Coronary Thrombosis and Major Bleeding After PCI With Drug-Eluting Stents

Baber, Usman; Mehran, Roxana; Giustino, Gennaro; Cohen, David J.; Henry, Timothy D.; Sartori, Samantha; Ariti, Cono; Litherland, Claire; Dangas, George; Gibson, C. Michael; Krucoff, Mitchell W.; Moliterno, David J.; Kirtane, Ajay J.; Stone, Gregg W.; Colombo, Antonio; Chieffo, Alaide; Kini, Annapoorna; Witzenbichler, Bernhard; Weisz, Giora; Steg, Philippe Gabriel; Pocock, Stuart J.

doi:10.1016/j.jacc.2016.02.064

Cited by 484 publications

(376 citation statements)

References 31 publications

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“…11,26 This variable was also not considered as candidate predictor for risk model building in PARIS registry (Patterns of Non-Adherence to Dual Anti-Platelet Regimen in Stented Patients). 27 Results from the present study suggested that the early discontinuation of P2Y 12 inhibitors even after newer-generation DES implantation may be associated with a risk of developing subsequent myocardial infarction (mainly nonstent thrombosis related) in patients with multivessel disease. This phenomenon was prominent in patients who presented with acute coronary syndrome but not in those who presented with stable coronary artery disease.…”

Section: Discussionmentioning

confidence: 59%

Association Between Duration of Dual Antiplatelet Therapy and Angiographic Multivessel Disease on Outcomes in Patients Treated With Newer-Generation Drug-Eluting Stents

Lee

Hong

Shin

et al. 2016

Circ: Cardiovascular Interventions

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Background-There is general agreement that the optimal duration of dual antiplatelet therapy (DAPT) in patients treated with drug-eluting stents should be individualized. We hypothesized that the extent of coronary artery disease may affect the clinical outcomes of DAPT. Methods and Results-We pooled patient-level data from 5 large, randomized trials comparing short-term DAPT with prolonged therapy. From the data, we identified 5476 patients who received newer-generation drug-eluting stents. Net adverse clinical event (NACE) was defined as a composite of all-cause mortality, myocardial infarction, stroke, or major bleeding. At 1 year, NACE had occurred in 171 patients (3.1%). Independent predictors of NACE were older age (>65 years), sex, presence of diabetes mellitus, left ventricular dysfunction (ejection fraction <40%), and angiographic multivessel disease. Multivessel disease and DAPT duration were significantly associated with NACE (P for interaction=0.002); the association was driven by the greater occurrence of myocardial infarction in patients with multivessel disease. In patients with multivessel disease, 6-month DAPT (versus 12-month DAPT) was associated with a higher incidence of myocardial infarction (adjusted hazard ratio=2.748; 95% confidence interval=1.375-5.491; P=0.004), compared with patients with single-vessel disease (P for interaction=0.001). Conclusions-In patients treated with newer-generation drug-eluting stents, a significant interaction between DAPT strategy and multivessel disease was found regarding the occurrence of NACE at 1 year. Among adverse events, myocardial infarction was more frequent in 6-month DAPT than in 12-month DAPT in patients with multivessel disease. (Circ Cardiovasc Interv. 2016;9:e004256.

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Section: Discussionmentioning

confidence: 59%

Association Between Duration of Dual Antiplatelet Therapy and Angiographic Multivessel Disease on Outcomes in Patients Treated With Newer-Generation Drug-Eluting Stents

Lee

Hong

Shin

et al. 2016

Circ: Cardiovascular Interventions

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“…previous revascularization) or at high risk of major bleeding (based on age, body mass index, smoking, anemia, renal function, and whether on an anticoagulant in addition to antiplatelet therapy). 128 In patients considered for long-term dual antiplatelet administration, the DAPT score (dual antiplatelet therapy; based on age, smoking, diabetes, MI at presentation, prior MI or percutaneous coronary intervention, stent type and diameter and heart failure) may provide a way of categorizing patients who are likely to receive a favorable net benefit from long-term DAPT, related to high ischemic risk and lower bleeding risk.…”

Section: Optical Coherence Tomography Plaque Rupturementioning

confidence: 99%

Novel Risk Markers and Risk Assessments for Cardiovascular Disease

Thomas

Lip

2017

Circulation Research

115

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Abstract:The use of risk markers has transformed cardiovascular medicine, exemplified by the routine assessment of troponin, for both diagnosis and assessment of prognosis in patients with chest pain. Clinical risk factors form the basis for risk assessment of cardiovascular disease and the addition of biochemical, cellular, and imaging parameters offers further refinement. Identifying novel risk factors may allow greater risk stratification and a steady, but gradual progression toward precision medicine. Indeed, the generation of data in this area of research is explosive and when combined with new technologies and techniques provides the potential for more refined, targeted approaches to cardiovascular medicine. Although discussing the most recent developments in this field, this review article aims to strike a balance between novelty and validity by focusing on recent large samplesize studies that have been validated in a separate cohort in most cases. Risk markers related to atherosclerosis, thrombosis, inflammation, cardiac injury, and fibrosis are introduced in the context of their pathophysiology. Rapidly developing new areas, such as assessment of micro-RNA, are also explored. Subsequently the prognostic ability of these risk markers in coronary artery disease, heart failure, and atrial fibrillation is discussed in detail. ( addition to these roles in the pathogenesis of coronary artery disease, lipid-related molecules have been identified to be markers of inflammation and oxidative stress (Table 1). Thrombosis-Related Risk MarkersAfter atherosclerotic plaque rupture, platelets adhere to exposed subendothelial components, such as collagen and von Willebrand factor, which promotes platelet activation and aggregation. 10 In addition, platelet activation is potentiated by exposure to released soluble agonists, such as thrombin and ADP.10 Activated platelets then further release ADP, which acts on platelet P2Y 12 ADP receptors and has a central role in amplifying the response of platelets to the initial stimulus. 10 Platelet reactivity to various agonists, including ADP, has been studied extensively in the context of acute coronary syndrome (ACS; Table 2). 11 The VerifyNow and Multiplate pointof-care tests allow for the measurement of platelet aggregation in response to stimulation, and it has been shown that high platelet reactivity is associated with adverse cardiovascular events. 26 Platelet microparticles are released on platelet activation, and their role in cardiovascular disease is an area of active investigation (Table 2). 15 Circulating microparticles are released from cells undergoing activation or apoptosis and are a type of small plasma membrane vesicle that retain defined properties from their original cell lineage. 15 Platelet activation and aggregation lead to the activation of the coagulation cascade and the formation of a stable crosslinked fibrin clot. The balance between prothrombotic factors and endogenous fibrinolysis determines whether the thrombus propagates or instead proceeds to dis...

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“…[32,33] Major cardiovascular events and mortality rates in the BVS-treated patients in our cohort were similar or even lower than in patients treated with other stents. Moreover, patients treated with BVS in our study had a higher number of vessels with significant lesions, and subsequently received more stents.…”

Section: [11]mentioning

confidence: 54%

Initial experience with bioresorbable vascular scaffolds for percutaneous revascularisation in patients with acute coronary syndrome

Cordero¹,

López-Palop²,

Carrillo³

et al. 2017

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How to cite this article: Cordero A, López-Palop R, Carrillo P, Frutos A, Gunturiz C, García-Carrilero M, Bertomeu-Martinez V. Initial experience with bioresorbable vascular scaffolds for percutaneous revascularisation in patients with acute coronary syndrome. Vessel Plus 2017;1:68-76.Aim: Bioresorbable vascular scaffolds (BVS) have recently been introduced to minimise the long-term complications of metallic stents in acute coronary syndrome (ACS), but their benefits have not been well analysed. Methods: The authors studied all ACS patients treated with any kind of stent at a single centre between March 2013 (when the first BVS was implanted) and June 2016. Results: The study included 951 subjects, mean age 67.9 ± 13.3 years, mean Global Registry of Acute Coronary Events (GRACE) score 148.5 ± 44.8, 75.2% men and 38.2% with an ST-segment elevation myocardial infarction. The mean number of stents implanted was 1.3 ± 1.0 and 54 subjects (5.7%) received at least 1 BVS. Drug-eluting stents were implanted in 57.3% subjects, followed by bare-metal stents (19.0%). The subjects treated with BVS were younger and had lower GRACE scores compared to the rest. Inhospital mortality was 4.8% and no subject treated with BVS died before discharge. BVStreated patients received dual antiplatelet therapy or new antiplatelet agents more frequently. During a median follow-up of 13 months, all-cause mortality was 7.8%, cardiovascular mortality was 6.1%, and at least 1 major cardiovascular event occurred in 26.4% of the subjects. Stent type did not affect prognosis. Conclusion: Coronary revascularisation using BVS in selected ACS patients is safe and effective. Key words:Bioresorbable vascular stents, stents, acute coronary syndrome, revascularisation, prognosis ABSTRACTArticle history:

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Coronary Thrombosis and Major Bleeding After PCI With Drug-Eluting Stents

Cited by 484 publications

References 31 publications

Association Between Duration of Dual Antiplatelet Therapy and Angiographic Multivessel Disease on Outcomes in Patients Treated With Newer-Generation Drug-Eluting Stents

Association Between Duration of Dual Antiplatelet Therapy and Angiographic Multivessel Disease on Outcomes in Patients Treated With Newer-Generation Drug-Eluting Stents

Novel Risk Markers and Risk Assessments for Cardiovascular Disease

Initial experience with bioresorbable vascular scaffolds for percutaneous revascularisation in patients with acute coronary syndrome

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