Management of acute myocardial infarction in patients presenting with persistent ST-segment elevation

Werf, Frans Van de; Bax, Jeroen J.; Betriu, Amadeo; Blomström‐Lundqvist, Carina; Crea, Filippo; Falk, Volkmar; Fox, Keith A.A.; Huber, Kurt; Kastrati, Adnan; Rosengren, Annika; Steg, Philippe Gabriel; Tubaro, Marco; Verheugt, Freek W.A.; Weidinger, Franz; Weis, Michael; Vahanian, Alec; Camm, John; Caterina, Raffaele De; Dean, Veronica; Dickstein, Kenneth; Filippatos, Gerasimos; Funck‐Brentano, Christian; Hellemans, Irene; Kristensen, Steen Dalby; McGregor, Keith; Sechtem, Udo; Tendera, Michał; Widimský, Petr; Zamorano, José Luís; Silber, Sigmund; Aguirre, Frank V.; Al‐Attar, Nawwar; Alegría, Eduardo; Andreotti, Felicita; Benzer, Werner; Breithardt, Ole A.; Danchin, N.; Mario, Carlo Di; Dudek, Dariusz; Gulba, Dietrich C.; Halvorsen, Sigrun; Kaufmann, Philipp A.; Kornowski, Ran; Lip, Gregory Y.H.; Rutten, Frans H.

doi:10.1093/eurheartj/ehn416

Cited by 1,850 publications

(289 citation statements)

References 246 publications

Supporting

Mentioning

265

Contrasting

Unclassified

Order By: Relevance

“…As the concomitant use of an antiplatelet drug and an oral anticoagulant is associated with bleeding 25, this combination should be avoided. However, there are indications, such as for those with atrial fibrillation undergoing coronary stenting, in whom the combination is indicated 14. In any antiplatelet drug users and in aspirin users, diabetes and hypercholesterolaemia were significantly associated with a lower risk of nonpersistence.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Patterns of antiplatelet drug use after a first myocardial infarction during a 10‐year period

Yasmina

Boer

Deneer

et al. 2016

Brit J Clinical Pharma

View full text Add to dashboard Cite

AimsThe aims of the present study were to assess antiplatelet drug use patterns after a first myocardial infarction (MI) and to evaluate the determinants of antiplatelet nonpersistence.MethodsThe present study was conducted in 4690 patients from the Utrecht Cardiovascular Pharmacogenetics cohort with a first MI between 1986 and 2010, who were followed for a maximum of 10 years. Medication use and event diagnosis were obtained from the Dutch PHARMO Record Linkage System. Antiplatelet drug users were classified as persistent users (gap between prescriptions ≤90 days), nonpersistent users (>90‐day gap and no refills), and restarters (a new prescription after a >90‐day gap). The association between potential determinants and antiplatelet nonpersistence was analysed using Cox regression.ResultsThe proportions of persistent users decreased from 84.0% at the 1‐year follow‐up to 32.8% at 10 years for any antiplatelet drug, and 77.3% to 27.5% for aspirin; and 39.0% to 6.4% for clopidogrel at 6 years. Most nonpersistent users restarted antiplatelet drugs later, leading to 89.3% overall antiplatelet drug users at 10 years after MI. Diabetes (hazard ratio [HR] 0.44; 0.32–0.60), hypertension (HR 0.77; 0.60–0.99), hypercholesterolaemia (HR 0.49; 0.39–0.62) and more recent MI diagnosis period (2003–2007: HR 0.69, 0.61–0.79; 2008–2010: HR 0.38, 0.19–0.77, compared to ≤ 2002 period) lowered the risk of antiplatelet nonpersistence, while vitamin K antagonist (VKA) comedication (HR 18.97; 16.91–21.28) increased this risk.ConclusionsA large proportion of patients with a first MI still used antiplatelet drugs after 10 years. The frequent discontinuations during this time frame are expected to reduce the effectiveness of antiplatelet drugs as secondary prevention of cardiovascular diseases. Diabetes, hypertension, hypercholesterolaemia, VKA comedication and MI diagnosis period were determinants of antiplatelet nonpersistence.

show abstract

Section: Discussionmentioning

confidence: 99%

“…The periods were ≤2002, 2003–2007 and 2008–2010. These periods were categorized based on the year when the ESC guidelines for MI 5, 12, 13, 14 were published. Adherence to antiplatelet drugs was reported as the average percentage, and the mean differences were analysed using the independent t ‐test.…”

Section: Methodsmentioning

confidence: 99%

Patterns of antiplatelet drug use after a first myocardial infarction during a 10‐year period

Yasmina

Boer

Deneer

et al. 2016

Brit J Clinical Pharma

View full text Add to dashboard Cite

show abstract

“…However, the indirect measures of the area at risk, myocardial reperfusion effectiveness, and enzymatic infarct size did not differ between groups. Third, the patients were treated with standard-of-care therapy for STEMI, accordingly to the current ESC guidelines, with the exception of the mineralocorticoid antagonists which were used in one-fourth of the patients with the indication to this specific treatment; this was in part due to the temporal trend of study enrollment that started in early 2007, almost 2 years before the implementation of the use of MRA in the ESC guidelines for STEMI patient [42]. It is, therefore, possible that the magnitude of the benefit we have observed with doxycycline might be reduced by treating with a MRA all the patients with this indication.…”

Section: Discussionmentioning

confidence: 99%

Effects of a timely therapy with doxycycline on the left ventricular remodeling according to the pre-procedural TIMI flow grade in patients with ST-elevation acute myocardial infarction

et al. 2014

View full text Add to dashboard Cite

Doxycycline has been demonstrated to reduced left ventricular (LV) remodeling, but its effect in patients with ST-elevation myocardial infarction (STEMI) and a baseline occluded [thrombolysis in myocardial infarction (TIMI) flow grade B1] infarct-related artery (IRA) is unknown. According to the baseline TIMI flow grade, 110 patients with a first STEMI were divided into 2 groups. Group 1: 77 patients with TIMI flow B1 (40 patients treated with doxycycline and 37 with standard therapy, respectively), and a Group 2: 33 patients with TIMI flow 2-3 (15 patients treated with doxycycline and 18 with standard therapy, respectively). The two randomized groups were well matched in baseline characteristics. A 2D-Echo was performed at baseline and at 6 months, together with a coronary angiography, for the remodeling and IRA patency assessment, respectively. The LV end-diastolic volume index ( [1,3,4], and patient outcome [5,6]. Conversely, an occluded IRA (TIMI flow grade B1) before primary PCI, which is observed in almost 2/3 of patients with STEMI [2], is associated with increased LV remodeling despite an optimal epicardial mechanical recanalization (post-PCI TIMI flow grade 3) [4]. This ominous relationship between low baseline TIMI flow grade and LV remodeling has been attributed to different factors [7][8][9] including a greater ischemia/reperfusion injury [10].In patients with STEMI and LV dysfunction successfully treated with primary PCI, we recently demonstrated that a timely short-term therapy with doxycycline, the most potent metalloproteinases (MMPs) inhibitor of the tetracycline class of antibiotics, reduced both 6-month LV remodeling and infarct size [11]. Several pleiotropic properties of doxycycline related mainly to its ability to act as metalloproteinases (MMPs) inhibitor can explain these beneficial effects [12].

show abstract

“…Th ey were treated with primary percutaneous coronary intervention (PCI) at Department of Cardiology, Sestre milosrdnice University Hospital Center (September 2011 -September 2012). Th e diagnosis was established and primary PCI performed using the criteria of the European Society of Cardiology 7,8 . Th e inclusion criteria were presenting within 12 h from the onset of symptoms (history of chest pain/discomfort lasting for 10-20 minutes or more, not responding fully to nitroglycerine), persistent ST-segment elevation on electrocardiography in at least two consecutive leads, or (presumed) new left bundle-branch block, and elevated cardiac laboratory biomarkers (cardiac troponin T (cTnT) and creatine kinase (CK)).…”

Section: Patient Populationmentioning

confidence: 99%

The Role of Anthropometry in Acute St-Elevation Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention

Jelavić¹,

Babić

Pintarić³

et al. 2016

ACC

View full text Add to dashboard Cite

SUMMARY -Th e aim of this study was to investigate the controversial infl uence of anthropometry on clinical severity and prognosis of acute ST-elevation myocardial infarction (STEMI). We prospectively analyzed 250 patients with acute STEMI treated with primary percutaneous coronary intervention (September 2011 -September 2012. Th ey were grouped according to the following anthropometric parameters: body mass index (BMI) (<25.0, 25.0-29.9, ≥30.0 kg/m²), waist circumference (WC) (<102/88, ≥102/88 cm), waist-to-hip ratio (WHR) (<0.90/0.85, ≥0.90/0.85) and waistto-height ratio (WHtR) (<53/49, 53/49-62/57, ≥63/58). Th e groups were analyzed by baseline, as well as severity (clinical, laboratory, echocardiography, coronary angiography, in-hospital complications) and prognostic parameters (major adverse cardiovascular events and sick leave duration during 12-month follow up). Patients with BMI <25.0 kg/m 2 had the highest rates of dyspnea and those with BMI ≥30.0 kg/m² had the longest hospitalization and widest stents; patients with WHR ≥0.90/0.85 had higher rates of signifi cantly stenosed proximal/middle coronary segments, while those with WHtR ≥63/58 had the highest rates of heart failure and total in-hospital complications (p<0.05). BMI <25.0 kg/m 2 increased (odds ratio (OR) 2.00, confi dence interval (CI) [1.09-3.68], p=0.026) and BMI 25.0-29.9 kg/m 2 reduced (OR 0.52, CI [0.30-0.91], p=0.022) the risk of dyspnea; WHR ≥0.90/0.85 increased the risk of signifi cant proximal/middle coronary segment stenosis (OR 3.34,.86], p=0.029) and WHtR ≥63/58 the risk of heart failure (OR 2.05, CI [1.13-3.71], p=0.017) and total in-hospital complications (OR 1.94,], p=0.017) (p<0.05). In conclusion, WHR and WHtR are better anthropometric parameters than BMI in predicting acute STEMI severity, while WC has no infl uence on it. Anthropometry has no infl uence on prognosis.

show abstract

Management of acute myocardial infarction in patients presenting with persistent ST-segment elevation

Cited by 1,850 publications

References 246 publications

Patterns of antiplatelet drug use after a first myocardial infarction during a 10‐year period

Patterns of antiplatelet drug use after a first myocardial infarction during a 10‐year period

Effects of a timely therapy with doxycycline on the left ventricular remodeling according to the pre-procedural TIMI flow grade in patients with ST-elevation acute myocardial infarction

The Role of Anthropometry in Acute St-Elevation Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention

Contact Info

Product

Resources

About