2009 Focused Updates: ACC/AHA Guidelines for the Management of Patients With ST‐Elevation Myocardial Infarction (Updating the 2004 Guideline and 2007 Focused Update) and ACC/AHA/SCAI Guidelines on Percutaneous Coronary Intervention (Updating the 2005 Guideline and 2007 Focused Update)

Kushner, Frederick G.; Hand, Mary M.; Smith, Sidney C.; King, Spencer B.; Anderson, Jeffrey L.; Antman, Elliott M.; Bailey, Steven R.; Bates, Eric R.; Blankenship, James C.; Casey, Donald E.; Green, Lee A.; Hochman, Judith S.; Jacobs, Alice K.; Krumholz, Harlan M.; Morrison, Douglass A.; Ornato, Joseph P.; Pearle, David L.; Peterson, Eric D.; Sloan, Michael A.; Whitlow, Patrick L.; Williams, David O.

doi:10.1002/ccd.22351

Cited by 111 publications

(113 citation statements)

References 158 publications

Supporting

Mentioning

101

Contrasting

Unclassified

Order By: Relevance

“…23 A drug-eluting stent could be used according to American College of Cardiology/American Heart Association (ACC/AHA) guidelines. An intravenous bolus of unfractionated heparin (100 IU/kg) was administered at the beginning of the procedure.…”

Section: Angioplasty Proceduresmentioning

confidence: 99%

“…Endpoints were recorded by an investigator who was not aware of the treatment status and clinical characteristics of patients. The primary endpoint was the rate of MACE, which included cardiovascular death, angiographically confirmed ST, recurrent ACS defined by the ACC/AHA guidelines, 23 and recurrent revascularization by either coronary angioplasty or bypass surgery. Secondary endpoints, recorded to assess safety, were major and minor bleeding.…”

Section: Clinical Endpointsmentioning

confidence: 99%

See 1 more Smart Citation

Modifying Clopidogrel Maintenance Doses According to Vasodilator‐Stimulated Phosphoprotein Phosphorylation Index Improves Clinical Outcome in Patients With Clopidogrel Resistance

Wang

Dai-fu

Zhuang

et al. 2011

Clinical Cardiology

View full text Add to dashboard Cite

Background: Despite dual antiplatelet therapy, the rate of major adverse cardiovascular events (MACE) after percutaneous coronary intervention (PCI) remains high. Ex vivo tests of clopidogrel resistance can predict MACE after PCI. The purpose of this study is to evaluate the clinical impact of adjusting phosphorylation analysis in patients with clopidogrel resistance undergoing PCI. Hypothesis: We hypothesized that VASP-guided clopidogrel maintenance doses, compared to fixed doses, improved clinical outcome. Methods: This monocentric, prospective, randomized study was performed on 306 patients undergoing PCI. Patients were randomized to a control group (n = 156) and to a vasodilator-stimulated phosphoprotein (VASP)-guided group (n = 150). In the VASP-guided group, patients received adjusted maintenance doses of clopidogrel to obtain platelet reactivity index (PRI) of <50% during 1 year after PCI. The primary endpoint was the rate of MACE. The secondary endpoints were major and minor bleeding. Results: All patients completed the PCI procedure and 298 patients completed follow-up. The control and VASP-guided groups had similar demographic, clinical, and angiographic characteristics. In the VASP-guided group, PRI was significantly decreased (from 72.1% ± 11.4% to 27.7% ± 8.4%; P = 0.001) in 128 patients (87.1% of all participants). During the 1-year follow-up, 14 MACEs were recorded in the VASP-guided group and 30 MACEs were recorded in the control group (9.3% vs 20.4%, respectively; P = 0.008). There was no difference in the rate of major and minor bleeding in the VASP-guided group compared with the control group (12.9% vs 16.6%; P = 0.06). Conclusions: Modifying clopidogrel maintenance doses according to platelet reactivity monitoring decreases the rate of MACE after PCI without increasing bleeding in patients with clopidogrel resistance during 1-year follow-up.

show abstract

Section: Angioplasty Proceduresmentioning

confidence: 99%

Section: Clinical Endpointsmentioning

confidence: 99%

Modifying Clopidogrel Maintenance Doses According to Vasodilator‐Stimulated Phosphoprotein Phosphorylation Index Improves Clinical Outcome in Patients With Clopidogrel Resistance

Wang

Dai-fu

Zhuang

et al. 2011

Clinical Cardiology

View full text Add to dashboard Cite

show abstract

“…33 for which focused updates were published in 2007 34 and 2009. 35 The American College of Physicians, American College of Emergency Physicians, and Society for Cardiac Angiography and Interventions (SCAI) participated in a joint initiative to update the guidelines. 5 The update focuses on recent developments in reperfusion therapy, the organization of regional care systems, transfer algorithms, antithrombotic and medical therapies (evidence-based), and approaches in secondary care that may improve patient-centered management.…”

Section: Risk Associated With Switching Antiplatelet Therapiesmentioning

confidence: 99%

“…36 The ACCF/AHA recommendations for supportive anticoagulant regimens are unchanged from the 2009 update 35 and comprise the use of unfractionated heparin, including bolus doses to maintain therapeutic activated clotting times (as required), with consideration of whether the patient has received a GPIIb/IIIa receptor antagonist (LOE: C) or bivalirudin, with or without prior treatment with unfractionated heparin (LOE: B). 5 They also note that bivalirudin monotherapy is preferred over unfractionated heparin and a GPIIb/IIIa inhibitor in patients who are at a high risk of bleeding.…”

Section: In Stemi Patients Who Are Receiving Antiplatelet Agents and mentioning

confidence: 99%

Acute Coronary Syndrome: Focus on Antiplatelet Therapy

Bobadilla

2016

Critical Care Nurse

View full text Add to dashboard Cite

The American Heart Association/American College of Cardiology in 2014 published a focused update of the 2007 and 2012 guidelines for non–ST-segment elevation acute coronary syndrome (NSTE-ACS). The management of ST-segment elevation myocardial infarction (STEMI) is described in a separate guideline published in 2013. The focused updates to the guidelines contain updated recommendations for dual antiplatelet therapy, including use of the P2Y12 inhibitor ticagrelor, which was recently approved by the Food and Drug Administration. Nurses caring for patients with acute coronary syndrome must have a good understanding of the current treatment guidelines for such patients, to help ensure delivery of evidence-based care. This review article uses a case study–based approach to describe how the new guidelines affect clinical decision making when choosing appropriate antiplatelet therapy for patients with NSTE-ACS or STEMI, depending on the patient’s clinical history and presenting characteristics.

show abstract

“…Later guidelines and scientific papers have urged the provision of care within regionalized systems as “a matter of utmost importance” (Kushner et al. 2009) and “mission critical” (Brush 2012). The “Mission: Lifeline” regionalized system demonstration project is underway; comparisons of outcomes to accomplishments of nonparticipating systems have not yet been published (Bagai et al.…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of regionalized systems for stroke and myocardial infarction

et al. 2015

View full text Add to dashboard Cite

BackgroundAcute ischemic stroke (AIS) and ST‐segment elevation myocardial infarction (STEMI) are ischemic emergencies. Guidelines recommend care delivery within formally regionalized systems of care at designated centers, with bypass of nearby centers of lesser or no designation. We review the evidence of the effectiveness of regionalized systems in AIS and STEMI.MethodsLiterature was searched using terms corresponding to designation of AIS and STEMI systems and from 2010 to the present. Inclusion criteria included report of an outcome on any dependent variable mentioned in the rationale for regionalization in the guidelines and an independent variable comparing care to a non‐ or pre‐regionalized system. Designation was defined in the AIS case as certification by the Joint Commission as either a primary (PSC) or comprehensive (CSC) stroke center. In the STEMI case, the search was conducted linking “regionalization” and “myocardial infarction” or citation as a model system by any American Heart Association statement.ResultsFor AIS, 17 publications met these criteria and were selected for review. In the STEMI case, four publications met these criteria; the search was therefore expanded by relaxing the criteria to include any historical or anecdotal comparison to a pre‐ or nonregionalized state. The final yield was nine papers from six systems.ConclusionAlthough regionalized care results in enhanced process and reduced unadjusted rates of disparity in access and adverse outcomes, these differences tend to become nonsignificant when adjusted for delayed presentation and hospital arrival by means other than emergency medical services. The benefits of regionalized care occur along with a temporal trend of improvement due to uptake of quality initiatives and guideline recommendations by all systems regardless of designation. Further research is justified with a randomized registry or cluster randomized design to support or refute recommendations that regionalization should be the standard of care.

show abstract

2009 Focused Updates: ACC/AHA Guidelines for the Management of Patients With ST‐Elevation Myocardial Infarction (Updating the 2004 Guideline and 2007 Focused Update) and ACC/AHA/SCAI Guidelines on Percutaneous Coronary Intervention (Updating the 2005 Guideline and 2007 Focused Update)

Cited by 111 publications

References 158 publications

Modifying Clopidogrel Maintenance Doses According to Vasodilator‐Stimulated Phosphoprotein Phosphorylation Index Improves Clinical Outcome in Patients With Clopidogrel Resistance

Modifying Clopidogrel Maintenance Doses According to Vasodilator‐Stimulated Phosphoprotein Phosphorylation Index Improves Clinical Outcome in Patients With Clopidogrel Resistance

Acute Coronary Syndrome: Focus on Antiplatelet Therapy

Effectiveness of regionalized systems for stroke and myocardial infarction

Contact Info

Product

Resources

About