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The impact of thienopyridine administration prior to primary stenting in acute myocardial infarction (AMI) has not been well studied. We therefore examined the database from the prospective, multicenter, controlled CADILLAC trial ...
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The impact of thienopyridine administration prior to primary stenting in acute myocardial infarction (AMI) has not been well studied. We therefore examined the database from the prospective, multicenter, controlled CADILLAC trial in which 1,036 patients were randomized to bare metal stenting with or without abciximab to determine whether patients who received a thienopyridine prior to bare metal stenting in AMI had superior clinical outcomes. Per operator discretion, 659 patients (63.6%; Th+) received either a 500 mg ticlopidine loading dose (n = 623) or a 300 mg clopidogrel loading dose (n = 40), while 377 patients (36.4%; Th-) received no thienopyridine prior to stent implantation. Baseline and procedural characteristics of the two groups, including abciximab use (52.5% vs 52.8%, P = 0.93) were well matched. Th+ compared to Th- patients had lower rates of core lab assessed TIMI 0/1 flow postprocedure (0.8% vs 2.7%, P = 0.01). Th+ compared to Th- patients also had significantly reduced in-hospital and 30-day rates of ischemic target vessel revascularization (TVR) (1.1% vs 3.2%, P = 0.01 and 1.5% vs 3.8%, P = 0.02, respectively) and major adverse cardiovascular events (MACE) (2.7% vs 5.8%, P = 0.01 and 4.0% vs 6.9%, P = 0.03, respectively), results that remained significant after covariate adjustment. In conclusion, in this large prospective, controlled trial, patients receiving a thienopyridine prior to primary stenting in AMI were less likely to have TIMI 0/1 flow postprocedure and experienced reduced in-hospital and 30-day rates of ischemic TVR and MACE compared to those not administered a thienopyridine prior to stent implantation.
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摘要 :
The impact of thienopyridine administration prior to primary stenting in acute myocardial infarction (AMI) has not been well studied. We therefore examined the database from the prospective, multicenter, controlled CADILLAC trial ...
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The impact of thienopyridine administration prior to primary stenting in acute myocardial infarction (AMI) has not been well studied. We therefore examined the database from the prospective, multicenter, controlled CADILLAC trial in which 1,036 patients were randomized to bare metal stenting with or without abciximab to determine whether patients who received a thienopyridine prior to bare metal stenting in AMI had superior clinical outcomes. Per operator discretion, 659 patients (63.6%; Th+) received either a 500 mg ticlopidine loading dose (n = 623) or a 300 mg clopidogrel loading dose (n = 40), while 377 patients (36.4%; Th-) received no thienopyridine prior to stent implantation. Baseline and procedural characteristics of the two groups, including abciximab use (52.5% vs 52.8%, P = 0.93) were well matched. Th+ compared to Th- patients had lower rates of core lab assessed TIMI 0/1 flow postprocedure (0.8% vs 2.7%, P = 0.01). Th+ compared to Th- patients also had significantly reduced in-hospital and 30-day rates of ischemic target vessel revascularization (TVR) (1.1% vs 3.2%, P = 0.01 and 1.5% vs 3.8%, P = 0.02, respectively) and major adverse cardiovascular events (MACE) (2.7% vs 5.8%, P = 0.01 and 4.0% vs 6.9%, P = 0.03, respectively), results that remained significant after covariate adjustment. In conclusion, in this large prospective, controlled trial, patients receiving a thienopyridine prior to primary stenting in AMI were less likely to have TIMI 0/1 flow postprocedure and experienced reduced in-hospital and 30-day rates of ischemic TVR and MACE compared to those not administered a thienopyridine prior to stent implantation.
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Background and purpose: There is strong correlation between cardiovascular diseases and risk factors such as hypertension, diabetes mellitus, serum cholesterol level. However, only 50% of coronary arteries diseases (CADs) are asso...
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Background and purpose: There is strong correlation between cardiovascular diseases and risk factors such as hypertension, diabetes mellitus, serum cholesterol level. However, only 50% of coronary arteries diseases (CADs) are associated with such factors. Different studies investigating the correlation between homocystein and CADs found different or even paradoxical results. This study aimed at investigating the association between plasma homocystein levels with mortality and complications of Myocardial Infarction. Materials and methods: A cross-sectional study was carried out on patients admitted to hospital complaining from chest pain during 24 hr who had no history of previous MI and with the diagnosis of STEMI. The patients were divided into two groups of normal and increased homocystein level. They were followed during hospitalization to determine complications of STEMI and mortality rate. Results: From the total of 230 patients, normal homocystein levels was observed in 150 patients (65.2%) and 80 patients (34.8%) had increased homocystein level. Death occurred in two patients with normal homocystein level, and in four patients with increased level of homocystein. Electrical complications were seen in 40 cases among patients with normal homocystein level and in 19 cases among the other group. Mechanical complications (including 2 VSD and 1 tamponade) were detected in patients with increased homocystein level, while these complications were not fond in the other group. Also, no mitral regurgitation was seen due to rupture in papillary or chordae muscles. Conclusion: This study found that there was not a significant difference between two groups of normal and increased homocystein level regarding mortality rate and electrical complications. However, among mechanical complications, VSD and tamponade were significantly greater in the group with increased level of homocystein.
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Lipoprotein-associated phospholipase A2 (Lp-PLA2) is an independent risk factor for plaque rupture and atherothrombotic events. However, the associations between serum Lp-PLA2 level and thrombus burden in ST-segment elevation myoc...
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Lipoprotein-associated phospholipase A2 (Lp-PLA2) is an independent risk factor for plaque rupture and atherothrombotic events. However, the associations between serum Lp-PLA2 level and thrombus burden in ST-segment elevation myocardial infarction (STEMI) patients remain unknown.
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Acute myocardial infarction continues to be the major determinant of death and disability in Western countries. Despite large improvements in management during the last 20 years, its high morbidity and mortality rates provide a st...
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Acute myocardial infarction continues to be the major determinant of death and disability in Western countries. Despite large improvements in management during the last 20 years, its high morbidity and mortality rates provide a stimulus to search intensively for different and widely applicable therapeutic options.
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To examine the relationship among heart rate turbulence parameters, arterial baroreflex sensitivity, and cardiac sympathetic nerve activity, 15 patients with acute myocardial infarction, presenting with sinus rhythm and > or = 3 v...
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To examine the relationship among heart rate turbulence parameters, arterial baroreflex sensitivity, and cardiac sympathetic nerve activity, 15 patients with acute myocardial infarction, presenting with sinus rhythm and > or = 3 ventricular premature beats/24 hr were studied at least 2 weeks after acute myocardial infarction. Turbulence onset (TO) and turbulence slope (TS) were averaged from 3 respective ventricular premature beats. Early heart-to-mediastinum ratio (H/M), delayed H/M, and washout rate were calculated from iodine-123-metaiodobenzylguanidine (123I MIBG) scintigraphy. Arterial baroreflex sensitivity was calculated by phenyrephrine method. Arterial baroreflex sensitivity correlated significantly with TO (r = - 0.75, p < .01) and TS (r = 0.53, p < .05). TO had no correlations with early H/M, delayed H/M, and washout rate. There were no significant correlations between TS and early H/M. However, TS had significant correlation with delayed H/M (r = 0.74, p < .01) and washout rate (r = -0.71, p < .01). Thus, heart rate turbulence of TO and TS parameters depend on sympathovagal balance.
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In patients with acute ST-segment elevation myocardial infarction, early, successful, and durable reperfusion therapy optimizes the likelihood of favorable outcomes. Fibrinolysis and primary percutaneous coronary intervention impr...
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In patients with acute ST-segment elevation myocardial infarction, early, successful, and durable reperfusion therapy optimizes the likelihood of favorable outcomes. Fibrinolysis and primary percutaneous coronary intervention improve survival compared to no reperfusion therapy in large part by reducing infarct size (IS) and preserving left ventricular ejection fraction. There is direct correlation between IS and clinical outcomes. In this article, we will review some of the more promising pharmacological agents geared toward reduction in IS, discuss the major pathways that can lead to this desirable outcome, and evaluate the results of clinical trials performed with these and other compounds.
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The comment of Peer Tfelt-Hansen is welcomed and needed for (more) rational medical and economical decision making in migraine treatment. The analysis and the conclusions are, however, not fully reflective of available data and cl...
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The comment of Peer Tfelt-Hansen is welcomed and needed for (more) rational medical and economical decision making in migraine treatment. The analysis and the conclusions are, however, not fully reflective of available data and clinical needs.In addition to the clinical trials referenced by Tfelt-Hansen, there is also a recent publication from Misra et al comparing 400 mg ibuprofen and 10 mg rizatriptan.2 They found superiority for rizatriptan in 2-hour headache relief (73% vs 53.8%, P= .0001) and in use of rescue medication but not for 2-hour headache freedom and 24-hour headache relapse. Both products were superior to placebo; this is no surprise as a recent meta-analysis of low-dose ibuprofen in acute migraine had clearly demonstrated3 the efficacy of 400 mg ibuprofen.
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