- Outcomes in newly diagnosed atrial fibrillation and history of acute coronary syndromes: insights from GARFIELD-AF. [Journal Article]
- AJAm J Med 2019 Jul 12
- CONCLUSIONS: In GARFIELD-AF, previous acute coronary syndromes are associated with worse 2-year outcomes and a greater likelihood of under-treatment with OAC, while two-thirds of patients receive AP therapy. Major bleeding was more common with previous acute coronary syndromes, even after adjusting for all risk factors.
- Antiplatelet treatment in acute coronary syndrome patients: Real-world data from the START-Antiplatelet Italian Registry. [Journal Article]
- PlosPLoS One 2019; 14(7):e0219676
- CONCLUSIONS: The analysis of the register has documented that both ticagrelor and prasugrel are associated with a statistically significant reduced total and cardiovascular mortality but both do not show a significant increased incidence of major and minor bleedings with respect to clopidogrel.
- Impact of Post-Discharge Bleeding on Long-Term Mortality in Percutaneous Coronary Intervention Patients Taking Oral Anticoagulants. [Journal Article]
- JCJ Cardiovasc Pharmacol 2019 Jul 11
- Although post-discharge bleeding (PDB) are known to negatively affect long-term outcome in patients undergoing percutaneous coronary intervention (PCI) with antiplatelet therapy (APT), the prognostic…
Although post-discharge bleeding (PDB) are known to negatively affect long-term outcome in patients undergoing percutaneous coronary intervention (PCI) with antiplatelet therapy (APT), the prognostic importance of PDB in patients who require both oral anticoagulant (OAC) and APT has not been fully elucidated. Among 3718 consecutive patients who underwent PCI, 302 patients were treated with both OAC and APT. We evaluated the association between PDB and 3-year all-cause mortality, as estimated by a time-updated Cox proportional hazard regression model. We performed nearest-neighbor matching on propensity score to adjust the differences of baseline characteristics. Among 302 patients treated with OAC and APT, PDB was observed in 98 patients at a median time of 239 days. Patients experienced PDB had significantly higher incidence of 3-year all-cause mortality in the overall cohort and 94 propensity-score matched pairs (hazard ratio [HR] 6.21, 95% confidence interval [CI] 3.29-11.72, p < 0.0001; and HR 6.13, 95% CI 2.68-14.02, p < 0.0001, respectively). The risk of subsequent mortality was the highest within 180 days after PDB (58.3% within 180 days, and 75.0 % within 1 year). In conclusion, PDB was significantly associated with long-term mortality in patients taking both OACs and APT after PCI.
- Antithrombotic Therapy in Patients with Atrial Fibrillation and Coronary Artery Disease Undergoing Percutaneous Coronary Intervention. [Journal Article]
- JCJ Cardiovasc Pharmacol 2019 Jul 11
- CONCLUSIONS: In conclusion, tailoring therapy to the individual patient is recommended considering the ischemic and bleeding risk as well as the risk for thromboembolism. For most AF patients 1 month of TT, and subsequently DT for additional 11 months is recommended.
- Ticagrelor vs Clopidogrel in Patients With Acute Coronary Syndromes Undergoing Percutaneous Coronary Intervention: Insights From a Single Institution Registry. [Journal Article]
- JIJ Invasive Cardiol 2019 Jul 15
- Dual-antiplatelet therapy is recommended for all patients with acute coronary syndromes (ACS), regardless of performance of revascularization. Ticagrelor (T) was shown to be superior to clopidogrel (…
Dual-antiplatelet therapy is recommended for all patients with acute coronary syndromes (ACS), regardless of performance of revascularization. Ticagrelor (T) was shown to be superior to clopidogrel (C) in a large, randomized clinical trial, but data from real-world practice are lacking. We identified ACS patients from our institutional registry who underwent percutaneous coronary intervention and received one of the two drugs at hospital discharge based on physician preference. Among 1439 patients, there were 774 patients (53.8%) in the C group and 665 patients (46.2%) in the T group. T and C patients were similar except for a higher incidence of ST-elevation myocardial infarction (MI) and lower frequency of prior MI in the T group (P<.05 for both). The primary endpoint - 1-year all-cause death - occurred in 58 C patients and 48 T patients (6.9% vs 7.9%, respectively; P=.42). Sixty percent of these deaths (n = 62; 31 C and 31 T) were considered cardiovascular in nature based on chart review. By multivariable logistic regression model, only dialysis (hazard ratio [HR], 2.64; 95% confidence interval [CI], 1.50-4.64; P=.01), age (HR, 1.83; 95% CI, 1.49-2.24 per 10 years; P<.001), and prior heart failure (HR, 1.78; 95% CI, 1.12-2.82; P=.02) were independent predictors of 1-year death. Treatment with T was not a predictor of death (HR, 1.21; 95% CI, 0.81-1.82; P=.35) or cardiovascular death (HR, 1.18; 95% CI, 0.72-1.94; P=.52). Landmark analysis from day 10 showed similar results (HR, 1.13; 95% CI, 0.71-1.84; P=.59). Thus, we conclude that C and T have similar rates of 1-year all-cause mortality, which is predominantly affected by age, end-stage renal disease, and pre-existing heart failure.
- Interaction between serum endotoxemia and proprotein convertase subtilisin/kexin 9 (PCSK9) in patients with atrial fibrillation: A post-hoc analysis from the ATHERO-AF cohort. [Journal Article]
- AAtherosclerosis 2019 Jul 04
- CONCLUSIONS: This study demonstrated, for the first time in vivo, that circulating levels of PCSK9 and LPS are associated with a mechanism possibly involving NADPH oxidase activation. Patients with concomitant increase of PCSK9 and LPS showed a higher risk of CVEs.
- Prevention of Stroke in Atrial Fibrillation After Coronary Stenting. [Journal Article]
- SStroke 2019 Jul 15; :STROKEAHA119026078
- Background and Purpose- The optimal antithrombotic strategy to balance thromboembolic and bleeding events, especially acute stroke, for patients with atrial fibrillation following coronary stenting r…
Background and Purpose- The optimal antithrombotic strategy to balance thromboembolic and bleeding events, especially acute stroke, for patients with atrial fibrillation following coronary stenting remains a matter of debate. We conducted a network meta-analysis to identify the antithrombotic regimen associated with the lowest rate of bleeding and thromboembolic events in atrial fibrillation after coronary stenting. Methods- PubMed, Scopus, and Cochrane Central were searched for randomized controlled trials and observational studies of patients with atrial fibrillation after coronary stenting. The outcomes of interest were stroke, myocardial infarction, major adverse cardiac events, mortality, and major bleeding. A network meta-analysis was performed comparing the available antithrombotic regimens in the literature. Results- Three randomized and 15 observational studies were included, with a total of 23 478 participants. Median follow-up was 2 years. Network meta-analysis demonstrated that vitamin K antagonist plus single antiplatelet therapy or direct-acting oral anticoagulant plus single antiplatelet therapy were the most effective regimens in preventing stroke. Direct-acting oral anticoagulant regimens were associated with lower major bleeding rates than vitamin K antagonist regimens. Regimens with dual antiplatelet therapy were associated with lower rates of myocardial infarction. Vitamin K antagonist plus dual antiplatelet therapy was associated with a lower mortality and low-dose direct-acting oral anticoagulants with decreased major cardiovascular adverse events. Conclusions- Direct-acting oral anticoagulant regimens were associated with less major bleeding and major cardiovascular adverse events, but vitamin K antagonists were associated with decreased mortality and stroke. These results suggest that the decision of antithrombotic therapy in patients with atrial fibrillation after percutaneous coronary intervention needs to be individualized.
- Predictors of early vein graft failure after off-pump coronary artery bypass grafting: angiocomputed tomographic results of 233 patients. [Journal Article]
- EJEur J Cardiothorac Surg 2019 Jul 13
- CONCLUSIONS: Early SVG patency after OPCAB was satisfactory. Increased preoperative platelet count, more perioperative RBC transfusions and higher CCr were predictors of patients with early VGF, whereas use of a left internal mammary artery graft was a protective factor. Increased preoperative platelet count, higher CCr, more perioperative RBC transfusions and endarterectomy were predictors of VGF, whereas dual antiplatelet therapy, larger recipient vessel diameter, greater graft run-off, higher preoperative RBC count and side-to-side anastomosis were protective factors. Recipient diameter >1.5 mm and graft run-off >25 ml/min were cut-off values for detecting VGF.
- Stent Thrombosis after Short-term Discontinuation of Ticagrelor for Coronary Artery Bypass Grafting. [Journal Article]
- ATAnn Thorac Surg 2019 Jul 11
- Antithrombotic strategy prior to open heart surgery in patients with recently implanted coronary stents has not been yet clearly established due to lack of clinical evidence. We report a case of sten…
Antithrombotic strategy prior to open heart surgery in patients with recently implanted coronary stents has not been yet clearly established due to lack of clinical evidence. We report a case of stent thrombosis in a patient who discontinued P2Y12 inhibitor (Ticagrelor) just for 3 days before coronary artery bypass grafting. The withdrawal period of antiplatelet drugs prior to coronary artery bypass grafting should be minimized in patients with recently implanted drug eluting coronary stents to prevent stent thrombosis.
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- Reply to 'Withholding antiplatelet therapy before noncardiac surgery might increase the risk of major adverse cardiovascular events: numbers often hide the truth' (Br J Anaesth 2019; 122: 170-179). [Letter]
- BJBr J Anaesth 2019 Jul 10