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Zhang S, Wang W, Sawhney JPS, Krittayaphong R, Kim HS, Nhan VT, Lee SWL, Ong TK, Chin CT, Pocock SJ, Huo Y, Qian J, Ge J. Antithrombotic management and long-term outcomes following percutaneous coronary intervention for acute coronary syndrome in Asia. Int J Cardiol 2020; 310:16-22. [PMID: 32192746 DOI: 10.1016/j.ijcard.2020.01.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 12/11/2019] [Accepted: 01/08/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Cardiovascular diseases account for approximately half of all deaths in Asia. The present analysis aimed to evaluate characteristics, antithrombotic management patterns (AMPs), and outcomes in patients with acute coronary syndrome (ACS) who underwent in-hospital percutaneous coronary intervention (PCI) and survived to hospital discharge, using data from the EPICOR Asia registry (NCT01361386). METHODS Two-year post-discharge follow-up data were analyzed from 8757 ACS PCI patients from EPICOR Asia (218 centers, eight countries). Major adverse cardiovascular events (MACE; death, non-fatal myocardial infarction [MI], non-fatal ischemic stroke), PCI characteristics, and AMPs were recorded. For MACE, time - to - event was analyzed using Cox regression. RESULTS Primary PCI was performed in 62.0% of ST-segment elevation MI (STEMI), 38.7% of non-STEMI (NSTEMI), and 24.2% of unstable angina (UA) patients. At 12 months, 88.1% of patients were on dual antiplatelet therapy (DAPT), with no differences by index event. Most (61.5%) still received DAPT at 2 years. Two-year incidences of mortality, composite MACE, and bleeding were 3.6%, 6.2%, and 6.6%, respectively. Risk of death and MACE was increased with STEMI and NSTEMI vs. UA. Patients from East Asia showed lower mortality and more bleeding vs. Southeast Asia/India. CONCLUSIONS Many patients in EPICOR Asia underwent PCI and received DAPT up to 2 years post-discharge. These real-world findings improve our understanding of AMP impact on outcomes in Asian patients with ACS undergoing PCI.
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Affiliation(s)
- Shuning Zhang
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wei Wang
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | | | | | - Hyo-Soo Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | | | | | | | | | - Stuart J Pocock
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Yong Huo
- Peking University First Hospital, Beijing, China
| | - Juying Qian
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Junbo Ge
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China.
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Acute coronary syndromes occurring while driving: frequency and patient characteristics. Environ Health Prev Med 2017; 22:82. [PMID: 29262778 PMCID: PMC5738902 DOI: 10.1186/s12199-017-0689-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 12/12/2017] [Indexed: 11/30/2022] Open
Abstract
Background Acute coronary syndrome (ACS) may occur during any human activity, including driving. The objectives of this study were to report the frequency of ACS occurring while driving, clarify patient characteristics, and analyze the behavioral patterns of drivers who sustained ACS. Methods A single-center, retrospective observational study was conducted using prospectively acquired data. Among 1605 ACS patients admitted between January 2011 and December 2016, 65 (60 men/5 women) patients who sustained ACS while driving were identified. Clinical variables were compared between these 65 patients and 1540 patients who sustained ACS while performing other activities. Furthermore, multivariable regression analysis was performed to identify variables associated with ACS. Results The frequency of ACS occurring while driving was 4.0% (65/1605). Compared with patients who sustained ACS while performing other activities, those who sustained ACS while driving were significantly younger (66.2 ± 13.0 vs. 57.5 ± 12.2 years, p < 0.001) and more likely to smoke (34.2 vs. 60.0%, p < 0.001). Multivariable regression analysis showed that age (OR 0.961; 95% CI 0.940–0.982) and current smoking (OR 1.978; 95% CI 1.145–3.417) were associated with ACS. While 55 drivers (85%) who remained conscious after ACS could seek medical attention without causing accidents, the other 10 (15%) who sustained cardiac arrest caused accidents. Conclusions The association between current smoking and ACS occurring while driving suggests that smoking cessation is advised for smokers who drive from the standpoint of driving safety. We expect that prospective studies be conducted to verify our findings and identify individuals at risk for ACS while driving. Electronic supplementary material The online version of this article (10.1186/s12199-017-0689-5) contains supplementary material, which is available to authorized users.
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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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Trenk D, Schrör K, Gawaz M, Kristensen SD, Storey RF, Huber K, Siller-Matula JM. How to improve the concept of individualised antiplatelet therapy with P2Y12 receptor inhibitors – is an algorithm the answer? Thromb Haemost 2017; 113:37-52. [DOI: 10.1160/th14-03-0238] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2014] [Accepted: 07/22/2014] [Indexed: 01/03/2023]
Abstract
SummaryWithin the past decade, high on-treatment platelet reactivity (HTPR) on clopidogrel and its clinical implications have been frequently discussed. Although it has been previously assumed that HTPR is a phenomenon occurring only in patients treated with clopidogrel, recent data show that HTPR might also occur during treatment with prasugrel or ticagrelor in the acute phase of ST-elevation myocardial infarction. Moreover, it has been postulated that there is a therapeutic window for P2Y12 receptor blockers, thus indicating that HTPR is associated with thrombotic events whereas low on-treatment platelet reactivity (LTPR) is associated with bleeding events. The current paper focuses on tools to identify risk factors for HTPR (pharmacogenomic testing, clinical scoring and drug-drug interactions) and on the use of platelet function testing in order to identify patients who might not respond adequately to clopidogrel. The majority of recent clinical randomised trials have not supported the hypothesis that platelet function testing and tailored antiplatelet therapy are providing a favourable clinical outcome. These trials, mainly performed in low-to-moderate risk patients, will be reviewed and discussed. Finally, an algorithm based on current knowledge is suggested, which might be of use for design of clinical trials.
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Scott J, Howard B, Sinnett P, Schiesel M, Baker J, Henderson P, Vassar M. Variable methodological quality and use found in systematic reviews referenced in STEMI clinical practice guidelines. Am J Emerg Med 2017. [PMID: 28623004 DOI: 10.1016/j.ajem.2017.06.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The objective of this study was to assess the methodological quality and clarity of reporting of the systematic reviews (SRs) supporting clinical practice guideline (CPG) recommendations in the management of ST-elevation myocardial infarction (STEMI) across international CPGs. METHODS We searched 13 guideline clearinghouses including the National Guideline Clearinghouse and Guidelines International Network (GIN). To meet inclusion criteria CPGs must be pertinent to the management of STEMI, endorsed by a governing body or national organization, and written in English. We retrieved SRs from the reference sections using a combination of keywords and hand searching. Two investigators scored eligible SRs using AMSTAR and PRISMA. RESULTS We included four CPGs. We extracted 71 unique SRs. These SRs received AMSTAR scores ranging from 1 (low) to 9 (high) on an 11-point scale. All CPGs consistently underperformed in areas including disclosure of funding sources, risk of bias, and publication bias according to AMSTAR. PRISMA checklist completeness ranged from 44% to 96%. The PRISMA scores indicated that SRs did not provide a full search strategy, study protocol and registration, assessment of publication bias or report funding sources. Only one SR was referenced in all four CPGs. All CPGs omitted a large subset of available SRs cited by other guidelines. CONCLUSIONS Our study demonstrates the variable quality of SRs used to establish recommendations within guidelines included in our sample. Although guideline developers have acknowledged this variability, it remains a significant finding that needs to be addressed further. FUNDING This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
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Affiliation(s)
- Jared Scott
- Oklahoma State University Center for Health Sciences College of Osteopathic Medicine, 1111 W 17th St, Tulsa, OK 74107, United States.
| | - Benjamin Howard
- Oklahoma State University Center for Health Sciences College of Osteopathic Medicine, 1111 W 17th St, Tulsa, OK 74107, United States.
| | - Philip Sinnett
- Oklahoma State University Center for Health Sciences College of Osteopathic Medicine, 1111 W 17th St, Tulsa, OK 74107, United States.
| | - Michael Schiesel
- Oklahoma State University Medical Center, 744 W 9th St, Tulsa, OK 74127, United States.
| | - Jana Baker
- Oklahoma State University Medical Center, 744 W 9th St, Tulsa, OK 74127, United States.
| | - Patrick Henderson
- Oklahoma State University Medical Center, 744 W 9th St, Tulsa, OK 74127, United States.
| | - Matt Vassar
- Oklahoma State University Center for Health Sciences College of Osteopathic Medicine, 1111 W 17th St, Tulsa, OK 74107, United States.
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Ohashi N, Okada T, Uchida M, Amioka M, Fujiwara M, Kaseda S. Effects of Dabigatran on the Resolution of Left Ventricular Thrombus after Acute Myocardial Infarction. Intern Med 2015; 54:1761-3. [PMID: 26179532 DOI: 10.2169/internalmedicine.54.4191] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Left ventricular thrombus (LVT) after acute myocardial infarction (AMI) is a risk factor for embolic complications. Although warfarin has traditionally been used to treat LVT, it has relevant disadvantages that limit its use. We herein describe the case of a 78-year-old man with AMI who had a history of paroxysmal atrial fibrillation. Following 10 days of urgent coronary reperfusion therapy, transthoracic echocardiography revealed a moderately sized LVT in the apex, which subsequently disappeared after 18 days of treatment with dabigatran. This case demonstrates that dabigatran may represent an alternative to warfarin as a therapeutic option in patients with LVT after AMI.
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Affiliation(s)
- Norihiko Ohashi
- Department of Cardiology, Hiroshima Red Cross Hospital & Atomic-bomb Survivors Hospital, Japan
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Huo Y, Thompson P, Buddhari W, Ge J, Harding S, Ramanathan L, Reyes E, Santoso A, Tam LW, Vijayaraghavan G, Yeh HI. Challenges and solutions in medically managed ACS in the Asia-Pacific region: expert recommendations from the Asia-Pacific ACS Medical Management Working Group. Int J Cardiol 2014; 183:63-75. [PMID: 25662044 DOI: 10.1016/j.ijcard.2014.11.195] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Revised: 11/12/2014] [Accepted: 11/24/2014] [Indexed: 12/26/2022]
Abstract
Acute coronary syndromes (ACS) remain a leading cause of mortality and morbidity in the Asia-Pacific (APAC) region. International guidelines advocate invasive procedures in all but low-risk ACS patients; however, a high proportion of ACS patients in the APAC region receive solely medical management due to a combination of unique geographical, socioeconomic, and population-specific barriers. The APAC ACS Medical Management Working Group recently convened to discuss the ACS medical management landscape in the APAC region. Local and international ACS guidelines and the global and APAC clinical evidence-base for medical management of ACS were reviewed. Challenges in the provision of optimal care for these patients were identified and broadly categorized into issues related to (1) accessibility/systems of care, (2) risk stratification, (3) education, (4) optimization of pharmacotherapy, and (5) cost/affordability. While ACS guidelines clearly represent a valuable standard of care, the group concluded that these challenges can be best met by establishing cardiac networks and individual hospital models/clinical pathways taking into account local risk factors (including socioeconomic status), affordability and availability of pharmacotherapies/invasive facilities, and the nature of local healthcare systems. Potential solutions central to the optimization of ACS medical management in the APAC region are outlined with specific recommendations.
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Affiliation(s)
| | - Yong Huo
- Peking University First Hospital, Beijing, China.
| | - Peter Thompson
- University of Western Australia, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.
| | - Wacin Buddhari
- Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Junbo Ge
- Zhongshan Hospital, Fudan University, Shanghai, China
| | - Scott Harding
- Wellington Cardiovascular Research Group and School of Biological Sciences, Victoria University, Wellington, New Zealand
| | | | - Eugenio Reyes
- University of the Philippines, Philippine General Hospital-Section of Cardiology, Manila, Philippines
| | - Anwar Santoso
- Department of Cardiology - Vascular Medicine, Faculty of Medicine, University of Indonesia and National Cardiovascular Center, Harapan Kita, Indonesia
| | | | | | - Hung-I Yeh
- Mackay Memorial Hospital, Mackay Medical College, New Taipei City, Taiwan
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Huber K, Bates ER, Valgimigli M, Wallentin L, Kristensen SD, Anderson JL, Lopez Sendon JL, Tubaro M, Granger CB, Bode C, Ohman EM, Steg PG. Antiplatelet and anticoagulation agents in acute coronary syndromes: what is the current status and what does the future hold? Am Heart J 2014; 168:611-21. [PMID: 25440788 DOI: 10.1016/j.ahj.2014.06.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Accepted: 06/17/2014] [Indexed: 01/10/2023]
Abstract
Mortality and morbidity in acute coronary syndromes (ACSs), caused principally by plaque erosion or rupture leading to thrombus formation and myocardial ischemia, have been reduced by a combination of antithrombotic agents (antiplatelet drugs and anticoagulants) and early revascularization. Aspirin is the foundation antiplatelet agent. New P2Y12 receptor inhibitors (prasugrel and ticagrelor) have clear benefits compared with clopidogrel for dual antiplatelet therapy, and cangrelor or vorapaxar, a thrombin receptor inhibitor, may be of value in specific settings. Anticoagulation uses 1 of 4 choices: bivalirudin, unfractionated heparin, enoxaparin, and fondaparinux. Moreover, some patients (such as those who have chronic atrial fibrillation) require triple therapy with aspirin, clopidogrel, plus an anticoagulant, frequently a vitamin K antagonist. New oral anticoagulants have been shown to be at least as effective as vitamin K antagonists in atrial fibrillation and led to fewer bleeding complications. Finally, the combination of aspirin, clopidogrel, and low-dose rivaroxaban has recently been approved by the European Medicines Agency (but not the Food and Drug Administration) for secondary prevention after ACS. Several strategies have been developed to balance the potential benefit of antithrombotic therapy against the risk of bleeding complications, for example, radial access in coronary angiography or restricted use of combination therapy, and others are under investigation, such as discontinuation of aspirin. This overview summarizes the current status of antithrombotic therapy in ACS and describes strategies currently explored to optimize its benefit/risk ratio.
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Lip GY, Windecker S, Huber K, Kirchhof P, Marin F, Ten Berg JM, Haeusler KG, Boriani G, Capodanno D, Gilard M, Zeymer U, Lane D, Storey RF, Bueno H, Collet JP, Fauchier L, Halvorsen S, Lettino M, Morais J, Mueller C, Potpara TS, Rasmussen LH, Rubboli A, Tamargo J, Valgimigli M, Zamorano JL. Management of antithrombotic therapy in atrial fibrillation patients presenting with acute coronary syndrome and/or undergoing percutaneous coronary or valve interventions: a joint consensus document of the European Society of Cardiology Working Group on Thrombosis, European Heart Rhythm Association (EHRA), European Association of Percutaneous Cardiovascular Interventions (EAPCI) and European Association of Acute Cardiac Care (ACCA) endorsed by the Heart Rhythm Society (HRS) and Asia-Pacific Heart Rhythm Society (APHRS). Eur Heart J 2014; 35:3155-79. [DOI: 10.1093/eurheartj/ehu298] [Citation(s) in RCA: 432] [Impact Index Per Article: 43.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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Lamberts M, Gislason GH, Olesen JB, Kristensen SL, Schjerning Olsen AM, Mikkelsen A, Christensen CB, Lip GYH, Køber L, Torp-Pedersen C, Hansen ML. Reply: A persisting dilemma for triple antithrombotic therapy: are we close to finding the correct answer? J Am Coll Cardiol 2014; 64:231-2. [PMID: 24509278 DOI: 10.1016/j.jacc.2013.11.049] [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: 11/19/2013] [Accepted: 11/21/2013] [Indexed: 10/25/2022]
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