Comparison of Triple Anti-Platelet Therapy and Dual Anti-Platelet Therapy in Patients With Acute Myocardial Infarction Who Had No-Reflow Phenomenon During Percutaneous Coronary Intervention

Lee, Ki Hong; Ahn, Youngkeun; Kim, Sung Soo; Rhew, Shi Hyun; Jeong, Young Wook; Jang, Soo Young; Cho, Jae Yeong; Jeong, Hae Chang; Park, Keun-Ho; Yoon, Nam Sik; Sim, Doo Sun; Yoon, Hyun Ju; Kim, Kye Hun; Hong, Young Joon; Park, Hyung Wook; Kim, Ju Han; Cho, Jeong Gwan; Park, Jong Chun; Jeong, Myung Ho; Cho, Myeong Chan; Kim, Chong Jin; Kim, Young Jo; Investigators, Kamir

doi:10.1253/circj.cj-13-0594

Cited by 13 publications

(11 citation statements)

References 25 publications

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“…In recent years, several large observational clinical trials (Obs) 9 , 10 and meta-analyses 11 , 12 have demonstrated that adding cilostazol to aspirin plus clopidogrel decreased the risk of major adverse cardiac events (MACE) compared to the conventional dual regimen. A recent meta-analysis published by Bundhun et al, 13 as well as several other randomized trials, 14 , 15 had stated the superiority of triple antiplatelet therapy (TAPT) for type 2 diabetes mellitus (T2DM) patients after intracoronary stenting procedure.…”

Section: Introductionmentioning

confidence: 99%

The clinical outcomes of triple antiplatelet therapy versus dual antiplatelet therapy for high-risk patients after coronary stent implantation: a meta-analysis of 11 clinical trials and 9,553 patients

Fan

Ding

et al. 2016

DDDT

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BackgroundThe optimal antiplatelet regimen after in-coronary intervention among patients presenting with complex coronary artery lesions or acute coronary syndrome (ACS) has remained unclear. This study sought to evaluate the clinical outcomes of triple antiplatelet treatment (TAPT) (cilostazol added to aspirin plus clopidogrel) in these patients.MethodsThe PubMed, EMBASE, MEDLINE, and other Internet sources were searched for relevant articles. The primary end point was major adverse cardiac events (MACE), including all-cause mortality, myocardial infarction, and target vessel revascularization. The incidence of definite/probable stent thrombosis and bleeding were analyzed as the safety end points.ResultsEleven clinical trials involving 9,553 patients were analyzed. The risk of MACE was significantly decreased following TAPT after stent implantation in the ACS subgroup (odds ratio [OR]: 0.72; 95% confidence interval [CI]: 0.61–0.85; P<0.001), which might mainly result from the lower risk of all-cause mortality in this subset (OR: 0.62; 95% CI: 0.48–0.80; P<0.001). The risk of bleeding was not increased with respect to TAPT.ConclusionTAPT after stent implantation was associated with feasible benefits on reducing the risk of MACE, especially on reducing the incidence of all-cause mortality among patients suffering from ACS, without higher incidence of bleeding. Larger and more powerful randomized trials are still warranted to prove the superiority of TAPT for such patients.

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Section: Introductionmentioning

confidence: 99%

The clinical outcomes of triple antiplatelet therapy versus dual antiplatelet therapy for high-risk patients after coronary stent implantation: a meta-analysis of 11 clinical trials and 9,553 patients

Fan

Ding

et al. 2016

DDDT

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“…Because drug-eluting stents can effectively help patients to avoid in-stent restenosis and there are cheap anti-platelet drugs, for instance, aspirin [66], they have been widely used in recent years [67]. However, anti-platelet drugs can become a heavy burden for patients who do not respond well to the typical pharmaceuticals and patients who need to take multiple types of anti-platelet drugs to effectively avoid thrombosis [68], [69].…”

Section: Discussionmentioning

confidence: 99%

An Agent-Based Model of the Response to Angioplasty and Bare-Metal Stent Deployment in an Atherosclerotic Blood Vessel

Curtin

Zhou

2014

PLoS ONE

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PurposeWhile animal models are widely used to investigate the development of restenosis in blood vessels following an intervention, computational models offer another means for investigating this phenomenon. A computational model of the response of a treated vessel would allow investigators to assess the effects of altering certain vessel- and stent-related variables. The authors aimed to develop a novel computational model of restenosis development following an angioplasty and bare-metal stent implantation in an atherosclerotic vessel using agent-based modeling techniques. The presented model is intended to demonstrate the body’s response to the intervention and to explore how different vessel geometries or stent arrangements may affect restenosis development.MethodsThe model was created on a two-dimensional grid space. It utilizes the post-procedural vessel lumen diameter and stent information as its input parameters. The simulation starting point of the model is an atherosclerotic vessel after an angioplasty and stent implantation procedure. The model subsequently generates the final lumen diameter, percent change in lumen cross-sectional area, time to lumen diameter stabilization, and local concentrations of inflammatory cytokines upon simulation completion. Simulation results were directly compared with the results from serial imaging studies and cytokine levels studies in atherosclerotic patients from the relevant literature.ResultsThe final lumen diameter results were all within one standard deviation of the mean lumen diameters reported in the comparison studies. The overlapping-stent simulations yielded results that matched published trends. The cytokine levels remained within the range of physiological levels throughout the simulations.ConclusionWe developed a novel computational model that successfully simulated the development of restenosis in a blood vessel following an angioplasty and bare-metal stent deployment based on the characteristics of the vessel cross-section and stent. A further development of this model could ultimately be used as a predictive tool to depict patient outcomes and inform treatment options.

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“…124 Finally, in a recent study, the addition of cilostazol (for 1 month) to double antiplatelet therapy with aspirin and clopidogrel in patients with angiographic CMVO improved the clinical outcome after 1 year. 126 The use of vasodilators (calcium-channel antagonist, dypiridamole) or metabolic drugs (ranolazine) at discharge needs future research having as endpoint reversion of CMVO, improved remodelling, and clinical outcome. 127,128 Finally, endothelin-1 may be another promising therapeutic target of.…”

Section: Controversial Therapiesmentioning

confidence: 99%

Coronary Microvascular Obstruction in Acute Myocardial Infarction

2018

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The success of a primary percutaneous intervention (PCI) in the setting of ST elevation myocardial infarction depends on the functional and structural integrity of coronary microcirculation. Coronary microvascular dysfunction and obstruction (CMVO) occurs in up to half of patients submitted to apparently successful primary PCI and is associated to a much worse outcome. The current review summarizes the complex mechanisms responsible for CMVO, including pre-existing coronary microvascular dysfunction, and highlights the current limitations in the assessment of microvascular function. More importantly, at the light of the substantial failure of trials hitherto published on the treatment of CMVO, this review proposes a novel integrated therapeutic approach, which should overcome the limitations of previous studies.

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Comparison of Triple Anti-Platelet Therapy and Dual Anti-Platelet Therapy in Patients With Acute Myocardial Infarction Who Had No-Reflow Phenomenon During Percutaneous Coronary Intervention

Cited by 13 publications

References 25 publications

The clinical outcomes of triple antiplatelet therapy versus dual antiplatelet therapy for high-risk patients after coronary stent implantation: a meta-analysis of 11 clinical trials and 9,553 patients

The clinical outcomes of triple antiplatelet therapy versus dual antiplatelet therapy for high-risk patients after coronary stent implantation: a meta-analysis of 11 clinical trials and 9,553 patients

An Agent-Based Model of the Response to Angioplasty and Bare-Metal Stent Deployment in an Atherosclerotic Blood Vessel

Coronary Microvascular Obstruction in Acute Myocardial Infarction

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