AIM: To investigate the impact of dual antiplatelet therapy (DAT) in patients on antivitamin K (AVK) regimen requiring percutaneous coronary intervention (PCI).METHODS: Between February 2006 and February 2008, 138 con...AIM: To investigate the impact of dual antiplatelet therapy (DAT) in patients on antivitamin K (AVK) regimen requiring percutaneous coronary intervention (PCI).METHODS: Between February 2006 and February 2008, 138 consecutive patients under chronic AVK treatment were enrolled in this registry. Of them, 122 received bare metal stent implantation and 16 received drug elutingstent implantation. The duration of DAT, on top of AVK treatment, was decided at the discretion of the clinician. Adequate duration of DAT was def ined according to type of stent implanted and to its clinical indication. RESULTS: The baseline clinical characteristics of patients reflect their high risk, with high incidence of comorbid conditions (Charlson score ≥ 3 in 89% of the patients). At a mean follow-up of 17 ± 11 mo, 22.9% of patients developed a major adverse cardiac event (MACE): 12.6% died from cardiovascular disease and almost 6% had an acute myocardial infarction. Major hemorrhagic events were observed in 7.4%. Adequate DAT was obtained in only 44% of patients. In the multivariate analysis, no adequate DAT and Charlson score were the only independent predictors of MACE (both P = 0.02). CONCLUSION: Patients on chronic AVK therapy represent a high risk population and suffer from a high MACE rate after PCI. An adequate DAT regimen and absence of comorbid conditions are strongly associated with better clinical outcomes.展开更多
Background No-reflow is associated with an adverse outcome and higher mortality in patients with ST-segment elevation acute myocardial infarction （STEMI） who undergo percutaneous coronary intervention （PCI） and is...Background No-reflow is associated with an adverse outcome and higher mortality in patients with ST-segment elevation acute myocardial infarction （STEMI） who undergo percutaneous coronary intervention （PCI） and is considered a dynamic process characterized by multiple pathogenetic components. The aim of this study was to investigate the effectiveness of a combination therapy for the prevention of no-reflow in patient with acute myocardial infarction （AMI） undergoing primary PCI. Methods A total of 621 patients with STEMI who underwent emergency primary PCI were enrolled in this study. Patients with high risk of no-reflow （no-flow score 〉 10, by using a no-flow risk prediction model, n = 216） were randomly divided into a controlled group （n = 108） and a combination therapy group （n = 108）. Patients in the controlled group received conventional treatment, while patients in combination therapy group received high-dose （80 mg） atorvastatin pre-treatment, intracoronary administration of adenosine （140 ~tg/min per kilogram） during PCI procedure, platelet membrane glycoprotein lib/Ilia receptor antagonist （tirofiban, 101.tg/kg bolus followed by 0.15 ~tg/kg per minute） and thrombus aspiration. Myocardial contrast echocardiography was performed to assess the myocardial perfusion 72 h after PCI. Major adverse cardiac events （MACE） were followed up for six months. Results Incidence of no-reflow in combination therapy group was 2.8%, which was similar to that in low risk group 2.7% and was significantly lower than that in control group （35.2%, P 〈 0.01）. The myocardial perfusion （A= 13） values were higher in combination therapy group than that in control group 72 h after PCI. After 6 months, there were six （6.3%） MACE events （one death, two non-fatal MIs and three revasculafizations） in combination therapy group and 12 （13.2%） （four deaths, three non-fatal MIs and five revascularizations, P 〈 0.05） in control group. Conclusions Combination of thrombus aspiration, high-dose statin pre-treatment, intmcoronary administration of adenosine during PCI procedure and platelet membrane glycoprotein Ⅱ b/Ⅲa receptor antagonist reduces the incidence of no-reflow after primary PCI in patients with acute myocardial infarction who are at high risk of no-reflow.展开更多
Long coronary lesions are associated with adverse outcomes after percutaneous coronary intervention since the era of plain balloon angioplasty. Long lesion and long stent length are considered as important predictors ...Long coronary lesions are associated with adverse outcomes after percutaneous coronary intervention since the era of plain balloon angioplasty. Long lesion and long stent length are considered as important predictors of restenosis after percutaneous coronary intervention. With the advent of newer generation drug eluting stents, there has been dramatic reduction in the rates of restenosis and repeat revascularization, even in complex cohort of patients with long coronary lesions. We report one such case of long coronary lesion which was intervened successfully with newer generation, thin strut, biodegradable polymer coated sirolimus-eluting stents.展开更多
Objective:To investigate the golden-time-awareness of and the necessary actions in response to acute myocardial infarction among the general public.Methods:This study was conducted with the use of a descriptive resear...Objective:To investigate the golden-time-awareness of and the necessary actions in response to acute myocardial infarction among the general public.Methods:This study was conducted with the use of a descriptive research design and convenience sampling.A sample of 800 subjects,using self-structured knowledge questionnaires,was selected for data collection and analysis.The study was conducted at Dr.M.G.R.Educational and Research Institute,India,from February to November 2022.Awareness of myocardial infarction symptoms and intervention timeline(the golden time)was investigated.A multivariate logistic regression analysis was performed to identify the demographic factors affecting the recognition of the golden time of acute myocardial infarction.Results:A total of 800 subjects were included.Among the subjects,367(45.8%)were male,433(54.2%)were female,and 443(55.3%)participants failed to recognize the golden time.Our multivariate logistic regression analysis showed that people with a bachelor’s degree(OR=0.41,95%CI:0.23-0.74,P=0.03)and a high school level diploma(OR=0.55,95%CI:0.31-0.97,P=0.03)are more likely to know about myocardial infarction(golden time)than illiterate people.Additionally,people who are employed(OR=0.59,95%CI:0.41-0.85,P=0.05)are more likely to know about myocardial infarction(golden time)than those who are not.Conclusions:The majority of people in the awareness group realize that taking myocardial infarction patients to the hospital would be the best course of action.The unawareness of the ideal treatment window for myocardial infarction may cause a delay in seeking medical attention,which can lead to an increase in mortality and morbidity.展开更多
Current percutaneous coronary intervention guidelines recommend dual antiplatelets(aspirin 100 mg + clopidogrel 75 mg daily) for at least 12 mo following drugeluting stent(DES) implantation if patients are not at high...Current percutaneous coronary intervention guidelines recommend dual antiplatelets(aspirin 100 mg + clopidogrel 75 mg daily) for at least 12 mo following drugeluting stent(DES) implantation if patients are not at high risk of bleeding.Several reports have tried to shorten the dual antiplatelet therapy to 3-6 mo,especially following next-generation DES implantation,for cost-effectiveness.However,the clinical results are inconsistent and the data regarding next-generation DESs limited.In this report,recently published important pivotal reports regarding the optimal duration of dual antiplatelets following DES implantation are summarized.展开更多
基金Supported by An EAPCI grant in Interventional Cardiology (to Brugaletta S)
文摘AIM: To investigate the impact of dual antiplatelet therapy (DAT) in patients on antivitamin K (AVK) regimen requiring percutaneous coronary intervention (PCI).METHODS: Between February 2006 and February 2008, 138 consecutive patients under chronic AVK treatment were enrolled in this registry. Of them, 122 received bare metal stent implantation and 16 received drug elutingstent implantation. The duration of DAT, on top of AVK treatment, was decided at the discretion of the clinician. Adequate duration of DAT was def ined according to type of stent implanted and to its clinical indication. RESULTS: The baseline clinical characteristics of patients reflect their high risk, with high incidence of comorbid conditions (Charlson score ≥ 3 in 89% of the patients). At a mean follow-up of 17 ± 11 mo, 22.9% of patients developed a major adverse cardiac event (MACE): 12.6% died from cardiovascular disease and almost 6% had an acute myocardial infarction. Major hemorrhagic events were observed in 7.4%. Adequate DAT was obtained in only 44% of patients. In the multivariate analysis, no adequate DAT and Charlson score were the only independent predictors of MACE (both P = 0.02). CONCLUSION: Patients on chronic AVK therapy represent a high risk population and suffer from a high MACE rate after PCI. An adequate DAT regimen and absence of comorbid conditions are strongly associated with better clinical outcomes.
文摘Background No-reflow is associated with an adverse outcome and higher mortality in patients with ST-segment elevation acute myocardial infarction （STEMI） who undergo percutaneous coronary intervention （PCI） and is considered a dynamic process characterized by multiple pathogenetic components. The aim of this study was to investigate the effectiveness of a combination therapy for the prevention of no-reflow in patient with acute myocardial infarction （AMI） undergoing primary PCI. Methods A total of 621 patients with STEMI who underwent emergency primary PCI were enrolled in this study. Patients with high risk of no-reflow （no-flow score 〉 10, by using a no-flow risk prediction model, n = 216） were randomly divided into a controlled group （n = 108） and a combination therapy group （n = 108）. Patients in the controlled group received conventional treatment, while patients in combination therapy group received high-dose （80 mg） atorvastatin pre-treatment, intracoronary administration of adenosine （140 ~tg/min per kilogram） during PCI procedure, platelet membrane glycoprotein lib/Ilia receptor antagonist （tirofiban, 101.tg/kg bolus followed by 0.15 ~tg/kg per minute） and thrombus aspiration. Myocardial contrast echocardiography was performed to assess the myocardial perfusion 72 h after PCI. Major adverse cardiac events （MACE） were followed up for six months. Results Incidence of no-reflow in combination therapy group was 2.8%, which was similar to that in low risk group 2.7% and was significantly lower than that in control group （35.2%, P 〈 0.01）. The myocardial perfusion （A= 13） values were higher in combination therapy group than that in control group 72 h after PCI. After 6 months, there were six （6.3%） MACE events （one death, two non-fatal MIs and three revasculafizations） in combination therapy group and 12 （13.2%） （four deaths, three non-fatal MIs and five revascularizations, P 〈 0.05） in control group. Conclusions Combination of thrombus aspiration, high-dose statin pre-treatment, intmcoronary administration of adenosine during PCI procedure and platelet membrane glycoprotein Ⅱ b/Ⅲa receptor antagonist reduces the incidence of no-reflow after primary PCI in patients with acute myocardial infarction who are at high risk of no-reflow.
文摘Long coronary lesions are associated with adverse outcomes after percutaneous coronary intervention since the era of plain balloon angioplasty. Long lesion and long stent length are considered as important predictors of restenosis after percutaneous coronary intervention. With the advent of newer generation drug eluting stents, there has been dramatic reduction in the rates of restenosis and repeat revascularization, even in complex cohort of patients with long coronary lesions. We report one such case of long coronary lesion which was intervened successfully with newer generation, thin strut, biodegradable polymer coated sirolimus-eluting stents.
文摘Objective:To investigate the golden-time-awareness of and the necessary actions in response to acute myocardial infarction among the general public.Methods:This study was conducted with the use of a descriptive research design and convenience sampling.A sample of 800 subjects,using self-structured knowledge questionnaires,was selected for data collection and analysis.The study was conducted at Dr.M.G.R.Educational and Research Institute,India,from February to November 2022.Awareness of myocardial infarction symptoms and intervention timeline(the golden time)was investigated.A multivariate logistic regression analysis was performed to identify the demographic factors affecting the recognition of the golden time of acute myocardial infarction.Results:A total of 800 subjects were included.Among the subjects,367(45.8%)were male,433(54.2%)were female,and 443(55.3%)participants failed to recognize the golden time.Our multivariate logistic regression analysis showed that people with a bachelor’s degree(OR=0.41,95%CI:0.23-0.74,P=0.03)and a high school level diploma(OR=0.55,95%CI:0.31-0.97,P=0.03)are more likely to know about myocardial infarction(golden time)than illiterate people.Additionally,people who are employed(OR=0.59,95%CI:0.41-0.85,P=0.05)are more likely to know about myocardial infarction(golden time)than those who are not.Conclusions:The majority of people in the awareness group realize that taking myocardial infarction patients to the hospital would be the best course of action.The unawareness of the ideal treatment window for myocardial infarction may cause a delay in seeking medical attention,which can lead to an increase in mortality and morbidity.
文摘Current percutaneous coronary intervention guidelines recommend dual antiplatelets(aspirin 100 mg + clopidogrel 75 mg daily) for at least 12 mo following drugeluting stent(DES) implantation if patients are not at high risk of bleeding.Several reports have tried to shorten the dual antiplatelet therapy to 3-6 mo,especially following next-generation DES implantation,for cost-effectiveness.However,the clinical results are inconsistent and the data regarding next-generation DESs limited.In this report,recently published important pivotal reports regarding the optimal duration of dual antiplatelets following DES implantation are summarized.
