Comparison of Outcomes After Percutaneous Coronary Intervention Among Different Coronary Subsets (Stable and Unstable Angina Pectoris and ST-Segment and Non-ST-Segment Myocardial Infarction)

Loh, Joshua P.; Pendyala, Lakshmana; Kitabata, Hironori; Torguson, Rebecca; Omar, Alfazir; Minha, Sa’ar; Chen, Fang; Satler, Lowell F.; Pichard, Augusto D.; Waksman, Ron

doi:10.1016/j.amjcard.2014.03.007

Cited by 34 publications

(16 citation statements)

References 30 publications

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“…Despite the advances in the treatment of coronary artery disease, recurrent stent thromboses remain problematic [32,33]. The introduction of DAPT (aspirin and a P2Y12 receptor antagonist) has mitigated the risk of early and late thrombosis after coronary stent implantation, yet the duration of DAPT remains controversial [34].…”

Section: Discussionmentioning

confidence: 99%

“…In contrast, Hahn et al included only patients with acute coronary syndrome (ACS) and showed a lower rate of composite ischemic events in the 12 mo DAPT group [15]. This may highlight the importance of longer duration DAPT in patients with ACS, as they have a higher rate of recurrent ischemic events than patients with stable coronary artery disease [32,33]. More trials with exclusively ACS patients are required, however, before solid conclusions can be made regarding the optimal duration of DAPT after DES implantation in such patients.…”

Section: Discussionmentioning

confidence: 99%

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Best duration of dual antiplatelet therapy after drug-eluting stent implantation: an updated network meta-analysis of randomized controlled trials

Barbarawi

Kheiri

Zayed

et al. 2019

Journal of Community Hospital Internal Medicine Perspectives

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Background: Drug-eluting stent(DES) implantation is the main interventional treatment for coronary artery disease, and dual antiplatelet therapy(DAPT) remains the gold standard strategy to prevent ischemic events. However, the optimal duration of DAPT after DES implantation remains controversial. Therefore, we aimed to evaluate the best duration of DAPT following DES implantation.Method: We searched PubMed, Embase, Cochrane Library, and clinicaltrials.gov for all randomized clinical trials(RCTs) that compared different durations of DAPT after DES implantation. Major adverse cardiac events(MACE) and major bleeding were the primary and secondary outcomes, respectively.Results: We included 16 RCTs (n = 42,993). The mean age of included patients was 63.1 ± 10.1. The primary outcome was statistically significant for lower MACE in patients who received DAPT for 24–48 months (mo) following DES when compared with those who received 3–6 mo of DAPT (odds ratio [OR] 0.75; 95% credible interval [CI] 0.58–0.97). There was nonstatistically significant difference in MACE when comparing those who received 12 mo of DAPT to those taking either 3–6 mo of DAPT (OR 0.86; 95% CI 0.69–1.08) or 24–48 mo of DAPT (OR 0.87; 95% CI 0.72–1.05). In contrast, major bleeding was significantly lower in those who received 3–6 mo of DAPT (OR 0.32; 95% CI 0.17–0.54) and 12 mo of DAPT (OR 0.43; 95% CI 0.27–0.63) than in those who received 24–48 mo of DAPT.Conclusion: In patients who undergo DES implantation, a longer duration of DAPT is associated with lower MACE, despite the increased risk of major bleeding events. Therefore, individualizing the duration of DAPT after DES according to the patient’s risk of bleeding and recurrent ischemia is recommended.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Best duration of dual antiplatelet therapy after drug-eluting stent implantation: an updated network meta-analysis of randomized controlled trials

Barbarawi

Kheiri

Zayed

et al. 2019

Journal of Community Hospital Internal Medicine Perspectives

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“…Всем паци-ентам с предстоящим ЧКВ следует проводить оценку ри-ска возникновения ИКВ-ОПП по шкале R. Mehran (табл. 1) [12][13][14][15]. Оценка ≤5 баллов соответствует низкому ри-ску развития ИКВ-ОПП, оценка 6-10 баллов -средне-му, оценка 11-16 баллов -высокому, оценка ≥16 баллов -очень высокому [15].…”

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Contrast-induced acute kidney injury after primary percutaneous coronary interventions: Prevalence, predictive factors, and outcomes

et al. 2015

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РезюмеЦель исследования. Изучить частоту, тяжесть, прогностические факторы развития и прогностическое значение индуциро-ванного контрастным веществом острого повреждения почек (ИКВ-ОПП) у пациентов с острым коронарным синдромом с подъемом сегмента ST (ОКСпST) и первичным чрескожным коронарным вмешательством (ЧКВ). Материалы и методы. У 216 пациентов, госпитализированных в городскую клиническую больницу Москвы с ОКСпST и подвергнутых первичному ЧКВ (средний возраст 64±13 лет, артериальная гипертония у 90%, инфаркт миокарда в анам-незе у 27%, хроническая болезнь почек у 7%, сахарный диабет 2-го типа у 21%), оценена частота развития ИКВ-ОПП по критериями KDIGO (2012). На основании логистического регрессионного анализа определены прогностические факторы развития ИКВ-ОПП, при телефонном опросе через 12 мес оценен прогноз. Результаты. ИКВ-ОПП диагностировано у 43 (20%) пациентов, которое представлено I (81%) и II (19%) стадиями. Паци-енты с ИКВ-ОПП были старше, характеризовались более высокими исходными уровнями креатинина в сыворотке крови, объемом контрастного вещества, отношением объем контрастного вещества/скорость клубочковой фильтрации, меньшей фракцией выброса левого желудочка. Выявлены независимые прогностические факторы развития ИКВ-ОПП: хроническая болезнь почек, многососудистое поражение коронарного русла, терапия в стационаре петлевыми диуретиками, нефро-токсичными антибиотиками, антагонистами минералокортикоидных рецепторов. Заключение. Развитие ИКВ-ОПП ассоциируется с неблагоприятными исходами: более высокой 30-дневной смертностью, более частыми повторными госпитализациями по поводу сердечно-сосудистых заболеваний.Ключевые слова: индуцированное контрастным веществом острое повреждение почек, острый коронарный синдром с подъемом сегмента ST, первичное чрескожное коронарное вмешательство. Aim. To study the incidence, severity, predictive factors, and prognostic value of contrast-induced acute kidney injury (CIAKI) in patients with ST-segment elevation acute coronary syndrome (STSEACS), who have undergone primary percutaneous coronary intervention (PCI). Subjects and methods. The 2012 KDIGO criteria were used to estimate the incidence of CIAKI in 216 patients (mean age, 64±13 years) admitted to Moscow City Clinical Hospital Sixty-Four and underwent primary PCI for STSEACS (hypertension in 90%, prior myocardial infarction in 27%, chronic kidney disease in 7%, type 2 diabetes mellitus in 21%). Logistic regression analysis was performed to identify predictive factors for CIAKI; following 12 months, its prognosis was assessed by phone. Results. Forty-three (20%) patients were diagnosed with Stages I (81%) and II (19%) CIAKI. The patients with CIAKI were older; they had higher baseline serum creatinine levels, a higher volume of contrast agent, a higher ratio of contrast medium volume to glomerular filtration rate, and lower left ventricular ejection fraction. Independent predictive factors for CIAKI were identified; these were chronic kidney disease, multivascular injury in the coronary bed, hospital therapy wi...

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“…Lack of compliance with treatment, eg, with antiplatelet agents, has been shown to be predictive of secondary events –such as stent thrombosis29 – in the follow-up of ACS patients.…”

Section: Discussionmentioning

confidence: 99%

High adherence to therapy and low cardiac mortality and morbidity in patients after acute coronary syndrome systematically managed by office-based cardiologists in Germany: 1-year outcomes of the ProAcor Study

Goss¹,

Brachmann

Hamm

et al. 2017

VHRM

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We aimed to assess patient acceptance and effectiveness of a 12-month structured management program in patients after an acute coronary syndrome (ACS) event who were treated in a special setting of office-based cardiologists. The program comprised patient documentation with a specific tool (Bundesverband Niedergelassener Kardiologen [German Federation of Office-Based Cardiologists] cardiac pass with visit scheduling) shared by the hospital physician and the office-based cardiologist, the definition of individual treatment targets, and the systematic information of patients in order to optimize adherence to therapy. Participating centers (36 hospitals, 60 office-based cardiologists) included a total of 1,003 patients with ACS (ST-segment elevation myocardial infarction [STEMI] 44.3%, non-ST-segment elevation myocardial infarction [NSTEMI] 39.5%, unstable angina pectoris [UA] 15.2%, and unspecified 1.0%). During follow-up, treatment rates with cardiac medication remained high in all groups, with dual antiplatelet therapy in 91.0% at 3 months, 90.0% at 6 months, and 82.8% at 12 months, respectively. Twelve months after the inclusion, a total of 798 patients (79.6%) still participated in the program. Eighteen patients (1.8%) had died after discharge from hospital (6 in the STEMI, 12 in the NSTEMI group), while for 58 the status was unknown (5.8%). Based on a conservative approach that considered patients with unknown status as dead, 1-year mortality was 7.6%. Recurrent cardiac events were noted in 14.9% at 1 year, with an about equal distribution across STEMI and NSTEMI patients. In conclusion, patients’ acceptance of the ProAcor program as determined by adherence rates over time was high. Treatment rates of recommended medications used for patients with coronary heart disease were excellent. The 1-year mortality rate was comparatively low.

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Comparison of Outcomes After Percutaneous Coronary Intervention Among Different Coronary Subsets (Stable and Unstable Angina Pectoris and ST-Segment and Non-ST-Segment Myocardial Infarction)

Cited by 34 publications

References 30 publications

Best duration of dual antiplatelet therapy after drug-eluting stent implantation: an updated network meta-analysis of randomized controlled trials

Best duration of dual antiplatelet therapy after drug-eluting stent implantation: an updated network meta-analysis of randomized controlled trials

Contrast-induced acute kidney injury after primary percutaneous coronary interventions: Prevalence, predictive factors, and outcomes

High adherence to therapy and low cardiac mortality and morbidity in patients after acute coronary syndrome systematically managed by office-based cardiologists in Germany: 1-year outcomes of the ProAcor Study

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