H., R.R.); Cardiology Centre AGEL, Pardubice, Czech Republic (I.V.); First Department of Internal Medicine, University Hospital Hradec Kralove, Charles University in Prague, Faculty of Medicine in Hradec Kralove, Czech Republic (J.D.); Institute of Biostatistics and Analyses at the Faculty of Medicine and the Faculty of Science of the Masaryk University, Brno, Czech Republic (J..J.); Cardiocenter, Department of Cardiology, Regional Hospital, Ceske Budejovice, Czech Republic (F.T.); Cardiocenter, Regional Hospital, Karlovy Vary, Czech Republic (B.M.); Cardiocenter, Hospital Na Homolce, Prague, Czech Republic (B.M.); Second Department of Medicine-Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic (S.S.); AGEL Research and Training Institute, Trinec Branch, Cardiovascular Center, Podlesi Hospital, Trinec, Czech Republic (M.B.); Cardiovascular Department, University Hospital Ostrava, Ostrava, Czech Republic (J.M.); Department of Cardiology, Krajska zdravotni a.s., Masaryk Hospital and UJEP, Usti nad Labem, Czech Republic (P.C.); and First Internal Cardiology Clinic, University Hospital Olomouc, Olomouc, Czech Republic (J.O.)
| | - Pavel Cervinka
- From Cardiocenter, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic (Z.M., J.K., P.W.); First Department of Internal Medicine-Cardioangiology, ICRC, Faculty of Medicine of Masaryk University and St. Anne's University Hospital, Brno, Czech Republic (O.H., P. Kramarikova); Department of Internal Medicine and Cardiology, Faculty of Medicine of Masaryk University and University Hospital Brno, Brno, Czech Republic (R.M., P. Kala); Department of Cardiology, University Hospital and Faculty of Medicine in Pilsen, Charles University, Prague, Czech Republic (M.H., R.R.); Cardiology Centre AGEL, Pardubice, Czech Republic (I.V.); First Department of Internal Medicine, University Hospital Hradec Kralove, Charles University in Prague, Faculty of Medicine in Hradec Kralove, Czech Republic (J.D.); Institute of Biostatistics and Analyses at the Faculty of Medicine and the Faculty of Science of the Masaryk University, Brno, Czech Republic (J..J.); Cardiocenter, Department of Cardiology, Regional Hospital, Ceske Budejovice, Czech Republic (F.T.); Cardiocenter, Regional Hospital, Karlovy Vary, Czech Republic (B.M.); Cardiocenter, Hospital Na Homolce, Prague, Czech Republic (B.M.); Second Department of Medicine-Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic (S.S.); AGEL Research and Training Institute, Trinec Branch, Cardiovascular Center, Podlesi Hospital, Trinec, Czech Republic (M.B.); Cardiovascular Department, University Hospital Ostrava, Ostrava, Czech Republic (J.M.); Department of Cardiology, Krajska zdravotni a.s., Masaryk Hospital and UJEP, Usti nad Labem, Czech Republic (P.C.); and First Internal Cardiology Clinic, University Hospital Olomouc, Olomouc, Czech Republic (J.O.)
| | - Jiri Ostransky
- From Cardiocenter, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic (Z.M., J.K., P.W.); First Department of Internal Medicine-Cardioangiology, ICRC, Faculty of Medicine of Masaryk University and St. Anne's University Hospital, Brno, Czech Republic (O.H., P. Kramarikova); Department of Internal Medicine and Cardiology, Faculty of Medicine of Masaryk University and University Hospital Brno, Brno, Czech Republic (R.M., P. Kala); Department of Cardiology, University Hospital and Faculty of Medicine in Pilsen, Charles University, Prague, Czech Republic (M.H., R.R.); Cardiology Centre AGEL, Pardubice, Czech Republic (I.V.); First Department of Internal Medicine, University Hospital Hradec Kralove, Charles University in Prague, Faculty of Medicine in Hradec Kralove, Czech Republic (J.D.); Institute of Biostatistics and Analyses at the Faculty of Medicine and the Faculty of Science of the Masaryk University, Brno, Czech Republic (J..J.); Cardiocenter, Department of Cardiology, Regional Hospital, Ceske Budejovice, Czech Republic (F.T.); Cardiocenter, Regional Hospital, Karlovy Vary, Czech Republic (B.M.); Cardiocenter, Hospital Na Homolce, Prague, Czech Republic (B.M.); Second Department of Medicine-Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic (S.S.); AGEL Research and Training Institute, Trinec Branch, Cardiovascular Center, Podlesi Hospital, Trinec, Czech Republic (M.B.); Cardiovascular Department, University Hospital Ostrava, Ostrava, Czech Republic (J.M.); Department of Cardiology, Krajska zdravotni a.s., Masaryk Hospital and UJEP, Usti nad Labem, Czech Republic (P.C.); and First Internal Cardiology Clinic, University Hospital Olomouc, Olomouc, Czech Republic (J.O.)
| | - Petr Widimsky
- From Cardiocenter, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic (Z.M., J.K., P.W.); First Department of Internal Medicine-Cardioangiology, ICRC, Faculty of Medicine of Masaryk University and St. Anne's University Hospital, Brno, Czech Republic (O.H., P. Kramarikova); Department of Internal Medicine and Cardiology, Faculty of Medicine of Masaryk University and University Hospital Brno, Brno, Czech Republic (R.M., P. Kala); Department of Cardiology, University Hospital and Faculty of Medicine in Pilsen, Charles University, Prague, Czech Republic (M.H., R.R.); Cardiology Centre AGEL, Pardubice, Czech Republic (I.V.); First Department of Internal Medicine, University Hospital Hradec Kralove, Charles University in Prague, Faculty of Medicine in Hradec Kralove, Czech Republic (J.D.); Institute of Biostatistics and Analyses at the Faculty of Medicine and the Faculty of Science of the Masaryk University, Brno, Czech Republic (J..J.); Cardiocenter, Department of Cardiology, Regional Hospital, Ceske Budejovice, Czech Republic (F.T.); Cardiocenter, Regional Hospital, Karlovy Vary, Czech Republic (B.M.); Cardiocenter, Hospital Na Homolce, Prague, Czech Republic (B.M.); Second Department of Medicine-Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic (S.S.); AGEL Research and Training Institute, Trinec Branch, Cardiovascular Center, Podlesi Hospital, Trinec, Czech Republic (M.B.); Cardiovascular Department, University Hospital Ostrava, Ostrava, Czech Republic (J.M.); Department of Cardiology, Krajska zdravotni a.s., Masaryk Hospital and UJEP, Usti nad Labem, Czech Republic (P.C.); and First Internal Cardiology Clinic, University Hospital Olomouc, Olomouc, Czech Republic (J.O.)
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Zeymer U, Widimsky P, Danchin N, Lettino M, Bardaji A, Barrabes JA, Cequier A, Claeys MJ, De Luca L, Dörler J, Erlinge D, Erne P, Goldstein P, Koul SM, Lemesle G, Lüscher TF, Matter CM, Montalescot G, Radovanovic D, Sendón JL, Tousek P, Weidinger F, Weston CFM, Zaman A, Andell P, Li J, Jukema JW. P2Y12 receptor inhibitors in patients with non-ST-elevation acute coronary syndrome in the real world: use, patient selection, and outcomes from contemporary European registries. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2016; 2:229-43. [DOI: 10.1093/ehjcvp/pvw005] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 03/01/2016] [Indexed: 12/22/2022]
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