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Stone GW, Christiansen EH, Ali ZA, Andreasen LN, Maehara A, Ahmad Y, Landmesser U, Holm NR. Intravascular imaging-guided coronary drug-eluting stent implantation: an updated network meta-analysis. Lancet 2024; 403:824-837. [PMID: 38401549 DOI: 10.1016/s0140-6736(23)02454-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 10/26/2023] [Accepted: 10/31/2023] [Indexed: 02/26/2024]
Abstract
BACKGROUND Previous meta-analyses have shown reduced risks of composite adverse events with intravascular imaging-guided percutaneous coronary intervention (PCI) compared with angiography guidance alone. However, these studies have been insufficiently powered to show whether all-cause death or all myocardial infarction are reduced with intravascular imaging guidance, and most previous intravascular imaging studies were done with intravascular ultrasound rather than optical coherence tomography (OCT), a newer imaging modality. We aimed to assess the comparative performance of intravascular imaging-guided PCI and angiography-guided PCI with drug-eluting stents. METHODS For this systematic review and updated meta-analysis, we searched the MEDLINE, Embase, and Cochrane databases from inception to Aug 30, 2023, for studies that randomly assigned patients undergoing PCI with drug-eluting stents either to intravascular ultrasound or OCT, or both, or to angiography alone to guide the intervention. The searches were done and study-level data were extracted independently by two investigators. The primary endpoint was target lesion failure, defined as the composite of cardiac death, target vessel-myocardial infarction (TV-MI), or target lesion revascularisation, assessed in patients randomly assigned to intravascular imaging guidance (intravascular ultrasound or OCT) versus angiography guidance. We did a standard frequentist meta-analysis to generate direct data, and a network meta-analysis to generate indirect data and overall treatment effects. Outcomes were expressed as relative risks (RRs) with 95% CIs at the longest reported follow-up duration. This study was registered with the international prospective register of systematic reviews (PROSPERO, number CRD42023455662). FINDINGS 22 trials were identified in which 15 964 patients were randomised and followed for a weighted mean duration of 24·7 months (longest duration of follow-up in each study ranging from 6 to 60 months). Compared with angiography-guided PCI, intravascular imaging-guided PCI resulted in a decreased risk of target lesion failure (RR 0·71 [95% CI 0·63-0·80]; p<0·0001), driven by reductions in the risks of cardiac death (RR 0·55 [95% CI 0·41-0·75]; p=0·0001), TV-MI (RR 0·82 [95% CI 0·68-0·98]; p=0·030), and target lesion revascularisation (RR 0·72 [95% CI 0·60-0·86]; p=0·0002). Intravascular imaging guidance also reduced the risks of stent thrombosis (RR 0·52 [95% CI 0·34-0·81]; p=0·0036), all myocardial infarction (RR 0·83 [95% CI 0·71-0·99]; p=0·033), and all-cause death (RR 0·75 [95% CI 0·60-0·93]; p=0·0091). Outcomes were similar for OCT-guided and intravascular ultrasound-guided PCI. INTERPRETATION Compared with angiography guidance, intravascular imaging guidance of coronary stent implantation with OCT or intravascular ultrasound enhances both the safety and effectiveness of PCI, reducing the risks of death, myocardial infarction, repeat revascularisation, and stent thrombosis. FUNDING Abbott.
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Affiliation(s)
- Gregg W Stone
- The Zena and Michael A Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | | | | | | | - Akiko Maehara
- Cardiovascular Research Foundation, New York, NY, USA; Columbia University Medical Center, New York, NY, USA
| | - Yousif Ahmad
- Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Ulf Landmesser
- Deutsches Herzzentrum Charité, Charité Universitätsmedizin Berlin, Berlin, Germany; German Center for Cardiovascular Research (DZHK), Berlin, Germany
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Okumura E, Onodera S, Jimbo H. Subacute In-Stent Occlusion 2 Weeks after CASPER Rx Stenting: A Case Report. JOURNAL OF NEUROENDOVASCULAR THERAPY 2023; 17:173-179. [PMID: 37609575 PMCID: PMC10442173 DOI: 10.5797/jnet.cr.2023-0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 06/03/2023] [Indexed: 08/24/2023]
Abstract
Objective CASPER Rx stent (Terumo, Tokyo, Japan) is one of the dual-layer micromesh stents for carotid artery stenosis. Although it is expected to be safe and efficacious even for vulnerable plaque, we report a case of in-stent occlusion 2 weeks after stenting with CASPER Rx stent. Case Presentation The patient was a 78-year-old man with a symptomatic, severely stenosed lesion of the cervical internal carotid artery (ICA). He had an unstable plaque and underwent carotid artery stenting with the CASPER Rx stent. There were no problems with the procedure or the patient's subsequent course, and he was discharged home 1 week after the procedure. However, on postoperative day 14, the patient had a transit ischemic attack and imaging showed acute occlusion due to thrombus in the stent and in the distal part of the ICA. Mechanical thrombectomy was performed and good recanalization was achieved, but postoperative cerebral infarction was observed and the patient was transferred to other hospital with modified Rankin Scale 2. Conclusion We experienced a case of in-stent occlusion 2 weeks after stenting with the CASPER Rx stent.
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Affiliation(s)
- Eitaro Okumura
- Department of Neurosurgery, Tokyo Medical University Hachioji Medical Center, Hachioji, Tokyo, Japan
| | - Sho Onodera
- Department of Neurosurgery, Tokyo Medical University Hachioji Medical Center, Hachioji, Tokyo, Japan
| | - Hiroyuki Jimbo
- Department of Neurosurgery, Tokyo Medical University Hachioji Medical Center, Hachioji, Tokyo, Japan
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Mijares-Rojas IA, Martinez EF, Leonor Lopez GL, De Marchena E, Alfonso CE. A Case of Subacute Stent Thrombosis. Cureus 2023; 15:e37725. [PMID: 37206507 PMCID: PMC10191453 DOI: 10.7759/cureus.37725] [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] [Accepted: 04/17/2023] [Indexed: 05/21/2023] Open
Abstract
A 67-year-old male presenting with an anterior ST-segment elevation myocardial infarction (STEMI) underwent stent placement in the left anterior descending coronary. The patient was discharged on an appropriate medical regimen containing dual antiplatelet therapy (DAPT). Four days later, the patient presented with repeat acute coronary syndrome symptomatology. Electrocardiogram demonstrated ongoing STEMI in the previously treated artery distribution. Emergency angiography revealed restenosis and total thrombotic occlusion. Post-intervention stenosis was 0% after aspiration thrombectomy and balloon angioplasty. Stent thrombosis is a high-mortality and therapeutically challenging condition requiring prepared clinicians who recognize predisposing risk factors and initiate early management.
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Affiliation(s)
- Ivan A Mijares-Rojas
- Internal Medicine, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, USA
| | - Enrique F Martinez
- Internal Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, USA
| | - George L Leonor Lopez
- Cardiology, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, USA
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Muacevic A, Adler JR, Contreras R, Jacobson A, Jarrett R. An Uncommon Case of Acute Coronary Stent Thrombosis. Cureus 2023; 15:e33834. [PMID: 36655155 PMCID: PMC9842189 DOI: 10.7759/cureus.33834] [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] [Accepted: 01/16/2023] [Indexed: 01/18/2023] Open
Abstract
Coronary stent thrombosis is an uncommon complication of percutaneous coronary intervention, which can result in myocardial infarction and often death. We present a case of acute stent thrombosis in a patient with newly diagnosed triple vessel coronary artery disease occurring within less than an hour of stent placement along with a review of the literature.
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Zhang MK, Zhang HW, Wu QY, Xue H, Fan LX. Coronary artery bypass grafting in patients with malignancy: a single-institute case series of eight patients. BMC Surg 2022; 22:359. [PMID: 36229802 PMCID: PMC9563462 DOI: 10.1186/s12893-022-01805-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 09/28/2022] [Indexed: 12/02/2022] Open
Abstract
Background The surgical strategy among patients with malignancy and coronary artery disease (CAD) remains controversial. In this study, we present the experiences of coronary artery bypass grafting (CABG) in patients with malignancy and analyzed the treatment outcomes. Methods From January 2011 to October 2021, eight patients combined with coronary artery disease and malignancy, six of them with three-vessel disease and two with anterior descending branch lesions on coronary angiography. The age ranged from 54 to 73 years (61.8 ± 7.7years). Four patients underwent CABG and staging for surgical oncology, and 2 patients underwent CABG and surgical oncology simultaneously. Four patients underwent CABG procedure with cardiopulmonary bypass (on-pump CABG), and the other patients underwent the procedure without cardiopulmonary bypass (off-pump CABG). All patients were followed up for 3 to 96 months (40.4 ± 31.5 months) postoperatively. Results The mean number of grafts was 2.6 ± 1.1, there was no in-hospital death, postoperative myocardial infarction, and stroke. Among the eight patients, one patient received chemotherapy and radiation before bypass surgery, which occurred postoperatively pulmonary infection, and the rest of 7 patients had no major adverse cardiovascular events during follow-up periods. Conclusion Based on the results of the present study, simultaneous or staged CABG and oncologic surgery according to the TNM stage of the tumor and cardiac assessment is an effective treatment for patients with severe CAD combined with malignancy.
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Affiliation(s)
- Ming-Kui Zhang
- Heart Center, First Hospital of Tsinghua University, No.6, 1st street, Jiuxianqiao, Chaoyang District, 100016, Beijing, China.
| | - Han-Wen Zhang
- Heart Center, First Hospital of Tsinghua University, No.6, 1st street, Jiuxianqiao, Chaoyang District, 100016, Beijing, China
| | - Qing-Yu Wu
- Heart Center, First Hospital of Tsinghua University, No.6, 1st street, Jiuxianqiao, Chaoyang District, 100016, Beijing, China
| | - Hui Xue
- Heart Center, First Hospital of Tsinghua University, No.6, 1st street, Jiuxianqiao, Chaoyang District, 100016, Beijing, China
| | - Li-Xin Fan
- Heart Center, First Hospital of Tsinghua University, No.6, 1st street, Jiuxianqiao, Chaoyang District, 100016, Beijing, China
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Akboga MK, Inanc IH, Sabanoglu C, Akdi A, Yakut I, Yuksekkaya B, Nurkoc S, Yalcin R. Systemic Immune-Inflammation Index and C-Reactive Protein/Albumin Ratio Could Predict Acute Stent Thrombosis and High SYNTAX Score in Acute Coronary Syndrome. Angiology 2022:33197221125779. [PMID: 36069742 DOI: 10.1177/00033197221125779] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Acute stent thrombosis (AST) is associated with increased morbidity and mortality. The main aim of this study was to evaluate the prognostic value of the systemic immune-inflammation index (SII) and C-reactive protein (CRP) to albumin ratio (CAR) in predicting AST and high SYNTAX score in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI). The criteria of the Academic Research Consortium were used to determine definite stent thrombosis. A total of 2077 consecutive patients with ACS undergoing PCI were retrospectively enrolled. Platelet, white blood cell and neutrophil counts, as well as SII, CRP, CAR, and peak cardiac troponin I (cTnI) values were significantly higher, whereas the lymphocyte count and albumin values were significantly lower in the AST (+) group compared with the AST (-) group (P < .05). SYNTAX score showed significant positive correlations with SII (r = .429, P < .001) and CRP (r = .402, P < .001). Multivariate logistic regression analysis showed that SII and CAR, as well as age, diabetes mellitus, stent length, and peak cTnI are independent predictors of AST and high SYNTAX score. In conclusion, the SII and CAR are simple, relatively cheap, and reliable inflammatory biomarkers that can predict AST and high SYNTAX scores in ACS.
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Affiliation(s)
- Mehmet Kadri Akboga
- Department of Cardiology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Ibrahim Halil Inanc
- Department of Cardiology, Kirikkale Yuksek Ihtisas Hospital, Kirikkale, Turkey
| | - Cengiz Sabanoglu
- Department of Cardiology, Kirikkale Yuksek Ihtisas Hospital, Kirikkale, Turkey
| | - Ahmet Akdi
- Department of Cardiology, 574949Ankara City Hospital University of Health Sciences, Ankara, Turkey
| | - Idris Yakut
- Department of Cardiology, 574949Ankara City Hospital University of Health Sciences, Ankara, Turkey
| | - Baran Yuksekkaya
- Department of Cardiology, 574949Ankara City Hospital University of Health Sciences, Ankara, Turkey
| | - Serdar Nurkoc
- Department of Cardiology, Yozgat City Hospital, Yozgat, Turkey
| | - Ridvan Yalcin
- Department of Cardiology, Gazi University Faculty of Medicine, Ankara, Turkey
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Sane M, Dighe V, Patil R, Hassan PA, Gawali S, Patravale V. Bivalirudin and sirolimus co-eluting coronary stent: Potential strategy for the prevention of stent thrombosis and restenosis. Int J Pharm 2021; 600:120403. [PMID: 33711467 DOI: 10.1016/j.ijpharm.2021.120403] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 02/12/2021] [Accepted: 02/13/2021] [Indexed: 11/19/2022]
Abstract
Localized drug delivery with sustained elution characteristics from nanocarrier coated stents represents a viable therapeutic approach to circumvent concerns related to coronary stent therapy. We fabricated a Sirolimus (SRL) and Bivalirudin (BIV) releasing nanoparticles (NPs) coated stent for concurrent mitigation of vascular restenosis and acute stent thrombosis. SRL NPs were prepared by nanoprecipitation method whereas the BIV vesicles were generated using hydrophobic ion pair approach followed by micellization phenomenon. MTT assay and confocal microscopic analysis indicated superior anti-proliferative activity and higher cellular uptake of SRL NPs into human coronary artery smooth muscle cells, respectively. DSC and ATR-FTIR techniques confirmed the formation of complex between BIV and phosphatidylglycerol via some weak physical interactions. More than 2 fold rise in log P value was obtained for DSPG-BIV at 3:1 M ratio compared with native BIV solution. The SAXS analysis indicated formation of oligolamellar vesicles of DSPG-BIV complex which was preferentially entrapped into lipophilic lamellae of vesicles. APTT, PT, and TT tests revealed that the BIV vesicles caused significant prolongation of clotting time compared to native BIV solution. The SEM analysis showed uniform and defect free stent coating. In vitro release study demonstrated that SRL and BIV were eluted in a sustained manner from coated stents.
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Affiliation(s)
- Mangesh Sane
- Department of Pharmaceutical Sciences & Technology, Institute of Chemical Technology, N.P. Marg, Matunga, Mumbai 400 019, Maharashtra, India
| | - Vikas Dighe
- National Centre for Preclinical Reproductive and Genetic Toxicology, National Institute for Research in Reproductive Health, J. M. Street, Parel, Mumbai 400 012, Maharashtra, India
| | - Rucha Patil
- Department of Haemostasis & Thrombosis, National Institute of Immunohaematology, Indian Council of Medical Research, 13th Floor, New Multi-storeyed Building, KEM Hospital Campus, Parel, Mumbai 400 012, India
| | | | - Santosh Gawali
- Chemistry Division, Bhabha Atomic Research Centre, Trombay, Mumbai 400 085, India
| | - Vandana Patravale
- Department of Pharmaceutical Sciences & Technology, Institute of Chemical Technology, N.P. Marg, Matunga, Mumbai 400 019, Maharashtra, India.
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Cioffi GM, Madanchi M, Bossard M, Cuculi F. Deferring stent optimization in stent thrombosis: A novel approach for STEMI management-Insights from a case series. Clin Case Rep 2021; 9:1150-1154. [PMID: 33768799 PMCID: PMC7981663 DOI: 10.1002/ccr3.3697] [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] [Received: 10/27/2020] [Revised: 12/05/2020] [Accepted: 12/09/2020] [Indexed: 11/20/2022] Open
Abstract
Treatment of ST represents a challenge. The presence of large amounts of thrombus combined with stent optimization increase the risk of distal embolization. A two-step strategy of stent implantation and deferred stent optimization might be appropriated. We hereby present three clinical cases of ST successfully treated with a two-step approach.
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Affiliation(s)
| | - Mehdi Madanchi
- Cardiology Division, HerzzentrumLuzerner KantonsspitalLuzernSwitzerland
| | - Matthias Bossard
- Cardiology Division, HerzzentrumLuzerner KantonsspitalLuzernSwitzerland
| | - Florim Cuculi
- Cardiology Division, HerzzentrumLuzerner KantonsspitalLuzernSwitzerland
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Albakr A, Ishaque N, Aljaafari D, Sairafi SN. Contrast-Induced Transient Neurological Symptoms Following Percutaneous Coronary Intervention: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e926956. [PMID: 33186339 PMCID: PMC7672509 DOI: 10.12659/ajcr.926956] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Transient neurological symptoms after a percutaneous coronary intervention (PCI) are not uncommon manifestations. In clinical practice, the development of these symptoms might be a warning sign for PCI-related ischemic or hemorrhagic stroke. However, there is a reported risk of contrast-induced neurological injury (CINI) after PCI, which results in a broad spectrum of transient and benign neurological symptoms. Advanced age, renal disease, diabetes, hypertension, and brain parenchymal lesions are risk factors for CINI. CASE REPORT A 78-year-old man with diabetes and impaired renal function developed left-sided hemiparesis and dysarthria within one hour of PCI. Non-contrast CT head showed hyperdense lesions in both frontal lobes, while the susceptibility-weighted sequence of magnetic resonance imaging (SWI-MRI) excludes hemorrhage. Hemodialysis had to be started for fast contrast clearance, and he had recovered completely within 24 hours. CONCLUSIONS This case demonstrates that CINI is an important differential diagnosis that cardiologists and neurologists must be familiar with, especially for high-risk patients. The prognosis is good; whether an appropriate contrast's dose or type for PCI or a need for early hemodialysis to avoid CINI in those patients is unclear.
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Affiliation(s)
- Aishah Albakr
- Department of Neurology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Noman Ishaque
- Department of Neurology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Danah Aljaafari
- Department of Neurology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Sabah N Sairafi
- Department of Neurology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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Stent thrombosis in acute coronary syndromes: Patient-related factors and operator-related factors. Anatol J Cardiol 2020; 24:274-279. [PMID: 33001053 PMCID: PMC7585955 DOI: 10.14744/anatoljcardiol.2020.69679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE Stent thrombosis (ST) is a common phenomenon in acute coronary syndromes (ACS) when compared to stable coronary artery disease. This study analyzed the patient- and operator-related risk factors of ST in ACS. METHODS Coronary angiograms of 1738 consecutive ACS patients admitted in a large tertiary center between year 2014 and 2016 were analyzed retrospectively for the presence of ST. The paired angiograms [ST in ACS during and after percutaneous coronary intervention (PCI)] of the patients were analyzed by two independent observers, with focus on lesion characteristics and procedure techniques. Clinical and laboratory data were collected. RESULTS Stent thrombosis was found in 29 (1.6%) ACS patients, with a combination of at least one clinical/laboratory risk factor and one lesion/operator risk factor identified in 28 (96%) out of the 29 ACS patients with ST. The following risk factors for ST were found: Renal insufficiency (OR=4.14, p<0.001, 95% CI=1.73-9.88), type 2 diabetes (OR=2.21, p=0.034, 95% CI=1.06-4.61), excessive alcohol consumption (OR=3.12, p=0.023, 95% CI=1.17-8.33), stent implantation for ST-elevation myocardial infarction (STEMI) (OR=2.28, p=0.029, 95% CI=1.08-4.81), left main (LM) or left anterior descending artery (LAD) as culprit lesion (OR=2.80, p=0.010, CI 95%=1.27-5.95), and absence of antiplatelet therapy prior to ST (OR=3.58, p=0.002, 95% CI=1.60-7.96). The following lesion/operator possible risk factors were identified: Bifurcation lesion (n=7; 24%), heavy coronary calcifications (n=13; 44%), in-stent restenosis with secondary plate rupture (n=6, 20%), inappropriate stent size selection (n=6, 20%), and errors in periprocedural drug administration (n=4, 14%). CONCLUSION ST occurred in 1/62 ACS patients after PCI. A combination of clinical/laboratory and lesion/operator risk factors were present in almost all ACS patients with ST. This finding may support the search for strictly individualized strategies for the treatment of ACS patients with ST after PCI.
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Fuertes Ferre G, Caballero Jambrina I, Ruiz Aranjuelo A, Jimeno Sánchez J, Galache Osuna JG, Andrés Esteban EM, Casasnovas Lenguas JA, Diarte de Miguel JA. Frequency and Reasons of Dual Antiplatelet Therapy Discontinuation and Switching of P2Y12 Inhibitors in Patients with Acute Coronary Syndrome Treated with Stent Implantation. Cardiology 2019; 142:203-207. [PMID: 31266007 DOI: 10.1159/000500977] [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: 05/06/2019] [Accepted: 05/13/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Incidence and reasons of dual antiplatelet therapy (DAPT) discontinuation and switching between P2Y12 inhibitors in acute coronary syndrome (ACS) patients treated with a stent have been poorly studied. METHODS AND RESULTS In a prospective single-center study, 283 consecutive patients presenting with ACS were treated with stent implantation between July 2015 and January 2016. Follow-up was achieved at 12 months in 273 patients using the electronic patient file and telephone interview. Switching from clopidogrel to a new antiplatelet agent (ticagrelor or prasugrel) or vice versa occurred in 60 (21.2%) patients. The most frequent reasons for switching were medical decisions not associated with bleeding events and concomitant use of chronic oral anticoagulation. Among the patients with a 1-year follow-up, 42 (15.4%) prematurely discontinued DAPT; 25 of them did so due to the need for an invasive procedure. DAPT premature discontinuation was not significantly associated with an increased 1-year risk of cardiovascular death or serious cardiac ischemic events (HR 2.08 [CI 95%: 0.88-4.94, p = 0.099]). CONCLUSIONS DAPT discontinuation and switching between P2Y12 inhibitors are not uncommon in patients with ACS treated with a stent. The most frequent reasons were the need for an invasive procedure and medical decisions.
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Raposeiras-Roubín S, Abu-Assi E, D’Ascenzo F, Fernández-Barbeira S, Kinnaird T, Ariza-Solé A, Manzano-Fernández S, Templin C, Velicki L, Xanthopoulou I, Cerrato E, Quadri G, Rognoni A, Boccuzzi G, Montabone A, Taha S, Durante A, Gili S, Magnani G, Autelli M, Grosso A, Flores Blanco P, Garay A, Varbella F, Tommassini F, Caneiro Queija B, Cobas Paz R, Cespón Fernández M, Muñoz Pousa I, Gallo D, Morbiducci U, Domínguez-Rodríguez A, Baz-Alonso JA, Valdés M, Cequier Á, Gaita F, Alexopoulos D, Íñiguez-Romo A. Incidencia anual de trombosis del stent confirmadas y factores clínicos predictores en pacientes con SCA tratados con ticagrelor o prasugrel. Rev Esp Cardiol 2019. [DOI: 10.1016/j.recesp.2018.02.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Ayesh BM, Al-Astal IR, Yassin MM. The clinical effects of CYP2C19 *2 allele frequency on Palestinian patients receiving clopidogrel after percutaneous coronary intervention. Int J Clin Pharm 2019; 41:96-103. [PMID: 30656556 DOI: 10.1007/s11096-018-00782-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 12/31/2018] [Indexed: 11/29/2022]
Abstract
BackgroundCYP2C19 loss-of-function polymorphic alleles (*2 and *3) have been documented to impair clopidogrel metabolism, and represent a risk factor for major adverse cardiac events. CYP2C19 polymorphism exhibits marked ethnic heterogeneity. Objective To determine the prevalence of CYP2C19 *2 and *3 alleles in a cohort of Palestinian patients managed with percutaneous coronary intervention and dual antiplatelet therapy, and to determine their role in causing major adverse cardiac events. Setting The blood samples were collected at the European Gaza Hospital, and the molecular techniques performed at the molecular genetics laboratory of the Islamic university of Gaza. Method The frequency of CYP2C19 *2 and *3 alleles was determined in 110 patients managed with percutaneous coronary intervention and clopidogrel. Genotyping was performed by PCR-RFLP. Personal and clinical data was obtained from patient record and 6-month follow-up for major adverse cardiac events. Main outcome measureCYP2C19 genotype, personal and clinical data and incidence of major adverse cardiac events. Results The frequency of CYP2C19 *1, *2 and *3 alleles was 82.3%, 15.5% and 2.3% respectively. Genotyping analysis showed that, 67.3% were homozygotes for CYP2C19 *1, 27.3% were *1/*2, 2.7% with *1/*3 genotype, 1.8% were *2/*3 and 0.9% were *2/*2. These frequencies were consistent with those of Caucasian populations. According to this study the poor metabolizers phenotype frequency was 2.7%, which is in the same range reported in Caucasians (2-5%) and lower than Oriental populations 13-23%. A strong significant relation was found between major adverse cardiac events and carrying the variant allele CYP2C19 *2 (P = 0.001). On the other hand, there was no significant relation between major adverse cardiac events and carrying the variant allele CYP2C19 *3 (P = 0.324). Conclusion The CYP2C19 *2 allele is relatively common in our population, and its associated reduced metabolic activity deserves attention as it leads to an increased incidence of major adverse cardiac events in the follow-up of patients receiving clopidogrel.
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Affiliation(s)
- Basim M Ayesh
- Department of Laboratory Medical Sciences, Faculty of Medical Sciences, Alaqsa University, Gaza, Palestine.
| | - Ibrahim R Al-Astal
- Naser Medical Complex, Laboratory Department, Ministry of Health, Gaza, Palestine
| | - Maged M Yassin
- Faculty of Medicine, the Islamic University of Gaza, Gaza, Palestine
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Yalta K, Zorkun C, Yilmaztepe M, Gurlertop Y. Late coronary ischemıc syndromes assocıated wıth transcatheter aortıc valve ımplantatıon: A revıew of mechanıstıc and clınıcal aspects. Indian Heart J 2018; 70:901-906. [PMID: 30580863 PMCID: PMC6306339 DOI: 10.1016/j.ihj.2018.06.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 01/18/2018] [Accepted: 06/15/2018] [Indexed: 01/09/2023] Open
Abstract
In the past years, transcatheter aortic valve implantation (TAVI) has emerged as a promising option for the treatment of aortic valve pathologies particularly in the the presence of surgically high-risk situations. Importantly, a variety of specific procedural complications including acute coronary osteal occlusion, though very rare, has been reported in major clinical studies. However, little is known about the late impact of TAVI on coronary system at the macro and microvascular levels. On the other hand, clinical studies as well as real life experiences have shown variable rates of acute coronary syndrome (ACS) readmissions among TAVI recipients in the short and long terms. Within this context, it may be suggested that even though late coronary ischemic events arising after TAVI, to some extent, appears to be spontaneous or attributable to certain stressors, TAVI may also have the potential to directly account for, accelerate or contribute to the evolution of these ischemic events on follow-up. Accordingly, the present review primarily focuses on potential association of TAVI with late coronary ischemic syndromes along with a particular emphasis on its mechanistic basis and clinical implications among TAVI recipients.
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Affiliation(s)
- Kenan Yalta
- Trakya University, Cardiology Department, Edirne, Turkey.
| | - Cafer Zorkun
- Trakya University, Cardiology Department, Edirne, Turkey
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Raposeiras-Roubín S, Abu-Assi E, D'Ascenzo F, Fernández-Barbeira S, Kinnaird T, Ariza-Solé A, Manzano-Fernández S, Templin C, Velicki L, Xanthopoulou I, Cerrato E, Quadri G, Rognoni A, Boccuzzi G, Montabone A, Taha S, Durante A, Gili S, Magnani G, Autelli M, Grosso A, Flores Blanco P, Garay A, Varbella F, Tommassini F, Caneiro Queija B, Cobas Paz R, Cespón Fernández M, Muñoz Pousa I, Gallo D, Morbiducci U, Domínguez-Rodríguez A, Baz-Alonso JA, Valdés M, Cequier Á, Gaita F, Alexopoulos D, Íñiguez-Romo A. Annual Incidence of Confirmed Stent Thrombosis and Clinical Predictors in Patients With ACS Treated With Ticagrelor or Prasugrel. ACTA ACUST UNITED AC 2018; 72:298-304. [PMID: 29954720 DOI: 10.1016/j.rec.2018.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Accepted: 02/28/2018] [Indexed: 11/17/2022]
Abstract
INTRODUCTION AND OBJECTIVES There is little evidence on rates of stent thrombosis (ST) in patients receiving dual antiplatelet therapy (DAPT) with ticagrelor or prasugrel. The aim of this study was to analyze the incidence and predictors of ST after an acute coronary syndrome among patients receiving DAPT with ticagrelor vs prasugrel. METHODS We used data from the RENAMI registry (REgistry of New Antiplatelet therapy in patients with acute Myocardial Infarction), analyzing a total of 4123 acute coronary syndrome patients discharged with DAPT with ticagrelor or prasugrel in 11 centers in 6 European countries. The endpoint was definite ST within the first year. A competitive risk analysis was carried out using a Fine and Gray regression model, with death being the competitive event. RESULTS A total of 2604 patients received DAPT with ticagrelor and 1519 with prasugrel; ST occurred in 41 patients (1.10%), with a similar cumulative incidence between ticagrelor (1.21%) and prasugrel (0.90%). The independent predictors of ST were age (sHR, 1.03; 95%CI, 1.01-1.06), ST segment elevation (sHR, 2.24; 95%CI, 1.22-4.14), previous myocardial infarction (sHR, 2.56; 95%CI, 1.19-5.49), and serum creatinine (sHR, 1.29; 95%CI, 1.08-1.54). CONCLUSIONS Stent thrombosis is infrequent in patients receiving DAPT with ticagrelor or prasugrel. The variables associated with an increased risk of ST were advanced age, ST segment elevation, previous myocardial infarction, and serum creatinine.
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Affiliation(s)
| | - Emad Abu-Assi
- Servicio de Cardiología, Hospital Universitario Álvaro Cunqueiro, Vigo, Pontevedra, Spain.
| | - Fabrizio D'Ascenzo
- Department of Cardiology, Department of Medical Sciences, University of Torino, Torino, Italy
| | | | - Tim Kinnaird
- Cardiology Department, University Hospital of Wales, Cardiff, Wales, United Kingdom
| | - Albert Ariza-Solé
- Servicio de Cardiología, Hospital de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Sergio Manzano-Fernández
- Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | - Christian Templin
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Lazar Velicki
- Medical Faculty, University of Novi Sad, Novi Sad, Serbia; Institute of Cardiovascular Diseases Voivodina, Sremska Kamenica, Serbia
| | | | - Enrico Cerrato
- Department of Cardiology, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy
| | - Giorgio Quadri
- Department of Cardiology, Infermi Hospital, Rivoli, Italy
| | - Andrea Rognoni
- Coronary Care Unit and Catheterization Laboratory, A.O.U. Maggiore della Carità, Novara, Italy
| | | | | | - Salma Taha
- Department of Cardiology, Faculty of Medicine, Assiut University, Asiut, Egypt
| | | | - Sebastiano Gili
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Giulia Magnani
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Michele Autelli
- Department of Cardiology, Department of Medical Sciences, University of Torino, Torino, Italy
| | - Alberto Grosso
- Department of Cardiology, Department of Medical Sciences, University of Torino, Torino, Italy
| | - Pedro Flores Blanco
- Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | - Alberto Garay
- Servicio de Cardiología, Hospital de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | | | | | | | - Rafael Cobas Paz
- Servicio de Cardiología, Hospital Universitario Álvaro Cunqueiro, Vigo, Pontevedra, Spain
| | - María Cespón Fernández
- Servicio de Cardiología, Hospital Universitario Álvaro Cunqueiro, Vigo, Pontevedra, Spain
| | - Isabel Muñoz Pousa
- Servicio de Cardiología, Hospital Universitario Álvaro Cunqueiro, Vigo, Pontevedra, Spain
| | - Diego Gallo
- PolitoBIOMed Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Umberto Morbiducci
- PolitoBIOMed Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | | | | | - Mariano Valdés
- Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | - Ángel Cequier
- Servicio de Cardiología, Hospital de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Fiorenzo Gaita
- Department of Cardiology, Department of Medical Sciences, University of Torino, Torino, Italy
| | | | - Andrés Íñiguez-Romo
- Servicio de Cardiología, Hospital Universitario Álvaro Cunqueiro, Vigo, Pontevedra, Spain
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Ferrari R, Campo G. Operator, Drug or Device: Who Will Break Down Acute Stent Thrombosis? Cardiology 2017; 137:244-245. [PMID: 28472805 DOI: 10.1159/000471791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 03/14/2017] [Indexed: 11/19/2022]
Affiliation(s)
- Roberto Ferrari
- Cardiology Unit, Azienda Ospedaliera Universitaria di Ferrara, Cona, Italy
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