Long-Term Versus Short-Term Clopidogrel Therapy in Patients Undergoing Coronary Stenting (from the Randomized Argentine Clopidogrel Stent [RACS] Trial)

Bernardi, Víctor; Szarfer, Jorge; Summay, Gabriel; Mendiz, Oscar; Sarmiento, Ricardo; Alemparte, Máximo Rodriguez; Gabay, Jose M.; Berger, Peter B.

doi:10.1016/j.amjcard.2006.08.034

Cited by 29 publications

(14 citation statements)

References 6 publications

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“…However, the participants enrolled in Cordoba were significantly younger, with a higher proportion of males and smokers but lower proportion of patients with diabetes, when compared with UMASS (table 4). In addition, and as expected,30 31 aspirin use was significantly lower among the cohort in Cordoba versus the UMASS population (40% vs 80%, p<0.0001, table 4). Despite these demographic differences, a higher incidence of prolonged closure times in patients with non-cardiac symptoms was observed at both sites: that is, the proportion of participants with closure times ≥138 s was 13% vs 10% in patients with non-cardiac chest pain and 1.9% vs 2% in ACS-positive patients at UMASS versus Cordoba, respectively.…”

Section: Resultssupporting

confidence: 81%

Point-of-care assessment of platelet reactivity in the emergency department may facilitate rapid rule-out of acute coronary syndromes: a prospective cohort pilot feasibility study

et al. 2014

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ObjectiveAccurate, efficient and cost-effective disposition of patients presenting to emergency departments (EDs) with symptoms suggestive of acute coronary syndromes (ACS) is a growing priority. Platelet activation is an early feature in the pathogenesis of ACS; thus, we sought to obtain an insight into whether point-of-care testing of platelet function: (1) may assist in the rule-out of ACS; (2) may provide additional predictive value in identifying patients with non-cardiac symptoms versus ACS-positive patients and (3) is logistically feasible in the ED.DesignProspective cohort feasibility study.SettingTwo urban tertiary care sites, one located in the USA and the second in Argentina.Participants509 adult patients presenting with symptoms of ACS.Main outcome measuresPlatelet reactivity was quantified using the Platelet Function Analyzer-100, with closure time (seconds required for blood, aspirated under high shear, to occlude a 150 µm aperture) serving as the primary endpoint. Closure times were categorised as ‘normal’ or ‘prolonged’, defined objectively as the 90th centile of the distribution for all participants enrolled in the study. Diagnosis of ACS was made using the standard criteria. The use of antiplatelet agents was not an exclusion criterion.ResultsClosure times for the study population ranged from 47 to 300 s, with a 90th centile value of 138 s. The proportion of patients with closure times ≥138 s was significantly higher in patients with non-cardiac symptoms (41/330; 12.4%) versus the ACS-positive cohort (2/105 (1.9%); p=0.0006). The specificity of ‘prolonged’ closure times (≥138 s) for a diagnosis of non-cardiac symptoms was 98.1%, with a positive predictive value of 95.4%. Multivariate analysis revealed that the closure time provided incremental, independent predictive value in the rule-out of ACS.ConclusionsPoint-of-care assessment of platelet reactivity is feasible in the ED and may facilitate the rapid rule-out of ACS in patients with prolonged closure times.

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Section: Resultssupporting

confidence: 81%

Point-of-care assessment of platelet reactivity in the emergency department may facilitate rapid rule-out of acute coronary syndromes: a prospective cohort pilot feasibility study

et al. 2014

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“…Comparison of the in-hospital and long term safety profile in terms of stent thrombosis and hemorrhagic complications among octogenarians between the BMS and DES groups remained similar as demonstrated by our study. Though the absence of differences in stent thrombosis and bleeding complications between the two groups may be partly explained by the limited number of events, it is comparable to and remained similar to other randomized studies [20][21][22][23].…”

Section: Discussionsupporting

confidence: 83%

Long term outcomes in octogenarians undergoing percutaneous coronary intervention: Comparison of bare metal versus drug eluting stent

Uthamalingam

Ahmado

Selvaraj

et al. 2015

International Journal of Cardiology

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“…Table 14 (Table S17) summarizes the quality of evidence and main fi ndings from our systematic review and meta-analysis of RCTs identifi ed by a systematic literature search (updated January 2010) comparing 1 month of dual antiplatelet therapy vs 6 to 12 months in patients undergoing PCI with placement of BMS. [89][90][91][92][93] The quality of evidence is rated as low because of risk of bias, indirectness (populations varied from PCI in ACS [PCI-CURE] to elective PCI in stable angina), and large imprecision in effect estimates for all outcomes. The results suggest that dual antiplatelet therapy for 6 to 12 months signifi cantly reduces MI (RR, 0.66) but does not confi rm or exclude a signifi cant effect on mortality, stroke, or major bleeds.…”

Section: Extended Duration Of Dual Antiplatelet Therapy Following Elementioning

confidence: 99%

Primary and Secondary Prevention of Cardiovascular Disease

Vandvik

Lincoff

Gore

et al. 2012

Chest

415

118

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Long-Term Versus Short-Term Clopidogrel Therapy in Patients Undergoing Coronary Stenting (from the Randomized Argentine Clopidogrel Stent [RACS] Trial)

Cited by 29 publications

References 6 publications

Point-of-care assessment of platelet reactivity in the emergency department may facilitate rapid rule-out of acute coronary syndromes: a prospective cohort pilot feasibility study

Point-of-care assessment of platelet reactivity in the emergency department may facilitate rapid rule-out of acute coronary syndromes: a prospective cohort pilot feasibility study

Long term outcomes in octogenarians undergoing percutaneous coronary intervention: Comparison of bare metal versus drug eluting stent

Primary and Secondary Prevention of Cardiovascular Disease

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