Prior chronic clopidogrel therapy is associated with increased adverse events and early stent thrombosis

Asher, Elad; Fefer, Paul; Sabbag, Avi; Herscovici, Romana; Regev, Ehud; Mazin, Israel; Nir, Shlomo; Zahger, Doron; Atar, Shaul; Hammerman, Haim; Polak, Arthur; Beigel, Roy; Matetzky, Shlomi

doi:10.1160/th15-05-0384

Cited by 3 publications

(1 citation statement)

References 31 publications

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“…Due to its observational non-randomized design, the current study is subject to limitations as described in detail previously [ 39 ]. Thus, despite efforts to control for confounding factors by applying multivariate analysis, we cannot exclude unmeasured factors which could have biased the results of the comparison between clopidogrel-treated and newer antiplatelet treated patients such as lesion characteristics and stent type and size.…”

Section: Discussionmentioning

confidence: 99%

Incidence and Clinical Features of Early Stent Thrombosis in the Era of New P2y12 Inhibitors (PLATIS-2)

et al. 2016

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Early stent thrombosis (EST) (≤ 30 days after stent implantation) is a relatively rare but deleterious complication of percutaneous coronary intervention (PCI). Administration of newer P2Y12 inhibitors (prasugrel and ticagrelor) combined with aspirin has been shown to reduce the incidence of sub-acute and late stent thrombosis, compared with clopidogrel. We investigated the “real life” incidence of EST in patients from a large acute coronary syndrome (ACS) national registry, where newer P2Y12 inhibitors are widely used. Patients were derived from the ACS Israeli Survey (ACSIS), conducted during 2006, 2008, 2010 and 2013. Major adverse cardiac events (MACE) at 30days were defined as all-cause death, recurrent ACS, EST and stroke.Of the 4717 ACS patients who underwent PCI and stenting, 83% received clopidogrel and 17% newer P2Y12 inhibitors. The rate of EST was similar in both groups (1.7% in the newer P2Y12 inhibitor group vs. 1.4% in the clopidogrel-treated patients, p = 0.42). Results were consistent after multivariate analysis (adjusted HR = 1.06 [p = 0.89]). MACE occurred in 6.4% in the newer P2Y12 inhibitor group compared with 9.2% in the clopidogrel group (P<0.01). However, multivariate logistic regression modeling showed that treatment with newer P2Y12 inhibitors was not significantly associated with the secondary endpoint of MACE when compared with clopidogrel therapy [OR = 1.26 95%CI (0.93–1.73), P = 0.136]. The incidence of "real life" EST at 1month is relatively low, and appears to be similar in patients who receive newer P2Y12 inhibitors as well as in those who receive clopidogrel.

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Section: Discussionmentioning

confidence: 99%

Incidence and Clinical Features of Early Stent Thrombosis in the Era of New P2y12 Inhibitors (PLATIS-2)

et al. 2016

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Trends in long-term prognosis according to left ventricular ejection fraction after acute coronary syndrome

Yahud

Tzuman

Fink

et al. 2020

Journal of Cardiology

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Our aim was to investigate trends in prognosis among survivors of acute coronary syndrome according to left ventricular ejection fraction during a 16-year period. Methods: Data were derived from the Acute Coronary Syndrome Israeli Survey during the years 2000-2016. Patients aged 18 years and older were included in the analysis (N = 11,725). Patients were classified into two groups based on their left ventricular ejection fraction: preserved (!50%) and reduced (<50%) and also according to their acute coronary syndrome onset (2000-2006 early period vs. 2008-2016 late period). Endpoints were all-cause mortality rates at one and three years after the index event.Results: Preserved left ventricular ejection fraction was present in 5047/11,725 (43%) of patients. As expected, patients with preserved left ventricular ejection fraction had lower 1 and 3-year mortality rates as compared with reduced left ventricular ejection fraction regardless of the acute coronary syndrome period onset (6% vs. 19%, p < 0.001). Nevertheless, in the late period the prevalence of reduced left ventricular ejection fraction decreased significantly, becoming equal to preserved left ventricular ejection fraction [2761 (50.5%) vs. 2713 (49.5%) respectively, p = 0.3]. Moreover, prognosis during the late period as compared with the early period was improved only in patients with reduced left ventricular ejection fraction (HR 0.79; 95% CI 0.70-0.89, p = 0.0001). Conclusion:The prevalence of reduced left ventricular ejection fraction has decreased and prognosis has improved during the past several years but is still much worse than the prognosis of preserved left ventricular ejection fraction.

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Temporal trends in prognosis of patients with acute coronary syndrome complicated by ventricular tachyarrhythmia

et al. 2021

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Objectives: To evaluate clinical characteristics and prognosis of patients presented with acute coronary syndrome (ACS) that developed ventricular tachyarrhythmia VTA and to analyse it according to the period of presentation. Background:VTA is an infrequent yet serious complication of ACS. There is limited data regarding the incidence and prognostic implications of VTA in the last decade as compared with the previous decade. Methods:We evaluated clinical characteristics, major adverse cardiovascular events, short and long-term mortality of patients hospitalised with ACS who were enrolled in the Acute Coronary Syndrome Israeli Survey (ACSIS) during the years 2000-2016.Patients were classified into three groups: no VTA, early VTA (≤48 hours of onset) and late VTA (>48 hours of onset). Data were analysed according to the period of presentation: early vs late period (years 2000-2006 and 2008-2016 accordingly). Results:The study population comprised 15,200 patients. VTA occurred in 487 (3.2%) patients. Early VTA presented in 373/487 (77%) patients and late VTA in 114/487 (23%) patients. VTA's, occurring in ACS patients were associated with increased risk of in-hospital, 30-days, 1-year and 5-year mortality rates during both early and late periods compared with no VTA. Moreover, late VTA was associated with the highest mortality rate with up to 65% in 5-year follow up (P < .001). Nevertheless, late VTA was associated with a lower mortality rate in the late period compared with the early period.Conclusions: Any VTA following ACS was associated with high short-and long-term mortality rate. However, over the late period, there has been a significant improvement in survival rates, especially in patients with late VTA. This may be attributed to early and invasive reperfusion therapy, implantable cardioverter-defibrillator implantation and better medical treatment. How to cite this article: Yahud E, Laish-Farkash A, Shlomo N, et al. Temporal trends in prognosis of patients with acute coronary syndrome complicated by ventricular tachyarrhythmia.

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Prior chronic clopidogrel therapy is associated with increased adverse events and early stent thrombosis

Cited by 3 publications

References 31 publications

Incidence and Clinical Features of Early Stent Thrombosis in the Era of New P2y12 Inhibitors (PLATIS-2)

Incidence and Clinical Features of Early Stent Thrombosis in the Era of New P2y12 Inhibitors (PLATIS-2)

Trends in long-term prognosis according to left ventricular ejection fraction after acute coronary syndrome

Temporal trends in prognosis of patients with acute coronary syndrome complicated by ventricular tachyarrhythmia

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