scholarly journals Cangrelor Use in Routine Practice: A Two-Center Experience

2021 ◽  
Vol 10 (13) ◽  
pp. 2829
Author(s):  
Niels M. R. van der Sangen ◽  
Ho Yee Cheung ◽  
Niels J. W. Verouden ◽  
Yolande Appelman ◽  
Marcel A. M. Beijk ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Stent Thrombosis ◽  
Major Bleeding ◽  
Cox Regression ◽  
Tertiary Care ◽  
Routine Practice ◽  
Data Mining Algorithm ◽  
P2y12 Inhibitor ◽  
St Segment Elevation ◽  
Definite Stent Thrombosis

Cangrelor is the first and only intravenous P2Y12-inhibitor and is indicated when (timely) administration of an oral P2Y12 inhibitor is not feasible in patients undergoing percutaneous coronary intervention (PCI). Our study evaluated the first years of cangrelor use in two Dutch tertiary care centers. Cangrelor-treated patients were identified using a data-mining algorithm. The cumulative incidences of all-cause death, myocardial infarction, definite stent thrombosis and major bleeding at 48 h and 30 days were assessed using Kaplan–Meier estimates. Predictors of 30-day mortality were identified using uni- and multivariable Cox regression models. Between March 2015 and April 2021, 146 patients (median age 63.7 years, 75.3% men) were treated with cangrelor. Cangrelor was primarily used in ST-segment elevation myocardial infarction (STEMI) patients (84.2%). Approximately half required cardiopulmonary resuscitation (54.8%) or mechanical ventilation (48.6%). The cumulative incidence of all-cause death was 11.0% and 25.3% at 48 h and 30 days, respectively. Two cases (1.7%) of definite stent thrombosis, both resulting in myocardial infarction, occurred within 30 days, but after 48 h. No other cases of recurrent myocardial infarction transpired within 30 days. Major bleeding occurred in 5.6% and 12.5% of patients within 48 h and 30 days, respectively. Cardiac arrest at presentation was an independent predictor of 30-day mortality (adjusted hazard ratio 5.20, 95%-CI: 2.10–12.9, p < 0.01). Conclusively, cangrelor was used almost exclusively in STEMI patients undergoing PCI. Even though cangrelor was used in high-risk patients, its use was associated with a low rate of stent thrombosis.

scholarly journals Changes in demographics, clinical practices and long-term outcomes of patients with ST segment-elevation myocardial infarction who underwent coronary revascularisation in the past two decades: cohort study

BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e043683
Author(s):  
Yasuaki Takeji ◽  
Hiroki Shiomi ◽  
Takeshi Morimoto ◽  
Yusuke Yoshikawa ◽  
Ryoji Taniguchi ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Stent Thrombosis ◽  
Major Bleeding ◽  
Cardiac Death ◽  
Cardiovascular Death ◽  
Coronary Revascularisation ◽  
Clinical Practices ◽  
St Segment Elevation ◽  
St Segment ◽  
Definite Stent Thrombosis

ObjectiveTo evaluate changes in demographics, clinical practices and long-term clinical outcomes of patients with ST segment-elevation myocardial infarction (STEMI) before and beyond 2010.DesignMulticentre retrospective cohort study.SettingThe Coronary Revascularization Demonstrating Outcome Study in Kyoto (CREDO-Kyoto) AMI Registries Wave-1 (2005–2007, 26 centres) and Wave-2 (2011–2013, 22 centres).Participants9001 patients with STEMI who underwent coronary revascularisation (Wave-1: 4278 patients, Wave-2: 4723 patients).Primary and secondary outcome measuresThe primary outcome was all-cause death at 3 years. The secondary outcomes were cardiovascular death, cardiac death, sudden cardiac death, non-cardiovascular death, non-cardiac death, myocardial infarction, definite stent thrombosis, stroke, hospitalisation for heart failure, major bleeding, target vessel revascularisation, ischaemia-driven target vessel revascularisation, any coronary revascularisation and any ischaemia-driven coronary revascularisation.ResultsPatients in Wave-2 were older, more often had comorbidities and more often presented with cardiogenic shock than those in Wave-1. Patients in Wave-2 had shorter onset-to-balloon time and door-to-balloon time, were more frequently implanted drug-eluting stents, and received guideline-directed medication than those in Wave-1. The cumulative 3-year incidence of all-cause death was not significantly different between Wave-1 and Wave-2 (15.5% and 15.7%, p=0.77). The adjusted risk of all-cause death in Wave-2 relative to Wave-1 was not significant at 3 years (HR 0.92, 95% CI 0.83 to 1.03, p=0.14), but lower beyond 30 days (HR 0.86, 95% CI 0.75 to 0.98, p=0.03). The adjusted risks of Wave-2 relative to Wave-1 were significantly lower for definite stent thrombosis (HR 0.59, 95% CI 0.43 to 0.81, p=0.001) and for any coronary revascularisation (HR 0.75, 95% CI 0.69 to 0.81, p<0.001), but higher for major bleeding (HR 1.34, 95% CI 1.20 to 1.51, p=0.005).ConclusionsWe could not demonstrate improvement in 3-year mortality risk from Wave-1 to Wave-2, but we found reduction in mortality risk beyond 30 days. We also found risk reduction for definite stent thrombosis and any coronary revascularisation, but an increase in the risk of major bleeding from Wave-1 to Wave-2.

scholarly journals Short dual antiplatelet therapy followed by P2Y12 inhibitor monotherapy vs. prolonged dual antiplatelet therapy after percutaneous coronary intervention with second-generation drug-eluting stents: a systematic review and meta-analysis of randomized clinical trials

2020 ◽  
Author(s):  
Daniele Giacoppo ◽  
Yuji Matsuda ◽  
Luca Nai Fovino ◽  
Gianpiero D’Amico ◽  
Giuseppe Gargiulo ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Antiplatelet Therapy ◽  
Stent Thrombosis ◽  
Random Effects ◽  
Major Bleeding ◽  
Second Generation ◽  
Randomized Clinical Trials ◽  
Dual Antiplatelet Therapy ◽  
Random Effects Model ◽  
P2y12 Inhibitor

Abstract Aims After percutaneous coronary intervention (PCI) with second-generation drug-eluting stent (DES), whether short dual antiplatelet therapy (DAPT) followed by single antiplatelet therapy (SAPT) with a P2Y12 receptor inhibitor confers benefits compared with prolonged DAPT is unclear. Methods and results Multiple electronic databases, including PubMed, Scopus, Web of Sciences, Ovid, and ScienceDirect, were searched to identify randomized clinical trials comparing ≤3 months of DAPT followed by P2Y12 inhibitor SAPT vs. 12 months of DAPT after PCI with second-generation DES implantation. The primary and co-primary outcomes of interest were major bleeding and stent thrombosis 1 year after randomization. Summary hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated by fixed-effect and random-effects models. Multiple sensitivity analyses including random-effects models 95% CI adjustment were applied. A sensitivity analysis comparing trials using P2Y12 inhibitor SAPT with those using aspirin SAPT was performed. A total of five randomized clinical trials (32 145 patients) were available. Major bleeding was significantly lower in the patients assigned to short DAPT followed by P2Y12 inhibitor SAPT compared with those assigned to 12-month DAPT (random-effects model: HR 0.63, 95% 0.45–0.86). No significant differences between groups were observed in terms of stent thrombosis (random-effects model: HR 1.19, 95% CI 0.86–1.65) and the secondary endpoints of all-cause death (random-effects model: HR 0.85, 95% CI 0.70–1.03), myocardial infarction (random-effects model: HR 1.05, 95% CI 0.89–1.23), and stroke (random-effects model: HR 1.08, 95% CI 0.68–1.74). Sensitivity analyses showed overall consistent results. By comparing trials testing ≤3 months of DAPT followed by P2Y12 inhibitor SAPT vs. 12 months of DAPT with trials testing ≤3 months of DAPT followed by aspirin SAPT vs. 12-month of DAPT, there was no treatment-by-subgroup interaction for each endpoint. By combining all these trials, regardless of the type of SAPT, short DAPT was associated with lower major bleeding (random-effects model: HR 0.63, 95% CI 0.48–0.83) and no differences in stent thrombosis, all-cause death, myocardial infarction, and stroke were observed between regimens. Conclusion After second-generation DES implantation, 1–3 months of DAPT followed by P2Y12 inhibitor SAPT is associated with lower major bleeding and similar stent thrombosis, all-cause death, myocardial infarction, and stroke compared with prolonged DAPT. Whether P2Y12 inhibitor SAPT is preferable to aspirin SAPT needs further investigation.

scholarly journals Demographics, practice patterns and long-term outcomes of patients with non–ST-segment elevation acute coronary syndrome in the past two decades: the CREDO-Kyoto Cohort-2 and Cohort-3

BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e044329
Author(s):  
Yasuaki Takeji ◽  
Hiroki Shiomi ◽  
Takeshi Morimoto ◽  
Yusuke Yoshikawa ◽  
Ryoji Taniguchi ◽  
...  
Keyword(s):  
Stent Thrombosis ◽  
Major Bleeding ◽  
Cardiac Death ◽  
Cardiovascular Death ◽  
Coronary Revascularisation ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
The Past ◽  
St Segment ◽  
Definite Stent Thrombosis

ObjectivesTo evaluate patient characteristics and long-term outcomes in patients with non–ST-segment elevation acute coronary syndrome (NSTEACS) in the past two decades.DesignMulticenter retrospective study.SettingThe Coronary REvascularization Demonstrating Outcome Study in Kyoto (CREDO-Kyoto) percutaneous coronary intervention (PCI)/coronary artery bypass grafting (CABG) Registry Cohort-2 (2005–2007) and Cohort-3 (2011–2013).Participants3254 patients with NSTEACS who underwent first coronary revascularisation.Primary and secondary outcome measuresThe primary outcome was all-cause death. The secondary outcomes were cardiovascular death, cardiac death, sudden cardiac death, non-cardiovascular death, non-cardiac death, myocardial infarction, definite stent thrombosis, stroke, hospitalisation for heart failure, major bleeding, any coronary revascularisation and target vessel revascularisation.ResultsPatients in Cohort-3 were older and more often had heart failure at admission than those in Cohort-2. The prevalence of PCI, emergency procedure and guideline-directed medical therapy was higher in Cohort-3 than in Cohort-2. In patients who received PCI, the prevalence of transradial approach, drug-eluting stent use and intravascular ultrasound use was higher in Cohort-3 than in Cohort-2. There was no change in 3-year adjusted mortality risk from Cohort-2 to Cohort-3 (HR 1.00, 95% CI 0.83 to 1.22, p=0.97). Patients in Cohort-3 compared with those in Cohort-2 were associated with lower adjusted risks for stroke (HR 0.65, 95% CI 0.46 to 0.92, p=0.02) and any coronary revascularisation (HR 0.76, 95%CI 0.66 to 0.87, p<0.001), but with higher risk for major bleeding (HR 1.25, 95% CI 1.06 to 1.47, p=0.008). The unadjusted risk for definite stent thrombosis was lower in Cohort-3 than in Cohort 2 (HR 0.29, 95% CI 0.11 to 0.67, p=0.003).ConclusionsIn the past two decades, we did not find improvement for mortality in patients with NSTEACS. We observed a reduction in the risks for definite stent thrombosis, stroke and any coronary revascularisation, but an increase in the risk for major bleeding.

scholarly journals Ticagrelor Versus Clopidogrel in ST Segment Elevation Myocardial Infarction Patients Candidate for Primary Percutaneous Coronary Intervention

2021 ◽  
pp. 263246362110048
Author(s):  
Hassan Mohamed Ebeid ◽  
Hossameldin Abdelkhalek Rasmy Mohamed ◽  
Khaled Ahmed Elkhashab ◽  
Mohamed Abdulaziz Aljarallah ◽  
Mai Magedi Abdo ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Stent Thrombosis ◽  
Coronary Intervention ◽  
Platelet Inhibitors ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Percutaneous Coronary ◽  
History Of ◽  
Definite Stent Thrombosis

Objective: To evaluate the incidence rate of definite stent thrombosis and major adverse cardiovascular events (MACE) with Ticagrelor versus Clopidogrel in ST segment elevation myocardial infarction (STEMI) patients candidate for primary percutaneous coronary intervention (PCI). Methods: STEMI participants naïve to antiplatelets, with no history of coronary artery disease (CAD) and candidate for primary PCI were included, while participants with history of CAD were excluded. Two hundred consecutive participants were selected, divided into 2 groups of 100 participants each, received either Ticagrelor or Clopidogrel, and followed up at 3 and 6 months. Results: The percent of patients in the Ticagrelor group who developed definite stent thrombosis (in-hospital and total) was 0%, while the percent of patients in the Clopidogrel group who developed definite stent thrombosis (in-hospital and total) was 8% and 9%, respectively. There were statistically significant weak associations between the class of P2Y12 platelet inhibitors and definite stent thrombosis (in-hospital and total) (X2 = 8.33, P = .004, V = 0.204 and Χ2 = 9.424, P = .002, V = 0.217, respectively). The percent of patients in the Ticagrelor and Clopidogrel groups who developed in-hospital MACE was 1% and 9%, respectively. There was a statistically weak significant association between the class of P2Y12 platelet inhibitors and in-hospital MACE (X2 = 6.74, P = .009, V = 0.184). Conclusion: Ticagrelor is more efficacious than Clopidogrel in preventing definite stent thrombosis (in-hospital and total) and in-hospital MACE in STEMI patients.

Predictors and clinical implications of stent thrombosis in patients with ST-segment elevation myocardial infarction

2013 ◽  
Vol 168 (3) ◽  
pp. 2632-2636 ◽  
Author(s):  
Salvatore Brugaletta ◽  
Manel Sabate ◽  
Victoria Martin-Yuste ◽  
Monica Masotti ◽  
Yoshitaka Shiratori ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Stent Thrombosis ◽  
Clinical Implications ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment

scholarly journals ST-Segment Elevation Myocardial Infarction Due to Early and Late Stent Thrombosis

2008 ◽  
Vol 51 (25) ◽  
pp. 2396-2402 ◽  
Author(s):  
Tania Chechi ◽  
Sabine Vecchio ◽  
Guido Vittori ◽  
Gabriele Giuliani ◽  
Alessio Lilli ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Stent Thrombosis ◽  
Late Stent Thrombosis ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment

Abstract 2567: Paclitaxel Eluting Stents are associated with a high rate of Stent Thrombosis compared to Bare Metal Stents in an Underserved Hispanic Population Presenting with Acute ST Segment Myocardial Infarction

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Atman P Shah ◽  
David M Shavelle ◽  
Kathleen Swenson ◽  
Sandra Jaquez ◽  
Michelle Martinez ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Tertiary Care ◽  
Bare Metal Stents ◽  
High Rate ◽  
Metal Stents ◽  
Care Hospital ◽  
Cardiac Events ◽  
St Segment Elevation ◽  
St Segment ◽  
Hispanic Patients

Background: Paclitaxel-eluting stents (PES) are shown to reduce restenosis and target lesion revascularization (TLR). The effectiveness of PES in Hispanic patients who present with acute myocardial infarction with ST segment elevation (STEMI) is not well established. Methods: A non-randomized, retrospective analysis was performed on 236 Hispanic patients presenting with STEMI between 8/2002 and 4/2006 at an academic tertiary care hospital serving a primarily indigent population. 150 patients received a PES and 86 received an uncoated stent (BMS). The incidence of cardiac death, myocardial infarction (MI), TLR, subacute thrombosis (SAT), and a composite of these major adverse cardiac events (MACE) was assessed at 1 year. Results: Baseline clinical characteristics in both groups revealed no statistically significant differences. All patients had clinical follow up at one year. There were statistically significant reductions in MI [2.0% (n=3 PES) vs. 10.5% (n=9 BMS), p=0.037] and TLR [6.0% (9) vs. 18.6% (16), p=0.04]. There was no difference in death [0.7% (1) vs. 1.1% (1), p=0.99]. SAT was increased in the PES group (6.0%, n=9) compared to the BMS group (1.1%, n=1, p=0.03). MACE was 14.7% in the PES group and 31.2% in the BMS group (p=0.017). Premature clopidogrel discontinuation (<6 months) was the etiology of SAT in 8 of the 9 patients. Conclusions: Use of DES is associated with lower rates of MI and TLR in Hispanics presenting with STEMI. There is an increased incidence of SAT in this population primarily due to premature clopidogrel discontinuation. The role of socioeconomic factors in premature antiplatelet discontinuation and its effects on SAT need further evaluation.

Abstract 17927: Bayesian Hierarchical Meta-Analysis Clarifies the Trade-Off Between Bleeding and Stent Thrombosis in Trials Comparing Bivalirudin with Heparin During Percutaneous Coronary Intervention

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
John A Bittl ◽  
Christopher D Lang
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Stent Thrombosis ◽  
Major Bleeding ◽  
Coronary Intervention ◽  
Platelet Glycoprotein ◽  
Bayesian Hierarchical ◽  
Percutaneous Coronary ◽  
Meta Analyses ◽  
Glycoprotein Inhibitors ◽  
Definite Stent Thrombosis

Introduction: Calculating the net benefit between bleeding risks and ischemic complications of antithrombotic therapy remains challenging. Hypothesis: Hierarchical meta-analyses may allow inferences to be made about the parameter θ, which reflects the underlying hypothesis that one therapy is superior to another conditional on the types of risks associated with various end points in clinical trials. Methods: We employed Bayesian hierarchical meta-analyses of 10 randomized clinical trials randomizing 34,658 patients to either bivalirudin or heparin, with or without platelet glycoprotein inhibitors, during percutaneous coronary intervention (PCI). Results: No difference was seen in the rate of death 30 days after using bivalirudin or heparin (OR 1.01, 95% Bayesian credible interval [BCI] 0.79-1.28), but the risk of major bleeding was lower (OR 0.58, 95% BCI 0.38-0.84) and the risk of definite stent thrombosis (ST) was higher (OR 1.86, 95% BCI 1.19-2.94) after using bivalirudin than after using heparin. For every 100 patients, using bivalirudin in place of heparin prevented 4.1 episodes of major bleeding episodes but caused 0.8 episode of definite ST. (Figure Legend: Probability density functions normalized to 1 for risk of major bleeding, death and definite stent thrombosis at 30 days after treatment with bivalirudin or heparin, with or without platelet glycoprotein inhibitors.) Conclusions: Neither bivalirudin nor heparin emerges as a preferred strategy in an analysis that accounts for mortality differences. Because bivalirudin reduces major bleeding at the cost of increased stent thrombosis, decisions between bivalirudin and heparin based on baseline bleeding risk and ST risk are likely to maximize net clinical benefit.

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